30 week update

We are enjoying this beautiful fall season!

This week I got the call with the official diagnosis of Gestational Diabetes. The doctor told me I would have passed before they made the standards more strict, but that I did fail by one point. Go me! I did most of my complaining about it last week- I feel more ready to tackle the challenge now. Even though I still get depressed about the situation sometimes. It's been hard to get the "diabetes stigma" out of my head because every time I talk about having it I feel fat, sick, and lazy. But I continue to remind myself it's a hormone thing and out of my control. In fact, at my doctor appointment this week they told me my weight has been the same to the pound for a month and I really need to be gaining at least a half pound a week. So...balance. I feel like I'm on the Atkins diet but am still expected to eat extra calories somehow without spiking my sugar. I'm sure with practice I'll get it. Sometimes miracles take a lot of hard work.

I went to my first appointment at the Diabetes Clinic today.  It was overwhelming- as I'm sure is normal.  I don't like the finger sticks- but I'm going to have to suck it up until I'm 6 weeks postpartum at least.  Honestly the "worst" part (even though it's good news) is I had a terrible lunch before I went- like the worst I've had in a week, and I warned them my sugar was going to be bad because it had only been an hour.  It came back perfect at 87.  Like, do I even have GD???!!  But alas, this is going to be my life now.  I didn't know I needed to test for ketones daily too.  They also want me to get enough carbs and gain weight for baby, so if that's out of balance I could get ketones which is bad.  They said ketones can give your baby a low IQ.  Ok...I will watch out for that.

This week I have been amazed by the generosity of people! I am floored by the goodness of humanity that sometimes is easy to overlook when you read the news. I've had gifts show up from people who I would never expect a gift from.  From those whose relationship with me has been mostly online only, or people I haven't seen in a decade.  There is so much love and goodness available in the world- and I am so blessed to have people all over that love me!  I never expected people to reach out in the way that has happened.  I feel like the world is celebrating our miracle with us, what a fantastic blessing and reminder of all that is good in the world!  I didn't ask for these gifts, so I get emotional when I realize how deeply others have felt what we have been through.

 

We passed October 15th this week (pregnancy and infant loss awareness day) and it was the best Best Wave of Light we've celebrated in many years!  Each year on this day we've lit a candle for each of our little lost ones.  I think the first time we participated we had three candles, and then we had to add one each year until we had six.  This was the first year where my number of candles was the same as the previous year!  It was a wonderful peaceful feeling to remember those losses and everything we went through, while feeling my miracle baby move around.  I still can't believe that we're one of the lucky ones to overcome Recurrent Pregnancy Loss.  I clicked on the hashtag #waveoflight and read all kinds of incredible stories from all over of those remembering their babies.  It was a beautiful and sad day to be a part of.  I'm thankful for each one of my babies.

For a fun family activity we were able to go to the pumpkin patch!  It's interesting to think about these activities as the last time as the 3 of us.  I'm trying to enjoy this special time we've had with Jack as an only child, and I'm really looking forward to being a family of 4.

I was so thrilled to have my 30 week maternity photo shoot!  This was such a major step for me.  I remember my best friend and I planning the shoot in the spring and talking about what we would do.  I always had this sinking feeling when we spoke about it like "I'm never going to make it that far."  But I did!  And now we will have family pictures of the 4 of us together, no matter what happens (I know that sounds morbid, but once again, it's a relief to me after dealing with the anxiety of loss.)  The setting of many of the pictures is beautiful, cold, and dead- basically a frozen Autumn.  I love the feel of the pictures because it looks so symbolic.  Everything may be dead within view, but then there is new life, bursting right in the focal point of the shot.  It's a miracle.  Such emotional photographs- I can't help but think of everything Aidia and I have overcome together.  I only have the one "sneak peek" photo so far, I can't wait to see the rest of them.

Never Give Up

On to the medical issues of the week...

I've had some really hard choices to make this week.  It's been very stressful and emotional for me because I tended to get really overwhelmed and felt like I didn't know how to keep my baby safe.  I've done lots of research and said lots of prayer hoping to find a peaceful solution.

