Hi guys I’m currently 31 weeks pregnant with my first baby and have some concerns about being Induced and who will control my insulin needs while in labor. My doctor advised me that he will induce me at 38 weeks? Is this normal? and i will also be able to wear my pump while in labor, what are some of your exper. with the pump doing labor?
Almost all diabetic women are induced during the 38th or 39th week.
It depends on your doctor, but for the most part they let you handle your pump. My husband and I asked about that when we were checked in for our 1st induction attempt. Inductions can take a couple of days to work, so prepare yourself for that mentally. I wasn’t prepared for that, so when it came to hour 36, I pushed to be allowed to go home. Since they hadn’t broken my water yet, I was able to go home. I came back 4 days later for induction attempt #2.
The nurse and doctor that were assigned to me both said that they would let me and my husband handle my pump. We checked my blood sugar 1/hr and made adjustments as needed to my basal rates. The nurse just asked to see the blood sugar results so she could enter it into her log. When the night shift nurse came on duty she wanted to check my blood sugar on the hospital machine.
Once you’re in active labor you won’t need much insulin. I was on 25% of my basal rates and still getting lows. I ended up with a c-section. I was able to leave my pump attatched during the c-section because I had the infusion site in my hip. If it had been on my belly, they would’ve had to remove it before doing the c-section.
Because you’ll be hooked up to so many monitors while you’re in labor, you need to be strategic about where you put your infusion set. Having it on my hip allowed me to clip my pump to my sports bra and keep it out of the way of the heart rate monitor they attached to my belly and kept me from dropping it on my many trips to the bathroom. If you’re comfortable with infusion sets in your arm, that might be a better place.
Yep, 38 weeks is just about right for diabetics. Our placenta’s usually start deteriorating earlier than non-diabetics. They induce earlier (even if everything is going 100% fine) to prevent still birth, which is a little higher percentage in diabetics. As far as insulin needs during delivery, I think that depends on the hospital. I’m at Joslin diabetes center in Boston. My OB and Endocrinologist both told me that I’ll be getting an IV insulin drip and glucose drip when I’m in labor. It lets the insulin reach you way quicker through the viens if your high and sugar if your low. I was told that the nurses will adjust the doeses and check my blood sugars every hour. Then after the baby is born and i’m in a regular hospital room i’ll go back to the pump. I didn’t like the idea of no pump at first but then I realized that it made sense. I’m going to be so anxious, excited, nervous, tired and propbably lethargic during delivery. I’m not going to want to be responsible for adjusting my pump and checking my sugars, on top of all of that. Good luck and congrats!
38 or 39 weeks is common practice, but not necessary across the board. I was really, really concerned about induction because I believe that my pregnancy and delivery will go best if only the necessary interventions are taken. I had an appointment set up with a different OB (recommended by a midwife I talked to) and was ready to switch so fast her head would spin if my original (and current) OB’s practice was across-the-board inductions of all diabetic mothers. Luckily, that’s not what she does. In fact, when I first asked her nurse practitioner about it, she acted like inducing before week 39 without evidence it’s necessary would be irresponsible. “Certainly never before week 39, unless we have to!” Then when I talked to my OB, she did advise me that “diabetic placentas age faster,” so I’d be having my ultrasounds done by a perinatologist (basically OBs who specialize in high risk pregnancies and fetal medicine). One of the things he would watch for is how quickly my placenta breaks down. If it breaks down too quickly, induction might be necessary so the baby isn’t partly starved of nutrition toward the end. But if the placenta is just fine (this depends primarily on our blood sugar control!), it’s best to let baby develop in the womb for a normal amount of time.
The only other thing mentioned was that the nurse practitioner said "we might want to discuss induction if it looks like you’re already growing a 10 pound baby for your first pregnancy."
I haven’t gone through labor yet (I’m only at 19 and a half weeks!), but these are things I’ve come to believe about labor/delivery:
- It’s not automatically a medical procedure. It’s a biological procedure, for which medical interventions/procedures are available when something doesn’t go right.
- As diabetics, we’re far more likely to need those medical interventions/procedures, and I think we need to prepare ourselves mentally and emotionally for that likelihood. But that doesn’t mean we absolutely will need intervention, or that our bodies have no clue how to have a baby! It’s entirely possible that your placenta could stay good through all 40 weeks, and that your baby will be of normal size at 40 weeks. Interventions should be done in response to evidence within our individual pregnancies/deliveries, not according to “procedure” based on our diagnosis.
- We have power within our pregnancy/delivery, and we ultimately make the decisions. Your doctor cannot strap you to the bed at 38 weeks and induce you against your will. Does that mean I walked into my OB’s office and said, “No way you’re inducing me, lady!!!” No. But it does mean I went in there and said, “I want you to treat me, my baby, and my individual pregnancy, not my diagnosis.” If she were to say, “I’m inducing you on such and such date,” I’d require evidence that that’s the best course of action. And I mean evidence from my pregnancy, not from research and statistics that are largely based on gestational diabetics (I’m a type 1). My placenta has broken down too much and you think the baby isn’t getting proper nutrition? Go ahead, induce me. But: my placenta might have broken down by now since I’m diabetic? Nuh uh, doc. Prove to me that it’s healthier for my baby to be outside of my body rather than inside my body before nature intends, then I’ll give you informed consent.
