Type 1 and Labor

I am 28 weeks (due July 18 2011), and have luckily made it through the pregnancy with zero complications so far . My A1C is currently 5.7 (will get newest results at my endo’s office on Friday). I have asked my OB about induction, and she told me that typically a diabetic’s placenta will begin to break down towards the end of pregnancy, so if I haven’t delivered or gone into labor by 39 weeks, she plans to induce. I let her know that I want to do everything as naturally as possible, and that as long as there are no complications that pose a risk to myself or the baby I do not want to be induced. I am very confused and have SO many questions about induction/labor/delivery…

Is she just going on what 'typically happens in a diabetic’s pregnancy or can my OB tell the condition of the placenta on an ultrasound or other specific tests to reveal this? Do any specific diabetes complications lead to a quicker ‘breaking down/deterioration’ of the placenta?

How does induction actually occur? Is the water broken or are drugs typically used? Are there any ‘natural’ ways of induction? I have read that being induced leads to a higher risk of having an epidural, which I do not want to have…and once you are induced, do you have to remain at the hospital? I wish to remain at home for as long as possible prior to delivery, as research has indicated that this as well will lead to a smaller chance of use of an epidural.

Have any of you used a birth doula? Have they seemed open to and/or knowledgeable about your diabetes?

What experiences/advice/information can anyone share about wearing your insulin pump and being in control of your own diabetes management during labor and delivery?

Is breastfeeding any different for diabetics immediately after birth? I have heard that it can take a while (how long???) for the milk start flowing, which I am confused about. I REALLY do not want to have to use formula and am curious how long the baby can go without breastfeeding and how long until I am able to feed him.

Sorry for such a long post, just wanted to throw it out there so I can get some advice before talking to my OB (I have a visit on Wednesday). Does anyone have any advice on specific questions I should ask her during my office visit/ultrasound now that I am in the third trimester??

She’s right about the placenta, though she is just going by a “typical” pregnancy in a woman with diabetes, and that would mean almsot entirely women with gestational D. The placenta doesn’t break down faster simply because you have D, it breaks down faster in the presence of higher than average glucose levels. The more normal you keep your blood sugar, the longer your placenta will be healthy.

It’s really common to induce women with D early, accross the board. Not every OB does it, though. My OB said she’ll only induce me early if she sees evidence that it’s necessary. To keep track of how the placenta is doing, she’s going to have me come in for weekly non-stress tests starting in week 32. If the baby starts to get less nutrition and such from the placenta, it’ll show in his activity level and heartbeat. She’s also having me go to a perinatologist for my ultrasounds, because his better equipment and specialization in higher risk pregnancies means he’ll be able to spot any visual clues that the placenta is breaking down (or other problems) better than the average OB can.

Induction does involve drugs, and it does require you to stay in the hospital. It’s not a pill or a shot, it’s an IV drip (usually of pitocin). You can ask your OB to try a membrane sweep first, where she would just run an instrument around the inside of your cervix to separate the membranes from it. It increases the chances that you’ll go into labor within a couple of days of the procedure, and you could stay at home for as much of the labor as you and your OB have agreed upon.

If you google “natural labor induction,” you’ll run across a lot of old wives tales. Who knows if they work, but why not try the ones your OB says are safe? My plan is to follow all of the wive’s tales for ripening the cervix as I can during the last month (provided my OB doesn’t recommend a different time table), then to pick an induction wive’s tale or two (with my OB’s safety approval!) to try during the last week. Like I said, who really knows if the wive’s tales work? But why not try the safe ones?

All of these questions are the same as mine. I’m sorry I don’t have any advise because I’m looking for the same responses. My OB wants to induce at 37 weeks but I’m afraid. I REALLY don’t want to use any medications and want to stay home during labor as long as I can. Also don’t want to use any formula- want to breastfeed from the get-go.

I’ve been type 1 for 13 years, so she said my placenta will likely breakdown early. I have an appointment with her tomorrow afternoon and will ask more questions regarding the induction. I’m at 27 weeks now.

This is just an opinion, but if your A1c’s and sugars have been good, and you are doing NST’s, and Biophysical profiles weekly to make sure that the baby is growing (which means that the placenta is doing it’s job) I can’t imagine ANY reason to induce at 37 weeks. I have most typically heard of 39 weeks being the time to induce becuase of the placenta. I was also T1 for 13 years before my first and had no problems with my "placenta’ but my sugars were well controlled! Diabetics also have to watch lung maturity in their babies, if it was me and things were going well I wouldn’t induce a day earlier than 39 weeks so that the lungs can keep developing. With that being said…if there are any other things not going well in the preg etc. then 37 weeks is a good time to induce b/c it’s "term"
Congrats! It almost makes me want another one hearing that your already at 27 week!!! Good luck!

