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Diabetes Pregnancy: Now and Then, Part Two.

Welcome to the continuation of Laddie’s pregnancy story, showing what pregnancy with type 1 diabetes was like back in 1979 and 1982.  Today is a continuation of her story, with details about her sons’ births, the cost of care, and how diabetes did, and didn’t, play a role in bringing her sons into the world.

For more about Laddie’s life with type 1 now, you can visit her blog.  She’s awesome.  🙂

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1979: Baby Boy #1

I was diagnosed with diabetes late in 1976 and became pregnant with Mike less than 2 years later. I was referred to the obstetrician down the hall from my internist’s office. I didn’t know to ask for more intensive care and my personality probably would have insisted that I was not “different” from other pregnant women in their mid- 20’s. There were no home BG meters in those days and I was in good health. So I am not exactly sure what would have been done differently.

What are some of my memories? I had “morning” sickness that got worse as the day went on. No puking—just sickening nausea. I was hugely sensitive to smells and barely survived the weeklong visit of my mother who smoked. Although women who suffer from morning sickness are advised to avoid greasy foods, I totally craved Kentucky Fried Chicken and without fail it made me feel better. I remember the clothes: two jumpers, one hunter green and one navy blue, that I alternated daily with different turtlenecks and the horribly-patterned tunic blouse that I wore with beige corduroy pants. Because we didn’t know the sex of our children before birth, I sewed gender-neutral Winnie the Pooh cafe curtains and yellow-checked bumper pads for the old wooden crib that had been my husband’s. Crib safety standards weren’t a big thing in the 1970’s.

If you want a clue about my birth experience with Mike, just look at his statistics: 11 pounds 11 ounces and 24 inches long. Labor and delivery were hugely painful and towards the end, I received a drug that was magical. Most of the delivery is a blur in my mind but my husband vividly remembers the forceps. We always joke with our grandchildren about the “yankers” used in the Berenstain Bears dentist book to pull out teeth. Well, Mike had the big yankers that pulled him from his warm comfy floating life inside Mom. It took weeks (or months?) for the dent on the side of his head to resolve.

Although I mentioned previously that I only had two glucose tests during my entire hospitalization, Mike had five on the day he was born. I assume that this was to monitor hypoglycemia that is common in babies of moms with “poorly-controlled” diabetes. There were other health concerns that required specialized monitoring, but ultimately Mike was fine. He developed jaundice and required a couple of days under the lights. In today’s world I would have gone home on my third day with daily nursery visiting privileges. Not in 1979. I was asked whether I wanted to stay in the hospital with him and I did for a total of six days. I might argue that for psychological reasons and breast-feeding, it was medically justified …

1979 Statistics:

  • Birth Month/Year:  April, 1979
  • Birth Weight:  11 lbs 11 oz
  • Birth Length:  24 inches
  • Mom Days in Hospital:  6 days
  • Baby Days in Hospital:  6 days
  • Total Fee to Obstetrician:  $450
  • Mom Hospital Bill:  $1,079
  • Baby Hospital Bill:  $1,044

1982: Baby Boy #2

When I became pregnant in 1981, nobody had learned their lessons from my first pregnancy. Once again I visited the obstetrician down the hall from my internist. Once again I visited my doctor every 6 weeks for a blood test and probably drank a lot of water to dilute the sugar in my pee for Diastix tests. It is only because I know the story of Chris’ delivery that I am appalled that I did not see a high-risk obstetrician during this pregnancy. I am appalled that a C-section wasn’t performed. I am appalled about a lot of things. But I didn’t know any better and I guess my doctors didn’t either. Once again I had no home blood glucose monitoring. My insulin regimen was better than in 1978-79 with the addition of Regular insulin. However, as far as I know the doses were fixed and not an equivalent of today’s MDI (multiple daily injections) regimens.

I remember less about this pregnancy than my first. Probably I was too busy taking care of a 2-year old to pay much attention to routine doctor appointments. I do recall that Mike knew where every bathroom was in the southern suburbs of Minneapolis. “Mom, why do you need to go the bathroom again?”

