With diabetes or gestational diabetes, blood sugars in your newborn can be affected and fluctuate immediately after birth.
Our particular concern is low blood sugars (known as ‘hypoglycaemia’). Our unit staff will be working with you to aim to prevent this. Newborns have immature systems which is one of the reasons why we try to stabilise your blood sugars during labour and prior to your planned Caesarean using a Variable Rate Insulin Infusion (VRII).
Within the first hour of birth our staff will be encouraging the baby to feed. Immediate skin to skin is proven to help start the process of ‘rooting’ and is recommended where possible. Furthermore, there are many other benefits of skin to skin which you can discuss with your midwife. If breastfeeding, support will be given, but whichever method of feeding you choose will be supported. If you require further information to help you provide an informed choice on the benefits of breast and formula feeding then please ask.
Blood sugar monitoring for your baby
A small blood sample is needed prior to each feed. We start this before the second feed and look for three readings above 2mmol/L. Provided they are not below 2mmol/L we can discontinue blood sugar testing after these three samples. We encourage feeding every three hours for 24 hours and are then happy for you and baby to continue ‘responsive feeding’.
In the result of low blood sugars the course of action is very much dependent on the reading and the advice from the Paediatrician.
If breastfeeding, we recommend hand expressing from 36 weeks. This can be done once daily to begin with and then build up to three or four times a day by delivery. This is beneficial because it can help with preparation by giving your milk to your baby if the baby isn’t ready to feed from the breast, or if we need to raise the blood sugars promptly. Expressed breast milk can also help to avoid giving top-ups of formula milk and reduce the need to admit the baby to Special Care Baby Unit.
If you require any further information please inform a member of the midwifery team.
Hand expressing
There are many reasons to learn the skill of hand expressing and this is how.
- Roll your nipple between your finger and thumb to make it stand out. Make a C-shape with your thumb and either your index or middle finger, and cup your breast. Place your finger and thumb about two to three centimetres from the base of the nipple.
- Holding your finger and thumb in this C-shape, press back towards your rib cage. This brings your finger and thumb back into the dense, milk-making tissue, away from the ducts near the nipple.
- Bring your finger and thumb together, so that they press into the milk-making tissue, and milk will begin to appear in droplets. Counting to three or four seconds can help as sometimes they is a little delay in the milk coming through. Use a sterile cup or bowl to collect it, and try to build up a rhythm. Try not to slide your fingers over the skin, as this will hurt and it will be more difficult to express milk. When the flow slows down, move your finger and thumb around the breast or express from the other side, and you can keep changing breasts until the milk slows or stops. It is helpful to hand express when in the bath or shower, the warmth tends to open up the ducts.
Useful definitions
Hypoglycaemia = when a blood sugar is low and may cause particular symptoms.
Rooting = is mouth like action indicating the baby is looking and ready to feed. This commonly occurs prior to crying.
Responsive feeding = this is when mother and baby are responding to each other’s needs and cues. For example when the baby shows rooting signs, when the mother’s breasts are full, if the baby is lonely and/or wants comfort etc.
VRII = a intravenous infusion made up to manage the peaks and troughs of blood sugar levels.
Practice makes perfect
If you are doing this when your milk supply is not yet established, you may need to repeat these three actions a few times to get the colostrum to flow. You can keep moving your finger and thumb around or use the other hand to take milk from all around the breast.
You may find it helpful to watch a DVD called ‘Expressing and giving breastmilk’, available at realbabymilk.org
