Thursday, April 21, 2011

Prenatal Visit - Labor/Diabetes Discussion

I had another prenatal appointment yesterday.  These appointments are really much less eventful than you might think.  I step on a scale, pee in a cup, get my blood pressure taken, and let the nurse use the doppler to hear & count the baby's heartbeat.  When the doctor comes in, the only physical thing she does at all is measure my belly.  Otherwise, she usually tells me that we'll start increasing monitoring before long and then answers questions I have.

This time, she said we'll start weekly monitoring at 32 weeks (I'm currently at 23), provided there are no signs that it's needed earlier.  She said this will most often involve going to the office, having me lie down, and hooking up a monitor that will let me watch the baby (for between 30 minutes to an hour).  Every time he moves, I push a button and the monitor will record his heartbeat.  She said that if he's healthy, the heartbeat will speed up during those times.  This is, from what I've read, a "fetal non-stess test."  The point of this is that if my placenta starts to break down too early (not uncommon in diabetic women), they'll start to see signs that the baby isn't doing as well as he should.  That could signal the need for an early induction.  Early induction is something I want to avoid, but this is one of the few likely diabetes related scenarios that I knew early on would be a valid concern.  Possible large baby?  Not an excuse for early induction.  Baby not getting the nutrition he needs to survive and grow?  That makes total sense.  Induce away, doc.

I also finally asked for a few more details on handling my blood sugar and insulin during labor.  I've heard of some doctors and hospitals letting mothers with diabetes manage everything themselves, as long as they let the nurses know what their blood sugar is on a regular basis.  But I've heard of others that want to take the management away from the patient the moment they walk in the door, putting them on an insulin drip and possibly a glucose drip.

But my OB's reaction when I asked, "Will I get to keep my pump on during labor," was:

"As apposed to someone taking it away from you?  Of course."  She clearly thought it was an odd question, so I clarified that I'd heard of other patients not being allowed to manage their own diabetes during labor, that some hospitals demand an immediate insulin drip instead.  She looked slightly aghast and said, "I see no logic in that at all!  No one's going to do a better job taking care of that than you.  The nurses will ask you for your blood sugar periodically, and we'd have to take over if you were unconscious for any reason, but that's it."  (I said, "In a case like that, you feel free!")

We discussed a few details.  For example, she'd normally tell someone on injection therapy not to take their long-acting insulin during labor since blood sugar is more likely to go low than high.  In my case, I'll reduce my basal immediately and watch to see if it needs to be turned off entirely.  Like many hospitals, this one doesn't allow women to eat after they've checked in for labor and delivery.  She confirmed that if my blood sugar goes low, they can give me "something like a popsicle."  (I still plan to stash a juice box or two in my bag, just in case.  Hospitals are busy places, and I want a back-up in case it takes too long for the nurses to respond to a buzz.)

She also asked how long it takes to change my infusion site, in case I had to have an emergency C-section, "because if it's on your belly, we'd have to remove it and that might disrupt your insulin delivery at an inopportune time."  We agreed that the easiest thing would be to wear my infusion site and continuous monitor sensor someplace other than my belly for the last week of pregnancy.  That way it won't even be a concern if I end up needing a c-section.

Which reminds me of yet another doctor's appointment I need to arrange: A check up with my opthamologist.  The perinatologist recommended that, though my control is good and my retinas looked great last time, I should go ahead and get checked out before having the baby.  If I have developed retinopathy, the opthamologist might recommend against vaginal birth if there's much risk of retinal detachment.  Pushing only adds pressure to the eyes, which isn't smart if your retinas are ready to detach!  I fully expect to be told my eyes look great and pushing would be safe, but it's best to know for sure.

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