Tuesday, January 31, 2012

Guest Post: Birth Story

Lauren, a reader of our blog, recently wrote to us lately and agreed to let us share her birth story with you all. Enjoy! And if anyone else has a birth story or an experience they'd like to share with us, please feel free to e-mail me at beth (dot) g (dot) turner (at) gmail (dot) com.

My name is Lauren, and I confess that I am in imperfect diabetic. I have had type 1 diabetes for 14 years and have had varying degrees of control along the way. When my husband and I started discussing the possibility of starting our family, I got to work on two things: 1) managing my blood sugars, and 2) educating myself on pregnancy and childbirth. I learned that keeping perfect control of my sugars was, frankly, impossible. But I kept working and trying and getting closer and closer to "optimal." I also learned a great deal about the human body's natural process of giving birth. The more I read, the more determined I became to have a healthy pregnancy and a natural childbirth free from unnecessary medical interventions. I firmly believed that type 1 diabetes and natural birth were not mutually exclusive. It took A LOT of work and preparation, but in the end, I had my first baby, a healthy little boy, in a natural unmedicated birth. I hope that my story can be an encouragement to others!

On January 10, I was 38 weeks and 6 days pregnant. I had been feeling the pressure from doctors for weeks to set an induction date, because they prefer type 1 diabetic moms to deliver by 38 or 39 weeks at the latest. I had maintained optimal control throughout the entire pregnancy (A1C’s between 4.9 and 5.8) and had no pre-existing complications from the diabetes. After much research, reflection, and agonizing, I was prepared to go to 40 weeks or longer before resorting to induction. Fortunately, whether as a result of our “natural” induction attempts or just plain luck, we didn’t have to!

At about 11:00 pm on January 10th I began to feel some minor contractions. I had not experienced any Braxton-Hicks contractions prior to this and had declined a vaginal exam at my 38 week appointment, so I did not think that labor was imminent. By 11:45 the contractions were about 5 minutes apart. The pain was still very manageable, so I wasn’t sure that it was actually labor. We called the doula and continued through another hour of contractions. By 12:45 contractions were 4-5 minutes apart and beginning to get more intense, though still manageable. At this point we called the doula again and asked her to come to the apartment because we thought this might be it! My husband threw together his overnight bag and some other hospital necessities (we sure did wait until the last minute!) and before I knew it, the doula had arrived.

By 1:30 am the contractions were growing more and more intense. I labored in a variety of positions but had a difficult time finding one that helped me to relax. Eventually I found that the only position that gave any relief was a sort of modified child’s pose, sitting on the floor with knees apart, toes together, and leaning forward. It was not one of the practiced poses from our Bradley class, but it worked! I went back and forth periodically between this child’s pose and a side-lying position for the next 6 hours, taking each contraction one at a time. My husband laid beside me on the bed, helping me to breathe and relax, and assuring me that I was doing great. Our doula sat on the floor beside the bed, timing contractions, encouraging me, and occasionally massaging my lower back. I want to emphasize how important it was that we prepared for the labor using the Bradley Method. It truly did help me to endure this time laboring at home, one contraction at a time. I never felt “out of control” even though I did feel pain. In reflection, I believe that preparing with Bradley helped me to be more responsive to my husband’s and doula’s suggestions to help me relax, make low guttural noises, breathe, and so on.

Throughout this entire time laboring at home, my husband and I also managed my blood sugars. By the grace of God, my sugars stayed in tight control throughout, between about 90 and 130. I wore my insulin pump and used both my continuous glucose monitor and hourly finger sticks to keep things steady. Although I thought that I would want to eat and drink during labor, it was surprisingly difficult (I was not interested in food), so my blood sugars really never needed to contend with that. Other than a few bites of toast and a ton of water, I didn’t put much in my system.

At about 7:30 am, I remember hearing my husband and doula discussing going to the hospital. I wanted to wait longer, as I didn’t know how dilated I was at the time. I was terrified of overzealous hospital doctors and nurses taking control of the birth and pushing interventions on me simply because I have type 1 diabetes. By 8:30 am, I remember my doula looking me in the eyes between contractions and saying, “Lauren, after this next contraction, we are going to start bringing bags downstairs to go to the hospital. It’s time.” This was the wakeup call I needed. If the doula says it’s time to go, then it’s time to go!

