If you’re pregnant with Type 1 diabetes, you’ve probably had the induction chat thrown at you already.
Usually with that look… the “well, you are high-risk” eyebrow raise.
As if your body might suddenly fall apart the moment you hit 38 weeks.
But here’s the part no one says out loud
Most of the research driving these blanket rules is older than your insulin pump.
Pre-CGM
Pre-Libre
Pre-modern insulins
Pre-“I actually know what my glucose is doing at all times”
Which means
You’re being judged by data from a world that isn’t yours.
Let’s look at what’s really going on.
The Data They Quote Isn’t About Women Like You
The big “scary” diabetes-in-pregnancy studies, the ones your consultant vaguely waves at when they say
“the risk goes up after 38 weeks” —
were done on women:
• without CGM
• without pumps
• without alarms waking them at 4am
• with blood sugars staying high for months
We are not talking about the random 10.6 after lunch.
We’re talking about A1cs and glucose patterns from another era entirely.
What the Famous 2014 Paper Actually Says (Not What You’ve Been Told)
Everyone quotes the 2014 timing-of-delivery paper (find it here)
but almost no one reads it.
Here’s what the authors admit:
1. There is NO solid evidence that routinely inducing all diabetic women at 38 weeks prevents stillbirth.
2. Most stillbirths in their data happened BEFORE 36 weeks, so 38-week induction doesn’t even target the main risk window.
3. There’s almost no data on what happens if well-controlled Type 1 mums go to 39 or 40 weeks… because they’re almost never allowed to.
4. Induction before 39 weeks carries a higher risk of breathing problems for babies, especially when early-pregnancy glucose was high.
Their final line
There isn’t enough evidence to justify a one-size-fits-all rule.
Which means your consultant saying
“We induce all diabetic mums at 38 weeks — that’s just what we do”
isn’t evidence-based care.
It’s habit.
It’s fear.
It’s policy stiffness.
It’s convenience.
Not personalised medicine.
Why CGM Completely Changes the Story
This is the part guidelines haven’t caught up with.
The big CGM pregnancy studies and all the smaller ones since, show the same thing:
When Type 1 mums use CGM, outcomes improve dramatically.
We’re talking:
• more time-in-range
• fewer very large babies
• fewer neonatal hypos
• fewer NICU stays
(Check the CONCEPTT trial, 2017)
(and this one saying how Continuous Glucose Monitoring in Pregnancy is completely changing the game here)
A 2022 review confirms it, read it here
Also a nice, new piece of research done in 2024 shows even tiny increases in TIR massively reduce complications (here)
A 2025 study showed modern CGM pregnancies had lower rates of pre-eclampsia, fewer big babies and fewer neonatal hypos than historic cohorts (here)
This is not the data the old guidelines were built on.
Think of it like sun exposure
A whole summer baking in 35 degrees is dangerous
A walk to the car without sun cream is not
Yet induction is often sold to Type 1 mums as if a single spike is catastrophic.
It isn’t
Another great article here with evidence, practical tips and common mistakes with CGMs.
Induction Isn’t a Switch — It’s a Cascade
Induction isn’t “just getting things going.”
It’s a process:
sweep → prostaglandins → balloon → waters broken → syntocinon drip
(Induction of labour overview here)
Some women do brilliantly with induction.
Others find it longer, more painful and far more medicalised than spontaneous labour.
You deserve to know what you’re being offered —
not just be told it’s “safer.”
CGM and Your Placenta — The Truth, Not the Fear
Old research described Type 1 placentas as big, thick and “abnormal” —
but that was overwhelmingly when blood sugar control was poor.
More modern studies show:
When glucose is well-managed, placental structure in Type 1 pregnancies often looks very similar to non-diabetic pregnancies.
2009 study here, 2003 study here,
A huge 2014 review here of every placental study ever done found that results were inconsistent, definitions varied wildly, and most of the evidence comes from before CGMs and modern insulin.
This is not evidence built on women like us.
Your placenta isn’t failing.
It’s adapting to the environment you’ve created, and with a CGM, that environment is better than ever, measured in the older research.
