Friday, August 22, 2014

Birth Story: part 1

It's been over 8 weeks since the birth of our daughter, the Tiny Fish. She is glorious and gorgeous and has the most delicious cheeky smile.

I've found a rare moment of quiet time where she is asleep, I am awake enough to type, and all is calm in our house. So I'm going to put down a really short and sweet version of my birth story. Before I forget too much.

My waters broke at 3am on 24/6/14. I drenched the bed, the bedroom carpet, hallway carpet, the Lino in the kitchen, porch hallway and then proceeded to flood the toilet floor too. I managed to clean the floor. Went and woke up my Hubby who took a second to click. I put a towel down and went back to bed.

Mild contractions started very gently half an hour later. They I had to get up and spend some quality time in the loo. Then I wondered how in hell I was going to get off the loo and not make another mess and wake my Hubby up again. I had time to download an app to time contractions. Good thing I did too as they were coming fast.

5.30am it was time to phone our midwife. 6.30am we phoned her again and said I wasn't going to be able to wait until 7am and we were gonna go up to hospital now.

We live just down the road from the hospital. I cursed every single one of the speed bumps on the way thru the hospital.

It had been raining. A friendly person in the corridor made a joke about it's gonna be a long night. Or day. We had no clue. Entering the maternity wing and this giant hug of warm air and weirdly soothing elevator music - which turned out to be the first morning alarm on Hubby's phone. We checked in and got room 4. G, a ward midwife looked after us until ours arrived.

Our mw wasn't there yet as she had to travel from a village outside of the city. Her battery went flat so she tried to jump start it and accidentally started a fire. She borrowed a car and it ran very low on petrol so she had to go back home and steal the lawnmower petrol. When she got there at 7.20am I was 9cm dilated already. I couldn't believe I was that far along.

Soon I was allowed to push. I never felt like I couldn't do it. I used breathing, saying out loud "relax everything" in between contractions, and etonox (gas and air). Looking back, I wish I had had an epidural. But nobody could have known what was coming.

Anyway, baby's heart rate was taking a few dips and not recovering very fast so my mw got me up resting over the back of the bed which seemed to help.

I pushed for 2hrs at which point my contractions started to taper off a bit. I personally thought this was delightful as I got a black spell of rest between the contractions. Empty painfree bliss. But apparently that was not good. My mw had me do nipple stimulation to try and get contractions happening with more strength and speed and it worked. But baby wasn't moving. She called in the OB who discovered that my baby's head was turtle-ing. A sign of shoulder dystocia.

My baby would need help. It's heart rate started dropping. The emergency bell was pushed and people flooded into the room. I felt calm under it all as I trusted those around me to take care of me.

First up the OB tried ventouse as baby's head had gone a bit crooked. The cap popped off a couple if times, so she moved on to forceps. And an episiotomy. Boo.

She was pulling so hard. Her foot up on the bed. At last I felt baby's head be born very quickly. And then all the pain of labour suddenly paled and was completely overwhelmed by this new thing which was just so big and massive I didn't know how to feel it. The pain was so incredible and multi faceted and discordant. I could feel my bones. Tiny Fish's shoulders were stuck. I remember writhing? Screaming noises I didn't know we're human let alone me. So high those noises. The OB working frantically. Eyes shut, open just for glimpses. The intense unbelievable indescribable feeling of pushing and actually feeling the resistance akin to pushing against a concrete wall. It was just not gonna move. The OB did the Woodward screw manoever where she had to get hold of an arm and spin the baby.

A huge movement and then the biggest physical and mental relief I've ever felt.

Tiny Fish was born arm-first at 10.29am. After 5hrs10mins of labour.

She landed on my chest and lifted her head and opened her black, disgruntled eyes and looked at me I will never forget that look. She was purple and wet and had hair that wasn't as black as I'd expected. The mw checked if she was a boy or girl. She was there about ten minutes I'm told but I kept blacking out so it felt like only 30 seconds. I have two memories of her on my chest: eyes and gender. My third memory is seeing her across the room on the baby bed where 3(?) paediatricians are working like mad over her with an oxygen mask. But I knew she would be fine cos she looked at me. And besides, what newborn can lift their head defiantly as their very first act? She did cry but I can't recall what it sounded like.

My husband. By my side helping me through. Together. Just being pure love. He always knew what I needed. I always cry thinking of what he went through that day, and the strength he has.

Tiny Fish had to go to NICU for potential breathing issues and hypoglycemia. I had brought along a small amount of expressed colostrum for her to have.

