Surviving Hypos in Labor
I felt the public health system had let me down when Miss five (daughter Olive) arrived into the world. It all seemed to go horribly wrong. When my blood sugars dropped drastically during labour, it was obvious the hospital staff in the room knew little about diabetes. My husband had to take charge and pull me back from hypoglycaemia. Testing my blood sugars and feeding me, all while convincing the staff it would take longer than 30 seconds for glucose to have an effect.
I woke hours later in a theatre recovery room, alone. I’d needed an emergency caesarean under general anaesthetic. I was joined by a nurse and asked her the terrifying question, “Do I have a baby?” I did! What a relief.
Hayden and I slowly adjusted to life with a baby, adamant we were never going through that again. But as time went by and memories faded we found ourselves preparing for the arrival of baby No 2. I was going to do everything I could to ensure this delivery was different. I called in the expertise of a private obstetrician, began using an insulin pump, imported a Freestyle Libre to test my blood sugars and agreed to a scheduled caesarean.
At 38 weeks I was admitted to hospital for steroid injections to speed up the baby’s lung development because he was scheduled to arrive early. This is common for mums with diabetes. As expected, the steroids increased my blood glucose levels. I monitored them closely and increased my insulin dose to bring them down. I had to explain to the midwives that I had enough insulin onboard to bring my blood sugars back within range so there was no need to panic. It seemed that once again the team on the ward were not diabetic experts!
My blood sugars settled down but after the final steroid injection they increased again and I developed ketones in my blood. I still had 12 hours until my caesarean …
The midwife on duty had no idea what to do. Then it hit me, of course she didn’t, she’s an expert in pregnancy and giving birth. It was unrealistic to expect her to be a diabetes expert too. At that point it was up to me. I tried to recall everything I’d learnt about ketones. I injected additional insulin and rehydrated via a drip. Slowly my blood sugars returned to normal and the ketones disappeared. Panic over! I had avoided diabetic ketoacidosis (DKA). Everything was going to be okay. Thanks to the help of the Hutt Hospital diabetes team during my pregnancy, and the use of an insulin pump, I had become the diabetes expert I so desperately wanted during the delivery of Miss Five.
A sense of calm came over me. The ward was quiet, my blood sugars were under control and in a few hours we would meet our new family member.
On 30 September at 10.52 a.m. Felix Mckechnie McGill arrived safely and calmly into this world, weighing 8 pounds 3 ounces.
Type 1 and pregnant? Ruby’s top tips
It has taken me more than 17 years to feel confident managing my diabetes, which certainly helped during this pregnancy and the delivery of Baby No. 2. But what if you don’t have 17 years to master diabetes? What if you only have nine months to get everything sorted? Here are a few things that really made a difference:
- Using an insulin pump during pregnancy meant I could easily adjust my basal rates, carb ratios, insulin sensitivity factor and see the insulin I had on board with the click of a few buttons.
- A Freestyle Libre allowed me to see my blood sugar level with a painless one second scan of a small sensor in my arm, automatically measuring and continuously storing the readings day and night. It made frequent testing while in hospital and while feeding or settling our little man a breeze!
- I discussed my ‘’diabetes delivery plan’’ with the endocrinologist and diabetes team. You will have spent the last nine months working together, preparing for the arrival of your baby. Make sure you are kept in the loop and everyone understands what to do if your blood sugar levels go astray during the delivery.
- Remember, it takes a village to raise a child so if you’re not able to be the diabetes expert during the delivery (it’s highly likely you’ll be somewhat preoccupied), assign the role to someone you trust such as your partner, a parent, or friend.