A bit disenchanted

I don't know what naturally started labour feels like, but two attempted sweeps on an "unfavorable" - ie, closed - cervix?

Painful.

*lying curled up in bed

Random thoughts on a Friday

Having gestational diabetes has made me realise how unavailable "diabetes friendly" food is in Christchurch's cafes, pubs and other food-retail places.

I'm not talking hardcore "chew on this bland stick" sort of food here. Rather, what I mean is food that is low(ish) GI - that's short for glycemic index for ya - and is basically generally low on sugar, low on carbs or simply packed with sort of ingredients that body takes a while to break down, and as a result, food that keeps sugar levels stable.

I can see and understand why that is, and I cannot blame food retailers for offering stuff that's selling and, therefore, creating an income and a profit - but still. It scares me.

Most places, when I look at the food cabinet, shelves are covered in straight-up "white flour, thick loaves, creamy fillings" sort of food, or extensively sugar-packed desserts, and little else.

I had somehow always assumed that besides the food I was ordering, there were healthier options available for people with gluten intolerance, or dairy intolerance, or just generally healthier, wholemeal foods, and it wasn't until I was up against my restrictive diet that I realised: holy sh*t, the food that we are eating and serving, on a daily basis, generally culturally speaking, in standard retail spaces... is a bloody dietician's nightmare. The food I am talking about relies so heavily on refined sugar and white, "fast-acting" flour as main ingredients that... no wonder I had learned to view cafe foods as "treats" because, generally speaking, that precisely what they are. So far I had, of course, assumed that my view towards cafes as "treat places" had more to do with the fact that I am frugal and tend not to eat out because of the cost - and when I do, it really is to treat myself with something sweet - but only now have I realised that there really isn't much more... available out there. Most cafe foods really are pies, cakes and thick sandwiches.

And if you ever get gestational diabetes, I have a feeling you will, too, soon learn to carry all your dietary requirements with you, in form of fruit, sandwiches and vegetables, and eat it, well, wherever, really.

***

Have you heard it said that New Zealand has an epidemic of overweight and obese people?

It occurred to me lately that I, for as much sense as this stuff makes, am part of it.

Because check this out: with a BMI (that's short for body mass index for ya) of 25.2, I, too, am classified as "overweight". (Everyone in a BMI bracket of 25-29.9 is, and whoever fits inside 20-24.9 bracket is considered normal.)

I looked at that printout in a hospital's office and sort of went... "Oh."

Because here's the thing: I have absolutely no problem with my weight or my body shape or whatever. I go places and climb things and keep healthy and eat healthy and feel well. In fact, staying in high 24's and having more of a laid-back lifestyle, I think, has done wonders to my reproductive system, definitely more than those low 19's days when I was pushing myself, physically, and didn't see a problem in that, either.

My priorities were different.

But anyway, it was just... weird, seeing that label, "overweight", applied to me in a medical chart, because I would by no means classify myself as overweight, not even on my bad days, and wouldn't use that label for other people who are of similar body shape, either.

It was another reason to listen to that news story being played on the radio, of the seriousness of this "epidemic", and to switch on my news-filtering part of the brain, yet again, because if I am, indeed, part of a problem in New Zealand's obesity crisis, then good riddance, guys, really.

***

I'm officially overdue. And I am officially in that much talked about part of the pregnancy where I get contractions, on and off, and pains, and can be generally uncomfortable, and impatient, and grumpy, and yet when I get checked by a midwife and they run a Doppler on my tummy, I am also officially sitting at 0 - no progress - and wanting to say it out loud that WTF!?!

Zero!?!
Really!?!

So what have all these pains been for, for Pete's sake!!!

And, yeah, I know there's more to it than that, I know about Bishop's scores, and about cervical efficacy, and yada-yada-yada, so please do not approach me with this big picture, "oh your body is doing it well, don't worry" talk - because I know all that, and do not need to be reminded about that.

But still... WTF!?!

