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Iâve found that people ask me a lot if Iâve written my birth plan yet. And Iâve got a two part answer to that question. In terms of a tradition birth plan, Iâve decided not to bother. Iâm happy with my hospitalâs standard procedures around the things that are important to me â stuff like having skin to skin contact straight after birth, staying mobile during labour and being helped to breastfeed. Iâve decided to take the rest of it as it comes â in theory Iâd love a natural, pain relief free labour but thatâs not something IÂ can reallyÂ plan for. If I decide I need pain relief at the time, Iâll make that decision then.
When it comes to diabetes though, my approach is completely different. Hypos or hypers are not desirable during labour. Hypos will make the whole thing a hundred times harder for me. And high blood sugars pass through to the baby, who in return pumps out extra insulin to deal with them. Then when sheâs born and stops getting the extra sugar from me,Â she’ll still have all that extra insulin in her system, meaning sheâs likely to go hypo. Not an ideal welcome into the world. So for me itâs really important that I do all I can to keep my BGs between around 4 and 7 during labour.
The standard approach at my hospitalÂ would be them to take control of my diabetes, using an insulin drip, testingÂ BGs every hour and the nurses would adjust accordingly based on a pre-written scale eg if sheâs an 8 give her 1 unit, if sheâs a 10 give her 2 etc. I find it very stressful to have someone else meddling with my diabetes. I justÂ donât share well. I like to be the one in the driving seat, especially when itâs as important as this to get it right.
I want to manage my own diabetes as much as possible, and I donât want to have to argue with a delivery team who are used to doing things a different way. So my diabetes team and I had a chat, and came up with a diabetes birth plan which gives me the freedom to manage my diabetes, unless Iâm unable to do so, or decide that I no longer want to do so. In which case, the hospital will take over.
We wrote the plan from scratch, so I thought it would be useful to share in case anyone else is having similar thoughts.Â Feel free toÂ steal it:
From: Alisonâs diabetes team To: Alisonâs obstetrics team (plus Iâve got copies in my notes and will have them with me during labour to avoid any confusion)
I met with Alison recently to discuss management of her diabetes during labour. I think it is very likely that Alisonâs glycaemic control will be better if she and her husband are allowed to self manage. We agreed the following approach:Â
Alison and her husband Geoff will continue to manage her diabetes using her insulin pump, CGM and regular testing during labour aiming for a target range of 4-7 mmol/l. Alison will take additional bolusses of insulin as required if her BG level is rising/is likely to rise above this threshold. Alison should be able to use Glucogel and/or dextrose tabs to treat hypoglycaemia as required. I have suggested that she doesnât use large volume solutions such as Lucozade in case C-section is required.
If Alison and Geoff are unable to maintain her BG within the agreed range, Alison should be switched to a glucose/potassium/insulin (GKI) infusion, preceded if necessary by IV insulin, aiming to maintain her BG within target range.
If Alison undergoes C-section under regional anaesthesia (ie epidural so Iâm still awake) she and Geoff will continue to manage her diabetes using the pump.
If C-section is required under general anaesthesia (ie Iâm put to sleep) standard hospital procedure should be followed as per point 2 above.
In summary, as far as possible, I think we should support Alison and Geoff and allow them to manage her diabetes with the proviso that if her BG becomes unstable or she requires general anaesthesia then standard hospital procedures should be used.
That simple letter takes away my fear of having to argue over who runs my diabetes. It means I’m confident that I will be allowed to get on with it myself, unless I’m incapable or decide that I don’t want to, in which case the hospital will take over. That leaves my mind free to think about more important things,Â like having a baby.