Thanks for the confidence booster. I think she’s concerned because I have had poor control in the past. I’ve had several bouts of Dka and insulin comas in the past 13 years. But, I was at a well-controlled 6.9% a year before conception. Last check was 3 months ago at a controlled 6.5% so I’m hoping the trend is going the same. Have been having some insulin resistance issues (had them pre-pregnancy too) so have been battling those steadily. I’d say I hover between 120-130 BG throughout the day. 70-90 BG before meals, 120-130 BG 2 hours after meals (tho the 1 hour mark after meals is more like 160-180). I start the non-stress tests in just a few more weeks to check on her development. I honestly believe we are 2 weeks farther along than the docs think because I’m pretty sure I know when we conceived. Which means if the doc wants to induce at 37 weeks, that will REALLY be 39 weeks. That’s what I’m hoping anyway. I’m just nervous. I want what’s best for the both of us. I have a tendency to realy listen to my body- only eating when I’m hungry, sleeping when I’m tired, etc. and don’t want to be rushed into anything.

Thanks for the responses, have definitely shed some light on the subject. Marps–let me know how you appointment with your OB goes today, I will be anxious to see if you get any new information. I have an appointment tomorrow and will try to get some time for Q and A (it’s only scheduled for a level 2 ultrasound, so may have to wait until my next office visit in two weeks to get time for most of my questions). I’m still looking for answers about breastfeeding-Sarah, any experience with that you want to share?

My docs wanted to incude at 38 weeks but they actually ended up inducing at 37 weeks and 5 days because he refused to move for about 30 minutes during a biophysical (of course he moved after I got off the table). I started with a pill that evening every four hours to soften the cervix…I was already 3 centemeters. The next morning at 9:30am I was given a drug called Petocin to induce… at around 11:30am or so the doctor broke my water… Contractions were light UNTIL she broke my water and i begged for an epidural. Baby came at 4:01pm… I went light on the epidural so I still ended up feeling a lot of pain. Personally, they didnt see anything drastic happening with my placeta… he always passed the part of the biophysical that monitored the blood flow… right up to the day of induction.

Keep in mind that a l ot of these docs seem to be very cautious with us diabetics so some docs won’t take much to yell “induce now.” My doctor didnt want to take chances so she sent me to the hospital right away.

I also told my doctor that I wanted to go into labor naturally, if possible, and he assured me that they would only induce if I went past my due date (because I guess diabetics have a higher risk of still birth?), or if there appeared to be a complication. So I’m hoping to not be induced, and there are definitely doctors out there who won’t automatically induce because you’re a diabetic.

I did not have type 1 diabetes with my first pregnancy only had “gestational diabetes”. I was induced 2 weeks early and I could not have asked for a more perfect delivery! I was against drugs and epidurals and other than the induction wanted to go all natural…that changed once I was in active labor lol. I was induced at 7am rested and tried to nap and by 12 pm I was pushing. Pushed 3 times and out he came.
I tried to induce my labor naturally a few different ways but I do not think any of it worked because I was trying it too early. A lot of midwives use castor oil to induce and I tried that but tried it too early so just ended up with the runs haha. The other thing I did was I pumped with a breastpump for about 30 min at a time because it releases natural pitocin into your body to induce labor. I also tried an enema which didn’t work.

Right- the risk of stillbirth is because the placenta tends to give out at the end of pregnancy in diabetics (typically in uncontrolled diabetes). So, as long as the doc is watching your baby on non-stress tests weekly (or more) then you should be good to go full term. Good luck!

Hey Hayley. I talked to my gyno, but we didnt have time to get into the induction process. I have another appointment in 2 weeks when I believe we are starting the non-stress tests. can’t believe we are already at that point! I’m writing my labor questions down this time so I dont forget to ask. I always have a million questions, but get me into the office and I forget all of them!

haha I was reading some of these too. Also have heard sex will cause braxton hicks, which will sometimes start real labor. Heard stripping the membranes at the doc’s office will induce natural labor within a few days afterward (I’m looking into this one more).

Hello everybody!

I am expecting and am on week 35! touchwood! just hoping and praying each day that I have a normal delivery.

I am a type 1 diabetic for 14 years now and have been on the insulin pump for 3 years.. so how to manage pump in labour? reduce basals and get hubby to help take charge of it? where do i wear the pump? considering its labour i won't have a pant to stick it on too.. just a stupid practical questions.. but would really appreciate to hear your views!

Thanks in advance!

Hi there. Have you talked to your doctor about who will be managing your diabetes while you're in labor? If so, apologies for some unnecessary advice. Since it's so important to keep your BG in a very narrow range while you're in labor, to avoid hypoglecemia in both you and the baby, it's usually necessary to have someone other than you managing your pump-- you'll have to focus on giving birth! It can be your husband, but it would probably be helpful to figure out who at the hospital will be helping to make decisions about insulin levels while you're laboring-- will it be the perinatologist on-call? Does this person usually have people stay on their pumps, or go on an insulin drip? If you're staying on your pump, which is awesome, most protocols I've seen have you reduce basals about 30% during early labor (I think this assumes you've stopped consuming anything other than non-caloric liquids), and then by another 20% (so, a total of 50%) during active labor/transition. Lows are often treated with a glucose drip, but you might be able to use glucose tabs or juice, too.

As for where to stick your pump: just clip it anywhere! As long as you aren't laboring buck-naked (which is also a totally excellent way to labor ;)) you can probably just clip it to a shirt, hospital gown, etc.