Friday, March 18, 2011

My Induction


A long, long time ago, when I wrote my birth story, I promised that I would write about how my husband and I decided to consent to an induction for the birth of our second son. After about 5 months, I think I'm finally ready to put it out there without any venomous words.

I was pretty frustrated at the time it happened. I did not know that my doctor would feel so strongly about it, nor did I want to be pregnant 2 days past my due date, nor did I know it would be so hard to find words to explain why I didn't think it was necessary. Now I think I've worked out some of the anger and objections I had, and I'm ready to talk about it. It's funny how much that sounds like a bad marital argument. And isn't that just the way we feel a lot of the time when our doctors, who are given such an intimate responsibility for the care of our bodies (just like a spouse is!), don't respect and address our concerns openly and honestly?

First of all, at my first OB visit in our new town, I asked our doctor how long he would feel comfortable letting me stay pregnant after our due date. I thought I heard 41 weeks. I was OK with 41 weeks for several reasons: that's when my first baby showed up, and that's when doctors usually start talking about induction with women who have normal, healthy pregnancies (which mine have both been).

So, that's why I say I was surprised when he asked me at 38 weeks when I wanted to schedule an induction, and indicated that it should be next week. I should have stopped and told him what I was worried about right then, reminding him that my first baby wasn't born until 41 weeks, that mine and baby's health was just fine, and that we had talked about it at our first visit. But alas, his hand was on the door knob, I was caught off guard, and I chickened out. Let me remind the reader that no identified problem with my health or my baby's health had spurred the suggestion; only the simple fact of my diabetes. Tight blood sugar control, perfect fetal health, my individual good health, and a lack of other pregnancy problems were not enough to merit a second look at a standard protocol treatment.

I returned for my 39 week visit and he almost slipped out the door before I reminded him that we needed to talk about the induction. Silly me! I wonder what would have happened if I had just kept my mouth shut. In the end, I agreed to it, but was in denial and thought for sure I would of just go into labor before it was scheduled, 9 days hence and 2 days after my due date.

I tried some natural induction methods. Google 'em if you're interested; after two babies, I am quickly losing my appetite for them. One new one suggested to me by a certified professional midwife was castor oil compresses. Rather than drinking the stuff, which can make you dehydrated from vomiting and diarrhea, I wrapped warm towels soaked in it around my abdomen with plastic wrap for an hour. Contractions would start and sometimes even feel like early labor, but they never got going strong enough to get labor started. After a few days, I remembered that I was trying to AVOID induction, even a "natural" one, so I stopped trying. I called and e-mailed friends who had been induced, a midwife, an aunt, and a labor and delivery nurse friend. Their words were of great assistance to me. Knowledge became power. I sure wish my doctor had felt comfortable giving that to me.

At my 40 week visit, I finally used the words, "I'm not comfortable with this." My doctor's response was that everything would be fine. I was a second-time mom, already had one vaginal birth under my belt, I was already dilated 3 cm, my health was great, etc etc. On my way home from this visit, I just cried. I knew that I would either be induced or piss off my doctor by refusing. I didn't want an angry doctor attending my delivery, and I didn't want to or think I needed to be induced.

The night before my induction, I talked with my friendly co-blogger, Jenn, who told me that under no circumstances should I consent to treatment that made me uncomfortable. I don't remember the details of the conversation, but I realized I had to own up to whatever course of action I took. Rather than just feeling sorry for myself, I had to take responsibility for whatever happened to my body and to my baby. That night, at Jenn's suggestion, I called the labor & delivery ward of the hospital and asked them to page my doctor and have him call me to discuss the induction one last time.

In the morning, at about 6:30 a.m., my doctor called. The normally friendly voice on the other end of the line was stern. His warnings focused on the way my hesitation would mess up the hospital's schedule, but if I had to guess, I would say he was probably also frustrated that we hadn't been able to communicate clearly and see eye-to-eye on this point. He did tell me that he would still attend my labor, even if I failed to show up for the induction, which I had worried about. When I reiterated my concerns about the increased rate of c-sections in induced labors, he told me, "no one can give you any guarantees about labor."

