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Posts tagged ‘appointments’

Aug 17 / Caro

The Fork in the Road

Thursday was D-Day. Decision Day. Commit to another course of IVF? Or not? Which way to go?

It seems a bit daft, writing it now, to exclaim that my choice about whether we move forward with more fertility treatment rested on a single day. Of course it wasn’t really that straightforward, as these things never are. But all the thinking, discussing and planning in the last few weeks had, in fact, led me to this one day, and in particular one result that I was due to receive then.

On Thursday morning, I set off bright and early for an appointment at my diabetes clinic in London. It was an overdue appointment really. One that had been shuffled and rearranged to fit around more pressing matters, including fertility related appointments. It’s almost certainly not the right attitude to have, but I tend not to place too much importance on these appointments, and I’m happy to leave long gaps between them. I’ve been diabetic for 31 years, and whilst I’m not arrogant enough to say that I know it all, I do know an awful lot about my personal diabetes, and I simply don’t find much of the input of the professionals on a routine basis useful. I much prefer to seek them out with specific problems than simply turn up at quarterly appointments in order to tick a box. This feeling has increased since many of the actual monitoring tests (kidney function, retinal screening, annual bloods etc) have now been passed out to GP care. In other words, I don’t even need to attend the clinic to get these important tests done.

On Thursday, however, I was nervous.

Long term readers may recall that I’ve done this exact dance before. I wrote about it back in February of 2013, when we’d been trying to conceive just less than six months. Back then I still had no idea of how much longer that pathway was going to be, or that 18 months on I’d still be sitting here as the mother of one child and still not even pregnant, with two failed IVF cycles behind me. But I wrote then about my fear that my blood glucose control might not be good enough to continue to try to conceive, because it is poor blood glucose control that contributes to many of the risks of a diabetic pregnancy. Somewhere between there and here, my blood glucose control has stopped being my number one concern. Obviously, we’ve now got much bigger concerns in relation to trying to have another child. But that doesn’t mean it doesn’t matter. Just that the amount of time and other hurdles have dulled its immediate presence at the forefront of my mind.

It is still important though. In fact there are concerning studies that show even non-diabetic women with modest (as compared to a person with diabetes) elevations in long term blood glucose levels have a dramatically decreased chance of success in assisted reproduction cycles. If anything, it’s more important than ever that I have good control.

And that’s why I was so nervous.

My decision on whether to go ahead had come to rest on this: I’d only consider going ahead with another round of IVF if my HbA1c (a measure of the average blood glucose levels over the preceding 2-3 months, for the uninitiated) was low enough. If we’re going to take our final chance, and spend all that money on it too, I need to know that I’ve done my absolute best and there are no factors I can look back on in regret.

The number was 6.

And just like that, the decision was made. My A1c when I conceived Thomas was 5.9%. “Normal” is usually stated as 4.0-6.0%

Until that moment, I wasn’t really sure what I wanted. I’ve written already about my uncertainty with going ahead, because once it’s done, there are no more chances and, if we’re not successful, all hope will be gone. I thought I was frightened of that. But when I saw the result staring back at me, I couldn’t have been more pleased.

So just like that, IVF number three, our final cycle, is go.

Right now I’m not ready to share exactly when it will be happening. I haven’t yet decided if I want to be as open about it in real-time as I was during the previous cycles. But we’re definitely doing it, the dates are all booked in to the diary and the drugs will soon be on order.

And one thing is for sure. If it works, you guys will definitely be amongst the first to know!

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Dec 1 / Caro

Top Tips For A Diabetic Pregnancy

Plan – Going in to pregnancy with more than 3 months of folic acid behind me and an excellent A1c made the early weeks much less stressful for me than I think they may otherwise have been. Aside from being less worried about potential complications, I didn’t have the problem of trying to drastically adjust what I was doing in terms of diabetes control. I’d already built in lots of good habits, so was free to focus on responding to the changes caused by my new hormonal status. I hated the thought that diabetes could be the thing to stop us trying to conceive once we were ready, but getting everything stable before we started was absolutely worth it.

