Modern Health Care

I've been busting my butt managing my gestational diabetic diet and exercise regimen, only to find that I'm having sugar readings above the University of Michigan cutoff for what's acceptable. Which is around ten points lower than the Merck cutoff for GD.

Last week my diabetic counselor offered to relieve my stress by putting me on insulin. Less meal planning, more flexibility with what and when to eat. Sounds great, no?

The little detail that was not mentioned (and I don't fully blame the diabetic health care folks for not mentioning this) is that if I am on insulin my primary care provider would no longer be a midwife but a regular obstetritian.

I almost typed "a mere obstetrician." Such are my strong feelings about being cared for by a midwife. I can't tell you how important it is for me to be in the care of a woman who understands that birth is a normal event, not a medical condition to be managed.

I do believe there are plenty of wonderful OB's out there. I worked with one last year during my miscarriage. Hopefully he can consult with me soon about these slightly elevated sugar levels and what actually constitutes risk to the baby and to me.

Another interesting fact about GD and insulin use: I would not be able to deliver in the birthing center's standard rooms, but would be put on a wing with the other "high-risk" births. No birthing tubs, smaller rooms (although pretty darn nice).

Oh - lest I forget to mention that my health care provider may decide to induce labor around 39-40 weeks, and would certainly be interested in not allowing me to go beyond my due date. Due dates are an estimated figure, so I've heard. Any OB worth their salt would be interested in fetal measurement and my weight gain rather than an arbitrary date.

All of these possible interventions. Certainly not part of my birth plan.

I'm in the information gathering stage right now, having gone through the freaking out stage and then the crying stage for a couple of hours last week.

I am thankful to be so carefully monitored and managed, all said. But sometimes I wonder about the medicalization of childbirth and its connection to legal liability and the needs of insurance companies. Altogether it's a learning process, and part of what I'm learning is to think about this in the way my wonderful midwife framed it:

"I also find it helpful to remember that this is the baby's birth and this little wise one is creating these circumstances for her own particular learning. We all can do our best to shape the experiences- but she's calling the shots!"

(Already this kid's running my life...ha!)

Weighing Things

Not literally things, although I do get weighed once a month at my midwife visits. I now weigh 163, by the way (get it? way? weigh? pregnancy brain?), which is the most I've ever weighed in my life.

Lately I've been weighing things like, is it worth it to continue to stand on my aching feet with my aching back and wash a sink full of dishes tonight so I won't be rushed in the morning? Is it a worthwhile endeavor to straighten the ever accumulating mess on the dining room table, or should I just go put my feet up and read? What serves me better: doing another load of laundry or taking a nap?

I don't see how single people get through the third trimester without support. Just working part-time, shopping for food, cooking (when I actually do it instead of relying on Dan) and cleaning up seems like enough, and I also take a pregnancy yoga class, a belly dance class, and we're taking pregnancy and childbirth classes on Wednesdays now too.

I've long believed it takes more than two people to raise a child, and now I belive it takes a village to maintain a healthy, happy pregnancy!

Thank goodness for Dan, my in-laws, my parents, my friends, my doula/massage therapist/holistic health care diva, and my midwife!

The Floor is How Far Down?

I've been dropping things lately. Not valuable glass vases or antique teacups, mind you, but just about everything else - papers, my belly belt, the soap in the shower, food...and the floor seems to be farther away than it used to be.

Most of the time I don't mind bending over or squatting to pick things up, but after the day's seventh clumsy drop, it gets old. My muscles and ligaments don't seem to want me to bend over! Dan has been super helpful and will pick things up for me, or put a heavy pot away in its bottom shelf spot, and I've been practicing picking things up with my toes and lifting my leg high enough to grab the offending article from my foot.

I'm reframing how I think about gravity - perhaps I need to do a few more forward bends and squats? They do strengthen my muscles and increase my consciousness of breathing and movement. Maybe gravity is my friend after all.

The Shuggah Dieuhbeetus

(That's how you'd say it if you were from the Ninth Ward in New Orleans.)

