Pregnant Type 1 Diabetic

[emcie0515]

Hello

I am almost 18 weeks pregnant with my first child. I am 21 years old, in good health, and I have had Type 1 Diabetes since I was 7 years old. My last A1c was 6.3 and I got it checked again yesterday, guessing its closer to 6.0 now. I went on the insulin pump about 6 weeks before I found out I was pregnant and have had great control, of my diabetes ever since.

Currently, I see a high risk OBGYN and an endocrinologist (I see both doctors every other week). I have been studying to become a Nurse Midwife and have always thought I'd have a natural birth (no drugs, no interventions) and most likely a home birth. No that I'm pregnant I've found out that I will be considered high risk simply because I am a Diabetic (regardless of the sort of control I have). I know that a home birth or birth center birth are unlikely but I'm hoping to find out if there are any women in a similar situation who perhaps were able to have a midwife on their team and avoid interventions? 

Any insight and advice is much appreciated,

Thank you 

[Sheepdoc]

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

This is the best place to start info gathering. 

Ask yourself -

1) What exactly makes me high risk?

- How could it be dealt w/ outside the hospital?  In the hospital?  (eg shoulder dystocia - at home Gaskin Manuver, at hospital c/s)  Then weigh the pros and cons.

2) What exactly does your high risk OB plan to do to support you?  Chances are they have a standard plan for _all_ their patients and use the same plan for everyone no matter what condition they have.  Are you okay w/ that plan?   

There really is no reason for a _controlled_ diabetic to not be considered low-risk and a great homebirth candidate.  Further, the risks of complications in a hospital are HIGHER for a diabetic since they heal slower and are more prone to infections. 

Best of luck,

Lori

[emcie0515]

Thanks Lori,

I would absolutely love to have a home birth, I am trying to prepare myself because I really have been led to believe that is NOT an option, for me. 

My high risk OB-GYN's plan is to induce me (she told me this at my very first visit when i was only 6 weeks pregnant) she said that Type 1 Diabetics are never permitted to go past 39 weeks (which I have looked up online and found out is not always the case). But it's definitely her plan to induce me, and honestly I am studying to be a midwife and know how the domino interventions works and am nervous that being forced to be induced to lead me to choose other interventions I also do not want. 

My OBGYN herself has said that apart from being a Diabetic i am low risk (i am young, i am healthy, i am not overweight or underweight, I have good blood pressure) and I keep reading that well-controlled diabetics are at no higher risk than normal pregnant women so I am just trying to make sure that I create a team that understands that home birth is what I always wanted and if i have to this in the hospital I still want the same type of natural birth experience. I am sort of afraid to approach midwives, even CNMs, cause I'm afraid they'll send me right back to my OB...I guess I don't really know how outlandish my request is

Thanks so much for replying 

[Knitting Mama]

I am a LADA diabetic, and I also was unable to find a midwife to work with me. It seems to be more common to find someone willing to work with you in the UK and Europe than in the US.

What I can tell you is this: you can have a natural birth in the hospital. You just have to do a lot more work that you would otherwise. First off, be very certain that your OB is on board with it. I suggest writing a birth plan sooner rather than later, and sharing it with your OB to make sure that he/she is willing and eager to work with you. Mine, thankfully, was, so that worked out fine. Yours doesn't sound as willing to work with you, so I would highly suggest seeking out another one. If there is a birth center or some midwives in your area, you can ask if there is an OB that they prefer to work with.

Next, find out how the hospital your OB works with handles birth procedures. Take a tour if they offer one and ask lots of questions. What I found was that the hospital where I was going to give birth was actually fine with everything on my birth plan, but that I had to be very clear about what I wanted, and had to make sure everyone attending my birth was also clear on it, in case they were asked. I followed some excellent advice from my Bradley childbirth teacher and provided a basket of snacks for the nurses and attendants and on it, I put a note that said, "Please enjoy a snack and take a moment to read our birth plan." It worked very well!

