Wednesday, July 27, 2011

Contemplating...


Hi from the long-lost me, Jenn. Sorry it's been so long, I think I've been in one of those, life-isn't-going-the-way-I-want-it-to-so-I'm-not-going-to-blog-about-it moods. :) I'm sure that I've mentioned before the hub's and my desire for more children, and because of the female quality of my person that desire has been a bit stronger for the last months than my male typified (reasoning) dearest husband. He's had a lot on his plate at work and just wasn't ready to have the discussion about adding on to the family when I was, which is reasonable for sure. He is after all the one who provides for our family and needs to feel like he is in a place where he can feed and parent another child.

Although, I must say that I am quite astonished that we have not welcomed a pregnancy in the last 2.5 years since Audrey's birth, we do not use hormonal birth control and wow, are we really that responsible? I guess we are. ;) All that is to say, we are contemplating growing our family these days. I'm extraordinarily excited about this and wondering since we haven't done this in 3 years or ever in this town what to do next!

We just got new insurance, which I felt very silly complaining to Beth about when she lost her's the next day. :( Our new insurance does not cover my beloved endo and I had to cancel my appointment with him just this past Monday. Only to find out that the only endo our new insurance does cover in town has a 3 month waiting list.


Well, with the possibility of pregnancy, I want to know where I'm at with the "dia-beets" and I'm not so keen on the idea of waiting 3 months to find out. I did interview the midwives in town a few months ago and still am hoping to have them work with me for the birth if we do get pregnant, however, I want to also find a perinatologist to manage the diabetes during pregnancy. So I'm thinking, I'm going to try and get in for my first ever "pre-pregnancy" diabetes meeting with a maternal-fetal specialist. The midwives work closely with one doc in particular here, so I'm thinking she must be decent as far as interventions go or they would have chosen someone else. Thankfully, our new insurance covers her and I'm hopeful that she will not have a 3 month wait when I call tomorrow :)

I feel a bit hypocritical going for such an appointment after this comment, and must admit my fault and regret over this passionate statement. I still believe that specialists make decisions based on fear of what might happen rather than the reality of what-is with diabetic women and know that I will have to hold my ground through another pregnancy, Lord willing to grant me this gift. However, I've also learned that the doctors are good at managing my diabetes and holding me accountable. A good thing for baby and something I want. I remember that feeling of I have to do everything I can to make this pregnancy as normal as possible by perfecting my blood sugar control to avoid complications and to ensure the best chance at a normal delivery.

I'm scared, though. I have two beautiful and currently healthy children. Am I crazy to do this again, what are the chances I could be successful? How much harder will it be to take care of myself with two toddlers running around? Do women get births as wonderful as Audrey's twice or am I pushing my luck? What if I can't get pregnant this time? (although that wasn't an issue AT ALL the first two times, what if I've changed?) What if I do have a miscarriage, even if it has nothing to do with my diabetes, will I ever really believe that? I'm older now, and certainly much wiser, than the 23 year old who had a surprise pregnancy and willed her way through it. I've lived through friends pain and loss over pregnancy and children now. I've lived through the lives of my own two kids and realized how much of a responsibility it is to care for and train up another human being. Am I really ready for this?

As I typed that last question an involuntary smile spread over my face because I know the answer to that question. Yes, yes, I am ready. And to the others, thankfully, like Beth, I trust in the grace and plan of the Lord for the rest. Knowing His sovereignty means I can live through the rest of those questions even if the answer isn't what I was expecting. The desire for a child is a GOOD thing. Even for me, even though I have diabetes. It means I have to put on my big girl panties and man up to the huge responsibility of my diabetes while it is affecting the miraculous formation of another human being, but this is a responsibility the Lord knew I could manage. I do covet your prayers as my husband and I contemplate this decision which is why I am writing today. Lord willing, I will have more to write about in the coming months, Jenn.


Saturday, July 16, 2011

Insurance Crisis

We recently suffered an insurance crisis. This won't be relevant to our non-U.S.-based readers, but I hope some of you can learn from my experience!

