Friday, February 28, 2014

Reducing C-Sections for First-Time Mothers

This is an excellent piece of news from NPR:
"Women with low-risk pregnancies should be allowed to spend more time in labor, to reduce the risk of having an unnecessary C-section, the nation's obstetricians say. 
"The new guidelines on reducing cesarean deliveries are aimed at first-time mothers, according to the American College of Obstetricians and the Society for Maternal-Fetal Medicine, which released the guidelines Wednesday online and in Obstetrics and Gynecology
"About one-third of all births in the U.S. are done by C-section, and most of those are in first-time mothers. There's been a 60 percent increase in these deliveries since the 1990s, but childbirth hasn't become markedly safer for babies or mothers. 
"That discrepancy has led many to conclude that the operation is being overused. A C-section is major surgery. The procedure can increase complications for the mother and raise the risk during future pregnancies. 
"Women giving birth for the first time should be allowed to push for at least three hours, the guidelines say. And if epidural anesthesia is used, they can push even longer. Techniques such as forceps are also recommended to help with vaginal delivery.
Read the full story here.

Homebirth midwives have often noted the wide variation in "normal" birth patterns that they've observed through years of experience. This is especially true of first-time mothers, whose bodies haven't ever done the enormous task of labor and delivery. Now there's apparently some observational data to back that up. Let's hope doctors take notice!

This would also be useful information for women who had a c-section with their first and are pregnant again. Doctors are fond of saying that such women will experience labor like it's the first time. Again, let's hope they'll take this advice to heart and give women attempting vaginal delivery an adequate amount of time and patience to try.

If either of these things apply to you, don't hesitate to bring this article to your doctor's attention!

Wednesday, February 12, 2014

Learning NFP

I have no idea how many of you are unmarried, and I would gather the answer is probably, "not many." But just in case there are a few single, Type I diabetics who come across this blog with some curiosity, and they  are interested in natural methods of preventing pregnancy as well as natural methods of giving birth, I'd highly recommend learning fertility awareness before marriage!

I stumbled upon natural family planning during college. I was a summer intern with a pro-life organization in DC. I was definitely on board with the anti-abortion part, but squeamish about some of my Catholic co-workers' opposition to contraception. At first, I was all like, "no way. Don't touch my birth control." And then this young woman literally took 20 minutes of her time to explain it to me, and I came away absolutely convinced that it was the only way I would even consider preventing pregnancy. All before we had even started work in one morning! I began charting during college, about two years before I got married, and I was really glad that I had all that extra learning in me before preventing conception would actually depend on it in marriage.

Highlights of natural family planning, from my perspective: knowledge of your body, respect for and attention to your body's natural patterns, and lack of side effects from hormonal contraceptives. Relationally, it's very affirming to know that your husband is willing to patiently wait for you, and sacrifice his desires for your good, every month. I also wrote a whole post about why it's not absurd here. I also wrote a bit about charting after you've had a baby here, here, and here.

Sunday, February 9, 2014

Week 21: Oh boy, oh boy, oh boy...oh boy!

I went for my comprehensive fetal anatomy scan last week and we found out we are having another BOY! That makes four little men in our home!

I hope all of my exclamation marks adequately convey my excitement about having four sons! This fact of my enthusiasm, however, is sometimes as much of a surprise to me as it is to many of the people I talk to about this matter.

By the time you have your fourth child, people are occasionally confused by your seemingly odd behavior. Four...what? Why would you do that? Some assume you come from a big family and are just continuing the family tradition. I was the fourth of four, so I suppose this is true in my case. Some joke that you must not have a TV, and therefore you lack other ways to entertain yourselves. We do have one, we just don't watch it...Some recognize that you are Catholic, and kind of get it. Although I would add the caveat that Catholics are not required to have lots of kids, only forbidden to use contraception. This very often has the same result.

