24 Weeks: Tunnel Vision

I am 24 weeks pregnant this week. And the cruel reality that I'm 6 months pregnant but I have 4 to go has hit me. Even though I'm over halfway through this pregnancy, I feel like I have a long way to go. Namely because I discussed my labor plans with my OB and endo this week, which means I have to think about her actually being here and that stresses me out because the only thing we've done is paint her room. (Actually, Trey painted. I'm banned from all paint fumes, and thus her room for the next few days.)  This post is rather long, so I'll try to break it up into each appointment to give any readers proper intermission breaks.  

OB: 

My OB appointment last week was filled with more questions on my part.  I'm pretty sure I talked more than my OB, but he's a patient guy and willing to indulge me for my sanity.  The appointment started out the same as all the others:  pee in this cup, step on this scale (I'm up 20 lbs total), sit here while we take your blood pressure (122/70).  This was the first appointment where Trey didn't accompany me, and it felt weird.  I told him he was welcome to come to any appointments he wanted, but he was busy with grad school shenanigans so I was flying solo this trip.  The nurse used the Doppler to find my little monkey's heartbeat, which was whump-whumping at 163 bpm.  She cooperated a little more this time, but I think she's running out of room to escape the intrusive wand.  

The doctor came in and he immediately noticed my list of questions on my iPod sitting in my lap.  "Go ahead.  Fire away."  The first thing I asked him was the plan for the rest of my appointments going forward.  He said the plan is to keep seeing me once a month until 28 weeks, then I'll go to every 2 weeks until 36 weeks.  After that I'll be going once a week to check my cervix (sorry, TMI) and baby's position for upcoming labor.  In addition, I'll also be doing non-stress tests 2-3 times a week starting at 37 weeks.  So for the last month of my pregnancy, I'll be camping at the doctor's office at least 3 times a week.  (I think I'm gonna go ahead and start my maternity leave then, because I'll be spending more time with the doctor than at my own office.)

The next thing I asked about was the plans for labor.  My OB said the current plan for me is to get to at least 39 weeks, but he will not let me go past 40 weeks.  He doesn't want me going into labor on my own.  Considering my mother didn't go into labor with me and my brother until 43 and 42 weeks, respectively (What were doctors in the 70s and 80s thinking, anyway?!), it's a good assumption that I will be induced.  His reasoning for this is that he wants to keep an eye on my numbers from start to finish.  I'm sure I'll do that on my own, especially with a CGM, but he'll be able to give me guidance on insulin dosage depending on what stage of labor I'm in.  He also wants me to keep my pump on during labor (thank you! thank you! thank you!), and I'll be allowed to treat lows at my leisure with juice or whatever to eat (so no glucose drip, yes!).  

At first, I was kinda "eh" about not being able to go into labor on my own.  I'm not a natural childbirth advocate or anything, and I've already said that is not the most important thing to me.  But I hate feeling like I don't even have the option.  But such is the life with diabetes.  Bottom line:  there are certain things I'll never be able to do because of this stupid disease like join the military, become an astronaut (even though my friend April is going to break that rule), and be allowed to have a granola experience with child birthing.  Now that I've had a few days to think it over, I'm at peace with this plan.  I'm more comfortable with things being planned in advance, and I know my doctor won't force my body to do something it's not ready for (I do trust him, by the way).  And I'd rather have time to get used to being induced and research it before that day arrives.  So it looks like May 28th is the absolute latest for my girl's birthday, or earlier depending upon induction date.  

ENDO:  

I also had an endo appointment yesterday.  I knew my numbers were still solid, but I didn't expect to hover around the 5.1% A1c I had last time.  In fact, my A1c crept up to 5.4%.  The nurse assured me that this is still a good number for pregnancy, but it's obvious that my insulin resistance is beginning.  I've increased my basal rates by 3 units this week alone.  But I also know that my number of lows has decreased dramatically.  So I'm taking this increase as a sign that things are settling out more than "OMG, need more insulin now!"  And I'm all for less lows.  

