Type 1 diabetic, labour and c-section

[DropsofJupiter1980]

Hi All

I am a type 1 (insulin dependent) diabetic and am currently 30+5 pregnant with my first (and, after 7 years of fertility treatment), much longed for baby.

I'm looking for some pearls of wisdom and am hoping some of you would be able to share some possibly similar experiences with me - sorry it's long but I'm trying to explain the best I can and not drip feed info!

Before my pregnancy my diabetes was perfectly controlled and I never had any issues, nor was I ever hospitalised. I was also very aware when my blood sugar dropped (for those who don't know, low blood sugar is referred to as a hypo (hypoglycemia)) so I could take steps to address it and get it back to a normal level.

However, since I became pregnant, it has been a total nightmare! I have suffered with terrible hypos, and I am no longer aware of them, so much so that I am not really able to go out on my own. I have been told I can't drive. I've fallen unconscious and been hospitalised a number of times. I also had a very bad hypo in the bath whilst my DH was out, and he returned home to find me under the water - thankfully I'm ok (I dropped the ipad when I lost consciousness which wedged underneath me and stopped me from going completely under!) but this terrified us both.

I am therefore completely unable at the moment to control things properly. I am very anxious about having a natural birth. I am told that I would have two drips - one insulin and one glucose to try to control my blood sugar (although from a previous operation I know that this is not, at least for me, that successful).

Because of these issues I would feel more comfortable having a c-section. I clearly can't control my blood sugar and have no awareness of when it is too low. I am worried about a lengthy labour which may last hours (or days!) and expending lots of energy which would make it harder to control my blood sugar and eat properly, as opposed to a c-section which would be over relatively quickly (I understand within an hour or less). I'm not sure if this is likely, but I have suffered terribly with vomiting throughout the pregnancy (I don't know if this is relevant but I suffer terribly with period pains and vomit as a result) and I understand that many women vomit during labour. Obviously if I was throwing up and not able to keep any food down it's going to lay havoc with my blood sugar as well. I'm also terrified about the risks to the baby - after all the treatment and heartache we've endured I want to ensure the safest delivery possible.

However, I have met with the obstetrics team, and while the midwives and registrars support my request for a c-section, the consultant does not and is unwilling to agree to a maternal request c-section. Diabetics are, at least in my area, usually induced and have a natural birth. However, I am aware of the NICE Guidelines and think I have a strong medical reason for a c-section.

Are there any other type 1 diabetics reading and if so what was your experience of blood sugar control during labour? Did you have lots of hypos?

Has anyone persuaded the consultant to perform a c-section for similar (or other) reasons?

I'd be really grateful to hear any advice or shared experiences. Thanks so much for reading - sorry it is so long!!

xx

[earthmoon]

Hi
Im sorry to hear about your struggles with hypos. Pregnancy and diabetes mixed together is like being between a rock and a hard place. Like you my sugar levels had been very good and the only time i was admitted to the hospital before pregnancy was during diagnoses. However, to be clear i haven’t been admitted for hypos, as i never been unconscious because of it. But i can tick all the other symptoms in the nhs symptoms check list, including one that’s not in there. For some reason my legs don’t work properly when sugar is below 1.2 so i usually crawly to get my hypo treatment or get someone to help me. Im now 28 weeks with DC2 and i have lost lots of recognitions to the signs. But as i learnt from DC1 i can get them back after the baby is out safely. I have also been told not to drive. the thing that makes it easier for me to trust myself is by testing and testing and testing my sugar levels again. By the time i had my first, my fingers where not very pretty, but the freedom i gained from it was worth it.
I was admitted for steroid injections for “erratic blood sugar control” by an obstetrician, thanks to something my midwife and my diabetes doctor later told me was more likely to be nocturnal hypoglycaemia that caused two rebound hyper reading in two specific mornings, after the first growth scan. I have changed hospitals this time around and i have been told it was unnecessary to do so and they will not do it, especially as my hb1c is good 6.4 (it was better last time at 5.8) What i learned from that is every hospital is different. I saw the same obstetrician at my last growth scan again and she managed to convince me to come in for an induction at 37 weeks for DC1.
I went in on a Wednesday morning to start the induction. I came 1cm dilated, and by Thursday night there was no change despite after they gave me three lots of gels. A dr came and after a long discussion i managed to convince him to allow me three more goes of the gel (i really wanted a vaginal birth). Come Saturday a female dr came and i knew i hadn’t dilated as i asked a midwife to examine me 1hr earlier who said i was still at 1cm. That dr was very kind and i had given up on my vaginal birth but she said she needs to check me before making a final decision and as soon as she put her hand in me my water broke. I was then transferred upstairs to labour ward where i was told i wasn’t allowed to eat. I was given insulin on the sliding scale and some glucose (but that is not its technical name but that is what it contained said dr) via drip on one right hand. The other hand i had another drip which administer some saline and the drip that brings on contractions (i forgot its name). i was also offered epidural at the same time, which i refused at that time. The no eating rule was broken twice. First time my sugar went a bit low 3.4 the midwife then increased the glucose thing in my arm. Half an hour later i felt odd and i tested my own sugar level, it was 2.4. i showed the midwife and she said she will increase the glucose for me again. I said there is no need and told DH to pass me the lucozade that was in my bag. The midwife didn’t respond and let me drink it.
Night came and the midwife changed and i was asked about the last time I ate was. I said last meal was breakfast and i mentioned i was hungry. The midwife called a dr in to explain to me why the no eating rule was there for and its disadvantages. After that i asked for food since i couldn’t justify starving myself to avoid vomiting in the eventuality of emergency GA c-section. I needed energy to push a baby out. The midwife went and got me a delicious cheese sandwich, which i used some novorapid to deal with.
Around 6am Sunday i ended up asking for some epidural. The dr agreed with my request despite being only 2cm dilated. Which was heaven until it caused baby heart rate to dip, apparently this is a common side effect and most time only temporary. But me being me, i didn’t do any prior research about epidurals since i was sure i was “never” gonna ask for it. The midwife had pressed the emergency button and the whole room was filled in seconds. They twisted and turned me and a dr placed a heart rate monitor on baby head. During the chaos, someone asked someone else why is the heart rate dropping? Is it uterine rupture ect... then the dr who placed gave me the epidural said she just put in the epidural and its the epidural fault. Hearing that broke my heart, but thank God DC1 heart rate stabilised and the reading of the head heart rate monitor got very good readings they put the hospital bed i was in back in its place. It was then i decided to ask for a c-section, but the dr told me to think about it a bit more and tried to reassure me the baby was fine. To be honest the chaos made me very emotional and i was crying like a baby. Around 10am and after dr changed, a big group of dr came and offered me a c-section for failed induction, which i jumped at.
This time around i’m hoping for the vaginal birth i wanted last time, which is less likely again to happen. i have already seen one obstetrician at 16 weeks instead of the midwife, he told me the failure rate of inductions are high and being induced early makes the failure rate higher. But he stated that the finally decisions will be made later, and if i wanted i could get c-section if i wanted it at that time. Last Friday i spoke to my midwife and she said no finally decision will be until after last growth scan if everything goes to plan. If nothing else works after your 36week growth scan talk to dr and do your research about c-sections before hand and inductions. If you still want c-section then be firm with you decision, i was never spoke about labour with the exception of midwife with drs but the dr who booked my induction did offer c-section, but i refused.

[earthmoon]

sorry about the long essay