Thursday, December 16, 2010

update

What would I do without you guys? You make me feel better just by wishing me so and empathizing. Thanks!
Ayden slept til noon, and then felt dizzy, earache, and feverish the rest of the day. He watched t.v. all day with his baby brother. Matthew was at school. Riley had a mild fever and cough, but nothing major. When Brent woke up I asked him to take the night off, and boy, did it ever make a difference already. I was thinking that I would need him for possible night wakings of the kids, but already he took all three boys to the doctor's office so I could go to my midwife solo, then he made dinner, cleaned up, and put the kids to bed. What an enormous difference that made!! Wow, I feel sick still but not nearly as trashed as yesterday at this point. Ayden has a very bad double ear infection AND a chest infection so he's on antibiotics now. Poor kid.
Three cheers for Brent!
My midwife said that in 17 years of practicing, she has only ever had 2 clients who had to go on insulin for gestational diabetes. Nice. Being the bottom of the minority chain is just so great. Fasting BG is the hardest one to manipulate. My daytime sugars are still perfect. Seriously, since I started testing I have not had a SINGLE reading over the recommendations in the daytime. Usually, the fasting BG is the LAST number to go high, but in people with fewer live and functional Beta cells, it is sometimes the one they struggle with. That's genetics.
She gave me some supplements (goodbye, $94) to support nighttime adrenal and liver function, to hopefully limit nighttime hypoglycemia and stored sugar leaking by the liver (which is what makes the fasting BG high: the liver thinks you're starving overnight and leaks stored sugar in the form of glycogen~we used to take advantage of this function at work, by giving glucagon shots to unconscious diabetics where IV glucose was contraindicated, causing their livers to dump all stored sugar into the bloodstream to get them to wake up enough to eat something). My mom's prayer chain is working hard. You guys are praying. I'm praying! At this point, the goal is to keep the fasting BG 6.1 or less: Cathy feels comfortable staying away from an OB consult and insulin at that point, though the recommendation is insulin if it's higher than 5.1. To me, the risk-benefit ratio is a bit ridiculous for under 6.0. Michel Odent has a good, well cited essay on the topic of GD (found here) that states that since the medical system started testing for and treating gestational diabetes, there has been NO improvement in infant or maternal morbidity rates. This essentially means that the gestational diabetes testing and treatment has not resulted in improved outcomes, statistically speaking. This makes me feel ambiguous about treatment.
Henci Goer (obstetrical medical research analyst and writer) also disparages gestational diabetes testing and treatment. She has an article (found here) that delineates how GD became a condition that was tested for, and how treatments were developed for it. She says something interesting at the very end of her article, though, that I think possibly applies to myself and my cousin and my mom and several aunts and and a few other women in my family:

Within the GD population lurk a few women who were either undiagnosed pregestational diabetics or who were tipped into true diabetes by the metabolic stress of pregnancy; a fasting glucose to screen for them might be prudent.

I would guess that since we are all within normal weight limits and none of us (save one) are obese, that pregnancy tips the women in our family into true diabetes, evidenced by large babies all around, normal maternal weight, and a tendency towards the correlated pregnancy diabetes and type II diabetes later in life. This makes the most sense to me, since research does NOT show a correlation between gestational diabetes diagnosis, management, and fetal macrosomia rates, BUT big babies run in my family of small women. This particular pairing, of big babies and small women, is rare.

We're so rare no one knows what to do with us.

My initial goal was BG below 5.3, because my homebirth was still on if we could keep my fasting sugars in that range. That has proven impossible since this week only one reading was below 6, no matter what I did. I haven't given up all hope, but most of it. My midwife hasn't given up hope either~she seems more hopeful than I am. Today we discussed that if I can keep my fasting sugars 6.1 or below, I won't need to be transferred to an OB's care. [Transfer of care in BC means the OB is 'in charge' of my care, but my midwife still follows me prenatally, catches my baby in hospital, and does my postpartum care: I see both professionals and they work together. A big relief because I won't lose my midwife, but a big pain in the ass because I will have to deal with an OB]. The BC recommendation is that women be on insulin with persistent fasting sugars of 5.1 or higher, but I am not comfortable taking insulin, a treatment with ambiguous results and much higher risk of cesarean birth because of the simple classification of 'high risk' and no improvement in infant or maternal morbidity (or mortality, but mortality isn't an issue with gestational diabetes; it can be an issue with women who have diabetes before they become pregnant but that's not me), at marginal rates. Also, I'm not sure what is in the insulin suspension itself: preservative? Suspension solution? Contaminants? I'm having a really hard time finding that info online and my midwife didn't know. My midwife said she'd be comfortable with me refusing insulin if my fasting BG was 6.1 or less. I *CAN* refuse insulin at any number; this is Canada, women have the final say when it comes to their medical treatment and can refuse anything. But I want to work with Cathy, not against her: she also might risk me out to an OB completely if I don't cooperate at a level she's comfortable with, I'm not sure. Plus I don't want a baby larger than 10 lbs 2 oz. I just don't.