My endo and I discussed my numbers and my recent ER visit.  I told him my OB's plan for inducing me, and I asked him if he had any plans, insulin wise, that I should be aware of.  I was a little surprised, because my endo told me that once I start having contractions I should suspend my pump.  *insert confused face here*  He explained that the uterus is one big muscle, and once it starts contracting it's like going through one long workout.  And I always suspend my pump if I'm going to workout, so the logic makes sense.  I just can't imagine going through such diabetes maintenance for 9 (10!) months just to say "Goodbye, pump!  See you in a few hours!"  He said even if I suspend my pump, it's still possible for me to see a lot of lows.  I'm still wrapping my head around this plan, and a lot of it will be making decisions hour-by-hour.  But right now I'm still walking around whispering "No pump?  No pump?"  I'm sure people think I need a white jacket. 

FINALLY: 

And finally, I have one big concern that's bothering me:  my belly button.  I've always been sensitive about my belly button.  I don't like anyone to touch it because it feels weird, like a dead sensation where there's no nerve endings but I know someone's touching and I don't like it!  It drives Trey crazy because he thinks I have a cute belly button, especially now because it's pushing out into an outie.  Well, it's like a half-outie at this point.   The top part is pushing out, making my stomach look like a face with no eyes or mouth and a weird looking nose.  And so that dead feeling is a constant because my belly button is rubbing on my tight shirts and maternity pants.  I know that pregnant bellies are beautiful and people want to touch them, but I'm not liking this, not one bit. 

 

My (whoa!) belly with said half-outie. 

So to recap:  baby is still in there (she moves all the time!) and doing great, both of my doctors are aware of the plan for the rest of my pregnancy and potential labor, and my expanding belly is sporting an outie belly button.  I hope you've enjoyed this super long post, because I need a potty break (something I'm doing every hour I'm awake). 

Don't be Afraid to Pee

Well, this post is by far the most embarrassing post I've ever written.  It seems that everything is on high alert with a diabetic pregnancy, or maybe just in my mind.  But the two questions my OB always asks me at my appointments are "Any bleeding?" and "Any loss of fluid?"  I didn't really understand what "loss of fluid" was, so I asked a nurse to clarify.  "Oh, it will feel like you peed yourself."  Lovely.  So be prepared for an extremely TMI post. 

This past Sunday, I was sitting in church and listening to the sermon, which was titled "Do Not be Afraid".  We're currently doing a sermon series on trusting God and not being afraid of death, rejection, etc.  When we stood up to sing the last song, I felt this "gush" of liquid.  I turned to Trey and said, "I'm going to the bathroom".  I'm sure he thought I was doing the typical pregnancy thing of going to the bathroom every hour or something.  

In the bathroom, I checked but couldn't tell if anything was wrong.  I called the on-call doctor as soon as we got out, and he said it might be urine but said to keep an eye on it for the rest of the day.  If it was my water leaking, it would be continuous and not one time.  Having my water break this early is a scary thing because it means my baby would have to be delivered within 24 hours, not OK with me!  So I cautiously went about my day, cleaning the house for a Super Bowl party.  I also laid down for a nap later, and still no more "gushing", thankfully.  

I called my doctor's office the next day (yesterday) to see if he confirmed the on-call doctor's instructions.  And I wanted to at least let him know that I had this issue.  He said if it happened again to go straight to the hospital to be monitored.  I wasn't sure if I could take this as a relief or instruction to be more cautious and aware.  

Yesterday, I went about my day, trying to ignore what didn't happen the day before.  I took the dogs for a walk, and Trey and I went to dinner with some friends.  When we got home, I tried to decipher if things were more "wet" than normal.  It could have seemed like more from sweat from my walk or more pee or more whatever.  I finally settled to just go to the ER and have them check me out, since that was my doctor said to do if I felt that it occurred again.  

After being admitted, putting on a gown, getting hooked up to a fetal monitor, and answering the bazillion questions required to be admitted as a patient.  They took a swab to test to see if what I was experience was my water leaking or something more embarrassing but less scary.  

I hung out in my labor and delivery room (somewhere I didn't expect to be for very long time) and watched Castle while I waited for the results.  It was getting really late at this point, and I started to feel silly for creating an ordeal for something that is probably all in my head.  The nurse came back and said, "Well, it's not amniotic fluid."  