Zero?!?

Grrrgh!

Grumpy pregnant woman.

***

I had a few more things to say, but it's so uncomfortable and time-consuming typing on an iPad that I'm done for today. Good night!

Ugh

Ugh.

Don't really know how to describe it other than "Ugh".

Tired, uncomfortable, occasionally in pain... and, yeah, annoyed and impatient, too! (Oh, hi, my dear husband!)

It's the sort of a feeling I have heard many women describe before, but one I haven't had the "privilege" of experiencing before. With The Kid I never got to that part - by now we'd had him out for over a week already and I never went into that pre-labour part, the waters just broke - but now, I guess, I am lucky enough to join the generations of women who have stood by the sink in the morning, thinking, "Ugh," and have then wondered, how much more of this stuff? And if there's much more, okay, I can handle that, but is this stuff at least achieving anything? Is it, you know, opening up what needs to be opened? Priming, or however they politely refer to it?

Ugh.

If this were some other, non-descript part of my life, I'd have just popped a Paracetamol by now and be done with it, but instead, I am doing this... breathe in, breathe out thing. Breathe in, breathe out.

And if my husband asks me one more time how I'm feeling, I swear, I am going to TRY to be polite, but that's about as much as I can promise, because, really? Do I really look like I'm in a mood for talking right now?

Ugh.

Blessed times.

Dan Pallotta: a TED talk worth listening to

Wow. Like, seriously: wow!

This TED talk is view-changing! I listened to Dan Pallotta talk for about ten minutes and it made more of an impact on how I think about charities than those many, many, many arguments I have heard on this very same topic in the years before.

Because, listen: what he says makes sense. It won't apply to every single charity in this world (because nothing applies to everything!) - but it does, I think, apply to very darn many!

And... wow. He has single-handedly put so many arguments I have heard mentioned before into one short speech, and he has said it well enough to really, really drive home the point - at least to me.

And: I've spent long enough of a time on the board of a not-for-profit youth organisation (I was in my late teens then) - and many more hours fundraising when I wasn't really sure how fundraising should be done - to relate to what he's saying on a very touching, personal level.

I highly, highly recommend having a listen!



A few of the things he said:

“We have a visceral reaction to the idea that anyone would make very much money helping other people. Interesting that we don't have a visceral reaction to the notion that people would make a lot of money NOT helping other people.”

“Our generation does not want its epitaph to read, ‘We kept charity overhead low.’ We want it to read that we changed the world.”

“The next time you're looking at a charity, don't ask about the rate of their overhead. Ask about the scale of their dreams.”

Good morning




In true doggie fashion, camera is filled with outtakes like this



Yup, starting to get nippy. Winter's here!

Good night



Induction postponed

To say that I am pleased would be a gross understatement.

I met with the obstetrician yesterday. (Backstory here, here and here.) It was lovely! I know it probably sounds a little weird calling a meeting with an obstetrician "lovely", but that's exactly what it was to me. I felt listened to, respected, supported and validated, all the things I think are so important when heading into this last stage of being pregnant which is essentially... waiting.

And I also felt grateful. Really, really grateful.

There was no arguing, no coercing, no liability leaflets. Instead, I told the obstetrician pretty much the same story I've told on this blog over the last few weeks - how I cannot see why an induction is really necessary, not according to the reading I've been doing, and would she please explain to me what their thinking on this topic is - and she then explained and confirmed to me what I'd been thinking all along, and that is: postponing induction is a valid decision to make. She didn't have a problem with that, or me, or anything else I was saying.

Turns out, I was right: women with gestational diabetes who (manage to) keep their sugar numbers well-managed aren't technically that different from women who don't have diabetes to begin with. Yes, risk factors go up - but it's really hard to say by how much exactly. Most of the research seems to lump women into one big group under a label "gestational diabetes", rather than split them into two groups of "well-managed" and "poorly managed" (even though the outcomes and underlying physiology may be very different) and as a result, risk factors get lumped over the general population also.

