Tuesday, May 7, 2013

As Soon As It's Safe.

For the entirety of my pregnancy, I've been working under a shared understanding with my regular medical team that as long as everything goes well, there is no reason I can't have a normal pregnancy.

I know; "normal" is a loaded word. What I mean by that, here, is: if my blood pressure stays where it needs to; if my type 1 diabetes behaves itself in a way that doesn't create a Snuffleupagus-sized baby (though I would totally be okay with her having his long, gorgeous eyelashes); if there are no indications that carrying Baby Girl to full-term would be detrimental to either of us, then a full-term pregnancy we shall have. There would be no reason to think otherwise.

And so far? My blood pressure is staying in range (the daily monitoring at home might even be helping it - less to stress about between appointments). While I tend to not share A1C results anymore online, I know that is something that many ladies who have pre-existing diabetes and want to become pregnant ask, so I might as well share for those curious: my first result after knowing I was pregnant was 7.1, and I've seen 6.8, 6.3, and now 6.1 this week. I'm not swelling up like a pufferfish (yet?). I've been gaining weight at a pace we're all happy with, and Baby Girl is moving around frequently. Thyroid levels? In check. Protein spilling into my urine? Nope. In fact, the only things I can complain about, post-prandials aside, is exhaustion and some mild heartburn (a fun new experience for me).

Fast forward, then, to the appointment I had last week with Charlie Brown's teacher the high-risk OB. Baby Girl was active, as usual, but also a bit shy this time, giving us a great view of her spine while shielding her heart. We couldn't get all of the heart measurements they wanted, so I'll be back again in 4 weeks with the hope that she'll be more cooperative. And her estimated weight? 31st percentile. BOOYAH!

Just as I was basking in the "yay, everything is okay!" feeling, the doctor concluded with, "Okay, so we're on point to deliver at 37 weeks!"


...excuse me, what?

"I was under the impression that if everything was going well, there was no reason to deliver early."

"With long-standing type 1, I want to get her out of there as soon as it's safe."

As soon as it's safe?

The words bounced around in my head for a moment before proceeding to prick at my heart. Because what he's implying is that, right now, she's not safe. That simply by having had type 1 diabetes as long as I have, despite it being reasonably well-controlled and free of major complications, her tiny apartment inside me is a danger zone. That no matter how hard I may work at it, no best effort is good enough to keep her cooking as long as she is intending to be. That, in my eyes, I can do nothing but fail to have the "normal" pregnancy I was hoping for.

I wanted to poke that doctor with something covered in bees.

He also offered his (unasked for) take on a couple of other items - that I start taking a baby aspirin daily to ward off high BP and eventual pre-eclampsia, and that the last bit of pregnancy "isn't actually insulin resistance", which he followed with some malarkey that I honestly just tuned out. I don't know what to think of this guy now - while I trust in his training and enjoy his sense of humor, what I do not trust is his confidence in calling the shots for a patient he only met a month ago, with limited knowledge of her medical history. (I also question his motive for wanting an early delivery, considering that the recent advice I've seen from the ACOG as well as from the professional organization's president himself, would directly contradict with that. Couple that with my control being "good" but "not too tight", and I fail to see where his concern can reasonably stem from.) I also question his advice on the baby aspirin, and am following up with the other members of my medical team before following through on that request. (I will say that when I relayed this all to my endo this morning, she raised the same eyebrow I did. At least I'm not alone.)

Everything seems a little more unsure now, and I don't like it.


  1. My OB's practice demanded that it be at 38 weeks each time, but my perinatalogist begged them to wait until 39 (they wouldn't). He said that he'd rather know the baby's lungs were given plenty of time to fully develop. I delivered my kids at 38w0d and 38w4d though.

  2. She's safe where she is. I'm pretty sure he meant as soon as it's safe for her to be outside. And I think he's thinking of you as much as the baby. But there's no reason that I know of that you can't keep her in there past 37. (I'm not a doctor) I do know that they wouldn't even consider inducing me before 39 weeks so the baby would be even healthier and "safer", but I didn't have T1 yet. I would definitely get a second or third opinion, babies really do so much better the longer they're in there, but by 37 weeks you may be so tired of being pregnant, you'll want her out of there!

  3. I'm sorry you had such a frustrating conversation with him. You are doing such a great job and it just sucks to have someone take all the wind out of your sails. Get some more opinions and remember to "celebrate the efforts, not just your successes"!

  4. She's safe and sound, but get used to that mommy worry cause it never goes away! I had a team of 4 OB's when I was pregnant and the biggest concern was lung development and size. My son was born at 38 weeks and he weighed in at 11 lbs. The only issue he had was maintaining control of his BG on the outside and so he was immediately taken to ICU for observation (don't be alarmed, I was told this was completely normal in a T1D birth). Sounds like you are doing everything you can to make her little "apartment" as happy and comfortable as it can be. As long as you have a good general plan, that leaves a little wiggle room for change you will do great and you will both be fine!