So they let me go home with instructions to come back if I felt anything like that again and assurance that I did the right thing.  That helped, because I was feeling extremely embarrassed for spending two hours in the ER over the fact that I simply peed myself. 

I Still Get Scared

You'd think being 23 weeks pregnant with a lively, kicking baby would make me feel like I'm "in the clear" as far as anything happening to her or losing her.  But I admit that I still get scared, of what I don't know.  I just never fully shook the feelings of the first trimester when I was in the "danger zone" until that first appointment.  I felt good after that appointment, until a few days before the next one.  The day and morning before an appointment, I'm a wreck.  I am so overcome with anxiety and worry.  "Is she still OK in there?  Is she getting too big?  Is she too small?  Why haven't I felt her move in awhile?  Is that stubborn high from last night going to do something to her?"  

But as soon as I hear her heartbeat, my fears are instantly eased.  My mood leaving the OB's office is a 180 degrees from coming in.  I'm good for a few days, feeling confident and less like I'm a high risk pregnant woman.  But then the cycle starts all over until my next appointment, which is tomorrow.  So you understand where this post is coming from now? 

The other thing that makes feel scared all over again is if I have a bad day with diabetes.  Like yesterday, I got to work and glanced at Constance before I ate my yogurt, and I also looked at my 24-hour graph and I had only gone high once in the past day (and just for the record, my high threshold is currently set at 160 mg/dL, tight control is a beast).  I was feeling pretty good about everything.  The little monkey inside me was extremely active the day before, my numbers were good, and I am sporting a nice baby bump that feels huge to me but everyone else says is "so little".  Then I went to lunch with my husband and a friend and we picked a Chinese buffet.  (You can see where this is going.)

I didn't go crazy at lunch.  The most carb-heavy things I had were some fried rice and some ice cream for dessert, other than that I stuck to my obsession when it comes to Chinese food--egg drop soup, delicious and low carb.  I SWAG bolused for the meal and added a few units that I call the "pregnancy factor", but I still ended up with a stubborn afternoon high that took me several hours to come down from.  I got scared, and the first thing I want to feel when I'm scared is her kicking me or jabbing me or anything that says, "Hey, Mom, I'm right here and I'm OK."  

It seems that I need to be on my game everyday to avoid these episodes.  Test my blood sugar, take my insulin at least 30 minutes before I eat, know the carb count, correct for lows without over-correcting, exercise.  I feel like if I slip in any one of these areas that everything falls apart.  I didn't get back on track until this morning, and I'm carefully watching my CGM like I did the first week I had it.  I don't like feeling like I can't handle one slip-up without a major emotional breakdown.  

I'm hoping my appointment tomorrow will put me at ease, that I can get back to feeling confident with this pregnancy and ready to do my victory lap of conquering a diabetic pregnancy once she's here.  Because after tomorrow's appointment, I can officially pack the hospital bag.  Not that I'll be expecting to use it for a very VERY long time, but her rate of surviving outside the womb goes up after 25 weeks.  Maybe once she's here I'll stop worrying . . . right . . . RIGHT?!?!?!?!?!!?

Meeting the Pediatrician

So per my OB's request at our last appointment, we started the process of trying to find a pediatrician.  The way we went about this was contacting our insurance company and getting a pre-approved list of pediatricians in our area.  It was really important to me to meet with a pediatrician first before I decide to go with them.  I had a ton of questions I wanted to ask, and I really didn't want to wait until my little girl is here before we do that.  Surprisingly, only one doctor on our list agreed to meet with me for a prenatal appointment.  I find this a little disturbing--that doctors won't agree to talk to new parents about their practice.  Apparently, it's not good enough to see me because I won't have to pay a copay.  Oh well, I just hoped that this one doctor would ease my fears and answer my questions.  

You'd think I would learn not to schedule an appointment for 8:15 AM, in rush hour, across town.  I was trying to follow the directions on my iPod while sitting in bumper-to-bumper traffic, trying not to stress out (too late).  But somehow, I managed to pull into a parking spot with 5 minutes to spare before my appointment time (after leaving the house 40 minutes earlier).  The place was extremely open and colorful!  It's been a long time since I've been to a pediatrician's office, but I couldn't stop staring at all the bright colors and crayons on the wall with the doctors' names on them.  They called my name (actually they called my unborn daughter's name, which was so weird and exciting to hear!), and they sent me back to a  waiting room. 

