Breast Milk, part two

So you know my last post on breast feeding? Thought I was done? Well, guess what? There's more!

Now that I've explained the complexity of breast feeding as a diabetic and how the balancing act is more a matter of self-care than baby-care, it's about time that I move onto the real impetus for getting around to writing these posts: Downton Abbey.  For those of you who watch the show, I've tried to give you all a few weeks to catch up on the fourth episode so as to not inadvertently spoil the plot for you, but seeing as this topic has been eating me up inside I just cannot wait any longer to vent about it.  Several Sundays ago, Lady Sybil died from eclampsia after giving birth to a beautiful, healthy baby girl.  I wept my freaking eyes out.  I simply couldn't believe that Julian Fellowes (the writer) would do something so horrible to the most wonderful character on the show... I mean for God's sake man, kill Bates if you have to, but not Sybil!

Many of you might find this to be completely random and not at all relevant to a diabetes related post about breast milk, but bear with me -- you see, when Mr. Carson, Mrs. Hughes and Mrs. Patmore began talking about the baby's need for a wet nurse I got to thinking.  While breast feeding is an extremely personal choice for mother's now a days and there are definitely social stigmas that go along with not just nursing, but sharing breast milk, the reality still exists that there are babies out there that need to be fed by other means than their own mothers.  Clearly formula is the go-to option now a days for such situations, but I'd heard tell about the practice of breast milk donation and wanted to check it out.

So off to Mr. Google I go to look into what organizations are out there and what it takes to become a breast milk donor (face it, with the image of Sybil Branson's baby fresh in mind who wouldn't want to help out?).  The search engine pops up with several different groups that collect donations for families in need and I delve into the mission statements, success stories and finally into the requirements pages... logically, the organizations insist that a donor have her own baby's feeding covered before considering donating extra milk; they also mandate that a donor's freezer be capable of reaching - 4 degrees Fahrenheit; and, oh yeah, donors under no circumstances can be diabetic.

Putting diabetes under the same category of disqualifying diseases as HIV (SERIOUSLY?!), using artificial insulin on a regular basis classifies me an "unhealthy" mother...  ouch.  Now I am not so irrational as to deny these organizations consideration of liability reduction in making this decision, but likening my milk quality to that of a disease that is actually transmittable from person to person and actually communicable through breast milk is just insulting.   Women with HIV cannot safely breast feed without taking antiretroviral medication to prevent transference of the disease to their babies, but women with diabetes - as I said earlier - are not only capable of breast feeding safely, but they are encouraged to do it!

Having the past several weeks to stew on this topic, I'm not angry with these groups because I cannot donate something I willing would under different circumstances, but I am furious with diabetes that it has taken something important away from me.  It never crossed my mind to donate milk while breast feeding GW, but now that I'm actively feeding GV and am in a physical position to do so now, it really stings to know what opportunity I missed and what difference I'll never be allowed to make for another mother.  Don't get me wrong, I know mothers today who can't or don't breast feed have alternative options with formula, but it's the principle of the thing...

While I understand that I have a disease I work tirelessly to manage it and make it as irrelevant as possible.  But, being of spiteful character, diabetes seems to take pleasure in continuously adding insult to injury -- making me wear a battery operated computer 24/7 was just selfish; forcing me to cut out cream of wheat was just rude; making candy a thing of necessity rather than pleasure was sick and twisted; and, worst of all, having my milk practically labeled as carcinogenic is just unforgivable.

Screw you, diabetes. And the horse you rode in on.

Breast Feeding and Diabetes

For months now I've been saying that I'd write a blog post about breast feeding as a diabetic.  I'd skipped the topic while still pregnant since it wasn't quite relevant at the time and for the past 11 weeks since GV was born I just haven't made a priority of writing about it since doing it seemed more important.  But seeing as she's happily asleep in her swing chair and GW is at least pretending to nap in his room, I'm going to take this opportunity to tell you about it since I know you all must have been anxiously loosing sleep over it since I first mentioned I'd write about the topic back in 2012.

No? Just me? Ah well, c'est la vie.

According to the American Diabetes Association, the best thing that a diabetic mother can do for her new born child is to breast feed.  Citing multiple research studies, the ADA explains that babies that are exposed to diabetes in utero and are breast fed for upwards of six months after delivery have a decreased incidence of respiratory infections, a lower risk of asthma and atopy, tend to have lower blood pressure and are less likely to develop childhood obesity.   All great things, right?  Well, combining these medical benefits with the fact that the disease is not transmittable, that there have been research studies connecting certain types of baby formula containing bovine protein to the development of autoimmune diseases like diabetes and that I thoroughly enjoyed breast feeding GW, the choice was easy for me.  The practice of breast feeding with diabetes, however, is not so easy.

Blood sugar affects everything we do in our daily lives because it provides us with energy, so it seems only logical that there be some relationship between blood glucose and the natural formation of breast milk.  While you've probably heard that breast feeding burns calories, you may not have taken the next mental step to connect that with blood sugar... Essentially, in a similar way to how our bodies burn both calories and glucose when we exercise, a mother's body burns both fuels to create milk for her infant. So while a non-diabetic mother can singularly reap the weight loss benefits of nursing her little one due to her self-regulation of glucagon and insulin, a diabetic mother needs to monitor her blood sugar with extreme caution so as to not put herself (and by extension her baby) in danger of hypoglycemia.

To prevent this and to keep blood sugar stable, it's important that I eat before, during and sometimes after feeding GV.  But that brings me to the next topic of difficulty: weight gain and nursing.  Because of my sugars I need to eat more to keep my blood sugar up to be able to safely nurse -- but then that means that although I am burning calories while nursing I am required to ingest more calories to nurse which means any weight loss I should have with breast feeding is replaced with weight maintenance, if not additional weight gain.  Obviously this creates a source of stress for someone as physically self-conscious as me, but to take it to a less superficial level, weight gain can change a diabetic's chemistry enough to change the body's response to glucose and therefore its artificial insulin requirements.  So... to keep this complicated... that means that I need to eat more to nurse more and that I must exercise more to compensate for not only remaining pregnancy weight (15 lbs to go) but the extra calories necessary to nurse (and exercise) all in order to keep my sugars stable enough to nurse in the first place.