  5. Oh sweetie, this news does sound like a downer. I'm sorry some d-bag is bring down ur high of having any sense of control. Any feeling of control will be few and far between in a few months...hold on to it as long as you can! And I agree with Heidi...right now u want her to cook in that oven as long as possible. But by 37 weeks you may be begging them to let her out!! Love ya, sista!

    1. This is Meggan btw...didnt know my screen name would only show 2G...didnt want freak ya out!

  6. Hello Kim. This enrages me. Long time Type One Diabetes means what? Half of the Type 1 Diabetics out there are healthier than me on paper and yet I've only been Diabetic for a few years. Lets assume for one second that you lost the T1D Associated with your medical chart, you'd be having a perfect pregnancy. I injured my finger a few weeks ago and EVERYONE freaked out. Initially, my Doctor wanted me to go to the ER. She treated me like I was dying. Today, I have a piece of metal stuck in my finger that will remain there indefinitely because aside from the original injury it isn't causing any issues. It seems like as soon as that D word is mentioned, everything turns into a critical condition. My wife, who is not Diabetic, was told something different every time she saw the obgyn. Half the time nothing good, or helpful. We have a very healthy son(knock wood)who will be 2, June 21st. Even now, they tell her he is under weight, but hes 1st percentile in height. So, I guess the point, if I made one, is that who really knows? You do what is right for you and the baby. If I may be myself for a second, "Eff Em". I hope you continue to feel well and be well. I know first hand how doctors can be, and how hard it is to find one that works well with you. Good Luck!
    - Steve

  7. Oh, how frustrating! Are you able to get a second opinion? I also have type 1 (for almost 20 years now, so I assume that counts as long-standing) and am only a couple weeks behind you now (23 weeks) with my second kid. Both times, my high risk OB (different hospitals) have said that they DO NOT like the idea of going past my due date, but other than that, assuming that everything stays normal, we'll just wait and see. With my first, I went in to labor on my own and had her at just barely 38 weeks. I'm hoping for a similar outcome here, but of course only time will tell.

    I think that some doctors have not yet learned to separate the likely effects of diabetes years ago when good control was much harder with the (often much more minimal) effects of type 1 in good control with all the tools and technology we have available now. I was fortunate with my first pregnancy to have a high risk OB who had seen it all (he was about to retire) but also stayed up to date, so he could tell that I was really not all that high risk just because I was diabetic. So far I've only see my OB this time once (he was out of town the first time) but he made it clear that these days, people with type 1 in good control tend to not have many more problems than anyone else. He still didn't like the idea of letting me go past my due date, but we'll cross that bridge if we come to it.

    Good luck. I hope that you have the option to find a doctor whose views are a better fit with current research, or that you can educate this guy.

  8. Oh, Kim, how I can relate. (My sobbing fit when our 37w delivery was confirmed: http://www.blahblahbklyn.com/2011/06/purse-guy-knows-so-you-should-too.html) They start talking about how your diabetes can affect lung development and placenta integrity and all of a sudden you feel like you're growing a tiny, defenseless baby in your giant acid-sack of a sugar-laden body.

    Take comfort from knowing that you're doing the work and taking care of you AND her. Keep your eyes on the prize - whenever and however she's delivered to you, as long as everyone is healthy that's all that matters. (And trust me when I say that in August, when all this is done, you're holding your daughter, and you no longer have to see your twerp OB, you'll say eff 'em and not think about it any more.)

    Forward, lady!

  9. I'm neither a doctor nor a mother, nor do I have the biological ability to become one; so I probably have no business saying what I'm about to say. But I think your reaction - to question your doctor and seek other medical, professional advice. You should take comfort knowing that, should your body suddenly become "unsafe" for the baby (or you), that she's got a well-planned exit strategy; but unless and until then, things are just fine and dandy as they are.

  10. Specialists seem to like to be right. Sometimes I think they make pronouncements that don't make sense in the specific instance so their expert opinion will stand out. Makes me nuts. I hope that you can get the balance you need from the rest of your medical team and that you'll be able to do what works for YOU.

  11. Kim, I am in medical school and tomorrow morning we are having a class/small group discussion on diabetes in pregnancy. I wanted to shore up my confidence by reading your blog as I have been doing all along the way. (Thanks by the way!) So I was extra bummed that you had this experience, both as a hopeful future doctor and as a hopeful future mother with diabetes.

    Remember, no doctor can decide for you about your medical care. They need your consent. I am by no means far enough along in my training to understand all of the the implications. However, I hope you can work with the doctors you trust to figure out a solution that you are truly satisfied with that is the best safest option all around.


