My Tips on how to approach maternity with diabetes
I recently met a woman who confided that she had avoided serious relationships with men because she believed her diabetes prevented her from having children, at least safely. When she discovered that I was pregnant with my third child, she wept with a mixture of sadness and joy. It makes me sad we could be in 2008 and that women are still getting the wrong information about pregnancy.
Everyone, at least to some degree, understands the miracle of birth, but I think maybe women with diabetes appreciate that miracle a little bit more. On Tuesday March 25, 2008, at 3:17 p.m, my husband, John, and I were thrilled to welcome a new little bundle of joy into the world. Our son was born very early – at 30 weeks – and has been progressing well – we feel very lucky. We're still trying to figure out whose lips and ears he has. He grows a phenomenal amount everyday and we sit and stare at him for hours on end in the ICU where he will be for about six more weeks.
John and I are super grateful to be living in a time when women with diabetes are not discouraged from having children, and that medical science allows for a complicated delivery like ours with a remarkable amount of assuredness.
The pregnancy both taught and reminded me about a few more things about diabetes care in America; some good, some not so good. To start, the good: It's much easier today, with continuous monitoring (see Test Drive in diaTribe #5) and frequent blood glucose monitoring, to get one's A1c down (as low as possible) in order even to get pregnant. Our blood glucose numbers can't be perfect all the time, but we sure as heck can fix it when it goes awry so we minimize the time spent outside our glucose target zones.
So better monitoring is a plus. On the negative side, figuring out how much insulin to take still isn't easy - harder still with the biological changes of pregnancy. The insulin issue can be especially challenging in the hospital. Hospitals, even great ones, definitely have different views of tight glycemic control. One of my nurses walked in one morning and said, “Looks like you had a great night, all except for this one low. Your blood sugar went to 86 mg/dl.” All I could do was nod and smile and then splutter: “Low! 90 is my goal! That's not low!”
Here are some tips from the maternity trenches:
If you're on a pump, try to refine the programming (basal rates, insulin/carb ratios, etc.) as much as possible before you get pregnant. This will make additional changes easier after the pregnancy begins – though things will change throughout, sometimes daily!
You have to ask questions and ask for clear answers. That may sound obvious, but I was surprised on this front.
You don't have to let hospital staff take over your blood glucose control, and if the hospital has an insulin protocol, ask what the targets are, and how often the protocol will be changed. Know that if you have good records, you can disagree with them. By discussing your reasoning with them, they may modify the protocol.
If you are on an insulin pump and the hospital wants to put you on IV insulin, you might be able to use the IV for basal insulin and dose the mealtime insulin yourself, if you have the right experience. I found this comforting, because it meant I could keep my pump on and more easily do corrections as well as properly cover my meals.
At some point, you have to trust your healthcare providers, particularly your diabetes doctor. You are literally entrusting them with your own life and that of your baby. If you don't feel totally confident in them, now is the time to talk to them and address concerns you may have, or start seeking out a new team. You may even rest easier finding a long distance team that can advise you and help you optimize work with your local team – in particular, we recommend calling Gary Scheiner and team at Integrated Diabetes Services (www.integrateddiabetes.com, 877-735-3648).
Know that pregnancy can be beyond difficult and ask for patience from those around you – goodness knows I needed it and was so lucky to get it!
Our last big of news - we had one other challenge: finding the right baby name, one that would complement the names of our first two children, Coco and Lola. We cycled through a wide range of options – from William to Throckmorton – but finally chose one that, translated, means “strong, healthy.” We think it's perfect. Hail, Valentino. And God bless every miracle.
So from John, Coca, Lola, Valentino, and myself, we say: