Monday, July 28, 2014

Pre-Term Labor

Ever since my first pregnancy, I have pined for an early delivery. Like, maybe even earlier than 37 weeks? Just a smudge? This is for several reasons, some of which are good and some of which are considerably less-than-good. Actually, most of which are not good. Here's something like how it went in my mind:

In the first place, the end of pregnancy is extremely uncomfortable. Avoidance of pain is not necessarily a good reason to deliver a baby, though, especially if he's not quite ready. Besides, bearing the pain of pregnancy placidly is good practice in bearing all the other pains (physical and psychological) of parenthood in a similar way. Easier said than done, but a worthy goal...!

In the second place, I kept thinking that if I could just stay skinny during one of these pregnancies, I would deliver my baby between 37 and 39 weeks like all my other skinny friends. Then, my doctor would love me because I'm skinny AND because I delivered my baby right when he wanted me to! But alas, I gained less weight with the last two pregnancies than with the first two (30-35 pounds each), and I still went nearly the full 40 weeks with both. I don't know how it would be possible for me to eat less or gain less weight without lying around the house moaning with hunger. (And if you've been keeping track, please don't worry about the baby: both of my skinny-pregnancies resulted in healthy eight pound babies at birth!).

In the third place, I kept thinking that little babies would be easier to deliver. A baby delivered at 36 weeks is bound to be smaller than a baby delivered at 40. But my 9.5 pound second son took all of 20 minutes to push out, so I no longer think that's necessarily the case. At least, not for my pelvic dimensions. Apparently there's plenty of room!

Even in spite of having some of these myths busted, I still kept thinking there would be some benefit to having a baby slightly before term. At least I could avoid the haggling over induction date with my doctor, right?

Well finally, a few things happened at the end of this pregnancy that firmly convinced me it's better to still be pregnant at 39 weeks than have a baby that's not ready to be born on the outside of the womb at 35 or 36.

One day, I was walking around our neighborhood, hugely pregnant, with my three boys in tow. A NICU nurse who lives nearby was walking her dog. We casually struck up a conversation about when I would deliver (I was 35 weeks at the time), and she said, "Oh no, you want to wait a few more weeks. Even babies born at 35 weeks have it rough. They especially have a hard time nursing." I love nursing my babies, and the thought of a baby really struggling to latch and be nourished by the milk that was made just for him made me very, very sad. I decided that I would wait as long as I had to, if it only meant he was ready to be nourished on the outside!

Secondly, I did almost give birth at 36 weeks this time around. I was completely unprepared! I suppose there might be a few things I could do to get ready before 36 weeks next time, just in case. But it was shocking to me that even though I had already done this three times before, I somehow wouldn't be even mentally prepared to have a baby when I was only a month away from my due date.

Thirdly, a woman with whom I am very close had a medically-indicated c-section at 34.5 weeks. Thirty-four-and-a-half-weeks! Wouldn't that be great! Skip those last 6, painful weeks of pregnancy! I've heard that 34-week-old babies almost always do well outside the womb, because they are usually able to breathe well enough on their own by then...

Well, this family I know had a terrible time of it. Their little boy was not, in fact, ready to breathe on his own at birth. He was in the NICU for 17 days. Almost as soon as he came home, he became sick and was back in the hospital for 48 hours with a spinal tap. I looked at myself, 39 weeks pregnant, on the day that this little boy came home from the hospital for the second time, and decided that I would rather be 39 weeks pregnant than go through all that!

So I know that there's a difference between 34 or 35 weeks pregnant and 40, and that a lot changes in those last few weeks. It is, of course, right about 37 weeks that it becomes less clear whether it would really be so terrible to have baby on the outside, even at the cost of an induction. I'll have more thoughts on that in another post. But suffice it to say, I am now resolved never to wish to go into labor earlier than 37 weeks, even if I might have been tempted to wish it so before!

Monday, July 21, 2014

The "Kangaroo Care" and "Back to Sleep" Campaigns Don't Play Nice in the Sandbox

Public Service Announcement: "The Back to Sleep" Campaign and Kangaroo Care do NOT play nice in the sandbox. And by that, I mean, a mother cannot really be expected to do both when she is taking care of her baby postpartum in the hospital.

(Secondary PSA: This post will also have nothing to do with diabetes, except that you may want to pull your blood sugar monitor into bed with the baby when you do it!).

After my first son was born, I felt very strongly that I wanted him in my room with me during recovery, and not in the nursery. This was encouraged by the Bradley Method childbirth classes my husband and I took, and besides, it just seemed to make sense. I just gave birth to a tiny human being and we need to spend a little time getting to know each other, right? Besides, shouldn't the baby be most comfortable closest to me, since he's been inside me for the last nine months?

As I lay in my hospital bed with my husband snoring on the couch next to me, they placed my first son in that little plastic box and prepared to leave the room. The nurse shut the door with a "call if you need anything." As the door clicked shut, I suddenly realized that my baby was all of five feet away, but I literally could not reach him. I wasn't even sure it would be possible for me to lift my body out of them bed to sit up, much less pick him up and position him properly to do anything. Then, he started crying...

I don't know what I did that first night in the hospital, but I have encountered the same problem every time I have been lying in the hospital bed next to that little plastic box. How to lift my body into a sitting position? How to sit up when my body is so weak and exhausted from labor? Is it worth it this time, or should I just let him cry for a few minutes? And then, the frustration of swaddling the baby, and putting the baby in the box, only to have him start crying again just after you lay your head down on the pillow.

So the "Back to Sleep Campaign" would have the baby on his back in the plastic box whenever he's sleeping, which, in theory, is most of the time. In fact, however, the baby is more often crying when he's on his back in the box, and almost always happy when he's nestled close to your skin. "Kangaroo Care," or something like it, is the obvious advice for those who have observed how much babies like to be next to their mothers - lots of skin-to-skin contact, holding baby close to your chest, nursing frequently, etc. It's also apparently very good for them.

But how to achieve the "Kangaroo Care" ideal when you a) are forced to lie down a lot because you're exhausted and b) the baby is sleeping most of the time he's with you, but simply won't sleep in that plastic box? Even my happiest baby (number two) would barely sleep in the box the first two days of life. "Back to Sleep" and "Kangaroo Care" just don't play nicely in the sandbox, and I'm frustrated by that. I want my babies to be safe and healthy and not crying, but these recommendations just don't seem to work well together.

So I am all ears to creative solutions to this problem, but the only solution I can come up with is to just pull that baby into bed with me. And most of the time they are not on their backs, because they are nursing. And very often, I was sleeping...or at least resting with my eyes closed. Believe me, I would not be likely to argue for co-sleeping with toddlers, since I like having a little more space in my own (rather small double) bed. But I am very close to considering it all almost necessary with a newborn!

Monday, July 14, 2014

My OB Snuck Pearls of Wisdom into my Discharge Instructions!

First of all, I would like you to envision the kind of man my OB is: he is definitely in his 50s, probably in his 60s, and might even be close to 70. I don't know, it's sort of hard to tell. As far as I can tell, he is one of the physicians responsible for coordinating the clinical education of medical students and residents at the hospital where I delivery. He is originally from Africa, but I'm not sure where. He speaks with a very thick accent, and his name is French. Sometimes I can barely understand him, but I can always understand when he walks into the room and commands my attention with the following words: "Mama Elizabet." And he always says it with a smile on his face. He can go from jovial to serious in the blink of an eye. I know this well because it happened with my last two labors when he realized how quickly things were progressing during the pushing stage.

Here's some postpartum wisdom from this man who has taken care of me during my last three pregnancies, and who probably just delivered the last of my babies that he ever will. He came into my room on the evening before I was discharged with a very conversational attitude, asking me questions about how I would care for myself and who would be taking care of me when I got home. Almost like a friend might. He knows I've got lots of little ones at home, and his job is to make sure I'm taken care of, too.

"Accept help from everyone, even your enemies."

This strikes me as a very African thing to say. I hope that doesn't sound culturally ignorant or awkward, because I only mean it in the sense that it seems to come from another culture...a culture where people might actually have formal enemies...a culture where people might actually have enemies who somehow offer to bring them food after they deliver a baby...

But then I realize that I have people that bother me, too. I probably wouldn't label them as "enemies," but I might avoid them on most other occasions. Perhaps the tension between us is unnamed, unknown, uneven. The point is that you should not be so proud as to turn down help from someone who offers it to you in your time of need. Thank them, and lay your irritations aside for a while!

"It's OK to eat off a paper plate."

This, on the other hand, is clearly an American thing to say. And true. Paper plates, or napkins, or right out of the serving bowl, or on the same plate for dinner as you used for's all fair game when you've just had a baby.

"No one knows half of what a woman does. And she does it all with a smile!"