Sort your hospital care out carefully – This is something I didn’t really do, and I ended up changing hospitals during the first trimester, which made for a bumpier ride than was probably strictly necessary. Think about the logistics of travel to your hospital both for frequent appointments, but also when it comes to actually giving birth. If there is more than one option locally, find out both about the general maternity services, but also what sort of experience they have in managing pre-exisitng diabetes in pregnancy. Ideally, you want to already know your diabetes consultant and DSN, and have a good working relationship with them.

Get used to lots of appointments – It can seem overwhelming. It can seem annoying, especially if you have a full time job to factor in. But all the appointments are there to make sure both you and the baby are well looked after. Try not to view them as an inconvenience and enjoy the unparalleled access to information about your pregnancy. Many non-diabetic women will be bemoaning the fact that they see their midwives so rarely.

However, Don’t be afraid to question what you are told, or what is usual “policy” – A lot of the care for pregnant women with diabetes is based on “one size fits all” policies. It’s essential that you are an active participant in the process though. If something is being suggested make sure you ask why. Ask what the alternatives are and what the risks and benefits of different approaches are. You can’t give informed consent if you haven’t been fully informed. It is often policy to see women with diabetes every two weeks, but in the early weeks, this felt excessive to me, as I was travelling a long way to talk about excellent blood sugars that we could easily have discussed by email. Remember that it is your body and your pregnancy. No one can “tell you” what to do. But at the same time, be sensible and respect the advice and experience of your health care team.

Test, test, test, or better yet, use a CGM – Honestly, I don’t think I have ever tested my blood sugars quite as much as I did during my pregnancy, and I don’t think I could have coped without a CGM to tell me which direction I was heading in at ay given time. The only way to have any chance of keeping your blood sugars as close to normal as possible is to know roughly where they are as often as possible. Testing, and writing down the results, is absolutely essential. You also need to be prepared to act on those results too.

Try to eliminate the lows – When you have the risks of hyperglycaemia drummed I to you frequently, lows can suddenly seem like a friend. Whilst it’s true that mild hypoglycaemia pose no threat to your unborn baby, it can carry risks for you. Frequent lows can lead to loss of the warning signs, which in turn increases the risk of severe hypoglycaemia, which may in turn put your baby at risk. Bouncing back from lows is also a major contributor to high blood sugars and a lack of overall stability. Eliminate the lows and it becomes easier to remain steady. Honestly.

Carb count carefully – eyeballing, or scientific wild guessing are no longer acceptable. The only way you can dose accurately for the food you eat is to know exactly how much you are eating. That means that wherever possible you need to weigh and measure your food. And you need to read food labels.

Low carb can be your friend – Eating low carb is a sure fire way to reduce or eliminate post-prandial glucose spikes. Low or no carb foods are also fantastic when you are hungry at a less than ideal blood glucose level. But don’t go mad. I had ideas pre-pregnancy that I would stick to low carb, and a limited range of foods whose effects I knew, for most of the pregnancy. This isn’t necessary and will make your pregnancy seem to last a lifetime. There is also some evidence that restricting carbs too much can be bad for your unborn baby.

Superbolus is definitely your friend – Minimising the post meal spike is one of the most challenging aspects of good control. The superbolus is a pump technique whereby you take some of upcoming basal along with your pre-meal bolus, and then reduce your basal rate to prevent a later low. This is much more difficult if you are not on a pump, but taking a larger bolus and then eating some of the carbs much later on is also a rough approximation. Bolusing 30 minutes before eating, especially in the morning, also gives your insulin a head start to increase the likelihood of its action matching the absorption of your food.

Don’t panic about occasional highs – this is so much easier said than done. I remember having a full on, tear soaked and snot-ridden melt down the first time I had a high blood sugar. People will throw around all sorts of analogies that are cheesy, but true: the occasional visit to the sweet shop for your baby won’t do them ay harm. It’s a fact of diabetes that highs happen, and you won’t be able to eliminate every single one. Just do your best to minimise them – with frequent testing, accurate carb counting and regular adjustments. Look at the bigger picture when faced with a high number. Frequent and sustained highs are much more of a problem than occasional spikes. It’s also easy to focus on the highs, so writing down all your results can help you to see that they probably aren’t as frequent as you think.