The OB was trying to sew me up. The midwives were massaging my tummy. There was blood on my thigh. Legs up in black leather stirrup things. Lithotomy position my birth notes say. Nurses were putting more IV lines in. Everything was hurting again. I was still having to breath through the pain. The placenta came but it was incomplete. I remember someone asking a nurse to measure the blood loss. 2 litres. Enough to warrant a trip to theatre to get stitched up. An episiotomy and a 3rd degree tear. When I asked how many stitches I had received later, the OB said she didn't bother counting.

Getting ready to go to the operating theatre was strangely calm after that. I got terrible shakes and said I was cold so they bundled me up in white. I had to shimmy across to another bed to make the long trip to the other end of the hospital. From the old wing to the new.

Hubby went out to meet my parents who had been waiting in the waiting room. Worried as they could hear everything. When he came back in the room he surveyed all the blood and fainted.

My parents met me as I was leaving the delivery suite. Tears and smiles and kisses and hugs. They would go to neonates and watch over their first grandchild.

Then there was the strange calm of being wheeled down endless corridors, fluorescent lights overhead. It was mid morning and the day was a drizzly grey winters morning. Fog and condensation on the windows. In pre-op Hubby couldn't come in so he went back to be with our daughter. My midwife was allowed to accompany me into theatre. I had 3 anaesthetists, one of whom has T1D and wanted to know all about my pump and Dex (diabetes stuff all went fine, in case you were wondering). The OB stitched me up and I woke up in post-op recovery so terribly thirsty. But content. I knew she was fine. I knew Hubby was with her. I was alive. I got what I wanted: everybody healthy and alive.

My mw came and said that she had arranged it so that I could be wheeled right into the NICU to meet my daughter again. I have never wanted to be wheeled faster. The urge to try and jump off the bed and hurry towards her. But I was so tired and heavy.


She was in an incubator. Someone got her out and laid her on my chest. She looked up at me with bleary eyes. She had massive bruising from the forceps and ventouse. Her head was a beautiful round shape. Black eyes. And torn skin from the forceps. She still has a scar even now.

