Sunday, December 24, 2006

One Year Old, Doctor Updates, and A Date

Managing the Sweetness Within is officially one year old this week.

I've learned a ton of stuff since my first post in 2005. A lot about living with type 1 and trying to conceive. A lot about infertility issues and invasive diagnostic tests and Intra-Uterine Inseminations (with Clomid and without) and In Vitro Fertilization. There have been disappointments, but thankfully, there have also been things to celebrate.

My year has been dominated by blood sugar control. By eating the same stuff every day to maintain that control. And it's also been filled with waiting: waiting for the right time to conceive, for another doctor's appointment, for the best time to have an IUI or to start IVF drugs. To schedule an egg retrieval or an egg transfer. To wait for a pregnancy test result. And then, finally, to move from trying to conceive to pregnancy itself, and all the waiting and watching pregnancy entails.

Thank you to all my readers and lurkers who have posted something over the past year. I've read and saved every single comment and love to get them--please keep them coming, as posting lets me know people are out there reading (and enjoying) this blog.

(And as a public service announcement, definitely go VOTE for Lyrehca at Managing the Sweetness Within for Best Female Blogger in the Diabetes OC. Voting closes by December's end, and if you like what you've read over the past year, go over and give me some love. I'll wait right here.)

And now, on to the pregnancy report.

I had three doc's appointments Friday morning. My endo continues to assure me that my blood sugars look fine and that I am weathering the pregnancy well. I still suspect she's being a bit of a Pollyanna, because I'm hitting insulin resistance hard and have been seeing much higher numbers than usual over the past week. At night, in particular, I can take a huge bolus to get my numbers back down to under 99 and will wake up hours later and the blood sugar hasn't budged. WTF? My seven-day average on my meter is higher than it's been in awhile, but I plan to actually get to the gym today for an elliptical workout (which I sorta stopped around the time I found out I was pregnant) to see if I can get some better control (and release some general aches and pains) today.

Of course, not eating all the holiday crap I've been eating will probably clear things up as well.


So yeah, Friday's docs.

I had a scheduled fetal echocardiogram, which is a detailed ultrasound that looks at the fetus's heart to make sure everything looks good (and is standard for diabetic moms). I went to the hospital where I was first diagnosed at age 7 to have this test done, and while I walked through the halls with Mr. Lyrehca, I pointed out how the builidng has changed. "That's where the gift shop used to be! That's where the old entrance used to be! I was admitted in an office right there!" Mr. L. certainly didn't have the history I had with this building (I saw my endocrinologist there until I turned 23).

The fetal echo went reasonably well. It's funny to be in a doctor's office where diabetes isn't the focus. I was there with another woman in the waiting room who was also pregnant, and the receptionist came out into the waiting room and offered us some pastry from a box on her desk. Mr. L. and I just said "No, thank you," but the other woman was like, "Oh, no, thanks, I'm diabetic." The receptionist was like, "Oh, I'm sorry." It's funny--you'd NEVER see something like that happening in a doctor's office serving primarily diabetics. Sure, there are signs telling you to ask for juice or peanut butter crackers if you're low, but free pastry? Never.

I looked over at the other patient. "Me too," I said. "Type 1 or type 2?"

"Type 2," she said.

I heard Mr. L. start to say something, like, "my wife rarely refuses food for diabetic reasons." I pointed out to him, after we'd left the waiting room, that I can take insulin and pretty much cover whatever I want to eat, while type 2s can't. It was an interesting little interlude.

The actual fetal echo went well-ish. It was about an hour and was an ultrasound focusing just on the kid's heart. Unfortunately, fetuses typically don't enjoy the prodding and poking that comes with an abdominal ultrasound, so while it didn't bother me at all, Baby L flipped and twisted and waved its hands so much that neither a technician nor the actual doctor could get a good look at about half the kid's heart.

"Jesus!" the doc said, after the kid vaulted out of the way yet again. This caused me to laugh, which threw everything off. "Laughing is like an earthquake during an ultrasound," the doc told me. I bit my lips, looked away from the monitor, and held it together until the doc finally gave up on seeing the entire heart that day.

The fifty percent of the heart the doc could see looked normal, which was reassuring. But we're returning to the hospital in another four weeks to see if the kid will give us another good look at its heart. Apparently by week 28 or so, the fetus will be bigger and there will be less room for Baby L to move around like a gymnast. So hopefully we can get past the heart issue by then. If there is a heart problem, the doc told us, a doctor will hear something through a stethoscope after the kid is born, or Mr. L or I will notice the baby isn't gaining weight, or eating or breathing right after birth. For some reason, knowing that half the heart looked fine to the docs makes me think that the other half is likely OK as well. And if it isn't, we'll do what we have to do to get the baby whatever procedure or medication it needs to treat it.

