Friday, February 24, 2012

Week 24: There Is A Reason I'm Exempt From Fasting

First of all, completely unrelated to the rest of this post: next week, I go for another ultrasound to make sure that the Statesman is not in danger from whatever kidney problem, if it even is a problem, that he's having. At this point, though, I'm not worried about it. I just can't imagine there's anything wrong, because my belly is getting so, so large. He's active, and I can tell his movements are getting stronger. The kidney dilation may not be gone, but my womb still seems like a good place for him to be. Sometimes you don't need a fancy ultrasound to tell you everything is just fine!

And, now, for a discussion of fasting, pregnancy, and Type I diabetes. I know, they probably don't even belong in the same sentence together, much less in practice. But such is my foolishness.

When my husband and I entered the Catholic Church two years ago, I wanted to be as Catholic as possible. In my mind, that required Lenten prayer, fasting, and almsgiving. After all, fasting was recommended by our Lord himself! At a minimum, all healthy adult Catholics are expected to fast on Ash Wednesday and Good Friday, and may offer additional fasting for special intentions (special emphasis on the word healthy).

I often think of myself, despite having Type I diabetes, as being no different than most healthy adults, so when I surveyed fasting requirements, they seemed very do-able. In fact, I had been assured by all my serious Catholic friends that the requirements had been significantly reduced following Vatican II. If current fasting consists of two half-meals and one small full meal (no snacks), that should be a piece of cake, right?

The first time it came up was Ash Wednesday of 2010. I had only just found out that I was pregnant with Braveheart, and thought surely no harm would come to a baby of only 6 weeks gestation if I fasted. I figured he would just take what he needed and I was the only one who would suffer. However, when my husband discovered my plan, he swiftly and decisively told me he did not approve. I gave it a half-go at breakfast, but decided I would be better off heeding my husband's wishes. Plus, fasting is hard, even if the requirements have been taken down a notch! Good Friday passed without any attempt at fasting, but mostly in grudging acceptance of my husband's wishes in the matter.

Ash Wednesday 2011 came around, and now I had a 4-month old. Now was my chance! I don't think I told my husband about my plans this time, and so I proceeded with fasting (again, two half-meals and a small full meal). This time, I learned what a mistake fasting is for milk supply. By that evening, I could tell that my son was NOT getting a sufficient amount of milk to satisfy him, and things continued much the same way for the next 36 hours or so - at least into Friday. I felt HORRIBLE when he would choke up at the end of a feeding, and knew that this choice had been a bad one. Besides, my blood sugars were also unpredictable, not on the day of the fast itself, but over the next couple days. It caused me some pain to forego it, but Good Friday 2011 involved no such attempt.

Ash Wednesday 2012 happened last week, and I was apparently still not convinced that fasting should be off-limits for me. I knew that a full fast (two half-meals and a small full meal still hardly seemed a fast, but I grudgingly acknowledged that might even be too much at this point) was inadvisable, but I thought I could at least eat a LITTLE less than I normally do.

So, at 23 weeks pregnant, I ate slightly smaller meals than I normally do and skipped snacks except to raise my blood sugar.

This was a big mistake.

I suppose it probably has something to do with what happens to your insulin resistance when you are not consuming normal amounts of food, but my blood sugar was 28 after dinner. Big fail.

I ate a little to bring it up, but because I was so darn hungry, I over-ate, and then needed to give a small amount of insulin to compensate. Two hours later? 25. Big fail number 2.

By now, it was the middle of the night, my blood sugar was low AND I just wasn't thinking clearly, but knew that I was ravenously hungry and my blood sugar was low. So I tiptoed into the kitchen, ate more than I needed to raise my blood sugar, was then put in the position of having to give a small amount of insulin again to compensate, and collapsed back in bed. Four hours later? 37. Big fail number 3.

For the next day or so, my blood sugars were trending quite low, in spite of the fact that I was eating normal meals and snacks. No more 30s, but a few 40s and a lot of 60s. Big fail number 4.

