The latest guidance from NICE, published in 2015, has extended the time by which women with gestational diabetes should give birth to 40 weeks, 6 days – not much less than the general guidance for all pregnant women, which is 42 weeks. If you have not gone to birth at this point, induction of labour will be recommended.
"When I was in the hospital, I felt I didn’t know what was going on. I would have liked more information about that part so I could have been better prepared." Gemma, mum of one
The main reason for induction is to prevent stillbirth. For all women, the risk increases when their pregnancy goes past 42 weeks. However, one study has shown that women with gestational diabetes may be at risk earlier. So for this reason, the guidance in England and Wales states that if you have gestational diabetes, you should not go beyond 40 weeks, 6 days.
An induction or caesarean may also be advised if your baby is very large (macrosomia) – as this may cause difficulties during the birth. On the other hand induction may also be recommended if the team detects poor growth in your baby.
In Scotland, most women with diabetes in pregnancy are induced within 40 weeks. The guidance says that this decision should be determined on an individual basis. If you are taking diabetes medication or insulin, it recommends that you should be assessed at 38 weeks and delivered by 40 weeks.
Choices you might need to make for labour and birth
Most women with gestational diabetes have a healthy birth. But before you make your birth plan, you may need to take some things into account to make sure you and your baby are safe during and after the birth.
If you have gestational diabetes, you will have less choice about where to deliver your baby. This is because you will need to deliver your baby in a hospital that can offer 24-hour advanced resuscitation skills.
If your ultrasound scans show that your baby is large (macrosomia), your antenatal team will discuss the pros and cons of a vaginal birth, induced labour and a caesarean section. Any medical intervention comes with risks of its own, so take your time to talk through any questions and come to the decision that feels right for you.
If you go into labour prematurely (before 37 weeks) you may be given medication to delay the birth - depending on how early you go into labour. You may also be given steroids to help your baby’s lungs develop properly. Steroids can raise your blood glucose levels, so if you are taking insulin, you may need to increase the dose or receive insulin in a drip.
Monitoring during labour
Your blood glucose needs to be monitored every hour during labour to ensure it stays within safe levels. If the levels are high, there is a chance that you may need to receive insulin and glucose through a drip during your labour and birth, which will make it harder for you to move around during labour.
This is more likely to happen if you are already giving yourself insulin injections. If you managed your blood glucose levels through diet alone, you may need very little additional monitoring during labour.
If you are exhausted, if your baby is distressed, or if he is not moving out of the birth canal, you may need an assisted birth. This means either forceps (which cup the baby’s head like spoons) or a ventouse (suction cap) to gently help him out. A ventouse can be used only at 34 weeks or more, once the baby’s head is sufficiently developed for it.
Both of these procedures are commonly carried out when there is an indication they are needed. Your obstetrician will go through the reason why they are recommending an instrumental delivery and any potential risks that are associated.
They may leave short-term marks, such as bumps and bruising on your baby’s head, but these will disappear over time.
What does all this mean for you?
You may have a straightforward birth or it may be more complicated than you hoped. If your birth experience is very different to the one that you had hoped for, it can be difficult to come to terms with this. It is important to remember that labour and birth often does not go to plan, whether it is complicated by diabetes or not. For many women, knowing more about induction and caesarean births (read more below) helps them feel mentally prepared for what lies ahead.
"I'd seen a lot of my friends have children, so I had an idea that labour can change dramatically in minutes. I knew that the ideal wasn't always possible. I think that helped a bit." Michelle, mum of two
If you do feel very emotional about any aspect your birth – even some time after the event – it can help to share your feelings with others. Talk to friends or family about it, speak to your midwife, health visitor or GP, or call one of the midwives at Tommy’s PregnancyLine on 0800 0147 800. It can help to remember that, while everyone would like to have the birth they had planned, the birth is just one step in the journey towards having your baby.
Induction involves starting labour artificially. To induce the birth, your healthcare team will put a pessary or gel into your vagina, a drip in your arm, or both. It can take 24 hours or more for the labour to start. Once it starts, the contractions are different from the contractions in a natural birth. They are often very close together and more intense, and you are likely to find it more painful. You might want to take this into account when considering your options for pain relief.
The team will need to monitor your baby’s heartbeat during the pregnancy. This is usually done with sensors on a wide elastic belt tied around your bump. Sometimes the sensor is placed on the baby’s head through your vagina instead. This can only be done if the waters have broken.
If the first induction does not bring on labour then, depending on how you and your baby are coping, you may be offered another induction, or you may be recommended to have a caesarean section. The team will discuss all the options with you.
