Tuesday, December 11, 2012

The Longest, But Most Informative, Post Ever

***Republished today, originally published May 12, 2010***
Because this is a popular post and because I'm hoping (cough) to start blogging again, I thought republishing this article might be a helpful way to start.  I've missed blogging, three children do take a bit of minding, but I think there may be time to squeeze some writing in, I'm hoping to share with you about baby #3 over the next months.  Please always feel free to email us your questions as well. Jenn


I wrote this article a couple of months ago... I'm thinking at this point it's not going to be used for its intended purpose and wanted to share it here, with you. Enjoy, it's the abridged version of the entire blog!

My name is Jenn, I’ve had type one diabetes for 15 years and I wanted to change how doctors look at diabetic birth.

“It doesn’t have to be that way.”

This was my only thought after delivering my son in a St Louis hospital after 2 and ½ hours of pushing, labor that stalled with an epidural administered at 8cm, a vacuum-assisted delivery, a 4-hour wait to hold my baby because he had to be taken to special care nursery for slow breathing, my baby given formula without my knowledge, supplemental formula every 2 hours there after for hypoglycemia, and a son who despite everything I did over the following weeks was never able to latch and breastfeed. I was frustrated, where did everything go wrong, why wasn’t anyone asking me how I wanted to care for my son, why wasn’t I getting to be his mommy, why did I feel so unable to care for him when they sent us home?

Now, I had a healthy, beautiful 8lbs 9oz baby boy - who had nothing wrong with him. And folks might say, “Isn’t that enough for you, lady?” Absolutely, but he walked away with a mother who now had a lot wrong with her...

I am a woman. For my entire life, I’ve never felt different than any other woman. That is, until I got pregnant. I was diagnosed with type one diabetes at age 12, pursued a career in nutrition, married a wonderful man, played sports, danced, traveled the world, worked in hospitals, and kept other people’s children, but then I got pregnant. And this was the first time in my life that I was treated differently because of my diabetes. At least, this was the first time I was aware of it.

My diabetes absolutely did require special monitoring to ensure my baby’s well-being,
but when it came time to push, was I really all that different from other women? All I wanted was a natural labor and delivery. I don’t know why I cared so much about this. Was it because it was the “in” thing to do, or was it because I didn’t like drugs? Was it because my mom had done it that way? I’m not sure.

I knew after giving birth to my son that I wished I had done it my way. I now believed natural birth was best. I believed that natural birth would have given me the confidence to care for my son. I wished I didn’t have the pain of an awful tear from a vacuum-assisted delivery. And I wished my doctor had listened to me and been honest, saying, “I don’t know how to do it that way.”

It wasn’t me. I could have done it my way. It wasn’t even my diabetes. It was my medical team. They didn’t know how to deliver babies without intervention; they were high risk specialists trained for the worst-case scenario. I am so grateful for the prenatal care I received from this team; however, I needed them to know I’m not an impending medical disaster. I can birth my children, I can care for them when they are born, I can be normal!

With my second child, the goal was not to pretend that I didn’t have diabetes. I wanted to give birth without regrets about how my baby came into the world. I wanted to show my doctors that diabetic women can give birth. I wanted to breastfeed my baby. I wanted to have confidence in my ability to care for a child. And I wanted to avoid the awful post-partum depression I’d experienced with my son.

This time, I wasn’t going to let diabetes be my prognosis when it came to childbirth. I was a woman who wanted to have her baby naturally, and I wasn’t going to be told “no.” Sure, I might need a million doctors visits to get me to the point of birthing a baby, but when it came time to push, if we had all done our jobs for the last 9 months, I didn’t need the doctors anymore. I needed to be a woman and be left alone to birth my child.

Doctors aren’t comfortable with leaving pregnant diabetic women alone. Maybe it’s because we do have high-risk pregnancies, maybe it’s because they’ve seen all of the horrible things that can happen sometimes. But maybe it’s also because they were taught not to leave us alone.

I planned to deliver my second child at smaller, non-teaching hospital in St. Louis, although I saw the same maternal-fetal specialist throughout my second pregnancy. I had all of the same extensive testing, but I asked my maternal-fetal specialist to allow another OB to deliver my baby if all went well. I worked weeks to find an OB reputably experienced and competent in both natural deliveries and c-sections (should I have needed one emergently). I met with both doctors throughout my pregnancy. I maintained even tighter control of my blood sugars during my second pregnancy (A1C below 6.0 the entire pregnancy). I met with the neonatologist to discuss ways to prevent hypoglycemia in my baby after birth and ways to treat it that did not involve bottle-feeding. I worked with a doula on natural childbirth techniques. I studied natural induction methods and used them to make sure my baby came before the specialist’s mandated induction at 39 weeks. I was as ready for a natural birth as I could have been. And then, I went into labor on February 22, 2009 for the second time...

I labored at home from 3pm until 10pm. By then, I was begging my husband to get me to the hospital because I’d changed my mind, I wanted those drugs! We arrived at the hospital having never even toured the baby center there because I was only 36 weeks pregnant, and with a 17-month-old little boy at home, we just hadn’t gotten around to it. My best friend was with us because I wanted a woman with me, but was too ashamed to call the doula because I just knew I was going to get an epidural.

We arrived at the hospital at 11pm and I was still able to remain calm during my contractions, as I’d practiced with the Bradley Method. The staff looked at me like I wasn’t really far enough along to be there and like they were planning to send me home. My nurse checked my progress, not knowing that I was teetering on the edge of begging her for an epidural and then announced that I was 7cm dilated. I told her of my internal struggle...my strong desire, possibly even need, to have this child naturally – a desire that was warring with the reality of how intense the contractions were. Being experienced in natural births, she calmly responded, “I think you’re doing great, honey, you can do this.” WOW! This was the opposite response of that I’d received with my son’s birth at another hospital...”Calm down, sweetie, so that we can get your epidural.” YOUR epidural – like they set it aside for me earlier that day!

I was allowed to labor off of the fetal monitor in the tub, I was allowed to move around however I needed, I was treated like every other woman who might have been in that room on a given night. My diabetes didn’t matter to them. The difference between this birth and my first: I was in charge of my labor. I wasn’t tied to drugs and stuck in the bed. I wasn’t doing what a nurse or doctor told me to because I couldn’t feel my body. I was giving birth with their help!

I told them I could manage my sugars and they let me. (For the three days leading up to the labor, my blood sugar never went above 120 and during my labor never over 100.) The nurse brought me juice when I needed it and kept my specialist updated on my progress.

Turns out choosing a hospital with a reputation for natural births made the difference for me this time. They didn’t have a set way of doing birth for high-risk pregnancies that involved induction, an epidural, or a scheduled c-section. Instead, they listened and encouraged me in the way I needed to be encouraged. My nurse and my doctor, the OB we’d asked to deliver, made the difference for me that night.

I gave birth to a 7lbs 10oz baby girl at 37 weeks gestation on Feb 23, 2009 at 3:24am. She was pink and I was the first person she saw when she opened her eyes because she was in MY arms. I made the decisions about when she would eat and when she would get her first bath, where she would sleep and who would hold her. She breastfed immediately after birth and never required any supplemental feedings (no hypoglycemia at all). She was never taken away from me. I asked for help with her if I needed it. I left the hospital the day after her birth and went home without fears of my ability to care for her. I had birthed that baby. I could do anything. It was right this time.

I share this story to let those of you who desire natural childbirth know that you can have it. You are a woman and you can birth. It takes a ton of work on your part to grow the healthiest, most normal baby you can despite having a disease that would have killed you without modern medicine. But with the right knowledge, the right medical team, a birth-attendant experienced in natural childbirth, and a little luck, you can do it. And you don’t have to wait for your second baby to prove yourself; you can do your homework the first time! A fellow type one mama in St. Louis birthed her first child naturally 11 short weeks after my story at 41 weeks gestation. (I’ve never heard of a type one going that far; her doctor was extremely supportive). The stories are hard to find, and doctors willing to work with you may be even harder to come across. But, if it’s what you want, or in my case, need, you can have it.

I wish all women (and men) with diabetes the best in having families. I never imagined in my wildest dreams that I would have two healthy children. They are an amazing blessing, no matter how they arrived into our lives. My story is one of realizing my dream to change the mold of diabetic pregnancy, and not meant to diminish the pain and hardship that having a family can be in the face of type one diabetes. Thanks for reading; I pray the information on the blog will encourage you.

Monday, October 1, 2012

It DOES Matter

How often have you heard this statement: "It doesn't really matter how your baby comes into this world, just as long as he's healthy"?

