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Saturday, May 14, 2011

Sugary Mess - Part 1

So, the past couple of months have - shall we say - stressful as far as my prenatal care is concerned. I've told some people bits and pieces so here's everything that's happened:

The week before my OB was going to the 1 hour screening for gestational diabetes, I asked the doctor I saw that day about skipping it. I was told it was mandatory. I assumed that meant if I didn't get go through with it, they'd drop me as a patient and as much as I'd like to say I wouldn't have cared, from all the research and all my (limited) options for a vbac, I was at the best practice - and hospital (which is very important too) for what I wanted. I should have asked the doctor to elaborate on what they meant by "mandatory".

The next appointment came, I drank the nasty glucose drink and had to wait an hour before getting my blood drawn. In the meantime, I saw a different doctor (as they like to rotate so you can see all doctors - in my case, only 3 total - before delivering). I spoke to this doctor about how I wasn't thrilled about having my hemoglobins checked every other visit as they routinely did if there was no other concerns pointing to that need. I explained I just wanted everybody to be on the same page and didn't wanna surprise the nurse again by refusing it and could we come up with a plan to put a different schedule on my chart. I wasn't opposed to checking - but every other visit seemed a bit much; especially when I'm paying for it. The doctor agreed and said we came up with a plan. This doctor seemed very open in saying, "I don't want you to ever feel bad about refusing a test. There are very little things that are mandatory. If you refuse something, we just have to document it for our own safety (lawsuits...yeah, I knew that)." I then explained I was told the previous visit that the glucose test was mandatory. The doctor replied, "Well, that's probably not the best word. Yes, we recommend it. But we've had other women refuse it. If you want, you can refuse the blood draw. But since you've already drank the drink, why don't we just see where you are?" I explained that even if I went ahead with the 1 hour, no matter the results, I'd refuse the 3 hour. He didn't so much blink an eye at that.

I was very concerned that IF I went ahead with it and IF, for some reason, it came back indicating I had gestational diabetes, they wouldn't be as supportive of my vbac. The doctor assured me that wouldn't happen. So, what did I have to lose right? I went ahead with it.

But I didn't want to. I'll explain why later.

A couple days later, the nurse calls back to tell me I didn't pass the 1 hour screening and needed to take the 3 hour test. I told her I didn't want to. She explained "this is how we do things". I told her I understood but I had spoken with the doctor and I didn't want to take the 3 hour test. She asked which doctor, I told her, and she said she's speak with them and call back.

A week later, the nurse calls back. She says the doctor told her they believe I should go ahead with the 3 hour test and would I like to schedule it. I replied, "No, I would not". She then said, "Ok, the doctor said if you said that, they want you to come into the office and speak with them."

What?!

At this point, I'm thinking the doctor was backtracking. Now I REALLY didn't want to do the 3 hour test. Because even though they previously said they'd still support my vbac, he also said I could refuse the blood draw from the 1 hour screening. And if I had just done that, no one would be any the wiser and we would be going along our merry way. So how am I to trust that they'll REALLY be supportive of my vbac if the 3 hour test results come in as unfavorable?

I asked Septtro to come with me - hoping that would help the doctor know I had his support and I wasn't just some crazy woman refusing tests left and right at the risk of my baby.

When we saw the doctor, he had a VERY different tone. He went on to say that he just didn't understand why I wouldn't want to go through with the 3 hour if all it would do would benefit my baby. I explained that, with a toddler, it's not exactly fun to find a sitter for very early in the morning for several hours AND have to go without eating for half a day while pregnant. I went through that with Ri's pregnancy and it was not fun - oh, and I passed by the way. Not to mention, I don't want anything permantly on my medical charts such as "gestational diabetes" that could somehow affect my future births. I don't know how insurance or laws may change in the future. And I don't want a diagnosis (that I don't feel is accurate - like I said, I'll get to that later) preventing me from doing what I feel is best for my health and the health of my future babies. I also said I had done research and didn't find any significant risks to not going through with the test. The doctor's reply??? "The risk is that your baby can die".

Wow.

