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.

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.

Am I Right to Accept Induction?

I can still say no to this. Right up to the moment that they actually start the medical process, I can decline to be induced. With forty-eight hours to go, it’s something that my mind still keeps returning to.

I know that I’ve had the best blood glucose control of my diabetic life in the last nine months. I know that my blood sugars have averaged similar to a non-diabetic, with very few major spikes. I’ve essentially had an uncomplicated pregnancy. I feel like I’ve mitigated the risks from being diabetic far better than I could ever have imagined, and the numbers suggest that my chances of problems at this late stage cannot far exceed those of a “healthy” woman. If I’m honest, I feel I deserve a straightforward birth experience as much as any one else.

I know that many women don’t get anything like their ideal, or straightforward birth. But I can’t help feeling that by accepting induction, I’m not giving myself the best chance.

I don’t want to be induced because I know that it carries risks. Chief amongst them, the increased risk of needing a caesarean section. And we know that I don’t want that . In fact several studies have suggested that increased induction rates are the single biggest reason for the rising caesarean birth rate. Even if caesarean is avoided, there is a greatly increased chance of other interventions including episiotomy, ventouse or forceps delivery. Induced labours generally require continuous fetal monitoring, which restricts the options for active birth, further increasing the risks of needing assistance.

These are all things which don’t sit well with my ideals for birth. And then add to that the fact that induction can also lead to breastfeeding difficulties and you can probably understand my personal apprehension. Furthermore, yet more evidence is also beginning to come to light that babies born between 37 and 39 weeks gestation are at risk of more health, developmental and behavioural problems than those born after 39 weeks. Unsurprisingly, the internet is littered with articles urging women not to be impatient and to let labour start of its own accord.

But…. I’m not doing this for convenience reasons, or solely because I’m impatient to meet our baby. I’m doing it because its what my medical team have advised me is the safest thing.

And the medical reasons to induce are, at least at first glance, extremely compelling. And particularly now I’ve managed to carry this little life safely inside me for almost nine months. I’d obviously never forgive myself if something went wrong right at the end that could be avoided. The bottom line is that if I decline induction, anything that goes wrong after that point will lead to me wondering if an induced labour would have avoided that problem. Ergo I feel somewhat obliged to go with what is, after all, the medical standard.

It’s the medical standard for a reason. Contrary to popular belief, big babies  are not the primary reason for early induction, although it does follow that delivering a big baby early avoids the opportunity for it to increase yet more in size and so decreases the chance of delivery complications including shoulder dystocia.(In reality, this is still questionable.) The most important reason, however, is the increased risk of stillbirth.

Yeah, that’s something that doesn’t bear thinking about.

Pre-existing diabetes in particular, and especially that which has been long standing, is associated with vascular changes that can lead to more rapid deterioration of the function of the placenta. If the placenta fails and the baby is not born within minutes…. Well, you get the picture.

And of course if you start asking questions about whether the risk is correlated with glycaemic control during pregnancy, or what the actual percentage risks are of stillbirth if waiting until 41 weeks, no one can tell you. Because early delivery is the standard of care. Because the potential risk exists, no one is going to give ethical approval to a study to quantify it which would mean putting women and babies at that risk. In fact, a recent systematic review of the evidence to support reasons for induction conspicuously excludes type 1 diabetes, mentioning only gestational diabetes, which it puts in the category of having no solid evidence to support routine induction. In fact, it concludes that there is little evidence for the majority of reasons given for induction.

But even if a study were carried out which proved that the risk of stillbirth in women  with type 1 diabetes waiting until beyond 40 weeks was, say 10%, that’s meaningless if you’re the one in ten and your world comes crashing down. To be honest, once you’re aware of the risk, it’s hard to do anything but contemplate getting the baby born safely as soon as possible.

