# Pregnancy and type 1 diabetes



## Autumn (Nov 29, 2015)

I am a midwifery student and have a presentation on pregnancy and type 1 diabetes I'm talking about normalising and a sense of coherence. I was wondering if you could tell me yours views on how we as midwives could make things more "normal" and make you enjoy and feel better during and afte pregnancy and birth. Any good or bad stories you would like to share and you don't mind me sharing with my peers anonymously would be great X


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## Northerner (Nov 30, 2015)

Please help Emma if you can!


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## Autumn (Nov 30, 2015)

Thank u


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## hellbell84 (Nov 30, 2015)

I'm only 8 weeks pregnant, and already been up the hospital twice, once for my booking in, and the second to see the consultant. I love the midwives at southend, they are fab, and listen to you without patronising you. the consultant on the other hand, was very blunt and made me feel like I was doing a rubbish job.

my hb1ac was 60 and I am working on that still, I am a member of slimming world and intend to stick to that throughout my pregnancy.

anyway, this is my second pregnancy so I will tell you what happened with my first...

I was admitted and had my son at 35wk 6days by "emergency c-section" and was put into SCBU as soon as he was born

I wasn't given the option of skin to skin. I couldn't even attempt to breast feed him as he had tubes up his nose. I got myself in such a state as I couldn't feed my baby and was very upset. so they tube fed him and when he was taken out of SCBU nobody taught me how to get him in the right position or anything to breastfeed. so I gave up and formula fed him. still rather angry about that. I hated the sliding scale thing as well, it didn't help my sugars stabilise at all, I actually got ketones whilst I was on it. just felt like a failure pretty much.

as a diabetic, I feel I wasn't given any options about my birth plan (that was completely ignored, I wanted delayed cord clamping, for example) and all of the choices I could have made were taken away from me. I tried my hardest and even though I appreciate the hard work the midwives at the diabetic clinic do, the aftercare was by far the worst. A bit off topic perhaps but hopefully this will help you. I will try and answer any questions you have whilst I undergo journey number 2 with the second little sprog.


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## Autumn (Nov 30, 2015)

hellbell84 said:


> I'm only 8 weeks pregnant, and already been up the hospital twice, once for my booking in, and the second to see the consultant. I love the midwives at southend, they are fab, and listen to you without patronising you. the consultant on the other hand, was very blunt and made me feel like I was doing a rubbish job.
> 
> my hb1ac was 60 and I am working on that still, I am a member of slimming world and intend to stick to that throughout my pregnancy.
> 
> ...




Thank you so much for taking the time to reply. postnatal care is just as important as all the other care provided and a shame that it was worse than what you had already been through. It's awful that you felt like a failure when your not. I hope that this time round is completely different for you. As a student I like to hear about different experiences and how I could help improve someone's care when I'm qualified. I have children myself and understand how difficult pregnancy can be and the care is so important and especially when you need additional appointments and consultant appointments.  Am I ok using some parts of your message to my class obviously will keep it anonymous it will be good to discuss how things impact on feelings and how you view yourself. Good luck with your next pregnancy I hope that it's a completely different experience this time around for you.

Thanks again x


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## hellbell84 (Dec 1, 2015)

yes of course, if you have any other questions please feel free. but I felt like a failure in the first preg when my sugars weren't on point (I even lied in my little blood sugar diary thing) and I still feel like one now. I still have the attitude of "if they think I'm not doing it right, then why should I even bother".  Midwives pre baby were great. consultants made me feel like I hadn't got a clue what I was doing. Post baby, it was like, "youre on your own"

good luck with your studies hun! xxx


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## Cleo (Dec 1, 2015)

Hi Emma.  My son is now 20 months, and we're now trying for baby nr 2.
My control was good throughout the pregnancy and my mid wife was very efficient.  I ended up (like many type 1s sadly) with an emergency c section (under GA) due to a failed induction.  Now I have no issues with C sections at all, but I wasn't prepared for it.  I thought / assumed that I'd have a vaginal birth.  I think perhaps this is something that could have been discussed with the midwife i.e. "Plan B" so that at the very least you're prepared for it.  I had a similar experience to HellBell in that baby was rushed to NICU, had to be fed via tubes etc etc so on day 3 / 4 when I was trying to establish BF-ing I could have done with more help than what I got.  Some of the midwives on the transitional care ward were awful ! when I asked one of them for help for BF-ing she said "you've been here for 2 days now you should have gotten the hang of it by now".  Really ?.  
They are working with woman who are probably at one of their most vulnerable points in their life - I think more care and support is needed at the time of birth and around establishing BF-ing. 
x