I hear it a lot. I hear it from people who reject the idea that the woman's experience is what matters, clearly recognizing that the baby's health ought to trump the woman's experience every time they go head-to-head. I hear it a lot from doctors who want to make women feel better about having a c-section. I hear it from doctors who hate natural childbirth and suspect that women who desire it are evil. I hear it from women who have had c-sections, and are fending off disappointment

In fact, it comes up almost every time I'm talking to someone about their pregnancy or birth. When I was pregnant, almost every time I brought up the fact that I didn't want to be induced, someone or another would wrap up the conversation by saying, "Oh, but at least at the end of it you'll have a healthy baby, and that's all that matters, right?"

And here's where I think it's right. A healthy baby is the greatest good of pregnancy and childbirth, no doubt about it. Mothers must make sacrifices, during pregnancy, labor, and beyond, to keep their vulnerable children safe. And sometimes, the sacrifice involves a c-section. Babies DO need to be cut out. Baby's heart rate drops. Baby has a disability that makes the stress of labor inadvisable. Baby is transverse (although I heard an Appalachian midwife once describe a transverse birth in which she gave the laboring woman some whiskey, sent her husband out of the room, and turned the baby with her hand...from the inside. OUCH!) Mom falls into a coma and is still unconscious when it's time for the baby to be born...wait a minute. Scratch that. Apparently you can deliver a baby vaginally while you're unconscious.

Anyway, the point is, I understand. I know that sometimes a woman will be called upon to give up one good - her much-hoped-for, healthy, vaginal birth - for a higher good - the life and health of her child. She will need to be brave, and make a sacrifice. It's where the childbirth rubber meets the baby road, and it's hard. At the end of the day, it's true, a healthy baby is what everyone wants. But let's choose our words carefully and understand what they mean. Because "all that matters" is a healthy baby? Not even close.

You know what a c-section is? It's a giant cut. Through your skin and muscle. On purpose. A hole created to pull a baby out when you already had a hole that you were born with to do the same work. Your body has a hole that was designed for the very purpose of getting a baby out and sure, it's tough. It's painful, even when nothing goes wrong. (You can thank Eve and that stupid snake for that). But the hole you were born with opens and closes on its own and I've never heard of it getting infected! On the other hand, a c-section creates a hole where there wasn't supposed to be one, and it's a hole that will make recovery that much more difficult. It's a hole that will put you at risk for problems in future childbearing. A hole that will make the prospect of future childbearing episodes even more terrifying. A hole created by someone else that makes you think, "is it possible that I'm not fit to do this work? To have babies? That I just can't do this?"

In order for a c-section to occur, a woman must consciously lay aside a very real and powerful inclination towards bodily integrity. And most women, very naturally, hesitate to do that.

As evidence of this, not many women want c-sections. Oh, sure. The c-section rate is way up. But elective c-sections, or "on-demand," just because a woman asked for it? A measly 2%. It's COMPLETELY NATURAL for a woman to hope that she doesn't have to have a hole cut in her abdomen to give birth to her child. Because a healthy baby is not all that matters - a healthy mom is supremely important, too. And having a hole cut in your abdomen is, generally speaking, contrary to good health.

In case you're not convinced of the value and importance of keeping the skin and muscle in your abdomen intact, try this thought experiment. What would you do if someone came at your abdomen with a scalpel when you weren't pregnant? Run the other way? Punch them in the face? Jump up on a car hood and begin making animal noises? All of the above are acceptable answers, as far as I'm concerned. You would not let someone to cut a hole in your abdomen if there weren't a really, really good reason to do so.



So if someone suggests that you undergo a c-section, they'd better have really good reason for it. A c-section versus a vaginal birth is not like the difference between vanilla and chocolate ice cream. It's like the difference between eating ice cream with your mouth and receiving it through a feeding tube.

So when I ask an OB whether a c-section will be necessary to deliver my child, here's the kind of answer I hope to hear: "I really hope not. I'm going to do my best to make sure that you have a vaginal delivery." That's all. I want to know that my doctor would find it as regrettable as I do that c-sections ever have to happen. Regrettable that a woman ever has to have someone slice through her abdomen to pull out the child she worked so hard to grow inside, nourish, and prepare for life in the world. Regrettable that a woman has to lay aside her own physical health for the health of her baby. Regrettable that motherhood isn't always sweet, comfortable, and peaceful - but is sometimes painful, sacrificial, and leaves you with scars forever.

I also think it's quite natural for women to be frustrated if, upon reflection following their c-section, they come to believe that their doctor did not explore all the options to help them have a vaginal birth. Maybe the doctor didn't know all the techniques available to help make it happen that way. Maybe the doctor wasn't willing to be patient with a woman laboring for the first time. Or maybe the doctor just didn't appreciate the fact that he was suggesting cutting a hole in your abdomen, not a different flavor of ice cream.

A healthy baby is not the only thing that matters in childbirth. A healthy mother is supremely important. If you want to avoid a c-section, don't let anyone make you feel bad about it. There's no reason to feel bad about wanting to keep your abdomen intact. There's no reason to feel bad about wanting to use the hole you were born with to do the work it was made to do. There's no reason to feel bad about hesitating at your doctor's recommendation and investigating alternatives before consenting. It's quite natural.

As for myself, I am beginning to appreciate on a deeper level the sacrifice that women make to have a c-section. I know these women, because it's every woman I've ever talked to that had a c-section. Assessing that her baby's life is so valuable as to give up the good health of her own body, the woman and her doctor know of no other way to get the baby out without surgery, and so the woman courageously makes the sacrifice to lay aside her own bodily integrity, permit a c-section, and welcome a healthy baby into the world.

Bravo! May your sacrifice be re-paid a thousand times with maternal joy.

Wednesday, September 26, 2012

PROOF

PROOF that pregnancy weight gain and loss is often totally out of your control.

After my most recent pregnancy, I had gained 35 pounds. By about 6-8 weeks, I had shed about 25 of it, was hoping to lose a total of 15 more pounds (to put me at 135, about 5 pounds under pre-pregnancy weight...hey, I can dream, can't I?), but those last several pounds were just hanging on for dear life. I felt like I was eating very responsibly, avoiding snacks, not going back for seconds, doing the Paleo thing with and for my dad, and occasionally going on walks when I was finally able to herd my cats into a mobile stroller/Radio Flyer wagon/Moby wrap/baby Bjorn unit.

By the way, I really think that going to the grocery store with all three children should count as exercise. Seriously. I have to lift those groceries a total of 6 times (off the shelf into the cart, out of the cart onto the belt, off the belt into the cart again, out of the cart into the trunk, out of the trunk into the house, off the counter to their appropriate places). That is no small feat with a baby strapped to my chest.

Anyway, so for the last two months, I've been stepping on the scale every few days, just to see what was happening. I knew that I would experience blood sugar spikes in conjunction with weight loss. I assume that's from unpredictable fat burn that's not covered by my normal basal rates and boluses, and it's a trend I've noticed during the last two years. In any case, the spikes never came, and the scale stayed stuck on one number for months.

Then, suddenly, within the last few days, with my baby at 3 1/2 months, I did nothing different but, lo and behold, I had several blood sugar spikes over 2-3 days. Out of curiosity, I decided to step on the scale and, sure enough, I lost 5 pounds.

Did I mention that I haven't done anything different?

Still eating the same things, still sleeping normally, still occasionally herding cats into a mobile stroller/Radio Flyer wagon/Moby wrap/baby Bjorn unit. Nothing different. And, like magic, the five pounds disappeared.

So, I have no advice to you if you are trying to lose weight after having a baby. I guess just eat as healthfully as you can, exercise when possible, and wait and see, I guess!


Wednesday, September 19, 2012

Ay, There's the Rub

So the last little bit of NFP to talk about is the abstinence part. In some ways it seems easy enough - just don't have sex when you're fertile. Right? RIGHT?!

I know. It's not always that easy. And many people who reject NFP do so not because they don't like knowing about their fertility, and not because they don't like the idea of marital relations without plastic, latex, or rubber, or whatever condoms are even made of these days. Not because they wouldn't prefer to avoid synthetic hormones that may, themselves, cause health problems and don't ever provide a permanent solution for the problems they are prescribed to treat. Not because they don't like babies. It's because they either think abstaining from sex might actually hurt them or their relationship with their spouse, or they think they just can't do it.

So if you're with me, you've got some concerns about what contraception does to you and your sex life, and you and your spouse see some advantages to NFP, but you REALLY need to avoid a baby right now, and you aren't sure you can swallow the abstinence bit, read on.

First, my good news/bad news about the abstinence part of NFP during the postpartum period:

The bad news: When using NFP to avoid pregnancy in the postpartum period, you may end up abstaining a few more days than you did before you got pregnant.
The good news: You may be so tired you will hardly notice (especially if you're breastfeeding exclusively and frequently)!

