Saturday, November 24, 2018

The Birth of Good News

Our first little girl was born to us at 2:30 in the afternoon. She was 7 pounds, 10 ounces, 21 inches, 40w4d, and “born in the normal way.”

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I know I’ve talked a big game about induction in the past, reiterating some of the things I don't like about how it's used by contemporary OBs. I’ve mentioned that it can sometimes lead doctors and patients to a false sense of control about the whole process. I've talked about the fact that induction is, at times, used unnecessarily as a preventive measure, when in fact there was (or is) nothing wrong with the mother and baby. I’ve talked about how pitocin contractions, caused by a synthetic mimic of oxytocin, hurts a bit more than natural contractions, which is caused by oxytocin

Well, as much as I think that spontaneous labor is generally best for mom and best for baby, because I do believe both are more likely to be ready for the taxing event of childbirth when labor begins spontaneously, I was ready to eat ALL MY WORDS and do an induction this week anyway. I knew that it was a great compliment to my body that baby was still in there, but I was really tired of on again, off again labor. I was tired of extreme pain in my pubic bone every time I laughed, coughed, sneezed, got out of bed, or walked up stairs. And most of all, unreasonable as it is, I was afraid the baby would get too big. Medical professionals caring for diabetics during pregnancy, take note: we hear you loud and clear about our risk factors!

Besides the physical pains and anxieties of pregnancy, there were social complications associated with baby’s delayed arrival. My mother in law had arrived from the west coast, and I did not want her to have to go home without meeting her first granddaughter. My husband had decided to take these two weeks off work, and while I welcomed his help for pregnancy, of course I wanted his help for at least one week after birth, too. And I had scheduled a court date in the expectation that baby would already be here for at least a week by that time. 

On Monday afternoon, three days after my official due date and one day after the very latest due date I could have possible given myself, I was still as pregnant as ever, having contractions all afternoon and most of the evening every day, occasionally waking up with a painful one at night, too. But this night, the contractions were maybe a little longer, stronger, and more frequent than in days past. We decided to go to the hospital. Part of me knew that if labor stalled tonight, this would simply bump my scheduled induction date up by a few days.

Contractions slowed a bit because I got cold and nervous during the car ride, and the nerves had not worn off by the time we arrived. In fact, the nerves intensified, because I could tell the contractions were weakening. I didn't want to wait too long to "pull the trigger," so to speak, on going to the hospital, because I didn't want to deliver a baby into the passenger seat of our car on a cold November night with cars whizzing by us on the highway. I didn’t want to be sent home.  I didn’t want to not have a baby tonight. I didn’t want to be pregnant for any more nights, or days, or even hours.

We came up to triage and were found to be at 4.5 centimeters with a posterior cervix. (Translation: cervical checks hurt more.) We were given orders to walk around the halls for a couple hours. By now, tired, sad, and with contractions slowing all the time, we were admitted, but at a rather weak 5.5 centimeters with contractions about 10 minutes apart. When the doctor checked cervical dilation again following admission, we had reached 8 centimeters, but the contractions had slowed to a complete standstill. 

This was, at one and the same time, thrilling and unnerving. I was at 8 centimeters with almost no pain! Hooray! But the last two times I had been told I was at 8 centimeters dilation, I was mere minutes away from pushing a small human being out of my body. Now, I was painlessly walking and talking and wishing I could lie down for a nap. Was something wrong? Was the baby malpositioned for labor? She seemed like she had been head down, LOA, for months. Was my uterus just too tired to give birth? Well, that didn't seem likely to change much between now and when I was hoping to give birth, so how on earth was I supposed to get the pregnancy over with?

They asked if I'd like them to break my water. Usually this causes the baby's head to descend a bit, apply pressure to the cervix, and the descent + pressure combination has, in the past, gotten things going right quick. But that also meant I had to will myself through intense pain after being awake all night and exhausted. Is there a painless way to get through this part? No. No, there is not. I started crying. I told the nurse and my husband that I was not in any pain at all, but I was merely afraid of  the pain I knew was coming. No one ever talked about an epidural, and I'm sort of glad I didn't have to deal with the question. The epidural is its own sort of scary anyway, they don't always work, and once I'm actually in pain, we're only looking at an hour, tops. So I asked for a little while to think about it. I sent a text message to some good friends, asking them to pray for us, and lamented my sudden cowardice. I laid down to try to rest.