So, the conclusion is that fasting is a bad idea for nursing and pregnant women, but especially for diabetics. I think I have finally laid to rest the idea that I may never be able to fast. It pains me, because I want to be able to do what the apostles and saints have done, and I want to engage in physical disciplines that bring spiritual maturity. Maybe I will re-visit it when I'm older, I'm not pregnant or nursing, my children are grown, and I can figure out how to adapt my insulin regimes for a few days to accommodate a fast. But for now, I have enough trouble keeping my blood sugars in line with two babies on the outside and one on the inside when I'm eating normal foods, so other physical disciplines will just have to take a back seat.

A good Catholic friend who self-reportedly "over-did it" on fasting noted that good control over my diabetes probably required regular "mini-fasts," at certain meals or certain times of the day. She's absolutely right about that - and it also reminded me that the best physical disciplines I can engage in right now are the ones that will keep me and the baby inside me healthy.

Please note that pregnant women and adults with health conditions that may be negatively affected by fasting are, in fact, exempt from required fasting that is normally required of healthy adults on Ash Wednesday and Good Friday. Nursing women are similarly exempt. My attempt at fasting was not a requirement of the Church, but borne of my desire to imitate more closely our Lord and the apostles. This was completely of my own initiative, so there's no need to think that the Catholic Church is just trying to keep me down.

Sunday, February 19, 2012

Nicknames

I've seen some mommy-bloggers use nicknames for their children and their husband in their blogs, and I kind of like the idea. I've typically just referred to mine as my first son (born May 2009), my second son (born October 2010), my third son (still in utero), and my husband. But I think I'd like to try out the nickname thing.

My husband is easy. He'll be the Professor. My first-year college friends who saw me out with him used to ask, "who is that graduate student that Beth is dating?" He's always looked about 10 years older than he actually is (and being old = being wise, right?). Since he also eventually hopes to be a professor, I think it's apt. Easy enough.

The kids are going to be harder. The first scheme I came up with is based on their personalities. That would yield something like the Leader, the Nice Guy, and the ? But since so much is still unknown about their personalities (particularly that of the not-yet-born one!), I didn't want to shape my own understanding of them by applying a personality trait that is so likely to change in the next few month or years. I thought I might have a hard time shaking that perception later on, and if I got stuck on it, it could make it hard for me to treat them according to who they actually are.

The second scheme I came up with is based on potential career paths I could see for them. That would yield something like the Priest, the Musician, and the ? Same problems as the first naming scheme, not to mention even more danger for me as a mother in shaping the way I raise these boys, and getting attached to something that will not be.

So what I finally came up with is to name them according to virtues of the saints we ask to intercede for them so regularly. We named our sons after saints in the hope that they would emulate those saints in virtue, even if not in vocation, and attain graces from spiritual communion with their heavenly brothers. I think it's acceptable for me, as a mother, to give them nicknames in the anticipation of and hope for such gifts.

The nickname I will use to refer to my first son, age 2 1/2, born May 2009, will be the Pious One. It's kind of appropriate, given that he's the only one of our children who actually knows any prayers, can accurately identify Jesus and the priest at mass, and can even answer a few questions of the Baltimore Catechism. But um, generally speaking, we're still working on it...sitting still through mass and prayers is first on the agenda.

The nickname for my second son, age 16 months, born October 22, will be Braveheart. No, he's not named after William Wallace or Mel Gibson. But his patron saint was courageous, and I think it's also good for a little guy with such a big heart. The courage part is not inappropriate for the way he conducts himself on a daily basis, either, given his capacity for throwing himself into things head first. No, literally, like diving off the edges of beds, chairs, pews, the floor, and so forth...head first. Um, we're working on it...

The nickname for my third son, due in June, will be the Statesman. Statesmanship or diplomacy is not a virtue specifically, but when I think about the saint after whom he's named, I think of a prudent and reverent leader who demonstrated strength and honor and promoted peace, justice, and generosity. Those, I think, are all characteristics of a good temporal ruler or statesman. Yeah, we'll get right on it...

Friday, February 17, 2012

Week 23: Away We Go!

Now that I am more than half way through this pregnancy, I am finally giving more insulin in a day than I would have on an average non-pregnant day. This week, I increased basal rates, bolus ratios, and even insulin sensitivities across the board. It will become increasingly difficult to chase the post-bolus lows, and only in my more foolish moments will I be caught outside the house without any Gatorade.

