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.