But you know what happens when you're staring down the chute at the most intense pain of your life? You're just not in the mood to take a nap. Every time I felt anything at all in my womb, whether part of a contraction or baby's reassuring kick that she was still alive and happy, I experienced a jolt of adrenaline that kept me wide awake. I thought about whether the contractions would start up again, how fast and how strong, how soon I would get to meet her, what would happen if they didn't? I thought about whether there was any hope that the delivery might be one of those painless ones I'd heard of and dreamed about. I thought about how this was the most natural thing in the world, and yet still so terrifying. I was afraid that if I went to use the bathroom, I might accidentally push the baby out into the toilet. I thought about how complicated the recovery would be if I had a c-section.

After a couple hours, I agreed to have my water broken, but contractions still did not begin as I expected them to. I knew the only option left was pitocin. It was like being at the top of the chute, but the slide is made for children not heavy pregnant women, and you can't gain enough momentum to actually get going down the slide. And you're just terrified to push yourself forward anymore, because you know there's pain down there at the bottom. I was getting hungrier all the time, feeling weaker, still exhausted, and still afraid. "This is not going well," my left brain thought. "I wish they could just put me to sleep like they used to and I'd wake up and have a baby," my right brain thought. After a while, the nurse asked about pitocin. I asked for a little while to think about it, laid down to try to rest, and found, again, that the same interior turmoil of before would not allow it.

Around noon, I agreed to start the pitocin. Contractions picked up almost immediately, but they weren't the kind of contractions that push a baby out. That was reassuring, because it meant that the baby would not be born without warning. At this point, labor felt utterly normal. The doctor had mercifully ordered only the very lowest dose, and it was enough. After a while, however, the contractions were so strong that I had to stop moving and couldn't talk when they came on. Between contractions, I was an emotional mess again. It hurts too much. I can't do this. The baby is going to get stuck. I'm too tired. ISN'T THERE ANOTHER WAY?!?

My husband reminded me that I couldn't get unpregnant if I didn't go through with it. "Good point," the left brain part of me mused. "What kind of lazy race of people are we that we haven't figured out a way to make this hurt less yet?!" the right brain part of my shouted. When I confided my fear of a too-big baby to the nurse, she looked at me as though dumbfounded, and tried very hard to be patient as she rattled off all the reasons that was unlikely. "You're right," said my left brain. "But what if it's not enough?" worried my right brain. I did a few squats, hoping to help the baby's head descend, because I knew that would speed things up. It quickly became too much effort to assume this position, however, and I climbed into the bed. I cried a little bit. I gave a few small boluses, but basically didn't worry too much about 130 mg/dL. I was alternately hot and cold. I was shivering. I was still scared.

After a little while, I told the nurse that I felt like pushing. She checked the dilation and said that the cervix was not fully dilated yet, but that it would be OK to push a little bit, just to relieve some pressure. They kept asking about whether I felt like I needed to push, and I kept saying 'yes.' My husband kept telling them it was close, and asking if the doctor would come in soon? Every time they left the room, I was gripped with anxiety and asked my husband if he was ready to catch the baby. He didn't answer. The nurse reassured us that the doctor was right outside and would be ready when the time came.

Suddenly, I experienced one big contraction in which the left brain part of me thought, "My cervix is posterior, therefore I need to lift up off the bed a tiny bit, so that I'm not pushing her out into the mattress," and the right brain part of me thought, "GET HER OUT! NOW! NO TIME LIKE THE PRESENT!" During this contraction, the following also happened: a) I could feel the cervix pull back around the baby's head, b) a pocket of amniotic fluid sprayed out and drenched the nurse, and c) an infant came out of my body.

Yep, that's right. All it took was one contraction, one push. The nurse was planning to help me push slowly to avoid tearing, but all she had time to do was tell me to put my butt back down on the bed while I was pushing so that the baby would have a big enough opening to come out. My left brain was mistaken about the posterior cervix, because it straightened itself out just fine! The nurse thought my hip-raising was a right brain response to the pain, but I tell you, it was utter determination to get the baby out before anyone had time to even think about shoulder dystocia. In any case, I still didn't tear, which really makes recovery a lot easier!

The doctor mentioned that the umbilical cord was short. This might explain why our little girl hadn't descended and applied pressure to the cervix, which probably would have sped things up some. This site says that prolonged labor (along with a bunch of other scary things) is a complication of a baby with a short umbilical cord. It probably also explains why the doctor swiftly put her hand up inside my uterus to be sure there was no part of the placenta retained. Everything stung or ached for about the next 30 minutes, I was trying to catch my breath for the better part of an hour, and one of the baby's nurses brought me yogurt parfait, a turkey sandwich, and something else which I devoured as soon as I was in my postpartum recovery room. I let my blood sugar rise to 270 mg/dL without an ounce of regret or anxiety for the first time in nine months.

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Our daughter is amazing. I know your baby is too, but I'm especially fond of mine. Even the two year old is in love, in spite of the jealousy that many parents fear and some kiddos experience. I cannot believe how small she is! I've always said that it doesn't matter how big the baby is, labor is going to hurt, but I do sort of wonder if the pushing was just really fast because of her (relatively) small size. And seven pounds, ten ounces, is not even all that small! The nurse seemed genuinely impressed with my "performance," but labor is almost as much something that happens to you as something that you do, so I don't think there's really much to be impressed by.

They gave me the dextrose drip by IV during labor, which I have never had before. My blood sugar was higher than during other labors, but hers fortunately never dipped too low. This makes me think that the theory about a diabetic mother's blood sugar being high during labor leading to an insulin response in the baby, which ultimately causes the baby's blood sugar to drop after she is separated from the mother's blood supply, needs some perfecting. At the very least, our definition of "high blood sugar during labor" should perhaps be relaxed from 70-100 mg/dL, which is where my blood sugar has often been during labor, up to 110-140 mg/dL, which is where it was this time. In any case, I was grateful that she nursed eagerly and frequently, and never got too sleepy, too cold, or too jittery. 

I think I basically ended up with an induction this time around, with labor stalling in the wee hours of the morning and requiring membrane rupture and pitocin to get going again. My fourth labor was a little bit like that. I wonder, if I had just taken another Epsom salt bath and laid down to rest like last time, would labor have started up hard and fast and left us catching our breath as we went from living room to car to triage to hospital room to baby is born? Perhaps. Maybe I could have avoided the emotional drama that sapped me of so much energy between 3:00 am and 12:00 pm. Either way, even a small amount of pitocin this time was more effective than spicy food, less violent than castor oil, and less exhausting than walking for miles and miles, so I'm OK with the way it all turned out.

We are poorer than we ever have been, and yes, I know this all just means one more mouth to feed. But we are so happy to have another baby, a daughter, and so ready to take on the difficulties we know will come, for the sake of our family. There are things we could wish for, things we could complain about, and things we regret, but the fundamental fact is that we somehow have hope that things will work out for the best, a chance to wake up tomorrow and discover something new together, and six loving, mostly healthy, innocent children with whom we can learn how to love God. We have discovered the Truth of Christ's teaching about welcoming the little children in His name, and we are still searching hard for the Way to follow Jesus through the wild thicket of their many childhoods. But we can finally say that Life itself has graciously entered our home, time and time again, in the form of an infant, a humble state which Our Lord embraced in both the pure womb of the Blessed Virgin Mary and a dirty stable two thousand years ago. May my body, our hearts, and this home be always ready to receive Him!

Monday, November 12, 2018

Week 40

I have been incommunicado, but I am STILL PREGNANT! I have passed every due date given to me, and stand now at 40w1d according to the very latest due date I could have possibly given myself, based on the ovulation predictions of a fertility monitor. According to the 20 week ultrasound due date, I am 40w3d. I blew past the last menstrual period due date a while ago. I'd stand at 41w4d if we went by that one, but we always knew that ovulation doesn't always occur on day 14 of the menstrual cycle, right?

Diabetic victory of the (last three) week(s): I can't remember the last time my blood sugar went above 160 mg/dL.

Diabetic failure of the (last three) week(s): I had a terrible nighttime low that really frightened my husband. The CGM normally prevents these, but I was in the two hour warm up phase when I fell asleep, and didn't wake up when the alert sounded to calibrate. I wasn't violent. In fact, I was endearingly attempting to cooperate by carefully placing the tip of my finger IN the Gatorade bottle so that my husband could check my blood sugar with it. He finally managed to convince me to drink the Gatorade by asking if I would be willing to drink what was in the shoe. It was a sweaty, middle-of-the-night, once-every-three-years kind of low that the CGM largely helps me to prevent, but it was still scary. I especially worried about the baby, but she is still alive and, as I write, kicking. Me. In the belly.

Mostly unfounded anxiety of the (last three) week(s): That she will be too big for me to deliver.

Most intangible joy of the (last three) week(s): I think my doctor finally recognizes me when I come in, and what's more, he is totally an utterly relaxed about all this. He did not mention induction at 38 or 39 weeks, and *I* was the one who had to remind him that I will be 41 weeks on Friday, and doesn't he want to schedule the induction now? I am still waiting to hear from the hospital about that, but basically just hoping to go into labor spontaneously. Yes, I've tried all the things except castor oil, because I don't want to be dehydrated when I actually do go into labor. Considering black and blue cohosh tincture some time this week.

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Another significant consolation to me during this time is that my baby is happy where she is. For too long, I have suffered the fear that because I am a diabetic, my body is dangerous for my babies, that they will die if they stay in too long, that I am not able to give them what they need. This might be true in part and some of the time, but let's be honest. Babies sometimes die when they come out, too, and as all moms do, I struggle to meet their needs after birth as well. So it's not as though the situation changes all that much once the baby comes out. This pregnancy has been marked by the conviction and satisfaction that my body is enough for my baby. It has been a relatively "comfortable" pregnancy, quite healthy, and I am looking forward to delivery. (Soon. I mean, it's not that comfortable).

I hope the next news you hear from me involves a fair amount of blood, no guts, and some very deep breaths from at least two of us. :)

Saturday, October 20, 2018

Week 37

Diabetes victory of the week: My overnight lows have been almost non-existent, and for some reason, this pregnancy, the post-breakfast lows in the morning haven't really been very troublesome, either. It's not that I haven't had ANY of them, but I think not worrying about weight (i.e. eating when I'm hungry, exercising as I'm able, rather than really stressing about those two things) and eating eggs every morning (prepared by my amazing older boys!) has helped a TON.

Diabetes failure of the week: Pumpkin bread. You know what I mean, right? Just another bite... And then maybe another half piece... And then a correction bolus two hours later because my blood sugar, to no one's surprise, kept going up...

Mostly unfounded anxiety of the week: That this labor will take forever and be more painful than the others. I'm not banking on less painful than the others, but I've never had an epidural, so I'm pretty sure that more painful is not realistic. It could probably stand to be a touch longer and that would be OK!

Mostly intangible joy of the week: When I asked my four year old what makes a princess beautiful, he answered, "Love." That's right, son. Look for the beauty within! This little girl has got some GOOD big brothers to welcome her to the world. :)

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It took a while, but I finally convinced my doctor that baby's due date is November 9, per the 20 week ultrasound, and not November 1, per last menstrual period. I still think it's November 11, per the fertility monitor's ovulation date, but two days is really splitting hairs, so I give up. Also, since she's consistently shown growth at the 50th percentile, it doesn't seem like they'll be pushing for an induction early anyway.

I had my first bout of contractions today, but as they say, labor can only ever be a retrospective diagnosis. It's funny that they insist on a different name for these contractions ("Braxton Hicks"), because they're basically labor contractions that don't get strong enough or go on long enough to push out a baby. I prefer to think of it as labor warm up. :)

Saturday, October 13, 2018

Week 36

Diabetes victory of the week: I adjusted my basals and my overnight numbers are pretty good. I adjusted my bolus ratios and my two hours postprandials are very rarely high.

