My last post was a little over a month ago, but I promise I have a very good reason this time...our sweet little girl is almost four weeks old! Everything I last wrote about seems like it happened in a different lifetime, because there is now a very clear distinction between our lives before and after baby...and I honestly can't believe how quickly time is flying by now that she's here! Speaking of which, I'll fill you in on the crazy journey that was her arrival...
As most of you know, we were scheduled for a c-section on January 25th. The day before, we were supposed to go for my last ultrasound and OB visit to confirm that our little one was still breech and to go over any last-minute details and questions. However, we never made it that far...it turns out that my mom's "feeling" that she would come before then was right! Around 2:30AM on the 24th, my water broke. After waking up my husband (whose first question was, "Are you sure?"...Yes, honey, I am positive that the huge gush I just experienced wasn't courtesy of my bladder!) and calling to talk to the doctor on call, we finished up packing the last few things so we could begin the hour-and-a-half drive to the hospital. The OB I talked to told me there was no reason to rush; that once we got there, they'd just plan to call our doctor and we'd do the c-section around 7:00 that morning as long as everything looked good.
While we got our things together, however, I started having contractions...contractions that were three minutes apart. I still didn't think much of it; after all, contractions were supposed to be irregular at the start of labor, right? We got everything (and ourselves) loaded up in the car and took off. Since we didn't think we were in much of a hurry, my hubby drove 75 the whole way, just five miles over the speed limit. Meanwhile, I was trying to hold it together and deal with the pain by breathing deeply. That worked for a while, but my contractions just got stronger and stronger and were definitely closer together...they were two minutes apart and a minute long the entire way. By the time we were 30 miles away, I was having a hard time dealing with the pain; when we got into town, I was thinking that I would definitely need an epidural if I was going to go through that for a few more hours!
When we arrived at the hospital, we parked in front of the ER entrance and grabbed my file folder of paperwork out of the car. Apparently, the triage nurse could clearly tell I was in active labor, because we were admitted instantly and taken up to the labor and delivery floor (fastest ER visit I've ever had!). Once we got to a L&D room, the nurses started prepping me for surgery and asking me a million questions. I was in A LOT of pain, and the nurse starting my IV had to keep reminding me to breathe deeply. They were debating on whether or not to check me to see how much I was dilated, but decided since I'd be having a c-section there wasn't any need. Right after that conclusion, however, I started to feel some pressure. Once I told them that, one of the nurses did a cervical exam and announced that I was complete...as in, completely dilated, all 10cm! (Oh, and she was still breech...which turned out to be a blessing in disguise, because if she'd been head down, she probably would have been born on the road somewhere between home and the hospital!) At that point, things started moving a lot quicker (and they told me not to push), but I still had to sign more paperwork before they took us back to the operating room...I'm pretty sure my signature was unrecognizable as my own, but I was in so much shock at how quickly everything had progressed that I honestly didn't care! I just couldn't believe that I'd progressed from 0-60 (relatively speaking, not literally of course!) in just a couple of hours, especially since first labors are supposed to be much longer, on average...Then again, nothing about me ever seems to fall on the "normal" side of things =) Either way, it explained why I was in so much pain...which, I'll admit, did give me a certain sense of accomplishment since I wasn't sure if I'd be able to handle labor without medication!
Once we got back to the OR, they transferred me to the operating table and quickly shaved me and got everything prepped for the c-section. Luckily, the anesthesiologist was waiting, so between (super painful) contractions, he did his thing. (The spinal, by the way, was a breeze...I've had insulin pump sites that were more painful, although I'm sure it seemed a lot less so in comparison to my contractions!) I was then able to lay down, and felt one more contraction before everything from the waist down went gloriously numb. Meanwhile, my hubby was scrubbing in for the delivery. He had planned to watch the c-section, but after everything had gone so quickly, he just wanted to be by my side through it all. The nurses in the delivery room were joking that they'd have to teach him to deliver babies for our next children, since they always say subsequent labors go faster than the first--yikes!
Up to that point, I'd been wearing my pump and CGM and had been checking my blood sugar every so often so I'd know where I was. Since I had been consistently around 110 throughout labor, I wasn't worried at all about my blood sugar during surgery; however, things in that respect unfortunately didn't exactly go as planned. My doctor had given me the go-ahead to keep my pump on throughout the whole process and my CDE was going to be on site in case the anesthesiologist had any questions or problems with it, but since neither of them were there at 5:00 in the morning, I was left to hash out the details with them myself. The anesthesiologist, though very, very nice and wonderful at his job, didn't like the idea of keeping my pump hooked up, so I had to take it off. By the time I was in recovery, I think my blood sugar was around 140 (if I remember correctly). Due to that fact, our sweet little girl's blood sugar was low upon her arrival into the world, something I never thought we'd have to deal with since my control had been so good through the entire pregnancy.
