It’s not always easy to #talkaboutdiabetes. When youâre 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? Iâve 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 whatâs happening and why. The answers help me understand whatâs 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 mightnât go to plan. No, Iâm just trying to understand whatâs happening here. Calm down and listen to me.
Iâve got a few questions about the birth. Youâre only 17 weeks, weâll discuss that much later on. But itâs 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 weâre going to be picky you asked me at 6 weeks if I intended to breastfeed, so chronologically, youâre ahead of me anyway. Well we canât say what will happen at your birth, itâs 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.
Whatâs your policy on inducing diabetics? Youâll 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, thatâs 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 youâll have to have a caesarean. Oh, and here was me willing to let my own child die just to avoid a scar. Iâm 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. Iâm sure you do, Iâm not accusing you of doing them as a hobby, Iâm just trying to get some perspective on whatâs going on. It really would be helpful if every question wasnât treated like Iâm deliberately trying to put my own child at risk.
How do we manage my diabetes during the birth? First answer â youâll 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 youâre doing and youâre on the pump, if you want to manage it yourself you can and if you end up too high and canât get it down, weâll put you on a drip. That sounds more like it, thanks. Itâs 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 babyâs blood sugar is low itâll be given dextrose. OK, but what if it isnât low and just needs food? Why are you opposed to giving it dextrose? Iâm not, just that if itâs not hypo my understanding is that itâd 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 itâll have to have dextrose. At which point did I say I wouldnât let that happen? Calm down and listen to the question, Iâm just trying to understand whatâs 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? Iâve learned that midwives are generally quite good at this. Theyâre now my first point of contact for any question, and then we refer to the Dr if required. Why didnât I start with this approach you may ask? Because at 17 weeks I said to the Dr âam I ever going to see a midwife again, I think they might be able to answer some of my questions?â. Apparently I should have been seeing one as part of every clinic visit, but somehow that wasnât happening. Itâs always worth asking the question. Sometimes you actually get a useful response.