Night times really matter – If you can get your night time basal insulin sorted to keep you steady and in range all night, this not only gives you almost a third of the day within target, but also gives you a good waking blood glucose level which starts the day off much better physically and psychologically than a high or low number. It’s worth making the effort to test overnight frequently. This gets easier in later pregnancy as sleep gets harder!

Get comfortable making adjustments yourself – If you are the sort of person who tends to rely on medical staff to make the bulk of the changes to your insulin regime, get ready to change. The adjustments needed in pregnancy are too frequent to wait between appointments, or for someone to keep calling you back. By all means seek advice as often as you need it, but get used to trusting your own instincts. You live your diabetes every day, so you really do know it best.

Remember that the old rules don’t always apply – Four will probably not be the floor, unless you have severe hypoglycaemic unawareness. 3.5 will suddenly become an acceptable fasting level. Correction doses are no longer reserved only for numbers above , or 10, or whatever you used to use. 6.5 is now a number you can and should correct. You no longer have to wait 3 days to see a pattern. It’s OK to make changes on the fly.

Don’t be afraid to ask for medication for morning sickness – even if it doesn’t seem “that bad”. The effect of morning sickness for women with diabetes is very different than for women without. Whilst there is no doubt it’s unpleasant for everybody, trying to deal with bolus insulin and not knowing whether your food will stay down is an extra challenge you don’t need. If morning sickness is interfering with your efforts for good control, then taking medication is the sensible option.

Don’t expect non-diabetes staff in hospital to have a clue about diabetes – Be prepared to be your own advocate. Be prepared to take care of your own needs possibly throughout labour if you want – but certainly during early labour or if you are admitted for induction. Take plenty of your own test strips and medication. Also take plenty of food and treatments for low blood sugars – don’t rely on the hospital to have what you need when you need it, no matter how shocking that sounds!

Remember to enjoy your pregnancy too – Remember that there is more to this than just blood glucose levels, carb counts and estimated fetal weights. Try to set aside the focus on diabetes at least some of the time and enjoy your changing body shape, shopping for your new addition and feeling them kick and move inside you. Remember that you are a mum-to-be, not just a medical machine.

Remember, it’s only 8 months of your life – By the time you find out you are pregnant, there are only eight months to go. The obsessional focus on everything diabetes is finite. And you have the biggest motivation you’ve ever had. Once the pregnancy is over and you have your child in your arms, it will all seem more than worth it.

Nov 3 / Caro

Maternity Day Assessment Unit

The MDAU is a slightly frustrating place. Despite any images its name may conjure up, it’s really just a group of four rooms and a waiting area located next to the antenatal ward and labour triage. When you arrive, there is no reception desk, or means to book yourself in. You’re expected to just “Take a seat and someone will be with you shortly.” Except, they can’t be with you shortly if they don’t know that you’re there. And my experience over the past couple of days has already taught me that even if you have an appointment, they won’t realise that you’re there for quite some time.

And it’s sort of frustrating to be there at all. I understand why we made the decision to do daily monitoring, and the reassurance that everything is fine at that moment is nice. But that’s just it: it’s only at that moment. In the 24 hours between assessments, anything at all could happen. From that perspective, the effort of dragging myself to the hospital and the hours spent waiting, and then actually being monitored, seem slightly pointless.

There’s a tiny part of me that thinks if we’re going to do this, why don’t we just get on with induction. But another part is still questioning whether induction is the right course of action at all. I just don’t know anymore. But I do know that sitting in that waiting area isn’t helping. Yesterday was a specific case in point, where I found myself in tears when I finally made it on to the couch to be monitored, and stupidly couldn’t really articulate why. A mixture of “normal” late pregnancy tiredness and hormones, with worry about whether the baby is OK, uncertainty about whether we should be waiting to induce or inducing at all, and frustration at having had to drag myself to the hospital and wait for so long. I don’t think I’d have been in tears if I’d stayed on the sofa with a cup of tea and a chocolate digestive. But there we are.