Let's think about this last statement for a moment. No one can give you any guarantees about labor. It's so true! Labor can be unpredictable. What my doctor inevitably meant by his statement was this: "You are sick, and terrible things are waiting just around the corner for you. If we don't intervene, it will probably go badly." But I also think about what else it can mean: "Take care of your body, and good things are waiting just around the corner for you. If we don't mess with it, your body will probably handle labor in a surprising and beautiful way." Unless the interventions are never harmful, it's worth questioning whether labor might proceed in a better way without them. In my opinion, labor interventions are often as harmful as doing nothing at all.

Another thing that immediately hit me when he said that "no one can give you any guarantees about labor" is that he had been trying to do just that at my final visit to the office! In response to my concerns about c-section risks increasing following inductions, he told me "everything will be fine." What is that but a false guarantee that he had no right to give me? He couldn't do the statistical math about whether I was more likely to undergo a natural stillbirth or my baby or I would die following complications from a c-section, and neither could I. And even if one of us could, in the end, there are still no guarantees about the outcome. The only guarantee is that if I am induced and something bad happens and I want to sue him, he'll win in a lawsuit, because he followed the protocol.

Alright, I think that's about as mad as I ever got and as mad as I will get for the rest of this post.

Now is a good time to mention the patience, trust, and support of my husband. I haven't mentioned him yet because he gave me a lot of space to explore these issues on my own and in consultation with my friends who were knowledgeable about the topic in many different ways. He told me he was comfortable with whatever I wanted to do - which is saying a lot when the lives and bodies of your wife and unborn baby are on the line. Think of the emotional drama, and then think of his wisdom in stepping back to let me wrestle with it. He is to be highly praised.

Now, back to approximately 1 hour and 15 minutes from the time I am supposed to arrive for my scheduled induction. My husband and I discuss briefly, and here's what we agreed: the statistical likelihood that an angry doctor will cause me stress for as long as this pregnancy continues, including during labor > statistical likelihood that something bad will happen to me as a result of being induced. Seriously. Wait, seriously?

When all is said and done, I underwent an induction because I didn't want relational drama with my doctor to influence the rest of my pregnancy or labor. I am fortunate to have a beautiful, healthy baby boy sleeping just down the hall in a room with his beautiful, healthy big brother. I am so grateful that for the first two weeks of his life, I experienced the greatest happiness that I have ever known. Except for a few problematic stitches in my perineal repair, I am as healthy as a horse.

When I look back on my induction, I don't think it was necessary. When I do the calculus, my doctor's fears about stillbirth were overblown, but my fears about problems with my induction were probably also overblown. My biggest problem with the decision to intervene was not what happened during the induction, but what didn't happen leading up to the treatment recommendation: lack of open, honest communication. If I could do it over again, I would tell my doctor how much I hoped to avoid induction, request that I be treated like the healthy pregnant woman (and baby) that I was, and make sure that the appointments lasted long enough for my concerns and objections to be addressed.

And, in fact, I probably will have to do this over again. My husband and I look forward to welcoming more children to our family, and my doctor told me that I would not find ANY doctor in the area where we are living that would "allow" me to go past 39 weeks gestation. So there will be another opportunity to get it right next time - for both me and the doctor helping us.

Phew! That was harder to write than the birth story. Hope my thoughts are helpful to some and would love to hear what others have gone through.

Wednesday, March 16, 2011

Yet Another Benefit to Natural Childbirth


Check out this page. The author is my cousin, Sarah Howard. She is herself a diabetic and a mother, and she initiated her research after her not-quite-2-year-old son was diagnosed with Type 1 diabetes also. She's searched high and low for possible causes of the disease in very young children, and she's pulled together a whole lot of hypotheses about what might be increasing the numbers of children diagnosed with Type 1 and Type 2 diabetes.

What caught my eye is the following related to gestation and birth:

"Interestingly, an analysis of data from 20 studies found that Caesarean sections were associated with a 20% increased risk of type 1 diabetes in offspring."

