Birth and Diabetes

In the past, babies born to women with diabetes tended to be large. This problem, called macrosomia, was the baby's response to having extra amounts of glucose from the mother's blood. To reduce the risk of delivery problems or stillbirth, these babies were usually delivered by inducing labor or a cesarean section (C-section) before or during the 37th week of a 40-week pregnancy. Now, because more women are able to manage their diabetes more intensively and better tests are available to monitor the baby's health, most women can deliver close to their due date.

Macrosomia is less common, but sometimes the baby is too large or the woman's pelvis is too small for a safe vaginal delivery. Trying to deliver a too-large baby vaginally can result in shoulder damage or respiratory distress for the baby. In this case, a C-section is performed.

Your blood pressure will be checked frequently throughout your pregnancy. High blood pressure can be a sign of preeclampsia, a serious condition that occurs more often in women with diabetes. Preeclampsia may also lead to early delivery, often by C-section.

Labor is work, and usually you will not be able to eat. You will probably get an intravenous catheter (IV) so that fluids or calories can be given as needed. Your blood glucose levels will be monitored frequently during labor. You can be given insulin either as injections or through the IV. Many women don't need insulin during active labor.

Your baby will be closely watched after birth. He or she is at risk for hypoglycemia and will have frequent blood glucose monitoring during the first 24 hours after birth. Hypoglycemia occurs because the baby has been putting out enough insulin to deal with high glucose levels in the uterus. This does not mean your baby has diabetes. Jaundice is also common and may require therapy with lights. If your baby was delivered early or is very large for his or her age, your baby will also be evaluated for respiratory problems. It is not unusual for these babies to be in an intensive care nursery for a short time so that they can be watched very closely.

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After Delivery

If you have type 1 diabetes, you may require less insulin for the first few days after delivery. If you have type 2 diabetes, you may not need insulin at all during this time. Your insulin needs will gradually go back to your prepregnancy level in about 2 to 6 weeks.

The postpartum period may be one of unpredictable blood glucose swings. Your hormones and body chemistry are in flux.

You are recovering from a major physical challenge. And you are probably exhausted from caring for your baby. If you find that keeping your blood glucose on target poses a greater challenge, try not to get too discouraged. If you find that you feel overwhelmed by trying to care for a new baby and diabetes or you are feeling depressed, contact your health care team. They can help you find sources of support or make a referral for evaluation or counseling. It's not a sign of weakness to need help at this time. Your baby needs a healthy mother!