In the past, many women with type 1 diabetes had C-sections due to concerns about diabetes causing a high-risk situation. With experienced obstetricians, more women with diabetes are going to term with their pregnancies and having vaginal deliveries. Follow the recommendations of your OB, and make sure that you are monitored and safe in the weeks leading up to delivery.
During labor and delivery, intravenous insulin is generally started and continued throughout the process. Sometimes the pump is left on and the doses managed in conjunction with the labor and delivery staff. Institutions have varying policies and procedures for the delivery process and it helps to learn what these are in advance. In the weeks leading up to delivery, your endocrinologist might create a plan for you to follow immediately after your baby is born. Regardless, bring all your diabetes supplies to the hospital so that they are available if needed.
After your baby is born and the placenta is removed, there is an immediate drop in insulin resistance.You will become very sensitive to the action of insulin. Generally insulin is held until blood glucose levels start to rise, usually within the first 24 h after delivery. Know what your pre-pregnancy insulin doses were and start back on a dose that is ≥10% below baseline levels. Key to management is, as always, adjusting based on blood glucose levels.
Breast-feeding helps mom drop excess weight, improves infant bonding, and lowers the child’s future risks of obesity and type 2 diabetes, among other benefits. Plus, it saves you money! The American Academy of Pediatrics recommends exclusive breast-feeding for 6 months, followed by at least another 6 months of breast-feeding plus supplemental feedings. There is some, slight, data that avoiding exposure to cow’s milk for the first year may reduce the risk of the development of type 1 diabetes in a child. Therefore, many women avoid feeding cow milk or cow milk–based products for the first year.
Women with type 1 have a few extra challenges when it comes to breast-feeding. C-section rates are higher in women with diabetes, which can make it more difficult to initiate breast-feeding. Infants of moms with type 1 are more likely to have latching issues. And women with type 1 may make less milk than is necessary to completely satisfy a child, requiring supplementation. Finally, there’s the issue of hypoglycemia: expelling carbohydrates into breast milk can increase your risk of blood glucose lows.
These barriers are mostly manageable with the help of an experienced lactation consultant. One of the best ways to get into the habit of breast-feeding is to stay with the infant after birth—encouraging skin-to-skin contact and night-time feedings.
You’ll need a new pattern of giving insulin to account for breast-feeding and new patterns of being up at night. Generally, this is relatively easy to adjust for since moms are by now so used to having well-managed diabetes.
If you are not going to breast-feed, consult with your pediatrician as to the best source of formula for your child. You don’t need to feel like you are short-changing your baby if breast-feeding doesn’t work out. It has certain advantages, but you, with support from your medical team and key family members, will make the best choices for you and your child.
You can become pregnant soon after having a baby. In the weeks leading up to delivery, discuss your birth control options with your OB.