Why might labour be different if you have Gestational Diabetes?

In our last post about Gestational Diabetes, we mentioned that labour and birth might be different if you have this diagnosis. Here we will go into more detail about the two main interventions that you are more likely to be recommended. They are an Induction of Labour and Continuous Electronic Fetal Monitoring during labour.

This might not sound like much, but depending on the type of labour you are planning, it can have quite an impact.

If you are planning an early epidural in labour and are happy for an induction of labour then this isn’t going to be an issue for you. These recommendations will not seem as intrusive for women who don’t wish to labour naturally. Continuous electronic fetal monitoring commences as soon as a woman chooses to have an epidural anyway.

You will need to have a conversation with your Health Care Provider to understand what they might recommend for you and to discuss your preferences.

If you’d prefer a natural birth

If you would prefer a natural birth, then these two interventions can significantly impact your experience. This is because they can interrupt the flow of labour and your ability to be in that lovely birth zone.

Here we will explore how labour is different when you have Gestational Diabetes in more detail.

Induction of Labour (IOL) – When and Why?

IOL is recommended for all sorts of reasons and is a very common procedure these days.

If your Gestational Diabetes is being managed well with diet and exercise, your blood sugar levels are stable, you haven’t developed any other complications and your baby’s growth is normal, then you are less likely to require an IOL unless you are overdue.

However, if you need insulin to manage your Blood Sugar Levels or you have developed other complications then IOL may be recommended to you from as early as 37-38 weeks. Your individual circumstances will dictate the safest course of action.

Research shows that every week of pregnancy counts and that there is a delicate balance between minimising risk and optimising the length of time the baby is growing in the womb.

For all pregnancies, there’s an optimal time for a baby to be born. If your pregnancy is healthy and progressing without any issues, then waiting for labour to begin on its own is the ideal plan. However, if a planned birth (by induction of labour or caesarean section) is needed, then that’s ideally as close to 40 weeks as possible.

If there are health concerns that might increase your risk of stillbirth, your health care professional will discuss with you how the timing of birth might reduce your risks, with your pregnancy continuing as long as it is safe for you and your baby. Through research we’re discovering that every week your baby continues to grow inside you makes a difference to their short and long term health and developmental outcomes.

Stillbirth Centre of Research Excellence – Safer Baby Bundle (link below)

How does an Induction of Labour impact plans for a Natural Birth?

What we are talking about here is your experience of labour and birth and your ability to make decisions about what is best for you and your baby.

In order for labour to progress well, our Autonomous Nervous System (the one responsible for flight or fight) needs to be in its relaxed state. This allows the hormones responsible for labour and birth to flow. When women are frequently interrupted and forced to switch to a more alert state, this can increase adrenalin which impedes these good labour hormones and slows the progress of labour down.

There are several aspects that might feel intrusive and that will break the flow of labour. Here are some of them:

1. You will probably be in hospital for anywhere up to a day before the labour actually starts. This means you won’t have time at home as the labour builds. It is sometimes easier to ignore the early part of labour when you are in your home environment and can more easily distract yourself.
2. You will require more frequent vaginal examinations. This is because your Health Care Providers need to know that the IOL is working.
3. Depending on how ready your body is for labour, you may need to try several different IOL methods before labour kicks in. This can be stressful and tiring.
4. Once labour starts, the contractions may increase in intensity faster than they would during natural labour. This means there is less opportunity for endorphins (mother nature’s pain relief) to build up in your system and help you cope with the contractions.
5. You will most likely be connected to an IV drip for your whole labour. An important strategy for managing contractions is for the woman to be able to move about freely. This may feel more difficult when you are attached to an IV stand.
6. Your Health Care Providers will need to attend more frequent observations of you and your baby. More frequent observations equals more frequent interruptions, which means more opportunities for adrenalin to build and interrupt the progress of labour.

How can Continuous Electronic Fetal Monitoring (CEFM) affect your experience of labour?

CEFM comprises two small monitors attached to the belly with stretchy elastic belts. One monitor uses ultrasound to measure the baby’s heart rate, the other detects when a contraction starts, peaks and finishes. This allows the midwives and doctors to assess how your baby is coping with labour.

CEFM can be disruptive to a woman in labour for the same reasons as IOL. This is because it can interrupt the hormones that allow labour to flow and your ability to be in that lovely birth zone.

Here are some of the reasons:

1. An important strategy for managing contractions is for the woman to be able to move about freely. Wearing an Electronic Fetal Monitoring device can make this more difficult.
2. The baby’s heart rate needs to be interpreted every 15 minutes to make sure the baby is well. This means that you will be interrupted frequently, which means more opportunities for adrenalin to build and interrupt the progress of labour. Sometimes this will be more than one person analysing the information, so it can start to feel crowded and you may be distracted by those conversations.
3. The monitor itself can feel annoying or irritating on your belly. As the baby moves down the pelvis, the monitors need to be adjusted accordingly. As you move around they may fall off, which means your midwife will need to fix them up again. All of this can be distracting.

This information is not designed in any way to alarm you! We understand for many women it is the safest course of action for you and your baby… but being prepared will help you to minimise the the impact of these interventions. There are ways that you can work on mindfulness techniques to block the distractions, and other techniques to optimise your ability to stay in that lovely birth zone.

Our Online Antenatal program for women with Gestational Diabetes has been specifically designed to help women with these challenges and minimise the impact of them. It is a structured program, walking you through all of the conversations you need to have with your Health Care Provider so that you know what to expect and they know what is important to you. We provide detailed information about how your labour is different with Gestational Diabetes, Induction of Labour, Continuous Fetal Monitoring and strategies for managing labour and birth with Gestational Diabetes.

Some women, after discussing their individual circumstances with their Health Care Provider, may choose not to have these interventions. Clearly, we cannot advise on the best course of action for you, but we strongly encourage you to start the conversation with your Health Care Provider sooner rather than later so you have time to weigh up your choices and prepare for the birth of your beautiful newborn.

As always, we wish you all the best.

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The websites below provide further information to help with decision making around induction of labour.

Every Week Counts – evidence based best practice for planned early birth across Australia

Stillbirth Centre of Excellence Research – Safer Baby Bundle is a nation-wide stillbirth prevention program