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Archive for July, 2011

Jul 30 / Caro

You Know You’re A Pregnant Diabetic When…..

  • You consider that you should get shares in the company that makes Lucozade. And glucose tablets.
  • You have spots of blood all over the top of your bed sheets from all those middle of the night tests
  • 3.8 is no longer considered a low blood sugar. But 6.5 is “Holy crap! High!”
  • Hospital receptionists are on first name terms with you…. And check you in when they see you coming, before you even open your mouth to give your name
  • You ask about the baby’s abdominal circumference before almost anything else at the scan, and you think more about what they will weigh when they’re born than which sex they are.
  • You see blood glucose numbers in your dreams
  • You look for pockets in maternity trousers, so you have somewhere to stash your pump
  • You just about see your toes, but you can’t see where you are putting your infusion sets and CGM sensors
  • You refill your Humalog prescription at least twice as often as before. And your pump seems to keep running empty far too quickly
  • You share your bed with not only a bump and a maternity pillow, but endless discarded test strips and crumbs from treating midnight lows
Jul 28 / Caro

Runny Eggs and X-Rays: Defining ‘Risk’

I like to bake. Big cakes, cupcakes, cookies, brownies… you name it, I love making it. And eating the results. And, if I’m truly honest, eating the partially made product, otherwise known as licking the bowl clean.

The day that we found out I was pregnant, I’d planned to make Peanut Butter cookies – my favourite and my speciality. We’d made a special detour to a local shop to buy ingredients, where we also unsuccessfully tried to pick up a pregnancy test. Managing to buy one later, I took that before starting on my baking. Only once we’d got the positive, I couldn’t bear to bake anymore, not only because I was too excited but because I suddenly realised that I couldn’t eat the raw dough. Raw eggs are on the no-no list for pregnant women due to the increased risk of salmonella.

It was only over the following few days that I really began to think about it, and look in to it, properly. For starters, I realised that British eggs stamped with the Lion Mark come from Salmonella free, vaccinated broods. So the chances of getting Salmonella from raw or runny Lion Marked eggs really are very slim. Which made me think about all the other “risky” things we’re advised not to do when we’re pregnant.

The thing is: nothing can eliminate all risks entirely. Being alive is a risky business, given that the only certainty is death. Being pregnant is certainly a risky business too, and absolutely everything in pregnancy – what to eat, what activites to do or restrict, what medications to take and what treatment to have – are a balance between risks and benefits. The problem is that nothing at all, even just walking along the street, can be proven safe because unfortunately some babies will be born with problems and it will be really hard , if not impossible, to identify what actually caused them – if anything specific. Things which are known for sure to have harmful effects should obviously be avoided. Thalidomide is a good example. But other seemingly forbidden things might not be so clear cut.

In fact, the vast majority of things in life seem to fall in to “grey areas”. If there is a small chance that something may cause harm, I think it is best avoided whenever possible, if only so you are not left wondering or feeling guilty if you should be unfortunate to have a problem. Many things are avoided without much difficulty. To use dentistry as an example here – routine x-rays are easily avoided as they can wait for 9 months. Cosmetic treatment is also easily avoided as it is not essential. Equally, most foods are easily avoided, even if we do miss them.

However, sometimes something that falls in to a grey area has a very clear benefit. Taking many medications falls in to this catergory. One medication that I take daily is not totally proven safe in pregnancy. But if I stop taking it, the potential effects for me, and hence on the baby, are overall greater. No one would take my medication if they didn’t need it, or could get by without. But I can’t. The benefits outweigh the risks.

Most medical and dental treatment is the same. The risks of failing to have toothache treated, to use another dental example, are ongoing pain which may be disruptive to your life, cause stress which can affect the baby and require you to continually take painkillers. Although paracetamol is safe on an occasional basis, taking it daily for 7 months is a bad idea in itself. You might also risk developing a nasty infection. In the very worst case, severe dental infections can spread and become very serious – again a potential threat to your pregnancy.

