Birth Planning in African Women with Diabetes

By Chinonso Cynthia Ukah, BNSc, RN, RM, RPHN. Freelance Health Writer. Medically reviewed by: Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), FMCOG, MSc. (Public Health).

March 12, 2026

A pregnant woman is sitting in an armchair, wearing a continuous glucose monitor on her left arm and smiling up at a man who is offering her a glass of water. On a nearby table are three medication containers and two insulin syringes. Generated with Gemini AI.

Highlights

• Diabetes in pregnancy is a condition in which a woman has high blood sugar levels while she is pregnant.

• Some women develop diabetes during pregnancy (gestational diabetes), while others enter pregnancy with pre-existing diabetes (Type 1 or Type 2 pre-gestational diabetes).

• Women living with diabetes require closer monitoring and careful birth planning to reduce the risk of serious complications for both mother and baby.

• According to the National Health Service (UK), early recognition of warning signs such as high blood sugar, vaginal bleeding, or reduced fetal movement can help reduce emergencies.

• Preparing for delivery with diabetes involves planning ahead for warning signs, choosing the right place to give birth, managing unstable blood sugar levels, and knowing what to expect during and after birth.

Introduction

Every pregnancy benefits from careful birth planning. For women living in Africa who also have a chronic condition such as diabetes, this planning becomes even more important. 

Diabetes in pregnancy is defined as a condition in which a woman has high blood sugar levels during pregnancy. It occurs in two main forms: 

• Gestational diabetes which develops during pregnancy
• Pre-existing diabetes (Type 1 or 2) which is diagnosed before pregnancy.

Approximately 7.2% of women of reproductive age in Africa are living with type 2 diabetes, and for most of them, daily life involves regular medication, dietary control, and frequent hospital visits. Having diabetes while pregnant increases the risk of complications for both the mother and the baby, and this makes proper birth planning very important.

This article discusses birth planning among African women living with diabetes, explains what it involves, and highlights why it is essential for safe motherhood.

What Birth Preparedness Means

Birth preparedness (birth planning)  is the process of getting ready for delivery. It involves making plans before and during pregnancy to ensure a smooth pregnancy, safe delivery, and a healthy postpartum (post elivery) period for both the mother and the baby [1].

Related: Essential Guide to Labour for African Women and Men

How Diabetes Affects Pregnancy

Diabetes, also known as high blood sugar, negatively affects pregnancy, labour, and delivery.

It can lead to [2]:

• Miscarriage
• Stillbirth
• Premature birth
• Birth injuries
• Infections
• Caesarean deliveries
• Risk of type 2 diabetes in the future 

Because of these, decisions about where to deliver, when to seek care, and how to prepare for emergencies become much more important than in pregnancies without diabetes.

Related: Diabetes in Pregnancy in Sub-Saharan Africa: An Overview

Issues a Woman with Diabetes Must Prepare For While Pregnant 

Preparing for birth with diabetes involves careful planning and attention to both medical and social issues. This is best done with the advice of your healthcare provider as well as knowing your expected date of delivery (EDD), the most appropriate route of delivery, and practical arrangements for a safe delivery. 

Medical:

1. Warning signs before labour

You must look out for the following warning signs and contact your healthcare provider immediately [3]:

• Too high blood sugar and pressure levels

• Water breaking: If your water (amniotic fluid) breaks and leaks from the vagina before or during labour

• Vaginal bleeding: Take any bleeding from the vagina during pregnancy seriously

• Reduced fetal movement: If you notice that your baby is moving less than usual or stops moving altogether

• Preterm labour: If you are less than 37 weeks pregnant and experience signs of labour, such as regular contractions or lower back pain

• Strong contractions: If you are having contractions that last longer than 2 minutes

• Frequent contractions: If you are having 6 or more contractions within 10 minutes

2. Choosing the Right Place to Give Birth

It is advisable to give birth in the same facility where you are already booked and receiving antenatal care, as your medical records and pregnancy history are already there. However, it is also important to identify a good hospital or maternity centre that is close to where you live. This is especially useful in case of an emergency.  When choosing a place to give birth, ensure that the facility:

• Has skilled birth attendants available at all times

• Can monitor blood sugar levels and manage diabetes during labour

• Has facilities for emergency care and referral if needed

3. Blood Sugar Control Near Delivery

Keeping your blood sugar in a normal range as you get close to delivery is one of the most important things to focus on if you have pre-existing or gestational diabetes. Good control helps keep both you and your baby safe during labour and after birth. The World Health Organization recommends monitoring fasting blood sugar levels in pregnant women with diabetes. Fasting blood sugar should generally be maintained below 5.3 mmol/L, with typical target values around 3.8–5.2 mmol/L to ensure good glycaemic control during pregnancy. To help stay in this range, you might need to:

