Revisiting: Difficult conversations

By | 14 June, 2018

It’s not always easy to #talkaboutdiabetes. When you’re a pregnant diabetic trying to gather as much information as possible #languagematters and it can all feel like a bit of a challenge. (This harks back to Alison’s pregnancy in 2013, she isn’t pregnant again, the world isn’t ready for that!).

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.

A conversation. In a park. Between two women. Sitting on benches.

A conversation. In a park. Between two women. Sitting on benches.

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 conversation? You listen to my question and try to answer it, that kind of thing? I’ve learned that midwives are generally quite good at this. They’re now my first point of contact for any question, and then we refer 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.

Category: Living with diabetes Pregnancy

About Alison

Diagnosed with Type One in 1983 at the age of four, Alison's been at this for a while now. She uses Humalog in a combined insulin pump and continuous glucose monitoring system and any blood glucose meter as long as it takes five seconds or less.

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