And then I was put into a room to recover. That will be the next part, cos the story is not over yet.

~~~Happy birthday, my sweet one. You are so wanted. Mummy and Daddy love you. Xoxo

Saturday, June 28, 2014

She is here!!!!!!

I went into early-term labour spontaneously at 37w4d, 3am on Tuesday morning.

Our beautiful daughter was born healthy at 10.29am later that same morning. Both now doing well after a somewhat rocky start, details on the birth to come later.

Huge thanks to the teams involved in our care and well-being.

Much love, Kaitake.

Sunday, June 8, 2014

35w2d CTG monitoring for suspected placental failure

Yes yes I know, there has been a major gap in my posting on here. Sorry to have worried anyone! I appreciate those of you who have given me a poke with the comment stick hehe. Basically all is fine. But third trimester exhaustion hit me and I've been dealing with insulin resistance (blood sugars kept creeping upwards). Every evening I thought of posting I would fall asleep!

Here are some pictures of what happened yesterday:

Hi Interwebs! Check out my belly!
Oh it hasn't been all napping and falling asleep in the armchair around here. Or struggling to make it through the last several weeks of work (only 5 working days left, folks!!!) Oh no! In fact yesterday things got all interesting again as I found myself back up in Labour and Delivery having the baby's heart rate checked out, to check for placental failure. Fun times. Don't let that smile fool you.

From about 24 weeks onwards I started to get insulin resistance meaning that my blood sugars would be slightly higher each day, and a dose of insulin which worked one day, would no longer be enough. The treatment is not difficult, but it takes a huge amount of observation and dedication and trial and error to get right. Especially since it has to be done at least once a week, more likely every 3 days or so: adjusting insulin basal rates up, making insulin:carb ratios stronger, and giving more corrections throughout the day (and night) when those two prior things weren't doing the trick.

Cut to Friday, my 6th to last day at work, and I was feeling like crap. Had an awful night with barely any sleep due to almost constant low blood glucose alarms going off. I must have drunk nearly 750ml of juice throughout the night! Plus now that I'm so huge, reflux/heartburn and belly/back aches have made my nights a bit of a living hell. If I could get away with just staying awake for the rest of this pregnancy, I think I'd take it as lying down can be most uncomfortable if I'm overtired.

I checked back over my blood glucose logs and noticed that my blood sugars had been dropping more and more from Wednesday through to Friday. This set off some mild alarm bells. It could be that because I was mid-34w that my insulin resistance was starting to wane, and that would be, from what I read, somewhat normal for the increases in blood glucose to plateau out a bit. But this was a drop. I was running -30% temp basals and still getting lows. I was drinking juice by the glass and needing more in half and hour. Not normal. Plus I felt like arse. So tired, so achy, got cankles. Boo.

After scouring the interwebs on Friday night and getting help from some lovely FB ppl, I decided to give things one more night and see if they would fix themselves. Nope. So Saturday morning I messaged my Diabetes Nurse Educator who promptly phoned my OB and they both wanted me in immediately for CTG monitoring just to check for placental failure (where the placenta has started to degrade and so the baby isn't getting the blood supply it needs). I once again felt like a silly fool traipsing up the road to the hospital when by all outward appearances I was well and good. But there are no maternal symptoms of placental failure so for once I was actually quite thankful to have diabetes - my blood sugar drop being a potential early warning sign! Yay for the silver lining! :)

A lovely little British nurse got me setup on the monitor at about 11.30am, and since I had told Hubby there was no real need for him to come and sit and be bored with me in hospital, I was left alone with the wonderful sound of Tiny Fish's heartbeat.

30 mins later she came back to check on me, and kinda hummed and hawed at the graph. She said that the heart rate was good, but there wasn't really much variability. It showed one "tightening" of the uterus, but didn't capture any braxton hicks contractions in the entire time I was there. She decided to leave the monitors on for another 30 mins. I rolled to my left side at her suggestion to try and wake Tiny Fish up, even though I thought baby was already awake with some gentle movement happening. This helped to increase the variability of the heart rate which was what the midwife was looking for. She said that normally this would be a perfectly acceptable graph, but with my diabetes and the low blood she wanted to see a "perfect" graph before letting me go.

It was really nice, one of the first things she said when she came in was "I've read your notes" (Wow!!!) and I see you are Type 1, I don't know much about Type 1 as most women we get through here are Type 2 or gestational. Tell me about it" Just, wow!!! That's so awesome to have a healthcare professional being so open and friendly, and genuinely wanting to know all about Type 1 and how I manage it. She was fascinated by the CGM, and kept asking me interesting and intelligent questions about how I deal with different aspects of my diabetes. She even wanted to check with me who she should call if there was a problem with the heart rate! (It was awesome that my OB was scheduled on shift that morning. I didn't get to see him, but I believe she checked the graph with him).

At one point I was on my own again, and I noticed that Tiny Fish's heart rate that had been sitting at about 144 - 146bpm was suddenly going 140, 139, 138, 137... I felt fine, but I checked my Dexcom graph and saw that I was indeed slipping ever so slowly low:

I had been in hospital for an hour and a quarter, right across lunchtime, and had no food. Lucky I packed a banana, muesli bar, mandarin, juice... My blood glucose meter was, as normal, slacking and only showed 5.5mmol (a no-drama number), and no alarms had gone off on the dex. So I decided to see what would happen for a minute. Not long, but it intrigued me greatly that the baby's heart rate would start dropping noticeably before I felt symptoms or got low alarms. Shortly after that, the midwife came back in and by that stage I felt it necessary to eat the banana. She too was interested, and of course insisted that I stay a further 30 mins. Gah. She also threatened me with a hospital lunch but I said no thanks I have plenty!

Another goodly wait and Tiny Fish got the hiccups. The were strong enough to be seen moving my belly, and through the CTG monitor they were very loud! They were so strong the monitor kept slipping to the point that I couldn't keep it lined up with my hand, and the CTG alarm started going loudly. So that, plus loud hiccups, plus dexcom alarms, plus my phone buzzing with incoming text messages (hey, I was bored!) and soon another midwife came quickly in to sort me out. She looked at the graph and decided it was pretty good. My midwife came back in and ripped off the paper print out and took it out to get checked, and then I was released!

I packed up and got all the jelly wiped off my belly. Walking back up the corridor I started bumping into folks from my antenatal class, another and another. What was going on? Oh riiiiiiight, this was the antenatal class tour of the labour ward! lol. I was starving (hey, a banana and muesli bar is NOT enough at this stage ok) and hubby was on his way to pick me up so I decided to flag the tour. But they were all like "oh is this where we meet?" "um, yeah, I've just been in here for monitoring, I'm not staying for the tour" "Oh! Are you ok???!" "Yep, got the all clear".

So it was the result I expected, no problems, and next scan is on Thursday. But since we live so close to the hospital it is worth getting checked out anytime I see something unusual. This week is my last week of work with handovers to all the new tutors (5 replacements!) and I have 4 official medical appointments, with a recommendation from the midwife to go for another CTG monitoring session after the scan on Thursday. Current thinking is that I will talk to my boss about working shorter hours this week as the exhaustion is just getting too much for me. Hopefully I can just work mornings??? We will see :)

Thanks for reading :)

Tuesday, April 29, 2014

29w4d Scan and stuff

I am on a two week mid-term break from work at the moment, so no teaching. But there are so many appointments and baby-things to do that it's not exactly a restful time either. I will try and put this down in the right order but things are starting to just become a big ol' blur!

Since my last post the weekend before Easter (when I got sent to labour and delivery for a minor bleed on a Sunday night 13 Apr) I took the Monday off work to rest up and recover, then on Tuesday morning I phoned my diabetes nurse educator (DNE) and told her what had happened and do a pump download. She promptly got me an urgent appointment with both her and my OB for Wed 23 April. She saw that my blood sugar levels were too high (averaging about 10 - 13 mmol/L semi-constantly) and was worried that this may have contributed to the bleed. She also saw that the tests the midwife had taken on Sunday night hadn't been entered in the hospital database and asked me to pop into hospital on my lunch break to re-do tests including a complete blood count and urine test for infections.

The Wednesday appointment was good, if for no other reason that getting two of my 3 medical care team in the same room! The OB took my blood pressure (118/73?? slightly elevated for me) and blood/ox (95% slightly low) the measurements were so out of character for me that the OB tested the machine on himself! That was like the highest BP I've ever had. But I know why... it was raining, I was stressing about my blood sugars and getting to the appointment, and having to reschedule the class I was teaching. Oh, yeah, and I was having another bleed just before leaving campus for the hospital! The OB basically said that since the bleeds were so minor, and apart from slightly elevated white blood cells, and slightly weird BP and blood/ox readings, and slightly raised blood glucose, everything was fine and there was no sign of any definitive problems. He wasn't fussed and put my mind at ease :) saying that some women just have bleeds, and that it could be the placenta previa??

My DNE took me up to her office afterwards, which is just two floors above antenatal clinic, and we went through my blood sugar CGM graphs with a fine tooth comb. I made another bunch of changes, and they seem to have worked out ok. Well, better for now, but things are requiring constant adjustments.

That was the last week of term, and the OB had speculated that it may just all have been caused by stress. An excellent time to have two weeks off!

First week of the hols was supposed to see me have a midwife apt, growth scan, and OB apt.

The appointment with my midwife was supposed to be on Easter Monday 21st April. And I promptly forgot all about it and we went out to have morning tea with friends then have lunch at a cafe instead. I felt VERY guilty when I looked at my phone and saw all these missed messages! Whoops! Brain fade. Got it rescheduled for later in the week.

In the meantime, on Wednesday 23rd April, I had my first growth scan ultrasound which was done at the hospital, and that was followed by another appointment with the OB.

At the growth scan we got to see Tiny Fish looking happy and healthy, with a good heartbeat of 142bpm. Growth sitting at 1417g which places in the 61% percentile. That lines up with what the midwife had measured with the tape measure at previous appointment. Baby was facing towards my spine with head down. Thankfully, we were able to see that the placenta had well and truly moved up and back, right out of the way. No more placenta previa hooray! This means I now have the opportunity to give natural delivery and/or induction a go.