If you're still reading, thank you. I know it can be boring to read through medical conditions you don't have yourself, so I appreciate you getting this far!

Other things discussed/discovered at my appointment:
blood pressure 120/80
fundal height 30 cm at 29 wks +1 day
fetal heart rate 140s via pinard horn (aside: baby had hiccups, something I've noticed for the first few times the past few days)
active fetus
total weight gain 19 lbs (lost one pound since GD diagnosis and diet manipulations and increased exercise)
urine normal

Also, I have restless legs especially at night. I know I need more sleep, and my legs get restless when I'm not pregnant and I'm overtired, but this is more severe than my pre pregnant symptoms. Magnesium is supposed to be good for that.

We discussed at length the hospital atmosphere and policies should we wind up there, and the fact that Cathy wants to send me for an ultrasound at 32 weeks. To check fetal size (eye roll) and placental functioning (high BG can cause the placenta to age faster than its gestational age, leading to complications later in pregnancy: hence the Non Stress Tests for women with GD later in pregnancy). She argued that an ultrasound performed by a perinatologist is more accurate than one by a radiologist, and that the perinatologist she uses is very accurate in his size measurements (I call them size 'estimations,' because they are known to be so horrifically inaccurate). I said to make the appointment but I'm still thinking about it. I haven't decided. She feels it's indicated because my fasting BG isn't under control as of yet. The placental age/functioning thing is more convincing to me than fetal size measurements. But how bad can it be with only one number per 24 hours out of control? C'mon.
She has suggested staying home as long as possible to avoid interventions, but we both agreed that my labor is likely to go more rapidly than average, since my first labor was only 8 hours first stage. She is totally comfortable with me refusing continuous EFM and using intermittent doppler checks instead (VBACs usually have cEFM), and being in water as often as I want. We can request a room with a tub and, although my hospital's policy doesn't allow water births, if I just don't get out of the tub she won't protest. Bummer. I wanted one of those nice, deep, birth pools built just for that purpose. Oh well. I wasn't even sure I'd want it, since with Riley all I could do was stand, so being in a tub was a disgusting proposition. But I did want the option.

I think that's all.
Now I need to go to bed, and y'all need to get praying. PRAY HARD!! BELOW 6.1! BELOW 6.1!

I'm trying to think positive. I am sick this week after all, maybe that's why my sugars are higher than last week. Here's hoping...
[here's watching my uncomplicated normal beautiful home birth recede into the mist...]

4 comments:

nancy said...

Hey Babe, glad Brent was able to stay home and do his Brent magic! Thank goodness for great husbands!
Sounds like a good MW appointment, all things considered.
I'm asumming tomorrows travels are still ago since I havn't heard otherwise. Poor Ayden! Hope the antibiotics kick in fast.
love you
mom

ms emili louann said...

Whew, Mama. Praying my tush off for you!!!!

*hugs hugs HUGS*

Jen said...

Oh Mel! I'm so glad I checked your blog because I've been wondering what the update was. I'm sorry you've been so sick and I'm really sorry you're still struggling to get your a.m. readings down and how that is affecting your birth plan. Your thoughts/reactions to possible treatment and the ultrasound all seem very reasonable to me. You're midwife sounds like a real gem. I'm glad you have her. Know that I am PRAYING HARD for you, too! Don't give up hope, dear friend.
xxoo

tamie said...

Brave Mel. Thanks for writing all that out, even though I didn't understand all of it, but I at least have a better idea of what's going on. Here's a question for you. Say you lived in the back-country of Australia and there were no hospitals anywhere around. What would happen if you just had the babe the normal way? In layperson's terms, what would happen?

Keep us posted, okay? Hang in there!!!