Monday, December 5, 2016

The Author's Birth Story

When I posted about my fifth son's birth on Facebook, a friend of mine told me she had a very similar experience with her fifth. She remarked that she couldn't tell if her labor had lasted three weeks or three hours. My post about the last week of this pregnancy sort of bleeds into this birth story for that reason, because I can't quite tell where the "false" labor ended and the "real" labor began.

On the way home from a second false alarm trip to the hospital, I finally identified the most immediate source of of my anxiety, amid all the other anxiety-producing aspects of giving birth: how will our children would be cared for when it's time to go to the hospital? I began the pregnancy with that anxiety, and it stayed with me all throughout. To relieve it, I called a friend and asked her to leave her phone on in case we needed to call in the middle of the night. When I realized how much weight had been lifted off my shoulders after I made this simple request, I resolved that for however many more nights this pregnancy lasted, I would find someone who could do the same. I just needed to know that if I woke up needing to go to the hospital in the dead of night, I could call someone that would immediately be available to help. This was the rather simple solution to a dilemma that had been keeping me awake for weeks: who will take care of our boys when my husband and I cannot? God bless all the good friends who give you permission to call at any hour and, with a good will, rush to your aid.

So we arrived home, after our second false alarm trip to the hospital, at about 9:00pm on Saturday evening. A friend - a different one, and God bless her, too - had actually managed to get our jumpy boys in bed by giving them a stern talking to. What's more, she had put away the uneaten soup I had left in the crock pot and was washing the large pot that, at 39 weeks pregnant, I could barely lift in and out of the sink. Washing that pot! You have no idea how much that meant to me. I think I probably cried a little bit more when we told her what had happened at the hospital, and she was very sympathetic. God bless her again.

In a turn typical of the emotional roller coaster we were riding and couldn't get off, the contractions had picked up again by the time we got home. When I pondered having another night of being half in labor, half out of it, and I began to wonder whether this birth would end in a c-section simply because I was too tired to finish it out. I know it happens. In a sentiment very uncharacteristic of my ordinarily strong feelings about everything having to do with the natural births I desired for my children, I hardly cared at this point. We decided to try an epsom salt bath for relaxation, recommended by a friend who had previously suffered prodromal labor with one or two of her births. The magnesium is supposed to relax the uterus to make the contractions stop. I paired it with a glass of wine, because that's how I get through the painful parts of pregnancy, and because relaxation, right?

Within minutes of stepping into the bath, I could tell that the contractions were gone. Those pre-contraction tingles that make you think another one might be coming were simply not there. I stepped out of the tub fully expecting them to begin again, as they usually did when I was up and moving around...but they didn't. I laid down in bed, thinking that when I was finally relaxed and not thinking about anything else, I would notice the familiar cramping in my abdomen...but I didn't. For the first time in a couple of weeks, I fell asleep almost as soon as my head hit the pillow. God bless friends with good advice.

I woke up two hours later around midnight. I assumed that my body was either telling me to get up and pee or roll over to keep my hips from aching, so I dutifully hauled myself out of bed to visit the bathroom. I sat down on the toilet, but nothing happened. That's strange, I thought. I drank a very large glass of water right before lying down, and normally at least a little bit comes out. I half-remembered that something similar had happened to me at some point around 7 centimeters when I was in labor with my first son, but in my sleepiness, I didn't make the appropriate connection in the moment.

OUCH. What is that? Oh, it's a contraction. That pinched a bit. Better lie back down and see if it goes away, or at least hurts less.

OUCH, ouch, ouch, ouch, ouch. That hurt even more. How far apart were those two? Not very. Where is my phone? I should start timing these. Should I tell my husband yet?

I carefully hobbled my way downstairs to tell my husband about the contractions. He said they seemed different to him, too, but we had thought that more than a few times in the last week. We decided to wait a little longer before crying "labor" again. I went upstairs to time them and try to get comfortable.

My contractions, as in labors past, did not follow anything close to a "one minute long, five minutes apart for one hour" pattern. The pattern was frustratingly difficult to discern. Some contractions seemed to have two peaks: a brief, painful one followed by a strong hardening like the flexing of a muscle. These contractions would last one and a half to two and a half minutes. Others were very short, and very similar to the contractions that I'd had for weeks. Sometimes only three minutes passed from the start of one contraction to the start of another, sometimes five, and at least once, almost nine minutes elapsed. The end of the contractions was almost indiscernible as the uterus relaxed ever so slowly and I couldn't put my finger on a true end to it. I was going crazy trying to time them. The only thing new about these contractions is that a good number of them were definitely painful (but not all of them). 

I'm not sure what made me confident enough that we should go to the hospital. Perhaps it was the fact that I had so many contractions during that hour. Perhaps it was that at least half of them were painful. Perhaps it was knowing that we wouldn't have to wake up the whole town for a false alarm, and that only one person would know about our trip to the hospital if we came back without a baby. Whatever it was, we called our friend. True to her promise, she slept with her phone on and hopped out of bed to rush over to our house. I am convinced that one of the best things that anyone can be for a pregnant woman in labor is reliable, and this friend certainly was. She helped me to the car while my husband, unusually animated, ran around tying up loose ends and gathering our bags for the third time in eight days.

It was almost as though my uterus remembered the last two weeks and knew that in the past, this was the time when it stopped its labor-work, right when we got into the car. I started crying (again!), thinking this would be our third time crying wolf and no one would believe me when I was truly in labor. Unlike you, dear reader, I still didn't know whether this was it...

The friend who had recommended the epsom salt bath told me later that she had woken up at about this time, thought of me, and prayed for me. Perhaps it was her intercession that made the contractions pick back up. It's also possible that it kept us from being pulled over by the darkened police car waiting in the median on the highway to catch speeders like my husband. We may or may not have been traveling fifteen over at that point. God bless friends who pray.

I tried to recall all the things that I had asked God for regarding this pregnancy and labor. I prayed that the baby wouldn't be too big. I prayed that he wouldn't get stuck with shoulder dystocia. I prayed that we would know when it was time to go to the hospital. I prayed that we would make it to the hospital in time. I prayed that I wouldn't have to be induced. I prayed I'd have one of those amazing labors that was not painful. Countless times I had also prayed that it would happen now, but so far that hadn't happened. At this point, I was in utter darkness about whether any of these prayers would be answered affirmatively. I was strangely confident of heavenly care upon the whole endeavor. That kind of confidence was extremely unusual given the amount of anxiety I've articulated here over the last several weeks. It was, however, a prayer that some ladies had made for me during my Birth Blessing, and God answers those prayers in good time. Yet even with that confidence in God's providence, it felt like I was walking forward with a blindfold on. I could feel a few things here and there and give an opinion of the situation on the other side of the blindfold, but it felt like a rather uninformed one. 

One of the things that I did feel was that sitting still made the painful parts of the painful contractions bearable, and that moving around made an epidural seem more attractive. (I don't even know what an epidural is like, but I've heard it can feel good). This means that the next forty minutes, upon arrival at the hospital around 2:30 in the morning, took every ounce of energy I had left. Walking from the car into the hospital went slowly, including a great deal of heavy breathing and a stop to lean on my husband's shoulders. Stepping on the scale in triage involved a considerable amount of wincing. Climbing into the wheelchair, out of the wheelchair, into the triage bed, and into the labor room bed felt almost impossible. Lying on my back to get the monitors strapped on and going to the bathroom to change into the hospital gown seemed like a special kind of torture reserved only for women in labor.

I was 8.5 centimeters when we arrived. They asked me if I'd like the doctor to break my water so that baby could be born right away, and I wasn't sure. Am I still in triage? I thought. Is it really going to happen so soon? I think I remember everything hurt more the last four times my water broke, and I don't think I want any more pain right now. I wasn't sure what I wanted at that point except ice chips. Yes, frozen bits of water! Of course that's what I want. No, I'm not ready for you to break my water.

One contraction later, I informed the nurses that I felt like pushing. That had happened an hour or so before my last one was born, so I felt confident that it would be over soon. Okay, the doctor can go ahead and break my water.

With the next contraction, I informed them that it would not be necessary for the doctor to break my water, as it had just broken on its own. The nurse looked down at the bed and confirmed, with surprise, that I was correct. 

With the next contraction, I informed the nurses that I could no longer avoid pushing. 

With the next contraction, my husband remarked, "There's meconium," and when the nurse looked down, she said, "Oh, and there's baby's head!"

With the next contraction, one of the nurses gave me some kind of instruction about pushing. I actually can't remember if it was "push hard" or "stop pushing," but fortunately it didn't matter in the end. I heard the words "nuchal cord," panicked just a little bit, and then couldn't help one more big push. Baby came all out. It was 3:10 in the morning. (It turns out the nurse was mistaken about the nuchal cord. His cord wasn't around it neck. What she had seen come out with his head was his hand. His hand!). I have no idea whether the doctor was there or not.

From the time I was awakened at midnight until the time he was born was three hours. I suppose I was finally convinced that I was in labor by the time we got out of the car at the hospital. The realization was not really a moment I could put my finger on. It was more of a slow slide into the stupor of labor, in which I half-chose and was half-forced to stop thinking so much, and then it was over. He was 8 pounds, 10 ounces and maxed out the length chart at 21 and 3/4". That's just how I grow them, apparently. He was born at exactly 39 weeks gestation. Baby chose a great birthday for himself, the Feast of Christ the King. He'll have to accept supernatural royalty by association on his birthday, though, since he'll have pretty stiff competition for the role-play kind in the games his brothers play.

