3 Minutes. 9 Pounds. No tearing.

So I have someone simply wonderful and absolutely perfect to introduce to the word: FG!

Born on Wednesday, February 11 at 3:55 AM, he surprised everyone on the labor and delivery floor by coming hours earlier than we anticipated.  Starting the Cytotec, a cervix ripening drug, at 9:00 PM, the nurse briefed the treatment plan that I would receive another dose every three hours until 6:00 AM when I'd have the option of an epidural before starting Pitocin at roughly 7:00 in the morning. Not having decided if I wanted an epidural this go around or not, HB and I nodded in acknowledgment of the schedule as we followed the nurse out into the hall way to begin our ritual of walking the baby out.  

Getting a bit too crampy and too tired to continue our laps by 11:30, we went back to our room where the nurse began to encourage me to take a dose of Ambien and Tylonal so I'd be able to sleep comfortably after receiving my next dose of Cytotec.  Decline both of these medications, the nurse administered the second dose of Cytotec and reported that I was slowly progressing and only 1 cm dilated before turning out the lights and leaving HB and I to a) stew about my lack of progress and b)  sleep.  

A little after 1:30 in the morning, the contractions changed and I couldn't sleep through their frequent and rising intensity.  Thwacking HB with my pillow to get him to wake up (did he take my Ambien?), he helped me to the bathroom and gradually began to look at me with consternation as I went from "me" to "cranky" (his words, not mine).  Attempting to breath my way through the pain, I finally asked HB to go ask the nurse for that dose of Tylonal she'd offered... finding that she was on break, the back-up nurse assigned to my room, Debbie, came in with the small pills and immediately asked if I wanted to consider that epidural. 

Feeling like a complete wimp for not having made it remotely close to 6:00 before giving in on the pain and accepting the drugs, HB translated my non-comprehensible grimace and whimper as an articulate "yes, please" and the nurse called for the anesthesiologist at 2:45.  Gathering supplies and bouncing back and forth from the hallway - before double checking my dilation - it was 3:30 by the time the back-up nurse began to register the look of concern on my face and  helplessness on HB's. 

As the anesthesiologist began to prep by lumbar spine for the epidural placement, I was beyond my own abilities.  Unable move due to my own tension, HB and Debbie helped me sit up and breath calmly though the first series of needles. Looking at Debbie the whole time, I told her in no uncertain terms that "I feel like I need to push - I'm not - but I feel like I need to."  Having not checked my progress yet, she had no idea what we stage of labor we were actually looking at and could only respond by parroting that I not push.  Within a few seconds of the large gauge needle being inserted into my spine, however, I couldn't wait for the actual medication to be administered and I flat out said "I don't trust myself - I have to push NOW!" 

Helping my lie down, HB and Debbie found the baby fully crowning.  Sending the anesthesiologist into the hall for reinforcements, he returned a moment later with the closest thing he could find to my doctor: two random residents and my primary nurse.  With minor instructions and as much encouragement they could find amid the general shock of the unexpected, the baby's head, his shoulders and then his body along with ALL of my amniotic fluid were out within 3 minutes.  Without tearing. 

Unfortunately for the residents, it was only after my water broke following delivery that the nurse remembered to state: "Oh, yeah, she's poly."  

Collectively feeling like what just happened was completely surreal, the nurses quickly began working on the Baby - who didn't start crying immediately - as the residents cursed the late arriving polyhydramnios warning as they delivered the placenta and collected the pieces necessary for our cord blood kit.   

"Holy cow! He's nine pounds and sleeping!" laughed the nurses from the warming table.

Bringing him over to me, the nurse casually informed us of the NICU nurse lurking in the hallway due to FG's low blood sugar levels of 34 mg/dL.  Having talked with our nurse earlier in the evening about our intent to correct his hypoglycemia ourselves with nutramigen upon birth, she bought us some time as HB held our newborn skin-to-skin on his chest and dripped the formula drop by drop into the baby's mouth.

Requiring that FG's blood sugar above 50 mg/dL in order to prevent his admission to the Neonatal Intensive Care Unit, it was half an hour later that we anxiously watched the nurse prick his heel and apply his blood to the glucose strip.  Feeling like the resulting two seconds of processing was closer to two hours, there was a collective sigh of relief when the number 51 finally appeared upon the screen.  Happily dismissing the NICU nurse to return to her other charges, the labor and delivery team put our paperwork together and transferred our care to the maternity ward where we were generally left in peace by the staff given our "veteran" parent status.