Furthermore (because why, really, would it end there?) not only should my blood sugar be kept from going low while breast feeding, but they should not be permitted to go high either.  While the majority of perinatologists, pediatricians, obstetricians and diabetes organizations insist that there is no connection between a mother's in-the-moment blood sugar and the quality of her breast milk, there is a school of thought out of the Sansum Diabetes Research Institute in Santa Barbara, CA that believes the value of a mother's breast milk decreases when her bg is over 150 mg/dL.  According to these researchers, such deficient breast milk can cause infants to have "reactive hyperglycemia" which causes them to vomit, be excessively irritable and require more milk to satisfy their nutritional needs.  While there aren't additional studies to backup these claims and I've never seen such negative effects in GV's behavior when I have nursed her while high, a lack of evidence doesn't necessarily refute the possibility and I've decided to play it safe rather than sorry.  Admittedly it voluntarily adds another level of complication to breast feeding, but what does it really cost me?  If it is no big deal, then oh well.  If it actually matters, then it's worth the effort.

The bottom line is, I am thrilled to be nursing; it's a very personal choice and I find it completely satisfying. But breast feeding and diabetes take a lot of conscientious thought -- and at 3 o'clock in the morning when GV wants to nurse that is a lot to ask for.  Don't get me wrong, glucose control is definitely less critical and requires far less attention to minutia now than in pregnancy, but it's still exhausting to continuously consider.  I could let it go and give myself an easy DKA-sponsored trip back to my skinny jeans, but I cannot justify cutting myself any self-satisfying slack on my sugar control since a lax take on it would imply irresponsible parenting at best.

Seeing as I take my vocation as wife and mother extremely seriously, I guess this is just another one of those necessary "diabetes says this is how it is going to be" horse pills to swallow and get over it... now if only they made that in a gummy I'd be happier.

Why take a horse pill when you can have a gummy?  

Farewell, my beloved breakfast.

This past Saturday at just before 9:00 in the morning, two hours after my breakfast, my jaw hit the floor when my blood glucose meter read 312 mg/dL.  Having calculated the carbohydrates in my breakfast precisely and then failed to drink my coffee my blood sugar should have dropped low, but like so many early day meals lately my glucose was off the charts.  I'd adjusted my pump settings last week in an attempt to self-correct my post-breakfast hyperglycemia, but seeing my meter read a clearly unhealthy, wholly intolerable number in the three hundreds (THE THREE HUNDREDS!!) I placed a call to my endocrinologist on Monday morning for some much needed help.

Since my two hour postprandial numbers have been high, but my four hour postprandial numbers have been low/almost low she didn't recommend changing my morning bolus ratio and, because my breakfast isn't always at the same time, she said my basal rates shouldn't be the issue.  I inquired about whether I should go back on the symlin injections, but because I am breast feeding she insisted that I do not since there isn't any information about whether or not artificial amylin is transmitted in breast milk and, if it is, it'd create an unsafe situation for GV.

Removing all the "simple solutions" to the issue and still without a clear path forward, Dr. Rogacz inquired about what I usually eat for breakfast.  Telling her that my everyday (yes, the same thing, everyday) go to breakfast is a bowl of cream of wheat and a cup of coffee, she made an "ah ha" sound and proceeded to break my heart by saying "your problem is probably the cream of wheat."  Citing the high glycemic index of wheat, as we loving call it in this house, she instructed me to drop it and similar "dense" carbs out of my diet in order to keep my sugars under better control.

(Insert mopey, pouty face here)

So what is the glycemic index (GI)?  The GI is a measurement of how much each gram of carbohydrate in a certain type of food raises a person's blood glucose level once it is consumed.  Foods that breakdown quickly in digestion and rapidly release glucose into the bloodstream are "high" (over 70) on the GI scale, where as foods that break down more slowly will gradually release sugar into the bloodstream and therefore are considered to be "low" (under 55).   Here are some examples for you:

High:  Rice, plain white bread, potatoes, breakfast cereal and watermelon.

Medium: Sweet corn, bananas, raw pineapple, raisins, pita bread and regular ice cream.

Low:  Raw carrots, peanuts, raw apple, grapefruit, peas, skim milk, kidney beans and lentils.

Because a lower glycemic response usually means less insulin is required to maintain a healthy HgA1C, foods that are low on the GI tend to improve long-term blood sugar control and cause less spikes in sugar like I am currently seeing at my two hour postprandial.  So, you see, on top of needing to be carbohydrate conscious on the basic this is bread that is pork level, my body has decided for the first time since becoming diabetic that it cares what carbohydrates I am eating and is forcing me to forfeit the lusciously dense carbs I emotionally love.

I know my doctor is right in making this recommendation and I'm only just beginning my research on what this actually means as a lifestyle choice, but my first response is that I am thoroughly peeved.  I am annoyed with my diabetes for messing with me again and on something so indulgent as my favorite breakfast.  I mean at least the doc didn't tell me to give up coffee (Lord knows THAT would have been impossible) so I at least still have that, but what to have with it will take some time.  I expect after an adequate period of mourning that I'll come up with something else to whip together in half sleepy delirium, but for the time being, in a state of melodramatic protest I refuse to replace it with something sub-satisfactory.

Running, sans supervision!

The last couple weeks have been over cast, cold and dreary - more or less the meteorological embodiment of my state of mind and energy levels.  I've avoided leaving the house without HB in an attempt to reduce the overwhelmed feeling I get when GW is melting down, GV is hollering to be fed and Lord knows what else is pulling me in six different directions and making my back seize with stress.  Fortunately when HB is home I've got the backup I need, but, I tell you, when it's just me and those clouds I couldn't feel more unmotivated to complicate my life with a trip to the grocery store or rainy playground outing.  But today things were different.  It was the nicest, warmest weather we've had in Virginia in ages - seriously the sky looked fake it was so blue! The sun was shining and, even though HB wasn't here, I decided to take my chances and get out of the house.

