Tuesday, November 30, 2010

Musing on Gestational Diabetes

For all intents and purposes, this blog refers to Type A1 gestational diabetes only: "abnormal oral glucose tolerance test (OGTT) but normal blood glucose levels during fasting and 2 hours after meals; diet modification is sufficient to control glucose levels"1

photo courtesy stockxchng

So, you're in the sixth month of pregnancy and the doctor says that at your next appointment, you are going to be tested for gestational diabetes. She explains that you are going to be given a drink an hour before blood is drawn to see if you have GD. She doesn't give you much other information. At some offices, you will be sent home with the glucola (sometimes you even get to pick your flavor), while at others, you go in the day of testing, an hour before, and are given the drink.

Let's say you're in the second group, like I was the first time. So, on the day of, you get up and have breakfast as usual. A couple hours later, you go in and you get your drink. You choke it down (I thought it tasted fine, but many women complain of the taste) and then go sit in the chairs to wait for your test. You go to the phlebotomist's chair and she either draws a vial of blood or pricks your finger, depending on the office. You get your bandaid and go home (probably craving something high in protein or a lot of water).

You go in for your next appointment to find out you failed the test. Next, you are told that you'll have to take the fasting three hour test. You are given a date and you fret and worry about what this means. Your doctor assures you that many women who fail the one hour test pass the three hour test.

So, on the day of, you go in, your stomach growling, possibly having a return of the dreaded morning sickness because your blood sugar is so low. They take your blood and send you off with your drink. You choke it down (it's even worse this time) and are informed that if you throw up or consume anything else, you automatically fail and have to do it again. You can have as much water as you want, though.

You go sit in the chairs and read a book or magazine for the next hour, or watch a movie on a portable DVD player. You get your blood taken again. Then back to the chairs. At this point, you may be feeling dizzy and faint. You reach your chair gratefully and try hard to distract yourself against how crummy you're feeling. The second hour takes forever to pass, but you get there and have your blood drawn again. At this point, you may feel irritable and nauseated. You don't want to do this again, though, so you desperately try to not throw up. Just one more hour. Maybe you have some water. You probably need to pee. The baby's hyper and the rolling around and elbowing you in the stomach is not helping your nausea. You pick up your book or movie and put it down, unable to concentrate. You space off. You finally get back to reading or watching and find out that you made it. One last poke and the vampire is done with you.

You bolt from the office right for the nearest fast food to appease the baby, who is sucking all the nutrients from your starved body. Food at last!! You find out at the follow up appointment that you failed. You're told your numbers: 80, 195, 156, 120. These numbers probably don't mean a lot to you, especially since you're devastated and wondering what this all means to you. No more crackers in the morning? No cake at your baby shower?

You're told that you just need to monitor your sugar and diet and see a nutritionist and that there is no reason to worry. You are now high risk and will probably have a huge baby who will need bottles to stabilize him after he's born, but it's okay. The doctor will perform a cesarean to save you from this all if she needs to. You should probably try to pump some milk to prepare if you don't want the hospital to give your baby a bottle.

Now, let's examine what you should have questioned in the above scenario.

"...you get up and have breakfast as usual."

The day of your one hour test, you should be careful about your breakfast. Avoid carbohydrates as much as you can--absolutely no juice or soda pop! If you drink coffee, it should be black. If you drink tea, the same thing. The absolute best thing for you is to only drink water. Even milk is full of sugar. No bananas! They may seem like an innocent fruit, but they are a sugar-spiking fiend in the least diabetic of people! Have some eggs and bacon. Not the healthiest breakfast, no, but you need protein to break down blood sugar in your body. Have a handful of raw almonds, too (or any natural nut of your choice).

"You go sit in the chairs and read a book or magazine for the next hour, or watch a movie on a portable DVD player."

Don't sit! If you have a long drive to the doctor after drinking your glucola, then go an hour early and drink it there. Walk around the office. Jog. Do some light exercise that you would normally do. But whatever you do, don't just sit there. Your body won't burn the carbs properly just by sitting. Don't worry about what other people think about it, lead by example or at least just protect your own body.