Another common assumption people have is that, if you have three boys and you are pregnant for a fourth time, you were probably trying for a girl. But this was definitely not true for me and my husband. This has never really played into our considerations for conception. We are always and only ever just trying for a baby. In fact, I have been so completely ambivalent about whether we were having a boy or girl this time around that I had a very hard time explaining it to myself or other people. With all my other pregnancies, I at least had a slight preference one way or the other. But this one, I simply could not decide which I wanted.

When I became pregnant with my first child, I was actually fairly desperate for a girl. I was a tad bit terrified to become a parent in the first place, in spite of the fact that conception was carefully planned. I thought it would help me be a good parent if I had a girl to raise: someone like me, someone whose personality and struggles I could identify with. I had experienced teenage girl angst. I had body image issues. I had a little bit of clinical depression and anxiety in my past. I could help someone through that. But anger? Withdrawal? Perhaps violent tendencies? Extreme behaviors like sky-diving, rock-climbing, and military pursuits? I just didn't think I would know what to do with those!

But three adorable little boys later, I am beginning to understand the destructive, loud, physical tendencies of these little creatures running around our house. They break stuff to figure out how it works. They push themselves into each other to see when and if and who will break. They are loud because they enjoy life. I'm not sure how different they are than girls, but I don't worry (as much, anymore) about the hitting and the damage done to property and the seeming desire to do these things over, and over, and over again. They are testing themselves against...themselves, each other, and the world.

In fact, I have gotten so used to being around little boys that I began to have the opposite fear with this pregnancy. Would I really know how to raise a girl? Would I really not be driven crazy by the challenges of parenting a female child? It could be fun...but what if I wasn't fit for it? I'm still not sure of the answer to the questions about my ability to raise a daughter, but we are thrilled to have a fourth man-child to add to our crew.

We are also quite certain and hopeful that this child will not be our last. I am only 29, and still very Catholic, after all. A girl, or a few!, may yet be in our future.  For now, we're just aiming for a baby.

Tuesday, February 4, 2014

Top 10: Dietary Changes I Never Expected To Make

When I first got diabetes, I remember being terrified to eat anything. I was 9 years old. My first day home from the hospital, I went into the kitchen in the morning and grabbed a graham cracker. After taking a few bites, I suddenly realized that something was different. Then I stared at it, wondering if this food which had once been so normal was now a poison to me.

Over the coming months and years, I gradually came to realize: "Hey, no problem! Insulin covers it!" I ate pretty much anything I wanted, whenever I wanted. My A1Cs weren't great, but I guess I didn't really know what they were supposed to be. People would often ask me, "So, you have diabetes. Does that mean you're not allowed to have sugar? Do you have to be careful about your diet?" The question was always a little embarrassing, because...I don't know, maybe. Maybe I was supposed to cut out sugar and be careful about my diet. But I didn't. No problem, insulin covers it, right?

I carried this attitude into my first pregnancy. But I quickly realized that when your bolus ratios are 1 unit of insulin per 5 grams of carbohydrate, you are tasked with the responsibility of assessing the number of carbohydrates in a giant plate of pasta, the life of another human being depends on it, and you get it wrong...? I was up and down a LOT during that pregnancy. Mostly down, because I was terrified to get it wrong. I overestimated a lot, and gave extra manual boluses all the time, simply out of fear that my blood sugar would be too high. I managed to keep my BGs down to a level with which my doctors were impressed, but it was only because I just pumped myself full of insulin and ate constantly.

By the time my third pregnancy rolled around, I realized that a stricter dietary regimen was in order. I was hoping to avoid the 50+ pounds of weight gain I accrued during my first two pregnancies, and not only because it was hard to lose it. It made me really uncomfortable at the end of pregnancy, and made my insulin resistance higher. But this was not a welcome realization. I resisted it. I wavered and faltered. I convinced myself that maybe I was fine "indulging," or eating like I did when I wasn't pregnant. I wasn't a super-hero, so how could anyone expect that I would act like one when I was choosing what foods to eat?

