Grieving For What Might Have Been

This week has been a tough week on the infertility front. It seems that a whole lot of babies have been in a rush to get themselves born before the school-intake cut off of September the 1st and consequently I’ve been hit with birth announcements on every social media channel as well as by text message and in person. There have been several blog babies born – including the lovely Carrie’s son on Tuesday – and Twitter has been awash with adorable baby pictures. In “real life” a friend also gave birth to a son on Tuesday, and another of my NCT group had her second daughter two days ago.

I’m genuinely happy at the news of these bundles of joy. It would take a heart of stone not to smile at the precious pictures of scrunched up newborns, snoozing contentedly on their mothers’ chests. How can I resent such joy when I know what it would mean to me? There is no doubt at all that it means just as much to all these mothers too. A healthy, happy baby is always news to be celebrated.

But it still hurts. In the deepest part of my heart, where I try to keep my desire for more children firmly locked, I feel it, heavy and sharp all at the same time. I can’t suppress it completely, and I’m not sure I’ll ever be able to. There will always be a part of my heart that grieves for the babies that might have been. Not just those that were miscarried – although so many birth, and pregnancy, announcements have reminded me that I should have been 31 weeks pregnant right now, counting down on the home straight to welcoming my own new arrival. But I’ll also grieve for the dreams I cherished that can now never come true. I can’t apologise for that. I know life rarely works out how we’d like. Men plan, God laughs. But we all have desires. Ambitions. Goals. Ideals. Hopes. Call them what you will.

In my dream life, my second child would have turned one this month. We’d have spent the last couple of months in a pseudo-debate about number three, but I know we’d have started trying by this month or next. And in another year or so from now, give or take a couple of months, we’d be parents to three children under the age of four. That was the dream, so starkly different from the reality.

Those children will never exist in this life, but they’ll always be in my heart. I’ll feel the weight of them there, even though I cannot feel it in my arms. Even though I cannot possibly rewind to make them a reality, I’ll still feel their presence. Or rather, their absence.

They say that time heals almost everything, and I know the pain and the hurt that I feel with each new pregnancy announcement will gradually fade. I know that we’ll have a lot of fun, as a family of three, or a larger one with bigger age gaps if that is what is meant to be. I know it will all be alright, however it turns out. How can it not, when I have a man that I love, and who loves me, and together we have such a wonderful, funny and bright kid. But locked in that deep, dark recess of my heart will be the babies that never were. The ones that never got a chance to shine. Never had the opportunity to make me smile and laugh the way my only born son does.

I’ll never know how it really would have felt to live that dream. What might have happened if it had come to pass. I’m sure it would have been hard. I’m sure there would have been times when I wondered why I wanted so many children. Perhaps it hasn’t happened for a reason.

I’ll never know.

I’ll only know the emptiness I’m left with. The absence. And wonder if it’s okay to grieve for something that you never even had.

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TTC With Diabetes

This is a post that I’ve been hesitant to write, because in some ways it feels a bit too intimate. Laying all my cards on the table opens me up to expectations and people asking me if I’m up the duff yet. I do wonder if it would be better to wait, and simply make an announcement when it happens, at a stage in the pregnancy that I feel comfortable to do so. But at the same time, this is something which is very important in our lives right now. It’s a part of our journey with Thomas that I didn’t really record, and this time I want to remember what it’s really like.

So here we are. We’re officially trying to conceive.

Everyone knows what trying to conceive involves. Plenty of frequent bedroom antics in the hope that a single sperm reaches the elusive egg. It’s important for everyone to take the best care of themselves that they can, and take their folic acid to reduce the risk of neural tube defects.

But diabetes has the potential to throw a huge spanner in the works when you want to make a baby. From the moment of conception, higher blood sugars than normal increase the risks of miscarriage and birth defects. The only way to mitigate these risks is to have the best blood glucose control possible.

But that isn’t always that easy. Diabetes is beast that isn’t that simple to tame. Everything that you can think of, from food to exercise, stress to the weather has the potential to affect your blood sugars. And of course blood sugars have the potential to affect pretty much everything in your life. That includes your hormones and hence, your cycles. And the more regular your cycles, the easier it is to conceive.