I was insured by Anthem (Blue Cross Blue Shield) for three years while we lived in St. Louis, through my employer. It was good coverage, high deductible, but I wasn't paying any premiums, so it worked out OK. Last spring I quit work as we prepared to move and I was on COBRA for several months. My husband began a PhD program and we signed both of ourselves up for one-years' worth of coverage on the student health plan, running from August to August. I also applied for Medicaid to cover our son and my pregnancy costs. I had United Healthcare Student Resources as my primary insurance and Medicaid as my secondary (being covered by two policies was actually a big headache to me, the insurance companies, and my doctors, but that's another blog post). When Medicaid ran out for me, both boys were still covered by it and I was covered by UHC StudentResources.

We received a letter from the school my husband attends during the first week of July that indicated dependent coverage on the student plan would be discontinued. This news = disaster for us. When I left my job in St. Louis, I knew that I wouldn't be eligible for most individual plans, and the availability of group coverage was a BIG part of the reason that we felt comfortable taking the plunge back into school. Even without 14K in healthcare costs, we are living off savings and shacked up with my parents.

So I started investigating my options (and my husband started thinking about what sort of full-time work he might like to begin immediately and do for the next 30 years). Turns out there aren't many, and they are all EXPENSIVE. If I am HIPAA-eligible, a proposition that's truth is yet to be confirmed or denied by an underwriter, the options are expanded, but the cost problem remains. I crunched some numbers, both to figure out exactly how much money we'd be out next year and to figure out exactly how much it would cost us for me to go without insurance (a possibility that neither my husband nor I relished, but really had to at least explore as an option).

If I paid for all my routine diabetes-related expenses (pump supplies, prescriptions, doctors' visits, and lab work) out-of-pocket, it would cost us $7,500. I would encourage every Type I diabetic to do this. It made me not so terrified of the costs associated with diabetes, and I'm really grateful that I now know. Turns out that actual care from doctors PALES in comparison to test strips. $3,000 for a years' worth of One-Touch Ultra test strips (I check my blood glucose 8 times a day)! Crazy! Anyway, that grounds me in the reality of what it costs for my medical care in one year. And that's only anticipated expenses - it doesn't include other illnesses or accidents. Being a very healthy Type I diabetic, I don't think I should have to pay more than $9,000 total to account for the risk of something crazy happening to me.

Last year, including insurance premium, deductible, co-pays, and coinsurance, we paid $3,600 for me (no wonder we're in the healthcare mess we are now...whose paying the extra $4,000 per year?! I guess now I will be paying for it!). When I began looking at HIPAA guaranteed-issue plans from Anthem and Aetna, it was going to cost a minimum of --- drum roll, please --- $13,600! That's right. A full $10,000 more each year, at a minimum. Yikes. What surprised me most was that there literally were not any options between my group coverage ($3,600) and a guaranteed-issue individual plan for someone with a pre-existing condition ($13,600). That news hurt!

...But it gets better (or worse, depending on how you look at it). I'm not even sure that I'm eligible for HIPAA guaranteed-issue plans. An Anthem representative and an employee of our state's department of insurance told me that I would not be, but United Healthcare seemed to think I would be. The reason for the discrepancy is that I've been covered on a student plan, rather than an employer plan. HIPAA language states that everyone HIPAA-eligible must have been on a "group plan", and the examples that the law gives include employer plans but not student plans. We will have to see what the underwriter thinks.

Failing a HIPAA guaranteed-issue plan, here are my only options:

BlueCross BlueShield Open Enrollment. BXBS has an "open enrollment" plan and the premium is literally just based on your age. There's no underwriting, they don't turn down anyone, and they don't cover pre-existing conditions for the first 10 months. Almost $500 per month premium, but decent coverage. However, because diabetes isn't covered, I would end up paying over $13,000 in the first year. Thereafter, I would pay about $8,000.

PCIP. In other words, the federal government insurance program recently-instituted by the PPACA. Yuck. The suckiest thing about this plan is that, despite President Obama's executive order to the contrary, it sounds as though abortions may end up being covered by these insurance plans (I read an article in the most recent issue of First Things describing a clever way of getting around his executive order, which carries little legal weight in contrast with the statutory language of the law itself. And pro-choice lawyers are clever...see Roe v. Wade). The second suckiest thing about this plan is that you have to be without coverage for 6 months before you are eligible. I just don't really want to go there.