Going through the pre-outing check list, I tested my post-breakfast blood sugar to make sure it'd be stable enough to take the kids out on my own.  My meter beeped and it read 230 mg/dL; way high.  Now, granted, hyperglycemic blood sugars ensure I wont randomly pass out and leave my children unsupervised on a walking trail or vulnerable on the swings, but for someone who takes pride in tight glucose control such high numbers are horrific.  I don't know what's causing them, but I've seen several high readings like this lately - I mean I am not under bolusing, miscounting carbs or over eating... I'm just off.   I'll need to talk to my endocrinologist about this...

So I punch in the bg numbers into my pump to see if a correction dose is necessary; which it isn't.  I've got 2.3 active units of insulin left in my system from my breakfast bolus and I only need a measly 1.3 units to get back down into my ideal blood sugar range.  But not wanting to wait for it to take it's sweet time (haha, get it?) to come back down I decided to throw out the mental debate I'd been having between taking GW for a bike ride or simply going to the playground and opt to go for a run instead. 

Now, I've never done this before... "this" being running with the stroller and "this" also being running by my-diabetic-self because HB always pushes the stroller and HB always runs with me.  You might think this is mean of me for not helping tote the extra weight around (stroller: 34 lbs + GW: 38.5 lbs + GV: 13.3 lbs + GV's car seat: 11.7 lbs = 97.5 extra lbs!) or you might think I'm genius for creating a scenario that "requires" HB to exercise, but the reality is the stroller makes my hands go numb (a sensation I loath) and I am terrified of the worst case outcome when combining diabetes with exercise, passing out.  If I pass out with HB around he knows what to do, but if I pass out without him the what ifs start to pile up and I typically don't find the risks worth running. Literally. 

But with my blood sugar sky high, the weather this nice and my mood more zipp-a-dee-doo-dah than normal, I detach my pump, place it on the night stand, lace up my Asics and we head to the car.  Since exercise works to improve insulin efficiency in the body, I know that by running my glucose levels will drop and by starting with my blood sugar so high, removing my pump and strategically checking my bgs along the way I can get back down into a healthy range sooner and then consume quick acting carbs as necessary to prevent going too low.  So without my babysitter and child-pusher, I put my music on and hit the pavement... within one mile my blood sugar was down to 138 mg/dL and by the end of the three mile loop it'd gotten down to 65.  

Admittedly I failed to keep my sugars in the safe range, but I accomplished everything else.  I'd put a mental block in my head about my ability to push that stroller and run on my own that didn't need to be there.  So what that my hands loose sensation? And, yeah, my diabetes still requires conscientious treatment, but oh well, c'est la vie. The point is I can do it - and not half badly either!  Granted I'm not about to let HB off the hook now and run on my own all the time, I'd still prefer to have him around... it just goes to show that the lesson learned today is that I run with HB because I want to, not because I have to.  

Two month update

GV is two months old already.  I don't really know where the past eight weeks have gone, but they have and, to be honest, the drama of the pregnancy feels like years ago. Our life with GV around feels so natural and normal - albeit crazy at times, but that is typical.  We've found a battle rhythm that seems to keep everyone happy, most of the time, and despite GW's lectures to GV that she "needs to poop in the toilet, not the diaper!" I think they're doing remarkably well together.  He is very eager to help out with her and she just lights up whenever he is around - lectures and all.

We took GV into the pediatrician today for her third well baby appointment and, despite the tears she shed over her three vaccinations, I am glad to report that it went really well.  She's a very healthy, happy baby and the doctor had nothing but positive things to say about her development and growth.  Check out her stats:

Weight: 13 pounds 3 ounces (96% up from 22% week two)
Length: 23 inches (75% up from 50% week two)
Head Circumference: 15 3/4 inches (81% up from 26% week two)

Despite the diabetic baseline and the number of additional complications we had in the pregnancy, it seems that the care I took to make sure she'd be safe both in utero and after birth paid off.  She's a perfectly normal baby and that is the most any mother - diabetic or not - could hope for!  I just continue to pray to God that she stays healthy, happy and safe for her whole life... and may it be a long one.

 

Love you GV - xoxo

Honesty: a scary policy.

I have been struggling the past few days with very conflicting interests.

On one hand I create these posts with the intention of providing family, friends and strangers alike with a comprehensive view of what my life is like as a type one diabetic.  I mean for them to act as an educational tool and a running commentary on my daily trials and tribulations so as to prevent perpetual ignorance about my disease and to demonstrate the breadth of impact diabetes has, regardless of the topic.  Of course this has been somewhat embarrassing at times, but in light of the goal I set out to accomplish with this blog I've been striving to say whatever I ought to say that is relevant to the subject.  Face it, one can't "comprehensively" talk about such things as pregnancy and diabetes without mentioning such socially uncomfortable details as one's cervix.

Which brings me to the other hand. The reality is, there are topics that I am quite self-conscious to cover and I avoid for fear of other's judgement and censure.  Not to mention, if I don't write about a topic, then I avoid acknowledging it and inadvertently providing validation to pieces of myself that I'd rather didn't exist. The lens that I voluntarily create, therefore, has the ability to insulate me from vulnerability by allowing me to share information on my own terms, edited as necessary.

But in placing my concern for criticism above my goal for "comprehensive" topic coverage, I stifle any self growth I could otherwise achieve and I might as well resign a career in creative writing before even starting! What's that old saying? If you can't stand the heat, get out of the kitchen.  Well... I like to cook and I like to write... so I'd better work on tougher, more heat resistant skin.  That said, I find myself being untrue to you, the reader, by purposefully not writing about something that is central to my current life with diabetes: postpartum depression.   

I'd suffered from chronic depression a lot when I was younger and, mainly due to the social stigma around the condition, I've always found it very difficult to talk about being unhappy and why I was so.  I remember a conversation I had with HB early on in our relationship where I tried to openly share this part of my world and he dismissed the diagnosis as snake oil and advised that I attempt "keep more busy." Obviously that hurt, but that was then and we've since had time to come to terms with the factual existence of complications caused by chemical imbalances and to build a more constructive, supportive relationship.  (To his credit, I must say that such a quote seems horrifically misattributed to him and I very much appreciate his new found open minded approach to me and the world.) 

