Talk with your doctor about what he recommends, and let him know your hopes for the birth, so that you can be on the same page as much as possible. Remember, women with diabetes statistically deliver by C-section more than other women. For some, this is a disappointing prospect. While many women with diabetes do have vaginal births, it’s worth making peace with the idea of a C-section, in case that becomes a necessary option.
Talk with your doctor about how your insulin will be managed during delivery. For example, many hospitals require a pump, including infusion site, to be removed during any surgery, including a C-section. If that is the case, ask how soon you will be able to reconnect to your pump. During labor and vaginal delivery, many women need little or no insulin because of the strenuousness of contractions. Who will be monitoring your blood glucose levels? Will your endocrinologist be consulted? Will the obstetrics team make adjustments? Knowing how all of these things will be determined ahead of time will help to make you feel more in control in the moment.
Also, make sure to talk with your doctor about the hospital’s policies on handling babies of women with diabetes. Some hospitals routinely take babies to the nursery for up to six hours after birth to monitor blood glucose levels; at least knowing this information can help you to prepare emotionally for this experience.
If you feel sad or angry that your baby may not be with you in the moments after birth, you are not alone. Many mothers with diabetes have been there and experienced that same frustration. “It felt like it took more time for my second daughter and me to bond,” says Karen Eason, whose daughter was placed in the nursery for blood glucose observation. “I knew that her blood sugar was going to be fine, but they were very strict at looking at the numbers.”
Delivery and beyond
Delivering a baby, vaginally or through a C-section, is truly awesome and completely exhausting all at once. Again, talking through what will happen with your insulin or medicine adjustments and blood glucose management ahead of time is important. Knowing that you may be feeling exhausted or overwhelmed, you may want to appoint an “advocate” for you—a partner, parent, or close friend who can help you reinsert your infusion site, check your blood glucose levels as needed, etc.
Having an advocate can be important because, unfortunately, not everyone you encounter among hospital staff will have the knowledge they need to help you. Many nurses know little about insulin pump therapy, and some have less education than they should about diabetes in general. Hypoglycemia can happen in the hours and even first few days after delivery as your body begins to adjust to being in a nonpregnant state. I remember checking my blood glucose to find it was 45 mg/dl the first night after my C-section and buzzing the nurse to bring me juice. Five minutes went by, then 10. I buzzed again…and when she finally came by she was annoyed that I had buzzed a second time. The next day I had my husband bring me glucose tablets so that I wouldn’t be dependent on the nursing staff again!
All of this adjustment in your body is taking place at the same time as you start to realize that you have given birth to your very own boy or girl. Whether they need to spend time in the NICU or nursery or get to be right there in your arms, the moment of realizing that you have just met your own child is like no other. “The first time I had a baby, before I was diagnosed with diabetes, I took getting pregnant and having a baby for granted,” recalls Karen Eason. “But when my second daughter was born, it truly felt like a miracle. You realize what a miracle bringing a child into the world truly is.”
And so your diabetes should not stop you from experiencing that possibility. Educate yourself as much as possible, make a commitment to yourself, and put your baby first as much as you can while you are pregnant.