My Big Fat Preterm Labor, Pre-eclampsia, Gestational Diabetes Pregnancy Update

Hello from the hospital preinatal unit where I will most likely remain until my boys are born.  I don’t think I’m going to be able to manage eloquence here but I do want to update everyone and get the facts out.

On Friday morning, Aellyn’s second birthday!, I had a non-stress test scheduled.  During the test I was having contractions every 5-7 minutes so off to OB triage I went.  These weren’t at all painful and I would have called them Braxton Hicks except they were so close together.  The hospital was packed and I spent a few hours in Recovery because Triage was full.  My contractions actually spread out to less than 4 per hour and my blood pressure stabilized as well.  I felt pretty sure I was about to be sent home but they wanted to do a cervical check first.

I was 2-3 cm and 50% effaced.  I couldn’t believe it.  Those painless little “tightenings” in my uterus were actually dilating me!  Well that changed everything.  No going home at 30 w 3 d while dilated.

I was admitted to Labor and Delivery and started on magnesium sulfate to stop contractions, antibiotics, and a shot of steroids for the babies’ lungs.

Ugh, “mag” what a drug.  Mag relaxes smooth muscle so in addition to stopping contractions of the uterus it makes everything dilate so it makes you hotter than Hades.  The worst was it makes you weak.  Rubber legs.  I can’t walk.  I’m having trouble typing – especially letters like “l” and the “.” that use my ring fingers – I keep missing them.  It gives you blurred vision as well.  Tons of fun!

I had a consult with the neonatologist which went really well.  He took his time with me and was very respectful even when discussing vaccines and such.  He admitted that HepB was no big deal and they only gave them  because they had a “captive audience” – hmmmm, I’ve been saying that haven’t I?? – and even better he said that if I can’t produce enough breastmilk for both babies they would supplement with banked human milk!  I didn’t even ask or talk about avoiding formula I just told him breastfeeding was important to me.  I guess they use the human milk for the smallest and sickest babies but I’m glad to know my boys’ intestines won’t have to deal with cow’s milk protein early (especially because of the darn antibiotics).

They did a 24 hour urine collection and my protein number was 842.  Three hundred is considered pre-eclampsia.   So, yep, I have pre-eclampsia.  I’ve heard of much worse cases.  I’m not experiencing any edema (swelling) even with the steroids and my blood pressure is moderate (130s/90s) while on the mag (which lowers bp).

So tomorrow morning they’ll take me off the mag.  The goal is to not deliver to 32 weeks at a minimum.  It sounds like after 32 weeks they wouldn’t necessarily stop labor depending on tons of factors like my blood glucose, blood pressure, etc.  What I do know is that I’ll be in the hospital until my babies are born

So how am I feeling?  I’ve been very upset at first – just shocked.  Now I feel like I’m in the best hands.  If my boys were born tonight they would have top notch care.  It could be worse.  My bp could be over 160.  My proteinuria could be in the thousands.  I could have been dilated beyond the point of no return and the babies wouldn’t have had the benefit of the steroids.  Survival rate is excellent for 30 week babies and I’m nearly 31 weeks.  32 weeks is even better  34 is fabulous.  My boys are a good size.  3lb 4oz and 3lb 8oz at my last ultrasound.  They are doing good – heart rates are awesome – accelerating when needed and not decelling.

I miss my daughter.  We had an impromptu birthday party for her in my hospital room.  I miss sleeping in my own bed with my husband.  I’m not really confident I’ll handle bed rest well!  I’m such a busy body and I get depressed when I’m bored.  And, obviously, you know I’m a research freak so my goal will be to keep busy but NOT obsess over every premature baby story ever.

I love Facebook.  None of this had to happen in a vaccum – all along I’ve updated family and friends and received their love and support through words on a simple website.  Really it is powerful.  Oh, and I have internet now!  That makes the whole world better, right?

I think that’s all the facts.  I hope I didn’t leave anything out and I don’t really have any hard and fast answers it is one day at a time.  Each day matters to my babies.

Thank you all so much and I will humbly continue to ask for your prayers!