If you’ve read my entries from my pregnancy with Thomas, you’ll realise that I was quite obsessive about keeping good control, and would have done anything and everything to keep him safe. But back then, diabetes was pretty much my sole focus. True, I also had a stressful full time job, but now I have a stressful part time job and a demanding toddler, as well as diabetes which an be just as stressful as the job, and just as demanding as the toddler.

I have a feeling that things will be a lot tougher this time. But yet, somehow, I want it that much more.

When I was pregnant with Thomas, hearing about people desperate to conceive their second or third child always made me think “But at least they have one child already. It’s not the same as wanting your first child”. I couldn’t understand how the desire could be so great as for a childless person. It’s true that it’s not the same, bu tnot in the way that I thought. Now I don’t just want a child for myself, I want a sibling for my son. And I feel more pressure and in a much greater hurry to get pregnant because I don’t want a huge age gap between my children. To the point that I was ridiculously disappointed not to have conceived in my last cycle as it was my last opportunity to have a second child before Thomas turns two. I realise that two under two would be making life hard for me in so many ways, so please no one point that out. It was just a milestone for me.

The first stage of pregnancy prep for a person with diabetes is making sure that those blood sugars are good enough. In effect we need to be given “permission to try” by our doctors. Of course no one can dictate what you do, and there is no forced contraception, but it’s done for the best of reasons. I’m on board with that. The crucial test is the HbA1c, which reflects control over the previous three months. (For any geeks, it is percentage of haemoglobin molecules which have been glycosylated – or have glucose attached to them. The higher the average blood sugar, the higher this percentage will be. And it covers about three months as this is the approximate life span of a red blood cell.) For non-diabetics, the range is somewhere between 4 and 6%. The advised target for women wanting to become pregnant is less than 6.5%. See above for all the factors that affect diabetes if you think that is remotely easy to do for the majority of women with diabetes. It takes hard work and commitment every single day, and through the night too, since diabetes never sleeps.

This morning we made a trip to the hospital to receive my latest “report”. It’s ridiculous, but I was nervous to the point of feeling dizzy and sick. I want this so much that I was petrified my control would have slipped and we’d have to stop trying. I want this, but I also want it with the minimum of risks. Ian was ever patient, trying to calm me down and point out that I’ve hovered around 6% since Thomas was born, and there was no reason to think that would have changed.

Except the month I spent without my CGM when the transmitter died and i was waiting for a replacement. Except the mild excesses of Christmas. Except the afternoon highs that have plagued me for the last few weeks.

I felt as nervous as if I was going in to an exam. And in a way, that’s what it feels like. I know that the number is just a number. That it isn’t a reflection of my self worth. It’s just a number which doesn’t represent failure. It’s just a piece of information to help me look after myself the best that I can. But even though I know all that, it still felt like so much was resting on this.

When we were called through to be seen, the very first thing I asked, before I even said hello, was “What was the number?”

The minute it took to get the results up on the screen felt like it was going in slow motion. And then came the answer.

Six.

And I turned to Ian with a massive grin, not even caring that he’d won the bet and been closer with his guess.

I felt the kind of elation that comes after finishing exams and knowing that there is no more revision but sudden freedom.

Except, diabetes doesn’t stop. It’s a relentless animal.

I have to keep doing this over and over and over. I have to keep doing it always, but especially whilst we try to conceive. There can be no slacking. No coasting.

While other women obsessively track signs of ovulation and time everything with precision, I’m obsessively tracking my blood sugars in pursuit of not just a pregnancy, but the healthiest pregnancy I can mange with the complications of my chronic health conditions.

That’s how trying to conceive with diabetes is different.

Fourteen

Behold!

 

Dear Thomas

Fourteen months old! I’ve been writing you a letter each month now since you were born and it’s amazing to look back and see how you’ve changed. It feels like you’ve always been part of our lives, but at the same time like the past fourteen months have gone so fast! You’ve now lived through your first full calendar year, from beginning to end, and we’re on to another!