I’m not telling you your doctor is making the wrong call or that you should go in there and just be stubborn. I’m just telling you that not every diabetic pregnancy is the same so it would be 100% reasonable for you to ask why your situation demands induction, and also that your doctor cannot force you to do anything you don’t judge as best for you and your baby. If the doctor tells you why he wants to induce at 38 weeks and you think he’s talking sense, then awesome, do it! If he says something that doesn’t sound right, express your concerns and have a discussion about it. Doctors often talk like their word is law, but it isn’t as long as informed consent is required by law and medical ethics.
OK, stepping down from my soap box.
Thanks for this post! Induction is common for diabetics here in Hungary. I managed to find an OB-GYN who doesn’t induce unless she sees a reason to (deteriorating placenta, stressed, or too large baby). I know that she has let women go until 41 weeks with daily monitoring near then end. I think that I will be hospitalized by week 37 so that they can monitor closely.
If you are healthy and your placenta is in good shape why are you being induced? That one baffles me…
I delivered a healthy 10 lb 11oz daughter at 40 weeks and 3 days (2 1/2 yrs ago). I’m a T1 and my daughter was delivered vaginally…yes, God bless the inventor of the epidural!!! I’m from Canada and was followed through out my whole pregnancy by a great team via an antenatal clinic. I would see an OB, nurse, dietitian and Endo every week and had a high risk OB who understood that I did not want to be induced nor have a C-section unless it was absolutely necessary.
I did have to have my cervix ripened but I was never given any med to induce labor. My placenta did tear (according to my sister is was freakin huge!) and I did hemorrhage but it was because my placenta caught on my muscle wall. I was on an IV drip (insulin & glucose) through out my labor. Just be mindful of one thing, it’s important that your sugars are as close to normal as possible before they cut the umbilical cord, I was a bit high and my daughter had a small sugar drop and had to be given some formula.
Hope you have a great delivery, it truly is an amazing experience.
I will use my pump during labor. Although I have heard that IV insulin can lower highs more quickly, my doctor prefers that we stick to the method that I know well and that way I can keep a close eye on my blood sugar levels.
I’m not to be induced until 39 weeks. Like when I had sugery for my tachycardia they are having someone that will be monitoring my blood sugar levels. I’m not on an insulin pump so it probably makes it a lot easier for them to give me insulin.
I could definitely see how it’d be easier for them to put you on a drip if you’re in injections instead of a pump. You can adjust either a drip or a pump if it looks like your basal rates should be higher or lower, but it’s not like you can go back in time and change how much long-acting insulin you took.
It sounds like you have an awesome OB!
I know labor is different for all, but if or when I have another child I will consider leaving my pump on based on my first child delivery. Here’s a few things that I would do different… I would have plenty of glucose handy. I didn’t anticipate struggling with a low while I was in labor and vomiting. I didn’t think I was ever going to keep any food down. Once again, I didn’t have any glucose tabs or gel. On the other hand, when things finally smoothed out and labor was more intense, the nurse ordered me to TAKE OFF MY PUMP. Now, at this point I should have followed my gut feeling and left it on. No, I didn’t have an insulin drip either like some of these ladies have mentioned. The nurse and doctor said they would control my sugars with Regular insulin. Two words! NOT EFFECTIVE. At this point I was getting really stressed because I had worked so hard all those months to have exceptional control and I could see my sugars rising as the moments were getting closer to delivery. When my son was born my sugar was a little over 200. NOT WHAT I HAD PLANNED! Then, still without my pump on, I spent the first night and early morning of my son’s new life, feeling like crap. At that point I was extremely frustrated and put my pump back on despite my nurse/doctor’s wishes. After I took control, my sugars came back down and I was able to take in the bliss of my new son. Next time, I will be more proactive and follow my own instincts. Best wishes!
Hey, congratulations on your pregnancy! I’m at 22 weeks and my OB is talking about inducing at week 37 because I’ve been Type 1 for 13 years. My A1c has been in the 6s for a year now. I’ve been training my husband for the past 2 months on how to inject insulin, how to check my glucose level, what my correction dosages are, etc. We will be carrying a full bottle of glucose tablets and gluco-gel into the labor room with us. I will refuse any insulin IVs as I’ve had some really bad experiences with them in the past. I’m allergic to certain brands of insulin and many times, the docs don’t understand my dosages or won’t monitor my glucose levels properly. I’m on shots and will remain on shots during labor.
We will likely have an IV of saline solution, but I’m very hands-on with my diabetes care, so I’ve already prepared my husband to be able to stand up and refuse an IV of insulin on my behalf if the nurses are giving me a hard time. I’ve talked with my OB about this and she said it shouldn’t be an issue.
