Sliding scale during labour, thoughts, advice and experiences.

[Smit]

Hi all
Really just wanted to know peoples experiences on a sliding scale during labour. I wanted to discuss this with my consultant today but saw his side kick who wanted to sit for ages and study by blood results. I mentioned the sliding scale and how I didn't want ti go on one straight away and be stuck to a bed. He said I'd need to go on one and i will be on the bed and not mobile, this really concerns me. He was happy to listen to my concerns about handing over my diabetes control and said he'd discuss it with the consultant at the end of the day. Am I being crazy not wanting to go on one straight away? I am on injections not a pump. X

 

[PhoebeC]

I dont really understand why people dont want to go on SS so badly.

But i wish i could have gotten out of bed.

I didnt leave that bed from the wednesday evening until Sunday afternoon. I didnt like that part one bit.

I had a horrid induced birth with pre-eclampsie at 34 weeks. It was the pre-e that made them keep me in bed and put me on the SS.
I was glad to not have to think about my diabetes at the hardest time in my life. Its the first time ever i have not had to worry about looking after this, i think if id had to i wouldnt have gotten through the labour.

I was really well looked after by the team at warrington, lots of people have a bad time there but they where fantasic with us.
I trusted they knew me and my case and how to get her out safe.

Most people hate the idea of the forceps but id have never have gotten her out without them.

I think they should give you all the infomation on why they think its best to you and baby. And how this is greater than your comfort. I think the more you can kwno about these things the better.
I think the more natural/normal a birth can be the better, but in some cases we need that extra bit of care.

xx

 

[Ellie Jones]

When I had my children sliding scale wasn't implemented until I got into the labour room...

I assume that they are looking to induce you..

They will start this process on the anti-natal ward, then they will monitor you for when your waters break, time your contractions they won't take you up to the labour ward until you reach a certain point, waters broken and contractions coming frequently enough...

And you find that mums that haven't been induced and walking around labour are in the early stages of labour, and will retreat to the bed at a similar time as you will be taken up to the labour ward, which is about the point you'll be wanting gas and air to help out...

And once you hit that labour bed, diabetes, blood glucose levels etc is the last thing on your mind so you need somebody else to step in to look after your diabetes, which if you are on injections is a sliding scale..

 

[Smit]

Thanks for your reply phobe. I have had some horrible experiences on sliding scales over the past 27 years that the thought of it now just freaks me out. I'm trying to go in with an open mind and what happens, happens but I agree I would rather be told all the pros and cons than just been told what to do. X

 

[Babysaurus]

Hi Smit, Hope your levels are levelling you (as per your last thread.)
I felt the same as you re the sliding scale. I didn't want anything that would hinder mobility unless there was no other option. I first had the pre natal apts when I lived in Bristol and discussed it with the diabetic obs lady there. She sounded quite open minded about trying other options and said that 'a couple' of her patients have tried it and been sucessful (most simply go with the flow.) She said, and sorry for not more detail - this was a pre natal apt so I only skirted round things - they managed it with a 'good supply of smoothies and testing strips!' However, when I moved here (Calderdale) it seemed very much a case of this is what happens, and that's that. Thankfully I am now on the pump so the sliding scale is not an issue any more.
I'd make a big point of voicing your concerns, and making sure they know why you have these concerns. After all, one size does not suit all! You may well want to hand over the control to someone else when in the throes of labour, but really nobody knows what they may want until they are in that situation so it's better, in my view, to keep an open mind with your options open. And good luck! xx

 

[Babysaurus]

Ps My husband is doing ALL the diabetic stuff at my delivery, and this was the plan (albeit provisional!) even when I was not on the pump. The first midwife apt I had I told the midwife I was reluctant to go down the sliding scale route due to mobility etc and she listened and then said 'I've been waiting for someone to say that for years' - hopefully you can find a similar minded midwife where you are!

 

[ScottyK]

Hi Babysaurus,

I'll be very interested to see how this one works out for you. I'm not pregnant yet (will be TTC in next few months though!) but I had an in-depth chat about delivery etc with my consultant and DSN who told me that they are totally open to pump users staying on their pump during labour if that's what the woman thinks is best. They also said that partners are encouraged to take control of the pump/insulin monitoring etc if that's something the woman would be comfortable with. Interestingly, the DSN said that around 60-70% of pump wearing women who had given birth over the past couple of years had decided to stay hooked up to it 🙂 Not sure what I'd prefer - guess it depends how labour progresses 🙂

Keep us updated!

k.

