Baby is on his way! Need Labor & Delivery Advice

Pregnancy
1

Hey everyone,

After driving myself crazy for the past 9ish months lil' dude is on his way! My induction is scheduled fro 2/15, but my doctor is pretty confident he'll be coming on his own before then. I'm having contractions and all that now but so far I think it's just false labor. I'm 2cm dilated and a little more than 50% effaced as of yesterday. Baby is doing well, gets perfect scores on all his biophysical profiles and was clock at 6 lbs 12 oz this week. I did get shots for his lungs back in early January during a hospital stay for early contractions, so if he is born now (I'm 36 weeks) they will not make any attempt to stop him. With all that said...

I am being allowed to manage my own numbers during L&D with my pump. Any advice? My endo says things will stay the same (might need to adjust my basal down if I'm working really hard) until the placenta is delivered. Then he wants me to take the pump off completely until we see my numbers starting to go up indicating that I will need to go back on the pump... but with my pre-pregnancy settings. Anyone go through this? Thoughts?

I'm also curious as to what range other T1D mommies aimed for during the L&D process. Right now I'm aiming for 7-100. Is that reasonable? Too high or too low?

I can't believe the time is almost here! In the next 2ish weeks I'll have a wee one!

 

2

Hi Rebekah!

How exciting for you!

Sounds like things are happening on their own and that you will probably go into labor naturally which is always preferred! My first was born at 35 weeks, and thank G-d he was born very healthy. I did end up being induced because my water broke but my labor did not progress quickly enough. I had a great epidural and everything went very well Thank G-d.

I left my pump in during both of my deliveries. I was a bit nervous to let my sugars be too low so I was more comfortable letting my sugars be higher than your goals. More like 120-150. I do remember drinking a juice box or tow to prevent lows during the process. I have read that many women require no insulin after delivering. For me that was not the case. I never unplugged my pump. I did change my rates though right away to my pre-pregnancy rates. Make sure to have them handy. I kept them on a paper in my wallet so I would have them. They changed like a trillion times so it would be too hard to remember! I continuously lowered my basal rates and bolus rates as I was dropping a lot in the few weeks after delivering. This may be due to breast-feeding, which my doctor explained lowers blood sugar levels in even non-diabetic moms. So definitely expect to be tweaking a lot.

You are really at the home stretch! Congratulations to you! I hope everything goes smoothly and easily for you with a healthy end to your pregnancy and a healthy baby!

3

For after delivery... I did not need my pump or any insulin for about 36 hours after delivery.  Of course, I had doctors & nurses wanting to give me shots, etc. the entire time (this was back in 2000 & 2002).   I had lots of lows.  After 36 hours, I did hook my pump back up after two consecutive >200 BGs.  I hooked it up at my pre-pregnancy rates for everything.  

Also - for nursing (since type1nation doesn't like the word B-R-E-A-S-T ;-), I had to drink 6oz of OJ before nursing each side.  Check BG before you start, check BG in the middle (while burping) and check BG at the end.  

Hoping for a safe & quick delivery for you.  

4

Hey there Rebekah,

I was a scheduled induction at 39 weeks went in and after 12+ hours of contractions they checked me and I only dilated .5 cm, I was already 1.5cm. I was having conractions every two minutes for 12 hours straight and all the breathing and pain was for only .5. I opted for a c-section.

Having said all that they planned to keep my pump on the entire time during L&D. my blood sugars for the 12 hours before I knew that I wasn't going to dilate, were all between 60-90. They didn't want me to be over 100 more than 2x in a row because then they would want to take my pump off. I was over 100 once and I think it was 114 and they wanted me to bolus. I told them NO! if they made me take insulin that I would  surely go low. I was already having low symptoms because of all that breathing and I felt like I was dropping. After 15 minutes they checked me again and I was 70, and then again 60, I took a glucose. But, if I was still 114 my pump was coming off and I was ready to fight them on that.

