Sunday, June 26, 2011

Stories


Does anyone have a story they'd like to share about their experience as a woman with Type I diabetes? It could be about your birth, your pregnancy, or even a small issue during one of your pregnancies. E-mail me at beth (dot) g (dot) turner (at) gmail (dot) com. We love to hear about natural childbirth, obviously, but any victory or failure that you encountered, related to being pregnant and having diabetes, is welcome. Your identity can be kept completely anonymous if you choose. I can't promise we'll publish everything...but I'm happy to read anything. :)

Pregnancy is hard. Children are worth it. Diabetes and medical intervention don't have to get in the way.


As I noted in my post on natural family planning, I wanted to write more about the following statement: "Being diabetic and pregnant is not easy."

Advocates of natural family planning usually want you to have more children than perhaps you originally thought you wanted. Count me among them. Advocates of natural childbirth, in their enthusiasm for the amazing thing that is a woman's body, tend to minimize what's hard about pregnancy, childbirth, and postpartum recovery. Count me among them. So what you're left with is someone who wants to have lots of babies, thinks other people should too, thinks that it should be easy because of how wonderfully a woman's body is made, and may be tempted to cover up or down-play the tough stuff. Yup, that sounds about like myself two babies ago. So in this post, I'm coming clean.

I came to the conclusion that being pregnant was hard the first time I did it. I've been told there are women for whom being pregnant is easy, but I don't think I am one of them. Or maybe I am and I'm just a big whiner. In any case, after posting several whiny Facebook statuses during the last six weeks or so of my first pregnancy, a friend chided me, saying: "Hurry up and have that baby already!" Feeling ashamed, I subsequently followed up each whiny sentence with an apologetic one.

During one of these subsequent conversations, my diabetic cousin, who has two children and also loves natural childbirth, told me that it was OK for me to whine, and that I didn't need to apologize. Why? Because being diabetic and pregnant is hard! Yes, being diabetic and pregnant IS hard. Even, I dare say, harder than for other women. That phrase and the idea has accompanied me closely for the last couple years as I finished my first pregnancy and, a mere 17 months later, finished a second.

As I dwelled on that phrase and that idea, and in an effort to justify all the complaining I did, I wanted to come up with the reasons that being diabetic and pregnant was hard for me. I came up with three:

1. Blood sugars. I had to watch my blood sugar like a hawk. Because I just couldn't seem to keep myself from eating a ton, I was frequently chasing lows (because I was giving large amounts of insulin to cover the huge amounts of food I was eating). I bit my fingernails every time my blood sugar was found to be over 200. My dawn phenomenon was worse, and I was hungry all the time. And all my bolus ratios and other insulin levels changed every few weeks.

2. Extra doctors visits. Between growth ultrasounds, special fetal echocardiograms, non-stress testing, regular OB check-ups, visits to my endocrinologist, and lab work, I had to pick my appointment times and routes to the hospital carefully to avoid traffic and asked for a lot of time off work. I corresponded with one woman with Type I diabetes who found herself at some doctor or another every week starting at the beginning of the second trimester!

3. I had to prove myself. I had to prove myself - to my doctors, to my family, and to myself. I had to prove that I could control my blood sugars, and I had to prove that I could grow a healthy baby. Finally, I had to prove that I could push a baby out, because everyone worried that my babies were going to be too big.

I think there are probably other conditions which make pregnancy more challenging for women with Type I diabetes. Retinopathy? Kidney damage? Hypertension? Blood vessel damage? There may be other things. I don't know whether pregnancy would make these conditions worse, or whether these conditions would make pregnancy even more difficult. I would love to hear about your experience.

But lest I be fully justified for my incessant whining, let me develop one further point. You know what I found hardest about being pregnant and diabetic? It hardly ever had to do with diabetes. Even managing my blood sugar became second nature. And with the good insurance we had for both pregnancies, our expenses for those many doctors' visits were not excessive. No, having diabetes was not what made being pregnant hard for me. It was the same stuff that makes being pregnant hard for every woman. It was the first trimester nausea, the sleepless nights, the aching back, the hourly visits to the bathroom, the fat feet, the fear of labor, the knowledge that your life is about to change dramatically, the uncertainty of it, the contractions that make you think you really just can't do another one (and then somehow you do it once, twice, three times more), and that final push. Much to my surprise, in the end, I found that diabetes management during pregnancy was an afterthought compared to the looming realities of being a woman with another small human being living inside me.

This brings me 'round to my original conviction about natural family planning and natural childbirth. As a true advocate of natural family planning and natural childbirth, let me never say that having another baby is just too hard because "being diabetic and pregnant is hard." If my husband and I choose to delay pregnancy, let it be because I really am struggling to control my blood sugars, or because we really don't have good insurance (or Medicaid or money) to pay for the doctor's visits. Let me never hide behind the fact that I have diabetes (and believe me, I'm tempted!). If issues come up that threaten my life or the lives of my babies, let me view my situation without the lens of fear which usually clouds my rational abilities.

I hereby propose a new idea on which to dwell to keep my spirits up over the next several years of childbearing: "Pregnancy is hard. Children are worth it. Diabetes and medical intervention don't have to get in the way."

