Many women with diabetes have to take three or four times the normal dose of insulin at this point in the pregnancy.
In fact, if your insulin needs start to drop at this stage rather than increasing, you should contact your diabetes team as this may show that your placenta is not working well.
From 28 weeks you will have regular ultrasound scans to monitor your baby’s growth and the amount of amniotic fluid around your baby, checking for polyhydramnios (too much amniotic fluid). If your previous eye checks were clear, you will be given another test. If they were not, you will already be receiving treatment.
From about 36 weeks you can start manually expressing colostrum (the nutrient-rich fluid that comes from your breasts before your milk comes in. When your baby is born, if he isn’t able to breastfeed, or if he needs some extra milk because his blood glucose level is low, the team can then give him your colostrum rather than formula. Some healthcare teams may not actively promote this approach but may be happy to help you if you ask. If you would like to know more, ask your team how to do it, and how to store it.
'Expressing and storing colostrum in the weeks leading up to birth helped me feel empowered and proactive. My stored colostrum was invaluable when baby was mildly hypo for 24 hrs after birth.' Zoe, mum of one
Planning your labour and birth
By 36 weeks your team should be working with you to plan your delivery. This may have begun far sooner as some women with diabetes will have delivered their babies by 37 weeks. You can expect to talk about:
- what type of birth will be best for you – vaginal or caesarean
- options for pain relief
- ways to control your blood glucose levels during the birth
- the care your baby might need after the birth
- breastfeeding with type 1 or 2 diabetes
- contraception and follow-up care.
If you feel unclear about any of these, don’t be afraid to ask your healthcare team.
The latest (NICE) guidance says that women with type 1 or type 2 diabetes and no other complications should be advised to give birth early (between 37 weeks and 38 weeks + 6 days) either by being induced or having a planned caesarean.
If you or your baby have other complications, the team may recommend that you have your baby before 37 weeks, through induction or casearean.
Vaginal birth does not need to be excluded because of diabetes even if you’ve had a caesarean in a previous pregnancy, unless you have complications.
Your baby's movements
If you have diabetes, there is a higher risk of your baby being stillborn. Although this is extremely rare – and the risk is further reduced with good blood glucose control – get in touch with your healthcare team straight away if you notice your baby is moving or kicking a lot more or less than usual
You will probably first notice your baby’s movements at from 16-24 weeks. There is no ‘normal’ pattern, it is different for each baby.
From 16-24 weeks on you should feel the baby move more and more up until 32 weeks then stay roughly the same until you give birth.
- It is not true that babies move less towards the end of pregnancy.
- You should continue to feel your baby move right up to the time you go into labour and whilst you are in labour too.
If you become aware that your baby’s movements have reduced or changed, contact your healthcare team immediately. Do not wait until next day or the next appointment. You will have a check-up to make sure your baby is OK.
Usually these checks show that there is nothing wrong, but it is very important you are checked just to make sure.