There is no appropriate time to talk about depression and there is certainly no easy way to go about it, but seeing as I've written about every other pregnancy complication I've experienced, it seems disingenuous to omit this one from the record simply to spare my own discomfort.  The fact of the matter is that postpartum depression is a childbirth complication that is caused by hormone changes and imbalances... and I seem to be struggling with it.  I'm moody, withdrawn, fatigued and frustrated.  Don't get me wrong I love being a Mom and some of these feelings are standard operating procedures for the job, but when showering sounds like too much work, the couch is my new best friend and I have no will to fight my son watching Chitty Chitty Bang Bang for the billionth time it is time to admit something isn't quite right.

I don't recall having issues with this after my first pregnancy, but in doing some reading about the condition, I am not at all surprised by its occurrence now.  As it turns out, a 2009 research study competed by the Harvard Medical School and University of Minnesota School of Public Health found a definitive link between diabetes and postpartum depression.  Among the 11,000 women who were tested, those with any kind of diabetes - be that type 1, type 2 or gestational - were two times more likely to develop depression during or after pregnancy.  Unfortunately the research did not extend farther to identify the connection between the two illnesses, but it is the first study to demonstrate the existence of a relationship and it certainly warrants further inquiry on the topic that I ardently hope they'll do.  Until then I guess I just happen to be one of the lucky 1 in 10 diabetic mothers who get to figure out how to deal with it... 

I wish I had a plan of action that would spell out S-U-C-C-E-S-S in treating this complication, but I don't want to be on medication and I can only guess at what other changes might be effective. I think writing about it here is at least one step in the right direction because no matter how hard it is for me to admit its exists or how much I dread what people may say, it is part of my reality and ignoring it wont make it disappear.  And if I am scared to write about this then what else am I going to be too afraid to publish?  I can't afford that fear and there shouldn't be a place for it here. 

I'm not perfect, but I am honest.  As terrified as I may be in saying these things, I believe it's the right thing to do and, on the off chance there is a diabetic Mom out there reading this and experiencing what I am, you're not alone.  It's not the best hand to be dealt, but we've got to face it and keep moving. If not for us, then at least for our kids. 

Two Year Anniversary

Two years ago today, at some forgotten hour in the afternoon my existence changed with a diagnosis of diabetes.  I remember the relief I felt that day when the doctor announced my newly acquired accessory (because, let's face it, diabetes manifests itself as battery operated, pocket sized baggage) as if I'd some how dodged a bullet and gotten off easy -- it's not cancer, after all.  But sitting here 730 days later I can't help but feel very sad that I wound up in such a serious, long term committed relationship with artificial insulin.

In a lot of ways I feel like I am married to my pancreas and not in a happily ever after, ride off into the sunset kind of way -- it is more like the drunken, bad idea, spur of the moment Vegas wedding with divorce banned in the prenup kind of way.  I was a happy, healthy and independent woman before January 24, 2011 and then BAM! I woke up and found myself in bed (one that I did not make, by the way) with a disgustingly lazy pancreas that is inexcusably and exhaustively high maintenance.  I don't like it, I certainly don't love it and I'm sick (literally) of it.

Honestly folks, I am tired of being diabetic.  I am (postpartum-exacerbated) depressed about being diabetic. I mean when you get the flu it is horrible and you curl up in the fetal position for a week or so and then you're back up on your feet, good as new.  But with diabetes, it's emotionally like I've had the flu ever since I left Georgetown Hospital.  I rationally understand that the disease I have could be a worse one and that my diabetes is not nearly as bad as it could be (or as the flu feels), but the work it takes to keep it this way and to prevent all of the worse diseases that diabetes can cause takes constant attention.  And I am tired.  I want to be done.  But there is no cure, there is just treatment.  Maybe someday this will change, but until then the unfortunate relationship continues.

So, my non-honey, anti-sweet, not-so-dear pancreas, happy anniversary.  Seeing as this is year two, I guess I'm supposed to give you something cotton and I think any one of these t-shirts expresses my true sentiments about you.  Take your pick!

Six Week Check

Now that GV is officially eight weeks old, I should probably get around to writing about my six week post-delivery follow up with the Perinatal Associates of NOVA as that appointment really and truly acts as the finishing period to a very long, run-on pregnancy sentence.  A lot happened over the course of those 38 weeks that I didn't expect and coming into this appointment I had a list of eleven multi-part questions I needed answers to.  Fortunately, the office purposely scheduled my appointment with Dr. Bronsky and seeing as he cared for the majority of my case I was able to receive much of the information I was looking for... Since you all have accompanied me on this journey, it seems only right that you get closure to my questions as well:

1.  What results did the placenta pathology find?

Instead of sending the placenta to disposal as hazardous waste as is typical of most hospitals, Dr. Bronsky sent my placenta to the lab for pathological analysis in hopes of more in depth answers to why my AFP levels were abnormal, the extent of the abruption and why my blood sugars were atypically trending low.  Unfortunately, the report wound up being predominantly uninformative, save one factor: the placenta's weight.  Apparently a typical, healthy placenta for a typical, healthy pregnancy weighs nearly 1800 grams or, at a minimum, 1/6 the weight of the baby at birth - which in GV's case would have been about 600 grams.   This placenta weighed 298 grams.

This excessively small size for a placenta could be the reason for the abnormal AFP levels and my blood sugars dropping given it's insufficient capacity, but there is no way to know for sure.  Furthermore, there is no way of knowing why the placenta was so small in the first place - it is possible that the abruption could have caused its small size or it is conversely possible the small size could have played a hand in the cause of the abruption... it's just another version of the chicken and the egg debate. Only God knows.

The only thing Dr. Bronsky definitively said on this topic was that he is shocked that GV was as large as she was at 6 lbs 14 oz because such complications usually present issues of growth restriction -- which if you remember was the concerns we had with possible placenta calcification.  Guess this goes to show that placenta deterioration was an issue, not because it was prematurely breaking down but rather because it was abnormally petite.