“But I had two highs today — am I hurting my baby?”
No.
Not according to the evidence.
It’s long-term patterns that matter, not isolated spikes
Brief spikes that you correct quickly are not dangerous
They’re part of real Type 1 life, especially during pregnancy.
Correcting them quickly is protective
(CONCEPTT trial here and 2024 review here)
Now Here’s the Part No One Talks About
Why Waiting for Labour (When Safe) Protects Your Mind, Hormones and Bond With Baby
This isn’t just about numbers.
It’s about your heart, your hormones, your nervous system,
and how you feel when you look back on the day your baby was born.
1. The way you give birth can shape your mental health
Women with fewer interventions report lower postpartum depression and anxiety, (check the study here)
Your mind doesn’t forget birth
It remembers the feeling
the pace
the level of support
the respect given to your body
Spontaneous labour gives many women that grounding sense of
“I did it.”
rather than
“It all happened to me.”
2. Feeling in control is one of the strongest protectors you have
A 2023 study (here) showed that a woman’s sense of control during birth strongly predicts lower postpartum depression
Induction can save lives, but it can also feel like handing over the wheel.
No control = vulnerability
No agency = increased trauma risk
Spontaneous labour gives you more of your voice back.
3. Your natural labour hormones are designed to protect you
When labour begins naturally, your body releases:
• oxytocin — love, bonding, calm
• beta-endorphins — natural pain relief
• prolactin — mothering behaviour
This hormonal flow supports bonding, breastfeeding and emotional regulation.
Synthetic oxytocin (the drip) creates contractions but doesn’t cross into the brain, meaning you get the intensity without the emotional oxytocin cushion.
4. Gentler births = less trauma and stronger bonding
High-intervention births, especially when women feel ignored or powerless, are linked to:
• PTSD
• postpartum depression
• breastfeeding struggles
• bonding difficulties
ScienceDirect, 2023 here
Bonding & birth experience review here
When women feel heard, supported and informed — even in medicalised births — bonding strengthens and trauma decreases.
Waiting (when safe) increases your chances of a calmer, connected birth.
5. Your emotional state in labour doesn’t disappear after birth
Birth isn’t something you “get over.”
It follows you:
• into feeding
• into sleep
• into bonding
• into how safe you feel in your own body
An interesting wikipedia page of what prenatal stress can do to your growing baby here
Waiting for spontaneous labour — when safe — protects both your baby’s transition and your mental health.
So Do You Always Need an Induction?
No.
You might need one if:
• blood pressure is rising
• growth scans are concerning
• Dopplers look poor
• your team has specific, evidence-backed concerns
But if:
• your A1c is decent
• your time-in-range is solid
• your scans look good
• you and baby are well
Then research supports waiting closer to 39–40 weeks check the research here and here
Not rushing everyone to 38 weeks by default.
What to Say in Appointments
“My time-in-range is X%. Studies like CONCEPTT and the 2022–2025 CGM reviews show this reduces complications. Based on my data, what are my risks if we aim for 39–40 weeks?”
“These induction policies were created before CGM. With my current control and normal scans, is there evidence that I personally need early induction?”
These questions shift the entire balance of power.
Final Word
You’re not reckless for wanting time
You’re not difficult for asking questions
You’re not naive for wanting your body to lead
You’re not wrong for wanting to birth in your power
You’re a woman growing a baby while manually operating a pancreas and doing it bloody well
If you want help turning this evidence into confidence
into phrases you can use
into a plan you can take into any appointment
come join my class
Because the body growing this baby is absolutely capable of birthing this baby with the right support around you.
If you want more studies, more research, or you want help turning all of this into actual confidence you can take into appointments, get in touch.
And if you want 90 minutes of live teaching, where we go deeper into the evidence and practise the exact phrases, and build the confidence to challenge the white coats and trust your body…
Come to my monthly live training.
You will walk away with more power, more knowledge, and the ability to look any consultant in the eye and say:
“Show me the evidence for me.”
This is where your birth changes.