***************

A mere hour before our little man came rushing into the world, I was uncertain of whether any of my prayers about this baby's health or the birth would be answered. I walked blindly. By some gift of grace, I had become just barely confident of God's care for us in the eleventh hour. For the last several weeks of pregnancy, though, my emotions had wandered here and there, and mostly in the direction of fear, anxiety, and tears.

Yet each of those prayers, it must be said, was answered in a definite way. The baby was not "too big," whatever that means. At least he was not too big to find his way out. We did not get stuck in shoulder dystocia. My husband and I knew when to go to the hospital, though we didn't know that we knew it at the time. We made it there in time and I didn't have to give birth on the side of the road. I was not induced. The "now" for labor eventually came, even though it wasn't the first two dozen times I'd asked for that moment to come.

And the pain? Well, it was painful, but the nurse noted that part of the reason they were not prepared when he was finally born is because I just didn't seem like I was that close. I was not anxious. I was not saying that I couldn't do it, as I had in other births. I was not acting hysterical. I did not give the Amazon-woman yell that my husband and I have come to expect when I'm pushing. As my husband put it, I "surprised the nurses with a composed and stealthy delivery." I was so calm, the nurse said. As with the gift of confidence in God's providential care, so too a gift of grace enabled me to avoid the telltale signs of transition such as doubt, despair, and fear. If you have read post after post about the anxiety this pregnancy has inspired in me, you might appreciate that such a calm can not be said to be natural - at least not natural to me, not to this pregnancy, and not to most Type 1 diabetic pregnancies I've observed in these last eight years. A very special group of friends prayed for me to have a "peace which passes understanding" during labor this time, and I truly did. It wasn't painless, but the physical pain did not disturb my spirit. I think that comes pretty close!

I'm about as tired and in pain now that the baby has been born as I was before, but I can at least say that now I am happy. Happy! Pregnancy was pain and anxiety, but it is nearly forgotten now that baby is here. I will always be happy for your life, little man, even when I feel utterly incapable of giving you all you need and deserve.



Saturday, December 3, 2016

Week 38: A Week Full of Tears...and More Contractions

The last two weeks of this pregnancy, I had spells of contractions every day that lasted several hours. For the most part they were far apart and short, except when they weren't. For the most part they weren't very painful, except when they were. They were like labor contractions in that they involved the entirety of my uterus tensing up, but they were unlike labor contractions in that I was still pregnant after they subsided. Since I barely made it to the hospital once before, and after hearing about one friend who delivered in the car on the side of the road and another who delivered at home attended by her husband, I was anxious to avoid finding myself in either of those situations.

I was in fits of tears every night. The contractions weren't painful, but almost everything else was. I couldn't put my own shoes on. I woke up every two hours because my hips were aching. Sometimes I stayed awake, if the contractions were enough to grab my attention, trying to figure out whether they were moving in the direction of pregnancy's end or not. I didn't want my husband to leave my side, but I knew he had to. Every morning when he left for work was a fresh agony. I couldn't even bear to have him sit downstairs reading in the evening while I laid in bed upstairs, because I wanted him to be close enough to dry my tears and hear me call. I didn't want to talk to anyone about my pain and anxiety, but I couldn't seem to think of anything else to talk about. Most of the time when I felt the contractions, I kept silent and tried to assume they would simply go away. Most of the time, they did. But how to keep my discomfort from my husband, to avoid causing him anxiety? Not easily. How to hold inside me and keep down all the anxiety about whether we'd get to the hospital in time? With great difficulty. How not to cry loudly for help, ask someone to come sit with me for a while and wait to see what would happen? With great loneliness.

I'll be honest and say that I was ready for pitocin or a c-section. I didn't actually think these things were right or good for me, I was just ready to buy the end of pregnancy at any cost. I half-thought they'd hook me up to pitocin any time after 37 weeks given that I'm a Type I diabetic and very few people seem to think I can safely carry a baby to its due date, but I think that recommendations for induction have changed since my first pregnancy. In the absence of a specific concern, induction is not prescribed until 39 weeks for anyone, and in spite of my pain, everything was totally fine. Baby's heart rate was fine. My blood pressure was fine, except when I was about to start crying (it was high at those times). Baby's size looked big-ish but not excessive. I do think it's the right call to postpone induction like that, but it sure didn't feel right at the time...

On Thursday I went to an appointment with my OB. The perinatologist was noticeably disturbed by the fact that my induction was not scheduled until the day after my due date; less so by the fact that all four of my children attended the ultrasound appointment. My dilation had only increased by one centimeter, to four.

On Friday afternoon, I began another bout of contractions. They seemed a little closer this time, maybe a little longer, and a little more consistent. I went to a friend's house for the boys to play and for us to chat. I figured getting out of the house and trying to forget what incredible pain I might be in at any moment would be a good idea - or at least an acceptable idea - given that the contractions were still far apart and not yet painful. The play date passed uneventfully and contractions came more frequently during the dinner hour. I nearly burst trying to keep the fact from my husband. I ended up blowing up about something else and we got into a huge argument, and I still wonder whether that may have stopped labor from happening at all that night. (Yet another reason it might be better to cry than yell!) Uncontrollable weeping - about our argument, my pain, and the uncertainty of it all - commenced when he left the house to take our children to one of their regularly-scheduled activities. More weeping as we hashed out our disagreement and apologized upon his return. Contractions slowed but continued.

In fact, contractions continued throughout that long, terrible night. I dozed but never really fell asleep. I got up and did some Sudoku puzzles, then laid down again. I got up later and baked some muffins. I finally laid in bed and sobbed loudly, waking up my husband, and declaring that I just wanted the contractions to end or give me a baby. All was in vain. I snatched a few minutes of sleep here and there in the early hours of the morning, occasionally waking to feel a contraction begin. The contractions were still not painful, just noticeable. Frequency and duration were changing constantly. If I'm honest, what really kept me awake was the anxiety. Will someone be here to watch my children when the time comes? Will we get to the hospital so that my husband doesn't have to deliver on the side of the road? I begged him to read an Emergency Childbirth manual I had on hand, just in case. He grudgingly consented.

About 2:30 in the afternoon on Saturday, contractions became more intense and more frequent. I waited an hour before saying so, and we waited another hour before marshaling the troops to leave for the hospital (again). We packed our things. With the wind blowing ferociously and coldly, ice rained down from the sky as we stepped outside to leave. I briefly wondered if the low pressure cold front moving through had caused my contractions to pick up, thus confirming my belief that the beginning of labor is in the hands of cosmic forces completely outside my control. We waved good-bye to our friends who came to take care of the boys, quickly ran to the car, and left, hoping that we'd have a baby by the morning.

But by the time we'd been in the car fifteen minutes, I could tell the contractions were slowing down rather than speeding up. I began to cry for the umpteenth time this week. We stopped for my husband to eat dinner, but I felt slightly nauseated and completely uninterested in eating. The darkening sky and the chill that was settling over everything helped me feel even more depressed (if that was possible). The hospital called to make sure the baby hadn't been born on the way, and I very sadly informed them that such was not the case.

By the time we arrived at the hospital, my anxiety about crying "Labor!" falsely for the second time was beginning to eat me alive (From the fear of being abandoned, deliver me, Jesus). The contractions continued to slow until they were almost gone. Our triage nurse was annoyingly cheerful as she told us the story of how she delivered her fourth ten minutes after arriving at the hospital with her three other sleepy children standing around the labor ward. I was not comforted, since I did not want to think about taking care of my other children when I myself was in such desperate need of care. It's very likely that her story would have had me laughing at any other time, but on this particular night, it only served to heighten my anxiety.

We waited in triage. By and by, my dilation was checked, and the news was disheartening. In 48 hours since my appointment at the OB's office, I had not dilated a single centimeter. Two long days and a night of contractions seemed utterly wasted. It was a feeling similar to when my OB proclaimed I "had more work to do" during my fourth labor and I felt crushed. I started crying again at some point. Probably multiple points, actually. The hospital registrar kindly brought me a tissue. The doctor said I couldn't get pitocin until the morning, since I wouldn't be 39 weeks gestation for another six hours. I wasn't even sure it would work and I definitely didn't want to go through another sleepless night, but there was no other option. It was about 8:30 in the evening. We collected our belongings, sent our "just kidding about being in labor!" texts, and drove home.

Tears, tears, tears!

Sunday, November 20, 2016

Baby is here!

Our newest little man flew into the world last night in what I can only describe as both a very short and a very long labor! His blood sugar is a little low (as almost always seems to happen to my babies), but he's nursing like a champ to bring it up and cute as a button regardless.

You'll get a birth story when you get one, which probably won't be very long from now, because I love writing it.

Happy Feast of Christ the King! Baby picked his birthday well. Viva Cristo Rey!

Monday, November 14, 2016

Google is Celebrating the Inventor of Insulin Today!

