Delivering a baby
Delivering a baby when you have type 1 diabetes will be
similar to that of other expectant mothers but with close
blood-sugar monitoring.
What to expect during a vaginal birth
Your birth experience will be similar to that of other expectant mothers who do not have type 1 diabetes (T1D) in a lot of ways. However, one main difference is that your blood-sugar level will be monitored very closely throughout the entire process. If you are not using a continuous glucose monitor (CGM), this means you may need to endure a lot of finger pricks (but, rest assured, it is all for a very good reason).
This kind of close monitoring is required to ensure that your blood sugars remain within the target range as the physical and emotional stress of labor can potentially increase your blood-sugar levels. If you do experience a high or a low during the birthing process, your medical team will give you the necessary amount of insulin or glucose needed to return your blood sugar to the target range.
If, in a worst-case scenario, you were to experience a complication during your vaginal birth that would require a C-section, your consumption of food or drink may further complicate the delivery of your baby. This is why blood-sugar levels must be closely monitored during labor.
As your baby’s arrival grows closer and your cervix dilates, you will be asked to push more and more frequently. Although it differs slightly from woman to woman, your insulin requirements will drop dramatically either just before or immediately after you give birth. Many women can return to their pre-pregnancy insulin requirements at this time. This varies from woman to woman and is dependent on several factors. Discuss adjusting your insulin dosage with your healthcare provider.
Hospitals often have limits on the number of people who can be in the birthing room, so consider checking with the hospital about its policies in advance and plan ahead. Also, consider having your entertainment options easily available that can keep you engaged and distracted while you wait for your baby. Labor can last for as long as a couple of days or be over in as quickly as one hour.
What to expect during a C-section
While a C-section can potentially be a last-minute surprise addition to the birth plan, a woman with T1D may need to plan and be prepared for a C-section in advance. There are several reasons that you may include a C-section in your birth plan, such as the size of your baby, retinopathy, or kidney issues. An early delivery may also be scheduled if you have had a previous C-section, or due to maternal or fetal health issues.
If your C-section is scheduled, you will have the opportunity to discuss the plan well before the actual birth. Some medical teams are comfortable letting the patient and their caregiver manage T1D during the birth, while others prefer to assign a doctor to this task throughout the surgery. If you wear an insulin pump, CGM, or other type 1 diabetes device, you may need to remove it prior to the surgery, but this is at the discretion of you and your medical team.
A spinal block (also known as an epidural) is used to numb the lower half of your body to prepare for the incision. Usually, two IVs will be in place for the surgery: one for fluids, and one for the insulin drip (if your pump is removed). The insulin drip is often combined with the glucose drip, and the contents can be adjusted based on blood-sugar levels. If your blood sugar starts to drop, your medical team can increase the amount of glucose in the drip, and vice versa.
The C-section surgery itself takes about an hour, though everyone’s surgical experiences vary.
Recovery from a C-section is very different than recovery from a vaginal birth. You may have a urinary catheter in place, and/or staples or stitches. As mentioned earlier, it’s important to carefully monitor your blood-sugar levels before, during, and immediately following your C-section, as hormone fluctuations and stress may have a huge impact on your insulin needs and blood-sugar levels. You’ll also heal better with blood-sugar levels as close to normal as possible. Some women experience “the shakes” or vomiting during and after their C-section, so talk with your medical team beforehand to put a low blood-sugar plan in place, should your blood-sugar drop unexpectedly.
After delivery, at the hospital
Immediately after delivery, your baby will likely be examined using the Apgar test—this looks for any immediate concerns regarding your baby’s breathing, heart rate, muscle tone, reflexes, and color. As a woman with T1D, your baby’s blood sugar will also be checked. It is common for babies of mothers with T1D to be born with low blood sugar. Your baby’s healthcare team will treat low blood sugar with glucose.
While diabetes management is just as important now that your baby is born, you might talk to your healthcare team about adjusting your time-in-range target at this time while you heal and adjust to life as a new mother!
More pregnancy guidance
Whether your pregnancy is planned or a surprise, there are a few steps every woman with T1D should take.
Developing a birth plan with your diabetes team can help you feel better prepared for delivering a baby.
Things to keep in mind while you are healing, feeling sleep-deprived, and juggling T1D as a new mother.
You and your partner are embarking on a very exciting part of life: becoming parents! Learn ways to support your pregnant partner with T1D.
Pregnancy support for T1D moms
Connect with others who have gone through pregnancy with type 1 diabetes in the Breakthrough T1D Community Forum.
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