By the way, I recently learned something interesting from my mother about Gatorade (she's a big fan too, for purposes of re-hydration). Unlike juice, Gatorade is absorbed in your stomach. With juice, you have to wait until it gets to your intestines. That's why, when your low blood sugar is low and you take a big swig of Gatorade, you feel better within 5 minutes, as opposed to 15. OK, promotional moment over.

This being my third pregnancy, I've noticed that I can divide my blood sugars into three distinct phases of pregnancy management.

Phase 1: Don't Go Too Far From Home

Immediately after I adjust my insulin rates, my postprandial blood sugars are usually closer to 60 than 100, and this is what I mean when I say I'm constantly trending low. In some ways, this feels more comfortable than the other two phases, because I can be quite confident that my next A1C will win me brownie points with all my doctors. On the other hand, 60 is closer to 40 than 100, and lows are a serious risk. I always keep Gatorade with me, and I don't hesitate to check it before the 2 hours is up if I think I might already be low. In my better moments, I can be pretty precise about how much Gatorade, crackers, cookie, or whatnot that I need to raise my blood sugar without going overboard.

Phase 2: Optimum

After a week, or two, or three with my 2-hour postprandials trending low, I find that they rise to about 100. Ahhhh. That feels good. Unfortunately, this phase always seems to be exceedingly brief, and I still have to worry about the fasting levels (3 hours or more). Because my meal-time boluses tend to be large, I have a lot of extra insulin hanging around in my system that keeps the numbers going down rapidly the longer I go without eating. Needless to say, fasting levels become increasingly uncommon as the pregnancy winds down (up?), since I just can't keep my blood sugar up with eating a small something.

Phase 3: Panic Mode

I despise phase 3. It gives me the creeps, on behalf of my unborn child. I will tolerate it only for about 5-7 days. During this phase, my 2-hour postprandials are 120 or higher, and if I get a day with 2 or more postprandials above 140, I make changes. I don't check with my endocrinologist first, but I always make sure he knows what I did. Since I'm sending him the blood sugars every week, he's sufficiently updated to know I'm not doing anything wild and crazy over here. Plus, now that I can adjust bolus ratios by decimal point (thanks, Minimed!), I don't need to do anything too dramatic to correct postprandial problems.


As for morning fasting levels, I check pretty frequently during the night. I check every time I go to the bathroom, which, by the end of the pregnancy, is 2 times every night. So I don't usually miss an unexpected high. I also use that to know when to adapt my basal rates, which seems to happen less frequently than adjustments to bolus ratios. Since I can barely go 3 hours without eating during the day, it's hard to know when I'm having a basal rate problem compared to a bolus ratio or carb counting problem. Night-time blood sugar readings are good for that.

In other pregnancy news, I am getting really, really large. I would include a picture, but it's kind of embarrassing. My oldest son said to me this week, "Mommy's belly is getting heavy." (I must have complained about having to pick him up or something). My 15-month-old son, who can't even say the word "baby," recently poked it, looked up at me, and grinned. My husband seems to think it's cute, but I have my doubts. I especially have doubts about how everyone is going to feel about it when I'm seven months pregnant and I look like I'm about to pop. I promise, I have gained far less weight this pregnancy (13 pounds) than others (24 pounds), but the bump is out of control.

Oh well. As Simcha Fisher so elegantly put it recently, "I love the way your abdominal muscles look, all separated like that."

Monday, February 13, 2012

When "No" Is Beautiful

I have been watching the drama unfold in the media and on my Facebook news feed since the January 20 Department of Health and Human Services issued their final rule to Catholic institutions such as hospitals, schools and charities: you must provide an employee health plan that covers contraception, the morning-after pill, and sterilization services. Facts about the mandate here. The Obama administration issued a compromise, but it has not changed the fundamental structure of the mandate.

The Catholic Church opposes contraception as immoral, and the U.S. Conference of Catholic Bishops has spoken out unreservedly over the ruling. There are a number of potential consequences for Catholic institutions and the people they serve. You don't have to be Catholic to oppose the federal requirement, and many people are doing so because they realize that their own religious convictions are threatened by the intrusion. In fact, even some supporters of contraception think it's a bad idea, because they realize that punishing Catholic institutions that are doing good work contradicts the common good of all. Some people argue that, practically speaking, contraception and abortion have failed to fulfill the promises made about them, and no longer deserve the public support that has so long been offered to them.