The doctor went on to explain how if gestational diabetes goes untreated, the baby can be too big and their shoulders can get stuck (shoulder dystocia) and they can suffer permanent damage to their shoulder and/or arms or even die. (Scuze me but have you ever heard of the Gaskin Maneuver? Not to mention, there are MANY reasons for shoulder dystocia (although many times, it cannot be prevented) - including getting an epidural. But do they warn women of that before administering the epidural? I know I wasn't. (source)

So we went back and forth as pleasantly as possible until I finally said, "Could I just monitor myself at home?" This is what they would ask of me anyway (as well as going to a class on gestational diabetes and having a nutritionist give me a strict diet) if the 3 hour test came back unfavorable. "Sure" was the reply, and then "but I would just think that'd be more of an inconvenience than doing the 3 hour test". I explained that if I could eat my normal diet, not have to find a sitter for my child, drive over to the office an extra time, and not fast for half a day, I found that to be much more convenient. He said he'd like to see the numbers for a week. A week? "Interesting", I thought, "as your office relies on a one-day test before slapping the label of gestational diabetes on a pregnant woman. A test that gives a sugar shock to a pregnant body and isn't even close to their normal diet." Oh well, I can prick my finger four times a day for a week...no biggie.

My next regular appointment was less than a week away. I went to the local pharmacy and got a glucose monitor that was on sale. I didn't open it as I wanted to speak with the doctor (a different one, again...the 3rd one) about how exactly how they wanted me to go about this at home.

Almost immediately upon this third doctor entering the room, he asks, "So what are we going to do about this glucose test?" I replied that I wanted to monitor at home. He didn't seem too thrilled with that idea. He went on to explain that "this is standard practice with OBs across the country". Excuse me while I don't currently agree with "standard practice". "Standard practice" used to be to completely knock out a laboring woman, automatic enema, shaving....

That's another blog.

This doctor's tone was very harsh, I might go as far as to say, condescending. I was then told that if I wanted to do self-monitoring, that I would have to do it the remainder of my pregnancy. I explained I was previously told a week - to which I don't remember getting a reply. I asked why, if my glucose numbers on my normal diet looked good, would I need to continue monitoring the remainder of my pregnancy. "Oh, because, for instance, at week 24 your insulin levels could be fine but then at week 28, they could be higher". This is true because of the placentas role during pregnancy as well as increased blood volume.

Interesting. So I asked, "Well then what about the women who pass the 3 hour test at 24 weeks. You don't ever test them again."

"Right, but in those cases, their urine sample would indicate something was up".

Oh. So my urine sample wouldn't? I didn't ask this. Like I said, he was very harsh. And I was by myself. He had on scrubs...and a shiny stethoscope! What did I know?

I think towards the end, he was starting to get annoyed and said, "If you don't monitor at home the rest of your pregnancy or do the 3 hour, that will affect how quickly we pull the trigger during labor". Thanks doc. That's super-duper encouraging!

Honestly, I didn't wanna monitor for the rest of my pregnancy. That really wouldn't be all that convenient. I wish I would have, though. I just felt like he was trying to make any alternative other than the "standard practice" of the 3 hour test such a pain, that I would ultimately choose the 3 hour test. So...I did.

I never was eating a lot of sugar during this pregnancy...I prefered fruit. In fact, for my birthday, I asked my mom to make fruit salad in lieu of cake. Especially because I'm at home, my food choices are limited and have been much better than with my pregnancy with Rilynn. I always eat whole grains, usually a snack consisted of an apple or some yogurt, I walk about 6 miles a week, I've gained near 20 pounds less than I did at this point with Ri, and I drink mostly water. The week before the test, I completely cut out sugar and tried to eat as much protein as possible.

I went in for the 3 hour this past Tuesday morning. I got dizzy and felt very sleepy. But thankfully, the time passed fairly quickly. Wednesday evening around 5:00, the nurse called. I failed.

And I lost it. I didn't expect that. And I didn't want that label.

The nurse said my first number (fasting level) was good. But after I drank the drink, my levels shot up REALLY high. Shocker...my body had nothing to eat since 9pm the night before and hardly gets sugar and then all the sudden, gets a drink full of it. Well once that number was that high, I was shot. There's no way the other two numbers could come down fast enough to be within their range limit. I never did get my 4th number but she said because my 2nd and 3rd numbers were too high, it didn't matter.

So...that's what's happened so far. I have a lot more to say about how I feel about GD after researching it from various sources...but that's another post. And then there's how I'm handling this in my relationship to Christ. That's another post too. :)

1 comment:

Terra Jones said...

Oh Susan. I'm so sorry you're having to deal with all this. It's bad enough how we have to fight tooth & nail for a VBAC along with every other "Standard test" they throw at you.

Praying for you sister.