Gestational diabetes and giving birth

The emphasis is on trying to keep the birth as normal as possible unless there is a particular reason to do things differently.

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 be advised to give birth in hospital. This is so your midwives and doctors can monitor your blood glucose levels carefully during labour, and offer 24-hour advanced resuscitation skills in case your baby needs help after birth.

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

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.

Read more about induction of labour here

Caesarean section

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.

Read more about what happens during a c-section.

Read about what happens after a birth with gestational diabetes

Read about treatment for gestational diabetes in pregnancy

Sources

  1. 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
  2.  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
  3.  SIGN (2010) Management of diabetes, a clinical guideline, Scottish Intercollegiate Guidelines Network http://www.sign.ac.uk/pdf/sign116.pdf
  4. 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
  5.  NHS Choices [accessd April 2015] Gestational diabetes - treatmenthttp://www.nhs.uk/Conditions/gestational-diabetes/Pages/Treatment.aspx Review date: 07/08/2016
  6. NHS Choices [accessd April 2015] Caesarean section - introduction http://www.nhs.uk/conditions/caesarean-section/Pages/Introduction.aspx Review date: 17/07/2016
  7. Macdonald S and Magill-Cuerden J (2012) Mayes’ Midwifery, Fourteenth Edition, Edinburgh: Bailliere Tindall Elsevier
  8. RCOG (2010) Antenatal Corticosteroids to Reduce Neonatal Morbidity (Green-top Guideline No 7) Royal College of Obstetricians and Gynaecologists
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Comments

  • By Mercedes (not verified) on 19 Oct 2018 - 14:05

    I feel so bad because I have a phobea of needles and I haven been able to test my blood I was wondering if I eat right do you think my baby will be alright I’m 5 months pregnant now i had an ultra sound 3 times and my bday is fine so far my baby it fully formed and has a strong heart beat can I just eat right ?

  • By Midwife @Tommys on 22 Oct 2018 - 09:41

    Of course eating the right foods is really important and it's good that you are focusing on that and doing your best. Are you saying that you haven't had any blood tests during this pregnancy? In the UK we have the advantage of many blood tests which help to ensure that pregnant women have the best chance of a normal and healthy pregnancy. I would strongly advise that you have the recommended blood tests as these will protect you, your baby and the medical team who will care for you in labour. Speak to your midwife or call us here at Tommy's if you need to discuss it further. 0800 0147 800

  • By Abby (not verified) on 1 Oct 2018 - 01:44

    Am 33 weeks and I have just been diagnosed with gestational diabetes I did the two hour test and the first hour it was at 7.9 and the second hour was 9.9.. I am a little confused. My doctor was trying to control it through diet but it wasn't really going down so he suggested taking the metformin and still remain with the diet but it's still not controlled this moment it's up and another its down . This is my first pregnancy I don't know what to do I don't know if this is affecting the baby because it keeps on fluctuating...

  • By Midwife @Tommys on 1 Oct 2018 - 15:08

    It can be very difficult controlling your sugar levels once you have been diagnosed. Have you been really strict with your diet? We have some good advice about how to restrict your carbohydrates here: https://www.tommys.org/pregnancy-information/pregnancy-complications/gestational-diabetes/treatment-gestational-diabetes/understanding-glycaemic-index
    Write down everything that you eat and drink and your midwife or diabetes specialist will be able to support you. Your consultant will see you regularly and will induce labour if needed. Best wishes

  • By Wendy Davis (not verified) on 7 Aug 2018 - 10:10

    My daughter has been diagnosed with GD but has only ever had high levels in the morning She is on a strict diet and takes insulin at night ... although the insulin does not seem to have had any effect on the sugar levels. On Monday she was told that although everything seems normal and there are no indications of any problems they want to induce at 37 weeks. She is very upset. They mentioned higher risk of stillbirth but I cannot find any stats to say HOW high ( 1 in a million? 1 in a hundred?? ) She would like to have a "normal" delivery if possible but feels unable to challenge the experts. The guidance on your website states "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." That's quite a difference!! They are talking about inducing on 23rd August which is VERY SOON. Any way she could get an urgent second opinion??? thanks

  • By Midwife @Tommys on 8 Aug 2018 - 16:34

    Hi Wendy
    Yes, she can request a second opinion from any doctor/midwife at her trust. She can tell them her preferences. They cannot force her to be induced. She has to give her consent for this. If she is given all of the information- about the risks and benefits - then she can make a decision that she is both comfortable and happy with. Whatever choice that is. It is her body and her baby.
    All the best and do let us know if you need any further advice or support.
    Tommy's Midwife

  • By Victoria (not verified) on 17 Jul 2018 - 20:05

    Hi,

    I'm a Brit living in the Netherlands so the system is slightly different here but largely the same.
    After doing the glucose drink test, my results had one result (of three) that was 1/10th too high. Because of this it was determined I should test my blood sugar 4 x a day for 3 weeks to see whether I would need to go under the care of the hospital rather than my midwife, and possibly be treated with insulin and thereafter be induced at 38 weeks.
    So treatment and outcome depend on my results after these three weeks.
    I have been doing the tests for 6 days, and have had four high results out of 21 tests. When I look at my food diary mean I can see why I got the high result.
    My questions; how much do I need to worry about those high results? Is that amount of high results normal, or a lot? Are those results abnormal for a person without GD? Are these high results already an indication that I will have to go onto insulin? Are they an indication that I do indeed have GD?
    I desperately do not want to be induced early. Of course I will do what's best for my baby in the end, but I really don't want to be induced early.