Yes, I have a case of the sugar diabetes, the gestational type. I responded with two "abnormal" sugar levels during a three-hour glucose tolerance test last week - "abnormal" is a nicer way to say I didn't pass.

The good news is gestational diabetes disappears as soon as the placenta is delivered in 97-98% of moms.

Today I attended diabetic counseling at the University of Michigan hospital, and from now until I deliver I am on a carb-counting, protein-including, finger-pricking schedule of fun. It's not so bad, really. I just have to be very mindful of what I eat, what type of food group it belongs to, and when I eat it.

All of this to ensure my health, the baby's health, and to make sure I don't grow a huge baby that would be hard to deliver.

I got to take home my very own Accu-Check Aviva blood sugar monitor that has digital memory, along with this cool finger pricker that loads six sharps at a time and doesn't even hurt my tender little fingertips. And I got a free lunch tote in the deal. At least there's a sunny side!

Where Are My...

FEET???




There they are! With a little cantilevering I can see them.

I've never disliked my feet, nor have I ever thought they were fabulous. Lately I've been paying attention to the veins on the inside of my feet, rubbing in rosemary cream and doing inverted yoga positions to minimize them.




My feet grow tired more quickly these days. I've been told I have small feet for my stature, and with the extra weight on them it's no wonder they grow weary!

Second Time Around

This is my second pregnancy. I miscarried last February at almost 20 weeks along, which (needless to say) was a huge disappointment. Especially after sailing through the first trimester, the time during which most miscarriages occur.

It's funny - I heard hardly anything about miscarriage until I had one. Then all of these women came out of the woodwork with their stories, and it's not so uncommon as the silence around it leads one to believe.

It turns out that having an amniocentesis caused the loss. I was doubly unlucky - most amnios do not result in a punctured amniotic sac, and most of those that do heal themselves. After being confined to three weeks of bedrest it was clear on ultrasound that there was simply not enough amniotic fluid being retained in the sac, and the pregnancy was not viable. Amniotic fluid serves many functions, among them providing a pressurized environment ensuring proper fetal lung development. Every day I went without a viable fetus increased the odds of my developing an infection, which could have led to a host of problems. A day after Dan and I made the decision to terminate the pregnancy I miscarried.

All in all the miscarriage experience wasn't so terrible. I was handled with competent care and sympathy by the staff at the UofM birthing center. The ordeal started around 3am and I was back at home by 11am. The miscarriage did give me some insight into childbirth, but my doula told me that successful childbirth shouldn't hurt nearly as bad.

It's been hard to not think about this experience with my second pregnancy. My body has been telling me from the start that everything is fine, but my mind sometimes wanders back and introduces doubts. It's easy to play out imagined dramas in my head - what if this or that goes wrong? What if I go into pre-term labor? What if???? I try to stay centered and keep my mind in balance with the wisdom of my physical being.

And, deep inside, I feel like this time around we will have success!

On Puking

What biological function, may I ask, does yakking up a perfectly good breakfast serve?

You should have seen the breakfast I cooked - whole wheat pancakes with cinnamon and local blueberries, local maple syrup, butter, scrambled eggs from my friend Kevin's hens, orange juice...it looked and smelled and tasted so good!

My stomach enjoyed it for about 20 minutes, and then I accidentally swallowed wrong - you know, when you have a little extra saliva, and it goes down the windpipe. I had to cough, and I told my stomach to not get involved, but since I've been pregnant my gag reflex is sensitive to strange things like coughing. I even puked one time after a vigorous sneeze.

I felt cheated, after making and enjoying such a great breakfast! I just don't see how losing my breakfast improved any situation.

And it's not like I have morning sickness, which usually plagues women in the first trimester. Now I'm almost 23 weeks along and well beyond my "morning" sickness experience. I say "morning" because what I had was all-day-and-into-the-night sickness for about five weeks. Unless I was actively shoving food into my mouth, my stomach was very unhappy. And, believe it or not, I can't eat all day long!

Thankfully that's over now. I'll try to be more careful when swallowing, sneezing, coughing and brushing my teeth - especially after blueberry pancakes!