Home Birth Reference Site

Diabetes and Home Birth, by Debbie Dooley

This is a talk which Debbie gave at a conference for midwives.

My name is Debbie Dooley. I have 5 children and I am an Insulin Dependant Diabetic of 4 years.

I'm here to tell you about my Home Birth last July and I'd like to give you some background on my reasons for choosing to birth at home, even though 'policy' for Diabetic Mums is hi-tech hospital labour and birth.

My first three children were all born in hospital with normal labours and deliveries, although I was induced with babies 2 and 3. I apparently had GD in both of these pregnancies.

However, both of these births were not monitored diabetically - by that I mean I had no insulin/glucose infusions and my sugars were never tested during labour.

Anyway, time passed and 10 years later in 2003, I found myself pregnant again. This time I lost the baby at 17 weeks gestation. I had felt quite ill throughout the pregnancy and felt that things weren't right, but just couldn't put my finger on it. A couple of months later I was pregnant again. At 5 weeks I began to feel very unwell, dizzy, light-headed, sick, but more than 'normal' early pregnancy symptoms. A little 'niggle' in my head told me to get something checked out. So I popped round to my GP's and asked him to check my blood sugars (BS). It was 28.5. Panic stations ensued and I was ordered up to my local hospital and immediately put onto insulin. I was then diagnosed Type II Diabetic. It explained the loss of my baby a few months earlier and the health problems I had been suffering.

During the pregnant I mastered controlling my BS and my levels were perfect. It was explained to me that I would be admitted to hospital at 37/38 weeks and induced as it was 'procedure' with diabetic mums. I would be hooked up to an insulin/glucose IV (Sliding Scale) and monitored constantly throughout my labour. My Diabetic Consultant wrote up the dosages for my IV at one of my appointments, just as a matter of course, and I accepted it in the same way.

Why? - Because that's what women have gotten used to.

We put our faith in the professionals, quite rightly of course, as our safety is forefront in the professional's minds, but quite blindly really. We are not individuals, we toe the party line and in that instance, choice is removed.

I meekly went into hospital, dreading the birth. Had my pessaries inserted and started to contract almost immediately. The Dr. had some trouble siting the IV, and with my chubby hands and arms he had a fight on his hands. By the time it was sited, (after multiple jabbings I might add!) I was pushing, and Cassie was born about 20 minutes later. I wondered what all the fuss had been about and wondered why I had needed the IV in the first place.

Now comes the good bit!

They tested her blood sugars with a heel prick and it was a little bit low, so the Midwife said she needed to feed. I am a militant breastfeeder so of course I put her to the breast. Another heel prick said it was a little better but still low; they wanted to top-up with formula. I refused for as long as I could, but they began to put mounting pressure on me to top her up. Then one midwife came and told me if I didn't let her have the formula, she would end up in SCBU with 'all kinds of tubes and needles and a tube down her throat'. Of course I agreed.

I was so upset to see them trying to force-feed my beautiful new baby girl with formula. She really didn't want it, she was gagging and choking, but they persisted shoving the teat into her mouth. When they were satisfied that she had swallowed enough they left her. She then projectile vomited the whole lot back up. To my shame I let them do it several more times before my instincts kicked in and I refused to let them do it any more. Her BS levels had dropped during all this and again I was left wondering what the point had been.

I BF my baby constantly for the next 6 hours and brought her levels up by myself, without any distress to her or me. I vowed then and there that if I had any more children I would do everything differently.

So, two years later, when I was pregnant for the 6th time, I began to look into a Home Birth. Initially I met with resistance from my family and friends so I just kept it to myself and started to quietly research on the internet.

I found a birth story on the AIMS website by Elaine Lawson, a diabetic mum who had successfully given birth to her son without a drip and at home. At last! I saw it could be done.

Following her lead I started to look into lots of the myths of diabetic birth and slowly I began to realise that a home birth would be possible. In fact, more than that, I found more and more evidence that maybe the procedures currently in operation were so outdated, they could actually be causing a lot of the problems encountered after the births.

The Sliding Scale possibly causing the hypo's in babies

C-Sections due to failure to progress, because of induction.

Intervention due to failure to progress etc etc

When I got to around 6 months pregnant, I drew up a detailed presentation for my Obstetric Consultant, Amanda Bellis and My Diabetic Consultant, Ian O'Connell, and took a deep breath!

To my surprise, they were both very open to the possibility of me having a homebirth and after reading my proposal they both backed me up fabulously. The only thing bothering my Diabs Cons was the possibility of Post-Partum Haemorrhage as I was onto my 6th pregnancy.

Again I reassured him that the ambulance station was 5 mins away from my house with the hospital 10 minutes away tops. I stipulated repeatedly that I would not hesitate to transfer if I felt things were going wrong.

