Postpartum Care

What happens after I give birth?

Many mothers  experience emotional "ups and downs" as their hormone levels return to pre-pregnancy levels and you return to normal activities. Insulin needs will be lower than while you were pregnant and insulin doses should return to pre-pregnancy levels within a few weeks after your baby arrives,

Patients who have diabetes before becoming pregnant sometimes have difficulty returning to their normal dietary routine after delivery. It can be hard to stick to a rigorous schedule for meals and snacks when caring for a new baby, but it's essential that you maintain good monitoring and eating habits for optimal control over your blood sugar.

If gestational diabetes developed during pregnancy, your doctor will probably discontinue insulin treatment after delivery and monitor a few blood sugars before releasing you from the hospital.

Most of the time (>90%) gestational diabetes will resolve after pregnancy, however, some women have persistently high blood sugars and require postpartum treatment. Fasting blood sugars should be drawn at the 6 to 8 weeks postpartum visits.

• If the fasting sugar is > 125 mg/dl or a random sugar is > 200 mg/dl (on two occasions), overt diabetes needing treatment is present.
• If the fasting sugar is 111 - 125 mg/dl, a 2-hour oral glucose tolerance test should be administered with a 75-gram glucose load for further evaluation.
• If the fasting sugar is < 111 mg/dl, the diabetes has resolved but a screening test should be performed every year particularly if insulin was required during the pregnancy since up to 60% of women will develop overt diabetes later in life.

Breastfeeding

Mothers with diabetes can definitely breastfeed their children but, as with all nursing mothers, caloric needs must be carefully adjusted. Add approximately 500 calories per day to your pre-pregnancy diet, which will make up for the extra energy needed for milk production. If breast feeding continues for longer than three months, you may need to consume more calories.

Breastfeeding moms who have pre-gestational diabetes are more prone to hypoglycemia, particularly in the nighttime hours between the bedtime snack and breakfast, so make sure to keep a record of your glucose levels,. You might need to have a snack before nighttime breast feeding

If an oral medication was prescribed to control blood sugars before pregnancy and your doctor switched you to insulin during pregnancy, insulin may still be needed while breast feeding. Do not take any oral medications while breast feeding without your doctor's approval.

Birth control

Choosing the safest and best time to have a child is one of the keys to planning a successful pregnancy for the woman with diabetes. Discus birth control options with the doctor or nurse before leaving the hospital. 

There is no specifically recommended form of contraception for women with diabetes, though contraceptives containing only progesterone (e.g. the minipill, Norplant, Depo-Provera) may make sugar control more difficult or have a negative effect on the cholesterol and lipids.

In addition, there is some evidence that in women who had gestational diabetes, using a contraceptive with only progesterone may increase the chance of developing overt diabetes later in life.

Remember, you can get pregnant again very soon after giving birth. Even if there has been no menstrual period, ovulation may still occur. Some people believe that breast feeding a baby will prevent pregnancy…. but this is not true!