It’s Over

Wow, what a difference a week makes. It’s a long way to fall from the top of the world and from this week’s bitter experience, I can confirm that it really, really hurts.

Yes, my pregnancy is over. Over before it even really began. I’m writing this whilst waiting to miscarry.

I really thought that we had done it. That we’d cracked the nut and were truly on our way towards parenthood again. Since receiving the diagnosis that changed everything at the end of last year, I’ve actually been unfailingly positive. I believed in IVF, that we had a good chance of success, even with all the obstacles that popped up along the way. And once I saw the second line on that stick, I suppose, like an idiot, I thought the hardest part was over.

Of course I knew miscarriage was a possibility. It’s not even as if I haven’t travelled this road before. But I suppose I thought we’d struggled enough. I carried Thomas successfully. I really believed that I could do it again.

Life is not that simple though, is it? If only IVF could carry with it immunity to further complications. When you’ve fought so hard just to conceive in the first place, to lose it seems especially cruel. Perhaps that is the hardest thing. It’s not as though we can just “try again” next month.

I’m talking about it now because I don’t have a choice. Having told you all that I was pregnant, it would soon be pretty apparent if no baby bump emerged. But I’m also talking about it because I truly want to.

In fact, right now I’d quite like to carry a sign around with me. That way every mum on the nursery run with their “Baby On Board” badge pinned proudly on their coat, or cradling their newborn in a sling will know that I’m not the parent with an only child by choice. So that every person in the street pushing a double buggy or rubbing a rounded belly can see that I’d trade places with them in an instant.

We’ve been at this for 18 months now. And whilst I know that is not terribly long in comparison to some people, it’s long enough. I’m now dealing with the fact that people who hadn’t even had their first (or second, or third) child when we started trying are now pregnant with their next child. And I can’t help but feel like they’ve jumped the queue.

It’s my turn. Surely, it must be my turn by now?

Amongst all the typical emotions – sadness, grief, guilt and feelings of failure – come some unexpected thoughts. They come to me in the middle of the night, whilst I haven’t been sleeping. Things like the fact that I will now be 35 by the time I have another child. If, we have another child, of course. Having had Thomas at 31, I thought I’d probably be 33 when number two came along and by 35, we’d be looking at number three.

Number three. There is a thorny issue in itself.

We have no fallback position. No frozen embryos from our first cycle. So to have any chance even of number two, we have to start this whole process again from the beginning. And that means throwing another seven thousand pounds at the problem. (Most people assume IVF costs “about three grand”. That isn’t far off the mark. But then you need to add consultations, blood tests and drugs. Then the extras like sperm retrieval and storage fees and the ICSI process. It’s a pricey business.)

Seven thousand pounds and we might still have nothing to show for it.

I’m not sure if I’m strong enough to do it again.

But I’m not sure if I’m strong enough not to, either. My heart hurts every time I consider never experiencing another pregnancy. Never holding another newborn of my own. Never breast feeding again.

Why do I not deserve my happy ending?

Shouting From the Rooftops – Why We’ve Shared Our Pregnancy News

I gave the prospect of sharing our pregnancy news this week some thought as far back as when we started our IVF Cycle. I already knew that if I were lucky enough to fall pregnant, I’d be sharing the news with a lot more people a lot earlier than I did when I was pregnant with Thomas, simply because we’d told so many people about our IVF attempt. It would be nigh on impossible to leave all those people hanging for eight weeks without them all jumping to conclusions anyway, whilst watching my every move for clues. Yet I also knew that I wouldn’t be making any general announcements until we were a bit further on. We selected the people we told about IVF, and who hence would know early on about any pregnancy, very carefully. I presumed, correctly, however, that as before I wouldn’t want the whole world to know right away.

But I wanted to share our IVF journey here, on my blog, for reasons that I shared in this post. Which is how I found myself considering the possibility of sharing the outcome on my blog too. And I quickly came to the realisation that in the same way I couldn’t keep my “real life” friends hanging for eight weeks, I wasn’t sure that I could keep up a non-committal front online for that length of time either.

