Wednesday, April 3, 2013

The "What If"s.

Aaron and I headed to the Maternal-Fetal Medicine division of Bergan Mercy hospital in Omaha on Tuesday for our first level 2 ultrasound.

It was our first experience with this office, this doctor, and an ultrasound that projected on a large flat-screen TV in front of us. Actually, it was Aaron's first everything - this was the first baby appointment which he's been able to attend.

Level 2 ultrasounds are also referred to as anatomy scans, which as you may guess, means that we got to see lots of detail this time: organs like the kidneys, heart, and stomach, as well as bones, feet, arms and hands, and some lovely profile shots. There were wonderful moments where we watched our baby's mouth move, its arms wiggle about, and its feet kick to and fro. Magical? Yes.

The good news is that, so far, everything looks normal and happy and just as it should be. I was asked to come back in four weeks for another ultrasound check, as they'll want to check the heart out again. "We're trying to measure something that's, right now, about this big", our doctor said while gesturing with the tip of his pinky finger, "so in four weeks we should be able to get a better look at it".

We must have asked him four or five different ways: "But everything looks okay? Nothing to be concerned about? The baby looks good so far?" And while we received all answers in the affirmative, the fact remains that I'm a woman with type 1 diabetes who is pregnant. To a doctor who sees a wide variety of high-risk patients in various states of self-care, that means a need to inform us of all the "what if"s. He began by asking me how my diabetes was, and because every other doctor in my medical history has seemed to want that answered with an A1C result, that's how I responded.

I found it curious, then, when he smirked. "Actually, I don't care much about your A1C." I'm not sure what, exactly, he cared about - I think he was looking for a bigger picture answer, or maybe that I could say that I've never launched above 120 mg/dL ever. I think he wanted to know if I knew the fasting and post-prandial goals to shoot for (which, as he told it, are under 100 for fasting numbers, and under 120 two hours after meals), or if I realized the myriad of complications that could occur due to a large baby. For a few minutes it was all Charlie Brown's teacher: "wah wah wuh wah stillbirth mrph wah wah c-section mrph wurr wah deliver early wah wah wurr pre-eclampsia wurr wah", and I suspected then that I had never really, seriously, discussed any of these possibilities with Aaron. Our conversation during the walk back to our car confirmed my suspicion.


I don't mean to cast our Maternal-Fetal doc in a bad light - he is doing his job, which is to make sure his patients are informed and cognizant of what may lie ahead. But I couldn't help but be reminded of something I've heard Dr. Polonsky say time and again:

"While poorly managed diabetes is the leading cause of most of the scary long-term complications, well-managed diabetes is the leading cause of...nothing."

That's why these risks are not top of mind for me, or something I mull over often. It's not that I'm naive; at least, I don't think I am. I know that any of this could happen. But much like worrying about a car accident every time I drive, a crashing plane every time I fly, or a gray strand every time I brush my hair, living life cannot be a process that is dictated by fear. It's why you wear a seatbelt; why planes are designed so carefully; why they invented hair dye. I am doing the very best I know how in order to have a healthy pregnancy, and while I'm placing some possibly unearned trust in my body, I also have to accept that the rest of it is out of my hands. Worrying is futile (and unhealthy for you, anyway); if something happens, we'll deal with it then, and in the meantime, I'll do the best I can to keep us both healthy.

I'd rather focus on the greatest "what if" of all: "What if everything turns out absolutely okay?"

* * * * *

I recently contributed a blog post to the Diabetes Advocates site on the topic of diabetes and pregnancy, sharing a bit of my own experience, as well as linking to resources for those planning a pregnancy while living with diabetes. Go check it out here, and if you know of a resource or blog we should add to the growing list, please share it!


  1. Hoorah! So happy that you can focus on it that way. As someone just beginning to navigate the idea of dealing with pregnancy AND diabetes, I'm terrified. Scared to the point that for years after my dx I swore I would never have children. Now I'm realizing that while we run different kinds of risk than non-D women, pregnancy is ALWAYS scary - for ANYBODY. I hope when my time comes to have a little one I can look at it the way you do.