Speaking of classes, I highly suggest taking a birth class aimed towards natural childbirth. Bradley Method is just one of several out there-- find out what one you resonate with and go for it.

Finally, be prepared to change things in the moment if needed. The unfortunate fact is that even with diabetes in control, things may happen that you didn't expect. While it's important to be strong and vocal and to stick to your guns, it's also vital that you understand that being diabetic can increase the risk of various things. Beside the risk of larger babies (which I was told is more of a gestational diabetes risk, but perhaps that is wrong), diabetes itself can affect the baby's heart and brain development, and diabetic women tend to be more likely to have blood pressure issues in labor. That is actually what happened to me-- my natural plan ended up revised in the moment when my blood pressure spiked very high during labor. However, we stuck to our guns postpartum, and got everything we had hoped for. So even though our birth didn't go as planned, our recovery did and that ended up being very healing. As well, the baby needs to be monitored after birth to ensure that his or her blood sugar doesn't go too low or too high.

All in all, I just want to be clear that you definitely can push for a natural birth and you can have one even if you're not at home or at a birth center. Good luck, and I would love to hear from you when your baby comes! I'm due with my second in late July or early August myself, and will be aiming for a natural birth again. We'll see what happens this time. 

[emcie0515]

Thanks for all the input.

I have found a new OB and I really feel more comfortable with him, he understands that my wish would be to go into labor naturally, avoid intervention, and have a home birth but I realize some of those things are not options because of my being Diabetic. 

I am really glad to have an OB who I feel will listen to my wishes and respect them, allowing me to have the birth plan I want as long as its in keeping with the safety of the baby, which of course is important to me as well.

Anyways, it was nice to hear from you, thanks and good luck with you 2nd baby!

[Knitting Mama]

That is very good to hear!!

[mrsavery]

Hi there,

I've been t1 diabetic for 18 years, and have been on the pump for 10 years. My A1C has been in the low 6's and my husband and I decided to start TTC a few months ago. I am 5 weeks pregnant w/ my second baby, as the first ended in miscarriage in February. I was told last spring when I first started talking to my doc about pregnancy that I needed to have my a1c in the 5's before I should conceive, and that I would have to be attended by a high risk OB as well. Since then I have gotten married, moved to a new state, and consequently have a new endo and a new GP...who I HOPE are on board with me trying to have as natural of a birth as possible, even though it will have to be in a hospital, since Nebraska is one of only 2 states in the US where homebirth is "illegal."

I see my endo next week, and see my family practice doc, who is planning on delivering the baby, at 11 weeks.

My biggest fear is that I will have myself so worked up trying to avoid all of the interventions at the hospital that I will in fact actually CAUSE some of those interventions to be necessary!

I would love to be able to just "talk" things through as they come up, and be here for encouragement, as well. As this point, I'm just a little overwhelmed, and frankly, scared.

[cabbitdancer]

Hi, I know this thread is kind of old, but I was wondering how things were going with all of you. I'm 17 weeks pregnant and diabetic. I was originally diagnosed as type 2 almost 3 years ago, but about a year and a half ago, all of the medications stopped working and I wound up on insulin with a potential adult onset type 1 diagnosis. However, when I was supposed to be tested to see if I was truly type 1 or not, I discovered that our attempts to conceive had proved fruitful. My last A1C was 5.9, if I remember correctly, and my current average meter reading is about 100. I have been on the pump since last December, with a CGM since February, I think. My memory is hazy on the details. My OB says he's on board with a VBAC and seems cool with me going to 41 weeks, at least, but it all depends on my sugars and baby's measurements.

I'd also really just love to be able to "talk" things through as the come up, with someone who understands what I'm going through.

[sweetlowmom]

Hi all,

I just saw this thread because of your new post, cabbitdancer, and wanted to chime in. I am also a T1 diabetic (since I was 10 years old) and am currently pregnant: 10 weeks with hopefully take home baby #2. I have one son, 3.75 years old and had two miscarriages previous to this current pregnancy.