And, by the way, none of these plans cover maternity. Neither the HIPAA guaranteed-issue plans, and not the open enrollment plan. I wasn't able to get good enough info on the PCIP, but I'd be willing to bet it doesn't cover pregnancy/childbirth costs. Apparently insurance companies and the government think they know better than women themselves how to define "too sick" and "too poor" to have a baby. If I weren't eligible for Medicaid, I would be begging on the doorstep of every homebirth midwife I know, pleading my case for a chance at an out-of-pocket homebirth. As it is, if I turn up pregnant this year, I will probably be seen by a maternal-fetal specialist on the baby-factory assembly line.

We'll see how it shakes out. I'll keep you posted (in case any of you are actually interested in this saga...based on the number of comments we get I'm thinking that no one actually finishes reading my posts :).

Tuesday, July 12, 2011

Pregnancy Weight

This was a special week for me. I stepped on the scale and I was finally back at my pre-pregnancy weight! Hooray!

I gained between 45 and 50 pounds during each of my two pregnancies. After my first, I had just barely lost the weight when I found out I was pregnant again. In fact, I didn't actually own a bathroom scale and the only reason I knew that I had lost it all was because I went for my initial prenatal visit of the second pregnancy and the scale read the exact same number that it had at the beginning of my first pregnancy. A few short weeks later, one of the few co-workers who knew I was pregnant smiled and whispered that I was starting to show a little bit (at 8 weeks). I groaned and told her that was the LAST thing I wanted to hear because I had only STOPPED looking pregnant 8 weeks before!

I lost about 25 pounds very quickly after my second pregnancy. I hung out there for about 6 weeks, then I lost another 15 over a few months. It took about 4 months to lose those last 10 pounds! My second son is now 8 1/2 months old. I haven't taken many active measures to lose the weight, except that I do try to avoid desserts on all but special occasions. Also, when my blood sugar is low, I try to drink only juice instead of eating more substantial (caloric) snacks between meals. That serves both my diabetes and my weight loss, and it keeps me healthy. I used to say that I didn't care how much weight I lost as long as I didn't have to buy a new wardrobe, but it turns out many of my clothes don't fit anyway. At least I did my part!

I have breastfed my son exclusively, and he continues to nurse 5-6 times a day. My mother swears that she lost her pregnancy weight within the first 6 months when she was breastfeeding, and she attributes that rapid weight loss to breastfeeding. I have a good friend who exclusively breastfed two children. She said that it took her a full 9 months to lose the weight both times. I have another friend who said she found it difficult to lose the last 5-10 pounds while she was still breastfeeding. I'm sure that all of these scenarios are normal, and I am just glad to be back at my normal weight before I jump on the roller coaster again.

By the way, have I mentioned that I'm really not pregnant again? I feel a need to keep making that disclaimer.


Monday, July 11, 2011

The Stick


My
idea for this post came from Calah at her blog, Barefoot and Pregnant. She is hilarious, and you should read some of her other stuff. I identify with her because she is also a Catholic convert and stay-at-home mom and her husband is getting his PhD, too.

The Stick. The stick I'm talking about in this post is not the "finger stick" of blood sugar monitoring or blood hemoglobin levels, nor the "heel stick" that draws blood for your baby to be genetically tested for a variety of rare diseases. Nor is it the broken branches my 2-year-old picks up in our yard and wields yelling, "Sword! Sword!" No. The stick I mean is the one you pee on that has the potential to change your life forever.

I take a lot of pregnancy tests. I have a stash of them in my cabinet. I buy them at the dollar store, and keep at least 2 around at all times. I gave away a few at the beginning of my last pregnancy thinking I wouldn't need them for a while, but 18 months passes quickly and I wish I hadn't because I'm as neurotic as ever. The pinnacle of my paranoia was the time I walked to a drug store a mile and a half away from my office building on my lunch break during a very cold winter afternoon and took one in the public restroom at the office where I used to work (it was negative).

I'm extremely skilled at hiding the evidence, especially from a) my husband who thinks I'm crazy, b) my co-workers, who thought I was a religious nut after my aspiring-Presbyterian-pastor husband and I converted to Catholicism after a full 4 years at a Presbyterian seminary, and c) my parents, with whom we are currently living, because my dad has the habit of emptying the trash in our bathroom from time to time.

