I had an appointment with my OB today and he informed me I would be on an insulin drip when I go into labor rather than my pump...WHAT??!!??!! I have an appointment with the maternal-fetal specialist in 2 weeks and I plan to question completely this and praying that he gives me a different answer. I have not had great experiences with hospital staff running my insulin flow in the past and to hear an OB nurse with minimal training will be trying to do this by IV has me in sheer panic :( My husband is fully capable of taking care of my pump if I am unable so I am unsure why the hospital would require me to remove it?? If you have any advice/insight on this I would LOVE to hear it...because it has me totally freaking out :(
I was afraid of this and asked my OB on the first visit whether she'd allow me to manage my own BG with my pump, or if she'd want a drip. Her response was, "I can't think of anyone more qualified to manage your blood sugar than you!" She told me that she would only have me put me on a drip if I were incapacitated and therefore unable to manage it myself. She said the nurses might ask to know my blood sugar now and then for my chart, but that was as nosy as they'd get.
If you've had bad experiences with hospital staff managing your BG before, I say you tell your OB this and let him know that you plan on using your pump. You might mention that you're willing to accept a hep-lock, which they'll most likely give you anyway, which is a type of IV connection that lets them switch from one solution to another quickly. This would let them immediately switch to an insulin drip if necessary.
Here's how things went with my blood sugar management:
Very shortly after labor started (it started with my water breaking), my insulin needs started going down. I soon turned my basal VERY low, and when I started pitocin I had to turn it off for most of the time. The pitocin made me sick, so I kept throwing up the popsicles I ate to bring up my BG. Eventually, it was clear I wasn't going to be able to keep enough down to treat my low. They switched my fluid drip to one that included glucose. (They did, by the way, ask me before doing it. They didn't just take it upon themselves to make the decision, but they told me they thought it would be the best one.) I think they kept me on it for maybe 30 minutes.
Around 22 hours after my water broke, I had a caesarian because I was only dilated to a 2 despite pitocin. I even stuck with my pump then. The insulin site and my CGM sensor were both on my butt, so they weren't in the way of the surgery. I tested before they took me to the OR and gave my meter/remote to my husband to hold. I had my pump clipped to the neck of my gown and I held my CGM receiver in my hand (no pockets!). When you go in for a C-section, they have you keep your arms stretched out to your sides. I just hung on to my CGM, knowing it would beep if I went high or low.
Next thing I remember, I'm in my room recovering. (The anesthesiologist really drugged me up for the closure because the whole feeling of it was really bothering me. Again, he asked if it was OK if he increased the dose even though I wouldn't remember the rest of the procedure.) I had a hard time sleeping that night, between the general discomfort and the night nurse coming in to check on me so often, and my blood sugar was running very low. After a while of lingering in the 50s and throwing up anything I ate because they still had me on pitocin, I asked the nurse to please put me on a fluid with glucose for a while. (She was actually really hesitant to, because it meant temporarily stopping the pit, but I was so fed up with that low!)
And that's more or less it. Very minimal intervention from staff, and everything was fine. But they were ready if the situation changed. Hep-locks make that very convenient for them to do.
You'll notice I pointed out a couple of times that I was asked before certain actions. And neither that hospital or my OB have good reputations with the local midwives and doulas for empowering mothers to do things their way! The fact is that you have the ultimate say over what happens to you, even in the most conventional, medicalized hospitals. As I mentioned before, I would simply tell your OB, politely but firmly, that you'll be managing your BG as long as you're conscious. He might respond in a manner that makes it sound like he gets to have the final say, but he doesn't. Tell him that you respect his opinion and methods, but you and your endocrinologist (or whomever helps you manage your D) both feel you'll do best if you are in charge.
If you decide to let him do the drip after all, do not--DO NOT!!!!!--give your pump to anyone but your husband or other trusted companion. I've heard stories about pumps being withheld for the duration of a patient's stay. There's absolutely no point of that once you start recovery!
During the birth of my first daughter, the hospital wanted to put me on an insulin drip too. My husband and I MADE IT CLEAR that I was responsible for my sugar levels, and that I want to be left on my pump. They did, however, insist on connecting me to some kind of sugar-water solution through an IV drip to make sure I didn't hipo during labor...
I kept asking my husband to check my sugar levels, and when the glucometer showed anything under 90, we just decided to switch the pump into "susped" mode - - no more insulin and figured I'm better off being a little high than passing out :P
The delivery went fine, and my sugar levels were fine too. I just made sure to check very often to keep on track.
During the birth of my second daughter, I had the "navigator" which checks my sugar levels every 5 minutes automatically and allowed us to see if there was a change in the direction of the sugar levels (going up or down) so we could correct it. at some point, I think we suspended the pump from giving me insulin during the second birth too (it's a bit of a blur, with everything else going on!)
I think being on your regular pump is a much better idea during labor - when the hospital wanted to connect me to an isnulin drip, they also wanted to use a different kind of insulin than I'm used to. I say - "why fix it if it ain't broke?!" right?
I hope things go your way, and you feel like your in control and, at the same time, in good hands :)
I used my pump during my c-section and it was OK, but I have to say that my blood sugars were changing quickly. So even with my years of experience in blood sugar management, I had never done blood sugar management during a birth before.
I think that one advantage of having an insulin drip is that the insulin starts working faster than when we give insulin via the pump (because the insulin from the pump must be absorbed through fat). With the insulin drip, I think that they are able to correct and adjust the blood sugars more quickly.