The dimension this debate has taken on in the public sphere is primarily one of religious liberty. I appreciate the threat to religious liberty, and I oppose the mandate for that reason, also. But I sometimes think that contraception gets shoved into a religious liberty corner, without addressing the deeply-held disagreements about its moral legitimacy. At heart, very few really set out to threaten religious liberty. Instead, the mandate reflects a public sentiment that the Catholic Church's assertion about the immorality of contraception fails to promote human love, does not allow individuals to flourish, doesn't make sense, and might even be dangerous.

So, it's difficult to make the word "no" beautiful (as in, "no contraception" and "no sex, at least during certain times of the month"), but I am going to give it a try. I realize that my words, and even the steadfast opposition of the Catholic Church, may not change any minds. But because the truth is beautiful, I want to try to explain the Catholic Church's teaching on contraception to you. Please don't be angry. I'm not angry with you, even though I might think your arguments are flawed. I love this teaching, and I really think it's beautiful.

Also, I hope that if you read this blog for any length of time, you will see the way my husband and I live it with our children. As you can probably understand, I don't share many intimate details, but anti-contraception is more than what happens in the bedroom. It is a way of life. Even more than formulating logical arguments to convince and persuade of the goodness of that way of life, the delightful task that falls to me is to live it. And because the way I learned to love it is by watching other people live it well, I hope I can live it well before you, in this post and in this blog. It's hard, it's messy, and it almost always feels like you're having to hack down bushes and fallen branches to make your path in the wild woods, but it changes you - and the change is good.

**********

Lots of people assume that the Catholic Church's teaching on contraception simply means that the Church thinks everyone should have more children, period. I think it's fair to say that we love children, and the big families in our pews attest to that fact. But I don't think it's the whole story. The use of contraception is not equivalent to saying you never want children and think people shouldn't have them, because even a couple that uses contraception can still end up having a larger-than-average family. For that matter, some couples that use NFP may end up having smaller-than-average families. In a small minority of cases, a couple that never uses any method to prevent pregnancy may never have any children at all (e.g., infertility). In short, in its prohibition of contraception, the goal of the Catholic Church is not only to get people to have more children.

Instead, the intention of the Catholic Church is and always has been the flourishing of human persons. In fact, the reason the Catholic Church likes big families is because more babies = more people to flourish! More children often promotes flourishing for the parents of large families, too. Children almost always improve their parents' lives, especially in their tender early years. Children are the fullest manifestation of love between people, and love promotes flourishing all around.
I am probably preaching to the choir on these points, because I gather that many of our readers are having children because they think they are good. :) This is probably particularly true of our non-Catholic, Christian readers, who surely share the belief that children are a blessing from God. By the way, Jenn and I have respectfully disagreed in the past over some of these issues, but we both love children.

Unfortunately, in a few cases, children can create a burden to a family that the family cannot support. True poverty is one reason. Unstable living conditions are another. Having a child who requires special needs could be another. The average American woman stops at 2 or 3, and I think most of those couples could have more if they released their grip on just a few more of the things that make them comfortable. My husband and I, for example, live with my parents and have a very modest graduate-student income, but we have judged our situation sufficiently stable to make room for one more (especially another boy - hooray for hand-me-downs!). We would also willingly give up my husband's academic aspirations for the sake of our children if a change in our circumstances required it. However, each family is different, and you and your spouse are responsible for making that decision for your own family. You are most capable of assessing your internal and external resources to determine whether your living conditions will permit the adequate flourishing of all the people in your home, including a new child. I will not judge you if you only have three kids.

One condition that I am familiar with that might make childbearing inadvisable, however, is a true danger to the health of the mother or the children she might potentially bear. Because I am a Type I diabetic, this is a concern with which I am well-acquainted. I have been told over and over that this is too hard. If you have read this blog for any length of time, however, you will notice that my risk threshold is pretty high, and I am willing to tolerate the difficulty, since each time I do it, it seems to turn out pretty well. So far, we have found that the additional human flourishing added to our home when a new baby is born is exponentially greater than the anxiety and discomfort that come along with it. And so far, no one has suffered any major health threats because of it.