Other than that, however, we were incredibly blessed to have a perfectly healthy baby girl! My husband got to watch them examine her while they stitched me up, and even got to have her little feet stamped on his disposable scrub shirt...he is so proud of that keepsake! After they cleaned her up, I got to see and kiss her before they took her to the nursery and wheeled me to the recovery room. They eventually brought her to me in there to breastfeed in an attempt to raise her blood sugar, but ended up having to give her some formula to do the trick. For the first 24 hours, they checked her blood sugar each time I fed her and had orders to give her an ounce of formula if it was low again; luckily, however, we never had to do that.
The first two nights, my blood sugar was running so low that I set a zero basal rate and stayed around 100. It's amazing how much easier my blood sugar has been to manage since delivery, other than the fact that I've had plenty of lows. I've just tried to stay on top of changing my rates accordingly, and everything has gone relatively smoothly d-wise!
I have plenty more to tell about our new life, but I'll save that for later. Right now, I'm going to enjoy holding our precious baby girl!
Saturday, February 18, 2012
Thursday, January 12, 2012
C-Sections/Delivery/Diabetes Management...It's All Reality Now!
I know what you're thinking...Two posts in one week, whoa! I'll admit, it hasn't happened much in the past several months. When you're growing a person, everything else kind of automatically and subconsciously takes a back seat to their well being! My last post was quite literally the shortest one I've ever written, mainly because I wanted to post something in the two seconds I had before I left work that day.
Any updates I could give today would mostly be reiterations from a couple of days ago; however, I did want to share that after my ultrasound and doctor's appointment yesterday, we are officially scheduled for a c-section on January 25th. Yes, our sweet little girl is still in the breech position, and call it mother's intuition, but I just don't see her turning anytime soon. After weighing our options, the hubby and I decided that opting for the c-section was the best decision for us simply because version seems like such an impossibility at this point...I honestly believe that due to the same reason she's still upright in there--according to the OB, my ab muscles are still pretty tight, which means that (a) my belly isn't very big for being nine months pregnant and (b) she just doesn't have much room to move. Of course I know this because her head has been jabbing me in the rib off and on for the past couple of days! Oh well, it's a pain that is well worth enduring =)
I also discussed what would happen immediately following delivery with my OB, and he said that as long as the baby is okay, they should be able to bring her to us while I'm in recovery...something that's very important to me since I plan to breastfeed. He and I both believe that the low blood sugar common in babies born to mothers with diabetes should be a nonissue for us, especially because the surgery is scheduled first thing in the morning, when my blood sugar is normally hovering around the 60-70 range. They'll check it nonetheless, though. [For those of you who are unfamiliar with this phenomenon, it goes something like this: When the mother's blood sugar is higher than normal, the baby's body also produces insulin to process the additional sugar. When the baby is born, and therefore no longer has that additional sugar to process, their own blood sugar drops from the excess insulin they've produced.]
In addition, I asked my OB about the necessity of the antibiotic eye ointment that is usually given following delivery. It just didn't make sense to me for them to do it following a c-section if the reason it's given is to prevent the transmission of STDs and other infections to the baby's eyes during a vaginal birth...therefore, the c-section eliminates this possibility entirely. The reason this even matters to me is because again, I want to try to breastfeed as soon as possible following delivery, and the eye ointment makes the baby's vision blurry for a while--thus having the potential for interfering with breastfeeding and bonding. My OB said that he didn't think they'd have a problem with not doing it, but that I'd have to tell them because it's pretty much standard protocol following every delivery.
What else?...Oh yeah, I asked him about returning to exercise following a c-section. I'm sure I won't be as worried about that a few weeks from now, but I figure that if I at least think about it, there's a possibility I'll actually do it much sooner than if I put it out of my mind. Believe it or not, I do miss the feeling of running, because I haven't been physically able to for the past nine months due to various reasons! The closer I get to delivery, the more amazed I am by that woman who gave birth after running a marathon a few months back...granted, she walked half of it, but that's a whole 13.1 miles that she actually ran! My hips and other joints hurt just getting out of bed in the mornings, so I can't imagine what they'd feel like after that kind of challenge!
Diabetes-wise, my CDE contacted me last week to discuss the changes I should expect in regards to my insulin needs following delivery. I told her I couldn't believe how much insulin I've been using recently compared to pre-pregnancy...that whole "your insulin needs will double or even triple by the end of pregnancy" thing? It's true. Mine have slightly more than doubled, and even though I knew it was to be expected, it's still shocking to see the amount of insulin I use now versus before! Not that it matters much (other than having to have my insulin refilled much more often)...it's just weird to me. Anyway, my CDE said my insulin needs will at least be cut in half post-delivery, and that hypos are going to be a possibility. I wouldn't be surprised if they're a reality, especially since I'll be nursing.
