Thursday, July 29, 2010

New CGM goes into human trials

CGMs, continuous glucose monitors, are a relatively new technology... I tried MiniMed's version that connected with my pump and it didn't really do it for me. I LOVED the information that it gave me, but the calibrations and the fact that if I didn't calibrate at the exact right time was more work than that information was worth for me. (granted if I were to get pregnant I would slap that thing on in a heart beat.) But for right now, no thanks.

I am, however, very excited about this report from San Diego, CA...a new CGM system that is implantable is in the works and looking promising. Love the exciting news. jenn

Wednesday, July 28, 2010

Cool Meal Idea for Mommies

On a fellow diabetes blog, I ran across this web page last week. I've joined to try it out because the dietitian in me couldn't resist and, I'm not going to lie... I LOVE it. MealMommy.com provides 5 healthy menus with recipes and a grocery shopping list for each week. The creator of the site is mother to a type 1 child and shares experiences of other mommies on the site each week. So, if you're a mommy, or mommy-to-be, you will one day face the question, WHAT AM I GOING TO COOK TONIGHT!!?? And for me, for the next few weeks, the decision is, thankfully, made by The Meal Mommy.

From a health stand point, she does a great job with balance and gives nutrition info (carb counts!!) for all of the meals. Hope you enjoy :) jenn

Monday, July 19, 2010

Finding a Doctor

As I mentioned in my last post, these are some thoughts I had based on my experience at a Level II ultrasound, the one they normally do between 18-20 weeks to check for fetal abnormalities such as heart and spine defects. Another thing the consulting doctor said after the ultrasound brought home the necessity of finding a supportive care provider to help you do things differently.

"Good luck getting your doctor to agree to let you go to 41 weeks."

The induction question was one of the first that I asked my new doctor and he's OK letting me go to 41 weeks.

I'm about to sound like every natural childbirth book that has ever been written, but this comment, and indeed, my whole experience at the high-risk clinic, demonstrates how important it is to find a supportive care provider! A provider that is willing to make different assumptions and use different methods, with fewer interventions, to help you. A provider that will treat you like an individual, not just a statistically-average diabetic. Even though diabetics, on average, may have elevated incidence of certain risks, you may not be average! It's OK to ask to be treated as an individual, which may allow you to avoid standard interventions such as early induction of labor and so on. Some tips on finding a doctor from someone who's had to do it in two different locales:

Ask around. You may see if you can find a homebirth midwife amenable to your situation. However, if you want to deliver in a hospital or can't find a homebirth midwife that feels comfortable assisting you at home, which is probably the case for many of us, ask homebirth midwives and doulas who they like to work with. Doctors that midwives and doulas like are generally open to low-intervention birth, and are willing to individualize care beyond standard protocol for diabetics. Maternal-fetal specialist groups often induce pre-existing diabetics at 39 weeks regardless of other circumstances (see Doing Things Differently), so I would avoid them unless complications require you to come under their care. Unfortunately, you probably won't be able to find a nurse midwife or a nurse midwife/OB practice to help you, either in a hospital or birthing center - they usually refer diabetics to maternal-fetal specialists.

Show them your numbers. A healthy pre-pregnancy weight, minimal diabetes-related health complications for you (retinopathy and kidney damage), well-managed blood sugars, low A1Cs, and any children with average birth weights that you have delivered before will help you make your case, particularly to an OB that doesn't normally work with pre-existing diabetics.

Be flexible. Whether you are working with a homebirth midwife or low-intervention OB, be willing to consult with maternal-fetal specialists if complications arise, or for routine ultrasound screening. It is important to be willing to compromise since your care provider may be taking professional risks or receiving criticism from their colleagues to help you with a low-intervention birth. In the end, the specialists will only be doing consultations and making recommendations, and you probably won't have to make any decisions until after you've had an opportunity to talk it over with your midwife or OB.

And just a note, you should be able to ask a doctor that you call for an initial consultation or interview. In my experience, if they are not in the habit of providing this service or resistant to doing so, this can indicate a practice or a doctor that is unwilling to discuss alternatives to standard interventions.

Have you had a great experience with a doctor? I'd love to hear about it. Let's make it civil, though, and keep our criticisms specific to behaviors and actions, rather than people.

Thursday, July 15, 2010

Doing Things Differently

I am currently pregnant with my second child. He is due in mid-October, and I am currently 26 weeks. I recently went for my "Level II" ultrasound, the one normally done at 18-20 weeks to check for fetal abnormalities (heart and spine defects, for example). The maternal-fetal specialist's comments to me during our consultation at the end of this screening reminded me of how and why my husband, my doctor and I did things differently the first time, and also reminded me of why it's so important to find a truly supportive doctor. I'll do two separate posts on these issues, using statements the consulting doctor made to spur my reflections (here's the post on Finding a Doctor).