If you look at the birth weights of my children, you might think that I had better diabetes control during my second pregnancy than my first. Fooled you! Chris was born three weeks early and missed the final weeks of sugar-saturated nutrition that is baby-poison.

Three weeks before my due date, I made a new casserole that had spaghetti sauce, hamburger,  and crescent rolls from the tube. This recipe is not on the list of the Top Ten Meals to have before delivering a baby and I have never made it again. Later in the evening my water broke and off to the hospital we went. My baby book notes indicate that I spent the night at the hospital with light contractions and Dad slept at home.

I did not go into labor and the next morning was given Pitocin to induce contractions. Pitocin labors tend to be “rougher” and ‘harder” than natural labors but I don’t remember whether this labor was worse than my first one. 5-6 hours later Chris was born. Once again, I want to ask: why wasn’t a C-section performed???

I don’t have many memories of Chris’ birth. I remembered the incredible pain of my first delivery but had the confidence that it would be over soon and I just needed to breathe and relax. My husband has the nightmarish memories of the birth of a baby who was delivered and stopped breathing. Chris had broken his collarbone during delivery which is not an uncommon occurrence. Unfortunately the broken clavicle bone pierced his trachea and lung. I don’t remember anything else before hearing from my husband later that Chris was in intensive care at Minneapolis Children’s Hospital and was doing OK. Actually I do not think that I even knew that there had been a problem with the delivery and must have been in some drug-induced stupor.

I recovered quickly from the delivery and 3 days later began the daily commute to Children’s Hospital. I was provided with a tabletop breast pump that I recall weighed a ton and was about a foot square. Chris was amply provided with breast milk through a feeding tube. I’m not sure that there had ever been a baby like Chris in the NICU which is usually filled with tiny 1-4 pound premies. At 10 pounds 3 ounces Chris probably weighed more than the combined weight of the other babies in the unit! He spent 15 days in the hospital on a ventilator as his trachea and lung healed and his lungs matured. In those 2 weeks there were two record-setting snowfalls of 18-24 inches and my memories are of cold and endless 11-mile commutes on slippery snowy back roads.

Chris ended up being fine and 35 years later I continue to give thanks for that. His close call didn’t need to happen. Of course I blame my diabetes for putting him at risk, but I also blame my obstetrician who didn’t perform a C-section based on the history of my first delivery.

1982 Statistics:

  • Birth Month/Year:  January, 1982
  • Birth Weight:  10 lbs 3 oz
  • Birth Length:  21.75 inches
  • Mom Days in Hospital:  3 days
  • Baby Days in Hospital:  15 days
  • Total Fee to Obstetrician:  $575
  • Mom Hospital Bill:  $1020
  • Baby Hospital Bills:  $898 + $14,795

Babies at Home:

I don’t have memories of how diabetes impacted my life once I was home with babies. However, just because I don’t recall anything doesn’t mean it wasn’t hard. If there were lows while nursing, they are lost in the brain frizz of watching soap operas and snippets of TV shows in the middle of the night and never knowing how they turned out. My scary memories of lows with young children are all a few years later when I was driving and I can’t stand to think about that. I didn’t know anyone else with diabetes when I was a young mom and I was very private about it anyway. I think I just ate lifesavers and took my shots.

I don’t recall worrying that my children would have diabetes and I don’t think that I ever pressed a Diastix strip into a wet diaper. Diabetes books indicated that the risk was low and without the DOC, I didn’t know any Type 1’s parents with Type 1 children. Also in my family, only my sister and I had diabetes and not my brother. Therefore only girls got T1 and I had boys…. That ignorance used to be bliss, but I now have 4 granddaughters.

I hate diabetes and it tried to rob me of a lot of good things when it came to having children. But it didn’t win. My babies were warriors and I was pretty darn tough also. I rejoice for the great medical care that women with Type 1 diabetes get these days and I admire how incredibly hard these women work throughout their pregnancies. Healthy babies are a prize worth fighting for.

