diabetic mother (type 1 insulin dependant) seeking info on home birth - Mothering Forums

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#1 of 15 Old 08-05-2006, 06:40 PM - Thread Starter
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I am a new father to be and my wife has type 1 insulin dependant diabetes. can you give any/all info on the possibility of having a natural home birth. thank you
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#2 of 15 Old 08-05-2006, 10:36 PM
 
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I think that with paralell care working with the team currently monitoring her diabetes, it could be a possibilty. It's a big job monitoring and managing blood sugars in pregnancy, and keeping tabs on her kidneys, etc, but if she's hale and hearty otherwise to begin with, and willing to continue to monitor/eat right/exercise, it could be something a midwife might be willing to take on.
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#3 of 15 Old 08-05-2006, 10:42 PM
 
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It partly depends where you live-- in some states it is illegal for a midwife to attend a homebirth of a woman with diabetes.
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#4 of 15 Old 08-05-2006, 11:26 PM
 
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Now, I will prefice this by saying that I don't know about Type 1 and giving birth *together*. But, I do know some about giving birth, and my son has Type 1. So, with that said, here are my thoughts.

I would think that it would not be idea unless you or the midwife knows *very* well how to take care of your wife's diabetes (monitoring bg, insulin doses, how many carbs are needed when low, etc.). Your wife is going to be busy, and won't be able to concentrate on that as well as birthing.

Other issues will come into play, and if this is her first child (sounds like it is), you aren't going to know how her body will react to the stresses of birthing. On the one hand, the stress of it will possibly cause her bg to go up, but at the same time the physical work she will be doing may cause it to go down. You won't know what her body will do until she's in the situation.

Can her midwife give an IV? Although I hated having an IV during labor, and they are very often unnecessary, one may be necessary for your wife. If her bg goes down and she can't take in any/enough food or fluid (I could hardly get anything in me during labor), she'll need an IV with a sugar in it (dextrose is, I think, what they use).

Are you in an area where she could be quickly and easily transported if need be?

Maybe your wife could talk this through with her endo. or a diabetes educator (with experience with Type 1, of course) and hear what she/he thinks. Some would be receptive and have some good thoughts, although I'm sure there are plenty who would not be.

Does her midwife have experience with this? If not, does she know anyone else who has experience? I would think that talking with midwives would be a good place to start.

If, for whatever reason, you decide (or the decision is made for you) that she needs to deliver in a hospital, you could probably still have a midwife attend, which would make the experience much better. I would look for a midwife who has a back-up dr. who is understanding and will allow the midwife to be involved.

Anyway, those are my initial, and disjointed, thoughts. Hope I've helped in some small way.

Congratulations on becoming a dad!

Christie

Christie ~ proud Mama to : 5/01, and : 3/07; and proud wife to my since 1992. We have 13 and 2 : It's looking more and more like either a farm or a zoo around here.
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#5 of 15 Old 08-06-2006, 09:55 PM
 
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I was following this thread http://mothering.com/discussions/sho...light=diabetic for a while since my co-worker has Type 1 and I was trying to learn more about motherhood and diabetes. I think you'll find a lot of info and make some nice contacts for your wife there.
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#6 of 15 Old 08-09-2006, 01:57 AM
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Where do you live? Different places have different legal and availability issues, so that could be a limiting factor.

I know it has been done at least once (there is a post about it here; I'll see if I can dig it up) but the mom was having her third or fourth baby, so there was some assurance that she knew how her body worked in labour.

For what it's worth, I am type 1 and just had my first babe. I desperately wanted to have a homebirth, and did *a lot* of soul-searching and research about the issue. I ultimately decided to have a hospital birth. I cried a lot about that decision.

The birth was pretty awful. I ended up with nearly every intervention in the book and have been grieving the experience ever since.

However, I would still make the same decision now. I think that homebirth should absolutely be the default choice for low-risk pregnancies, but much as I didn't want to, I finally accepted that my situation was not low-risk. (I haven't ruled out a possible future homebirth, though that possibility is now further complicated by the fact that it would be a VBAC.)