And here’s something about the one everyone thinks is a no-no: x-rays. Yes, they can be used in pregnancy. Once again, it’s a case of risks vs benefit. Having an x-ray does not mean you will definitely have a problem with your pregnancy or baby. In fact, the overwhelming balance of evidence is that you won’t have a problem at all. Having routine x-rays is unwise because even the tiniest risk isn’t worthwhile if there is no gain. In certain cases though, there is potentially a big gain. Sticking with the dental examples, that may be the preventon of pain and infection and not losing a tooth. The dose from a small dental x-ray with modern digital equipment is not any greater than if you take a couple of medium-haul flights durng your pregnancy. Pregnant women living on Dartmoor receive more than a dental x-rays worth of extra radiation compared to a woman living in London, but there is no coresponding increase in birth defects in Devon. The x-ray tube is pointed towards your teeth and well away from the baby.

I think that there are a lot of misconceptions about what is and isn’t safe in pregnancy. But I also think unnecessary avoidance of too many things, especially foodstuffs, has the potential to cause stress that surely is not good for pregnancy itself. And sometimes the avoidance of things like medication amy cause more harm that taking it. Women need to be supported to weigh up the risks and benefits for themselves, and understand what they are sacrificing and why, rather than just given a dictatorial list of things they must not have or do.

There are no guarantees. We just have to do the best we can.

Jul 26 / Caro

Other Second Trimester Goodies

While all is pretty quiet on the diabetes front, the second trimester is throwing up a couple of other issues. Most of them I’ve sort of been expecting.

The hair is not dropping out of my head anywhere near as much as it does out of my non-pregnant head. Sadly this is not evidenced by thicker, more lustrous locks, but purely by the lack of hair in the plug hole and all over the bedroom floor, especially in the vicinity of the hairdryer. Ian is very thankful for both of these things. I’m kind of sad that my hair isn’t visibly thicker though, and concerned that when this hair does fall out, it will look visibly thinner instead.

On another hair related note, I’ve started to have trouble taming that other area of hair.

You know the one.

You do know the one.

You are not going to induce me to call it by any of the ridiculous names that pop up on internet forums. No, you won’t.

You know, like “lady garden”.

Damn it. Ridiculous!

Anyway. Yes. I’m having a little trouble visualising what I’m doing down there. Of course this means that I also don’t know if I’ve done a wonky job, so I’m going with out of sight, out of mind. I’m a little reluctant to go for a professional wax as so many people have warned me how much more that can hurt during pregnancy. And it hurts enough when I’m not pregnant! We’ll see how I feel about it when I’m approaching the part of pregnancy where that part of my body will become fair game for examination by a variety of medical professionals.

A final hair related point is one that I wasn’t expecting. The hair on my legs has stopped growing pretty much entirely, which is great news as far as I’m concerned. I can be… how can I put this…. a bit lazy, about getting rid of leg hair. I hate doing it, so I tend to put it off. Not having to do it is bliss. Shame that the, ahem, lady garden (!!!) has not been subject to the same effect really. I’ve no idea what’s caused it. Google suggests that it means the baby is a girl. Something to do with hormones. However, it also suggests it’s a boy. Again, something to do with hormones. I’m guessing that the baby is a baby, and something about the hormones involved in growing him or her is causing my leg hair not to grow. So there.

Something else that I have been expecting has finally arrived with a vengeance. Heartburn.

I suffer from reflux at the best of times. So it’s not much wonder that a baby pressing in to my stomach is exacerbating the problem. I’m now glugging Gaviscon like it’s going out of fashion and just hoping that it doesn’t get too much worse.

Unfortunately the heartburn has brought along its friend: insomnia. The heartburn itself is keeping me awake at night, but I’m also starting to struggle to get comfortable in bed with both lying on my front and lying on my back (my favoured positions) now out of the question. Flangelina also seems to think that night time is party time, and as soon as I climb in to bed he or she starts dancing around in there. I really, really hope that this doesn’t mean they will be a night owl after the are born as well.

That’s about it for now. I’m still getting ever rounder and more ungainly. I have to check myself before trying to squeeze through gaps, and my feet are starting to get difficult to reach. But I’m acutely aware that there is a lot more growth to come. Just hopefully not of the hair variety.