I wanted to recommend a FB group for all of the diabetic moms and moms to be, it's called DMs supporting DMs. This FB group is a spinoff from the AMAZING forum http://www.diabeticmommy.com which is much less active now than it was during my first pregnancy four years ago (the Facebook revolution!!) ... most of the women have all moved over to FB. In any case there are some great women on there and it is a really good resource. Pregnancy with diabetes can be incredibly stressful and non-diabetics, while sympathetic and caring, often don't "get" it in the way that other diabetics will. So check it out!

As for homebirth etc ... all I can do is share my experience. My A1c was in the 5's throughout my first pregnancy (6.7 at conception and then rapidly got it down) and it was a very non-eventful pregnancy (according to the drs at least!) ... that said it being my first experience, and my DH was in another country at the time (long story), I didn't try to go the homebirth route. I was lucky because I had a very progressive (or perhaps a better word would be old-fashioned!) OB who wanted to induce me with cytotec at 39 weeks, but said that if the induction didn't take she would send me home for another week as long as everything continued to look fine. Perhaps this is an option you can discuss with your OB if he/she wants to induce you. In any case I was induced and it DID take after about 6 hours and my son was born vaginally. A few comments: while I think there is definitely a huge value for homebirth, I felt much more relaxed being at the hospital (note: it was also a progressive hospital, in California hippy-land, so that made a big difference). There was one point where DS's heartbeat really really slowed down and they considered taking me in for a C-section; it then came up and it wasn't necessary, but I was glad to have that emergency option available with no time delay. The other thing is the question of how you will manage your sugars during the birth. For most of the pregnancy I thought I would prefer to wear my pump, but my endo finally convinced me that the insulin/dextrose drip was the way to go as the nurses are really on top of things and can adjust your sugar FAST - way faster than it would be if you were just infusing insulin subcutaneously.  I have to say, it ended up being a huge relief to not have to focus on the diabetes on top of trying to get through the contractions - I never thought I would want to relinquish control, but it ended being the best thing for me, and my sugar was perfect throughout the whole labor, and my son's sugar was very stable after birth. It would have been a lot more stressful if I had had to be "in charge" of keeping my sugar perfect while trying to focus on labor. Also, something to think about ... I was very pro-natural birth, but was actually hugely relieved to get the epidural after 24 hours of labor. Just something to keep in mind - you might WANT that pain relief even if you don't really "need" it - everyone has to come to their own decision on this.

Anyway. I think hospital births are rather scary, because we've all heard the horror stories and don't want to be pushed around. But - I had an amazing birth experience in the hospital and felt completely taken cared for and I didn't have to worry at all about my blood sugar. Keep it in mind! And let us know how things turn out for you!!

All the best.
 

[cabbitdancer]

I had a cesarean with my first, so there will be no induction for me. It's VBAC or CBAC, as the risk of rupture with induction is too great.

You do make a good point regarding the drip. It is definitely something I've been thinking about.

Thank you for the site rec! I'll have to check it out. :)

[Sheepdoc]

As I understand it the only study of automatically giving diabetics a dextrose drip in labor was done in Canada and it showed significantly worse outcomes for those mothers and their babies than if they did have one.  So unless new research has been done the doctors recommending an automatic drip are subjecting your babies to increased risk of complications just because they think its a grand idea.  They may make it sound like they're making life easier for you but who really benefits if no one has to monitor the patient?

You can go to the link I posted above about diabetic home births and I believe the mothers in them cite the studies.

[rubidoux]

I'm a type I and I've had two very successful births. Both were c-sections. I was and continue to be very pro-natural birth, but I was able to be very active in the decision-making the first time around and feel great about the 30 hours I was in labor and pushing and I feel it happened just as it should. When I saw my little guy I had no qualms about how he came out. It was a perfect experience for me.