 

[ScottyK]

Hi Babysaurus,

I'll be very interested to see how this one works out for you. I'm not pregnant yet (will be TTC in next few months though!) but I had an in-depth chat about delivery etc with my consultant and DSN who told me that they are totally open to pump users staying on their pump during labour if that's what the woman thinks is best. They also said that partners are encouraged to take control of the pump/insulin monitoring etc if that's something the woman would be comfortable with. Interestingly, the DSN said that around 60-70% of pump wearing women who had given birth over the past couple of years had decided to stay hooked up to it 🙂 Not sure what I'd prefer - guess it depends how labour progresses 🙂

Keep us updated!

k.

Also, I meant to address that post to Smit as well as Babysaurus obviously!

 

[Smit]

Thanks Ellie for your insight and how things happen. I always need to know every little detail and would rather know everything than nothing. So it was good to hear what may happen. I know this can all change as labour may not be straight forward.

Babysauras good to hear from you, I am going to speak about it again next week with midwife, obs consultant and diabetes consultant. I think I have the right to the choice if things are running smoothly. The problem is I get in a terrible panic when I ask these things and feel silly. Silly I know, just a nervous thing about hospitals and doctors. The bloods have been going good the last few days, upped ratios to 1.5 for breakfasts, lunch and dinner worked for the past few days, then today 2 hours after lunch blood was 1.9. Didnt do anything different. Had the same breakfasts and lunch as yesterday and major hypo. Wasn't doing anything active, was actually sleeping on thw sofa, having a wee afternoon nap! This is how it goes, great for a few days then crashes. X

 

[Monkey]

I can add my experience of a sliding scale, which was overwhelming positive.

I was induced at 11am, was left to get on with it for 6 hours, and we wandered around the hospital to try and get things going. I handled my diabetes as usual - the protocol was no SS until in established labour - ie 3cm and able to have your waters broken.

I'm not sure why there's a perception that SS = not being mobile - I had a SS in one arm, synctocinon drip in the other, TENS button in one hand and G&A in the other and still wasn't on the bed for my whole labour - in fact, it wasn't til very late on (9cm +) that I really couldn't bear to move. My MW was wholly supportive of me being as mobile as possible, and yes, I couldn't go in the pool or have a bath, but there was plenty of opportunity to bounce on a ball / rock in a rocking chair / wander around as I could.

To be totally honest, I couldn't have thought clearly enough in labour to look at my BG, think about what insulin I had on board, and work out what I needed next - particularly given that I didn't know what would happen in the next hour of my labour and what energy needs I'd have. I appreciate that would be different on a pump, but from a MDI point of view, it worked for me.

I'd echo what Ellie said about diabetes being the last thing on your mind in labour too! It's harder, of course, but then isn't everything when you put diabetes and pregnancy in the same sentence?!

 

[Smit]

Oh monkey thank you so much for sharing your positive experience, doesn't sound as bad as I am imaging. I've had a total panic tonight about it, think it was the doctors attitude today. I think I am just worrying as no one has explained how this induction will go, I know it may not go as planned but would just like some idea. OH has suggested i write down everything I want to know and ask my consultant next week, he also suggests calling the DSN tmw to help put my mind at ease. Hearing your positive experience has really helped. Thank you. X

 

[Medusa]

i had a sliding scale but they didnt do it straight away was in the labour room and once they did i could still get up i just had to drag the drip trolley hanger thing around with me....

 

[Monkey]

Oh monkey thank you so much for sharing your positive experience, doesn't sound as bad as I am imaging. I've had a total panic tonight about it, think it was the doctors attitude today. I think I am just worrying as no one has explained how this induction will go, I know it may not go as planned but would just like some idea. OH has suggested i write down everything I want to know and ask my consultant next week, he also suggests calling the DSN tmw to help put my mind at ease. Hearing your positive experience has really helped. Thank you. X

🙂 Pleased to be of use. My induction really was positive - I know that seems weird, given that I did have an emergency c-section, but it really was. Can post my story that I wrote for my own records after C was born if it'd help - and if there are other things you'd like to know, please ask away - happy to add what I can!

