Type 1 Pregnancy “Natural” Birth Choices

[Tegen]

Hi all,
Was wondering if any type 1 women had opted to not be induced to have their babies? Or just are able to share their experience /any advice on the actual birth/labour? Particularly if anyone decided not to go with interventions.
I’ve been type 1 for 15 years on injections (fiasp and levermir), well within Hb1ac target ranges (pre-pregnancy) and Time in Range (on Dexcom) since getting pregnant, did folic acid 5mg 3 months before and for the first 12 weeks, and I’m fairly young (28 year old) so doing everything by the book. So far all normal with every test.
I’m 25 weeks pregnant and starting to think about my birth plan and stressing about what I want versus the unclear risks and interventions. I can’t find much data on pregnancy outcomes/risk factors for well controlled T1 pregnancies so any advice here would be great?!
Thanks for listening and any advice 🙂

 

[Inka]

Welcome @Tegen and congratulations on your pregnancy 🙂 I was induced for two of my three pregnancies. I went into labour naturally with the other one. For my last pregnancy, I was tempted to refuse induction until close to my due date, but having looked at the facts over many weeks, I changed my mind. For me, it simply wasn’t worth the risk - if something had happened, I’d have blamed myself totally.

However good your control (and mine was excellent), diabetic placentas age faster than non-diabetic placentas. So ‘due date’ for us is 38wks, if you get what I mean. Also, I read that the muscles of the uterus and area can be affected if you’ve had Type 1 any length of time and become less efficient. People with diabetes have a higher risk of stillbirth. There are a number of studies online. I can’t remember all the ones I read because I read so many, but having read the risks, small as they might be, I couldn’t risk it.

However, despite having an induction, I had an active birth with an ambulatory drip, lots of movement around and kneeling on the floor to give birth. I wrote my birth plan in bullet points and covered as many possibilities as I could think of so that I wasn’t having to make decisions in labour.

Have you asked at what point they’d induce you? It would be good to have a discussion with your OB and get input on the best time for you as an individual. You might be able to be induced at the end of the recommended time, giving you more chance to go into labour naturally.

 

[Tegen]

Hi Inka,
Thank you so much for sharing your experience and being so open about the decision making process you went through.

I’d heard about placenta deterioration but hadn’t yet managed to find a study that showed it was causally linked to T1 Diabetes rather than hyperglycaemia. Thanks to your comment I found one that found a causal link in rodents (good human proxy) [here’s the link of anyone is interested: https://www.ncbi.nlm.nih.gov/pmc/ar...and,membrane, hence reducing oxygen transport.]
As you say there’s an increase in stillbirth and mother mortality with diabetes - what I’ve been wondering recently is the scope of this risk in well controlled type 1s. I’ve been looking up studies too but running into the issue of either studies spanning gestational, type 2 and type 1 (with type 1 making up 4-10% of the sample group) or type 1 studies where only 10%-20% meet target ranges/have done recommended pre-prep. What in an ideal world I’d like to get my hands on is any study that shows risks associated when data has been aggregated by type 1 long term good control and pre-prep - maybe a pipe dream but if anyone has any leads.
Interesting about the uterus if you can point me in a direction of any studies that’d be much appreciated.
It was originally Victoria’s story of home birth on diabetes uk that got me thinking about my options and wanting to become more informed rather than going to everything by default [link to story here: https://www.diabetes.org.uk/your-st...-whom-has-given-birth-to-two-healthy-children].
How lovely that you had such an active birth!
The last obstetrician I saw wasn’t very forthcoming with information but said they’d be looking at 38 weeks. When I asked about a birth plan he wasn’t willing to discuss it and said the best birth plan is no birth plan so I’m now trying to muddle my way through - bullet points sound great. At my diabetic antenatal clinic you just get any OB who happens to be there so hoping I get someone different next time who is more helpful/willing to answer my questions. Nice thinking on giving more time to go into labour naturally.
Thanks again Inka and have a lovely day.

 

[Inka]

Sorry your last OB wasn’t very helpful @Tegen Mine was lovely, and it made all the difference. Birth plans are crucial IMO. Birth is an active process not something that’s done to you. I believe that very strongly. Of course, we sometimes need medical support or intervention, but an active birth reduces the chances of that. Interventions are a cascade - one can increase the risk of another, eg an epidural increases the risk of an episiotomy and C section.

