Birth Plans

Patient Expert

Pregnancy Tracker: 31 weeks, 3 days

Size of the Baby: Crown to rump length is over 11 inches** Biggest Obstacle:** Scheduling all my doctor's appointments.

During the latter stages of pregnancy, people start discussing their "birth plans." Decisions have to be made about everything from whether you want an epidural or not, if you're going to deliver in a birth center or Labor and Delivery, to what type of relaxation and breathing techniques you want to employ. Especially for first-time mothers, these options and decisions can seem overwhelming. It's difficult to know what you'll want until you've actually experienced the pain of child birth!

For mothers-to-be with preexisting diabetes, the choices are different and somewhat limited. I, for example, don't have the luxury of choosing a birth center for my delivery. High-risk pregnancies require constant fetal monitoring, which is done in Labor and Delivery. For high-risk moms, other factors have to be considered such as potential complications that may be addressed by inducing labor early.

Today I had an appointment with my main OB. He'd been gone for several weeks, during which I met with his partner. Both doctors are awesome, but they take somewhat different approaches.

A few weeks ago, my secondary doc mentioned that they'd probably induce labor for me at 38 to 39 weeks. She explained that type 1 diabetics have a slightly higher risk of still birth than the average. This risk only increases the longer you stay pregnant, thus some doctors choose to take the baby early. We're talking a very small risk, which largely is based on your level of blood glucose control throughout your pregnancy.

I wasn't thrilled about the idea of being induced, since it does increase your chance of needing a cesarean, which I would like to avoid, if possible. However, my attitude has always been that we'll do whatever is necessary to delivery a healthy baby.

At today's appointment, I asked my main doctor about being induced early. He explained that because of my level of control, coupled with the baby's average size and my low blood pressure (no signs of preeclampsia)I don't need to be induced. He'd prefer for me to go into labor on my own, naturally.

Of course, other complications could certainly arise between now and then, which might make induction or even a cesarean the healthiest choice for me. But for now, I'm excited that my doctor feels this pregnancy is going so well that I can have a regular, vaginal birth without diabetes-related complications.

Another decision that diabetic moms and their doctors have to make is how to deliver insulin during labor and delivery. My doctor has encouraged me to take off my pump and receive my insulin and glucose through an I.V. I'll continue to test my blood with my glucose monitor throughout labor. Letting go of control over my insulin will feel odd, but that's really just one more thing to think about during an already stressful time.

These are just a few of the birth plan considerations I've been thinking about lately. As the big day draws nearer, I'm sure many other aspects of childbirth will demand attention.


At my baby shower!

Read more of Kelsey's posts here.

Editor's note: We think Kelsey's having a girl. What do you think?