I mentioned it last time too, but I have to say it again...these last weeks seem incredibly strange time-wise. During the day, I have a hard time focusing on anything at hand because my "before the baby gets here to-do list" is constantly running through my mind, and at the end of the week, I can't believe how fast time has flown. It's a weird, weird dichotomy to be caught in the middle of. At least at this point, I can start the countdown to being able to take off work...just four more business days left, and I have an ultrasound appointment on one of them! I have two ultrasounds next week along with an OB visit and an appointment with my endocrinologist, so I have a feeling I'm going to be doctored-out by the time the week is over...but I guess I can't complain too much, because my OB has let me slide in that regard so far! In the beginning, he told me that since I was high-risk, I'd have to see him twice a week at the end, but he's only made me come once a week up to now since everything has gone so well...and because we live two hours away. Even going weekly wears me out, so I can only imagine the toll twice-weekly visits for an entire month would take! Well, I guess I better go...the work day is finally over, so I'm going to go home and relax a bit!
Any updates I could give today would mostly be reiterations from a couple of days ago; however, I did want to share that after my ultrasound and doctor's appointment yesterday, we are officially scheduled for a c-section on January 25th. Yes, our sweet little girl is still in the breech position, and call it mother's intuition, but I just don't see her turning anytime soon. After weighing our options, the hubby and I decided that opting for the c-section was the best decision for us simply because version seems like such an impossibility at this point...I honestly believe that due to the same reason she's still upright in there--according to the OB, my ab muscles are still pretty tight, which means that (a) my belly isn't very big for being nine months pregnant and (b) she just doesn't have much room to move. Of course I know this because her head has been jabbing me in the rib off and on for the past couple of days! Oh well, it's a pain that is well worth enduring =)
I also discussed what would happen immediately following delivery with my OB, and he said that as long as the baby is okay, they should be able to bring her to us while I'm in recovery...something that's very important to me since I plan to breastfeed. He and I both believe that the low blood sugar common in babies born to mothers with diabetes should be a nonissue for us, especially because the surgery is scheduled first thing in the morning, when my blood sugar is normally hovering around the 60-70 range. They'll check it nonetheless, though. [For those of you who are unfamiliar with this phenomenon, it goes something like this: When the mother's blood sugar is higher than normal, the baby's body also produces insulin to process the additional sugar. When the baby is born, and therefore no longer has that additional sugar to process, their own blood sugar drops from the excess insulin they've produced.]
In addition, I asked my OB about the necessity of the antibiotic eye ointment that is usually given following delivery. It just didn't make sense to me for them to do it following a c-section if the reason it's given is to prevent the transmission of STDs and other infections to the baby's eyes during a vaginal birth...therefore, the c-section eliminates this possibility entirely. The reason this even matters to me is because again, I want to try to breastfeed as soon as possible following delivery, and the eye ointment makes the baby's vision blurry for a while--thus having the potential for interfering with breastfeeding and bonding. My OB said that he didn't think they'd have a problem with not doing it, but that I'd have to tell them because it's pretty much standard protocol following every delivery.
What else?...Oh yeah, I asked him about returning to exercise following a c-section. I'm sure I won't be as worried about that a few weeks from now, but I figure that if I at least think about it, there's a possibility I'll actually do it much sooner than if I put it out of my mind. Believe it or not, I do miss the feeling of running, because I haven't been physically able to for the past nine months due to various reasons! The closer I get to delivery, the more amazed I am by that woman who gave birth after running a marathon a few months back...granted, she walked half of it, but that's a whole 13.1 miles that she actually ran! My hips and other joints hurt just getting out of bed in the mornings, so I can't imagine what they'd feel like after that kind of challenge!
Diabetes-wise, my CDE contacted me last week to discuss the changes I should expect in regards to my insulin needs following delivery. I told her I couldn't believe how much insulin I've been using recently compared to pre-pregnancy...that whole "your insulin needs will double or even triple by the end of pregnancy" thing? It's true. Mine have slightly more than doubled, and even though I knew it was to be expected, it's still shocking to see the amount of insulin I use now versus before! Not that it matters much (other than having to have my insulin refilled much more often)...it's just weird to me. Anyway, my CDE said my insulin needs will at least be cut in half post-delivery, and that hypos are going to be a possibility. I wouldn't be surprised if they're a reality, especially since I'll be nursing.
