Week 25: So Normal, So Extraordinary

I've felt that there has been little interesting to say about my pregnancy in the last several weeks. In my first pregnancy, I'm pretty sure I never thought or felt that. It was so new! And strange! And painful! And exciting! And then as soon as I started writing for this blog, I tricked myself into thinking that reflections I had about pregnancy were more interesting than they actually were, just for the sake of having something to say.

But ever since I found out, at 20 weeks, that the baby appears to be developing normally, I guess things have just seemed pretty normal. Normal aches and pains. Normal(ish) blood sugars (at least the awkward overnight lows have been fewer and farther between). Normal doctor's appointments. Normal shortness-of-breath. Normal schedule, normal this, normal that.

Pregnancy was so shocking the first time I did it, partly because it was so HARD and PAINFUL! And I couldn't even take ibuprofen for the symptoms! And I was so TIRED all the time! And I couldn't even bend down to tie my own shoe! Sitting down in a chair practically knocked the wind out of me! And then I was chasing a couple toddlers, I was changing two sets of diapers, AND I was pregnant! A  very good friend of mine, at that time, when I was pregnant with my third, asked me, "But...it gets easier, right?" And in some ways, that's true. For example, you get more efficient at clearing the breakfast table and getting everyone into the car. You know exactly when to check your blood sugar and what you need to have with you before you leave the house. But efficiency can only get you so far before the difficult tasks of daily living demand your attention once more (and sometimes, all at the same time). So what it really boils down to, and what I told her, is, "No, it doesn't get easier. You just get used to being tired and in pain."

This truth is one I have known intimately, for I have been living in the depths of pregnancy-, baby-, and toddler-induced fatigue and pain for 6 years. The minor aches and pains and irritations of  pregnancy or nursing or parenting are just so ordinary and normal at this point. Perhaps that seems horrifying to you. It was to me, too, for a long time...except for the fact that it was my life and I still had to live it. And you know what? I just can't afford to be outraged about the horror of it all all the time. So I've given in, and stopped being mad about it. I've stopped feeling like I'm special, or that life is unfair, or that everyone should congratulate me all the time because I have diabetes and children. All the aches, pains, fatigue, and irritations are just par for the course now. The good news is I'm still alive, and those problems haven't caused my demise yet. Nothing terrible has happened, and in fact, very many good things (ages 26 weeks gestation, 1, 3, and 4) have happened! They are continuing to happen right before my very eyes.

So the most extraordinary thing I have experienced during this pregnancy has nothing to do with all the things that I normally write about, that is, the physical symptoms related to diabetes and pregnancy. The most extraordinary thing I've experienced these last few weeks is interior collection and peace. For all I know, being tired actually helps with that...not a lot of excess energy to be mad, complain, or try to change the world to AVOID ALL THE PAIN. All the fears and anxieties that have lived in me for so long, for so many pregnancies, are gradually fading away. I am not worried about labor, I am not worried about recovery, I am not worried about bringing a new baby home, I am not worried about high blood sugars, I am not worried about low blood sugars, I am not worried about whether my baby will be too big, and I am not even worried about having a c-section. My life is still full of aches and pains and irritations and exhaustion and minor failures but those don't seem so shocking or new or strange anymore.

Instead, all of the day-to-day pains and irritations are fading away before the extraordinary joy of being present and open to my children each and every day. What's so shocking, strange, new, and exciting now is all of the lovely things they see and do and notice and say. Like when my 4-year-old Pious One starts coming up with math problems in his head and solving them out loud, or when 3-year-old Braveheart courageously "makes a sacrifice" and decides to walk through the grocery store so that his two brothers can sit in the grocery cart, or the fact that two of my little Statesman's first words happened to be "brothers" and "excited." Or when the Pious One tells me, after much careful thought, that he is afraid of death in one way, but not in another. Or when Braveheart proudly declares that he will NOT wet his bed tomorrow night, or the next night, or ever! Or when the Statesman gently lays his head down on my shoulder, sucks his thumb, and gently says, "Mama."

