Creating a Birth Plan and Preparing for Delivery
If you have type 1 diabetes (T1D) and become pregnant, a birth plan is something you will want to consider. Whether or not to have one and how in-depth to make your birth plan is a very personal choice, and you are the best judge of that. A birth plan is, in essence, a wishlist of how you would like your baby to arrive into the world. Sometimes this is an official document, and other times it is a discussion that you may have with your doctors and family members. Regardless of the formality, it can help the parents-to-be feel better prepared for the big day.
Of course, no one lives in a perfect world, and in reality, only few birth plans are followed fully. Yet, for a woman with type 1 diabetes, a huge part of the birth process is diabetes management. It is important to discuss blood-sugar management with your medical team to plan how your blood-sugar will be managed from the time you arrive at the hospital until the time that you leave, and what you will do to ensure these plans are followed.
What Questions Do You Want Your Birth Plan to Answer?
First, talk with your support team about what your ideal plan would be. Discuss your concerns about pain management, birthing options and using a midwife or doula. There are so many questions surrounding childbirth that you may want to get answers in advance, and the best way to figure out what options are right for you is by doing research and seeking information from your medical team.
Below are a few questions that may help you to get started. You can build on this list as you and your partner develop your birth plan and generate your own questions:
- Do I want to receive pain medication at any time during labor, or do I prefer to give birth naturally?
- Who will manage my type 1 diabetes during the labor and delivery (my partner, my doctor, someone else?)
- Will I be able to wear my insulin pump during labor and delivery?
- Do I want to breast-feed or formula feed?
- If my baby experiences a low blood-sugar level after delivery, what are my options?
- Who are the people I want present in the room during my child’s birth? Are there any restrictions on how many people can be there?
- If there is an emergency situation, who will make medical decisions on my behalf or my child’s behalf if I am unable to do so?
- After birth, do I have any plans for the umbilical cord and/or placenta, which can be used for type 1 diabetes research, stored or encapsulated?
Bring your doctor into the discussion and explain your wants and needs. Work together with your medical team to plan for an uneventful birth and prepare for one that may deviate from expectations.
Remain flexible and open to changing the plan to accommodate any emergencies. The most important end result is a healthy mom and a healthy baby, and the goal of your medical team is to help you achieve that.
Planning for Delivery with Your Diabetes Team
First, ask your obstetrician or midwife if there is a hospital protocol in place for women with type 1 diabetes who give birth and more specifically, if there is a protocol for women who use insulin pumps and continuous glucose monitors (CGMs). You will want to be aware of any protocols (such as removal of insulin pump, a certain type of insulin that must be used, an insulin drip that must be used, etc.) that do not align with your birth plan. This may require some pre-labor discussions on your part in order to remain on current medications throughout the birth experience.
It is also important to discuss your plans for managing any change in insulin dose just prior to and immediately after birth. In addition, your obstetrician or endocrinologist will be able to help you plan for insulin dose changes immediately following birth, during your hospital stay, and once you go home.
Take a copy of these instructions and bring them with you to the hospital. Make sure your endocrinologist and obstetrician have a copy for their charts as well. Having this information will serve as a great source of comfort if the hospital experience becomes hectic or other aspects of the birth process feel out of your control. Most importantly, make sure that you and your healthcare team are in agreement about how your type 1 will be managed during and after the birth of your child.
Can I Wear My CGM During Labor?
You may be using a continuous glucose monitor (CGM) during the course of your pre-pregnancy and pregnancy months. This can be a very useful tool to help monitor the ever-changing insulin needs of a pregnant body, and may improve blood sugar management, leading to better health outcomes for mom and baby. However, the ability to use a CGM during the actual birth process depends on the delivery method and the individual hospital.
Check with your medical team to see if you will be able to keep your CGM on during labor. If you are having a C-section, your doctor may require that the sensor be removed before surgery. Other doctors may allow you to keep the sensor on. Ask your doctor about their protocol and where they prefer you to wear it (so it doesn’t get in the way) and be sure to voice your preferences.
With type 1 diabetes, even the best-laid plans can change at a moment’s notice depending on the situation. It is good to have a plan for how you’d like your child’s delivery to unfold, but remember, we can’t control everything! Whether or not the delivery goes exactly as planned, know that you are in good hands with your medical team throughout the birth process and in the exciting days and weeks that follow!