Saturday, October 26, 2013

35 Week Bumpdate

Again, good reports for Baby Girl this week.  NST was normal.  Good accelerations of her heart rate with movements.  Apparently I was also having fairly regular contractions every 2 to 4 minutes, but not feeling them.  The OB said they are likely Braxton Hicks.  My uterus is practicing.  I wish it would practice HARDER and do the real thing soon.  I don't think this belly can get much bigger!

Hubby took off for the BPP this week.  She must have been happy her daddy went because she immediately did her practice breathing and body rolls.  Baby Girl scored 8/8 points again, everything looking normal.  The doctor came to check us out and said, "So, looks like scheduled c-section for 39 weeks."  Well... kind of... assuming she's not growing to the size of a small dinosaur in there.  I told her last week the other doctor had mentioned the possibility of an earlier delivery due to her increasing size, and we would have to keep monitoring.  Then she said, "Mmhmmm well yes, we will have to measure her but I think at this point 39 weeks is reasonable."  OK.  I am done with everyone and their different opinions.  That has been one of the most frustrating experiences so far during this pregnancy.  I know a lot of things depend on what may or may not happen and there are no definitive answers at certain points, but at least get together people and think about what your patient is thinking every time she hears a different opinion!

And that's definitely a problem when you see a group of physicians.  I cannot adjust my schedule to make an appointment with the same MFM physician every week because A.)  I work and B.)  They float from facility to facility without rhyme or reason to their schedule and C.)  I have 30 other appointments that are scheduled.  While it would probably be best (the least frustrating) to see the same doctor each week, for most people in my situation it's not very practical and so you end up with 3 different opinions about the same issue.  However, they all have the same chart in front of them with the same data, they are in the same practice, so why do these opinions vary so much?

I am really looking forward to next week's BPP when they measure her again.  That should give us a better idea of when they might want to deliver her, if need be.

I am getting a little more tired, physically and mentally.  I am not as on the ball with my diabetes logging as I once was, feverishly writing down every carb I ingested and every unit of insulin I injected.  And sometimes I even eat things that can make my blood sugar a little more (gasp!) unpredictable.  Thirty-five weeks of super intense management is wearing.  I have never paid so much attention to diabetes in my life.  Don't get me wrong, it's ALWAYS there somewhere, but it can sometimes be pushed to the back of your mind...at least for a few hours.  Not with pregnancy.  I feel like it's forefront and center nearly 24/7.   It's been a lot of hard work and I am ready to see the result!  And to eat a high carb breakfast or a bowl of cereal again.  I am getting really tired of cottage cheese and eggs.

A few humorous points:
-  My belly is so big that it is sometimes difficult to wash my hands in certain sinks.
-  My belly seems to bump into people and things a lot.  I am used to 29 years of living without a               beachball in my belly.
-  Pregnancy makes you burp.  A lot.  Around the clock.  Well, me anyway.
-  Getting out of bed sort of resembles a Weeble wobbling.  Like this.
-  The cats are really interested in sitting on my belly now.  I think they know something.


And a very happy birthday to my husband and dad this week!  I love you both!



Thursday, October 17, 2013

34 Week Bumpdate

This week began on a high note.  My husband and I celebrated our second anniversary on Tuesday.  He took the day off to go to my appointments with me, and then we cooked a nice dinner together.  We started off at the endocrinologist's office with a pretty standard appointment.  Still happy with my control, but some adjustments were needed.  We actually backed off a little on some overnight basals to prevent me from getting up low and drinking a juice box every night as had been the trend for the last 5 days or so.  My endo said the baby is most active at night and so she's using up some of my glucose stores.  Especially now that she's bigger herself and requiring more energy to move.  And we increased my breakfast and dinner bolus ratios AGAIN.  I am now requiring 1 unit of insulin per gram of carbohydrate I consume meaning I am bolusing the HUGEST amounts of insulin I have ever heard of.  Definitely concerning at times, as in how am I not dying from giving 45 units of insulin for a salad, fruit, and bread?  I don't know.  It just works.  I have been easing myself into dosing these crazy amounts by using the old 1:1.5 ratio and adding a random amount of extra units not quite equal to the 1:1 ratio and then usually deciding later that I could have bolused 1:1 and been fine.  I'd just rather test the waters first since these amounts of insulin are so crazy.

My endo also reassured me that I was still doing a great job and sometimes no matter what your blood sugar control, you are still going to grow a larger baby.  Another diabetes mystery.  But hearing it from his lips made me feel a teensy bit better.  After the endo we went to pick up some groceries for our anniversary dinner.  Nothing with too much sodium or too many carbs to try to curb highs and prevent swelling, so we decided on filets with broccolini and a small side of mashed potatoes.  And I mean a small amount of potatoes because my husband had also bought a small replica of our wedding cake to celebrate, and I wanted to eat it!

Next we went to my regular OB appointment.  Again, the NST was perfectly normal along with my blood pressure and urine specimen.  No signs of preeclampsia.  Since we were both present, we also had the chance to tell the OB how we felt as a couple about our chosen mode of delivery.  We stated very clearly that we did not want an induction and felt that a c-section would be better for my health if the baby has to come early.  This time I think she got the message and made a note in my chart.  Hopefully there is no further talk of induction because for me, it's not really up for discussion.  I've made my decision after considering everyone's opinions because I feel it's best for me and Baby Girl.

Today I had my weekly BPP test.  Baby Girl scored 8/8 points again and everything looked fine.  I got a few printouts of some cute 3D pics of her little face.  It's hard to say who she's looking like, but I'm thinking Daddy.

So, all status quo for this week.  Hard to believe she could be here as soon as 3 weeks from now!  It will be nice to be able to sleep comfortably again (even if it's not for a long period of time), to not pee every hour, to be able to bend over without squishing all internal organs, and to be able to get out of a position without feeling like my pubic bone is splitting.  Why do women keep the crotch pain a secret???  Expanding cartilage is painful!  Maybe everyone forgets about it, otherwise no one would have more than one kid!  Have a good week!


Friday, October 11, 2013

33 Week Bumpdate with a side of Mommy Guilt

33 Weeks.  Wow!  Baby Girl and I only had 2 appointments this week.  One with the regular OB for my non-stress test and one with MFM for a BPP.  Again, everything looked beautiful on the NST.  Her heart rate was accelerating when she moved and then returning to baseline.  Every time they hook me up to that machine I feel like I am at the racetrack.  Her heartbeat sounds like a galloping horse.  My blood pressure remains completely normal and my weight is still on track.

Baby Girl also passed her BPP with 8 out of 8 points again.  Amniotic fluid looks good, placenta seems ok, baby is moving around in there doing her baby yoga while staying head down.  And she is doing her practice breathing consistently.  Aside from my new found discomfort this week in my lower pelvis and my inability to get a good night's rest, everything has been moving along pretty swimmingly.

Until the doctor came in and we started talking about her measurements.  Just three weeks ago she was measuring 3 pounds 6 ounces, ranking her in the 68th percentile.  This week she is measuring 5 pounds 7 ounces, shooting her into the 82nd percentile.  Not what I wanted to hear.  Also her abdominal measurement is slightly ahead of that at the 91st percentile.  I felt disappointment.  Guilt.  Failure.

I was hoping I would have the exemplary pregnancy with type 1 diabetes.  I was hoping I would not have a "big baby"associated with poor diabetes control.  My control has been fantastic throughout my pregnancy, but others will still attribute her size to something I did.  And I did do a lot... right.  I've stalked my blood sugar into compliance most of the time.  But it doesn't seem to be enough.  I feel exactly like Kim in this post.  

Maybe I would have had a larger baby even without diabetes in the picture.  I was born over 5 pounds at just 34 weeks.  Baby girl isn't too far ahead of that.  But maybe I should have contacted my endo sooner when I was noticing some periods of high blood sugar.  Maybe I should have bolused earlier to prevent some after meal spikes.  Maybe I should never have looked at Doritos during this pregnancy.  Maybe, maybe, maybe... the truth is, it's impossible to know.  All I can do is my best, and that's what I've been doing all along.  But I still feel like I've let her down, as if I haven't given my daughter the best environment to grow and develop.

Many bloggers including myself have said before that diabetes comes with a lot of guilt.  Guilt about what you eat or don't eat, guilt about how much insulin you might require compared to someone else, guilt over complications that arise.  This pregnancy is no exception.  The guilt is intensified because not only do my actions affect me, they directly affect my baby.  I only want the best for her.

I know having a bigger baby isn't the worst thing that could happen.  Compared to all the other risks, it doesn't even sound like it should be an adverse outcome.  Only this time when someone assumes her size is "because of my diabetes," I might have to agree.  And in that, I feel like diabetes won this round.

Her size will continue to be monitored.  If she stays on this trend, she will likely need to be born at 37 weeks.  Like many other things, we will just watch and wait.  Hopefully seeing her chubby little cheeks when she gets here will melt the guilt away.

Saturday, October 5, 2013

Week 32 Bumpdate

Pregnancy Symptoms-  Minor swelling in my ankles after working one day.  First time that's happened.   Some heartburn.  Trouble sleeping.  It's usually my bladder or my brain.  Or back/hip pain from sleeping on a side for a couple hours at a time.  I can't wait until I can sleep on my back and stomach again.

Diabetes-  Numbers seem to be compliant.  Slight highs are usually because I miscounted carbs.  I consider  a slight high over 150.  Lows are not too frequent.  My endo cut back on some overnight basals because I was waking up low at night some and having to eat or drink juice.  I had a 50 one night after I already drank a juice, so it was probably lower than that to begin with.  Sometimes I don't feel the low until I'm on my way back up.  That's how this one was because after I ate glucose tablets and half a granola bar I felt like I was sweating to death after running a marathon.  My heart was pounding.  You would think your body would try to "slow down" to conserve sugar but it seems to be the opposite.  My endo was ecstatic this week after looking at my CGM data collectively.  He said he wanted to make it a slide because it was so awesome!  Hourly averages were all in range and my standard deviation was less than 25, which is amazing!  Insulin to carb ratios were kept the same for now which translates to 1 unit of insulin per 1.5 grams of carbohydrate.  I try to keep meals to under 45 grams of carbs because taking that much insulin still scares me, even though I really have not had any post prandial lows.  I was told to keep emailing my data every 3 days or so, but could wait two weeks til my next endo appointment because I am doing such a great job.

Baby Status-  Still cooking!  This week I had my routine non stress test on Tuesday and passed with flying colors.  Baby was moving like a rock star and her heart rate was accelerating appropriately.  Then I had a routine BPP Thursday.  No growth measurements this time, but she got 8 out of 8 points for everything they assess and we were done in 30 minutes.  At the last one I had, she was not doing her practice breathing so I had to have another NST after the BPP.  I also found out she has hair!  It's probably peach fuzz, but still...

Eye Follow Up- The retinologist dilated my eyes again to see if there was any progression of my retinopathy.  Everything looked stable from last time, so that was great news.  He wants another follow up in 5 weeks and if everything is still stable, my eyes should have no impact on the method of delivery.  He did say that at my first visit, my retinopathy would have been classified as mild to moderate nonproliferative.  Now it is severe nonproliferative, most likely due to the pregnancy.   But usually only proliferative retinopathy would dictate a c-section or not.   Again, he talked about probable regression after delivery but also said that postpartum hormones can also cause progression.  It will be another wait and see if I will need further testing or treatment after baby girl arrives.

Labor Plan- Delivery at 39 weeks.  The current plan is to attempt a vaginal delivery if baby girl wants out any time before 39 weeks.  But if she needs to be coaxed, I want a c-section rather than an induction.  I don't like the idea of chemically inducing my body to give birth.  I don't like the potential side effects of Pitocin.  I know surgery is surgery and involves longer recovery time, but I just find it to be the more practical option, especially with my diabetes.  It's interesting because each doctor I've seen has a different opinion about it.  My regular OB was on board with my plan, but said he may still try to twist my arm for an induction at the end if my cervix is very favorable.  One high risk OB from MFM said it is totally my decision as long as I was educated about all of the options.  She did not feel my controlled diabetes would have any severe effects on my healing if I chose to have a c-section any more than the average person.  Another MFM physician said she recommended induction if there was any way I could have a vaginal delivery since there are more potential complications with c-sections.  My endo said he prefers all his type 1's have c-sections because it's quick and controlled and probably the easiest option to manage blood sugar control.  Talk about confusing.  But I've realized that ultimately it is my decision.  I feel if my body is ready to deliver spontaneously, we'll roll with it.  If not, it's surgery. I just want what's best for my baby, me, and my diabetes.