Ay, there's the rub. I think it's very possible that, while you're getting the hang of things in the postpartum period, and if you're really serious about avoiding another pregnancy, you will need to abstain for longer periods of time than usual. Because things look different after you have a baby, and seminal fluid really does obscure your fertility symptoms. It blurs the lines between a woman and her man, and it can be distracting and confusing. So sometimes, it's best to just go without for a while until you get it figured out.

So that's my confession. NFP does involve some self-restraint and that can be hard. It's a sacrifice. But abstinence from marital relations, if you really need to prevent pregnancy and that's what it takes to get a handle on your cycles, will not harm you. I repeat: it will not physically harm you in any way.

Consider this:
  • In ye olden times, some devout people used to abstain for the entire time that a woman was pregnant plus a few weeks afterward. Plus during the penitential Church seasons of Advent and Lent. Saint Louis IX, King of France? He and his wife had 11 children. Following these rules, can you imagine how many marital relations they didn't have?!
  • There are thousands, if not millions, of young people around the world who wait until marriage to enjoy its relations. You may have been one of them. Oh how did you ever survive adolescence?!
  • There are thousands, if not millions, of people around the world who forego marital relations for their entire lives. They are called priests, nuns, and monks. Some Hindus and Buddhists do it to, to avoid distraction from spiritual contemplation. Even a radical feminist group at one point promoted celibacy! (The war on women just keeps getting more complicated, doesn't it?)
  • I am quite confident that even people who don't give a rip about saving themselves for marriage will go for months or years at a time if they don't find a partner that lives up to whatever standards they do have for a sexual partner.
  • My husband and I have done it, too. When our second son was two months old, I told him I just needed some time to figure out the new normal. So in addition to the fact that we had abstained for the first 6 weeks postpartum, we took another break. And I figured it out, and we successfully planned the conception of our third child when we were ready.
Here are a few other ways to think about it, to make it easier to tell yourself and your spouse no. Because "no" to sex doesn't have to be a total downer:

Consider it free health care, if you need to prevent pregnancy for health reasons. The Obama administration wants to provide free contraception to everyone, but abstinence is always free! Not always easy, but always free. And Type I diabetics do, on occasion, for health reasons, need to prevent pregnancy. If pregnancy prevention is therefore to be considered healthcare, then let's call abstinence free healthcare. There, I give it to you. Free. Healthcare. Sacrifice sex, save a little money and keep your body healthy (because Lord knows that contraception won't do it). Knowledge is power! Now all you have to do is not have sex for however long it takes you to figure out how to use NFP to avoid pregnancy.

Or perhaps consider it a sacrifice that you offer for your spouse, your children, and your future children, so that their lives may be better. If the issue is concern for the health and education of your existing children, then you offer it for them. If it is so that your husband can focus on his work and not have so much of his life wrapped up with the family, then it's for him. If it's for your psychological health and sanity, then it's for you. Sacrifice for a greater good. Just like sometimes we even give our lives as a sacrifice for a greater good, as in the example of St. Gianna Beretta Molla.

You really will be tired after you have a baby. It's true what they say. Don't I know it, three years and three babies later! If you're reading through this with bleary, nursing-mom eyes and you're desperate to figure out how NFP works, you know this because you're trying to avoid finding yourself in this situation again in the near future. So use the extra time to sleep, or take care of your relationship in another way. Marital relations are an amazingly unique and wonderful way for a couple to nurture their relationship, but there are other ways too. Go mini-golfing. Read a book together. Take a walk with your screaming, tired baby whose making you screaming and tired, too.

And if, in the end, after doing the NFP/abstinence thing for a while, you find yourself unable to make the sacrifice, maybe it's because, in the secret calculus of your head, you've determined that children are really pretty awesome. And maybe you're not willing to sacrifice so much to avoid them, because you'd rather sacrifice a lot to have them. What this may come out of your mouth sounding like is this: "Ugh, I just can't do it any more. I want to be with my spouse, and it's too hard to abstain. Why did we decide this was a good idea again?" And perhaps what it means is that your brain is smarter than you think it is, and it is making you forget what you were worried about, and telling you that babies are good, and your reasons for not having them are coming up short. After all, many excuses just don't cut the mustard, because pregnancy is hard but children are worth it!

Monday, September 17, 2012

A Hodgepodge of How-Tos for Women Charting Postpartum

As I mentioned in my last post, you should check out 1flesh.org (to convince you if you're not already using NFP, and for some laughs if you already are) and iusenfp.com (for some instruction) if you want to read up on the awesomeness that is natural family planning.

In my last post, I talked about my personal experiences using natural family planning in the postpartum period, and while breastfeeding. Now that I'm having my third go-around, I'm brushing up on my rules and sharing some of my observations with you all. I think I might *actually* be good enough at it now to give general advice to other people.

Please note: I am not a doctor, and I am not an NFP instructor. I am not a member of the Couple-to-Couple League. In fact, I don't even follow one method (Creighton, Billings, symptothermal, or any other) according to the letter of the law. My only qualifications are that I used NFP successfully to delay my first pregnancy (two years) and my third, and I have spent an unusual amount of time looking at this website (http://www.fertilityuk.org) and charting my cycles (8 years). My second conception was an experiment in "let's see what happens if we fail to abstain reliably to prevent pregnancy." (The answer, if you are happily married as I am, is apparently a baby born about 10 months later. Who knew?). What this all means is that I've only used NFP reliably during one postpartum period of my life, and I am self-taught. So take my comments with a grain of salt, and if you want more information than your body and I can give you, call around to natural family planning instructors in your area!

One bit of good news is that, for women who are fortunate enough to use the most natural method of feeding their baby, breastfeeding does tend to inhibit fertility. This may only be true when babies are nursed frequently and exclusively, so if you want to take advantage of it, you should start getting snuggly with your baby...a lot.

The lack of menstruation that women experience during breastfeeding is evidence of the fact that fertility is inhibited while a woman is breastfeeding, since no menstruation frequently also means no ovulation. Women do occasionally ovulate prior to menstruation while breastfeeding, but they also frequently experience anovulatory menstrual cycles, even after their period comes back. So even after her first few periods, a breastfeeding woman may still not be ovulating. No ovulation, of course, = no baby.

But if you've been paying attention, you'll note that I'm using words like "frequently" and "occasionally." And of course, "occasionally" does not equal "never," so what it all boils down to is this. Some women can and do get pregnant while breastfeeding (that is, assuming they are enjoying marital relations on occasion). La Leche League doesn't teach women about tandem nursing for nothing. Women even can and do get pregnant before their period returns while breastfeeding (that is, assuming they are enjoying marital relations on occasion). So you could do what my husband and I did for our second conception - "let's see what happens if we don't try to not have a baby?" But if you have a serious need to avoid pregnancy, you'd better fire up your cervical-mucus-interpretation skills, even before that period comes back.

OK, so here's my instruction manual.

The bad news: Your signs will look different than they did before you got pregnant.

The good news: After taking 10 months off, you probably won't remember what your signs looked like before you got pregnant. So just consider it a friendly reintroduction to your amazing fertility!

If you used a certain NFP method before pregnancy, your instructor will likely have some rules for postpartum pregnancy prevention, too. Mucus will be the only way you can determine fertility accurately before you get your period back, because the postpartum time is one giant pre-ovulatory stage until you are regularly menstruating again, and mucus is the only way to tell when you move from pre-ovulatory to fertile stage. So get comfortable with the words "goopy," "sticky," "tacky," and "slippery," because you're going to be hearing them a lot! I think temperatures, cervical changes, and any other signs and symptoms you have could be useful to cross-check your mucus readings if you think ovulation has already occurred. But in any case, you can't get around the mucus.

The presence of fertile mucus is the only way you'll be able to tell that you might get pregnant. I believe Creighton teaches women certain wiping methods to check their mucus on toilet paper, Billings teaches women to take heed of the sensation at the vaginal opening, and others probably want you to pay attention if anything shows up in your underwear. For me, I use all of the above AND what I see on my fingers following cervical checks, because, as I mentioned, I'm apparently super-fertile, and I don't want to miss any sign or symptom of the beginning of fertility. I don't often rely on sensation alone to determine the beginning of my fertile period, because between postpartum urinary incontinence and sweat, sometimes I can't distinguish it from fertile mucus. But if I do feel a wet or slippery sensation, I sit up and pay closer attention to my underwear, toilet paper, and fingers following cervical checks. Fertile mucus disappears after ovulation.

If you use them, cervical checks should be done once per day. You won't be able to tell the difference between a fertile and an infertile cervix if you don't track changes, and changes can only be detected over multiple readings. Always wash your hands BEFORE the cervical check, so that you don't introduce any nasty bacteria to your lady-parts, which are very sensitive to the disruption.

