Earlier this month, I gave birth to a healthy baby boy after living with diabetes for almost 21 years. After 9 months of extremely tight blood sugar control and maintaining an A1C of 5.4 throughout my pregnancy, giving birth to a healthy, 7 lb 8 oz baby was truly the best moment and proudest accomplishment of my entire life. In case you missed reading about my pregnancy journey, I wrote about each trimester, along with all of my diabetes changes throughout in these posts.
I also want to mention that this is a positive birth story. While my labor had plenty of twists and turns, I am thankful for every part of it and the overall experience filled me with pride, strength, and the biggest sense of accomplishment. And it was 100% less scary than expected in every way!
Adam was my primary support parter throughout this process. My cousin (and closet thing I have to a sister), Nette, an OBGYN from New York, flew in to be my “additional support partner with years of medical experience in this field who can steer me in the right direction in case anything came our way that we were unsure of”, which ended up being so helpful to have!
Induction
As mentioned in my third trimester recap, I was induced at 38 weeks. Getting induced a few weeks early is common for moms living with type 1 diabetes to prevent complications associated with our high risk pregnancies. Talk to your doctor for more information! Being induced was my doctor’s recommendation, and as this was my first pregnancy, I decided to move forward with what she suggested for the safety of myself and my child.
At 38 weeks and 4 days, I went into triage at 6:30am on Thursday morning to have a cook balloon placed by my OB. The goal of the balloon was to dilate me at least 4cm and of course, induce labor. I was sent home shortly after with the instructions to come back into the hospital if the balloon falls out. If not, I was to head back at 10pm that evening to continue the induction with a different method.
Around noon I started having consistent contractions, which lasted anywhere from 45 seconds to 1 minute every 7-8 minutes for the majority of the day. These initial contractions were a bit uncomfortable but weren’t anywhere near the point where I couldn’t speak or function.
I noticed that my insulin sensitivity was higher the day I went into labor. Insulin was working much faster and more effectively than it had previously in the week.
Side note: I’m really happy that I had the opportunity to start my induction and labor at home with the balloon. Being able to watch tv on the couch, bounce on my yoga ball, stretch, and take a shower, kept me incredibly calm leading up to heading back into the hospital. Also, the cook balloon wasn’t terribly uncomfortable. It’s sort of like a big tampon that got inserted a little wonky and I got used to the feeling of it pretty quickly.
Unfortunately, the balloon did not fall out on it’s own and we went back to the hospital Thursday evening at 10pm to learn that I was still only dilated to 1cm.
After checking in and settling into our labor and delivery room, I started on a 1/4 of a dose of cytotec, a pill meant to soften my cervix and continue my contractions. After 4 hours, I had still only dilated to 2cm so we continued with a second dose of 1/2 a cytotec pill. That second dose kicked my body into gear and after another 4 hours I had dilated to 4cm, with contractions coming pretty frequently.
Labor
At this point I was laboring standing up and walking around the room, which I also think helped progress things. During every contraction, Adam was massaging my lower back or giving me one of his hands to squeeze. I brought some cooling towels which were so nice to wrap around my head to keep me cool during this process. By 4cm I was ready for an epidural, however the anesthesiologist was currently in an emergency c-section, so I had to deal with my pain for a little longer than I had expected.
By the time I had my epidural at 8:45am the following morning (which was one of the parts I was nervous about in labor), I was so ready to get a break from my contraction pain that it was a welcomed procedure. It was quick and painless (from what I can remember) and was so effective that I finally got some rest.
About an hour later, my mom came into the delivery room to see how I was doing. She took a moment to comfort me and then talk to the baby. She said, “hurry up and get out here so I can read you books”. Less than a minute later my water broke on it’s own! It was such a sweet moment and a big relief.
Time to Push
By 1pm I had finally dilated to 10cm, was 100% effaced (how thin your cervix is) and it was time to push. I actually didn’t mind pushing at all. My epidural was working and I personally didn’t find it painful at all. There was a lot of pressure down south, but I never felt like I was in a lot of pain during pushing.
After 4 hours of pushing, our baby was still hanging out in a sunny-side up position, having difficulty dropping lower into position, and started to have some concerning drops in heart rate after each push. I was also absolutely exhausted at this point. For the safety of both mom and baby, we decided to move forward with a c-section.
