Friday, February 18, 2011

Well, Duh

I figured out why I'm suddenly more comfortable. And likely why I had that horrible back pain day; the baby dropped! Duh, why didn't I think of that?? I don't remember how soon before birth they drop, but they settle in deeper at some point, getting ready to be born.

I watched Orgasmic Birth again last night; I ordered the DVD online last year or the year before and LOVED it. It's tough on the one hand because all these amazing birth stories are happening at home, in tubs and on porches and in livingrooms, and the few hospital births shown seem like caricatures of what birth can be in comparison. I have to remind myself that beautiful births happen in hospitals too. And the whole reason I watch these DVDs is to increase my confidence in my body's ability to do what it's designed to do, and I do get that out of watching them. It's hard to be a birth nutter and want a certain thing and not get it~especially as its preached by other nutters as the superior way to go. The nutters pay lip service to the "high risk women" being in hospitals but do they really believe it? And how about advocating for less interventive, more evidence based practice for those high risk women in hospital? I know myself from experience that as soon as one is labelled high risk, technology, machinery, and medicine are loaded upon a high risk pregnancy without pause. Suddenly, its cause for talking about dead babies, looking at them in utero repeatedly, inductions, cesareans, ad infinitum. I have an amazing team; midwife, OB, and perinatologist, not to mention my diabetic clinic nurse and dietician who believe in me, home birth, and natural birth. But they have some colleagues. Just brushing up against the colleagues once in awhile has been enough to make me shudder. Plus, knowing some other women who have grappled with the high risk label (friends and family) and knowing their stories is difficult too. Who's advocating for evidence based care for US? Only us, I guess. Of course it's that way with low risk natural birthers, too, there's just more of them!
Gestational diabetes should be labelled 'Medium Risk' anyways, since nobody's dying.

I saw the perinatologist again on Wednesday for an ultrasound. I love this perinatologist, as I've mentioned before! He's in his seventies, and very compassionate, calm, easy going. He's the one who said, "You're the boss!" when I told him I wanted fewer ultrasound scans. He measured the baby fairly quickly, in half the time the original doc did (the one I didn't like who talked induction at 39 weeks, and dead babies). He said the baby measured in the same percentile as before (95th), at 9 lbs 4 oz (give or take 1 lb 6 oz). I don't feel its that big, but I guess we'll see when its born. At first I felt fine. 9 lbs is not 11, and its not freaky big compared to my other babies.
The perinatologist said, "I think you have some genetics for big babies going on here, as well as some diabetes, because your baby follows the curve even though it is above it. Diabetic babies who are not well controlled often have spikes in their growth charts. Plus, you have good blood sugar control, and still your baby is big."
And later he said, "I don't want you to feel you've done anything wrong. You're doing a good job!" How did he know I was turning guilt over in my mouth, scanning my choices and evaluating them? I'm a quiet person. I didn't say anything. I didn't cry or even look sad. I think he's a bit intuitive that way. And how does a man in his seventies really *get* a pregnant woman in her thirties like that? Intuition. Lots of humanity. Lots of years of listening with an open mind.
He put on my report, "Large for gestational age. No further scans required unless medically indicated." He gets me! He gets birth! Awesome.
And he also told me I would have no problem getting this baby out, since my last baby was big and born vaginally. That's what a woman needs to hear in the final weeks of pregnancy: you can do it!

At the end of the ultrasound he took the probe and tucked it down low on my right side, just to show me the baby's face. He said, "That's a happy baby in there, breathing away! There is your baby's face!" So cool. I didn't even have to ask.

The scan was a hit to my emotional state, though. It took me a day or so to figure out why. It's because I worked so hard and controlled my diet so strictly and took high doses of insulin and followed 'the rules,' my emotions rode this roller coaster that followed the ups and downs of my blood sugar readings, I exercised so much it exhausted me and made my body HURT, and still my baby is nearly as big as my previous one.
It's not that I regret the treatment, I just feel like a failure for not having a smaller baby. Like somehow, somewhere, I did something wrong, or the treatment failed me and just didn't work, and I'm going to have this LGA or possibly macrosomic baby everyone will judge me for. And whose risk of type II diabetes will be higher, despite everything in my power to prevent that. The part I could have done differently was to go on insulin earlier, instead of fighting it for so long. Although the endocrinologist said this was possible; some women have big babies AND gestational diabetes, and average for gestational age just doesn't happen for them even with insulin. I do have lots of aunts who had big babies, on both sides of my family. Who knows, really?

Anyways. Baby dropped. Perinatologist awesome and sweet and kind. Midwife visit yesterday at 38 weeks 1 day;
Blood pressure 110/70
Fetal heart rate 140-144
Fundal height 39 cm
Baby's position LOP (optimal for giving birth) and engaged, head down

We discussed my birth plan and my post natal plan (for baby exams, blood sugar tests, etc). I'm bringing milk with me to the hospital, donated from a friend who is lactating. I'll add my colostrum to it when I get around to pumping some!! Jeepers, so many things to do, so little time...