And then it was back across the street to the adult hospital to see the high-risk OB. She had called me earlier in the week with a decision.

Due to my diabetic eye issues, my eye doc didn't want me to give birth with a lot of pushing, which could further mess up the tiny blood vessels in the back of my eyes which are already plenty messed up. So Eye Doc and High Risk OB determined I should either give birth vaginally using forceps or a vacuum, or schedule a planned ceserean section.

Vaginal births with forceps make me think of a kid coming out with clamps on its head (not a good "welcome to the world" journey, in my mind). A vaginal birth with a vacuum, my OB said, is common with non-diabetic births, but because diabetic moms, even in tight control, tend to have larger than usual babies (and the estimated calculations the OB makes pre-birth are usually a little off, either over- and under-weight, because they're estimates, so it's hard to know exactly how big a kid will be at birth). With the potential of bigger babies, OB said, a vacuum can cause shoulder dystocia, which means the kid's shoulder could get stuck behind my pubic bone and could cause the baby some permanent shoulder paralysis or disability should the dystocia situation actually happen.

I definitely do not want that for my kid. So a planned c-section it is.

"Are you OK with that?" the OB asked. "I'd only want you to do an assisted vaginal birth if you were planning to have many children, because repeat c-sections aren't recommended for that." Repeat meaning five, four or three kids. I have never wanted that many kids in my life, and had always thought two was my limit. I figure I'd wait to see what one was like before definitely planning for two. While I have recently entertained short thoughts about three children, birthing four or five myself is most definitely out of the question.

I've read some stuff about the natural birth movement, and recently read (and recommend) a book about the history of childbirth that came out this fall. I know some women feel very strongly about having a vaginal birth because they consider it crucial to the experience of being female. That a cesarean birth is sometimes seen as a procedure that cheats women out of a particular kind of birth experience. And there are many arguments about the high risks of c-sections in the United States and how many low-risk women are given c-sections to speed the process along, when a longer vaginal birth could have been done if the doctors would have just waited it out.

Frankly, with all my medical issues, these are all positions I don't feel I have the luxury to hold. And while I haven't given birth yet, I feel like the experience is just something to have so you can focus on the main event: loving and raising the actual child. It's akin to focusing too much on your wedding day and not thinking as much about the marriage afterward should proceed.

"I want my kid to get out happy, healthy and alive," I told the OB. "And I want to be happy and healthy as well. If a ceserean is the way to do that, then that's fine with me."

So when I met with the OB on Friday (we'd had this conversation over the phone a few days before), she told me that she's in the process of scheduling the c-section in early-to-mid April (about two weeks before my due date) and is coordinating with another doc who can assist because the large abdominal scar from a previous surgery and there may be pesky scar tissue in the way. There's a book about preparing for a c-section I need to track down, and while my estimated due date remains April 24, if I don't go into premature labor for any reason, my kid's birthday is expected to be on April 9, 2007.

I looked up the day in an astrological chart and at least for my astrological sign (which will be the same as the kid's), April 9, 2007 is a good time for new beginnings. That sounds like great circumstances for Baby L to come into the world. And if anyone has any further advice, zodiac-related or otherwise, about having a c-section on April 9, 2007, please do send it my way.


Anonymous said...

April 9, 2007 is a WONDERFUL day to have a baby. It's my 31st birthday.

:) And the thought had crossed my mind that you might end up having the baby on that day...

Thank you for sharing your experiences this past year!

Kassie said...

I think it's great that you are comfortable with the birth plan. That's a bonus, one less thing to stress over!

My first was born at Brigham & Women's on 4/9/97. A good day, indeed.

I also experienced the "we can't get a good enough picture to sign off on the heart" moment. Then, a month later, they (of course) signed off on it, but they didn't like the look of one kidney. It never ends! All worked out fine, though.

And knowing your doc as I do, I think you don't have to worry about her being overly pollyannish about numbers. She knows her stuff, I think, and is no doubt thrilled to have you as a patient!

Flmgodog said...

Not having given birth either, I can't say either way which is better however happy and healthy seems like the most important thing to me. Sounds like I will be in the same boat as you come birth time for lil Cletus.
Getting them on the outside healthy and happy with a healthy, happy mother sounds like the right thing!!!!

Anonymous said...

