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BSparl's Birthday: Part Three.

Babies rule.My last entry, about the birth of my daughter, was simply about her.  About how she joined our family and how much we loved her even before we heard her cry.  I didn't want to focus on all the diabetes crap because it paled in comparison to becoming her mom.

But.

Diabetes was definitely in the mix of things.  Of course, right?  So here's the gist on how diabetes played into BSparl's birthday.

After she arrived and I was sewn back up, I don't remember a whole lot.  I know I ended up in a recovery room in the labor and delivery department of Beth Israel, but how I got there is a mystery to me.  As I was preparing to write this post, I had my head in my hands.  Chris came over.

"What's the matter?"

"Dude.  I clearly remember going into the operating room, and I remember all the moments about her birth, but I have no idea how I got into the recovery room.  Did she come with us?  Did they ever take her away from us?  I think I was in a fog after the delivery."

So Chris filled me in on what my brain missed.  Apparently, we all stayed in the operating room together.  The nurses took BSparl at first to clean her off, but after that, she was with her mom and dad until we all left the OR.  Chris told me that I was moved from the surgical table to a hospital bed, and BSparl was in a glass-walled bassinet on wheels.  When the surgical team was finished putting me back together, I was wheeled down the hallway to the recovery room, and my baby followed.  

I was completely in a fog, but Chris told me that the baby was removed from the recovery room for about 15 minutes so they could take her to the nursery and test her blood sugar.  I remember when they returned - the nurse said that BSparl's blood sugar was 20 mg/dl.  They seemed somewhat casual about that number (I guess a baby's blood sugar is most often close to 60 mg/dl, so 20 mg/dl wasn't enough to send them scrambling.)  However, I wasn't able to wrap my head around that concept.  I knew what 20 mg/dl felt like, and my heart broke.  I know it's common for the babies of type 1 diabetics to have low blood sugar issues after birth, but still ...

"We can give her a bottle, or you guys can give her a bottle.  Either way, she needs to have something."

The anesthesia was hitting me hard, and waves of nausea were taking over rational thought.  I knew my blood sugar was fine (I'd been testing every 30 minutes or so since 6 am, and it was now about 10 am), but if my baby was having trouble, I wanted someone to feed her immediately.

I blinked.  Or maybe dozed off due to the drugs.  But when I came to, I saw Chris, sitting in a chair by my recovery bed, holding our daughter and giving her a bottle.  "She's fine now.  She'll be just fine," he said to me, not looking up but instead keeping his eyes locked on his child.

"Have they been testing her blood sugar?"  I could see these little bandaids on her heels, proof positive of the blood sugar checks.

"They're going to check her again in a few minutes.  Don't worry," Chris said.

They did - she was monitored steadily for the first 12 hours of her life.  And after that initial post-birth low, her numbers held in the 68 mg/dl - 75 mg/dl for the rest of her hospital stay.

On my end of the diabetes stuff, the situation got a little tricky once I was back in my hospital room.  After about an hour and a half in the recovery room (during which time Chris called all of our friends and family members to spread the good news about BSparl's safe arrival, and I opted not to talk to anyone for a bit because I kept throwing up into the handy bedpan - yum), Team Sparling was escorted back to the hospital room I'd been captive in for weeks.  I was still hooked up to the insulin drip, the glucagon drip, and was being monitored by my own glucose meter at my discretion.  

Problem was, my numbers started to bottom out.  And I wasn't able to keep anything down, due to my body's reaction to the anesthesia.  Some c-section ladies get "the shakes" after the spinal, but I didn't have that issue.  I had "the pukes."  I threw up - like a champ - about seven times in the hours following BSparl's birth, which the doctors said was normal but my blood sugars weren't digging it.  I was stuck, for about three hours, at a blood sugar of 50 mg/dl.  I tried to keep down some grape glucose tabs but they made their way back out, so we buzzed the nurses and asked for the dextrose drip to be turned up.

"Okay, we work off a sliding scale for this sort of thing, so we'll increase you to 20u of dextrose over the course of the next hour."

Even though I was still in the post-surgery fog, this wasn't a good plan to me.

"But I'm dropping.  A lot.  Like right now.  Can't we truncate the time frame on that dextrose?  Maybe get the 20u administered in the next 15 minutes?  Instead of over the course of an hour?"

Nope.  The sliding scale (bah) didn't call for that kind of action.  The best they could do was to turn off the insulin drip for a little bit to help counteract the plummeting blood sugar.  This scene played out for about three hours, with me calling for the nurses and asking for upped dextrose, watching my meter continuously throw out results under 60 mg/dl, and any attempts at glucose tabs or gel immediately evacuated by my body.  BSparl was being cuddled by my husband and then my mother (my mom came up to the hospital for the surgery - I may have been having my daughter, but hers was having surgery, so she was nervous), so baby girl was safe.  But I was stuck in the lows for hours.  And by the time I was starting to come up, the insulin drip had been "off" for three hours, I had been dosed with a pile of dextrose over the course of those three hours, and my blood sugar was rising fast.  (Why, oh why, couldn't they just quick dose me when I was low, instead of the sliding scale crap?)