My mom is here again. Blissful, help from mom....


Lauren @ Hobo Mama said...

Do you think full-term babies are getting bigger in general? I only say this because almost all the babies I know who were born recently were over 8 pounds, and several were even larger. Mine was 11 pounds, 13 ounces, and I didn't have gestational diabetes. I'm pregnant now and was told by my midwife, We need to watch that weight gain this time. And it really offended me, and gave me that taste of guilt like you describe, like I did something wrong last time to have had a big baby, and like I should do something to keep this baby on the small side, as if that's even possible. I can see where the potential for guilt must be higher when you have GD and are already feeling that sense of doing something "wrong" (according to cultural/medical norms), even though it's just the way your body is reacting to pregnancy.

Anyway! Sorry to ramble in your comments section. I just wanted to say that your note that low-risk natural-birthers aren't as compassionate to high-risk natural-birthers who have to go the hospital route gave me food for thought. I'm low risk so far (but haven't had my GD test yet…) and am planning a home birth, but last time I planned a home birth and ended up transferring to the hospital. I don't feel much condemnation from anyone but myself on that, and I am somewhat hard on myself but trying to lighten up. Part of the reason is that my hospital experience, while a good outcome, was not what I wanted, and I regret that a lot. But what I've heard from people in high-risk situations or who for their own reasons chose a hospital birth — if you know ahead of time, you can better plan for the outcome you want, surround yourself with the care providers who are supportive (like your awesome-sounding perinatologist) rather than who talk about "dead babies" (ugh), and do more to prepare yourself and the environment. So I wish you a peaceful, safe, and satisfying birth.

Ali said...

My first was 9lbs 7oz...nurses asked if I was GD and definitely commented on how that was a big baby. I'm guessing this next one will probably be pretty close to that size as I'm gaining almost the exact same amount of weight. I'm sorry you feel like you've not done a good enough job but I think it's got so much to do with genetics and that you've managed the GD so well!!! I'm hoping/praying for the best birth you can imagine, despite it not being in the building you'd like. You can totally do this!!!!!! (And although I can't relate to being 'high risk' (or medium-risk as GD should probably be termed), your body is just as able to birth this one as it did the last!!!!)

Louise Chapman said...

You are so close and I'm so excited for you! Although we are so different in our pregnancies, I know all about genetically large babies! You have done a wonderful job throughout your pregnancy, getting educated and caring the best that you could for you and your baby. I can't wait to see who's in there:)

melissa said...

@Lauren, I DO think full term babies are getting bigger in general. And it's something I can't make up my mind about! We eat differently than any generation before us, but is it really that? I know that my mom's generation actually dieted during pregnancy: are we 'normal' and they weren't? Was there a lot of alcohol being consumed in generations prior to that? I dunno! I can't figure it out, and if its pathological or not!

I know that Mikko was 11.13, I remember being awed at your power to birth that first time around! But look at Mikko now: he's a football player. I really think it's just him.

There is DEF. a medical-cultural bias against large babies and the implication of 'irresponsible' women who grow them, as you can see from Ali and Louise's comments too! But there is absolutely evidence out there that big babies DO genetically happen. If your hubby is 6'4" or built like a football player, or you yourself are tall or broad shouldered or bigger than average, OR your kid is built like a bruiser, doesn't a big baby make logical sense?
Even my endocrinologist acknowledged that. So did my OB.

But I'm tiny, my hubby is average, and my kids are scrawny once they hit one year of age. I don't know if that means its illogical for me to have genetically large babies or not...
my aunt had 2 ginormasourauses who are now an average sized man and a very petite woman...maybe I take after her!

Anyways, I appreciate you, and Ali, and Louise commenting on this~big babies do just genetically happen, I firmly believe that. And I don't know if its that the low risk birthers are less compassionate towards us medium/high riskers; we're just not on their radar as much as I wish we were, I think.

AND if you DO have GD, diet and exercise work well to manage it for the vast majority of women. And homebirth is still totally on the table until you need insulin.

Best of luck to both Lauren and Ali on your pregnancies!
And Louise: best of luck for the duration of your adoption pregnancy, however long a gestation that may be

Caryn Ouwehand said...


My Mother is 5'0'' tall and her babies were 9lbs 1oz, and 10lbs 0oz. She didn't overeat, or gain too much weight with either pregnancy, and she still popped out big babes. But I do think it is genetic. Funny too, because the "larger" side of my family gives birth to the smaller babies (6-7 pounders) and the "tiny" side of my family gives birth to the 10 pounders. Hmmm...strange, what is up with that?

ms emili louann said...

No guilt! Just PEACE and the knowledge that you have maintained an outstanding approach through all of this. Your baby will be here so soon, Mel. Your healthy, beautiful, perfectly-sized baby :)