My T1D Labor & Delivery Story — The Ultimate Diabetes Guide

Before I became pregnant, I scoured the internet looking for detailed stories of women who had navigated pregnancy and labour with type 1 diabetes so I’d have a better idea of what to expect when my time came. While there are some great articles and books out there, I wanted to hear the first-person experiences. There are so many stories people have shared and each is unique, and seeing the common threads helped me to feel more prepared. So, I want to add my story to the mix for anyone curious about giving birth with T1D!
A few notes before we begin:

I made a TikTok video of my experience that I’ve link below if you’d prefer to listen vs. read!
I’m going to do a separate post about postpartum because there’s a lot to cover, so stay tuned for that.
I delivered my baby in a large hospital in Toronto, Canada, so please keep that in mind if you’re located elsewhere.
I had a positive experience overall, so there are no scary bits incoming (yay!)

Induction

I had a scheduled induction at 38 weeks on the dot, which is protocol at my hospital when you have T1D. My baby was measuring normally and there were no concerns, but I still opted to deliver at 38 weeks based on my healthcare team’s recommendation. I arrived at the hospital at 11am in the morning and was not dilated or effaced (aka how ready the cervix is for birth) at all so we were starting from ground zero. Our nurse told us that I could continue using my own insulin pump and CGM but that I needed my blood sugars to stay between 4.0 and 7.0 to avoid activating their protocol for an insulin/glucose drip. I was nervous about this as any type 1 will know that’s a super tight range to stay within at the best of times, but my nurse was confident it would be okay. I put my husband on CGM watch (he shared my blood sugar readings with our nurse every hour) and hoped that the Tandem Control IQ would be enough to keep my blood sugars stable, which is what my pregnancy and endocrinology team had recommended.

I prepared for the induction by including a section about diabetes on my birth plan so anyone involved in my care would know without me or my husband having to explain it to them. For me, this looked like including the following section:

Diabetes Management

I plan to wear my insulin pump and continuous glucose monitor throughout labour and have discussed this with my endocrinology team (see signed paperwork)
I would like to not have an insulin or glucose drip unless absolutely needed
Prior to active labour I would like to eat my own snacks/food
If my blood sugar drops throughout labour, I have brought my own clear juice to drink
Jeremy will help with diabetes management as needed
If C-section is required, I/Jeremy would like to manage my diabetes throughout the procedure

The induction started with a few doses of misoprostol, a drug given to help induce contractions, and a foley balloon. The misoprostol and foley balloon combo was successful in kicking off labour and within two and a half hours I had dilated to three centimeters (I will say that the balloon was one of the least pleasant things I’ve ever experienced from a healthcare standpoint…but luckily it didn’t last too long!). Throughout this initial part my blood sugars remained steady around 6.0.

Since this was the beginning of labour I was still allowed to eat and definitely had an appetite. I brought a ton of snacks with me to the hospital and had a few Clif bars and handfuls of trail mix over the first six hours. Before the induction really got started, Jeremy also went to the food court and got us both sandwiches and salads, so I had that too. I bolused for these things using my usual pregnancy routine of a 20 minute prebolus and a higher dose of insulin.

From the start of labour throughout the first 12 hours, my blood sugars fluctuated a little, but never went above or below 4.0-7.0. There was also no consistent pattern of my readings trending higher or lower, just the usual daily ebbs and flows.

This was me about 4 hours in, blissfully unaware of what was coming (lol)!

Epidural

I was able to continue labouring for several hours after the initial doses of misoprostol and the foley balloon, although my appetite and interest in food completely disappeared as my contractions ramped up (I was so worried the hospital would restrict my food intake to manage my blood sugars and energy levels throughout labour, but turns out my body did that all on its own!). After about 12 hours of strong, consistent contractions but minimal progression in terms of dilation, I opted to get the epidural. I was quite tired and hadn’t been able to do anything between contractions as they were about 15-25 seconds apart and the delivery team wasn’t sure how much longer things would take, so that was enough to push me to get the epidural.

I had intended to try to deliver without the epidural but knew that it might be challenging since I had heard having an induction can make contractions a lot worse, so I had proactively moved all of my diabetes devices off of my back just in case. I had my CGM on my arm and my insulin pump on the very lower edge of where my back meets my stomach, but not on the bump. These two spots were good because then I didn’t need to worry about my devices getting in the way of the epidural placement (there’s a lot of adhesive film and tape on your back with an epidural) or heart rate monitoring. It did take two tries to get the placement correct, but thankfully (or not??) I didn’t notice too much because of the ongoing contractions.

Once the epidural was in place and working I was finally able to relax (the best feeling ever!). Surprisingly, my blood sugars had remained in the 5.0-6.5 range all throughout the contractions and the epidural placement—possibly because my body knew I didn’t have the energy to worry about diabetes! With the epidural in place I was able to finally take a nap while Jeremy continued to keep an eye on my blood sugars and share the readings with the nurses.

Pushing

After 16 hours of labour, I was finally ready to push. My pregnancy endocrinology team had prepared a sheet of hospital orders that I gave to my nurse upon arrival which stated I should change my insulin pump settings before pushing, so that’s what I did. I thankfully preloaded the settings into my pump beforehand so it was a simple switch when the time came, which I definitely recommend other type 1 moms do. Even taking 15 seconds to switch my settings felt like a lot during such a huge moment when my attention was elsewhere, and I remember thinking that I was glad I wasn’t having to mess around with my pump more.