Keep in mind that a big issue with type 1 is the risk of neonatal hypoglycemia. This is probably overdiagnosed in the general population, but is much more of a genuine risk in this situation, and can have devastating outcomes.

Best of luck to you and your wife. I hope you have a wonderful birth, wherever you decide to do it. (P.S. Check out the Type 1 diabetic mamas tribe.)

professor & maman de DS1 (6) & DS2 (1)

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#7 of 15 Old 08-09-2006, 02:08 AM
 
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My concern would be (after having worked in a Level III hospital with a regional program for pregnant women with diabetes) twofold: first, BS control in labor is extremely difficult for many women because of the physical effort and the stress response. We would often put women on insulin drips because good BS control was so hard to achieve otherwise, and some women who were otherwise well-controlled would become quite brittle in labor.

the second concern I would have would be the newborn. Infants of diabetic moms are at high risk for neonatal hypoglycemia and also immature lungs long after one would normally not see RDS. Often, the initial glucose is fine and then the sugar will dive, just because the baby's pancreas is so used to overproducing insulin to cope with sugar swings in mom.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#8 of 15 Old 08-11-2006, 03:06 PM - Thread Starter
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thank you all for the replies. a few follow up questions. maxmama what was the hospitals protocol if the infants bg levels did dive? and for ~pi can you email me some of the sites or references that you used for research? thank you all so much. much love and peace
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#9 of 15 Old 08-11-2006, 03:52 PM
 
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Quote:
Originally Posted by kpt
thank you all for the replies. a few follow up questions. maxmama what was the hospitals protocol if the infants bg levels did dive? and for ~pi can you email me some of the sites or references that you used for research? thank you all so much. much love and peace
It depends a lot on the hospital. In ours, if the sugars drop below 35, then the baby is supplemented (our protocol uses formula at the breast during nursing). If sugars cannot be stabilized above 45 with supplementation, then the baby's put on an IV. Glucose IVs in babies are not something that can be handled at home; the volume and reaction of the body to the glucose is too unpredictable.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#10 of 15 Old 08-11-2006, 07:54 PM - Thread Starter
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thanks a lot maxmama. do you have any other sights that i can locate info and take my research and quest for a homebirth forward?
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#11 of 15 Old 08-11-2006, 08:27 PM - Thread Starter
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can we use a glucose home meter for reading the baby's bg levels?
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#12 of 15 Old 08-11-2006, 08:38 PM
 
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Quote:
Originally Posted by kpt
can we use a glucose home meter for reading the baby's bg levels?
Yes and no. Most home meters are not calibrated for truly low sugars (what is normal in an infant would be critically low in an adult); they're inaccurate below about 60 since that's damn low and doesn't matter.

I have very significant reservations about a Type I diabetic having a home birth, and I think you need to talk with a neonatologist about what to expect with an IDM. The RDS in IDM can be significant, and the sugar drops (especially if mom is at all brittle in labor, which as I said is quite common) can be severe and incredibly quick. I don't know personally of any midwives (CNMs or otherwise) who would attend a home birth with a Type I diabetic for those reasons. I know that home birth is a very hard thing to give up (I was a home birth transfer for severe preeclampsia) but the data showing its safety involves healthy women having a normal labor, and I don't think, given the issues of BS control in labor and the issues of IDM, that a Type I diabetic can be included under those criteria.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#13 of 15 Old 08-12-2006, 12:52 AM
 
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Quote:
Originally Posted by maxmama
Yes and no. Most home meters are not calibrated for truly low sugars (what is normal in an infant would be critically low in an adult); they're inaccurate below about 60 since that's damn low and doesn't matter.
I don't know the specifics on all meters, but the Accucheck Advantage and Freestyle Flash will give an accurarate reading well below 60. 20-500 is the range for the Freestyle. I can't find the booklet for the Accucheck right now, but I'm sure it's right about the same.

You *would* need to know what the normal and low ranges are for a newborn, though. And there's still the question of whether it's safe to be at home rather than a hospital. I know that ds, being only 5, has a potentially greater risk when low, since his glucose stores are smaller. I would think that a newborn would/could have virtually none.