A note about resuming cervical checks initially following birth. You may want to wait several weeks after birth before beginning them, because of lochia (which makes cervical checks messy), tearing (which makes cervical checks potentially painful and/or likely to cause and infection to the wound), and confusion (because the cervix takes a little while to resume its normal shape and position following birth). If you are breastfeeding exclusively and you begin cervical checks at 6 weeks postpartum, I think you can be safe in assuming that your first three cervical checks, before enjoying any marital relations, will give you a good baseline for "infertile cervix." Make sure you do these before you resume marital relations, because as I describe below, seminal fluid kind of messes with all your observations. Cervical checks will not be able to tell you when your fertile period has begun, but it can be a helpful tool to confirm that ovulation has already occurred if you are abstaining during your fertile period.

During this postpartum time, our rules for avoiding pregnancy are thus:

RULE NUMBER ONE:

First of all, I think it's a good idea to wait the full 6 weeks following birth before resuming marital relations at all. You will be tired, you may have some tearing in your perineum, and it's just a good idea for your doctor to check out muscle tone and any scar tissue that has developed down there before you introduce a new...activity in the region. Not to mention any lochia/postpartum discharge. So I make that recommendation whether you are trying to avoid pregnancy or not. (P.S., I'm still not a doctor, but recommendations are recommendations.)

To avoid pregnancy, cease marital relations at the first sign of fertile mucus. The first days of ovulatory, fertile mucus are white and sticky, then they grow stretchier and stretchier, until the mucus is very clear and slippery right before and at ovulation. Additional tips for determining fertile mucus patterns, including illustrations, here.


RULE NUMBER ONE IN THE REAL WORLD:

So those are the general guidelines. Here are my observations about what happens in the real world, using myself as the one and only Example A (because no modest woman in her right mind goes around sharing these things in pub...oh, shoot):

Early mucus looks kind of like a yeast infection, but without the smell. If you suspect it might be a yeast infection and you have been doing your cervical checks, you will know you are infertile if it's smelly and your cervix is in the same spot, same firmness, and same opening.

Seminal fluid WILL mess with your observations if you don't know what to expect. If you are enjoying marital relations on occasion (which I also highly recommend for those who are happily married...still not a doctor, but recommendations are recommendations), you should see slippery "mucus" in the one, two, or three days following intercourse. It's actually seminal fluid, but there's no way to tell the difference, so to avoid pregnancy, you should wait for a few dry days before enjoying marital relations again.

In the absence of a yeast infection, and in the absence of seminal fluid, you may notice a pattern of infertile mucus on your fingers following cervical checks. One or two little bell-pepper-seed-sized clumps of white. I called them "vaginal boogers" in my last post. I promise, I am going to restrict talk of "vaginal boogers" to posts about natural family planning, lest I drive away all my readers (which I may have already done. Thank you if you've gotten this far.) This is more of an FYI, so you don't freak out and think that you are fertile ALL THE TIME simply because you are seeing a little bit of vaginal discharge every day. It may take some time for you to interpret this infertile discharge.

RULE NUMBER TWO:

If you are happily married but still trying to avoid pregnancy, wait for three days following the disappearance of fertility indicators to resume marital relations.

After you ovulate, your mucus will dry up. You should wait for a full three dry days before resuming marital relations to be confident of having entered the infertile state.

Enter, stage right, cervical checks. As I mentioned, the cervix is not terribly useful on the front end, because the presence of fertile mucus is a much more universal and easily-identifiable indication. BUT, if you are abstaining during your fertile period, cervical checks ARE useful for confirming that ovulation is complete and you have entered the infertile, post-ovulatory state. When you're infertile, the cervix is firm, high, and the opening is closed. As you approach the peak day of fertility, you will see mucus and you will notice your cervix begins to soften, drop, and open. After ovulation, your cervix will firm up, rise, and close immediately. Additional tips about cervical changes here. Again, wait for three days after the cervix firms up.

RULE NUMBER TWO IN THE REAL WORLD:


Oh, seminal fluid. Our dear friend AND bearer of much confusion. You who blur the lines between man and woman...

The cervix also changes in the presence of seminal fluid. In fact, just as seminal fluid resembles your most fertile mucus, seminal fluid will effect changes to your cervix that make it look like you are ovulating. This is owing to the prostaglandins in seminal fluid - which is incidentally the same thing that ripens your cervix for labor and why marital relations may induce labor in women who are pregnant. So your cervix, in the few days following marital relations, will be soft, low, and open, just like it is when you are ovulating. It will gradually rise, firm, and close up over a few days.

Since seminal fluid is so indistinguishable from your hyperfertile mucus, you should wait for three dry days following marital relations. That way the pre-ovulatory fertile mucus won't be masked by seminal fluid.

I note again that cervical checks are really only useful if you do them every day, because you won't know the difference between a firm and a soft cervix, or a high or a low cervix, unless you've been feeling it day after day and suddenly one day it feels different. Sometimes, in the first few months after delivery, you may feel your cervix get higher and lower depending on whether your rectum (which is right next door to the cervix) is full. This is because the muscles which hold your rectum in place are loose and stretched out following pregnancy and birth, and may permit some bulging in the rectum (which is, as I mentioned, right next door to your cervix).

Oh, wow, could this possibly involve any more bodily functions about which people do not normally speak in public? Probably not. But then again, I've never been shy to talk about these things, much to my husband's chagrin...

As I mentioned, you can't get around the mucus, and it's absolutely necessary to chart mucus to avoid pregnancy, but I really appreciate having a cross-check to mark the post-ovulatory period. It gives me peace of mind to know that my mucus observations and my cervix are telling me the same thing.


If there is a discrepancy between the disappearance of fertile mucus/return of dryness and the firming up of the cervix, choose whichever is more conservative. The discrepancy should only be a day or so (in my experience).

After the mucus dries up and the cervix firms up, you have entered the infertile, post-ovulatory state. If you are confident that ovulation has occurred based on mucus readings and cervix checks, after three dry days, marital relations carry a low risk of pregnancy (low as in, 0.5-8.0% percent low. By the way, that percentage of pregnancy prevention is at least comparable to some contraceptive methods, and  blows other contraceptive technologies right out of the water).


I assume you know how to do the "marital relations" part, since you did just have a baby, so I won't go into that in further detail.


Hope this is helpful to some of you who are trying to use natural family planning following the birth of a child, but would really like to plan your next conception carefully, like those of us Type I diabetics. Feel free to e-mail me with questions (beth dot g dot turner at gmail dot com). And do check out fertilityuk.org. I learned almost everything I know from that site, and I can't imagine you will come away from it without some useful tidbits.

Friday, September 14, 2012

Adventures in Postpartum Charting

In case you haven't yet seen them, you should visit 1flesh.org and iusenfp.com. They are awesome, and I am so excited about what they are doing to spread the word. Whether you are trying to conceive or trying to avoid it, these sites will give you a fresh perspective on the question. Just as I very firmly believe that a woman's body can do all sorts of wonderful things during pregnancy and childbirth, these sites extend that principle all the way back to pre-conception. ENTER, stage left, Natural Family Planning!

My husband and I have used NFP since we were first married six years ago. We have never had to try very hard to conceive, so unlike many diabetics who have trouble getting pregnant, I have had the opposite problem. NFP is awesome for how it respects your body AND respects your need to space your children OR helps you conceive if you're having trouble, but after a few months off and a baby it's...a little bit confusing.

First, a brief history of how I ended up with three children. (The short version is...well, everyone should know that short story).

After my first child was born, my period came back when he was 6 months old. My husband and I then decided that we didn't really care all that much when we had another baby, and lo and behold, a short few weeks later, I was walking to a drug store on my lunch break, squeezing in a trip to the bathroom at work before my lunch hour was up, and seeing two little lines on a chalky white strip.

After my second child was born, I knew that I wasn't going to be able to rely on a half-hearted, "I'm breastfeeding so I'm immune to pregnancy" attitude to prevent conception, so I decided to actually chart. I picked up my charting tools again just before my 6-week postpartum visit, and found out that it was a little more difficult than I had anticipated. My temperatures were everywhere, my mucus was always sticky and sometimes smelly, and I was all like...what? 

First of all, my postpartum temperatures were everywhere because my sleeping patterns were so irregular. If the baby happened to go to bed early and I could sneak a glass of wine (aaaah...), my temperature was elevated in the morning (d'oh!). If I happened to sleep in in the morning because both babes decided to sleep an extra hour (aaaah....), my temperature was off (d'oh!). The uncertainty meant we were spending more time abstaining than we needed to, and even when we didn't, we were never quite sure whether the temperature patterns were actually reflecting ovulation or exhaustion.