By "woman," he of course meant a mother. But there is something sweet about being referred to as a woman at the time when I am most likely to consider myself "mother" before anything else. I am, first of all, a woman, and only a mother second. I like being reminded of that. It's dignifying.

Now, I don't always have a smile on my face when I'm washing dishes, faces, and clothes around our house. In fact, I'm probably frowning most of the time. But his comment reminded me that when I do smile while I'm engaged in these mundane, tiring activities, it's amazing. At least, he thinks it is. I'm glad someone can appreciate that.

"And she is so forgiving. A vengeful woman...this is worse than war."

Again, I'm not always so forgiving. See the above comment regarding frowning. I'm trying, but it's hard, and I fail often. And you know what I've noticed? He's right. When I'm bitter and snapping at children and my husband and finding fault with everyone, we are ALL more miserable. And when I'm able to lay those critical thoughts aside, find reasons to be pleased with them, see the best in their actions, give everyone the benefit of the doubt, and at the very least just stay quiet when someone annoys me, the children actually do scream less. It's kind of amazing.

In any case, his comment was a good reminder that my attitude affects my whole family, and I have the ability to foster either a peaceful environment or a very unpleasant, hostile, bitter one. That's a weighty responsibility, but in some ways, empowering to know that I do have the ability to create a climate of love and mercy in my home.

I'm not sure where my OB learned these things, but I would suspect he loves his mother and his wife very much. It seems that in order to have such a profound wisdom about the state of motherhood, one would have to observe a woman and mother very carefully and with great reverence. It makes me wonder what his mother was like, what his wife is like, what their relationships were like. So my OB and I, we don't always see eye-to-eye on everything. But I have to hand it to the man: his respect for women and mothers goes deep. Way deep.

Monday, July 7, 2014

Group B Strep

In addition to that crazy bit about having a baby lying posterior, I was also GBS positive this time around. I apologize for making this disclaimer so often these days, but I'm pretty sure this post will have nothing to do with diabetes.

I know several people who have had a variety of experiences being GBS positive. I know one woman who was GBS positive with her first two vaginal births, received the antibiotics during labor and experienced no complication. I know another woman whose baby became sick because she was GBS positive and didn't go to the hospital soon enough to receive antibiotics after her water broke. I know another woman whose baby was very cranky after she received antibiotics during labor and her baby received them intravenously postpartum. I wasn't GBS positive with my first son, but he did receive antibiotics intravenously for about a week after birth, and he was a very cranky baby, too. I've often wondered if the antibiotics contributed to the problem.

In any case, I was caught off guard by this development at my 36 week visit. It's easy, when you are pregnant the fourth time, to think that everything will be just the same as your previous three. This is especially so when your previous three were so similar to each other (similar baby weights, similar feel during labor, similar gestational delivery dates, similar aches and pains during pregnancy, for example). I've heard of yeast infections being more common in diabetics during pregnancy. I suppose the same could apply to other kinds of bacterial imbalances in the birth canal, I had just never experienced one.

In any case, I took probiotics following the GBS positive diagnosis, and I did receive antibiotics during labor (three doses). IV antibiotics are given 4 hours apart, and the doctors like for you to have at least two doses before baby is born, believing that is sufficient to reduce the risk of infection for the baby. I do suspect, as I almost always suspect when antibiotics are involved with newborns, that it may have made my little man cranky for the first few days after birth. I have no definitive proof of that, only a series of anecdotes, but the suspicion grows over time.

So next time, I think I will take the probiotics before the GBS test. If it's still positive, I will ask them to test again a little closer to my due date (because, let's be honest, I never go into labor before the last week of pregnancy). I hope to avoid antibiotics again in the future, though I will almost certainly take them again if I'm still GBS positive at birth.

Monday, June 30, 2014

Posterior Lie

As a disclaimer, I'm not sure this post has much to do with diabetes, either.

One thing we learned at our 36-week labor scare was that baby was lying posterior. This means that if I were lying on my back and he came out, he would be looking up (towards the ceiling) upon emergence, rather than down (towards the floor). I heard one funny story from a friend whose husband almost passed out when he saw her third baby emerge posterior. I had heard scary stories about posterior babies getting stuck, and labor hurting a whole lot, mostly in the back. I had been told by my doctor that sometimes baby turns right before labor begins, and sometimes baby twists during labor. I had heard about the Rebozo technique, using a special blanket and two labor companions to encourage baby to turn. I had heard about inversions for getting a baby to turn, but I had also heard this could cause cord prolapse, where the umbilical cord slips between the baby's head and the cervix and gets compressed during contractions, cutting off blood supply to the baby.

To correct baby's position, to put him in the ideal "LOA," or left occiput anterior, I spent a lot of time on hands and knees, doing pelvic tilts, in the hope that the tilting would dislodge his head just enough and the weight of baby's back would pull down just enough to twist him around. But alas, 3 weeks and almost an hour spent on hands and knees every day and he would always return to the same position. I became familiar with how it felt when he was partially rotated, with his back to one side, and when he was firmly posterior, with his spine lined up almost exactly with mine.

I did have back labor, but the good news is that he seemed to turn enough to come out. I don't know how or whether this would have been different if he had been my first, not my fourth. I don't know whether his size had anything to do with it, but he wasn't that much bigger than any of the others. I don't think diabetes had anything to do with it, but I'm sure that someone can come up with a crazy hypothesis that explains why the two are related. I still have no idea why or how it happened, given that I did nothing different this pregnancy than any other.

One interesting note I will make is that I still have pain way down low, in my sacral area, on my back. I feel certain this is related to the baby's position and possibly the stress of labor. I'm hoping that it resolves as I continue to recover. Going to see a chiropractor is something I've heard wonderful things about, and may consider if it doesn't improve.

Tuesday, June 24, 2014

Birth Story #4: The Scholar

Our fourth son was born on Monday, June 16 at 9:26 a.m. after about 12 hours of labor, at 39w1d or 39w5d gestation (depending on whose due date you like best). He was eight pounds, eight ounces, 19.5 inches, and had an unbelievably full head of hair!

So I almost went into labor at 36 weeks, but didn't. By the time 39 weeks rolled around, I was finally starting to get a little antsy. I was in quite a bit of pain, most of the day, as is normal for me at the end of pregnancy (and probably most people? I don't know, no one else I know seems to complain as much as I do). Baby was in a posterior lie, which meant that my belly button was being stretched to hitherto unknown dimensions by little feet. My blood pressure had been slightly elevated at my most recent prenatal visit. And on top of the physical distress, we had scheduled my induction for 10 days hence at my most recent prenatal visit. This was, of course, accompanied by the threat that "if anything else happens or your blood pressure hasn't improved by next visit, we're going to move that date up." So I was really anxious to go into labor spontaneously and avoid the somewhat more painful and difficult process of a pitocin induction. (So helpful to be anxious when you're blood pressure's already high).

On Father's Day, we had one of my husband's friends and his family over for dinner. The two other times I went into labor spontaneously, we'd just finished a nice, relaxing meal, so I secretly hoped that might happen this time, too. And sure enough, we got cleaned up, I sat down, and I started to feel contractions that were...different. Unlike other episodes of contractions I'd had in the last 6 weeks, these were more consistent. They were more frequent. Some of them were longer. No matter what I did, they didn't go away. But I could also tell that we had a little bit of time, because they weren't yet especially painful - only a short twinge of pain in the middle of some of them. So I told my husband I'd lie down, and if they didn't go away, I'd like to go to the hospital as soon as possible. They didn't go away, so we went to the hospital. We even got through the intake procedures this time, and I received my first dose of IV antibiotics for GBS positive results from the 36th week of pregnancy.

On the way to the hospital, I was making a great effort to be calm and relaxed. I was making a great effort not to give into the fear and anxiety which childbirth often inspires, but I just couldn't quite shake the fear of what I was about to undergo. I made mention of this to my husband, and he said, "That's completely natural. Even Jesus asked for a way around the pain He knew He would suffer during His Passion. There's nothing wrong with that fear. Perfection is submitting to God's will in spite of the pain." That consoled me. I continued to pray "Thy will be done" throughout all of labor, knowing that in God's will, childbirth almost always includes pain. But love is often proved in pain, and I knew how much I loved this baby. As St. Maximilian Kolbe said, "Let us remember that love lives through sacrifice and is nourished by giving. Without sacrifice, there is no love." So I was mostly able to maintain peace throughout the night with this thought in mind. Jesus, I trust in you, in spite of the pain. Thy will be done, even if it means pain.