If you fail the one hour test still, there isn't a lot you can do for the three hour test, except to remain active throughout, no matter how crappy you feel. You can avoid a lot of carbs the day before it, but you need to keep your blood sugar as level as possible.

Next, know your numbers! The list of numbers I gave before indicates someone who does not have diabetes. In fact, they were almost exactly my numbers. The first is a normal fasting glucose number, then the second is a high spike that isn't an abnormal reaction to the amount of glucola that they give you. The third is one point above fail, which is a faster sugar drop than they are looking for, but they look solely at numbers, not at pattern. The final number is more than just a passing number--it's a pass with flying colors. Again, this pattern should be seen as a sign of insulin working pretty well, but it's a definite fail. If the numbers had looked like this:

95, 200, 165, 145

Then you most definitely have a problem.

Now, it's not a bad thing to follow a healthy diabetic diet with a failed test and to monitor your sugar, particularly if you've had symptoms (extreme thirst, dizziness, nausea) to identify problem areas. Me, I found out that I was waking up borderline hypoglycemic (70mg/dl) if I didn't have a chocolate cake at bedtime each night. Yes, Little Debbie and I had a standing appointment. She didn't spike me and I didn't feel like crap when I woke up in the morning. Win-win. Medicinal chocolate, lol.

Now, where it is dangerous is the assumption that any level of glucose intolerance (including just being intolerant to the stupid test) will negatively impact the baby. Let's start with "big baby".

First, as recently as the early 1900s, a 10lb baby received congratulations to the mother for growing such a 'healthy baby' and a 6lb baby was received in hushed tones and worries about such a small baby being born. Sometimes the mother was even scolded for 'starving' her baby (even though 6lbs is a valid weight, as is 10lbs). Now, the average is 7.5lbs, but that's hardly a cutoff. After all, women can birth nearly 14lb babies naturally.2 Many women that I've known report that their bigger, 9-11lb babies were actually easier than their smaller (6-8lb) ones! Not always, of course--my best friend's mom had problems with her nearly 12lb baby in that she tore six ways to Sunday, but her others were 11-something, 10-something and a couple of 9lbers and she didn't have problems.

A lot of the worry about big babies comes from shoulder dystocia. This is a very rare complication that can occur in babies of any size, but is considered higher risk in babies of larger sizes. The true risks of shoulder dystocia include: malpositioned baby, mother in the lithotomy position or otherwise on her back and/or tailbone and any monitoring or drugs that limit mother's movement (if you're going to get an epidural, make sure it's the lowest dose they can do or that it's turned off long before pushing!). If you suspect a large baby, it's important to have a provider who knows the Gaskin Maneuver,3 which has been shown quite successful and is pretty easy--just roll mom onto all fours. From that position, if baby is not released by the act of rolling over, some otherwise difficult maneuvers become much easier to perform to attempt to dislodge baby. If unsuccessful, mom can be rolled back and the usual "nurse jumps on the fundus" maneuver that most OBs use exclusively, can be performed. This is very dangerous for the baby, so it should be left as a last resort. However, a cesarean is not needed in most cases and never to just prevent the possibility of a rare incidence.

If you're worried about a big baby and tearing--let me tell you, as someone who's had both a cesarean and a terrible, messy tear with my VBAC, that a tear is preferable to recovering from abdominal surgery. Especially with a dependent infant!

The next risk for a baby in regards to gestational diabetes is elevated blood sugar leading to crash at birth. If mom's sugars are well-regulated, this isn't actually a risk. Some researchers believe that much of the elevated sugar accompanied by no symptoms is actually natural stores in the maternal bloodstream as backup for the baby and doesn't actually go to the baby.4 However, in cases of controlled sugars, there is no excess to cause the spike that leads to the crash and it's more likely that the fasting during labor may be a bigger risk to the baby (eat during labor, ladies, regardless of 'hospital policy' or diabetes status! It matters!), leaving baby born with low blood sugar. Bring baby straight to breast from birth to help with this.