"The midwife who I had in labour had herself been induced with a drip. It was nice to have a midwife who had been through the same, because she could understand what it felt like." Gemma, mum of one
If you have a vaginal birth, you can receive the usual pain relief but your blood glucose levels will need to be monitored every hour.
A caesarean – also known as a C section – is an operation in which your baby is lifted out through a small incision in your abdomen.
Your caesarean may be booked in advance, but if it is unexpected – for example, if induction does not work for you – then you may have an unplanned, or ‘emergency’ caesarean. This may sound alarming, but is just the term for caesarean carried out without notice, and does not necessarily mean that you or your baby are in danger.
For most women with gestational diabetes, blood glucose levels return to normal immediately after the birth.
Gestational diabetes does not have any effect on your ability to breastfeed your baby.
If you have had gestational diabetes in pregnancy you will be at higher risk of having it again in a next pregnancy and of getting type 2 diabetes in later life.
Most women are daunted initially by the unfamiliar territory they find themselves in with gestational diabetes. Find some tips here on how to cope mentally.
Women who are overweight are at higher risk of developing gestational diabetes, although many women who develop it are not overweight at all.
Exercise during pregnancy has a wide range of benefits for you and your baby. If you have gestational diabetes, you have even more reason to exercise: it can help reduce your blood glucose.
If you have gestational diabetes, your diet will become an important part of managing your condition and keeping your pregnancy safe.
Gestational diabetes is treated by making changes to diet and exercise to manage blood sugar levels, and using medication if necessary.
If you have gestational diabetes, measuring your own blood glucose levels will become something you do regularly.
Some women can control their glucose levels through diet and exercise alone but the majority will need to take tablets or injections to help control it.
- NICE (2015) Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period, National Institute of Health and Care Excellence https://www.nice.org.uk/guidance/ng3
- NCCWCH (2015) Diabetes in pregnancy Management of diabetes and its complications from preconception to the postnatal period NICE guideline 3 Methods, evidence and recommendations. National Collaborating Centre for Women's and Children's Health http://www.nice.org.uk/guidance/ng3/evidence/full-guideline-3784285
- SIGN (2010) Management of diabetes, a clinical guideline, Scottish Intercollegiate Guidelines Network http://www.sign.ac.uk/pdf/sign116.pdf
- NHS Choices [accessd April 2015] Inducing labour http://www.nhs.uk/conditions/pregnancy-and-baby/pages/induction-labour.aspx#close Review date: 12/02/2010
- NHS Choices [accessd April 2015] Gestational diabetes - treatmenthttp://www.nhs.uk/Conditions/gestational-diabetes/Pages/Treatment.aspx Review date: 07/08/2016
- NHS Choices [accessd April 2015] Caesarean section - introduction http://www.nhs.uk/conditions/caesarean-section/Pages/Introduction.aspx Review date: 17/07/2016
- Macdonald S and Magill-Cuerden J (2012) Mayes’ Midwifery, Fourteenth Edition, Edinburgh: Bailliere Tindall Elsevier
- RCOG (2010) Antenatal Corticosteroids to Reduce Neonatal Morbidity (Green-top Guideline No 7) Royal College of Obstetricians and Gynaecologists
By Sylverline (not verified) on 1 Jan 2018 - 14:44
I was told I. Have gestational debatics at week 28. Been on medication since then
I am in week 42. The baby head is not engaged and the medical team to coombe women hospital Ireland seems not to be interested in doing a year thing for me or the baby. Please anyone out there with any suggestion. Am becoming desperate
Been in the hospital since yesterday but have not been seen by any Doctor
By Midwife @Tommys on 4 Jan 2018 - 13:30
Hi, Thank you for your comment.
Not sure if you are still in hospital or you are being induced, but we would advice that you ask to speak to the Ward Manager or Head of Midwifery at the hospital. They will be able to give you a clearer picture of what is the delay in you being seen by a doctor if the ward staff cannot give you any information. You can also contact the hospital PALS ( Patient Advice Liaison Service) if you have any issues in the care you have been receiving. Hope this helps. Tommy's Midwives x
By Anonymous (not verified) on 8 Dec 2017 - 15:54
i am 40 years old. my first pregnancy. now at 36 weeks. through ultrasound the baby weight is 1.8 kg. i was diagnosed to have diabetes 6 month before I got pregnant. I'm taking insulin.
Now , doctor is to have early delivery, before 38 wks. baby's lung is mature. My BP is ok. no hypertension.
Is it save to have normal delivery?
By Midwife @Tommys on 13 Dec 2017 - 12:36
Hi, Thank you for your comment.