Right around 4:30am, I was pretty tired for not having slept all night. The contractions were slowing down and becoming slightly less intense. My water had broken, but just a slow leak with each contraction. While I had been very relaxed and peaceful up until now, I began to lose my composure. I knew they would start to do things to move me along. And as I expected, my doctor came in and called for pitocin. Ugh, I thought. I could see some value in it, to get things moving so that I would have a baby before an infection set in or before I was even more exhausted than I already was. But I also sort of wondered if they left me alone, maybe I could rest and labor would go more smoothly when it resumed? Oh, well. My OB has often intervened when I wish he wouldn't, but nothing terrible has ever happened because of it. Jesus, I trust in you, even when it's not clear what the best way through this is. Thy will be done, even when I have to submit to someone else's judgment.

I received my second dose of antibiotics, and right about 7:30am, my husband mentioned to the nurse that things were starting to heat up. I noticed it too. I had progressed to 7 centimeters, and baby's descent was noticeable. I had also begun to have the dreaded back labor because of baby's posterior lie. I mostly suppressed the back pain by adopting the same position I have in every other labor: sitting up in the hospital bed with the back of the bed raised. I have done this four times now and I seriously cannot figure out how it is ever comfortable to do hard labor in any other position. The thought of having to hold my body up on my hands and knees, or squatting and making it more likely that the baby will just fall right out, or trying to actually use my legs to stand up? I keep waiting, thinking that one of these labors, I will find these activities or positions appealing, but it still hasn't happened yet. In any case, these new back pains were distracting, largely because I worried that it would affect the progress of labor. I know a posterior position from the baby can sometimes make labor stall, and I worried it would. Plus, I worried it be make labor more painful. But no...there's no energy for worrying about these things. Jesus, I trust in you, even if labor stalls. Thy will be done, even if it means this takes forever and hurts more than usual.

The nurse who came on at the morning shift change was pretty chatty. Some of it was helpful, some of it was not. She told us how bad parents don't vaccinate their kids. She was extremely pro-bottle-feeding (but not anti-breastfeeding? One couldn't quite tell). One thing we discussed was how, in my last labor, I came very close to not tearing, but I finally did when I pushed out the shoulders. I rushed that part because the attendants in the room during the last labor seemed a little panicked, and I picked up on their fear and pushed too hard. She told me she had learned about slow pushing from a doctor she worked for in Illinois, and she seemed very convinced that slow pushing would make it possible to avoid tearing. At some point she was telling us about the importance of Kegel exercises. Somehow it seemed either a little too late or a little too early for that conversation...For the most part, however, I avoided responding to her conversation, hoping she would get the message that I was doing some pretty hard work and would rather concentrate than converse. She didn't seem to pick up on the hint though, or she ignored it. Maybe she was nervous? No, probably not. But I can hardly stop talking most of the time, too, so I'm hardly one to complain about that particular fault. Just move on, she's just trying to take care of you. Jesus, I trust in you, even when the people you've placed around me are annoying the heck out of me. Thy will be done, even if it means overlooking the irritating habits of others.

At this point, I thought that perhaps I could will myself into a state of transition, the part of labor where you really think you can't do it anymore but you're actually almost done. I kept purposefully saying things to my husband like, "Wow, this really hurts. I'm not sure I can do this much longer." But apparently he saw right through it, and a little part of me knew I wasn't really there yet, too. At some point, though, it really did hurt so much that I was beginning to suspect that I might not be able to handle it. That was the unfortunate moment when my doctor walked in and checked my cervix, only to pronounce, "she has more work to do." Terrible, terrible words for a psychological moment in which I was tottering on the edge of losing it. I was only 8 centimeters.

I swear, all my own efforts to will myself into transition failed but that one statement actually made it happen. Suddenly, I cried out in an almost involuntary way, "I don't think I can do this anymore!" The nurse asked me what I wanted, and I said, "I don't know." She offered an epidural, but that wasn't what I wanted. My husband said I didn't need one, and that made her mad. Secretly, I knew there wouldn't be time for one. I could tell my husband and the nurse were having a tense, silent struggle over the epidural. I didn't know what I wanted but I did want her to go away. She then offered to change my position in the bed, but I couldn't imagine moving my body enough to do that, either. Finally, someone offered ice chips. YES, SMALL BITS OF FROZEN WATER WHY DIDN'T I THINK OF THAT BEFORE?! OF COURSE THAT'S WHAT I WANT. Jesus, I trust in yougggghh...YOU DIED ON A CROSS, MY GOD, THAT MUST HAVE HURT.

I was, in fact, thinking in the mental equivalent of caps lock at this point during labor. And fortunately, the ice chips did just what I needed them to for the next two contractions: distraction. And as it turns out, I was right: there would have been no time for an epidural. I must have dilated a full centimeter with each of those next two burning, hurting, burning, hurting contractions. Then, with the third contraction, I started pushing because I couldn't not push anymore.

I informed them of the laboring-to-pushing change, but they were still having to tell me to slow down and not push when the next contraction came. Fortunately at least the medical student had his gloves on, and I'm pretty sure he was the only one ready to catch the little man's head. On the fifth contraction after I said I couldn't do it anymore, and about 6 minutes after I started pushing, our baby was all out! His lie had been posterior, but he twisted just enough during his descent to come out facing sideways. I can't say it felt all that different, except the part where my doctor had to dig around inside for the last part of the placenta (NB: the digging around sans epidural is still not more painful than labor, just a painful surprise after you thought you were finished with the most hurt-y part).

And you know how much I struggled with the minor irritations of our nurse? Well, in spite of all the things she said and did which got under my skin, I will always be grateful for the help she gave me at a crucial moment while pushing. She and I both remembered that bit of conversation we had about the doctor in Illinois and the pushing slowly. At exactly the right moment, some time during the two contractions when I was pushing, she said, calmly and slowly, "Remember what we talked about. Gentle and slow." It worked, and in spite of baby's awkward position and my difficulties in accepting her other advice, I experienced no perineal tear. Jesus, I trust in you, and I suppose the annoying people you put around me often benefit me more than my first impression suggests!

And since this is a blog about diabetes and natural childbirth, I suppose I should mention something about my diabetes here, too. Funny how diabetes seems to be less and less of an issue with each pregnancy I go through! My blood sugars were completely normal during this delivery, as they magically seem to have been during all of my labors. My blood sugars stayed in a pretty good range, even during my first and longest birth (30 hours). But I will note that the hospital staff has a little bit of trouble keeping track of what I'm doing. They basically let me do my thing, and they just ask me to tell them when I do something (check my blood sugar, give a bolus, or drink juice). I think we've all figured out that it's not a good idea to wait 10 minutes for them to come check my blood sugar if I feel low or worry that I'm going high, so it makes much more sense for me to just do it myself. But then they're not there when I'm actually doing my diabetes thing, and they forget to ask when they come back in the room. Owing to the fact that I'm in labor at that point, I never remember to tell them, either. So then their records are filled with holes about what my blood sugars were and when and how they got there and even though I'm 100% fine, they've got ants in their pants about all the information they don't have. This same pattern seemed to continue postpartum, too. I felt a little bit guilty about their confusion, but I decided that I have more than enough on my plate to make sure I'm healthy and push a baby out on the day of birth. I'm going to let them sort out how they want to maintain their own records from now on!

Baby had a basically healthy but very uncomfortable first 48 hours, which I will write about in another post. We came home last Wednesday. I swear he's the cutest baby I've ever seen, except for all my others. We love being a family of six!

Friday, June 13, 2014

Early Labor?! But Still No Baby

At about 36 weeks, I had a bout of pre-term labor. Granted, I was barely pre-term at that point, but I was totally unprepared to have a baby. I hadn't given much thought to much of anything except pulling out a box of baby clothes. I didn't have any baby diapers, and I certainly hadn't packed a hospital bag! (NB: The most important part of the hospital bag for me is Gatorade. The upshot of all this is that I just threw a few extra in the back of the car!).

Here's what happened.

My husband had surgery, somewhat unexpectedly, in the middle of May. It was supposed to be a relatively easy, common, outpatient procedure for which he would be discharged the same day and recovery would take 3-6 weeks. He wouldn't be able to sit for about a week, but figured we'd get it out of the way with before baby was born so that he could help me afterwards. And I'd never delivered early, so we thought surely we had about 5 more weeks.

Surgery was difficult, and the next few days of recovery were a bit of a trial for all of us, but we were handling it OK. Sitting was painful, so he would eat dinner standing up and then be found lying down or standing or walking most of the rest of the day.

But then, after about 10 days, the surgical wound became infected, and he was still in quite a bit of pain. Back to the ER he went. This was difficult, but we were still handling it OK.

Then, he woke up the next morning and could barely walk. He'd slipped getting out of the hospital bed the day before, and his Achilles tendon now seemed to be swollen.

Oh, wow. So now, 11 days post-surgery, he couldn't walk, and sitting was excruciatingly painful.

Back to the ER we went.