And you really are growing up, no longer a baby, but a bona fide toddler. You’re walking confidently and spend your days charging up and down and around in circles. You can even kick a ball – although that may be more by accident than design! We had to buy you your second pair of shoes (although your feet haven’t actually grown) and backpack reins to keep you safe while we’re out and about. When I drop you off at nursery now, I take your coat off and you toddle off on your own before I can get my own shoes off. You bang on the door to be let in and then charge across the room without a backward glance. I love that you’re so confident, but I feel sad that you don’t always seem to need me.

What you are charging across the room for at nursery, of course, is your toy broom. You have an absolute obsession to the point that the nursery staff have nicknamed you Mr. Sweep. Apparently you carry the broom around all day, getting very protective if anyone tries to take it from you, and periodically stopping to sweep bits of dirt up. I have no idea where you learned this domestication from!!

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You’ve suddenly become much more independent and more creative in your play. You fly your toy space ship around, accompanied by enthusiastic “Eeeeeeeeeeeeeee” sounds, and push cars and trains around too. You’re starting to stack things on top of one another and you’re becoming a pro with all your shape sorters. Emptying remains your favourite game, however, with the contents of the DVD shelves (especially Shrek) and the changing bag, and tissues from a box, high on your list of “emptying” targets. You’re also an expert at opening and closing doors and drawers – often emptying as you go! Your favourite toys are still all the objects that aren’t really toys – especially the cordless phone, our mobile phones and remote controls. Anything which looks even remotely like a phone is now lifted straight to your shoulder. It’s invariably facing the wrong way, but you shout “eh-oh” in to it and then wander around keeping up an endless stream of babble. I’m quite disturbed about your intuitive knowledge of what to do with a phone, but even more so by the fact that you will point a remote control at the television and expect something to happen!

You still seem to love books too, and this month they have been starting to fuel your speech. In addition to turning the pages and lifting the flaps in books, you now also point to the pictures and make appropriate sounds. The first was “Moo” for a cow, followed by “neigh” and “baa” Cars are now “Nee nars” and trains are “toot toot”. You’ve always been so vocal and chatty, it’s lovely to hear your speech gaining some real shape. You also want to sing, and have long had a brilliant ability to repeat tunes back to us. Now you sing “up above” along to “Twinkle winkle Little Star” and point up to the ceiling as you do so.

With so much learning and developing, things can obviously be frustrating at times. You have a new habit to deal with your frustration that frustrates your mummy in turn: you like to bang your head against things – the side of the sofa, the back of the highchair and the floor, to name a few. When you do it, part of me wants to giggle, because you do look funny, but the bigger part wants to stop you hurting yourself and I just feel sad that I can’t immediately ease the confusion of the world for you.

You’ve also had a bit of a regression with your sleep, especially with all the excitement of Christmas. On Christmas Day, it took us nearly four hours to get you to go to sleep, which has been completely unheard of lately. You’ve gone back to rejecting naps too, in particular for Mummy. You seem to want you Daddy to put you down instead, and he clearly has the knack. In fact, Daddy has been very much flavour of the month, and I frequently catch you together looking as if you hatching an evil plan!

 

Stealing Daddy's Breakfast

Eating has seen some big changes this month too. You still have no teeth, but that doesn’t stop you munching through anything and everything. But you’ve finally started feeding yourself properly – whole meals – with a spoon. You can even manage peas! You’re so fiercely independent that if we try to help you you will often bat our hands away as if to say “I want to do it myself!” You sat at the head of the table and ate your whole Christmas dinner all by yourself, followed by Christmas pudding too! You seem to have been absolutely starving of late as well, polishing off everything we give you and frequently coming back for seconds. Not forgetting, of course, the fact that you also help yourself to our food. Nothing is safe around you and most of Daddy’s breakfast ends up in your tummy each morning!