That being said, however, and it being the responsibility of the husband and wife to decide when more children are good for their family, the most natural question that arises is: why is one method acceptable to delay childbearing (NFP) and not another (hormonal or barrier method contraception, or sterilization)? If the goal is to prevent pregnancy, why aren't these methods equivalent to one another? You may, in fact, be screaming this question at your computer screen right now. I'm glad I didn't make any promises about this being a short post.

The first principle to keep in mind when answering the question, "why one method and not another?" is that the means to arriving at any given ends do, in fact, matter, and not all ways of arriving at that end are morally acceptable. We know that to be true in a thousand ways. So, there's our goal (in this case, preventing pregnancy), and then there's a right way and a wrong way to attain that goal. I assume that's a pretty non-controversial statement, but just in case, consider the following analogy. It matters whether you steal your money from someone or whether you rightfully earn it, even though at the end of the day you have $1,000 in your pocket.
In the same way, it matters how you prevent pregnancy, even though at the end of the day, you don't have a child that you could have had. When you steal, you injure the rightful property owner. When you use contraception, you injure your spouse and yourself.

Now, returning to contraception as a legitimate or illegitimate method of pregnancy prevention, we must look closely at the sexual union itself. I mean really closely (sometimes things get awkward right about now).
We are not talking about the general sexual relationship between two spouses. We are not looking at their long-term intentions to include children in their family, and we are not looking at their sexual life as a whole. We are looking at one individual act of sexual union. We are looking at the integrity of each and every sexual union which unites them. Each and every time they get together, it's important. If any man rapes any woman just once, it's a problem, even if he never does it again. For the same reason, our disposition towards our bodies and their potential to create children in each and every sexual union matters, regardless of how many times we end up having babies. This is why I said that the Church's teaching on contraception is not just about big families. Not every sexual union will produce a child. But to promote the flourishing or perfection of the spouses, every act of sexual union must maintain its natural integrity and perfection. Sexual union can only maintain its natural integrity and perfection if the spouses bring their bodies, whole and entire, to the act which unites them.

Contraception then, in each and every sexual union in which it is used, subverts the natural integrity and perfection of the sexual union by placing a direct, deliberate impediment to the normal, healthy functioning of the human bodies in question - specifically, the procreative purpose and capacity of those bodies. It deliberately contradicts the natural integrity and perfection of the human body by impeding fertility. Infertility is unnatural and should not be chosen willingly. Not only does contraception deliberately disrupt the childbearing potential of the union, but it also places a barrier to full union in between the spouses. It prevents the bearing of children, which any number of couples may not be able to do at various times throughout their marriage, due to natural infertility (e.g., post-menopausal) or through infertility caused by disease (e.g., endometriosis), but it also keeps spouses from being fully united, fertility and all. Blessed John Paul II would say that spouses using contraception are not able to make a full gift of themselves to one another.

The best way I have heard this described is as follows. The use of contraception during sexual union is a way of telling your spouse, "I want this part of you, but not the other," or a way of giving only a part of yourself and withholding another. Sexual union is meant to be a full gift of your body to your spouse, and neither spouse should deliberately withhold that which is natural to their body and the union itself.

On the other hand, NFP works with the normal, healthy functioning of the bodies of the spouses. It makes no demands on the fertility of either spouse, and places no barrier between them. It's true that not every sexual union results in a child, but that is because, naturally speaking, it is rarely ever the case that every sexual union results in the conception of a child. For example, during pregnancy, postpartum amenorrhea, when one or the other of the spouses is ill (infertile), and during the days of your cycle when ovulation is less likely to occur. Each and every sexual union that honors the body's natural capacity (fertile and infertile times included) is acceptable. Each and every sexual union that subverts the body's natural fertile capacity is not. To deliberately subvert the natural integrity of the bodies involved in the sexual union is a deliberate choice of imperfection, which deliberately contradicts human flourishing. That, in my understanding, is the definition of a sin.

