After your baby is born, for women with type 2 diabetes
Managing diabetes after delivery
After your baby is born, your diabetes team will review your diabetes management. How your diabetes is managed after the birth will depend on a number of factors. These include your diabetes treatment before pregnancy, your blood glucose levels in the days after birth and whether or not you are breastfeeding. If your usual treatment before pregnancy was lifestyle and/or metformin, you are likely to return to this form of management.
If you were started on insulin during your pregnancy, this is likely to be stopped as soon as you deliver. However, depending on your blood glucose levels, you may need to restart insulin or start taking metformin.
If you were taking insulin before you became pregnant, it’s likely that this will need to be continued. The type of insulin, number of injections and doses you need will be reviewed by your doctor.
If you need insulin after pregnancy, the doses will be lower than when you were pregnant and will need frequent review, especially in the first month after delivery. If you are breastfeeding, metformin and insulin are the only diabetes medications suitable for use. Other diabetes medications may be prescribed for you when you finish breastfeeding.
You will still need to do frequent blood glucose checks after your baby is born. The target blood glucose levels after delivery will be higher than your pregnancy targets. This helps to reduce the risk of hypos while you are establishing breastfeeding and a new routine with your baby. It is usually recommended to keep blood glucose levels between 5 and 10mmol/L at this stage.
Your diabetes in pregnancy team will discuss changes to your diabetes management plan with you.
After birth, your baby will be examined by a paediatrician, obstetrician or midwife.
If your blood glucose levels have been stable during your pregnancy and the birth, and your baby has no problems, your baby will go with you to your hospital room where skin-to-skin contact and breastfeeding is encouraged.
If your baby is born very large, very small, prematurely or is having breathing problems or low blood glucose levels, they may need to be observed in a special care nursery for a day or two.
Not all maternity hospitals are equipped with a high-level special care nursery, so in some circumstances, your baby may need to be transferred to another hospital.
Skin-to-skin contact between you and your baby will be encouraged at birth because it will help you to develop a close bond with your baby. It also allows your baby to suckle and helps keep their temperature more stable. Ask your midwife about skin-to-skin contact if you and your baby need to be separated.
Your baby’s blood glucose level
Your baby will be checked for low blood glucose levels for at least the first 24 hours after birth.This is done by heel prick—usually within two hours of birth or before your baby’s second feed. Blood glucose checks are done at regular intervals until the baby’s blood glucose levels are in range.
Heel prick blood glucose tests are done to check for low blood glucose levels. This is not to check to see if your baby has diabetes and does not mean that your baby will develop diabetes in the future.
If your baby’s blood glucose level is low (less than 2.6mmol/L), they may need to have supplementary feeds or some glucose. Talk to your midwife about using your breast milk for supplementary feeding.
Taking a new baby home is incredibly exciting, but it can also be a stressful time.
Some women with diabetes find it very hard to make their own health a priority and give their diabetes the attention it demands during this busy period.
Take advantage of any assistance your family and friends can offer. If you don’t have any support nearby, it may be a good idea to organise help with things like shopping, cooking and housework. It is best to start thinking about this and getting plans into place before the baby arrives.
When you first go home with a new baby, especially for the first few weeks, you will be kept busy looking after your baby. You may find that this new routine, along with disturbed sleep, means that you don’t manage your diabetes as well as you would like.
To make sure that you and your baby stay healthy and safe, remember the following:
- Don’t forget to take your medication or insulin as prescribed.
- Avoid hypos so you are safe to take care of yourself and your baby.
- Check your blood glucose levels at least four times a day, to help manage your diabetes.
- Aim to keep most of your blood glucose levels between 5 and 10mmol/L.
- Make appointments with your diabetes health professionals, they can continue to help you manage your diabetes after your baby is born.
Contraception and future pregnancies
Make sure you are using an effective form of contraception to avoid having another pregnancy before you are ready. Remember that planning another pregnancy and having your diabetes well managed beforehand will help you to have a healthy baby.
If you decide not to have any more children, you may want to consider a tubal ligation or discuss a vasectomy with your partner. There are also a number of very effective long-term but reversible contraception options, including intra-uterine devices (IUDs) and hormone implants. Discuss the available options with your doctor.
Looking after your health
Once you are getting some more sleep and managing a new routine with your baby (usually 3–6 months after your baby is born), it is a good time to become more aware of your health needs again. Review your diabetes management with your diabetes health professionals to keep yourself healthy, so you feel well, reduce the risk of long-term health problems and enjoy your new baby.