"Maybe we do things differently here on the east coast, but we've never let a pre-existing diabetic mother go to 41 weeks. We usually induce at 39."

The maternal-fetal specalist was extremely surprised that I went to 41 weeks with my first baby. I was surprised that he had never seen a pre-existing diabetic proceed to 41 weeks. I'm glad I had the opportunity to show him that it could be different. The vibe I get is that it is standard operating procedure for maternal-fetal specialists to induce Type I diabetics at 39 weeks because of the increased risk of pregnancy-induced hypertension, a baby that is "large for gestational age" and therefore "too big" to fit through the mother's pelvis, and fetal demise or stillbirth in Type I diabetics.

During my first pregnancy, which, as I mentioned, went a week past my due date, I was concerned about the aforementioned risks. A few things helped me to decide that, in my situation, it was reasonable for me to assume that my pregnancy was proceeding within the bounds of normal and didn't require induction:
Is my baby too big? Growth ultrasounds showed that my son was hanging out somewhere between the 30th and 50th percentile. Because of the possibility of inaccuracy in growth ultrasound measurements, I think that even if he had been measuring larger than the 50th percentile, I would have asked my doctor to allow me to at least try to push my baby out when my baby was ready before resorting to early induction or a scheduled c-section. I place a high premium on avoiding these interventions.
Pregnancy-induced hypertension: My understanding is that most mothers' blood pressure naturally increases slightly over the course of a pregnancy, and it is more or less normal. Obviously, a simple blood pressure measurement will tell you whether your blood pressure is in a healthy range, and you don't need a scheduled induction to avoid it. At my last visit before my son was born, on Thursday, my blood pressure was, indeed, elevated (keep in mind that I was already 4 days past my due date at this point, which was making my doctor, my husband, and myself itchy to get it over with). My doctor, instead of immediately signing me up for induction, asked me to come in the next day. It was still high. Again, instead of immediately signing me up for induction, he told me to quit work because it was probably stressing me out just to get out of bed in the morning, get dressed, and get myself in the office. Guess what? Two hours after leaving the office, my blood pressure had dropped to an acceptable level. A little more than 24 hours later, I went into labor without induction.
Is my baby going to die before he's born? This was the most terrifying possibility of all three of the increased risk factors I mentioned above. The danger also increases for low-risk pregnancies that progress past their assigned due-dates, which is why induction may be recommended for any woman who has reached her due date. To monitor for this risk, I did kick counts every day after I started feeling him move. In my third trimester, I went into the office for fetal heart rate monitoring frequently to be comfortable that the baby was thriving. Even non-diabetics who reach their due date may be asked to undergo fetal heart rate monitoring.
What about me? Is this pregnancy making my health worse? I am one of the most fortunate diabetics that I know because I have lived with Type I diabetes for 17 years and the only apparent evidence is scars in my fingers from checking my blood sugar level and in my waist area from my pump sites. My eyes are fine, and my kidneys appear to be functioning normally. At such a point when my body does start to show signs of decay, which I expect will eventually come, I will have to decide how comfortable I am with my body getting a little "beat up" in the course of having more babies. That is a deliberation, however, that I hope is many years and many babies away. I once asked an endocrinologist whether there were additional risks of multiple pregnancies on the health of diabetic patients, and whether I should consider limiting the number of children I have based on said risks. He could not think of any reason to limit the number of children I have, or any risks of multiple pregnancies to my long-term health.

Any risk factors I've missed? Would love to hear about your experiences, why you were induced or how you and your doctor chose to do things differently than what is normal for pregnant diabetics. Maybe I can talk another time about why I would like to avoid induction, but many of you will probably already be familiar with the reasons that advocates for natural childbirth like to avoid it.

Birth Story #1: The Pious One

Hi, I'm the other contributor to this site. I hope to tell you a little bit more about my experience with pregnancy and Type I diabetes, particularly as I go through my second pregnancy. For my first post I'll share with you the birth story for my son. I wrote this shortly after it happened:


My first son was born Sunday, May 31, 2009 at 10:46 in the evening, at 8 pounds, 2 ounces, one week past his due date. What follows is some of what I remember.

On Saturday afternoon, I began having contractions similar to contractions that I had periodically for exactly four weeks leading up to this day. After dinner, I confessed to my pregnant friend, who had delivered her first baby unmedicated, not induced and vaginally (all goals to which I aspired), that the contractions were different than they had been before. I wondered aloud, to her and to myself, if I might have my baby this time.

I never fell asleep, and around the wee hours of the early morning, I was quite uncomfortable and worried that the car ride to the hospital might be unbearable if my husband and I waited any longer to leave. But when we arrived at the hospital, I was only 4.5 centimeters. This was not so much progress as it seems, since I was at 4 centimeters prior to the onset of labor. Contractions were anywhere from 4-7 minutes apart. I'm pretty sure the nurse thought I was a pansy. But I'm telling you, they hurt.