The real risk of being diagnosed with gestational diabetes is that your chances of cesarean skyrocket because management may lead to risk factors for pre-eclampsia. Also, many women are not properly counseled or are told to "avoid carbs" (very dangerous for both mom and baby! Diabetics take in more carbs than you are probably aware!) or go straight on insulin (also dangerous, as taking insulin with no need can lead to an insulin coma).

So, before you just blindly consent to the test, ask your doctor or midwife what options are available. If you are in a low risk category, request being allowed to skip. If you cannot, ask what other forms of testing are available that would be easier on your body and your baby if you fail the one hour test (and do not consent to the fasting one hour test--it's outdated). Find out how your practitioner will respond if you fail the tests and if they start talking about cesareans--get another doctor. I still, to this day, regret not following that advice. Also find out hospital policy as to what they will do to your baby, particularly if you plan on breastfeeding.

In the end, non-insulin-dependent gestational diabetes is really not a cause for concern--at least not regarding birth. Don't freak out and don't let yourself be 'managed' into unnecessary surgery.

Like many women, after I was diagnosed with gestational diabetes, I never showed any symptoms and my sugar never spiked into the danger zone. The worst it got was after my baby shower, where I had ice cream cake, fruit pizza and bread rolls. It was no higher than expected in a non-diabetic after that fair, either! My baby was the exact same weight at 42 weeks as her sister at 39weeks, 6 days (who I did not have GD with).

Knowing this is important as well to know that not all women diagnosed with GD are at risk for Type 2 diabetes, despite the media hype to the contrary.

If you'd like to avoid the risk altogether, you might consider Dr. Brewer's Diet which is available for many dietary needs.

1.Gabbe S.G., Niebyl J.R., Simpson J.L. OBSTETRICS: Normal and Problem Pregnancies. Fourth edition. Churchill Livingstone, New York, 2002
2. CTV News: B.C. Family Welcomes Very Big Bundle of Joy
3. The Gaskin Maneuver and The Farm Midwives: Dystocia
4. "Gestational Diabetes: Myth or Metabolism?" by Joy Jones, RN (p. 59)

Friday, November 26, 2010

You're Doing It Wrong!

Men aren't as helpless as most women think. And the helplessness they display is not imprinted on the Y chromosome, no matter how much we've convinced ourselves otherwise. The fact is that men are trained to be helpless--usually by the very people who most want their help: women.

I'm not talking about domestic duties (although many men act like the trash magically gathers itself and that they might blow up the washing machine if they have to try to use it) but in being an equal partner in parenting.

Now the defeatism usually starts in that first year when most babies are programmed to automatically want Mommy for everything. If Mom's breastfeeding, this typically means that when it comes to feeding (which, in the first two months, seems to be every waking moment!) Daddy IS helpless. The things he can do at those times promote more of a bond with Mom than Junior (and is that a bad thing? Staying bonded with Mom?). However, feeding is hardly the end-all of parenting a new baby and most women don't breastfeed or at least don't do it exclusively. Dirty diapers are not the only other thing that babies need taken care of, either.

However, the really defeating thing comes when Mom says, "Here, let me do it." There's a learning curve, ladies! We had to do it, so does he! Also, guess what? There's not just one single way to do everything.

I know that's hard to hear. It's hard for me to deal with, personally. I hear my husband taking care of the kids and I want to run in and correct this or that and despite what he'd say to the contrary, I actually have been practicing restraint lately and letting him just do it.

Now, some things, he's always been a pro at--like diapers and dressing the kiddos--but he had an advantage: a baby sister. I was the last born in my immediate family and until I was holding my own, I never touched a new born baby. My sister called me in to help out with her second and I loved it, but she was already a few weeks old before I actually held her. I did learn some tricks to colic, though, that were nice and useful! But for real baby care, of course she did most of it and mainly when I wasn't there.

My husband, however, was right there with his little sister for it all. He even did his share, since he was an older child when she was born. So he came with more confidence and expereience than the average man--and yet, he was just as nervous as any new father and felt just as clueless as to what to do with himself.

Now, I'm not going to sacrifice the baby by just leaving her with him (she was a nursing maniac and wanted nothing to do with him, poor guy--it's no wonder he ended up feeling helpless!), so he didn't get thrown into the deep end like many men who become baby pros do.