I had no idea that this guy first had the idea to try insulin to control diabetes in humans. I actually know precious little about the development of insulin therapies except the fact that I'm grateful for them. Thanks to Google, now I also know this little tidbit. Apparently the Canadian Sir Frederick Banting was the first person to try isolating insulin from cows and pigs to use in human beings.

In other news, Sir Frederick Banting was the youngest of five children. Hey, I'm pregnant with our fifth! I guess I can always hope that this baby of ours, growing healthy in utero as a result of the insulin that fifth child Sir Frederick Banting discovered, will grow up to "pass it on" and do something great for his generation and posterity. (But even if he's not the youngest and turns out to be a middle child instead, we can all rest assured that I'm populating the world with middle children. Apparently they are the most well-adjusted adults).

Sunday, November 13, 2016

Week 37: A Week Full of Contractions

I had a lot of contractions this week! There's still always something new to experience with each pregnancy, I suppose. I've always had a good number of contractions towards the end of each pregnancy, but the firsts this time around were 1) contractions that lasted all day but didn't result in a baby at the end of said day, and 2) contractions that woke me up in the middle of the night but didn't result in a baby the following morning. Late last week the contractions had been so consistent for two whole days that we did make a visit to the hospital, where we learned that dilation had not progressed from last week. Contractions petered out and we were sent home. So we're going to call that hospital visit a practice run. Our neighbors and friends now know that they could be receiving a call from us at any time of the day or night in the next two weeks, and they also know where the extra bagels are kept...

The contractions I've experienced lately have not, for the most part, been what I would call "painful." In fact, I haven't really tended to experience "painful" contractions until transition, and that's just the last few contractions (I read somewhere that it's only about 10-12 contractions, all told) of first stage before you begin to push baby out during the second stage of labor. If I were to wait until the contractions became painful, my babies would for sure be born at home or in the car on the way. The only reason I really woke up at all was because I had to time them. Then I began remembering my third son's birth, which went kind of fast, and then I got kind of anxious and had trouble falling back asleep. 

The most consistent theme of this pregnancy seems to be anxiety. True to form, I had a lot of anxiety this week. I worried about whether we'd get to the hospital on time. Everyone has heard of other women who have accidentally delivered at home without a caregiver or on the side of the road. I personally know five such women, and I'm not anxious to join their ranks! I worried about my blood pressure and blood sugar readings once we got there, and whether the doctors would think they were bad (From the desire of being approved, deliver me, Jesus). As everyone knows, worrying about your blood pressure is probably the best way to be sure they'll show up higher than normal. I worried about the pain of labor, especially after I heard another woman enter the triage stall next to me in such obvious pain with her contractions. It's funny how three centimeters dilation can feel so different to different women... After the doctor sent us home, I worried that all the people we had told about our departure would think I was a drama queen (From the fear of being despised, deliver me, Jesus).

So how do I cope with the anxieties of the last few weeks of pregnancy? A few helpful suggestions:

1) Cry. Because you're allowed to, and it doesn't mean you're doing it wrong. It also might very well be better than getting mad. It also might make someone pity you enough to help you out. There's seriously no shame in crying for help when you are about to go through one of the most intense experiences of your life. I guess the Litany of Humility prayer might be working, because I really find it hard to care if people around uncomfortable about the fact that I'm weeping uncontrollably, and I also don't feel the need to explain myself to anyone. I cry at Mass, I cry in the grocery store, I cry while talking to friends, I cry while cooking dinner, I cry when no one is around and I'm lying in bed. I woke my husband up when I started sobbing early this morning, loudly proclaiming my desire for contractions that would either just STOP or SPEED UP. 

2) Drink wine. I know the Surgeon General's warning as well as anyone, but...I'm having a hard time caring. I mean, as long as it's moderate. One doctor I spoke to said the only case of fetal alcohol syndrome she saw during her medical school education was brought about by a woman who was actually trying to cause a miscarriage in herself by drinking. In light of that anecdotal evidence, I figure a glass here and there is probably not going to do a lot of harm. Also, I've had more than a few glasses of wine during the second and third trimesters of this and my last three pregnancies, and no abnormalities have popped up so far with any of them.

3) Drink tea. Whatever kind makes you feel good. Put some honey in it if your blood sugar is low!

4) Pray. I always used to think that prayer was supposed to take the anxiety away, but ever since I became a praying person, it's never really worked like that. I used to think that meant that I was doing it wrong, and that made me even more anxious. But now I don't that's the case. Prayer doesn't take the feeling of anxiety away. It just helps me put words to the anxieties that I'm feeling, spend a little time figuring out how important they truly are, imagine how I might act if various worst-case scenarios came to pass, and then ultimately make an act of faith in God's providence. God's power and care for me does not depend upon my emotional state, so whether or not the anxiety remains when prayer time is over is becoming less and less important as time goes on.

Speaking of prayer, a friend of mine threw me a Birth Blessing party on Saturday. It was sort of last minute, pretty small, and almost got cancelled when we took ourselves to the hospital on Friday evening thinking baby could be coming soon, but it was really lovely. Obviously my level of anxiety about pregnancy speaks to this, but there's so much more to childbirth than just what's happening in the body. Caring for the soul in preparation for (and during!) birth is a great gift to give yourself and all the pregnant women around you. That's why I became interested in pregnancy and childbirth in the first place, why I went through doula training, why I followed a midwife around one summer, why I considered becoming a midwife, why I read birth stories at all. It's gotten somewhat lost in the diabetes numbers management of this pregnancy, but it remains a critical element every single time a woman becomes a mother. That goes for baby number one or baby number seventeen and every other one in between.

For now, I raise my glass (of wine, tea, sparkling water, Gatorade, or other beverage) to another week of waiting! (And I'll probably cry a little bit before I go to bed, too, because it's better than yelling).

Sunday, November 6, 2016

Week 36: Hello, Full-Term!

I am officially full term today. Should labor begin tonight, no one would try to stop it. Hooray!

I visited my OB on Friday. Over the last few weeks of pregnancy, I'll be meeting several of the doctors that work at the practice in the hopes that the face of the person who delivers my baby will be a familiar one. No matter, though. I think only one of my previous four babies was actually caught by the doctor treating me during pregnancy. I usually push them out too fast. Here's hoping for a repeat performance, because the pushing part is the one that makes everyone most nervous when you're looking at an increased risk of shoulder dystocia...

One lovely part of my most recent visit was all the detailed questions the obstetrician who examined me on Friday asked me about diabetes. She was so genuinely curious about the CGM, the pump, and my past experiences being pregnant and giving birth with Type I diabetes. Forgive me if I use the word too often, but the term "refreshing" comes to mind. At this point, though, I'm really looking forward to those first few hours after delivery when I can turn my pump way down and think about something other than my blood sugars for a while.

I also had a positive experience with my doctor's office when scheduling induction last week. At my 35-week visit, the doctor I saw then (a caregiver previously unknown to me) had recommended scheduling the induction for 39 weeks. When I pressed her on the point, citing my previous experiences with labor that begins spontaneously at 39 weeks or later and the ease of delivery, the health that my babies and I have had with all my labors, and the discussions I'd had with other OBs in the practice, she said we could schedule it "between 39 and 40 weeks."

Well it turns out that "between 39 and 40 weeks" is Thanksgiving Day, and hospitals and doctors don't like to schedule routine induction on major holidays. (Duh). So when the scheduler from the OB's office called me mid-week, I found myself having to negotiate the induction date once again. There were no appointments except on Monday that week, which would be only one day past 39 weeks and a few days earlier than any of my other labors began spontaneously. I once again explained that I'd done this before, had considered the risks (shoulder dystocia) in light of the facts on the ground (my previous labors, growth ultrasounds during this pregnancy), and that I'd really prefer to give myself a few extra days to go into labor spontaneously in the hopes that labor might proceed more smoothly if it began on its own. The best news of the week came about an hour later when the scheduler called me back after discussing the case with one of the practice doctors and they found it acceptable to postpone induction until the Monday following my due date (40w1d). One way or another, I should have a baby out of this weary body of mine and into my expectant arms on or about November 28. I hope it's on terms set by baby.

Also, I just came across this study in which the researchers are no longer recommending induction for diabetics until "approximately" 40 weeks gestation unless baby's weight on ultrasound is estimated to be greater than 4500g (9 lbs 14 oz). "Early delivery without maternal or fetal indication in women with diabetes is no longer the norm unless fetal lung maturity is documented." I have no idea where that recommendation comes from, but it's at least there in this study from India published in 2012. As far as I can tell, the recommendation for induction at 39 weeks was always somewhat arbitrary, anyway. 

In other news, contractions have increased in strength and frequency over the last couple of weeks. I have a few hours-worth of contractions every evening before going to bed, and cervical dilation so far confirms it. I was 3 centimeters dilated on Friday. Hoping for a baby this week (because who isn't excited for pregnancy to be over already?), but prepared to wait a few more. Come on out, baby. We're as ready as we're ever going to be!

Wednesday, November 2, 2016

CGM Trial and Error

At the beginning of pregnancy, I wrote a little bit about choosing settings for my CGM. What kinds of goals would I set for my blood sugars? Coming up with rules for diabetes management is not an easy thing, and I tend to rely on A1C values to tell me whether I'm pointed the right direction or not. But A1Cs only come once every three months, and something has to be done in the meantime.