So, not every sexual union must produce a child. No, thank heavens, no. I only have two and one on the way and I am exhausted. I know women who can tell you about six or eight, and though we all love our children, we are glad to have space between them, too.
A husband and his wife who are practicing NFP will be capable of making the best decisions for the flourishing of their own family, and they are permitted to space children to allow for it. What they may not do, however, is contradict the natural integrity of the sexual union and their bodies so that they may enjoy sexual pleasure and bonding apart from its natural integrity and perfection.
Many people protest that the abstinence required by NFP is too hard, or damages the relationship between the spouses. However, to the extent that such abstinence honors, loves and respects a wife's, husband's, or child's need for space between additional children, it is actually the best way to love your spouse (and your children). Rather than asking your spouse to reduce his bodily perfection so that you can enjoy him (or the remaining part of him), which would be contrary to the flourishing of both of you, with abstinence you respect the integrity of yours and your spouse's body and demonstrate sacrificial love towards him. Besides, it's a relatively small sacrifice. The abstinence in NFP is only for a short time each month. Spouses can intentionally create space for one another on either side of the fertile ovulatory period so that they may come together in sexual union and not conceive. Abstinence in marriage is only harmful if it is non-consensual or spiteful. Those are real but manageable dangers.
Another point about periodic abstinence. While sexual union is the unique way in which spouses give and receive one another, it is not the only way. Spouses demonstrate love (and thereby give themselves) in dozens of ways every day. Spouses are choosing, all day long, between behaviors that will demonstrate love to their spouse, weighing their own personal work and childcare responsibilities, those of their spouse, and other demands placed on their time an energy.

Sometimes, choosing not to have sex and instead getting ready to leave for work, may, in fact, be the best way for spouses to love one another. Abstinence, in a situation like that, is itself a gift. Any NFP-practicing wife whose husband has ever said to her, "let's abstain during your fertile period this month. Our children are young, you are tired, and another pregnancy would be very difficult for you right now," knows this sacrificial love very, very deeply. As with the choice to try for another baby or not try for another baby, any decision to abstain or not abstain must be assessed according to the internal and external resources of the husband and wife, and is a matter to be decided upon prudentially between them.

Consider one final case scenario regarding abstinence. When we make our marriage vows, we promise to be with our spouse "in sickness and in health." If illness makes it impossible for one spouse to come together in sexual union with the other, is the healthy spouse somehow entitled to find another sexual partner to unburden himself of the abstinence that has suddenly become his lot? Absolutely not. As I mentioned before, abstinence is not an unhealthy state per se. Sexual union has the potential to contribute to a person's well-being, but under improper circumstances, sexual union may actually cause psychological or physical harm. Either way, it is not a vital function like breathing or eating, and if you have promised to be with someone "in sickness and in health," you absolutely may not justify marital infidelity according to some supposed health benefit of sexual satisfaction.

In conclusion, Catholics do want people to have more children, because more babies = more human flourishing. When it comes to pregnancy and childbearing, a safe rule is to give until it hurts, and then give a little more. But there are also times when it is acceptable to space children. Pregnancy is difficult, and the spouses' internal and external resources are not endless. Spouses are capable of choosing responsibly when they will seek to conceive a child and when they will wait a few more months or years.

When spacing your children, though, keep in mind that not all methods are equal, and deliberately contradicting the natural function of your body will always make sex something less than what it should be. If you use contraception, your relationship may seem stable and loving and may continue to be mostly happy and healthy for a long time. But it is not right to ask your spouse to make himself imperfect so you can experience a little bit of fleeting pleasure. Do not give less of yourself than you have. When you give it, give it all, and when you can't, offer your sacrifice for the good of your spouse.

I promise, it's beautiful!

Friday, February 10, 2012

Week 22: You Mean I Have to Wait HOW Long?

This week was characterized by an unfamiliar and very early longing to meet my son. Soon. And I'm only 22 weeks pregnant!

I don't know why I didn't feel this way with the other two. Well, I do sort of know why. With my first pregnancy, I was so focused on getting through pregnancy that I failed to think about what it would be like to actually have a baby, except that I knew I thought it was a good idea. Net result? I was confused right up until the time I delivered my son, and pretty terrified for a few weeks afterwards.