I think there are two reasons I am hyper-sensitive to the first news of pregnancy. One is because, as we all know, people who practice NFP are called parents (smile/gag). Lest you think it's NFP that doesn't work, I will tell you now that I've taken my fair share of chances during potentially fertile periods, so NFP should not be considered unreliable on the basis of my experience.

The second reason I take a lot of pregnancy tests is that I have diabetes. Early blood sugar control is important for a healthy baby, and I want to make sure that I am organizing my life around my new baby as soon as possible - waking up in the middle of the night to check my blood sugar, controlling dawn phenomenon and other random blood sugar spikes associated with early pregnancy, making sure I have all the extra insulin and pump supplies I'll need later on during pregnancy, figuring out how to work walks into my routine more regularly, and so on and so forth. As much as I try to practice these things when I'm not pregnant, there's nothing like knowing you have a tiny human growing inside you to kick your butt into extra-healthy mode.

Paranoia or responsible parenthood, I'm not sure, but I'm going to keep pregnancy tests handy.

Saturday, July 9, 2011

Vitamin D

When I wrote my post on things I want to try next time I'm pregnant to keep my babies from being "too big," I forgot to mention Vitamin D. I have no idea how or why it works to keep your baby small, but here's a couple of things I've learned about it recently.

It might make gestational diabetes easier to control. At least the Navelgazing Midwife says so (maybe anecdotal experience?). Anyway, it's worth a shot.

It might make labors shorter and less painful. Again, the Navelgazing Midwife says so. That would be awesome, although short or long, I maintain that labor is going to be hard work and a little scary, no matter what way you slice it. At least on this side of Eden, anyway.

Some mothers and therefore their breastfed babies are deficient. It's the reason that pediatricians recommend breastfed babies receive D-Vi-Sol or some other vitamin D supplement. Also, my husband tells a funny story about a conversation that he had with one of my doctors once. When I was breastfeeding my son, age 7 months, I had some blood drawn. My vitamin D was low and my endocrinologist reported the results to my husband over the phone. He apparently spent a long time trying to impress upon my husband the severity of the national epidemic. OK, maybe it's only funny if you know my very serious, earnest, well-meaning, and apparently (though not truly) naive endocrinologist from St. Louis.

It may prevent the development of Type I diabetes in my children. See this post by my cousin. I'm just not seeing any downside to vitamin D at this point!


I asked a maternal-fetal specialist about Vitamin D when my levels came up low again at the beginning of the third trimester of my second pregnancy. She said that OBs don't recommend vitamin D above 400 IU (the daily recommended dose for non-pregnant women) because there's evidence that at REALLY high levels (40,000 IU) it hurts you. Or something like that. Well, I've seen a lot of recommendations and I don't know who really knows what level between those two extremes is the best. I take 4,000 IU daily, and my vitamin D levels are now clinically normal but on the low end.

Friday, July 8, 2011

Happy Anniversary!

Today, my husband and I celebrate our anniversary. I am so glad to be married to a man who takes care of me when my blood sugar gets low, wants all the same good things for our children that I do, supports me during all the hard parts of pregnancy, labor, and postpartum recovery, and trusts me to make good choices for our children when they're inside and when they're out.

It's not hard to love a man like that!

Wednesday, July 6, 2011

Prenatal Testing

I'm not sure why I'm on such a blogging kick lately. Maybe I'm doing some pre-pregnancy psychological nesting? As we all know, I do want to have more children. I guess it's good to be prepared at any moment (especially when you're practicing NFP, since we all know that people who practice NFP are called parents, I don't know whether to smile in assent or gag).

Here's a list of testing I had during my pregnancies, and what I learned from each:

A1C. I love the hemoglobin A1C. It makes me feel secure and validated about my blood sugar management. I am motivated but not anxious if it's less than 7.0, pat myself on the back if it's less than 6.5, and celebrate my victory if it's less than 6.0. I had mine tested every trimester both pregnancies.

24-hour urine. I actually don't know a lot about what this test tells my doctor, except that it has something to do with your kidney health and mine have always been OK. Also done every trimester.