The 45 minute drive to the hospital in LA traffic was horrendous. I labored in the car and cried because I just wanted to get there as quickly as possible so that I could get out and move. Of course we finally made it, and when we were checking in, I had two contractions back to back. I fell to my knees both times and literally could not complete the paperwork. Two nurses - absolute angels - walked me back to a triage room, helped me out of my nightgown, into a hospital gown, and onto the bed in seconds flat. At this point, things seemed to happen really quickly. They attached the electronic fetal monitor and finished asking me admission questions between contractions. These contractions were incredibly intense, and I basically lost all focus on relaxation and breathing. I just made low vocalizations and gripped the bed handle for dear life. At one point the handles were rattling, and I actually thought, “Oh my God, I think I’m going to break the hospital bed!” Thankfully, I did not. When the nurses had their fetal monitor strip, they tested my blood glucose (it had crept up to 154), and they measured me, and gave me the best news I had heard all day: I was at 8 centimeters! I knew from Bradley classes that 8-10 usually went very quickly, so I knew things would be happening fast. They immediately wheeled me to a labor and delivery room, where they put in an IV for antibiotics, since I was GBS positive. My OB was not at the hospital yet, so for a few minutes I actually had a midwife helping me labor. Very soon after, my OB arrived and took over.

It felt like no time before I was 9 ¾ centimeters. However, 9 ¾ to 10 felt like an eternity. I felt the need to use the restroom, so I shuffled to the bathroom and immediately felt the intense urge to push. When I said this, everyone in the hospital room yelled, “Don’t push! Breathe through it!” so I tried to breathe as I willed my way back to the hospital bed. The doctor measured me again, and I was still 9 ¾. Not good. It felt impossible not to push. I tried to contain it for a couple more contractions, then knew that I had to push no matter what they said. Fortunately at that moment, my OB said that I could push whenever I was ready! Hallelujah!

It was a relief to finally push with each contraction. However I quickly realized that pushing was incredibly painful and difficult. The nurses, OB, and doula all told me that I was doing an amazing job and pushing very effectively. Yay! They helped me to hold my knees back, pull my elbows up, and put my chin down. I kept pushing, knowing that each time my baby was getting lower and lower. I gave every push my all, using every bit of energy and force that I could muster. My guttural noises turned to grunts and screams. Finally I knew that my baby was almost there when I heard my husband’s encouragement go from general (“You can do it! Keep going!”) to very excited and specific (“Oh my God! His head is right there! You’re pushing his head out!”) It gave me that last bit of energy that I didn’t know I had. I felt the baby crowning, and my OB told me to “half push” several times. These “half pushes” were unbelievably painful, but thankfully they saved me from tearing too badly. So I half pushed until I felt the baby’s head slide out. One more push for the rest of his tiny body, and at 10:41 am, my son was born! I was completely overcome by the flood of emotion. I was crying when they put him on my chest. It was the most incredible moment of my life.

My little boy was born completely healthy in a high-risk, unmedicated hospital birth. He weighed 6 pounds 14 ounces and was 20.5 inches long. Even his blood glucose was perfect - 83! I could not have asked for a better birth experience. Everyone, from the doula to the nurses and OB, were so supportive. My husband was my rock throughout the entire experience. It really went better than I could have ever hoped. I feel incredibly lucky that things turned out this way, since I know that even those who prepare and do everything “right” don’t necessarily have the experience that they want. I am extremely lucky and blessed to have my beautiful baby boy!

Sunday, January 29, 2012

Week 22 of Baby # 3

As Beth just mentioned in her last posting, it's been difficult to write this pregnancy, much more difficult than I'd expected, in fact. When I created the blog nearly two and a half years ago, I was coming off of the highs and passion of having just won what was one of the biggest battles of my life it felt, having a baby outside of the standard operating system that was around me at the time.

That experience left me with a lot to say. As my children grew and demanded more of my time in addition to my husband's rather demanding job of being a minister on our family and my returning to work part time; finding the time to write has not been a priority as I'd hoped it would be. Of course as any pregnant woman out there knows, there certainly is plenty to write about during this time, especially when one adds the managing of blood sugars to the mix and how I wish I'd been updating you all on the journey this pregnancy has been already. Please forgive me for not writing as frequently as I'd like to and as would be helpful if you are experiencing this journey for the first time! Here's a New Year's resolution to try and blog more frequently!

All of this said, I've been so afraid this pregnancy which is one of the sad things that keeps me from writing. I'm afraid of something going wrong this pregnancy. This of course is marred by my sinfulness as I know in this world, because of my Christian worldview, that things do go wrong and this is the curse of sin...however I'm called not to sit around worrying about these possibilities but to live faithfully, trusting in the Lord's plan for me as part of His people. Sorry for all of the theological talk, but it's important for me to say that one of the reasons I haven't been writing is just down right fear and this is not the way I should live my life.

On a high note, things HAVE been going "normally" so far this pregnancy. I am 22.5 weeks along now and so thankful for the second trimester. I feel wonderful, truely wonderful for a pregnant lady. The first trimester was hard, as is to be expected and I'm sure the third trimester will bring on new struggles with fatigue, however for the time being, I'm SO happy to be in the second trimester! Here's a 20 week picture of my hubby and I on the cruise Beth mentioned, it was a much needed and wonderful time for the two of us!

