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Archive for October, 2011

Oct 31 / Caro

Birth Month Eve

By the time next month comes to a close, we’ll definitely be parents.

Tomorrow, I’ll be 38 weeks pregnant. Throughout my pregnancy, we’ve talked about 38 weeks in much the same way that non-diabetic women talk about their due dates. Even when I was very unsure about whether I wanted to agree to early induction, I saw 38 weeks as the anticipated goal for a type 1 pregnancy. Even when I didn’t want to go through with induction, I knew it was a likely scenario, and 38 weeks is always the expected date. I suppose I’ve been regarding 38 weeks like my due date, and any time I go longer than that like the post-dates wait. So it’s odd to be sitting here today with the date that I’ve been fixated on for so long looming large.

I’m not, however, booked for an induction tomorrow. That in itself does not particularly surprise me. Aside from all my doubts about going though with it, I also knew the chances of having it booked at exactly 38 weeks were no higher than the chances of labour beginning spontaneously on the due date, so I’ve never really believed anything would happen on November 1st. I’m slightly surprised though that I have absolutely no idea yet about when I will be going in. Although in my mind I’ve made peace with the idea of being induced – am even, (as I think predicted way back) quite keen because I just want to meet our baby – we (us and the obstetric team) haven’t actually decided whether I will wait a bit longer, or try to go to forty weeks.

I have an antenatal appointment tomorrow morning. I’m expecting to be examined, with a stretch and sweep thrown in if things are looking favourable. My ideal scenario at this juncture would be to go in to spontaneous labour before being induced. If a stretch and sweep can help things along, the that will be great. I know that by the time I leave the hospital tomorrow, I’ll almost certainly have a date and a concrete plan though.

And yes, by month’s end, pregnancy will be in the past. Even if we go up to my due date before induction, that only takes us just over two weeks from now. Hell, even if I were a “normal” person, with a “normal” risk pregnancy, I’d be more than two weeks overdue by the 30th November and at the very least in the process of being induced. But I’m not. I’m high risk, and it’s time to get the show on the road.

I feel like I’ve been waiting for November ever since that second pink line appeared. Tomorrow it’s here.

Bring it on.

Oct 30 / Caro

Getting Ready For Baby

In amongst all of the deliberation and worry about exactly how the baby will be arriving and whether they will be OK, I think I might sort have lost sight of the fact that a baby is indeed coming. I still have an awful lot of unanswered questions about what exactly we need to do with him or her once they get here!

I can kind of get my head around the basics – things like changing nappies and getting them dressed – and I know that there will be midwives on hand in hospital to help out immediately after the birth. I’ve touched before on fears about feeding  but even with that, at least I know where to look for support and help should I need it. I’ve memorised the number of the breastfeeding support line and the times of our local drop in support sessions.

The worries I’m left with have now are more about what I need to actually do with this small person, other than feed and change them and keep them warm. I know that they’ll sleep a lot to begin with. I also know that cot death prevention guidelines say it is safest for them to sleep in our room with us for the first six months. But what about during the evening, before we go up to bed. If they are asleep then, do we put them in our room with the baby monitor on? Or keep them with us? But is we do that, will the sounds of our voices, us eating or watching the television, wake them up? If they go upstairs, is that putting them at risk?

In fact, whilst I think about it, where do I leave the baby at other times – like when I want to go to the loo? I’m assuming that I’m not going to be in the same room as the baby for every minute of the day, but it’s hard to get my head around the fact that they’ll go from being inside me to independent from body. It feels weird to think about leaving them out of sight. But at the same time, I imagine I’d quickly go insane if I’m never able to step away.

How on earth will I ever get anything done though? If I find it hard to leave them alone, how can I do the laundry whilst they sleep? What if I’m in the middle of a task and they begin to scream? Where exactly will they be when they are awake, and how on earth will I entertain them? I don’t actually know how to put the pram together. Nor do I know how I’m going to manage to get it in and out of the house with a baby too. What happens if I need the loo when I’m out on my own with them?

And beyond these practical considerations, what if the baby does nothing but cry, and I can’t soothe it at all? I’ve seen those checklists, where you offer food, cuddles, check the nappy etc etc. All common sense stuff. But what on earth do I do when that doesn’t work? What if I can’t comfort them, or lull them to sleep. Everyone I speak to talks about maternal instinct. But what if I have none?