My question was the same as yours - if the increased risk of stillbirth applied to me as an individual with excellent control and an easy pregnancy. As you say, lots of the studies lump people with diabetes together. My last pregnancy was a few years ago and I can’t remember all the studies I read. I literally read about it every single day from a similar stage to yours. I did find one that concentrated more on Type 1. I keep wanting to say it was a Danish study, but I might be misremembering that or muddling two different studies. I only found one brief comment, but it suggested there was still a risk even if the person had excellent control. I asked my OB and she confirmed my baby was at increased risk simply because of the Type 1 despite my excellent control. I was still so keen on going into labour naturally, but as I got into the last few weeks my feelings changed. I realised that I couldn’t risk it because I couldn’t live with myself if something went wrong. Added to that, baby’s movements decreased a little (I was doing Count the Kicks).

For your birth plan, start off with your strong preferences eg you might want baby skin-to-skin immediately after birth; you might not want an epidural; you might want to deliver baby in silence or to music; you might want a delay to the cord-cutting; you might want you or somebody with you to cut the cord; you might have preferred delivery positions, etc etc. I ordered mine in stages, so the midwives could clearly see my wishes. I made three copies - one for my notes, one to give the midwife when I went in, one to keep with me. I also wrote my preferences if I needed any intervention eg ventouse not forceps, keeping my insulin pump on through labour, etc.

I found this book very empowering:
Active Birth by Janet Balaskas

.

 

[PhoebeC]

I was told all along I would be induced at 37-38 weeks, and they wouldn’t want to give me a C-section, and that I would need to be on sliding scale. (This reminds me I have question I need to post about this for an operation I will be having)

So fine, I did yoga before I was pregnant and then special pregnancy and birth sessions one on one with my instructor, least having things I could control plus my breathing would help. I would definitely suggest controlling what you can, your bag, whose their, music, who is your contact with the outside world if you want that etc.

All my posts about my pregnancy are on here plus I think a birth one, she’s 12 now. Have a search if you like. There’s a few peoples stories on here and honestly these women and this forum got me through so many hard times. We are both alive because of them.

I went for a check up 34 weeks and I flagged as having pre-eclampsia. They included me the next morning and 36 hours later she was born. I was basically in bed for the whole time as they wanted to control / measure everything in and out and if I needed a section I wasn’t even allowed to eat or drink. One of the worst things was the dry mouth, they wouldn’t even let me brush my teeth.
It was the worst experience of my life but the whole pregnancy was a battle and I was in and out of hospital for various reasons. And I don’t want to scare you, she was worth it and I would do it again for her. Just not again for another.

As Inka said have your ideal plan, but have a few other plans, and actually when it happens it might all go out the window. Accept that as even normal births can be like that.
We also read all the studies on both the pregnancy and births. I would say share with your team and your birth support family/friends so they can speak for you if needed.

I think I would have agreed to have my head removed if the medical team
had suggested it.

Just try not to panic and focus on what you can control. Sounds like you’re doing well.
We are here for support even if we don’t know the answers. Take care x

 

[RSz]

Hi @Tegen, I'm so glad you asked because I was literally coming on here to ask the exact same thing! I'm 32 weeks and very nervous about being induced. My levels aren't as well controlled though at the moment (stubborn highs but lots of hypos frustratingly with even one unit changes swinging everything the complete opposite way!). But anyway just wanted to share you are not alone in considering this! Ultimately I will take the medical advice because I won't want to risk something going wrong and thinking it was my poor decision making but I did ask my consultant today if there was an option not to be induced. He said they would never recommend it but he would of course support any decision I made. He did say they could do a sweep (don't ask me what this is..I'm very unprepared at the moment with no birth plan in place yet!) at 37 weeks to see if this brought on natural labour at 38 weeks and then we could do it by induction if that didn't work. This sounded like a good compromise to me and perhaps a safe but natural option? I think I'm going to look into this a bit more. Best of luck with your baby and feel free to connect - it would be great to hear what you end up adding to a birthplan too!

 

[42istheanswer]

Hi @Tegen, I'm so glad you asked because I was literally coming on here to ask the exact same thing! I'm 32 weeks and very nervous about being induced. My levels aren't as well controlled though at the moment (stubborn highs but lots of hypos frustratingly with even one unit changes swinging everything the complete opposite way!). But anyway just wanted to share you are not alone in considering this! Ultimately I will take the medical advice because I won't want to risk something going wrong and thinking it was my poor decision making but I did ask my consultant today if there was an option not to be induced. He said they would never recommend it but he would of course support any decision I made. He did say they could do a sweep (don't ask me what this is..I'm very unprepared at the moment with no birth plan in place yet!) at 37 weeks to see if this brought on natural labour at 38 weeks and then we could do it by induction if that didn't work. This sounded like a good compromise to me and perhaps a safe but natural option? I think I'm going to look into this a bit more. Best of luck with your baby and feel free to connect - it would be great to hear what you end up adding to a birthplan too!