I have a wonderful new doctor. After getting fired, I made lots of calls locally to find a doctor comfortable with natural births. Finally, my husband and I decided to go with the recommendation of the local midwifery practice and see their overseeing physician. He was booked up when I phoned them but had just welcomed a recent graduate of the local (well-known) OB residency program to the practice part time. I agreed to meet with her and feel like God sent me exactly who I needed.

She is the mother of a two year old, and I recently learned that she is pregnant as well! (one week behind me to be exact). I don't know that there could be a more compassionate and understanding OB. She listens, she learns, and she respects me. She is medically trained and more "traditional" than I'd like when it comes to birth, probably, however, she also knows her stuff.

Diabetes management seems to come like second nature to her and multitasking is no problem, which turns out to be quite nice from a physician when you consider the many things that one must accomplish at an office visit with a type one diabetic mother-to-be.

She just finished 4 years of training with the 5 maternal-fetal specialists who are in this area (the only practice for miles!!) and was all over my diabetes and the true lack of control I had at my first appointment with her. I mentioned months ago how I'd had to change endocrinologists due to my husband's insurance changing. There are only two practices in our area, sadly, and my new endo is NOT up to snuff for pregnancy and diabetes. OB was appalled at the recommendations endo was giving me, gave me her own goals (those that matched what I remembered from my previous pregnancies - fasting between 65-96, after meals below 140) and phoned my doc to encourage him to rememeber these goals for pregnant women since he was wanting to run my sugars much higher to avoid lows.

Well, that conversation was around 13 weeks of pregnancy. This week she and I finally decided it was time for a change, new endo guy is not going to get the job done and so she made calls to the maternal fetal OBs and they have agreed to see me and still allow her or the other OB in the current practice to deliver the baby! This is wonderful news since the reason my husband and I had avoided the maternal fetal specialty practice in town was because they require that you allow a resident to deliver the baby, not to mention the absurd size of the practice (30 docs or so in all)

I had my level 2 ultrasound around 18 weeks and baby looked well at this ultrasound. I will go next week for the fetal echocardiogram ultrasound and am prayerfully hopeful that this will be good news as well.

Baby is a MOVER, she has been very active since about 14 weeks although with her growing size that movement is starting to wake Mommy up in the middle of the night already :) Did I mention she looks like a girl. I have only had the 2 ultrasounds this pregnancy, which seems strange because with the last two babies it seemed the doctor looked everytime I was in the office. The first ultrasound was at 10 weeks, which I posted when the just wanted to confirm there was a baby there, and then the level 2 at 18 weeks baby had her legs crossed but "looked to be a girl".

My bloodsugars have been much better since going to new OB doctor. She sees me every two weeks which is a pain but good for accountability. My endo has also been seeing me every two weeks, but just because he has no idea what he is doing but seems to like the allusion that he does :) (maybe that was too harsh) I'm SO thankful that I have already cancelled my next appointment with him and am looking forward to working with someone new on managing my bloodsugars.

My A1C was 7.3 around the time of conception, I believe, but has consistantly dropped (endo checked it every 2 weeks...silly right) to 6.0 for the last 6 weeks. The dexcom has been amazing and I don't know how I had two babies without it now, I feel so spoiled! I lost the receiver on Christmas day and had a week long stretch without it and I thought my finger tips might fall off. I fingersick maybe 6-9 times a day with dex (he's not as reliable during the pregnancy I've found - before pregnancy it was 2-3 times/day) but when I didn't have dex that week I think I checked my sugars about 15-20 times a day!!! Simply because I didn't remember how to manage without all of the extra data. I'll have to ask Beth how many times she is checking her sugars during pregnancy, I remember it being around 12-15 times a day with my last two pregnancies.

I've started re-reading Natural Childbirth the Bradley Way by Susan McCutcheon and am so glad I'm rereading. It helps me remember what I'm fighting for and why its all worth it... there is a baby coming that I will be able to hold in my arms in a few short months and she deserves the best chances in life I can give her... my choices now affect her (and on that note, I think I'll skip the chocolate cake I was just craving!) :-P Not to mention, the help I need to start preparing for a third birth. Remembering and knowing the sensations I will feel are natural and intended for children to enter the world is helpful in the environment of avoid the "pains" of labor in which we all live.

And with all of this, I hope that this blog will continue to be a place of help and encouragement to women (and men) who live in the world of type one diabetes and childbearing! jenn

Friday, January 27, 2012

Week 20: Back on Track

You may have noticed that I took a break from my weekly pregnancy updates for a while. The reason for this was twofold. First, we flew across the country to visit my husband's family, which left little time for thinking about all the witty things that I would write to you about my pregnancy (that was a joke). Second, things became so difficult to manage while we were gone and after we got back that it was actually painful to write about. I don't always do it well, but I try not to think out loud while I'm blogging (with more or less success, especially when I am trying to write something down every week), and I also try not to get really angry or really pitiful when I'm preparing a post (again, with more or less success). Jenn has also been struggling with the emotional toll of having to find a new doctor, and you'll notice she's been a little quiet lately. Um, she also went on a Caribbean cruise, so I imagine she's probably still feeling too relaxed and groovy to sit in front of the computer for hours. :)

So, I've spent a lot of time trying to think about my blood sugars over the last few weeks. Think, not simply react. Think, not freak out. Think, not cry. Think, not assume that this pregnancy is just going to go badly and give up. Think, not just cave to pressure from my interior emotional turmoil.