 

[Smit]

Hi Monkey that would be great if you don't mind re posting it. I think I am just starting to panic about things as the due date gets closer and closer. I am being induced at 38 weeks, all being well till then. So 5 and a bit weeks to go. Doesn't help that i've finished up work and have far too much time on my hands to think about it.

 

[PhoebeC]

Monkey you have made my day too 🙂

Its nice to read a nice birth.

Mine was horrid and everyone is shocked when i talk about it. My husband doesnt want more children because of it, which breaks my heart but i understand his reasons.

Each birth is so different.

Best thing you cann do is go in with an open mind.

I didnt want pain relief but had gas and air and an epidural. You change your mind when your doing it 🙂

 

[Babysaurus]

Your post was very thought provoking Monkey as I have heard, via a couple of midwives and an obs, that a sliding scale does mean you are less mobile. Good to hear that this is not neccessarily the case! Maybe it's yet another case of different views and policies in different PCT's...?

 

[Monkey]

Your post was very thought provoking Monkey as I have heard, via a couple of midwives and an obs, that a sliding scale does mean you are less mobile. Good to hear that this is not neccessarily the case! Maybe it's yet another case of different views and policies in different PCT's...?

I think it's probably a combination of things - I suspect some mums don't realise they can ask to still be able to move around, and I also imagine that if I'd had a different MW they might not have been as keen.

At the same time I think you just really don't know how you'll deal with labour til you're there, doing it.

Will repost my story when I've had a quick read to check for typos!

 

[Babysaurus]

Monkey, I'm keen to read your story too!

Smit, I am wondering if, like me, you don't like to be simply 'told'. I have found that some HCP's do the telling and some do the explaining and sometimes, after things are explained (from your point of view too) things are a lot clearer and also, sometimes, a good compromise or middle ground is found.

 

[Smit]

Babysaurus you are spot on, I like things to be explained to me, why they are going to do this or that and not just tell me that this is happening because thats what happens to all type 1's blah, blah, blah. My consultant has already said i'm not the usual type 1 was insulin dropping all over the place so I think this all needs to be taken into account with the obs consultant when we discuss it on Tueday.

I had a very scary experience when I had stomach problems a few years back, I was put on a sliding scale, had most horrific pains in my tummy and was screaming for pain relief. I was given some sort of pain killers which knocked me and and left for 4 hours with no monitoring. When my Mum arrived I thought I was on a beach (imagine the scene from Bridget Jones where she takes magic mushrooms) and was away with the fairies. My Mum test my blood and it was below 1. I was on the verge of fitting. Was a nightmare. The surgical ward just knocked me out and left me on a sliding scale and didn't bother to monitor me. I know labour will be different, OH will be with me and they will all know I'm diabetic but the thought of this still scares me. Even typing about it has got me very upset, such a wet wipe, blaming the hormones!!! 😱

 

[Babysaurus]

Smit, you are not a wet wipe! Goddit?

I have found the problem to be that the docs, understandably, cater for all diabetics so while we may be more 'unusual' (for wont of a better word) the majority can be far less clued up or even interested.
One of the nurses I have been seeing said that a) Type 2's and Gestational Diabetics, in particular, can often (I'm really sorry if I offend here, I don't mean to) 'cheat' or not take it as seriously as they should. Her pet hate is GP's who tell Type 2's they have 'a touch of diabetes' or similar, which would / could make it sound less of an issue than it is / can be which hardly helps the DSN's etc. She also said that b) She see's a lot of cheating - "I've been testing all the time" only to find there are next to no results on the bg montior, or "I've not been eating anything I shouldn't" while, clearly, they have. She said that as soon as something goes wrong, however, its time to start kicking off and threatening to sue. Hence, the catch all, seems to be that you are 'told' what 'has to happen' to ensure that they are the one's with the control and are the one's making the decisions. Its understandable, but bloody frustrating at times!

Add to this that you have had a horrible experience with a sliding scale, and also, like myself, like to have a large hand in making any decisions, and it's no wonder you are stressed. I am starting to find, a bit anyway, that once you get to know the staff who are doing the endo / obs work with (note 'with' not 'on' 😉) it can get a bit easier and you start to be looked at like someone with a brain rather than 'a diabetic patient'.

I have an apt come through to meet the consultant midwives on the 2nd April so am back to read Monkey's story and then to start a list of what to ask etc.