Labor, Delivery + After with Type 1 Diabetes
4/6/17
WRITTEN BY: Pamela Hoffman, MPH
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Editor’s Note: If you are pregnant and have Type 1, take this survey on Glu and help field research for future generations of mothers.


Can I just pat you on the back for a bit, Mama? You are doing an amazing job with your pregnancy! You have assembled a medical team you trust to guide you throughout the remainder of your pregnancy, courageously navigated the fluctuating blood sugars and hormones that come along with the first and second trimesters, and you’re now waddling around with the best of them!

Your baby is so lucky to have a mother who loves him or her so much that she is striving to keep both of you as healthy as possible. You are going to be a great mom! No guilt allowed here – you are doing your best!

You cannot wait to meet your new bundle of joy, but you might be feeling anxious about what to expect when your water breaks or your OB/GYN announces “it’s time.” We want to share some tips to help you better prepare for your labor and delivery, as well as offer some advice for taking care of you and your new baby upon arriving home.

Manage stress

Don’t let the stresses of managing your Type 1 take away from the joys of your pregnancy. Relish in those baby kicks, proudly share your ultrasound photos far and wide, schedule that maternity photo shoot and take time to enjoy life’s little luxuries before your baby arrives.

Create your birth plan

  • Discuss your birth plan with your OB/GYN and endocrinologist.
  • Ask how your medical team will approach your diabetes management during your time in the hospital. Make your personal desires known and be your own advocate.
  • Your team will help you develop a plan for how to handle your changing insulin needs on the day of delivery and the days after. Most women will need to reduce their insulin dramatically on their delivery day and each day following due to the physical activity involved with giving birth and increased insulin sensitivity (4).
  • Discuss whether fasting on the day of delivery will be required and how to handle lows that may occur during labor.
  • If you are going to use your insulin pump during labor and delivery, consider whether you will want to put on a fresh infusion set the day of delivery and of the best placement on your body for your infusion set.
  • Prepare for the reality that your birth plan may not happen exactly as you’d hoped. Women with Type 1 are at a higher risk of requiring induced labor or delivery by C-section (3). Discuss these scenarios with your health team to help you to feel empowered and prepared.

Attend all OB/GYN and endocrinology appointments

Beginning at approximately 34 weeks, you will begin seeing your OB/GYN once per week (4). These appointments are especially important for monitoring for signs of pre-eclampsia (women with Type 1 are at a higher risk of developing this), evaluating your baby’s positioning and movements and checking your A1C. If you have a history of retinopathy, you will also have regular vision checks throughout pregnancy (1).

Pack your bag

It’s best to pack your “go bag” early in the 3rd trimester, just in case you need to go to the hospital earlier than expected. As a mom with Type 1, you will need a few extra items in your bag, including:

  • Insulin management supplies: glucose meter, needles/pens, insulin, test strips
  • Insulin pump supplies: infusion sets, batteries, charging cord or batteries
  • Continuous Glucose Monitor (CGM) supplies: sensors, transmitters and charging cord
  • Quick sugars you are familiar with to treat lows

Find support

Connect with other moms with Type 1 who have already successfully navigated the birthing process. Ask them about their experiences, or watch/read about successful pregnancy stories online (5, 6). If you can’t find a local mom, join an online group of Type 1 moms on social media, like Beyond Type 1’s Beyond the Bump group in their app. Ask for advice when needed, share any negative emotions you might be experiencing, recognize that you are not alone and embrace the encouragement.

Select a qualified pediatrician

You will want to interview and select a pediatrician for your new baby that is familiar with and sensitive to the unique needs of babies born to mothers with Type 1. Often, a baby’s pancreas after delivery will need a few days to self-regulate, and your newborn’s blood sugars will need careful monitoring during that time (2). Don’t fret – this does not mean that your baby will have Type 1!

Breastfeeding tips

Although not for everyone, breastfeeding can provide your baby with immune antibodies that may reduce his/her risk of developing Type 1 (1). When breastfeeding, it is important to continue to monitor your blood sugar carefully – especially during the first few days following your delivery, as blood sugars can decrease rapidly while your baby is nursing. You will want to stay hydrated as well. Keep a basket of snacks and drinks near the comfy chair where you nurse your baby.

Enlist help

Newborns can be demanding, and it’s important not to neglect your own health and wellness in your efforts to meet your baby’s every need during the first weeks home.

  • Communicate openly and honestly with your partner about how to best help you. Your partner can bottle feed or bring your baby back and forth to you at nighttime to be nursed, handle the diaper changes so that you can get more sleep, bring you juice and snacks when your blood sugar is low and give you a break when you need some time to yourself.
  • Take your friends up on their offers to start a meal rotation for you after you bring your baby home. Let them know what kinds of foods would be appreciated and also fit into your nutrition plan.
  • If the emotional strains of motherhood with Type 1 feel too overwhelming at any stage, talk with your medical team and seek help.
  • Take care of yourself. Enjoy a long shower, splurge on a massage every now and then, take time for a lunch out (or in) with your girlfriends and celebrate the fact that your amazing efforts brought a healthy baby into the world!

Enjoy your new baby snuggles, Mama! You’ve earned them! It is finally time to savor being a new parent.


References:

  1. Neithercott, T. (2010, August). “A Guide to Pregnancy with Diabetes,” Diabetes Forecast.
  1. Pregnancy Overview: “Before and After.” (2015, May 20). Beyond Type 1.
  1. Tenderich, A. (2012, January 5). “C-sections vs. Natural Birth in Diabetic Moms,” Healthline.
  1. USF Health. (2016, October 26). Health Professional Trimester 3 Final.
  1. USF Health. (2016, October 26). “Trimester 3: Keeping Your Diabetes On Target. Natural Delivery, C-Section, Blood Sugars…Oh My.”

Visit Beyond Type 1’s Pregnancy Resources! 

Pamela Hoffman, MPH

Pamela Hoffman, MPH, is a freelance writer, blogger, and public health researcher living in Minneapolis, MN with her husband and two sons. Type 1 diabetes has been a big part of her life since her older son was diagnosed at age 2. When she has spare time, Pamela enjoys cooking, hiking and biking with her family and friends, home décor, traveling and reading. You can read more of Pamela’s blog posts at: http://withhugsandquiches.com.