Blood. I had my blood levels measured early in my first pregnancy and again towards the middle of the second trimester. I say "blood levels," because all I know is that I had my blood drawn and they tested it for some stuff. Not sure if it was a CBC or what. Anyway, it was tested again at the beginning of my second pregnancy and again at the beginning of the third trimester. Two problems I encountered were Vitamin D (borderline low during the middle of my first pregnancy and clinically low right before I got pregnant the second time, while breastfeeding), and elevated cholesterol. As it turns out, elevated cholesterol during pregnancy is normal, so it's probably not even worth checking.

Link
Blood pressure. Man, I get so anxious when I see that cuff now - even when I'm not pregnant. They don't like pregnant women to have blood pressure over 140/90. Mine rose at the very end of my first pregnancy, and improved after my doctor told me to quit work (I was already 40w5d). I avoided induction because of that advice!

18-20-week comprehensive ultrasound. This one takes a while and they do a whole lot of measurements. They measure head circumference, chest circumference, length of arms and legs, and tell you whether your baby is a boy or girl. They check out the baby's heart, and look at placement of the placenta. They also measure blood flow through the umbilical cord and in the baby's brain. It is AMAZING what they see at this ultrasound. I asked a ton of questions. With diabetics, they worry about babies that are too big (although you are less likely to see a baby LGA this early on), and heart defects. They will confirm your due date or note discrepancy. If they see a possible defect, they may recommend additional testing. Otherwise, they will send you home amazed at what you know about a baby that weighs about as much as a cell phone.

Fetal echocardiogram. This is to look more closely at the baby's heart. It was never recommended to me in St. Louis, but I was told it was standard protocol here in the large metropolitan area where we live now. I declined it because two comprehensive ultrasounds during my second pregnancy failed to show any problem with my son's heart, and I thought it would be a waste of time and money. I asked the doctor whether it would affect delivery and he said no. He also thought it unlikely that they would need to operate on the baby immediately after birth, which made me think that if there really was a problem we could safely wait to discover it until after birth. Further research also showed me that some non-life-threatening heart defects in babies may even correct themselves after birth. My son has not showed any problems with his heart so far.

Echocardiogram. This one was for me! I still have no idea why my doctor in St. Louis asked me to do this, but it made me feel pampered. It was like the ultrasound equivalent of a pedicure. In hindsight, if I had known more about it, I probably would have declined it, filing it under the category "waste of time and money." I have never had a heart problem and I'm not even sure how it related to pregnancy and delivery. In any case, my insurance company paid for it and I left feeling very confident of the health of my heart.

Growth ultrasound. I published a separate post on this so I'll just hit the highlights. Babies add weight during the third trimester and if they are going to get too big, this is when it will happen. Growth ultrasounds usually start at 28 weeks and are done at 3 week intervals, but if your doctor is chill, he/she may wait until closer to delivery and do them less frequently (or, if you pester him/her not to). They may not be reliable, and it's unclear how to determine whether a baby is really "too big to deliver." I'm going to try these things next time around to keep my babies from being too big, just in case, but I'm not convinced that it's as common a problem as doctors cite it to be.

Amniotic fluid volume. These are done by ultrasound, always along with the growth ultrasound and sometimes by themselves. They measure amniotic fluid to make sure you don't have too much or too little, which are both higher risks for diabetics. I've never had a problem with it.

Fetal non-stress testing. Measures contraction activity (Braxton-Hicks included) and baby's heart rate. They look for appropriate variability associated with baby's movements and mom's contractions, and make sure that the heart rate doesn't stay elevated (above 180) or lowered (below...I think 120?) for long periods of time. It may be done once or twice a month until 36 weeks, when it will be done every week. After 40 weeks, if you insist on going that long, they'll ask you to come in 2x per week.

Biophysical Profile. I think this is abbreviated Fetal BPP. I haven't ever undergone one of these, but I think Jenn might have. It includes the contraction measurements and fetal heart rate measurements of the normal non-stress testing, but they also do a continuous 30-45 minute ultrasound in which they measure amniotic fluid and they look to make sure the baby is making breathing movements (opening and closing the mouth?) and maybe a few other things. I think Jenn told me they decided a few years ago that this test was not worth doing most of the time.