Gestational Diabetes: For Real This Time

I “had” Gestational Diabetes (GD) during Aellyn’s pregnancy.  I say had with quotes because it went down like this:  I failed the 1 hour and then the 3 hour and that’s it.  I never had another bad number.  My fastings were always in the 70s or 80s.  I definitely think I fell into the many women who are wrongly diagnosed with this due to poor clinical diagnostic criteria.  This bad diagnosis led to interventions such as looming induction near 40 weeks and continuous electronic fetal monitoring.  This pregnancy I’m not likely to make it 40 weeks and I’m expecting much more interventions.  I have chosen to go with a more medicalized birth for my twins so I was less worried about getting a GD diagnosis this time.

Well I failed the 1 hour with flying colors.  My 1 hour number was 207.  Failing is 140.  I failed so spectacularly that I didn’t have to take the 3 hour (which is good because I think fasting for 12 hours in inhumane for pregnant women).  So I dug out my glucomoeter and started taking my fasting blood sugar just to see if things were like I expected from last time.

Well, they aren’t.  My fasting (first thing in the morning) blood glucose (BG) has been:  120, 130, 121, and 119.  Those are obviously all over the “under 90” criteria.  My post-prandial (2 hours after meal) have been 173 and a whopping 257.

So, it was with trepidation that I went in to talk to the nutritionist today.  I actually cried!  I mean I’m pregnant and emotional but I’m usually pretty positive about my treatment with an “I can tackle this” mentality.  I think this brought out several sub-conscious prejudices I didn’t realize I had.

See when I say “I had GD but it is well controlled with diet” I didn’t think there was more behind it than that.  But there is.  There is a “because I’m healthy and take care of myself – *I* didn’t need medication.”  Diabetes is something that happens to “bad” people who don’t eat right and often to “fat” people.  I’m fat but I’m healthy.  So of course I didn’t need medication.

This time it looks like I’m going to need medication so this must mean I’m “bad” in the way I eat and I had it coming because I dare to be fat.

Wow!  What a lot of sub-conscious prejudice to come bubbling up all at once in front of the nutritionist!

I can’t be the only person who has felt this way.  Skinny or fat, being diagnosed with GD feels like a failure on your part.  If you had eaten differently this wouldn’t be happening to you.  Right?  Wrong.  Let’s look at what GD really is.

In every pregnancy insulin resistance happens during the second trimester.  It is supposed to happen, it needs to happen.  Hormones produced by the placenta, namely cortisol, progesterone, human placental lactogen, prolactin and estradiol
bind to receptors that insulin would normally attach to in order to allow glucose into the cells.  This increases the amount of glucose circulating in the blood stream which makes your body amp up its insulin production.  The reason this is normal and desirable in pregnancy is your body needs that extra glucose available to perform the monumental task of building babies!

In a twin pregnancy you either have a larger single placenta (in the case of identical twins) or two whole placentas pumping those hormones into your blood stream.  For this reason, twin pregnancies have two to three times the incidence of GD.

No one knows why some women’s bodies can’t compensate with an increase in insulin and require management through diet and/or medication.  Risk factors include family or personal history of GD, obesity, age, and ethnic background.  However, a full 60% of GD patients have no discernible risk factor.  It just happens.

(side note: whenever a “risk” factor list includes obesity I’m always skeptical.  Using weight as an assignment doesn’t tell us if that person was a healthy (eats right, gets exercise) person or not.  I imagine if they quantified it by “health” instead of just weight they might find that many obese people are at risk because they eat Krispy Kreme for breakfast AND many skinny people are at risk because they eat Krispy Kreme and both groups over-tax their pancreas.  But, no one looks at it like that.  They look at the number only.)

It isn’t my fault (or yours) if you have GD.  And if you do have GD and end up on medication you aren’t a “bad” patient.  You can’t “good student” yourself out of this one.  If your care provider makes you feel it is your fault get a new care provider.

Mine did not make me feel it was my fault.  She assured me it was not and that having to go on a pill or insulin did not describe levels of failure.  She looked at my diet and although I was eating too large of a breakfast (have you ever been pregnant and then woke up in the morning?) and too small of a lunch, in general my diet was in line with a good diabetic diet.  She gave me some hints and tips here and there but no major changes.  I have to go back in on Friday to see how my numbers are.  Given that my diet isn’t changing that much I’m pretty sure on Friday I’ll need at least an oral medication intervention or perhaps even insulin given how high my numbers are.

And that’s ok.

Found a Pediatrician!