And, FWIW, 60 isn't really that low. Maybe during labor, but not the rest of the time. We've been told to treat with food if ds drops below 70, but they're not really concerned about 60. They feel like he's doing well if he stays above 45. They were so pleased at our last appt. because he had a good a1c without anything below 50. *We* feel like he's doing well if he stays above 55 or 60. He doesn't have a rebound effect from a low if he stays above 60 (sometimes 55). Understand I'm talking about *lows* here, not target bg or averages.



Quote:
I have very significant reservations about a Type I diabetic having a home birth, and I think you need to talk with a neonatologist about what to expect with an IDM. The RDS in IDM can be significant, and the sugar drops (especially if mom is at all brittle in labor, which as I said is quite common) can be severe and incredibly quick. I don't know personally of any midwives (CNMs or otherwise) who would attend a home birth with a Type I diabetic for those reasons. I know that home birth is a very hard thing to give up (I was a home birth transfer for severe preeclampsia) but the data showing its safety involves healthy women having a normal labor, and I don't think, given the issues of BS control in labor and the issues of IDM, that a Type I diabetic can be included under those criteria.
As I said earlier, I don't know enough about this to make much comment. Everything you've said makes sense given what I know (except your hospital's policy of giving formula before trying breastfeeding, but that's them, not you ).

To the OP, though, there is mention of one home birth in the thread linked earlier by ~pi -- the type 1 mama tribe. I looked at the thread, but didn't make it through the whole thing. It looks like a very, very good place to find resources/support/information. I highly recommend checking it out.

Christie

Christie ~ proud Mama to : 5/01, and : 3/07; and proud wife to my since 1992. We have 13 and 2 : It's looking more and more like either a farm or a zoo around here.
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#14 of 15 Old 08-12-2006, 12:55 AM
 
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Quote:
Originally Posted by ChristieB
I don't know the specifics on all meters, but the Accucheck Advantage and Freestyle Flash will give an accurarate reading well below 60. 20-500 is the range for the Freestyle. I can't find the booklet for the Accucheck right now, but I'm sure it's right about the same.

You *would* need to know what the normal and low ranges are for a newborn, though. And there's still the question of whether it's safe to be at home rather than a hospital. I know that ds, being only 5, has a potentially greater risk when low, since his glucose stores are smaller. I would think that a newborn would/could have virtually none.

And, FWIW, 60 isn't really that low. Maybe during labor, but not the rest of the time. We've been told to treat with food if ds drops below 70, but they're not really concerned about 60. They feel like he's doing well if he stays above 45. They were so pleased at our last appt. because he had a good a1c without anything below 50. *We* feel like he's doing well if he stays above 55 or 60. He doesn't have a rebound effect from a low if he stays above 60 (sometimes 55). Understand I'm talking about *lows* here, not target bg or averages.




As I said earlier, I don't know enough about this to make much comment. Everything you've said makes sense given what I know (except your hospital's policy of giving formula before trying breastfeeding, but that's them, not you ).

To the OP, though, there is mention of one home birth in the thread linked earlier by ~pi -- the type 1 mama tribe. I looked at the thread, but didn't make it through the whole thing. It looks like a very, very good place to find resources/support/information. I highly recommend checking it out.

Christie
We do try BF first. The baby's usually on the breast while the initial sugar is being checked (needs to be within 30-60 minutes of birth) and formula is always given at the breast (tube & syringe) if needed. If not, great.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#15 of 15 Old 08-12-2006, 01:02 AM
 
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Quote:
Originally Posted by maxmama
We do try BF first. The baby's usually on the breast while the initial sugar is being checked (needs to be within 30-60 minutes of birth) and formula is always given at the breast (tube & syringe) if needed. If not, great.
Sorry, didn't catch that in your earlier post. I did notice, however, that the formula was given at the breast. I was impressed with that and wondered why breastmilk wasn't tried first. Now I get it!

Christie

Christie ~ proud Mama to : 5/01, and : 3/07; and proud wife to my since 1992. We have 13 and 2 : It's looking more and more like either a farm or a zoo around here.
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