(When I met with my diabetes physician half an hour earlier, I outright asked her that if I am not getting spikes or lows in my sugar numbers - which is where damage to cells would otherwise be done - are there any other ways diabetes can affect my health and the health of my baby? And the answer was: no, not really. Diabetes works through its end result (high sugars, low sugars), rather than through having the condition itself.)

We also talked about being a VBAC, which is now more and more widely accepted as a valid way of giving birth after having had a Caesarean section in the past. Again, it does come with risk factors - everything does - but there isn't a reason for pushing for an early induction with a VBAC alone, not unless something else is wrong also.

We talked about how being a potential VBAC with gestational diabetes - but with well-managed sugar numbers - we are really looking at a part of obstetrics where good research simply hasn't been done, not in a way where we could look up some numbers and then weigh it all statistically. It's a bit of a guessing game, and it's got lots to do with hospital policies and people's attitudes to it, rather than research.

What we could essentially do was to simply look at the risk factors of giving birth on its own, compare those risk factors to healthy VBACs, and then maybe only guess at what the gestational diabetes on top of that would be capable of doing because in the end, we really do not know.

And in the end, when it came down to stillbirth statistics of 1.06 per 1000 births at 40 weeks, versus 1.27 per 1000 births at 41 weeks - a number that applies to giving birth as it is, regardless of whether there's anything else going on with health, or not - I just could not equate that number in my head to 1 in 200 chance of rupturing my uterus if I were, indeed, induced with Syntocinon at 40 weeks.

Yes, risk factors change, I can see that. But the question is: by how much? And what would I replace it with if I were trying to avoid the risk?

It's, like... driving a car - I drive. Riding a bicycle on public roads - I do. Skydiving - I have. Everything I do in this life comes with risks, including breathing, and avoiding all risk full-stop is simply not an option, not if I am interested in living - and especially if I am interested in living AND experiencing things!

What is an option, instead, is weighing risk according to what I am comfortable with, and making as good of an informed decision as I can, and leaving the rest to... God, religious people would probably say here; I'd like to say leaving the rest to life.

I walked out of that hospital yesterday happy, and so did The Man, and I think even the obstetrician might have. It felt as something I imagine maternity care should be like - should feel like - and instead of dread or resentment what I have is... calm.

Every now and again practice contractions come up: some rhythmically, some not so. Next week I will pop into the hospital to check how the baby is doing, and the same the week after that, too - unless she decides to come before then - and whilst I am waiting, I will try to relax.

And feel grateful.

I think The Dog is growing up

Have you noticed there's been a lot less moaning about The Dog's antics on this blog lately? No? Well, there has.

At one stage I wasn't sure I was really going to be able to say this, ever, but... I think she's growing up. Finally!

What made me think of it is that I saw this photo on internet today...


...and straight away related to it in that very, ha!, I know what you're feeling, mate! I've got a Lab, too! way. In fact, if we had things delivered to our doorstep, this could've SO easily been our photo, and our dog.

And then it occurred to me: we haven't had anything eaten around this house for a... while now. She doesn't bring cr*p to our steps any more, hasn't eaten carpet underlay, books now get destroyed by The Kid rather than The Dog, I haven't had to get a new washing basket, The Man can pee in peace. This list could go on.

She follows basic commands. Stays (mostly) off furniture. Eats things that are meant to be eaten, and can distinguish doggie toys from kiddie toys and shoes. I mean, don't get me wrong: she still goes off on adventures if what's "out there" is more interesting than us shouting, "Come here!" She's not an angel dog.

But it's little, minor stuff, really.

Because mostly, she's an... enjoyable dog now! For all of us.


And weirdly enough, it sort of makes me... miss those times when chewed-up stuff was a daily occurrence, and when she could be such a royal pain in the a$$, and when I thought, oh my God, I have picked a Lab that's got ADHD and is going to be like this forever.

Does it mean I am one day going to miss The Kid's tantrums, too?

