BF with Pre-Eclampsia & Gestational Diabetes

[Fantail]

Does anyone have any experience/tips/hints to do with breastfeeding for someone who has both pre-eclampsia and gestational diabetes (I have both and am currently 35+3 and in hospital until the birth).

do you mean you are breastfeeding now, or when the baby arrives?

I don't know enough about breastfeeding with pre-eclampsia but I can answer about GDM.

If you have true GDM (and this is not Type 2 diabetes that just happens to have presented during pregnancy), your glucose will go back to normal within minutes of delivering the placenta. Your diabetes team will be able to tell you whether they want you to stop all treatment, which is what we do in most cases, or significantly reduce treatment.

Assuming you are on no treatment, you can carry on with breastfeeding with no special considerations. If you are on treatment, remember that your blood sugars don't need to be as tight as before and it is far better to run higher for the next few days and weeks than it is to run low and end up hypo with a little baby.

In terms of the baby, as I am sure your team will have told you, there is a risk of hypoglycaemia for the baby in the hours after birth. This is because the baby will have produced more insulin than normal to deal with your slightly higher blood sugars so it is really important to keep your blood sugars as normal as possible even up to the birth.

Hopefully you'll get help to breastfeed and it will all be fine. Sometimes, however, with all the best will in the world, babies do need a little bit of expressed milk or formula to raise their blood sugars so they have enough energy to latch on and feed properly. This is not a disaster and does not mean the end of breastfeeding, think of it as a medicine to help things, so that the baby can get on with breastfeeding properly feeling a bit more with it!

Hope you are not getting too bored in hospital and that all is well with you and your baby.

I meant breastfeeding after the baby is born.

Thank you for your advice Mrs G!

I will need to have a more detailed talk with all concerned at some stage. At the moment I am just trying to gather my thoughts and hope that we make it another 10 days or so until I am at term! I would not object to formula or expressed milk being given as a suppliment, but I would prefer it by syringe or cup rather than bottle.

Fantail - I can't answer about the pre-eclampsia, although obviously the smaller the baby the more likelihood there is of the baby having a small mouth and a weaker suck reflex which could (and I stress could) make BF more difficult.

I've got GD in this pregnancy, and feeding method immediately post birth was one of my main worries on diagnosis. I've discussed it with the specialist midwife, and my consultant and I'm going to raise it again when I go into hospital to have the baby (it will be the only thing on my birth plan actually!). I have been assured that whether I have a vaginal birth or an ELCS that they will be keen to help me have skin-to-skin asap and feed as often as possible as quickly as possible.
They will not be testing the baby's blood sugar until 3-4 hours post birth OR after the 2nd feed, whichever comes sooner which I am happy with. What I was very keen to avoid was a sugar test immediately followed by formula straight away, which I am aware is policy in some hospitals.

Agree that if formula or expressed colostrum needs to be given, then you should request either a cup or syringe - I plan to do the same.

It really depends on how well/unwell you are re: the pre-eclampsia and what kind of delivery you have. You can still have early skin to skin (if you wish)and breastfeeding is certainly encouraged by any sensible midwife/doctor in either PET or GD.
Baby will be on a neonatal hypoglycaemia policy - in my trust that means early feeding, 3 hrly feeds & blood sugar measurements (BMs) until 2 good BMs of 2.5 or over are achieved consecutively. This may mean a top up of either ebm or formula as appropriate and this can certainly be given by syringe or cup. Get to grips with the technique for hand expressing prior to delivery so that you can express straight away if you need to/feel up to it.
Of course if baby is small for dates or any other complication, they will probably be on 3hrly feeds and BMs for that reason also.

Thank you, that is really helpful. To be honest it is the post birth stuff that I am most concerned about. Obviously, if the baby is in immediate distress then it will need to be attended to, but if not then I want the skin to skin.

The baby is measuring big according to scans and given genetics I was never likely to have a small bub anyway.

Thank you also for the hint about the fact that some hospital have a policy of an immediate sugar test followed by formula.

print this out discuss it with your midwives. put a copy in your birth notes and in your labour bag. good luck.

yes, our diabetes specialist midwife discusses expressing in the antenatal period with diabetic women at our hospital. Worth thinking about if you really want to avoid formula top-ups.

Oh thank you, that is very helpful advice. I was wondering how you expressed prior to birth.

Fantail, I have no experience re gestational diabetes but dd was born at 35 weeks because of my Pre E. She was 4 pound 7 and fighting fit and a keen breastfeeder from birth despite her tiny size.

I know she was getting plenty of colostrum and then milk but the hospital insisted that she was cup fed formula for several days. Once her blood sugars were ok and they stopped doing them I stopped topping her up just neglected to mention it

Personally I was very ill and had a dural headache from the epidural that was receommended to try and keep my BP down during the labour. It took ten days to sort all this out and for about 9 of those i could barely lift my head off the pillow.

Strangely enough i never considered stopping breastfeeding it felt like the only thing out the whole experience that had worked (induced forceps delivery etc).

I was on a lot of pain and blood pressure medication but that was fine. if you are on metyldopa now they will probably change it after the birth. I was on methyldopa and nifedipine and then continued on nifedipine and one that started in l i've forgotten.

Don't be surprised if you are on bp meds for a while after the birth that quite normal.

Good luck, trust the hcps and try not to worry :)