Has anybody with Diabetes on insulin ever U/C????

[tylersmomma]

This is baby 7 for me. All hospital births and the last baby my birth was a nightmare. I cant find a MW that will do a HB with me cause I'm a diabetic on a insulin pump. But we really want a HB. So our only option is to go U/C. I'm due 8/5/12 so we have lots of time to think about this. I really don't want to deliver at the hospital i had my last baby at cause of the manner we were treated, and hospital policy of babies born to diabetic moms. Can i get so opinions from you ladies to help me with our decision?

[Tzipporah]

I can't pretend to say I have personal experience with this, but I will say that diabetes is generally considered high-risk by most care-providers for a reason.

I'm not all against UC, either. I've had one and I have a few health problems myself, but nothing I wasn't sure I could control reasonably well. (well as much as you can be sure of anything). Is this something you feel you could have reasonable control over without the assistance of a midwife or OB?

Have you considered a birthing center? It's way better than a hospital, and more in many midwive's comfort zone regarding things like diabetes.

My only caution would be this--choosing a UC be because you believe in it, not simply because you want to avoid a hospital. I would give it some time, do some soul searching and exploring around the forums and so forth to see what it is you really want. You gotta little time yet ;)

[swede]

Originally Posted by tylersmomma 

This is baby 7 for me. All hospital births and the last baby my birth was a nightmare. I cant find a MW that will do a HB with me cause I'm a diabetic on a insulin pump. But we really want a HB. So our only option is to go U/C. I'm due 8/5/12 so we have lots of time to think about this. I really don't want to deliver at the hospital i had my last baby at cause of the manner we were treated, and hospital policy of babies born to diabetic moms. Can i get so opinions from you ladies to help me with our decision?

Please don't UC.  I don't feel like getting into ti, I am just hoping to bump this thread so someone with more patience than me can respond.  Are you Type 1/Juvenile?  really - what does your endocrinolgist say about this?  there is a very high mortality risk for babies of diabetic moms.  Your only option isn't to go uc.  You could suck it up and have a hospital birth and a baby in your arms at the end of it all.

[AlexisT]

Originally Posted by Tzipporah 

Have you considered a birthing center? It's way better than a hospital, and more in many midwive's comfort zone regarding things like diabetes.

IDDM mothers may be risked out of birth centers because of the issues with managing glucose/insulin in labor. BCs rarely have much more equipment than home, and many midwives will not handle insulin dependents at all (or if they do, will only do so in consultation with maternal-fetal medicine).

[~pi]

I don't usually post in UC but I am type 1 on a pump and saw your post. I'm very sorry you had a rough time with your last baby.

I would not UC. Even with excellent control, there are still additional risks that could be very difficult to manage on your own. (Shoulder dystocia, for example, is significantly more likely.)

Other ideas for you that might help you avoid the problems you had last time:

1) New hospital. I had a difficult hospital birth with my first. For my second, I switched hospitals and had an experience that was way, way better. Until I had my second, I had always felt a little wistful that I wasn't eligible for home birth, but having a good hospital birth totally erased that feeling. I am still thrilled about how well everything went and how great everyone was.

2) Do you have or can you get a CGM? I had a CGM for my second pregnancy and it helped me maintain even better control than the first time. Having absolutely gorgeous numbers throughout the pregnancy made everyone at the hospital much more relaxed. It may also have helped my baby have great blood sugars after birth, so he never needed to leave my arms.

3) Can you hire a doula? I didn't have a doula the first time, but did the second, and she was very helpful.

4) If policies are the issue, can you consult with your specialists and/or neonatologists about which parts of the policies have wiggle room? Some hospital policies haven't caught up with evidence yet, so you might be able to get physician support for things like keeping the baby with you, staying on the pump during labor, etc. (I don't know what, exactly, created problems for you last time, but those are common issues.)

Hugs to you. It is tough to be in a high risk situation when you favor a low intervention approach, but, at least in my experience, it is possible to find a middle ground.

[swede]

Originally Posted by ~pi 

I don't usually post in UC but I am type 1 on a pump and saw your post. I'm very sorry you had a rough time with your last baby.

I would not UC. Even with excellent control, there are still additional risks that could be very difficult to manage on your own. (Shoulder dystocia, for example, is significantly more likely.)

Other ideas for you that might help you avoid the problems you had last time:

1) New hospital. I had a difficult hospital birth with my first. For my second, I switched hospitals and had an experience that was way, way better. Until I had my second, I had always felt a little wistful that I wasn't eligible for home birth, but having a good hospital birth totally erased that feeling. I am still thrilled about how well everything went and how great everyone was.

