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Re: [IPk] pregnant pumping

I am at the moment trying to update policies within our unit, what I have 
been aiming for is that mums go into labour naturally without being induced 
-it does happen rarely! we check Bg's (that is the mum herself partner or 
myself depending on her wishes) if it is her second or third baby then 
labour is usually shorter so you dont get time to start a sliding scale 
anyway and even if you are induced this can happen too. You are using a lot 
of energy in labour as well as releasing insulin antagonist hormones so I 
guess the advantage of antra-venous sliding scale versus a pump is that the 
result is supposedly quicker as your body is trying to do so many other 
things it may not be able to absorb the sub-cutaneous insulin so readily.- I 
know this comment may cause comment but I am prepared!
I still feel inductionn pre-term is better because noome is ABSOLUTELY sure 
what causes unexplained intra-uterine death in babies of IDDMs. the idea of 
being controlled in labour is to ensure that the baby does not develop  
severe hypoglycaemia a few hrs after delivery BUT there is NO need for baby 
to go to SCBU at any time unless there is a problem. Our BG meters are 
incompatable with neonatal blood but the neonatal ones are portable and the 
nurses can easily come and check the baby on the ward with you as well as 
they can in the neonatal unit.
Post delivery your insulin requirements will drop dramatically as you are 
aware so YOU need to be in chargs . Midwives are generally perplexed by 
diabetes and I think you will find they will be only too happy to let you do 
your own thing and remember to reduce the rate to your prepregnancy dose and 
start straight away. Colostrum has a much higher glucose content than bottle 
so start to feed the baby straght away to keep her supplies up. Good luck 
and I will try and get more info for you Carmel

>From: "Rod Protheroe" <email @ redacted>
>Reply-To: email @ redacted
>To: <email @ redacted>
>Subject: [IPk] pregnant pumping
>Date: Mon, 10 Dec 2001 22:07:09 -0000
>Please help!
>I'm 29 weeks pregnant with my 3rd child and have been on a minimed pump 
>March 2001. So far I have had no severe hypos / DKA, no pregnancy
>complications and blood sugars have been well controlled (last HbA1c 4.6).
>Despite this, my hospital (Maidstone) seem determined to follow their 
>policy for diabetic mums (apparently I'm the first one to be on a pump) -
>1. labour to be induced at 38 weeks (though I have been told that the
>increased risk of stillbirth only starts after 40 weeks if sugars are well
>2. the pump to be removed for labour and a sliding scale insulin and 
>drip used instead, (the midwives have no experience of pumps though my 
>plans to be there to monitor my sugar and adjust rates as necessary)
>3. the baby to spend its first 24 hours away from me in a special-care unit
>for monitoring (I have been told that this policy is because they are short
>staffed on the postnatal ward, but surely they could do a heel prick every 
>hours when they check that I'm not going hypo? - it worked ok with my first 
>(born pre-policy) who didn't go hypo. Also I am hoping to start 
>every 3 hours rather than having to express.)
>I realise that things don't always go to plan and I would obviously put the
>baby's health before my wishes, but their policy seems a bit inflexible. So
>far some doctors and one of my DSNs agree with me and are trying to 
>others but it seems unlikely that they will succeed. Has anyone had similar
>experiences? Am I justified in challenging the hospital policy? - if so, 
>anyone any advice?
>Tessa Protheroe (email @ redacted)
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