A "sweep" is a manual examination where the midwife or doctor feels and then "sweeps their fingers across" the cervix. Usually if it is going to work labour starts within 48 hours after it. (It's effectively a mild attempt to induce labour, but without the immediate necessity to escalate to doing something else if it doesn't work, as it doesn't usually cause the waters to break). It isn't completely risk-free but is usually considered to be low risk.

It is also worth considering how you would like labour to happen if you do have an induction and discuss that with your consultant. Some maternity units are happier for women to have things like birth balls while hooked up to a drip and monitors than others. My induction was for "dates" rather than anything else (I probably did have Gestational Diabetes but they hadn't been able to confirm diagnosis so didn't induce me until I got to 42 weeks by scan) but because I had supportive midwives in labour, and encouragement to have an active birth, it was a much better labour than my previous one (at a different hospital) where I hadn't felt supported or listened to.

 

[Leadinglights]

However well planned you are sometimes you have to keep an open mind and discuss your options with your midwife of obstetric consultant but be prepared that sometimes things don't go according to plan but that doesn't mean there will not be a good outcome.
My daughter (not diabetic) with first baby had an emergency C-section at 33 weeks as she had pre-eclampsia, the second she was booked in for a C-section at 38 weeks but went into labour the day before, the third an emergency C-section at 34 weeks as the growth scan showed the baby had stopped growing so better out than in. They all did really well even though none went to plan.
You should have a specialist midwife and frequent checks.
I hope all goes well for you.

 

[RSz]

A "sweep" is a manual examination where the midwife or doctor feels and then "sweeps their fingers across" the cervix. Usually if it is going to work labour starts within 48 hours after it. (It's effectively a mild attempt to induce labour, but without the immediate necessity to escalate to doing something else if it doesn't work, as it doesn't usually cause the waters to break). It isn't completely risk-free but is usually considered to be low risk.

It is also worth considering how you would like labour to happen if you do have an induction and discuss that with your consultant. Some maternity units are happier for women to have things like birth balls while hooked up to a drip and monitors than others. My induction was for "dates" rather than anything else (I probably did have Gestational Diabetes but they hadn't been able to confirm diagnosis so didn't induce me until I got to 42 weeks by scan) but because I had supportive midwives in labour, and encouragement to have an active birth, it was a much better labour than my previous one (at a different hospital) where I hadn't felt supported or listened to.

Thank you for the insights 🙂 I thought I'd read about something like this but wasn't sure of the name. I'll definitely read up on it a bit more and the risks.

Today was the first appointment where the consultant actually started discussing birthing options - I felt a bit unprepared because he kept asking if we had any thoughts / questions and I genuinely don't really know as yet... I definitely need to do a lot more research about the possibilities. My antenatal classes start on Sunday so hoping that will spark some inspiration as well. I'm definitely more keen to keep things as natural as possible but also going to be very pragmatic that what I plan won't necessarily be possible so I have to understand all the alternatives as well.

 

[Inka]

I really recommend the Active Birth book I linked to above @RSz Also, some of the major pregnancy forums have a lot of chat about birth plans and that might give you some ideas that you can think about in order to assess how you feel about them and what you’d put in your plan.

I personally would avoid a sweep. It can be very painful, runs the risk of introducing infection, hasn’t been proven to work, and is rarely used elsewhere in Europe. There are other safer/nicer ways to encourage labour to start.

 

[PhoebeC]

Thank you for the insights 🙂 I thought I'd read about something like this but wasn't sure of the name. I'll definitely read up on it a bit more and the risks.

Today was the first appointment where the consultant actually started discussing birthing options - I felt a bit unprepared because he kept asking if we had any thoughts / questions and I genuinely don't really know as yet... I definitely need to do a lot more research about the possibilities. My antenatal classes start on Sunday so hoping that will spark some inspiration as well. I'm definitely more keen to keep things as natural as possible but also going to be very pragmatic that what I plan won't necessarily be possible so I have to understand all the alternatives as well.

I would suggest you do your research as my daughter was born at 34 weeks and it took us by surprise.
Also pack your hospital bag as much as you can, these things other people can do for you, but from personal experience I wouldn't leave it too my husband again. I had shampoo but no hairbrush and hadn't been out of bed for 5 days 😱