I mentioned it last time too, but I have to say it again...these last weeks seem incredibly strange time-wise. During the day, I have a hard time focusing on anything at hand because my "before the baby gets here to-do list" is constantly running through my mind, and at the end of the week, I can't believe how fast time has flown. It's a weird, weird dichotomy to be caught in the middle of. At least at this point, I can start the countdown to being able to take off work...just four more business days left, and I have an ultrasound appointment on one of them! I have two ultrasounds next week along with an OB visit and an appointment with my endocrinologist, so I have a feeling I'm going to be doctored-out by the time the week is over...but I guess I can't complain too much, because my OB has let me slide in that regard so far! In the beginning, he told me that since I was high-risk, I'd have to see him twice a week at the end, but he's only made me come once a week up to now since everything has gone so well...and because we live two hours away. Even going weekly wears me out, so I can only imagine the toll twice-weekly visits for an entire month would take! Well, I guess I better go...the work day is finally over, so I'm going to go home and relax a bit!
Tuesday, January 10, 2012
The Shortest Blog Post I've Ever Written
It's getting down to the wire, and it seems like I'm constantly busy these days! For that reason, I decided I'd sum up the past few weeks' updates in a short blog post...Undoubtedly the shortest one I've ever written! So here it is:
- Baby is still breech.
- Because said baby is still breech, we are tentatively scheduled for a c-section in two weeks.
- I've come to peace with all of this, because as I decided in my last post, there are some things you just can't control!
- Diabetes management is still going well...not like super amazing or anything, but good enough.
- We've almost finished the nursery, and our shower is scheduled for this Sunday, when I'll be 37 weeks!
- I finally discussed my maternity leave with my bosses/parents, so now I know what to expect as far as that goes. Thankfully I'll have six weeks off after she's born to enjoy her!
- I've been getting things done, but it always seems like for everything I get accomplished, something else pops up for me to do...oh well, such is life =)
- The last couple of weeks feel a lot like a kid waiting for Christmas...it seems like time is just crawling by, even though I know it's going to fly in retrospect!
I think that pretty much sums it up, so until next time...=)
Friday, December 23, 2011
Giving Up Control
I wrote last week about my OB appointment and my disappointment at the prospect of a birth experience that was nothing close to what I'd imagined thanks to the fact that I'm automatically high risk due to my diabetes. Since then, with a lot of thinking and a new perspective (thanks, hubby!), I've come to realize that (a) I can't control everything, in life or labor; and (b) as important as the idea of the labor and delivery experience is to me, it really doesn't matter as much as having a healthy baby in the end.
Of course, all of this may be a non-issue if she doesn't head south pretty soon. I had another ultrasound (which was a Biophysical Profile, or BPP) the day before yesterday, and while it did go super fast since she was moving, responding, and "breathing" like a pro, she was still breech. Since I'm at 33 weeks right now, we have just a couple more weeks for her to turn (until week 36) before we'll have to think about an external cephalic version in which the doctor attempts to turn the baby manually. If you're curious (like I was) about what this procedure looks like, here's a video to help you visualize it:
The problem is, it's not only supposed to be uncomfortable; it also only has a success rate of about 58%. And, of course, there are several factors that make it less likely to work, of which I have at least a couple. My OB said that because this is my first pregnancy (and, therefore, my ab muscles are still tight) and since my fluid level is on the lower side of normal, there is a greater likelihood that a version attempt wouldn't be successful. For that reason (along with the already low success rate), I'm wondering if it's even worth it to try. There are, of course, risks associated with the procedure as well, and although they're rare, they are pretty scary: placental abruption (which causes bleeding), uterine rupture (yikes), and premature labor due to rupture of the membranes.
At this point, I suppose it's just a waiting game. If she turns on her own (Note to baby: Please do!), we won't have to worry about the alternatives. If not, we'll have to go from there. If anything, mentally dealing with these prospective outcomes has made me a lot more flexible in terms of my expectations of labor and delivery...There is definitely something to be said for giving up control and going with the flow! Of course, I should realize all of this by now. As anyone with diabetes knows, you can only control so much when it comes to your body; the rest is up in the air. Even eating and doing the exact same thing on two different days will produce different blood sugar results, and sometimes you just can't predict how your body is going to respond to certain things.
Even so, there comes a point when you realize that there are some things you can control, and all you can do is your best when it comes to those things...and the rest? Well, you just hope that it all leads to stable blood sugars. If not, you correct it and go on. That perfect balance is so hard to find, and impossible to have all the time. It's probably one of the most frustrating things about this disease, and leaves you feeling like you're playing a huge guessing game (see also: S.W.A.G. Bolus). Either way, you learn to live with it (and accept it)...eventually...most of the time.
