Tuesday, June 19, 2012

Gestational Diabetes Screening

WARNING: 1am stream of consciousness ahead. More practical advice to come in subsequent posts!

So in case you missed the news flash...I am expecting once again, but expecting only one this time! There has been much that has been different, and much that has been the same about this pregnancy. But this gestational diabetes is new for me. I failed my one hour glucose screening. This is test is usually done around the start of your third trimester (unless you have risk factors for diabetes like family history). You get to drink a sugary beverage...in my case it was just like orange pop [yum], but without the carbonation [blachh]. Then they draw your blood an hour later and see if your blood sugar levels are within an acceptable range. If they are not, then you get to come back for the torture of drinking another disgusting flat pop on an empty stomach first thing in the morning and then waiting 3 hours after that before you get to eat anything else so they can draw your blood 3 times and see how your body handles that nasty concoction. I failed that one too. Supposedly, there are risk factors that contribute to your likelihood of having gestational diabetes...like being overweight, being over age 35, having a family history of diabetes, being of Asian decent, or (of course) carrying twins or more!

Of course, what is odd for me is that when I WAS carrying twins, I didn't have gestational diabetes. This time, I didn't have any of those risk factors, so for me it is a mystery. Although I am eerily close to age 35, and maybe eerily close to 'obese' too, though I didn't feel like it.  I was hoping to not have to feel 'old' yet, or gluttonously overweight, but this GD certainly is making me feel both!
I had been so excited to have a simple, easy, low-risk singleton pregnancy, now I have gestational diabetes to throw me back into an elevated risk category. [sigh].
In all honesty, I wasn't that anxious about having 'GD' with it's implications for eating and potentially for taking medicine. But I was more anxious about how labor and delivery was going to be handled now that I had this new label. Basically, my doctor said that as long as I could control it with diet, labor and delivery would be the same...except that they might induce me a week early or something - especially if the baby looked large. To her, it seemed no big deal. To a mom who has twice been induced with twins because her body did not go into labor on its own and who really does NOT want to be induced again...kinda big deal.

Here I am a month later. I've been pricking my finger after every meal and once in the morning to test my blood glucose levels. I've been watching what I eat, and at 34 weeks and 6 days, so for it's been pretty easy to keep my numbers in 'normal' range and to control with diet alone. Heck, on good days I can get away with eating pretty much what was normal for me anyway, minus juice, pop, chocolate and cookies! (I know that sounds depressing, but really, I can still eat an occasional cookie, I just can't pop them like Valium when my kids are having a bad day!) I can even get away with eating ice cream as a bed time snack at night!

Well, the one thing this motivated me enough to do, was to change health care providers. I love my doctor, she is a complete sweetheart and would have been the one to personally attend and deliver my baby - not just whoever was 'on call'. But, in the end, I felt like she was just a peon in a big medical conglomerate who really wasn't free to use her personal judgement in anything to do with my health or pregnancy. Instead, protocols and procedures and establishment requirements reign supreme, regardless of what my doctor and I might think is appropriate or acceptable in a given situation. I learned that from being with her for my twin pregnancies too- there was always 'that's just the way we have to do it' as the common answer to my question of 'why do I have to _______?'
As it was, I was not looking forward to going back to the hospital I delivered at before...in general it was just not friendly to moms who don't actually lay in bed with an epidural for their entire labor. There is no bathtub in the laboring rooms. The nurses look at you funny when you move around and ask you to just sit still so they can get a better tape of the babies' heart rates. When they see you have a birth plan, they roll their eyes. Then when they see you have a doula and a friend coming, they feel free to make a snide remark about how this is going to be a big crowded party. Can we just say I have negative vibes?
A month ago, I was willing to go back to that hospital and grin and bare it by thinking that I was a low-risk singleton mom who was going to go in, pop out the baby and leave in less than 48 hours. But now, I'm back in the 'special' category again. and I just can't feel good about going there and getting the 'special treatment' again. At least not when I know there are other options.
So after talking to a friend who switched care to a midwife group late in her pregnancy, she encouraged me to look into doing the same...then I called...and then I did it. The Midwife group told me that as long as my diabetes was controlled with diet alone  and medication was not needed (and as long as I didn't have any other big red flags in my medical history) that they could take my case...even at 32 weeks. They said that I could even do a water birth if I wanted. Or, I could just labor in the tub in my room (yes, even after my water was broken...which was a huge no-no at the hospital I was at before, they only let me do a shower, and for that I had to walk across the hall of the hospital to even get to the undersized-for-a-twin-mom shower). They said that since research didn't show any benefits to 'larger' babies of GD momma who were induced early, that they generally do not induce GD moms if their babies appear large... another big relief for me! After having gone through 2 inductions, I can safely say that inductions aren't my bag 'o tea.
Anyway, I am now totally pumped and feeling so much better and less anxious about this birth. I'm so glad I made the switch. Now, I feel like I should write my doctor a dear John letter, and let her know that it really wasn't anything personal...