I have to say, having Eva by caesarean was a thoroughly pleasant experience. A couple of weeks before she was born we
Controlling diabetes during a c-section
I wanted to maintain control of my diabetes throughout rather than go on a sliding scale, so we had a chat with the anaesthetist who’d be doing my op. He had his own views on how I should manage my diabetes, but we didn’t agree with them. He wanted me to aim to go into theatre at around 7 or 8, which was fine by me. He suggested I achieve this by reducing my basal to 80% the night before and then to 0% as I went into theatre to avoid going hypo once the baby was born.
I agreed with what he was trying to do – it made perfect sense to play safe and aim to be around 8 for the op. High enough to avoid hypos, but low enough not to cause the baby to mass produce insulin in response to the amount of glucose she’s getting from me and then end up low when that glucose supply stops at birth. I was also just as scared as he was of a post birth hypo – once the placenta has been delivered all those hormones that have been causing insulin resistance for months suddenly disappear, and insulin requirements return to pre pregnancy levels almost immediately.
But I didn’t think his plan would work. So, I explained my plan to him. I’d run at normal basal rates the night before the op, because the stress of knowing I was having a baby in the morning would keep me plenty high enough without reducing basal rates. I’d also monitor it closely through the night and correct if required. I was nil by mouth but we agreed I could use Hypostop gel to treat lows if needed. To avoid the post birth crash, I’d reduce my basal rates to pre pregnancy levels 2 hours before the c-section started, meaning that by the time they got the placenta out, I’d have the right levels of insulin in my system.
He agreed, and it worked. I entered theatre as an 8 and left as a 7, staying around a 7 for the next few hours. He came to visit me the next day to double check what I’d done because he wants to adopt that as his diabetic plan from now on. Isn’t it nice when a doctor actually listens?
Preventing post-birth lows
I controlled my sugars throughout delivery to try and prevent any post birth lows, but I was conscious that there was no guarantee that would work, and anyway, 8 is still higher than a non diabetic woman would run at so there was still some risk of hypos to the baby. For that reason I decided to express colostrum in the week prior to birth, so that we’d have food available for Eva as soon as she was born, without having to resort to formula.
So we headed into theatre with several tiny syringes filled with less than a teaspoon each of colostrum. We explained to the midwife that if the baby needed food before I could breastfeed we’d like her to have this rather than formula. The midwife said regardless of blood sugar, she’d recommend we give the baby the colostrum anyway, so she could have food as soon as possible. That seemed sensible, so as soon as Eva was born and handed to Geoff, the midwife helped him give Eva her first feed of breastmilk via a syringe. They were putting me back together for the next half hour so I couldn’t feed Eva, but it meant she got some decent food straight away even though her blood sugars were fine. As soon as I was stitched up, they handed her to me and she started feeding within 5 minutes. It worked a treat – we were both relaxed because I wasn’t panicking that she’d has no food and could go low and she wasn’t starving hungry.
When to cut the cord
The final request we had was for the surgeon to delay cutting the umbilical cord until it had stopped pulsating. Practice varies, but the current NICE guidelines state that the cord should be cut as soon as the baby is born. My initial concern was that the baby gets all its glucose from me, so to reduce the risk of lows, I’d like it to get every last bit of glucose before being cast adrift. If they leave the cord attached for a few extra minutes, until it stops pulsating, it’s estimated the baby gets an additional 30% of blood in her system. This just seemed to make sense to me, and further reading showed that it also seemed to reduce the risk of anaemia in the baby, because they kept hold of more blood so didn’t have to manufacture it themselves.
We spoke to the surgeon about it and said we’d like her to only cut the cord once it had stopped pulsating. She said it wasn’t standard practice in a c-section, but she was happy to do it. And then admitted if it was her baby, she’d do the same. Interestingly, a few days after Eva was born I saw this article on the BBC saying that pressure was mounting for this to be adopted as standard practice.
Thankfully everything went to plan and we couldn’t have wished for a better experience. I felt like I understood what was happening, and everything that was important to me was being done. A brilliant patient experience coming from an informed patient and a team who were willing to listen. Great stuff.