Jul 25 / Caro

Second Trimester: Diabetes Update

I haven’t talked specifically about diabetes for a while. That’s mostly because there isn’t a whole lot to say. Things are pretty much just plodding on. I do still have a strong focus on my blood sugars and overall control, and I still worry every day whether I’m doing enough, but a lot of diabetes control tasks are done on autopilot and I’m having success with suppressing some of the fears that I can do nothing about. It’s still hard work, but I guess I’m balancing it with the experiences of general pregnancy better than I was before. It helps that I’m probably at my most stable ever right now. The lows of the first trimester are gone and I’m shocked to be spending days at a time in range, with no in-your-face highs and lows to keep highlighting diabetes.

My insulin needs are still increasing on an almost daily basis, but I’ve become quite comfortable with adjusting them almost daily too and I feel pretty in tune with what I need to do. I’ve also somewhat moved past my issue of meal boluses sounding just too big to be possible, so I’ve eradicated some of the post meal highs I was seeing and feel much more confident with what I’m taking. Some of these doses are getting huge now though. I would never have taken 8 units, or more, for a single meal pre-pregnancy. I’m still craving carby foods, so the low carb resolution I made before I got pregnant has totally gone out the window. I don’t feel bad about that though, as I’m managing to stay on top of things and the sole reason for going low carb was improve the stability of my blood sugars. If I can have my carbs and my good blood sugars, then it’s a win-win! Cake? Don’t mind if I do!

I’m still very reliant on the CGM. I honestly don’t know where I would be without it. More stressed for sure. Likely with a higher A1c and experiencing more lows. Probably wanting to give up work sooner to have more time to focus on diabetes management. I’m not sure I could have allowed diabetes management to blend in to the rest of pregnancy so easily without it there to help me out. I’m in total awe of women who go through pregnancy without one, I really am. They are the vast majority of pregnant diabetics, so I know how lucky I am. People keep complimenting me on my excellent control and how hard I must be working, and it makes me feel like a bit of a fraud, to be honest, as it’s the technology that’s doing the lion’s share!

My growing belly is creating some diabetes management issues though. There is a bit of a shortage of real estate for pump infusion sites and CGM sensors. I know some women continue to use their bellies during pregnancy, but to be honest, everything feels so tight the idea of sticking a needle in there is something I can’t get my head around. I have a comedy image in my head of my belly popping like a balloon stuck with a pin. I’m also a bit limited with where I can place infusion sets around the back based on how far I can reach, which is now considerably less far than it was pre-pregnancy. Now it’s your turn for a comedy image of a woman-resembling-whale trying to reach the middle of her back! I also can’t get used to just how often I need to fill up the reservoir in my pump. Now that my total daily dose is pushing up above 70 units per day, I’m needing do it every other day. The good thing is that it reminds me to also change my infusion sets this often. I was frequently lackadaisical about this task pre-pregnancy, but it’s more important than ever to avoid infusion set issues, so I’m being pretty good with it.

What’s to come? Well obviously, there are no certainties. Each day is the most pregnant have ever been in my life! I am expecting my insulin needs to continue to rise. I’m probably expecting things to get a bit harder again too, as it seems almost too calm and easy right now (There we go… just jinxed myself!). I’m just hoping I can keep plugging away at it and doing what needs to be done. I do have the greatest motivation in the world ever though. And that growing belly is all the reminder I need.

Jul 24 / Caro

The Fear of a Caesarean Section

(I’m reproducing this post from elsewhere, with minor edits for context. I wrote it back when we were in the early stages of our journey towards having a baby, but it still applies now. If anything, now that I am actually pregnant, my fear of requiring a c-section has grown rather than diminished. This is the reason that I’m so undecided on early induction as per policy for type 1 diabetic women, as induction is associated with an increased risk of requiring a c-section.)

 

I spoke with a former midwife this week. We weren’t talking about pregnancy, birth or even children. We were, however, talking about my multi-faceted medical history. Out of the blue she announced to me “Don’t ever get pregnant will you?” The question mark was very barely there.

She must have seen the involuntary look of shock on my face. Because having a baby is very much what I do want to do. And there is no good reason why I can’t achieve a successful pregnancy with a happy, healthy outcome, even if that may be more difficult for me and my healthcare team than for the mythical “average” woman. So she back peddled a bit and said “It’s just the midwife part of me talking. A woman like you would be a nightmare in labour.”