When I chose those pregnancy settings for my CGM, I had only been on the CGM for about four months. Because we had just moved to a new town, I was still looking for a doctor and hadn't yet been for an A1C blood draw. My first A1C on the CGM was 7.1%, and that was taken in late April. I assumed it was a little high because I hadn't been as disciplined about my blood sugars before pregnancy started, and thought that keeping a tighter watch on the blood sugars and my food intake would bring it down below 6.0%.

My next A1C was taken in July, and it was 6.2%. Not quite as low as I'd hoped, but still good enough for baby, I assumed. I don't remember what all my A1Cs have been during all my pregnancies. I do know that I had a 5.2% which occurred during the months when I almost drowned myself in a bathtub with a low blood sugar, so that made me think that aiming for 5.5%-6.0% was probably best. I didn't want to be trying so hard for a low A1C that I was forced to suffer severe lows in compromising situations (driving, bathing, exercising, etc.).

My most recent A1C, taken in October, was 5.9%. The somewhat high number was a source of some dismay to me, because my monitor readings were really very good during the six months prior, yet I was barely inside my the target A1C that I'd been shooting for. In addition, my Dexcom clarity report indicated an estimated A1C of 4.7% for the same time period. Confusing and a little upsetting.

When I wrote about my growth ultrasound of 32 weeks, which showed a baby that was a bit on the large side, the anxieties I was having about the CGM readings and its apparent inaccuracy were very present in my mind. Evening calibrations were regularly showing up 20-30 mg/dL higher than morning ones, and that made me unsure of whether my blood sugar was being accurately reflected on the monitor the rest of the day. I assumed that if my blood sugar was actually 20-30 mg/dL higher for most of the day (and night?), that would explain why my true A1C was so much higher than Dexcom's estimate.

So my sensor receiver may tell me that my blood sugar is 55 when it is, in fact, 75 on my glucose monitor. Except that there are times when the monitor says my blood sugar is 55 and it actually is. No, I haven't figured out yet how to tell the difference. Also, I usually love being at 75, except when I don't. Sometimes 75 feels really terrible and lightheaded and weak and shaky. Likewise, I usually feel pretty junky at 55, except when I don't. Sometimes 55 feels as normal as 75 usually does.

So then comes the question: what to do? What are the rules for this situation? I have to write a whole blog post to explain it to myself and I'm still not sure I understand it. There's no way I can squeeze all this information into a 15 minute endocrinology or diabetes education exam. I've just got to make up new rules for myself as best I can. I've finally decided, as with other pregnancies, that I probably just have to be comfortable riding a low blood sugar line that most people are not used to and that most endocrinologists caution you to avoid.

The upshot of it is that I've lowered my target range considerably, hoping to squeeze out the last few weeks at a lower A1C than the first seven months. I have no low alert besides the built-in "Urgent Low" that appears when the sensor reads 55 mg/dL. I even sometimes ignore that if I feel OK and I'm at home and can get food quickly, should the need arise. My high alert is the very lowest the sensor will allow, at 120 mg/dL. I very rarely get above 130 mg/dL, because I begin treating with a modest 3.0 unit correction bolus any time my blood sugar gets to 120 mg/dL.

I was sincerely hoping that the sensor would allow me to avoid the worst pregnancy lows that I've suffered in the past, but the consistent margin of error with calibration simply requires that I assume my blood sugar is a little higher than the sensor is telling me and I have to hang out a little lower than the targets recommended by most endocrinologists (e.g., 80 mg/dL as the ideal reading on the sensor instead of 100 mg/dL as the ideal reading on a glucose monitor). The sensor does, at least, alert me at night when my blood sugar is dropping. That was information I did not have in previous pregnancies. But I still have to keep Gatorade with me everywhere I go, I still have to ask people to help me when my blood sugar gets low while I'm out of the house and I've run out of Gatorade, I still have to hang out at that junky-feeling 55 or 75 for a lot of the day, and I still have to give correction boluses with my fingers crossed, hoping that I'm just the right amount of low two hours later.

No one said having a baby with diabetes was going to be easy! But neither is going to medical school, and I'm pretty sure your endocrinologist thought that was worth it. Sometimes the hard stuff totally is.

Sunday, October 30, 2016

Week 35: The Gift of Tears

A few weeks ago, you could probably tell I was kind of mad at the perinatologist. I may still have some reason to be mad, but the justification for my anger is more likely...slim. As I'm discovering more and more, there's usually just a whole lot of sadness and weakness and pain underlying a lot of my anger, a lot of the time. Often the person who happens to be in the room when I feel that way gets jumped on, whether or not that person is directly responsible for doing anything wrong to me.

So recently I prayed to Saint Louis, King of France, to give me the "gift of tears." It was a gift he himself prayed for, to be able to shed tears of repentance over his sins. I assume that, as a king, he didn't have a lot of time to sit alone in the bathroom and have a good cry. I know that feeling. Usually it's because someone else needs to use the toilet or I need to run interference on a wooden-block-throwing two-year-old. I also prayed to Saint Jerome (good old patron saint of grumpy people) to pull the thorn out of the paw of the lion that tends to start roaring when I get angry. You can read some of his letters some time if need proof that even angry people can become good... 

In any case, I wasn't thinking about those prayers in preparation for my visit this week, and I was quite prepared to get a little sassy with the perinatologist when I woke up on Friday morning. To be fair, perinatologists have been wrong a couple of times in my case. Like in my first pregnancy when they told me my son was in the third percentile and my OB recommended three weeks of bed rest. He was, in fact, in the 35th percentile and born perfectly healthy at 41 weeks. Or in my second pregnancy when they insisted on early induction because they were worried about shoulder dystocia with a big baby. He was my largest baby, but still came flying out in 20 minutes-worth of pushing. Or in my third pregnancy when they told me my son might have trisomy 18. In fact he was missing a kidney, but it turns out you can be quite healthy with only one. I didn't let them make any mistakes or bad recommendations during my fourth pregnancy...

So anyway, here I am, ready to be sassy. A thin veneer lying on top of a whole lot of anxiety. The tech did the ultrasound, and the baby measured somewhere between 80th and 90th percentile again. This was a different ultrasound tech than the last one, so with a second tech finding the same thing as the first, it seemed unlikely that her measurements were a repeat error. More likely, it was true confirmation of the "big baby" finding. 

As she stepped out of the room to go find the doctor, I began to pray: praying to our little one's patron saint for help controlling my blood sugars, for me to trust God's will even if the worst thing (c-section or shoulder dystocia) should happen, wisdom for the doctors, wisdom for all the nurses and staff who would attend me during labor and delivery at the hospital...and then the tears just started squeezing out of my eyes. They are showing up at all kinds of awkward times and places these days! Thank you, Saint Louis...but...well, just thanks, I guess. Yeah, I did actually ask for it.

Faster than I could wipe them away, I heard the perinatologist at the door. Shoot. I thought I might have a few minutes to let out some more before putting on sassy-face again, but my hands were over my eyes and my cheeks had just flushed red when he came in. I thought about acting like everything was normal but the tears could have started pouring down my cheeks at any moment even if I had tried to put on a good face about it. Kind of embarrassing, but it was too late to worry about that now. (From the fear of being humiliated, deliver me, Jesus).

When he asked what was wrong, I just started telling him, half-laughing (to keep myself from really losing it) and half-crying (because that's what I really wanted to do), that I had been trying so hard to exercise, to eat properly, to control my blood sugars and my weight gain and my blood pressure and it just felt like I had failed because now I had a big baby. I explained about how exhausting it had been to get up and walk every day, how I was crying at the end of every day, how hungry I was all the time, how I couldn't handle the blood sugar spikes and that when I stopped walking it just seemed to fix all my problems but now I was worried about shoulder dystocia and the need for induction before baby and I were truly ready...

I have no idea what he thought of me or my theories about this pregnancy or diabetes or my past experience or the fact that I was both laughing and crying at the same time. I honestly didn't care. (From the desire of being esteemed or praised or honored, deliver me, Jesus). He didn't seem uncomfortable. He spoke a bit more quietly and slowly than usual. He's probably used to pregnant women crying in his exam room. He does, after all, have the crummy job of bearing bad news to women about major defects that will make it impossible for their children to survive past a few hours.

At this point, I truly couldn't and didn't expect anything good to come from this visit. My anger of last visit was probably mostly unjustified. He'd probably be right to be a little offended if he knew about it. The sassiness I arrived with this morning was simply a sham covering up feelings of diabetic failure. And now, dissolving into a puddle of tears, I resemble a little kid, not unlike the children whose tears I often wipe away. Sometimes I do so happily, sometimes grudgingly and impatiently, and sometimes with a secret grin as I turn my head to keep them from seeing how amused I am by the silly things they cry about. All in all, something less than my best self is what showed up here today, and and it seemed reasonable to expect that something less than the best is what I would get in return.

The news from the perinatologist was the following:

- Your baby is big, not fat. He's big everywhere, and probably not because of your diabetes.
- You probably just grow them this way.
- Your baby will probably be somewhere between 8 and 9 pounds at birth.
- Your OB should know what to do for shoulder dystocia if it happens, but it probably won't.