Fortunately thus far the CTG traces have been fine. And no matter how much I protest, it is some reassurance. Flangelina was feeling sleepy today, and it seemed to take forever for the criteria for satisfactory monitoring to be met. But the whole time I could hear their heartbeat and was feeling occasional movements, so I wasn’t worried. I suppose I was getting comfort from the fact that I was in the right place to deal with any problems.

I am confused, however, by the contractions that keep showing up on the monitor. Both yesterday and today, the traces showed regular (as in, every five minutes, lasting a minute or so) contractions up to 90%!! Sounds exciting until I tell you that I can’t feel them. At all. The midwife looking after me today expressed surprise when she looked at the trace ad asked “Are you having contractions?” with a look of total shock on her face – which is understandable given that the baby is still 4/5 palpable and the head is not fixed. I looked at her blankly, and shrugged. She felt my bump though and concluded that no, I’m not actually contracting.

So why the regular contractions on the trace? Mystery to me! I’m still none the wiser about Braxton Hicks contractions either, as I certainly do feel odd tightening sensations – and have done on and off over the last few weeks – but when I questioend whether these could be Braxton Hicks I was told “No, you’ll know if they are”

Or, perhaps not? Given that I haven’t done this before, how exactly would I know? Ack. Frustrating.

Oh, and about that 4/5 palpable. It’s otherwise know as barely engaged. Which is deeply depressing given that they really need to engage to be born, and that first babies are generally found to engage well in advance of labour. Even more depressing that last week the head was apparently further engaged, and from the stabbing pains down below, I really thought things had been moving in the right direction, rather than in reverse.

Sigh.

I don’t think this post has a point at all.

I’m just ready to be done now. That is all.

Nov 1 / Caro

Meh

Things went much better at the hospital today than two weeks ago.  I think perhaps I did succeed in making my point after all, and that standing up for what I believe in may have paid off. I certainly felt as though I were treated with a little more respect, at any rate. And somehow, I think I may be left alone to manage my blood sugars as far as possible. We’re all meant to be on the same team, but it feels like a victory of sorts, and even more so when I got through the entire appointment without a single tear.

The appointment itself, though, was a bit…. Well, meh. Not terribly bad, but really really not that great.

I described how Flangelina was definitely slowing down his or her movements in there. But it turns out that they are barely 1/5 engaged, and with that in mind the slowing down of movements could be a sinister sign. A vaginal examination (aka “a necessary evil”) did nothing to improve the outlook either, as I’m less than 1cm dilated and my cervix is still high and posterior (Holy TMI, I’m sure). In other words, nothing much is happening yet. On the one hand, this means that induction is looking pretty inevitable as I’ve now reached the golden 38 week mark in my diabetic pregnancy. On the other hand, inducing too soon may not be the best approach as there is more ground to cover from where we are now. It would have been a whole lot better news if we could have done an effective sweep and felt that things might start moving soon anyway.

But, after some discussion, we finally have a plan: Unless I go in to spontaneous labour before, I’ll be induced this coming Sunday, 6th of November. I’ll be 38 weeks and 5 days pregnant. Between now and then I’ll attend the hospital on a daily basis for cardio-tochography (CTG/fetal wellbeing check) and I’m to go in to triage if I have concerns about movement, or anything else, at any other point.

It’s a bit “meh” because I know how unlikely spontaneous labour is before the deadline we now have, and whether I’ve admitted it or not, that’s what I’ve been hoping for all along. It’s a bit “meh” because I’m not sure if all the sudden extra monitoring means I should be worried, yet they can’t be that worried if they’re willing to delay induction until Sunday. I don’t know what to feel really. Fear? Disappointment? Excitement? Or just not very much at all?

But by this time next week there is a very real possibility we’ll have a baby, or at least be well on the way. That’s what I’m going to focus on whilst I’m living in the hospital maternity day assessment unit for much of the week.

