Don’t worry friends–I won’t leave you hanging on that cliff for too long! Here is part 2 of our birth story. If you missed Part 1, you can check it out here. To learn more about life with Type 1 Diabetes, you can check out this FAQ post.
On the way to the hospital, I noticed my blood sugar was dropping–not dramatically, but enough to cause a problem in about 30-60 minutes. I turned my insulin pump off, hoping this would help. When we got to the hospital and checked in, they sent us back to OB triage where I was given an IV bag made up of 5% dextrose (sugar) to nudge my blood sugar level up, since it was still dipping. The nurse went ahead and did another ultrasound to confirm baby was still breech (she was) and checked my sugar again after. It was 68 mg/dL. Low, but not frightening.
Having managed this very fickle disease insanely closely for well over a year in preparation for this baby, I knew that to correct this low blood sugar, all I needed was two, maybe three glucose tabs. These tabs are about the size of a quarter, are made of super fast acting sugar, and dissolve very quickly. But they wouldn’t let me have any. Hospital rules: you can’t treat yourself. No, instead they brought out the big guns: a tube of D50, which is a solution made of 50% dextrose (sugar) used to treat severe hypoglycemia (low blood sugar).
I guess it was protocol? But a blood sugar of 68 mg/dL in pregnancy is not severe hypoglycemia. I later explained to my husband that the manner in which they treated this low blood sugar was akin to trying to kill a cockroach with a fly swatter (the 5% dextrose IV) and then, when that didn’t work, using a shotgun.
Fifteen minutes after they injected the D50 into my IV, my blood sugar shot up 130 points and was already at 198 mg/dL! A full SEVENTY EIGHT points higher than the highest it should be during birth! And my C-section was going to happen in one hour. Remember how you don’t want elevated blood sugars leading up to birth because they can cause low blood sugars in baby afterward?
I was livid. And mildly freaked out.
Especially since just a couple self-administered glucose tabs would have solved this problem before it even became a problem! I asked the nurse if they were going to correct the high blood sugar. “We only correct blood sugars higher than 200,” she said.
This, friends, is why it’s frustrating having diabetes in a hospital: you have to relinquish control of a disease YOU manage 24/7, one that affects your body in ways only YOU really know best. Since hospital protocol demanded adherence, I demanded to speak to my OB.
By the time he came in, we were T-minus 45 minutes to surgery. It usually takes a good couple hours for my blood sugar to come down from a high around 200 and I didn’t have that kind of time. I was about ready to correct the high myself by administering my own insulin via my pump, but I figured I would hold off and at least see what my OB had to say. My OB encouraged me to leave things be, saying that he thought my sugar would naturally drop in time for surgery. I really thought he was wrong: my sugar has never dropped that much that quickly before. I was torn between fixing things myself and simply hoping everything turned out okay.
When he stepped out, my mom and husband said a quick prayer for me, the baby and my blood sugar situation. I used my personal glucose meter to check my blood sugar and found that in the course of my brief conversation with my OB, I had naturally dropped down to 168 mg/dL. Not great, but not nearly as bad as it was. I went against my better judgment and decided to leave things be, reasoning that if I dropped that much in 15 minutes, perhaps I would see even more of a drop without intervening. It was unprecedented, but maybe–just maybe–my body would behave on its own.
And boy was I glad I listened to my OB! I don’t know if it was because of my placenta wonking out, or a healthy dose of prayer, a pinch of luck or some characteristic of D50 I just don’t know about, but by the time they wheeled me into the OR about 40 minutes later, my blood sugar was back down to 90 mg/dL and steady — in other words, it was perfect.
[2018 UPDATE: I later learned that my C-section with Little Bo was likely unnecessary. She was breech, this is true. But had my doctor encouraged me to attempt an ECV (manually turning baby) or try the Webster technique or Spinning Babies, there is a very reasonable chance she may have turned. Some babies even turn in labor! After speaking with two different OBs and new MFM prior to conceiving my second baby, I learned there is no literature or evidence to support the claim that once insulin needs drop 20% across the board, placental insufficiency is a concern–this is especially true in the absence of abnormal antenatal testing! While I regret not questioning what I was told at the end of this pregnancy, I rest easy knowing I made the best decision I could have made with the information and support I had at the time.]
The C-section was a super weird experience. After they wheel you into the OR, they have you sit on the operating table in your hospital gown, which is open in the back. While I was sitting there basically naked in that flimsy piece of fabric, my OB and anesthesiologist were discussing basketball games and their weekend plans like it was just another day at the office–which, for them, I guess it was.
I think the thing I was most focused on at this point was the spinal block. I’m not generally afraid of needles but I won’t lie: this needle had me worried. I was so cold I could barely sit still and I was afraid the chills would cause me to jump at an inopportune moment. Fortunately, it really wasn’t that bad. The anesthesiologist had me sit up hunched over on the table and injected the numbing shot into my back. I felt the typical “pinch” of a needle, but it was actually a lot less painful than MANY of the shots I’ve had to administer myself over the years. I immediately felt a big “POOF” sensation in my lower spine, more so on the left side than the right (which, they said, was normal). Next, I waited for him to administer the BIG needle. I never even saw the needle, but it was big. Probably.
So I waited. And I waited. And before I could ask “Are you going to put the big needle in now?” the anesthesiologist said he was all done! Whatever was in that first “POOF” shot was sure good stuff, because I didn’t feel a thing.
