Friday, December 16, 2011

OB Appointment//Limitations Due to Diabetes

I had my latest ultrasound and OB appointment yesterday, and while it wasn't super eventful, it was a little frustrating.  We found out that our little one is still breech, so she only has a couple more weeks to flip or we'll have to start discussing a C-section or an external cephalic version, neither of which are options I hoped to be considering.  For those of you who are familiar with my personality, you know that (a) I'm a slight perfectionist and (b) that I like to know as much as possible about everything that is happening to me (or might be in the future).  Because of this, I've not only read more than 20 books on pregnancy (and I'm not even exaggerating--just ask my husband, who gets exasperated by the stacks laying around the house!); I've also read another five or more books specifically on labor and childbirth--all so I can feel more prepared for what's to come.

The more I came to learn about everything, the more I realized that I wanted as natural a birth as possible with little or no interventions.  As long as the baby and I are doing well, I want to go into labor on my own and be allowed to progress naturally (i.e., no Pitocin, artificial rupture of membranes, etc.) with no stringent time limits.  I want to be able to be as active as possible during labor, with access to a birthing ball and bath/shower instead of an epidural.  Of course this means that I would forgo the usual EFM (External Fetal Monitoring) in favor of a nurse listening to the baby's heartbeat intermittently with a Doppler or fetoscope, because EFM requires you to be tethered to a machine.  Ideally, I would like to be allowed to eat and drink as needed, especially because I've had no issues with nausea during my pregnancy.  I will control my insulin pump as long as I am capable to do so.  When it comes time to push, I want to try pushing spontaneously (NOT on my back) without stringent time limits, and to risk a natural tear rather than having an episiotomy.  After delivery, I want to be able to hold the baby immediately, before any routine procedures are done.  I also want the cord to be cut only after it stops pulsating and to deliver the placenta spontaneously and without assistance.  Because I plan to breastfeed exclusively, I would ask that no sugar water, pacifiers, or formula are given unless deemed medically necessary.

I completely realize that this scenario is somewhat idealistic, and relies on everything going perfectly.  And of course, there is also that big elephant in the room that begs everyone's attention: the fact that my diabetes automatically labels me "high-risk," even if everything was to go perfectly.  Apparently, my diabetes makes medical professionals nervous, even though I've had an almost superwoman-like level of control and everything up to this point has progressed easily with no red flags...which brings me to the most frustrating part of my visit yesterday.  My OB has been fairly laid-back about everything thus far, but once we started discussing labor and delivery, it became clear that in his eyes, my having diabetes limits my options drastically.  Never mind that I've only dealt with this disease for a little over a year, or that my highest A1c to date (right after diagnosis) has been 6.5%...or that I've had absolutely NO complications to speak of--not even a hint of the possibility of a complication, or that I'm otherwise healthy.  Apparently, the fact that I (very purposefully) brought my A1c down to 5.7% (well within a normal person without diabetes' normal range) prior to conception and to 4.9% during the first half of my pregnancy doesn't matter when it comes to statistics.  Women with diabetes have a higher incidence of certain complications, and that's that.  That is what I have a problem with: I have a sneaking suspicion that when people refer to these statistics, they fail to differentiate among all of the factors and extremes of the disease.  All of us, type 1 and type 2, poor-controlled and well-controlled, those with complications and those with none, are lumped into one giant category of "women with diabetes."  Of course there will be a higher incidence of risk in such a group when these factors are not controlled for!

For that reason, I have a huge problem with being treated according to statistics instead of being evaluated as an individual.  I refuse to be placed in the same category as someone who has a very poor level of control, preexisting complications from the disease, and little interest in their health overall.  I also feel that the fact that my sister (who also has T1 diabetes and had blood pressure problems during her pregnancy) saw the same OB works against me.  Yes, we are sisters, and yes, we both have diabetes; however, we are very different in every way, least of all in regard to our individual disease.  Just because she happened to have a not-so-great outcome for her pregnancy (she delivered in late October by emergency C-section at 34 weeks due to the preeclampsia, but the baby is fine now) doesn't mean that I will.  I do not appreciate being told that "things can go downhill very fast for women with diabetes," because once again, there has been zero evidence to lead us to believe that this will be the case in my case.

I was super disheartened after my appointment yesterday, and still haven't decided what to do.  On one hand, I wonder if it's worth it to confront my OB about all of this, because you just can't change some people's minds.  On the other hand, I feel like I have the responsibility to at least try, not only for me but also for the women with diabetes that will come after me.  At this point, I'm just so tired.  It's not fair that I have to fight to be treated normally because of a disease I did not ask for, or that it would all be a non-issue if I didn't have diabetes.  I feel like I fight this fight on a daily basis in order to change the public's perception of the disease, so that I have to deal with this while trying to enjoy the last of my pregnancy seems especially cruel. Like many women with diabetes have commented, this is the one time I've truly felt limited by my disease.  If I had to have a C-section due to the fact that my baby is breech, fine--that's obviously beyond my control; but to be told that I can't have the birth experience that I so badly want solely due to my diabetes, even and especially if everything goes perfectly, is heartbreaking and extremely frustrating.  I want to be a part of changing the world's perception of this disease, but sometimes that mission can seem so futile and tiring.  Sometimes, and especially now, I just wish more than anything that I could have a normal, working pancreas.


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