After thinking, I decided that one thing I needed to do was to restore the pre-Christmas discipline that I had with respect to my eating habits. I avoided excessive a lot of weight gain during the first trimester thanks to those habits, and I do believe my blood sugars were so solid for the first trimester as a result also. For me, a huge part of discipline involves not overreacting to lows: finding the perfect amount of juice to raise my blood sugar, instead of slamming down a tall glass of juice, a banana, AND some toast to raise it up. I'm so accustomed to continuing to eat until I feel better (over the course of, say, 20 or 30 minutes), rather than eating something small and trusting that my blood sugar will rise. I had been doing that quite well during the first trimester, and got off track when we traveled and I had to get used to new foods.

The second part is eating smaller portions. I was talking to my sister-in-law about eating habits, and she mentioned that at some point, she realized that any time from 11:00a until she went to bed, she just could not eat enough to fill her up. She was having to just draw the line with her portions, even though it meant that she wasn't fully satisfied at the end of her meal. During my first two pregnancies, I satisfied my hunger fully almost every meal and snack, and justified it saying that it was probably best for the baby. I also gained 50 pounds both times. So this time, I took an approach similar to my sister-in-law's. I gauge my portions based on what my husband eats, and try to eat a similar or smaller amount at most meals. The result, I believe, is more modest ups and downs with my blood sugars, since my average carb count is lower for each meal.

The third is limiting snacks. Putting a small amount of food on a small plate in between meals, and having that just be it - peanuts, fruit, crackers, cheese, whatever - but just enough to revive my spirits until the next meal. It helps that my children have regular snacks, also, so I have a little time to think about it, and sit down and eat it before I get up and go. The reality is I usually ending eating two large-ish snacks or smallish during the middle of the day (early lunch, late lunch) that correspond to pre- and post-nap time meals.

There were three great rewards to this discipline. The first I noticed was, after about 6 weeks, I actually did begin to feel satisfied with a small dinner. I guess my stomach shrank. The second was that I really feel like Sunday can be a feast for me. I don't have to be stuffed to enjoy myself at a meal - but I may have an extra helping that I wouldn't take during the week. Or I might have dessert, when ordinarily I would decline. Or I might have a late morning snack, a normal lunch, and a late afternoon snack. You get the idea. The third reward is that I have gained half as much weight as I gained during my first two pregnancies.

So maybe I did come up with some New Year's resolutions, after all. :) Things have improved considerably since we got home and after the stomach bug. I'm having a funny afternoon spike (not very high), and still a little trouble with post-breakfast lows, but all-in-all, they are pretty manageable and not keeping me awake at night.

In other news, I AM anemic. I knew it. I am off to go make some meat for dinner.

Tuesday, January 24, 2012

Excellent News

I passed the quad screen! That's the blood test that assesses the likelihood that your unborn child has Down's (trisomy 21), trisomy 18, trisomy 13, or open neural tube defects. I know that it's not a guarantee, since there are several chromosomal defects that are not screened by this blood test, but it sure does bring some relief.

Monday, January 23, 2012

Houston, We Have A Problem

I had my level II, comprehensive ultrasound last week, also known as the 20-week ultrasound. The good news is: my due date is officially June 15! I'm glad I'll have a little extra time before I'm pressured to induce, since my babies don't seem to come out early. Also, maybe now I can start my "pregnancy week-by-week" updates, since I know what my "official" dates are. Also, we're having another baby boy! I've now officially given up hope that our family will ever have the male/female balance I wanted, but we've got some GREAT boys' names lined up.

The bad news is that the doctors seem worried about this little man's kidneys. He has bilateral hydronephrosis/pyelectasis, which means that there is likely some kind of obstruction that is creating a urine back-up (I think that's roughly the gist of it).

In addition to those findings, they found cysts in the choroid plexus (part of the brain). They can be indicative of a systemic chromosomal problem, such as trisomy 18. They also found an intracardiac focus (I think that's what they called it), which is a bright spot in the center of the baby's heart. The heart appears to be structurally and functionally intact, but the intracardiac focus can be a weak indicator of Down's syndrome (trisomy 21).

Because of all these findings, they want to monitor closely (every 2 weeks!), and they also recommended genetic screening and diagnostic testing for chromosomal defects.

GULP. When the doctor came in to tell us the news, my blood sugar was low (surprise, surprise - I was there for a looooong time and had slurped down the only bottle of Gatorade I brought with me well before this moment). She was very kind, and repeated everything about 5 times, which helped me my unable-to-concentrate diabetic self to take it all in. She used different words to describe the problem and put the phrases together in a variety of ways. We asked a TON of questions and I felt like we had a grasp of the facts at least by the time she left the room.

