Labour and birth, for women with type 1 diabetes
Planning for labour and delivery
Your diabetes in pregnancy team will work with you towards the ultimate goal of having a healthy baby. As a woman with diabetes it may be possible for you to have a full-term delivery and natural birth. However, your doctor will probably recommend delivering your baby at around 38-39 weeks or even earlier if there are problems during your pregnancy.
Reasons for earlier delivery may include high blood pressure or pre-eclampsia, your baby becoming too big or perhaps not growing enough. Occasionally it may also be because your diabetes is getting difficult to manage or if there is a concern about a fall in your insulin requirements or your baby’s activity level.
Your health care team will discuss what to expect during labour and delivery. This will include a plan for insulin adjustment, blood glucose management and who to contact if you go into labour earlier than expected.
Managing diabetes during labour
Your own blood glucose levels in the time leading up to the birth have an important effect on your baby’s blood glucose levels. The higher your blood glucose is, the higher the glucose supply will be to your baby before birth. The extra glucose stimulates the baby’s pancreas to make more insulin.
At birth, your glucose supply to your baby suddenly stops, but your baby may continue to produce excess insulin for several hours and even up to one or two days after birth. This can cause hypoglycaemia in the baby. If you have blood glucose levels close to the recommended range during labour, this lowers the risk of your baby having low blood glucose levels at birth.
When an induction or caesarean section is planned, your health care team will discuss with you a plan for managing your diabetes. This will include adjustment of your insulin doses/pump rates or changing the way insulin will be delivered.
When you are in labour, your blood glucose levels will usually be monitored hourly. The amount of insulin you are being given will be adjusted to keep your blood glucose within a specified target range.
An intravenous (IV) insulin infusion and IV glucose (sugar) are often used throughout labour, which allows small amounts of insulin and glucose to run into your blood continuously. Alternatively, rapid-acting insulin injections every two to four hours may be used during labour to manage your blood glucose levels.
If you use an insulin pump, you may be able to continue using it, but with changes to your basal rates and smaller bolus doses. This will only be the case if this can be managed safely at the hospital where you will deliver your baby and blood glucose levels can be kept within the target range.
Induction of labour
Depending on how your pregnancy is progressing, you may need to have an induction, which means helping your body to start labour. An induction can be performed in several ways and sometimes a combination of two or more methods will be used. These include:
- Gel insertion—this involves inserting a prostaglandin pessary or gel into your vagina, to help the cervix to soften and open. This, in turn, tells your uterus to start contracting. Some women need two or three doses of gel before labour begins.
- Oxytocin drip—this method involves an intravenous (IV) line (or drip) being inserted into a vein in your arm, and the oxytocin hormone being slowly delivered into your blood to help your uterus start contracting. The drip may be used alone or with a gel insertion.
- Balloon induction—this involves a catheter being inserted into your vagina. Water is then pumped into the device, which gently puts pressure on your cervix, assisting dilation and encouraging your uterus to start contracting.
- Rupture of membranes (breaking waters)—this method involves rupturing the membrane, or bag of fluid, around your baby. Your membrane is gently broken using an ‘amnihook’, which looks like a long crochet hook, and the gush of fluid may encourage your uterus to start contracting and bring on labour.
If your doctor is concerned about you not being able to have a vaginal birth (for example, if they suspect your baby is large or there are other obstetric problems), they will discuss this with you when you are making a plan for your baby’s birth. This is usually towards the end of your pregnancy, at around 35–36 weeks.
If a caesarean section is advised, it will be according to your obstetric needs, not just because you have diabetes. Birth by caesarean section is not a decision taken lightly, as there are risks involved with such major surgery. The medical decision to perform a caesarean section should be discussed with you in detail, so your doctor can explain the risks and benefits involved.
If you are having a caesarean section, you will usually have to fast for about six hours beforehand, so you should discuss with your health care team the options for managing your blood glucose levels and insulin doses (if relevant) during this time.
It is a good idea to make a management plan with your health care team well before the birth.
In some circumstances, a caesarean section is undertaken as an ‘emergency’. This might happen if there are problems with you or your baby, or because the labour is not progressing the way it should.