Diabetes management and Labor

Hi everyone,

I am 38 weeks pregnant and my due date is just around the corner. I'm on the pump and using a CGM to monitor BG's. My doctor is strongly suggesting not to go past the due date because it increases the risk for complications. So next week, we'll be discussing inducing labor if baby doesn't make his move on his own. I wanted to see what other women's experiences have been in this regard. Have your doctors suggested the same thing? 

My second question is about insulin/BG management during labor. Did your healthcare team just take over, or did you manage some parts on your own (maybe with partners help). My doctor stated that they will give me insulin per IV, although I am wondering if keeping myself on the pump during labor would make more sense. They are nervous about the pump site ripping off during labor. On the one hand I would like to monitor my BG's myself with my husband's help, on the other hand I know I will be busy with contractions and husband will be my support person. 

I am hoping to give natural birth. If anyone could describe their experience, I would love to hear from them.



Although it is rare, i managed to hang on until 41w1d.  I applaud your team for letting you go to your due date if all is going well for both you and the baby. 

I had a natural labour and birth.  I was not induced with pitocin, and had no epidural. Hospital policy where i gave birth is to put mums with diabetes on insulin and glucose drips for labour and delivery.  At the time i considered myself lucky that i was able to keep my insulin pump for the first 6 or 7 hours of labour.  They didn't put the IVs in until i was about 6 cm dilated.  However, next time i will fight tooth and nail to be able to keep my pump and manage my own blood glucose levels.  While my husband and i were checking and adjusting, my glucose stayed between 70 and 100 mg/dl.  As soon as i was on the drips, it started rising and got as high as 300 at one point.  I was miserable but they kept saying that hospital policy said they could only make adjustments every hour, not before.  They were terrified of me going low and actually increased the glucose drip when my blood sugar finally got back down to 165 a couple of hours after the birth.

There is no reason your pump site should rip off if you put it nicely out of the way (in case of a Csection).  Put it around to the side/lower back upper butt and you should be fine. As i was busy with contractions, my husband checked my blood sugar every 1/2 hour all the way through labour.

Hope that helps a bit.  Good luck for this last week or two!


My son was born 2 days past my due date with no complications. I was on lantus and humalog all throughout my pregnancy. My doctors were pretty stupid about diabetes and never told me about an insulin drip to be put on. I had a full dose of lantus on board when I went into labor and once i was admitted in the hospital they told me I couldn't eat anything until after I had delivered. HA....within an hour of being there I went low and after being yelled at by nurses who saw my husband sneaking food in to me I asked to speak to the head director of the hospital because they did not seem to understand that I had to eat something. After I spoke with someone in charge the rest of the labor and delivery went very smooth and easy. I know that this does not really help you out but I just thought you might find it amusing how stupid some dr's can be. good luck with everything and happy mothering:)

Congratulation Manuela on your soon to be born baby.    I was induced at 38 weeks with my first daughter because of low placental fluid.  They said it was not necessarily diabetes related.    I chose to be induced at 38 weeks with my 2nd daughter because I was having lows I could not feel several times per day and had a 20 month old at home, along with working full time.  I did not feel safe driving, or being alone with my daughter.   Both of my daughters were 6lbs.

As for during delivery, this was all almost 10 years ago, and pumps were not quite the norm like they are now.  I let the hospital take care of it with an insulin and glucose drip.  I went low once during labor but was fine in delivery.   I was in labor for 22 hours for each baby. 

I think it's up to you how you want your delivery.  A hospital can't force you to take your pump off.  Believe me, you know WAAAAYYYY more about diabetes than they do.  If you and whomever you have helping you through delivery are up for taking care of it, do it. 

Hopefully you've read my post out here somewhere about after giving birth.  The hospital will want you back on your pump and normal insulin levels right away.  DON'T DO IT.  I'd go with the temp basal and scaled back boluses that first day until you see BGs that indicate your body is needing more insulin.  I spent the better part of 24 hours low after giving birth the first time because I simply was not prepared for this.  Your body may not need insulin in that first day or so.  Watch it and be prepared to make decisions about your diabetes care the entire time you are in the hospital. 

Good luck and I hope you have a safe/happy and delivery like you want.

Manuela -

All are very good questions. I had both of my children at 37 weeks and 3 or 4 days for that reason. In mothers with diabetes, the placenta ages more quickly than in one without diabetes, despite the glycemic control throughout pregnancy. As the placenta ages, it proves increasingly suboptimal blood supply for the fetus. The longer you wait, the greater the chance that the baby will receive inadequate blood and thus nutrition/oxygen/etc. and this could lead to severe consequences such as stillbirth or cerebral palsy. I would be very worried about any OB/GYN or perinatologist who did NOT recommend this for these reasons. People never imagine catastrophe until it happens to them and it is devastating.

Secondly, you and your child will be far better off on IV insulin. It can be titrated to keep your blood glucose levels absolutely perfect throughout labor. IV insulin is immediate and can be titrated to keep your blood glucose levels between 80 to 100 without waiting an hour for it to be absorbed, as it is with your pump. Your husband can still test your blood glucose throughout labor if he wants. I actually wore my CGM for my c-section. It was fun for both me and my anesthesiologist.

Finally, naturally birth is great if thats what you desire. Its unnecessary with regard to your baby's health and will definitely be felt more. However, everyone has their own preference.

Hope that helps!

One thing I might add is that if you DID need a c-section or if there is a sizeable tear, poorly managed glucose levels throughout the labor can greatly increase your risk of infection and post-partum complications.

Thank you everyone for the great information and sharing your experience. It is so helpful to hear others perspectives. I saw my doctor on Friday and she wants to schedule an induction for next week. I am quite nervous and really would have liked for baby to come on his own, but my doctor is quite adamant about inducing. Hayley, your explanation of the aging placenta was very helpful. I wish my doctor would have told me that. We'll see the doctor again Tuesday and reassess the status.