My sugar control was 'exemplary', to use Ian O'Connell's word, and I would stress that this HAS to be the case for any Diabetic mum birthing at home. All my research is based on having excellent control throughout the pregnancy and also being able to judge your own dosages. You have to be confident in your body's abilities and above all else 'know' yourself. I have had natural births with all my babies and have let nature take its course and just followed my instincts. Intervention and hospital birth takes the mum's instinct out of the equation and this is the travesty. What is more natural than giving birth? It IS pure instinct.

I feel very lucky that I didn't really meet with much resistance on the surface of it, in fact after Amanda Bellis sent my Birth Plan and proposal to Lesley Price, my Supervisor of Midwives, I received a phone call from Lesley offering her support and the way she spoke to me was fabulous. She really gave me the confidence to stick to my guns to trust in myself that I could do it.

The only negative experiences came in the shape of one midwife and one understudy obstetrician. I saw the midwife at my GP's surgery on my one and only visit.

She was covering for my normal team of midwives and told me in no uncertain terms that I was being very foolhardy and putting myself and my baby at risk. She continued by saying that Diabetic birth needs constant monitoring and there are so many things that could go wrong, and had I thought it all through.

I tried to tell her about my research and my findings, but she really didn't want to know. I comforted myself with the fact that she wasn't on my 'team' so I was unlikely to have her attending me.

The Dr. was at ante-natal clinic who tried to scare me, by telling me my baby had a very high chance of having shoulder dystocia and we could both encounter grave difficulties with a home birth. He tried so very hard to get me to agree to come to hospital, but I stood my ground and politely asked him to go and see Amanda Bellis. He did and when he came back he apologised and said that Mrs. Bellis had explained the situation. He looked quite bemused and I had the distinct feeling he was very much out of his comfort zone. In his mind, there was no leeway, I was Diabetic, I came into hospital, I was induced…..END OF!

One person I would like to mention is Therese Whittle, the attending midwife. She did my home visit and made no bones about how she felt about my decision, but she was totally wonderful about it. She was matter-of-fact and said that even though she didn't agree with all these 'new' home-births for high-risk cases, if she ended up being my attending midwife she would support me 100% and do her best to help me have a positive homebirth experience. I was so grateful for her straightforward approach, but also for her honesty. Laughingly as she left, she said it would be just her luck to be the one on call when I went into labour. It was so funny to see her face when she walked into my living room after my membranes had ruptured!

Therese was fabulous; she supported me totally and even though the house was full of people, it was as if it was just me and her. I listened to her soft, calm voice and she talked me through every contraction. She treated me no different than any other labouring mum, which was lovely. My blood sugar levels were perfect throughout the 20 hour labour, I only had to administer one shot of Insulin and I sipped on Orange Juice to keep my levels up if they dipped at all. Everything I had read and believed was being proven. My body naturally regulated its own glucose levels. It did work!

Therese asked my permission every time to monitor the baby with a Doppler, in fact, she pretty much asked me before she did anything. So different to all my other hospital births, where you are TOLD what IS going to happen next, no discussion, no permission sought.

I gave birth to my 9lb 5oz baby boy without any IV's, no intervention, no tearing or episiotomy and more importantly nothing invasive done to the baby after the birth. I was active throughout the labour and even had my birth pool set up and raring to go.

I had harvested my colostrum after wonderful advice from Jane McAllister, my Diabetic Nurse Specialist, so it was sitting in the kitchen ready for the little man if he had shown any signs of hypoglycaemia, which he didn't. He went to the breast wonderfully and fed whilst he was still attached to the cord.

I had a physiological third stage, which again helps the baby's glucose levels to stabilise, another thing not done in hospital and in my mind vital in Diabetic birth.

So, in short, we need to change 'procedure' in Diabetic Birth, we need to try to show that it is still as natural as a 'normal' birth and as long as Mum has good glucose control, which is vital, then there really is no need to make it a high-tech birth at all.

In fact, I feel so strongly about this and Breastfeeding, I am currently training to become a Breastfeeding Supporter and am hoping to help Jane with advising and supporting Diabetic mums in understanding that 'naturally' is always the best way.

I'd like to thank Lesley for her support through all of this, and I understand she virtually 'ordered' her midwives to support me. Also, big thanks to Amanda Bellis and Ian O'Connell, for being open-minded enough to support my decision, and taking the time to read my research and wafflings. It was very important to me to have the backing of these two people as I respect them both so much and I hope I didn't let them down. And finally, thanks to Jane, who supported me with great enthusiasm and made me leave my ante-natal appointments with a smile and total confidence that YES I could do this!

So please everyone, listen to us, give us the choice and see us as women and individuals, not procedures.

Thank you.

Debbie Dooley

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