Maybe read that list one more time. Just a big baby? Between 8 and 9 pounds? Probably this is just how I grow my babies? And that terrifying thing you've been fearing is something your doctor should be able to handle? I've gone over it in my mind a few times, today, too. It is almost exactly what I have been hoping is true for the last three weeks...

I wonder if God was wiping my tears away grudgingly, with a secret grin, or happily today. Perhaps it was all three. "You must become as a little child" (Matthew 18). "Blessed are those who mourn" (Matthew 5). Blessed be God in his saints, who pray for us unceasingly!

Tuesday, October 25, 2016

Week 34: Trusting Your Gut

I think it's appropriate to call the title of this post "ironic." I'll explain that in a minute.

During my last two pregnancies, I focused on resting my body and eating a little less. This served the purpose of controlling my weight gain and my blood sugar levels. Reduced weight gain reduced both insulin resistance and blood pressure readings. Reduced food intake kept my blood sugar levels more even. Everyone was happy, and babies were born at 8 pounds each. Perfect.

This pregnancy, though, the doctor I saw during the first several months at my rather large OB practice insisted that I needed to be walking for at least 30 minutes every day. "No big deal," I thought, because we live in a small town with a post office, a library, a parish, several friends' homes, and even a grocery store within walking distance. Plus I have boys, we homeschool, and it was a perfect opportunity to squeeze in some P.E. and get those little guys moving.

Over the summer, though, I was walking a lot less because of the heat and the fact that trying to keep four little boys safe on bikes is a bit like herding cats. There were days when it was downright terrifying. So I felt guilty answering, "Yes," when the doctor queried me about the walking. Basically, it was only happening a few times per week. She grew concerned about my weight gain one month when I had jumped up about four pounds in four weeks. I began to think that perhaps she was right, and I should be more intentional about getting that 30-minute walk into my day. For their safety, I'd have to do it without the kids.

The only way to do it was early, so I started waking at 5:30 every morning. This was refreshing for a couple of months. I probably would have said that I enjoyed it for a couple of months. I got to walk at sunrise every morning under the shadow of a mountain that I have come to love dearly. Waking up the birds as I walked past the tree where they were sleeping and praying the rosary first thing in the morning became a lovely and delightful routine. So really, I did enjoy it for a couple of months. It had some positive effect on my blood sugars. I certainly noticed that they went haywire if I skipped a few days of walking... I began to trust that this was good, and it would work to keep my weight gain down and my baby's weight gain down. So far, so good.

But then September came and it got kind of cold some mornings. Mornings were darker and it was pretty clear that cars didn't always see me until they were a little too close for comfort. One four-day period it rained every single morning and I told my husband that I could do cold, I could dark, or I could do wet, but I simply couldn't get up and walk when it was all three outside.

I was also exhausted. I pulled myself out of bed by sheer willpower to walk three miles every morning. I was actually finding myself falling asleep during the day. Like, while driving. Yikes! I always thought it would be a low blood sugar that would do me in if it came to that... I was crying from fatigue every night before dinner. I was only sleeping for about 6 hours every night. I began to develop something like a stress fracture in my foot. I could barely keep myself from eating all the leftovers off my kids' dinner plates because I was so hungry all the time, yet I knew that I had to put the brakes on for every single meal because otherwise my blood sugars would get too high.

And still, I pressed on. Doctor's orders, right? It's good for baby. I have to. Plus, it was corroborated by all popular wisdom, the recommendations of countless other doctors, and every magazine article you've ever read. Eat more fruits and vegetables, exercise more, and all your problems will disappear.

But you know what the worst part about this plan was? I mean, aside from the falling-asleep-while-driving and crying every day part? I've gained more weight during this pregnancy and my A1Cs have been slightly higher all pregnancy than during the last two. Walking 30 minutes per day was prescribed to help lower my blood sugars and to keep my weight gain down, and it has done neither. In the last six weeks, I have gained 10 pounds. I haven't experienced pregnancy weight gain like that since my first pregnancy when I was eating like a horse! My latest A1C really was pretty good (5.9), but still somewhat higher than in other pregnancies. My last two pregnancies, which were completely devoid of exercise and full of rest, had lower A1Cs throughout and much more moderate weight gain. My total weight gain up to 35 weeks this pregnancy is now 40 pounds. Last pregnancy, I gained less than that the whole nine months.

At my last doctor's appointment, when I saw the number on the scale clock in at a full 5 pounds higher than my visit a mere two weeks before, I resolved to utterly abandon the walking plan. I slept nine hours the first night, eight hours the second, and no less than seven hours ever since. I took two (yes, two) naps on Sunday and still went to bed at 9:00. And I feel great. I decided not to worry about weight gain at all this pregnancy and just call it water under the bridge, since what has happened since the beginning is someone else's fault and no one has a crystal ball to tell me what will happen in the last few weeks. My blood sugars, which I was especially worried about, have been totally great since I stopped walking. (That part I can't explain, except perhaps to thank the patron saint of our in utero baby, to whom I have been praying unceasingly about this anxiety).

So I have returned to trusting my "gut." That is to say, trusting my instincts about how to get through a diabetic pregnancy safe and sound, given all the circumstances of my life. At the beginning of pregnancy, I planned to follow the pattern of the last two, eating moderately and resting a great deal, because those two ended really well. But then my doctor's insistence that I exercise got in the way. I wish all along that I had ignored her counsel and trusted what I know has worked before!

And as I mentioned at the beginning, the ironic part about "trusting my gut" is that I find I actually have to say 'no' to my gut an awful lot. I don't eat everything I want to, and I pretty much want to eat everything all the time. At least now I don't feel like I have to get out of the house and run away from it by walking three miles a day. I just pour myself a glass of sparkling water and take a nap!

Sunday, October 16, 2016

Week 33: "You're A Worrier, Aren't You?"

The clouds do part occasionally, even though I have been super grumpy about my last visit to the perinatologist, and I think it's worth mentioning that my obstetrician - that is, the one who will actually deliver this baby, the one who will be attending me in my hour of need, the one who will be helping me through really intense moments of self-doubt, the one who will sew me up if I tear, the one who is far more responsible for helping me to have a healthy baby than the perinatologist who sits comfortably in his office behind a computer making dire predictions about life and death - is far less concerned about this than I am.

"You're a worrier, aren't you?"

That was the obstetrician's question to me at my last visit. Half statement, half question, but he definitely nailed it. Yeah, I guess I am feeling a little jumpy about having my ability to give birth to a healthy baby called into question for the umpteenth time in five pregnancies. I guess the anxiety every time I see my blood sugar climbing up those sensor dots is palpable in the exam room. I suppose that when I talk as fast as I do during my visits, it's pretty plain to see that I think and stress about these things so often that I can't even put it all into words that will fit into a 15-minute office visit.

He told me I was a little big, but also said, "maybe you just grow your babies that way." He said it sounds like I'm doing everything I can. He was utterly un-phased by the ultrasound news. He said we could do the testing in his office, rather than sending me over to the perinatologist, except for the growth ultrasounds every few weeks. Thankfully at this point, I should only have two more growth ultrasound visits to that office to endure.

Why is it that I'm not able to absorb my OB's confidence? Why is it that the perinatologist's disapproval about the size of the baby and my fears about what the endocrinologist would say about the low blood sugars are totally winning right now?

Anyway, I thought it worth mentioning that the OB is really not worried, and he's the one I really need to impress. Not everything is going badly as a result of one (possibly inaccurate) ultrasound reading. But of course, if I'm honest, I'm still kinda grouchy and anxious, and it's not even about whether or not the baby will be healthy. I'm utterly convinced about the fact that I am capable and that this baby will emerge strong and healthy one way or another. Oh, isn't that the irony? How terribly miserable to be the slave of someone else's opinion of you when you know that opinion to be false!

From the desire of being approved, deliver me, Jesus.

Wednesday, October 12, 2016

A Picture of My Kids

A while back I got freaked out because it seemed like some traffic from porn sites was being forwarded to my blog. I guess when you're talking about vaginas and all the other stuff that goes into making a baby, you're bound to get a few weird hits. So I had a couple pictures where my boobs might have been partly showing because nursing, and those had to go for sure. But I ended up deleting every single photo on the site, save the one on my "About Me" page, and I've been hesitant to post any others. I don't know, some days it feels like there are people who are just so gross that even the most mundane things get them started on dirty jokes or worse.

But I think I've decided that I just can't resist showing you a picture of those four sons I have. You know the healthy ones that I keep talking about? Well, none of them are babies anymore, even though I can still remember their births like it was yesterday.


 In order: The Scholar is age 2, The Pious One is age 7, Braveheart is age 5, and the Statesman is age 4

Here they all are, eating ice cream, for the first time that day. (I'm the one that has diabetes, not them, okay? I ate no ice cream that day, unless my blood sugar was low at 1:00 am. And yes, I do check their blood sugar with some regularity just to make sure. I will also happily check your child's blood sugar if you're worried about diapers that seem wetter than normal lately!).

Aren't they cute? People ask me all the time when we're out in public, "Are they all yours?" Sometimes I can't believe they all are!