This wasn’t really getting any better. Frankly, I was offended. I don’t wish to be made to feel as if I would be some massive burden to healthcare staff by choosing to have a family. And I’m sure that as in every other sphere of medicine, there are apparently routine and straightforward things that quickly turn in to nightmares that were not foreseen, and things that look to be a challenge beforehand, but turn out to be a walk in the park. If we were to prevent all potential difficulties of child birth, we’d have to bring an end to human kind.  So I felt myself shifting uncomfortably, trying to formulate a response that wouldn’t be equally rude, but would make clear the offence taken. Meanwhile she back peddled a bit more and said “Well, anyway, you’d definitely have to have an elective section, and the whole thing would be stage-managed.”

“Probably” I responded, appearing to concede because I realised that this conversation would never go anywhere.

“Definitely” she said.

It wasn’t her place. She won’t be involved in my care should I ever reach the point of discussing the labour and delivery of our child. A caesarean section may well be what happens, if that is what will be safest and healthiest for the both of us either due to my medical conditions or some other factor.

But it won”t be “elective”. Planned, yes. Elective, no. Because there is nothing elective about something that you really don’t want to happen, something that you would only do if there were no other safe choice. Accepted, not elected, for the latter implies some sort of choice.
 


Choice is not something there is much of if you’re pregnant, or considering pregnancy, with less than perfect health. I feel strongly about this. I’m annoyed with the way in which women with diabetes who become pregnant do not seem to be treated as individuals. The blanket policies on care and delivery that do not take in to account the very different needs and wishes of very different people are just plain wrong. As they would be if talking about women without diabetes. Every person, when they are a medical patient for any reason, deserves to be treated as an individual person first and foremost. But that is really a rant for another day.

I feel strongly about it for a much more personal reason. I’m terrified by the thought of a caesarean section. There is a word for the fear of child birth – tokophobia. What I feel about caesarean birth is identical but there isn’t, as far as I know, a word to encapsulate that.

Ironically it is the situation that contributed to a chunk of my potentially problematic medical history that also gave rise to this fear. Through multiple attempts at lumbar punctures (or spinal taps) during my bouts with meningitis and encephalitis, I learned that I have “unusual spinal anatomy” that I’ve since been told means that a spinal block or epidural will be very difficult, if not impossible, for me. And that means I might need a general anaesthetic to deliver our child. Missing the moment I become a mum is the thing that petrifies me the most. The alternative, attempting the spinal anaesthetic but having it leave me with the sort of nerve injury I suffered before – or worse – is not a much better proposition, and scares me almost equally.

I’m also afraid that the attitude I encountered this week will prove to be more than a one off. That I’ll always been seen as a medical problem first and everything else second. I’m reminded that there are people out there who think that I shouldn’t have children and believe that it’s selfish and wrong.
 


Sometimes everything about expanding our family beyond the two of us feels like such a monumental challenge. But I’m definitely not done yet.

Jul 23 / Caro

Taking Leave: Justifying my “Laziness”

I’ve written a little bit before about maternity leave and intimated that I’m planning on taking a good couple of months off before Flangelina is due to put in an appearance. The thing is, I’m starting to come in for some criticism for that decision, to the point that some people are implying I’m lazy! I know it’s no one else’s business, but I do find myself justifying what I’m planning to do, much as I’m about to here, right now.

It’s quite simple really. Why struggle when I don’t have to? No one awards any kind of medal to women who work right up to their due date. I understand that for some women it’s a necessity, but I’m lucky that financially I don’t need to do it. In fact, my earnings would likely drop off even if I were working the same hours as negotiating a huge bump will surely have a negative impact on my efficiency. And that’s not to mention all the time I’ll need off for my frequent “high risk” pregnancy appointments which will only increase in frequency. I certainly don’t want to be working the same hours being less productive and suffering discomfort and exhaustion as a result.