Second of all, my sticky, smelly, white mucus was actually a yeast infection (sorry, TMI, but I want no one to go uninformed about these things). I had never had one before, and my theory is that it may have been related to everything that happened down there...bacterial and hormonal changes associated with pregnancy and birth and all that. Besides that, diabetics are more prone to yeast infections than other women. This is where the cervical checks come in for me, to confirm whether I'm ovulating or just have a yeast infection.

Thirdly, seminal fluid looks exactly like the most fertile mucus. So if I went from dry one day to "super-fertile" the next day, usually all I had to do was try to remember what I did last night, and after a little reflection, I was able to breathe again. But curiously, seminal fluid would sometimes continue to show itself for a few days after marital relations, not only in the one day following. Interestingly, seminal fluid also has the same effect on the cervix as ovulation does, so cervical checks following marital relations only led to further heart palpitations. Alas, it only means that I could not use the cervical check following marital relations to determine infertility. I just had to wait for a few days of dryness to come back.

Lastly, cervical checks showed me very clearly what kind of mucus I had, and then some. What I mean is that if I had fertile mucus, I would almost definitely see it on my fingers following a cervical check. But what I mean by "and then some" is that I occasionally saw stuff on my fingers following a cervical check that was, in fact, a light, normal, infertile mucus pattern. For me, it looked like small (think bell-pepper-seed-sized or grape-seed-sized) clumps of white stuff, usually only one or two clumps per check, if at all. I can only assume these are the equivalent of vaginal boogers (white blood cells clumping together and getting ready to exit your body).

Uh...I can't believe I just said that. I think I may have just weirded MYSELF out.

In any case, after a few months of observing this trend, I was able to distinguish "vaginal boogers" pretty clearly from fertile mucus. Fertile mucus always showed up in more abundance (a gloopy glop closer to the size/volume of a small pumpkin seed), either upon wiping after using the toilet or cervical check.

Are you creeped out yet after this discussion of cervical mucus, yeast infections, seminal fluid, and vaginal boogers? My profuse apologies, if so. I'm just hoping my experience can help elucidate the signs and symptoms for other women in the postpartum period. Believe me, as a Type I diabetic, I know how important it is for women to be able to plan conception carefully, and that includes recognizing the signs and symptoms after birth!


So to sum it up, I ended up rejecting temperatures altogether in favor of a mucus-only method of NFP. I also learned more about cervical checks and how to use them to confirm when I suspected ovulation was complete (this is a very useful tool and most methods don't make use of it, but I highly recommend it). I discovered a normal, non-fertile, light mucus pattern that was easily identifiable, but only after I'd been seeing it for a few months. As a result, the only surprising thing about our third conception was that it happened the very first month we stopped not trying to have a baby.

So we're at it again, and hopefully my experience will help anyone who is struggling to get to know their amazing fertility again after birth.

Wednesday, September 12, 2012

Letter to Jenna Rachel

A young woman recently diagnosed with Type I diabetes recently stumbled upon my blog and commented on my post, "Pregnancy is hard. Children are worth it. Diabetes doesn't have to get in the way." She gave me a high compliment and said this would be her new mantra.

Well, since it's my mantra over here, too, I just wanted to give a big online welcome to Jenna Rachel! The concern she expresses on her blog about whether she'll be able to have children without a c-section, and whether she'll be able to have children at all as a Type I diabetic, made my heart very heavy for her.

But I assure you, it doesn't have to get in the way, and anyone who tells you otherwise just doesn't have a very active imagination about how to make it work. Keep us up to date on what you learn, and keep on keepin' on!


Monday, September 10, 2012

The Waste of An Education

I come from an extremely well-educated family. Both of my grandmothers went to college (in the 1930s), and nearly all of my aunts, uncles, and cousins have graduate education of some kind. My mother is an emergency room physician, my brother and father have PhDs in economics, and my sisters are both pediatricians. I then went and married a bookish man who is getting his PhD in moral theology.

Even beyond my family, every single one of my closest friends from high school went on for additional education beyond their graduate degree. One has an MBA, one has a PhD in biology, one has her MPH and is a registered dietician, and another has a master's in aeronautical engineering (yeah, she's totally a rocket scientist). It was a sad day for me when my last high school band buddy e-mailed all of us to say that he was headed for a master's in...well, I don't remember what it's in, because I began weeping as soon as I got past the first line of the e-mail.

                   

I have often been tempted to self-loathing over this apparent waste of my education. I graduated from the University of Virginia with a BA in psychology, got married, did the receptionist thing at a veterinary clinic, taught a few flute lessons, and spent a few years working at a law firm. It was all well and good, until I had some babies. And instead of slogging through it to use the fine education I received in a wage-earning, tax-paying kind of way, I quit. I quit to take on the mundane tasks of staying at home, washing everyone's laundry, preparing everyone's meals, frequently washing everyone's dishes, and starting all over again the next day. Not surprisingly, in moments of self-doubt, I simply feel like a high-school drop-out with a college degree.

I am most fortunate that I have not ever heard a word from a member of my family or my friends about this, my apparent waste of an education. In fact, to the contrary: one of my pediatrician sisters once told me that if I wanted to graduate from college and then have children and stay home to raise them, she thought that was a good and noble choice. I still remember that conversation, and I cherish it. But the thought still nags at me. Did I waste it? Did I waste the chance to make a difference with my work? Did I waste the chance to make something of myself by foregoing a career? Did I waste my college education?


Well, I'm going to leave that question hanging, because that's not what this post is really about. I'm not going to get into whether or not it would have been better for me to stay home to raise my kids, "wasting my education," or go to work to "make something of myself." The thought I recently stumbled upon, which will forever be my response to the mean voices in my head, is this. If I stopped having kids now, I would be seriously wasting another kind of education: my education in motherhood.

Think about it. Having a baby is a serious crash course that brings out so many hidden talents that you didn't know were talents, much less that you actually had them within you. You, as a mother, have skills that you didn't even know were possible to acquire before you had kids. Classes you could teach at a university level include:

Clothing Management: How to store clothes for the next size, next season, and next child. Additional lessons in baby poop stain removal and sock matching.

Time Management: How to accomplish anything in the miniscule amount of time you have during nap time after going to the bathroom, grabbing a drink and a bite of food, and sweeping the floor before your baby wakes up. How to wrap up any activity in 5 seconds flat when you hear screaming.

Food Management: How to prepare your own organic baby food and handle the rejection your child will no doubt visit upon your efforts. How to remove stains from ice cube freezer trays.

Relationship Management: How to talk to your spouse about something other than your children. How to turn walking outside with a screaming 6-week old who just won't go to sleep into a bona fide date.

Disaster Management: You should probably just take a First Aid class, buy a kit, and memorize the number for 911, because you're definitely going to need it at some point. Preferably this will be accompanied by moving in with a medically-trained relative (thanks, Mom!).

But, you say, this is silly. Anyone can learn how to do those things. To which I respond: yes, but how many people actually have to? How many people are forced to learn such mundane skills, and to do them all with such speed, that she can actually do them with a baby strapped to her chest at the same time?

Beyond simply learning how to do the mundane things with your hands, there is a mental energy associated with raising children that, as the mother of one six-week-old, I thought might make my head explode. While I was nursing the baby, changing diapers, tip-toeing around our one-bedroom apartment to avoid squeaky floors, and preparing meals, there were thoughts racing around my brain. For example, thoughts about how to squeeze out a little bit of time for myself and my husband this weekend. How to organize my day to accomplish the things I wanted to accomplish. How to balance life at home with life outside it. Which of these tasks staring me in the face actually matters right now? How will I raise this tiny person to know what things are important? How will I keep us all from hating each other at the end of 18 years?

I have three children now, and in some ways, my life is harder than it has ever been (oh, the laundry!).


But in others, I'm finally hitting my stride. Because I know how to clean baby poop out of a onesie, and I know when it matters whether the poop comes out or not. I know when to say "yes" to activities outside the house, and when to say, "maybe we'll be able to handle it a few years from now." I'm learning that teaching children what is important is not like writing on a blank tablet, because children naturally want to be good. And I've been telling myself, "it will get easier some day," for so long now that I've finally started to believe it.

So, to the mother with only one child, and to myself, I say: Self, you are learning valuable lessons. Motherhood doesn't only get easier once you teach your older children to help. It gets easier because it teaches you, too. 

Here's to an education that I couldn't have paid for!

Saturday, September 8, 2012

This Makes Me Happy


I stumbled across this on Facebook, linked to from one of my favorite sites called www.iusenfp.com, and it just makes me happy. Smile-all-day-thinking-about-posting-it happy.