So that is the first reason that I’ve shared this fantastic news here, just a day and a half after we found out ourselves: because I didn’t have the heart to keep it from people who have played a massive role in my support network over the last few weeks and months. It may seem odd that virtual strangers know something so important about me when not all of our friends and extended family yet know that news, but somehow it is easier sharing this kind of thing online. It’s somehow less intimidating to do from the relative safety of the space behind a computer screen. I don’t have to answer any questions that I don’t want to, and I can update everyone in one go with the clatter of a few keys and the click of a button. If the worst should happen – as it is, after all, extremely early days – then I don’t have to face each of you individually with that update.

Ah yes – because that is the oft cited reason for keeping the news to yourself: the fact that there will be a lot of un-telling to do if, like so many pregnancies sadly do, it ends in miscarriage. But not only is it easier online to do that un-telling, I actually think it is something worth sharing. I wanted to write about IVF because there is still a relative scarcity of readable first-person accounts of the process, and still a bit of taboo surrounding infertility outside of the most popular infertility support boards. Why stop there? Miscarriage is also still shrouded in mystery for many people. When I began bleeding during my first pregnancy, I had no idea what was normal, and there was very little relatable information out there. Lots and lots of cold, bare medical facts. Despite its frequency, it is still not something that is widely understood. So if it happens, I don’t want to ignore it.

And I don’t want to ignore it because whatever happens, this pregnancy has existed. Even if it ends prematurely, I want to remember and acknowledge exactly how I’ve felt about it.

Only a few short weeks ago, I didn’t have a lot of hope that I would ever be pregnant again. But now, I am. And for as long as that lasts, I want to celebrate it. I want to celebrate that we beat the odds, creating an embryo from an impossibly tiny number of viable sperm and finding success in our very first cycle of IVF. I want to let everyone know that a diagnosis of azoospermia, alongside my own health issues, now including more than three decades of type 1 diabetes, haven’t been enough to stop this happening. We might not get a baby to bring home – a sibling for Thomas – at the end of it, but for now I’m over the moon that we’re in with a chance. This could really happen. Thanks to the wonders of modern medical science, and to techniques – such as ICSI – that are actually newer to the world than we are.

It’s news that I can’t help but want to shout out loud about. We’ve got this far, and I’m determined to enjoy this feeling for as long as it lasts.

To My Tiny Blob of Cells

I’m writing this with a photograph of you in my hand. A photograph taken when you were six days new. Just a collection of cells too small to see with the naked eye, but containing so much potential. So much hope.

Your Dad and I had been through a lot to get you to that point, and I was afraid that once you were back inside my tummy it wouldn’t be enough. That I couldn’t take good enough care of you. I was afraid you would fade and slip away, taking a piece of my heart with you.

But yesterday, ten days after that photograph was taken, I took the most nerve wracking test of my entire life – worse than my driving test or University finals. A plastic stick that would either fulfill or shatter our dreams. It was the test that would tell us if you were still there.

 

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And just like that, you made your presence known by a second pink line.

Already you will have grown and changed since we saw you in the laboratory where you started you life. And now I feel full of new hope that you will go on doing so. And I will do my very best to keep you safe, whatever it takes.

When you’re older, and we tell you the story of how you came to be, I hope that there will be no doubt about just how loved and wanted you are.

You are our longed for second child. And I can’t wait to meet you.

All my love always,

Your Mummy xxx

Two Years Ago

Two years ago today, I found out that I was pregnant. I didn’t know then, of course, that the end result would be Thomas. I had no clue about the little person he would become, the joy and challenges he would bring in equal measure, or how he would change me.

Two years ago, I didn’t know that the end result would be anything at all. Or rather, I didn’t know whether I was on a road to nothing more than heartache. I worried from the moment I saw that second pink line, which I think is normal for expectant mothers. But alongside the typical fears about miscarriage and carrying a healthy baby to full term, I worried constantly about whether my best efforts to control my own broken body would be good enough to keep my child safe. Or whether my own body’s failings, and my inability to mitigate them, would leave an indelible mark on my child. I worried about failing them before they were even born.