I don't know. These things may not seem that extraordinary to you. I guess they didn't seem all that extraordinary or exciting to me a few months ago, either. A few months ago, I just couldn't wait for them to get to the next phase, or at least get to the point where they just wouldn't NEED me so much. I was so impatient and constantly felt like their needs were dragging me down and I JUST NEEDED TO GET AWAY and HAVE A NAP and SOMEONE GIVE ME AN IBUPROFEN AND TEACH MY KIDS HOW TO DO STUFF FOR THEMSELVES. I've had to make a conscious effort to slow down and work harder at the things that are important: caring for my achy body, being attentive to my diabetes, and addressing all the needs of my children that I possibly can. And then, I do my best not ti worry about all the things I can't do. Sometimes they cry and I can't be there for 10 more minutes. Sometimes I'm absurdly hungry and I just have to wait 15 more minutes until I can get a healthy meal prepared. Sometimes I'm so mad that they did that thing again that I've always told them not to do and this time, one of my mom's dishes is broken all over the kitchen floor and I have to clean it up right at this very moment when the oven timer is going off and oh by the way, my blood sugar is starting to get low. But I've decided I'm not mad at them or my life for requiring my attention anymore, and I'm not worried about all the things I'm not doing anymore. And now, all these anxieties, pains, and irritations truly pale in comparison to the amazing little things that I am seeing in my children's lives. And that has been so, so beautiful.

The only ache that really matters to me anymore is the ache in my heart that I feel for all the ways I've pushed my children away and resented their needs. I wish I could take back all the angry words and all the running away, all the times I rolled my eyes because they were crying again about wanting the same thing that I took away in the first place because they kept breaking it. I wish I could go back and open my heart to them in the past. I might still have had to say no, or left them crying for a long time, or taken away a toy, or done something else that made them upset; but at least I could have left my heart open and avoided treating them like they were the enemies of my happiness. Because they are definitely NOT the enemy of my happiness - they are the very substance of it! For that reason, I also burn with another kind of heartache: wanting to love them more and give them more. I still find there are a thousands of things I want to do for and with them, to teach them, and to say to them. There don't seem to be enough hours in a day. I'm not even sure there are enough moments in a lifetime for it all.

So in the last few weeks, this pregnancy has been very normal in all the ways that I usually write about: fatigue, bodily aches, joint pains, blood sugars, medical testing, etc. But it has been very extraordinary in ways that are more difficult to speak about. The aches are in the heart, and those aches have flowed from an abundant joy that I've experienced in the presence of the very people that pregnancy is all about. Caring for the child within is much easier in weeks like these, when I am able to catch a glimpse of all that's coming for him, and for us together, in the next few years!

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.

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!

Week 19: Insurance Saga, Part 1

Since my husband entered graduate school, our insurance situation has been a bit dicey. It changes every year, every pregnancy, and every new massive-healthcare-law-and-associated-regulations-passed.

With my first pregnancy, I was on my employer's insurance plan. There was a deductible, there was a co-pay, and I'm certain we achieved out-of-pocket maximums that year, but they weren't especially high.

With my second pregnancy, I carried my husband's student insurance plan as my primary and held Medicaid as secondary. Little did I know, but carrying two insurance plans is apparently a *major* pain for your doctors. Also, little did I know, but Medicaid is apparently a major pain for doctors, too. In fact, it's such a major pain that I called 22 doctor's offices and only one of them would accept Medicaid patients. I drive 45 minutes each way for my appointments.

In 2011, at the end of the first year of my husband's Ph.D. program, the school dropped dependent coverage for their Ph.D. students. This was a bit of a crisis for us. I signed up for an "open enrollment plan" through Blue Cross Blue Shield. It cost us $500 per month, and the premium increased by about $50 per year each year I was on it. The deductible was high and the out-of-pocket maximums were high, but fortunately most doctors accepted this plan. Unfortunately, the plan did not cover maternity costs.

So when we conceived our third child in the fall of 2011, I went back on Medicaid. My OB's office administrator confessed to me that it had been such a disaster to bill Medicaid as secondary insurance the last time they had me as a patient that they were no longer willing to do so. Medicaid would have to be primary, or they wouldn't accept it. I had difficulty explaining to the Office of Family Services why my private insurance couldn't really be considered primary for the pregnancy (since it didn't cover maternity). And although I never followed up on all this, it seems to have been resolved satisfactorily to all parties. In the process, I also learned that private insurance pays about $3,000 for a vaginal delivery. Medicaid pays only $900.

