Difficult conversations

By | 12 December, 2012

Whatever medical condition I have I like to get a good understanding of it. How does it work, why are things happening, what are the pros and cons of all the options for treating it? I’ve always seen this as critical to successful diabetes management.

Open conversations with medical professionals are key to this. I need to be able to ask questions about what’s happening and why. The answers help me understand what’s going on and inform my decisions.

Taking this approach to pregnancy is proving challenging. There seems to be a default setting that means any question you ask will be construed as you either having a positive desire to recklessly put your unborn/newborn baby in danger or for you being completely unable to cope with the concept that birth is a natural process and mightn’t go to plan. No, I’m just trying to understand what’s happening here. Calm down and listen to me.

I’ve got a few questions about the birth. You’re only 17 weeks, we’ll discuss that much later on. But it’s worrying me now, and I want to discuss it now so that I have time to think things through, do more research, discuss it with my husband etc. And if we’re going to be picky you asked me at 6 weeks if I intended to breastfeed, so chronologically, you’re ahead of me anyway. Well we can’t say what will happen at your birth, it’s too early. I know, but you can talk me through the decision making process you use so I can get a feel for what happens, when and why. Well yes, I suppose so. Thank you.

What’s your policy on inducing diabetics? You’ll be induced at 38 weeks. End of conversation. How helpful. So I asked someone else, this time slightly differently. What decision making process do you go through to decide when to induce? We look at the size of the baby, and also other signs such as blood pressure, protein in urine, scan results which may indicate the start of an issue with the placenta. Ah, that’s more helpful. Now I understand how you make the decision and why. And lo, no babies were harmed by us having that conversation.

What percentage of your inductions end up in an emergency caesarean? If baby is in danger you’ll have to have a caesarean. Oh, and here was me willing to let my own child die just to avoid a scar. I’m just trying to get a feel for how often that happens, so I can manage my own expectations of what could happen. Is it likely, is it rare? Well we only do them when necessary. I’m sure you do, I’m not accusing you of doing them as a hobby, I’m just trying to get some perspective on what’s going on. It really would be helpful if every question wasn’t treated like I’m deliberately trying to put my own child at risk.

How do we manage my diabetes during the birth? First answer – you’ll be put on a sliding scale drip. Ah, and you do that with everyone? Yes. So I asked a different Dr. Oh, you seem to know what you’re doing and you’re on the pump, if you want to manage it yourself you can and if you end up too high and can’t get it down, we’ll put you on a drip. That sounds more like it, thanks. It’s a shame I feel like I need to ask that question 3 more times to make sure I get a majority view.

Would you recommend expressing colostrum before the birth to give to the baby immediately after birth for its first feed? If baby’s blood sugar is low it’ll be given dextrose. OK, but what if it isn’t low and just needs food? Why are you opposed to giving it dextrose? I’m not, just that if it’s not hypo my understanding is that it’d be better off with a decent meal of breast milk, and the experience of others seems to show that sometimes the quickest way to get that in is by expressing it pre-birth and then feeding it to the baby. Thus reducing the risk of a subsequent baby hypo. Well, I suppose so, but if baby is hypo it’ll have to have dextrose. At which point did I say I wouldn’t let that happen? Calm down and listen to the question, I’m just trying to understand what’s going on here.

Can we please just have a normal, grown up conversations? You listen to my question and try to answer it, that kind of thing? I’ve learnt that midwives are much, much better at this than Drs. They’re now my first point of contact for any question, and then we refer up to the Dr if required. Why didn’t I start with this approach you may ask? Because at 17 weeks I said to the Dr “am I ever going to see a midwife again, I think they might be able to answer some of my questions?”. Apparently I should have been seeing one as part of every clinic visit, but somehow that wasn’t happening. It’s always worth asking the question. Sometimes you actually get a useful response.

14 thoughts on “Difficult conversations

  1. Melissa

    That really puts a general frustrating conversation with a GP into perspective!

    I’m amazed by your patience with doctors who don’t seem to be listening. Here’s hoping you’ll get to talk to midwife (and/or sane doctor) soon!