Of course, in my rush to get to the place on time, I forgot my list of questions in my car.  So I was praying that I could remember them all, or at least enough to make me feel confident in this doctor.  She comes in, extremely bright and cheerful.  I introduce myself and she tells me to go ahead with any questions I had, then she would tell me a little more about the practice.  I started firing off the questions as fast as I could because I wanted to get them out while I remembered them.  I hope the doctor didn't think she was on some rapid-fire quiz or something.  

I'm type 1 diabetic.  What, if anything, do we need to do for her?  Obviously, watching her blood sugars post-birth will be an issue, but the NICU pediatricians will do that if needed.  Other than that, we'll just keep an eye on her if any symptoms pop up (which I know by heart), but no blood screening for potential markers or anything like that.  She also said that her getting milk (either by boob or formula) for the first 6 months was very important, more so than when she starts any solid foods.  Having that good nutritional foundation is key.  I'm also glad she said either breastfeeding or formula would work, because I don't want any added pressure to be a good breastfeeder when it might not be physically possible.  Plus, I was breastfed and my brother wasn't, yet I'm the one with type 1 diabetes--it really is just a crapshoot.  I briefly mentioned tinkering with a gluten-free diet to add in that extra variable of protection, and she said she's fine with that but didn't say one way for or against. 

I got the feeling that my daughter would be treated the same as if any other child whose parents weren't diabetic.  I'm not sure how I feel about that right now.  On one hand, if we did do the blood screening early on and saw she was destined to have type 1, then there's not much we can do other than wait for the inevitable.  But I also don't want to spend her whole childhood watching her and following her around with my meter.  If she gets it, she gets it.  There's not much I can do.  I'm fine with this decision, for now.  

How do you handle frantic phone calls in the middle of the night or outside of office hours?  This was really important to me, because being a first-time mom is all about figuring this out and going "HELP!" at the same time.  Basically, there will always be someone at the other end of the phone, either a nurse or the doctor on call.  They like to at least talk with parents over the phone first before going to the ER, because exposing kids to everything in the ER is worse than just waiting for an appointment the next day.  I couldn't agree with this more!   But if going to the ER is necessary, they coordinate it for you so that someone is waiting on you when you get there.  

We are going to a couple weddings within a month after she's here.  I posed this more as a statement than as a question.  I didn't want her to think that I was considering NOT going to these (one is for a fellow DOCer, anyway!), but I wanted tips on what to do with taking such a new baby out to the "real world".  She applauded me for planning to go and said to just ask anyone who wants to hold her/touch her to wash their hands first.  So I'm going to be "that mom" at those weddings--armed with a gallon of hand sanitizer and bags under my eyes from very little sleep.  Party on!  

Overall, I felt really good about this doctor.  I still have the feeling that I'll be the one calling the shots on her medical care, which I prefer.  I can't stand pushy doctors.  I want to feel like we're all a part of a team, much like my plethora of diabetes doctors.  I want to feel like we can discuss things together, combining the powers of mother's intuition and many years of medical practice (getting a visual a la Captain Planet).  

As I was leaving the office, I was handed a goodie bag of diaper cream and formula samples.  Now I'm ready!

I'm jealous of those who can finish their workouts

I've always had a little insecurity about going to the gym.  Most of the time, I'm content to do 30 minutes on the elliptical or follow along with a class.  I've never known my way around the gym completely.  Between all the different machines and my perfectly-built gym goers, I'd much rather stick to doing something by myself at home either on the Wii or the Total Gym.  I don't have to worry about how I look or forgetting my shoes, hairband, or glucose tablets.  

But I do have a free gym membership through work, so I might as well take advantage of it.  It at least gives me a different scenery for some cardio stuff.  And the other day, I happen to meet someone from my office there at the same time.  She's a great lady and someone I look up to as far as a professional, but she's also one of those people that make me dread going to the gym.  You know who I'm talking about:  perfect body, perfect hair, and somehow after having 3 kids.  We showed up at the same time and left at the same time, but our workouts were vastly different.  