The scan itself was quite quick, and Tiny Fish seemed too big to fit in the picture nicely like had done in the past. And was hiding and squirming about making it nearly impossible to get a nice shot of the head. Here are the pics:

This is, believe it or not, a front-on shot of the head. It is upside down, with the nearly horizontal curved line in bottom-centre of image the top of skull. See the two white horizontal lines on the left of image? They are pointing to Tiny Fish's chin. You can kind of see the right eye socket, and some smudges where nose and mouth are. Tiny Fish was head down way down low, and did NOT want to be photographed thank you!

This one is easier to understand. It is a whopping great foot. See the two little cross-hair markers, those are the heel (top) and toes (bottom) and it is nearly 6cm long! Wow that is big!
The OB appointment was good, and after the Dr talked for a little bit and made happy noises about no more bleeds, that I was looking better, and my blood sugars were now averaging much lower, I made sure to ask a bunch of questions:

  • Can I keep my pump and CGM on during labour? Yes, that sounds like a good idea for you to do that.
  • Is it possible for me to avoid an induction, as I have read that artificially induced contractions can be much more painful. Plus I don't really want the additional risk of more interventions - specifically a c-section. Yes, if you spontaneously go into labour before 40w, and you are both still healthy then that should be possible. Ideally you would start or be induced between 38 - 40w. But you can't go longer than 40w. That's the max.
  • I want to restrict who will have management rights of my diabetes, will that request be respected? Yep we are happy to work with you.
  • Can the IV line be placed nice and early in case I need dextrose / glucose? Yes.
  • What is causing the nerve pain in my thigh? That's your femoral lateral subcutaneous nerve.
  • I had more questions to ask, but silly me didn't actually pull out my phone to look at my list. D'oh. Oh well, next time.
Yes, this post is continuing... feel free to reach for some snacks and refreshments. You deserve some form of chocolatey treat for reading thus far!

Thursday 24th April rolled around and I decided to bake a cake to have ready to come out of the over at just the time when my midwife was due to pop round. What a coincidence! I was thinking that would be a nice touch since I had stood her up on Monday :P

Well, cake was delicious*, but midwife didn't get any of it cos SHE forgot! hahaha We figured that she had been called to a birth as she told me when I rebooked the appointment that that could happen. No drama. More cake for meeeeee! *it had ganache om nom nom.

The step kids came for the weekend and we had some family in from out of town. We went to the 10am ANZAC Day service at the Cenotaph, then took poppies up to Hubby's Grandfather's grave. I Facebooked my midwife and she phoned up terribly apologetic to have missed our apt and we got another one scheduled for tomorrow. Third time's the charm!

Oh, and yesterday I lost my sh*t for the first time in this pregnancy journey. It wasn't a bleed, or blood sugars, or even concerns about whether I will make a good Mum. It wasn't worries about breast-feeding, or how my diabetes will be managed in labour, or what it will be like to leave my job and go on maternity leave. No, all of these things are scary to a certain degree, but have not yet freaked me out.

So what did it?

I feel silly admitting this, but I lost the plot over our earlier purchase of stroller and capsule. See, I was thinking how the capsule didn't have much/any real padding in it and from there it was a short trip to looking at online safety ratings websites and finding that our capsule wasn't listed at all. This did not give me a good feeling and my instinct was that I needed to get a better capsule. The stroller is ok, not great, but I could live with it.

Then things got awfully complex quickly, since that particular model of stroller and capsule are designed to go together, and capsules with higher safety ratings wouldn't fit in the stroller at all. Not even with adaptors. The old capsule we thought had the option of getting a base as the lady at the store we got it from advised us, but when I called the shop they said no, no base to go in the car. Boo. And then I started thinking about how hard the stroller was to fold up. And I wanted to get rid of them and start again. It was a difficult thing to admit because a) I felt stupid b) I felt like I was making a fuss c) the items in question were not broken and would probably be perfectly fine d) Hubby didn't understand, initially, what I was trying to communicate, which upset us both e) I was incredibly confused about what I actually wanted to do to remedy the problem - or even how I defined the problem in the first place.

But once I got my ducks in a row and explained my worries more clearly to Hubby, he was lovely and understood my sometimes awkward feelings-logic.

The end result is that we will look at either selling the current stroller and capsule (about $300 worth) or if we can't then may keep them as spares. I have selected a top-ranking capsule which was an absolute bast4rd to get a stroller to fit it, however I had a ray of sunshine from a local store owner who actually knew what she was talking about. I visited her today and she presented a plan of attack to get the capsule I want with a base that fits in my car (we can hire this for 6 months), with a fantastic new stroller that is easy to fold up. Just waiting on her to order the adaptor and check that the two items will indeed marry-up. Other than that, it looks like a go. So you will get pictures of said stroller etc once it's all done and dusted :)