Come on baby, we’re nearly there!

Oct 18 / Caro

36 Week Appointment

I don’t feel like things went very well at the hospital this morning. Maybe my expectations are out of whack, or maybe it’s just all the hormones, but yet again there were a lot of tears.

Things didn’t actually start out too badly. In fact, they started out rather well. My fourth (and hopefully final) growth scan revealed a baby that not only looks completely healthy, but looks a very average size. This is complete contrast to the 28 week  and 32 week scans, which had suggested that they were turning in to a little chubster. I can’t help it; I still see the size of the baby as a measure of my success or failure at pregnancy. So hearing that they are sitting right around the 50th centile, with only a slightly increased abdominal circumference is naturally welcome news.

The less good part of the scan was the re-assessment of the placenta. Back at my 20 week scan  it was noted that the placenta was lying low in my uterus. It wasn’t completely covering the cervix, but a concern was raised about whether it would prevent a vaginal delivery. At the last couple of scans, the sonographers have said that things looked fine, and to be honest it had gone out of my mind. When it came up again today, I instantly panicked that this would be the unforeseen end to my desire for a natural birth.  And then, I was further disappointed that, having made it this far in pregnancy without a single internal ultrasound (with the dildo-cam) the sonographer apologetically informed me that the only way to get a conclusive measurement of the distance of the placenta from the cervix was to go in from the bottom. Cue lots of panic that my bikini line has not yet been prepared for B-Day, and since I can’t see it, I was horrified about what she may be about to witness. Thank goodness for discreet, unflappable sonographers. And thank goodness that after all that, the placenta was in a good position and I was signed off for vaginal delivery.

Things went properly downhill, though, when I went in to see the obstetrician. Bear in mind that I’ve always understood that the hospital (and general diabetes in pregnancy) policy is induction at 38 weeks. Although I’ve agonised a bit about this, mainly because of my desire to avoid an epidural.  I have come around to the idea in order to make sure we end this journey with a healthy baby. (The fact that I’m gettting impatient to meet our baby helps too.) I’ll be 38 weeks in two weeks time, so I was fully expecting to actually make some plans today about when I would come in and how things would progress. I’d gone to the appointment armed with my birth preferences and a list of questions that I wanted to discuss.

But everything got off on entirely the wrong foot when the obstetrician sort of dismissed the scan results and told me not to place too much importance on them. Removed from the situation, I can rationlise that she didn’t mean to be nasty or dismissive of what I was regarding as potentially an achievement. I know she was giving me exactly the same line that she did when the scans gave less favourable results, and I know that she is right that today’s scan could be the misleading one. But irrespective of all that, her dismissal left me feeling utterly deflated and wondering just why I’d been going through these scans. Before I knew it, the tears were on.

It went from bad to worse, as my questions were glossed over. I think my previous deliberations about induction might have been misinterpreted as me definitely not wanting to go for it, because there was no discussion at all of booking a date, just that we’d review it next time. Again, with hindsight I can sort of see this positively, because it means they have no concerns and are willing to let me go a bit beyond that. But at this stage, I really want some clearer idea of what is going to happen. Delivery is no longer too distant to think about. I’ll reach full term between this appointment and the next and it’s possible that I may not even make it to the next appointment. The baby could be here before that.

Some of the things that we did get to discuss were met with unsurprising answers. Like being told that yes, I will be pretty much confined to the bed throughout induction, and there is no hope of me getting anywhere near a birth pool even if I go in to spontaneous labour. I don’t have the fight in me to debate these points. My obstetrician seems to firmly believe that I will opt for an epidural when I’m actually in labour, which just cements my belief that no one really understand quite how much of a fear this is for me.

The biggest chunk of the appointment, though, was devoted to a stand off about something in which I do really passionately believe: my right to take care of my own blood sugars for as long as I feel able during labour. It’s something about which I won’t back down.

