Giving birth if you have diabetes

If you have diabetes, it is recommended that you give birth to your baby when you are between 38 and 39 weeks pregnant. Reasons for this can include:

• the size and maturity of your baby
• the development and maturity of the placenta (an organ that connects your baby to the womb during pregnancy)
• problems with your blood pressure or blood sugar control

Many people with diabetes have a vaginal birth, but there is a higher chance of needing a caesarean section. This is an operation to deliver your baby through a cut made in your tummy and womb.

Your doctor and midwife talk to you about your own personal situation to plan for the birth of your baby.

Having your labour started early (induced)

We may offer to induce your labour. This means helping your body to start labour at an earlier time to reduce risks for you and your baby.

We can induce labour in several ways. Sometimes, we combine 2 or more methods.

• Pessary or gel: We put a pessary (tablet) or gel into your vagina. This helps the neck of the womb (cervix) to 'ripen' and open, which in turn encourages your womb (uterus) to start contracting. Sometimes, you may need more than 1 pessary or gel before labour starts.
• Breaking waters (artificial rupture of the membranes): We gently break the bag of fluid around your baby using a small tool called an amnihook. This looks like a long crochet hook. The gush of fluid may encourage your womb to start contracting.

• Oxytocin (syntocinon) drip: We put a drip into a vein in your arm. This slowly releases a hormone called oxytocin (syntocinon) into your blood to help your womb start contracting. We may use the drip alone or give you a pessary or gel as well.

Place of birth and your birth plan

If you have diabetes, we recommend that you give birth in the hospital birth centre. This is in view of the equipment and monitoring that you need. It is also easier to get any help that you might need from specialist midwives, doctors and neonatal (newborn baby) doctors.

You can talk to your midwife about your birth plan and what is important to you during the antenatal (before birth) period. A birth plan is a record of what you would like to happen during your labour and after the birth. Please make a list of any questions and ask them at your appointments.

Managing your blood sugar during labour

Controlling your blood sugar levels during labour helps your baby to have better blood sugar levels at birth. 

The mother’s blood sugar levels immediately before the birth have an important effect on the baby’s health. Mother and baby have the same blood sugar level at the time of birth. 

Your baby produces their own insulin. When outside of the mother, there is a chance that the baby may produce too much insulin and have low blood sugar (hypoglycaemia). If your blood sugar is within the normal range during labour, this makes it less likely that your baby will have low blood sugar at birth.

Actions to prepare for a healthy birth
 

If you have type 1 or 2 diabetes and your blood sugar is above 6mmol/L when labour starts, we usually give you an insulin and sugar (glucose) drip. You have this drip into a vein of your arm throughout the labour. 

The drip allows us to release small amounts of insulin into your blood continuously. We can adjust the insulin and glucose through the drip depending on your blood sugar level. In this way, we can keep your blood sugar within the normal range much more simply.

When you give birth, your blood sugar needs to be tested frequently to adjust the insulin dose. We recommend that you take your own diabetes equipment to hospital. Wherever possible, we encourage you to continue your own blood sugar testing and insulin injections.

Actions to prepare for coming into hospital

The birth

After you have given birth, we examine your baby in the room with you. Your baby can then go with you to your ward if:

• your blood sugar levels have been stable during pregnancy and labour
• your baby does not have any problems

A neonatal doctor may recommend that we observe your baby in the neonatal unit if they:

• are born prematurely
• have breathing problems
• have low blood sugar

Our nurses often have instant cameras. You can ask for a photo of your baby if you are separated from them.

Blood tests on your baby

We test your baby’s blood sugar levels 3 hours after birth and then before feeds, until they are regularly above 2.0mmol/L.

If your baby’s blood sugar level is less than 2.0mmol/L, your midwife or doctor will give your baby some dextrose (sugar) gel. They also help you with feeding the baby. If your baby keeps getting low blood sugar, your doctor may suggest that we monitor them in the neonatal unit.

Talk to your midwife about using your own milk to feed your baby. You can even express breast milk before your baby is born. This milk can then be given to your baby while you get used to breastfeeding. 

Your baby may have produced extra insulin to deal with any extra sugar passed across the placenta during labour. It usually takes 1 to 2 days for your baby’s pancreas to adapt and return to producing a normal amount of insulin again. This does not mean that your baby will get diabetes in the future.

Feeding your baby regularly (at least every 3 hours) on the first day helps to keep their blood sugar levels above 2.0mmol/L. Your midwife gives you more information about breastfeeding, hand expressing breast milk and preventing low blood sugar levels in your baby at birth.