2) Do you have or can you get a CGM? I had a CGM for my second pregnancy and it helped me maintain even better control than the first time. Having absolutely gorgeous numbers throughout the pregnancy made everyone at the hospital much more relaxed. It may also have helped my baby have great blood sugars after birth, so he never needed to leave my arms.

3) Can you hire a doula? I didn't have a doula the first time, but did the second, and she was very helpful.

4) If policies are the issue, can you consult with your specialists and/or neonatologists about which parts of the policies have wiggle room? Some hospital policies haven't caught up with evidence yet, so you might be able to get physician support for things like keeping the baby with you, staying on the pump during labor, etc. (I don't know what, exactly, created problems for you last time, but those are common issues.)

Hugs to you. It is tough to be in a high risk situation when you favor a low intervention approach, but, at least in my experience, it is possible to find a middle ground.

This is excellent input.

In response to the op's questions - NO.  I am T1 on an insulin pump, and I would never attempt UC.  I wanted a live baby at the end of my pregnancy.

[tylersmomma]

im T2 aqnd my 2 insulin babies were 7lbs6ozs and 7lbs10ozs so i just dont grow big babies.

[swede]

Originally Posted by tylersmomma 

im T2 aqnd my 2 insulin babies were 7lbs6ozs and 7lbs10ozs so i just dont grow big babies.

My babies weren't either.  But there are other very possible complications with diabetic mothers.

[swede]

Originally Posted by tylersmomma 

im T2 aqnd my 2 insulin babies were 7lbs6ozs and 7lbs10ozs so i just dont grow big babies.

Also, T2 on a pump probably means you're not managing your diabetes as well as possible.  Please do not go UC.  There are worse things in life than a hospital birth.

[alegna]

I would consider your history- you've been pregnant and birthed before.  How were your babies?  Large?  Average?  How was your control?  Did you have any BG issues during labor or after?  How has your control been this pregnancy (and compared to your others)?  What's your A1C like?  

Have you tried fighting back at hospital births? (sorry if that's a given, just worth asking)  Perhaps even going in with a lawyer letter stating what you do and do not consent to?

How far are you from a hospital in case of problems?

Good luck!

[AlexisT]

Her history may not be entirely indicative because of how type 2 can progress. Were those insulin babies insulin for pregnancy only (switch from oral meds pre-preg), or had you been insulin dependent before? Were you pumping, or on injections? This makes a difference. If your disease has progressed and your need for insulin has increased since your previous pregnancies, your risks may be different too.

If you require a pump to deal with Type 2, you really, really need to be working closely with your endocrinologist. I would advise you to look for a better hospital and team.

[Spirit Dancer]

Honestly I would not automatically rule out a UC. This is babe #7 - how did your other births go- was there complications form your Diabetes? Since you still have a lot of time before the birth I would really research this a TON so you can make an informed decision. And comments about "Don't you want a live baby" - just ignore them. Good luck!

[swede]

Originally Posted by Spirit Dancer 

Honestly I would not automatically rule out a UC. This is babe #7 - how did your other births go- was there complications form your Diabetes? Since you still have a lot of time before the birth I would really research this a TON so you can make an informed decision. And comments about "Don't you want a live baby" - just ignore them. Good luck!

That's laughable.  WHy should she ignore "those" comments?  Spirit - do you haev diabetes??  I do.  Type 1 - Juvenile.  There are very real risks to the mother and the baby.  UC is for healthy moms and babies.  Diabetes (especially type 2 that requires the use of an insulin pump) indicates that mom is NOT healthy.
 

[Perpetunia]

I have type 1 DM and use an insulin pump and had a UC last year. I would not recommend this for most people but it was the right decision for me. My blood sugars were extremely well controlled and I knew my baby was not big. I have wicked fast labors and knew that getting to the hospital in time would be challenging. I work in the medical field and felt fairly confident that I would recognize complications. I would have lived to have a birth center or home birth midwife but DM, even well controlled, risks you out.

[Spirit Dancer]

Swede- I do not wish to argue with you. Surely you can understand the problem of the so often played "dead baby" card. I truly believe every women should be able to decide for herself as she informs herself, where and with whom she wishes to give birth.

Tyler'smomma- According to this in the UK you can have a homebirth even if you have insulin dependant diabetes. Not that you live there but it can be very helpful to look at other countries policies on birth then just the US.

http://www.homebirth.org.uk/gd.htm

http://aims.org.uk/Journal/Vol12No4/diabetes.htm

[AlexisT]

That first page is a link on GESTATIONAL diabetes.