Spending the following 24 hours going through the typical newborn routine, he received his first round of vaccinations, his hearing exam (which, unfortunately, he failed), bilirubin checks (slightly elevated) and his first pediatrician visit.  The pediatrician indicated some concern over his red color (likely a result of elevated hemoglobin levels) and his hips clicking (likely caused by his position while in utero), but indicated that the various abnormal results could be resolved with time or on an out-patient basis.  Otherwise granting a clean bill of health, the doctors found FG fit enough to  earn us a discharged ticket home.

Now that we're here... life with three kids will certainly take some time for us to get accustomed.  Upon walking in the door and introducing the baby to big brother GW and big sister GV, we found ourselves swimming in the deep end as FG promptly peed on the couch mid-diaper change as GV went into a full-on overtired two year old tantrum and GW raced about the house showing off his latest drawings and demonstrating his race car speed for his new brother (it was only on lap number three that he slipped on the hardwood in his socks and began to cry after careening into a cabinet).  I think things will be just fine when we develop our new rhythm, but for the mean time, I'm going to let the contentment of my post-delivery glow and a touch of mommy-brain carry me through.

Happy, happy, happy Mama!

Newborn GV

So in the last post I think I got the point across that despite all the concerns that labor and delivery itself went well and that as of 10:12 AM on November 27 HB and I have a daughter.  Yes? Okay then, moving on!

Once she was out, the nurses began their typical new born checks and double checks and successfully reported that GV scored highly on her APGAR and has ten fingers and ten toes (which after 21 sonograms was redundant, but still good news).  But seeing as I am not a normal mother, they had to run atypical checks on her as well to make sure she was healthy diabetes impact wise.  Course I knew that was coming and had worked hard to mitigate the worst case scenario with tight glucose regulation during labor (see my "Induction Begins Tonight" blog post for an explanation), but checking her blood sugar regardless of my control was just the responsible medical thing to do.

Pricking her little heel, the nurse applied the Accucheck test strip to the blood and reported a bg reading of 41 mg/dL for newborn GV.  While I would consider that number dangerously low for me, any number above 40 mg/dL is considered to be normal for newborn babies; in other words, she was borderline and verging on hypoglycemic despite my efforts to ensure her glucose would be in a safe range.  Hoping her sugars would go up on their own, the nurse handed her back to me for skin-to-skin time, immediate nursing and explained they'd need to check her sugars again in 30 minutes.

Holding that little baby and keeping her safe in my arms after so many months of worrying felt phenomenal... but in what felt like mere seconds after handing her to me the nurse was back to check GV's sugars again.   With HB supervising and being my emotional proxy, the nurse started the whole process again and pricked her heel.  The meter read 32 mg/dL.

Shit.  (Pardon my french).

Asking the pediatrician for a call on whether she needed to go directly to the NICU, the nurse reported back that GV's hypoglycemia wasn't "bad enough" to warrant a trip to the second floor but that we'd need to get her on formula right away.  Because a new mother's breast milk doesn't come in for two to three days after delivery and colostrum doesn't contain much in the way of glucose, we grabbed our Nutramigen formula and I tried to get at least an ounce into her before the next bg check in 45 minutes.  Warning that if her bg wasn't up by then we'd need to take "alternative measures" (aka the NICU), the nurse wished us luck and left us to it.

Fortunately, if there is one thing this kid does well, it's eat!  By the time the next check came around she'd gone up to 53 mg/dL!!  Unfortunately, they had to have a minimum of three readings over 70 mg/dL so even though her sugars were in the right range, the nurses on the "Family Centered Care" floor had to prick her several more times over the next 12 hours for record purposes -- all of which, thank the Lord, were in the perfect range.

But would that be the end of it?  Heck no -- that would be far too easy of an ending to an otherwise medically stressful pregnancy.

So we get up to the 7th floor recovery unit and we learn that GV's bilirubin levels are excessively high for a few hour old baby at 6.8.   The pediatrician initially said that they'd just keep an eye on it and see how she responded to simply being fed, but if the levels weren't better the following morning that they'd need to put her under the ultra violet lights for 24 or more hours.  I tried my darnedest to feed her  and combat the onset of jaundice (at 38 weeks, really?!), but the next morning her bilirubin levels had risen to 8.4 and the pediatrician made the call to get her under the lights.