Diabetes failure of the week: It turns out that in late pregnancy, there's such a narrow range of "acceptable" that you're always going to feel like you're failing. Too many blood sugars that seem low and your Dexcom Clarity bar graph is ** ALERT ** ALL RED ** MAJOR HYPOGLYCEMIA RISK ** ALERT **. Too many high blood sugars and they automatically assume your baby will die from shoulder dystocia during delivery. After 10-14 days of feeling that my postprandials were just too close to 150 for comfort and adjusting all my basal rates and bolus ratios, this week it was too many lows.

I still believe that it's more important for me to pay attention to how I feel than to what my sensor is reading, because for some reason, the sensor readings seem artificially low. I do not suffer from hypoglycemic unawareness at any time other than while I'm sleeping, so I can tell the difference between a genuine 50 mg/dL blood sugar and a sensor reading of 50 mg/dL that comes out to 70 or 80 mg/dL when I stick my finger. Case on point? My sensor read 42 when I woke this morning. I had a drink of Gatorade. When I calibrated 15-20 minutes later, my sensor read 48 and my blood read 82. But it is an uncomfortable line to walk, and not one that many people, doctors or otherwise, understand.

Mostly unfounded fear of the week: I had a growth ultrasound this week, showing baby in the happy middle, 50th percentile. And still every pound I gain, every time someone tells me I look big, every time I feel my abdomen stretch in a new and uncomfortable way, I'm paralyzed by the anxiety that this baby will be TOO BIG. Actually, I've put my finger on the real anxiety. I don't truly doubt that the baby and I will be fine. What's really happening is that I'm worried someone in the hospital will THINK she's too big and insist on induction/c-section/other unnecessary intervention. It's amazing how one collection of bad experiences can so overwhelm all good experiences to the contrary. Except I guess I haven't had very many good experiences with doctors believing in my ability to deliver a healthy baby, and so I'm continually anxious that the healthcare providers I encounter during pregnancy and delivery will likewise doubt this. 😓

Mostly intangible joy of the week: My four year old confessed at breakfast this morning, a little shyly, that he loves Jesus more than me. I struggled to explain to him how important it was that he do so forever. Then he walked around the house, repeating, "Jesus is the most I love." My one/almost-two-year-old, likewise, walked around the house, chanting, "Jesus. Most. Love." It was amazing, and I understand what people mean when they say they wish their kids could stay little forever. (Except I do want them to learn how to take a shower and put their shoes on, for lots of reasons, so you know, there's both good and bad about growing up. :)

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As I mentioned, my growth ultrasound showed a very normal sized baby, and all BPPs have been perfectly normal. In any case, all my babies have been eight pounds, and I expect she will be, too. 

My regular OB had accidentally cancelled my appointment based on a misunderstanding at the receptionist's desk, so I happily skipped it this week. 

However, I was a little disappointed to realize, at one of my recent appointments, that my OB didn't recognize me after we'd had three appointments together. That was a little discouraging. I suppose I could blame it on myself for switching doctors yet again. He has enough excuse, having moved from one practice to another in the last two months and all new faces to learn. I hope he'll remember me by the time I deliver. I was thinking that bringing all my kids to the next appointment might make me more memorable, but nine, seven, and six year old boys + cervical exam = completely awkward. We will see...

I'm GBS negative. This is good, because I'm not convinced we are going to make it to the hospital with enough time for antibiotic delivery anyway, and I don't want the pediatrician to give the baby antibiotics after birth. (I have a suspicion, lacking anything like proof, that my oldest son developed celiac in part because his digestive tract got so messed up from 7 days of IV antibiotics after birth). 

Here's a funny story that may or may not have gotten my doctor's attention about how to handle what could be a precipitous delivery for me:

"So what happens if I don't make it to the hospital in time for antibiotics?"
"Well, once you get to the hospital, they'll deliver two courses of IV antibiotics four hours apart."
"And if there's not time?"
"It's one of the first things they'll do. They'll ask you about your GBS status when you arrive."
"They didn't make it through intake questions last time. I delivered about 20 minutes after arriving. In fact, it's happened that fast twice."
"Oh..."