Five Months.

To my Guy,

Five months old!  (And I’m pretty sure I forgot to write you a letter at the four month mark, so here’s a quick high five for turning four months old a bit back, too.)  Five months ago, I was excitedly awaiting your arrival and folding piles of baby clothes.  Now, I am greeted by your big, toothless smile every morning while you excitedly slap your legs against the crib like a mermaid.

Sorry.  MerMAN.

You are a tiny sweet potato with an appetite for both pears and destruction.  Despite being on the more petite side at the moment (single digit percentile for weight and barely double digits for height), you eat like you are a teenage boy.  In the last few weeks, I’ve had trouble keeping up with your food demand, so we’ve started working in the occasional formula bottle here and there.  I’m still breastfeeding and pumping as often as possible, but you need to eat, so formula is at the ready for the moments when I’m not.

You’re more tolerant about tummy time these days and you spent a lot of time on your play mat.  (Although when you’re feeling done being on your stomach, you fling yourself to the side to roll over, like you’re trying to roll down a hill.)  Just like your sister, you are content to holler happily at the plush animals dangling overhead.  This morning, though, you slammed a rattle against your head and engaged in your first “crying because of little injury” jag.  Real tears. It sucked.  And now you are giving that rattle some major side-eye.  Welcome to the world, little Guy.

Real food is also a recently introduced thing, and you’ve joined us at the table in your very own (belonged to your sister and is more than six years old but whatever – we like to save stuff) high chair.  The food you’ve tried so far are pears, and that first go wasn’t very successful.  Lots of confusion about what on earth a “spoon” is and also WTF “pears?”  But now, a few days and many attempts later, you wait with your hands on the high chair tray all excited, ready for the SPOON! and PEARS! and the mess that follows.

At the table. #milestone

A photo posted by Kerri Sparling (@sixuntilme) on

In the last few weeks, you’ve gone on your first trip to New York City to meet some friends, slept over at your Grammie’s a few times, and you’ve decided that Loopy is your favorite cat because she has a fluffy tail and she walks circles around you and makes you laugh, while Siah is the one who watches you sleep from afar, not daring to go closer but keeping tabs on you all the same.  The world is starting to crack open and let you peek inside, and it seems like you’re a fan.

It still amazes me, even though I’ve done this once before, how quickly the weeks change you.  You used to be a little thing with half-closed eyes and unable to hold up your own head, snuggled carefully and warmly against me at all hours.  Now you’re this much sturdier little man, smiling all the time and entertained by books, patty cake, and the series of foolish songs we make up and sing to you.  I’m afraid to blink because you’ll be crawling, then running, then refusing to eat your eggs before school every morning.

Time goes by very quickly, and I’m trying to appreciate these moments when you are little.  

Thank you for being part of our family. And for sleeping. And for the smiles that make me feel like I must be doing something right. You’re my littlest friend and I love you bunches.

Love,
Mom

Full Body.

The scar on my lower abdomen is close to healed, after six weeks of careful care.  The incision is evidence of the arrival of my son, the same place my daughter escaped from.  The skin above the incision is still swollen from months of pregnancy and oddly puckered due to surgery.  It’s not a flat, perfectly sculpted specimen of an abdomen.

But I try hard not to care.  My kids were created here.

The marks on my fingertips move every few days as I use a lancet to draw blood every few hours.  Sometimes the dots left behind look like I stuck my finger into a jar of ground pepper, other times they are light brown marks that appear to live deep beneath the surface of my skin.  But they represent moments when I needed to check my blood sugar and actually followed through on gathering that data.

When I look at them, I see evidence of me taking good care of myself.

The scaly patches of skin on my outer thighs are itchy and refuse to respond to lovely lotions and dermatologist intervention.  They are left behind by continuous glucose monitor sensors that I wear to keep tabs on my blood sugars throughout the day and night.  These skin issues are not comfortable or enviable, but the protection provided by streaming my glucose data helps me to sleep better.