Immediately my legs started to feel like they were falling asleep, sort of numb but without the pins and needles feeling you’d usually get. My lower half, basically from my chest down got very warm (a welcome sensation given I was so cold I could barely keep my teeth from chattering), but the rest of me was still freezing. They drew up the big blue curtain and had my husband come in and sit down next to me while they spread my arms out, put warm blankets around me, and gave me a bag to puke in in case I needed to (a common side effect of the spinal drugs I fortunately didn’t experience).
The surgery itself was a completely awkward experience. Nothing like lying completely naked on a table so everyone can stare at your crotch! And although you’re numb and can’t feel pain, you can still feel being touched. Not so much the surgeons individual hands or fingers, but tugs and pulls.
I never watched any videos of what a C-section looks like, but after experiencing one this is what I imagined was happening: After they did their incisions (which I, of course, didn’t feel), they rolled my stomach skin up from my lower abdomen like a carpet. Then there was a series of big TUG TUG TUGs, like they were pulling a fitted sheet over a mattress that was too big. Then my OB dug around my insides like Mary Poppins’ carpet bag. The whole thing only took about 5 minutes and, of course, didn’t hurt.
The next thing I knew, I heard a faint little whimper, and over the blue surgery sheet what did I see? MY BABY! The doctor held her up over the sheet like a puppet and said “Hi Mom! Hi Dad!”
It was overwhelming. I was in tears. I had worked so long and so hard for this precious little girl, and then all of a sudden, there she was! It happened so fast I almost wasn’t prepared for it. I was both overcome with emotion and feeling like “Oh, wow. That was fast. She’s here? Already? That’s it? That’s all I have to do?” Regardless, it was beautiful, and I don’t think I will ever forget the sight of her precious little face popping up over that curtain.
I heard her cry and saw the nurses bring her over to the warming table. At this point I was starting to feel super anxious. I wanted nothing more than to go over and see my little girl, and I was insanely jealous that my husband was able to go be with her, especially when I was the one who worked for her so hard and for so long!
I was also anxious to know what her APGAR scores were and whether or not she had a low blood sugar. But I had to wait. And wait. And wait. It felt like they took an eternity to close me up (although in retrospect I have to say I’m glad they did a thorough job). I later learned her APGAR scores were 8 after 1 minute and 9 after 5 minutes. Not bad for a mommy with diabetes, if I do say so myself! (Again, shamelessly proud over here).
NOT OUT OF THE WOODS
After they stitched me up, they wheeled me into recovery where I got to take a closer look at our little girl about 45-60 minutes to an hour after her birth. We were able to do skin-to-skin at this point and attempted nursing for the first time. I was worried about being able to nurse, and baby wouldn’t latch. She was acting really lethargic, and the nurse let me know this was a sign of hypoglycemia and that they would need to check her. Her blood sugar was 27 mg/dL (normal in newborns is 40-70 mg/dL).
I was crushed. I felt like I had failed her.
Since she wouldn’t latch, I was given a nipple shield to try in case that would help. Now she would latch, but her suck was too weak to draw out the colostrum. As much as I didn’t want her to have to have formula, I could see it was going to be necessary and gave her a small bottle of it. Her blood sugar immediately shot up to 60 mg/dL and she was just fine. They would need to check her again and have 3 more readings within normal range before allowing her to go home with us.
Little girl was poked in the foot several more times over the course of the night. I felt guilty, like it was my fault this was happening to her. I had to remind myself that technically this could happen to any baby and that I did absolutely everything I could to prevent it. It didn’t keep my heart from breaking every time they poked her, but I don’t think anything could have.
Her next two pokes were great, but her last poke yielded a blood sugar of 39 mg/dL, which was too low. It also meant that they would need to KEEP poking her little foot until she had another three blood sugar readings in a row over 45 mg/dL. It also meant we would need to supplement with formula, which I hated doing. Her next two blood sugar readings (at this point her foot had been poked 6 times) were good, but her next reading was 43 mg/dL. This was super frustrating to me, not only because I hated to see my little girl poked (those hospital pokers are little guillotines too, let me tell you), but also because I know that even the best glucose meters have a margin of error, and 2 mg/dL probably fell within that margin. But once again there was nothing I could do: hospital protocol and whatnot.
Fortunately, my nurse took it upon herself to ask the pediatrician if he thought it was necessary to keep poking her. He said as long as her wet and dirty diapers looked good and we supplemented with formula or expressed colostrum, we were going to be just fine. Hearing that was a huge relief.
A year and a half of planning. Nine months of careful monitoring. And we made it!
Mama could finally breathe easy.
The next couple days went by in a blissful blur. Lots of feeding, lots of cuddling, lots of diaper changes. Neither The Mr. nor I got any sleep, and those first 24 hours were the longest of my life. I’ll leave you with an excerpt of a conversation The Mr. and I had that pretty well sums up the exhaustion of those first hours as new parents:
The Mr: “All in all, I think we’ve had a pretty successful first two days as parents.”
Me: “Two days? It hasn’t even been 24 hours yet.”
The Mr: “… Oh.”
The Mr. and I named our little girl in honor our mothers, who both happen to have the same first and middle names. The Mr.’s mother, who also had type 1 diabetes, passed away in 2004. I never had the opportunity to meet her, but her loved ones will tell you she was an amazing woman. It seemed fitting to name our daughter after her as well as after my own mom, whose guidance was instrumental in helping me find the faith necessary to have a baby despite the challenges of diabetes.
P.S. Lastly, in case you were wondering, babies of mothers with diabetes do not automatically have diabetes themselves and are very likely to never develop it. You can learn more about the lifetime odds of a child developing type 1 or type 2 diabetes here.