On the second, you need to know how the UK works. She forced them to do something they didn't want to. She was able to do this because in the UK, if you refuse to go to the hospital they have to send a midwife. I can tell you, having had my first on the NHS, that diabetics are officially risked into consultant care.

[JynxGirl]

Originally Posted by swede 

That's laughable.  WHy should she ignore "those" comments?  Spirit - do you haev diabetes??  I do.  Type 1 - Juvenile.  There are very real risks to the mother and the baby.  UC is for healthy moms and babies.  Diabetes (especially type 2 that requires the use of an insulin pump) indicates that mom is NOT healthy.
 

I'm a type 2 on an insulin pump and would really love for someone to tell me what these risks are. Because so far, all I get told is that diabetics have larger babies. I can't honestly see why this is such the nightmare situation that "requires" me to be induced three weeks early and have a C-section if I'm not delivered within 12 hours... (That's what I'm being told. Labor starts by pitocin, I'm strapped to fetal monitors and not allowed to get up, and then have 12 hours to deliver or I'm operated on...)

Honestly, I'm not being snarky, I really do want to know what the actual, life-threatening, going to deliver a dead baby risks are...

[AlexisT]

Increased risk of stillbirth, miscarriage, and birth defects, and this is correlated to BGLs; this is why tight control is emphasized preconception. A lot of the information on diabetes in pregnancy is about GDM, which only occurs later in pregnancy and doesn't have the same risks.

Possibly preeclampsia. Diabetes is always listed as a risk factor, but I don't know if they've separated out risks for T2 and T1 (T1 is a risk because it's an autoimmune disorder). OTOH, type 2 can cause vascular damage and type 2 diabetics may also have chronic hypertension, a BIG risk factor for PE.

[JynxGirl]

Originally Posted by AlexisT 

Increased risk of stillbirth, miscarriage, and birth defects, and this is correlated to BGLs; this is why tight control is emphasized preconception. A lot of the information on diabetes in pregnancy is about GDM, which only occurs later in pregnancy and doesn't have the same risks.

Possibly preeclampsia. Diabetes is always listed as a risk factor, but I don't know if they've separated out risks for T2 and T1 (T1 is a risk because it's an autoimmune disorder). OTOH, type 2 can cause vascular damage and type 2 diabetics may also have chronic hypertension, a BIG risk factor for PE.

Short of a stillbirth, all of these things would be ruled out by ultrasound before birth. And preeclampsia wouldn't be undiscovered before birth either.

I guess where I'm failing to see the issue with UC for a diabetic mother (namely myself...) is that my control is crazy good, especially with the pump, and therefore, my risks should be minimized. I'm not saying there isn't a risk. I'm saying that treating me like I'm a heart patient mother while I'm in labor isn't what's best for my baby or for me. 

Edit: Thank you. :) This is the first answer other than "A big baby" that I've gotten.

[Buzzbuzz]

Found this study:

Participants 323 women with type 1 diabetes who became pregnant between 1 April 1999 and 1 April 2000.

Main outcome measures Maternal, perinatal, and neonatal outcomes of pregnancy.

Results 84% (n = 271) of the pregnancies were planned. Glycaemic control early in pregnancy was good in most women (HbA_1c  7.0% in 75% (n = 212) of the population), and folic acid supplementation was adequate in 70% (n = 226). 314 pregnancies that went beyond 24 weeks' gestation resulted in 324 infants. The rates of pre-eclampsia (40; 12.7%), preterm delivery (101; 32.2%), caesarean section (139; 44.3%), maternal mortality (2; 0.6%), congenital malformations (29; 8.8%), perinatal mortality (9; 2.8%), and macrosomia (146; 45.1%) were considerably higher than in the general population. Neonatal morbidity (one or more complications) was extremely high (260; 80.2%). The incidence of major congenital malformations was significantly lower in planned pregnancies than in unplanned pregnancies (4.2% (n = 11) v 12.2% (n = 6); relative risk 0.34, 95% confidence interval 0.13 to 0.88).

Conclusion Despite a high frequency of planned pregnancies, resulting in overall good glycaemic control (early) in pregnancy and a high rate of adequate use of folic acid, maternal and perinatal complications were still increased in women with type 1 diabetes. Neonatal morbidity, especially hypoglycaemia, was also extremely high. Near optimal maternal glycaemic control (HbA_1c  7.0%) apparently is not good enough