Yesterday was such a good day!  We had an appointment in the morning with Dr. Lavin of Advanced Pediatrics in Beachwood, Ohio.  He was wonderful and our search is finally over!  I told him my primary concern was having a doctor who was willing to work with us even if we didn’t vaccinate.  He at first talked about MMR and autism (which I’m realizing most people see as the “reason” people don’t vax).  His studies, which he had typed up into a report, show that autism is completely out of hand but NOT being caused by the MMR vaccine.  He cited a Denmark study, I’ll try to find it.  However, I told him that the MMR/autism link was not my reason for not vaxing but that I honestly believe people *should* get measles, mumps, and rubella.  He agreed.  We talked about Chicken pox and how we were throwing nature out of balance with the vaccine.  He agreed.  I said my infant does not need Hep B.  He agreed.  Overall it was a great conversation.  He said he tries not to be a slave to a certain ideology and that his job was to give me information so that I could do my job of making the best decisions for my daughter!  We also talked about our IVF experience and he totally “got” it.  This is important to me.  When I tell someone that it took us 9 years to get where we are I want them to see how that might effect our decisions.  He acknowledged how special our little girl was going to be!

And boy is she special.  We got to see her again at our ultrasound yesterday afternoon.  We got to see her face and her little hands.  She had a full bladder and then she peed and we saw it!  It was so cute!  LOL.  I’ll post pics as soon as I can scan them.  I also had a non-stress test which I’ll get every week from now on.  I think that is overkill for gestational diabetes but I’m playing nice so I can stay with the midwives.  Baby is firmly head down but her legs are all bent up so I’m not getting rib kicks at all.  Of course I can’t breathe at all.  I have to lean my seat back in the car to be able to breathe!  8 more weeks!  She said they don’t like to let GD patients go past their due date.  I’ve decided not to argue now, we’ll see how it goes.  If it comes down to induction I’ll take in some studies about the lack of improved outcomes with induction for GD and plead my case then.  I feel like I am walking a tight line between being the pushy patient and staying with the midwives.  I DO NOT WANT THE OBs TO DELIVER MY BABY!  That is goal #1.  Goal #2 is anything relating to Aellyn after she’s born – no vit K, no eye drops, no hepB vaccine, etc.  So I’m convincing myself that my “birth experience” take the #3 slot.  I need to let some of that go and focus on what really matters.

I got tagged by Wishing for One!  I love getting tagged and I’ll work on that next.

Foray Into Homeopathy

***Canyonlands NP in Utah is the most beautiful place on Earth.  Take a minute to tell our leaders we don’t want oil companies plundering this land!***

I’ve always been intrigued by homeopathic medicine.  My doctor growing up was open minded enough to offer homeopathic remedies from time to time  (he also wrote a bible verse on a prescription pad for my dad, lol).  I’ve been reading about homeopathic remedies for children since studies show that cold meds are terrible for them.  Well I’ve been researching homeopathy for gestational diabetes and I think I’m going to try chromium supplementation.  Mainstream medicine doesn’t spend much time on homeopathic remedies but I did find this great study about chromium for GD.  

My numbers have actually been great.  Fasting numbers in the mid 80s, most post-meal numbers between 95-110.  I just DO NOT want to need insulin since I’m sure that would bump me to the OBs.  

We are scheduled for a ultrasound on Monday and meeting with the OB and then our midwife.  I’m going to ask some pointed questions about reducing interventions in spite of the GD.  I really want to only intervene if evidence exists of a problem.  Sometimes to “err on the side of caution” GD mothers are induced or even scheduled for a c-section.  I would do those things but only if there is an identifiable problem with the baby.  I also don’t want electronic fetal monitoring during labor unless absolutely necessary since this will keep me out of the labor pool and tied to the bed.

We also have an appointment with a pediatrician Monday morning.  I got a recommendation from the ladies at Mothering.com message boards (aka “crunchy” mama land) to try Dr. Lavin at Advanced Pediatrics for a no-vax friendly doc.  I was excited to see that “In order to provide our patients the best uninfluenced information that science has to offer, we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.”  I’m really hopeful that he will make a great choice for us (even if he is 45 minutes away).  It will certainly be a relief to have that out of the way!

Oh by the way, I’m 31 FREAKING WEEKS PREGNANT!  Holy crap!  I can’t believe it!!!  It is downright surreal.  It definitely feels like it is going fast now.  SOOOO much to do!  Being on bed rest the house is a mess.  I hope that “nesting instinct” kicks in soon!  Right now my “getting as much sleep as possible” instinct has taken over!