My health is worth the inconvenient itch.

And, of course, there’s the shifting of my body, shaped by time and illness and exercise and pregnancies.  Baby weight.  Aging, even when I don’t remember to.  My leg muscles are softer, but eager to be used again.  My eyes have improved during this pregnancy, somehow.  My blood pressure is carefully watched.  My stomach is paunchier than it was 10 months ago.  I weigh myself to see what’s happened over the last six weeks and try not to get too excited or sad at the result.

But the number on the scale doesn’t define me.  Neither does the number on my meter.  Neither does my age.

… right?

I look at my body sometimes and feel a little embarrassed or ashamed because I don’t physically conform to what magazine pages and commercials suggest I should look like.  I’m not tall and willowy with shiny hair and slender arms.  And I admittedly care about the size of the pants or the cut of the dress.  It’s been harder than normal lately because I’m trying to recognize this new person in the mirror, the one who has carried two children and thirty years of chronic illness under her skin, never mind life’s normal wear and tear.

I’ve lived with body image issues that haven’t caused chaos but have given me pause from time to time.  Diabetes has forced me to see my body through a specific lens, not always rose-colored.  Sometimes diabetes makes me feel like I’m broken, unable to make insulin and struggling to create a child.  It’s weird to look in the mirror and see someone who doesn’t look sick but who has felt unwell physically many times, and who requires effort to stay emotionally well.

Other times, the diabetes lens makes me feel as if I have superpowers … like, shouldn’t I be dead because I don’t make insulin?  Every mile I’ve run or weight I’ve lifted stands in contrast to my unmotivated pancreas.  How has my body managed to stop producing a life-sustaining hormone and yet I’m still here?  Can’t I fly, too?  And melt steel doors with my eyeball lasers?

I have to remind myself that there are marks and imperfections on this body that I’ve fucking earned.  There are a lot of scars.  Some visible, others harder to see, but all of them, earned or self-imposed, have contributed to creating me.  This body is recovering from, responding to, reinventing itself in life, and that’s the image of my body I’m holding tightly to.

Releasing the Kraken … Into Our Home.

… he’s definitely not the Kraken.  That nickname will never stick because so far, our littlest friend is mild mannered.  He’s more Clark Kent than Kraken.  (Mixing my superheroes and myths this morning; feel free to blame the sleep debt and my attempt to repay it with caffeine.)

But he’s home, and even though he’s a sweet boy, he’s still an infant and our house is ROCKED by his presence.  My body remains equally as rocked by his escape, and my diabetes management is so confused that my pancreas, were it to have a head, would be scratching it with confusion.

OUR HOUSE:  Remains in the middle of our street, only it’s bursting at the seams with burp cloths and tiny little articles of clothing that require origami skills in order to snap up.  The laundry this little man produces is astounding, as are the number of diapers he rips through … and the number of times he’d like to eat during the course of a day.  For someone so small, the baby came with a lot of stuff.

(But I’m so glad he’s here.  I’ve never been so happy to have my house turned inside out in my life.)

MY BODY:  Is slightly less than a wonderland.  I talked about the c-section and cannot stress enough how different it was from my first surgical birth experience.  When I examined myself after having Birdy, I had a sizable scar and serious gas pain, but didn’t feel as though I’d been put through the wringer.  Ringer?  (W)ringer.  This c-section was very different because it felt busy during (lots of pressure and they actually needed to use the vacuum to assist in removing my son from the womb, poor kid) and the aftermath was not pretty.  I had a lot of bleeding after this one, more than the first time.  I also didn’t get a good look at my scar, etc. while I was in the hospital (they are smart to keep full length mirrors OUT of the postpartum recovery rooms) so I saw the mess for the first time when we came home.

Holy shit, the bruising.  The three or four inches of skin real estate underneath my incision was entirely black and blue and it looked as though I was wearing blue underpants.  I (am embarrassed to say) that I cried when I saw it because it looked so frigging VIOLENT.  Thankfully, 15 days later, the bruising is entirely gone and all that remains is the incredible shrinking uterus and the healing incision, but for the first week or so, I had a hard time checking the incision because it looked so Frankenstein’s monsterish.

