36 Week Appointment

I don’t feel like things went very well at the hospital this morning. Maybe my expectations are out of whack, or maybe it’s just all the hormones, but yet again there were a lot of tears.

Things didn’t actually start out too badly. In fact, they started out rather well. My fourth (and hopefully final) growth scan revealed a baby that not only looks completely healthy, but looks a very average size. This is complete contrast to the 28 week  and 32 week scans, which had suggested that they were turning in to a little chubster. I can’t help it; I still see the size of the baby as a measure of my success or failure at pregnancy. So hearing that they are sitting right around the 50th centile, with only a slightly increased abdominal circumference is naturally welcome news.

The less good part of the scan was the re-assessment of the placenta. Back at my 20 week scan  it was noted that the placenta was lying low in my uterus. It wasn’t completely covering the cervix, but a concern was raised about whether it would prevent a vaginal delivery. At the last couple of scans, the sonographers have said that things looked fine, and to be honest it had gone out of my mind. When it came up again today, I instantly panicked that this would be the unforeseen end to my desire for a natural birth.  And then, I was further disappointed that, having made it this far in pregnancy without a single internal ultrasound (with the dildo-cam) the sonographer apologetically informed me that the only way to get a conclusive measurement of the distance of the placenta from the cervix was to go in from the bottom. Cue lots of panic that my bikini line has not yet been prepared for B-Day, and since I can’t see it, I was horrified about what she may be about to witness. Thank goodness for discreet, unflappable sonographers. And thank goodness that after all that, the placenta was in a good position and I was signed off for vaginal delivery.

Things went properly downhill, though, when I went in to see the obstetrician. Bear in mind that I’ve always understood that the hospital (and general diabetes in pregnancy) policy is induction at 38 weeks. Although I’ve agonised a bit about this, mainly because of my desire to avoid an epidural.  I have come around to the idea in order to make sure we end this journey with a healthy baby. (The fact that I’m gettting impatient to meet our baby helps too.) I’ll be 38 weeks in two weeks time, so I was fully expecting to actually make some plans today about when I would come in and how things would progress. I’d gone to the appointment armed with my birth preferences and a list of questions that I wanted to discuss.

But everything got off on entirely the wrong foot when the obstetrician sort of dismissed the scan results and told me not to place too much importance on them. Removed from the situation, I can rationlise that she didn’t mean to be nasty or dismissive of what I was regarding as potentially an achievement. I know she was giving me exactly the same line that she did when the scans gave less favourable results, and I know that she is right that today’s scan could be the misleading one. But irrespective of all that, her dismissal left me feeling utterly deflated and wondering just why I’d been going through these scans. Before I knew it, the tears were on.

It went from bad to worse, as my questions were glossed over. I think my previous deliberations about induction might have been misinterpreted as me definitely not wanting to go for it, because there was no discussion at all of booking a date, just that we’d review it next time. Again, with hindsight I can sort of see this positively, because it means they have no concerns and are willing to let me go a bit beyond that. But at this stage, I really want some clearer idea of what is going to happen. Delivery is no longer too distant to think about. I’ll reach full term between this appointment and the next and it’s possible that I may not even make it to the next appointment. The baby could be here before that.

Some of the things that we did get to discuss were met with unsurprising answers. Like being told that yes, I will be pretty much confined to the bed throughout induction, and there is no hope of me getting anywhere near a birth pool even if I go in to spontaneous labour. I don’t have the fight in me to debate these points. My obstetrician seems to firmly believe that I will opt for an epidural when I’m actually in labour, which just cements my belief that no one really understand quite how much of a fear this is for me.

The biggest chunk of the appointment, though, was devoted to a stand off about something in which I do really passionately believe: my right to take care of my own blood sugars for as long as I feel able during labour. It’s something about which I won’t back down.

I’ve had bad experiences before in hospitals, where non-specialist staff do not understand the first thing about diabetes. Even something as elementary as the importance of uninterrupted insulin supply for a type 1. I could go in to details about the time an IV insulin infusion failed at night and the staff told me replacement was not a priority until morning, 8 hours later. EIGHT hours with no insulin could, likely would, have put me in to DKA. Long and multiple stories short: I don’t trust other people to do it anywhere near as well as I can. I don’t want to transfer to an IV sliding scale just as a matter of course, because I know they can be prone to failure in my rubbish veins, and I will be left with the problem of transitioning back afterwards.

I’ve worked so hard on my control since before I fell pregnant. I’m not letting go right at the end. All I really want is for Ian and I to be in control, including the ability to say “actually, we don’t want to be in control now, so please take over and put up an IV sliding scale”. I didn’t expect this to be a problematic point. I thought the team knew me well enough, knew what a control freak I am, how important this is to me and how well I can do it. I thought I’d proved all of that. But what I was met with was that it was “inappropriate”. That I had to “learn to be a patient and let go”. And that I couldn’t ask Ian to help me, never mind that he wants to, because it’s such a massive part of our everyday relationship. He’s happy, at this point, to know he’ll have a definite way in which he can help me during labour. And if it all goes pear shaped and we can’t do it on the day, then we’ll say so. It’s not as though we have to commit to what will happen right now.

My tears were a mixture of frustration and downright anger.

I have no control over where or how I give birth. I’ve accepted that the process needs to be medicalised to degree to keep me and the baby safe. This is the one thing – ONE THING – that I want to be in control of. I can’t understand why that is being denied to me. I understand that I’ve never been in labour before and that I might find that when it comes to it, I don’t want to be worrying about diabetes. What I’m asking for is the space to make that decision at the time, when I am in labour and I do know how I feel.

The appointment stalled around this point. I had more questions, although I can’t really remember them now. Mainly about what will happen after the birth. But I was too worked up to go on. I felt as though I was being treated like a silly, naive little girl who knew nothing about what she was discussing. When the obstetrician asked to see the piece of paper I’d scribbled my notes on, something snapped internally. I told her I’d asked them all, even though it wasn’t true. Because suddenly I don’t want to do it their way. I don’t care about the answers to those questions, because I’m determined to try and makes the answers be what suits me. I absolutely DON’T want to sacrifice the health and safety of my baby. But that, ironically, is exactly why I don’t want to relinquish my diabetes control.

I was so angry when I walked away that I almost wanted to hire an independent midwife who’d be prepared to work with me for a home birth, ridiculous as that sounds. But having realised how much nobody wants to listen to and work with me, I suddenly felt very lost. I’ve not felt frightened of labour at all during this pregnancy and I’m still not frightened of labour itself. But I am petrified of how I will be treated. I can envisage clearly now how I’ll be dehumanised and treated as a medical entity. A problem. A number.

Is it really too much to ask to be treated as an individual, rather than simply a “pregnant diabetic”.

I haven’t put a question mark to that question, because after today I feel like the answer is definitive. And it’s yes.

I’m not sure where to go from here. I thought I’d have an induction date planned. I have an appointment in two weeks, where I’ll probably be given a sweep. I wouldn’t really turn my back on hospital care, because I do know it’s the safest and best place for me to be. But I feel so let down. So misunderstood. So disrespected.

So no, things did not go well at all at the hospital today. But all I can do is keep waiting and keep refreshing my resolve that when it comes to it, I’ll stand up for myself and for my unborn baby. I will do what is truly best for us, not what is best for the hospital staff.

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