  12. Wouldn't it make it more sense to "get her out of there" when it is no longer safe IN there - size, placenta, etc rather than the moment it is "safe"? Lungs are scary. Way off estimates of baby size are scary. Momma knows best!

  13. You know how I feel about this ... effing BEEEEEEEEEEEEEEEES!!!!!!!!

  14. Kim, I've been thinking about your post since I read it the other day. I want you to know that I totally understand what you are feeling. My #1 is 15 months and I am currently 17.5 weeks along with #2. When I was about 26 weeks with #1, my bgs started creeping up (I had kept my A1C under 6 until then). All of a sudden my perinatologist started saying things like you heard. I felt awesome about the pregnancy until then and he left me feeling like a deflated balloon. I was scared that I was ruining my baby and the guilt was overwhelming. I doubled down and worked hard to prove the dr wrong. And it went pretty well...until 35.5 weeks. All of a sudden my bg was plummeting like I was still in my first trimester and, after discussing it will all of my drs, I knew that continuing to hold onto my need to have a "normal" pregnancy may not be in the best interest of my baby. I had an amnio and delivered at 37w1d. And he is healthy and I'm glad I swallowed my pride and did what needed to be done. Could he have waited longer? I don't know, but I'm not sorry that took the path I did. Having a healthy little guy was more important than being pregnant for a couple more days.

    I think that your feelings are completely normal and justified. Reading your post, I feel my own sting all over again (and fear that I will hear it again in a few weeks).

    I would encourage you to let it be for now. You have a "long time" until 37, 38, 39 weeks. Lots can happen between now and then. In the end, you get to make the decision...well, unless she decides for you :) Hang in there!


  15. I have so much to say, but will try to keep it short! First, you are doing an amazing and wonderful job, and I'm sorry that doctor said what he did. Many medical professionals are not aware of the powerful impact that their choice of words can have.

    I had 2 healthy babies, 23 and 20 years ago, after more than 15 years with type 1 diabetes, both delivered a week after their due dates. Both babies were large (though with perfect A1C's throughout, I'm convinced it wasn't diabetes related) and I'm very small, so I needed c-section deliveries, but no complications other than that. It was the hardest work I'd ever done (until actual parenting!), and along with parenting, the most satisfying and fulfilling!

    Keep in mind that you know your body and your baby better than anyone else, even "experts", and listen to your intuition, as well as the medical advice. It's a huge challenge, especially if someone is telling you that your baby could be in danger, but scare tactics are not necessarily helpful. Many women before you have done this, and you are in great company.

    Thank you so much for sharing your story so openly and vulnerably - it truly makes a difference in the world!

  16. At the hospital where I was followed during my pregnancy (in Denmark), the procedure was to induce delivery at 38 weeks, regardless how well mother and baby were doing. Problems could of course lead to ealier delivery. In my case, we were doing great. My daughter had perfect belly and femur measures, but a slightly smaller head measure so she was 10-15% below average weight the whole time. By bgs were giving me A1c's similar to healthy women, and I was feeling well too, so I had long discussions with both midwife and OB/endo (they sit at the same table for each appointment, which is VERY convenient) about NOT being induced at 38 weeks. I managed to get them to wait until 38+2, but then a bad hypo came in the way at 37+6, and that made them change their minds, being convinced that it was a sign of a failing placenta. I still today do not believe that the placenta had anything to do with that hypo. I think that I have a very good explanation for it happening, but it didn't change the doc's oppinion, and being first time parents, we of cause also wanted to play safe. Induction was unsuccessfull though, neither my body nor my daughter wanted anything to happen, so it ended up in a semi-acute C-section at 38+5. She was small (47 cm, 2745 grams), but had no bg issues. It took her a few days to get her digestive system up running though, something I think we can at least partly blame the way and time of delivery for. She had difficulties gaining enough weight, so we had to supplement her by bottle from 3 weeks of age. That, however, cause significant reflux for her, so didn't change her weight curve at all - she kept growing more by length. All in all she's had a difficult start of life, possibly because she - due to my diabetes - was not allowed to decide when to enter this world.

    Should we ever decide to have a second child, I think I'll reject their induction plans if thing are as they were with our daughter. It is so difficult when your own intuition and gut feeling contradicts doctors orders. I hope that you manage to get as many of your wishes for a perfect delivery of your daughter come through, even if it means a couple of word fights with your OB :-)

  17. Doula here. I have not yet supported a Type 1 diabetic mother, but I have worked with multiple women who have medical reasons to induce early. My biggest piece of advice is to try to bargain with your OB. Sometimes if you agree to having a NST (non stress test) once a week, twice a week, or even daily once you hit 37 weeks you can negotiate for a little more time. Also remember that this is your body and your baby and you have the right to give or deny consent for any medical treatment. While I don't suggest you throw all of your OB's medical advice out the window, know that he does not have to power to force you, the decision is always in your hands.