I know I have been stingy with the belly pics, but it is nearly midnight and I was awake until about 6.30 AM!!! last night (3 x lows, 2 x pee trips + lots of general aches and uncomfortableness) I saw dawn. So I am too tired to take photos right now. I promise to take some more but I will probably just post them to my twitter feed - you can get that over here in my sidebar - - - - - - - - >

Got my HbA1c results in, and even with that spell of higher glucose results, I have dropped ANOTHER mmol/mol:

Don't you dare call me normal.
And now my brain is feeling really scattered, but I will just tack this on the end. I promise, it's the last thing:

I had a bit of a scare on Saturday night when my blood sugar came down from a high to normal reasonably fast, over about 2hrs, and I noticed an anomaly in the vision of my right eye. I was trying to read the fine text on a Beatles album cover that my step-daughter was playing, and I noticed this blurry fizzing shape that was tracking with my vision, just to the right of the centre of focus.

Because I have a Dad who had detatched retinas, and because I am a pregnant Type 1 Diabetic, all these warning signs lit up in neon and screamed OH-MY-GOD-YOUR-VISION-IS-CRAPPING-OUT!!! Followed by a whispered ***don't panic, it's Saturday and no eye place is open now. Just be calm, be calm, and call them on Monday morning***

I called my optometrist first, noting that ironically I have just had my diabetic retinopathy screening within the past 3 weeks and got the all clear. They explained that I needed to see an opthalmologist, and to go via my GP to get a referral. I called the GP's nurse/receptionist and we both agreed that I may be able to phone the opthalmologist directly and get a private appointment quickly. Nope. They were booked up and short staffed and the only was in was for me to go to the GP and get an "acute referral". The nurse phoned me back and said, sorry, you'll have to come in for an appointment. So I did that yesterday (Monday), and the GP had me lay on the bed while he shone the light in my right eye, checking the blood vessels and looking for signs of any pressure or damage. He found none, and declared my eye ball perfect, like that of a 10 year old, and said I didn't need to the urgent appointment since there had been no change in 48hrs. Although he did say to monitor it like a hawk and any change at all I could get the referral letter in a flash. It's still there, but no change so far. I am wondering if I should go back to my optometrist anyway?

So yeah, it's been a busy 3 weeks.

Sunday, April 13, 2014

27w2d First official trip to maternity

Okay, so you may remember that at about 12w I had a minor bleed and ended up in the emergency room in the middle of the night? Well, this evening I had another, very very very minor bleed.

It took me all of 3 seconds to argue with myself about whether or not to call my midwife. I lost that debate and texted her immediately. I knew with near certainty that everything was fine, but bleeding is literally at the top of the list of things to call her for. And last visit she had drilled all the signs of pre term labour into me. And she would have my head on a platter if I didn't call her. So. I behaved myself and called.

She was really lovely and concerned, but it is always a hyper-awkward conversation discussing the intricacies of a bleed. Look away now cos TMI coming up....

... Went to the loo and wiped, got a mixture of pale pinky brown mucus type blood and also some bright red fresh blood. But only a super teeny tiny amount. And baby was (is) moving. And I felt fine. Well, sore lower back which is kinda new, and oh shit isn't that a sign of pre term labour? Yes, txt the midwife!

She let me know that I needed to go straight up to labour and delivery. She would call ahead for me, and that I would most probably have to stay in overnight so pack a bag. I am sooo thankful that we live less than 2mins drive from the hospital. Can see it from the road out front of our house. Comfortingly close.

Hubby was out of the house with the 2 younger step kids (eldest has gone to college last week!!!!) and in characteristically he had left his phone on the armchair. So I was just about to call step-daughter to try and get hold of him when they pulled up in the car. He helped me pack, grab extra supplies for the pump and Dex, and we both kind of felt a bit of nerves about having to go up there and the enormity of maybe needing to stay overnight. Serious stuff. But we were calm.

We got up there and met with the on call midwife, S. Ours was 40mins away and didn't know whether it was serious enough to warrant her coming in. S was lovely and looked after us very well. She made up a room for us and got me to do a urine sample, then took my blood pressure and hooked up the CTG monitor to check baby's heartbeat.

Everything came back fine and normal. We got a good long look at Tiny Fish's heartbeat sitting around 120 - 140bpm. There was also heaps and heaps of fetal movement. It seemed that Tiny Fish took an instant dislike to the CTG monitors strapped to my belly as he/she kept trying to kick it off!

Hubby ducked out the room to go to the bathroom and there was drama in the corridor as a lady got wheeled in a wheelchair at top speed towards a delivery suite, right past him. She was screaming some mighty screams - arrived right in the nick of time by the sounds of it!

After S switched the monitor off cos the results were perfect, showing no contractions and a very good heartbeat for bubs, we had to wait a short while for a doctor to arrive to do the exam. We used the time to install a new Dexcom sensor since is taken the old one off that arvo, after 21 days of brave and valuable service.

Then Dr K arrived and asked a few more questions. S prepared me for the exam with a sheet overtop and it was actually quite a hilarious event as all four of us were laughing and joking about how with S doing the exam (training) that she was going to put all the doctors out of a job! Hehe

