Your birth experience may be different to the one that you had expected, and this can be hard to come to terms with. Finding out what might happen could help you feel mentally prepared for what may lie ahead.
It can help to remember that although the birth itself is important, it is just one step in the journey towards having your baby.
Where to give birth with type 1 or 2 diabetes
If you have diabetes, it is recommended that you give birth in a hospital with the support of a consultant-led maternity team. It is not unusual for babies of mothers with diabetes to be larger than normal, which could lead to birth difficulties such as shoulder dystocia (in which the baby’s shoulder gets stuck during the birth). This means that options such as home birth are unlikely to be recommended.
When to give birth with type 1 or 2 diabetes
You will be advised to give birth early if you have diabetes. This is to reduce the risk of stillbirth.
It is recommended by NICE that women with type 1 or type 2 diabetes and no other complications should give birth between 37 weeks and 38 weeks +6 days – either by being induced or having a planned caesarean. If you have any complications that pose a risk to you or the baby, you might be offered an even earlier delivery.
'I had always been aware that I would be on the ward for high-risk cases. I am so grateful to be pregnant, I’m not going to complain about stuff like that. If there is an issue, I would rather be ready for it.' Svenja, mum-to-be
How to give birth with type 1 or 2 diabetes
As the recommendation is to give birth by 38+6 weeks, you are likely to be offered an induction or a caesarean section. Diabetes is not in itself a reason that you cannot have vaginal birth. Unless there are other complications there is no reason this should not be possible. This applies even if you have had a previous caesarean (known as vaginal birth after caesarean or vbac). Surgery can present challenges for people with diabetes and the idea of a caesarean may be worrying, especially if this is your first pregnancy. However, your antenatal team will explain each of the options and the pros and cons of each option, and will explain the risks. Don’t hesitate to ask questions about this if you are worried.
If you are having an induction, the team may need to keep a monitor on your baby’s head to ensure that the birth is not causing any distress. This means that options such as water birth may not be possible. But the birth may take place naturally and you can receive the usual pain relief offered to any other woman having a vaginal delivery.
'I was upset when I found out that a water-birth would not be an option for me. So following the suggestion of a midwife, I had a warm bath before my waters broke, this turned out to be a beautifully natural way to relieve the pain and relax me before labour.' Hazel, mum of one
If you are exhausted during the birth, 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 gently cup the baby’s head like spoons) or a ventouse (suction cap) to gently help him out. Both these procedures are safe. They may leave short-term marks, such as bumps and bruising on your baby’s head, but these will disappear over time.
'I'd tried my best to avoid a c-section but I ended up having an emergency c-section – and it had nothing to do with the diabetes. I was sad, but mostly I was just glad that she was healthy.' Maria, mum of one
During the birth
The team will need to continuously monitor the baby’s heart rate during labour and to manage your glucose levels carefully. This means you may not be able to have a water birth. Discuss the options, and the associated risks, with your consultant and midwives to work out what is best for you and your baby.
If the baby is born early you may need to take steroids to help your baby's lungs to develop properly. If this happens to you and you are taking insulin, your insulin dose will increase because steroids can raise your blood glucose levels. You may be given this extra insulin through a drip, in addition to your normal insulin regime.
'With my first birth, I had 'given up' fairly quickly and decided to just lie back on the bed, because all the tubes and wires made me feel a bit restricted. The second time around, I decided to move around as much as possible. It really helped with the pain, and it felt much more natural.' Megan, mum of one
Make sure you and your team talk through the various options and that your preferences are on your birth plan. If you plan for someone to be with you at the birth – a partner, friend or family member – share the birth plan with them so that they can help you voice your preferences.
Controlling your glucose levels during the birth
It is important that your blood glucose is well controlled during the labour and birth. If your blood glucose levels are raised, this can cause distress to your baby and may cause high blood glucose levels in your unborn baby. This will make him produce extra insulin, which can lead to your baby becoming hypoglycaemic after the birth.
For this reason, your blood glucose needs to be closely monitored every hour during labour to ensure it stays at the ideal levels for you (usually between 4 and 7 mmol/litre) – and every half hour if you have a general anaesthetic until you are fully conscious.
If you have type 1 diabetes, or if you have type 2 diabetes and your blood glucose is not staying within the ideal levels during labour and birth, you may be given insulin and dextrose through a drip. Most women using pump therapy can continue on their pump for delivery, either vaginally or by caesarean. The team pre-programmes the pump to reduce the dose when the baby is delivered.
'I was told that I’d be taken off the pump when I was ready for the healthcare team to take over. But stayed in control of it until about an hour before I gave birth, and I went back on it an hour or two after the birth.' Zoe, mum of one
Using diet and exercise helps keep your blood glucose levels within safe limits.
You may need support with your emotional well-being as you go through a pregnancy with type 1 or 2 diabetes
Whatever treatment you were using to control your diabetes before you became pregnant may change. If you were using tablets, you may have to start using insulin.
If you have type 1 or 2 diabetes, managing your blood glucose levels can now be much harder in pregnancy. Testing is an important part of self-care.
If you are treated with insulin in pregnancy, by the third trimester your insulin requirements are likely to be much higher than they were before.
If you have type 1/2 diabetes in the first trimester you will be referred to the joint diabetes and antenatal clinic.
By the second trimester, as your baby grows and starts to kick, you may need more insulin. Your medication and insulin needs will be regularly reviewed with you.
If you have type 1 or 2 diabetes in pregnancy you will get extra care.
Women with type 1 or 2 diabetes are at higher risk of some complications but the majority have normal pregnancies and healthy babies. There is much you can do to reduce the risks, for you and baby.
If you have type 1 or 2 diabetes, you should to talk to your healthcare team if you are thinking about having a baby. There are some things you can do now to make your upcoming pregnancy safer.
- NICE (2015) Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period, NICE guideline, National Institute for Health and Care Excellence
- Plodkowski RA, Edelman SV (2001) Pre-surgical evaluation of diabetic patients.Clinical Diabetes April 2001 vol. 19 no. 2 92-95
- RCOG (2012) Information for you. An assisted vaginal birth (ventouse or forceps), Royal College of Obstetricians and Gynaecologists,
- NHS Choices. Gestational diabetes treatmenthttp://www.nhs.uk/Conditions/gestational-diabetes/Pages/Treatment.aspx
- NCC-WCH (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.
ℹLast reviewed on September 1st, 2015. Next review date September 1st, 2017.