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

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

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.)

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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.

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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.

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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

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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.