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Type 1 Diabetes and Home Birth, by Victoria S

Victoria is a Type 1 Diabetic, who researched her condition thoroughly and decided that this should not automatically dictate her maternity care. You can read more about Diabetes and Homebirth elsewhere on this site; I am very grateful to Victoria for this well-researched and thorough article.

I have been a Type 1 diabetic for the last 30 years and at the age of 27, I fell pregnant with my first child (2003). For me, diabetes has always been no more than an inconvenience which I have had to accept and incorporate into my lifestyle.

However, when I reflect back on the difficult circumstances that surrounded the birth of my first child and the poor attitude of the NHS towards my desire to give birth to my second child (2005) at home, I felt that the time was right to try and give some weight to the growing argument that diabetic mothers (if not all mothers) should be given more choice in the way they manage their pregnancy. I spoke to several organisations specialists in providing information for diabetics but none of them were prepared to publish an article on homebirths because they did not want to encourage homebirths in type 1 diabetics.

I believe a lack of information in this field is part of the problem with the general attitude of healthcare professionals to diabetic mums who do not want to follow the standard procedures. So this is my story:

When I fell pregnant for the second time in 2005 I decided that I would look at the possibility of having a homebirth even though I was a type 1 diabetic I felt it was something that could be possible.

My reasons for wanting a home birth came from my experience of having my daughter in hospital in 2004.

I had had a relatively trouble-free pregnancy. My HBA1Cs (a measure of average blood glucose levels) had been within the range of 6.2-7.0 throughout the pregnancy and all my scans showed that my baby was within the normal weight range.

My biggest problem was the way the hospital treated me throughout the course of the pregnancy. From the initial scare mongering session where they explained all the terrible things that could go wrong due to my condition right up to the birth where I had to ban a Registrar from the delivery room because he told me I was being irresponsible and could kill myself and my baby by not having the glucose/insulin drip.

I had made it quite clear to my obstetrician prior to labour that I did not want a glucose/ insulin drip during the initial stages of labour as I felt able to manage my sugar on my own. I was happy to agree a point where the drip could be introduced if I began to feel I was not able to manage myself. My obstetrican reluctantly agreed but he too felt I was taking an unacceptable risk.

Several months later when I arrived on the labour ward to have my waters broken I was told that I would be put on the glucose insulin drip. My refusal prompted the Registrar to come into the delivery room and without reference to my notes or even the decency to ask me why I had opted for this particular course of action, he told me I was 'irresponsible', going on to say 'did I not know how difficult childbirth was and I could kill myself and my baby'. This attitude made the whole run up to the labour stressful and was certainly the last thing I needed in the run up to delivering my baby. Careful and calculated consideration to all risks had been made months before I went into labour.

During the whole process of delivering my daughter the attitude of all those involved was very much a nervous impatience to get me through the birth as quickly as possible. For example, once my waters were broken it was decided because I was a diabetic and apparently more susceptible to infection that I should be placed on the syntocin drip and heart monitor almost immediately, instead of allowing 2 or so hours to see how things progressed naturally. Not only did they put me on the drip, they increased the flow of the drug to maximum within a very short space of time resulting in full contractions almost instantly.

3.5 hours later I gave birth to a healthy baby girl weighing 7lb 7oz and managed this without the aid of the glucose/insulin drip.

What upset me the most was the way just about every medical person connected with the birth used my diabetes as a convenient excuse of why something could or could not be done. But when pushed on the real reasons it became clear that few of them really understood the condition and most were just following a set of very cautious and in flexible procedures which were riddled with stereotypical traits of diabetes. This attitude led me to explore the possibility of a homebirth when I became pregnant with my second child in 2005.

My obstetrician thought I was joking when I first mentioned this even though my previous pregnancy and labour had been well managed he was totally opposed to the idea. I persisted with my enquiries throughout my pregnancy and was confronted with a similar response each time. Instead of weighing up things like my excellent sugar control and simplicity of my first delivery against the slight additional hazards presented by a diabetic mother at the point of birth I was told that I was putting myself and my unborn child at unnecessary risk.

When I challenged this I was fobbed off with stories of catastrophic incidences during childbirth. It became clear that the doctors were trying to put me off but not to protect my health more, so to avoid any negative publicity and ultimately litigation.

I spoke to my midwife who couldn't see a problem but after speaking to her superiors she too told me it would not be possible, I even tried a birthing centre, but again I was classed as "high risk" so I started a case of investigating whether there was any information available to support my argument for a home birth. There was limited evidence, no research had been carried out by the British Diabetic Association - the only information I received was a paragraph stating 'It is not advisable'.

Further research lead me to the AIMS website where Elaine Lawson, who was a type one diabetic, had had a successful home birth I discussed this with my midwife who wanted me to meet with another midwife who had experience of diabetic mothers in labour. Again, she talked me through all the things that could go wrong and I explained I was aware of this and how I planned to manage the situation I agreed a plan of action with the midwives as to how my home birth would be carried out.

The process for the home birth was arranged via a very supported midwife who suggested a way in which I could make the home birth more possible by having a stretch and sweep booked in at my local hospital. This was arranged on the Friday and I was already 3cm dilated. I went home and my midwife had told me to do lots of walking around, bouncing on a ball to get things going. On Saturday evening I was having really light contractions. On Sunday morning my midwife came round as she was on call that weekend and examined me. I was still 3cm so she decided to break my waters, again she told me to go out for a walk, bounce on the ball to get things going and she would be back after her other community visits.

On her return I was 5 cm dilated so she called for another midwife, who arrived with a student midwife. My contractions were not really progressing and I was informed that if things did not get going within the next couple of hours then I would have to go to hospital, so myself and my husband walked around downstairs to get things going. Not long after I was having really strong contractions. The midwives checked my baby's heart rate with a portable monitor and everything was fine.

My contractions got much stronger so I went back upstairs. I was examined again and I was still only 5 cm dilated. My midwife felt that it may be time to go to the hospital but I was in so much pain I could not move. The Senior Midwife disagreed and said that she felt the baby would be here soon. 15 minutes later my son was born weighing 8lbs 10 oz (at 40+ 2 days). There were no complications and it was actually the student midwife who delivered my son (it was her first homebirth).

It was one of the best experiences of my life, but it did not come without having to put in an immense amount of hard work during the entire pregnancy and was very stressful due to the lack of information available to type 1 diabetic mums. For this reason I have provided some notes that any diabetic mother should take into account when considering a home birth:

RISKS

Things can go wrong in any home birth but there is a greater risk for diabetic mothers including:

WAYS IN WHICH THESE RISKS CAN BE REDUCED MY PLAN OF ACTION

There are a few things to note. I had been a type 1 diabetic for 27 years, I have always had very early warning signs when my sugar has dropped and I am well aware of the need to take on board sugar or insulin as appropriate.

Throughout my second pregnancy my HBA1s were between 6.1-6.8, I had no other complications and my scans revealed that my baby was within the recommended weight range. Bearing all this in mind I proceeded with my home birth taking the following precautions:

In order to even consider the possibility of having a home birth I would suggest the following points are essential:

Any home birth is not without its risks, I am not a medical expert but I am an expert in my own condition. I hope this information may be able to assist other Type 1 diabetics who are considering a homebirth. Homebirths are obviously not right for everyone, but for me this experience made the 9 months of stress and worry worth it.

Victoria S

Related pages:

Diabetes and Home Birth - discusses both Insulin-dependent diabetes and gestational diabetes.

The Third Stage of Labour - what are your options, and the pros and cons of each?

Home Birth Stories

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