And aside from the obvious diabetes stuff, I’m currently taking a blood thinner (thank you, Factor V Leiden) for six weeks, and am also unable to drive for six weeks.  The blood thinner is a little painful but totally manageable (one injection every night – easy enough).  The not driving thing is MAKING ME GO BANANAS because my freedom is entirely MIA.  I’m relying on friends and family for trips to the pediatrician, picking up prescriptions, getting groceries … every little thing requires assistance from a volunteer chauffeur.  And since I don’t want to trouble anyone more than I already have to, I’m placing some screwball orders on Amazon … like for the dry erase board eraser required on my daughter’s back-to-school list.  Or the long sleeve, size 0-3 month onesies for my son.  Or coffee, damn it.  I’m really excited to be able to get back behind the wheel and reclaim some semblance of independence.

DIABETES HEY OOOOH:  I cannot complain about how diabetes did its thing during the 38 weeks of pregnancy.  I didn’t have any tragic lows, there weren’t unmanageable highs, and the lack of pre-eclampsia was an excellent change of pace for this round.  During delivery, even though I was terrified, my blood sugars stayed solid.  And throughout my stay at the hospital, my blood sugars were without issue.  It was kind of awesome, and surely will stay that way forever, right?

HA HA HA HA HAAAAAAAAAA … now that my placenta has been kicked out of my womb and I’m breastfeeding a newborn, all kinds of diabetes hell has broken loose.  My blood sugars – once calm and dare I say predictable? – are now pinging and ponging all over the damn place.  My insulin:carb ratios are 1:20 (versus pre-pregnancy 1:11 and during pregnancy rates as low as 1:5) and my basal rate is 0.3u per hour (versus pre-pregnancy of .5u and during pregnancy rates as high as 1u per hour).  And absent the breastfeeding, these rates would probably hold tight for a few weeks until they started to require increasing, eventually bringing me back up to where I was pre-pregnancy … at least ish.

But breastfeeding is its own circus.  The act of breastfeeding does not make me hypoglycemic, but the act of producing milk does, so I’m going low mostly while my milk supply is filling up.  If this was a predictable cycle, I could plan snacks/meals around my son’s appetite and my anticipated refilling, but the cycle isn’t one I can map.  I can’t even guess.  Some times, I go low 15 minutes after feeding him.  Other times it takes up to an hour and a half for the low to hit.  I’m not sure when I should eat, causing my CGM graph to look all Ms and Ws.  If my experience with Birdy helps inform this round, I should have a more predictable blood sugar response around the time that my son is a month old.  Which means that I have two more week of letting my body ebb and flow and get all confused before it aligns to some kind of schedule.

The madness of a newborn added to the mix of an already all-over-the-place family is exactly what we had anticipated.  We’re exhausted.  (While driving home from a pediatrician appointment, Chris turned to me at a stop light and asked, “This is really happening, right?  Like this isn’t a dream?  We’re actually driving right now?”  The lack of sleep is like we’re on the tumble dry setting in the dryer, all jumbled and confusing and warm and is this real life?)  We’re adjusting.  (Birdy is doing her best to make sense of the new little creature in our house.  She loves him.  But I’m on the watch for sibling angst as well.)  We’re grateful.  (Issues like a messy house? Exhaustion? Sore body?  Bring those issues on, because I’m happy as hell to have these as my problems.)  And we’re in love with this little guy, who despite being only 15 days old, feels like he’s been part of the party forever.

 

Being a Rotten Patient.

Yesterday, I was a rotten patient.

At this point in my previous pregnancy, I had already been in hospital on bedrest for two weeks, so this whole rolling around on the “outside” while a few days shy of 37 weeks pregnant is new to me.  The emotions I felt on bedrest were really volatile and I cried a lot and HEY that same shit keeps happening even though I’m not on bedrest currently.  Which means that my third trimester experiences are consistent, at least emotionally.