From what you have described, your Doctor may want to induce you because baby is a bit on the small side for your gestation? would this be right? It is reassuring that you have no other medical conditions and your BP is ok. As we cannot look at your scan reports or your medical notes, it is difficult to comment on your individual situation but feel reassured that the doctors would not recommend induction if it wasn't safe for your baby. Sometimes when babies are not growing as well as they should, it is better to deliver them early and then feed and grow them on the outside in a controlled environment so that we can keep a close eye on them, monitor their blood sugars and making sure they are gaining the correct amount of weight before you are discharged home. If you have any concerns about your plan of care then we would suggest that you speak to your Consultant or midwife who will be able to discuss this with you in more detail. Hope the helps, take care, Tommy's Midwives x
By Anonymous (not verified) on 8 Dec 2017 - 15:18
Hi i m having gestational diabetes and its 35 week of my pregnancy and my due date is 14 jan.today when i visited my doctor he said v have to go for induce labour in 38th week or so ..my baby movements are normal and sugar level is between 100 to 160. Can i not wait till natural labour pain starts
By Midwife @Tommys on 13 Dec 2017 - 12:15
Hi, Thank you for your comment.
The protocol for mothers with gestational diabetes would be to induce at 38 weeks depending on what your obstetric team recommend. This is because babies of diabetic mothers may be larger and there may be an increase risk of the shoulders getting stuck, this is called shoulder dystocia. This cannot be predicted because even the smallest of babies can become stuck so inducing early may reduce the risk of this happening. If you are concerned about the plan of care then you need to speak with your Consultant or midwife. An induction can only happen when you fully consent and you can only do this if you have all the information and you are sure that you are making the right choice for you and your baby. Hope this helps, please feel free to contact the Tommy's midwives on [email protected] or call us on 0800 0147 800 9am-5pm Monday to Friday. Take Care, Tommy's Midwives x
By Anonymous (not verified) on 8 Dec 2017 - 06:56
Iam 18weeks pregnant and when i went for check up they told me my sugar level was high tried to check it was 8
After a week i tried to check before eating it was 6 and checked the following day before meals it was 5.3
What could be the cause
By Midwife @Tommys on 13 Dec 2017 - 11:16
Hi, Thank you for your comment.
Your blood sugar can go up for a number of reason, if could be related to eating sugary foods but if you have not eaten anything sugary then it may be an indication that you are developing gestational Diabetes. It sounds like the other days that you checked your blood sugars were not as high. If you are concerned then we would suggest that you contact your Midwife, they may want to do a GTT ( Glucose Tolerance Test ) this is a blood test that checks what your sugars are before and after eating then they will determine if you have Gestational diabetes and your will be referred to the Diabetic team. Please try not to be alarmed, the blood sugar of 8 could of just been a one off but it is better for you to be checked and if you need further treatment then this can be provided. Hope this helps, Take Care, Tommy's Midwives x
By Anonymous (not verified) on 6 Dec 2017 - 18:02
I’m in week 36th of pregnancy. I just found out that I had the gestational diabetes and I’m taking insulin right now. However, I only concern about my baby. Is there any chance to deliver a healthy baby without any serious disease in the future after my child’s born?
Meanwhile, my blood pressure is always good and my baby’s heart rate is always good everytime I see the doctor. Moreover, the baby has been moving or kicking a lot. Hence, is it a good sign that he is doing good even I had diabetes ?
By Midwife @Tommys on 7 Dec 2017 - 11:39
Hi Luccy, Thank you for your comment.
Having Gestational Diabetes does not mean that your child will be diabetic or even develop it in the future. As long as you maintain stable blood sugars and take your insulin correctly, together with a good balanced diet then this is the best way to maintain a healthy pregnancy even with gestational diabetes. Hopefully you are under the diabetic team at the hospital and you are having plenty of follow ups to see how you are getting on.
Having a normal blood pressure and good movements from baby is very reassuring that everything is going well at this stage of your pregnancy. If you do have any concerns about your baby's movements or anything else regarding your pregnancy then please contact your midwife or maternity unit for further advice. Hope this helps, Take Care, Tommy's Midwives x
By Shahid (not verified) on 6 Dec 2017 - 13:00
If a female has daibetes already
Can she give birth to a normal and healthy child
By Midwife @Tommys on 6 Dec 2017 - 13:14
Yes, she can
A pregnant woman with diabetes will be under both midwifery and obstetric care at her hospital so that she has dual care. She will also be seen by the diabetic specialist midwife to best control the diabetes during pregnancy.
Please feel free to contact us by phone or email if you have any further concerns that you wish to discuss privately
Sophie, Tommy's Midwife