Too much Coldplay

I would like to one day see Coldplay perform live. Somewhere. Anywhere.

Sort of like I loved seeing Phil Collins live. Bloody expensive, but was so bloody worth it!

Clearly, have listened to too much Coldplay today. But... they're just, you know, so great!

The only regret I have is that I didn't see Michael Jackson back when he was on his world tour, years ago. If I'd had, it would've been my top three of greatest ever performers to be seen.

Coldplay.
Phil Collins.
Michael Jackson.

Taste buds and taste preferences

According to Annie Murphy Paul babies learn about tastes whilst still in the womb. If a mother drinks, say, lots of carrot juice in her pregnancy's third trimester (baby's taste buds are shaped by the time it's about 7 months in), her baby will tend to prefer carrot juice once it's introduced to solids.



It made me smile in amusement. Because you know what this baby of mine, still in the womb, will have learned to taste then, if this research is true?

Peanut butter.
Carrots.
Cabbage/lettuce.
Beans/peas.

Low GI diet, basically.

And not much in a way of sweets, I'll tell you that.

Just a few more weeks and you can have chocolate, Maria, just a few more weeks and you can have chocolate, Maria, just a few more weeks and you can have chocolate, Maria...

PS. To people who complain that Coldplay's new album is boring - pfft! Sounds just fine to me.

Coldplay is Coldplay.

Good morning

On another note though: good morning Lyttelton!








Whinge

I think I am so used to being physically capable that as soon as I get ill, I think I've got a depression. Sound familiar? It does to me.

Whinge, whinge, whinge, whinge - and more whinge. Almost everything feels like a chore, but unlike yesterday, I think I am going to get my a$$ out of this house today and go get groceries at least, because going by yesterday's experience, staying at home with a toddler isn't any more restful.

I think it's a... spectacular combination, being heavily pregnant, with a cold and a stomach upset, whilst on a strict diet, whilst caring for a toddler. Spectacular, I say!

I feel like I've been sucked on with a vacuum cleaner.

Whinge.

* she writes, whilst sitting on a sofa, it's 7 am in the morning, and The Kid is already watching a cartoon on the computer.

Whinge

I told The Man I've been doing a lot of whinging lately. And I have.

I have yet another cold. (Really!? It's not even been 5 weeks since the last one!) My back aches. Actually, scrap that - a whole bunch of things ache at the moment, back included. I'm not getting decent enough rest. I'm tired. Short of breath.

I'm 38 weeks pregnant, basically.

Saturday morning musings

Wow! What fascinating way of treating something! Researchers at Mayo Clinic injected a woman with a massive dose of measles to... get her rid of her cancer.

Like, wow. Would you have thought of that?

***

Kim Hill was talking to Aubrey de Grey on Radio New Zealand National just now. Aubrey specialises in the topic of aging - namely, in ways of stopping aging. (Have a look at his TED talk, if you wish.)

As they were discussing cell division and replacement and yada-yada-yada, he said something about the human body working better at the age of 20 rather than, say, when it's much older than that.

It made me wonder: if I could "stop" my body from aging at a certain point and if I could then keep it like that for a certain amount of time, what age would I choose?

Would it really be 20? I'm not sure.

I know it would be from before I had The Kid, ie from before my abdominal muscles got cut through during my Caesarean section - I'd kinda like that part of my body intact again. But 20? Probably not. 25 maybe.

But what I'm also thinking is, this whole idea of "stopping" - I would only do it as far as my physical body goes, but I would not want to go back to my 25-year-old self, mentally!

I like where my personality has come, over the years, and will probably enjoy where it goes in the future also - I would not want to be my 20-year-old self again, not for all the internal... struggles that were going on at the time. I am much more comfortable in my own skin now than I was back then, and I am much less people-dependent (or, to be precise, people's opinion dependent) than I was back when I was 20, and I would definitely prefer keeping it that way.

