A significant part of a woman’s experience of pregnancy is birth and delivery. Current guidelines on the management of labour for women with diabetes in pregnancy recommend a range of often intensive regimes aimed at maintaining maternal euglycemia to reduce the risk of neonatal hypoglycaemia.
At our institution, we have been following a low intervention approach to management of maternal blood sugar levels for women with both gestational and pre-gestational diabetes for more than 20 years. This includes issuing a personalised plan to each woman documenting the required frequency of capillary blood glucose monitoring as well as a protocolised approach to the use of supplemental insulin and/or glucose. Insulin and dextrose infusions are rarely used, even for women with pre-gestational diabetes. Insulin pump therapy is continued throughout labour unless contraindicated.
Our audit figures confirm that a low intervention model of care for women with gestational and pre-gestational diabetes undergoing vaginal birth is desirable and safe. This model more closely meets women’s desire for “a physiological labour and birth” and “if intervention was needed or wanted, women wanted to retain a sense of personal achievement and control through active decision-making”.