It was over quickly and the good news was my cervix showed no signs of dilation or any serious bleeding. The urine test came back negative for bacteria so that helped rule out a bladder/kidney infection. They concluded that we may never know what caused the bleed, although the low lying placenta could be a potential cause.

I am intrigued to realize that both this bleed and the previous one have been right on the cusp of a change in trimester. Maybe it's partially a hormonal fluctuation causing it? Maybe it's exhaustion, or blood sugars (had a few more lows overnight, but a bit high today, generally ok though, just done a big set of pump changes with DNE) or maybe it's a delayed reaction to having the flu shot and whooping cough vaccination last week. Who knows.

The good news is that all is well, and even if I feel a bit ridiculous traipsing up to the hospital I am very relieved to know for sure that it's all well and good. Tiny Fish is happy in it's apartment. :)

Tuesday, March 25, 2014

24w4d Viability and Type 1 Diabetes control

If you are more interested in reading an update about Tiny Fish then please skip down a bit :)

Diabetes and Pregnancy at 24 weeks:

I am starting to think that the first whispers of insulin resistance may be appearing.

My last two weeks - CGM data
Although in general, my blood sugars are averaging right on target (7.5 mmol), there are now some worrying patches where it is going too high for my liking (above 10 mmol). It's still brilliantly wonderful compared to the pre-pump, pre-pregnancy results, but now that I get tired so easily that little additional couple of mmols really makes me feel like crap. Tired, dry mouth, lethargic, and fuzzy-brained. What's more, if I sit at 10+ for more than 2hrs then I start to get a headache caused by the additional dehydration. Boo.

So here you can see the actual CGM readings from the last two weeks:

The raw CGM data plotted with each day as a different colour.
I was getting higher and higher reading overnight, even though they held pretty flat. Of course, nothing is guaranteed to last more than 3 days in Diabetes Land so I've started having 3am lows (note the red line) in the last 2 nights. Sigh. And I was just about to raise the overnight basals! Must be another growth spurt for Tiny Fish?

My Diabetes Nurse Educator (DNE) likes to tinker with insulin to carb (I:C) ratios first, as these are quite a quick tool to see if they are working. I think the breakfast I:C ratio is doing ok, by looking at that graph above, but it doesn't show you that I've been having to add 30%+ temp basal increases to claw my blood sugar back down during the morning for the last several days. I believe a gentle strengthening of that I:C ratio is in order. (Changed! It was 1:7g and I've just moved it to 1:6g - that may not sound like a lot but I would prefer to adjust things gently as low blood sugars/hypos really tire me out and I seem very sensitive to insulin changes.)

Lunch is definitely my nemesis. Look at that awful peak! Every colour goes up (with the exception of purple, whatever day that was??) meaning the I:C ratio is probably quite shot. I have just changed it from 1:6 to 1:5, and although I expect it will need to go further I still get very nervous giving a bolus of 5 units or more... so I will adjust the basal rate for lunchtime as well to provide a bit more of a gentle boost. Basals should start about 1hour before your want to see the result, so I will look at altering the basal from about 11am onwards thru to 3pm. I've just put it up from 0.675u p/hr to 0.7u p/hr. Not a great increase, but I will see how it goes and keep doing gentle increases every 3 days as needed.

Dinner is a bit of a moveable feast with the actual eating occuring anywhere between 5pm and 8pm. I don't really want to tinker with anymore basals or I:C ratios considering the changes I've made to earlier in my day, so will leave this chunk of the day until the next download. Best to change just a few things (or one! But I'm too impatient! lol) and know which change affected what.

Tiny Fish update:

Hooray for 24 weeks and "viability" - whatever that is. I take it to mean that should I (heaven forbid, touch wood, throw salt over shoulder etc etc) go into early labour then the medical folks would have a crack at saving the Tiny Fish. I very much like the idea that the outside world now considers Tiny Fish worth saving. I have thought him/her worth it since I knew she/he existed for us. It is interested now that I am Showing with a capital S how people react differently to me. My pregnancy has felt very real to me for a long time now, so it is strange to see how other people are just starting to catch on with the idea. I am now well over half way there, and I have been rather full of mirth this week when colleagues and students react in surprise when they ask "am I pregnant?" get a "yes, over halfway now!" in response. Hehe.

I have a nearly-flat belly button. This intrigues me, as my belly button has always been quite sensitive and now it seems to have lost a lot of sensation. I still have a waist, but only just. I can no longer wear normal pants and have been in maternity jeans since the day I bought them.

There is a little bit of reflux, but this is more from the fact that my stomach is getting compressed and I can no longer eat a huge meal. Even though I feel like the cookie monster and have an appetite that could crush mountains. It's a cruel irony that now I am "allowed" and even encouraged to eat more, I can't fit it in without reflux or terrible painful indigestion. My weight is now about 64Kg, give or take, and I still get a bit worried when I see it plateau or drop. Nearly 10Kg+ from my original weight of 55Kg.