We haven’t been out and about so much this month, with Christmas and so much rainy weather, but you do go a bit stir crazy cooped up in the house and still love to be out in the pushchair, looking around. Daddy finally made me turn the pushchair around to face forwards this month. I miss being able to have a face to face conversation with you, but you seem happy to be able to see so much and kick your legs in excitement as you are pushed around. You’re a bit unsure of walking anywhere outside or unfamiliar, though. Oh, and with the cold weather we have a continuous battle of the hat. Mummy puts the hat on…. And Thomas takes it off again!

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Yet again, you’re on the cusp of so much change. You went to your first Tumble Tots session today and I have no doubt that it won’t be long before you’re climbing and running all over. Your speech is coming on each day, and I know that you understand more and more of what we say to you. Some days I miss my little baby boy, but I love my bigger toddler boy… more than words can say.

All my love, always

Mummy

2011: The Year of Baby Making

There is no way of putting it that isn’t an enormous cliche. 2011 genuinely has been quite a year. If you’d told me this time a year ago that I’d be sitting here now with my newborn son – that I’d be a mother – I’d have hoped with all my heart that you were right, but wouldn’t have dared to believe you.

This has been a year consumed with the process of becoming parents. From receiving an HbA1c result of 5.9 in the first few days of the year that signalled the best possible start for a child we were yet to conceive, through the process actually trying to conceive that child – and then succeeding. As the year progressed my belly grew with the life inside it, as I juggled the fears and anxieties shared by many new parents-to-be, as well as those unique to a mother with diabetes thrown in to the mix. And then, seven weeks ago Thomas burst on to the scene, changing everything in an instant.

There is nothing I can write that doesn’t sound cheesy. It is cheesy. But waiting for midnight to roll around with my husband and baby, at home, on the sofa with just a single glass of bubbly (owing to the fact that I’m breast feeding) beats hands down any New Year’s Eve night out. Now I’m doing this, I think it is what I was made for.

Next year will be full of more exciting firsts as we watch Thomas grow and develop, and we grown and develop as parents, and as a family. I can’t wait.

Happy New Year!

Santa’s Littlest Helper: For Which We May Never Be Forgiven

For the first time ever we’ve decided to send personalised Christmas cards, so we spent some time yesterday morning taking appropriate photographs. And obviously none of our friends and family want to see Ian’s and my faces gurning at them from the front of our holiday greeting. So this is what we did:

 

I’m sure this is the first item on what will become a long list of things for which we will not be forgiven by our son. I can almost hear him saying “Muuuuuuuuuuuum, you dressed me up like what?”

But I love every snuggly inch of him, and can’t wait to show him off on our Christmas cards.

Yes. I’ve turned in to one of those mums!

Diabetes During Delivery

What I didn’t include in all my lengthy posts about Thomas’s entrance in to the world is mention of my diabetes. I didn’t really want diabetes to intrude on those memories. To be perfectly honest, I didn’t want diabetes to be a part of it at all, but unfortunately there are no breaks from chronic medical conditions and even amongst all the turmoil of a failed induction and a very much unwanted c-section, my blood sugars still needed to be managed.

When I was admitted for the induction, it was agreed that I could stay on my pump, and monitor my own blood sugars, until I was in active labour. You may recall that I’d already had a frustrating discussion with my obstetrician about what would happen from that point. I’ll admit that I never had any intention of letting the hospital get in the way of what was best for me, but made a conscious decision to take things one step at a time. I was happy that they were happy to leave me to it to begin with, meaning I could save any battles for later. I was, however, told that if my blood sugar went above 8, I’d have to be transitioned to an intravenous sliding scale.

Of course, given that I was responsible for monitoring my own blood sugars, the easy way around this was not to tell them if I went above 8! But equally, I knew that there were good reasons for keeping tight control of my blood sugars at this final hurdle. So I set about managing them with military precision, using the task as something concrete to focus on during all the anxious waiting. Here, I can be honest and say that I did have a couple of blood sugars over 8, but since these were post-food and always came down quickly as the bolus insulin took effect, I wasn’t ready to own up to them. Similarly I stuck to treating lows myself with the stash of Lucozade and Jelly Babies we had amongst my bags. I didn’t trust the hospital not to want to treat low blood sugars with something wholly inappropriate – like milk, or hot chocolate, as I have experienced before, or rush to get me on to IV glucose that could start a whole unnecessary roller coaster soaring up high, and crashing back low.