Which sets the stage for yesterday. I had an appointment at the maternal fetal medicine offices and then at my endocrinologist, both up in Boston.  Usually, the ride takes me about an hour and 45 minutes, but I give myself 2 hours and 15 minutes every time, to anticipate traffic.  Yesterday, the ride took two and a half hours because of wicked traffic on Brookline Avenue, which made me late for my scheduled ultrasound.

I do not like to be late.  And yesterday, being late made me all emotional.  My car crawled up Brookline Avenue while I imagined having to reschedule my appointment for the following day, making the stupid drive all over again.  By the time I pulled into the parking garage, I had six minutes to find the right hospital wing and check in for my appointment.

Which, of course, I did not do efficiently.  Late pregnancy hormones and emotions have my brain mostly scrambled, so I ended up in the wrong wing of the clinic, nowhere near where I was supposed to be.  My blood sugar started to tumble at this point, bringing emotions even more to the surface while I left a trail of glucose tab dust along the hallways of Beth Israel.  Add that to the fact that I was late and mildly lost in the myriad of signs and corridors and I lost my cool.

Man, I felt stupid.  I was crying while waddling through the hospital, asking random people how to get to the proper hospital wing.  Their directions weren’t making sense to my slightly hypoglycemic head.  I could not pull myself together, awash with frustration and embarrassment and unable to control the emotional maelstrom swirling around me.  I was unjustifiably angry that the best care for myself and my kid included a four hour road trip for every doctor’s visit.  I was so tired from the low blood sugars that kept me up from 3 – 5 am and were the most symptomatic I’ve had in ages.  I was angry that I couldn’t guarantee safety for my child as a result of my own health garbage.  I was afraid that the stress of the moment was kicking my blood pressure into dangerous ranges.  I was a frightful mess and it wasn’t anyone’s fault but mine but holy moly, I was blowing up balloons by the dozen for this ridiculous pity party I was throwing for myself.

By the time I arrived at the right place, I was 15 minutes late and trembling.  And angry.  So when the nurses were waiting outside of the bathroom to grab me for my appointment, I snapped at them.  When they took my blood pressure while I was crying (could NOT stop for some reason), I knew the result would be elevated and would trigger a whole catalog of panicked responses from my healthcare team.  Of course it was high, and of course I snapped at them again.  Not their fault that I was late and my BP was high, yet they were the unfortunate recipients of my rage.

When the nurse I’ve been working with and a new doctor came in to discuss the results of my ultrasound (baby is fine) and my blood pressure (elevated for reasons I knew but they couldn’t pretend it couldn’t be a symptom of preeclampsia), I was still ranty and snapping.  I could not calm down and I felt terrible – TERRIBLE – that I was lashing out at a medical team whose purpose was to protect my health and the health of my baby.  But I still couldn’t get my shit together and acknowledge that for more than five minutes.

I was a rotten patient, all frustrated and angry.  (The ultrasound technician told me it was okay and that they see a lot of emotions during appointments, and I felt myself simultaneously apologize and then get all upset again.  No control.)  I snapped at healthcare professionals who were not to blame for my terrible mood.  I could not control my emotional responses to their reasonable requests.  I’m embarrassed at how I acted.  I hate admitting all of this.

The appointment circuit was finished later that afternoon, after everyone had reached the conclusion that I was able to go home until the next appointment (later this week) and reassess then.  I apologized to the people I had acted bananas towards and drove home, hoping to be more emotionally stable the next time.

I need to see this pregnancy through safely, but the last nine months have really opened my eyes to what I need to receive, as a patient, and just as importantly, what I need to bring to the table, as a patient.  Sometimes I can’t effectively perform as a full-time pregnant person, or a full-time person with diabetes (and clearly I’m struggling with doing both of those things at the moment), and I need to own that part of my healthcare experience.  Or at least stop crying in the stupid elevators, making everyone on there with me think I’m about to give birth in front of them.

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