Not surprisingly, I started to notice some contractions sitting in the car on the way home from the hospital. Contractions continued after I picked him up from the ER, where he got crutches, but fortunately no more serious diagnosis. Contractions continued as I dropped him off to attend the last mass we knew of happening nearby that day. Contractions continued as I sat at the playground with the little boys. Contractions continued, many were more than a minute, and some were as little as 4 minutes apart, as we drove home.

By the time we got home, I was in a panic. My father and mother were out of town and wouldn't be able to watch the boys for us. My husband was also not in great condition to watch the boys. And between the walking and sitting issues, it seemed extremely unlikely that he would be able to either drive me to the hospital OR help me during labor. My sister-in-law had just delivered her baby early, and they were struggling with the ups and downs of his NICU stay, so neither she nor my brother would be able to help, either. I had not even thought to ask for help from anyone else. I had never thought I would need help so soon, nor that all the likely candidates would be unavailable at the same time!

It had also suddenly dawned on me how quickly my last baby was born. If this labor was anything like that one, we would have about two hours from the time I realized I was actually in labor until the birth. The hospital is 45 minutes away on a good day, more like an hour at any time remotely close to rush hour. So that leaves about an hour to figure out one person to take care of the kids and another to drive me to the hospital, and having to accomplish these tasks in between intense contractions, when I might very well need to recover from the last one and prepare for the next, much less make phone calls!

Yikes. As you can imagine, I was very, very grouchy when we got home that Sunday evening. I told my husband that I really needed to take some time to eat, drink, use the bathroom, take a shower, and SIT DOWN, or else I might go into labor. But of course first we needed to put the kids to bed...Poor injured, wounded husband, I think he may have had to do that completely by himself that night. Lord, what would I do without him?

Contractions slowed, and you'd think that might be the end of the story. But then, I woke up in the middle of the night and could not fall back asleep because of the contractions. This was exactly how my third labor started, and so I decided we definitely needed to go to the hospital this time. I couldn't bear the thought that dawn and rush hour traffic would come, I would start my day like normal, and then BAM! I would suddenly find myself nearly pushing a baby out into the passenger seat of our car. My mom had arrived home by this point, so we left the boys in her care and headed out.

To make a long story short, contractions continued to slow in the car and while lying in the hospital bed. My wise doctor suggested I walk around for a couple of hours to see if they would come back, but they did not. After about four hours, we left the hospital - dilated 1 cm, 80% effaced, with baby in a posterior vertex lie.

So that's one thing that happened in the last three quiet months!

Wednesday, March 12, 2014

Olympic Skier with Type I Diabetes

I'm a little behind the eight-ball on this one, since the Olympics were a month ago. But here's an article about a neat athlete named Kris Freeman. As an amateur professional athlete, he was diagnosed with Type I Diabetes at age 19 and told he probably wouldn't be able to continue competing. Instead, he set about learning as much as he could about the disease and his own body. He collapsed during a race with a low blood sugar at the 2010 Olympic games, but he came back to Sochi in February of this year:

"He immediately started taking insulin and testing his blood sugar. He knew that he had to alter his lifestyle but refused to believe his career was over. Freeman read everything he could about diabetes in his spare time, setting out to tame the disease similar to the way he dominated mountains. He gained control over his body and lifestyle, adhering to a strict diet and carefully managing his health. Even though there was no track record to follow in terms of diabetes management for workouts and endurance competitions, he was determined to continue his career...

"Four years later, Freeman continues to adjust his diabetes management in a quest to master his body and avoid the diabetes-induced disappointment of 2010. The difficulty is that regulating blood sugar is a bit like trying to kick a football through moving goalposts; the body constantly evolves, as do external circumstances, such as food differences around the world and varying air pressures. What works one day might generate poor results due to different conditions on another day...

" 'Sometimes if he has a bad race, I feel it should be about the blood sugar, and he doesn't, Caldwell says. 'The last thing he wants is to be defined by diabetes'...

"At age 33, Freeman's hopes of medaling in Sochi are slim. But the ability to represent the United States as well as the diabetic community in the Olympics for the fourth time is a testament to the diligence and intensity that has characterized his training and diabetes management since his diagnosis and particularly in the last four years...

" 'I don't want anyone with diabetes to feel like it's a limitation and that you have to set your sights lower,' Freeman said. 'It certainly makes some things more difficult, but I don't believe the disease has to stop anyone from reaching their dreams.' "

Read More:

I feel like there are a lot of comparisons between being pregnant and having children and competing in athletic events. It seems this man's experience as a professional athlete is very similar to what I have experienced as a pregnant, Type I diabetics: doubt about my ability to do it successfully, determination to know as much as possible about my disease and my body and experiment with treatment options, major low-blood-sugar failure, continued diligence and experimentation, and the conviction that diabetes makes many things more difficult, but not necessarily unattainable or foolish.

Sunday, March 9, 2014

Week 25: So Normal, So Extraordinary

I've felt that there has been little interesting to say about my pregnancy in the last several weeks. In my first pregnancy, I'm pretty sure I never thought or felt that. It was so new! And strange! And painful! And exciting! And then as soon as I started writing for this blog, I tricked myself into thinking that reflections I had about pregnancy were more interesting than they actually were, just for the sake of having something to say.

But ever since I found out, at 20 weeks, that the baby appears to be developing normally, I guess things have just seemed pretty normal. Normal aches and pains. Normal(ish) blood sugars (at least the awkward overnight lows have been fewer and farther between). Normal doctor's appointments. Normal shortness-of-breath. Normal schedule, normal this, normal that.

Pregnancy was so shocking the first time I did it, partly because it was so HARD and PAINFUL! And I couldn't even take ibuprofen for the symptoms! And I was so TIRED all the time! And I couldn't even bend down to tie my own shoe! Sitting down in a chair practically knocked the wind out of me! And then I was chasing a couple toddlers, I was changing two sets of diapers, AND I was pregnant! A  very good friend of mine, at that time, when I was pregnant with my third, asked me, " gets easier, right?" And in some ways, that's true. For example, you get more efficient at clearing the breakfast table and getting everyone into the car. You know exactly when to check your blood sugar and what you need to have with you before you leave the house. But efficiency can only get you so far before the difficult tasks of daily living demand your attention once more (and sometimes, all at the same time). So what it really boils down to, and what I told her, is, "No, it doesn't get easier. You just get used to being tired and in pain."

This truth is one I have known intimately, for I have been living in the depths of pregnancy-, baby-, and toddler-induced fatigue and pain for 6 years. The minor aches and pains and irritations of  pregnancy or nursing or parenting are just so ordinary and normal at this point. Perhaps that seems horrifying to you. It was to me, too, for a long time...except for the fact that it was my life and I still had to live it. And you know what? I just can't afford to be outraged about the horror of it all all the time. So I've given in, and stopped being mad about it. I've stopped feeling like I'm special, or that life is unfair, or that everyone should congratulate me all the time because I have diabetes and children. All the aches, pains, fatigue, and irritations are just par for the course now. The good news is I'm still alive, and those problems haven't caused my demise yet. Nothing terrible has happened, and in fact, very many good things (ages 26 weeks gestation, 1, 3, and 4) have happened! They are continuing to happen right before my very eyes.

So the most extraordinary thing I have experienced during this pregnancy has nothing to do with all the things that I normally write about, that is, the physical symptoms related to diabetes and pregnancy. The most extraordinary thing I've experienced these last few weeks is interior collection and peace. For all I know, being tired actually helps with that...not a lot of excess energy to be mad, complain, or try to change the world to AVOID ALL THE PAIN. All the fears and anxieties that have lived in me for so long, for so many pregnancies, are gradually fading away. I am not worried about labor, I am not worried about recovery, I am not worried about bringing a new baby home, I am not worried about high blood sugars, I am not worried about low blood sugars, I am not worried about whether my baby will be too big, and I am not even worried about having a c-section. My life is still full of aches and pains and irritations and exhaustion and minor failures but those don't seem so shocking or new or strange anymore.

Instead, all of the day-to-day pains and irritations are fading away before the extraordinary joy of being present and open to my children each and every day. What's so shocking, strange, new, and exciting now is all of the lovely things they see and do and notice and say. Like when my 4-year-old Pious One starts coming up with math problems in his head and solving them out loud, or when 3-year-old Braveheart courageously "makes a sacrifice" and decides to walk through the grocery store so that his two brothers can sit in the grocery cart, or the fact that two of my little Statesman's first words happened to be "brothers" and "excited." Or when the Pious One tells me, after much careful thought, that he is afraid of death in one way, but not in another. Or when Braveheart proudly declares that he will NOT wet his bed tomorrow night, or the next night, or ever! Or when the Statesman gently lays his head down on my shoulder, sucks his thumb, and gently says, "Mama."

