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? Iâ€™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 whatâ€™s happening and why. The answers help me understand whatâ€™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 mightnâ€™t go to plan. No, Iâ€™m just trying to understand whatâ€™s happening here. Calm down and listen to me.
Iâ€™ve got a few questions about the birth. Youâ€™re only 17 weeks, weâ€™ll discuss that much later on. But itâ€™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 weâ€™re going to be picky you asked me at 6 weeks if I intended to breastfeed, so chronologically, youâ€™re ahead of me anyway. Well we canâ€™t say what will happen at your birth, itâ€™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.
Whatâ€™s your policy on inducing diabetics? Youâ€™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, thatâ€™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 youâ€™ll have to have a caesarean. Oh, and here was me willing to let my own child die just to avoid a scar. Iâ€™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. Iâ€™m sure you do, Iâ€™m not accusing you of doing them as a hobby, Iâ€™m just trying to get some perspective on whatâ€™s going on. It really would be helpful if every question wasnâ€™t treated like Iâ€™m deliberately trying to put my own child at risk.
How do we manage my diabetes during the birth? First answer â€“ youâ€™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 youâ€™re doing and youâ€™re on the pump, if you want to manage it yourself you can and if you end up too high and canâ€™t get it down, weâ€™ll put you on a drip. That sounds more like it, thanks. Itâ€™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 babyâ€™s blood sugar is low itâ€™ll be given dextrose. OK, but what if it isnâ€™t low and just needs food? Why are you opposed to giving it dextrose? Iâ€™m not, just that if itâ€™s not hypo my understanding is that itâ€™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 itâ€™ll have to have dextrose. At which point did I say I wouldnâ€™t let that happen? Calm down and listen to the question, Iâ€™m just trying to understand whatâ€™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? Iâ€™ve learnt that midwives are much, much better at this than Drs. Theyâ€™re now my first point of contact for any question, and then we refer up to the Dr if required. Why didnâ€™t I start with this approach you may ask? Because at 17 weeks I said to the Dr â€śam I ever going to see a midwife again, I think they might be able to answer some of my questions?â€ť. Apparently I should have been seeing one as part of every clinic visit, but somehow that wasnâ€™t happening. Itâ€™s always worth asking the question. Sometimes you actually get a useful response.