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?

2 comments:

  1. I definitely understand your frustration! I feel like my high risk OB is very condescending and makes it seem that because we disagree about protocol (like how much monitoring) I must not be caring enough about my baby's health. Personally I decided to go to the appointments just because of something did go wrong I would be able to tell myself that I followed the monitoring advice but it's also my first baby so I am extra paranoid... I hope we can both find some more peace in these last 7ish weeks :) I keep telling myself that it won't matter as long as baby and I are healthy in the end but I am already thinking I will try to do it differently for the next pregnancy - how I don't know but I hope to find a good primary care who will trust me...

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  2. Ack! Grrrrrr! Arggghh!! Sucks. And man I hate the litany of humility. It always works too well...

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