I don't know. These things may not seem that extraordinary to you. I guess they didn't seem all that extraordinary or exciting to me a few months ago, either. A few months ago, I just couldn't wait for them to get to the next phase, or at least get to the point where they just wouldn't NEED me so much. I was so impatient and constantly felt like their needs were dragging me down and I JUST NEEDED TO GET AWAY and HAVE A NAP and SOMEONE GIVE ME AN IBUPROFEN AND TEACH MY KIDS HOW TO DO STUFF FOR THEMSELVES. I've had to make a conscious effort to slow down and work harder at the things that are important: caring for my achy body, being attentive to my diabetes, and addressing all the needs of my children that I possibly can. And then, I do my best not ti worry about all the things I can't do. Sometimes they cry and I can't be there for 10 more minutes. Sometimes I'm absurdly hungry and I just have to wait 15 more minutes until I can get a healthy meal prepared. Sometimes I'm so mad that they did that thing again that I've always told them not to do and this time, one of my mom's dishes is broken all over the kitchen floor and I have to clean it up right at this very moment when the oven timer is going off and oh by the way, my blood sugar is starting to get low. But I've decided I'm not mad at them or my life for requiring my attention anymore, and I'm not worried about all the things I'm not doing anymore. And now, all these anxieties, pains, and irritations truly pale in comparison to the amazing little things that I am seeing in my children's lives. And that has been so, so beautiful.

The only ache that really matters to me anymore is the ache in my heart that I feel for all the ways I've pushed my children away and resented their needs. I wish I could take back all the angry words and all the running away, all the times I rolled my eyes because they were crying again about wanting the same thing that I took away in the first place because they kept breaking it. I wish I could go back and open my heart to them in the past. I might still have had to say no, or left them crying for a long time, or taken away a toy, or done something else that made them upset; but at least I could have left my heart open and avoided treating them like they were the enemies of my happiness. Because they are definitely NOT the enemy of my happiness - they are the very substance of it! For that reason, I also burn with another kind of heartache: wanting to love them more and give them more. I still find there are a thousands of things I want to do for and with them, to teach them, and to say to them. There don't seem to be enough hours in a day. I'm not even sure there are enough moments in a lifetime for it all.

So in the last few weeks, this pregnancy has been very normal in all the ways that I usually write about: fatigue, bodily aches, joint pains, blood sugars, medical testing, etc. But it has been very extraordinary in ways that are more difficult to speak about. The aches are in the heart, and those aches have flowed from an abundant joy that I've experienced in the presence of the very people that pregnancy is all about. Caring for the child within is much easier in weeks like these, when I am able to catch a glimpse of all that's coming for him, and for us together, in the next few years!

Friday, February 28, 2014

Reducing C-Sections for First-Time Mothers

This is an excellent piece of news from NPR:
"Women with low-risk pregnancies should be allowed to spend more time in labor, to reduce the risk of having an unnecessary C-section, the nation's obstetricians say. 
"The new guidelines on reducing cesarean deliveries are aimed at first-time mothers, according to the American College of Obstetricians and the Society for Maternal-Fetal Medicine, which released the guidelines Wednesday online and in Obstetrics and Gynecology
"About one-third of all births in the U.S. are done by C-section, and most of those are in first-time mothers. There's been a 60 percent increase in these deliveries since the 1990s, but childbirth hasn't become markedly safer for babies or mothers. 
"That discrepancy has led many to conclude that the operation is being overused. A C-section is major surgery. The procedure can increase complications for the mother and raise the risk during future pregnancies. 
"Women giving birth for the first time should be allowed to push for at least three hours, the guidelines say. And if epidural anesthesia is used, they can push even longer. Techniques such as forceps are also recommended to help with vaginal delivery.
Read the full story here.

Homebirth midwives have often noted the wide variation in "normal" birth patterns that they've observed through years of experience. This is especially true of first-time mothers, whose bodies haven't ever done the enormous task of labor and delivery. Now there's apparently some observational data to back that up. Let's hope doctors take notice!

This would also be useful information for women who had a c-section with their first and are pregnant again. Doctors are fond of saying that such women will experience labor like it's the first time. Again, let's hope they'll take this advice to heart and give women attempting vaginal delivery an adequate amount of time and patience to try.

If either of these things apply to you, don't hesitate to bring this article to your doctor's attention!

Wednesday, February 12, 2014

Learning NFP

I have no idea how many of you are unmarried, and I would gather the answer is probably, "not many." But just in case there are a few single, Type I diabetics who come across this blog with some curiosity, and they  are interested in natural methods of preventing pregnancy as well as natural methods of giving birth, I'd highly recommend learning fertility awareness before marriage!

I stumbled upon natural family planning during college. I was a summer intern with a pro-life organization in DC. I was definitely on board with the anti-abortion part, but squeamish about some of my Catholic co-workers' opposition to contraception. At first, I was all like, "no way. Don't touch my birth control." And then this young woman literally took 20 minutes of her time to explain it to me, and I came away absolutely convinced that it was the only way I would even consider preventing pregnancy. All before we had even started work in one morning! I began charting during college, about two years before I got married, and I was really glad that I had all that extra learning in me before preventing conception would actually depend on it in marriage.

Highlights of natural family planning, from my perspective: knowledge of your body, respect for and attention to your body's natural patterns, and lack of side effects from hormonal contraceptives. Relationally, it's very affirming to know that your husband is willing to patiently wait for you, and sacrifice his desires for your good, every month. I also wrote a whole post about why it's not absurd here. I also wrote a bit about charting after you've had a baby here, here, and here.

Sunday, February 9, 2014

Week 21: Oh boy, oh boy, oh boy...oh boy!

I went for my comprehensive fetal anatomy scan last week and we found out we are having another BOY! That makes four little men in our home!

I hope all of my exclamation marks adequately convey my excitement about having four sons! This fact of my enthusiasm, however, is sometimes as much of a surprise to me as it is to many of the people I talk to about this matter.

By the time you have your fourth child, people are occasionally confused by your seemingly odd behavior. Four...what? Why would you do that? Some assume you come from a big family and are just continuing the family tradition. I was the fourth of four, so I suppose this is true in my case. Some joke that you must not have a TV, and therefore you lack other ways to entertain yourselves. We do have one, we just don't watch it...Some recognize that you are Catholic, and kind of get it. Although I would add the caveat that Catholics are not required to have lots of kids, only forbidden to use contraception. This very often has the same result.

Another common assumption people have is that, if you have three boys and you are pregnant for a fourth time, you were probably trying for a girl. But this was definitely not true for me and my husband. This has never really played into our considerations for conception. We are always and only ever just trying for a baby. In fact, I have been so completely ambivalent about whether we were having a boy or girl this time around that I had a very hard time explaining it to myself or other people. With all my other pregnancies, I at least had a slight preference one way or the other. But this one, I simply could not decide which I wanted.

When I became pregnant with my first child, I was actually fairly desperate for a girl. I was a tad bit terrified to become a parent in the first place, in spite of the fact that conception was carefully planned. I thought it would help me be a good parent if I had a girl to raise: someone like me, someone whose personality and struggles I could identify with. I had experienced teenage girl angst. I had body image issues. I had a little bit of clinical depression and anxiety in my past. I could help someone through that. But anger? Withdrawal? Perhaps violent tendencies? Extreme behaviors like sky-diving, rock-climbing, and military pursuits? I just didn't think I would know what to do with those!

But three adorable little boys later, I am beginning to understand the destructive, loud, physical tendencies of these little creatures running around our house. They break stuff to figure out how it works. They push themselves into each other to see when and if and who will break. They are loud because they enjoy life. I'm not sure how different they are than girls, but I don't worry (as much, anymore) about the hitting and the damage done to property and the seeming desire to do these things over, and over, and over again. They are testing themselves against...themselves, each other, and the world.

In fact, I have gotten so used to being around little boys that I began to have the opposite fear with this pregnancy. Would I really know how to raise a girl? Would I really not be driven crazy by the challenges of parenting a female child? It could be fun...but what if I wasn't fit for it? I'm still not sure of the answer to the questions about my ability to raise a daughter, but we are thrilled to have a fourth man-child to add to our crew.

We are also quite certain and hopeful that this child will not be our last. I am only 29, and still very Catholic, after all. A girl, or a few!, may yet be in our future.  For now, we're just aiming for a baby.

Tuesday, February 4, 2014

Top 10: Dietary Changes I Never Expected To Make

When I first got diabetes, I remember being terrified to eat anything. I was 9 years old. My first day home from the hospital, I went into the kitchen in the morning and grabbed a graham cracker. After taking a few bites, I suddenly realized that something was different. Then I stared at it, wondering if this food which had once been so normal was now a poison to me.

Over the coming months and years, I gradually came to realize: "Hey, no problem! Insulin covers it!" I ate pretty much anything I wanted, whenever I wanted. My A1Cs weren't great, but I guess I didn't really know what they were supposed to be. People would often ask me, "So, you have diabetes. Does that mean you're not allowed to have sugar? Do you have to be careful about your diet?" The question was always a little embarrassing, because...I don't know, maybe. Maybe I was supposed to cut out sugar and be careful about my diet. But I didn't. No problem, insulin covers it, right?