Sunday, October 9, 2016

Week 32: From the Desire of Being Esteemed, Deliver Me

These last few weeks have been so extremely normal, and it has been good. There were a few days when I could not get out walking in the morning, and since my insulin regimen depends quite heavily on about an hours' worth of walking between 5:30 and 7:30 in the morning, it really threw me off for a couple days. "But," I thought to myself, "as with most diabetes-related things, this probably feels worse than it actually is." I jumped back into the walking, then went to visit the maternal-fetal specialist late in the week, and got some really bad news.

Baby has jumped up in growth percentile, from just under 50th to 80th. In addition, they insist that his chest measurement - the one they use to distinguish a big baby from a baby that's big due to diabetes (macrosomic) - is excessively high (97th percentile).

My A1C was, as of Thursday, 5.9%. This is somewhere around where my A1Cs have been during all my pregnancies. I have always started out pregnancy with a somewhat high A1C. My first pregnancy was over 8.0%, and this one was 7.1%. My all-time lowest pregnancy A1C was 5.2%. This fabulously low A1C occurred during my third pregnancy, and if I'm honest, I will say that was one heck of an uncomfortable second trimester. Most of them have been under 6.0% I think, but probably a few in the low 6.0%s too. I don't remember every single one; I guess because it never seemed to matter so much before.

So the A1C is at the high range of normal, but not that much higher than what I've had before. The news of a big baby was a huge blow. But wait a minute, what's the problem with a big baby? I've actually delivered mostly kind of big babies, and mostly kind of fast when it gets to the pushing-out part. All of them were over 8 pounds, and one was 9 and a half. No one has gotten stuck. Three of them had slightly low blood sugar after birth but recovered just fine. So what's the problem again?

The problem is that suddenly the perinatologist seems to be calling into question my ability to take care of myself and make good choices for my baby, and that makes me more angry than I can even put into words. Two weeks ago with the perinatologist, it was, "I trust you. I wouldn't trust everyone, but I trust you." That was when the baby appeared to be in the 50th percentile. But did you catch the sub-text there? "I wouldn't trust everyone [with their own health, or the health of their baby]. But I trust you [right now, or at least this week]."

Then this week, the perinatologist and I had a discussion about how frequently I will be going to see them for monitoring now that I'm approaching the end of my pregnancy. I insisted that I will not come in more frequently than once a week - in other words, on the same schedule that I'm coming to see the obstetrician who will deliver, and on the same schedule that I came in for all my other pregnancies - because I simply do not find any benefit to these anxiety-producing tests which have never told me anything of value about any of my babies. It's too far to drive, too much sedentary time in the car, too much money to pay a babysitter, too much money to pay out of pocket after insurance gives their due, and most importantly, could still leave me with a dead baby at the end of it all. In fact, none of my babies were about to die and were saved, none of my babies were very sick and needed to be induced immediately, none of my babies were too big to be delivered full-term without a c-section. Nothing of importance has been detected by these tests at any time, in any pregnancy, except that my babies and I are pretty healthy. But now that I have a baby that has now appeared to increase in size significantly, the comment from the perinatologist was, "Well, I'm just trying to make sure you have a healthy baby." Did you catch the change in the sub-text? "Well, I'm just trying to make sure you have a healthy baby [and I'm not sure whether you can or whether you care to]."

This is infuriating for several reasons. First of all, because I ALREADY HAVE, AND I GUARANTEE YOU THAT I CARE MORE ABOUT THE BABY'S HEALTH THAN YOU DO. I HAVE HAD MANY HEALTHY BABIES, AND DON'T YOU KNOW THAT NO ONE CARES ABOUT A BABY'S HEALTH MORE THAN A MOTHER. Okay, off caps. Second of all, because none of these tests have ever told me anything of value about any of my babies, and believe me, I've been through a lot of them. Third of all, are we allowed to consider that your measurements are wrong if they have suddenly changed in the course of a month even though I haven't been doing anything different with my blood sugars? I know for a fact that ultrasounds technicians don't always do their job correctly. One time they told me that my baby was in the third percentile and he was actually in the 35th. And fourth of all, is it possible that when you see the "diabetic" label on my chart, you might actually be looking for evidence - perhaps even to the point of drumming it up - to confirm what you suspect is true of diabetics? That we are fat people who eat too much, don't exercise, can't take care of ourselves and therefore have babies that are too big?

Grr...er, I mean, I have a list of several things that I am telling myself to keep calm.

"You have delivered a big baby before."
"You are doing everything that your doctors have recommended for your blood sugars (walking per the OB, using the CGM per my desire to have more blood sugar information to help me make decisions, not letting them get so low as they did in other pregnancies per the endocrinologist)."
"You are doing your best to eat with precision, not overeat, and eat the right kind of foods."
"Ultrasounds and doctors can be wrong about the size of a baby."
"Your A1C is still technically within the normal range of 4.0%-6.0%, even though it's at the top of that range."
"Some babies are just big."
"This baby's father was 9 pound 3 ounces at birth."
"Extra monitoring at the end of pregnancy has never been correlated with a reduction in stillbirth for diabetic mothers. Babies can die 24 hours after passing these tests with flying colors."
"Your sensor goes for days at a time without topping 130 mg/dL."

But I tell you what, I can say these things to the perinatologist pleasantly, firmly, confidently, with a smile, and repeatedly until I'm blue in the face and I still don't get the sense that it matters one iota to them. It does not change his mind about what he thinks are the most important facts: that I am a diabetic, need extra testing, probably can't be trusted to have a healthy baby, and that was just confirmed by (what might be an inaccurate) ultrasound reading (though it's totally offensive to ask such an impolite question with the technician in the room, because her feelings and sense of competence must be respected at all times!).

From the desire of being esteemed, deliver me, Jesus. I do not need a perinatologist's respect to deliver a health baby.

From the desire of being praised, deliver me, Jesus. I do not need the perinatologist to tell me that I am doing a good job to grow a healthy baby.

From the fear of being suspected, deliver me, Jesus. The perinatologist can suspect whatever he likes, but the data about baby's size and whether it will be a problem for me to delivery vaginally is far from definitive and clear.

From the fear of being wronged, deliver me, Jesus. The perinatologist may slander me all he wants in his mind and soul, but this baby is still mine and I am perfectly capable of making him healthy and strong and giving birth to him in the same manner.

For now, just in case, I'm doubling down on letting those blood sugars dip low. I'll spend long periods of time low overnight. I'll spend long periods of time low while I try to bring it up very slowly and incrementally. Whenever I suspect that I might be able to go through a 3.0-5.0 unit blood sugar spike, I'll give a bolus, even though it may mean I'm chugging juice an hour or so later. Whenever I'm at home and think I can afford to spend a little more time with a low blood sugar because I'm near food and I can lie down if I have to and worst-case scenario my kids can call my husband to come home and take care of me [NB: this worst-case scenario never actually happened, I walk the low blood sugar line pretty well and have done it lots]...I do it. This has the unfortunate effect of making me angry at endocrinologists who insist that my low blood sugars are too dangerous. What am I supposed to do if the endocrinologist thinks it's too low but the perinatologist thinks the baby is too big? There is not a lot of wiggle room in here, folks. Not a lot of wiggle room. It's like the ideal A1C is somewhere between 5.5 and 5.7. NOT A LOT OF WIGGLE ROOM.

So I'm not in a very good mood this week. I feel fat every time I look in the mirror, even though I haven't gained an unusual amount of weight (31 pounds over my starting point). I feel grouchy at all doctors who have ever given me advice about anything diabetes-related. I know somewhere in the back of my mind that this will probably not matter in the slightest about two months from now, but...I'm grouchy, that's all. Thanks for listening, I think?

Sunday, September 18, 2016

Week 29: Anxiety and Rest

Pregnancy has, blissfully, continued to be boring these last two weeks. Two weeks ago saw me at the office of the maternal-fetal specialist with nothing to report except a perfect health score for my baby. He's got a name now, a couple great godparents, a baptism date, a place to sleep, and a borrowed infant bouncy seat to rest in provided he'll let me put him down at all during the first few months and his 2-year-old brother doesn't show his affection with excessively strong gestures. (Clothes to wear will be forthcoming as soon as I can find the box in the basement).

But the stakes are so high with pregnancy that it can often feel like a constant test or a disaster that is just about to happen. By this point in pregnancy (30 weeks), I know women who have miscarried, mothers who have given birth to children with severe defects, babies that have suffered a fight for their lives because they were born too soon, women who have given birth to children they already know have died, children that have died during labor, children that have died shortly after being born. These are not simply stories that I have heard about women I do not know personally, and they are not stories about women who are otherwise at risk for any complication with their pregnancies. They are healthy women, and they are women that I know: friends, neighbors, acquaintances, family members. These stories are everywhere you turn, at least if your friends have as many children as mine do and you have the habit of asking (politely) probing questions about your friend's experiences with motherhood.

So the more time I've spent listening to stories about pregnancy and birth, the more sober I become about the whole process. The rewards are very great, but so are the risks. And the fear associated with these risks is something that has not left my side for long during this particular pregnancy. My pregnancy has been the picture of (physical) health since the very beginning. It is has not varied dramatically from any one of my other pregnancies, at least as far as pregnancies can be measured through blood pressure numbers, A1Cs, weight gained, baby's growth percentiles, and so forth. Each one of my other pregnancies turned out well, and I have no concrete reason to believe that this one will not likewise turn out well.