I look back to that day and remember only too well the anxiety that settled heavy in my chest and weighed me down for the following eight months much more than my growing bump ever could. But I remember too the excitement. The expectation and the feelings of possibility for the little life that was only just taking hold and beginning to grow, an entire future just waiting for them. I can’t believe how far we’ve come in these two short years, and how those possibilities are being fulfilled each day. Watching Thomas grow fills me with more pride and a greater sense of achievement than anything else I have ever done.

And now, I’m ready to do this again. I know that when I next see those two lines, I’ll still feel an irrepressible panic. But I know now something that I didn’t know two years ago: That the effort, the worry and the sacrifices are all absolutely worth it. I know my next child won’t be another Thomas, but I do know that I’ll love every inch of them and that no matter who they turn out to be, they won’t fail to bring me joy. I know that they, like Thomas, will be worth it.

TTC With Diabetes

This is a post that I’ve been hesitant to write, because in some ways it feels a bit too intimate. Laying all my cards on the table opens me up to expectations and people asking me if I’m up the duff yet. I do wonder if it would be better to wait, and simply make an announcement when it happens, at a stage in the pregnancy that I feel comfortable to do so. But at the same time, this is something which is very important in our lives right now. It’s a part of our journey with Thomas that I didn’t really record, and this time I want to remember what it’s really like.

So here we are. We’re officially trying to conceive.

Everyone knows what trying to conceive involves. Plenty of frequent bedroom antics in the hope that a single sperm reaches the elusive egg. It’s important for everyone to take the best care of themselves that they can, and take their folic acid to reduce the risk of neural tube defects.

But diabetes has the potential to throw a huge spanner in the works when you want to make a baby. From the moment of conception, higher blood sugars than normal increase the risks of miscarriage and birth defects. The only way to mitigate these risks is to have the best blood glucose control possible.

But that isn’t always that easy. Diabetes is beast that isn’t that simple to tame. Everything that you can think of, from food to exercise, stress to the weather has the potential to affect your blood sugars. And of course blood sugars have the potential to affect pretty much everything in your life. That includes your hormones and hence, your cycles. And the more regular your cycles, the easier it is to conceive.

If you’ve read my entries from my pregnancy with Thomas, you’ll realise that I was quite obsessive about keeping good control, and would have done anything and everything to keep him safe. But back then, diabetes was pretty much my sole focus. True, I also had a stressful full time job, but now I have a stressful part time job and a demanding toddler, as well as diabetes which an be just as stressful as the job, and just as demanding as the toddler.

I have a feeling that things will be a lot tougher this time. But yet, somehow, I want it that much more.

When I was pregnant with Thomas, hearing about people desperate to conceive their second or third child always made me think “But at least they have one child already. It’s not the same as wanting your first child”. I couldn’t understand how the desire could be so great as for a childless person. It’s true that it’s not the same, bu tnot in the way that I thought. Now I don’t just want a child for myself, I want a sibling for my son. And I feel more pressure and in a much greater hurry to get pregnant because I don’t want a huge age gap between my children. To the point that I was ridiculously disappointed not to have conceived in my last cycle as it was my last opportunity to have a second child before Thomas turns two. I realise that two under two would be making life hard for me in so many ways, so please no one point that out. It was just a milestone for me.

The first stage of pregnancy prep for a person with diabetes is making sure that those blood sugars are good enough. In effect we need to be given “permission to try” by our doctors. Of course no one can dictate what you do, and there is no forced contraception, but it’s done for the best of reasons. I’m on board with that. The crucial test is the HbA1c, which reflects control over the previous three months. (For any geeks, it is percentage of haemoglobin molecules which have been glycosylated – or have glucose attached to them. The higher the average blood sugar, the higher this percentage will be. And it covers about three months as this is the approximate life span of a red blood cell.) For non-diabetics, the range is somewhere between 4 and 6%. The advised target for women wanting to become pregnant is less than 6.5%. See above for all the factors that affect diabetes if you think that is remotely easy to do for the majority of women with diabetes. It takes hard work and commitment every single day, and through the night too, since diabetes never sleeps.