It wasn't until about 7 pm that night that I was able to keep down some food.  And it wasn't until about 12 pm that they let me remove the insulin drip and reconnect the Ping pump.  My pump, once cranked beyond recognition in efforts to accommodate my third trimester insulin needs, was dialed down to a flat basal rate of 0.3u per hour and programmed with an insulin:carb ratio of 1:20.  They err on the side of caution with lows, post-birth, because of the nausea, etc.  And my body responded in kind, with blood sugars over 260 mg/dl for the next 48 hours.

"Oh, fabulous.  I'm 300 mg/dl now.  This is a far cry from the control I had just yesterday, right?"  I asked my husband.

He was holding BSparl in our now-quiet hospital room, looking at all the hair on her head and her tiny features.  I didn't want to wake her up.  I just wanted to watch him hold her, seeing the bond between the two of them grow as I watched.

"She's still okay, right?  Her blood sugars are okay?  She's okay over there?"

BSparl whimpered and stretched a little bit, her little hands reaching.  Her dad smiled.

"She's perfect."

Comments

Ok kerri, again with the beautiful stories :D This has made my day even greater, thank you so much for posting :D

Kerri - hope you've gotten a handle on those blood sugars by now and are getting adjusted. It's good to hear from you! Congratulations and happy Mother's Day ;-)

How beautiful. :) I'm so glad you all came out wonderfully in the end. I didn't know that about T1 babies having low blood sugar. 20?? Wow. That's major. New info to be filed away for possible future use. Thanks. :)

I am so in awe of your restraint in not howling for the Joslin team to be called! Sliding scale? SLIDING SCALE??? Oh, come ON! Right, because D is identical in everyone, and ... well, yeah. Just really angry on your behalf about that.

But *yay* for everything else :)

Great post, Kerri! I'm so sorry you had such a bad case of the pukes ~ I imagine that felt GREAT on top of the invasive abdominal surgery you'd just undergone, eh??

I have a long way to go before my daughter is delivering a baby, but it is awesome to read your story and learn how you and the dr.'s handled it. It is, once again, comforting to see how in control you can be of such an out of control disease.

Oh - and I also love how you so get what your mom would be feeling through all of this.
Thanks again for sharing your experience. Yvette

Kerri, they probably gave you medication (Fentanyl, Versed) after the baby was born that made you sleepy and gave you some amnesia. Not unusual for that stage of a C/S. Given that you're a Type 1, it's doubtful that BSparl was really 20 mg/dl or that they'd treat a 20 with formula. That's IV glucose territory for neonates. Again, amnesia comes with the territory.

That sliding scale crap sucks, that is so crazy! I would have been beyond frustrated! So sorry about that! And, wow, I knew the baby of a T1 would be low, but 20? Wow! Thanks for all the info about Bsparl's birth with Diabetes. So happy for you! Happy Mother's Day! :)

Puking after abdominal surgery is absolutely no fun. And the rest sounds like heck. Sorry you had to go through that kind of management in the first hours of life with baby girl.

Hopefully you are back in control (or what passes for "control" in a home with a newborn!) now and feeling very, very well.

Happy Mother's Day, Kerri!

I haven't heard the term "sliding scale" in a long time. I can't imagine trying to maintain regular (what ever that is) BGs during pregnancy and breast feeding. Congratulations! You've met the second love of your life. She's a treasure.

MidlifeMidwife - I wish that number was amnesia kicking in. But my husband remembers the same blood sugar reading, and it was also written on my daughter's chart.

Crying right now reading this, as I hold my BTull :D Watching the dh with the baby makes you fall in love with him all over again, right?

Sucks that your first hours were messed up by the nausea and sugars, but in the end it doesn't matter. Because you'll have the whole rest of your life to treasure her.

Happy first mother's day!

Thanks for this post, Kerri! Nice to know the technical D side of things with birth.

Happy early Mother's Day! =)

Well, it just goes to show what we all already know: different hospitals do things differently. Where I work, 25 mg/dl is considered a "critical value" and requires an immediate transfer to the NICU.

MLMW - You've seen waaaaaaay more of this whole "birthday" stuff than I have. This is my first and only run with type 1 and pregnancy! But different hospitals do things completely differently, it seems. From what I've heard, in other hospitals, I wouldn't have been told to have a c-section based on the retinopathy in my eye. Other docs would have let me push. But in this situation, it seems to have worked out all right on all sides: I'm healthy, and so is the kid. :)

@Kerri: Please don't feel obligated to answer if this is too nosy, but "first and only"?

Holly - LOL! Not too nosy at all. And I'm never one to say "never," but Chris and I have no plans for a second child at this time. We didn't have plans for more than one when we got married (has NOTHING to do with the whole pregnancy experience, trust me!). Team Sparling works well with three members for the moment. :)

Kerri,
I totally feel for you. Same thing happened to me with my BG after I had Izzie but I did not have a c-section. It was awful. I was lucky I was able to control my own insulin needs before and after her birth. I piled in as much glucose as I could but the more I gave myself the lower I went. I was even unattached from my pump for several hours.

I am so glad BSparl is here and safe (and absolutely freaking adorable). Well done momma, well done!