***

Going through this experience of gestational diabetes now (oh my god, how I would LOVE to eat chocolate again!), it's made me realise how many foods and desserts I have left untried so far.

Almost every day - or radio, on internet, in people's conversations - I keep on coming across foods that I do not know the taste of, and cannot really try now either because of how rich/sweet they are.

And it's probably not the healthiest of approaches, but hell, I think I am going to have a new-found appreciation to all things deliciously rich, gooey and decadent. So many foods to try yet!

***

And to finish off: I would so not want to live where Australian spiders live. Geesh!

Small paychecks and big memories

I don't know where this quote is from, but when I saw it, I thought, "Man, yes! This is what backpacking was like. This!"


If I were maternally inclined, I would probably apply the same quote to even now, the age of stay-at-home parenthood.

But what I'll do instead is go put the washing machine on. Because... this: this is what stay-at-home parenthood is like, on a rainy day.



What medical guidelines say about VBAC inductions

I am still trying to get my head around the issue of using - or not using - Syntocinon for being induced for a VBAC. (See a background story here.) My appointment with an obstetrician is coming up rapidly and I want to understand this topic as much as (reasonably) possible for when we meet.

In an effort of digging up information that may be relevant, I've been reading up on how different hospitals (and countries) handle VBAC inductions, and whether world practices differ from what is offered at Christchurch Women's or New Zealand in general. In doing so, I've looked through a fair deal of publicly shared medical guidelines. Some I have found quite helpful!

And now, in an effort of helping someone else who might be - just like me - trawling the internet in search of information, I'll try and share some of it here.

Because, look, it's one thing to read anecdotal evidence from baby forums - I know I have done a lot of it, and so have probably other women who've faced a situation similar to mine. Forums have thousands, thousands of posts on VBAC inductions.

But the thing with forums is that they're... one-sided. (Or at least can be.) People who write on forums have an agenda, a vested interest in sharing what they're sharing. As much as I am grateful to thousands of women who have left their footprints in the world wide web in form of forum posts, left in their moments of personal heartache or maybe contentment, I've also tried looking past forums and seeing what actual medical professionals have had to say.

So here's a sample of what I've read.

Canadian Society of Obstetricians and Gynaecologists, for example, says in their clinical practice guidelines that:

"8. Oxytocin augmentation is not contraindicated in women undergoing a TOL after Caesarean section (II-2A).
9. Medical induction of labour with oxytocin may be associated with an increased risk of uterine rupture and should be used carefully after appropriate counselling (II-2B).
10. Medical induction of labour with prostaglandin E2 (dinoprostone) is associated with an increased risk of uterine rupture and should not be used except in rare circumstances and after appropriate counselling (II-2B)."


That, in simple words, means that:

1) if your labour has already started on its own, then helping it along - ie, augmenting - with Syntocinon is not necessarily a bad idea,
2) if your labour hasn't started, but you need to be induced, then doing it with Syntocinon isn't really... straightforward, and
3) if your labour hasn't started, but you need to be induced, then doing it with prostaglandins is, how to put it politely... not recommended.

King Edward Memorial Hospital in Perth (which has got a VBAC success rate of approx 75%, and in world context, we are talking high!) says in their clinical guidelines that:

"The available evidence suggests that the use of oxytocin is associated with a reduced success of vaginal birth and a doubling of scar rupture/dehiscence1, 6. However, oxytocin may be used with caution in women with a previous caesarean section, following discussion with the obstetric consultant on-call for Labour and Birth Suite1."

In a nutshell, it's sort of what Canadians were saying above, and that is: use Syntocinon if you really, really have to, but... bear in mind that it's really not a good option overall. 

The Royal Women's Hospital in Melbourne seems to, also, be very similar in their approach:

"There is a 2-3 fold increased risk of uterine rupture with induction or augmentation of labour. The risk of C/S is increased 1-5 fold with these procedures. Induction or augmentation of labour should only be considered with consultant involvement and a clear understanding by the woman about the increased risks."