This morning we made a trip to the hospital to receive my latest “report”. It’s ridiculous, but I was nervous to the point of feeling dizzy and sick. I want this so much that I was petrified my control would have slipped and we’d have to stop trying. I want this, but I also want it with the minimum of risks. Ian was ever patient, trying to calm me down and point out that I’ve hovered around 6% since Thomas was born, and there was no reason to think that would have changed.

Except the month I spent without my CGM when the transmitter died and i was waiting for a replacement. Except the mild excesses of Christmas. Except the afternoon highs that have plagued me for the last few weeks.

I felt as nervous as if I was going in to an exam. And in a way, that’s what it feels like. I know that the number is just a number. That it isn’t a reflection of my self worth. It’s just a number which doesn’t represent failure. It’s just a piece of information to help me look after myself the best that I can. But even though I know all that, it still felt like so much was resting on this.

When we were called through to be seen, the very first thing I asked, before I even said hello, was “What was the number?”

The minute it took to get the results up on the screen felt like it was going in slow motion. And then came the answer.

Six.

And I turned to Ian with a massive grin, not even caring that he’d won the bet and been closer with his guess.

I felt the kind of elation that comes after finishing exams and knowing that there is no more revision but sudden freedom.

Except, diabetes doesn’t stop. It’s a relentless animal.

I have to keep doing this over and over and over. I have to keep doing it always, but especially whilst we try to conceive. There can be no slacking. No coasting.

While other women obsessively track signs of ovulation and time everything with precision, I’m obsessively tracking my blood sugars in pursuit of not just a pregnancy, but the healthiest pregnancy I can mange with the complications of my chronic health conditions.

That’s how trying to conceive with diabetes is different.

What I Learned About Clothes During Pregnancy and Immediately After

1. Interim jeans are worthwhile. Interim jeans are ones in a size bigger than your regular size. I wish I had bought some before buying maternity jeans rather than struggling with using a hairband to hold my pre-pregnancy jeans together. Because now that my pregnancy is over, maternity jeans no longer fit, but neither do my pre-pregnancy jeans. So I’ve invested in a couple of pairs of interim jeans to wear until I DO get back into the pre-pregnancy ones (because I WILL!). I could have had more wear out of them by buying them in early pregnancy though.

2. You can wear pre-pregnancy hoodies and baggy jumpers without stretching them. Many of the T-shirts I wore in late pregnancy were not expensive “Maternity” T-shirts, but regular Lycra T-shirts and they’ve all retained their shape just fine. The unseasonably mild temperatures at the end of my pregnancy meant that I got away without needing a maternity coat, but I lived in warm hoodies instead and they are also undamaged. The drawback of this is that I will not be able to tell my child/ren not put their knees inside their jumper “because you’ll stretch it” in the way that my own mother did!

3. It is perfectly possible to get away with buying larger sizes of basic clothes such as stretchy tees, rather than buying expensive maternity t-shirts, despite what the akers of maternity clothes will tell you. See the above point about non-stretching. The worst thing that will happen in the T-shirt will be longer at the back that at the front over the bump. So what?!

4. Lots of maternity jeans and trousers do not have pockets. But many do, if you search for them.

5. Maternity jeans are more comfortable, and fit better, than almost any other kind of jeans I’ve ever worn. Why all jeans do not have a stretchy wasitband, I do not yet understand! Although obviously it would need to be a stretchy waistband without the shape to cover a beach ball!

6. A hairband is an excellent accessory for prolonging the life of pre-pregnancy trousers and jeans, and costs a fraction of the price of expensive proprietary bump band extender thingys. However, see point one about interim jeans.

7. Maternity bras are not sexy. Or particularly supportive. Ironic, no?

8. Maternity knickers are not required. I was quite shocked when I learned of the existence of specific maternity knickers at about 37 weeks pregnant. I continued to wear my own pre-pregnancy knickers throughout pregnancy, although I‘ll admit that from six months on I only wore boy-shorts style ones. They sat perfectly comfortably just below the bump. I would not advise spending the extortionate amount of money asked for knickers with a bit of a cut away for the bump.