The second time around I was kinda bummed about the scheduled C at 39 weeks, but the day before my C I went for an amnio and all stats were great. The next morning at 6 am pre-op my BP was high and protein quite high in my urine, so it turned out to be a really good thing. Just the same, though, I would have rather had the chance to labor but that was obviously not in the cards. The scheduled C was not a bad experience, but a little flat for me. I think you're kinda meant to do some work to get the baby out. But out he came, cute as a button, latched on like a champ in the recovery room and we had a really nice first few hours because I wasn't out of my mind with exhaustion like the first time.

I would never try to talk anyone into a c-section, but I tell my story bc I want you guys that haven't had your babies yet to know going into it that you can have a positive experience even if things go that way. The first time I was pretty hell bent on no meds and vaginal birth but for whatever reason I didn't see myself as a failure or see my births as less than they should have been and I think it is important for us to be open to seeing whatever the outcome is positively. I see so many posts by women w beautiful cuddly babies who can't enjoy them bc they are destroyed by the lack of natural vaginal birth. The deck is really stacked against us -- not bc we are in bad physical shape, but bc of this 38/39 week timeline they've given us. So while I think it's great to push for a natural birth, I think it's a good idea to wrap our heads around the fact hat it might not happen that way.

As far as the 38/39 week time limit goes, and all my info is old bc I haven't researched this stuff since my first pregnancy in 2003, iirc stillbirth rates for type I's go way up at that point and they don't know why. During my 1st pregnancy I fought hard to be allowed to go to 40 weeks and all my labs were excellent and my perinatologist finally agreed. But after he was born I was really kind of horrified with myself for that. It still feels really creepy to me that I was willing to risk his life for a better birth. It feels very different to think about that when he's sitting here next to me. When I was pushing for that extra week to be able to go into labor, he wasn't the reality to me that he is now.

[cabbitdancer]

The risk of my dying as a result of major abdominal surgery is far greater than my risk of losing my baby due to complications of vaginal birth and I look at it this way, as horrible as it might seem: that I would much rather lose my baby than die myself and leave two children without a mother. Though, honestly, if all my NSTs and kick counts and everything are fine, I don't see why going over 39 weeks is that big a deal. I would much rather give my baby the chance to fully mature than have a c-section "just in case."

As it is, I was pressured to have a c-section early with my daughter for all the wrong reasons and, between the pressure and the experience that I had on the table, I really don't want to repeat the experience. I am hoping, if this pregnancy DOES come to a c-section, that I can have as wonderful experience as I have heard some women have had, but I would prefer not to have the C in the first place.

[rubidoux]

Ya know, I think I have a particular fear of baby dying in there for no good reason (and when I say no good reason, I mean my subjective idea of no good reason, doesn't need to apply to anyone else).  Even if the stats say that I'm more likely to die in surgery, I feel like I kind of understand that risk somehow, and understand some of the factors that go into it and I can assess them in my situation  -- ie, I feel confident in my doctor and the hospital has a good rep/I've had good experience there, I am in good shape, good control, etc.  I'm not saying that any of those things alone or together will save me, but I can tick them off in my head and feel good about them.  It really freaks me out that the stillbirth thing doesn't seem to be tied to anything I can tick off.  Last time I read about it (again, almost ten years ago now, so maybe there's new info), they were saying that it was not related to blood sugar control and they didn't know why it was happening.  

Anyhow, if I were pregnant for the first time, knowing what I know now, I would do everything in my power to have a natural vaginal birth, other than put it off too long.  I don't know that I'd necessarily agree to be induced at exactly 38 weeks, but I also don't think I'd push to go as long as I could in the hopes that I would go into labor, like I did with my first pregnancy.  I'm sure the comfort zone is different for everyone.  But I would also try to prepare myself for having a positive c-section experience.  It seems so tragic to me that so many women hate themselves after a C section.  That's a really rotten thing to deal with when you have a brand new baby and it's completely unnecessary.  