The biggie is my leg. I have tried physio (4 sessions) and that seemed to help a tiny bit, but not really. Honestly, they don't seem to be able to help. When I went last week the physio suggested I try a stretchy type of maternity belt thing to try and hold my belly up and off the nerve in my hip. This works for about 15 mins, or until I move, when the stretchy band will roll up and try to cut me in half. I wore it for 2 days before ripping it off for good. The pressure of it squishing my belly was just too much, and I got a very good impression of what a sausage would feel like!

Today I had to take my students on a field trip. About 30mins before we were due to depart, I remembered that on this particular field trip there are very few places to sit. It would be standing for about 2 hours. I started to panic because at the moment I can't stand up for more than about 10 mins before the searing, burning, buzzing, icicle-stabbing pain goes through my right front thigh muscle. I can no longer wear shoes with a heel of any sort. This, I do not like. I spent most of the field trip propping my right foot up on anything the right height, looking like a flamingo, trying to take the weight off that hip. Not that it relieves the pain or anything, it just means I don't collapse.

I managed a gentle 20 min walk along the seaside walkway on the weekend, but couldn't walk back so Hubby had to get the car to collect me. This piece of exercise did me good and yesterday way brilliant with loads of energy. today not so great but that's cos I forgot my pre-natal vitamins!

So I have decided that the physio has reached it's limits. I will instead look at something for more whole-body relaxation, like a pregnancy massage. And I want to do more swimming and more gentle walks even though it hurts. The exercise does me good in the long run.

Depending on whether Tiny Fish is having a growth spurt (I get headaches, tiredness, and all over achiness +++) or not, then my sleep is either reasonable or complete crap. On the nights where I wake up multiple times with low or high blood sugars, plus a couple of times to pee, and then every time I need to rollover I "wake" exhausted in the mornings. The achiness is something else. Shoulders, upper back, hips, all my belly, and legs all aching together. On those nights I build a fort of towels and pillows in the bed and try to be careful with rolling over. Last night was pretty good, no towels or pillows necessary so I could spread out a bit, and just Sockington the insulin pump (in his snazzy blue sock) to take care of when I roll over. I never thought sleep would be such a complex drama. But insomnia sometimes grabs me when I am very over tired and that just makes things worse. The key is to go to bed early. Easier said than done!

Sorry for the ramble-ness of this post, that's about as coherent as I get these days.

Thank you to all of you who have taken time to post comments, it's lovely to hear from you! Even though I am not posting super-regularly I am reading all your blogs every day!

Tuesday, March 11, 2014

22w4d Shopping for baby hardware

I didn't expect to come buy a stroller and a capsule already. Really! We were just going in to have a look. I was relieved when we walked into the baby-stuff shop and saw only four strollers. "This won't be too hard," I thought to myself.

But then I turned around, and there were 20 more strollers and a whole wall of capsules! So overwhelming! Hubby, having some experience in this area before, saved my bacon on this one. He knew what he was looking for and he knew when he had found a bargain. There was a shop demo model (aren't they all demo models??) that was nearly half price and it had a matching capsule. Here's what we got:

Urban Escape II stroller

Urban Escape II Capsule
It all looks far too big for a newborn to me. I use the phrase "I have no idea!" multiple times per day when talking about baby stuff. It is all so foreign and new to me, so unfamiliar, that I want to learn more about it. Spending a lot of time looking at all the many weird contraptions for sale on baby-stuff websites. Trying to make tentative lists of the basic things I would like to purchase. Reading a lot of reviews and watching some YT vids of what items people found useful. But really, I won't know until we get there. Or rather, until Tiny Fish gets here. Lots of kicking in response to that!

My diabetes has been a bit naughty over the weekend and I think this is because there has been another growth spurt. I have gained 2kgs, so now +7kgs for a total of 62kgs. I am very glad to finally be gaining a bit of weight as I was very concerned for a while there. So I got a couple of highs and a few more lows, just more fluctuations than I would have like over the weekend. My diabetes nurse and I made some adjustments last week to try and bring the afternoon blood sugar levels down, so I know that will potentially have messed things up. And I got the traditional bad 2 day headache which panadol barely touches and means I have to sleep more. Long story short: I am thinking that maybe I am getting a taste of the 2nd trimester insulin resistance, or at least needing slightly more as my weight increases.

My leg. Oh geezjus my right thigh is painful. It hurts to stand, and now it hurts to sit and sometimes even to lie down. I cannot find any stretches which alleviate the buzzing, burning feeling in the muscle. Swimming used to give me about 40mins of bliss in the water, but we went for a swim on the weekend and even in the water my leg ached and burned :( Now when I touch the skin gently on my thigh, it burns and buzzes. Not good. I have another appointment with the physio this week so I will see if there is anything else I can do. She had mentioned I might need to wear a belly-belt to support the tummy, but that doesn't usually get prescribed until much later in pregnancy.

Today I feel really high. Sick, thirsty, like I have ketones or something which I don't. My blood sugar is pretty stable and level. I am just sitting at my desk waiting for class to start. I notice stress is doing this to me, as well as having an empty stomach: makes me feel sick. Just tired and exhausted. I'm sure I will perk up once I get into class though :)