9. Slip-on shoes and flip flops, however, are a must have. Bending down to put your shoes on whilst eight-and-a-half months pregnant is possible, but why strain yourself? Likewise following a c-section. And when your feet balloon to twice their normal size due to hot weather and too much standing in late pregnancy, you’ll be very glad of a pair of flip flops. Even in October!

10. Maternity clothing catalogues are very seductive. They are full of women who looking absolutely blooming, with their neat little bumps as they skip in a sprightly fashion along the sea front. They sell an ideal that if you spend £50 on that tunic, you too will look sleek, neat and gorgeous, rather than hot, tired and ungainly. It’s not true. And once the baby is born, avoid like the plague. Those lovely images will have you missing your pregnant body and wanting to do it all again!

Top Tips For A Diabetic Pregnancy

Plan – Going in to pregnancy with more than 3 months of folic acid behind me and an excellent A1c made the early weeks much less stressful for me than I think they may otherwise have been. Aside from being less worried about potential complications, I didn’t have the problem of trying to drastically adjust what I was doing in terms of diabetes control. I’d already built in lots of good habits, so was free to focus on responding to the changes caused by my new hormonal status. I hated the thought that diabetes could be the thing to stop us trying to conceive once we were ready, but getting everything stable before we started was absolutely worth it.

Sort your hospital care out carefully – This is something I didn’t really do, and I ended up changing hospitals during the first trimester, which made for a bumpier ride than was probably strictly necessary. Think about the logistics of travel to your hospital both for frequent appointments, but also when it comes to actually giving birth. If there is more than one option locally, find out both about the general maternity services, but also what sort of experience they have in managing pre-exisitng diabetes in pregnancy. Ideally, you want to already know your diabetes consultant and DSN, and have a good working relationship with them.

Get used to lots of appointments – It can seem overwhelming. It can seem annoying, especially if you have a full time job to factor in. But all the appointments are there to make sure both you and the baby are well looked after. Try not to view them as an inconvenience and enjoy the unparalleled access to information about your pregnancy. Many non-diabetic women will be bemoaning the fact that they see their midwives so rarely.

However, Don’t be afraid to question what you are told, or what is usual “policy” – A lot of the care for pregnant women with diabetes is based on “one size fits all” policies. It’s essential that you are an active participant in the process though. If something is being suggested make sure you ask why. Ask what the alternatives are and what the risks and benefits of different approaches are. You can’t give informed consent if you haven’t been fully informed. It is often policy to see women with diabetes every two weeks, but in the early weeks, this felt excessive to me, as I was travelling a long way to talk about excellent blood sugars that we could easily have discussed by email. Remember that it is your body and your pregnancy. No one can “tell you” what to do. But at the same time, be sensible and respect the advice and experience of your health care team.

Test, test, test, or better yet, use a CGM – Honestly, I don’t think I have ever tested my blood sugars quite as much as I did during my pregnancy, and I don’t think I could have coped without a CGM to tell me which direction I was heading in at ay given time. The only way to have any chance of keeping your blood sugars as close to normal as possible is to know roughly where they are as often as possible. Testing, and writing down the results, is absolutely essential. You also need to be prepared to act on those results too.

Try to eliminate the lows – When you have the risks of hyperglycaemia drummed I to you frequently, lows can suddenly seem like a friend. Whilst it’s true that mild hypoglycaemia pose no threat to your unborn baby, it can carry risks for you. Frequent lows can lead to loss of the warning signs, which in turn increases the risk of severe hypoglycaemia, which may in turn put your baby at risk. Bouncing back from lows is also a major contributor to high blood sugars and a lack of overall stability. Eliminate the lows and it becomes easier to remain steady. Honestly.

Carb count carefully – eyeballing, or scientific wild guessing are no longer acceptable. The only way you can dose accurately for the food you eat is to know exactly how much you are eating. That means that wherever possible you need to weigh and measure your food. And you need to read food labels.