That’s what it comes down to at the end of the day. I’m afraid that I simply won’t have the instincts that experienced mothers tell me are the key. I’m sure that some of the questions I’ve written here will have mothers everywhere laughing at me for my stupidity. But I really, honestly can’t imagine how a day in the life of the mother of a newborn runs. I’ve been so focused on getting safely through pregnancy that I’ve not dwelt on it too much, but I feel a lot like I’m about to sit an exam for which I’ve done absolutely no preparation. Life is definitely about to change, and I think perhaps I ought to start swotting up!

Oct 29 / Caro

Passing Time

I’ve got an odd feeling this weekend. It could very well be our last full baby free weekend, yet I feel too tired, huge and uncomfortable to do much to take advantage of that. And here’s a shameful admission…. I’m feeling sort of jealous that the first of the couples in our NCT group have had their baby this week. Totally irrational, because I know in two or three weeks time, so will we. And I’ll probably be wishing I’d made more of the freedom I had. But I suppose it’s natural to be desperate to meet your baby this close to the end of pregnancy, and to be rid of the physical inconveniences of having them hanging out inside you.

In an effort to both take my mind off the waiting and make the most of our remaining baby free time, we’re going to head out for lunch, and then to an afternoon showing of Contagion at the cinema. I’m trying to appreciate being able to do these things, despite feeling tired, huge and uncomfortable. And I really want to see the film, so that’s a positive incentive.

You never know, there could even be hidden benefits. There was a discussion amongst some friends on Facebook this week about the relative scariness of Contagion, which spiralled in to a debate about whether it may be sufficiently disturbing to prompt my body in to labour. I’m tending to think not, based on the trailer, but what a shock in would be for the person next to me if my waters should pop half way through.

Ordinarily I’d wonder whether a refund would be forthcoming in that sort of situation. But if it does happen, I think I’ll be too preoccupied to care!

Oct 28 / Caro

Balancing Pregnancy With Pre-Existing Diabetes: The Book

It has suddenly occurred to me that it wouldn’t feel right to conclude my type 1 diabetes and pregnancy chronicle without mentioning one of the only books I’m aware of which deals specifically with the situation, and which I’ve personally found to be a helpful resource.

Balancing Pregnancy with Pre-Existing Diabetes, as the title clearly implies, is written specifically for women who had diabetes before becoming pregnant. Many of the well known pregnancy guides include references to diabetes in pregnancy, but they almost always cover more about gestational diabetes then the pre-existing kind. This may be understandable given their relative prevalence, but frustrating nonetheless. And there are almost no books which talk only about diabetes in pregnancy, as opposed to diabetes management in general, with a chapter devoted to the journey to parenthood. Given that it’s such a monumental challenge, a single chapter can rarely do it justice. (Hell, this blog, where I’ve been writing almost daily for a few months now, doesn’t do it justice!)

Written by Cheryl Alkon, a 30+ year veteran of type 1, who now has two healthy children of her own, it’s a down to earth, honest girlfriend-to-girlfriend account of the kinds of issues and challenges that can arise in a diabetic pregnancy, and a wealth of tips on how to deal with them. It’s written in a straightforward, readable style, rather than being a heavy clinical handbook. The book covers everything from pre-conception goals, through what to expect from your blood sugars in each trimester, to labour and birth and even the early post-natal days. It includes lots of stories from women who’ve had their own successful diabetic pregnancies, and this kind of reassurance and the not-feeling-alone factor, is invaluable. Reading the book months before I actually fell pregnant, I loved the fact that the opening chapter is entitled: “You Can Definitely Do This – And Do It Well.”

The main drawback of the book for a British audience is it’s very obvious American origin. Some sections are therefore not entirely relevant – such as how to choose doctors and some of the details of appointment and testing schedules – and blood glucose numbers are reported exclusively in mg/dL. However, diabetes is still diabetes and although we may work in different units and see a different selection of health care professionals to our friends across the pond, our blood sugars, and our behaviour, are still subject to the same hormonal influences no matter where we live.

The book has been a go-to resource for me throughout the last 9 months – more, in fact, as I read it cover to cover prior to conception! It’s useful to have an easy reference of whether something I’ve been experiencing is typical or a potential sinister sign, and to have that without having to brave the internet which is prone to throwing up horror stories and an excess of information that a worried, hormonal mess can deal without having to wade through. The book’s presence on my shelf has been as comforting as it has been useful.

