September 17, 2006
permalink Being on a drip.. grrr...

At the risk of casting a shadow on what was a truly beautiful event, it was quite horrible at times, being hooked up to the insulin dextrose drip for the two days before the birth, day of the birth and morning after.

The first issue was that the midwives could not find me a mobile drip. I knew in advance that I wanted to keep as mobile as possible before and after the birth. Partly because it helps you recover quicker, also because being immobile and having a caesarean (also probably having diabetes and kidney disease) increases your risk for developing DVT (Deep Vein Thrombosis) post birth.

Mobile drips (where you can walk around but take your drip with you) were available at the hospital, but it was difficult for the nurses to track one down for me. It took them a day, so I was immobile. I think people thought I was mad (when I finally did get the mobile drip) the night before the birth and the morning of the birth when they saw me wandering the hospital corridors attached to my drip. But I was determined to be as fit as possible. Even the one day lying mostly immobile had affected my body making me feel a bit stiff and weak!

The other thing that happened to me that seems to have faded into insignificance now but was actually scary and potentially life-threatening at the time, was that I was given a massive dose of insulin via the mobile drip accidentally on the day my son was born.

Partly the problem resulted from the fact that the midwives did not seem to know how to operate this drip. For the entire time I was on the drip (thirty six hours before the birth and at least a day after) an alarm would go off intermittently indicating that there was some error. Some midwives would try to sort it out themselves. Others would get another midwife with more expertise to come an help, while others would simply flick at it and seem to be pressing buttons almost randomly to make the drip stop beeping! It was totally disconcerting and resulted in me not getting much sleep at all the night before the birth.

But the scary incident happened on the day of the birth. The alarm went off to notify the midwives that my drip had run out of insulin. The midwife attached the new bag to the drip and entered the two required numbers into the drip machine. One was the amount of total insulin in the bag. The other was the hourly rate at which the insulin was to be infused. We did not realise it but she had gotten the two numbers wrong. Result: I was given a huge dose of insulin in a short time. The machine would have gone on giving me this amount (something like 60 units an hour) only the machine beeped again, causing the midwives to come in yet again and realise what they had done. So they switched the figures and set the machine up properly.

The worst thing about this was that although they fixed the rate problem, it didn't dawn on them that they had just given me a massive dose of insulin. I started to have a hypo that felt like the bottom was dropping out of my universe and then my partner who luckily was there at the time, realised what had happened. I skulled a lot of lucozade and was eventually okay, but it was quite upsetting nonetheless.

My obstetrician apologised to me the next morning and said that she would make a recommendation to the hospital that a protocol would be set up for this machine that would require two nurses to be present whenever the drip was being set up or an alarm was being tended to.

It's so difficult in these situations, as the nursing staff are often under a lot of stress and time pressure due to staffing limits, but as my obstetrician said, had it been, for instance Morphine, that was in the drip, it could easily have been life-threatening.

The other foul thing about being on the drip was the sliding scale used to determine how much insulin I should be having. It was really hard to come to grips with this after so tightly controlling my own blood sugar levels for so long using the pump.

My sugar levels did definitely increase due to the two steroid injections but perhaps not as much as my doctors thought they might. On quite a number of occasions I was told that I would be given an amount of insulin by infusion based on the sliding scale calculations that was way smaller than what I would have given myself on the pump for the meal I was about to eat. I knew my sugar levels would rise considerably after this and it was extremely stressful knowing that this would pass over to my baby and more than likely result in hypoglycemia in his early hours. On a few occasions I gave myself injections of fast acting insulin to lower the sugars that I knew would result from the sliding scale method. I was not meant to do this but felt compelled to in order to avoid massive highs passing through to my baby. I also avoided eating some of the sweeter foods. My doctor assured me that the insulin dose required would be so high and the sugars so hard to control that what I ate would not make an impact, but I disagreed.

I'm not sure that I would have done anything differently. But it was difficult relinquishing control at this time and I think in retrospect I probably would have tried to keep my pump on and adjust my own levels during this pre birth steroid period (in conjunction with my doctor). I feel I might have had a chance at keeping my sugar levels better controlled than they were.

Posted by patton at September 17, 2006 11:46 AM
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