We agreed to do the blood screening test (quad screen). The test only gives us a probability of chromosomal defects (not a diagnosis), and is more likely to turn up a false positive this late in the second trimester. I think its value to us will lie in a negative outcome. If the blood screen is negative, meaning the probability of a chromosomal defect is very, very low, then I think we will all breathe a little easier about this little man's prognosis.

Upon further discussion with the medical director (a different doctor who came in after the first), we had an even better grasp upon the situation. She thought the choroid plexus and intracardiac focus were not anything to be terribly concerned with at the moment. Choroid plexus cysts, she said, often resolve by 24 weeks. She also said that she sees an intracardiac focus with some regularity, absent other findings, but that without other stronger indicators of Down's syndrome (flap on the back of the head, and something about the nose), she thought Down's was unlikely.

My husband thought she indicated that, if a chromosomal defect were present, it was most likely to be trisomy 18. As an example of the difference between my husband and myself, however, I heard the doctor say that she thought it unlikely that there was a chromosomal defect at all (I would drive myself crazy having to emotionally prepare for a stillbirth or death shortly after birth, all to find out that was not the reality of our situation! My husband likes to brace for the worst). She said that, given my age and ability to manage my blood sugars successfully, it was more likely an isolated problem with the kidneys, possibly due to my diabetes.

The problem is bilateral, which makes it a little more serious, and the dilation is bordering on severe, given his age (10 mm on one side, 9.4 mm on the other). The biggest concern with hydronephrosis is that there is an obstruction so severe that the baby cannot pass urine. In that event, we would see poor growth and low amniotic fluid. Fortunately, at this point, growth and amniotic fluid levels are both perfect.

So, as I mentioned, baby and I will be receiving ultrasounds every 2 weeks. They will monitor the baby's growth and amniotic fluid, to be confident that the obstruction is not getting worse or affecting the baby's development. In addition, they will be searching more closely, as the baby gets bigger, for indications of a chromosomal defect. They will, of course, look at the dilation of the kidneys, and the choroid plexus, to see whether the cysts dissipate on their own.

We have talked to many, many friends about this and all sorts of people are coming out of the woodwork, telling us that someone told them their baby's kidneys had a similar problem during one of their prenatal ultrasounds. Every single one of them has also told us that the problem resolved on its own (before or after birth), and no surgery was necessary. We seriously, seriously hope that's the case for us, too.

On the other hand, my husband is probably right to brace for the worst, which I think at this point is trisomy 18. I guess there are other chromosomal defects that could be lethal to the baby, too, which we would only know on amniocentesis. If our blood screen is positive and the ultrasound readings continue to show indicators of a chromosomal defect (worsening cysts in the choroid plexus, or other problems), then we will probably have an amniocentesis late in the third trimester. That's just so we have a little time to know what kind of life we can expect with this little man shortly after his birth. Link
If you do so and think of us, please pray! May God have mercy on all of us.

Saturday, January 21, 2012

The Man Does Not Give Up

I visited my endocrinologist again this week.

Maybe I should just end my post there, since you probably know what's coming next, based other things I've written about him.

I dreaded the visit, knowing that I would have to tell him about the stomach bug and bathtub incident, and the difficulty I'd been having with my blood sugars ever since Christmas. I was ashamed, and questioned whether this pregnancy might be less healthy than the other two, whether I might be having trouble keeping it together, and whether I might be crazy for wanting more children.

But I knew it would be better to own up to the difficulty and seek his advice. I was ready to acknowledge that, even though I know a lot about managing my own blood sugars, it's useful to have an extra pair of eyes.

After explaining the trouble I'd been having, and especially the stomach bug incident, he grumbled. He made sure I knew that next time my blood sugar showed up that low, no matter how inconvenient it might seem, I really ought to wake someone up to help me. I got defensive, but I concurred.

Then, he used the incident to bolster his case against future children.

Him: "You really want to do this again?"
Me: "Yes."
Him: "OK, well you really need to wait at least 3 or 4 years. Your body needs a break."

Maybe it's just because I feel like a teenager talking to my dad when I'm in the office (never mind the fact that my own father would never, ever say that). Maybe I just like to play the part of the embattled Catholic. Maybe I have a rebellious, youngest child streak in me that looks for opportunities to buck the system. Or maybe he's really actually wrong... I'm not sure, but after I got over the shame and confusion, I was just plain miffed.

First of all, I'm already pregnant, and I already feel bad about the way the blood sugars have been going in the last month. Can we move forward? With some problem-solving? Rather than making future plans, let's just deal with what we have. It's unnecessary for me to decide right now whether I'm going to have 3, 4, or 8 children. For now, all I need to do is get through is this pregnancy. Focus, focus, focus.