There's more, too, but after a while they sort of start repeating themselves.

***

So overall - and the more so the more I am reading about - being induced with Syntocinon is really not that... flash of an option, really. Not whilst being a VBAC.

Which basically just leaves me with a question of why exactly they think I need to go by the time I am 40 weeks pregnant, considering that I have what they refer to as "excellent glycemic control". Once that is answered, choosing whether to be induced or not to be induced will be easier. I hope.

But it's not a question I've been able to find an answer to on the internet, so for that, I really just need to wait for that appointment, and that talk, and... until then, I'll just keep on doing what I'm doing.

Fun times! =)

A typical conversation these days + A pregnancy moan

People, "Oh, you don't look like you're about to pop / 37 weeks pregnant / that far along (insert your version of "big") at all!"

The Man, "Yeah, it's amazing what you can fit inside a woman when you start diminishing her lung capacity, and her stomach capacity, and her bladder."

***

I lay awake last night trying, trying and trying to get comfortable somehow, changing sides, arranging pillows, but whichever way I lay, my back ached. At some point I even wondered if this is what women refer to when they say that in early labour they have that niggling, unrelenting lower back pain for... for a long time, basically.

But no, I don't think so. I think this is just my back aching because my hips are so loose and my whole repertoire of sleeping positions consists of either my left side, or my right side, and that's about it.

And possibly it's also because I had an attempt at gardening yesterday, even whilst my hip kept coming out of its socket and I... "lovingly" tried ignoring it.

Oh dear. It's seven o'clock in the morning and I already feel like I'd like to pop a Paracetamol or two.

And just for the record: under normal circumstances, I'm not a Paracetamol sort of a girl. I don't treat them like they're a food group. If I pop one, it usually means that stuff actually hurts.

Just a few more weeks, Maria, a few more weeks.

Saturday evening labour musings

I'm tired - that Saturday evening sort of tired. You know the sort?

Washing's been dealt to, a pile of garden rubbish has been burned off, house has been tidied and warmed through and now I am sitting on a sofa, legs stretched out in front of me, and... phew. It's that Saturday evening sort of sitting - the sort where Sunday is still ahead and The Dog is stretched out on the carpet in front of me and it's... quiet. And nice.

That sort of Saturday evening tired.

I feel like I want to write down a few thoughts on the upcoming birth, but on the other hand I am not so sure what I want to say here because... I'm not really anxious enough. It's not bugging me.

Sure, several other things with this pregnancy have been bugging me and I have duly been letting my steam out in this space right here - you've probably noticed - but when it comes to this upcoming birth, it's somewhat... quiet.

Three months ago when I first stepped into an obstetrician's office at the hospital, I was asked - just like everyone else is, I think - what my thoughts and hopes for the upcoming birth were. What kind of a birth was I wanting?

For a long while my answer was, "A safe one." At 20-something weeks it was really too early for me to be going into details on whether I wanted a Caesarean or a natural labour or whatever, because in the end, I simply wanted what was best, both for me and for that little bugger in my tummy, and I didn't know how it was going to play out yet. I didn't know if any of the complications of The Kid's birth were going to show up again, and if they did, what the implications would be, so all this talk on birth plans was, really, theory to me.

Now, at 37 weeks, we're talking practice. I have a much better understanding of what's happening to my body this time and because of that, I have much more specific wishes and ideas now. The first priority, to me, is still "a safe birth", so in that respect not much has changed because in the end, as long as we do our best and it all goes well, all is well.

But I do have a certain amount of... assertiveness piled up.

I told my midwife when I discussed my obstetric concerns - for lack of a better word - with her that I'm not after an "earth mama" experience, and neither am I dead set on doing a VBAC: disagreeing with an obstetrician is not a case of "taking a stand" for me.

Instead, it's a case of taking responsibility - both for my own health and wellbeing, and that of my child - and doing what makes sense to me.