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## Autumn (Dec 4, 2015)

hellbell84 said:


> yes of course, if you have any other questions please feel free. but I felt like a failure in the first preg when my sugars weren't on point (I even lied in my little blood sugar diary thing) and I still feel like one now. I still have the attitude of "if they think I'm not doing it right, then why should I even bother".  Midwives pre baby were great. consultants made me feel like I hadn't got a clue what I was doing. Post baby, it was like, "youre on your own"
> 
> good luck with your studies hun! xxx


 
Thank you so much this information is great and good to know so I can have an insight to how you feel and I understand what you mean.  I hope that during this pregnancy you have a better experience and please keep me updated love hearing how people get on. Thank you so much.


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## Autumn (Dec 4, 2015)

Cleo said:


> Hi Emma.  My son is now 20 months, and we're now trying for baby nr 2.
> My control was good throughout the pregnancy and my mid wife was very efficient.  I ended up (like many type 1s sadly) with an emergency c section (under GA) due to a failed induction.  Now I have no issues with C sections at all, but I wasn't prepared for it.  I thought / assumed that I'd have a vaginal birth.  I think perhaps this is something that could have been discussed with the midwife i.e. "Plan B" so that at the very least you're prepared for it.  I had a similar experience to HellBell in that baby was rushed to NICU, had to be fed via tubes etc etc so on day 3 / 4 when I was trying to establish BF-ing I could have done with more help than what I got.  Some of the midwives on the transitional care ward were awful ! when I asked one of them for help for BF-ing she said "you've been here for 2 days now you should have gotten the hang of it by now".  Really ?.
> They are working with woman who are probably at one of their most vulnerable points in their life - I think more care and support is needed at the time of birth and around establishing BF-ing.
> x


 
Thank you for your reply am I ok to use some of your comments for my presentation obviously keeping it anonymous. Postnatal care or lack of support seems to be the main thing when it comes to diabetes. I will feed this back to my class. Good luck with trying or baby number and keep me updated etc and anything else you may want/like to share my presentation isn't till feb so loads of time to keep adding points. The more we can be aware the more we can discuss as what can be done to provide better support.

Many thanks


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## Autumn (Dec 4, 2015)

hellbell84 said:


> yes of course, if you have any other questions please feel free. but I felt like a failure in the first preg when my sugars weren't on point (I even lied in my little blood sugar diary thing) and I still feel like one now. I still have the attitude of "if they think I'm not doing it right, then why should I even bother".  Midwives pre baby were great. consultants made me feel like I hadn't got a clue what I was doing. Post baby, it was like, "youre on your own"
> 
> good luck with your studies hun! xxx


 

Thank you my presentation isn't till feb so any further information or comments that you would like to share would be great

Many thanks


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## Autumn (Dec 4, 2015)

hellbell84 said:


> I'm only 8 weeks pregnant, and already been up the hospital twice, once for my booking in, and the second to see the consultant. I love the midwives at southend, they are fab, and listen to you without patronising you. the consultant on the other hand, was very blunt and made me feel like I was doing a rubbish job.
> 
> my hb1ac was 60 and I am working on that still, I am a member of slimming world and intend to stick to that throughout my pregnancy.
> 
> ...


 

Can I ask why your son was admitted to NICU just to see why they admit them and if theres a pattern was it due to prematurity and also why you had a C-section if its to personal I completely understand.

Many thanks
Emma


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## Autumn (Dec 4, 2015)

Cleo said:


> Hi Emma.  My son is now 20 months, and we're now trying for baby nr 2.
> My control was good throughout the pregnancy and my mid wife was very efficient.  I ended up (like many type 1s sadly) with an emergency c section (under GA) due to a failed induction.  Now I have no issues with C sections at all, but I wasn't prepared for it.  I thought / assumed that I'd have a vaginal birth.  I think perhaps this is something that could have been discussed with the midwife i.e. "Plan B" so that at the very least you're prepared for it.  I had a similar experience to HellBell in that baby was rushed to NICU, had to be fed via tubes etc etc so on day 3 / 4 when I was trying to establish BF-ing I could have done with more help than what I got.  Some of the midwives on the transitional care ward were awful ! when I asked one of them for help for BF-ing she said "you've been here for 2 days now you should have gotten the hang of it by now".  Really ?.
> They are working with woman who are probably at one of their most vulnerable points in their life - I think more care and support is needed at the time of birth and around establishing BF-ing.
> x


 
Can I also ask why your son was taken to NICU just so I can see if there is similar reasons why and what gestation was you when you had your son. If it is too personal I completely understand.

