Monday, April 11, 2011

guidance for planning a type 1 diabetic birth (just my 2 cents) ~

I wanted to write this post because now that littlebird and I are settling in, I know there are still a lot of unanswered questions and/or thoughts regarding my pregnancy and birth. There were certain things (especially towards the end) that were very, very helpful that I think gals can take advantage of and try doing in an attempt to have as healthy and natural a labor and delivery as possible. Of course, as you can read from my birth story below, not everything always goes as planned (ie, I ended up getting an epidural and some pitocin assistance even though I went into active labor on my own). As far as getting my body into natural labor though....hmmm, well, you can leave that up to the "experts" if you like, but I truly believe that many of the things I was doing during my pregnancy and especially those couple of weeks before littlebird's delivery (weeks 37-39) assisted in essentially opening my body up for his arrival (ie, going into natural labor rather than being induced).

[Added later: I just thought of this, but feel it's really important and helpful. If you can, please buy Cheryl Alkon's book "Balancing Pregnancy with Preexisting Diabetes". No, she didn't pay me to say that. :) It's really just the most informative book out there on the subject and you won't regret her guidance.]

Things I think are essential to a healthy Type 1 diabetic pregnancy:

Plan it. Don't ignore the things you need to work on.
Yes, it's that easy. And that hard. Give yourself at least 6 months to do this. Whether you need to get your weight under control, your BG in better control, or your emotional state...just plan it. Go after it with fire and fight if you have to. If you want a healthy kid, the best thing you can do for them and yourself is go into it with your best state of physical and emotional health. If you don't do this and just "wing it" (like my CDE told me some gals do because they're just so frustrated and drained and just want a baby---can I hear a collective W.T.F?!) you will end up being extremely stressed out that first trimester. As if you won't be enough. Don't add fuel to the fire! Not only will you be nervous from knowing this is the window most common for 'regular' miscarriage---a fear every woman has---but also all the fears your diabetes brings up. Increasing diabetes-induced stress is a big no-no, in my humble opinion. Don't do that to yourself. It's not worth it. I was so nervous when I got pregnant but....I knew my body and mind were healthy and doing well. I knew my type 1 was in control when we got pregnant. I knew it wasn't an issue. I was better equipped to handle those common 1st trimester lows. I was also not sitting there royally freaking out during those early 1st trimester ultrasounds wondering if his brain, heart, and spine (those most affected by out of control blood sugar during conception) were ok. Deep down, I knew my kiddo was ok and if not, it was most likely not due to my type 1 and we'd just deal with all that from there.

Pick your OB and pregnancy CDE (and if you can, Perinatologist) before you conceive.
The OB is most important, I think, because they make the final calls on how and when you deliver...and will actually be delivering your baby. Trust me, you need to love them. Not just be "ok" with them. You need to really respect and be comfortable with your OB---and feel they give you the same. These are, most often, the 3 you will see---depending upon your state of health, you may have other specialists assigned to assist you. I just saw these 3 providers. Also, your CDE absolutely needs to know pregnancy and diabetes inside and out. If not, you're going to have a very hard time. While I loved my OB, he also didn't know the ins and outs of how to deal with my type 1. You will, with a good CDE, be talking to them weekly (or moreso) to make adjustments...especially when you hit that insulin-resistant phase during the 2nd trimester and literally might need changes every few days.
*A note on perinatologists: I met several before I got pregnant in my planning phase the year before littlebird was even conceived. Now, if any perinatologists are reading this, please don't be offended. :) Honestly, I felt that many of them took the same approach. They all wanted to automatically induce me at 38 weeks and due to their training, obviously, they are not really around "natural" birth a lot. They're dealing with high-risk pregnancies all day long, after all. So what I'm saying is that you need to keep this in mind if you end up with someone a bit *ahem* high-strung. It's their job to worry a lot and make recommendations based on the reason you've been referred to their clinic, ie, your disease process[es] present. If you're not into natural birth, most of their suggestions and input will be welcome. In my case, I felt mine went overboard a bit; however all in all it went very well. My point: I think choosing your OB (the person who would actually deliver your wee one) is more important than the Peri---the doc making recommendations from your ultrasound and fetal monitor results.

Decide if you want to manage your Type 1 DM via your pump (yourself) or via IV insulin drip.
My recommendation is that you use your pump (if you have one). I never met resistance with this idea at the hospital I ended up choosing. Strangely enough, at the local University hospital when I was interviewing OBs there, they preferred IV insulin. The problem with IV insulin during labor is that, as we already know, insulin's pretty difficult to measure. It's got quite a window of error with syringe measurements. We also know that IVs aren't that accurate as far as giving you a dose (that really needs to be as accurate as insulin needs to be). Think of how it is when you try to give yourself a quarter of a unit via insulin syringe. Difficult, right? So, my point is that if you can get on a pump or use your own pump, do it. You'll be able to make small corrections as needed or even disconnect completely if you're so sensitive at the time---giving birth is like running the marathon of your life. You'll be under a lot of stress though, too, so that's why it's important to be able to give yourself those minute corrections, if need be. Also, just think of how nice it is to not be hooked up to an IV the entire time you're in active labor at the hospital....ugh.