With my second son, I was again apprehensive. We found out we were having another baby in February, a short 8 months after our first was born. We knew we were going to have to leave St. Louis in May, but we didn't know where we were going. Finally, I was leaving a well-paying job in April so that we could go to a school where my husband's income was not guaranteed (and certainly not as high as the income we were leaving). We found out not long after that we would be moving to an expensive area, living with my parents, and that our income would be modest, to say the least. I had some misgivings about it, but went along for the ride. I was, by the end of the pregnancy, at least not afraid to have another baby - but I wouldn't say I was actually excited to meet him until an ultrasound conducted the morning of my induction. His eyes were open! Something clicked at that moment, and it really made the delivery much easier.

For whatever reason (I like to think that I have grown in motherly virtues, but that is subject to debate), I just cannot wait to meet this little man. Maybe it's because we've already given him a name, or maybe it's because now I know a little more about what happens to little boys when the grow up a bit (my kids are really cute). Or maybe it's because I remember what it's like to be 40 weeks pregnant and I really don't want to go there again. I'm just so excited to have him on the outside, here with us, where we can watch him grow and smile and laugh and learn and do all the other adorable things that little children do.

Come soon...but not too soon!...I mean...you know what I mean.

Monday, February 6, 2012

Second Ultrasound

I went in for another ultrasound, a 2-week follow-up to my comprehensive, last Friday. After speaking with the maternal-fetal specialist, I am even more confident now that the most likely problem is NOT a chromosomal defect, but an isolated kidney issue. The choroid plexus cysts have almost entirely dissipated (in just two weeks!), and she said that if a chromosomal defect pattern were to show up on ultrasound, it almost certainly would have made its presence known by now. The dilation remains the same (both kidneys are affected, and the size of the dilation is quite significant), but baby's growth and the amniotic fluid levels were fine, which means that kidney function does not appear to have been affected at present.

This is a huge relief!

After sharing the news with friends and family two weeks ago, I have had at least 4 people e-mail me to tell me that their child had a similar kidney problem before birth. None of their children required surgery after birth, none of them had to deliver early, and only one parent continued with monitoring for just the first year or two of their son's life. It was simply an unusual pattern of normal in utero development.

This is also a huge relief!

My mother, who is an emergency room physician, did some research on hydronephrosis and found that it is one of the most common abnormalities detected on prenatal ultrasound, even in low-risk women ("Hydronephrosis is the most common pathologic finding in the urinary tract on prenatal screening by ultrasonography, accounting for 50% of all abnormal findings"). Very frequently, the baby outgrows the problem before birth ("In more than half of the cases where hydronephrosis shows up on ultrasound, it resolves itself by the time the baby is born or soon after"). In all of the cases where hydronephrosis caused a problem with the pregnancy or the immediate postpartum period, oligohydramnios (low amniotic fluid) was detected ("In the presence of a bilateral obstructive process, oligohydramnios is the best predictor of an adverse outcome").

This is yet another huge relief!

I have some concerns about the way the problem is being monitored and, therefore, the way recommendations are being made about the care and treatment. Both my pediatrician sister and my mother seemed to think that oligohydramnios was the most important thing to monitor for, but I actually had to remind the doctor to check the amniotic fluid. When I asked the maternal-fetal specialist how she would know whether there was a problem, she said she was looking at "kidney function." I questioned her about how she knew whether the kidneys were functioning, and she said it was by looking at the structure of the kidney - how compressed it was as a result of the dilation. But that didn't seem right to me. I'm sure that more compressed kidney is more likely to impair kidney function, but isn't amniotic fluid the best way to measure whether the baby's kidneys are actually functioning? I mean, since amniotic fluid is basically just baby urine. She was somewhat equivocal about that. She said she didn't think early delivery would be recommended, because we would want to keep the baby in as long as possible to give him a better chance to develop properly. I repeated the question about the amniotic fluid. If it begins to drop rapidly, might it not be a good idea to get him out so we can correct the problem? I didn't mean right now: I know that the baby couldn't survive outside me now. But say, if the problem develops later in the third trimester? I guess I thought there might be surgery they can do on the outside to fix it that would be impossible or more difficult in utero. But she kept stressing kidney function (by which she meant the compression of the kidney), rather than amniotic fluid.

So, I'm a little bit confused. I also asked her whether they might be able to locate the obstruction - or whatever it was that was causing the fluid to be retained in the kidneys and dilate them - and it didn't really seem like that was possible, either. I thought perhaps she'd be able to see it as the baby grew older, but she was pretty non-committal.