Many thanks


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## Cleo (Dec 4, 2015)

hi Autumn, no don't worry not too personal at all.

I went in for my induction at 38weeks and he was born the next day weighing 2.53 kg.

The reason the induction failed is because I had a bad reaction to the prostaglandin pessary.  this problem was compounded by the fact that I wasn't being monitored adequately (with the ECG monitoring).  They only monitored me for about 30min - 1 hour (don't ask!)…..So by the time they realised there was a problem my son's heart rate had fallen dramatically to 60 beats per min .  Thats why I needed a general anaesthetic as they didn't have time to faff about with a local.  I called the midwife at 6.45am when I wasn't feeling too well and he was born at 7.14 am.   Then they rushed him off to NICU due to respiratory distress - basically they needed to resuscitate him (this is all in his discharge notes so not my own interpretation of events).  

So essentially the primary reason he was in NICU was due to respiratory distress (which shouldn't have happened in the first place) but he also had hypoglycaemia which I believe is very common with maternal type 1.  

To be honest the whole thing was a complete mess and should have been avoided.  But he's fine now .  

Needled to say, the next time I'm asking for an elective and Im not going to listen to anyone try to talk me into anything else! 

Please do feel free to ask any other questions. x


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## hellbell84 (Dec 8, 2015)

Autumn said:


> Can I ask why your son was admitted to NICU just to see why they admit them and if theres a pattern was it due to prematurity and also why you had a C-section if its to personal I completely understand.
> 
> Many thanks
> Emma


no of course

his growth had spiked, so I was kept in from Thursday (when I saw my consultant), they gave me steroids to strengthen his lungs prior to him being born on the Monday. he went to NICU as he had problems breathing, he was taking large gasps of air, which was quite scary to see, didn't have any skin to skin either which made me sad but understand his life comes first!!! his sugars weren't low or anything, it was mainly for monitoring I believe, to be honest, it wasn't really explained to me. if it was, then I was probably in a state of shock that it didn't go in properly. he was the biggest baby on NICU at 8lbs 6oz and the consultant made me feel guilty about why he was in there. I asked if I could try to breastfeed whilst he was in NICU and was told no as he was being tube fed. all i remember is the consultant saying "your baby is in here due to your poorly controlled diabetes and i hope you understand he is very sick." scared the cr*p out of me. x


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## Northerner (Dec 8, 2015)

hellbell84 said:


> ...all i remember is the consultant saying "your baby is in here due to your poorly controlled diabetes and i hope you understand he is very sick." scared the cr*p out of me. x


What a dreadful thing to say


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## Autumn (Dec 22, 2015)

hellbell84 said:


> no of course
> 
> his growth had spiked, so I was kept in from Thursday (when I saw my consultant), they gave me steroids to strengthen his lungs prior to him being born on the Monday. he went to NICU as he had problems breathing, he was taking large gasps of air, which was quite scary to see, didn't have any skin to skin either which made me sad but understand his life comes first!!! his sugars weren't low or anything, it was mainly for monitoring I believe, to be honest, it wasn't really explained to me. if it was, then I was probably in a state of shock that it didn't go in properly. he was the biggest baby on NICU at 8lbs 6oz and the consultant made me feel guilty about why he was in there. I asked if I could try to breastfeed whilst he was in NICU and was told no as he was being tube fed. all i remember is the consultant saying "your baby is in here due to your poorly controlled diabetes and i hope you understand he is very sick." scared the cr*p out of me. x



Hi sorry I've not replied sooner xxx that's an awful thing to say and completely not what u want to hear when you are so vulnerable and worried xx thank u for the reply these are really helpful for us to hear and can feed back in my presentation !


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## Autumn (Dec 22, 2015)

Cleo said:


> hi Autumn, no don't worry not too personal at all.
> 
> I went in for my induction at 38weeks and he was born the next day weighing 2.53 kg.
> 
> ...