Oh yeah: exhaustion. I want to avoid that. I’m already starting to have difficulties sleeping. When I’m lying awake in the wee small hours I’m making things worse by worrying that I’ll not have had enough sleep to function well at work the next day. My tossing and turning disturbs Ian, who in turn doesn’t sleep well. When I don’t have to work, I’ll be able to get up in the middle of the night without worrying, if that’s what suits. I can read a book, leave Ian to sleep and go back when I’m ready. I can nap during the day, and adjust my activity to suit my energy levels. I want to enter motherhood feeling as rested as possible, not with a lagging sense of stress and tiredness from working. Labour will be tiring enough!

Selfishly, I’m also looking forward to some “me time”. The calendar is already filling up in September and October with stuff to do. I’m looking forward to meeting friends for lunch, a spa day, trips to the theatre and at least one photo shoot. It will be great to be able to go swimming regularly and I’m looking forward to having a chance to read some books and catch up on craft projects, as well as doing all the laundry for the baby and make practical preparations. Far from being bored, it’s already starting to look as though I’ll be pressed to fit everything in.

Once Flangelina is born, I’ll not have the same level of freedom that I have right now for a very long time. I’ll always have the baby to consider whenever I plan anything. I won’t be able to come home from work and pop out for a quick swim. We won’t be able to go to the theatre or cinema without arranging a babysitter. Even when I’m at home, the opportunities to fit in quiet time reading a book will likely be limited, especially in the early days.

I want to make the most of this last opportunity to be just me, and save myself potential difficulties. I’m not sure why that is so hard for so many people to understand.

Jul 22 / Caro

First Rule for New Parents: Never Pay Full Price

I’ve discovered something, and I think it’s an important lesson to anyone having a baby. When you buy things for your baby, never, ever pay full price.

Here’s the thing: the baby goods market is competitive. Way more competitive than your average supermarket or high street electrical store. That’s because it’s big business, but still pretty niche. The percentage of the population having babies at any one time is still relatively low and so the baby manufacturers want to do everything they can to get YOUR business during a small window of opportunity.

This much should be obvious from the “Bounty Pack” in which many women receive their maternity notes. Stuffed in with this important medical document that you’ll be schlepping around for 7 or 8 months are a magazine full of adverts, free samples and hundreds of coupons for everything from nappies and wipes to baby food and bras. The ethics of advertising to women in this way may be questionable, but it’s so easy to save money with these kind of coupons, so I’ll live with it.

It’s worth remembering that discounts are available without coupons too – a lot of items are on what I regard as “perma-offer”. The advertised prices for baby wipes, for example, are very rarely charged. Huggies Pure wipes appear to retail at £2-something per pack, but in reality, at least one retailer somewhere will have them on “offer” for £1 per pack at any given time. It pays to shop around before purchasing as you’re bound to find a deal somewhere.

Most of the major retailers also have “Parenting Clubs” that you can join – Boots, Mothercare and Babies ‘R’ Us, to name a few. Signing up will mean you have to tolerate a deluge of junk mail and frequent e-mails trying to score extra business, but when you do spend there are all sorts of benefits. The Boots Parenting Club, for example sends you vouchers that can score you 20% off your pushchair and a free changing bag when you buy a pack of Pampers. Again, this aggressive promotion is not to everyone’s taste, but there are more subtle benefits such as the fact that you can gain extra points in their regular Advantage Card loyalty scheme. Instead of 4 points per pound (worth 4p, so equivalent to a 4% saving across the store) you can earn 10 points per pound spent on baby goods. That’s essentially a 10% discount!

Many of these schemes offer further bonus events. For examle Babies ‘R’ Us offer weekend promotional codes for 20% off everything bought online over that weekend. One such code arrived in my inbox earlier this week for this coming weekend. So tomorrow we’ll be ordering a bunch of stuff we’ve yet to purchase, including the baby monitor and the cot bed. The cot bed (so named because it’s a cot that later turns in to a bed) we’ve chosen is actually pretty much the first one we looked at, and we’ve come back to it over and over in the last couple of weeks. We liked it even more when we looked at it in person. I’d been toying with ordering soon, as it was already discounted by about £20, but held off in order to check out other options and so that we could get the nursery in a state nearer to completion. I’m so glad now that we waited.

Nothing beats the feeling of shopping for the baby, but getting a hefty discount makes it even more exciting!

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