Wednesday, March 17, 2010

Some Final Thoughts on Managing Pregnancy With Type 1 Diabetes

This post was prompted by the realization that I just ate two slices of Zachary's pizza, a chocolate chip cookie, and an iced latte for lunch on 4 units of insulin. And my after lunch bloodsugar was 94. (Type 1 diabetic ladies, breastfeed, because it makes your insulin needs miniscule!)

(Also: I love my Moby.)

So, here's a list of some of my top considerations and ideas for successfully managing a healthy pregnancy as a Type 1 lady:

1) Exercise. This is my biggest piece of advice. It will make you feel better every single day. Exercise even in the first trimester when you feel nauseous. Exercise in the last trimester even when you feel like a beached whale. It will improve your body and your emotional state. And it will also help you to recover after your pregnancy. I labored without pain medication for 26 hours and then was up walking around the hospital 14 hours after my eventual c-section, and I credit that largely with my regimen of swimming, hiking, pilates, and yoga.

2) Check your bloodsugars religiously. I checked mine 10 to 12 times a day. If you can, push your doctor to approve a continuous glucose monitor for your pregnancy. This will mean you won't have to wake up three or more times a night. But seriously: even if, like me, you are waking up at midnight, three, and five in the morning to check your bloodsugars, it's all worth it. I mean, look at him. Isn't a beautiful, healthy baby like him worth all those finger pricks?

3) Cut yourself some slack. Try to eat a very low-carb diet, but don't drive yourself crazy. If you need a bowl of ice cream to take the edge off a particularly crappy pregnancy day, take the extra insulin and treat yourself. But then get off your butt and take a walk!

4) Start managing your pregnancy before you're pregnant. Get your a1c down months in advance, get used to checking your bloodsugar all the time, and start eating a healthy diet! It will make everything so much easier.

5) Get on an insulin pump. If I'd tried to manage this pregnancy with needles, I would've been much less healthy. My insulin pump enabled me to go from an a1c of 7.4 to 5.1 in just over a year. That is huge.

Any other diabetics, or non-insulin challenged ladies, have advice for maintaining a healthy pregnancy? Please share!

Saturday, March 13, 2010

Our First Two Weeks

Wow. Motherhood. Fatherhood. Babyhood. We've had a pretty good first two weeks. I can't believe how overwhelmingly emotional this transition has been. I sometimes just look at him and start crying because I love him so much. I wasn't expecting that, for sure. And sometimes I cry because he won't stop crying. Overall though, Uli is a very good baby. He sleeps for 3 to 3 1/2 hours between feedings most nights, doesn't have too many inconsolable freakout crying sessions, and in general seems pretty content to have us as parents, which I will take as a compliment.

We're so grateful for all of the lovely gifts that have been arriving on our doorstep, from books and CDs for Uli to this gorgeous quilt that Auntie Vickie sewed for Uli. Thank you so much!

Challenges have included my oversensitivity to his every change in appearance and feeding/excreting patterns — one of the weird side effects of being a diabetic is worrying that your baby is going to be less than perfect, healthwise. So far though, he's doing well. We found a great pediatrician, had a good meeting with a nice lactation consultant in Oakland (and a really bad consult with a bitchy consultant in Walnut Creek; Peter told her that we weren't coming back for a follow-up because I didn't appreciate her bedside manner — she told me that my right nipple was "the double black diamond of nipples" among other insensitive comments).

We've even been out for meals now and then! I'm finding it's all about timing. If I nurse him first, he's mostly happy to sleep in his sling through brunch/lunch. What a good boy!
Parenthood, in these first two weeks, has been an amazing rollercoaster of emotions, experiences, and new patterns, and I'm sure it will continue to be this way for the next 20 years at least. But we're excited to see where this ride takes us!

Tuesday, March 2, 2010

When the Birth You Need Becomes the Birth You Want

Spoiler alert: The baby is here. He is beautiful, healthy, cuddly, lovely, absolutely perfect!

But it took us a while to meet him.

A week ago, I started to get really itchy. Really itchy. This was combined with some rather impressive swelling. The doctor and my doula had both said that the swelling wasn't out of the normal range for pregnant women (i.e. preeclamptic swelling), but I had a feeling something was weird. I went in for an appointment with my perinatologist on Tuesday afternoon, and nothing seemed particularly off: my blood pressure was fine, there was no protein in my urine, and I wasn't grossly swollen. Still, Dr. Maier ordered a CBC and two liver tests.

Of course, being me, I checked on the liver test results at 7 in the morning, three hours before Dr. Maier got to this clinic. And the liver results were pretty much off the charts. One test, whose normal range is 10 to 40, and my last pre-pregnancy test result had been 12, was now 92. Another was crazy high as well.

As soon as Dr. Maier came in, he called me and told me that we needed to get to labor and delivery immediately. The baby had to be born now. My liver was acting like the organ of someone who had cirrhosis, and worse yet, my blood platelets were dropping. This meant that if they got below a certain level, I wouldn't be able to clot, which means I could bleed to death.

Still, my number was okay enough to actually allow me to labor. Peter came home and we drove to Walnut Creek, checked in, called our doula, and started misoprostol, a cervix ripener that we hoped would get me dilated. Nickie, my doula, and Elly, my sister, showed up, and we hung out, chatted, played Scrabble, and waited for things to happen.

