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As your pregnancy progresses, you will probably start thinking more about labour and the birth of your baby. You may be wondering how gestational diabetes might affect your birth plans and your baby’s health and wellbeing.
Your diabetes and maternity health professionals will work with you to help keep you and your baby healthy during pregnancy, labour, and birth. Make sure you ask them as many questions as you need to. This will help you to be more prepared.
Talk to your doctor or midwife about writing your birth plan. It is best to do this around 36 weeks of pregnancy. A birth plan needs to be flexible and may need to be adjusted as your pregnancy progresses.
A birth plan is a written document that outlines what kind of care you would like when you are in labour and giving birth. It can include:
Who you want with you during labour and delivery
How you would prefer to manage pain
What your cultural or religious preferences are
How you would like to feed your baby after delivery
Make sure you have a printed or digital copy of your birth plan ready to take to hospital. Use this handy checklist from the Department of Health and Aged Care’s Pregnancy, Birth & Baby website to make sure you and your baby have everything you might need. Talk to your diabetes health professionals about any diabetes supplies you need to pack.
If you live in a rural or remote area discuss available options for delivering your baby with your local health professionals. They can let you know about services available to you locally and whether travel to a larger maternity hospital may be needed.
There is financial assistance available to help with travel and accommodation costs when you need to travel long distances for health care not available locally. Ask your general practitioner (GP) for more information. Find out more on the healthdirect website.
Most women with gestational diabetes will be able to deliver their baby close to their due date and most are able to have a vaginal delivery.
If your baby grows too large or there are any other concerns about your pregnancy, your maternity health professionals may suggest an induction, one or two weeks early. An induction means helping your body to start labour. Talk to your maternity health professionals about the possibility of induction, when it might be needed, and the different methods used.
As with all pregnant women, there is a possibility that you may need a caesarean birth. Sometimes a caesarean may be required if your baby is too large. There are other reasons a caesarean might be needed such as low placenta, if your baby is breech or if you have had a previous caesarean delivery. It is a good idea to talk to your maternity health professionals about caesarean delivery, so that if it is needed, you are well prepared.
Once labour starts, it is important to keep your blood glucose level in the target range. This will help prevent your baby’s blood glucose from dropping too low in the first few hours after birth. When you are in active labour your maternity health professionals will look after your gestational diabetes management. This includes regularly checking your blood glucose level. You may be given insulin by injection or through a drip (an infusion). This is more likely if you needed treatment with high doses of insulin during your pregnancy. Some women may also need a glucose drip during labour, although this is not very common.
After your baby is born, a paediatrician, your obstetrician or midwife will check your baby. They will continue to check on your baby for the first 24 to 48 hours.
This will include checking your baby’s:
Midwives will check your baby’s blood glucose by doing a heel prick. This is not to check if your baby has diabetes. This is to check that your baby’s blood glucose level has not dropped too low after birth.
If it is low, your baby may need to have some extra feeds or some glucose. Talk to your midwife about using your breastmilk for extra feeds for your baby. Your midwife will regularly check your baby’s blood glucose until it is back in the healthy range.
Breastfeeding has many benefits both for you and your baby. It can:
Support your baby’s immune system, growth, and development
Help you bond with your baby
Reduce the risk of future type 2 diabetes for you and your baby
After your baby is born, you will be encouraged to have skin-to-skin contact and start breastfeeding straight away. Breastfeeding at least every three hours during the first few days will help maintain your baby’s blood glucose level.
Establishing breastfeeding can take time and may sometimes be challenging. Make sure you get all the information and support you need. Your midwife or lactation consultant can support you to establish breastfeeding and help with strategies for successful breastfeeding.
This means placing your baby on your bare chest as soon as possible after birth. This has many benefits for you and your baby.
A lactation consultant is a specially trained health professional who can provide information, support, and advice about breastfeeding. Ask your midwife or obstetrician about how to access a lactation consultant in your local area.
For breastfeeding information and support, call the National Breastfeeding Helpline on 1800 686 268. You can get support 24 hours a day, 7 days a week.
Local breastfeeding support networks are available in hospitals and in the local community. Ask your midwife, lactation consultant or child and family health nurse for more information.
If you have difficulty breastfeeding or are not able to breastfeed, you may need extra emotional support at this time.
Antenatal expressing
The practice of expressing and storing breast milk during late pregnancy is becoming more common among women with gestational diabetes, with the hope of having some colostrum (the first milk) to offer if baby has low blood glucose levels after the birth.
It is very useful to learn the skill of hand expressing, so that you are prepared for when your baby arrives. Antenatal expressing may not be suitable for all women, so it is recommended that you talk to your maternity health professionals for advice if you are considering expressing breastmilk during late pregnancy.
After your baby is born, your blood glucose levels will usually return to the healthy range, and you will no longer have diabetes.
If you were using metformin or insulin to manage gestational diabetes, this will usually be stopped.
Your diabetes health professionals will let you know how often to check your blood glucose to see whether the levels have returned to the healthy range (usually 4 to 8 mmol/L).
After pregnancy, there are a number of health checks that you will need. This includes a health check six weeks after your baby is born. This will usually be with your GP or obstetrician.
Your doctor will talk to you about your physical and emotional health, and the support you have. They will also discuss contraception with you. Be sure to remind them that you had gestational diabetes, even if it was just for a short while.
You will be advised to have an oral glucose tolerance test 6 to 12 weeks after your baby is born. This is to make sure your blood glucose levels have returned to the healthy range.