On the day of Thomas’s birth, things were further complicated by the fact that I wasn’t allowed to eat anything in preparation for surgery. Since a c-section seemed so likely, I was actually made to fast from around 2am. The biggest challenge with fasting is avoiding hypoglycaemia, since treating it requires ingestion of food and so would instead have been an automatic transfer to intravenous glucose and insulin without passing Go and without collecting £200. With birth so imminent, I didn’t want to risk highs either, for a variety of reasons including not wanting to have a raging thirst, or hunger, whilst fasting, worry about healing less well if the surgery was performed at a higher glucose level and of course worry about increasing the chances of low blood sugars for my baby. My new “acceptable range” was between 4 and 7.

I’ll admit that I felt under pressure, if only from myself. With everything else slipping out of my control, I wanted to do something the way that I really, really wanted. By a strange twist of fate however, my body picked that very day to act a little as though I was cured. If it couldn’t do labour “properly” at least my blood sugars were behaving! I actually ran a temporary basal rate of close to or at zero for much of the day leading up to going down to theatre. I bounced along nicely just above the lower limit on the CGM, testing with a finger stick every 30 minutes to confirm. I was also tossed a life line by the lovely anaesthetics registrar who said that consumption of Glucogel was absolutely fine as it was so rapidly absorbed it would not pose a problem even with GA. In the hours before going down, I did consume the best part of a whole bottle to keep myself on the right side of the line. My final stroke of luck was having a midwife who herself had type 1 diabetes, and therefore completely “got” my need to do things my way, and fully supported me in that.

Testing Times

I was due a new insulin pump infusion set on the day of Thomas’s birth and I elected to put this in my arm so that it would be well away from the operating field. The CGM was more problematic. The week old sensor was on the left side of my abdomen, on the front of my hip. Right on the edge of the operative field. I assumed that I’d have to remove it and was nervous about flying blind. There wasn’t time to insert a new sensor and get it working, and since the first day often throws odd numbers anyway, I wouldn’t have felt the same confidence had I done this. To my utter surprise, however, I was allowed to leave the sensor in place, covered by a fresh piece of Opsite tape, which meant I could keep the CGM going throughout. Ian also kept my testing kit in his scrubs pocket whilst I was in theatre, although I can’t recall that we actually used it!

Once in theatre, diabetes went clean out of my head. I had bigger concerns about the spinal and whether or not I was dying. Ian, however, stepped up to the role we’d always planned for him to have, keeping a close eye on what was going on. We’d clipped the pump to the neck of my hospital gown and Ian diligently checked the DexCom line for me. Either the stress or the Glucogel caught up with me and he informed that I had double up arrows, indicating that I was rising fast. I opted to take a very tiny bolus to head off the high, but switched back to a zero basal rate again, ready to mitigate the effect of the removal of the placenta. I really didn’t fancy a crashing low. I did breach the high cut off, right at that last moment, but by then they were already opening me up and it was really too late to worry about.

I think the fact that I managed to keep such tight control, along with a few helpful healthcare professionals and not drawing too much attention to diabetes is what allowed me to get through with minimal fuss. Getting through with such brilliant blood sugars is a victory I want to claim all as my own, though. I’m still ridiculously proud of this graph form the day of delivery.

A short while after my transfer back to delivery suite, the DexCom sensor ended and needed to be restarted. Once I’d eaten, I commenced the pre-programmed lower basal profile on my pump – a profile much lower than my pre-pregnancy doses with the aim of avoiding hypoglycaemia whilst dealing with a newborn and to balance the possible blood glucose lowering effects of breast feeding.

Beyond this, diabetes doesn’t really feature any more in my thoughts or recollections. I am proud, for I have much to be proud of, but I’m so glad that this is the extent of what I can remember about diabetes on the day I became a mum.

