Prepare for a confident birth – The Birth Class

Episode 488

Emily – type 1 diabetes, private obstetrician, induction, spontaneous labour

In this episode Emily details her diagnosis and experience with Type 1 diabetes. It has significantly informed her three pregnancies and births because she’s deemed high risk (diabetes increases the risk of placental deterioration, stillbirth and hypertension). She takes us through her different models of care in the private and public hospital system as she navigated inductions, extra scans and monitoring as well as antenatal expressing (colostrum helps raise the baby’s blood sugar levels).

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“Two months after I was married in 2018, I was diagnosed with type 1 diabetes. It was a big shock because I don’t have any family history of it and when I learnt that it can affect my fertility, it did become a bit of a bump in the road of our plans.

“I conceived in the first month we tried which was a relief, mostly that the diabetes hadn’t affected me. I opted for private obstetric care and it was really successful for me. I had to share all my blood sugar levels averaged across the months to prove that I was a well-managed diabetic. I also got blood tests every month. My endocrinologist and OB were really insistent that I keep monitoring and really keep on top of it. My obstetrician encouraged an induction at 38 weeks – that was a definite preference – as there’s more risk of hypertension, placenta deteriorating, stillbirth and your baby being bigger if you have poorly managed your sugars.

“I had to have additional scans and Zimi was tracking small which was a cause of concern and again, they used it as a reason to induce. I didn’t do any education around induction, I just went along with their suggestions and booked it in. I stayed overnight in the hospital and they inserted the gel about 8pm. I had a few niggles but after six hours there was no progress so they gave me the gel again. I woke up in the morning and there was still no progress so they inserted more gel and again, nothing.

“I was really disheartened and the midwife warned me that the obstetrician may recommend a caesarean. Instead, he came in and suggested I stay overnight for monitoring and if nothing had happened, he was going to send me home. I’d come into the hospital every second day for monitoring and I’d be induced in a week’s time. I returned at 39+2 for a stretch and sweep and two days later I went in for the induction and I was already 2cm so the midwife gave me an intense stretch and sweep and I went to my room and at about 9pm contractions started and they moved me to the birthing suite.

“My obstetrician broke my waters in the morning and then labour really ramped up. I laboured all day and she was born just before 4pm, weighing only 2.9kg. Often babies born to diabetic mothers need to spend time in special care but no one warned me of this. She was on a glucose drip for five nights in special care to bring her blood sugars up. Breastfeeding was really smooth for us, but I really had to keep eating snacks to keep my blood sugars up.

“Again, we conceived really quickly and I returned to the same obstetrician and private hospital. I ended up collecting about 50 ml of colostrum because I knew I needed it to bring her blood sugars up after birth. I did find out that I’m a carrier of cystic fibrosis but my husband isn’t…but it means that my girls are carriers too.

“I was anti-induction and this time I didn’t feel like I needed to justify my choices. My Ob suggested induction but I really advocated for going into spontaneous labour. They were going to let me go to 40 weeks and after that I’d need to be induced and I was really happy with that.

“At 39+5 I had my first contraction and it was just really lovely to be labouring in the comfort of my own home. I went to hospital and met my midwife and my obstetrician made it just as Valli was crowning. Unfortunately she needed to go to special care but I was prepared and I knew I’d done everything I could. She only needed to be in there for one night and we were just warned to make sure she wasn’t lethargic once we were discharged as that’s a typical sign of low blood sugars.

“The private hospital I’d birthed at with my first two had closed and I was keen to give the public hospital a go. But I realised that I’d only spoken to people who were low risk. I’m considered high risk which means I couldn’t access MGP care. All my appointments were in Geelong and I saw a different OB at most appointments and they were always running hours late. At one of my later scans the sonographer noticed a small tear in my daughter’s heart so I got a referral to a specialist at the Royal Children’s and he wasn’t concerned at all; he said the only reason we knew about it was because I had an extra scan. One of the benefits for seeing him was that he made a recommendation for a vaginal birth as it was safer for my baby.

“I went back to my hospital and a senior doctor told me I was a diabetic, my blood pressure was elevated, my baby had a heart defect and he’d be cutting my baby out next week. I called the midwife centre and asked to come in and get my blood pressure monitored and they reassured me that everything was looking great. At 38 weeks I had a midwife appointment and she was so polite in informing me that it looked like my baby hadn’t grown so she gently encouraged me to go home, pack my bag and come back as I may need to be induced. That night I went in for monitoring and everything was looking great so they sent me home.

“At 39+2 I went in for monitoring and I requested a stretch and sweep. At 39+6 I got my first contractions and I was so happy and it was such a quick labour. I laboured for four hours at home, I had the urge to push in the car and five minutes after we arrived at hospital she was born. I had skin to skin with her for four hours and they made sure I was nice and warm. Every time they checked her blood sugars they came back above average and I’m sure it was because of the skin to skin. It was a very different experience and we actually went home in the early afternoon.”

Topics Discussed

Antenatal expressing, Breastfeeding, Induction, Private obstetrician, Spontaneous labour, Three babies, type 1 diabetes

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