2. What happened to the epidural?

There is no way to know why the epidural failed.  Dr. Bronsky said that there were clearly some mistakes made by the nursing staff in that they didn't attempt to fix the issue quickly or call anesthesiology to have them evaluate what was occurring. But given how quickly GV arrived their intercession would have likely been irrelevant in this case anyway.

3.a. Are additional pregnancies safe?

Assuming my blood sugar is under tight control prior to conception, Dr. Bronsky believes there are no reasons why future pregnancies would be inadvisable.  Granted, they will all be complicated and high risk because of my preexisting diabetes, but my safety and the well being of potential babies is not inherently in jeopardy based on what he saw with this pregnancy.

3.b.  Are there different timing requirements between pregnancies for a diabetic?

No, diabetics don't need to wait x number of months longer than non-diabetics to conceive again.  However, like with all women, it is advisable that new mothers wait twelve months before trying so as to permit their bodies time for full recuperation before attempting the physical stress subsequent pregnancies.

4.  At what age should I stop having babies due to compounding diabetes and age risks?

Knowing that pregnancies are considered to be high risk for women over the age of 35 due to an increased risk for birth defects, low birth weight, and macrosomia, Dr. Bronsky explained that while it's not exactly advisable the reality is that it all depends on how things go between now and then.  If over the next several years pregnancies go smoothly and I continue to stay healthy, then there is no reason post age 35 pregnancies can't happen safely.  Alternatively, if pregnancies become more difficult and present more serious complications, then fewer pregnancies, even before age 35, may be called for.

5.a.  Will multiple pregnancies as a diabetic increase my risk of diabetes complications?

No, but the longer that my body is exposed to the disease of diabetes, regardless of the number of pregnancies I may have, the more likely I am to have complications.  Fortunately the better controlled my diabetes the less probable complications are.

5.b.  Will multiple pregnancies as a diabetic increase the in utero risks for future fetuses?

No, the number of pregnancies I have as a diabetic is irrelevant to the degree of risk future babies may face.  The complications of previous pregnancies, however, will potentially increase this risk factor and should be considered after the completion of any additional pregnancies.   See question 11.

6.  Will the complications from this pregnancy be likely in future ones?  And can I do anything to proactively prevent them?

All of the complications I faced with this pregnancy are possible - and to one degree or another, more likely - in future pregnancies, but there isn't a definitive way of predicting what complications may or may not happen again.  Seeing as this will be discovered on a case by case basis, there isn't anything I can do now to prevent x, y or z complication except to be as healthy as diabetically (diabolically?) possible.

7.  Is there anything I can do differently in future pregnancies that will prevent complications?

No.  (Hmph)

8.  Can we expect my blood sugar to behave similarly in future pregnancies?

No.  It could be the same, it could be better or it could be worse.  (Hmph)

9.  Should I assume that the next baby will arrive faster that GV did?

As the skids are greased with GW's quick arrival and GV's 3 pushes, it is quite likely that the next baby will arrive quickly as well.  Dr. Bronsky advised we move closer to the hospital before then... I tend to agree. 

10.  Is there anything I should do perpetually to prepare for any possible future pregnancies?

Beyond keeping my diabetes in check with a stellar HgA1C, the only thing I can do regularly is take a folic acid supplement.  Since the majority of critical organ development happens almost immediately upon conception daily pre-pregnancy doses of folic acid decreases the likelihood of birth defects and ensures proper neural tube formation.

11.  Will I always be a class B diabetic or will that change?

Yes it will change, but background information first: there is a scale called the "white classification" used by perinatologists to classify diabetic women into various explanatory groups based on their diabetes and the risks associated with it.  I currently fall under the "class B" group as I am a person who was diagnosed less than ten years ago and after the age of twenty.  In eight years, however, I will become a "class C" diabetic because my exposure to diabetes will be greater than ten years and in eighteen years I'll once again be "upgraded" to a "class D."

The White Classification was created by Priscilla  White in 1949
to partially predict the course of treatment for a pregnant diabetic
and the chances of newborn survival.

And there you have it...

I'll admit to being extremely relieved that this appointment didn't shatter my dreams of a large family.  I've long been fearing that one complication or another may push me over the edge in terms of risk, but for the time being I'm alright and that is all I can ask for. I'm not sure how many kids we ultimately want in the end (maybe four? maybe five? maybe twelve? ... just kidding... sort of), but God willing however many healthy babies we can have we'll get - after that there's always adoption, HB willing.

Inabilities.

For the past several weeks I have been fighting tooth and nail with the word "can't."  I can't cook dinner with a migraine.  I can't nurse GV and "rock-a-baby" GW simultaneously.  I can't test my blood sugar one handed.  I can't find a spare moment to write more than a sentence or two at a time.  I can't fit my new books onto the already full bookshelves.  I can't get GW to take his (much needed) nap - and consequently I can't take a (much needed) nap.  I can't get a quality resolution picture of GV with my camera phone.  And, the cherry on top of it all, I can't stand GW saying the word "can't."

I guess my little sponge has picked up on my repetitive use of the word lately and has usurped it for his own use.  I shouldn't blame him for adopting the vocabulary he hears - I mean, at least we don't use vulgar language around him - but you can imagine my annoyance with his perfectly quipped and quick response to "go to time out" being a simple "I can't." Fortunately, being infinitely wiser than he at age 3 (wiser sounds much better than older, don't you agree?), I have miraculously found maternal ways to overcome such toddler identified inabilities; unfortunately, the limitations I find myself facing aren't quite as easily solved by sitting in the green and white striped chair in his room for some predetermined number of minutes.  Granted, GW regularly tries to send me to said chair and I'm sure he would love to see me work through my "case of the can'ts" from the corner, but the double sided nature of being Mom is that while I'm immune to such punishment, my problems are as well.  Seeing as I can't shake my troubles that way, I'm forced to find alternative methods of treatment... which appears to be gripping about them here.

