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After your baby is born, for women with type 2 diabetes

Managing diabetes after delivery

After your baby is born, your diabetes management plan will need to be reviewed.

If you were taking metformin during pregnancy, this may be continued after your baby is born if your blood glucose levels are outside your target levels.

If you were changed from tablets to insulin before or during pregnancy, your insulin may be stopped after delivery. Depending on your blood glucose levels after delivery, your doctor will advise you on whether you still need insulin treatment or whether you may return to treatment with tablets. If you continue to need insulin, the dose is likely to be much lower and require frequent review, especially in the first week after delivery.

You will still need frequent blood glucose monitoring after your baby is born.

To reduce the risk of hypos while you are establishing breastfeeding and a new routine with your baby, target blood glucose levels after delivery will be higher than what they were during your pregnancy. At this stage, it is usually recommended that keep blood glucose levels are kept in the 5–10mmol/L range. Your diabetes in pregnancy team will discuss changes to your diabetes management plan with you.

Your baby

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 probably go with you to your hospital room.

Your baby may need to be observed in a Special Care Nursery for a day or two if your baby:

  • is born very large, very small, prematurely
  • has any breathing problems
  • has low blood glucose levels.

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 your baby is in Special Care Nursery after birth.

Your baby’s blood glucose level

Your baby will be tested for low blood glucose levels for at least the first 24 hours after birth. Blood glucose tests are done by heel pricks at regular intervals until the baby’s blood glucose levels are in the normal range. This test is to check for low blood glucose levels, it is not a check to see if the 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 2.0-2.5mmol/L), they may need to have supplementary feeds or some glucose. Talk to your midwife about using your breast milk for supplementary feeding.

Going home

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.

It is very important—both for you and your baby—that you stay healthy and safe, so remember the following:

  • Don’t forget to take your medication or insulin as prescribed.
  • Try to 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.
  • Ask your diabetes in pregnancy team for help (even after birth).

Contraception and future pregnancies

Make sure you are using suitable 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 life with your new baby.