Now, half-way through my fourth pregnancy, I am fully convinced of the necessity of combining healthy, controlled insulin rate changes AND dietary changes to achieve the healthiest pregnancy I can. Believe me, I don't like it. It's stinkin' hard, most days. But I've had my fun, and it turns out that some kinds of fun leave you pretty miserable and either in a sweaty, unconscious, hypoglycemic mess or an always-thirsty, anxious mom making constant trips to the bathroom.

So with that, my list of the top ten dietary changes I never expected to make:

10. Resist the urge to eat when my blood sugar is high but I feel weak like a low. Ugh, this one took forever to get through my head. It still takes every ounce of willpower I have to resist eating.  It's so counterintuitive, because food usually makes me feel so much better when I'm weak like that. This often happens in the morning, after breakfast, and after dinner before bed. During my first pregnancy, I just pumped myself full of insulin, thus necessitating - among other things - a "second breakfast" at work right about 10 o'clock in the morning. But by my third, I realized that keeping my weight gain down would mean cutting out extra snacks meals to be a realistic goal.

9. Sleep instead of eat. This is related to #10. Once I had two toddlers and was in my third trimester of pregnancy with my third child, this was actually not very hard. Feeling like eating after dinner before bed? Don't. Don't start the cycle that might end with a high or a low. Your bed is calling. Answer it. But I will admit that I love a post-kids-bedtime-celebratory-milkshake, and those are now out (boo hoo). (Auto-correct just changed "boo hoo" to "boo hop." There, it did it again. Is that even a real phrase?)

8. Don't eat within two hours of bedtime. Again, I don't like to start the cycle that may make me high or low while I'm sleeping. It also helps me get my basal rates in order, since I don't have to wonder whether it's my basal or my bolus that's setting off my readings. If my basal rates are good, I just rest in the confidence that they'll carry me through to the morning.

7. Middle-of-the-night snacks. Pretty much every rule has an exception, and the big exception to the above three rules are the times when I wake up in the middle of the night and truly can't get back to sleep because I'm so hungry or my blood sugar is low and I need to eat. I take this as my body's way of making sure it gets what it needs...but I make it work pretty hard to communicate its point.

6. Eat like a dinosaur! One thing that helped me get on a better dietary regimen during my third pregnancy was my father's adoption of the Paleo diet. This diet includes no carbohydrates (corn, beans, potatoes, bread, rice, etc. are all out) except for the natural sugars found in fruit. Since we live with my parents, and I like to cook food for them as a way of thanking them for their hospitality, I ended up cooking a lot of meat and vegetables dishes and serving carbs sparingly. This also taught me to decrease my carbohydrate portions, even when I did serve them.

5. Breakfasts devoid of carbohydrates are a total wild-card. For every rule an exception, right? I remember a few times having a carb-free, eggs and sausage breakfast, without any accompanying toast. I thought to myself, "Great! No hassle trying to estimate carbohydrates with crazy-high insulin resistance in the morning! We'll just cut that part out all together." BIG MISTAKE. High or low, it doesn't matter. It's going to be off two hours later, guaranteed. Mornings are so weird. I eat the same thing literally every morning so as to cut out at least some uncertainty. This pregnancy, it's a cup of milk with a splash of coffee, a cup of Greek yogurt, and a slice of toast.

4. Have a doctor recommend ice cream to raise my blood sugar. I don't actually have ice cream when my blood sugar is low, not least of all because I can't take it with me nor can I actually measure out one-half cup accurately to figure out how many carbs I'm eating. But I do carry pre-packaged pudding cups. Those are, I have discovered, a great low blood sugar snack!

3. Gatorade is my life-line. Just so you know, I get very sensitive when people start talking about banning sports drinks in schools. Sports drinks save my life when I'm out of the house with toddlers and I need to raise my blood sugar fast to keep them from running into the street and/or peeing in their pants. Sports drinks are designed to get into your system fast and they do just that when your blood sugar is low. I wonder if they could market that to the tiny demographic of pregnant, Type I diabetic moms: "Not just for athletes!"