I am still heading into this experience emotionally ready for an emergency Caesarean, if need be, or an induction, if need be, or an epidural, if need be - whatever needs doing, really, if need be, to get both this baby and me to the other side safely - and as long as we get there as such, I think it'll be a good experience. I am ready to assert myself, but I am also ready to simply play it by the ear and see how we go once we go there.

I think because of that, I am feeling rather calm and very supported. My midwife is there backing me regardless of how I choose, and The Man is there to help and back me regardless of how we go, and personally, I am ready for whatever happens because I know that I will simply do my best, whatever that best is, and the rest is just... life.

So, yeah, this is how I feel. Told you I didn't really know how to put it into words! =)

Photo Friday

It's like a game for him: put on daddy's hat and then try and do things blindfolded



You comin' already?


Lazy afternoons in Hagley park

A new stage: actually BUILDING stuff with Duplo!


We all like the colorful squares on building fences. The Kid, especially.

Ordered a new car seat off internet. The Kid's favorite part? The box, of course.


37 weeks.

On gestational diabetes and induction, again

I've already written about it somewhat, three days ago, and to those of you not interested in more pregnancy-related reading, I suggest you stop reading right about now because what's going to follow is exactly that - more pregnancy-related reading.

Namely, inductions and gestational diabetes. 

(A fun topic, isn't it, eh?)

So: I spent my morning at the hospital again with routine, check-up sort of stuff. I got to speak to a midwife - not my own, but a hospital one - and I got to tell her about my concerns with the upcoming induction. I told her that I'd started reading up on why an induction was necessary to begin with and that I couldn't see much sense in it any more. Could she maybe give me a few pointers?

She did; and she was helpful, in two things mostly.

First of all she was helpful in confirming what had become my plan anyway, and that is: I am going to speak to my obstetrics team about it. Yes, gestational diabetes comes with risk factors - I am well aware of that - but according to my research so far it comes with risk factors because of what damage high sugar numbers do. Without high sugar numbers (ie, when diabetes is well controlled, which is me) the case isn't as straightforward any more.

Yes, gestational diabetes tends to come with other risk factors piled on top of it, like high weight and BMI for example, or high blood pressure, or older age, and all of the above can point towards an early induction, too - but again, I have none of these risk factors.

Which brings me to another thing this midwife was helpful with.

As she was looking through my notes she started saying how being over 40 there are risks associated with going overdue, which is another reason why an induction may be indicated, and as she was saying that I thought to myself, "Who's over 40?"

And so I asked her that. And you know what?

Turns out that the very first obstetrician I saw, oh, must've been almost three months ago now, had written right on the front page of my file where a summary of facts are lined up, that I am, "Diabetes, 40+ years"

40+ years.

That's, like, me being 40+ years old. (Say what?)

I looked at this midwife, puzzled, and she looked back at me, also puzzled. She then looked down at my file again where at the top there is also that sticker with my private details, amongst which is a line where it says, correctly, that I am only 29 years old at the moment, and right about then, I think, both of us had a sort of a "A-ha" moment.

I don't know if any of the other medical professionals who have opened my file, like this midwife did, have looked at me being "40+ years old" and made their conclusions - have simply gone from that line, that I'm a pretty old mother (even if I look pretty darn well-preserved for my age). Or maybe none of them have even noticed it - maybe they've all looked at the sticker with the correct information instead.

But either way, that "40+ years" has been listed on my file under risks factors for as long as I've been listed under Christchurch Women's, without anyone correcting it, and it begs a question that... have any of the decisions so far been made as a consequence of a moment of distraction? Or has that obstetrician simply got a really bad case of handwriting, which others may have then gone by?

Either way, what I am going to do is simply continuing with what they refer to as "excellent control" with my sugar numbers, and when I see my obstetrics team two weeks from now, I am going to talk to them about it. And unless there is an actual reason to being induced at 40 weeks, with Syntocinon nonetheless, whilst being a VBAC, and that reason gets articulated to me and The Man, then there's a good chance I am going to simply say that, sorry, guys, but I can't see how this makes any more sense than giving it a little more time, and seeing if this girl of mine is wanting to come out at her own terms instead.