We are going to start monitoring the baby with stress tests during the 3rd trimester, twice per week. If the baby shows any symptoms of stress, we are prepared to induce as early as 37 weeks. If no stress is shown, we will hold off until 39 weeks to ensure proper development of the lungs.
My baby girl is currently right on target with weight gain and height according to her gestional age, so I am hoping we don’t have an extra large baby. I’ve had really tight control of my glucose levels, but once per day (in the late morning) I go a little high. I am anxious about my next A1c result and hoping for something closer to the high 5% to reflect the hard work my husband and I have been doing with my BG control.
Good luck. I am still researching what is best for me and my baby as far as inductions go. I would like to go into labor naturally and deliver vaginally, but we’ll see what my little girl has planned for us in a few months.
That sucks about how the insulin/blood sugar issue went for you last time! That’s part of what concerns me about labor, too. I haven’t had the full discussion with my OB about how we’ll handle it, but I do know that I absolutely won’t hand my pump over to anyone except my husband, doula, or family member. My mother is a nurse and said that some hospitals ask you to hand it over to them the moment you check in. So even if my OB says it’s no problem for me to use or keep my pump, I’m going to be ready with a letter from my endo and probably a few memorized quotes from the patients bill of rights! If at any point I hand over my insulin therapy to the medical staff, I want the ability to take it back from them if they’re doing a crappy job of keeping my blood sugar in range.
I think the words “I do not give consent for you to administer insulin, and if necessary I will show you a copy of the pateint’s bill or rights or call my lawyer,” should be enough to get them to back off if they start trying to pressure you into IV insulin.
haha. Good point. I’m pretty aggressive with my diabetes treatments and don’t trust anyone that i’ve just met. Including nurses in ICU, ER, or anywhere else. Sorry if that offends anyone, but I’ve just had too many bad experiences.
I’ve only got one life.
This is such a great thread - thanks ladies! Oddly enough, I haven’t thought to ask my OB what her plans are as far as induction, c-section, etc. I have now made a list of questions to ask her next time! And I’ll be instructing my husband on helping to fight for me if they try to take my insulin pump. I would rather manage myself then worry about them dosing me corrrectly during labor.
I met my OB-GYN today and given that our baby is measuring large (macrosomia), she said it is likely that she will induce or do a c-section at 37-38 weeks. I was pretty upset when I heard this news, as I was hoping to go full term and go into labor naturally. I would still prefer to be induced than to have a c-section, but she said it will depend on how big he is at the time.
I was really happy to have found an endo who doesn’t induce all diabetics, but given that our boy is growing so quickly, I will be one of her patients that doesn’t go full term.
I had my first non-stress test today and he was really active and seems to want to kick the sensor off So he seems to be doing fine, just big. No one understands why he is growing so quickly. My blood sugars have been great (last A1c was 6.0 with almost no lows). So I am telling myself that I have done everything that I can, but will need to prepare for our little guy to arrive early.
I finally talked with my OB team regarding induction and long-term type 1. He told me that they will try to avoid natural labor with me as much as possible. They want to start me on pitocin IV drip slowly, then watch my entire labor laid up in the hospital. They believe it will be safest for my baby and for myself, to be monitored throughout the pregnancy.
They did say that they want me to have as natural of a birth as possible. They want me to hold her as soon as she’s born. They want her to stay in the room with me. They want me to breastfeed. They want me to monitor my own glucose and insulin levels. They want me to try to go without an epidural. They want me to have a vaginal delivery.
We are all on the same page except for the pitocin. I really want to go into labor naturally, but we’ll have to wait and see what happens. He explained that pitocin is a hormone that is produced naturally by our pituitary glands when our bodies are preparing for delivery. Instead of allowing my body to get to that point of producing pitocin on my own, they will be doing a slowly increased dose of pitocin in the hospital so they can watch every step of my labor. They’re afraid that due to 13 years of brittle type 1 that my placenta will fail in the middle of labor and will hurt my child. So, even if she does come early and I go into labor on my own, I’m to call the OB and go immediately to hospital.
Healthy babies, healthy babies, healthy babies…
Marps – this is mostly good news! I know that you also want a natural labor and you will get many of the important elements of that. I have heard of many people who used pitocin, but were able to keep all other parts of the labor natural. Also, even if they don’t want you moving around a lot, there are multiple birthing positions that you can try on the bed.
If you know that you will get induced, that you can try some natural methods to get your body to go into labor. Many times they don’t work, but it could help you just before you go into the hospital to have the induction done anyway.
But, yes, the focus should be on healthy babies. I’m trying to focus on that now too
Yes. I still have this lingering feeling that she will be joining us on June 20th. Not entirely sure why that date keeps popping into my head, but there it is. The latest they will let me go is July 16th. So, I guess I have atleast somewhat of a due date finally set.
How are you holding up Kristin? I know you’re a few weeks ahead of me.
I go in for measurements first week of June. She’s 2 lbs 12 oz as of early last week. I bet she’s bigger now. She just feels different to me. This Wednesday is my first non-stress test for her.