Many hospitals still persist in inducing diabetic mothers at 38 weeks. Anna Knopfler, who set up the self help group Diabetic Pregnancy Network, suggests asking your doctor what percentage of diabetic births at your hospital are induced. If it is high, you should shop around for a hospital with a more enlightened attitude, and make sure your doctor knows that you want to go to term unless there are real rather than just feared complications.
Dr Odent says there is no reason why a healthy, well controlled diabetic shouldn't have a natural birth. By that, he means privacy, comfort, familiar surroundings and freedom to move around. Even if home birth isn't yet an option for many diabetics, you should try to mimic those ideal conditions as far as possible.
A speedy birth is particularly important for diabetics, yet medicine contrives to create conditions where that is unlikely to happen naturally. Dr Odent says all mammals instinctively seek privacy when giving birth for good reason. Undisturbed labour allows the "primitive structures" of the brain which should be active during birth to come to the fore. "When you take a woman and observe her and subject her to strong light, you make it impossible for her to make this change in her conscious level," he says.
The hospital setting itself, therefore, slows up the birth process and makes it more hazardous. To counter a problem of its own design, medicine has designed a daisychain of interventions.
In the British Diabetic Association's pregnancy pack,it describes a mother strapped up to four drips during labour; hormones to precipitate contractions; glucose; insulin; and a drip to raise her blood pressure which was expected to fall as a consequence of the epidural she had been given.
The process of intervention is self perpetuating. The pain and distress accompanying an induced birth will in themselves help make the diabetic's blood sugar levels unstable, which increases the likelihood of needing glucose and insulin drips.
Before selecting your hospital, check whether you can elect to manage your own insulin doses during labour.
According to research published in The Lancet (13 June 1992), birth without infused insulin and glucose remains rare. Some 87 per cent of respondents (representing 128 of the UK's 218 health districts) routinely use insulin and glucose drips, citing "standard practice" or supposed "difficulty in managing without a drip". The report's authors are in no doubt that drips are used simply for the convenience of hospital staff; drips make for "ease of administration and simplicity of approach, and can be used by staff who may not be experts in diabetes management." Just 2.3 per cent of respondents had ever elected to manage labour in eight insulin dependent women without drips. (Instead, they used a regime of 4-6 hourly insulin injections and sips of glucose taken as necessary which leaves the diabetic and her partner far more in control.) In all eight: "The outcome of the pregnancy was a live delivery without major neonatal problems."
In some hospitals it is still standard practice for the baby to be taken away for 24 hours after birth for observation and to be tested for hypoglycaemia. Dr Odent deplores this practice. "The best way for the baby to avoid hypoglycaemia is for it to get plenty of colostrum as soon as possible," he says. Again, you should check with your hospital whether you will be able to keep your baby with you after the birth.