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! I've also posted this on the childbirth forum but thought there might be a bit more traffic on here....

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

You won't need to persuade a consultant, you have a very serious medical condition and I am surprised they have not discussed this option with you so far.

I would speak to your midwife and ask to see a consultant ASAP and get the facts you need to make an informed choice.

I hope you are being well looked after and don't have any more incidences of this, it sounds very scary!

You tell the consultant what you want after getting referred to them from your midwife.

They will try and persuade you otherwise at all the stages, just to pre warn you.
As in just before you have the section done while laying on the table they ask you if you are sure that's what you want.

I found this odd and unsettling, but they have to legally do it, but when you are already feeling quite vulnerable it kind of puts you off.

I would just like to say I have had two c-sections (for medical reasons)

The first was an emergency. the second was planned.

The second was amazing, everything was so calm and the planning made me feel even more at ease.

I did not have any resistance from the consultant (I had seizures in my first labour which resulted in the EMCS)

However they do always ask before the procedure when elected that you are sure of what you want.

I am having another c-section this time and that thought makes me feel very much at ease.

Hey drops I'm also type 1 diabetic and am 34+4 today. I started off thinking I'd want a CS so I could feel more in control of my sugars (have also been told I was running them too low but have luckily kept hypo awareness, slept when asleep and ended up having ambulance to hospital nearly 2 weeks ago due to hypo whilst sleeping).

I've looked more into my hospitals policy on the sliding scale insulin/glucose drips and have since decided to try induction if I can, but am aware I need to be oped to other possibilities. At my hospital they only put you on the scale when you're n established labour, which was a big issue for me as I wanted to control my own sugars as much as I could. They then test your sugars every hour, but I've been training DH to do it for me so it can be tested more frequently to put my mind at ease. Perhaps you could do this and get him to test you every 30 mins if you're worried about missing a hypo?

I think being sick is not an issue when in established labour as you'll be on the drip and probably not eating anyway?

All that said, if you have real concerns, and I understand you are different to me because of the loss of hypo awareness, then push again for a CS, you should be allowed one if its what you choose but at my hospital they make you wait until 39 weeks for a CS, but will induce at 38.

Hope this helps.

*slept = except

Ask for another referral to another consultant. Labour is unpredictable and in your case an elcs is a sensible choice

I have developed gestational diabetes and am pregnant after 4 years of infertility and ivf treatments and I am booked in of an elcs with full consultant support. Yours sounds like a right dick!

Good luck

You've mentioned the hypos that you've had but what about hyperglycaemia? Are your levels all over the place or rarely high? I just ask because you could argue that you don't want to risk a vaginal birth due to the risks associated with hyperglycaemia eg shoulder dystocia. You could argue that growth scans are inaccurate do you don't want to risk it.

Having said that, sliding scale should hopefully be more predictable during labour rather than if you are poorly (especially with an infection). What does your endocrinologist think about your suitability for sliding scale and labour?

I think your problem may be that you are arguing against induction because of the sliding scale insulin. But you are likely to be put on sliding scale during a c section. You also need to consider your risk of infection is quite high as a type 1 diabetic so they will be reluctant for that reason (especially as it affects their stats).

I'm a thpe 1 too and currently 15 weeks pregnant.

My 1st was induced at 38 weeks as in my area, they won't let diabetic women go over 38 weeks. My control during my 1st pregnancy was fine with lots of hypos but I was able to feel most of them (only went to A&E once). Once I started to be in labour (about 4 hours since the 1st pessary) I was put on a drip of glucose and drip of insulin. No food allowed and bed bound. To cut a long story short, I ended up having an emergency cs. My blood sufar took a few weeks to go back to normal after the birth.

Now 5 years later, despites a well controlled diabetes pre pg, I'm all over the place, I cannot feel some of my hypos which resulted in crashing my car, been seated in my own vomit, and an ambulance been called. My obstetrician has told me with my 1st delivery, I will be advised to go for an elective cs and this is what I want too

If your obstetrician is against a cs, why not talk to your diabetes specialist as he may be able to support your case?

Good luck

I'm another type 1, currently 28 weeks pregnant (well, will be tomorrow).

I've been quite lucky in that my control has been good so far, although I am starting to not feel hypos until lower than I was previously so I am a bit worried about losing my warning signs.

It does sound like you have a pretty good case and reasoning for asking for a CS. Is the obstetrics consultant you've seen one who specialises with diabetics or more general? I see an obstetrician who specialises in diabetes fortnightly and it is a great help in addressing concerns as they arise.

Thanks everyone for your responses

As daft as it sounds, putting it down in writing and your comments has given me a bit of reassurance that I'm not over-exaggerating and things have been pretty bad!

It's also good to hear from some other type 1 diabetics.

ZylaB, thanks for your comments, my DH is well trained and we have been taking my blood sugar at least every hour, if not more. I'm so sensitive to insulin and my blood sugar changes so quickly we have to do this. He is the only person who can tell if I'm having a hypo.

onmatlleave, I agree that labour will be unpredictable which is partly why I favour a CS. At least it will give me some control and will most likely be over much quicker than a natural birth.

noroom, I've had a few highs but they are not really the problem. I understand that I will also be on a sliding scale if I had a CS, but if I understand correctly, the whole process of a natural birth may take hours/days, whereas a CS would be completed in, say 1-2 hours in total. So I'd be on the drip for a much shorter period and there is less time for my blood sugar to go haywire. I hadn't thought about infection so thanks for raising that - however, I guess the risks are not too bad because my blood sugar is low rather than high.

Stone, that sounds awful, I hope you are ok. You have my sympathies! I really do think I need a controlled environment and I don't want to risk any issues with the birth and an emergency CS, particularly given how long it has taken us to get this far! I have suggested a CS to the endocrinologist, but she was pretty non-committal. I don't know if it is because they prefer to decide this later at say 34 ish weeks, but I'd rather get it sorted now.

Choco, I go to the diabetes antenatal clinic every fortnight at my local hospital. I don't know if the the obstetrician specialises in diabetes but will ask. I've hardly seen the obstetrician team to be honest - it is usually a fleeting appointment with a different dr every time. In fact, I haven't even seen the obstetrician who has refused the CS - this has all been conveyed to me via a registrar (who I have only seen once but convinced him that I should have a CS. Unfortunately he doesn't make these decisions!).