Hire a Doula.
This is a woman who assists and advocates for you during birth. I don't care if you're having the most medically intensive birth you can imagine. It's helpful to both you and your partner to have someone there to qualm fears, tell you you're doing great, offer guidance---other than your partner. They're going through their own "labor and birth" in a way. They need just as much support as you do! If you give your partner a job (MAC's was to check my BG every 30 minutes+ and to also love me up as much as possible [believe me, you need positive reinforcement when in active labor!]) they will be a TON more helpful to you than if they just stand there and have the opportunity to freak out more. They need a job; it makes them feel a helluva a lot better about watching you in a situation they've never seen you in.

Pack your own snacks and juice boxes.
Then, if you have a low, you know the exact carb count on the juice box and snacks and don't over-treat because you just eat or gulp from some random cup the nurses hand you! I don't recommend your favorite low BG treatment, whatever it is, i.e., Skittles. If your nauseous (which you will most likely be) I suggest apple juice: it's neutral in flavor mostly and non-acidic. Don't bring orange-juice---way too acidic and most women will vomit from it. Sorry to be so graphic, but that was some good advice from my own doula---because when the time came to need juice in labor, I was so damn grateful for that plain apple juice!

Drink Raspberry Leaf Tea all throughout your pregnancy.
This herb is one of *the* women's herbs. It's specific to the uterus and while it does not bring on labor, it certainly makes it more efficient as far as contractions go. It also tones the uterus (as it is smooth muscle) and is just soothing in general. It is also astringent, so will assist
postpartum with your bleeding.

If you want to try to go into natural labor, use Evening Primrose Oil capsules.
You will insert 3 of these up by your cervix every night before bed starting at week 37. They'll just dissolve over night as you sleep. They release prostaglandins (which is also in semen; hence why doctors tell you to have sex to 'induce' labor if you can tolerate it) which essentially "ripens" your cervix. EPO (and prostaglandins in general) soften the cervix, which is essential for dilation and effacement. Think of your cervix as being hard during the pregnancy (keeping the baby inside) and needing to soften in order to open to allow the baby to come through. Only makes sense, right? I did this and truly believe it helped me to go into natural labor during week 39. Maybe it won't work for everyone, but from what I've read and researched, it seems to help most women. In the least, it helps with the softening and so if you need to be induced, will help things along so you are not having an induction on a hard, completely unready cervix.

Don't freak out, you're doing great.
Seriously. I can't tell you how many times my OB and my pregnancy CDEs told me this. And you cannot hear it enough. Keeping your eye on the target (a healthy you, a healthy baby) is the goal. Just remember that. You sometimes think you're going through hell and back because of the unpredictability of the situation, but with the right healthcare support team you will succeed! No matter what happens (and you need to be flexible with whatever "birth plan" you have in your head or create on paper because pregnancy is like the 'last frontier'---you simply cannot plan and predict its outcome) remember to be flexible. Your body and baby will thank you. Before you know it, you'll have a wee one of your own to take care of---and as all type 1 moms can tell you: that's a whole other ball game to learn how to play. ;)


Sysy said...

As someone reading this AFTER having had twins two years ago, I can say that I SO agree with what you say AND I wish I had had this to read before my pregnancy.

I would have liked to have done the following:

A)I would have hired a doula. It is seriously an emotional time for a woman with diabetes and my experience in the hospital was rough because I was in a lot of pain and I was busy advocating for myself through tears and yelps and wincing and a doula would have certainly provided me relief.

B) I would have also packed my own snacks and juice because the hospital was just giving me sugar free jello and bread rolls (lol).

And C) I would have relaxed more. I freaked out and went through many hours of labor while a doctor kept pleading with me to let them do a c-section. They tried to induce me and that did no good and yet I held on to the fear that my babies would not be ok if born 4 weeks early. But they were ok :) SO the freaking out part really does us no good.

Love your two cents, Emily :)

birdy said...

wow, thanks sysy!! i'm SO glad you liked this post. i wasn't sure if my ideas/recommendations would be welcomed. i really want to be as helpful as i can to other gals. hopefully between you (with a twins experience!!) and myself, people will find some helpful info, haha!

Anonymous said...

we are thinking about starting a family soon but my hba1c is 8.4 at the moment. way too high. i am type 1 diabetic since i was 6, so 23 years. I am scared about becomming a mom,and scared that there will be something wrong with my baby. so i must clear these negative thoughts and also bring down my bloods before we ttc. i even have my 5mg of folic acid at home and have come off my blood pressure tablets, so prep has started. hopefully all will come good soon!

Lauren Willett said...

I am a Type 1 diabetic and have been diagnosed since I turned 5, so 20 years. I have two littles, my daughter who is 4 1/2, and my son who is just about 3. I am on my 3rd and last pregnancy and am trying to do my research on the options I have to have as natural of a labor as possible. I was induced with both of my previous pregnancies, fact being that I didn't know enough and it was standard procedure for the doctors I had at the time. I really love all of the information you provided and suggestions on how to have a more pleasant experience. I am in the process of uniting with a doula. I have had one heck of a time trying to keep my blood sugars stabilized primarily because I have been seriously insulin sensitive up until this past month.I am 4 1/2 months pregnant, so I am hoping that from here on out I will be able to keep everything as controlled as humanly possible and at least be able to go into labor naturally.

CaJa said...


I am so glad I came acrossed this! What great information! So excited to find this that I totally forgot that I need to finish my birth plan.

I am an anti-planner (with pretty much everything) and have a terrible time discussing those things with my doctor. It has worked well for me and so I will say that there is hope for spontaneous beings such as myself.