So the moral of today's story is that, as with diabetes, there are just some things in pregnancy (and life) that you have no control over...and the best thing you can do to keep yourself sane is to accept it and go with the flow. Otherwise, you'll end up like I do a lot of the time: pulling your metaphorical hair out over things that you have absolutely no influence over, and usually not realizing this until you're metaphorically bald. Hopefully this time I can follow my own advice. ;)
Of course, all of this may be a non-issue if she doesn't head south pretty soon. I had another ultrasound (which was a Biophysical Profile, or BPP) the day before yesterday, and while it did go super fast since she was moving, responding, and "breathing" like a pro, she was still breech. Since I'm at 33 weeks right now, we have just a couple more weeks for her to turn (until week 36) before we'll have to think about an external cephalic version in which the doctor attempts to turn the baby manually. If you're curious (like I was) about what this procedure looks like, here's a video to help you visualize it:
The problem is, it's not only supposed to be uncomfortable; it also only has a success rate of about 58%. And, of course, there are several factors that make it less likely to work, of which I have at least a couple. My OB said that because this is my first pregnancy (and, therefore, my ab muscles are still tight) and since my fluid level is on the lower side of normal, there is a greater likelihood that a version attempt wouldn't be successful. For that reason (along with the already low success rate), I'm wondering if it's even worth it to try. There are, of course, risks associated with the procedure as well, and although they're rare, they are pretty scary: placental abruption (which causes bleeding), uterine rupture (yikes), and premature labor due to rupture of the membranes.
At this point, I suppose it's just a waiting game. If she turns on her own (Note to baby: Please do!), we won't have to worry about the alternatives. If not, we'll have to go from there. If anything, mentally dealing with these prospective outcomes has made me a lot more flexible in terms of my expectations of labor and delivery...There is definitely something to be said for giving up control and going with the flow! Of course, I should realize all of this by now. As anyone with diabetes knows, you can only control so much when it comes to your body; the rest is up in the air. Even eating and doing the exact same thing on two different days will produce different blood sugar results, and sometimes you just can't predict how your body is going to respond to certain things.
Even so, there comes a point when you realize that there are some things you can control, and all you can do is your best when it comes to those things...and the rest? Well, you just hope that it all leads to stable blood sugars. If not, you correct it and go on. That perfect balance is so hard to find, and impossible to have all the time. It's probably one of the most frustrating things about this disease, and leaves you feeling like you're playing a huge guessing game (see also: S.W.A.G. Bolus). Either way, you learn to live with it (and accept it)...eventually...most of the time.
So the moral of today's story is that, as with diabetes, there are just some things in pregnancy (and life) that you have no control over...and the best thing you can do to keep yourself sane is to accept it and go with the flow. Otherwise, you'll end up like I do a lot of the time: pulling your metaphorical hair out over things that you have absolutely no influence over, and usually not realizing this until you're metaphorically bald. Hopefully this time I can follow my own advice. ;)
God grant me the serenity to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference
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.
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.
Wednesday, December 7, 2011
Basal Rates, Artificial Pancreata, and D-Judgment
Oh, how quickly time seems to get away from me these days...I intend to write a blog post, then other things come up, and before you know it it's been another two weeks since I last posted! I have to say, I really admire those in the DOC who are able to consistently update their blogs on a daily basis. Between managing diabetes (which, of course, is another full-time job) and life in general, I have a hard time keeping up with mine at times. Sometimes I wonder how I'm going to manage it all once the baby is here, but I know it'll work out...somehow!
At least life according to the D-monster has been better lately. I was getting frustrated with my numbers and my apparent inability to control them despite all of my effort, so I finally (FINALLY!) took a step back to evaluate the situation. Duh. My basal rate patterns didn't make sense at all, and it took me a couple of months to figure that little piece of information out! I suppose with everything going on, I was just increasing the rates themselves over time without looking at how my overall pattern was functioning (not well, by the way). The day that I realized this, I decided to start from square one and recalculate everything based on the total daily dose of insulin I'd been using. To do so, I had to pull out my trusty "Think Like a Pancreas" book by Gary Scheiner and review how to calculate all of the basal/bolus rates and ratios. With a little math (which I always enjoy--seriously, because I'm a nerd), I had a basal/bolus pattern that was a little more sane looking:
It had been so long since I'd done such a complete overhaul that I was a little worried about highs and lows the next day, but everything worked out surprisingly well. It's amazing what a little perspective can do...I was just metaphorically kicking myself for not doing it sooner! My numbers have been much more even, and I haven't had near as many out-of-range results as I was having before. Not that they were horrible before; it's just that I'm kind of a perfectionist and like for all of them to be as close to "normal" as possible--is that so much to ask?!
In other D-news, how about that Artificial Pancreas Project?! I'm so excited that the FDA has started the process that will hopefully lead to approval in a timely fashion. It's such a major step in the right direction for those of us living with T1, and although it's not a cure, it does represent a major advancement in treatment technology. For more on what this means for us, please read this article: Interpreting the FDA Guidance for the Artificial Pancreas
This morning I got a blog update from Jacquie Wojcik at Typical Type 1 in my email, and it was an awesome one. You can read the full post here, but the general gist of the post was about how judgmental people without diabetes can be at times. If you deal with this disease, no matter the type, you've no doubt encountered it at some point--if not more frequently. Even when people don't make rude comments or say anything out loud, sometimes you can feel their judgment anyway. It can make eating in public a psychologically difficult experience, because you know that if you split a dessert with your lunch buddy, there will probably be somebody who is thinking, "She has diabetes, she shouldn't be eating that!" It's not that I mind talking about my disease or correcting misconceptions when people are genuinely interested; it's the ones that try to impress their diabetes "knowledge" and horror stories upon you that can be irritating at times.
I like to think I generally have a good, positive attitude and outlook on life, but even that can be challenged when dealing with this type of thing on a regular basis. I've thought before about printing some of these diabetes etiquette cards for people who don't have diabetes to keep on hand for such situations, but I don't know how well received or effective that would be. Instead, the action I've taken is one I'm super comfortable with: I wrote. I mentioned it in my last post, but for American Diabetes Month I wrote an article for our local newspaper about the myths and misconceptions surrounding the disease so that maybe-just maybe-it will reach those that need to know these things. Like I've said before, even though it's hard, I can deal with the negativity...it's the kiddos who live with diabetes that I worry about. Life with this disease is hard enough without having to defend yourself and your decisions all the time. We already have to micromanage ourselves, so it's no fun when others try to do it for us as well. Like one person in the comments said of Jacquie's post, "It’s amazing how much more people care about/watch what I eat since I was diagnosed Type 1. They didn’t give a crap about what was on my plate before." So very true. The not-so-nice part of me sometimes wants to ask these people, "So just because you don't have diabetes, it's okay for you to eat that third piece of cake?!" But I don't, because I could never actually say that to anyone, no matter how rude they've been to me. In the end, I have to realize that there are some people who just don't get it. I can try to change their perceptions, but sometimes their ideas are so long-held and concrete that there's not much anyone could do or say to fix the situation. So instead, I just try to do the best I can and educate the ones who are willing to learn.
At least life according to the D-monster has been better lately. I was getting frustrated with my numbers and my apparent inability to control them despite all of my effort, so I finally (FINALLY!) took a step back to evaluate the situation. Duh. My basal rate patterns didn't make sense at all, and it took me a couple of months to figure that little piece of information out! I suppose with everything going on, I was just increasing the rates themselves over time without looking at how my overall pattern was functioning (not well, by the way). The day that I realized this, I decided to start from square one and recalculate everything based on the total daily dose of insulin I'd been using. To do so, I had to pull out my trusty "Think Like a Pancreas" book by Gary Scheiner and review how to calculate all of the basal/bolus rates and ratios. With a little math (which I always enjoy--seriously, because I'm a nerd), I had a basal/bolus pattern that was a little more sane looking:
 |
| Before |
 |
| After |
It had been so long since I'd done such a complete overhaul that I was a little worried about highs and lows the next day, but everything worked out surprisingly well. It's amazing what a little perspective can do...I was just metaphorically kicking myself for not doing it sooner! My numbers have been much more even, and I haven't had near as many out-of-range results as I was having before. Not that they were horrible before; it's just that I'm kind of a perfectionist and like for all of them to be as close to "normal" as possible--is that so much to ask?!
In other D-news, how about that Artificial Pancreas Project?! I'm so excited that the FDA has started the process that will hopefully lead to approval in a timely fashion. It's such a major step in the right direction for those of us living with T1, and although it's not a cure, it does represent a major advancement in treatment technology. For more on what this means for us, please read this article: Interpreting the FDA Guidance for the Artificial Pancreas
This morning I got a blog update from Jacquie Wojcik at Typical Type 1 in my email, and it was an awesome one. You can read the full post here, but the general gist of the post was about how judgmental people without diabetes can be at times. If you deal with this disease, no matter the type, you've no doubt encountered it at some point--if not more frequently. Even when people don't make rude comments or say anything out loud, sometimes you can feel their judgment anyway. It can make eating in public a psychologically difficult experience, because you know that if you split a dessert with your lunch buddy, there will probably be somebody who is thinking, "She has diabetes, she shouldn't be eating that!" It's not that I mind talking about my disease or correcting misconceptions when people are genuinely interested; it's the ones that try to impress their diabetes "knowledge" and horror stories upon you that can be irritating at times.
I like to think I generally have a good, positive attitude and outlook on life, but even that can be challenged when dealing with this type of thing on a regular basis. I've thought before about printing some of these diabetes etiquette cards for people who don't have diabetes to keep on hand for such situations, but I don't know how well received or effective that would be. Instead, the action I've taken is one I'm super comfortable with: I wrote. I mentioned it in my last post, but for American Diabetes Month I wrote an article for our local newspaper about the myths and misconceptions surrounding the disease so that maybe-just maybe-it will reach those that need to know these things. Like I've said before, even though it's hard, I can deal with the negativity...it's the kiddos who live with diabetes that I worry about. Life with this disease is hard enough without having to defend yourself and your decisions all the time. We already have to micromanage ourselves, so it's no fun when others try to do it for us as well. Like one person in the comments said of Jacquie's post, "It’s amazing how much more people care about/watch what I eat since I was diagnosed Type 1. They didn’t give a crap about what was on my plate before." So very true. The not-so-nice part of me sometimes wants to ask these people, "So just because you don't have diabetes, it's okay for you to eat that third piece of cake?!" But I don't, because I could never actually say that to anyone, no matter how rude they've been to me. In the end, I have to realize that there are some people who just don't get it. I can try to change their perceptions, but sometimes their ideas are so long-held and concrete that there's not much anyone could do or say to fix the situation. So instead, I just try to do the best I can and educate the ones who are willing to learn.
Monday, November 21, 2011
Update Time!
I honestly can't believe it's been so long since I last posted! Suffice it to say, it's been an incredibly busy one, especially because it's American Diabetes Month...It seems like I've had something diabetes-related to do since the beginning of November. I'm not complaining, though--I am a very willing participant in all of the awareness activities I've done, and truly believe that all of our efforts are making a difference for the people who benefit from them!
I was contacted last month by Laura from Extreme Southern Couponing. She has a 9 year old daughter who was diagnosed with type 1 diabetes two years ago, so she was putting together guest posts to feature on her blog throughout the month of November. She had come across my blog and asked me to share my story with her readers. Many of you already know most of the details of my diagnosis and journey thus far with T1, but if you're interested you can read it on her site here.
On November 15th, I had an OB appointment and ultrasound in Amarillo, so my mom, sister, and I met my aunt and cousin at Beef O'Brady's for their second "Dining for Diabetes" fundraiser. They donated a portion of their ticket sales that night to the JDRF, so we got to eat some good food for an awesome cause! I also got to meet the Branch Manager for the Panhandle JDRF in person, as well as some of the other board members. They are all incredibly nice, welcoming people, and I can't wait to work with them.
The next day, the article I wrote for the local paper on diabetes awareness was published. I was incredibly excited to see it happen, because it's something I've wanted to do for a while. I decided to focus on the myths related to diabetes, because there are so many misconceptions surrounding the disease. For those of us living with it, having to clear up these myths on a regular basis adds to an already challenging life, so my hope was that by reaching people in our community on a larger scale, things would be a little easier for people with diabetes--especially the kids and young adults who have to deal with it. It turned out to be a long article, so I'll save it for another post!
I *think* that covers everything diabetes-month related thus far, but I could be missing something. I was reading "Do Chocolate Lovers Have Sweeter Babies? The Surprising Science of Pregnancy" a few nights ago, and it said that a woman's brain shrinks by 4-6% during the nine months of pregnancy in order to build the baby's brain (at least according to one theory)...my husband says I'm definitely on the 6% end of the range! Either way, my brain power has been somewhat diminished for the past several months...it's a strange feeling, being in a constant fog. Then there are the days that I'm convinced I'm losing it, like the day I posted this on Facebook:
My sister also had her baby a month ago after she developed preeclampsia and had to have a c-section at 34 weeks. Her baby is still in the NICU-she had some breathing problems in the beginning and digestive issues after that, but she's stabilized and is doing better. She just has to meet all of her milestones before they'll let her go home! My relationship with my sister has been better since her baby was born, and I'm glad that we've been able to put most of the anguish of the past several months behind us. The selfish part of me still finds it hard that everything is revolving around her and her baby at this point, but that's just because everyone is so focused on all of that that I sometimes forget we're having a baby soon. I hear about it so often that I sometimes think of our little one by her baby's name, and that frustrates me!
It's also been hard having my parents gone so often, because it leaves me to take care of the office by myself--something that isn't out of the ordinary, but that can be incredibly stressful at times...and right now, I need to start slowing down rather than taking on more than my share. We don't have much longer until she'll be here, and we still have so much to do! I know it will all get finished, but it's still hard sitting at the office when I know there's so much I could be doing at home. Hopefully I'll have enough time off in the end to get a few things done that I haven't been able to work on, like the quilt that I started over a year ago...The quilting part is not far from being finished, and then I have to bind it, but I never have a solid chunk of time to get it done.
Then I still need to get in touch with a pediatrician, work on my birth plan (/wish list), and about a million other things to prepare for the actual labor and delivery part of things...I try to not let it all stress me out, but sometimes the amount of things I have left to do hits me like a ton of bricks--or at least with the force with which our little girl kicks me sometimes! Oh-speaking of her kicks, my hubby finally got to feel her kick for the first time about a week ago...I'd been able to feel it from the outside for about a month, but she never would cooperate when he was around!
Well, I think that pretty much covers what's happened over the past few weeks, so I guess I better get back to work!