Second of all, stop harping on it. The Man Does Not Give Up. I dread my visits, because it's like he's a broken record stuck on the track titled, "Stop Having Babies." I'm tempted to lie to him, and pretend everything is perfect, because I'm tired of feeling like he's looking for reasons to tell me to stop having babies. And besides that, he's condescending. "You really want to do this again?", as though the "solution" is just SO OBVIOUS. I'm sorry, but it's NOT obvious that using my down-and-out mood to manipulate me into agreement with your personal prejudice is a good solution, even if you do think the "recommendation" is meritorious (which I obviously don't). The ends don't justify the means (and I'm not prepared to assent to the ends in this case, anyway).

Finally, he used an incident that very well could have happened apart from pregnancy as a reason for me to stop having children. Stomach bugs happen all the time in this household. They've never caused a low blood sugar like that. Maybe it would have happened, pregnant or not. But regardless, the problem is diabetes, not pregnancy. He should stick to his area of expertise: both of us would be happier.

My sister-in-law can always tell when someone has gone too far in ascribing negative intentions to another person, and she is to be highly praised for so gently reminding me today that it sounds like he really does care about my health. And I want you, dear reader, to know that I am trying to give him the benefit of the doubt. But please understand that it's hard when every time you go into the office, you are scolded, chastised, and manipulated into an ideological conclusion that is not the only or best alternative. In fact, it goes far beyond patient care (which would include assisting me in blood sugar management and immediate solutions to immediate problems) and strays dangerously into badgering me into life decisions that can, in fact, be reasonably managed in a different way.

I do want to be careful to say that I am certainly aware that low blood sugars are not to be sneezed at. They are dangerous for me, and they are therefore dangerous for my babies both on the inside and on the outside. I know that taking care of myself is a very important part of taking care of my children, and I am doing my best. It may mean that waiting a little longer is advisable next time, and I have not taken that consideration off the table. In fact, it was something I thought very carefully about before my husband and I agreed that we could start not not trying to having a baby again - particularly, whether I could manage the lows well enough to keep myself healthy, and whether I could manage the highs well enough to keep the baby inside healthy during another pregnancy. My assessment at the time was: it's hard, but worth it.

Unfortunately, I can't always predict when a massive stomach bug will hit and keep my blood sugar low for hours. I can't always know exactly when things will get hard. I wasn't having trouble before I got pregnant. I didn't have this kind of trouble the last two times I was pregnant. In fact, I haven't had a low blood sugar incident that bad in years (since before I was pregnant with my first son). I thought it reasonable to open my heart and body to another baby at that particular time. So I did, and now I'm praying extra hard to my guardian angel to help keep me and these children safe.

My doctor is blinded by his ideological convictions that contraception is acceptable, NFP doesn't work to delay childbearing, two children are "enough," having diabetes and being pregnant is too hard, and babies of diabetic mothers are in constant, unmanageable danger within the womb. His conviction is so forceful that he feels that it is justifiable to bully me into assent.

But there really, truly is an alternative to this conviction: NFP does work to delay childbearing, children are not commodities like cars, having diabetes and being pregnant is hard but can be done, and babies of diabetic mothers are at a moderately increased risk of mostly manageable danger within the womb. I may be convinced that I need to take a longer break after this baby is born, but with a good 15 years of potential childbearing ahead of me, I will NOT be bullied into the conclusion that future children should be barred from my life. It's just not necessary or reasonable to say that.

Tuesday, January 17, 2012

Is it really harder this time, or is this just a hard time?

Things have been up and down, up and down for the past 4 weeks, with Christmas, travel, and our return to something kind of like normal. I've been feeling pretty discouraged about it. I can't tell you how many times I've adjusted my bolus ratios and basal rates, but I still don't feel very confident about where they are now. I'm at 1:10 for breakfast, 1:11 and lunch and 1:9.5 for dinner. My basal rate is 0.65 over night, 1.20 from 5:30a to 8:00a, and 0.90 during the afternoon (I've had some moderate late afternoon highs, in the 180s range).

The uncontrollable highs started it, while we were traveling, over Christmas. Last week, after the stomach bug and my near-death experience in the bathtub, I had more 2-digit blood sugars that began with the number "3" than I am comfortable admitting. I can't really explain the lows, except maybe to say that I was eating a little less than usual during my stomach bug recovery.

So these are the facts: The last four weeks have been hard. And I've been anxious. The pregnancy itself is otherwise fine, but diabetes is making it hard. At the end of this pregnancy, I might be eating humble pie, because I wrote the opposite a few months back.

I'm hoping, though, that after the baby is born and I'm getting some sleep again, I'll be able to look back and say this was a blip, a problem I solved (or at least limped through), and a variation of normal for me as a Type I diabetic. After all, whether I'm pregnant or not, I'm constantly noticing blood sugar trends and making small adjustments to improve my numbers. Is this really all that different? It may just be the anxiety that's killing me (although getting into the bathtub when your blood sugar is 30 is never a good idea).