It was really later, though, as he was building up his confidence because she started wanting to spend time with him (as everyone had assured that she would!) that I started breaking it down. Correcting small little things, "Oh, I don't do it that way." "You're taking too long, let me do it." "Oh, no, you're doing it wrong!" I don't know why. I just don't seem to know how to walk away and let him do it, so I hover and watch, (which, let's admit, is like watching someone with a different video game style playing--you want to take over and show them how it's really done). Instead, lately, I've started forcing myself to find other things to do when I've asked him to help out or if the kids have asked him.

But it doesn't start when baby comes home. It starts long before that, when our husbands were boys and somebody's sons. First, the gender boxing. "Boys can't wear pink." "Boys can't play with dolls (and if they do, we must call them action figures)." Boys even often get kicked out of playing house in pretty much all forms. They might wander their way into a play kitchen.

Now I don't know if this attitude is as widespread as it was when I was a kid, because I live in this neat little bubble where the vast majority of my friends are against gender boxing. I still have some that were raised with and cling to the idea of boys toys vs. girls toys, but they are the minority now.

This continues later as boys grow into young men. Girls in the family are often sent to look after siblings and do domestic duties while boys are sent to look after cars and do yard maintenance (which leads to the feminine version of helplessness where women think they can't change a tire or mow the lawn). It's becoming more popular to let boys in on the domestic duties (especially since most major chefs are men and men need to pick up after themselves, too) and teach girls car care, but mainly, boys are still not included in the child care development.

This discrepancy can really be seen in one of the first teen jobs: babysitting. Now, while I know parents who'd take a boy babysitter who's known to be responsible, this isn't true in most homes. Even most homes who say they'd hire a boy to babysit, if offered the choice between two inexperienced teens, one male and one female, they are going to pick the girl. Women are just identified as more nurturing and boys are held with the misandrist view that they're unpredictable and dangerous.

I happen to know someone who's first husband lost his virginity to his babysitter when he was 10. So, uh, yeah... nurturing... And yet, more people would be horrified if the gender was reversed--somehow, it's okay for a 10 year old boy to decide to have sex with a 16 year old girl, but the other way around? They're both statutory and they're both just as harmful for the 10 year old.

But that's beside the point. This all leads to men having less training when the kids get in in a lot of homes, but certainly not all! I've seen homes where the women had less experience, most definitely. Sometimes even in these, though, the men are made helpless by that mama bear instinct.

It bothers me a lot when a group of women is talking about their husbands and one brings up a situation she wants to change where the group response is, "What do you expect? He's a man!"

That is just as wrong as a woman going into a new profession, stumbling and having the men say, "What do you expect? She's a woman!" Oh, there the tempers fly! Misogyny cannot be let go, but blaming a gender for the inefficiencies of its individuals who happen to have a Y chromosome? That's fine. Actually, that's called misandry and it's not fine.

It's damaging. It damages the men who are just left to flounder, unaware that they could learn the very skills they have been told men just aren't any good at. It damages our sons, who hear this garbage and grow up believing that's just how it is. It damages marriages who crumble because women have been taught that they're supposed to do everything. It damages women who really are left to carry more burden than they can handle and don't know that it's okay to ask their husband for help and to let him learn and let him make mistakes. We made them, too.

Yes, sometimes we had our mothers, sisters, aunts, random other women in our lives standing over us and correcting us. But most of us have the strength to say, "I'm glad that worked for you, but this is what works for me." Men aren't taught to communicate that way. Most end up angry, hurt, resentful and not knowing how to express that in a way that doesn't blow up in their faces or just assuming that they really can't do it.

Obviously, not all men are like this, just as not all women are. But this is the average family. And it doesn't have to be.

Men can wear their babies, dress them, bathe them, give them solids when they're six months or older, play with them, do tummy time and Gymboree with them. Oh, yes, they can! They can hold them close and make rumbling noises in their chest that we can't and that babies find soothing. He can take Junior to the potty in a super-hurry because she's got to go NOW! He can gather up toys and decide how the playroom is arranged and pick out the kids' clothes (and it's not the end of the world if his fashion sense is different from ours). He can wipe their face differently, he can put their socks on after their pants and their hat on before their shirt and it still all ends up on there. He can brush their teeth and play video games with them, etc.