Thomas’s Birthday – Recovery

The hour or so between Thomas’s entrance to the world and me being ready to be transferred back to the Delivery Suite felt a lot longer than a normal hour. Ian had been cuddling Thomas the entire time (and been weed on by his son too!) He’d also been weighed in at 7lb and 11oz. Right on the 50th centile, completely in proportion with no sign of an increased abdominal circumference that suggests diabetic macrosomia. All my “big baby” fears  vanished instantly with that news. And I couldn’t help but feel just a little it proud of myself.

Once I’d been stitched up there was a lengthy delay in waiting for a suitable bed to transfer me on to. I had expected to be transferred to the recovery area, but that never happened. Instead they eventually procured a proper bed from the Post Natal ward, which meant I’d only need to be transferred once. Once the bed arrived, I was unceremoniously hauled from the operating table across to it ready to be moved directly back to my room on Delivery Suite. I could not wait to finally be able to cuddle my boy properly, but the moment I’d moved, I knew I was going to be sick. Being sick when your stomach is empty from hours of no food or fluid AND you’re numb from the mid chest down is a very surreal sensation.

Eventually the heaving subsided and finally Thomas was placed in my arms. Until that moment I hadn’t realised that I had a baby shaped hole right there. He filled it instantly, snuggled tightly against my body. I felt spaced out from the drugs and surgery, not to mention lack of food and sleep, but I could not stop grinning as I stared down at my tiny, dark haired boy. As we were wheeled along the corridors to my room, I felt a swell of pride in my heart, to be holding my beautiful boy for everyone to see.

My parents were already waiting in the room as we arrived and I invited them to “Meet your Grandson” through yet more tears.

The next few hours are a bit of a blur. A different midwife came to take care of me and Thomas, which included getting him straight on to my breast and testing his blood sugar for the first time. My heart broke just a tiny bit at the shrill squeal he let out as they pricked is heel for the blood sample. Having kept him safe for so long, I felt guilty that his entrance to the word was being marked with pain because of MY condition and the problems it might be causing for him. Fortunately his level, whilst on the low side, was within normal range for a newborn. And with the midwife’s help, he latched straight on to feed. There was never any need for the frozen syringes of colostrum we’d prepared in advance, as he sucked like a pro and his second and third blood sugar levels were absolutely fine.

I do remember being insanely itchy throughout this time. I was holding Thomas to me with one hand and scratching my skin all around him. It was an absolutely skin-crawling, insatiable itch. Apparently it was a reaction to a drug that I’d been given and once I was given an intravenous antihistamine, the itch subsided. I was also sick again, with a cardboard sick bowl balanced unceremoniously on poor Thomas’s head as he continued to eat!

Family

After a couple of hours, I was allowed to eat. The bendy straws we’d been advised by so many people to pack in my labour bag finally came in handy allowing me to drink a cup of tea whilst feeding Thomas and not being able to move to sit up properly! I also demolished a slice of toast in about three seconds flat. I may not have had a natural delivery, but it’s still true that the first cup of tea and slice of toast following the birth of your child tastes much better than any tea or toast that has ever gone before!

The first of many!

The midwife and my mum helped Ian to change the original nappy that had been put on – his first ever nappy change – and dress Thomas in the yellow sleepsuit with two little elephants on that we’d chosen especially. We took lots and lots of pictures. Surprisingly I look half decent in a few of them.

Ian looked absolutely wrecked, however. Neither of us had had much sleep since Saturday night. I really wasn’t keen on the idea of an emotionally charged and over tired drive home, even though it wasn’t far. Fortunately my parents were able to take Ian home and we could leave our car in the hospital car park overnight. One less thing for me to worry about. At this stage I was still waiting to be transferred upstairs to the post-natal ward, but he looked so dead on his feet that I urged them to leave.

I have no idea what time I was finally transferred, once again holding Thomas to me. I was still pretty numb and starting to get itchy again. As soon as we arrived in my room on the post-natal ward, the midwife settled Thomas in to his little plastic crib, and he happily fell asleep. I could have watched him all night, twitching and snuffling in his sleep, but I was exhausted myself after what I can safely say was the biggest day of my life. It didn’t take too long for my own eyes to close.