    1. Alison Post author

      Interestingly, I actually think my team are quite good, but there seems to be a general problem with having sensible conversations about stuff they can’t give a firm answer to. I nearly didn’t publish this because I wondered if it was me being unreasonable, but I’ve read very similar things from 5 different people on other forums regarding trying to have conversations about birth. It seems to be quite a common problem, and a bloody irritating one at that!

    1. Alison Post author

      @joy114 I was so tempted to do that just for entertainment purposes. But then decided it was probably cruel and with the morning sickness I didn’t really have the energy. When they asked me where I wanted to give birth, I did tell them I didn’t realistically think I had a choice – they agreed, but said they had to offer me a choice anyway. Madness 😉

          1. Joy

            Not quite, had a plan ready and went into labour but then baby changed her mind. In the end I gave birth on the Midwife led unit with no interventions other than having my waters broken and intermittent monitoring. It took a lot of hard work to get there though but I think it was good to challenge the staff a bit.

  2. Angie

    This is the part that I’m really not looking forward to – everything else is going to be difficult, but I can already hear the conversations I’m going to have, especially trying to get liver doctors, diabetes doctors and everyone else all on the same page. It’s one of the reasons I’m going to try and make sure that I see the same doctor next time I’m in clinic – while we’re not planning on trying for a little while yet, I’m hoping that then I’ll at least have a good relationship with some of the team!

    I’m glad to hear the midwives are helpful though – I can see it being a bit like DSNs, who I’ve generally found to be much better at answering questions.

  3. katherine cromwell

    I had not only a midwife who was diabetic but my dsn was as well! Team work is essential and in Poole they have a clinic where you see the nurse, midwife, dietitian, radiographer, diabetic consultant and obstetrician all at the same (lengthy) appointment the result is they achieve alot of happy mums to be.
    My experience is that the baby will be born no later than 40 weeks. If inducing doesn’t work then elected c section made. If its elected I don’t see a problem in keeping your pump on. I know its not ideal but at the end of the day you and baby want to be ok. I did feel a bit defeated when I wasn’t allowed to try natural with my second pregnancy but I can honestly say i never had any pain before,during or after either of my sections.
    My 3 all went into NICU and its horrible visiting them in their just because of their hypo state. However, you realise that when you see your little darlings next to those babes who are in their fighting for their lives actually a little hypo isn’t really to bad. Hormones do play havoc with your bloods and therefore its understandable if babe blood is alittle sugary (especially when your strapped to monitors and not knowing what is happening and will baby be ok yes stress =high b/s) You’ll be fine though Alison your so well informed just listen to the obstetrics and then confirm things with the DSN. Babies don’t listen to birth plans!

  4. lizz

    My first labour was ghastly as I had drips in every arm and was tied to the bed. Took forever and actually getting the baby out was very hard work – I was given that injection in the spine to block pain and you just can’t push as effectively. The second time I was given that stuff (sorry brain won’t fish it up from my memory banks at the moment) to stimulate labour as I had been having scans every day towards the end as the placental fluid was getting low. As soon as my waters broke and labour was underway I said I wanted to walk about, and I disappeared with my OH down to the tunnel at the bottom of the maternity hospital that linked it with the children’s hospital at the time. I walked, walked walked up and down that tunnel until I could hardly walk any more – then went up and asked to be examined. You won’t be very far yet they said – oh, hang on – they whipped me into a delivery room and my son was born about an hour later.

    It is natural to stay upright as much as possible and for as long as possible – the weight of the baby’s head bears down for you and helps with everything. Oh my goodness, so much easier, even allowing for it being my second birth. I would very much recommend walking in the early stages even if they won’t let you later!

  5. Sue

    When I had my 5 children (last ‘one’ turned out to be God’s idea of a joke…twins!!!) 25+ years ago, the damned doctor Dr. Knight, Australian, never to be forgotten by me (If I ever meet up with him, well, he’d better run for the hills!), he checked my blood glucose levels by pricking my foot whilst I was in the middle of a contraction, on the basis that I wouldn’t feel it. Soon as you get to the labour ward, check that this isn’t done any more!!!! It really hurts! All worth it in the end though! Best of luck, and thanks for this blog, it’s great.

    1. Alison Post author

      That makes me wonder how on earth he thought you coped with the agony of blood tests the rest of the time when you weren’t having contractions!

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