To look at it another way, though, as an individual you’re still extremely unlikely to suffer adverse complications. As one article puts it:

“Fortunately, it is uncommon in this day and age for a baby born at full-term to die around the time of birth or experience serious illness or injury. However, these outcomes still occur despite advances in obstetric and neonatal care. Doctors or midwives may recommend inducing labor as a way of lowering the chance of these problems happening. However, it is impossible to know which women should be induced because injury and death are often unpredictable. As a result, thousands of women may have labor induced to prevent just one injury or death, and all of those women and babies will be exposed to the risks of labor induction, which may include cesarean surgery, instrumental delivery (assisted by forceps or vacuum extraction), and newborn breathing problems.”

I wish there were more definitive tests to establish individual risks. I wish that this process of giving life weren’t so fragile and precarious. I wish I could just let it go and accept that what will be will be, rather than continuing to agonise over choices that don’t really exist. It was different before I was pregnant and I could indulge in being idealistic, with my image of a “normal” pregnancy and natural, spontaneous labour. I naively thought that so long as my control was good, I could be managed like a healthy person, rather than an ill person.

That was before I had a second heart beating inside me. Before I knew the kind of love and powerful, instinctive protection you can feel for someone you’ve not yet met.

My reasons to decline induction are largely selfish, and now that I’m about to be a mum, I can’t be selfish anymore. I don’t want forceps or a caesarean, but the risks of these procedures to my child seem less than the potential risks of not getting labour going sooner rather than later. I don’t want anything bad to happen to my baby either way.

Am I right? I’m right, right?

Meh

Things went much better at the hospital today than two weeks ago.  I think perhaps I did succeed in making my point after all, and that standing up for what I believe in may have paid off. I certainly felt as though I were treated with a little more respect, at any rate. And somehow, I think I may be left alone to manage my blood sugars as far as possible. We’re all meant to be on the same team, but it feels like a victory of sorts, and even more so when I got through the entire appointment without a single tear.

The appointment itself, though, was a bit…. Well, meh. Not terribly bad, but really really not that great.

I described how Flangelina was definitely slowing down his or her movements in there. But it turns out that they are barely 1/5 engaged, and with that in mind the slowing down of movements could be a sinister sign. A vaginal examination (aka “a necessary evil”) did nothing to improve the outlook either, as I’m less than 1cm dilated and my cervix is still high and posterior (Holy TMI, I’m sure). In other words, nothing much is happening yet. On the one hand, this means that induction is looking pretty inevitable as I’ve now reached the golden 38 week mark in my diabetic pregnancy. On the other hand, inducing too soon may not be the best approach as there is more ground to cover from where we are now. It would have been a whole lot better news if we could have done an effective sweep and felt that things might start moving soon anyway.

But, after some discussion, we finally have a plan: Unless I go in to spontaneous labour before, I’ll be induced this coming Sunday, 6th of November. I’ll be 38 weeks and 5 days pregnant. Between now and then I’ll attend the hospital on a daily basis for cardio-tochography (CTG/fetal wellbeing check) and I’m to go in to triage if I have concerns about movement, or anything else, at any other point.

It’s a bit “meh” because I know how unlikely spontaneous labour is before the deadline we now have, and whether I’ve admitted it or not, that’s what I’ve been hoping for all along. It’s a bit “meh” because I’m not sure if all the sudden extra monitoring means I should be worried, yet they can’t be that worried if they’re willing to delay induction until Sunday. I don’t know what to feel really. Fear? Disappointment? Excitement? Or just not very much at all?

But by this time next week there is a very real possibility we’ll have a baby, or at least be well on the way. That’s what I’m going to focus on whilst I’m living in the hospital maternity day assessment unit for much of the week.

Come on baby, we’re nearly there!

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.

Waiting

You could look at pregnancy as one big long waiting period. You wait for the positive test. You wait for your first scan, and then the second. You wait, patiently or not, for the arrival of the little bundle. At this point, eight months in, I can tell you that in some respects it seems like a pretty long wait.