Now, I could spend the next several paragraphs writing about any number of things I can't stand or can't fix, but when it comes down to it there is only one thing that has me completely infuriated: my inability to make air rise.  Scientifically speaking this should be a God given faculty that I share with every other human being on earth - I mean it is a known fact that warm air rises and that density has a correlational relationship to gravity - but for whatever reason I am physically impaired in this department.  Let me explain:

Scenario One:  When I do an infusion change, I have to attach a new reservoir to an insulin vial in order to fill it with the appropriate number of units to last me two to three days.  I make sure that the reservoir is full of air, I attach it to the top of the vial, inject the air and invert the vial.  By doing this I create pressure in the vial and enable the insulin to transfer containers more easily when I pull the plunger back down and suck insulin into the reservoir.  At this point I need to get all of the remaining air in the reservoir back into the vial so that I do not wind up with air pockets in my pump tubing, so I tap the side of the reservoir to make the bubbles rise and then I inject them back into the vial.

Only problem is that I can tap, flick, even bang the reservoir until my fingers bleed, my pencil breaks or the reservoir flies off at impact on the table and I still can't get those fricking air bubbles to rise.  They stubbornly stick to the bottom or side of the reservoir and I can imagine them cackling at my frustration each time they evade my scientific understanding of liquid vs. gas.

It's maddening.

Scenario Two:  My little GV is a phenomenal eater.  At seven weeks old, she has put on just under four pounds since birth and she's starting to put 2 + 2 together and she makes a beautiful smile every time I pick her up to nurse.  She usually nurses for twenty to forty minutes at each feeding and, typically, she needs to be burped once in the middle and once at the end.

Unfortunately, however, no matter how I attempt to burp her or how many times I pat her on the back I can't get that gorgeous little girl to eruct! I'll spend an infuriating amount of time attempting to fix my loosing record, but every time I wind up needing to pass her off to HB who immediately gets her to burp within seconds of the exchange.

Again, maddening.

After attempting what feels like every possible technique change known to man, I don't know what else I can do to change such obnoxious inabilities.  I've tried hard to be creative in my solutions (and yes, I've even tried time outs) but sometimes it just seems like the deck is stacked against me and there is just no winning.  I'm trying my darnedest to cut the can'ts out and to implement a more can-do optimism to my naturally pessimistic self, particularly for GW's vocabulary sake, but with frustration and annoyance I am throwing my hands up and leaving the raising of air to the rest of humanity.

Perhaps there is something else, like the completion of this blog post for example, I actually can do something about... take that can't I'm attempting a come back!

Left: My fall 2009 can-do solution to GW wanting to be held
and the necessity to finish a grad school research paper.
Right:  My can-do solution to GV wanting to be held and
the need to complete summer 2013 course reading.   

Coming soon...

So I've been working on a blog post titled "Inability" for about a week now and I just seem unable to finish it.  How ironic.

2 miles down, 22 lbs to go

I CANNOT TAKE IT ANY MORE.

I made it four, almost five, weeks without exercising, but waiting another two will drive me absolutely mad.  Between the beckoning my running shoes are incessantly doing, the taunting the scale does each morning and my mental stream of expletives each time I have to put on maternity pants rather than normal jeans I'm just about at the end of my post-bed rest couch potato rope.  So, to quote Rafiki, "it is time."

Godiva exercise fuel...
 quick carbs or extra calories?

After a much needed trip to the local Target to pick up running pants that fit (ug, how mortifying!), HB and I laced up our dusty sneakers, packed the kids into our new Bob Dullie (thank you CraigsList) and hit up one of our old running loops for a "test run."  Between his ACL reconstruction this past August and my involuntary pregnancy induced running hiatus, it's been months since either of us have put one foot after the other for more than a gimpy shuffle or waddle.  Clearly we weren't going for much in the way of distance or speed and, considering this was only day one, I must admit that our one goal was to prove to ourselves that neither of us are either too old, too out of shape or too broken to do it... which I am tickled pink (maybe it's just my asthma?) to report we accomplished! Granted tomorrow we might be a bit sore, but by jove, such mental exercise was well worth it. 

With my starting blood sugar reading at 177 mg/dL, we ran five minutes on one minute off for four sets around the local YMCA sports fields.  The high wind was an additional challenge and I over bundled myself for the weather something fierce, but we kept it mutually positive and pushed at an average ten minute mile pace (okay, HB pushed the pace and I tried to keep up... BUT I'LL FIX THAT!).  By the end of our second mile, my legs were exhausted, my blood sugar had dropped to 84 mg/dL and my body was soundly expressing it's disproval for my bra selection.  It's normal to have glucose ranges drop that far when exercising, but seeing that this was my first time running while breast feeding and diabetic I am thrilled to see that my sugars are acting like they did when I was running and simply diabetic.  Obviously I'll monitor it each time we go out, but hopefully the numbers I saw today will be a trend (and how about next time I nurse GV before we go, rather than after... ouch).  I'll keep you posted.

So with two weeks remaining before I'm officially cleared to exercise at my six week check up, I'm taking my life back and saying screw it.  HB and I both have about 22 pounds to lose before we get back down to our pre-pregnancy weight - and, for me at least, this is after losing 20 lbs in child birth! I definitely gained more this go around than with the first baby (only 26 lbs gained with GW), but hey, I was allowed to exercise in the first pregnancy and I didn't have to scarf simple sugar to keep myself going.  I don't think it'll be all that hard to drop the baby weight with the right amount of effort, the real challenge will be seeing how much time it takes to get back into competitive running... I'm thinking maybe going for a full marathon this year, so hopefully the pounds will shed right off and I can start training to step up into the big leagues of diabetic endurance athletes! I mean, really, half marathons are so last year... 

What an idiot!

I've been having one of those days.  You know what I mean - when you not only wake up on the wrong side of the bed, but you fall out of it as well? It's not that I'm in a bad mood or anything, it is just that I'm just not entirely there...  putting the clean dishes away in the refrigerator and the milk in the pantry, shaving only one leg, writing the return address on both the "from" and "to" lines of a card and misspelling just about everything on the grocery list (let's just pretend I was writing in code).  All things considered, these aren't that significant of mistakes - especially when I have HB looking over my shoulder and laughingly correcting my blunders - but the one that is the real kicker, that really gets a burr under my self-loathing saddle and will have me lying in bed cursing myself for stupidity this evening is my forgetting to put the insulin vial back in the fridge.