I carried this attitude into my first pregnancy. But I quickly realized that when your bolus ratios are 1 unit of insulin per 5 grams of carbohydrate, you are tasked with the responsibility of assessing the number of carbohydrates in a giant plate of pasta, the life of another human being depends on it, and you get it wrong...? I was up and down a LOT during that pregnancy. Mostly down, because I was terrified to get it wrong. I overestimated a lot, and gave extra manual boluses all the time, simply out of fear that my blood sugar would be too high. I managed to keep my BGs down to a level with which my doctors were impressed, but it was only because I just pumped myself full of insulin and ate constantly.

By the time my third pregnancy rolled around, I realized that a stricter dietary regimen was in order. I was hoping to avoid the 50+ pounds of weight gain I accrued during my first two pregnancies, and not only because it was hard to lose it. It made me really uncomfortable at the end of pregnancy, and made my insulin resistance higher. But this was not a welcome realization. I resisted it. I wavered and faltered. I convinced myself that maybe I was fine "indulging," or eating like I did when I wasn't pregnant. I wasn't a super-hero, so how could anyone expect that I would act like one when I was choosing what foods to eat?

Now, half-way through my fourth pregnancy, I am fully convinced of the necessity of combining healthy, controlled insulin rate changes AND dietary changes to achieve the healthiest pregnancy I can. Believe me, I don't like it. It's stinkin' hard, most days. But I've had my fun, and it turns out that some kinds of fun leave you pretty miserable and either in a sweaty, unconscious, hypoglycemic mess or an always-thirsty, anxious mom making constant trips to the bathroom.

So with that, my list of the top ten dietary changes I never expected to make:

10. Resist the urge to eat when my blood sugar is high but I feel weak like a low. Ugh, this one took forever to get through my head. It still takes every ounce of willpower I have to resist eating.  It's so counterintuitive, because food usually makes me feel so much better when I'm weak like that. This often happens in the morning, after breakfast, and after dinner before bed. During my first pregnancy, I just pumped myself full of insulin, thus necessitating - among other things - a "second breakfast" at work right about 10 o'clock in the morning. But by my third, I realized that keeping my weight gain down would mean cutting out extra snacks meals to be a realistic goal.

9. Sleep instead of eat. This is related to #10. Once I had two toddlers and was in my third trimester of pregnancy with my third child, this was actually not very hard. Feeling like eating after dinner before bed? Don't. Don't start the cycle that might end with a high or a low. Your bed is calling. Answer it. But I will admit that I love a post-kids-bedtime-celebratory-milkshake, and those are now out (boo hoo). (Auto-correct just changed "boo hoo" to "boo hop." There, it did it again. Is that even a real phrase?)

8. Don't eat within two hours of bedtime. Again, I don't like to start the cycle that may make me high or low while I'm sleeping. It also helps me get my basal rates in order, since I don't have to wonder whether it's my basal or my bolus that's setting off my readings. If my basal rates are good, I just rest in the confidence that they'll carry me through to the morning.

7. Middle-of-the-night snacks. Pretty much every rule has an exception, and the big exception to the above three rules are the times when I wake up in the middle of the night and truly can't get back to sleep because I'm so hungry or my blood sugar is low and I need to eat. I take this as my body's way of making sure it gets what it needs...but I make it work pretty hard to communicate its point.

6. Eat like a dinosaur! One thing that helped me get on a better dietary regimen during my third pregnancy was my father's adoption of the Paleo diet. This diet includes no carbohydrates (corn, beans, potatoes, bread, rice, etc. are all out) except for the natural sugars found in fruit. Since we live with my parents, and I like to cook food for them as a way of thanking them for their hospitality, I ended up cooking a lot of meat and vegetables dishes and serving carbs sparingly. This also taught me to decrease my carbohydrate portions, even when I did serve them.

5. Breakfasts devoid of carbohydrates are a total wild-card. For every rule an exception, right? I remember a few times having a carb-free, eggs and sausage breakfast, without any accompanying toast. I thought to myself, "Great! No hassle trying to estimate carbohydrates with crazy-high insulin resistance in the morning! We'll just cut that part out all together." BIG MISTAKE. High or low, it doesn't matter. It's going to be off two hours later, guaranteed. Mornings are so weird. I eat the same thing literally every morning so as to cut out at least some uncertainty. This pregnancy, it's a cup of milk with a splash of coffee, a cup of Greek yogurt, and a slice of toast.

4. Have a doctor recommend ice cream to raise my blood sugar. I don't actually have ice cream when my blood sugar is low, not least of all because I can't take it with me nor can I actually measure out one-half cup accurately to figure out how many carbs I'm eating. But I do carry pre-packaged pudding cups. Those are, I have discovered, a great low blood sugar snack!

3. Gatorade is my life-line. Just so you know, I get very sensitive when people start talking about banning sports drinks in schools. Sports drinks save my life when I'm out of the house with toddlers and I need to raise my blood sugar fast to keep them from running into the street and/or peeing in their pants. Sports drinks are designed to get into your system fast and they do just that when your blood sugar is low. I wonder if they could market that to the tiny demographic of pregnant, Type I diabetic moms: "Not just for athletes!"

2. Pull out a measuring cup for my morning cereal and milk. I laughed at myself the first time I did this. And the worst part is that it didn't even help all that much, because my blood sugars are just crazy in the morning. Now, I rely on pre-packaged bread and yogurt to save me some time. I put an unmeasured glop of peanut butter on the bread, just to keep me a little on the wild side...But seriously, eating the same thing in the morning helps make sure that it's at least not my carbohydrate estimate that's off. So I also get really sensitive when people talk bad about pre-packaged, processed food. No one has yet managed to convince me that the evils of preservatives are so great that I should prefer unpredictable blood sugars to the consumption of them...

1. Hot herbal tea and seltzer water. These are a carb-free way to make me feel special and not deprived, even though I basically am. :)

What are your rules and tips for healthy eating during pregnancy?

Sunday, February 2, 2014

Week 20: Insurance Saga, Part 2

In my last post, I wrote about my insurance history and our most recent decision to move to "cost-sharing" through Christian Healthcare Ministries. My routine diabetes expenditures will not be covered, but all the unexpected things will be. This is OK, because after calculating it, my routine diabetes expenditures + the monthly cost of the program = about the same or a little less than what I was paying on insurance.

But then, I'm also pregnant. And unfortunately, CHM won't cover costs for this pregnancy, even though it does cover pregnancy costs under some conditions. So it's back to the Office of Family Services I go, to try to explain our complicated insurance situation, hope they'll agree that I'm poor enough to cover with Medicaid, and probably have to make several phone calls to see if I can get in touch with someone who can understand what's going on with us and won't just tell me to wait 10 more days, or 30 days, or until I get a letter in the mail.

Well, I applied for Medicaid on October 30. As of January 21, I had no word back. I had accrued about $700 worth of medical bills, and I was not sure whether they'd be covered. I had an ultrasound scheduled, which would be another several hundred dollars, and I didn't know whether it would be covered. I called two times, and they said they would get back to me. One woman called and said they were still processing applications from July, and that since I had primary insurance, I would have to submit more paperwork and wait longer. I don't think she realized that a) I was pregnant, and b) my primary insurance didn't cover maternity expenses, and c) I had actually dropped the insurance plan because it was absurdly expensive and not covering the maternity I needed it to cover anyway. I tried to explain, but she refused to give me her name and just said, "I'm just helping out. We are very short-staffed."

I was anxious. I didn't how long to wait before calling again. Each call was approximately 45 minutes-worth of hold time before speaking to someone. This someone often can't tell you anything concrete or definite. We are definitely willing to pay out of our own pocket to have this baby, but knowing that we are financially responsible would completely change the way that I agree to (or refuse) certain kinds of care and testing. I wouldn't be able to simply do every blood draw, every NST, and every ultrasound they suggested. It's a fight to get Medicaid, and a different kind of fight to insist to my doctors that I don't have the money to pay for, nor do I really need, a lot of testing. In short, I was feeling poor, pinched, without many good choices, and a lot stressed about it.

This experience taught me a lot about what it is like to be on the margins of society. What great pity we should have for the poor! I am only poor temporarily, while my husband is in school. We also live with my parents, who are so generous to us. But chronic poverty? Chronic uncertainty? Chronic dependence upon a system whose response is uncertain and you cannot always rely upon? Chronic admonishments from your doctor about the necessity of testing and treatment your health, coupled with a true inability to pay for the recommended care? I don't know how government assistance can be made more effective for the poor, and I'm not certain that a constantly-changing set of government mandates under the Affordable Care Act really makes for the best healthcare situation for the most people. But I can now at least say, with certainty, that the poor are to be pitied by each and every one of us, and we ought to be willing to stretch ourselves out with compassion for them!  I don't only say this for my poor self, but especially for those who constantly live on the edge of poverty all their lives.