I know even "normal mothers" have to put their babies in the grow box sometimes - heck even my husband had to go in it when he was born - but after everything this complication was simply one I hadn't emotionally prepared myself for.  I braced myself for all the plausible diabetes and abruption complications, but jaundice? It hadn't even crossed my mind.

Only able to take her out every three hours for a brief feeding, we sat up the entire night on Wednesday watching her tiny little chest rise and fall with each breath.  Feeling helpless to fix the problem, we waited for five o'clock Thursday evening to roll around and the defining bilirubin levels check to be completed.  If the labs showed that her levels were still high, I'd be discharged and sent home while she'd remain hospitalized in that incubator, but if her levels were low "enough" we'd be able to bring her home with us.  Needless to say we were praying and risking to hope for the second of those outcomes.

So with bated breath, we watched the clock until 6:00 PM on Thursday, November 29 when the nurse finally came in and gave us the verdict... GV could go home!!  Her bilirubin levels were still elevated higher than they ought to be, but not so high that at two days old she'd be in any risk by going home.

Thank God.

Labor & Delivery

On Monday, November 26 at 8 PM we wandered into the Fairfax INOVA Women's and Children's Hospital in exceedingly high spirits.  After months and months of worrying about how the hour long drive along I-95 and the Beltway would go it was a relief to calmly pull up and saunter in without traffic or fear of imminent baby delivery on the lobby floor.  But, with major relief, I was suited up in an oh-so-glamourous hospital gown and lying in a hospital bed well before Baby made her debut into the world.

After debriefing my nurse and getting fully checked in to their new computer system, the MFM resident came in to check Baby's position via sonogram one last time (#21) and to evaluate the condition of my cervix.  At about 70% effaced, 3 CM dilated and -3 vertex station, he decided to hold off on the Cervidil until 2 AM to make sure that things didn't progress too quickly over night -- which given the last quick delivery made HB and I very happy because, let's face it, we didn't work with Perinatal Associates of NOVA all this time to wind up being delivered by some random resident.  So the resident (to give at least this one credit, he was a nice, competent guy) put in the orders, requested that my blood sugars to be checked every four hours and instructed the nurse to start Pitocin at 6:30 Tuesday morning.  Completely on board with the Cervidil and Pitocin plan (what the heck do I know about that to have an opinion on it?), HB and I decided to blatantly blew off the blood sugar instructions and checked my bgs every hour to make sure they were tight for delivery... Needless to say that kind of ate away at our last night of sleep with out an infant, but we kept my sugars in between 70 and 80 mg/dL from the first time I sat down on that bed to the time I was being wheeled to a recovery room baby in hand.  

Go me!

So with irregular Braxton Hicks, the nurse put me on Cervidil from 2 AM to 6 AM -- which initially was no big deal, but after a few hours caused the start of real, regular contractions at just under 5 minutes apart.  Having spent the past nine weeks of merely uncomfortable contractions wondering if I wanted an epidural this time, when the nurse asked me if I wanted one I politely said "HELL YEAH" and got my name on the first slot of the sign up sheet for the day.  Needing 30 minutes between Cervidil and Pitocin, the nurse got fluids hooked up and into my system so that by the time the anesthesiologist got there somewhere between 7:30 or 8 o'clock (or by every 3 minute contractions on my watch) I was ready to get the show on the road.  The epidural was no big deal (the iodine scrub brush was the worst part of it) and once the magic meds kicked in, HB and I agreed that this was the perfect opportunity for him to get himself breakfast before he collapsed from hunger exacerbated excitement. 

But, really folks, is sending your husband off during labor a good idea?   NO! 

He wasn't gone more than three minutes when the nurse came rushing in to flip me on my side, stop the Pitocin and put me on oxygen.  Baby's heart rate was dropping well below the acceptable range of 110 to 160 after each contraction (now spaced every 2 minutes) and that kind of fetal distress this "early" is very worrisome given the intensity of active labor.  So by 8:30 my new day-shift nurse paged Perinatal Associates and - much much to my surprise - a different doctor from the practice assigned herself to my case and within minutes arrived to evaluate the situation.  Seeing the progression of contractions and the baby's positive response to oxygen, Dr. Al-Kouatley (who, I must say is the nicest woman in the world) decided to manually break my water, restart Pitocin and asked me to turn off my pump before the real exercise of labor began.  Since I wasn't having any issues with my blood sugars and I could afford to go higher by another 20 mg/dL, I thought this made sense and we moved forward. 