This pregnancy, though, has involved more waiting than most given that I have appointments at least every other week in a clinic that almost never runs to time. I try hard to occupy myself during the waiting time, but it’s difficult when you need to also keep an eye on the screen for your name to appear. My mind invariably wanders to thoughts of the baby and what still needs to be done to prepare. And of course thoughts of whether I, and they, are doing ok. But sometimes, when I want to push those worries aside and spare myself from bursting in to emotional tears before I’ve even been called in, I think about how much of my lifetime, nevermind this pregnancy, I’ve spent sitting in hospital waiting rooms. I do wonder what better things I might have done in all that time, given the choice.

Most appointment waits fill me with a strong sense of deja vu. Please tell me that I’m not the only one who feels like this:

It begins with optimism that it won’t be that long. The hands on the clock slowly turn round. You have to verify with your watch: yes, you really have only been here five minutes. Ten minutes come and go, and finally fifteen. You keep double, and triple, checking the screen to be sure that you haven’t just missed your name popping up.

Frustration begins to creep in, because although you have no other pressing engagements, you have taken an afternoon off work to go to the appointment and if you can get it over with quickly, you could have the remainder of the afternoon at leisure. Fantasising about how to spend an illegitimate free afternoon eats up another ten minutes.

You start wondering how to pass the time. You casually wander over to the magazine stand/table/pile on the floor and start reading a great article. However, you fly into an internal rage when you turn over the page to find the end of the article has been torn out, no doubt because the person who last read this particular magazine wanted the 25p off washing up liquid/chocolate chip cookies/pasta sauce coupon printed on the reverse.

You turn your attention back to the waiting room with its peeling paint, wilted pot plants and water-marked floor (a defective water machine, you hope) Alternatively: soft chairs, fresh paint and artwork – lucky you! You fight the urge to let out a large sigh. By this point you’re almost certainly bursting for the toilet, but don’t want to go because you must be called in soon and you know that they’ll want a urine sample from you.

Other people get called in, and you’re sure they arrived after you. You try to console yourself with the fact that they are probably seeing a different doctor. And anyway, you don’t want your doctor to be rushing through the patients, because you wouldn’t want him to rush your appointment either.

You start to wonder if maybe it is personal. Do you smell? Were you rude last time you met, or are you being punished for the time you were late? You consider checking with the receptionist in case you’ve inexplicably been forgotten, but decide against it for fear of seeming pushy. You briefly reconsider using the pressure in your bladder as a reason that you *must* be seen soon, but shelve that idea because you don’t want the whole waiting room to know that you’re desperate to pee.

You decide to try reading another magazine, but find you can’t get into it, because you’re sure it must be your turn soon, and you don’t want to be wondering about the end of another good story you don’t get to finish. Added to the fact that screen checking frequency is now up to every 20 seconds or so. And you’re also now fidgeting in your seat with desperation to relieve your bladder.

Finally you decide to go to the ladies. That will give you the opportunity to double check that you don’t smell/have bad breath as a possible reason for not being seen. You can also then legitimately enquire with the receptionist on your return, in case you missed your turn while you were gone, and can put in a good huffy protest about your wait time when they ask for the sample you won’t be able to produce. All round win!

No, you didn’t miss your name whilst you were gone. The receptionist flashes you a grin and tells you they are “really busy, you know how it is?” You get really frustrated now, and can feel your blood sugar, not to mention blood pressure soaring in response. When (if) you get to seen, you vow to tell the nurse/doctor/midwife exactly what you think of them, and then find yourself a new doctor.

Finally you hear your name being called. The person apologises and thanks you for your patience; “you know how it is?”

And of course you find yourself agreeing that you do know how it is and saying that it is quite alright… really not a problem at all…

Oh… and that pee sample. Not a problem either. You are heavily pregnant, after all!

Thirty Two

Thirty-two weeks pregnant. Holy cow, I’m getting close to the finish line – four fifths done. And holy cow, I’m getting big. I can’t remember what my feet look like and putting shoes on is a massive struggle that adds several minutes to the time taken to leave the house.