Giving her the benefit of the doubt, it's possible that she wasn't thinking long-term, and was only giving me answers about what she was seeing on the current ultrasound. And of course, she would recommend waiting as long as possible if I'm only at 21 weeks now. It was of some concern to me, however, that she didn't look for the amniotic fluid levels until after I mentioned it. If she didn't think the amniotic fluid would be an issue, and she wasn't going to ever be able to locate the obstruction, and she thought keeping the baby in as long as possible was the best answer, why am I coming in for ultrasounds all the time? There's a lot I don't understand about the long-term prognosis and course of treatment here. I may just try to schedule a consult with a pediatric urologist to find out more. Or maybe I need to give her another phone call.

It was also somewhat irksome that she kept saying that my baby probably has a kidney defect because I'm a Type I diabetic. She never once mentioned how common this problem is, nor the fact that it frequently resolves before birth ("Antenatal hydronephrosis without associated urinary tract anomaly is the etiology in the vast majority of infants with hydronephrosis (79-84%) and has been termed isolated antenatal hydronephrosis (IAHN)"). I'm not saying it's definitely not because I'm a diabetic; I just don't think it's a foregone conclusion.

Sunday, February 5, 2012

Happy February!

In late January and early February, thousands upon thousands of small, purple crocuses push up in my parents' yard. There are other yards in the neighborhood with a few crocuses here and there, but not it's not the same. My parents' lawn is just covered in them. It was a most pleasant surprise the first winter we lived in this house.

The crocuses' blooming has always brightened a month which is otherwise extraordinarily dreary for me: February. If you're tired of the extra 3 coats, hats, and pairs of mittens that you've had to throw on just to take a walk, February is the worst. If you hate wet, freezing cold, February is definitely the worst. If you've ever had seasonal affective disorder, February is the worst. It's actually the same reason why I, contrary to most of my anti-sentimental instincts, actually love Valentine's Day. Because why not do something nice for people you love? It's better than sitting inside and crying.

But this year, I say happy February! Even more than the crocuses (which only make me happy for a few days), my two boys make me feel like my heart might burst, even during the worst month of the year, all year long.

Friday, February 3, 2012

Week 21: I have no theme

I think I have finally recovered from the trouble I had over Christmas and through the first two weeks of January. My blood sugars have been very stable (with a few lows still in the late morning), and my last A1C was 5.5, from January 16. My bolus ratios are all 1:9, and I have elevated basal rates during the 3 hours before waking and 3 hours after lunch.

My brother and sister-in-law came over last weekend and I found it really helpful to puzzle through my recent negative experiences with my endocrinologist. My brother asked the question which my endocrinologist should have asked: "What kind of changes do you think you can make to correct these low blood sugars? How can you or your family make this easier?" It surprised me, but the answer came right out: "I could just hang around the house more often in the mornings, so that if my blood sugar gets low, I will be close to the food and Gatorade I need." When I think about why that's not happening, I realize it's because I actually just want to leave the house. My family responsibilities are not sending me out, since my kids don't have any scheduled activities, and about the only thing I ever need to do is go to the grocery store and doctor's appointments. In fact, my kids seem to enjoy hanging around the house. I think I could exert some discipline over my desire to get out, or at least plan shorter outings (go to mass and come home, rather than go to mass, and the grocery store, and the local park...). So that will be a project for the rest of pregnancy.

I had an appointment with my OB this week. They hadn't received the report from my comprehensive ultrasound, so I had to report everything as I had understood it. The nurse practitioner at my OB's office seemed to agree with me, though, that it probably wouldn't be that big a deal. She said that, more than anything in OBs, they look at trends, rather than measurements at a single point in time. I told her about the growth ultrasound with my first baby that landed me in the hospital overnight. The next morning, a different ultrasound at a different clinic showed that the baby was fine. In any case, I have another ultrasound to look at baby's kidneys, amniotic fluid, choroid plexus cysts, and any other indicators of chromosomal defect tomorrow.

The weather was so unusually warm this week, and I felt a nesting mood coming on. I rearranged the boxes we have stored in my parents' attic, and isolated all the baby stuff that had been put away as my second son outgrew it. Now that I know we're having another boy, I can start picking through all of the baby boy clothes we have!