While all of this was happening, I'd been texting HB to let him know what was going on and that he might want to get his butt back to the delivery room sooner rather than later.  Since he didn't respond I guessed he'd missed the messages, which by the look of absolute horror on his face when he came back at 8:45 to my much altered appearance, was confirmed.  The nurse and I explained what was happening and that there was no longer a big need to worry, but I've got to give the guy a lot of credit because even with that reassurance he didn't let go of my hand after that and he was johnny on the spot for all of what happened over the next hour.   

Side bar:  It is a really regular occurrence for me that women at random places like doctors offices, the grocery store or  the play ground pull me aside and comment about how wonderful my husband is for being so supportive and involved.  While I can't explain how I got so lucky to have him be  my other half, I can with 100% authority say that I know how good I've got it and that I appreciate every one of the little things that you do, HB.  Thank you for being there with me each step of the way, for blessing me with your love and making my world better by simply being in it.  

Now this whole time, as the endocrinologist had warned us to do, HB and I were explaining to the nursing staff that my first delivery went quickly, that my blood glucose control has been fantastic throughout the pregnancy and that this baby was last measured at over a pound less than GW was at birth.  But, seeing as the typical experience with diabetic mothers involves wanton neglect of sugar control resulting in gigantic babies and hours of pushing, my nurses apparently didn't believe us and ignored our hints that a) they should be ready and b) things were progressing:

At 9:15, much to my previously drugged surprise, I began to feel some serious contractions again and HB went to tell the nurse something was changing either with the contractions or the epidural (before the epidural my contraction pain was at about a six on a one to ten scale, now it was about at a seven or eight).  Saying she'd be there in a minute, we waited and I attempted to breath through the every 45 second contraction pain I was now experiencing...

At 9:30, HB went back out to the nursing station to tell them that the pain was seriously much worse (about a nine) and that I was feeling "pressure" - which if you haven't had a baby means that the baby is ready to exit.

Finally, at 9:45 a nurse came in and checked the baby's position - which HELLO, was right there at +1 station (typically you don't start pushing until +3 station, but waiting for that was seriously not going to happen) and frantically tried to get the completely unprepared room prepped for delivery.  She called the Dr. Al-kouatly, who needed about ten minutes to change into scrubs and come up from the testing center, so low and behold look who walked in to check on me but my worst nightmare Dougie Howser... at this point I was without any pain meds (we don't know what happened to the epidural) and doing everything I possibly could mentally to not push until a doctor - a real doctor - was there and ready to catch.  But before I had a chance to slap him for his horribly arrogant, "I haven't read the chart" bed side manner and instructions to do practice pushes (seriously?! BAD IDEA KID!), my prayers were answered... It was at this point that a Hollywood director would have flooded the room with white lights, used slow motion camera effects and some sort of "halleljah" music because Dr. Bronsky just happened to walk in ready for action.  Ridiculously unhappy with the lack of preparedness, my MIA pain plan and his not having been paged for "his case," he barked orders at the nurses to get their act together and, within ten minutes of sitting down, delivered my beautiful daughter, GV at 10:12 AM.  

While things didn't go 100% smoothly communication-wise for delivery at INOVA Fairfax, HB and I are incredibly pleased with Dr. Bronsky's phenomenal care for me as an individual patient and I must say that I am grateful for his Hail-Mary reception of GV.  I am sure that Dr. Al-Kouatly would have done a wonderful job as well, perhaps even Dougie too (gag), but Dr. Bronsky helped get me from pre-conception nerves to post-delivery beautiful baby... Assuming that there aren't complications or reasons I've yet to learn (the placenta has been sent to pathology), I am really looking forward to working with him again for future pregnancies because we have a battle rhythm and positive relationship that I wouldn't trade for the world.  

Alright, all for now, the little one has been peacefully sleeping in my lap for all these paragraphs and now wants to be fed... Consider this post one of a few on the diabetes and L&D topic, I'll fill in the post delivery blanks soon. Thanks again for the support and love -- it is appreciated like always!

Induction begins tonight

Well, today is the day.

I go into the hospital tonight to begin fetal monitoring, receive a dose of Cervidil and then bright and early tomorrow morning we'll begin Pitocin to really get things started.  Based on my past pregnancy history and the dosing amounts he's planning, Dr. Bronsky expects that we'll have the baby by sometime tomorrow afternoon.  On one hand I am absolutely relieved to know that there is a definitive plan and an end to the pregnancy in sight, but I conversely find it a bit weird to know for a fact when the baby is arriving after so many weeks of uncertainty.