Hospitals have all of these crazy rules for Type 1 patients and you have to tell them how you feel even if their meters say a different number than yours. I was checking on the same blood they took for their meter because I honestly didn't trust another meter other than mine.

If you are having contractions you will know. They come in consecutive times. Its really uncomfortable and your stomach is soooo tight for those minutes and then you get relief. False labor is erratic. The Friday before I had my son I was having false labor and it was really apparent because the contractions were so far a part. I was induced that Sunday.

I just want to tell you what to expect about being induced, be prepared for people to really get up in there and they tell you to relax but, it completely hurts like hell, there is no relaxing. And they have to check you twice to see if it worked. And yep a whole hand all the way up to your cervix. I am very good with pain but it was awful. They stick this small tampon looking thing  what feels like their entire arm. You will have a lot of people checking you so I hope you aren't shameful! haha Even my husband cringed and nothing phases him.

I did have a c section because after 16 hours I was like forget this, I didn't want to go through another 12 maybe 24 hours extra and not dilate and then need a c-section anyway. So, I chose on my own. The C-section was literally 50 minutes from the time I went in till my FAT BABY came out! Luckily I did choose the section because he was 10 pounds 13 oz and estimating before that to be 8-9pounds. That was with a1c all in the 6's so i am not sure why he was so big! ha

After they took out my placenta I did go low almost instantly but I had no idea because I was given some good stuff in my IV to keep me relaxed! haha They shot glucose straight into my arm and it burned really bad and was sore until after I came home. Like over a week. My insulin levels were pretty low, I think I was on a basal of like .3 or .4 for a couple of days and then it increased each day and now I am back to almost where I was. Even at those rates I would go low so my target range went up to 180 and my carb ratio was 1:12. It was nice being on such little insulin and sometimes not having to bolus for meals but, that is short lived and then things just get all crazy again! hash

Anyway, I hope this helps and I hope you have a nice fast, pain free delivery!

5

Use your own meter.  The hospital meters are ancient and their lancing devices really hurt and bruise your fingers.  Sometimes you may have to fight with the nurses to use your own meter, but the worst they will do is write a snippy note in your chart.  

I was in labor for over 20 hours and kept my pump on.  My blood sugars stayed pretty steady throughout.  You can't eat so that really helps keep numbers steady.  Thought I would have stress highs from the pain, but I didn't.  I set my pump's target glucosed for 90 and ate a few glucose tablets (maybe 5 over the whole course of labor) and took a couple very conservative corrections to stay between between 80-90.  

My labor was unproductive.  I removed my pump before having a cesarean.  After I came out of anesthesia I insisted on getting off the insulin drip because it was making me low.  I actually took no insulin at all for a couple weeks after delivering.   I was ravenously hungry and had my husband running down to the snack bar non-stop since the nurses didn't want to give me food since I wasn't taking insulin.  I remember crying the night my husband and parents went to Olive Garden because I couldn't go too. =)  Guess I was hungry.

Like Katie said, breast feeding will drop your blood sugar so make sure to drink juice or regular soda. Those drinks also helps give you calories.  You don't get to sleep much the first few months, and sometimes it's too much trouble to eat.  I was grateful for a friend who brought sandwich fixings, fast to make and easy to eat.

6

Thanks for all the input! I feel really lucky that my doctor’s plan is to completely leave my diabetes management up to me… Which is sounding pretty rare! I’m glad my target range sounds reasonable too. Woohoo! I guess another question would be about your baby’s sugar level after birth. Did anyone have trouble with the baby being low? My doc told me they wouldn’t intervene (except to get him nursing really soon) unless he was below 30.

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Both of my daughters had to have glucose put into their stomachs a few hours after birth -I don't remember how low their BG got, but after that one bonus, they were fine.   I had 22 hour induced w/ pitocin labor for both...  And I let the hospital control my bgs with IV drip.

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My son was kept in the NICU for 24 hours his blood sugars were in the 50's right after and kept going up over the course of the 24 hours. That is why they want you to be between 60-100 to prevent the baby co I g out with hypoglycemia. You will do great! Right before giving birth was the only time I felt really anxious and then scared. During I was fine and felt much  calmer!