If you've read my posts, you'll notice that I have tended to blame my doctors for the extra anxieties attached to my pregnancies. While I've written a great deal about that, I still don't think that quite tells the whole story. Every doctor has to be on the lookout for complications; that's just a hazard of the job. Perhaps I could blame whatever existing anxiety and depression I had prior to the pregnancy for my present anxieties. But I also don't think that tells the whole story, since the anxieties I had prior to pregnancy related to my competency as a mother, not the terrible things which happen to women and their children that cannot be attributed to anyone's competency or lack thereof. I suppose it could be thought of as a premonition of some terrible way in which this pregnancy will end. But I have not received any special revelation about this baby and this pregnancy indicating an unfortunate outcome here, unlike St. Joan of Arc (whose biography is well worth reading. See! I'm so relaxed I even have time to cultivate my interior life by reading!).

For now, it simply remains a curious fact of this pregnancy that I am exceedingly aware of everything that could go wrong...and still, nothing has. Nothing! Baby has a name, some great godparents, a perfectly average size, all major organs in their proper places, brothers that are very excited about his arrival, a tiny little basket lying on the floor next to my bed, and some clothes somewhere in this house which will be pulled out by the time he is.

There is, at least, some rest from the anxiety to be found in those facts.

Wednesday, September 7, 2016

The Power of Experience

The more pregnancies I go through, the more I pity Type I diabetic women going through their first. By trying to describe my experiences, I want more than anything to help other Type I diabetic women who have never done it. I want to help them avoid some of the worst and most unnecessary anxieties that might be imposed upon them by their doctors, by their medical history, by the world around us which finds children somewhat detestable at times, and by the very real dangers that accompany this journey of motherhood we find ourselves on.

The other day, I realized that, towards this goal of reducing anxiety for Type I diabetics, I now have something that probably most obstetricians might not even have. I have experience, from start to finish, with four whole Type I diabetic pregnancies. I was going to do some statistical analysis, but I think I'd just screw it up. So I'll simply note that there are not that many Type I diabetics in the U.S., and an even smaller proportion of them are women of childbearing age. Not very many of those women will have more than one or two children, at least in part because doctors have a way of making pregnancy so frightening and unpleasant for women with high-risk conditions like Type I diabetes. That means that there just aren't many Type I diabetic pregnancies for obstetricians to observe.

Maternal-fetal specialists probably have more experience, because they only see women with high-risk conditions. But they also don't follow pregnancy all the way through delivery. They never really get the whole picture. I have never returned to a MFM after delivery to tell them how awesome everything turned out. They have no idea that all the fretting and anxiety about all the things which might possibly go wrong never came to fruition, and that the upshot was an awesome and normal little kid.

So if I have any power at all, during these days when my physical strength is waning, it's the power of my experience. I wish I could give this power to every Type I diabetic who has ever contacted me, either on the blog or over e-mail. I wish I could tell you that everything will turn out fine, as it has for me, after every single one of my anxiety-filled pregnancies. I wish I could tell doctors a few simple ways they could avoid freaking out and over-burdening their Type I diabetic moms. I wish I could give you a healthy, positive pregnancy and delivery experience with a few strokes on the keyboard. 

I know that some things cannot be given except by living them, and I know that not everything turns out fine every time, and I will certainly not be there to help you in the delivery room when you need to make important decisions for yourselves and your babies. But if there is any question you have about diabetes and pregnancy, please feel free to ask! I don't have much, but I do have the power of my experience, and perhaps something I've learned may help you, too.

Sunday, September 4, 2016

Week 27: Rules, Rules, Rules

So on Wednesday, I was frustrated by all the rules that I've been given by my OBs and endocrinologists over the years to (apparently) have a successful and healthy pregnancy. I've given a bit more thought to this question over the last few days, as I'm not one to simply reject rules just because I'm struggling to implement them.

Last night, I thought I was frustrated because my children were running into the kitchen, not cleaning up the house like they'd been asked and like we do at the end of everyday, and occasionally throwing things in my vicinity while I was trying to heat something up on the stove. (You know, like most days). But what shocked me was when my husband came into the kitchen, asked me what he could do to help get dinner prepared, and I simply exploded:

"I just can't do it all! I can't get my postprandials below 130, hit a fasting 60-90 target, walk for 30 minutes every day, and keep my weight gain between 25 and 35 pounds. She just needs to pick two! I can't do all of them!"

It turns out that having stuff thrown at me while I'm trying to sear meat at a high heat in a pan on the stove top bothers me much less than it used to.

So anyway, after identifying the real source of the stress in my life these days, I realized something. The problem with these rules is the complicated relationships between them.

For example, following walks, I tend to get unpredictable lows that last for long periods of the day. I can at least guess that they will probably last for a little while after the walk, but I don't know ahead of time exactly how long they will last, nor do I know how deep they will go. Setting a temporary basal, under these conditions, is total guesswork that's usually wrong. That means the most reliable solution is to keep eating small amounts all day long to keep my blood sugar up. But in that case, I'm just making up for calories burned by consuming those same calories at a later time in the day. If these walks are for the sake of my weight gain, it's a total fail. And it's occasionally setting me at low blood sugar levels that are rather debilitating for hours at a time.

Following walks, I also get unpredictable spikes in my blood sugar. They sometimes happen at lunch, sometimes happen at dinner, and sometimes happen at night. If the spike happens over night, then my fasting blood sugar will be off in the morning. If the spike happens between meal times, I have a hard time remembering what was a meal spike and what was a random glycolysis spike between meals when I look back over my graphs. And if I'm hanging out at a low blood sugar level for hours, and then I finally get sick of it and eat just a little more than the tiny bit that I normally eat to correct, then I can't tell if it's a meal spike, a random glycolysis spike between meals, or a rebound/low blood sugar correction error.

The final kicker is that none of these things happen in anything like what we can call a regular pattern. Believe me. I've been watching for it. Have I had three days these last two weeks in which a consistent pattern has emerged? No. Several different patterns have emerged (spikes between lunch and dinner, spikes after dinner, spikes at 1am, spikes at 4a, lows at 4a, lows at 1a, lows before dinner), but nothing that I can reliably change my insulin rates to accommodate. Because I just can't make a pattern to accommodate both lows and spikes at 1a, both lows and spikes before dinner.

Whether these walks my OB has prescribed are meant to control for weight gain or blood sugars, it's accomplishing neither.

I should probably be reassured by the fact that there is absolutely nothing wrong with me or this baby except that I am so absurdly anxious about these rules. And I've also had four healthy babies already. I still spend a good 12-18 out of 24 hours at or below fasting level, between the time spent with low blood sugars and those times when the spikes are not happening. The highs are never above 230 mg/dL, rarely above 200. I can only hope my A1C is staying where it's supposed to be. But the principle remains: the rules, as they've been communicated to me, are simply not working. They're stressing me out, and they don't work in concert with one another. Maybe it's more nuance that I need. How many postprandials below 130 mg/dL are expected in a week? What's an acceptable range of error? Once per day? Three times per week? How many mornings during a two week period do I have to wake up between 60 and 90 mg/dL to affirmatively answer the question, "are your fasting blood sugars between 60 and 90 mg/dL?" Is 10 out of 14 enough? Why are the doctors still wondering whether I'm handling this properly? And why am I still second-guessing the judgments that have gotten me successfully through four other pregnancies?

Wednesday, August 31, 2016

The Rules Are Not Working

Now that I've had a CGM long enough to observe my blood sugar patterns following certain kinds of meals and certain kinds of exercise or activity levels, I've learned that many of the rules that have been given to me over the years about where my blood sugar should be at what times simply do not work. Or at least, they don't work in an absolute way. Or there are so many exceptions to them that it's not really a rule any more. Or I can't achieve them with the tools currently placed at my disposal. Or something. This is especially true during pregnancy.

The "rules" I'm referring to are threefold:

The first is the rule about waking up with my blood sugar at 60-90. My "fasting" glucose. I put "fasting" in quotes because do you have any idea how often I have to eat during the night to bring my blood sugar up from a low? I have tried to explain to doctors that sometimes my "fasting" glucose is more of a reflection of the blood sugar drama of the night before, and may have as much to do with a correction bolus given at 3:00 in the morning following a midnight snack as it does with the accuracy of my basal rates. And do they know how weird my basal rates get during the night, in an attempt to prevent the midnight low, and how hard it is to get that right in the first place? Furthermore, I spend a good percentage of daytime hours at or below fasting level when I'm pregnant, because I limit my carbohydrate intake to avoid blood sugar swings and because I tend to err on the side of low rather than high. That means that if I'm at 130 mg/dL all night because I can't otherwise figure out how to keep my blood sugar from dipping too low while I'm asleep, baby still gets his fasting blood sugar time and I get a good night's sleep. I assume that the 60-90 mg/dL number comes from non-diabetic women, which I am not, and which I have not been for 23 years. So I am henceforth excusing myself from following this rule.