When I became pregnant this time, we were expecting that the roll-out of the healthcare law would give us more options. My private insurance premiums had increased yet again, and I was paying $600 per month. I also learned that Blue Cross Blue Shield in Virginia had decided to voluntarily cover all abortions, for any reason, under their new plans. The new plans also all covered maternity expenses, but they were going to cost us more per year than we were currently paying (the difference of about $1,000-$1,500 per year). Given our income level, I would have certainly qualified for a subsidy, but I applied and never heard back. I went on the website twice and got kicked off twice. I've had so many bad experiences trying to get answers from the Office of Family Services about anything that I decided it was not worth the anxiety of waiting months and months and months to finally be told, "Please send us more information about your income," in spite of the fact that I submitted all the information they asked for (and more) the first time.

We finally decided to make the jump to Christian Healthcare Ministries. This means that I will be paying only $150 per month for "coverage," but all my routine diabetes expenses will be out of pocket. This includes prescriptions, doctor's visits, and bloodwork. Unless it is an unexpected complication of my diabetes, hospitalization, or new diagnosis, my medical bills will not be eligible for "sharing" through the program. 

This sounds frightening, but when I calculated the actual costs of my routine diabetes care without insurance, it came to about $7,500 per year. If you add $1,600 for the Christian Healthcare Ministries program to that, it's about $9,100. The insurance premium plus deductible for the plan that I was on already cost about $9,000 per year, and the new insurance plans I was looking at (without subsidy) cost about $10,000 to $10,500. So I will now be paying roughly the same, or perhaps a little bit less. I know that some healthcare providers (pharmacies, etc.) will also charge a little less for people who are paying out of pocket, because then they don't have to deal with crazy insurance company billing rules. I'm hoping that, between these two things, I will at least break even. I also won't be paying for abortions, nor supporting an insurance company which is taking upon itself the task of making abortions seem like routine health care, rather than the intentional killing of another very small human being. 

 

Week 18: Endocrinologist, Round Two

My husband and I recently decided to switch to Christian Healthcare Ministries, rather than signing up for a new insurance plan. This affects the way I seek medical care, because all preventive and/or maintenance care for pre-existing conditions is not covered. (Medical emergencies related to the pre-existing conditions are). This means that trips to the endocrinologist, prescriptions, and routine bloodwork are not covered, and I have to be careful about the way I spend my dollars on these expenses.

Since my endocrinologist has asked me to come in to see him every month ($190), and also have blood drawn each time (not sure how much this total is, but at least $55 or more) for an A1C, this will be a significant burden. I've never thought it was necessary, though I played along as long as someone else was picking up the bill. But that is no longer true. 

Since my endocrinologist fired me at the end of last pregnancy when I wouldn't come in on his monthly schedule, I decided to be up-front this time, and explain my situation. I'm not sure how he'll feel about it, but the diabetes educator I met with at his office today said, "I don't think he'll budge." So here's the note I sent to her explaining our situation, which she said she would discuss with him:

"We signed up for a health insurance alternative called 'Christian Healthcare Ministries.' They don't cover maintenance or preventive care for chronic or pre-existing conditions. If I were only coming 4 times a year, like normal, we calculated the cost and figured this might actually save us money, but coming once a month will cost too much.

"As my doctor knows, I feel very comfortable managing my blood sugars, since I've learned a lot in my last three pregnancies. I would be happy to come every other month (or, perhaps I could come every month, we could do bloodwork every other month, and he could cut the charge of the office visit in half). My OB could also order whatever bloodwork is required, and I imagine Medicaid would likely cover the charges submitted from my OB's office.

"Alternatively, I could see him on an as-needed basis, with whatever waiver/disclaimer he needs me to sign for legal purposes so that he is not on the hook for a bad outcome with my health or the baby's. He knows me well, the office staff is friendly and competent, and kindly accommodates the strangely high number of toddlers who accompany me to my visits. It's always nice to have someone to call when you have strange symptoms or need some diabetes advice. 

"I understand that both of these situations might leave your staff inadequately compensated for the time spent reviewing my blood sugar readings every week, so I am content to forego that service.

"Hope to see you again soon! If neither of these situations works, I'll probably try to find another doctor just during the duration of the pregnancy. But if he'll have me as a client again in July, I'd happily come back."

I tried to understand where they were coming from, but also give a reasonable explanation for how I think things could go during this pregnancy. I really hope he doesn't drop me again, but I finally decided that it would be better for me to be dropped and have to find someone else than continue to pay for services where seem rather unnecessary to me.

UPDATE: They did not drop me, but they did make me sign a waiver releasing them from all liability regarding my outcome or the baby's.

