Having kids is a milestone in life for anyone who has them, and for me as a mum with Type 1 Diabetes, the times I was pregnant and looking after a newborn stand apart in my diabetes life. There were so many new challenges and things to worry about. It wasn’t just about me anymore and the distant concern of long term complications. It was about making sure my body was a safe environment for a baby to grow in, and the stakes had never been higher.
I had two very different experiences with my babies. Diabetes barely registered as a factor in my pregnancy with my daughter (who is now 8), but it hung around as a cloud over my pregnancy with my son (now 6). This is a brief run down of what happened the first time round.
Pregnancy #1 – smooth sailing
I was well aware that I needed to have stable blood sugars and an acceptable HbA1c before trying to get pregnant and my T1D was well controlled in those early years. I had been on multiple daily injections up to that point but my endocrinologist strongly encouraged me to switch to an insulin pump when she knew I was planning a pregnancy. I got my pump the week I found out I was pregnant.
Care in pregnancy
I was living in Sydney when I had my kids, and I had private health insurance, so as well as my endocrinologist I had a private obstetrician who had been recommended to me by my GP and whose office was across the street from my office in the Sydney CBD (Central Business District). The benefit of this was that I had continuity of care and my endocrinologist and obstetrician kept in direct contact throughout my pregnancy and in planning for the birth.
I had my pregnancy ultrasounds in the city too, at a specialist clinic. I had a few more than I think were standard for a “normal” pregnancy but they were all fine with no concerns. The baby was a “normal” size and everything was developing well.
Throughout this pregnancy I worked full time and was extremely diligent in checking my blood sugars. I was very anxious about all the risks I’d read about being a mum with Type 1, as well as it being my first baby, so I was checking my blood sugars 10 times a day. I did let myself give into my cravings though (which happened to be burgers!) and took full advantage of the insulin pump which made it easier to make tweaks when my insulin needs dramatically increased. My HbA1c stayed at a good level throughout and at no stage either before or during my pregnancy did any of my healthcare team make me feel anything other than great about my blood sugar management.
From 36 weeks onwards I was asked to go to the hospital for twice weekly foetal heart monitoring until the birth. I loved going to the hospital for this. The midwives were lovely and made a fuss of me and I got to know the hospital so it was all familiar when I went in for the birth. I went on maternity leave from 37 weeks (and moved house at 38 weeks) and was due to be induced at 39 weeks (standard practice according to my obstetrician).
Leading up to the birth there were two big things I was worried about, other than the obvious worry of the pain of labour. I was worried about being induced (it sounded horrible), and having someone else take over managing my insulin. I didn’t want to be hooked up to a drip and I didn’t want anyone else controlling my blood sugars (as long as I was conscious!)
I spoke to my doctors about these concerns. My endocrinologist wrote to my obstetrician and copied my letter to the hospital instructing them to leave my insulin pump on and leave the management of my blood sugars to me during the birth and throughout the time I was in hospital. This meant that I had to give my husband lessons in testing my blood sugar for me, and how to do an insulin pump set change in case I pulled out my cannula during labour (which never happened but it was good to be prepared). We also went to antenatal classes together where I heard about the book “Birth Skills” by Juju Sundin which was massively helpful in both my labours.
My obstetrician explained that the plan for my induction was to get me into hospital one evening to apply a gel that would enable him to break my waters the next morning. When the day came, the midwives at the hospital were all primed for my arrival and knew I was a pumping T1D who was going to manage my own blood sugars and treatment. They were completely fine with that and it was never in question. So that’s what happened. A few hours after my waters were broken I went into labour and my daughter arrived six hours after that (smallish baby at 3.1kg / 6lb 14oz).
My blood sugars were in range throughout the labour and my daughter’s blood sugars were checked at various times following the birth and they were normal and stable too. The night of her birth my blood sugars skyrocketed (hormones?) so I rang my endo and she advised me to correct and reassured me it was normal. I was happy to be on the pump as made it easy to switch back to my pre-pregnancy basal rates and insulin to carb ratios straightaway. The nurses looking after me in hospital were generally really intrigued by my pump and I enjoyed explaining how it worked, and one of them even asked if they could observe me doing a set change, which was fine with me. It was a fantastically supportive, nurturing place to recover from the birth and get to grips with having a newborn.
I was so relieved to have got through the pregnancy without any major dramas, grateful that the birth was straightforward and most importantly that the baby was safe and healthy. I got on with being a mum and after maternity leave I went back to work. I had an easy baby, support with childcare and reduced hours at work (I went down to four days a week). I switched back quite easily into my usual T1D self care routine, testing my blood sugars, keeping all my medical appointments, keeping an eye on my HbA1c knowing that I wanted to have another baby in the not too distant future.
The second time round, diabetes got involved. I think. Or maybe it would all have happened anyway? More on that tomorrow.