I can completely understand wanting to use the pump. Perhaps you could get them to agree to use a pump, but to be set up for an insulin drip in case you have a high that they want to bring down quickly. You will likely need the glucose drip anyway, as I guess that you are more likely to have lows.
Even with a c-section (so without the physical labor), my blood sugars were dropping fast. I needed a glucose drip immediately after the surgery even with my basals reduced to 50-70%.
Either way, you can check your blood sugar whenever you want. I think you should make it clear that you want to be involved in the decisions as you have lots of experience with this!
When I went in to labor the OB just let me manage my own sugar levels since I kept it so under control my whole pregnancy. They would make me check it every hour and as long as it was under 150 they said they wouldn't bother me. Their is sugar in the IV they give you so u do have to watch it cause you it will get a little high, but right after you give birth your basal needs to be cut in half since you will not be needing as much insulin after you r no longer pregnant. I think they worry that you will forget to manager your sugar levels cause their is soo much going on. But if you have your husband helping you and the nurse has to enter your sugar numbers in the computer every hour so it really no big deal. Like my OB told me we do this everyday and we know our bodies better then any doctor could.
I wasn't on the pump for my first child but did for my second. I was planning a vbac and was given the go ahead to use the pump during active labor by and with a advice from my endo. I ended up with a repeat c-section and still used the pump during the c-section. I had a back up plan for using my pump in both scenarios. I told the doctors that I would sign a release stating that I was controlling my own insulin therapy and no one could say anything at that point. The endo is the one that gave me the release so see if your endo will do the same. The hospital and the ob really don't know and will hassle you less if at all if your endo gives you the ok. Unfortunately even after signing the release I did still run into a few nurses who tried to give me a hard time about doing my own pump therapy. I had to stand my ground and tell them to read the release. Even the anesthesiologist agreed that diabetics doing their own insulin thereapy healed up better and was all for it.
But if this is your first baby, do get the endos advice on how the insulin rates will need to change especially after the birth. Your body will need significantly less insulin after the baby is born. I dropped my rates down as I went into the surgical suite by a huge amount.
Thank you all SO MUCH for the feedback and advice. I really appreciate it and it is a huge comfort to hear your experience with this. Thanks for replying!!!
I went off my pump when I went into labor,I was afraid I'd get too out of it to properly manage my diabetes. My OB nurses (during the 24 hours I was in labor) were fantastic though, they checked my blood sugars every hour & notified the OB/tweaked the basals with the IV. The last nurse actually had type 1 herself..and used a pump.(double score)I trusted her with my life, she "got it." As labor progressed,my insulin needs actually went up and they had to triple my basal rate & make frequent adjustments. I got to 8 cm dilated and the epidural wore off & my blood sugars were the last thing I was worried about.Never went low,they pushed glucose through my IV if I was trending toward that. Labor was not progressing,& I had to have a C-Section.(after which, my nurse cut my insulin rate to 0.0 until about 12 hours later when I put my pump back on with much reduced basals)That was my experience..I was very nervous about trusting them, I know I got lucky.(communication is key, whatever you decide to do.My OB nurses kept me informed with what changes they were making,and why)
Hi, I'm currently 32 weeks pregnant with my first munchkin, and just last week at my appt with my Endo/Diabetes Nurse/Nutritionist, they briefly introduced my options of staying on my pump during delivery or having the staff manage me through an IV. They asked which I would prefer? And I for some reason had just assumed that since they will be taking care of everything else, they would probably be giving me insulin through the IV as well...but this really opened up my eyes to the fact that I have the option of staying connected to my pump and checking my blood sugars hourly and that during active labor I would have to lower my basal rate by 50%....I asked them which options mothers usually choose and they said to self-manage. And that makes sense to me, when I was diagnosed at age 9 and in the hospital, the staff couldn't get my blood sugars in control for days & it was so frustrating. They only have general knowledge of these things whereas we live with our sugars and diabetes everyday and have a way better feel for how our bodies respond to insulin & activity, so I think I might just stay on my pump as well.
I actually was going to log on and ask what mothers have done in the past to get an idea of what I should do, so I'm glad this discussion was already here!
I used my pump and cgm for the entirety of my labor, delivery, and recovery. Blood sugars stayed between 85 and 155, and were around 100 pretty much the entire time. It is totally possible for you and your husband to do this! Fortunately I didn't really have to battle my doctors on the decision, as they were all on board way in advance. I guess I would just suggest telling your doctors that you strongly prefer to manage your own blood sugars and corrections, and that you feel very uncomfortable with the other options. Hopefully, if you have doctors who respect your preferences, then they will go along. By the way, they cannot "make" you give up your pump/cgm at the hospital. You must consent to any medical intervention at the hospital, including their insertion of an insulin drip. Ultimately it is your decision. Good luck!!
exact quote from my MFM: "you will stay on your pump during the delivery. the hospital staff doesn't know what they are doing."
Be firm in your decision. They can't treat you against your will. Have your MFM write a note to your OB to back you up. The same thing happened to me. I asked about it at my OB's office earlier in my pregnancy and they were insisting that I'd be placed on an insulin drip. I freaked out, but later talked to my MFM and the OB who will be delivering me and both were in full support of me regulating myself on my own.
From what I hear from my doctors, there have been a lot of recent advancements in the management of pregnant patients with type 1 diabetes. Things like the pump and CGM are revolutionizing the way patients can manage themselves, greatly reducing risks to the fetus and resulting in fewer complications in pregnancy and delivery. My MFM said 5 years ago it was standard to do an amnio at 37 weeks to check lung function and then deliver. Now, his office lets type 1's go until 39.5 weeks before induction (and no amnio).