The end result of all of this is that I was, in fact, accepted for Medicaid coverage. This is a great relief. In fact, it's an answer to a prayer I forgot to make. I spent so much time worrying about who I should call, whether I should cancel my doctor's appointments, how and whether we would pay for various kinds of treatments and tests, and so on and so on, that I forgot to rest in the confidence of God's love and serenity. In His kindness, He gave it anyway!

Friday, January 31, 2014

Conversion Story

For those of you who might be interested to know how I became Catholic, I have my conversion story posted over at a blog called "Called to Communion." 

Important disclaimer: it has nothing to do with pregnancy, or diabetes.

Perhaps some day I will write my natural childbirth and NFP conversion stories for this blog!

Monday, January 27, 2014

Week 19: Insurance Saga, Part 1

Since my husband entered graduate school, our insurance situation has been a bit dicey. It changes every year, every pregnancy, and every new massive-healthcare-law-and-associated-regulations-passed.

With my first pregnancy, I was on my employer's insurance plan. There was a deductible, there was a co-pay, and I'm certain we achieved out-of-pocket maximums that year, but they weren't especially high.

With my second pregnancy, I carried my husband's student insurance plan as my primary and held Medicaid as secondary. Little did I know, but carrying two insurance plans is apparently a *major* pain for your doctors. Also, little did I know, but Medicaid is apparently a major pain for doctors, too. In fact, it's such a major pain that I called 22 doctor's offices and only one of them would accept Medicaid patients. I drive 45 minutes each way for my appointments.

In 2011, at the end of the first year of my husband's Ph.D. program, the school dropped dependent coverage for their Ph.D. students. This was a bit of a crisis for us. I signed up for an "open enrollment plan" through Blue Cross Blue Shield. It cost us $500 per month, and the premium increased by about $50 per year each year I was on it. The deductible was high and the out-of-pocket maximums were high, but fortunately most doctors accepted this plan. Unfortunately, the plan did not cover maternity costs.

So when we conceived our third child in the fall of 2011, I went back on Medicaid. My OB's office administrator confessed to me that it had been such a disaster to bill Medicaid as secondary insurance the last time they had me as a patient that they were no longer willing to do so. Medicaid would have to be primary, or they wouldn't accept it. I had difficulty explaining to the Office of Family Services why my private insurance couldn't really be considered primary for the pregnancy (since it didn't cover maternity). And although I never followed up on all this, it seems to have been resolved satisfactorily to all parties. In the process, I also learned that private insurance pays about $3,000 for a vaginal delivery. Medicaid pays only $900.

When I became pregnant this time, we were expecting that the roll-out of the healthcare law would give us more options. My private insurance premiums had increased yet again, and I was paying $600 per month. I also learned that Blue Cross Blue Shield in Virginia had decided to voluntarily cover all abortions, for any reason, under their new plans. The new plans also all covered maternity expenses, but they were going to cost us more per year than we were currently paying (the difference of about $1,000-$1,500 per year). Given our income level, I would have certainly qualified for a subsidy, but I applied and never heard back. I went on the website twice and got kicked off twice. I've had so many bad experiences trying to get answers from the Office of Family Services about anything that I decided it was not worth the anxiety of waiting months and months and months to finally be told, "Please send us more information about your income," in spite of the fact that I submitted all the information they asked for (and more) the first time.

We finally decided to make the jump to Christian Healthcare Ministries. This means that I will be paying only $150 per month for "coverage," but all my routine diabetes expenses will be out of pocket. This includes prescriptions, doctor's visits, and bloodwork. Unless it is an unexpected complication of my diabetes, hospitalization, or new diagnosis, my medical bills will not be eligible for "sharing" through the program. 

This sounds frightening, but when I calculated the actual costs of my routine diabetes care without insurance, it came to about $7,500 per year. If you add $1,600 for the Christian Healthcare Ministries program to that, it's about $9,100. The insurance premium plus deductible for the plan that I was on already cost about $9,000 per year, and the new insurance plans I was looking at (without subsidy) cost about $10,000 to $10,500. So I will now be paying roughly the same, or perhaps a little bit less. I know that some healthcare providers (pharmacies, etc.) will also charge a little less for people who are paying out of pocket, because then they don't have to deal with crazy insurance company billing rules. I'm hoping that, between these two things, I will at least break even. I also won't be paying for abortions, nor supporting an insurance company which is taking upon itself the task of making abortions seem like routine health care, rather than the intentional killing of another very small human being. 

Saturday, January 25, 2014

Week 18: Endocrinologist, Round Two

My husband and I recently decided to switch to Christian Healthcare Ministries, rather than signing up for a new insurance plan. This affects the way I seek medical care, because all preventive and/or maintenance care for pre-existing conditions is not covered. (Medical emergencies related to the pre-existing conditions are). This means that trips to the endocrinologist, prescriptions, and routine bloodwork are not covered, and I have to be careful about the way I spend my dollars on these expenses.

Since my endocrinologist has asked me to come in to see him every month ($190), and also have blood drawn each time (not sure how much this total is, but at least $55 or more) for an A1C, this will be a significant burden. I've never thought it was necessary, though I played along as long as someone else was picking up the bill. But that is no longer true. 

Since my endocrinologist fired me at the end of last pregnancy when I wouldn't come in on his monthly schedule, I decided to be up-front this time, and explain my situation. I'm not sure how he'll feel about it, but the diabetes educator I met with at his office today said, "I don't think he'll budge." So here's the note I sent to her explaining our situation, which she said she would discuss with him:

"We signed up for a health insurance alternative called 'Christian Healthcare Ministries.' They don't cover maintenance or preventive care for chronic or pre-existing conditions. If I were only coming 4 times a year, like normal, we calculated the cost and figured this might actually save us money, but coming once a month will cost too much.

"As my doctor knows, I feel very comfortable managing my blood sugars, since I've learned a lot in my last three pregnancies. I would be happy to come every other month (or, perhaps I could come every month, we could do bloodwork every other month, and he could cut the charge of the office visit in half). My OB could also order whatever bloodwork is required, and I imagine Medicaid would likely cover the charges submitted from my OB's office.

"Alternatively, I could see him on an as-needed basis, with whatever waiver/disclaimer he needs me to sign for legal purposes so that he is not on the hook for a bad outcome with my health or the baby's. He knows me well, the office staff is friendly and competent, and kindly accommodates the strangely high number of toddlers who accompany me to my visits. It's always nice to have someone to call when you have strange symptoms or need some diabetes advice. 

"I understand that both of these situations might leave your staff inadequately compensated for the time spent reviewing my blood sugar readings every week, so I am content to forego that service.

"Hope to see you again soon! If neither of these situations works, I'll probably try to find another doctor just during the duration of the pregnancy. But if he'll have me as a client again in July, I'd happily come back."

I tried to understand where they were coming from, but also give a reasonable explanation for how I think things could go during this pregnancy. I really hope he doesn't drop me again, but I finally decided that it would be better for me to be dropped and have to find someone else than continue to pay for services where seem rather unnecessary to me.

UPDATE: They did not drop me, but they did make me sign a waiver releasing them from all liability regarding my outcome or the baby's.

Thursday, January 23, 2014

Week 17: Letting Go

I am finally learning to release the anxiety I have about my blood sugars. I am learning that anxiety does no one any good. Every time I have a high or a low one, I take the most reasonable course of action (correction, up or down), and then I wait. I don't immediately start changing my basal and bolus rates to prevent the problem in the future. I try to reflect on what I could have done differently. I observe whether it's a pattern over a few days, or just an isolated incident. And then I trust that whatever will be, will be...and know that the One who cares for us now will not abandon us in trouble. I pray almost every time I feel the anxiety creep up on me, and this has helped.

It is freeing to be able to approach the matter this way. It's still true that I will strive to spare nothing of myself. I will avoid eating those things which I have identified as problematic, and I will avoid eating at times when eating may be problematic, and I will push myself to go out on walks with the kids, and so forth. But I will not worry when all my best efforts fail me, or even at those times when I do fail to exert my best (God's mercy is great!). This way is best.

Tuesday, January 21, 2014

Week 16: Life Within!

This week marks the first time I felt the baby move this pregnancy. What a relief! I have recently heard two stories of women who miscarried late - at 15 weeks - and was sincerely hoping that my child hadn't passed from life to death inside my womb and was waiting to also pass out of my body. In my first three pregnancies, I felt movement absurdly early: 9 weeks with my first, 10 or 11 with my second, and 10 with my third. So this was normal given the pattern of most pregnancies, but atypical for me. The midwife at my doctor's office suggested that it might reflect a different placement of the placenta (anterior instead of posterior).