Week 17: Letting Go

I am finally learning to release the anxiety I have about my blood sugars. I am learning that anxiety does no one any good. Every time I have a high or a low one, I take the most reasonable course of action (correction, up or down), and then I wait. I don't immediately start changing my basal and bolus rates to prevent the problem in the future. I try to reflect on what I could have done differently. I observe whether it's a pattern over a few days, or just an isolated incident. And then I trust that whatever will be, will be...and know that the One who cares for us now will not abandon us in trouble. I pray almost every time I feel the anxiety creep up on me, and this has helped.

It is freeing to be able to approach the matter this way. It's still true that I will strive to spare nothing of myself. I will avoid eating those things which I have identified as problematic, and I will avoid eating at times when eating may be problematic, and I will push myself to go out on walks with the kids, and so forth. But I will not worry when all my best efforts fail me, or even at those times when I do fail to exert my best (God's mercy is great!). This way is best.

Week 16: Life Within!

This week marks the first time I felt the baby move this pregnancy. What a relief! I have recently heard two stories of women who miscarried late - at 15 weeks - and was sincerely hoping that my child hadn't passed from life to death inside my womb and was waiting to also pass out of my body. In my first three pregnancies, I felt movement absurdly early: 9 weeks with my first, 10 or 11 with my second, and 10 with my third. So this was normal given the pattern of most pregnancies, but atypical for me. The midwife at my doctor's office suggested that it might reflect a different placement of the placenta (anterior instead of posterior).

I also went on retreat with the Sisters of Life this week. Their work is to promote the sanctity of human life through prayer, but they also run a few mission houses where they serve women with crisis pregnancies and women who have had abortions. Women may come and stay with them during their pregnancies, up to a few months after the baby is born. It's a beautiful work, and you should check it out!

In any case, a lot of mostly hidden anxiety came out about this pregnancy while I was reflecting on my life. There's something about silence during a retreat that really helps to focus your attention on the fears within your heart. That certainly happened for me this week, and my greatest fears these days seem to be about my blood sugars (especially the low ones).

I should probably preface this by mentioning that earlier this week, a few days after Christmas, my blood sugar was very low when I woke up one morning. I became very stubborn when my husband tried to help me. It happened several days in a row, these severe lows, and I was very discouraged by it. It's one of the only reasons my endocrinologist can point to justify why he believes I shouldn't have more children (which is something he says almost every visit). At least I didn't almost drown myself in a bathtub this time, but I think I rather disturbed my spouse!

So lows are a continual challenge. It's interesting to note that it was about the same time of year, same time of pregnancy, when this happened last time around. Most of the time I think that I just need to get better about dealing with the lows (which is true!), and then sometimes I wonder if it really might be wiser not to have more children. I'm not sure the answer is all that clear-cut, given how awesome babies are. But I do know that, at least this time around, I just have to play the hand I've been dealt and manage the lows as safely as I can.

How do you and your family deal with your stubbornness when your blood sugar is low? I told my husband to just keep repeating the same words over and over: "Your blood sugar is 34. Can I help you? Your blood sugar is low. Would you like me to bring you something? Your blood sugar is 34. What can I do for you?"

Week 15: Christmas

After the blood sugar management failure of the last couple of weeks, Christmas was actually a surprising reprieve. I have been dialing back my insulin levels, ever so slowly, to combat the overnight lows. I have been able to bring my eating back to a healthy level, and have not gained any more weight. Fighting through the weakness of hunger can successfully get me through the 2-3 hour postprandial slump, and back into a reasonable amount of energy until the next meal time (or low blood sugar).

This was actually part of our plan all along. We wanted Christmas to be a time for low-stress blood sugar management. We often travel across the country with our kiddos to visit my in-laws for Christmas. It is something we usually all look forward to, especially my husband and the boys. I felt bad, but I made the request that we stay home this year, for the sake of my blood sugars. It's hard enough to manage them when you are pregnant, and hard when you are traveling, and hard during the holidays. The hat-trick of hard is all three, and we've done that twice now. And I've learned, the hard way, that my disease really does need special accommodation sometimes.

Midnight mass on Christmas morning also happens to be a great way to check your overnight basal rates (when you wake up, while you're at mass, and after mass)! (Turns out mine were too high).