  2. I just love that whole paragraph at the end. It's totally my philosophy on life.

    Congrats on having a healthy mini-texting plucking away at becoming a full-on human babychile.

  3. That's all you can do, your best!!!! If something happens, then you deal with it.
    I'm 23 weeks now and had my anatomy scan at 19 weeks. They told me I needed to scheduled my fetal EKG for 24 weeks. Are you getting one of those? If not, maybe they want you back, in lieu of that??? I'm excited to now start seeing my baby every 4 weeks in an ultrasound. Ahhh, the only perk of a diabetic pregnancy!!!
    I'm so glad my husband didn't come with me to my pre conception visit with the maternal fetal specialist. It was 50 mins of all of the horrible things that can go wrong in a diabetic pregnancy. With a 5 min talk of "But your A1c is great so you probably don't have to worry about those things..." I was surprised that I still went through with it!
    And regardless of what happens, everything will be ok :)

  4. I LOVE that. "diabetes is the leading cause of nothing". It's the truth. We don't say that enough..

    Can't wait to meet Baby BOY Vlasic. Because he's a pickle at this point, in my head, and that's how I say your last name. :)

  5. At our first appointment, my wife (an exercise physiologist with a doctorate) asked about exercise recommendations. The Dr replied to "keep the HR under 140 BPM". She mentioned that was the recommendation in the 70's, and that ACOG had revised that a few years ago. He said he'd read up on it. Next appt with him, he told us he had started the new recommendation.
    Later in the pregnancy, a different Dr in the practice gave us the greatest advice, one that I even use now with my healthcare team... He said "challenge your doctors"
    Here's that story...

  6. The last paragraph is spot on! Great attitude!

  7. The nurse at our MFM office did the same thing. But she didn't stop with diabetes! She went into the consequences of drinking before you know you're pregnant (guilty), side effects of other medications I was taking, family history . . . basically every single thing that could ever go wrong ever.

  8. Aw I am so glad your baby is all healthy! It really gives us hope for the future! I love the last paragraph about life cannot be dictated by fear c: if you get a chance could you check out my blog and share it around please? c:
    - Ellie, 15, Type 1 Diabetic from London, England.

    1. Thank you, Ellie!

      Could you share the link to it? :)

  9. Great post. My first pregnancy was filled with "what ifs" and my obgyn even scared me at 37 weeks reminding me of all of the horrible complications that "could" happen at delivery and made me feel bad for not inducing early, even though the specialist at MFM cleared me to go until 39 weeks. Everything turned out fine and I didn't even have to have a c-section though my son was pushing 9 lbs. At least my specialists knew that because my diabetes was under control I was more likely to have a normal birth. The worry and "what ifs" are there for anyone, diabetes or not, but it's not fair that some doctors treat us (type 1s) like we are going to have problems, even though all signs point to normal.

  10. That's the biggie, isn't it? Putting trust in something that's completely failed you in the past - it's *hard*. On the other side of it now, I still look at L in disbelief - "I made her. She's healthy. MY flunky body did that" - and I feel like cutting myself some slack.

    Our bodies truly are magnificent machines. We've got overachiever immune systems, true, but we're still capable of so very much.

  11. I spent almost every moment of my pregnancy scared, sure something would go wrong, wondering how bad it could be and how much I could deal with. I had a bunch of complications, but in the end, I had a beautiful perfect little girl who's now 9 yrs old. Worry doesn't make it easier when bad stuff happens, but it wrecked my pregnancy. Keep up with the positive attitude, know you're doing everything you can do to keep your little one safe, and pat yourself on the back for the awesome mom you already are!

  12. I so agree that you should do your best, and hope for the best. Don't spend your life worrying about the obscure (or at least improbable) what-if's.

    With that said, if I found three new gray hairs a day I'd be absolutely ecstatic. I'm lucky to find three hairs of any color on my head nowadays...

  13. As someone who comes by worrying quite easily I love how you ended this post :D

    Now I can't wait to hear about the gender...

  14. YAY! That's so great Kim! You and other like you inspire me not to be terrified of getting pregnant in the future. I just don't think it's possible to always have type zero BGs (no matter how hard you try) and I hate when (type zero) doctors think otherwise :) You're doing great!