Hi thanks for your reply wow what a scary time thank you for sharing your experience and allowing me to feed it back in my presentation its good to see a mothers perspective and hear your feelings thank you for sharing xxx


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## grainger (Dec 22, 2015)

Hi Autumn,

Just wanted to share mine. Had good and not so great experiences. 95% of the people I saw were fantastic and really supportive without patronising. Saw one consultant who made me feel horrendous and told me my hba1c (6.5% at the time) was awful and I should be looking after myself - needless to say I left in tears but my DSN basically told me not to worry and she was being an idiot!

Other than that I was induced at 38 weeks but it was unsucessful and at 38+2 in the evening I was given an emergency c-section. My little one was born perfectly happy and healthy weighing 7lb 12oz and I was lucky enough to leave hospital with him about 24 hours later. My midwives were amazing, especially the last two (I had a few) and I couldn't thank them enough for all the support they gave. One thing I thought was brilliant at Chelsea and Westminster was when I was in the labour ward I wasn't treated differently as a diabetic - I was treated like I assume any normal woman in labour (although I imagine with many more wires attached to me!). 

The thing I found hard was that once I'd had my little one my diabetes was just sort of ignored - they tested my son etc but I was left to my own devices apart from a quick 5 min chat with my dsn. Would have been nice to have a bit more support given having not slept for 3 days and just been through major surgery. Also, remembering my old doses etc was tricky.

I guess the only thing that would have been nice would have been more consistency with who came to see us once little one was born - I honestly think I must have seen 10-15 different midwives/nurses. Just felt a little less looked after, like baby had been delivered so job was done (but that's me being really picky).

Hope that helps.


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## Autumn (Dec 22, 2015)

grainger said:


> Hi Autumn,
> 
> Just wanted to share mine. Had good and not so great experiences. 95% of the people I saw were fantastic and really supportive without patronising. Saw one consultant who made me feel horrendous and told me my hba1c (6.5% at the time) was awful and I should be looking after myself - needless to say I left in tears but my DSN basically told me not to worry and she was being an idiot!
> 
> ...




Thank you for your reply this is really interesting and a debate we have had !!! Some trusts monitor mums blood sugars postnatally where others allow mum to. The majority opinion was that allowing mum to continue her own etc was best so it didn't seem like it was not sure how to word it but basically so it wasn't a case of whilst your here we don't think you can do it but then you go home and are expected to do it. Does that make sense your thoughts would be greatly appreciated.continuity is one thing which is always brought up and I know each trust works differently could u not have asked when the same midwife was on again so she could come out to see you ? Its good to hear you was treated as normal and had some good experience other than the consultant xx thank u so much for taking the time to reply I can't wait to discuss this with my peers if you are ok with me doing so ?


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## trophywench (Dec 22, 2015)

You are supposed to discuss admissions with the hospital when you are admitted (or before if it's anything that is planned) and actually agree exactly what will happen eg will they slap you on a sliding scale, how often will they test your BG etc - even if it's something totally unrelated - eg pregnancy or appendicitis.  And that should be that.  They will do what everyone has agreed.

However, Grainger - from what all sorts of people say both on here or elsewhere you pretty much can't trust em to do what they are sposed to, even if it has been agreed (unless you happen to be in intensive care) so you are better off actually DIY.  Own insulin, own meter and strips, own hypo remedy - all to hand - day and night.


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## HOBIE (Dec 23, 2015)

Autumn said:


> I am a midwifery student and have a presentation on pregnancy and type 1 diabetes I'm talking about normalising and a sense of coherence. I was wondering if you could tell me yours views on how we as midwives could make things more "normal" and make you enjoy and feel better during and afte pregnancy and birth. Any good or bad stories you would like to share and you don't mind me sharing with my peers anonymously would be great X


Good luck with things. Its a stressful time for everyone.


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## Autumn (Dec 26, 2015)

HOBIE said:


> Good luck with things. Its a stressful time for everyone.