Type I diabetes means that pregnancy and birth are not risk-free. Oh, wait a minute...it never has been, for anyone! But since pregnancy and birth are such a unique and beautiful part of what it means to be a woman, not to mention the precious babe himself, it's a sacrifice worth making. For every woman in every time and place, it means conquering some fears and giving generously of yourself in so many ways for a new little human being who can't do it on his own. For a Type I diabetic, those sacrifices include the additional cost of managing blood sugars like a hawk and going to a bajillion doctor's visits.

But really and truly, pregnancy changes you. Birth changes you. Being a mother changes you. And, if you let it be so, the change is good. No pain, no gain! 

Wednesday, August 29, 2012

You May Have Noticed

You may have noticed that I was offline for a few days, and that is because I discovered something that creeped the heck out of me. Apparently two pornographic sites have posted links to this blog, and while I love visitors, I would rather pick lice out of my hair than entertain that kind of visitor with pictures and stories of myself and my children.

Now, I have tried very hard not to post anything exciting on this blog, either verbally or photographically, so it beats me why someone would come here looking for a thrill. I have no idea which post or posts might be the source of such unwanted attention. But alas, I suffered the incredible misfortune of clicking on each link on my "Traffic Sources" page...twice...just to be sure. And I'm still wishing I could wash the images off my eyeballs with soap.

So, I'm thoroughly confused, creeped out, and ready to shut this whole thing down. If you came here looking for something (or someone) to use for your own base pleasure, please just go somewhere else. If you came here looking for something (or someone) to use for your own base pleasure and instead found some things that made you laugh or think, then feel free to stay. And maybe let me know that you didn't find what you came looking for, so that I can be confident I'm not giving anyone a reason to sin.

If anyone else has a blog and knows how this might have happened or what I can do about it, please e-mail me (beth dot g dot turner at gmail dot com). For now, I'm going to delete all the pictures of myself, Jenn, and our children, and keep track of this for the next week or so. I may take it down permanently, but I'll give you warning if I do.

Monday, August 20, 2012

Letter to My Baby

Dear Little Statesman,

When we learned that your body might be missing a few parts, or have some parts that shouldn't be there, or have some parts that weren't working quite right, we were horrified. It scared us. But we were also skeptical. After shedding a few confused, worried tears, we ultimately settled on denial as our preferred reaction. After all, as a diabetic, I know that all kinds of medical testing is not always necessary, nor is it reliable, and even if it tells you that something is "off," it may very well not have any practical consequences to one's health or treatment. After your birth, we were told, we would know much more. We hoped that the prenatal ultrasound was just smoke and mirrors. We hoped that the patron saint after whom we had chosen to name you would come through with a miracle. We hoped that it might go away during the last few weeks in utero, or that it would resolve shortly after birth.

But now, denial is no longer possible. One of your kidneys just doesn't work. And so, since you are so fresh out of my womb, where I was responsible for nearly everything that happened to you for nine months, I ask, what could I have done differently? Why did this happen? And the only answer I hear ringing around my head is: "The children of type I diabetics have an increased risk of birth defects."

It kills me, because I will probably never know. Did my diabetes do this to you? Did I neglect my blood sugars, or take too many risks? With my food? My exercise? Should I have taken my endocrinologist's advice, been grateful that I had two healthy kids, thrown in the towel, and never given life to you at all [difficult thought experiment that makes me alternately repulsed by the horror of you not being alive and confused by the fact that you didn't actually exist just a short year ago]?

It also drowns out all the other things that I hear somewhere in the background: "I did my best." "There is no known correlation between this problem and diabetes." "Women with normal blood sugars have children with this condition, too." "Neither this man nor his parents sinned,...but this happened that the works of God might be displayed in him." "It could have been worse." "My A1C was the best it's ever been."

It's true that very little of your life will be different than the life your brothers have. In fact, one of your aunts tells a wonderful little story about a man with whom her mother worked. A sonographer by profession, he was giving his son's high-school class a tour of the hospital. When he pulled out his probe to show all the students how the ultrasound machine worked, and pulled his son over to demonstrate, he discovered, for the first time, that his son was missing a kidney! His son had never known, and probably wouldn't have ever known except for the odd showcase. After I told her, a friend of mine who is also missing one of her kidneys joked to me, "I still tinkle with the best of them!" Your grandmother, after hearing the news about you, looked at me and said, "I don't know for sure if I or any of you kids have both kidneys. Maybe it runs in the family!?"

So your cross will not be heavy. Contact sports are out, you won't be able to follow your grandfather's footsteps in military service, and you will never be a kidney donor.  But your life will almost certainly be rich, full, and rather normal.

But still, wouldn't life be better with two kidneys? Isn't it just better to have all the parts that a body is supposed to have? Just as I might be able to live happily and comfortably with diabetes, and it doesn't feel like a problem, isn't having one kidney bad? Of course it is. And so I, as your mother, don't want just what's functionally the same as what other people have for you, my son. But I want what is actually the most complete, best, and perfect for you. I want your little body to be perfect. I want you to have all the best things in the world, including two kidneys. A body that is whole and entire.

So it may be my fault, or it may not be, and for whatever fault is mine, I'm sorry. I will probably never know, and with no additional evidence to prove the contrary, I'm going to take an agnostic position on it for the sake of my sanity. But I can only hope that your sorrow over your loss, if you have any, will be your gift from God, a cross perfectly fit for you, and a force to impel you towards the completeness that can only be found in Him. I hope that your life may actually be rich and full because of your cross, not just in spite of it. And I hope that for whatever I lack as your mother, and whatever you lack at my hand (kidneys included), you will be consoled and aided by graces from heaven.

We love you, little boy.

Yours always,
Mom

Wednesday, August 15, 2012

The Difference 15 Pounds Makes

During my most recent pregnancy, I worked very hard to gain less weight than I had with my first two. During my first two pregnancies, my weight gain was in the neighborhood of 45-50 pounds, and with this one, my weight gain was 35 pounds.

I had several hopes for lower weight gain. First, I hoped it would keep my blood pressure more firmly within the safe zone towards the end of the pregnancy, as my blood pressure had gone up considerably (even though not out of a normal range) with the first two. Second, I hoped I might have a smaller baby. Third, I didn't want to barely be able to squeeze into size Large maternity clothes and possibly be forced to go out and buy more. And lastly, I had a pipe dream that maybe, just maybe, the baby would decide that I was too skinny to maintain him much longer and evict himself earlier so that I could avoid induction.

In order to accomplish my goal, I tried to avoid eating when I felt bad. As a diabetic AND as a pregnant woman, this was very, very difficult. During the first trimester, I chose to lie down instead of eat when things got rough. During the second and third trimesters, I chose to eat just enough to bring my blood sugar up when it was low, but no more. Snacks were small, and I often considered anything I used to bring my blood sugar up a "snack," even if it was just a bottle of Gatorade. I also tried to manage my mealtimes so that they coincided with lows. For example, if I found my blood sugar low at 11:00a, I'd eat lunch a little early. I drank a lot more water. I would avoid going for seconds at dinner, and avoiding eating after 8:30p, so that my blood sugar could stabilize before bed. No "second breakfast" like I had during my first pregnancy, when I remember eating a piece of lasagna at 10:00 in the morning sitting at my desk at work. That was, of course, in addition to a full lunch!

Another circumstance that coincided with my efforts to keep my weight gain down was my father's adoption of the Paleo Diet. It was recommended to him for a variety of ailments he suffered, and ever since we moved in with my parents, as an expression of gratitude, I try to make meals we can all enjoy together. So when my dad adopted the new diet, I got a crash course in a new way of eating.

In short, it's a no starch (including rice, corn, and potatoes), no dairy diet that pretty much restricts your food intake to meat, vegetables and fruit, and it turns out to be a good diet for a pregnant diabetic, too. I've mentioned a few times that I try to keep my carb intake to 60g or less for each meal, and making Paleo-friendly meals was a great way to do that. I made lots of vegetable side dishes instead of starches, and plainer, leaner meats prepared simply. I think eating lots of veggies helped me fill up at each meal, but not take in too many calories. I also got plenty of protein. My postprandials were pretty great, because a low carbohydrate intake at each meal meant I was less likely to under- or over-estimate my carbohydrates so badly that I was really high or really low two hours later.

All in all, my experiment was somewhat inconclusive. For one thing, my blood pressure still peaked a little closer to 140/90 than I would have liked. As before, however, it never got so high that anyone worried about it. I did fit into my maternity clothes better, but I'm not sure I'd say that alone was really worth the effort. My baby wasn't that small, but he was about a pound smaller than the last one. Who knows? Maybe he would have been a lot larger if I had gained an extra 10 pounds. And he did evict himself *slightly* early, but I was, after all, at my due date.