Back in April 2011, I remember when I was being tested on my pump skills by a pair of Medtronic representatives (yes, they test you to make sure you wont kill yourself before they arm you with insulin) that one of them said to the other that "diabetics DO NOT like to waste insulin." For whatever reason, that statement got stuck in my head and I have been an insulin conservationist ever since... I might only have 0.50 units left in my pump reservoir, but I'll wait that extra 15 minutes for my basal injections to deplete that measly amount before I do an infusion change because - and I quote - "diabetics DO NOT like to waste insulin."

So after doing my infusion change this morning, I got distracted by something - I don't remember what exactly, but with two kids, two barky dogs and a Christmas cooking list about a mile long (I'm obsessed with holiday cooking) it's really not surprising - and I left the vial sitting on the counter.   While it's not that big of a deal to leave insulin out for twenty or thirty minutes, it's a completely different story to leave it sitting out for hours upon hours... it's not that insulin is like milk and curdles or straight up spoils, but the efficacy of artificial insulin goes down the longer it is exposed to inconsistent temperatures (I wonder if Goldilocks was a type 1 diabetic?).   Granted there is no way to know one way or another if that insulin had really "gone bad," but seeing as this vial was probably 3/4 full and that is about another month of insulin for me, I can't risk injecting myself with sub-standard insulin for fear of knock on side effects (hyperglycemia).  Into the trash it went.

Boo.

Which reminds me... I did a similar bone headed move while at the hospital.  The night that HB and I went to INOVA Fairfax to begin the induction process, I packed an extra vial of insulin just in case I needed to do an infusion change while there.  I put the vial in an insulated lunch bag with a couple freezer packs to keep it cool and we rolled out.   Several hours after I was checked in and we were anxiously awaiting the labor process to begin, I remembered my vial and asked HB to pull it out and get it into the refrigerator behind the nurse's station desk.  Retreiving the lunch bag from my purse, HB pulled out a completely frozen vial of insulin... I mean rock solid, white as snow, nothing resembling usable frozen.  What was worse was that this vial was brand spankin' new - the cap hadn't even been removed yet!

Agh!

So I don't know what it is that has me so distracted - maybe mommy brain? Simple exhaustion? Holiday exacerbated drama? - but whatever it is it has crossed a line!  Messing with my ability to complete simple tasks is one thing, but screwing with my insulin is below the belt! As mortifying as it'd be, I'd rather make inedible cookies for Santa (gasp!) than waste as much insulin as I've absentmindedly  squandered in the past month.  Somehow I think dear old Mr. Claus would be far more sympathetic than our insurance company will be...

Learning to Juggle

Finding time to write with two little ones certainly is harder than I initially anticipated.  I remember what it was like right after I had GW - in between nursing sessions I'd work on whatever I wanted while he was napping.  But now, while GV is napping I'm tending to GW and while he is napping I'm quite often tending to GV or whatever other to do list item that is pressing.  Don't misconstrue what I mean, I am certainly not complaining, but I am quite baffled at what happened to my clocks while I was at the hospital... I think my Mom and GW must have reprogrammed them because there is absolutely no way that 24 hours pass as quickly or as unnoticed as they do now.

No? Wishful thinking.

For months now, HB and I have been told that the most difficulty parents of multiple children will have is in the transition from one to two kids.  I'd rationally thought it through while pregnant and come to the basic conclusion that, yes, that makes sense. But now that I am physically trying to juggle two kids - one with a newborn fragile neck and the other with 38 lbs of momentum - I must admit that I while I anticipated there'd be difficulty, I didn't comprehend what shape or degree that difficulty would be.

Things between GW and GV are phenomenal.  He's taken to her like he's been waiting for her arrival his whole life.  He constantly asks to hug or kiss her and he always does so with the most gentle actions you previously thought were impossible from an otherwise over-enthusiastic three year old.  When she cries he'll drop whatever he is doing and rush to her side to ask "what's wrong?" or to say "it's okay, honey" and if his arrival doesn't sooth her he'll immediately attempt to corral me or HB by yelling "hurry, GV needs you!"  He even - get this - likes to help with diapers... 

Obviously at three weeks GV is still a bit too young to express sentiment beyond quiet contentment or outright audible frustration, but she doesn't mind his near by antics (she sleeps through everything) and quite often seeks GW out with her eyes if he is within her line of sight.  In fact, I believe she might even prefer GW's singing to mine given her faster response to his oh-so-cute version of "Goodnight My Someone"... I think they'll be just fine together. 

Me on the other hand, thank God I know this is supposed to be hard.  In those moments where one's tantrum is topped off by the other's wailing it's all I can do to figure out who is on first... then you throw in low blood sugar, the oven timer going off and the dogs growling because something is bothering their baby (our Cane Corsos have decided that GV is most definitely their baby) and you've got a recipe for instant tears.  And there I thought I was just making Christmas cookies...

In a lot of ways my life right now reminds me of middle school - and not because of the weird things hormones do to one's complexion.  In seventh grade I tried out for my school's basketball team and after five days of busting my tail to get that dang ball into that hoop I was cut.  Mortified and heart broken, I went home and cried and cried and cried about it because I was sure that I blew "my shot" in more ways than just putting points on the score board.  But, instead of crumpling under such pre-teen humiliation, I kept practicing my dribbling and I went over to my neighbor's driveway to work on my shooting every day until eighth grade try outs... and some how that second go around I made the team.  

Now while it may seem like there is nothing that corresponds between this outwardly random story and my current reality, there is one similarity that I boil it down to:  practice makes perfect -- okay, perhaps not perfect, but at least markedly better.  Back then I needed that extra year to improve my ball handling, and now I cannot expect to be perfect day one (heck, month one) and I need to take each day to practice my zone defense... I may be on the junior varsity team of multi-child moms for the foreseeable future but one day all the struggling I'm doing now will pay off.  I'm not sure when that day will be or what  I can do to make the grade sooner rather than later, but hey, at least there is the comforting thought that when we eventually have more kids, I'll have figured out the juggling routine with these two to the point that adding a few more will be a cinch!  

Until then, I'm just going to be grateful that GW and GV get along and that she's growing beautifully (she's officially outgrown premie clothes!).  The rest, well, we've got time and many more blog posts for that... 