Friday, January 13, 2012

When "Violently Ill" Just Doesn't Do It Justice

It was a Sunday night. I was 17 (or 18) weeks pregnant (depending on whose pregnancy wheel or ultrasound you trust). We had some friends over for dinner, as is our usual custom, and I rolled up some hearts of palm in flattened chicken breasts. I made a corn, black bean and tomato salad for the side, and we had fried plantains to go with it. Yum.

Two hours after dinner, I checked my blood sugar and it was a jaw-dropping 34. Not what I expected after such a large meal, but I assumed I just gave too much insulin (which I am prone to do when I am pregnant and I eat generously). I drank some juice.

I was downstairs, sitting at the computer, checking Facebook and sending some e-mails when...


and again.
and again.
and again.
and again.

Oh, wow. Um, that was unexpected.

I finally got it cleaned up, came back upstairs, and an hour after I checked before, my blood sugar was a shocking 30.

Now, at this point, you are probably thinking to yourself, "Oh, shoot. Her stomach wasn't absorbing any of the food she'd eaten over the last 3 hours because she had a horrible, nasty stomach bug that would take her down for the next 36 hours." If my blood sugar hadn't been 30, I might have thought the same. Instead, I tried drinking more juice.

I hopped in the shower, which ended up becoming a bath in a hazy low-blood-sugar-confusion. I think I may have briefly passed out because I don't remember some of what happened in said bath, but I do remember thinking that I might fall down several times. I think that's why I turned it into a bath, so I wouldn't have to stand up. And then...


and again.
and again.
and again.

At this point, you are probably thinking, "Your guardian angel must really like you, because natural selection clearly should have selected you OUT by now. What were you THINKING getting into a slippery shower, much less running a BATH, when your blood sugar was dangerously low?" If my blood sugar hadn't been 30, I might have thought the same thing. And believe me, I've cried many tears since thinking how stupid it was to draw up a vat for myself to drown in.

Instead, I barely managed to throw the bath mat into the tub, throw some towels on the smelly floor, and check my blood sugar and lo and behold, it was 20.

I don't think my blood sugar has EVER been that low before. And if it ever has been, I probably wasn't conscious to remember it, much less dealing with it on my own.

At this point, you are probably thinking, "Well it's at least a good thing you were in the shower so your pump was not connected to you for a while. You'll want to suspend your pump for a little while, or at least put it on a temporary bolus of zero for a couple hours until you can wake up and figure out whether you can eat anything to bring it back up. And for goodness sake, wake someone up to help you, and maybe call an ambulance." I might also have thought of those things if my blood sugar hadn't been 20. So what I did instead was drink some more juice (not sure why I hadn't figured out that the juice wasn't...oh wait, I know...my blood sugar was 20) and passed out in bed. By now, it was 11:30, approximately 2 hours after my blood sugar first showed up at 34.

At 3:30 in the morning, I roused again, got up out of bed, and ran to the kitchen sink, holding the vomit in my mouth to keep it off the floor. My blood sugar was at least up to 51 (since when has that ever been a victory?!). I think I drank more juice.

I was mostly awake lying in bed the rest of the night, and finally dozed off at about 6:30am. My husband, saintly man that he is, stayed home with the kids so I could sleep in. I still felt like death the rest of the day, and of course my blood sugar went to the opposite extreme during the course of the morning (278 at its highest).

The good news, however, is that I survived and apparently the baby survived, because he or she is still kicking at regular intervals. The moral of the story, however, is that I am an idiot when my blood sugar is low.

I hate being pregnant during stomach bug season.

Thursday, January 12, 2012

Weaker Contractions in Type I Diabetic Women?

My cousin forwarded this article to me, about why women with Type I Diabetes may have more c-sections. It certainly provides a provocative physiological hypothesis about women with diabetes - that their uterine muscles are not as strong - but I also have a few other thoughts about it.

My pushing experience with my first son actually seems to anecdotally confirm the hypothesis. My contractions were extremely spread out - never closer together than 4 minutes. In fact, after I had been pushing for 2.5 hours, my contractions were STILL sometimes 7 minutes apart. Fortunately, my doctor didn't seem perturbed by it, suggested a little bit of pitocin, and we got the job done vaginally. I always chalked it up to being a first-time mom who was scared to death of having a baby.

But with my second son, I was induced with pitocin to begin with. Contractions didn't get very intense until after they broke my water. I asked the nurse to turn the pitocin off after they broke my water and I felt like I had NO REST in between contractions. I finished dilating about 2 hours after the pitocin was turned off, and then he came flying out in 20 minutes! I actually have no idea how close together or far apart they were, but they were intense. And his rapid exit surely says something about the effectiveness of my uterine muscles.

So was it the difference between a first-time mom and a second-time mom? Or was it that I needed the pitocin to assist me? Perhaps the pitocin was actually still working by the time I pushed my second son out, but my impression is that it doesn't stay in your system quite that long.

