The good, the bad, and a beautiful baby!

Pregnancy
1

I thought I would share my pregnancy story which for the most part was uncomplicated except a hiccup near the end. I just want to share that even though I had a complication, I got through it and me and my baby are doing great!

I have had T1D since age 17. I am 29 and just had my first child, a beautiful and healthy baby girl.

Pre-pregnancy my A1C was 6.9, and was down to 6.3 during the pregnancy. I had no trouble conceiving, all my ultrasounds were normal, including a fetal echo. I gained 30 pounds and my endo, perinatologist, and diabetes educator were all happy with my glucose control. I take multiple daily injections (Lantus and Humalog) and started using a CGM (Dexcom) at 13 weeks gestation.

Now for the "complication". I started non-stress tests once a week at 32 weeks gestation (my OB's wanted me to start twice a week at 28 weeks, but my perinatologist didn't want to start them until 34 weeks, so this was a compromise). At 34 weeks I started going twice a week. Fetal heart rate and activity were always normal, as was the amniotic fluid level, until 35 1/2 weeks. On that day, the perinatologist said my amniotic fluid was low. He asked if I had been leaking fluid. I said no. I told him my blood sugars had been lower over the previous two weeks (I had been taking more than twice my pre-pregnancy amounts of insulin and starting at 33-34weeks felt like the insulin resistance I had built up was starting to go away). He said these were both signs that the placenta was starting to fail and I would have to have my baby right away. I had time to go home, inform my husband, pack a bag, talk to my OB, and then was in the hospital at 8pm that night. 

My OBs plan was to ripen my cervix using Cervidel, then induce contractions with Pitocin. The Cervidel was inserted at 9pm, and I actually started having contractions throughout the night. In the morning I was already 3cm dilated, so they did not start the Pitocin. I ended up progressing on my own, requested an epidural when the contractions got really bad, and delivered my baby girl at 12:15pm the day after I was admitted. She was 6lbs4oz and 18.5 inches long. In terms of diabetes management during the delivery, I had an insulin and glucose drip that the doctor and nurses dealt with. I had my CGM on me the whole time and was running about 140 most of the time. During the delivery, the doctor said I had almost no amniotic fluid, so it was good I was induced. She said that the placenta looked fine (I think the perinatologist caught the low fluid just in time and if I had continued on there would have been more complications while I was pregnant).

At delivery I got to hold my baby girl, then they checked her glucose which was a bit low (47). Their policy was to take her to the NICU to follow-up. Her glucose ended up going up on its own, but at that point they noticed she was having respiratory distress (breathing too fast). Although she came out with great APGAR scores (8,9,9) and was screaming, her lungs were not quite yet ready given she was early (a complication the perinatologist warned me could happen). She ended up spending 8 days in the NICU, which was really difficult, but she is now 1 month old, has been home with us for 3 weeks, and she is perfect!! Her lungs are all better and she is not expected to have any other complications due to being pre-term!

So, even if a complication does arise, it doesn't mean it will be something that lasts, just something to deal with in the short term. This forum has been a great resource for me and it's great hearing about all the healthy babies other T1D moms are having. Good luck to you all!

2

Congratulations and Thank you for sharing you story!  It is such a relief to know that healthy T1s can have healthy babies and naturally too kudos to you!

One question for you though... I'm kind of a control freak about my diabetes.  I've heard that most diabetics go on a glucose/insulin drip and have the nurses control it.  I'm REALLY nervous about this.  I know that myself and my family would do a better job than some random nurse.  

I lied... More Questions.  Were you allowed to eat or drink anything during labor?  How did you manage your diabetes prior to being admitted?

Thank you again for sharing your experiences, it is a big help!

Brigid

3

To add my 2 cents worth...

I used my pump through labor.  You're not allowed to eat or drink anything except ice chips.

When I finally had a cesarean, pump was removed and I was put on insulin drip because they knocked me out as soon as my son was delivered.  

Bring your own glucose meter and snacks to the hospital, for after delivery.   Most hospitals don't test often.  I went back on my pump about a day after delivering, but once my breast milk came in discontinued for  a few weeks.  Because of breastfeeding and post-pregnancy hormones I didn't need ANY insulin for that first couple weeks, after 28 years of being an insulin dependent type 1.  Then insulin levels slowly increased to prepregnancy levels.  

4

They wanted to take my pump off also but I would not let them. They finally decided we had to have a c-section and the pump had to come off. After delivery they didn't put me on a drip or give me insulin or anything for almost 3 hours! My sugar went over 300. I finally stopped listening to them and had my husband put my pump back on me. (I was too drugged up!) Definatly bring your own meter and extra pump supplies. All of the nurses were great but not many of them know much about type 1s. I would make sure to train your husband / boyfriend/ or whoever will be with you so they can work your pump if they need to and test for you.

5

I don't know about rishmack, but for me, I was allowed to eat and drink during labor. It all depends on the doctor, and sometimes the hospital. The hospital where I delivered let the doctors decide most things and my doctor allowed me to eat and drink during labor. Once we decided to do a c-section, I wasn't allowed anything, but everything I had previously eaten and drunk did not interfere in any way with my health or comfort.

If being allowed to eat and drink during labor is important to you, find a doctor who allows it. I think it's good to eat and drink because it helps your energy to be able to deliver naturally (although it didn't work out that way for me for other reasons).

I didn't have a glucose or insulin drip during labor. Find out what your doctor's and hospital's policies are and see what you can negotiate. After all, it's YOUR body, and you know it better than anyone. But you may be too exhausted or distracted by the labor to remember or care to take care of yourself, so instruct a family member or friend on what to do beforehand (if the hospital staff won't be doing it).

After I delivered, I had no insulin and I didn't need it. Once while still in the hospital I had some cake a family member had brought in and the nurse tested me right after- I was like 250 or something. It was at around 10pm, and she wanted to give me insulin, but I told her my sugar would come down naturally, and I didn't want any hypos at night, so she agreed to wait until we tested again at 3am. I was 90-something, so it's a good thing she didn't give me anything. This doesn't mean it'll be like that for you- just know your own body.

BTW, I had a healthy, beautiful baby girl January 29th, two days before her due date, 7 lbs. 0 oz. 20 inches. Her sugars never dropped below 45, the threshold for my hospital. She did have to stay in the NICU for antibiotics due to an infection for 7 days, but she is doing great now, and breastfeeding great too. You can do it! Good luck!

6

to answer Brigid001

I was fine being on the insulin and glucose drip throughout labor, and kept my CGM on me so I could let the nurses know if I was too high or low (they also did finger sticks so they would have their own readings).

I was not allowed to eat or drink during labor. My understanding is that this is typical for non-high risk pregnancies as well so that if an emergency C-section is needed they know your stomach is empty.

I take Lantus and Humalog and also use the Dexcom CGM (I got it at 13weeks gestation, prior to that I dud finger sticks 8-12 times per day).

After delivery I needed less inulin than I did before I was pregnant. I brought snacks with me, although the hospital food was pretty good! My OB had written and order for insulin and the nurses wanted to give me "Regular" insulin according to a sliding scale she had written up. I explained to the nurse I had never used Regular insulin, and that I didn't feel comfortable taking it because I didn't know how it would work in my body. We went back and forth for a while... she checked with other nurses, the pharmacy, and my OB. My OB said I could do whatever I wanted, but the hospital required a written order from her, so she had just sent something standard over. I had my insulin pens with me, so my OB sent a new order saying something like "Patient to administer her own insulin based on carbohydrate content of meal. Patient to count carbs". After that the nurses let me do my own thing and occasionally asked how my blood sugars were!

Good luck!