We passed the morning laboring quietly. My husband and I had taken a Bradley Method course in natural childbirth, and he assisted me through the contractions. He also checked my blood sugars every hour and helped dial in boluses and give me juice from a straw. We did a lot of things, but mostly what I remember helping was holding myself up with my arms at the peak of the contractions and counting the number of breaths it took to get through them. In the early afternoon, the nurse checked my dilation and I was only at 7 centimeters. That was a blow. The silence in the room began to feel oppressive. Though no one said it, I knew they were all looking at the monitor and thinking that the contractions needed to be closer together and more intense before the baby would come. But I didn't want them to be any more intense. I wasn't sure I would be able to handle this much pain for much longer. They hurt really bad.

I told my husband several times during the afternoon hours that I couldn't do it. He said, "yes, you can." I repeated my statement, thinking maybe he didn't really understand what I had said, or that maybe he didn't really understand how much they hurt. I purposefully kept myself from changing the chorus line because I thought he might give in and let me have the epidural. I thought at one point that I would even be OK with a c-section. I didn't really want that, but I was starting to feel desperate. In fact, it felt a lot like the last four weeks had - waiting, getting our hopes up, wondering how much longer it would be. Except now there was pain and exhaustion times ten.

Around 4:00 in the afternoon, I brought out the big guns. "I
don't want to do this anymore." Without missing a beat, he responded, "that's not true." I bristled a little at that, but only because he was more right than I wanted to admit. How did he know?

My contractions were still 4-7 minutes apart, as they had been since the wee hours of the morning, but at some point, they became longer and the peaks became more intense. I know because I had to count more breaths before they were over, and I was holding myself up with my arms for more breaths. I didn't need the monitor to tell me that.

At 5:45 in the evening, they broke my water, and I cried happy tears, feeling so relieved that I would have my baby soon. About an hour later, I was fully dilated.

I tried squatting, lying on my side, standing on the bed, hands and knees. You know, all the things they tell you to do when you're pushing. At some point, however, I guess I lost the urge. I was exhausted. So after 2+ hours, we still did not have a baby to hold. Discouragement crept in again, only this time it felt more like panic. More tears, this time sad ones. My doctor suggested pitocin to get the contractions closer together, since they were still 4-7 minutes apart. He assured me that the contractions couldn't possibly hurt any more than they already did, so the pitocin wouldn't make a difference. After some deliberation, we agreed. I took naps in between contractions while we waited for the pitocin to begin working.

I don't know whether it was the pitocin or something else, but at some point everything changed. Whatever calm demeanor I had had during the previous day of labor disappeared. I was hot, weak, exhausted, and noisy. I couldn't think of anything else but getting the baby out. Darkness crept in after the sun set. They turned on some really hot lights that made me feel like I was on a stage during the climax of a play. Before, it had been quiet with only brief, gentle interruptions by our nurse. Now, there were people in and out of the room, setting up equipment, looking at me, talking. Everything was messy but I didn't care anymore. I felt guilty for making everyone wait so long. Then I felt the ring of fire.

At the very last, my son's head literally seemed to pop out and it felt weird. I was so weak that I could barely reach down and touch my slippery baby. After 22 hours or so, our harrowing journey was blissfully behind us.


For the first week, I spent some mental energy trying to figure out how I was going to tell my husband that I thought we might be a one-child family. But a short six weeks later, I was already looking forward to the next one...

Tuesday, July 13, 2010

a great twist to the story

Thankfully, I've learned, though Cheryl, that I'm not the only "crazy" T1 out there who wanted to have her kids naturally. I call myself crazy, because that's what my doctors said ;)

So, I'm very eager to share more stories and experiences on the blog as they are available. I'm waiting on my copy of Balancing Pregnancy with Pre-existing Diabetes to arrive, and I'm not going to lie, pretty excited about it after email interactions with the author.

http://ecx.images-amazon.com/images/I/41YjYtSIaSL._SL500_AA300_.jpg

I hope that natural birth could become more accessible to type one moms as it is becoming more accessible in general right now because we are tired of stories like this one. And now I must go and grab that birthed baby who is waking, hoping you have a great day!

Wednesday, July 7, 2010

Why do I read diabetic blogs?

I just get annoyed. I really should stop. I know, I know... Hi Pot, I'm Kettle, you're black.

http://www.loc.gov/loc/lcib/9804/images/oliphant_3.jpg

So, all that out of the way, a new book on type one and pregnancy has been released. I am going out tomorrow to find a copy, but after reading this post detailing the author's opinion of natural birthing moms, I was discouraged. Granted that post was 4 years old, but it was also the only post related to natural birth after a search of "natural" on the blog's provided search engine.

I'll let you know what I find, I'm hopeful, since it's one of the few resources for type one women on pregnancy and birth. However, I'm fearful if you're a type one who honestly believes natural birth is better for you and your baby, you might find more helpful anecdotal info here. ;) More to come on this new resource!