There were some other things I noticed that I didn't expect. My insulin resistance was lower, so I was giving less insulin at each meal and my total daily insulin was about 65-70 units compared to 100 or more with the first two. My bolus insulin : basal insulin ratio was about 50:50, where during the first two pregnancies it was more like 65:35. Finally, my placenta was quite a bit smaller, and came out quite a bit faster (but healthy, as far as I know).

It's hard to say whether this experiment was worth it. It was hard, a real squeeze to keep my calorie consumption down. I was uncomfortable and weak sometimes. My blood sugar hung out just above low for long hours during the day. There were times that I woke up in the middle of the night absolutely famished, and I would snag a spoonful or two of peanut butter or a glass of milk. Discipline was hard. I usually stopped eating well short of full, and knew that I might be hungry again a little longer than I'd like to be before my next meal. I would distract myself from hunger by playing with the kids, and sip on Gatorade just enough to keep me mentally focused. There were some weeks when I got used to it, and didn't mind, but there were other times when impromptu dessert after dinner was a serious temptation. Sometimes when I was tempted to have an after-dinner snack, I'd just go to bed so I didn't have to feel hungry anymore.

But lest you think I was starving myself or my child, please note that I *did* gain 35 pounds, and my child *was* 8 pounds, 5 ounces at birth. It was more a matter of adjusting expectations, finding other ways to comfort myself when I felt bad, and being disciplined about eating, rather than grabbing food every time I walked through the kitchen. Indulgence was not out of the question, but I tried to limit it to special occasions, rather than just, "I had a bad day today, so I deserve a cookie." Sunday, for example, the great solemnity of the resurrection, was a special day every week.

So I think that, in the end, it was an exercise in temperance and sacrifice for me, rather than a real deprivation. I adopted a greater level of self-discipline over my eating habits than I exhibited with the last two, and they seem to be good habits that I will use for the rest of my life. I had a healthy, normal-sized baby (although I still maintain that there's no reason to freak out over babies that are larger), and he did come out right on time. I do anticipate losing the baby weight a little faster. It is nice to fit back into non-maternity clothes.

Perhaps most importantly, however, now I know what healthy hunger feels like. It was like fasting without the crazy blood sugars, and therefore an excellent way to unite my sacrifice to the penitential practices of the Church. My physical discomfort was not so great as to feel like a punishment, and the physical benefits were real, especially as a help to managing my blood sugars. I know that I can be content and healthy with less. I don't need to be afraid of a little bit of hunger, and food is not the only thing I have to comfort myself when things get difficult. Above all, the longing for food points to the heavenly bread that will never leave me hungry, and I think that's a lesson worth repeating every day for the rest of my life.

Monday, August 13, 2012

Actos and a Class Action Lawsuit

I don't know how many Type II diabetics read this site, nor how many of you are taking the drug "Actos," but there are a few serious health complications that may be associated with long-term use of it. A class action lawsuit has been filed against the manufacturer, and if you're concerned that you may have injuries related to its use, you can find information about it here: www.drugwatch.com.

Friday, August 10, 2012

Birth Stories

I ran across these birth stories at www.diabeticmommy.com the other day. I went through all of them and picked out a few I liked.

Amy tells two birth stories, and her first one sounds just awful! A pouting doctor makes for a terrible experience, even if he doesn't manage to actually screw up the delivery. Her second went lightning fast!

Cheryl, with gestational diabetes, had a difficult pregnancy (I can't imagine having to get used to diabetes *after* you're already pregnant!) but a quick birth and relatively easy birth.

Yvonne, also with gestational diabetes, has success with an epidural. A vaginal delivery of a teeny-tiny five-pound baby!

You can browse the other birth stories on the page, too. Can't believe I didn't know about this before!

Wednesday, August 8, 2012

A New Start

I went back to see my endocrinologist last week, for the first time since he told me he didn't want to see me again. He told me that I could come back when I wasn't pregnant, but that if I wasn't prepared to see him every month and follow his recommendations during my pregnancy, he didn't want to be responsible for my care. He also disapproves of me getting pregnant again, which reveals a more fundamental ideological disagreement between the two of us than just, "how many times I need to have my A1C checked while I'm pregnant?"

Well, I'm not pregnant any more, and I could have just found a new endocrinologist, but I can see lots of advantages to this one. First of all, he's been my doctor since the day I was diagnosed with diabetes. Second, for all but about 4 years when I lived in St. Louis, he's been my doctor. Third, he has told me before that he knows I can manage my own blood sugars, so he's unlikely to run roughshod over my intuitions. And fourth, I can get to his office, have my appointment, and be back to my house in one hour.

So it was with some fear and trembling, but I decided to go back and see if we could just agree to disagree. Next time I want to have a baby, I'll find someone else.

I was jumpy from the minute I walked in the door, and listening for a hushed whisper to fall over the women behind the counter about the defiant, non-compliant patient that just walked in. (It never did). Every time the door to the back of the office opened, I caught my breath a little. Finally, the nurse called me back.

My doctor's first words to me when he came in the exam room were: "I'm so mad at you," but he had a big smile on his face, and the words were accompanied by a hug [slightly awkward]. It was merely his way of opening the conversation, and not trying to pretend nothing had happened.

He proceeded to affirm, as a wise father might say to his teenage daughter, "I know you'll do it your own way," and "I can't make you do anything you don't want to do"; "I'm just here to give you information," and "please be careful."

I explained that we really couldn't pay for visits every month when I was pregnant, but that perhaps I underestimated his willingness to accommodate my circumstances. I told him that I was doing my absolute best to manage my blood sugars so my children wouldn't hurt for it, and that we were comfortable abstaining if the need to prevent pregnancy arose.

And, at the end of the conversation, I told him about my son's multicystic dysplastic kidney (which is something I swore I wouldn't do, to avoid giving him fodder for making me feel guilty about hurting my child!), and asked whether he thought it might be related to my diabetes. He said he knew of no association between MCDK and diabetes, and that I had absolutely no reason to feel guilty about it, especially since my blood sugars were so well-managed.

Right before he left the room, he looked at my baby, sighed, smiled, and said, "these are the things that make being a physician worthwhile."

Phew. Happy ending/new start.

Monday, August 6, 2012

Ch-ch-ch-changes!

If you've been reading for a while, you may have noticed some changes on the blog.

First, Jenn has decided to spend a little more time with her family and not blog for a while. I am secretly hoping that she will come back in time, mostly so that I don't feel guilty about stealing time away from my own family. But in any case, until further notice, you won't see posts from her. She will be missed!

Second, I changed the layout, so hopefully it will be easier to find your favorite posts, and visitors will be able to find the most interesting things quickly (birth stories, anyone?!).

Third, I need a new name! Does anyone have suggestions? "Type I Diabetes and Natural Childbirth" seems too clunky, even if it basically gets to the point. On the other hand, I sometimes have a hard time pinning down exactly what I mean by "natural childbirth," since what I mostly hope for women is that they'll be able to have a vaginal birth, and I tend to think that fewer interventions is a better way to make that happen. I also sometimes write about things that are unrelated to Type I diabetes. "Diabetic Mommy" is already taken, as is "Diabetic Mama." So, I'm taking suggestions to capture the full gamut of topics I like to write about. In the meantime, here are some possible alternatives:

Diabetic Birth (just like our web address)

Diabetes and Pregnancy (since I spend much more time writing about pregnancy than birth...speaking of which, does anyone have a birth story to share?)

Diabetes and Natural Childbirth (I feel like this is a little bit of a misnomer since I really only write about Type I diabetes)

Healthy Diabetes, Healthy Birth (this is the one that comes closest to being what I like, but it also seems a little clunky)

Or is a name change unnecessary? What do you think about blog naming? Should I try for something catchy? Funny? Edgy? Not totally related to subject matter?

Anyway, I'll keep thinking about it. 

Wednesday, August 1, 2012

My Take on Big Babies, or, Don't Get Your Knickers in a Twist

Every time I start writing a post like this, a post that deals with issues over which well-meaning midwives and obstetricians disagree, I end up opening more Google tabs on my Safari browser than I have time to read, and fretting that I have missed something and someone is going to berate me for it. But alas, I think at this point it's safe to say that my readership is small enough that no one who hates me for saying this will ever see it.

Besides, what I'm really trying to grapple with is the buzz I hear from women and doctors about babies that are too big, and why everyone is freaked out but no one seems to have a good answer that doesn't involve doing c-sections on thousands of women who don't need them. And I hear it all the time!

"Oh, they said my baby was too big, so they scheduled me for a c-section at 38 weeks."
"My baby was 10 pounds when he was born and my doctor said I must have had gestational diabetes and we just didn't know about it."
"My baby was 8 pounds and everyone comments on how huge he is."