Amniocentesis. They usually wait until at least 35 weeks to do these, and it seems the main reason is to figure out whether the baby's lungs are ready to breathe outside the womb (they also do them early in pregnancy to detect genetic defects in the baby). It can cause premature labor, so it's usually only for women that they are anxious to deliver early - maybe in the case of preeclampsia or if the baby is measuring weeks and weeks ahead of his or her gestational age.

Happy reading!

Tuesday, July 5, 2011

Effect of Pregnancy on Diabetes


I have asked two physicians - my OB and my endocrinologist in St. Louis - whether being pregnant a whole lot will adversely affect my diabetes condition. That is to say, not whether having diabetes will make pregnancy worse, but whether having babies will make diabetes worse. The answer was no, both times. In fact, I flat-out asked my endocrinologist in St. Louis how many babies he thought I could have and he said, "I don't really have an opinion about that. No one has asked me that question. Five or six? Or as many as you want?"

I guess it's just new territory, since women with Type I diabetes may not have historically survived long enough to have many children and contraceptives have assisted women to voluntarily limit their family size in the last 50 years.

Has anyone else heard differently? Does pregnancy adversely affect diabetes?

Sunday, July 3, 2011

Diabetes, Diabetes, and Diabetes


At the risk of offending my diabetic sisters, I want to draw some distinctions among different kinds of diabetes in an effort to clarify why I feel so strongly that Type I diabetics have the potential to be excellent candidates for natural/low-intervention childbirth.

I am not a doctor, and have not met nearly as many diabetics as, say, and endocrinologist has. So with that caveat, here's a composite profile of different kinds of diabetics, with a heavy emphasis on the psychological component:

Type II diabetes. Most women that I know with Type II diabetes are past their childbearing years. But among the women I have met within their childbearing years, all of them have struggled to lose weight for a long time (some since childhood), and some of them have given up on the project of improving their health. I think most people would agree that Type II diabetes and being overweight are intimately connected. That implies eating and exercise habits which leave something to be desired. The net result for a pregnancy? An overweight woman who may have allowed her health to take a back seat, finds herself sick and tired at the beginning of the first trimester, and is bombarded with cultural ideas that it's OK to pig out every now and then because you're "eating for two." I hope I am not over-stepping my bounds here, and I would love to hear from women with Type II diabetes who have maintained a health weight and established good, healthy eating habits. (Hint: maybe you can write a guest post for us about your fabulous natural childbirth!)

Gestational diabetes. This is a tricky one. Some women with gestational diabetes have struggled with weight, but sometimes they start out skinny as a rail and for no apparent reason develop gestational diabetes. My cousin is an excellent example. You can read her story here (it turns out she actually had Type I diabetes all along). I think what throws most women with gestational diabetes off their guard is not knowing any of the "tricks of the trade": detecting and dealing with highs and lows, knowing what foods cause what kinds of reactions, knowing when and how to exercise and eat to manage a new beast. A lot of them are probably more than able to manage healthy eating and exercise habits (as my cousin is), but have to play catch-up with the day-to-day realities of managing diabetes.

Type I diabetes. Forgive me if I use glowing terms to describe what is, any way you slice it, a disease. A malfunctioning of the human body. An illness. That being said, here's what I've found about a lot of Type I diabetics. Most of us acquired the disease at a young age, so it is just a part of life. Many of us are of a normal weight. Many of us are accustomed to tweaking our diet and exercise plans to improve our health or at least accommodate our disease. That leaves a pregnant woman with Type I diabetes in a situation very similar to the one she was in before: healthy (or at least not overweight, with its accompanying psychological and physicopathological baggage, yes I made that word up) and disciplined about her habits to keep herself healthy. Is this not one of the best ways to be when pregnant? Willing to jump through hoops, accustomed to extra testing, familiar with medical jargon, without any pretense of invincibility but with a strong conviction regarding the value of her own life and that of her baby? We know that our lives depend on modern medicine, and we are profoundly grateful, but we have gone even further than gratitude. We have grabbed that bull by the horns and are making it work for us - carb counting, insulin pumps, exercise, blood counts, and so on - because for the most part we haven't every lived life without the bucking animal between us and the ground. Is that not someone who, absent some other significant pregnancy or diabetes problem, might just be a very good candidate for childbirth without a lot of intervention?