Dad can do it. And if we're lucky enough to have a husband who wants to (even if just to try), or even is just willing to try, we darn well need to let him.

Friday, November 12, 2010

Breastfeeding Isn't Easy

I see comments all the time about how "it was just too hard" as though the mothers who continued breastfeeding had it easy. Because sore nipples, plugged ducts, mastitis, feedings every 1-2 hours, dealing with flow issues and upset tummies as a result, worrying about supply because there's no ounce markers, having to change one's diet to adjust for baby's intolerance(s) or allergies, feeding sessions lasting up to three hours, cracked nipples, bleeding nipples and blood blisters, scathing remarks/glares if we dare feed our babies out of our own house and in some cases, supplemental feeding systems... are easy?

Honestly, though, who said parenting was easy? And taking shortcuts may not be cheating in the traditional sense, but it cheats baby out of the benefits of the standard of care. Not just nursing, but in all aspects of parenting. "You aren't managing a convenience, you're raising a human being."

045.jpg kisses picture by Xakana

I'm not looking for your story about why it was so much harder for you than my friend who doesn't make 50% of the supply she needs to exclusively nurse and yet doesn't use bottles. Or me, who had a baby who screamed at the sight of my breast, weak suck, latch issues, one side preference, etc. Or blood blisters, choking from overactive letdown, living in horrible pain postponing surgery to get to a point where my baby would have enough of my milk to get through it... Or the mom friends I have with PCOS. Or those who've had to adjust their medications for breastfeeding-friendly ones. Those who live in daily pain trying to reach a minimum goal of nursing before going on medications or having surgery that would make it all better.

I've heard all the stories and I know moms who really couldn't do it (I have friends that even I would have/did encourage to stop for both mom and baby's sanity/health) and moms who did it when no one else believed they could--because they refused to take "no" for an answer.

The whole point of this is that it's NOT always easy with floods of happy hormones. I don't enjoy nursing. I enjoy the benefits, sure, and how deliriously happy it makes my kids. I don't notice any "special bond" or go to la la happy hormone land. I don't do it for me.

Inspired by HeidiLJ

Less than 2% of women don't make enough milk to exclusively breastfeed. That doesn't mean they shouldn't breastfeed at all, just that they need to supplement. Even that can be done at the breast now. Less than 5% can't do that for other reasons (mastectomy, medications, psychological trauma, etc.). But the number of mothers who bottle feed is closer to 40% that goes up the closer to a year you get. The number of women who nurse to the recommended 2 year minimum is only like 12%.So those who even make it half way (one year) is only like 35%. So all of those women have a reason to be proud--out of the 93%-95% that should have nursed that long, they were the ones who did. I'm not saying that bottle feeding is never okay or even necessary! I'm just saying that parenting isn't easy and there are more options than most people even know!

Friday, November 5, 2010

One Becomes Many

Every one counts. Sometimes, when we try to share the information we've learned, even if it's lifesaving (such as simply sliding up the chest clip on an infant in his car seat or pulling the straps tight), it's rejected. And sometimes, someone thanks you because they just didn't know. Other times, you receive no thanks, or even get cursed. Some of those people think angry thoughts about you for a little while and forget you forever after. Others are angry until they realize that what you said is not only true, but that you only meant to help.

Dr. Martin Luther King, Jr. once said, 'The first question which the priest and the Levite asked was: "If I stop to help this man, what will happen to me?" But... the good Samaritan reversed the question: "If I do not stop to help this man, what will happen to him?"'

Recommending "first do no harm" is so often met with disdain, sarcasm, dismissal, defensiveness ("Well, that's the way it was for me and I'M fine!"--often from people who are anything but) and outright hostility. It makes no sense and it's discouraging. Sometimes one wonders why to even keep trying. Well, with much thanks to Danielle at Peaceful Parenting for sharing a story that explains why we do keep trying, I'm passing this story along:

Image courtesy ~foureyestock

From The Star Thrower by anthropologist and writer, Loren Eiseley (1907-1977)

Once upon a time, there was a wise man who used to go to the ocean to do his writing. He had a habit of walking on the beach before he began his work.