I cannot believe you've got a 'due date.' I actually welled up a little when I read that. I can't wait to read more.

Anonymous said...

Congrats on the one year blogiversary.

As for c-sections, I had them with all three of my kids. Hearing their first cry and seeing their slimy little bodies was just as emotionally rewarding. I didn't feel cheated in the least from the "birthing" experience.

Major Bedhead said...

I had a c-section with O. I didn't particularly enjoy it, but mine wasn't planned. Knowing that I had to have one might have made it a better experience.

I can say that your insides are going to feel like they're spilling out when you stand up, at least for the first few days. I spent a lot of time with my hand on my tummy every time I stood up. I wish someone had told me that, because the feeling was really, really weird.

I'm so happy to hear everything is going well and that you have a due date already. That's so cool.

Anonymous said...

That's great that you have a birth plan (and a date!!). That alone must be such a relief.

You know I'm sort of a die hard natural birth advocate - but only because (as you touched upon) I think that many women are choosing elective c's out of convenience and cosmetics (think Britney Spears lol), not medical necessity like yours and others.

Honestly if I had a choice between an elective C and an 'assisted' vaginal delivery, I'd pick the C also. Vacuums and forceps scare the bejesus out of me for many of the reasons you mentioned.

Birth experience for me was about control - whether or not I had a c, vaginal or natural birth. With #1 I felt cheated because I felt like I lost control when things didn't go the way I wanted them to. With #2 I was more 'go with the flow' whihc empowered me and I had more control over my experience. I had an alternate birth plan in the event of an emergency c because I realized what a factor control played.

I'm glad things are going well despite the pesky resistance. It's a bitch - just when you get it figured out, it changes AGAIN!

Kelsey said...

I love reading your blog right now... it's like a preview of coming attractions for me :)

It sounds like a c-section is the best plan for you. My mom had three of them (after being in labor with me for 36 hours!) and she doesn't feel that she missed anything major about being a mom.

I've always thought I'd prefer a c-section since that's all I'd heard about from my mom. After some research I realize it's not the way to go, unless it's medically necessary, which as a diabetic is a potentiality for me too. So my plan is the same as yours, hope for a vaginal birth and be willing to be flexible if a c-section is necessary.

I can't wait to hear more about your experiences as April 9th nears!! :)

Anonymous said...

What a victorious event, to go back to the hospital where you were diagnosed, only now as a mom-to-be. I love it!

Lyrehca said...

Hey everyone--thanks for your comments and good wishes. Funny, I didn't think of being told "a c-section is best for you" is a real birth plan. Heck, who can really plan for any of this, really? And Kelsey, I just tried to email you directly but you're super anonymous online, but feel free to email me directly anytime with the whole trying to conceive as a diabetic thing happening soon... and at this point, the vaginal birth isn't happening at all for me. Honestly, I'm secretly relieved to think nothing will get stretched out too much downstairs that way--a sick and twisted way to think, yes, but truthful.

Anonymous said...

Thanks for sharing this part of your journey and all the decisions you're facing--as I begin this process, they are both helpful and reassuring! I am so glad things seem to be going well, and will be thinking of you as we inch closer towards April 9th!

Anonymous said...

I had a c-section with my daughter and it was also planned. She was breach and it didn't seem like the odds were in my favor with flipping her, and I wanted to know up front that I was going to have the surgery rather than having to have an emergency c-section. In any event, I kept my pump on during the surgery, but I would recommend just bolusing and having your hubby bring it in to you in the recovery room. I had to go in the morning even though my surgery was in the afternoon to be put on a glucose drip. You can't eat for 24 hours before the surgery so to avoid crazy ups and downs with the blood sugars I was in the hospital for a few hours before the delivery.

As far as resistance, I think I tripled the amount of insulin I was taking by the third trimester and I had about 3 or 4 different basals going. The pump was a godsend in helping me manage my control during pregnancy and now after, I'm still in great control.

Good luck! It's very exciting to know EXACTLY when the baby is coming.

Anonymous said...

You have really learned a lot. Best of luck with all the doc visits, blood sugar testing, and baby growing that lies ahead!

YouGuysKnow said...

hey congrats on everything going well so far. your flexibility in terms of the C-section is wise, in my opinion. I wanted to thank you for your comment on my blog which led me here - I will definitely take advice from a seasoned Type-1 superwoman when it comes to managing blood sugar! I'll be back. hugs

Anonymous said...

There's great book out there called 'the worry free c-section' for anyone interested in how to plan and prepare. I thought it was a really good read.


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