Yet another reason to ditch the C-section and go natural if you can. She also puts in a plug for breastfeeding as a way to reduce the risk of type 1 diabetes in children.

Natural Family Planning


I have been tempted, but afraid, to write this post for a long time now. I've taken some heat from doctors, family members, friends, and co-workers for refusing to use contraception, and I know that most people have strong feelings about the subject. But since we are a blog about Type One Diabetes and Natural Childbirth, I thought it appropriate to pen some thoughts on the most natural method of postponing pregnancy and childbirth.

Natural family planning has always jived better with my love for natural childbirth than any contraceptive. It's just, well, natural. In the same way that I think women's bodies work pretty well during pregnancy and childbirth, I think they work pretty well during the ovulatory cycles, also. There is something to be said for these bodies we've been given. An easy way to sum up my non-religious perspective on the matter is: If it ain't broke, don't fix it. My belief on this point has been informed and fortified by the Catholic faith that I have embraced, but before that, it all began with a love for the way my body works and a curiosity about what was happening the other 21 (or 25, or 34) days of the month.

The first pushback that I got was from the first endocrinologist I visited after my husband and I got married and moved to St. Louis in 2006. She queried me on my childbearing plans, and when I told her we were using NFP, she thought I was joking. She began to write me a prescription for the pill. I told her that I was going to throw it in the trash. Then she got serious and said she understood that I had convictions, but assured me that being pregnant and diabetic was too hard. I told her I was confident that we could use it successfully to postpone pregnancy, and that I was planning to have children at some point anyway. Then, in a last ditch effort, she told me to come over and babysit for her children (whom she called "monsters") some time, and that would cure me of a desire to have children. I sincerely hope that I never even think of my children in this way, but if I do, I hope that I'm smart enough to keep my mouth shut and pray for God's mercy. Needless to say, my first visit to said endocrinologist was also my last.

This story, my first visit to an endocrinologist as a married woman, is by far the worst. But it's not the only time I've heard jokes, warnings, horror stories, and derision when I've confessed to our use of natural methods to postpone pregnancy. As a diabetic, the stakes are high, since being pregnant and diabetic is hard (the endocrinologist was right about at least one thing), and using natural family planning to postpone pregnancy is not always a walk in the park. As a woman, I am encouraged to see in myself and others that it works. As both a diabetic and a woman, I have a strong interest in monitoring my body's natural patterns and working with them to ensure my continued good health.

I have lots of other thoughts on this subject (especially the "being diabetic and pregnant is hard" and "natural family planning to postpone pregnancy is not always a walk in the park" parts), but I will save them for another post.

Juice

The first few times my older son saw me pull juice out of the refrigerator and chug the whole glass of it to remedy a low blood sugar, he threw fits. Several of them ("How dare she not share!"). Fortunately, he got used to it after a little while.

However, he's also gotten better at asking for what he wants. Yesterday, when I pulled some juice out of the refrigerator, he exclaimed, "Mommy! Juice!" Then, after reflecting on this fact for a moment, he ran to the refrigerator, yelling, "Juice! Also! Juice! Also!" I, of course, got him some juice also.

Glad to share my juice with you, kiddo - just glad I don't have to share my diabetes, too. Let's both drink to that. :)

Thursday, March 3, 2011

Type I Diabetes Risk in Children of Type I Diabetics

Though it's not related to natural childbirth, I thought these statistics were relevant and interesting. I worry a lot about my kids' health. For example, should I expect them to get diabetes because I have it? My Type I diabetic cousin's son was diagnosed with diabetes just before his second birthday. My little boy is approaching this age rapidly, so I worry about his health.

"Although the risk of developing type 1 DM is increased tenfold in relatives of individuals with the disease, the risk is relatively low: 3–4% if the parent has type 1 diabetes and 5–15% in a sibling (depending on which HLA haplotypes are shared). Hence, most individuals with type 1 DM do not have a first-degree relative with this disorder."

In other words, my children do have an increased risk of having Type I diabetes, but the risk is still very low.

The full text is here, if you're curious.