Learning all about labour – Helen German
A few months ago I thought making a birth plan and having any opinion about labour was a pointless affair; that diabetes would make these decisions for me.
But this is not true.
In the throes of a diabetes downer (and we’ve all been there) it’s very easy to let our life-long disease take over and to then feel powerless. When diabetes becomes the dictator, choice no longer has free-reign. It is so important to know that even in pregnancy, when blood sugar management is of the utmost importance with so many greater risks at hand, you are always in the driving seat.
I’ve attended several antenatal classes over the last few months, from ‘active birthing’ to ‘yoga in pregnancy’ to a ‘birthing information’ session at the hospital where I will have my baby. I’ve read labour and birthing books, watched videos, and heard from countless friends their experiences of childbirth. Every single one of these is linked by one common denominator and a two-word label: low risk.
And this is not a label used for type one diabetic women facing labour and due to give birth.
No, we are categorised as ‘high risk’. What this apparently seems to mean is that every book I’ve read, every video I’ve watched, every story I’ve been told, simply does not apply to my label.
In fact, in every class I attended, once I mentioned to the facilitator I’m Type one diabetic, then most of their information became suddenly irrelevant or not-applicable to ‘my case’. Even a ‘tour’ of the maternity ward in my hospital was actually redundant as I will be in the ‘high risk’ ward.
And it would appear that ‘low’ and ‘high’ – terms all too familiar for a diabetic – are like chalk and cheese. While I am yet to experience labour and birth (so can quite easily be told to ‘shut up’ and that I know nothing), I have read quite a bit about how physiologically women are designed for this challenge. How, over the whole natural history of the human race, women have dealt with labour and coped with childbirth. What has been most interesting to read is how childbirth has gone from a mammalian process to a medical one; and how our modern, sedentary lifestyles have ultimately affected birthing, from the tilt of the pelvis to the positioning of the baby.
From all I’ve read, an active birth and labour for me makes the most logical and natural sense. A labour that makes use of movement and gravity is an idea that has only just come back into the game after decades of women being advised to lie down and be bed-ridden. Recent research and studies now indicate that being on your back can make for a more difficult, long, and painful labour, for both mother and baby. I’ve also read about the importance of relaxation and creating a calming, stress-free birthing environment.
After reading all this history and then attending the active birthing classes, which I was invited to through the antenatal care system, my mind is focused on a labour and birth plan centred on mobility. I was then very worried when I was told by the class instructor and other voices within the healthcare profession that being ‘high risk’ means I would be restricted in terms of possible movement. I know I am likely to be induced, I know I can’t have a home birth, or a water birth… but suddenly I am now faced with an immobile birth? As the birthday approaches, the only thing that scares me most about labour is not being able to move with the pain. I manage my pain and discomfort by moving – usually a rhythmic rocking. My questions now seemed to be facing these type of answers:
My husband and I sat down and made a very long list of questions to ask my diabetes midwife and nurse (who are lovely by the way!) at the next antenatal clinic. And we were pleasantly surprised with what we found out. So here’s what I’ve learned about labour, in the lead-up-to-labour:
Antenatal Classes & Choices
The general reaction to being a type 1 diabetic, pregnant woman is that birth choices are limited. Most of the classes I’ve attended are all aimed at ‘low risk’ women, and I’ve certainly given feedback that it is perhaps just as important – if not more important – that relevant classes are offered to high risk women too. Especially when there’s potentially a lot more going on than with a ‘normal’ birth. I think the approach of most healthcare professionals running these information classes is to ‘shutdown’ when they hear diabetes (which I guess I’m grateful for considering my last experience with a sonographer who thought she was a diabetes expert!) But don’t be deterred. High risk doesn’t actually mean you don’t have choices.
When I asked my midwife about active labour, the answer was yes! Of course I can move about, let gravity help baby move down that birth canal.
When I asked about still being connected to my pump during labour, the answer was yes, providing my husband or I are able to monitor and manage my diabetes then I will not be hooked up to a sliding scale drip. I was worried that a nurse would then have to keep adjusting the drip to my needs, whereas it seemed more logical to me to keep the pump going for as long as possible, seeing as it is already in sync with my body.
Diabetes and labour
Another question I asked was about the relationship between diabetes and labour, whether diabetes affects the progression of labour. And the answer is more of the other way around: labour affects diabetes, in the same way that exercise or physical exertion can lower blood sugars or in the same way stress and pain can raise blood sugars. Which way it goes can only be found out during labour!
The obstetrician explained that it is pain that has the biggest impact on diabetes, and as we know only too well, there’s never any telling which way stress is going to mess up our system, but mess it up it will! This is why they recommend an epidural, because it is the ultimate pain relief, and if the pain is virtually non-existent then stress factors are reduced, and theoretically, diabetes will stay pretty level. For reasons of my own, however, I do not want an epidural.
But this made me think about the approach to ‘high risk’ diabetic labours. If stress and pain has such a big influence on diabetes, then surely all the methods used in low risk labours to help create a calming and positive birthing experience are just as crucial, if not more so, for a woman already faced with the prospect of a difficult birth?
I also asked about C-section as this came up very early in my pregnancy when labour and birth was first mentioned. Again, the usual ‘high risk’ label seemed to immediately imply I would have a caesarean section. This is not the case; an emergency C-Section will happen only if there are complications during labour (for example the position of the baby, whether it’s in distress, and if the baby’s heart rate lowers too much).
Eating and drinking
What with all the carb counting us diabetics do, the general advice about eating during labour I half-listened to and then decided to check with my diabetes nurse. Because labour is physically challenging, and can be a long process, then you need to keep your strength up. Little and often and slow-release carbs are the way forward: wholegrain crackers, rice cakes, apples, and so on. Hypo treatments are the same as what you would usually have, and continuous monitoring of blood sugars is the key.
I’ve been told the baby will be hypoglycaemic when born (in fact most babies are) but due to my diabetes s/he may struggle to stabilise their blood sugars during the first few hours. Breast milk is the best to help regulate the baby’s blood sugars however I’ve been warned by the infant feeding specialists in my local community and at the hospital, that there can sometimes be a bit of pushing and pressure from midwives or doctors to simply give the baby formula milk in order to quickly fix low blood sugars. But a ‘quick fix’ is never a good solution.
From what I’ve read this can set back the progress of breast feeding and recent studies have shown that formula (or cows’ milk) can greatly increase the risk of diabetes in babies, especially babies born to an already diabetic mother. Diabetic mothers are also advised to harvest colostrum (first stage of milk) before birth so that there is a supply readily available for your baby after birth, which to me is a much better quick-fix option should one be needed.
And so I am now only a couple of weeks away from being induced. I’ve written up my birthing plan, and made sure to be very specific when it comes to wishes normally swept aside by the ‘high risk’ label. Whilst diabetes and pregnancy is certainly no easy ride – it is hard and it is challenging – this still shouldn’t predetermine your labour and birth of your baby. Therefore, I have dethroned diabetes from making my decisions for me and instead considered the choices I do have.
And with diabetes, there are always choices.
Read other pregnancy blogs from Helen.
Find out more about pregnancy and diabetes on the Diabetes UK website.