Hopefully my body will be responsive to the drugs and things will go smoothly with the induction, but seeing as I've been struggling with my blood sugar in hypERglycemic ranges the last couple days I'm a bit concerned about what this means for Baby.  I'm not sure where the high numbers are coming from exactly, but I'm trying to do whatever I can to get the numbers back down into normal ranges as soon as possible because if my sugars are high when she is born Baby will be required to go to the NICU to correct her hypoglycemia.

I think I've explained this before, but just in case I haven't or simply for review, when a fetus is in utero it's pancreas creates extra insulin to balance the excess glucose that is transmitted via the placenta from the Mom if her blood glucose is too high.  But when the baby is born and the external sugar source is cut off (literally), the insulin the newborn's pancreas is putting out becomes excessive and leads to their blood glucose dropping into dangerously low ranges.  Since the only way to correct hypoglycemia is to ingest more carbohydrates and colostrum does not contain much beyond antibodies, the NICU needs to feed the baby supplementally with sugar or formula and monitor his/her blood sugar until the baby is stable on its own.  Once the blood glucose balances out, the baby shouldn't need to stay in the NICU longer unless there are other complications that require additional intensive care... knock on wood.

I'm doing everything I can to keep things were they need to be, but if the placenta makes a last ditch effort to screw with my blood glucose then it's kind of out of my hands since hormones are simply unpredictable.  The reality is that Dr. Rogacz told me to expect Baby to go to the NICU and since we don't know with 100% certainty that her lungs will be fully developed by tonight I've kind of resigned myself to the fact that she might need more help than vitamin D like GW did when he was born.  Of course HB and I have prepared ourselves emotionally and medically for this and we're as ready as we can get...  At the most basic level, instead of using what basic brand the hospital provides, we've decided to bring our own hypoallergenic formula if Baby needs supplementation because research studies have indicated there may be a link between cow protein based formulas, type 1 mom's and babies developing autoimmune diseases later in life.  I can explain more about this research later since this topic goes hand in hand with the breast feeding post I still need to write (good thing we're not quite there yet), but we've decided not to take any chances and we're covering down on every detail we possibly can to keep her as healthy as we are able to.

Anyway, we'll see how things play out over the next two days.  I keep sending up prayers that the increased risks for infection and slower healing time because of diabetes will be of no concern coming out of this, but like I said, we'll see.  There's nothing about diabetes that makes life easy and it effects everything that involves the body -- much like carrying a baby, go figure.  I've somehow managed to avoid the swollen ankles and several other unpleasant side effects of pregnancy this go around, so here's hoping that some of the diabetes and delivery complications will be irrelevant as well.

I expect this will be my last blog post for a while since the hospital has spotty internet connectivity and I'm planning to be very busy with our TWO wonderful kids for a while...  But I'll be sure to put up an update when we get home and we're all settled (please don't call while we're at the hospital since we're not out of the woods yet).  Until then, thank you so much for reading my posts and giving me your support and encouragement over the past many months.  Writing about what is going on is a great outlet for me and, although things have been rough with the pregnancy, knowing people out there care is appreciated more than you know.

Talk soon :)

Week 36, part two

For the third night in a row, I woke up in hell this morning with my blood sugar much lower than it ought to be.  Wednesday I was 34, Thursday I was 32 and today at 2:45 AM I was 43 -- what the heck?!  I mean I love the excuse to wantonly eat simple, quick acting carbohydrates like I am a care free non-diabetic child again, but within the context of the last few weeks of a class B diabetic pregnancy I'm not thrilled in the slightest to need to open my bed side table drawer and raid the stash of sweets HB and I have stock piled for moments like this.  It'd be nice to want a piece of candy for once!!

Any way, I've been going back and forth with my new endo via the phone practically every day this week and I lowered my basal rates by 0.05 each night in an attempt to curb my plummeting blood sugars. Heck, I've practically cut the rate from 12 AM to 3 AM in half over the past three days -- but unfortunately to no avail.  Needless to say my Friday appointments with the perinatologist and endocrinologist couldn't have been better timed this week...

