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03/07/2007: "This just keeps getting better and better"
An inauspicious visit with Maggie the Midwife yesterday. Without going into extreme detail, she is not at all confident that diet will help me bring the diabetes under control. Basically, here is her thinking:
1) My fasting glucose level was 112 when they want it under 94. This indicates that my pancreas is lolling around like a useless bum for hours and hours after I eat. Fasting glucose should be a gimme, but mine was already too high even before we started the test.
2) My one and two hour numbers were "the highest I've seen" according to her. This is not comforting.
3) My hemoglobin numbers are lovely. This is good because I am nothing like anemic, but it indicates that my diet is already peachy keen.
4) I have not gained any weight over the pregnancy (given my starting weight, this was the goal). In fact, I've lost something like 6 lbs net. Thus, the glucose rampage is not related to out of control portion size, rapid weight gain or junk food, which are the sorts of culprits that the diabetes diet is targeting.
Ultimately, she thinks I will be on insulin soon and for the duration of the pregnancy. This, on it's face, doesn't alarm me all that much. Not that I think it's thrilling or anything I actually wanted, but it's not a huge surprise and it's only a few months and you do what you need to do for the well-being of your child etc etc etc.
The bummer of the deal is that if I wind up on insulin I am slapped with the "high-risk" label and thrown to the OB's. I can't stay with my wonderful midwife, who I love to death. I suspect the delivery becomes a lot more filled with protocol and possible interventions because Kaiser's just sort of like that, too. On the one hand, it's not like it really matters that much who I see in the office for the last few months, because, much more likely than not, they won't be on-duty in Hayward when I give birth anyway. On the other hand, any time you get that high-risk label, the tendency for birth to be considered a medical condition and not a natural thing goes sky-high. Particularly when you're going into a situation where you're unlikely to have ever met the on-call OB, or any of the nurses, and they don't know you beyond your medical chart.
The thing I most want to avoid is a C-section. Managing the diabetes so that the baby isn't ginormous is a critical part in that, but so is dealing with the medical staff. Gestational diabetes tends to lead to things like induction, which can lead to long, unproductive labors, which leads to C-sections. I hope I'm borrowing trouble, I honestly do, but I feel like I need to go through all the possibilities to see how I can work to avoid them. It's a sad thing to say, but I have no confidence that anyone at Kaiser will advocate for me or go out of their way to help me have a good birth experience beyond the midwives, who I had great confidence in. If - and I hope it doesn't come to this, but I do have to prepare myself for it - if I can't work with the midwives anymore, I really feel like I'll have to be my own advocate at a time when I will be hard pressed to do much more than get through the next minute or two.
People offer suggestions like, "Hire a doula" but that doesn't appeal at all to me. I don't want someone I've had to hire with me when I give birth. It's an intimate family experience that I don't want to share with anyone I'd have to consider an employee. And perhaps it's wrong of me, but I can't think of it any other way. I'm not the sort who bonds with other women naturally, so... it's just really not an option for me.
I don't know. For the next few weeks I will hope that Maggie the Midwife is wrong and that diet will cure all evils, but I am not betting on it. I'll do everything I'm supposed to, so that at least if it does come down to insulin I'll know I did everything I could. And I will continue to keep in mind that, yes, the object is my happy, healthy daughter, however she gets here.
But I will not go down without Googling the living shit out of everything I possibly can and being the best informed patient possible. That much you can put money on.
Replies: 2 Comments - Read 'em!
on Wednesday, March 7th, Barbara said
While this birthing business seems like a solitary adventure don't forget Dave will be with you. I'm sure he can get the neccessary points across when needed. And I expect your Mom will be there. I can't imagine anyone being able to keep her from being there. Know what you want, then trust the people close to you to make it happen.
Love you. Hang in there.
on Thursday, March 8th, Joanne said
Hi, I came to your blog through pregnancy.org (I post there as JoanneJoanne). I left a little note there on your post about the glucose test but I wanted to add here a thought about doulas. I totally understand your feeling and certainly you have to go with what feels best for you. We just hired a birth doula and I just wanted to say that one of the advantages of a doula is that they are trained to be compassionate and helpful but they are also able to be objective because they are not close to you (usually, unless you hire a friend). When we interviewed our doula we found that this was really comforting as there is no chance she'll freak out from personal worry about me or seeing me in pain or anything (like say my husband or mom could). Her job is to stay focused when things get harried or scary and bring my husband and I back in sync with one another. Just a little thing I thought I'd throw in. But I totally understand the feeling that you don't a stranger there. You could always look into interviewing a few in your area and see if you click with any and if not don't worry about it.
I hear you on avoiding the medical interventions. I feel exactly the same way. I will send good vibes your way that the diet will help with the GD and that your birth will go the way you want.
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