2. Pull out a measuring cup for my morning cereal and milk. I laughed at myself the first time I did this. And the worst part is that it didn't even help all that much, because my blood sugars are just crazy in the morning. Now, I rely on pre-packaged bread and yogurt to save me some time. I put an unmeasured glop of peanut butter on the bread, just to keep me a little on the wild side...But seriously, eating the same thing in the morning helps make sure that it's at least not my carbohydrate estimate that's off. So I also get really sensitive when people talk bad about pre-packaged, processed food. No one has yet managed to convince me that the evils of preservatives are so great that I should prefer unpredictable blood sugars to the consumption of them...

1. Hot herbal tea and seltzer water. These are a carb-free way to make me feel special and not deprived, even though I basically am. :)

What are your rules and tips for healthy eating during pregnancy?

Sunday, February 2, 2014

Week 20: Insurance Saga, Part 2

In my last post, I wrote about my insurance history and our most recent decision to move to "cost-sharing" through Christian Healthcare Ministries. My routine diabetes expenditures will not be covered, but all the unexpected things will be. This is OK, because after calculating it, my routine diabetes expenditures + the monthly cost of the program = about the same or a little less than what I was paying on insurance.

But then, I'm also pregnant. And unfortunately, CHM won't cover costs for this pregnancy, even though it does cover pregnancy costs under some conditions. So it's back to the Office of Family Services I go, to try to explain our complicated insurance situation, hope they'll agree that I'm poor enough to cover with Medicaid, and probably have to make several phone calls to see if I can get in touch with someone who can understand what's going on with us and won't just tell me to wait 10 more days, or 30 days, or until I get a letter in the mail.

Well, I applied for Medicaid on October 30. As of January 21, I had no word back. I had accrued about $700 worth of medical bills, and I was not sure whether they'd be covered. I had an ultrasound scheduled, which would be another several hundred dollars, and I didn't know whether it would be covered. I called two times, and they said they would get back to me. One woman called and said they were still processing applications from July, and that since I had primary insurance, I would have to submit more paperwork and wait longer. I don't think she realized that a) I was pregnant, and b) my primary insurance didn't cover maternity expenses, and c) I had actually dropped the insurance plan because it was absurdly expensive and not covering the maternity I needed it to cover anyway. I tried to explain, but she refused to give me her name and just said, "I'm just helping out. We are very short-staffed."

I was anxious. I didn't how long to wait before calling again. Each call was approximately 45 minutes-worth of hold time before speaking to someone. This someone often can't tell you anything concrete or definite. We are definitely willing to pay out of our own pocket to have this baby, but knowing that we are financially responsible would completely change the way that I agree to (or refuse) certain kinds of care and testing. I wouldn't be able to simply do every blood draw, every NST, and every ultrasound they suggested. It's a fight to get Medicaid, and a different kind of fight to insist to my doctors that I don't have the money to pay for, nor do I really need, a lot of testing. In short, I was feeling poor, pinched, without many good choices, and a lot stressed about it.

This experience taught me a lot about what it is like to be on the margins of society. What great pity we should have for the poor! I am only poor temporarily, while my husband is in school. We also live with my parents, who are so generous to us. But chronic poverty? Chronic uncertainty? Chronic dependence upon a system whose response is uncertain and you cannot always rely upon? Chronic admonishments from your doctor about the necessity of testing and treatment your health, coupled with a true inability to pay for the recommended care? I don't know how government assistance can be made more effective for the poor, and I'm not certain that a constantly-changing set of government mandates under the Affordable Care Act really makes for the best healthcare situation for the most people. But I can now at least say, with certainty, that the poor are to be pitied by each and every one of us, and we ought to be willing to stretch ourselves out with compassion for them!  I don't only say this for my poor self, but especially for those who constantly live on the edge of poverty all their lives.

The end result of all of this is that I was, in fact, accepted for Medicaid coverage. This is a great relief. In fact, it's an answer to a prayer I forgot to make. I spent so much time worrying about who I should call, whether I should cancel my doctor's appointments, how and whether we would pay for various kinds of treatments and tests, and so on and so on, that I forgot to rest in the confidence of God's love and serenity. In His kindness, He gave it anyway!