Low carb can be your friend – Eating low carb is a sure fire way to reduce or eliminate post-prandial glucose spikes. Low or no carb foods are also fantastic when you are hungry at a less than ideal blood glucose level. But don’t go mad. I had ideas pre-pregnancy that I would stick to low carb, and a limited range of foods whose effects I knew, for most of the pregnancy. This isn’t necessary and will make your pregnancy seem to last a lifetime. There is also some evidence that restricting carbs too much can be bad for your unborn baby.

Superbolus is definitely your friend – Minimising the post meal spike is one of the most challenging aspects of good control. The superbolus is a pump technique whereby you take some of upcoming basal along with your pre-meal bolus, and then reduce your basal rate to prevent a later low. This is much more difficult if you are not on a pump, but taking a larger bolus and then eating some of the carbs much later on is also a rough approximation. Bolusing 30 minutes before eating, especially in the morning, also gives your insulin a head start to increase the likelihood of its action matching the absorption of your food.

Don’t panic about occasional highs – this is so much easier said than done. I remember having a full on, tear soaked and snot-ridden melt down the first time I had a high blood sugar. People will throw around all sorts of analogies that are cheesy, but true: the occasional visit to the sweet shop for your baby won’t do them ay harm. It’s a fact of diabetes that highs happen, and you won’t be able to eliminate every single one. Just do your best to minimise them – with frequent testing, accurate carb counting and regular adjustments. Look at the bigger picture when faced with a high number. Frequent and sustained highs are much more of a problem than occasional spikes. It’s also easy to focus on the highs, so writing down all your results can help you to see that they probably aren’t as frequent as you think.

Night times really matter – If you can get your night time basal insulin sorted to keep you steady and in range all night, this not only gives you almost a third of the day within target, but also gives you a good waking blood glucose level which starts the day off much better physically and psychologically than a high or low number. It’s worth making the effort to test overnight frequently. This gets easier in later pregnancy as sleep gets harder!

Get comfortable making adjustments yourself – If you are the sort of person who tends to rely on medical staff to make the bulk of the changes to your insulin regime, get ready to change. The adjustments needed in pregnancy are too frequent to wait between appointments, or for someone to keep calling you back. By all means seek advice as often as you need it, but get used to trusting your own instincts. You live your diabetes every day, so you really do know it best.

Remember that the old rules don’t always apply – Four will probably not be the floor, unless you have severe hypoglycaemic unawareness. 3.5 will suddenly become an acceptable fasting level. Correction doses are no longer reserved only for numbers above , or 10, or whatever you used to use. 6.5 is now a number you can and should correct. You no longer have to wait 3 days to see a pattern. It’s OK to make changes on the fly.

Don’t be afraid to ask for medication for morning sickness – even if it doesn’t seem “that bad”. The effect of morning sickness for women with diabetes is very different than for women without. Whilst there is no doubt it’s unpleasant for everybody, trying to deal with bolus insulin and not knowing whether your food will stay down is an extra challenge you don’t need. If morning sickness is interfering with your efforts for good control, then taking medication is the sensible option.

Don’t expect non-diabetes staff in hospital to have a clue about diabetes – Be prepared to be your own advocate. Be prepared to take care of your own needs possibly throughout labour if you want – but certainly during early labour or if you are admitted for induction. Take plenty of your own test strips and medication. Also take plenty of food and treatments for low blood sugars – don’t rely on the hospital to have what you need when you need it, no matter how shocking that sounds!

Remember to enjoy your pregnancy too – Remember that there is more to this than just blood glucose levels, carb counts and estimated fetal weights. Try to set aside the focus on diabetes at least some of the time and enjoy your changing body shape, shopping for your new addition and feeling them kick and move inside you. Remember that you are a mum-to-be, not just a medical machine.

Remember, it’s only 8 months of your life – By the time you find out you are pregnant, there are only eight months to go. The obsessional focus on everything diabetes is finite. And you have the biggest motivation you’ve ever had. Once the pregnancy is over and you have your child in your arms, it will all seem more than worth it.