If you have type 1 (or type 2) diabetes and are thinking of conceiving, trying to conceive or already pregnant, I can highly recommend it!

Oct 27 / Caro

Preparation For Parenthood

I can’t sleep. Again.

When I expressed to a friend earlier in the week that I’ve reached the stage where I can’t wait for the baby to be born, they told me to “be patient and enjoy sleep whilst I can”. I scoffed involuntarily.

“Sleep?’ I said “What’s that then? I can’t remember the last time I had a proper one!”

Between the heartburn, the struggling to get comfortable whilst worrying about what position I’m in,  needing a crane to shift myself should I choose to alter that position, and needing to trek to the bathroom at least once an hour to have a little dribble of a pee, sleeping is not something that I’m doing much of.

I’m trying to regard it as Mother Nature’s way of preparing me for what’s in store. After all, you can’t store up sleep, so there would be little to be gained by getting lots of it right now. Far better that I practice going without so it won’t come as quite such a shock.

And it seems that Mother Nature is not leaving Ian out of the prep either. According to him when I do sleep I snore loudly enough to wake the dead. And when I’m not sleeping allegedly I’m fidgeting and sighing. It’s all just to make sure that he is getting prepared too!

Oct 26 / Caro

Evicting Flangelina

Time is very nearly up for Flangelina to make an appearance of their own accord. Honestly, I’d rather he or she really did get to choose when to arrive and that there wasn’t an induction deadline. But since there is – albeit not yet fixed in stone or finalised in any way – the next best thing would be for us to be able to encourage him or her out before they get the big guns out at the hospital. With that in mind, I’ll hold my hands up and say we’ve been trying out some of the suggested methods to get things going.

Almost universally, there is no evidence that any of these methods achieve anything at all. But there also seem to be very few risks. The only cited risk to most is, in fact, the potential to initiate contractions. That would be a risk if we weren’t at full term and trying to do exactly that! It’s been interesting, though, to read a bit more about why it’s suggested that these things might work.

[A note before we start: I’m not a medical professional. I researched these methods mostly online and looked for any associated risks, but please don’t assume they are safe for you. Trying to induce labout yourself is not recommneded by health professionals, please speak to yours before copying me.]

Let’s not beat around the bush and get the TMI out of the way up front. It’s the one that most people suggest with a coy smirk when you say you’re ready for the baby to arrive: Sex.

Yes, we’re trying it. No, it’s not easy or even particularly enjoyable. There is pretty much only one possible position and there is absolutely nothing romantic about it as we attempt to get it over with before my knees give out or I’m overcome by heartburn. Interestingly the reason that sex is suggested is because semen contains natural prostaglandins that can work to soften (or ‘ripen’ in gyno speak) the cervix in preparation for dilation. In fact prostaglandin pesssaries and gels are the first stage of a medical induction if you are insufficiently dilated to allow the waters to be broken. The deposition of semen close to the cervix, along with the mechanical action (ooo…err!) is postulated to be enough to kick start things.

Yes, we’re still waiting. But we’ve only managed it twice so far, and I think a more dedicated and sustained approach may be required.

I’ve also discovered that other agents have this potential to soften the cervix. The main one is Evening Primrose Oil. What is not totally clear from all the references that I found is whether this works when taken orally or applied directly as there seem to be multiple conflicting reports. Not wanting to get it wrong, I decided to try both. Taking it orally is self explanatory. I’ve started popping a couple of capsules each day. The “direct application” is much more tricky. Essentially I’m talking about inserting a couple of capsules and leaving them to dissolve. When I first tried this last night, I discovered that no way, no how can I even remotely reach my cervix any more. Whether this is because it has adopted a higher position in pregnancy, or is simply because the bump and my new inherent lack of flexibility combine to prevent me getting right up there… well, you’d have to ask a qualified midwife. So I did what any helpless pregnant woman would do; Fluttered my eyelashes and asked my husband to help me! Nothing more to report on this one at the moment either, other than to say it’s extremely messy in the morning.

Enough TMI for one day? Sorry, I’m not quite done yet. The other thing that good old Google turned up frequently during a search for natural induction methods was nipple stimulation. I was already aware of the supposed link between nipple stimulation and contractions from my discussions about antenatal expression of colostrum. As I said then, I think it’s one of those things that is only likely to work if you’re close to going in to labour anyway. Apparently nipple stimulation causes an increase in secretion of the hormone oxytocin, which is necessary to help labour progress. I’ve read a lot of conflicting information on this one, but it appears that to have any chance of being successful, you need to twiddle your nipples for upwards of TWO HOURS a day. I’m notachieving anything like that, but I will admit to tucking my hands inside my bra whilst I’m sitting catching up with a bit of TV…..