I was contacted last month by Laura from Extreme Southern Couponing. She has a 9 year old daughter who was diagnosed with type 1 diabetes two years ago, so she was putting together guest posts to feature on her blog throughout the month of November. She had come across my blog and asked me to share my story with her readers. Many of you already know most of the details of my diagnosis and journey thus far with T1, but if you're interested you can read it on her site here.
On November 15th, I had an OB appointment and ultrasound in Amarillo, so my mom, sister, and I met my aunt and cousin at Beef O'Brady's for their second "Dining for Diabetes" fundraiser. They donated a portion of their ticket sales that night to the JDRF, so we got to eat some good food for an awesome cause! I also got to meet the Branch Manager for the Panhandle JDRF in person, as well as some of the other board members. They are all incredibly nice, welcoming people, and I can't wait to work with them.
The next day, the article I wrote for the local paper on diabetes awareness was published. I was incredibly excited to see it happen, because it's something I've wanted to do for a while. I decided to focus on the myths related to diabetes, because there are so many misconceptions surrounding the disease. For those of us living with it, having to clear up these myths on a regular basis adds to an already challenging life, so my hope was that by reaching people in our community on a larger scale, things would be a little easier for people with diabetes--especially the kids and young adults who have to deal with it. It turned out to be a long article, so I'll save it for another post!
I *think* that covers everything diabetes-month related thus far, but I could be missing something. I was reading "Do Chocolate Lovers Have Sweeter Babies? The Surprising Science of Pregnancy" a few nights ago, and it said that a woman's brain shrinks by 4-6% during the nine months of pregnancy in order to build the baby's brain (at least according to one theory)...my husband says I'm definitely on the 6% end of the range! Either way, my brain power has been somewhat diminished for the past several months...it's a strange feeling, being in a constant fog. Then there are the days that I'm convinced I'm losing it, like the day I posted this on Facebook:
I've come to the conclusion that I'm losing my mind! I had to call Mom to ask her a question, but when I dialed her number on my cell phone, the office phone started ringing, so I had to hang up on her. I then picked up the office phone, and no one was there, so I tried Mom's number again. About that time, the office phone started ringing again, so I had to hang up to answer it...And once again, there was nobody there. This went on about five times and I was starting to get extremely frustrated before I realized that *I* was actually calling the office instead of Mom's cell phone number and hanging up on MYSELF. I think I need a break...♥The diminished mental status and achy hips and back, though, I can deal with. They're constant reminders that my body is on a higher level of functioning right now to make sure our baby gets everything it needs, and I'm completely okay with that. When I had my ultrasound on the 15th, I was nervous once again--though not quite as nervous as I was before our first big one in September. I suppose the worry that everything is developing as it should never quite goes away, but I'm glad that things were still on track with our little one! She's in the 60th percentile even though I'm measuring smaller, and although she was breech, everything else was where it should be. As it is in diabetes, "normal" is an amazing thing when it comes to your baby's development! I'm just hoping she decides to head south sometime in the next 9-10 weeks...=)
My sister also had her baby a month ago after she developed preeclampsia and had to have a c-section at 34 weeks. Her baby is still in the NICU-she had some breathing problems in the beginning and digestive issues after that, but she's stabilized and is doing better. She just has to meet all of her milestones before they'll let her go home! My relationship with my sister has been better since her baby was born, and I'm glad that we've been able to put most of the anguish of the past several months behind us. The selfish part of me still finds it hard that everything is revolving around her and her baby at this point, but that's just because everyone is so focused on all of that that I sometimes forget we're having a baby soon. I hear about it so often that I sometimes think of our little one by her baby's name, and that frustrates me!
It's also been hard having my parents gone so often, because it leaves me to take care of the office by myself--something that isn't out of the ordinary, but that can be incredibly stressful at times...and right now, I need to start slowing down rather than taking on more than my share. We don't have much longer until she'll be here, and we still have so much to do! I know it will all get finished, but it's still hard sitting at the office when I know there's so much I could be doing at home. Hopefully I'll have enough time off in the end to get a few things done that I haven't been able to work on, like the quilt that I started over a year ago...The quilting part is not far from being finished, and then I have to bind it, but I never have a solid chunk of time to get it done.
Then I still need to get in touch with a pediatrician, work on my birth plan (/wish list), and about a million other things to prepare for the actual labor and delivery part of things...I try to not let it all stress me out, but sometimes the amount of things I have left to do hits me like a ton of bricks--or at least with the force with which our little girl kicks me sometimes! Oh-speaking of her kicks, my hubby finally got to feel her kick for the first time about a week ago...I'd been able to feel it from the outside for about a month, but she never would cooperate when he was around!
Well, I think that pretty much covers what's happened over the past few weeks, so I guess I better get back to work!
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