C-Section Delivery
C-Section prep was quick and easy. I somehow had the energy to put on a little makeup, while Nette and my OB braided my hair before I was transferred to the OR. The procedure itself is so fast and by the time Adam met me in the operating room, we met our baby in about 5-10 minutes.
Paul William was born at 6:50pm on 9/6/24 weighing 7lbs and 8oz! He ended up having his umbilical cord wrapped around his neck, which could have been the reason for his stressed heart rate during pushing, so I was thankful we made the decision to move forward with the C-section. He arrived happy, healthy, and everything we’ve alway dreamed of.
Recovery
Prior to birth, I hadn’t done much research on C-section recovery, not knowing if that would end up being my experience or not. I quickly learned that recovery is a lot more intense than I expected. It’s a major abdominal surgery and it’s important to rest and recover as much as you can post-op. This, of course, is a bit complicated when you are also now in charge of a new human, but still doable! I plan on talking more about my c-section recovery and postpartum experience in an upcoming blog post.
Diabetes Management
During my pregnancy, I spent some time thinking about if I would prefer to manage my own diabetes during labor, or have the hospital/nurses oversee my blood sugars throughout. Eventually, I came to the conclusion that I would prefer to manage my own diabetes, with the help of Adam if needed. Both my high risk doctor and my OB felt like I would be a great candidate for this, as my management throughout pregnancy had been well within target range.
At my 37 week appointment, my high risk pregnancy doctor (who has been overseeing my diabetes management during my pregnancy) gave me a breakdown of my recommended pump settings during labor, in case of a c-section, and post-birth.
Here’s what I did:
On the way to the hospital for my induction, I set my Omnipod 5 in manual mode and set a temp basal at 50%. I didn’t eat anything during labor except for half an otter pop and a few spoonfuls of ice chips throughout. I only took slight insulin corrections during labor, as I wasn’t eating anything (nor was I hungry) and because I didn’t want to risk going low.
For the majority of my labor, my blood sugar hung out around 140-160mg/dL. Once we had decided on the c-section, I was instructed to pause insulin entirely since the procedure itself is relatively short. This brought my blood sugar to about 180mg/dL during surgery and birth.
Afterwards, once I had unpaused insulin, and changed my pod (I timed that pretty well!), I changed my insulin settings and pulled things back to my pre-pregnancy settings (my doctor had taken note of those at the start of my pregnancy). My blood sugar ran in the mid-200s for the remainder of the evening, which I attributed to pausing my insulin, and the immediate decrease of both my basal rate and insulin to carb ratio.
Paul’s blood sugar was tested upon his arrival to find that his initial reading was low (he was given glucose gel to raise it). It’s common for babies of T1D moms to be born with low blood sugar if the mom’s blood sugar is elevated during birth. This is due to the baby’s pancreas overworking to correct that number even after they are no longer connected to the placenta. After his initial reading, they monitored his glucose every 6 hours until he was a day old, and thankfully all other readings were above the recommended threshold for newborns.
My blood sugars continued to run a bit higher the following day, so I manually adjusted my settings, backing off the abrupt pre-pregnancy settings decrease in order to come back down into range. I personally think my body needed at least a day before needing to change back to my pre-pregnancy settings. This could have also been caused from the period of paused insulin, changing my pump, surgery meds, etc.
Birth Thoughts and Feelings
I am so incredibly proud of my body for allowing me to experience the beauty of childbirth. Although he arrived differently than I had originally expected, I truly feel nothing but pride, appreciation, and positivity for the journey we both went through to get him here safely.
Paul is my greatest accomplishment. I feel so proud to have birthed a healthy baby boy after living with type 1 diabetes for almost 21 years. Controlling my blood sugars throughout pregnancy seemed like a full time job, and although they weren’t always picture perfect, it was such a relief to know that I did my very best to bring him into the world.
Labor and birth felt so much more intuitive and transformative than I had ever realized. It felt daunting and scary leading up to the big day, but once I was in labor and focused on my end goal of meeting my son, I felt stronger than I ever have before.
Paul is now 2.5 weeks old and we are in newborn heaven, spending our days getting to know him and adjusting to our new life as parents. I will be sure to check back in after my 4th trimester to share more of my experience managing my type 1 diabetes postpartum! In the meantime, don’t forget to check out my pregnancy with type 1 diabetes blog posts, and follow along on instagram for updates!
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