Some anecdotal evidence on the reaction (overreaction?) to big babies:
  • I vaginally delivered a healthy 9lb 8oz baby boy a little less than two years ago with no problem. My endocrinologist's reaction? "That's a little bigger than we like to see." I'm not sure why it's any concern of yours since *I* was the one to push him out *and* I did it in less than 20 minutes, but whatever.
  • A friend of mine delivered a baby boy at 9lbs 2oz so fast that an ambulance picked her up off the sidewalk and he was breastfeeding 15 minutes after arriving at the hospital. Simply on the basis of his weight, they told her that she probably had insulin issues, despite the fact that she passed the glucose tolerance test.  
  • Another friend of mine has six children. She does not have any form of diabetes. All but one of her children have been 9lbs or more, including one baby who was close to 11lbs, all but one of her children have been delivered vaginally, and she has never failed a glucose tolerance test. Her one c-section birth was not related to the size of the baby.
  • My sister-in-law gave birth to a 10lb 6oz baby vaginally with no complications.
  • I asked the nurse who delivered the Statesman what she thought about the average size of babies at birth, and I questioned her about the 7 1/2 pound average. Her response? "I don't know. I see an awful lot of 9-pound babies born in this hospital." 
  • I heard of a woman who was told that she needed to be scheduled for a c-section prior to the birth of her child because he was anticipated to be more than 9 pounds. His true weight at birth? 7 pounds 12 ounces.

So now that I have done it three times, watched a bunch of other Type I diabetic mamas do it, heard stories from countless women who were told their babies were "too big," heard doctors fret about it, and spent an embarrassing amount of waking time thinking about it, I'm proposing that we all just chill out about big babies and take a look at the real problems (and the real benefits!) of growing them large.

First of all, no one seems to know just how to classify a baby that's "too big." The average is 7 1/2 pounds (give or take a few ounces). My endocrinologist thought 9 1/2 pounds was too big (again, I'm not sure why it's bothering him). If you read my links, you'll notice that some say 8 pounds 8 ounces is too big and some say 8 pounds 8 ounces is optimal (whaaaaat...?), and some put the cut-off at 9 pounds 15 ounces. I had people tell me my first son, 8 pounds 2 ounces, was "massive" and "huge." I wrote some things about this 2 years ago, when I was pregnant with my 9-1/2-pounder, and I think they are all still true. "Too big" is not very well-defined, nor is it easy to measure, and nor can it always be chalked up to diabetes.

So what are the problems with having a big baby anyway? Well, one thing you've probably heard is that having a large birthweight is linked with obesity later in life, but please, people. Correlation does not equal causation.



So as far as I can tell, the worst problem with having a big baby is shoulder dystocia. Frightening, to be sure, life-threatening, and not predictable by clinical symptoms alone. Ultrasound is not always reliable to detect baby weights, and neither are palpations. You don't really know it's happening until the baby's head comes out and...the rest of the baby won't. Women who avoid an epidural have more options if it happens.

In fact, women who avoid an epidural seem to have one of the most excellent options available to women whose babies get stuck: the "all-fours" maneuver. In a 1998 study, shoulder dystocia treated with the all-fours maneuver alone resulted in the live birth of the child 82% of the time. There is unfortunately no information on the long-term outcomes of these births (most notably, no information on brain damage), but I'd say getting the baby out alive is a pretty big deal when you're talking about a complication that cannot be reliably predicted or prevented beforehand. Some other techniques here, by Spinning Babies and here, by the Thinking Midwife.

So in addition to my thoughts here, avoiding an epidural may actually help save your baby's life, should he or she get stuck in transit. Hooray for natural childbirth! I knew there was another reason I thought it was a good idea, and especially so for diabetics whose risk of having a baby with shoulder dystocia is a bit higher.

And here's what else I know about big babies: pediatricians LOVE them. March of Dimes wants you to  wait as long as possible before inducing labor, partly because big babies do better. My big babies had APGARs of 8 and 9, both of them. I heard a 70-year-old woman in the grocery store tell me, "babies these days are so alert, so smart, and so strong. Much stronger than when I had my daughter." My mother-in-law is convinced that my husband slept through the night at an early age because he was so big when he was born (9 pounds 13 ounces). I'm convinced he sleeps through the night because he's secretly trying to shove all middle-of-the-night child-care duties onto me, but that's a different story.

Anyway, I acknowledge that it is possible to have a baby "too big." There's clearly an optimal birthweight somewhere between 5 pounds and 16 pounds, and I'm no expert, but I'm still not sure why everyone seems to think that having a baby with birth weight in the double digits means you must be really fat. Maybe some women just grow their babies big, and maybe some women can blame their husbands for being big at birth (ahem). Maybe it's just evidence that women are eating well, and nourishing their babies well prior to birth.

As one midwife puts it, "I think people get their knickers in a twist about big babies. If the labour progesses, then the baby will be born safely. After all, you can get problems with six-pounders. You need vigilance."


Yeah. What she said.

Monday, July 30, 2012

Healing and Divine Mercy: In Between

I've been working on this series for a long time. Since Easter, in fact. I thought I would save it, to give you something interesting to read while I am up during the night changing diapers and feeding a baby and only half-awake during the day, trying to make sure a few meals make it to the table and I don't set anything on fire. I will publish it in four parts.

This is the fourth and final post in a series in which I explore how to ask for healing from diabetes without losing faith, and without experiencing disappointment when it doesn't happen immediately.

I finally realized that diabetes is, in fact, a problem.

When I asked for healing, and didn't receive it, it was, in fact, very disappointing, and made me worry that maybe God wasn't faithful towards me, or loving towards me. He was holding out on me, so I thought, just like Eve thought that God was somehow keeping her from something she deserved or needed.

Then, I was reminded that God wanted me to ask for his mercy, and that I just needed to wait. Just like if Eve had waited, she would have received the great perfection she desired.

So now, I am figuring out what to do in the meantime. What to do in the meantime, until I am healed? Especially if this lasts the duration of my earthly life and I don't see healing until the resurrection of the body at the end of time?

Well, I don't have an awesome answer to that question, but here's what I've been doing.

I pray, because Christ asked us to pray. He asks us dozens of times in the Gospels, and he renewed his request in his revelations to Sister Faustina. "Let the sinner not be afraid to approach Me. The flames of mercy are burning Me - clamoring to be spent; I want to pour them out upon these souls." Prayer draws us close to his heart, and a non-immediate answer requires us to quell our childish fears and trust him every single moment.

I keep doing my best to manage my diabetes, to safeguard my earthly life for my children and others who depend on me. If my health is exactly what I'm asking God to restore, so that my life may be enhanced and prolonged, then treating my body like a piece of junk will never get me closer to the end that I seek. If my body is a gift that God has given to me, treating it like a piece of junk will probably actually make him angry. So I do my best to give it the care it needs.

I imagine what a life without diabetes might look like if it happens before the end of my earthly life. Maybe I could have more children. Maybe I will drink a milkshake without feeling guilty. Maybe I will give all the money that I would have spent on doctor's appointments and health insurance for the rest of my life to someone else who needs it. Maybe I will give thanks for my health every day. Maybe...

I meditate on the glories of heaven. Even if I am healed tomorrow, I will still almost certainly suffer death as he did. My health will not be permanent if it is restored to me before the resurrection of the body at the end of time. So pondering healing makes me mourn the loss of health that all human beings experience at death, whether their health in life has been good or poor, and punts me into meditation on the beauties of heaven, where health never ceases.

I am afraid that if God doesn't heal me, it's because I'm just not good enough, or he doesn't love me enough. I am afraid of living with diabetes for the rest of my life. I am afraid that my kidneys will fail, and I will die before I get to see my grandchildren grow up. I am afraid for every child that will be conceived in me in the future, that he or she will suffer birth defects because of my condition. I am afraid that I will not have the self-discipline to control my blood sugars - that some day I will just give up - and suffer the consequences.

This quote strikes the heart my fear (Notebook 1, Entry 2 in the Diary of Sister Faustina). For me, the fear was and has been that, if I pray for healing and don't receive it, it will mean that God doesn't love me. But in truth, my relationship with God comes first, even before healing. He need not prove his love to me in healing because he has already proved it on the cross. The present moment is sufficient for God to lavish his love upon us, and for us to know and respond to God's love. I will be healed in heaven, I may be healed before then, but God's love is for me at every moment between now and then:

When I look into the future, I am frightened,
But why plunge into the future?
Only the present moment is precious to me,
As the future may never enter my soul at all.
...

O present moment, you belong to me, whole and entire.
I desire to use you as best I can.
And although I am weak and small,
You grant me the grace of your omnipotence.

And so, trusting in Your mercy,
I walk through life like a little child,
Offering you each day this heart
Burning with love for Your greater glory.