I’ve had bad experiences before in hospitals, where non-specialist staff do not understand the first thing about diabetes. Even something as elementary as the importance of uninterrupted insulin supply for a type 1. I could go in to details about the time an IV insulin infusion failed at night and the staff told me replacement was not a priority until morning, 8 hours later. EIGHT hours with no insulin could, likely would, have put me in to DKA. Long and multiple stories short: I don’t trust other people to do it anywhere near as well as I can. I don’t want to transfer to an IV sliding scale just as a matter of course, because I know they can be prone to failure in my rubbish veins, and I will be left with the problem of transitioning back afterwards.

I’ve worked so hard on my control since before I fell pregnant. I’m not letting go right at the end. All I really want is for Ian and I to be in control, including the ability to say “actually, we don’t want to be in control now, so please take over and put up an IV sliding scale”. I didn’t expect this to be a problematic point. I thought the team knew me well enough, knew what a control freak I am, how important this is to me and how well I can do it. I thought I’d proved all of that. But what I was met with was that it was “inappropriate”. That I had to “learn to be a patient and let go”. And that I couldn’t ask Ian to help me, never mind that he wants to, because it’s such a massive part of our everyday relationship. He’s happy, at this point, to know he’ll have a definite way in which he can help me during labour. And if it all goes pear shaped and we can’t do it on the day, then we’ll say so. It’s not as though we have to commit to what will happen right now.

My tears were a mixture of frustration and downright anger.

I have no control over where or how I give birth. I’ve accepted that the process needs to be medicalised to degree to keep me and the baby safe. This is the one thing – ONE THING – that I want to be in control of. I can’t understand why that is being denied to me. I understand that I’ve never been in labour before and that I might find that when it comes to it, I don’t want to be worrying about diabetes. What I’m asking for is the space to make that decision at the time, when I am in labour and I do know how I feel.

The appointment stalled around this point. I had more questions, although I can’t really remember them now. Mainly about what will happen after the birth. But I was too worked up to go on. I felt as though I was being treated like a silly, naive little girl who knew nothing about what she was discussing. When the obstetrician asked to see the piece of paper I’d scribbled my notes on, something snapped internally. I told her I’d asked them all, even though it wasn’t true. Because suddenly I don’t want to do it their way. I don’t care about the answers to those questions, because I’m determined to try and makes the answers be what suits me. I absolutely DON’T want to sacrifice the health and safety of my baby. But that, ironically, is exactly why I don’t want to relinquish my diabetes control.

I was so angry when I walked away that I almost wanted to hire an independent midwife who’d be prepared to work with me for a home birth, ridiculous as that sounds. But having realised how much nobody wants to listen to and work with me, I suddenly felt very lost. I’ve not felt frightened of labour at all during this pregnancy and I’m still not frightened of labour itself. But I am petrified of how I will be treated. I can envisage clearly now how I’ll be dehumanised and treated as a medical entity. A problem. A number.

Is it really too much to ask to be treated as an individual, rather than simply a “pregnant diabetic”.

I haven’t put a question mark to that question, because after today I feel like the answer is definitive. And it’s yes.

I’m not sure where to go from here. I thought I’d have an induction date planned. I have an appointment in two weeks, where I’ll probably be given a sweep. I wouldn’t really turn my back on hospital care, because I do know it’s the safest and best place for me to be. But I feel so let down. So misunderstood. So disrespected.

So no, things did not go well at all at the hospital today. But all I can do is keep waiting and keep refreshing my resolve that when it comes to it, I’ll stand up for myself and for my unborn baby. I will do what is truly best for us, not what is best for the hospital staff.

Oct 5 / Caro

Waiting

You could look at pregnancy as one big long waiting period. You wait for the positive test. You wait for your first scan, and then the second. You wait, patiently or not, for the arrival of the little bundle. At this point, eight months in, I can tell you that in some respects it seems like a pretty long wait.

