Birth Planning with Gestational Diabetes: What to Expect During Labor and Delivery

February 15, 2023

Birth Planning with Gestational Diabetes: What to Expect During Labor and Delivery
labor delivery birth plan gestational diabetes pregnancy postpartum

Birth Planning with Gestational Diabetes

As your pregnancy progresses, thoughts naturally turn toward labor and delivery. Having gestational diabetes adds some additional considerations to this process, but with proper preparation, you can approach your birth with confidence. This guide covers what to expect during labor and delivery with gestational diabetes, from planning to postpartum.

How Gestational Diabetes May Affect Your Birth Plan

Gestational diabetes can influence certain aspects of your labor and delivery experience:

Timing of Delivery

  • Well-controlled GD with no complications: Most providers allow pregnancy to continue to 40 weeks, with spontaneous labor or induction shortly after
  • GD requiring medication or with complications: Your provider may recommend induction between 37-39 weeks
  • Signs of a very large baby (macrosomia): Earlier delivery might be considered

Mode of Delivery

  • Vaginal birth: Still the most common and preferred delivery method for most women with GD
  • Cesarean section: May be recommended if:
    • Baby is estimated to be very large (typically over 4500g/9.9lbs)
    • There are other complications besides GD
    • Previous cesarean or other medical factors exist

Monitoring During Labor

  • More frequent monitoring of both baby and blood glucose levels
  • Possibly continuous electronic fetal monitoring
  • IV access for potential administration of fluids or insulin

Preparing Your Birth Preferences

While maintaining flexibility is important, having a birth plan helps communicate your preferences:

Questions to Discuss with Your Healthcare Team

  • At what point would they recommend induction?
  • Under what circumstances would they recommend a cesarean?
  • How will blood sugar be managed during labor?
  • What monitoring will be needed for the baby after birth?
  • How might GD affect immediate postpartum care?

Birth Plan Considerations

  • Preferences for pain management
  • Movement during labor
  • Support persons present
  • Initial bonding time with baby
  • Breastfeeding initiation
  • Placental birth preferences
  • Newborn procedures timing

Remember that a birth plan with gestational diabetes should be flexible, acknowledging that medical needs may necessitate adjustments.

What to Expect During Labor

Blood Sugar Management

Your blood glucose will be monitored regularly during labor, typically every 1-2 hours. Management approaches include:

  • If blood sugar is well-controlled: Monitoring only, with IV fluids as needed
  • If blood sugar is elevated: IV insulin may be administered
  • If blood sugar is low: Dextrose solution may be given

In most cases, you won’t need to continue your usual gestational diabetes management regimen during active labor, as the physical work of labor typically keeps blood sugar levels from rising significantly.

Pain Management Considerations

All standard pain relief options are generally available to women with gestational diabetes:

  • Epidural anesthesia
  • Nitrous oxide
  • IV pain medication
  • Natural comfort measures

Some pain medications may affect blood sugar levels slightly, but this is usually manageable with monitoring.

Labor Progression

Labor may progress differently for women with gestational diabetes:

  • Some studies suggest a slight increase in labor dystocia (difficult labor)
  • Induction may be longer if the cervix isn’t ripe
  • More frequent monitoring may limit mobility somewhat

Immediate Postpartum Period

Your Body After Birth

Almost immediately after delivery of the placenta, insulin resistance typically resolves:

  • Blood sugar levels usually return to normal quickly
  • Insulin or oral medications are discontinued
  • Dietary restrictions are lifted
  • Follow-up testing is scheduled for 6-12 weeks postpartum

Newborn Monitoring

Babies born to mothers with gestational diabetes require some additional monitoring:

  • Blood sugar checks: Typically starting 30 minutes to 2 hours after birth and continuing for 12-24 hours
  • Feeding: Early and frequent feeding helps stabilize baby’s blood sugar
  • Temperature regulation: Some infants may need additional support maintaining temperature
  • Monitoring for jaundice: Slightly higher risk necessitates careful observation
  • Breathing patterns: Occasionally monitored more closely, especially if born before 39 weeks

Breastfeeding and Gestational Diabetes

Breastfeeding is highly recommended after gestational diabetes for several reasons:

  • Helps stabilize baby’s blood sugar levels
  • May reduce your risk of developing type 2 diabetes later
  • Supports weight loss efforts postpartum
  • Provides all the usual benefits of breastfeeding

Most women with gestational diabetes can breastfeed successfully, though some may experience delayed milk production if their blood sugar was poorly controlled. Early and frequent nursing or pumping can help establish milk supply.

Postpartum Follow-Up

Blood Sugar Testing

Six to twelve weeks after delivery, you should have a follow-up glucose test:

  • Usually a 2-hour oral glucose tolerance test
  • Determines if glucose metabolism has returned to normal
  • Identifies women who may have had undiagnosed diabetes before pregnancy

Long-Term Risk Management

Having gestational diabetes increases your risk of:

  • Developing type 2 diabetes (by approximately 50%)
  • Having gestational diabetes in future pregnancies (30-70% recurrence rate)

Risk reduction strategies include:

  • Maintaining a healthy weight
  • Regular physical activity (aim for 150 minutes weekly)
  • Healthy eating patterns
  • Annual diabetes screening
  • Preconception counseling before future pregnancies

Supporting Recovery and Adjustment

Physical Recovery

Physical recovery after birth with gestational diabetes is similar to recovery without GD, but with added attention to:

  • Blood sugar patterns
  • Gradual return to exercise
  • Nutrition that supports healing and lactation
  • Adequate rest and stress management

Emotional Processing

Many women benefit from processing their gestational diabetes experience after birth:

  • Acknowledge any feelings of disappointment or guilt
  • Recognize the hard work and sacrifices made for your baby’s health
  • Connect with others who’ve had similar experiences
  • Focus on the positive health habits developed

Planning for Future Pregnancies

If you plan to have more children, consider:

  • Achieving a healthy weight before conception
  • Meeting with a healthcare provider for preconception counseling
  • Early screening for gestational diabetes in subsequent pregnancies
  • Maintaining healthy lifestyle habits between pregnancies

The Bottom Line

While gestational diabetes does add some considerations to labor and delivery, with proper management and preparation, most women have positive birth experiences and healthy outcomes. The condition typically resolves immediately after birth, though follow-up testing is important to ensure your blood sugar has returned to normal levels.

Remember that the adaptations you’ve made during pregnancy have given your baby the best possible start in life, and many of the healthy habits you’ve developed will benefit your long-term health as well.

In our next article, we’ll discuss the postpartum period in more detail, including how to recover while caring for a newborn, when to be screened for diabetes, and how to maintain the healthy habits you’ve established.