Insulin Pump During Natural Childbirth

I know I have posted a similar post a few months ago, but as I get closer to my due date I was wondering if there are any new opinions/advice on the following:

I have type 1 and am on an insulin pump and CGM. I plan to have a natural birth (in a hospital), and want to prevent being hooked up to machines at ALL costs. The main reason for this is to be able to be mobile throughout labor in order to use walking, my birth ball, etc for pain management and to help move my labor along.

I feel VERY strongly about keeping my insulin pump on to avoid getting an insulin/glucose drip via an IV, as this will greatly reduce my mobility. Another reason for wanting to keep my pump on is that I have SO much more trust in myself and my OWN management of my disease than the nurses in a hospital, no matter how ‘specialized’ my OB insists they are. My Endo has said he ‘recommends’ the insulin/glucose drip, but I am certain that he is not used to diabetics wanting a natural childbirth. My husband is also very involved in my diabetes management, and can help monitor my blood sugars and knows how to set temporary basal rates, treat lows, bolus for highs, etc.

I would LOVE any advice/advice/input on any or all of the following questions:

Does anyone have experience wearing and insulin pump during labor and childbirth? If so I am curious to know how much were your insulin needs decreased due to the intensity of the labor, and how was the process of managing the lows? I know they say ‘no eating’ once you are admitted and in labor, but do glucose tablets count? Did you come prepared with a letter from your doctor stating that you could keep your pump on? How did the nurses and doctors at the hospital react? How were you able to convince your OB and/or Endo to get on board with you wanting to wear your pump instead of having an IV?

Thanks in advance :slight_smile:

Great questions Hayley! I’m very early in my pregnancy, but I’ve been wondering the same thing. The thought of giving up control of my pump and cgm is very disturbing to me for a few reasons. I’m also curious as to how others have managed to keep their pumps and cgms on during labor and delivery. Logistically speaking, was it complicated? Did you find that you “forgot” or were unable to manage your own bg’s and wished that someone else was doing it for you? Very curious…

I’m not pregnant yet, but most of my docs encourage ALWAYS keeping your pump on, during surgery, etc, and as we know YOU as the patient are so much more knowledgeable to your needs and how to control your pump. That said, when my CDE had her children, she was hooked to a glucose pump/insulin drip, to handle the fluctuations, but having to go that route means someone else controlling your BG’s. I mean, I’ll admit I’m a control freak, but any time I’ve had to let hospital professionals handle my BG’s (aside from dx at 14 when I knew nothing) the care/control has been terrible. If you want to keep your stuff on, I say fight for it! And if I can ever get pregnant I also feel confident in my husband helping out if necessary, so maybe that can be part of your argument? I mean, I don’t know that they can make you go the other route (is that against the law?) but they sure as heck will fight to do so. Good luck, stick to your guns, congrats on your pregnancy, and your great A1C :slight_smile:

I was always able to keep my insulin pump on, no questions asked. And I believe that candies like Lifesavers or even Jello should be OK. Have you done a birth plan? If you are apprehensive about the protocols and conditions in the hospital, definitely do a birth plan. Be sure to make it blunt and to the point, but don’t make it look like a list of demands. The plan will just voice your preferences to the med staff and RNs. Get your OB to sign off on it after you have discussed it with him.

My endo has been very supportive of my decisions, so I’m not in the same boat as you on this one. However, I’m sure that your endo will not be at the birth. Plus, you can refuse consent to not having an IV drip. It is ultimately up to you.

I realize this is a bit old, but I'm curious if anyone has newer experiences to share regarding pumping and delivery? Especially Hayley?

I'm at 36 weeks and just discussed insulin dosing during and after delivery with my endo. Both my endo and I agree that I'd do much better controlling things on my own with the pump during delivery than being hooked up to an IV that someone less experienced with (at least MY) diabetes controls.

My OB hasn't seemed to really understand day to day diabetes care. A single out-of-range blood sugar freaks her out and makes her ask me if I'm brittle. She'll often say things like, "This can't be happening now. You're 24 weeks. Your blood sugars won't do this until 25 weeks." I've had great A1c's (lower 5's) and a low standard deviation for blood sugars (so not a lot of highs or lows).

Given all that, I'd rather handle my own insulin rather than have the OB or nurses hook me up to an IV and base my doses on a formula based on my weight rather than on the amount of insuiln I was taking pre-delivery.

I understand you want to do this your way but I think it is a very stressful position if you don't trust your doctor to help you make the best choice for you and the baby.Have a plan but don't be rigid.

I think the process is best when you are not stressed and have a positive mind set focused on healthy mom and baby.

Type 1 for 28 years since I was 11. Now I'm 39 and I have a 10 yr old. I am on the pump.

I just read the other posts and I can see this is also a personality thing. I'm a go with the flow, not a stand your ground person.

GodBless

I think there are a couple of things to consider here. The first is that yes, it is in many ways ways better to have your pump on during labor. That's what I plan to do, and it's what several of my T1 friends who have given birth in the last year have done. You can move around more, you have more control over your insulin levels than you do when waiting for a L&D nurse to make an adjustment, you know yourself best, etc. That said, labor is pretty stressful, and I think it's very hard for most people to focus both on giving birth to their baby AND on diabetes management. Everyone I know who kept their pump on had another person with them whom they trusted to make decisions when they couldn't. For some people that was a wonderful CDE or nurse who knew about diabetes, for others it was a partner who was very involved in making diabetes-related decisions. In any case, I think keeping the pump on is great if possible, but you also want to be able to focus on giving birth. I think this also depends on what kind of pain management you think you'd like. If you will have an epidural, then maybe you'll be less distracted by pain. If you're trying to do a natural birth, then it might be harder to focus on you pump.

Good luck!

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Haha, I just read this and realized that I replied to the original post waaay back when I was pregnant the first time, before I had given birth. Well now that I HAVE experienced labor, I will say that I used my pump and cgm all the way throughout a natural hospital delivery, and it went great! I was able to move around whenever I wanted (granted, by the time I got the hospital, it was practically time to push!) I helped my husband to get a better understanding of my pump and cgm in the months prior, so that he felt confident making decisions during labor if needed. If I remember correctly, he mostly just helped me by testing my blood sugar in the very end stages of labor when I couldn't think straight. We didn't actually have to give any corrections during labor, I don't think. It really was no big deal to wear both my cgm and pump. I think that I told my OB and Endo that that was my preference, and they didn't have any problems with that. I drank lots of water throughout labor and had a small snack, which I was fully able to give own bolus for. Yes, you definitely should feel comfortable correcting lows during labor. Glucose tablets, juice, etc... are just fine. :)

Thanks for that, Lauren! I actually just discussed all this with my doctor, so it's useful to hear other people's experiences.

I wanted to share my experience not taking off my pump and cgm since I figure it might be helpful to others trying to make a decision. Losing control of my blood sugar monitoring to a nurse was the most stressful part of my birthing experience. No one knows the ups and downs of my diabetes like I do and hospitals get people from all walks of life. A lot of times they aren’t great at listening to you, which was the case for me. I noticed my blood sugar was creeping up and asked for bolis, but no one would listen. They lost control and my blood sugar ended up in the upper 400’s. They wouldn’t let me see my baby till I got the sugar under control so I didn’t meet him for 4 hours!!! I ended up lying and telling them I had to go to the bathroom and injecting myself with insulin. I am pregnant with my 2nd baby now and this time I will fight to keep my pump and cgm on. Way less stressful than not.