Pregnancy and what I don't want to forget

Not too much longer now, and unlike with Del's pregnancy, we know the plan is to not get pregnant again. (With Del, we didn't have an opinion either way about whether that would be the last pregnancy or not ... until after she was born).
I always tell photography clients who are seeking a maternity shoot that this time is so relatively short in comparison to life. It's hard to remember looking back that you actually had that baby inside of you and your belly grew to accommodate your baby. It feels long in the present, but it's just not. Pregnancy is fast.
So I'm trying even more so to live in the moment, relishing every pregnant detail.
This time I'm waddling. A first. And it started around 20 weeks gestation. I've realized this has nothing to do with how small or big I am, just how loose my pelvis is.
Everyone comments on how tiny I am. And to be fair, I have a hard time gaining weight (this is largely due to a restricted diet that comes with gestational diabetes. At least, that's my theory. I think of oreos, doritoes, tacos, pasta, etc were part of my diet, it wouldn't be so hard to gain and keep weight on.).
I want to wear a shirt that says: "I'm 8mos pregnant. Yes, really."
And even when people are saying: "you're so small!" - I feel like I look huge. I know "huge" is culturally a negative thing, but not in this case. I can't believe how much my stomach has stretched. I keep feeling amazed that my body has done this!
I can't walk as fast. And I'm often out of breath more quickly.
But I also don't realize how much I'm doing until I sit down and realize my body is tired!
It's harder to squat than last time (say for milking - although I wasn't milking last time, I was faithfully squatting to prepare for birth).
When pregnant, it seems the rest of my body gets smaller, my muscles become more defined, and my belly grows.

This baby seems to be the most active of the three pregnancies.
I try to keep this in perspective - I'm experiencing this pregnancy now, and memories fade. So maybe I'm exaggerating? But I don't think so. They say that babies form a routine in utero and take naps.
I don't think this one naps at all.
Ever.
It's constantly constantly on the move.
You can see it bump, nudge, and rub my belly as my skin moves across my uterus.
And it can be intense. This is a strong person and I'm seeing a lot of heel pushed up against me, I'm guessing.
Even intense movement, I want to remember. How amazing to think there is a person inside of me!

Braxton Hicks are real. This time. And all the books/websites say Braxton Hicks are "mildly noticeable" at worst. That's a lie. They are most definitely noticeable. And if this was a first baby, I'd have been the mom who cried labor multiple times already. The pressure from these contractions wakes me in the night. That's not "mildly noticeable". And if there isn't a bathroom nearby - watch out! The contracting uterus puts intense pressure on my bladder. When we're out and about (say, in the car), this can be awful. I take a deep breath, shocked by the sudden need to empty my bladder, while trying to relax through a Braxton Hicks.
The children find this incredibly funny ... after Ren Man told them the baby finds my bladder and squeezes it and says: "oooh, this is squishy squishy!" So now the children will randomly say to me: "squishy, squishy" in a sing-song voice. As a side note: laughing while trying not to pee is really hard.

This baby has been head down with its back to my right, and feet and hands pushing on my left side. It's not uncommon to get a jab to my bladder, or a head (I presume) rolling across my bladder. Hiccups happen occasionally - maybe once or twice a day. I remember Noah having hiccups and it was painful because it was right under my ribs.

Physically, I feel great overall. Yeah, it's harder to breathe and I'm starving one minute and two bites later feel super full ... only to be starving 20 minutes later. And the gag reflex is still intense at times.

Colostrum happens before the baby comes. I can't believe how full and ready these milk makers look and feel!

The hardest thing about this pregnancy has been diabetes. I'm so so relieved that my numbers have been fine after some weeks where they kept creeping up. I think what made a difference was increasing veggie intake significantly (a large salad a day). I'm sure experience has also helped, I know what works and what doesn't and just hammering that out has been huge. For example, conventional gestational diabetes advice includes a night-time snack - as in, right-before-bed, to decrease the risk of "dawn phenomenon" where your number spikes in the morning. I found that a night time snack doesn't help, and seems to increase my fasting number. So if I'm hungry before bed, I'll eat something small, but my number is lower if I skip the night-time snack.