The second is the rule about postprandial targets (one hour after a meal aim for 130 mg/dL, two hours after a meal aim for 120 mg/dL). During my first pregnancy, I tested my blood sugar 12 times a day in order to monitor all these values, and by the middle of the second trimester, I had determined that a one-hour postprandial of 130 mg/dL was impossible unless I wanted to be at 75 mg/dL and falling two hours later. Which I didn't want to be. So the way I left it is that I would shoot for below 130 two hours later, and I would just eat less frequently and fewer carbohydrates to avoid the BG spikes altogether. However, this has still left me with so many low blood sugars that my endocrinologist didn't like to let me manage my own BGs during pregnancy, I could have drowned in a bathtub when I decided to clean the remains of my thrown up dinner off my skin while my blood sugar was somewhere below 30 mg/dL, and I one time drew blood scratching my husband's hand when he tried to force-feed me Gatorade during a nighttime low BG episode. So I haven't worked out what my new 2-hour postprandial target will be, but I have a feeling it's going to have a lot more to do with where my BG started when I began the meal and how the curve on my sensor screen looks or should look. Otherwise these numbers - which are also probably based on blood sugars for non-diabetic women, a fact which has not been true about me for 23 years - haunt my imagination every time I go to adjust my basal rates or bolus ratios. I've also sometimes wondered whether synthetic insulin works differently enough in a diabetic's body that taking postprandial targets for women who produce insulin naturally simply places an unfair burden on a diabetic using the synthetic stuff.

The third rule is about bolus insulin/basal insulin percentages: that you're supposed to be giving 50% of your insulin by basal rate and 50% by bolus. I mess with my basal rates too often: during and following hard exercise, following a big meal, during sedentary periods on Sundays and travel days and sick days and all the rest. I use a combination of temporary basals and square correction boluses for this, and the numbers are just bound to work out incorrectly when I look at the percentages on my pump. I suppose I could use more temporary basals instead of square correction boluses to fix this problem and increase the percentage of basal rate insulin that it appears I am delivering, but somehow it feels easier to say I need to add 2-3 units over the next 2 hours than to calculate percentages to increase my basal rate (what is it again?). So I am going to do my best to not worry about this one anymore, either.

The only real rule I follow is that I'd like my A1C to be below 7.0 apart from pregnancy, and below 6.5 during it. I think that's manageable, and it leaves me a lot more room to experiment and try things out for a few months, rather than a few days. I'm not sure I should be held to non-pregnancy blood sugar rules on a day-to-day basis, as long as my A1C shows that I'm averaging out somewhere close to normal. Somehow I've been able to have 4 healthy babies and I haven't ever been able to follow the rules precisely. So I'm at least doing enough right to make it work out, right?

But I am looking for a new set of rules. Have you found any blood sugar management rules that just don't work for you? Managing my blood sugars without rules is a bit of a trial. Suggestions you've heard from your care providers, or that you've discovered on your own by tweaking your pump settings and observing CGM trends, are welcome!

Sunday, August 28, 2016

Week 26: It Does and Does Not Get Easier

This week I became overwhelmed by the thought that I would have to do this for another three months. Three months! I have the whole third trimester ahead of me. Traditionally, the third trimester has been the most difficult for me. Random ligament and joint and muscle pains, an inability to get good sleep, the frustrating grind of daily life which does not cease simply because my baby is taking up more and more room in a space that simply cannot go on expanding to accommodate him.

There are a few things that have gotten easier throughout five pregnancies. I know that so many pains the come because of pregnancy and labor likewise pass away. I've got a few tricks up my sleeve for keeping my blood sugars normal and my A1Cs down. I know some things that one should really freak out about (postpartum hemorrhage) and some other things that one really needn't worry about (babies with only one kidney). One is that I do not feel the need to apologize when other people have to accommodate my weakness. When I need someone to open the door a little wider so I can fit through, or when someone needs to slide their chair a little closer to the table so I can squeeze behind, or when someone has to walk a little slower so I can keep up, or when someone has to bend down and pick up something that I dropped because I simply can't get down there anymore. These things do not make me blush with shame. Some may resent me for it, some may appreciate the everyday opportunity to care for another human being, some may mock me, and I may wish that I were at the height of my strength so I could avoid the inconvenience it causes others. But I know that this will pass, that it's not a bad thing for other people to notice and meet the needs of a pregnant woman, and a great number of people become weak at the end of their lives and never recover, requiring compassionate care for months or years until their natural deaths. So I do not feel ashamed of my weakness.

But on the whole, I would not say that having babies really gets any easier. Why is this?

I was one time at a doula training. In a room full of two dozen women dedicated to natural childbirth, only a handful of these women had delivered their babies without an epidural. One woman, in particular, stood out, because she had given birth to nine children at home with a midwife. Nine babies! Nine epidural-free deliveries! She was the subject of much awe. This mother's experience took center stage one afternoon when another would-be doula asked her whether she was still afraid of giving birth, or whether she was just so accustomed to it that it was like no big deal. Chuckling and blushing, she said no. No, she still approaches birth with fear and trembling. It's too different, too important, and too intense to ever treat like it's no big deal. At the time, I couldn't possibly understand this. Hadn't she seen just about everything she could see during a pregnancy and labor so that she would feel absolutely confident in doing it again? Hadn't she experienced such a quantity of pain that no pain could ever again frighten her?

But now that I am enduring my fifth pregnancy and approaching my fifth labor, I realize how what this mother said can be true. I have known pain, and fear of the pain of childbirth doesn't own me. I did, after all, agree to a second, third, fourth, and fifth pregnancy. But it does not mean that I am not still afraid of the pain. Furthermore, I've heard countless women's birth stories and pregnancy tales. I've got my own to add to the bunch. But rather than giving me a sense of security about it, all it means is that I know just how high the stakes are. Sometimes seeing it so many times just tells you how many things have to go right for a woman to end up with a healthy baby at the end, and how important it is to the mother, the father, the doctor, the baby, their friends and family that baby and mother come through it unharmed. That truth gives me some pause and a sense of trepidation in the face of this monumental task.

To put it more simply, a friend one time asked me if it doesn't get easier? I answered, honestly, no. No, it doesn't get easier. You just grow accustomed to, and you stop raging against the fact of, being tired and in pain. I like to think it's humility, not cowardice, that keeps me from facing it without some fear and trembling...

Sunday, August 14, 2016

Week 24: Vacation

We were on vacation last week in the north woods of Wisconsin, which is why I did not post anything. But, since pregnancy has been happily boring lately, there wasn't a lot to say.

During the first few days of the trip I did have another few days of really high highs, similar to the problem I had when my husband and I went away for our anniversary at the end of June. I remembered the lessons of the last episode and increased basal rates rather than bolus ratios. This worked beautifully, though I tweaked the bolus ratios a tiny bit, too, and had to work out a few kinks for a few days in the basal rates.  In fact, I've been adjusting basal rates pretty much since then. I should probably admit that I'm adjusting my basal rates slightly all the time, really. But some adjustments are more dramatic, and that's what happened a couple of weeks ago.

My current basal rate regimen has a moderate rate (0.75 per hour) for the early morning hours, beginning at the early time of 3:00a. This basal rate remains until dinner time, at which point it increases to 1.10 per hour. It drops to 0.45 in the late evening, about bed time, and stays there for the earliest part of the night, until the regular day time rate begins in what seems the middle of the night (3:00a).

I went to visit my doctors this week, too. My OB is - somewhat surprisingly - a little concerned about my weight gain. I gained 6 pounds this month, bringing me to 21 pounds of weight gain and exceeding the normal pace of weight gain throughout pregnancy. I blamed it on vacation. Since the recommended level of weight gain is 25-35 pounds, she's worried I'll exceed 35 in the next 15 weeks of pregnancy. I get it. I've written about weight gain before, especially the benefits of not gaining too much, and I can certainly imagine that excess weight gain for mom could lead to an LGA baby. I've written about this before. But I honestly don't know what more I can do. I'm eating as little as it feels is humanly possible during pregnancy, and will continue to do so, but I've also got blood sugars to maintain.

So she wants to make sure I am walking every day. I, um, kind of am, but I don't actually leave the house very often. So I was trying to explain to her how infrequently I actually sit down during the day, what with taking care of four boys and all, making sure that the crayons are staying on the paper rather than the wall and hanging diapers and helping a pre-schooler figure out which bin is the right one for the Matchbox cars and turning on videos and turning on videos and turning off videos and coming downstairs to see if anyone is bleeding and so forth. I'm not sure she entirely understood, and she just repeated her question about walking for at least 30 minutes every day. I'm also not sure she entirely understood that leaving the house when your blood sugar is hanging out between 70 and 80, with three children who don't understand traffic signs, to go out on a walk in 90 degree heat, is actually probably not very healthy. She did tell me that I was the first person she'd ever known with more than three male children, so perhaps that accounts for the lack of comprehension about my daily life. I'm just going to keep answering in the affirmative, because I am certain that I spend at least 30 minutes walking around my house during the day, and probably more like 2 hours. I might be fudging it a little, but I think it's close enough to the truth to say it honestly!

I also visited the maternal-fetal specialist this week, and he said he was perfectly happy with baby's growth. Baby is right in the 50th percentile, moving like a champ, no problems to speak of. And the placenta previa is gone. Didn't I always say that was probably a problem no one ever needed to know about? Knowledge is not always power. Just ask Eve.