It's... interesting, being late-term pregnant now. I am learning quite a bit.

Definitely different from what it was like last time.

Gestational diabetes and induction - why?

I feel a little confused. And I'm not really sure what to do about it, either - not at this stage anyway. I need to think about it a little further.

I was at the hospital's outpatients clinic yesterday. It was the usual stuff: checking how this pregnancy of mine is going, checking how this diabetes thing is going, checking if I need any help with managing my blood sugars, or whether anything of importance is showing up on tests.

In short, everything's fine: The Girlie is growing well, and is right "on dates" on pretty much every measurement they do, and there are no concerns regarding blood pressures or sugars or proteins or whatever. Everything looks lovely through and through! Except my weight: just as I suspected, I have lost a little weight as a result of my "sickie" a fortnight ago. And, anyway, I haven't been able to put any weight on since getting diagnosed with diabetes to begin with, which was... two months ago?

But back to the topic: where I am a little confused now is that a date for an induction has been set. It's standard practice with women who have gestational diabetes, apparently. I, for example, have been able to manage my sugar levels with diet and exercise alone thus far, and so I've been "granted" - not really the fairest of words here, but this is how it feels, to me - the right to wait until my due date before an induction is due.

Which is cool. Was cool - until The Man started asking what exactly happens after the due date then and I started to do a little reading on what the risk factors are exactly, and why it's standard practice to induce ladies with gestational diabetes by the time they're 38 weeks or 40 weeks or whatever.

And that's where it gets confusing.

From what I had read on gestational diabetes before, I knew that babies tend to come overly large, placentas tend to fail sooner, stillbirth numbers go up compared to "healthy" pregnancies, and so it seemed fair that getting them out a bit sooner was a thing of interest if health of both the mother and the child was important.

But what I kept seeing now that I was doing this reading - wanting to have an answer to The Man's questions, because this is how our relationship works - is that... unmanaged sugar numbers do that. Babies come overly large when mothers carry too much glucose around; and placentas fail sooner when too much sugar is involved; amniotic fluid amounts go down when/if diabetes numbers are unmanaged.

But mine is managed. Technically, if you set aside the fact that when I was given 75 grams of refined sugar on an empty stomach two months ago - a glucose tolerance test - my body wasn't able to clear it as quickly as "healthy" bodies do, I'm not actually any different from a standard, non-diabetic pregnant mother next to me. On a daily basis, I do not carry high sugar levels - I prick my fingers with a needle 6-9 times a day and manage my carb/sugar/protein/fibre intake very closely.

Impressively closely, actually.

But there doesn't seem to be such a distinction when information about gestational diabetes gets printed/published and handed out to ladies at the outpatients clinic, or on internet as a whole.

I have found it impressively difficult, actually, to find information on what are the differences between managed and unmanaged diabetes cases; and from what I can see, I am not alone in that.

I do not have a science degree - so don't even think I consider myself knowledgeable on this topic, because I don't - but I have spent enough time in university doing my various research papers to understand that a difference in sample size and in criteria for how the sample was selected will impact the results. So, say, if someone's making a paper on the effects of gestational diabetes and involves enough women with unmanaged sugars, of course the risk factors go up.

But how do I find information on what the risk factors are for me?? Me, considering that I keep my sugar levels well managed? I want to see risk factors NOT for gestational diabetes in general, but for women who keep a tight control on their glucose levels, which is me.

There seems to be very, very little information out there on that.

I think I might ask them about that when I go to the hospital next week.

Instead of crowding this post with links, I am going to post just one - an article I found to have the most references to actual research. If you want to read more, I suggest you do your own googling.

MidwifeThinking: Induction of Labour: balancing risks at
midwifethinking.com/2010/09/16/induction-of-labour-balancing-risks