This pregnancy, though, has involved more waiting than most given that I have appointments at least every other week in a clinic that almost never runs to time. I try hard to occupy myself during the waiting time, but it’s difficult when you need to also keep an eye on the screen for your name to appear. My mind invariably wanders to thoughts of the baby and what still needs to be done to prepare. And of course thoughts of whether I, and they, are doing ok. But sometimes, when I want to push those worries aside and spare myself from bursting in to emotional tears before I’ve even been called in, I think about how much of my lifetime, nevermind this pregnancy, I’ve spent sitting in hospital waiting rooms. I do wonder what better things I might have done in all that time, given the choice.

Most appointment waits fill me with a strong sense of deja vu. Please tell me that I’m not the only one who feels like this:

It begins with optimism that it won’t be that long. The hands on the clock slowly turn round. You have to verify with your watch: yes, you really have only been here five minutes. Ten minutes come and go, and finally fifteen. You keep double, and triple, checking the screen to be sure that you haven’t just missed your name popping up.

Frustration begins to creep in, because although you have no other pressing engagements, you have taken an afternoon off work to go to the appointment and if you can get it over with quickly, you could have the remainder of the afternoon at leisure. Fantasising about how to spend an illegitimate free afternoon eats up another ten minutes.

You start wondering how to pass the time. You casually wander over to the magazine stand/table/pile on the floor and start reading a great article. However, you fly into an internal rage when you turn over the page to find the end of the article has been torn out, no doubt because the person who last read this particular magazine wanted the 25p off washing up liquid/chocolate chip cookies/pasta sauce coupon printed on the reverse.

You turn your attention back to the waiting room with its peeling paint, wilted pot plants and water-marked floor (a defective water machine, you hope) Alternatively: soft chairs, fresh paint and artwork – lucky you! You fight the urge to let out a large sigh. By this point you’re almost certainly bursting for the toilet, but don’t want to go because you must be called in soon and you know that they’ll want a urine sample from you.

Other people get called in, and you’re sure they arrived after you. You try to console yourself with the fact that they are probably seeing a different doctor. And anyway, you don’t want your doctor to be rushing through the patients, because you wouldn’t want him to rush your appointment either.

You start to wonder if maybe it is personal. Do you smell? Were you rude last time you met, or are you being punished for the time you were late? You consider checking with the receptionist in case you’ve inexplicably been forgotten, but decide against it for fear of seeming pushy. You briefly reconsider using the pressure in your bladder as a reason that you *must* be seen soon, but shelve that idea because you don’t want the whole waiting room to know that you’re desperate to pee.

You decide to try reading another magazine, but find you can’t get into it, because you’re sure it must be your turn soon, and you don’t want to be wondering about the end of another good story you don’t get to finish. Added to the fact that screen checking frequency is now up to every 20 seconds or so. And you’re also now fidgeting in your seat with desperation to relieve your bladder.

Finally you decide to go to the ladies. That will give you the opportunity to double check that you don’t smell/have bad breath as a possible reason for not being seen. You can also then legitimately enquire with the receptionist on your return, in case you missed your turn while you were gone, and can put in a good huffy protest about your wait time when they ask for the sample you won’t be able to produce. All round win!

No, you didn’t miss your name whilst you were gone. The receptionist flashes you a grin and tells you they are “really busy, you know how it is?” You get really frustrated now, and can feel your blood sugar, not to mention blood pressure soaring in response. When (if) you get to seen, you vow to tell the nurse/doctor/midwife exactly what you think of them, and then find yourself a new doctor.

Finally you hear your name being called. The person apologises and thanks you for your patience; “you know how it is?”

And of course you find yourself agreeing that you do know how it is and saying that it is quite alright… really not a problem at all…

Oh… and that pee sample. Not a problem either. You are heavily pregnant, after all!

Sep 20 / Caro

Thirty Two

Thirty-two weeks pregnant. Holy cow, I’m getting close to the finish line – four fifths done. And holy cow, I’m getting big. I can’t remember what my feet look like and putting shoes on is a massive struggle that adds several minutes to the time taken to leave the house.