One day, as he was walking along the shore, he looked down the beach and saw a human figure moving like a dancer. He smiled to himself at the thought of someone who would dance to the day, and so, he walked faster to catch up.

As he got closer, he noticed that the figure was that of a young man, and that what he was doing was not dancing at all. The young man was reaching down to the shore, picking up small objects, and throwing them into the ocean.

He came closer still and called out, "Good morning! May I ask what it is that you are doing?"

The young man paused, looked up, and replied, "Throwing starfish into the ocean."

"I must ask, then, why are you throwing starfish into the ocean?" asked the somewhat startled wise man.

To this, the young man replied, "The sun is up and the tide is going out. If I don't throw them in, they will die."

Upon hearing this, the wise man commented, "But, young man, do you not realize that there are miles and miles of beach and there are starfish all along every mile? You can't possibly make a difference!"

At this, the young man bent down, picked up yet another starfish, and threw it into the ocean. As it met the water, he said, "It made a difference for that one."

Note: This is a true story that Eiseley wrote about. He was the 'wise man' walking the beach before his morning writing session. He encountered this young man throwing starfish back into the ocean and was forever impacted by the experience. His story is told in many forms, in many places - but rarely is credit given to Eiseley as the original author and subject of the narrative.

Another discouraging thought many people have is: "How does my voice matter? I'm only one person." This is from anything in life that we want to see change. Yes, you are one person. Just as the person who shared their knowledge with me was just one person. Now we're two. From there, many hear our words and if just one person listens to each of us, we are four. Then eight. Sixteen. Thirty-two. I think you can continue the math. Rarely, though, does one person only affect one person.

Look at a teacher in a classroom--a typical classroom of an average of 20 students. Every year or even twice a year if high school. For twenty years of teaching, that is 400-800 kids. I had a microbiology teacher who imparted life wisdom that was actually usable in addition to the science. He taught me about Shettles and delayed cord clamping and the importance of avoiding debt (except for home ownership) because he thought it would be interesting to us. I don't know how many of my classmates listened, but I did. I pass that information along to people who pass it along.

One person is only one person when their voice is silent. Gandhi said, "Nearly everything you do is of no importance, but it is important that you do it," and "Non-cooperation with evil is as much a duty as is cooperation with good." Voltaire said, "Stand upright, speak thy thoughts, declare The truth thou hast, that all may share; Be bold, proclaim it everywhere: They only live who dare." As well as, "The instruction we find in books is like fire. We fetch it from our neighbours, kindle it at home, communicate it to others, and it becomes the property of all." Dr. King said, "History will have to record that the greatest tragedy of this period of social transition was not the strident clamor of the bad people, but the appalling silence of the good people."

They were all "one person." I'm not saying that we will become famous for spreading the information, just that "one person" doesn't mean a lot, because all groups are made up of a lot of "one person".

Almost always, the creative dedicated minority has made the world better." -Dr. MLK, Jr.

"Be the change you wish to see in the world." -Mohandas Gandhi

Monday, November 1, 2010


Today is my 6th year wedding anniversary with my husband. We have been a couple for 9 years now.

When I met his home for the first time (don't seem to have any scans of us together when we first met):

a pic of him when we first met, before the one above:

When I brought him back here:

Our wedding (handfasting):

guest book:

The altar (each bowl had one of each element: air, earth, fire, water):

water, fire, earth, air:

Me, the bride (that's a parrot play gym we built from PVC in the background, lol):

The women of the wedding (back: two bridesmaids, me, my maid of honor. front: my nieces: jr. bridesmaid and flower girl)

The men (and female groomsman--DH's little sister) of the wedding: Groomsmen, best man (DH was his best man, too) and groom:

fire's moment in the ceremony:

our hands, tied (how many people actually 'tie the knot?' LOL):

The kiss:

and the cake: