Sunday, January 01, 2006

Natural, Schmatural

At a New Year's party last night, I talked with a woman who is pregnant with her second child, due sometime in the spring, and is one of those people who is hiring a midwife. She proudly didn't use any drugs the first time around, and actually said she didn't want more ultrasounds than necessary (she had five the first time) because, as her husband said, "they raise the temperature of the womb."

I pointed out that a high risk pregnancy gets a lot of ultrasounds, and the woman was quick to note that yes, a high risk pregnancy justifies the extra numbers of ultrasounds. What I didn't say was that, as a T1, I always thought that having all the extra tests and ultrasounds with a diabetic pregnancy was a good thing. Sure, there's more likelihood of having something go wrong, but at least the doctors are keeping a close eye on you along the way. And if you're doing all you can to maintain those freakishly normal blood sugars, as many D pregnant women have said they have been able to do, your chances of having a healthy kid are the same as a non-diabetic woman. So all that extra monitoring sounds reassuring to me.

Frankly, I've never heard of the theory that "extra ultrasounds" equal "heating the womb" and the subsequent conclusion of "overheating your fetus." I'll have to run this by a doc on my next visit, but the whole idea made me realize, again, how diabetes has colored my opinions about medical care.

As I've stated before, I've been T1 for 28 years, since age 7. To me, diabetes was always a condition that responded well to medical intervention. Without insulin and blood tests and (showing my old school roots here) urine tests, I'd have been dead years ago, and if I'd only had insulin and no blood or urine tests for 28 years, I'd likely have more horrendous complications today (if I were even still alive) than the relatively well-managed (and in my opinion, minor) complications I do have today.

Unlike many of my non-D peers, I don't fear going to the doctor and I certainly don't avoid it because "I feel fine so nothing's wrong." To me, going to the endo, or to the eye doc, or even the dentist (where unbelievably, my dentist gushes over how perfect my teeth are. My gums and plaque; well, they're another story. But at least my teeth haven't been affected by diabetes!), is another way to closely monitor the sweetness within. Are the A1c and fructosamine tests within range? Are my eye vessels staying out of the retinopathy designation? Is my cholesterol still in check? The kidneys still filtering the way they should?

When the answers are yes, or close to yes, I'm relieved. When there's something amiss, the doc visits are frequent enough that something can be attended to quickly, before a lot of damage or problems have set in.

So when I hear about women like this one last night who was proud of not using drugs while giving birth, or who wants to avoid extra ultrasounds, or about another D-blogger who thinks birth is overmedicalized, I don't get it. To be fair, the other D-blogger is a recently diagnosed T1, so I'm thinking she and I have different histories and experiences with medicine and doctors. But to me, the extra monitoring makes sense. It is expensive and results in a blizzard of insurance paperwork, I'll admit, but I'm fortunate to have the financial means, the intellect and patience to pay for, understand, and wade through the process to get the care (and coverage) I know is beneficial and gives me peace of mind.

And as one last note--the pregnant woman's two-year-old, strictly breast-feed, natural-birthed son was playing last night with my nearly-two-year-old nephew, who was fed with formula and delivered by c-section. Maybe it was the excitement of being up late on New Year's Eve, or maybe it's different parenting styles or just innate personalities. But I couldn't help but notice that the earth son was more of a wuss than my nephew, didn't have as big a vocabulary, and didn't fight for himself when when my younger nephew wouldn't share his toys, even though the earth son was a head taller than my nephew.

"At day care, bigger kids pick on our son to get toys from him," earth son's father said. I'm no parent (yet), and I'm all in favor of raising sensitive boys into terrific men who aren't jerks, but I certainly want my kid to be able to stand up for himself and be confident about it. If an epidural or anesthetized c-section is somehow part of that process, I'm not going to avoid it. After all, who undergoes any other kind of surgery without anesthesia or painkillers?

Bring on the drugs. And fast.

9 comments:

Kassie said...

I know lots of people with diabetes who are disappointed at the medically intense pregnancy - and the increased likelihood of a c-section. I think it's tough to balance a desire for a more natural approach with the need to do what has to be done for a healthy baby.

I had 2 c-sections and felt little or no remorse about never having labored. All's well that ends well, right? But if there is hope for a 'natural' delivery, I understand the disappointment.

I think women with diabetes who work with OB's experienced with diabetes get the benefit of a closely monitored pregnancy without the assumptions that sometimes come with diabetes. My second OB told me during our first visit that he 'sections all his diabetics at 38 weeks, or induces them if they really want to try it'. Had I been a less confident or experienced mom, this would have disappointed me. As it was, I knew I was headed for a c anyway (and would be lucky to get to 38 weeks) so it didn't faze me. My second was quite a contrast from my first, where the hospital offered me induction up to the very last minute (which, at 31 weeks with pre-e, not the least bit dilated, and sick as a dog after 36 hours of magnesium sulfate, I thought was just silly).

Penny said...

I have 2 children. The first, I birthed au natural. Not really because I wanted to but because I was young and didn't really ask for drugs. With my second, I had an epidural. It made a world of difference. I'm sure everyone is different. But, man, if I ever do it again, I say, bring on the epidural! It made my birth experience so much more enjoyable. Yes, I actually enjoyed it. Now, the first one, no joy, just "get this kid out of me!!!"

As far a c-sections go, I know women that are so dead set against them that they insisted on vaginal births and now their babies have problems because of it. That is not always the case, but it happens. Still, I'm a nurse, and I'm with you. We have all this technology, why not use it?