*Sidenote: I went from having 12 basal segments and insulin to carb ratios during pregnancy to having three segments with only one insulin to carb ratio for the pushing/post-delivery basal profile. I asked my healthcare team several times if this was correct as I just couldn’t believe it was (even before pregnancy I had 8+ segments and several different insulin to carb ratios), but they assured me it was. Just a heads up for anyone else that this is normal! Essentially after having the baby you’re going to have to figure out all the new settings that you need and add them manually over the coming months, so the initial profile they give you to start with is very minimal. It reminded me of when I was first diagnosed.

I pushed for about 20 minutes and my blood sugars held steady around 5.0. I wasn’t sure how that would go because there was both adrenaline and physical activity happening, but the Control IQ was able to maintain my blood sugars at a good number throughout and I didn’t think about diabetes at all.

Post-Delivery

After 20 minutes of pushing we welcomed our son, Wyatt, into the world! It was such a surreal moment that I will never forget. However, diabetes is never too far from mind, and shortly after delivering my blood sugar started to drop. I dropped to 3.5 and my husband gave me juice so I didn’t need to start a glucose drip, as per the hospital’s protocol.

Taking some time to admire my handiwork before heading upstairs to the postpartum unit!

Following the juice, my blood sugars stabilized around 6.0 for the next few hours and I was thankfully able to forget about diabetes for a while and focus on my new baby. I had been worried that diabetes would impact the initial few hours of having a newborn if I was on a blood sugar rollercoaster, but thankfully we were able to avoid that. I had a brief snack of a Clif bar about an hour after delivery and then prepared to be moved to the postpartum unit.

Once we were settled into our postpartum room, I sent my husband in search of the post-delivery meal I had been dreaming about for months: greasy pizza and ice cream cake. I didn’t have many cravings throughout pregnancy but I had really wanted pizza and DQ ice cream cake towards the end. However, I didn’t want to have to struggle through the insulin resistance and potential spikes that come with the third trimester so I decided to save it until after delivery. To put into perspective how much your insulin needs change once you deliver (it’s actually the placenta that causes all the resistance!), I took about 20% of the insulin I would have needed before to cover the pizza and ice cream and only prebolused a few minutes in advance and I STILL trended down. It was nice after so much diabetes math and avoiding carb-heavy foods in the last few months of pregnancy!

My well-deserved ice cream cake (that I shared with friends and family!)

For the remainder of the time in the hospital my blood sugars generally stayed in the 4.0-7.0 range, but I did have a few lows as I started breastfeeding (I’ll do a separate post on breastfeeding and the recovery experience with diabetes shortly!).

Supply List

Thankfully I didn’t need to do any site changes or any big diabetes tasks while at the hospital, but it’s always good to be prepared! Here are the diabetes things I packed in my hospital bag:

2 insulin pump sites and reservoirs
2 Dexcom CGM sensors
1 Dexcom transmitter
Backup glucose meter and strips
3 Gatorades (full sugar versions)
1 box of Clif Bars
1 bag of trail mix (a lower carb snack in case I was hungry but needed less carbs)
Insulin pump charging cable
Hospital orders from my endocrinology team (these were on a special sheet of paper that the nurse took upon arrival which stated I was approved to use my own diabetes devices)
Birth plan with details on diabetes management wishes (no glucose/insulin drip if possible, keeping my own devices, my husband being the point person for diabetes management, etc.)

Summary

All in all, I was pleasantly surprised by how little type 1 diabetes impacted my labour & delivery experience. It was definitely there in the background, but I was able to outsource the blood sugar checks to my husband and my nurse and didn’t have to worry much about highs and lows. Having an automated insulin system definitely made the process easier, but when looking back on my data I noticed that the automated loop system didn’t actually kick in all that much, so don’t worry if you don’t have one. Getting the pushing/post-delivery basal profile set up made the process quick and easy when it came time to push, but the adrenaline and physical activity didn’t have anywhere near the impact I thought it would. I’d like to think my body knew there was something bigger than diabetes going on and didn’t complicate the process further, but I don’t have any research to back that up (lol).

In hindsight, I’d recommend doing the following things if you’re a type 1 preparing for birth:

Speak with your healthcare team about their thoughts on induction and using your own devices (they should prepare orders for you to bring to the hospital)
Include notes about your preferences around diabetes in your birth plan
Back all the supplies you’ll need just in case (I packed the same supplies as if I was going away for a weekend trip)
Bring lots of snacks, with and without carbs!
Bring fast-acting sugar sources, like juice or Gatorade
Prepare your support person so they know what to expect/how they can help you
Put your CGM and insulin pump in places where it won’t interfere and need to be removed (i.e., keep your back, bump, and at least one arm free for blood pressure readings and IVs)
Plan a post-delivery meal that you’ll be excited to eat (ideally with lots of carbs!)

If you’re delivering soon, you’ve got this! Diabetes can be a pain in the butt in a lot of ways, but, at least in my experience, it stayed out of the way for delivering my baby which I was super thankful for!

Video Version

Check out the video below and follow me on TikTok for more diabetes content (which will be ramping up now that I’ve found more of a routine for life with a new baby!)

My T1D Labour & Delivery Story