Part 4: The Birth
If you're a VBAC candidate, there is a good chance that you have not actually experienced vaginal birth before. You may not have even experienced labor. My advice is to read up on the birthing experience - Birthing From Within and The VBAC Companion are two good starting points - so that you have an idea of what to expect when the time comes.
There aren't really any books out there that address what to expect as a diabetic mother. In general, you can expect labor and delivery to proceed more or less as a non-diabetic woman's would, except that the labor and delivery staff will be monitoring your blood sugar levels and insulin requirements throughout labor. They will probably want to run an IV, so that they can more quickly administer insulin or glucose as necessary. When they start the IV, and anytime they change the bag, ask them (or have your labor support person ask them) what's going into the IV. If they're administering a glucose solution, you want to know. There are good reasons for them to possibly want to administer glucose, for example if you're not eating during labor and they don't want your blood sugar to plummet, but you should definitely be aware, so that you don't see a higher than normal blood sugar reading and freak out.
Keep in mind that the hospital staff are going to be much more reluctant to let you experience low blood sugar than high blood sugar; this is one of the reasons they may want to run a glucose drip. You or your labor support person may need to be proactive about checking your own blood glucose levels during labor and requesting additional insulin if necessary, because the labor and delivery staff may be willing to let your blood sugars run quite a bit higher than you are accustomed to, to avoid the possibility of experiencing a low. Research studies suggest that it's your control over the last few weeks of pregnancy that has the greatest effect on whether or not your infant will experience hypoglycemia after the delivery, but running high numbers during labor certainly can't help.
Before you go into labor, ask what your doctor's policies are about insulin and blood sugar during labor and delivery. Are they going to run an IV? How often are they going to check your blood sugar? Will it be OK for you to bring your own meter and use that instead? What are their guidelines for when to administer insulin? You don't want to be surprised by any of this stuff while you're in full labor.
Also find out what the hospital's policies are on treatment of babies after delivery. Are they going to want to remove the baby to a special care nursery for observation? That's something else you don't want to find out at the last minute. They will definitely check the infant's blood sugar levels, but you need to find out what the treatment procedure is for low blood sugar. The best scenario is one where they administer formula or glucose water through a tube taped to your nipple, so the baby is close to the mother's skin and does not experience nipple confusion. Ask if this is possible if your baby needs supplementation for low blood sugar. They may want to take the baby to a nursery to administer the formula or water; if so, request to come with the baby, or send your labor support person instead. Ask them to administer the fluids through a dropper or tube rather than a bottle to avoid nipple confusion.
If the baby's blood sugar is extremely low, or isn't responding to formula/glucose water, they may need to run glucose through an IV. Be prepared for this possibility. It will not be pleasant, but when it's necessary, it's necessary.
Next page: My Experience