Hi all. I'm getting close to my delivery date (my dr is planning to induce no later than Feb 2) and wanted to hear what other people experienced. My OB is recommending that I go off my pump and CGM once I'm induced and they will check my BG every 2 hours and provide insulin through an IV based on a sliding scale.... I asked him to consider letting me manage my sugars on my own with my pump and CGM and he was going to run it by the other doctors and let me know if they would allow.
I'd love to hear pros/cons of each so I am sure to fight for the best option. I have a lot of concerns about letting them do all the monitoring/adjusting... but I tend to be a little bit of a control freak - so not sure if it is warranted.
I am a Type 1 and am now about 5 weeks away from delivering my 3rd child. I have been lucky enough to have an excellent high risk perinatologist, who is herself a type 1.
My first delivery was an induction turned c-section and then a planned c-section. I will have a planned c-section for this third baby as well.
My opinion, which is based on my personal experience (and the fact that I as well am a control freak about my diabetes as well as being an ICU nurse) is that I would ABSOLUTELY wear my CGM during delivery and the days after... and that I would absolutely wear my pump and manage my sugars without an insulin drip. Luckily, like I already mentioned, my OB practice is very used to type 1's managing themselves during delivery. After you deliver, you become SO sensitive to insulin, that a CGM is the best way to avoid any unexpected lows that you can very likely experience. Why not keep a safe guard in place? There is no draw back to wearing it. As for wearing the pump, you couldn't pay me enough to take mine off... but this will have to be a decision made between you and your care provider.
I had my son in August via natural delivery and monitored myself using my pump and cgm throughout labor. My OB thankfully was all for deferring the responsibility to me, but I also didn't trust my blood sugars to the nurses and staff. You know your body best.
My DE helped me to setup 2 separate patterns for during delivery and afterwards; nursing really lowers your bloodsugars! Given that in a hospital setting they do not allow you to eat once you are in labor (for fear of needing to perform surgery or anesthesia, etc), I really wanted to be able to control my own "drip" on a very tight basis. The only thing I was allowed to eat within the 28 hours that I was in active labor was something similar to a natural italian ice that they had in the kitchen. That and glucose tablets when my sugars dropped slightly. I think if I had been on an IV drip, trying to get someone to adjust things when I felt it was not an appropriate amount would be an exercise in negotiating bureaucracy.
If you feel confident in you ability to control your BS under stress, then I would recommend you trust yourself. You can always ask them to take over if you feel that there is too much going on. Otherwise make sure to put it in your birth plan and discuss it with you caregiver (OB/Doula/Midwife) and especially notify the nurses so they know to look out for you. :)
My other tip for you is not to go to the hospital too early if you can manage and on the way to have an energy bar or something to try to hold you off for the next few hours so that you have energy. You will do great! Stay calm and focus on the reason you are doing all of this! :)
Best of health and happiness!
*Feel free to check out www.mommabetic.com for more tips on pregnancy, motherhood and diabetes.
I used my own meter during my induction / turned c-sec. (I left my dexcom at home b/c the old dexcom 7 wasn;t as helpful as the new 7+). I (against my will!) went on the novolog insulin drip and I was shocked! It was great! I ran a perfect 70-100 throughout. Luckily, my endo was the one who created the formula for the amount of insulin to use in the drips that the area hospitals use. I guess they knew more than I gave them credit for. (;
I had a scheduled c-section with my 1st child. My husband helped me keep track of my bs and we just reported it to the nurse. The hospital was going to charge us $25.00 a test strip. So we thought we would just watch my diabetes ourselves. The doctor gave me some counsel on how to react to the different blood sugar levels and if we had a problem the nurse would contact him and ask for his advise. I would recommend keeping tack yourself. Just because the nurses are too busy to worry about your diabetes (that was my experience with the nurses after delivery.)
The doctor allowed me to keep my pump on the whole time during the c-section. I did not really discuss the options before the surgery. He just told me I could leave it on.
Thanks for all the responses. After consulting with my endo my OB has decided to let me wear my CGM and use my pump for my basal during delivery... they will administer insulin through the IV for corrections only since it will bring down highs faster (but they'll use my correction factor - not the sliding scale). I'm much more comfortable with this plan than what they originally recommended. I'll be sure to let everyone know how it went.
I'm just 10 days from my induction date (at 39 wks) and all is looking good. It's been a lot of work, but so worth it every time the doctors tell me the baby looks strong & healthy =). I'm so excited to meet this little person!
That's great news -- I'm sure you'll feel more comfortable with your own CGM, pump, and meter.
Will you be hooked up to a dextrose drip in case of lows? You won't be eating and will be working hard during parts of labor, so your normal correction factors may be too much. You'll want to make sure there's a plan in place in case they're too high. Also, make sure you have a plan in place to CUT your insulin as soon as the baby is born b/c your BG's will drop.
I'm sure you're labor will be great. Some women with T1 have had difficult labors (as have those w/o D), so I was very worried leading up to my labor. But, it went fine. Not as bad as I'd thought. I think the majority of us were ok. I'm sure you'll do great!
That's great! Out of curiosity, have you looked into alternative methods of induction as opposed to pitocin? My doctor manually stripped my membranes in order to stimulate dilation and it worked after 3 sessions (over about 1 week) and a day of walking in the heat and swimming. Given that Pitocin can have other side effects and lead down the road towards a c-section; this was my preference. I did have a long labor but was able to go naturally.
Either way, best wishes for a healthy and happy delivery! You'll be amazed how much love you have to give when you see that little babe!