I also went on retreat with the Sisters of Life this week. Their work is to promote the sanctity of human life through prayer, but they also run a few mission houses where they serve women with crisis pregnancies and women who have had abortions. Women may come and stay with them during their pregnancies, up to a few months after the baby is born. It's a beautiful work, and you should check it out!

In any case, a lot of mostly hidden anxiety came out about this pregnancy while I was reflecting on my life. There's something about silence during a retreat that really helps to focus your attention on the fears within your heart. That certainly happened for me this week, and my greatest fears these days seem to be about my blood sugars (especially the low ones).

I should probably preface this by mentioning that earlier this week, a few days after Christmas, my blood sugar was very low when I woke up one morning. I became very stubborn when my husband tried to help me. It happened several days in a row, these severe lows, and I was very discouraged by it. It's one of the only reasons my endocrinologist can point to justify why he believes I shouldn't have more children (which is something he says almost every visit). At least I didn't almost drown myself in a bathtub this time, but I think I rather disturbed my spouse!

So lows are a continual challenge. It's interesting to note that it was about the same time of year, same time of pregnancy, when this happened last time around. Most of the time I think that I just need to get better about dealing with the lows (which is true!), and then sometimes I wonder if it really might be wiser not to have more children. I'm not sure the answer is all that clear-cut, given how awesome babies are. But I do know that, at least this time around, I just have to play the hand I've been dealt and manage the lows as safely as I can.

How do you and your family deal with your stubbornness when your blood sugar is low? I told my husband to just keep repeating the same words over and over: "Your blood sugar is 34. Can I help you? Your blood sugar is low. Would you like me to bring you something? Your blood sugar is 34. What can I do for you?"

Sunday, January 19, 2014

Week 15: Christmas

After the blood sugar management failure of the last couple of weeks, Christmas was actually a surprising reprieve. I have been dialing back my insulin levels, ever so slowly, to combat the overnight lows. I have been able to bring my eating back to a healthy level, and have not gained any more weight. Fighting through the weakness of hunger can successfully get me through the 2-3 hour postprandial slump, and back into a reasonable amount of energy until the next meal time (or low blood sugar).

This was actually part of our plan all along. We wanted Christmas to be a time for low-stress blood sugar management. We often travel across the country with our kiddos to visit my in-laws for Christmas. It is something we usually all look forward to, especially my husband and the boys. I felt bad, but I made the request that we stay home this year, for the sake of my blood sugars. It's hard enough to manage them when you are pregnant, and hard when you are traveling, and hard during the holidays. The hat-trick of hard is all three, and we've done that twice now. And I've learned, the hard way, that my disease really does need special accommodation sometimes.

Midnight mass on Christmas morning also happens to be a great way to check your overnight basal rates (when you wake up, while you're at mass, and after mass)! (Turns out mine were too high).

Friday, January 17, 2014

Week 14: Advent Was Supposed to Be for Fasting

When we became Catholic, I learned that Advent - approximately four weeks before Christmas day - are supposed to be a time for penance. Almost like Lent, except not that serious. But it's the same liturgical color (purple) and everything! Fasting and almsgiving and preparatory prayers are recommended the same way they are in preparation for Easter.

So this year, I made firm my resolve to abide by the eating habits I laid out a few weeks ago: eat only at regular meal times, normal portions, and when my blood sugar is low. No snacking without a strict need.

Talk about best-laid plans sometimes failing. Or a lot of times failing. I don't know *what* happened, by my lows got really bad over the last few weeks. I have been ping-ponging all over the place. And besides that, I've just been so hungry that I'm eating at all the wrong times. And ugh...all the slow weight gain I was trying to achieve, for the sake of my health and the baby's, exploded from 3 pounds up to 10 pounds when I last stepped on the scale. (I haven't been able to bring myself to do it since).

I have learned a lot about Divine Mercy in the last few years, and God continues to teach me. Failure, in the face of our best efforts, is so painful. Trust in mercy, trust in the Goodness of The Plan, trust in the face of uncertainty and pain is so hard! I am so afraid of and overwhelmed by failure. Each day, the hardest thing I do is resolve to try again, trust in His help, not fear His anger. And so I do. Because caving in to the fear is no way to live.

What do you do when you've failed with your blood sugars and you're afraid to fail again? How do you shore up your resolve to do better next time?

Wednesday, January 15, 2014

Week 13: Sticking to My Guns

I know it's a little thing, and I probably shouldn't be so bothered by it. A really small thing, and most women probably don't even notice the difference. But I've always been a detail person, and this happens to be a really important detail: the due date.

Very early on in pregnancy, I estimated that my due date was probably June 22. This was based on when I believed ovulation to have occurred (September 28), so it was even more accurate than simply knowing the date of intercourse. Conception, after all, does not often happen on the day of intercourse (unless you have impeccable timing!). Conception occurs when you ovulate. That egg, it's precious. All the sperm are just lying in wait for it to be revealed.

(I don't think I would ever say that out loud to someone that I didn't know. I probably don't know you. This has now become slightly awkward.)


Anyway, so this is what I had figured out. When I had my surprise ultrasound at 5 weeks, guess what? She said that, by her measurements, my estimated date of ovulation and due date were right on. RIGHT ON. What I heard was: "you are a natural family planning genius."

So I was a bit dismayed that I could not convince the sonographer who did my 11-week ultrasound that I already knew my due date, and that her date was too early (she came back with June 18, based on her measurements). I explained to them about ovulation (I can't believe they didn't know, I can only assume they thought I didn't understand it well enough). I explained to them about the early transvaginal ultrasound (but I'm certain it was in my chart). I even explained to them that my husband is unusually tall, and all of our children so far have been unusually long at birth (my quack theory about why my due date keeps getting pushed up with each pregnancy). Alas, to no avail. It goes in my chart as June 18.

The reason I care about this so much is because I know that at 37 weeks, they are going to start asking me about induction. It's so predictable that it's almost funny, except not, because I've had one, and induction hurts. My children are not born before 40 weeks. They just aren't. And I have a stronger bargaining position if I simply refuse induction until my due date! Oh well. I'm sticking to my guns on this one, bargaining position be darned.

Monday, January 13, 2014

Week 12: First Ultrasound

I had my first ultrasound this week! The sonographer said everything looked great. I had all three boys with me, and they were great, too.

Because I had the boys with me, I asked her not to do ultrasound transvaginally. I thought a transvaginal would a) be awkward with a 4-year-old male child in the room, b) make it more difficult for me to calm the 1-year-old male child in the room with us, and c) not be necessary given the transvaginal I had at 5 weeks and the fact that I was already far enough along to see things clearly on an abdominal ultrasound. I would not have thought this would irritate her, but her demeanor was clearly annoyed by the request. Sonographers of the world, I beg of you: please don't be offended when a pregnant mother of three toddlers asks for a simple favor! We are adults and sometimes even think for ourselves, in advance, about what treatments might be good for us at any particular time!

The other thing I spent a lot of time talking to the doctors about was the genetic testing for Trisomy 18 and Down's Syndrome. I'm very skeptical of prenatal testing, not least of all because of what happened with the Statesman. In the end, he was a very healthy boy who happened to be missing a kidney. So anyway, I guess there's a blood draw they can do between 11-13 weeks that gives them a pretty good risk assessment for those diseases (although it's not a definitive diagnosis). I went back and forth, considering the alternatives, but ultimately decided not to do it. Here's why:

  • First of all, it's only a risk assessment, not a diagnosis. This means that there could be a false positive or false negative. Even though these rates are not very high, it's a big heartache for nothing if it is.
  • The ultrasound looked very normal - good, even. If it had not, perhaps there would be a reason to investigate further.
  • The reason they suggest and push the prenatal testing is so that you have the information, and can be prepared. For some patients, this may be code for, "so you can get an abortion." But I would not kill my child to spare him (or us) pain: that would be an ultimate embrace of the power of death to ruin us. No, not that.
  • So there is a value to having information before a baby is born, planning for medical needs, etc. But I realized last time that prenatal diagnoses change and develop many times over before they are finalized, so plans cannot really be made until the third trimester anyway. Not to mention, there are so many things that must be revealed about the child's health that cannot be revealed until birth. In short, we will have to be flexible at birth, whether the child has extraordinary medical needs or not. Only birth will tell us definitively what the needs are.
  • The cost. It was going to be $223 to maybe tell me something that might be true, or not, and might help us plan, or not. Since I'm paying for these things out of pocket until Medicaid kicks in? Not worth it! We're happy to live with the uncertainty for a little while longer, knowing that all is in a kind God's hands.
Did you do early prenatal testing? What did you think? And has anyone ever had a sonographer give them attitude about the transvaginal/abdominal choice? Why does this keep happening to me?