Diabetes has been so stressful because it limits my diet, making food an obsession. You have to think about every.single.bite and its potential effect. For a few stressful (and tearful) weeks when those numbers kept inching up, it was very frustrating. What more could I do?! If my numbers didn't come back down, insulin talk would begin. If insulin was started, then the homebirth was off the table. And that was very discouraging.
Ren Man started doing (even more) research and found that people on low carb diets will have a sugar numbers without huge swings post-meal. What this means for fasting numbers is that they tend to be higher than the conventional norm. This doesn't mean it's HIGH though, in comparison to the conventionally recommended diabetes diet (that includes carbs).
After seeing this, suddenly my numbers weren't so scary and even started declining into that conventionally expected range (this all refers to fasting numbers as post-meal numbers were always more than okay - they need to be below 140, and were typically below 100). Which speaks highly of the effect stress can have on those numbers!

In light of gestational diabetes, the midwife asked that I see an OB she trusts for a second opinion. I was nervous. An OB!! She ended up being really authentic and as mellow an OB as can be, I'm thinking. She did say she wanted an ultrasound. My feeling is - it shouldn't just be done to be done, there should be a purpose. And the big concern with diabetes is a big baby. I'm measuring over 2 weeks small based on fundal height. But that has wiggle room for inaccuracy - as does everything. Ultrasounds are no different - I've read they can be up to two pounds off. So telling someone they are having a 10lb baby, could really be an 8lb baby ... or a TWELVE lb baby!
The ultrasound happened at 32weeks when the average baby is 3.75lbs. This baby was 3.5lbs. Well, inaccurate or not, it was nice to have an ultrasound show a smaller reading rather than a larger one.

So here are my baby predictions: I think it's a girl, lots of dark hair, hoping for blue eyes, she'll come early (I'm guessing June 13 - the day after our last wedding, or June 21 - the day after our annual solstice party) .... but this baby has been a surprise all along and if it's small then maybe this is the baby that will go past my due date?, she'll be 7.5lbs (smallest baby yet). I'm nervous about how active this baby is! We'll see how that plays out after birth :)

I'm so relieved that we're homebirthing. No matter what, there will be a baby. I know. But the thought of just birthing without having to over think anything (is this it? Or not yet?) or stay on guard to be sure silly things like wearing your own clothes or eating when you're hungry can happen.

Is there anything else I'm going to forget about pregnancy? It's hard (and I had forgotten that) and it also feels so empowering. I'm growing a person. I'm going to birth a person. Our family will grow. And my diabetes sugar numbers are awesome.

Gestational Diabetes (and why I have it)

Gestaional diabetes tends to effect women over 25yrs old who are overweight and have a family history of diabetes*. During my first pregnancy, meeting none of these criteria, I was very surprised to be informed that given my medical history I would likely get gestational diabetes. Funny, because my health history had never played a huge role in my life - it was my normal.
But suddenly the fact that my perfect functioning pancreas (for me) was about to be stretched to its limit.

