Has anybody with Diabetes on insulin ever U/C???? - Page 2

[swede]

Originally Posted by JynxGirl 

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.

It's not just the birth, it's the immediate post partum period, as well.  My blood sugars dropped pretty rapidly following birth.

You asked - people answered.  Most people are not going to think it's a good idea.  Like it or not, you have a pretty serious disease.  Good luck.
 

[tylersmomma]

but that was for type 1 and a few of us are type 2

[RobynHeud]

Whether you decide to go hospital or home, one of the important things to remember is to delay cutting the cord and breastfeed as soon as possible.  Both of these things will allow the baby's insulin and sugars to adjust to their own levels.  When my mother-in-law was pregnant with my husband, he was a big baby and the first thing they did when he was born was cut the cord.  His sugars crashed because his insulin was still riding high and they had to rush him to the NICU.  And as far as the study that was cited by BuzzBuzz, it makes me wonder how many of those complications are caused by "standard hospital procedures" such as cutting the cord too soon, not permitting skin-to-skin contact or immediate breastfeeding.  I'm not saying these are cure-alls, but I feel like when a pregnant woman has diabetes, whether it's gestational, T1, T2, insulin dependent or not, it's assumed that everything that can go wrong, will go wrong, and in their rush to prevent these things from happening, sometimes they're the ones causing them.  If you're being rushed to push out a baby and not being permitted to choose your position but lay flat on your back, it severely increases the chances of shoulder dystocia, yet this is constantly touted as the "safe" thing to do.  I agree with other posters.  Really take the time to review your past pregnancies and think about what you are most comfortable with.  If you decide to go to the hospital, make it a point to review with your doctor, and whoever else might be attending your birth, exactly what you expect.  It doesn't have to be a lengthy list, but simple things like freedom of movement, intermittent fetal monitoring, and delayed cord clamping.  It also might be helpful to research studies that show favorable outcomes for mother and baby and what they did to achieve those results.  Just remember, you need to do what is best for the baby and yourself, not anybody else.

[RobynHeud]

Whether you decide to go hospital or home, one of the important things to remember is to delay cutting the cord and breastfeed as soon as possible.  Both of these things will allow the baby's insulin and sugars to adjust to their own levels.  When my mother-in-law was pregnant with my husband, he was a big baby and the first thing they did when he was born was cut the cord.  His sugars crashed because his insulin was still riding high and they had to rush him to the NICU.  And as far as the study that was cited by BuzzBuzz, it makes me wonder how many of those complications are caused by "standard hospital procedures" such as cutting the cord too soon, not permitting skin-to-skin contact or immediate breastfeeding.  I'm not saying these are cure-alls, but I feel like when a pregnant woman has diabetes, whether it's gestational, T1, T2, insulin dependent or not, it's assumed that everything that can go wrong, will go wrong, and in their rush to prevent these things from happening, sometimes they're the ones causing them.  If you're being rushed to push out a baby and not being permitted to choose your position but lay flat on your back, it severely increases the chances of shoulder dystocia, yet this is constantly touted as the "safe" thing to do.  I agree with other posters.  Really take the time to review your past pregnancies and think about what you are most comfortable with.  If you decide to go to the hospital, make it a point to review with your doctor, and whoever else might be attending your birth, exactly what you expect.  It doesn't have to be a lengthy list, but simple things like freedom of movement, intermittent fetal monitoring, and delayed cord clamping.  It also might be helpful to research studies that show favorable outcomes for mother and baby and what they did to achieve those results.  Just remember, you need to do what is best for the baby and yourself, not anybody else.

[swede]

Originally Posted by tylersmomma 

but that was for type 1 and a few of us are type 2

You're on insulin - it sounds like your pancreas doesn't work.  Not much difference between you and a type 1 at this point. 

It sounds like you just wanted people to confirm your choice.  The answer to your OP "Anybody with diabetes on insulin ever UC", is NO. 

Good luck.

[Spirit Dancer]

I would try looking for info from other sources. You got some here but overall I find this board not always the most UC supportive- though it is good to get varying views. For example one thing you could try is contacting Laura Shanley and asking if she has any info/ stories of insulin dependant moms UCing. Sometimes it can be hard to find info for one side of something but I think you will find it worth do you can make your own informed decision. Whatever you do Good luck!

[alegna]

Originally Posted by swede 

You're on insulin - it sounds like your pancreas doesn't work.  Not much difference between you and a type 1 at this point. 

It sounds like you just wanted people to confirm your choice.  The answer to your OP "Anybody with diabetes on insulin ever UC", is NO. 

Good luck.

This is not necessarily true.  Type 2s often need MORE insulin than "normal" due to insulin resistance.  And Type 2s don't have the auto immune issues that type 1s do.  It's a different creature in every way.  So just because she needs insulin does NOT mean that her pancreas is not producing insulin.

[JynxGirl]

Originally Posted by alegna 

This is not necessarily true.  Type 2s often need MORE insulin than "normal" due to insulin resistance.  And Type 2s don't have the auto immune issues that type 1s do.  It's a different creature in every way.  So just because she needs insulin does NOT mean that her pancreas is not producing insulin.

Thank you! We've had a bit of a hectic week and I forgot to check back here.

Type 2s on insulin are a way different creature than Type 1s. Right now, I'm going through almost 300 units of Humalog through my pump every day. As annoying as that gets, I prefer refilling a cartridge to 8 shots a day, which is what I was at when I got pregnant. As far as I know, and will confirm after this little guy is born, I have type 2 diabetes. I'm waiting to find out if I have LADA, which is a whole nother ball of wax...  (For those who aren't aware, it's a form of diabetes being refered to as type 1.5 because it has the autoimmune portions of type 1 and the insulin resistance portion of type 2.)

My diabetes is in control because of my pump and insulin regimen, not out of control because I've got to use one. My pancreas still produces insulin. It's the rest of my body that has a hard time absorbing and using it effectively. 

[alegna]

Holy cow that's a lot of insulin!  lol  I have a type 1 friend who just had a baby and she was "all the way up to" 120 units/day when she had him.

[JynxGirl]

Originally Posted by alegna 

Holy cow that's a lot of insulin!  lol  I have a type 1 friend who just had a baby and she was "all the way up to" 120 units/day when she had him.

It really is, and apparently isn't the most insulin my doctor's ever seen while someone is pregnant. Apparently the most he's ever see was a woman who needed around 700 units a day, and was still having trouble controlling her sugars.

I'm really hoping that my diabetes goes back to what it was before my last (lost) pregnancy in March and April. You know, where I could pretty much just eat whatever I wanted and my body adapted perfectly to it...My family doctor said I was pretty much non-diabetic back then, and then all of a sudden, I am "really really diabetic" (his words)

It's funny, I've had to learn a lot in the last few months (I'm 21 weeks pregnant tomorrow) and the more I learn about diabetes, the more frustrating a disease it becomes.

[Perpetunia]

Insulin resistance is not part of LADA. LADA is type 1 diabetes that develops in adulthood.

Most pregnant type 1 women end up on significantly higher amounts is insulin compared to non-pregnant due to the placental hormones.

[JaimeF]

Have you seen "Food Matters"  If you have Netflix, you can watch it there.  It has a lot of good info on how to reverse diabetes buy just eating a plant based diet.  You can reverse it and have your U/S.

[Mothoki]

Originally Posted by JaimeF 

Have you seen "Food Matters"  If you have Netflix, you can watch it there.  It has a lot of good info on how to reverse diabetes buy just eating a plant based diet.  You can reverse it and have your U/S.

That documentary is so full of inaccuracies and irresponsible health advice. A vegan diet is no cure for diabetes. Adequate protein (not of the soy variety) and fat are essential for diabetes management. There is no cure for diabetes, but it can be managed and a lot of the symptoms reversed with proper diet and lifestyle adjustments.

[McGucks]

OP, I am sure you can find some folks who were insulin-dependent and U/C if you look hard enough.  However, you are asking for opinions.

I was insulin-dependent GD and wouldn't have considered a homebirth, but that's just me.

I would strongly encourage you to look at some of the excellent suggestions offered to you by the poster below.  They will give you some options and controls you might not have had before.

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.

[Alenushka]

What is more important to you? The perfect birth experience or a live baby?  Is it important to you that your children have a mother or not?

I am sorry if I sound blunt but this is what it boil es down too.

Any way you look at it , you are a high risk mother. Yes, the risk of SD is much higher. Even if you call 911 right away, you will not make it on time. We do not teleport people to OR from home.

I sympathize that you have bad experience with your provider and hospital. But going and doing something risky nos is akin to a kids mad at his mom "I am gonna climb the tree and show you". Well, when the kid falls of the tree and breaks his scull...yep, she showed her mom.

Go interview different OB's. Take tours of different hospitals. Find CNM/OB office.

There many many functional ways of dealing with your situation, but risking your baby's and your life in the name of perfect natural birth is not the way.

[Haelmoon]

Originally Posted by RobynHeud 

Whether you decide to go hospital or home, one of the important things to remember is to delay cutting the cord and breastfeed as soon as possible.  Both of these things will allow the baby's insulin and sugars to adjust to their own levels.  When my mother-in-law was pregnant with my husband, he was a big baby and the first thing they did when he was born was cut the cord.  His sugars crashed because his insulin was still riding high and they had to rush him to the NICU.  And as far as the study that was cited by BuzzBuzz, it makes me wonder how many of those complications are caused by "standard hospital procedures" such as cutting the cord too soon, not permitting skin-to-skin contact or immediate breastfeeding. 