• Avoid sugary drinks and sweets
• Stay active as your doctor recommends
• Eat regular, balanced meals
• Check your blood sugar often
• Take your insulin or medications exactly as prescribed

4. Medications and Insulin Planning

Your care provider may put you on insulin injections or oral diabetes medications if you are diagnosed with gestational diabetes. If you already had diabetes before pregnancy, your drugs and doses may be reviewed to make sure they are safe for your baby. It is important that you follow your prescription carefully, and keep checking your blood sugar to make sure it stays in the normal pre-prandial or fasting range of 3.8–5.2 mmol/L for gestational diabetes and 3.3–5.4 mmol/L for pre-existing diabetes). [4] This will help you avoid your sugar dropping too low (hypoglycemia) or going too high. 

5. Timing and Mode of Delivery

Sometimes delivery may be scheduled a little earlier than your due date if there are concerns about your health or your baby’s health. Whether you have a vaginal birth or a cesarean section depends on: 

• your pregnancy
• your blood sugar control
• your baby’s size and
• any additional complications

6. Emergency Planning and Referrals

Preparing for birth does not mean emergencies cannot happen. A complication can become serious if you delay seeking care after noticing a warning sign, wait too long to contact a care provider, or get held up at the hospital because it is busy. [1] It is therefore important to plan for emergencies in advance (complication readiness). To plan properly,

• Make sure you have the phone numbers of your midwife and obstetrician 
• Have a responsible adult available at all times who can transport you to the hospital when needed. This could be your husband, relative, or even a trusted taxi driver.
• Know the quickest route to your hospital or clinic
• Always ask your care provider what to do if you notice any of the warning signs above

7. What happens after birth

After your baby is born, your blood sugar may return to normal or stay high, so it is important to keep monitoring it. Your doctor may adjust your medication if needed. You will be advised to start breastfeeding early and attend all postnatal check-ups. Some post-delivery warning signs you may need to watch out for and contact your care provider immediately are:

• Heavy bleeding
• Fever
• Infection [3]

Related: Complications of Diabetes in Pregnancy: What Africans Need to Know

Social:

1. Money and Transport Preparation

It is important to plan ahead for money and transport before your baby arrives. Make sure you have enough money saved for hospital bills, medications, and any emergencies. Decide how you will get to the hospital when labour starts, whether by car, taxi, or public transport, and have a backup plan in case of delays.

2. Family Support and Decision-Making

Having support from your family can make a big difference during pregnancy and birth. Discuss your birth plan with your partner or family members so they know what to do if labour starts or if there is an emergency. Make sure someone you trust can help you with transport, hospital stay, and looking after other children if needed.

Conclusion

Birth planning is especially important for women living with diabetes in Africa. Because diabetes increases the risk of complications during pregnancy and delivery, careful preparation helps protect both the mother and the baby. Paying attention to warning signs, choosing the right place to give birth, controlling your blood sugar, and planning for emergencies can greatly improve pregnancy outcomes. With early planning, regular antenatal care, and support from family and healthcare providers, women with diabetes can have safer pregnancies and healthier births.

References:

1. Alamrew A, Sisay A, Ayele M, Shitie Lake E, Kumie G, Hailu Mossie H, Emagneneh T, Mulugeta C. Determinants of birth preparedness and complication readiness practice among reproductive-age women in Africa a systematic review and meta-analysis. BMC Public Health. 2024 Nov 13;24(1):3154. doi: 10.1186/s12889-024-20654-y. Available from here.

2. Centers for Disease Control and Prevention. Diabetes during pregnancy [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2024 May 15 [Cited 2026 Jan 17]. Available from here

3. National Health Service. Signs that labour has begun [Internet]. London: National Health Service. Last reviewed: Nov. 9, 2023. [Cited 2026 Jan 17]. Available from here 

4. American Diabetes Association. 12. Management of diabetes in pregnancy. Diabetes Care. 2015;38(Suppl 1):S77–S79. doi:10.2337/dc15-S015. Available from here 

Related Resources:

• Type 1 Diabetes Mellitus: An Explainer for Africans
• Type 2 Diabetes: What Africans Need to Know

Published: March 12, 2026

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