9

My son was born with a normal blood sugar.  No glucose needed.

Our struggle was that the hospital staff were such strong breastfeeding advocates and said feeding formula would keep my son from wanting to nurse.  The problem was that it took almost a week for my milk to come in (because I was induced and because of the c-section) so he was starving but got nothing from nursing.  I finally insisted they give him formula, which they did with a little shot glass.  After going home I both nursed and my husband fed a bottle of formula a couple times a day.  My son was happy to get food in whatever form it came.

10

Love all the responses! Thanks everyone! Now if only he'd show up so I can start to take all the great advice I've been given! For the past 8 days (WARNING: TMI) I have had regular contractions, horrible back pain, loose stools, nausea, a flareup in acne (awesome), I'm leaking some colostrum, and it feels like the baby is about to fall out. HOWEVER... on the multiple occasions I've been to the hospital my doctor has informed me that I have not progressed any further and therefore am not in 'real' labor. Still 2 cm dilated and ~50% effaced. It is driving me crazy! I can't sleep, hardly eat, and I am now more confused than ever on what to look for in terms of labor. My contractions have been 2 mins apart and about a minute long for DAYS! Am I just crazy?! Is my body even more broken than I thought?! I think this kid might wind up being born at home or in the car since I just can't bring myself to drive the 45 mins to hear the words 'false labor' again.

Once again...I beg of all you veteran mommies... share with me your wisdom!

11

This is just to prepare you for all the crazy, slightly comical things that will happen to you as a mother!  

I'm sorry you're going through this.  My best friend had early labor for basically weeks before her labor officially started.  Hospital staff sometimes make you feel like false labor is an elaborate hoax created by bored expectant moms.  But the truth is you haven't been through this before and don't know what labor will be like.  

I'm not a doctor, but the common thing I've heard from all my friends is they knew labor was for real when their water broke.   It basically feels like you're peeing your pants, but it's clear fluid.  

I'm not sure what your faith beliefs are, but I'm a Christian and had enormous peace when I realized God knew my baby's birthday and exactly how my son would be born.  That took away a lot of my uncertainty and stress.  

12

Hi Rebekah,  I'm going to make this short b/c I tend to go on rants that become to long to read. In my opinion a sugar of 100 during labor is a little on the low side. For a type 2 that is good but a type 1 can drop so fast w/out feeling it - it's better to be a little higher at this time than low. In my opinion a BS of 130 is perfect. Not high so you feel good and gives you room to drop and catch that you are dropping before you start to feel weak. Also, def keep your meter close and if you have a sensor wear it. I made sure my husband knew how to work my meter, and pump before we went in. Good thing too, I had a c-section so before delivery they finally (made) me take off my pump. (I wouldn't take it off during labor and while they were trying to induce me). When they finally had "control" of my sugars - they didn't have CONTROL! They forgot after the c-section that they had me on a glucose drip during the surgery and they kept me on it... I started not feeling well and asked my hubby to check me. I was 400+. I asked the nurse to stop the drip and put me on insulin and she said she would have to order it. 30 minutes passed and I asked her again. Another 15 or so passed and my sugar got up to 460+ so I had my husband put my pump back on me and give me a bolus. The nurse didn't get there to take the sucrose drip off and hook up the insulin until almost 2 hours later. By then, I would have been probably over 600. And don't get me wrong - this is a great hospital w/ fantastic doctors and nurses. But they get busy and they have to follow protocol. So it is a good idea to have all your stuff as a back up.  Also, just a heads up but you probably know this. Loose stool is a sign that baby will be coming soon (when it's this close to delivery and frequent). If you want to "push" things up go take a warm bath and stimulate your n - i - p - p - l - e - s . My BFF has 6 kids and she did that trick to induce herself w/ 3! The last one only took her about 10 minutes but the first two she said she was in there for over half an hour pinching and twisting. It releases a hormone .... Good luck!