Week 14: Advent Was Supposed to Be for Fasting

When we became Catholic, I learned that Advent - approximately four weeks before Christmas day - are supposed to be a time for penance. Almost like Lent, except not that serious. But it's the same liturgical color (purple) and everything! Fasting and almsgiving and preparatory prayers are recommended the same way they are in preparation for Easter.

So this year, I made firm my resolve to abide by the eating habits I laid out a few weeks ago: eat only at regular meal times, normal portions, and when my blood sugar is low. No snacking without a strict need.

Talk about best-laid plans sometimes failing. Or a lot of times failing. I don't know *what* happened, by my lows got really bad over the last few weeks. I have been ping-ponging all over the place. And besides that, I've just been so hungry that I'm eating at all the wrong times. And ugh...all the slow weight gain I was trying to achieve, for the sake of my health and the baby's, exploded from 3 pounds up to 10 pounds when I last stepped on the scale. (I haven't been able to bring myself to do it since).

I have learned a lot about Divine Mercy in the last few years, and God continues to teach me. Failure, in the face of our best efforts, is so painful. Trust in mercy, trust in the Goodness of The Plan, trust in the face of uncertainty and pain is so hard! I am so afraid of and overwhelmed by failure. Each day, the hardest thing I do is resolve to try again, trust in His help, not fear His anger. And so I do. Because caving in to the fear is no way to live.

What do you do when you've failed with your blood sugars and you're afraid to fail again? How do you shore up your resolve to do better next time?

Week 13: Sticking to My Guns

I know it's a little thing, and I probably shouldn't be so bothered by it. A really small thing, and most women probably don't even notice the difference. But I've always been a detail person, and this happens to be a really important detail: the due date.

Very early on in pregnancy, I estimated that my due date was probably June 22. This was based on when I believed ovulation to have occurred (September 28), so it was even more accurate than simply knowing the date of intercourse. Conception, after all, does not often happen on the day of intercourse (unless you have impeccable timing!). Conception occurs when you ovulate. That egg, it's precious. All the sperm are just lying in wait for it to be revealed.

(I don't think I would ever say that out loud to someone that I didn't know. I probably don't know you. This has now become slightly awkward.)

(...)

Anyway, so this is what I had figured out. When I had my surprise ultrasound at 5 weeks, guess what? She said that, by her measurements, my estimated date of ovulation and due date were right on. RIGHT ON. What I heard was: "you are a natural family planning genius."

So I was a bit dismayed that I could not convince the sonographer who did my 11-week ultrasound that I already knew my due date, and that her date was too early (she came back with June 18, based on her measurements). I explained to them about ovulation (I can't believe they didn't know, I can only assume they thought I didn't understand it well enough). I explained to them about the early transvaginal ultrasound (but I'm certain it was in my chart). I even explained to them that my husband is unusually tall, and all of our children so far have been unusually long at birth (my quack theory about why my due date keeps getting pushed up with each pregnancy). Alas, to no avail. It goes in my chart as June 18.

The reason I care about this so much is because I know that at 37 weeks, they are going to start asking me about induction. It's so predictable that it's almost funny, except not, because I've had one, and induction hurts. My children are not born before 40 weeks. They just aren't. And I have a stronger bargaining position if I simply refuse induction until my due date! Oh well. I'm sticking to my guns on this one, bargaining position be darned.

Week 12: First Ultrasound

I had my first ultrasound this week! The sonographer said everything looked great. I had all three boys with me, and they were great, too.

Because I had the boys with me, I asked her not to do ultrasound transvaginally. I thought a transvaginal would a) be awkward with a 4-year-old male child in the room, b) make it more difficult for me to calm the 1-year-old male child in the room with us, and c) not be necessary given the transvaginal I had at 5 weeks and the fact that I was already far enough along to see things clearly on an abdominal ultrasound. I would not have thought this would irritate her, but her demeanor was clearly annoyed by the request. Sonographers of the world, I beg of you: please don't be offended when a pregnant mother of three toddlers asks for a simple favor! We are adults and sometimes even think for ourselves, in advance, about what treatments might be good for us at any particular time!