When I was pregnant with Jack, I took baby aspirin all the way through delivery and stayed on it for the first 6 weeks postpartum to help prevent blood clots.  I knew there was a slight increase risk for hemorrhaging in delivery but I wasn't too concerned about it since it was a low dose.  Everything was fine, we didn't have any complications.  I assumed I would pursue the same course of action with this baby.  I did Lovenox injections for the first little while in this pregnancy, but if the MFM decided it was overkill in pregnancy, how would it not be overkill postpartum?

The problem with blood clotting prevention is that it can be dangerous to not take precautions, but taking blood thinners can have dangerous side effects too.  It is a game of risk vs. benefit for each medication.  The issue is in the more than 5 years that have passed, every doctor I've talked to has a different opinion.  My OB this time around was concerned about Patent Ductus Arteriosus and Atrial Septal Defect- which basically means the holes in baby's heart that are supposed to close after birth may not close completely if I stay on the aspirin.  However, I can't imagine feeling comfortable with stopping thinners at the most dangerous time of the pregnancy.  Especially when I think of placenta and cord function in the last few weeks.  I tried to ask him more in depth questions about the risks, but his answers were for me to try and call a neonatologist at the hospital or try to call a pediatrician (isn't that your job to do phone consults for a patient?)

I was also concerned about breastfeeding on aspirin because I was worried about Reye's Syndrome, which can be fatal, and is avoided by not giving aspirin to children.  I read that baby can get about 4% of the dose I take through the milk, and if I'm on a low dose anyway it's "probably" ok- but it's possible the aspirin can build up over time.  I talked to other women in my same situation and tried to weigh all my options.

So I decided to write out what I remembered different doctors telling me and do some research in medical journals.  What I found was very poor quality evidence and case studies (since there aren't usually controlled studies with pregnant women, it's too dangerous.)  Here's my list I jotted of the different instructions I've been given:

Hematologist: If the pregnancy is healthy- baby aspirin through the pregnancy and six weeks postpartum.  If continued miscarriage introduce Lovenox.

MFM- Lovenox through the pregnancy and six weeks postpartum

MFM- Lovenox is overkill, stick with aspirin

OB- Just Aspirin

RE- It's kind of up to you- indication could go either way

MFM- Stop baby aspirin at 32 weeks, no blood thinners until delivery, then Lovenox injections 6 weeks postpartum

MFM- Stop aspirin at 34 weeks, no thinners until delivery, Heparin injections 6 weeks postpartum.  Aspirin should not be used as a blood thinner for pregnancy (seems to think I’m only on it as treatment for recurrent miscarriage not actual clotting risk.)

OB- Baby aspirin through delivery and 6 weeks postpartum

OB-Stop aspirin at 36 weeks, resume after delivery, 6 weeks postpartum.  Perhaps Lovenox postpartum instead.

From the reading I did, it seems that Patent Ductus Arteriosus (or the opposite problem where it closes too early in the womb) is pretty rare.  This risk wasn't even discussed with me when we had Jack!  Baby aspirin being considered a reason for it happening is in less than 0.5% of cases.  I read about the signs and symptoms of it and I made the hard decision to continue the aspirin because I feel like that birth defect is rare and less scary than a sudden clot/issue in the placenta/risk of stillbirth.  Most correlations seemed to be in regards to much higher doses of NSAIDS.  Sometimes that birth defect just happens anyway- so normal care and monitoring should catch any issue.  Guilt would haunt me forever if something happened because of a choice I made.  But sometimes you just have to pick a plan, do your best, and go forward in faith.  I'm doing my best to keep her (and me) safe.  I'm going to breastfeed while taking it too- but I'll try to time taking it and nursing so she gets the least amount possible.

I'll probably still call the pediatrician.  Maybe I'll see if I can't get an email for a neonatologist who might take pity on me even though I'm not a patient and discuss the situation with me.  I don't really think it would change anything though, so maybe not.  Stress is high- but I am feeling better having made a decision than I did several days ago when I was totally overwhelmed.  We can do this!