This morning was a busy morning. I had the 32 week growth scan, followed by an antenatal clinic (ANC) appointment, and then my third trimester eye dilation and retinal photographs. It didn’t start out well when I found myself waiting first ten minutes, then twenty minutes past the time of my scan appointment. Then I reached the time I was due to be in antenatal clinic. Fortunately the two clinics are adjoining and do actually speak to one another, so I was assured they wouldn’t fail to see me in ANC. By the time I was called in to my scan though, I’d worked myself up in anticipation, and because I was worrying about getting away from the hospital to make my eye screening appointment.

The sonographer performing the scan was the same one who did my 28 week scan. She complimented me again on the fact that I must be taking good care of myself. But I could hardly bear to ask just how big my big baby had got.

When I looked at the print out of the scan measurements, I couldn’t suppress my tears. The abdominal circumference measurement is now above the 95th centile – even higher than it was before. And it’s the abdominal circumference that suggests a diabetes-induced big, fat baby. Fair enough, it’s not that far out of proportion of all the other measurements. (Except femur length – Flangelina obviously has short legs. Like their Mum.) And the estimated fetal weight is only at about the 65th percentile, but I feel like such a failure and there really is nothing more to say.

When I made it around to the antenatal clinic, I was stressed out enough that my blood pressure had climbed to a ridiculous 140/95. Which sent me in to a panic about pregnancy induced hypertension and pre-eclampsia . My obstetrician firstly reassured me that it was only a blip because I was worked up and she wasn’t concerned, plus there was no protein in my urine. Then she tried to move straight past the numbers in the scan report. She reminded me that scans are not totally accurate, a problem that may be accentuated by having the same sonographer do two consecutive measurements, as their bias in reading the values may be higher. She trotted out the old line about how I am doing such much more, and so much better than all their other patients. How the effort I am putting in, and the results I am getting out, are second to none. How it’s “normal” and “common” to see these kind of increases in babies of diabetic mums, and how they still turn out healthy and OK. But I don’t care about anyone else, or their babies. I care about my own pregnancy concluding safely. I don’t want to have a “normal diabetic” pregnancy. I want a “normal normal” pregnancy. I felt frustrated and resentful and noting was going to get me out of that funk.

I was a hormonal, tearful mess. And like I do, I descended in to panic about everything. Suddenly I couldn’t cope with the whole diabetic pregnancy a moment longer and wanted to be the same as all the carefree women in the waiting room receiving happy news from their scans and appointments. Of course, there were bound to be women there receiving far worse news than me with my little fatty. And after a ten minute melt down, I realised it, and remembered to thankful that nobody was suggesting that Flangelina is not healthy. Just big. And big is not necessarily bad.

We managed to discuss, through more tears, my fear of spinal anaesthesia and hence of a c-section. I’ve been waiting for several weeks now for an appointment to see a consultant anaesthetist to really discuss these fears, and whether they are founded. I’m beginning to panic that it won’t come through and I’ll be in established labour before I get to talk about it. The reassurance here was more concrete, as they called through to the consultant’s secretary to confirm that I was in the system, and an appointment will apparently be with me shortly.

We also discussed a bit about antenatal collection of colostrum and fortunately the reaction was very positive. I was, however, advised that I needed to wait until 37 week because of the risk that nipple stimulation would cause labour. Having Googled the topic, I’m sceptical in the least about this statemet, and I’m sure my body would only go in to labour if it were ready to. But since I need sterile syringes from the hospital to collect the colostrum in, I’ll have to stick with them on this. The amount that is leaking out, I don’t think I’ll have a problem collecting enough in just a couple of days.

Despite the lateness, and all the tears, I made it to my eye screening on time. They never give anything away whilst your there, but everything has been fine up until this point. I have enough else going on, so I’m not going to dwell on the possibility of something cropping up in my eyes. I am just very glad that I’m now on maternity leave, as there is no way I could have gone back to work with my red-rimmed and hugely dilated, blurry eyes – a combination of crying and dilation for the retinal photographs.

So, what now? Keep working at it I guess. If the baby is already fat I can’t make it actually slim down in utero, but I guess I can try to stop it gaining too much more weight. I have no idea how, because I really feel like I’m doing all that I can. But I suppose I just have to do even more.