The goal of delayed cord clamping is to increase the hemoglobin and iron stores in the newborn. It will decrease the risk of being iron deficient in the next few months of life. Nhowever, it has NO effect on blood sugars and insulin. Insulin is produced in the fetal/newborn pancreas. When the baby is exposed to high glucose levels, it ramps up its production of insulin. Then when the baby is born and cut cof from mom's sugar supply, it must crank back the production of insulin. However, this does not occur immediately, and the high insulin levels will cause the baby's blood surger to drop. Delaying cord clamping will just delay the drop in sugar by the length of time ord clamping is delayed, not actually preent it if the baby is producing too much insulin. Blood sugar levels in the thenty-four hours prior to birth are the most important for predicting neonatal hypoglycemia. This is the reason for hospital protocols regarding blood sugar testing and insulin infusions in labour, not just mindless intervention because they can. It reduces neonatal complications and attempts to keep more babes with more moms.

The risk of UC with DM2 depends in part what degree of prenatal care one seeks. Diabetes is. Very good example of home good prenatal care can reduce intrapartum and neonatal adverse outcome. Inductions are recommended not because the baby may be big, but there is actually a real risk of stillbirth, particularly after 40 weeks gestation. Will every diabetic have a still birth - absolutely not, but induction will always be offered recommended because there are no good tests to determine which moms are at the most risk. Good blood sugar control does not completely reduce the risk, in part because we can only measure sugars so many times a day. There are still to many unexplained stillbirths in this population. I am not saying that a UC or home birth would cause that but refusing an induction may result in a prelabour stillbirth.

The thing with diabetic pregnancies is that they tend to have larger placentas, which consumer more of the glucose and oxygen crossing through them. To compensation, fetuses of diabetic moms tend to increase their number of red blood cells to help gather romper oxygen. However, this leads to complications and caus the baby to require even more oxygen and glucose to maintain these cells. As a result, the pH of diabetic babies (per-labour) is often lower, and more marketedly so after 40 weeks. This may be related to the still birth risk.

Back to the extra blood cells, this is one of the reasons not to offer delayed cord clamping, because it would further increase the red cells, and when it comes time for the baby to break down these cells and convert to adult cell type, it will increase the risk for jaundice and complications related to such.

So, should a diabetic UC? First, make sure that you take care of yourself and baby as well as you can prenatally. This includes good prenatal care and fetal surveillance. If everything is optimal, and less that 40 weeks, labour would most likely be fine no mater where it occurs. However, how would blood sugars be monitored in mom during labour and in the newborn after birth? What would be the plan for feeding baby? Often breastmilk will be in enough, but sometimes not. I am not advocating formula here, but if you don't have access to in intravenous line at home, how would you maintain baby''s blood sugar? At least having a midwife, these sugars would be monitored, and if baby did need extra support, then you would have the proper team in place. After 40 weeks, there are real risk, and I would consider an induction for baby's sake, but that is my opinion and your choice to make. Finally, I would be cautious about delayed cord clamping. Generally it is a good thing, but not in all cases. It is important to educate you self on reasons to do thing and not to do things. There is actually a lot of good evidence on how to optimize care in pregnant patients, and that is where some hospital protocols come from. Inductions yes, but the. Have the patience to allow the process to work, no give up a predefined time.

Overall, I wish you a happy and healthy pregnanya and a birth that you can feel comfortable with and a beautiful happy baby.

[Almi]

I don't have much to add as far as diabetes goes as I don't know too much about it, but I did want to point out one thing...

UC works for healthy mothers and babies because if you are healthy and have good genes, you have a higher chance of reproducing.  It's natural selection.  If you have problems such as diabetes that makes reproduction more difficult (for a reason...normally without medical help diabetes would naturally disappear), then your chances of having a happy, successful UC go down.  So while you can still have a uncomplicated birth and post partum period, your risk is definitely going to be higher than normal.  Your job is to decide if you are willing to take the risk.

[kel32brown]

Why not find a more baby friendly hospital within a reasonable distance of driving for you?

Every single diabetic pregnancy is different -- and you cannot predict if/when you will have a baby born with low blood glucose.  You have other children by your signature, and if you're accused of negligence, then your other children can be 'protected" by CPS in New York state.

Canandaigua, NY has a very diabetic mother friendly hospital and is within a couple of hours drive of you, no?

I've heard other diabetic mothers mention how they really liked Geneva, NY's birthing center. 

Those are the two that I'm aware of, as a diabetic mother who birthed in hospitals.  Aftercare for a baby born to a diabetic mother should be your primary concern. Mine had their heelsticks while nursing, so they'd take it better, painwise. None of them were away from me in any special nursery or anything, because the hospitals are baby-friendly and only do that when absolutely necessary. One diabetic baby was born at 34 w5d and did require blow by oxygen, but nothing more than an ounce of formula to bring her glucose back up.