So, overlap between these categories is inevitable and it is definitely a problem for any of us to to paint anyone with a broad brush simply on the basis of a diagnosis code. That applies to all types of diabetes. Women with Type I diabetes may struggle with their weight, and Type II diabetics may be totally on top of it. By the way, did I mention we'd love to hear about your experience with diabetes and natural childbirth? That doesn't mean that your doctor didn't intervene in any way, it only means that you wanted it, you tried, and may have succeeded or failed. We'd love to hear about it. We may even post it.

I hope I haven't offended anyone and if you are a doctor or nurse and you want to put me in my place about the diabetics with whom you have interacted, I welcome it.

Friday, July 1, 2011

Big Babies and Good Nutrition


It seems that doctors use two risks to prod pregnant women with Type I diabetes into induction and c-section. One is still birth, on which I wrote a post when I was 38ish weeks pregnant with my second child. I wrote about my subsequent induction here. My doctor strongly recommended the induction on the basis of an increased risk of still birth.

The second risk that doctors use to prod pregnant women with diabetes into induction and c-section is the threat of a big baby. I have a complicated relationship to this issue, because both of my boys were on the large side (8 lbs 1 oz and 9 lbs 8 oz). I also gained between 45 and 50 pounds with both pregnancies, which is more than "recommended."

I bristle when people talk about my newborns being "monsters" or "giants." Or, sometimes it's something along the lines of, "no wonder you looked so big when you were pregnant!" After my 9 lb 8 oz-er was born, my endocrinologist said, "that's a little larger than we like." (I'm not sure why he cared, since I'm pretty sure it was only my perineum and my OB's malpractice insurance on the line, but that's beside the point.) I'm sensitive about it because I know that doctors will assume that a large baby means I haven't taken good care of my blood sugars AND that I won't be able to have a vaginal delivery, which are both dear to me.

I've picked up some tips about babies that are LGA (large-for-gestational-age, or "too big"), and shared some ideas for dealing with growth ultrasounds that show a big baby in this post. I've been doing some more thinking and reading about it and have decided that in an effort to keep my babies as reasonably-sized as I can, I will try to incorporate some dietary changes during my next pregnancy. Heck, I may even start practicing sooner, so that I won't be scrambling to change my grocery shopping list when I feel sick and tired at the beginning of my next pregnancy.

A lot of this advice comes from the Navelgazing Midwife. She has some pretty lengthy posts about gestational diabetes. She hasn't addressed Type I diabetes, but I think most people would agree that there are enough similarities to make a comparison. She may tend towards the "skeptical-that-diabetics-really-can-or-do-take-care-of-themselves" camp, but she at least has some ideas about pregnancy management for women with diabetes that don't necessarily include induction or c-section.

Cut out dairy. Low-fat dairy has more sugar and high-fat dairy has more fat. Both can really pump up a baby's weight. Also, growth hormones used on cows may end up getting to your baby, too. This will be next to impossible for this milk- and cheese- and especially-during-pregnancy-cottage-cheese-lover. Here's to trying.

Eat "tree-bark carbs." I love this description. I already eat a lot of whole grains, but I could definitely try harder to avoid white rice and white pasta.

No sugar. You'd think a woman with Type I diabetes since age 9 would already be totally on board with this one, but I must confess that I've got a sweet tooth. Moderation, right? Well, maybe...but I'm probably better cutting it out all together. This poses a challenge for managing low blood sugars, but again, here's to trying.

Walk after every meal! That's a tall order. I'm not sure whether I'll be able to convince my sons that mommy absolutely has to take a stroll around the neighborhood and they have to sit in the stroller or keep up, but I'll do my best. I guess they'll get used to making sacrifices for their baby siblings early on.

Things I would add to her list are to avoid gorging myself at any one meal and eat smaller amounts more frequently, which I have mentioned before. Also, avoid eating after dinner. It throws off my bedtime blood sugars and can make things tricky over night. Plus, I've heard that post-dinner eating contributes to weight gain more than eating at other hours of the day.

Another thing she says is to eliminate juice, but I'm just not sure I can swing that with my low blood sugars. I'd love to hear suggestions if you have any!