Also, both my children were bottle fed. My 14 year old is on the Beta Club (have to have good grades for that) and other than diabetes, my 3 year old has never really been sick. He's NEVER taken any prescribed medicine, other than insulin. My cousin's son was breast-fed and he is constantly in the Dr's office for one thing or another.

Sorry, long comment on that. I feel very strongly that people need to do what works best for them. But, with my second pregnancy, I felt quite a few mother's looking down thier noses at me because I didn't breast feed. It seems that those that feel that natural birth and breast feeding are best tend to want everyone else to do it too. I can see why they may want to, but that just isn't for me.

One more thing, as far as I know, there are no studies that show that ultra sounds can be harmful to the baby.

Shannon said...

I've had 3 c-sections, numerous amounts of ultrasounds and my kids are fine...except that my son has diabetes. But I don't think the c-sections and ultrasounds had anything to do with it.

Tiffany said...

Hi there,

I stumbled onto your site via Kerri's blog and wanted to let you know that I've enjoyed reading your posts. Although I haven't had kids (yet) I hope to be dealing with similar issues one day, so it's great to read your experiences.

Although I haven't had kids, I do have a medical background and can tell you that ultrasounds are relatively safe and worth any minute risk. (DO NOT GOOGLE THIS, as you will probably read things you don't want to see lol) The myth is that the ultrasonic waves heat the amniotic fluid surrounding the baby and also may corrupt cell growth, but there is no substantiating proof of this.

And hey, my mom had several US when I was a kid, and 25 years ago the technology was not as advanced today. Far as I can tell, there's nothing wrong with me as a result (as for everything else wrong with me, well...lol)

Good luck and thanks for a great read!

Erica said...

That was my blog you linked to and you are right - I think being recently dx'd Type 1 has a lot to do with my attitude towards birth and to medicine/drs. in general.

Many many people with diabetes or not feel the same way as you do - the more monitoring and prenatal testing the better. They want as much information as possible. It comforts and reassures them.

But you (not you directly, the collective you) need to weigh both sides. At first I questioned why I would need so many NSTs in the last trimester, Kassie pointed out that it is so they can guage the health of the placenta. Great! Bring 'em on! However, offer me the Afp/Triple Screen and I'll give you 20 reasons why I'll decline, the biggest one being that it has a really high false positive rate. Pregnancy is stressful enough - who needs to worry about that and the more invasive tests it can lead to.

I had several ultrasounds with my dd and when it was determined that everything was fine, I was still offered an amniocentisis. That is a procedure that is NOT without very real risks. And the fact that it wasn't warranted made me question every intervention offered to me.

I don't know how to explain my pov any better but I only want an intervention that is absolutely necessary and/or beneficial to my health or the health of my baby. If that means a c-section - fine but tell me exactly why you want to give me a c-section, don't play Dr. God-Because-I-said-so.

I guess I am one of those freaky natural birthing wannabes (dd was induced due to PIH and the epidural failed). Just like having an epidural to enjoy birth, some women are empowered by feeling the pain/process of birth.

What it all comes down to, is that in the end, no matter how we got there, we are all moms. We may have different parenting styles and attitudes about medicine but we all need to support each other because motherhood is a tough job. No one deserves to be judged.

Sorry this is so long. This is one topic I could go on and on about forever.

A really good read - that I find to be very balanced is Henci Goer's 'A Thinking Woman's Guide to a Better Birth'. The book goes through all the medical 'stuff' during pregnancy/birth and cites the pros and cons based on valid research studies.

Meredith said...

Erica,

Very well said.

In general, OBs are pretty cautious people and like to have as much information about pregnancies as possible -- especially "high risk" pregnancies.

I did have the AFP/Quad Screen with my daughter and got a false positive for Spina Bifida. It was a horrifying three weeks until our Level 2 ultrasound. I wanted to decline it (and the recommended over-35 amnio) for my son, but my husband was pushing for the amnio and we compromised on the AFP test again -- knowing it was very likely to come back positive. Which it did ... and it was false.

I believe it's important to know which tests are useful, how they're done and which ones you might want to decline. (I also believe the same to be true about labor and delivery practices.)

Also, I was one of those who'd hoped for natural delivery, but my first was breech, and the risks of attempting anything other than a c-section were too high. My 2nd was going to be allowed to be VBAC if he came on his own early enough, but he didn't. I would have liked to have experienced at least some labor, but with some time/perspective, I'm no longer sad about it.

Anyway ... I'll get off my soapbox. Another great book is called The Birth Partner by Penny Simkin. It's written for your "coach" but is a good read for expecting women, too. (Even my husband read it and liked it.)

Good luck to all ...

Meredith

Jenn said...

I may be 4 years late on this one, but I've stumbled upon your blog since your book was just released. I'm disappointed upon reading this post as long-term T1 (15 years) who happens to side with "Erica" whose blog is no longer around it seems. I have 2 children, and a blog to encourage women who hope to go the natural route... diabeticbirth.blogspot.com
I'm eager to read Balancing Pregnancy, and am hopeful for a more open minded approach to "earthy" moms like myself.

Lyrehca said...

Jenn,

I hope you get this--there was no way to contact you directly. I definitely found women in my book who delivered naturally, without any drugs, and were type 1. One even had a home birth against medical advice. So while I am still strictly pro c-section and pro-painkillers, there are definitely other women with type 1 who share your views and desires about natural childbirth. In fact, I'd be interested to hear what you think of the book after you read it--please email me at Lyrehca AT gmail DOT com and let me know.

Jenn said...

Looking forward to reading, Lyrehca, thanks for that information!

 

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