Without knowing a lot about the science of contractile intensity of uterine muscles, my greatest question about this new science would be: are induced labors more likely to be affected? That is, if you induce labor at 39 weeks, are you more likely to find that you suffer from ineffective contractions? It seems like a no-brainer to say "yes," but I actually have zero science to back that up. It's just an intuition, but it does seem like a pretty reasonable one. Oh, and not anecdotally applicable in my situation either, since my first labor (the spontaneously-begun one) had weak contractions and my second labor (the induced one) had normal contractions.

My other question would be, could pitocin be used to augment labor that has already begun, rather than jumping to a c-section? I mean, I'm as afraid of pitocin as the next lady, but I guess since it's been used to such positive effect in both my labors, my position on it has softened somewhat. And particularly when it means avoiding a c-section, I'd be all for it.

Monday, January 9, 2012

Week 15: Sometimes, Things Fall Apart

You may have noticed that I skipped week 14. That's because I don't remember what happened, and it probably wasn't that interesting.

At the end of week 14, however, we flew across the country to visit my husband's family. I always really enjoy seeing them, but it tends to be a blood sugar management crisis, especially at Christmas. In fact, it was so bad this year that it's a little painful to write about. In fact, it was so bad this year that I'm actually embarrassed to send my blood sugar numbers to my endocrinologist next week. I feel like writing a note in large letters on the fax cover sheet saying: "DON'T JUDGE ME. I'M MORE WORRIED ABOUT IT THAN YOU ARE. AND NO, YOUR HELP WOULD NOT HAVE MADE A DIFFERENCE."

But that's clearly over-the-top, not to mention impossible to prove.

As an example of the fire I went through, take the following day.

On Christmas morning, I woke up at about 2 am with a coughing fit. I checked my blood sugar: 91. Great. But by the time I woke up just before 6:00a with another coughing fit? 223. Heck if I know...

I gave insulin and hoped that it would drop before we at breakfast. Unfortunately, at 7:30 when breakfast was ready, it was only at 159. I had this feeling that it was not going to drop quickly or easily. Breakfast was heavy on egg and cheese, and I usually find that if I avoid carbs altogether at breakfast, it makes the spike worse.

After breakfast, we went to mass. In my paranoia, I probably gave myself a total of 5 units extra bolus in the 2 hours after we'd eaten breakfast, just because I suspected my blood sugar was still going up. It wasn't terribly low at lunch (59), but I hate being on the defensive like that.

I needed to over-estimate my lunchtime carbs, but 2 hours later was fine.

Things were basically fine up to dinner, but then post-dinner (mashed potatoes, stuffing, gravy, turkey, and a roll) was 190. GAH! I had already given a generous bolus by purposefully overestimating my carbs.

I feel panicked and defeated. Of course, I would like to solve the problem and move forward to get those blood sugars down, but I also have a serious need to address the emotional upheaval these last 10 days have served upon me.

Breathe. It's happened before. A handful of high blood sugars don't kill your baby. Severe defects happen to mothers with completely normal pregnancies. Diabetic mothers who don't manage their blood sugars have healthy babies. Breathe. You're doing your best. You will get home, and you will get control over it once again. Did I mention that panic doesn't actually get you any closer to the blood sugars you want? Breathe. It might have helped to have your endocrinologist's input, but it rarely has before. Even if it had, there's no way to know. Besides, there was no way for you to send him your numbers and get his suggestions while you were gone. Breathe.

I hope it goes without saying that the emotional turmoil lingers even now, but I DID have to move on, so I tried to come up with some theories about what was happening.

I think the biggest problem was this: I didn't move at all in between meals. Seriously. My mother-in-law did all the cooking, there was nothing to clean, no laundry to do, no children to pack in or out of the car, and barely any children crying to attend to, since they were so well-amused by their grandparents. So what I did in between meals was SIT, and sit and sit.

In addition, the food itself was problematic. Holiday diets are always high in fat and carbohydrate, and combined with sitting and sitting and sitting, blood sugars are bound to be unpredictable.

Finally: unfamiliar foods take a while to get used to. At home, I have my standby blood sugar-raisers (gatorade, certain kinds of juices, etc) and breakfast foods (Cheerios, toast, etc). But when I'm gone, the choices are different and have different effects on my blood sugar. If I'd been there for another two weeks, I probably would have gotten it all figured out. As it was, though, I was just barely getting used to the new foods before we hopped back on a plane to fly home.

So I raised my bolus ratios, at least temporarily. I may have to reduce them again when we get home and into a normal routine, but for now, I think it's the only way to combat the highs. Heaven forbid I actually get up and do something on my vacation....

Sunday, January 1, 2012

Happy New Year!

Happy New Year, all!

I, being pregnant, have absolutely no New Years' resolutions. I would justify all kinds of rule-breaking on the basis of growing another being inside me. Maybe next year. :)