There are a number of theories about various foodstuffs that if ingested in sufficient quantities can help to start labour. The classic example is a hot curry, which I’ve definitely tried. The idea here is that there is a close relationship between the innervation to the lower intestinal tract and the uterus. Anything which irritates the lower intestines sufficiently, may therefore have a referred effect on the uterus and help to bring on contractions. The same principle lies behind one method that I definitely will not be trying – castor oil. As far as I can see, all this does is cause severe abdominal cramps and diarrhoea. Imagine if it did also bring on labour…. I could do without dealing with diarrhoea at the same time, thank you very much! The curries haven’t really done much other than causing an increase in heartburn, but maybe I need a few more, and maybe I need to go hotter!

Other things we’ve yet to try are principally mechanical. There are people who swear by going on a bumpy drive, walking up and down stairs or even walking along the road with one foot on the curb and the other on the road. Aside from the shock of narrowly avoiding a road accident putting you in to labour, I’m not really sure how these are supposed to work. I’m guessing that it increases the pressure exerted by the baby’s head on the cervix. So again, only likely to really work if labour is pretty imminent anyway. By the end of the week, you’ll probably find me jogging up and down the stairs in between my sessions bouncing on my birthing ball, but we’ll have to see if I’m really up for it!

I’ve also not tried using acupuncture of TENS. There seems to be a school of thought that stimulation of specific points (that relate to the uterus according to traditional thinking) may precipitate labour. I do have a TENS machine. I also have acupuncture needles as I use them professionally (for reduction of the gag reflex). I’ve even checked out a couple of YouTube videos showing which points to stimulate. However, there doesn’t seem to be much conclusive evidence about these mechanisms. I’ve found links to a few studies which demonstrated the presence of contractions following acupuncture or stimulation with a TENS machine, but nothing to say that these contractions led to progressive labour. And if I’m honest, despite the fact that I use and have seen the benefits of acupuncture for specific applications myself, I’m sceptical about the ability of these methods to work.

Mind you, I sank to a new low this afternoon. I drank a cup of cumin tea. With a cube of potato in the bottom. I think the potato is supposed to absorb some of the bitterness of the cumin, rather than help stimulate labour. But I’ve no idea how the cumin is supposed to work. I just felt a bit desperate this afternoon, and figured a bit of stewed cumin couldn’t do much harm to anything other than my taste buds. Evidently it isn’t working.

Yet. Check in again later, and we’ll see!

Oct 25 / Caro

Full Term

37 weeks.

I’m officially “Full term”. Meaning that if the baby makes an appearance now, it’s considered perfectly “normal”. They wont be considered early and there will be no automatic need for special care or monitoring beyond standard blood glucose checks in the first 12 hours.

I’m not sure if it’s perfectly normal to feel such a sense of achievement at reaching this arbitrary mark. I suspect it probably is, but diabetes always makes achieving all these “normal” benchmarks that little bit sweeter.

Of course, now I’m just uber-impatient to meet this little dude or dudette. I feel enormous. I practically need a crane to shift me off the sofa and rolling over in bed is like moving an articulated lorry. I can’t sleep for more than an hour or so between the horrific heartburn and the almost constant need to pee. Which wouldn’t be so frustrating if every time I drag myself to the bathroom more than a dribble would appear!! I’m also permanently hot, with my in-built central heating, and all the effort of moving around just makes that worse. My rings don’t remotely fit and my ankles have been replaced by genuine bona-fide cankles. I’m so hormonal that the Dulux advert reduces me to tears – ridiculous!

Still, I don’t mean to moan. I feel incredibly blessed to have fallen pregnant, let alone reached this stage with fairly minimal problems. Pregnancy may be uncomfortable and damned hard work, but it is still a magical process that I feel lucky to have experienced.

I do really want to meet the child that we’ve created now though. I want to see who they are and welcome them to the outside world where I can snuggle them close. And I’m all the more impatient for knowing that all the statistics show that now is a perfectly safe time for them to make that entrance. It’s hard to remain patient, but at least I know it won’t be any more than another 3 weeks. That’s one positive of diabetes – it spares me the potential two week post-dates wait.

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