Still gawd-awfully sick with this respiratory infection (I'm now on a new uffdah-uffdah prescription of antibiotics and still coughing like day one), we went back to the Antenatal Testing Center this morning for yet another round of non-stress tests and my 17th sonogram.   The NST was enough reactive to pass and the AFI was much higher than last time (19 on Tuesday, 24.6 today), which the sonographer and resident (ug) dismissed as "symptomatic of being a diabetic."  However, given the smorgasbord of health complications I've had this week - an optical migraine on Sunday, the coughing and vomiting of this infection and contractions - on top of my seriously unstable blood glucose, the resident kicked my case back to Doctor Bronsky who felt it was worth a cervix exam and blood panel to make sure I didn't necessitate immediate hospitalization for preeclampsia or placenta failure.  

Fortunately the blood panel came back showing normal liver function (thank God) so immediate hospitalization wasn't necessary, however Dr Bronsky placed orders for me to have an amnioenteses done on Tuesday (day one of week 37) to evaluate Baby's lung maturity so that he can move the delivery date up from November 27 to as soon as possible.  Soooo, essentially things with my blood sugar aren't stable enough for her to make it another 10 days in utero but the doctors cannot risk her coming out too soon since diabetic babies are notorious for having immature lungs (even at "full term") and you throw in my respiratory infection in on top of that and they've got a very delicate line to walk between letting her stay in and getting her out safely.

Furthermore, from talking with Dr. Bronsky about the possible use of additional steroids as a fail-safe to help her along, HB and I found out that subsequent injections of steroids to mature a premie baby's lungs for delivery is highly controversial after the first dose and there is mixed evidence regarding not only its efficacy, but the safety of it.  So while the doctors back at Stafford Hospital on Sept 25 made the right emergency choice to administer the steroids to me for a possible pre-term delivery, the reality at this point is that my docs aren't sure what they're going to do if a) I go into spontaneous labor sooner than induced or b) if the amnio shows her lungs to be less developed than ideal for a before Nov 27 delivery.

Generally we're feeling like deer in the headlights and overwhelmed by the delicacy of the entire situation.  Having lost the mucus plug and had some show already, I'm feeling like a passenger in a uncontrollable rail car with no clear, straight forward escape plan... thank God HB is the one who has to drive the truck to NOVA, thank God the Perinatal Associates are the best of the best high risk pregnancy docs Virginia has to offer and thank God that Fairfax INOVA has one of the top 5 NICU in the country!

After leaving the testing center, we went straight to my appointment with Dr Rogacz in Fairfax.   Taking a sharpened pencil to my chart, she slashed my basal and bolus rates with the finesse of a Michelin Star Chef at the cutting board.  She then brought up the ever present topic of "when labor begins" ... to which I must say, as a pregnant woman you're constantly thinking about what's this sensation and even as a second timer I find myself worrying about whether I'll know when my water breaks, but adding diabetes management to something I'm already stressed to the gills about is simply exhausting.  It's really no wonder I'm so sick.

Any way, she walked us through what she wants me to do with my pump settings for active labor.  Similar to an endurance athletic event, which let's face it, labor is, the whole physical process of pushing a baby out of your womb causes blood glucose to fall sharply in diabetics because of expended energy... That being said, she's asked me to cut my rates from what they are "normally" (ha, as if they are stable and normal now) to my lowest setting and keeping them at that low 0.2 unit setting until the baby is out.  Of course if my blood glucose continues to drop even at that low basal rate, we'll need to decrease it further and have me put on a glucose drip to make sure I don't go into hypoglycemic shock while in active labor.  Fun stuff.

So after Baby and the placenta are out, I'll need to reprogram my pump again since I'll be back to pre-pregnancy (actually probably lower) insulin needs because the placenta will no longer be present to create an insulin-resistant environment in my body.  For this Dr. Rogacz has instructed me to initially cut all of my basal rates in half, suspend use of the symlin injections and go from there.  Being naturally so hyper-sensitive to insulin will likely make the postpartum diabetes dance a difficult one, but I've been rightly warned that any non-diabetic symptoms I may display -- in other words maybe not even needing artificial insulin -- will be temporary as my body recovers and returns to a new normal.

I only have one word to describe all of this: over-frlcking-whelming.

I wish I was in the blissful period of enjoying the last few days of pregnancy with out a care and an extra foot rub or two, but the reality is that this pregnancy will be medically complicated start to finish.  I knew what I was signing myself up for, but conceptively rationalizing risk and tangibly feeling fear are completely different things.  Honestly, I'd like to just get this show on the road already so that I can know it how things turn out, but it's out of my hands.