NO BIG SHARP!

So this morning, while stressfully attempting an infusion change in between nursing GV and dressing myself for Mass (which we were of course running late for), GW walks in on me in our bedroom and begins to cry.  Yelling "No, Mama don't!" he crumples onto the floor in complex anxiety and begins a chorus of extraordinarily loud "NO! NO! NO!"  Rousing HB to abandon his half-eaten bowl of cereal, I quickly found myself the center attraction of an early Sunday morning family circus.

Since delivery, I've been able to swap my infusion site from the side of my torso back to my abdomen because my uterus is no longer in the way and, frankly, I find my stomach to be a much easier place to reach for insertion purposes.  Unfortunately, however, in making this switch I apparently forgot to debrief my toddler and he was absolutely horrified to see me putting a needle to a formerly identified "big ouch" spot.  Attempting to put me in time out so as to stop the wreck from unfolding before him, GW pointed at my belly and sobbed "no big sharp on the baby!!"

Despite his sister being bundled in her chair beside him and my obviously (dear Lord I hope it is obvious) smaller belly, GW apparently doesn't quite understand that the baby is no longer in my belly... which I must admit is either enough to make a person collapse from laughter or in tears.  HB picked up the crumpled kid and pointed out that GV is safely out of the way of the trajectory of the needle for my infusion change.   Sniffing and wiping his tears away with the back of his sleeve, GW looked from his sister back to my stomach with a perplexed look and, with an expression of at least some understanding, he changed his tune:  "Oh...  NO BIG SHARP FOR MAMA!"

Ah well... I wish I could acquiesce his request, but alas diabetes reigns and no amount of toddler passion will dethrone it.  I love that he is already protecting GV, even if he doesn't exactly know where she is, and I appreciate that his attempts to save me too are at least sealed with a make it better kiss.  It might not be the cure for insulin dependence, but if I have to stab myself then I will happily accept his cherry on top of an otherwise unpleasant experience.

Mommy Genes

You know when you stop doing something for a while how difficult it can be to start up again? Even if it's something you love like exercise, cooking, flossing or ... writing ... it's just hard to get back in the habit after letting things slide to a tranquil, yet non-evolutionary stop.  But as GV and I have been home for two weeks and she is growing ounce by ounce (up to 7 lbs 6 oz!), it's really about time that I get back on the horse and begin regularly writing again... So thanks to some persistent and much needed prodding from HB, here goes:

While I can rationally look at the calendar on my refrigerator and see that I was pregnant only a matter of days ago, it physically and emotionally feels like it has been ages.  While I am still not entirely sure how to parent two kids at the same time instead of just one, it feels natural to have both GW and GV here and I love them both like they've always been the best part of me.  All of the traumatic worrying and flaming mental "what if" hoops of the pregnancy are now seemingly irrelevant and inconsequential - which at the time I thought would never come to pass.  Essentially, the magic "mommy genes" have once again kicked in and wiped the slate clean... 

After my first dose of mommy genes back in 2009, I happily anticipated their wondrous impact this go around: the phenomenal disappearing act it makes of labor pain upon first sight of the new baby, the awe inspiring, tantrum-taming patience it provokes, the sleep-deprived juggling and plate-spinning it balances and don't even get me started on the gigantic seemingly oversized heart it straight up causes.  It's like when the Grinch's heart grows three sizes in that one day - Dr Seuss must have mistakenly infected that green-goof ball with mommy genes!!  But, in all seriousness, the biology behind child birth and motherhood amazes me in it's combination of emotional simplicity and physical complexity...  there's nothing quite like it and, no matter how sympathetic a person you may be, until you've got 'em, you just don't really get 'em.

Big brother week one - October 2009

Little sister week one - November 2012

Actually, I must admit that despite having two children I still don't understand the breadth of impact mommy genes have on a person - especially on a broken pancreas.  Don't get me wrong, I remember very well the differences between the before GW me and the after and I've done more than enough reading on the medical explanations of what to expect when you're diabetic and expecting to catch the gist, but these super-genes have still managed to surprise me in the last few weeks with their significance... namely their apparent panacea for insulin dependence.  Okay, maybe that takes it a bit far... I wish mommy genes were like some hopped up version of stem cells or something that could actually cure diabetes, but the effects breast feeding is having on my body are a pretty darn good consolation prize.  

So, breast feeding while diabetic is like constantly running or doing any other endurance sport because the body is perpetually burning calories and glucose to make milk.  This means that there is an incessant risk for diabetic mothers to become hypoglycemic and, as such, results in a decrease in the artificial insulin required to maintain a healthy HgA1C.  Combine this with the much lower presence of hormones in a new mother's body and you're looking at insulin rates that are at - and in my case, much lower - than pre-pregnancy levels.

On one hand this means that, if not careful or aware of on setting hypoglycemia, that there is an increased risk for new mothers to go into shock post-delivery (remember my third trimester hypoglycemia was abnormal).  On the other hand, this can mean a very welcome return to eating carbs with absent minded fervor... for example (yes, this is seriously a big deal) I can eat upwards of six - repeat: SIX - miniature Heath bars just because I feel like it before my blood sugar will respond like they "ought" to.  Now that I am reading this it sounds kind of wantonly gluttonous to eat that much candy in one sitting, but pardon me while I cackle at my new found ability to smuggle simple carbs past my pancreas! THANK YOU MOMMY GENES!

Now I doubt this new trick the mommy genes have introduced to my body will do anything positive toward me getting back into my other jeans, but hey, we've got to cut them some slack... they have me cooing and gooing over my sweet little girl (she's sleeping in my lap right now and so darn cute with her smiles - see video) and able to pretend I'm somewhat normal for the time being.  Exercise is still four weeks off before I'm "cleared" to hit the pavement again by the perinatologist and there is plenty of time to cover that topic once HB and I've figured out our post-pregnancy work out plan.  In the mean time, I'm going to continue enjoying my maternity pants, turn my insulin pump on ultra-low, and grab a candy bar -- I'd rather be snuggled up with these two kids than out running anyway!

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!