  • By Midwife @Tommys on 18 Jul 2018 - 14:30

    Hi Victoria
    Thanks for getting in touch. My answer is not as helpful as i'd like it to be for you - my apologies.
    The person best placed to answer your questions is your obstetric doctor and the specialist diabetic midwife. They train especially to be able to answer in depth questions like yours and to be able to guide the type of treatment that needs to be undertaken.
    If you have an accurate food diary and good test results, then they may determine that GD seems unlikely with so few "high" readings.
    You have a lot of say in the type of care that you receive - you could ask to be referred to a dietitian for instance to see if they can amend your dietary intake to help regulate your blood glucose and in turn, keep you off the GD medication.


    Here is our hub on info on GD which may be of use to you.
    https://www.tommys.org/pregnancy-information/pregnancy-complications/gestational-diabetes
    Here are some other links you may find useful
    Sophie, Tommy's Midwife
    https://www.rcm.org.uk/tags/gestational-diabetes- rcm pages on G.D
    https://www.nhs.uk/conditions/gestational-diabetes/
    https://midwifethinking.com/2018/03/20/gestational-diabetes-beyond-the-label/

  • By Saj (not verified) on 4 Jun 2018 - 15:03

    Hi
    I am 36 weeks 3 days had two previous c section one is emergency n second one is scheduled at 36+1 day n my boy had breathing problem n he was In nice about a week n than after 11 days he came home. This time my dr has scheduled my c section at 37+6 days my question is my baby's weight is normal about 3 kg at 36 week scan he is moving well ,dr said woman with Gdm should go for c section 37 week they have scheduled my steroids shots at 37+1.can I go for c section at 37+6 or cancel it?? Worrying about baby's lung n breathing..reply plz..

  • By Midwife @Tommys on 6 Jun 2018 - 14:27

    Hi Saj
    Fetal lungs are fully matured from 36+6 weeks onward. Babies are considered full term from 37 weeks onward. It is possible that your baby had breathing problems at 36+1 weeks due to the lungs not being quite ready, but it is possible that there may have been some infection present too (you could ask to see your notes from his birth to reflect on what happened) but planning your next c/s for after 37 weeks is sensible. If you wish to call and talk this through on our pregnancyline in more detail, please do. Wishing you all the best , Sophie, Tommy's Midwife

  • By Dhanashri Deshmukh (not verified) on 26 Mar 2018 - 12:50

    I am 38 week pregnant and 29 years old. According to last scan at 35 week baby's weight was around 2349gms,HR is 140 bts/min.Placenta is grade 3 mature.
    What are the chances of normal delivery / c-section?
    Is it recommended to reach till 40 week? And is there any risk in my case? Thanks in advance.

  • By Midwife @Tommys on 26 Mar 2018 - 15:47

    Hi Dhanashri, Many women with gestational diabetes go on to have a normal delivery. Your healthcare team should discuss with you the best time for delivery. In many cases this is between 38 and 40 weeks. Most important thing for you to do is to control your blood sugars. Have you arranged another appointment for this week?

  • By Vikki (not verified) on 18 Feb 2018 - 13:37

    "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."

    This is completely not true and is scaremongering. Women always have the right to choose where they give birth, and in some cases gestational diabetes causes no higher risk than a 'normal' pregnancy.

    So disappointed in this - women have enough stress to deal with when pregnant without incorrect information on what should be reputable websites.

  • By abanting_2922 on 19 Feb 2018 - 17:09

    Hello Vikki,

    I'm very sorry that you were disappointed by the wording of this article. The passage you have referred to comes from the NICE guidelines (https://www.nice.org.uk/guidance/ng3/chapter/1-Recommendations#neonatal-care), and NHS (https://www.nhs.uk/conditions/gestational-diabetes/treatment/#giving-birth), and is therefore in-line with current advice and best practice for women with gestational diabeties.

    While the information was not wrong, I agree that the precise wording wasn't clear enough and more context was needed to help inform, not frighten. I have therefore tweaked this and hope that it more clearly explains why women with GD are advised to give birth in hospital.

    We would never intentionally scaremonger, and check all articles we publish with professionals and at least 6 women with lived experience to make sure the tone and content is right. We take all feedback very seriously. If you would be interested in reviewing our information in future, we would really welcome your input as it has been very helpful here.

    Please let me know if you would like any more information about the way we produce content, or if you have any further feedback.

    Best wishes,
    Amy

  • 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 ?
    Thank you,
    Luccy N

  • 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

    Hi Shahid.
    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

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