@Kerri: Good deal. The most I've ever heard of a T1 having was 5 kids. That's a lot for any woman, though!

So true, Kerri! Healthy mom and healthy kid is what it's all about! (And, by the way, my hospital also would have scheduled you for a C/S, so there's some agreement there.)

Oh, Kerri!!! So many flashbacks to my own delivery. Even though there are many differences (I had gestational [now Type 2] and vaginal births), worrying about your baby going low is something we both have in common. I'm glad everything is going well for the three of you!

Wow- thanks for the post. Very informative. I would love a post that explains how your insulin needs have been changing since the birth. I know everyone is different, but a point of reference is always helpful.
Oh and Happy Mother's Day!!!! Yeah for you!!

Wow!!! I can't even imagine how horrible it feels to be low and puking after surgery. Hopefully the pain meds were still working full force?

Looking forward to meeting sweet little BSparl (and catching up with you in real life) soon!!

Congrats! Just wondering if you're breastfeeding at all? I was curious how that affects blood sugars.

BSparl sounds PERFECT!

Looking at the 20 mg/dl must have been like waking up in the middle of the night, seeing 5:30 on the alarm clock and freaking out about being high!

I am so relieved to know that BSparl is healthy and happy! You, Chris and baby are a wonderful, amazing family!

Let us know how the cats are adjusting! :)

Puking after the C-Section?!?!?!! I can't even imagine the pain you went through while wretching with a "fresh" incision. OMG. 25 weeks until my C-section and now I am terrified I am going to tear it open. But you were okay, so I'll be okay too. Yes, those will be my thoughts until it's over. Glad to hear everything went well in the end :) I can see it has been totally worth it!!

As someone who puked DURING both of her c-sections, repeatedly, I feel for you! Anesthesia is the suck. But as you know, it's so worth it in the end. That tiny fist wrapped around your finger makes it all worthwhile. :-)

Every time I read a post about BSparl, it makes me want my own so badly!! I share these stories with my husband and he just gets this smile on his face and says "We'll have our turn soon" :) (actually not very soon, like 3 years)

I have never been at 20 mg/dL, so I can't imagine how that must have made you feel to know that's what your baby was at. I'm glad everything is a-okay!

Hey Kerri,

I'm really excited for you guys. Puking after anesthesia just sucks. I've never given birth, but when I had my wisdom teeth out (with full anesthesia), I puked for three days. Ick. So glad BSparl is safe. Was sad for you through this post wondering when you finally got to hold her!

You take care,

Melissa

Diabetics are notoriously bad patients... for this very reason! You know better. :D Did you talk to the doctor [just out of curiosity] or just the nurses? Also... you needed your glucagon pen--a quick 1/4 or 1/2 dose would have gone a long way, and those nurses would have been so proud of themselves for getting it right. *wink* haha. JK

HAPPY MOTHER'S DAY!!

I think you did great Kerri and just look at BSparl - perfection! You should be so very proud of how you did. Now enjoy every moment. Thanks for sharing your story. I know it helps many people out here in the DOC and beyond. Now, go get some rest :0)

Happy first Mothers Day, Kerri.

Thank you for sharing!!
and HAPPY MOTHERS DAY!!!!!!!:)

Kerri,

Another great reflection post and a wonderful learning opportunity for me as a nurse. One of my goals for a clinical project right now is to improve our gestational diabetes teaching in pregnancy with a focus on management in labor and delivery. I would love to spend a day at a place like Joslin!

Enjoy your special day! Happy Mother's Day!!!!!

I already commented, but I forgot this-

HAPPY FIRST MOTHER'S DAY, KERRI!

Enjoy your day and your daughter :)

Oh, fun times. Sorry you were low for so long...I really don't understand why hospitals are so enamored with sliding scales. I also had the same problem with hanging out in the high 200s and 300s when I reduced my basals after delivery; I plan to only cut my pregnancy rates by 50% next time instead of 70%. (Then with my luck I'll be -50 all of the time!)

Happy Mother's Day!!!

And doesn't the sliding scale suck?! It's one of the few times when you really do hand over control to an outsider. Feels strange huh? Oh and puking? Yep. I puked all over my OB. Oops :p

No one had told me that my baby would have low blood sugar after he was born. Did you know that before your delivery? My son's was 2.x (something) I'm in Canada, and we test metric!! LOL! Which is about 45 or so (multiply or divide by 18.1818181818) and I remember thinking the same thing... that's SO low! (I made the mistake of telling my Dad that his sugar was low... As if he wasn't worried enough before..!!)

Have you tested BSparl's blood sugar since you took her home? I haven't tested DS's... yet.

I had my ability to self-administer insulin taken away from me after my c-section because I was a little overzealous and not adjusting to the post-delivery new reality -- oh, how annoying it is to have been put in control of this nearly impossible project -- having a healthy baby -- and then having that taken away from me! It's been five and a half years and I still feel the frustration when I think about it.
Looking back, the whole delivery and immediate post-delivery is not a time to be looking for perfect control -- it's about avoiding crashing on either end of the scale given that your body is under unbelievable stress.
I'm so happy for you all, Kerri!

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