Labor Worries-  If I labor, I am nervous about controlling my blood sugar.  My endo suggests I keep my pump on under his orders.  MFM suggests I do an insulin and glucose IV because they don't know what do with pumps in case an emergency situation arises.  Plus IV insulin is instant in action.  Subcutaneous insulin from the pump can have absorption issues.  I talked to my endo about this.  He said he is willing to give orders for either options.  They are like apples and bananas...both fruits.  (Are we sensing a little My Big, Fat, Greek Wedding in here?)  He is just biased towards the pump, but I should make a decision based on my comfort level.  Can someone please just tell me what to do!?  How am I supposed to know what I'm comfortable with?  I've never given birth with diabetes before!

I will keep my CGM on my arm, for my own peace of mind.  I know there is lag time on that as well but I would feel better with it on, tracking trends while laboring in between the hourly blood sugar testing that will occur.

I worry about epidurals or spinals gone wrong.  I worry about when I should get the epidural if I am laboring.  Should I try and wait it out as long as possible so as not to slow labor or decrease the intensity of the contractions?  I worry about recovery after surgery if that's the route we go.  I am nervous that my choices will be wrong.  I need to let it go!

7 More weeks, at most.  I can't wait to see her pretty face.

Tuesday, October 1, 2013

Random Reflections

I can't believe this week will be 32 weeks!  Only 7 more to go, at most!  This pregnancy has flown by and I'm not sure if it's because my day to day diabetes management takes up so much brain space, or the little lady has sucked out some brain cells that control my perception of time. Either way it is amazing and exciting.

She is moving A LOT now, and she flipped to the head down position as she must be preparing for her landing.  I have also noticed lots of hiccups which feel like little rhythmic twitches inside of me.  The wiggles and movements are what I will miss the most about being pregnant.  They are constant reminders that my body is miraculously building a whole new human.  For me, there is no greater accomplishment.

Sometimes I still can't believe that I will be a mother.  It will be a whole new identity to relish.  Like my mom has said (and like I've admittedly done so many times) she will only see me as her mother for many many years.  She won't think of me as a whole person who had a life before her.  She won't really believe that I was just like her with dreams and fears and insecurities and hobbies and good days and bad days...she will only know that I can and will take care of her and that I love her.  For that, she'll call me mom.

She won't really be able to process how I met her father and how it has been an emotional journey into marriage and beyond. Or that her father and I were really just two strangers that met and became a family and one day hoped for a little one to title us parents.  She will think we were born parents like everyone else thinks of their own mother and father until they reach a certain age.

She won't know that I love sitting on my porch on a Sunday morning with the sunshine glinting on the leaves and the sounds of the birds and the crickets filling up an empty sky.  It is my quiet time to reflect or sometimes write.  For me, it is a spiritual time.  It's my church.

Funny how the happiest and most joyous occasions in life are usually marked by the tiniest slivers of mourning.  I suppose it's the juxtaposition of the two that really makes the joy that much more heartfelt.  I am in NO WAY regretful or sad about becoming a mother, but I recognize that this life as I know it will simply not exist anymore once she is here.  There will be small glimpses of it that I will miss, even though I know Baby Girl's arrival will undoubtedly be the happiest and most emotional moment in my life.  It is a change for the better but still a major change.  An unceremonious closing of the previous chapter while ringing in a new one.  Change, good or bad, always makes me anxious.

I'm the kind of person who likes to know what's coming.  I'm a planner, a "lister", a comparison chart maker...I like doing anything where I can look at the facts and analyze them to see an outcome.  Momentous occasions just don't come with those kinds of charts.  And babies don't come with instructions.  I hope I can handle it!