The other thing I spent a lot of time talking to the doctors about was the genetic testing for Trisomy 18 and Down's Syndrome. I'm very skeptical of prenatal testing, not least of all because of what happened with the Statesman. In the end, he was a very healthy boy who happened to be missing a kidney. So anyway, I guess there's a blood draw they can do between 11-13 weeks that gives them a pretty good risk assessment for those diseases (although it's not a definitive diagnosis). I went back and forth, considering the alternatives, but ultimately decided not to do it. Here's why:

• First of all, it's only a risk assessment, not a diagnosis. This means that there could be a false positive or false negative. Even though these rates are not very high, it's a big heartache for nothing if it is.
• The ultrasound looked very normal - good, even. If it had not, perhaps there would be a reason to investigate further.
• The reason they suggest and push the prenatal testing is so that you have the information, and can be prepared. For some patients, this may be code for, "so you can get an abortion." But I would not kill my child to spare him (or us) pain: that would be an ultimate embrace of the power of death to ruin us. No, not that.
• So there is a value to having information before a baby is born, planning for medical needs, etc. But I realized last time that prenatal diagnoses change and develop many times over before they are finalized, so plans cannot really be made until the third trimester anyway. Not to mention, there are so many things that must be revealed about the child's health that cannot be revealed until birth. In short, we will have to be flexible at birth, whether the child has extraordinary medical needs or not. Only birth will tell us definitively what the needs are.
• The cost. It was going to be $223 to maybe tell me something that might be true, or not, and might help us plan, or not. Since I'm paying for these things out of pocket until Medicaid kicks in? Not worth it! We're happy to live with the uncertainty for a little while longer, knowing that all is in a kind God's hands.

Did you do early prenatal testing? What did you think? And has anyone ever had a sonographer give them attitude about the transvaginal/abdominal choice? Why does this keep happening to me?

Week 11: Thanksgiving

I am proud to report that my plan from last week, not to overeat and to only eat regular meals at meal times or when my blood sugar is low, went swimmingly well over the Thanksgiving weekend. As you all know, this is a tricky time of year.

I also went to visit my endocrinologist this week. He had to think long and hard, and look at me for a few moments, to figure out whether I was joking, when I told him that I was pregnant. After the usual heckling, he asked me seriously:

"Do you all have a number in mind?" (Read: are you ever going to just stop having babies?)

"No, there's no number. We'd like to have as many as we reasonably can. We also recognize that life is highly variable."

Right now, my husband and I are really learning to surrender our lives to our children (ages 4, 3, 18 months, and in utero). We are enjoying them more each day, when we used to spend more time being irritated and feeling inconvenienced by them before. But we are also feeling the pinch and the pain of so much responsibility. Our attentions only go around so far, the crying can really disturb everyone's peace, and we are exhausted and physically in pain and grossed out with great regularity. We are also continually uncertain about whether we are addressing the right need at the right time and in the right way.

So we don't make commitments about the number of children we'll have, because we love them so much but life is also more complicated because of them. The only commitment we make is to love each and every one, to the best of our ability, from the moment of conception onward!

Week 10: Hunger

Morning sickness drags on, but my blood sugars have (mercifully) been very normal. Somehow, they always seem to be even a bit more even-keel during the first trimester. This is either a special grace of God, or a result of changes in my eating habits. Or perhaps both.

As for changes in my eating habits, this pregnancy, I will basically try to do the same thing I did last time: Eat at regular meal times and only at other times when my blood sugar is low. Low blood sugars happen surprisingly frequently during pregnancy, with tight control over my blood sugars, so this really shouldn't be too much of a problem. And yet, I become like a little baby when I feel the weakness of even mild hunger! This weakness strikes about 2 hours after eating, whether my blood sugars are low or not. If I can push past it to 3 hours past eating, I can usually make it to the next meal time without hearing too much feedback from my body.

When I was pregnant with my first son, I was under the tutelage of people who assumed that, whenever you are pregnant and hungry, you should eat. This might be true, if I were willing to eat carrots or celery at these times. But instead, I would eat rich foods, thinking, "if I can't do it during pregnancy, when can I?"

In reflection, I think this was actually a bad idea. I gained 50+ pounds with my first son. He was a modest size, but it was hard to lose the weight, and I was very uncomfortable by the end of that pregnancy. I gained a similar amount of weight with my second son, and he was not in any danger of being too small at birth. This was all well and good, but then I noticed that babies tend to get bigger with subsequent pregnancies. Since I knew my doctors would not be too keen on my having a 10 pound baby (even though I wasn't especially worried), I decided I needed to rein it in a bit.

With my third pregnancy, I worked hard, and kept my weight gain to about 35 pounds. Voila! Healthy, 8 lb 5 oz baby, not too big, not too small. So that's what we're shooting for this time, too.