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.

Sigh.

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.