A labour of love – by Helen German
After thirty-eight weeks of growing in what could easily have been a compromised environment, (salvaged only by managing my diabetes carefully) my healthy baby girl was born. Weighing 8lb 6oz, with ten tiny fingers and toes, and a headful of dark hair, I fell in love at first sight – and yes, I still had a little energy left to do that!
There had been a long, exhausting labour leading up to that first cry and cuddle, some of which is a bit hazy but most I remember and will share my experience here. Don’t worry, however, this is not a horror story. It’s not one of those gruesome tales that some women feel compelled to share in all its glory to new expectant mothers. Having now experienced childbirth, for me I don’t think it’s that bad. Yes I’m serious! If it was then it would be called ‘torture’ rather than the highly appropriate name of ‘labour’, for that is exactly what it is: exhaustingly hard, hard work. And this is coming from me, someone who loves a physical endurance challenge!
For those reading this blog for more insight into diabetes and pregnancy, and in this case, labour, please remember this is my experience. Every woman and their diabetes is different. If like me when I was pregnant, you are reading as much as possible to combat the fear of the unknown, then this is just one version of an event that can go any which way. I think the best approach to labour is to go with the flow, try not to have too many expectations; it is what it is; what will be, will be.
So. Because of my diabetes I was induced at thirty-eight weeks. The baby wasn’t big and I had no other complications, but due to the increased risk of stillbirth for diabetic mothers post-thirty-eight weeks, induction is the usual outcome. And quite frankly by thirty-eight weeks, I was ready to get the baby out! I do not envy women who reach forty weeks and are still waiting. In this respect I am actually grateful for diabetes; at least I knew the week when our baby would be arriving.
I went into hospital on a Monday at 9am to be induced. Alongside the usual hospital bag, I had a ‘diabetes’ bag too. This included enough test strips, spare batteries for my pump, and charger for my glucose meter; Lucozades for hypo treatment, snacks, pump infusion sets, cannulas, lancets, and insulin pump cartridges, labelled in a clear plastic bag to be kept in the hospital ward’s fridge.
Secretly in my head I was hoping to be done and home by Wednesday, mainly because my husband would only have used three days of paternity leave waiting for our baby to arrive. Sadly this wasn’t the case.
I was induced with a prostaglandin tablet, this is placed just behind the cervix and should start to soften and dilate the cervix. The first tablet however didn’t work. Six hours later, they tried a second prostaglandin. I spent Monday night in some discomfort with what felt like bad period pain. By 7am, it had eased off. I saw the consultant late Tuesday morning who gave me my options. We could try a third lot of prostaglandin to soften my cervix or he could book me in for a caesarean section later that day. I opted for the first option. So in went a third tablet.
During this time, I managed my diabetes. I tested regularly and carb counted my meals. I ate and drank as normal while waiting for the prostaglandin to work. I also moved about freely. My husband and I walked around the hospital corridors in the hope gravity will help. No such luck.
So the fourth and final tablet went in early hours Wednesday morning. By 11am the obstetrician gave me a sweep but unfortunately my cervix was only dilated by a centimetre. The sweep was excruciating. In fact, I’d go as far as to say it was the worst part of the whole experience. A side effect of prostaglandin is it makes the vagina and cervix extremely sore and tender, to the point that any examination in that area causes a searing burning pain. I begged the obstetrician to stop and was reduced to a sobbing wreck. My first thought was if I can’t handle a sweep, how on earth was I going to cope with a baby coming out! However, as bad as it was, the sweep got things moving and I spent the rest of the afternoon high on gas and air, bouncing on an exercise ball while my husband wrote down the frequency of my contractions and tested my blood sugars.
Due to the anxiety and adrenalin and pain, I found my blood sugars generally ran low. I reduced my basal insulin to 70% to try to avoid hypos, and I just informed the nurses what my blood sugars were. Come Wednesday afternoon I no longer was capable of thinking about my diabetes let alone managing it, so my husband did it for me.
By 7pm, a delivery room was available. Moving there was a daunting and scary moment. I realised this was the room where we would finally meet our son or daughter! They broke my waters at 8pm, which was the strangest sensation ever. A slight pop and then a gush, like weeing everywhere but without any control! They then gave me two hours, to see if my body would progress naturally, and to allow me to move. I had my last meal, as two hours later, my body still hadn’t done anything on its own.
So it was time to come off my pump and on to a sliding scale of insulin and glucose through a drip on one hand. In the other, they started me on the hormone syntocinon to force contractions and get labour moving. Normally, they recommend an epidural with the syntocinon as the sudden onset of contractions can be painful and the body does not have time to manage it naturally. I opted out of an epidural, and kept on the gas and air. I was now bed-ridden, unable to move due to the drips I had in each hand.
Four hours later I had been managing the increasing pain. I was singing on gas and air! My husband continued to test my blood sugars and the midwives adjusted the insulin accordingly. Overall my sugars had climbed to ten and pretty much stayed there for the duration of my labour. They increased the amount of syntocinon every thirty minutes, and by 3am the pain was becoming more difficult to breathe through with gas and air. I was examined and unfortunately had only dilated another couple of centimetres. So I begged for the diamorphine!
The next five hours are very hazy in my memory. I remember continually feeling the need to poo, which I did on more than one occasion, and they needed to empty my bladder via a catheter three times. The joys of eating and drinking up to the point of my waters breaking I suppose! My memory becomes clearer from about 8am where the need to push was very strong. The diamorphine had relaxed my body; an induced state of rest I suppose but not enough to replace the three days and nights I’d already spent in the hospital. Pushing was therefore hard going. I was so exhausted and had to dig deep to find the energy to push.
People have asked me about this moment, especially the pain, and to be honest, I don’t recall pain as such, it’s more pressure. I liken it to constipation pressure, but obviously on the hardest scale imaginable as I was pushing for a good three hours according to my notes. I only remember the last hour and a quarter. Then with a sudden burning and stretching sensation at the end of a contraction and big push, a wave of relief came over me.
Our daughter was finally born at 9:12am on the Thursday, four days after I arrived at the hospital. I was exhausted and could just about hold her as they put her on my chest, where she weed on me! Hello mummy!
I did have a small, superficial tear so once the placenta was delivered, I was stitched up while my husband had a skin-to-skin cuddle with our daughter. They removed the insulin and glucose drip and I was back on my pump after I’d showered. I also remember eating a sandwich which I didn’t bolus for, but my blood sugars were fine. What amazes me is once the placenta is delivered, the body reverts immediately back to the insulin profile it was on before pregnancy. Luckily I had this already saved on my pump so I simply activated this profile. We had to stay in for 24 hours to be observed, but we could finally go home Friday evening.
So after thirty-eight weeks of pregnancy, five days in the hospital, but eleven hours of established labour, I sat staring at my beautiful baby girl, amazed at what we made. All the fears and worries of enduring pregnancy with diabetes were immediately forgotten. I did it; it wasn’t easy; but there she was, a perfect little human being. I’ve faced many challenges and had many achievements with diabetes, having Eloise is by far the proudest moment of my life. With her, our life has definitely got sweeter.