Monday, June 20, 2011

GROAN


I visited my endocrinologist today and was dismayed to discover that he, too, advised against another pregnancy. He groaned when I told him that I planned to have more children, as though that were some burden to him. I groaned inwardly when he asked me to "please wait a while." What is he even worried about? My children and I are healthy. Does he think that he's going to have to pay for their college tuition or something?

A little history here. After we moved from St. Louis, back to my hometown, I returned to the same endocrinologist that I had seen since I was first diagnosed at age 9. He's a friend of my family, and has apparently always been in the business of being generally awkward about my fertility. Not that I really minded my dad knowing, I just didn't want to talk about my period while he was in the room when I was 14.

Next time, I plan to ask him how many children he thinks I should have and why. If he even comes up with a number that doesn't have anything to do with my health, I'm going to groan outwardly so he knows that the feeling is mutual. I'm quite confident that it doesn't have anything to do with concrete information about my body or my previous pregnancy history.

Thursday, June 2, 2011

Happy Birthday, Part II, and My Diabetes Life Story


As a special birthday treat to begin my 28th year of life, I'd like to tell you more about myself (um, I promise I'm not a total narcissist?).

I was diagnosed with Type I diabetes at age 9. Fortunately, my mother is an ER physician and recognized the signs and symptoms of diabetes. It helped to have a cousin who had been diagnosed a few years prior. My family cut short our summer vacation to bring me home and check me in to the hospital. And not a few of my older siblings inwardly groaned at the number of pit stops we had to make on our 11-hour drive home!

I was quite proud of my diabetes. I told all of my friends about it. Once I was checking my blood sugar and giving shots myself, I was happy to show anyone who asked. I was on a regular/NPH regimen. I was also a pretty normal teenager. I remember an A1C below 8.0 being a good number. I had very few A1C values below 7.0, and probably only one below 6.0. At some point, I think during my sophomore year of high school, I upgraded to Lantus/Humalog regimen. The doctor I saw in high school and college (1998-2006) did not like the insulin pump, because he thought it was not worth the money. I had a diabetes buddy during high school who also did not have the pump, and also had similar blood sugars, and our common experience was pretty normative for me. He is in Mongolia, on horseback, a destination of his own choosing, for the next couple months (I mention it because if you're the type, you should pray for him).

During college, I got into midwifery and read everything I could get my hands on. I followed around a homebirth midwife in my hometown one summer, and spent some time with my aunt, who had been a homebirth midwife in Oregon. I did not see any births, but a few prenatal visits. I spent a day with some CNMs. Mostly, I spent a LOT of time trying to understand why midwives do what they do.

After graduating from the University of Virginia, I got married and moved to St. Louis, Missouri. New town, new doctor, new diabetes buddy! Our neighbor happened to be Jenn, my friendly co-blogger, and this was a match made in heaven (though not the romantic kind). Two things happened, diabetically speaking, when I moved to St. Louis: 1) Not being on an insulin pump put me in the same category as dinosaurs and antique furniture and 2) I got to watch Jenn go through pregnancy as a diabetic woman, and it gave me a real leg up when it came time for me to go through it. I got an insulin pump and started thinking about how to manage diabetes during pregnancy.

I called around to OB/Gyns, and eventually found one that I loved. He was a maternal-fetal specialist, but was not part of a hospital practice. He attended all his high-risk deliveries himself (very midwife-like of him!), and he was very respectful of my experience as a diabetic, my ability to monitor my own blood sugars, and all the research I had done on pregnancy and childbirth. When I came to him for my first prenatal visit in 2008, my A1C was 8.something. I kicked my butt in gear and the next measurement was 6.2! I went in for a ton of Linktesting, but he didn't mess with me unless he actually SAW something wrong, rather than just assuming the worst would happen and intervening to prevent the worst case scenario. I was hospitalized overnight at the beginning of my third trimester because of concern that my placenta wasn't supplying enough nutrients to my son, but in his infinite wisdom, my doctor sent me for a second opinion. I was then sent home on bedrest for two weeks and had no further problems. You can read my son's birth story here.

I turned up pregnant again when my son was 8 months old, and you can read about my pregnancy adventures here, here, here, here, here, here, here, and here. You can read about my childbirth adventures here, here, and here (there was a lot to say, I thought).

Happy birthday to me!

Wednesday, June 1, 2011

Interview with Ina May Gaskin


Love, love, love Ina May Gaskin. Her approach is so reasonable:

"It's very rare to see an undisturbed birth in a modern U.S. teaching hospital, but when you see a woman who isn't frightened, who's giving birth without interference, you stand back in awe and realize how little needed you are except in the rare circumstance. That doesn't mean that you shouldn't be around in case there is a problem. It just means that you should be able to tell when there's a problem, and you should be able to tell how not to create problems."

The bold highlighting is mine. For so many Type I diabetic women who have lived with diabetes forever and are basically healthy, diabetes itself is NOT a problem. Real problems associated with diabetes include fetal heart defects and babies that may be too big, but these things can and should be monitored and treated separately. Diabetic women know how to take care of their blood sugars and should be allowed to do so. They should be treated as a high-risk pregnancy only when there's actually a problem.

Read more: http://www.time.com/time/health/article/0,8599,2062393,00.html#ixzz1O3HGVYi6