This morning was a busy morning. I had the 32 week growth scan, followed by an antenatal clinic (ANC) appointment, and then my third trimester eye dilation and retinal photographs. It didn’t start out well when I found myself waiting first ten minutes, then twenty minutes past the time of my scan appointment. Then I reached the time I was due to be in antenatal clinic. Fortunately the two clinics are adjoining and do actually speak to one another, so I was assured they wouldn’t fail to see me in ANC. By the time I was called in to my scan though, I’d worked myself up in anticipation, and because I was worrying about getting away from the hospital to make my eye screening appointment.

The sonographer performing the scan was the same one who did my 28 week scan. She complimented me again on the fact that I must be taking good care of myself. But I could hardly bear to ask just how big my big baby had got.

When I looked at the print out of the scan measurements, I couldn’t suppress my tears. The abdominal circumference measurement is now above the 95th centile – even higher than it was before. And it’s the abdominal circumference that suggests a diabetes-induced big, fat baby. Fair enough, it’s not that far out of proportion of all the other measurements. (Except femur length – Flangelina obviously has short legs. Like their Mum.) And the estimated fetal weight is only at about the 65th percentile, but I feel like such a failure and there really is nothing more to say.

When I made it around to the antenatal clinic, I was stressed out enough that my blood pressure had climbed to a ridiculous 140/95. Which sent me in to a panic about pregnancy induced hypertension and pre-eclampsia . My obstetrician firstly reassured me that it was only a blip because I was worked up and she wasn’t concerned, plus there was no protein in my urine. Then she tried to move straight past the numbers in the scan report. She reminded me that scans are not totally accurate, a problem that may be accentuated by having the same sonographer do two consecutive measurements, as their bias in reading the values may be higher. She trotted out the old line about how I am doing such much more, and so much better than all their other patients. How the effort I am putting in, and the results I am getting out, are second to none. How it’s “normal” and “common” to see these kind of increases in babies of diabetic mums, and how they still turn out healthy and OK. But I don’t care about anyone else, or their babies. I care about my own pregnancy concluding safely. I don’t want to have a “normal diabetic” pregnancy. I want a “normal normal” pregnancy. I felt frustrated and resentful and noting was going to get me out of that funk.

I was a hormonal, tearful mess. And like I do, I descended in to panic about everything. Suddenly I couldn’t cope with the whole diabetic pregnancy a moment longer and wanted to be the same as all the carefree women in the waiting room receiving happy news from their scans and appointments. Of course, there were bound to be women there receiving far worse news than me with my little fatty. And after a ten minute melt down, I realised it, and remembered to thankful that nobody was suggesting that Flangelina is not healthy. Just big. And big is not necessarily bad.

We managed to discuss, through more tears, my fear of spinal anaesthesia and hence of a c-section. I’ve been waiting for several weeks now for an appointment to see a consultant anaesthetist to really discuss these fears, and whether they are founded. I’m beginning to panic that it won’t come through and I’ll be in established labour before I get to talk about it. The reassurance here was more concrete, as they called through to the consultant’s secretary to confirm that I was in the system, and an appointment will apparently be with me shortly.

We also discussed a bit about antenatal collection of colostrum and fortunately the reaction was very positive. I was, however, advised that I needed to wait until 37 week because of the risk that nipple stimulation would cause labour. Having Googled the topic, I’m sceptical in the least about this statemet, and I’m sure my body would only go in to labour if it were ready to. But since I need sterile syringes from the hospital to collect the colostrum in, I’ll have to stick with them on this. The amount that is leaking out, I don’t think I’ll have a problem collecting enough in just a couple of days.

Despite the lateness, and all the tears, I made it to my eye screening on time. They never give anything away whilst your there, but everything has been fine up until this point. I have enough else going on, so I’m not going to dwell on the possibility of something cropping up in my eyes. I am just very glad that I’m now on maternity leave, as there is no way I could have gone back to work with my red-rimmed and hugely dilated, blurry eyes – a combination of crying and dilation for the retinal photographs.

So, what now? Keep working at it I guess. If the baby is already fat I can’t make it actually slim down in utero, but I guess I can try to stop it gaining too much more weight. I have no idea how, because I really feel like I’m doing all that I can. But I suppose I just have to do even more.

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