Type 1 Diabetes and Pregnancy: Baby is here!!

Today is my Diabetes Anniversary! I was diagnosed 14 years ago: March 14th, 2000. It seems so fitting to be posting about and reveling in the birth of my son today!!!

Our baby has arrived and is almost a six weeks old! WOW how time has flown by and how busy it has been.

I love being a mom. The exhaustion is definitely an adjustment and I couldn't be happier about having to deal with it for what I have in return.

I'm going to share a little about my labor/delivery process........

I went in on a Thursday night at 10pm to prepare for a Friday morning induction. The nursing staff did my intake and attached me to monitors for the baby's heart rate and contractions. I was administered Cervadil in order to soften and hopefully begin dilating the cervix.

 The hospital standards are that diabetics be placed on an insulin drip. I had strongly indicated that I was not keen on going on one at all. This topic became a constant conversation during my doctor appointments. She was very strongly working to persuade me that it would be difficult for me to not go on one. I finally agreed that I would be open to being on a drip once the IV was started on Friday and once I had the opportunity to discuss the administration of the insulin with the nursing staff. I'm quite a control freak about my diabetes and I've been the only one administering myself insulin for 14 years. I was not keen on the idea of handing over that control.

Friday morning at 830am my doctor checked in on me. I had only dilated to about another centimeter putting me at 2 centimeters. She gave the nursing staff the go ahead to start pitocin. My nurse recommended I eat breakfast and get up for a walk before starting. At 11am they started the IV of pitocin to induce contractions. I felt good for a few hours and got up to walk the halls to hopefully help move things along. This required a lot of help from my husband to drag along the IV and monitors attached to me.

My wonderful doctor must have put it in my charges that I was a control freak about my diabetes because my nurses were beyond respectful about my wishes. They even admitted IV drip protocols are written based on gestational and type 2 diabetes. They agreed to allow me to wear my pump as long as my blood sugars stayed below 120. This freaked me out because that's so difficult for a type 1 to pull off! I had amazing nurses, but I still felt they didn't readily grasp type 1 diabetes. For example, my blood sugar did spike to 140 after breakfast and right after they started the pitocin. The nurse let me take a correction bolus and said we'd start the IV if it wasn't down in an hour. Well she didn't check me for like an hour and a half and I was down to 70. Then she asked me why I thought it dropped so much!!! This is a completely typical change of numbers any day in the life of a type 1. As for "why?"...I took insulin...that's why...or because I'm in labor.....

 After that a diabetes miracle happened and my blood sugars stayed between 80-100. This may have been partly thanks to them not letting me eat! According to one of the nurses, "labor is the equivalent of your body running a marathon". Because I was being induced I was not allowed to eat due to increased risk of unplanned C-section. So a 15 hour marathon and no food. Awesome.

I was able to stay on my insulin pump thanks to my supportive nurses and great luck with blood sugars. The nurses even told me the rest of the staff thought they were crazy for not having me on a drip, again, I felt very thankful.

Around 4pm my contractions were a minute long and a minute apart. They were hurting to say the least and I was starting to have a hard time coping. I hadn't written a birth plan in order to keep an open mind. My doctor had checked in on me at 430pm and told the nurses I could have pain meds whenever I wanted. Around 6pm I decided I wanted them. My nurse gave me Fentanyl through my IV to take the edge off while we waited for the anesthesiologist. He arrived pretty quickly and the Epidural insertion didn't hurt due to the fact that I had the IV medicine. The Fentanyl only last about 40 minutes just enough time for the epidural to kick in. My legs were very numb and heavy feeling, but to my relief I could still FEEL them.

The nurse checked to see how far I was dilated and to my dismay I was still on 3.5 cm after a full day of pictocin. I was feeling a little stressed and worried that if things didn't progress I would have a c-section and my hope was for a vaginal birth. I relaxed, reminded myself to keep an open mind, and decided to try to get some much needed sleep.

Thanks to the epidural I was able to sleep about 5 hours and woke up right before midnight. The nurse checked in and I had dilated to 6-7cm, finally! My husband had finally fallen asleep himself. I decided to wait until I was closer to 10cm to wake him. He woke up around 130am and it was time to start pushing a little after that.

Our son was born at 3:14 am weighing 7lbs 8oz. They placed him on my chest immediately and I was able to hold him for at least 30 minutes until they needed to weigh him, check his blood sugar, and give him a bath. All this happened 5 feet from my bed in the newborn warmer.

My blood sugars initially skyrocketed after labor. Possibly from a variety of reasons: They finally let me eat so I stuffed my face with granola bars because that's all there was until breakfast, I had also been receiving dextrose through my IV in order to avoid spilling ketones (I had a few ketones before they gave me dextrose because of how hard my body was working and not receiving food), and my body had just been through labor so the stress could have spiked things too. 

My sugars stabilized after breakfast. They continued to check my son's blood sugars at intervals until he "graduated" from blood sugar checks after 12 hours. He had been borderline low for an infant and they gave him some formula to be on the safe side. (My son has a very low chance of developing type 1 diabetes. The blood sugar checks at the hospital are to look for lows. Babies born to diabetic mothers have usually been exposed to a sweeter environment prenatally, even with good control. After birth their own pancreas might be overcompensating and this can result in low blood sugars.)

My insulin amounts decreased steadily the days following delivery and I am actually now on smaller rates than pre-pregnancy. Breastfeeding has lowered my blood sugars and made me thirsty/hungry often. My endocrinologist called me after I was home to congratulate me, ask how things were going, and follow up with some prescriptions!! I happily told her how diabetes now appears "easy" compared to managing it when I was pregnant!! Haha! All about perspective.

Diabetes and pregnancy has been my greatest challenge with type 1 diabetes. I feel so thankful to have had a healthy pregnancy and blessed with a beautiful baby boy. My husband and healthcare team were above and beyond. The hard work has really only just begun, but the newborn challenges are so much more rewarding!

*What works for me might not work for you. If you have questions, concerns, or are thinking of making changes to your diabetes care always contact your doctor.