Another thing I meant to say something about earlier and forgot, not really related to the birth so much, but something I'd want to think about if birthing at home...  I would want to make sure that there was someone there (probably my partner) who had a good handle on how to manage my blood sugar and insulin and deal with lows.  I think I had the worst low in my 20 years of being diabetic the night after my second was born and nobody in the hospital picked up on it.  I was asleep alone in the room with Augie and he started crying and I was laying there thinking "oh crap, will someone come feed this crying baby I'm trying to sleep!" and I don't think it dawned on me that he was mine!  And I was in such bad shape that I don't know if I could have done anything to help myself or let someone know.  I'm willing to bet that if my husband had been there he would have realized immediately what the problem was.  But the nurse who responded just fed Augie (formula!) and didn't realize I was having an issue.  But anyway, if you're home, I'd say make sure there's someone who understands how to handle those things and make sure that you're not left alone for maybe at least 48 hours.  I can't remember if it was the first night (so at like 15-18 hours old, or the second  which could have been really close to 48 hours.  My basals had been cut in half and I wasn't doing any boluses at that point (not eating).  I remember the basals were significantly lower than I was using pre-preg.

[bearandotter]

I have no story of my own to add here. But my sister has type 1 and had a lovely natural hospital birth even with the high risk OB. Despite A1Cs in the sixes, my niece was born amost 9lbs at 27 weeks (natural onset of labor) and the doc was amazing at working with her to get a good squatting position to naturally deliver the baby with the least trauma possible (my sister is SMALL).The baby did require 2 days of NICU monintoring and IV for extreme hypoglycemia. My sister was able to room in in NICU and had amazing BFing/kangaroo care support. 

Nautral, low intervention birth can happen in hospital and I know my sister is happy hers happened there. I remember a 4 person team recussitating  the baby when her sugars really crashed about an hour after delivery - it would have been tricky for 2 MWs to do the same at home. 

[rubidoux]

Originally Posted by bearandotter 

I have no story of my own to add here. But my sister has type 1 and had a lovely natural hospital birth even with the high risk OB. Despite A1Cs in the sixes, my niece was born amost 9lbs at 27 weeks (natural onset of labor) and the doc was amazing at working with her to get a good squatting position to naturally deliver the baby with the least trauma possible (my sister is SMALL).The baby did require 2 days of NICU monintoring and IV for extreme hypoglycemia. My sister was able to room in in NICU and had amazing BFing/kangaroo care support. 

Nautral, low intervention birth can happen in hospital and I know my sister is happy hers happened there. I remember a 4 person team recussitating  the baby when her sugars really crashed about an hour after delivery - it would have been tricky for 2 MWs to do the same at home. 

That sounds like a great birth story, though it must have been scary when baby's blood sugar crashed.  I was pretty bummed when my second one was having low blood sugars maybe 15 hours or so after birth.  The doctor put him in the NICU and I couldn't go because I was on a mag drip and had just had the C-section (I think it was the mag drip that was the problem, though).  When they took him they said he'd be there for 24 hours and I was practically hysterical about that.  Ugh.  I wouldn't have been able to nurse or anything.  But then, I don't know if it was my freaking out or what, they decided after about an hour and a half that he could be back in my room with me.  Phew!  I'm happy your sis got to be there.  

[bearandotter]

Originally Posted by bearandotter 

I have no story of my own to add here. But my sister has type 1 and had a lovely natural hospital birth even with the high risk OB. Despite A1Cs in the sixes, my niece was born amost 9lbs at 27 weeks (natural onset of labor) and the doc was amazing at working with her to get a good squatting position to naturally deliver the baby with the least trauma possible (my sister is SMALL).The baby did require 2 days of NICU monintoring and IV for extreme hypoglycemia. My sister was able to room in in NICU and had amazing BFing/kangaroo care support. 

Nautral, low intervention birth can happen in hospital and I know my sister is happy hers happened there. I remember a 4 person team recussitating  the baby when her sugars really crashed about an hour after delivery - it would have been tricky for 2 MWs to do the same at home. 

eek - just re read this. Baby was 37 weeks not 27. That would have been a whole other story (and not a lovely natural birth). So sorry to all who read this :)