When the nurse checked my cervix it was dilated 1 cm, and starting to efface. We then started an IV of pitocin, and everyone else fell asleep, and I snoozed on and off throughout the night, waking up when contractions started to get bad.

Along with the pitocin, I was also on an IV of magnesium to prevent seizures due to my liver issues, a saline drip, and later, I would be on a second IV pole for insulin. Which, let me just say right now, is total bullshit. There is absolutely no reason why an in-control diabetic should have to be on an insulin drip. My bloodsugar had been in the low 100s the entire labor up to this point, but as soon as they put me on an insulin drip, with THEM regulating it, my bloodsugar jumped to the mid to high 100s, which was unacceptable to me. I did not want my baby to be born with a pancreas that was in overdrive due to mama's high bloodsugar. This would mean that they would give him formula when he was born, and I absolutely did not want this to happen.

By 9 am I had dilated to between four and five inches, which was really exciting! I felt as if maybe this labor was going to happen. The contractions were getting a little more difficult, but nothing I couldn't handle with breathing, foot rubs, the yoga ball, and the help of my husband, doula, and sister. Shortly after that, my water broke, and I started to really feel optimistic.

The hardest thing about laboring as a high-risk woman was the amount of medical equipment they had placed on me. There were the two IV poles with five bags of meds, and then there was the fetal heart rate/contraction monitor, which was plugged in, and gave me about five feet or room to walk, move, and labor. As someone who deals with pain through movement, this was not cool. Also, I had to have all three of my helpers help me get to the bathroom and back every time I had to pee, because they had to help me unplug everything, wrap the cords, and push the poles to the toilet. It was insane.

So, I labored from 9 to 4 pm trying to get dilated. They turned the pit up to 26 (this is really high) and kept it there. At one point I was having monster contractions that lasted for 5 to 6 minutes, with 30 seconds of rest in between each contraction, and hten another giant contraction. It was really fucking hard, but I was optimistic, because these monster contractions just had to be doing something, right?

Apparently not. When my cervix was checked at 4 I was still between 4 and 5 centimeters dilated, with no sign of anything changing. The baby was still really high in my uterus and was not descending.

This kind of broke me. The contractions were one thing, but the lack of progress, too? I was reaching the end of my rope.

The doctors told me that my platelet count had again dropped, and if it went any further they would have to give me steroids to prevent me from potentially bleeding to death in case of hemorrhage or the need for a c-section. I agreed at that point to get an epidural and maybe labor a little longer. The doctors were, of course, advising for a section.

Of course, trying to sit still for the epidural while these monster contractions were blowing through me was also really freaking hard. I really have to say thank you to Toni, a wonderful nurse who just held my hand through the entire epidural process and helped me to breathe and stay perfectly still.

After the epidural was placed, Peter tried to talk me into laboring for another hour or two to see if anything was going to happen. He knew how much I'd wanted a vaginal birth, but at this point, I firmly believed that the baby wasn't going to descend. I made the call to get a section.

Everything after that happened very quickly. I was prepped for surgery, given the epidural, and whisked away. Peter came with me to hold my hand, fan my face, and hold the baby after he came out. The section went totally fine. As soon as Uli came out, Peter said there were stunned gasps as he just kept coming out. The guy was 22 inches long! He was also almost 10 pounds, but he was just really darn long as well.

He was inconsolable, crying, screaming, kicking around. That is, until Peter talked to him. At that moment, he hushed completely and his eyes snapped open. He recognized his dad's voice.

I cried in relief and happiness as they sewed me back up (a very small incision and scar for a very big baby, the nurses in maternity would later tell me), and then when I was wheeled to recovery, they gave me my baby to hold for the first time. And I totally fell in love. I cannot describe this feeling. It is completely overwhelming, and took me by total surprise. The love I have for this baby!

Uli Forster Spoerl, 9 pounds, 11 ounces, 22 inches long, with a silky head of black hair, was a champ throughout the birth process. He also latched on immediately, and my colostrum came in very quickly. However, he did come out with a bruise on his entire right side, which the doctors think may have something to do with why he didn't come out vaginally; he may have been caught up on my ribcage or another part of my body.

Unfortunately, because of this bruising and other factors, he had to get photo therapy because he had borderline levels of bilirubin (jaundice). This occurred on Sunday, which meant I'd already had two and a half days of falling in love with my baby and sleeping with my baby and touching my baby constantly. And then they took him off the nursery for 24 hours of photo therapy. I was only able to take him out of the little nursery case once every three hours for a half an hour of feeding each time. And though I was welcome to stay there and touch him and talk to him, it only agitated him to have me that close and not picking him up. So basically I spent all of Sunday weeping. Again, I can't believe how completely I'd fallen in love with him.

By Sunday night his bili levels had dropped, and by Monday morning, they were low enough for me to bring him back to my room for lots of snuggling and cuddling. And by 2 we were out of the hospital. Home. Safe. Happy. Exhausted.

Even if this was not my ideal birth plan, I still am profoundly grateful for what I did get. I got to labor for 26 hours without pain medication. I was surrounded by support from my sister, husband, doula, and the wonderful nurses at Kaiser Walnut Creek. And my after care as well was just absolutely wonderful from the nurses and doctors. I never thought I would feel so content about having a c-section, but I am. It simply didn't matter how he arrived here, as long as he arrived healthy and happy, which I think I can say he is.

Welcome to the world, Uli boy. We sure love the heck out of you already.