Thank u Xx


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## grainger (Dec 26, 2015)

Autumn said:


> Thank you for your reply this is really interesting and a debate we have had !!! Some trusts monitor mums blood sugars postnatally where others allow mum to. The majority opinion was that allowing mum to continue her own etc was best so it didn't seem like it was not sure how to word it but basically so it wasn't a case of whilst your here we don't think you can do it but then you go home and are expected to do it. Does that make sense your thoughts would be greatly appreciated.continuity is one thing which is always brought up and I know each trust works differently could u not have asked when the same midwife was on again so she could come out to see you ? Its good to hear you was treated as normal and had some good experience other than the consultant xx thank u so much for taking the time to reply I can't wait to discuss this with my peers if you are ok with me doing so ?



I completely agree that in most cases that allowing the mum to be in control herself is absolutely the right idea. For me personally though it would have been nice to feel a little more supported simply something like maybe a couple of conversations about levels etc/correcting doses etc. I hadn't slept in quite a while, been through major surgery and had a newborn (my first!) - I think if there's ever a time when the more support given the better this would be one! Would also be nice if the first follow up visit at home could include a conversation about how's your diabetes going - but I know that's asking a lot and a huge amount of additional knowledge would be required (because you'd have to include any chronic condition not just diabetes really to be fair!)

Absolutely fine with you discussing anything I've said on here. Hope it helps. If you need anymore info just let me know.


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## Autumn (Dec 30, 2015)

grainger said:


> I completely agree that in most cases that allowing the mum to be in control herself is absolutely the right idea. For me personally though it would have been nice to feel a little more supported simply something like maybe a couple of conversations about levels etc/correcting doses etc. I hadn't slept in quite a while, been through major surgery and had a newborn (my first!) - I think if there's ever a time when the more support given the better this would be one! Would also be nice if the first follow up visit at home could include a conversation about how's your diabetes going - but I know that's asking a lot and a huge amount of additional knowledge would be required (because you'd have to include any chronic condition not just diabetes really to be fair!)
> 
> Absolutely fine with you discussing anything I've said on here. Hope it helps. If you need anymore info just let me know.




Thank you so much for all your information xx


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## Autumn (Dec 30, 2015)

Hi its me again can i ask anyone what thoughts/concerns did you have extra whilst you was pregnant ?


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## trophywench (Dec 31, 2015)

Autumn - have you seen the newly published report on Diabetes care whilst planning or being pregnant?  It's the 2013 results they have based it on, its the one in Summaries billed as 'Pregnancy Care for Women with Diabetes'

See  https://www.diabetes.org.uk/Professionals/Service-improvement/National-Diabetes-Audit/NDA-reports/

It contains all sorts of useful info like the incidence of planned or emergency Caesarians, what general effects higher HbA1cs have, etc. 

One piece of info that caught my eye, was the fact that for ALL diabetic women of child-bearing age, ALL general diabetes appointments should include info on pre-conception and pregnancy.  Apparently T1 patients get the right advice more often and quicker than do T2s, since they are much more likely to do all the right things/see the right people earlier.  This doesn't surprise me at all because T1s are much more likely to be seen in hospital diabetes clinics than the vast majority of T2 people of either gender.  So - bearing in mind the paucity of brilliant GP care for T2 in the first place - these are definitely things that ALL GPs, their surgery nurses and ALL pregnancy practitioners at surgeries and in hospital need to be aware of so that they are able to ensure that patients have access to the right people at the right time.

I'd be interested to know whether forum ladies of child bearing age DO get that advice at general diabetes appointments, wherever they take place, in the first place?


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## Autumn (Dec 31, 2015)

trophywench said:


> Autumn - have you seen the newly published report on Diabetes care whilst planning or being pregnant?  It's the 2013 results they have based it on, its the one in Summaries billed as 'Pregnancy Care for Women with Diabetes'
> 
> See  https://www.diabetes.org.uk/Professionals/Service-improvement/National-Diabetes-Audit/NDA-reports/
> 
> ...




Thank you for sharing that document I hadn't seen that one I'm gng to share it with my cohort it looks a really interesting read and there is loads of information I can use. I'm going to print it tomorrow always easier reading on paper. You also raise some good questions part of our presentation is to find out this information. 

Many thanks


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## trophywench (Dec 31, 2015)

Worth a read of the actual audit for you too, to see how your area score! - whether, and where you need to improve !

I hadn't realised that they aren't quite as strict about BGs now as they were even a short time ago.  have to admit I'm not always fully au fait with all the preg stuff - difficult to absorb it all when it doesn't apply personally!  LOL


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