March 6, 2011
We are so excited to welcome our daughter Kendall Elaine on Feb. 17 at 12:57 am. She weighed in at 7lbs 8oz and she was 19 ¾ inches long, and she is absolutely perfect in every way. We are slowly adjusting to life with a newborn which equates to very little sleep and lots of diaper changes, but our hearts are filled with so much joy and excitement to finally hold her in our arms.
So much has happened since my last blog post, but I thought I would start with my labor and delivery experience and how I managed my diabetes throughout the entire process. So here goes …
I was originally scheduled to check into the hospital on Mon. Feb. 14 around 6:00 pm for a scheduled induction. As I mentioned before, my healthcare team decided that it was best to induce me as close to my due date as possible to prevent me from going beyond 40 weeks. I was a ball of nerves the entire day just waiting to go the hospital because I just wanted to get the show on the road. Around 4:00 pm I received a call from the hospital saying that they were too full and that I needed to wait until the next morning to be admitted. ARGH – the waiting was killing me.
I did check in on Tues. Feb. 15 at 6:00 am and was quickly admitted to a room. I met with my OB and we discussed the plan for the induction. I was cautioned that the induction process could take a long time (i.e. maybe even 2 days) since I had only dilated about 1 cm when I got the hospital. We talked about how I would manage my diabetes throughout the process and if and when I would be able to eat something. The plan for Tues. was to use a cervical ripening agent for about 12 hours to get my cervix to dilate so they could officially start the induction on Wed. morning. So Tues. was spent just visiting with family and friends and waiting for my body to respond to the medication. As far as diabetes goes – I had a few low blood sugars throughout the day that I treated with juice and small snacks. I was able to eat small amounts throughout the day and for the most part my blood sugar stayed below 120.
By the end of the day on Tues. I was only dilated about 3cm so they decided to let me eat dinner (thankfully) and take a break until the next morning when they started Pitocin to help move labor along. They started me on Pitocin in Wed. morning, and as the day progressed so did my labor. I remained on my insulin pump, but as my labor progressed I started decreasing my basal rates by about .05 units every couple of hours with the goal of getting back to my pre-pregnancy basal rates by the time I delivered. Trust me this method is not based on any kind of scientific findings, but rather just a “hunch” I had about how to manage my diabetes and how my body responds to physical exercise (i.e. labor).
Around 7:30 in the evening my contractions were getting closer together and more intense so I asked for an epidural. Unfortunately three other people asked for an epidural at the same time so I had to wait about an hour for the anesthesiologist to get there. By the time he arrived around 8:30pm, I had experienced several low blood sugars in a row that I decided to reduce my basal rate by 60%. Again this is not a scientific decision, but rather my personal approach to how I manage my blood sugars. Over time I’ve learned that I can reduce my basal rate by 60% about an hour before exercise and for an hour during exercise (essentially this equates to no basal rate insulin) in order to maintain “good” blood sugars during physical activity.
My memory of the next few hours is kind of “cloudy,” because my labor really picked up after I received the epidural. In all honesty I was pretty much done with diabetes, and if it weren’t for husband checking for me every hour or so I probably would have just let it go. He was so helpful in that he would check my blood sugar and then ask me what to do on my pump based on my blood sugar. I do recall my blood sugar being fairly “normal” for these last few hours of labor that I just decided to disconnect my pump completely. Again I’m not sure how I made this decision, but it just felt like the right thing to do. Maybe I just got a little too confident because my blood sugars had cooperated throughout the entire induction process.
Finally after hours of labor, the doctor came in and said it was time to push. My husband checked my blood sugar one last time and it was a little low. Since I didn’t know how long I would have to push I decided to drink some juice to get me through the pushing phase. Luckily I only had to push a few times, and then our daughter was born healthy and strong. The entire room was filled with so much joy and the doctors and nurses (and me too) were all so happy that she was here. Honestly I think we were all holding our breath a little because we all knew how hard we had all worked to get her here without any complications. I worked hard throughout the pregnancy to manage my blood sugars. My OB worked hard to make sure there were no signs of distress in the baby before she was born. My endocrinologist worked hard to keep me sane and helped me realize that a few “bad” blood sugars along the way weren’t going to have a negative impact on my baby.
For the first few minutes after delivery we were all elated and sharing in the miracle of a new life. I didn’t even think about my blood sugar or my pump for the matter. I was still disconnected and had probably been without basal rate insulin for about 4 hours. Suddenly everything changed when the OB said that I was having a slight complication and would need to go to the operating room. In short I had something called a “retained placenta” that required the OB to manually/surgically remove the placenta because it would not deliver on its own. Immediately I was carted off to the operating room, and I have very little recollection of the next few hours.
My only memory is getting back to my room and my husband checking my blood sugar for me and noticing that it was around 260. I shouldn’t have been surprised because I had been disconnected from my pump for so long. Also I did get sick toward the end of labor and during the surgical procedure that I started vomiting. As we all know vomiting can cause high blood sugars, so I think it was just a combination of all the factors that caused me to be a little on the high side. I was literally still so out of it from the minor surgery that I probably would have just crawled in bed and left my insulin pump disconnected and drifted off to sleep. Luckily my husband was still on top of things and he worked his way through my pump and gave me a correction bolus. By the time I moved to the post partum room the next morning, I was back in the low 100s.
So, this is my story of how I managed my blood sugars throughout the induction process. For months I wrestled with the decision of whether I should manage my blood sugars on my own or if I should go on an insulin drip. In the end I am so grateful that I was able to have a successful labor and delivery and a healthy baby and that I was able to manage my diabetes.
I’m still not sure what caused me to have the “retained placenta.” I asked if it was diabetes-related, and the answer I received was “maybe.” Typically, I would research the heck out of it until I found some research study that indicated that there is in fact some scientific correlation between diabetes and the retained placenta. But I’ve been way too busy with a newborn to try to uncover that minute detail.
In the end, we have a healthy baby girl, and she has already filled our lives with so much joy.