I decided I wanted to do a cardio circuit:  10 minutes on the treadmill, 10 minutes on the bike, and 10 minutes on the elliptical.  Even though I had set a reduced temporary basal before I left from work, Constance said I was 73 mg/dL before I started my workout.  I decided to ignore it because, darnit, I wanted to get in my workout.  By the time I was done with the treadmill, I was below 55 mg/dL.  Nevertheless, I kept going and said I was at least going to get in 2/3 of my workout.  I started the bike, which was very uncomfortable due to my growing belly--my knees kept hitting the bottom of my belly with each turn.  After 5 minutes, I felt my legs getting heavy and my mind getting foggy.  I knew I wasn't going to get to the elliptical.  Finally, the 10 minutes were over and I sludged my way to the locker room and tested:  29 mg/dL.  

I felt frustrated, defeated, and mad at myself that I didn't stop sooner or took some glucose tabs before my workout.  I started chomping on my glucose tabs.  I don't even remember how many I ate, 10 or 15 at least.  I sat in my car and listened to my audiobook while I waited to come up, which was also a stupid move because I could have passed out in the car and no one would have noticed.  I concentrated on listening to the rest of the book, and 10 minutes later I was coming out of the fog.  I waited a few more minutes before I started the car, I at least had enough sense to tell myself, "Don't you dare try to drive right now!"  A few more minutes passed, and I was finally high enough to drive.  

As I was pulling out of my spot, I noticed my colleague coming out of the gym after her workout.  Now I had a new reason to be jealous of her--she got to finish her workout. 

Safe.

Now that I'm halfway done with my pregnancy, the idea of someone calling me "Mom" one day has me a little weak in the knees.  I'm feeling extremely maternal lately, from choosing our daughter's future pediatrician and signing up for baby classes (why are there so many classes?!).  But one thing is for sure:  I love her already.  And there's one thing I want her to feel above anything else:  

Safe.  

Safe with me, her dad, her whole family.  But most of all, I want her to know that she is safe in God's arms.  This world is a scary place.  It even starts out being scary before she even gets here because she has a diabetic momma, though I doubt she's even aware of that fact right now.  But I am.  And whenever I feel scared and vulnerable due to a high blood sugar or a scary low and what effect it might have on her, I remember one thing:  I am in charge of very little when it comes to her growth.  Yes, she's inside me and healthy mommy =  healthy baby and all that, but I've been floored with how little this pregnancy has to do with me.  

The God that created this universe is in charge of my very small girl.  He's the one that gave her her little heartbeat at that first ultrasound appointment.  He's the one who's made sure that she is thriving despite my setbacks.  And I know that despite my best control, He could take her away from me tomorrow.  Scary, and humbling.  She is a gift everyday I have her, and I want to engrave it on her heart that God loves her (more than me).  She will always ALWAYS be safe under His umbrella.  

That's how I describe my Christian faith when people ask.  If I lost everything today--my job, my house, my husband--I would still have enough because I have Him.  It's that indescribable peace that makes it OK to cry into a pillow all night long and wake up feeling comforted.  I've been in situations where I've felt that way.  In a not-so distant past (pre-D), I felt that exact feeling after some not-so great decisions on my part.  I prayed to simply be back in His loving arms, happy to be the single, crazy cat lady for the rest of my life.  But He chose to bless me with an amazing man that I don't deserve and a wonderful life that's 180 degrees from where I was. 

And that brings me back to the title of this post.  When I got pregnant, my song of choice to soothe me during those high blood sugar/stressed out fits was "Safe" by Phil Wickham.  The whole song is amazing, but the chorus is what really gets me and is my personal lullaby to her during those times.  

You will be safe in His arms
You will be safe in His arms
'Cause the hands that hold the world are holding your heart
This is the promise He made
He will be with You always
When everything is falling apart
You will be safe in His arms

To my little girl, my prayer for you everyday is that you find a safe place in Him.  Your dad and I are going to do our hardest to make sure you see Him through us, until you're old enough to find Him for yourself.  And Dear God, please help me not to screw it up! 

God is my refuge and strength, my very present help in time of trouble. (Psalm 46:1)  

20 Weeks

20 Weeks, a photo by Arnold_and_Me on Flickr.

Things are really starting to pop around here!