I was born with something called Nesidioblastis. This is a rare condition (1 in 25,000 to 50,000 source) in which an overactive pancreas secretes too much insulin. In my case this meant I wasn't waking to eat as a newborn and couldn't maintain my temperature. However, because it is so rare, it took the doctors about 5 weeks to figure out what was happening as blood tests before that were inconclusive.
At 3months old, after trying various unsuccessful protocols and researching all the options, the doctors explained that the best option was to remove 95% of my overactive pancreas. The hope was that the remaining 5% would be sufficient to sustain my insulin needs. If it was still too overactive, another surgery would need to be done and I would likely be a brittle diabetic.
Fortunately the surgery was a success. Turns out, 5% of my pancreas is perfect. I would have periods of hypoglycemia as a kid, and in order to avoid seizures I needed to eat regularly. My mom explained to anyone who was curious that I was the opposite of a diabetic - I had to work to keep my sugar levels up instead of working to keep them down. If my routine was off or I was stressed (for example, on vacation or during a week of VBS), I would have a grand mal seizure. My mom remembers when I was young, the behaviors I would start showing that said a seizure was coming. I remember (obviously I was older) an aura - I would feel numb-ish and rainbow-y spots would come into my vision - and I'd say: "umm, I'm having a seizure" and then there would be a rush to get honey and I think there was puking and drooling involved but I would be fairly out of it by then. I'd wake up a few hours later with a headache. Seizures happened a few times a year. Again, this was normal for me - it never felt like I had a health "problem".
My last seizure was when I was nine and I haven't had one since.
The only other funny health thing (which has no bearing on gestational diabetes, but does seem like a bigger deal to me because I was older and more aware) was that I had severe stomach aches off and on from the time I was six years old that would last a couple of hours. I was brought to doctors. No one could figure it out and a few attributed it to stress/school - despite my mom's insistence that I didn't seem stressed. Finally at 14 years old, I had constant stomach pain for 3 days. By the third day I couldn't keep anything down - not even water. So my parents brought me to the doctor who was dumbfounded and in the end decided with my parents that I should be brought to the hospital. After several days, the doctors reluctantly but not knowing what else to do, decided to operate again, over my original scar. At that point they removed 6inches of my small intestines and scar tissue that had adhered to the small intestine. They warned us that this could happen again, but hopefully with me being older and now mobile, it would keep scar tissue from attaching to the small intestine.

Now, back to my surprise during my first appointment after finding out I was pregnant for the first time. When the midwife explained that I would likely get gestational diabetes, my first thought was: "she's confused! I have the opposite of diabetes!" At around 20 weeks gestation I happily sucked down glucola (people complain about the taste, but yum!) and was told I needed to do a three hour test (only 15% of women who test positive in the one hour test, are actually positive in the three hour test and thus diagnosed with gd - talk about unnecessary stress!). And I was surprised to learn my body wasn't working as well as it seemed to be on the outside. The three hour test confirmed that gestational diabetes was a definite. I met with a nutritionist. The whole thing was overwhelming. I had never had to worry about what I eat or didn't eat - and now suddenly all this label-reading and rules! In addition, the midwife was concerned at every appointment that I wasn't gaining enough weight. I politely informed her that my diet was very similar to this new-at-the-time-fad-atkins-diet that people were raving about because they were LOSING weight. You can't have it both ways - low blood sugar and low weight gain, or high blood sugar and more "normal" weight gain.
Insulin was discussed, I'm sure, but was never needed.
Baby number two - I declined the yummy glucola test and just asked for a prescription for a meter and the test strips as gd seemed inevitable. As it was a second pregnancy I was much more laxed about diet (frozen yogurt has fat and protein .... and some carbs ... so why not?!) ... and her birth weight and subsequent drop on the growth chart (she's been about 50% most of her life ... except at birth), I think reflects that less-than-ideal-gd-diet.

With this baby, I did the same thing. I just assume I have gd (and my numbers show me that I do).
The challenge with this baby is that I'm older and this is a third pregnancy - both factors make gd harder to manage with diet alone.
The thing hanging over my head is that our home birth midwife has made it clear that she is not comfortable attending our birth if I have to go on insulin. I have every confidence that she is knowledgeable and experienced and can handle any birth complication thrown at her. I'm also fairly certain that home birth in our state, while legal, is tenuous and she doesn't want to risk** anything - which I think is very fair and understandable.

Given the increased challenges on my body (age, third pregnancy), this round of gestational diabetes is definitely more challenging. At my last prenatal appointment the midwife suggested going off carbs entirely. This had the immediate effect of dropping my numbers impressively, which was very gratifying. But there's still a long way of pregnancy to go and hormones constantly challenging my body's ability to process food ....

*having researched gestational diabetes extensively I have strong feelings that the sugar number levels that pregnant women are expected to keep are not physiologically appropriate (the pancreas makes changes that leads to increased blood sugar to give the baby time to absorb what it needs - but the gd mom is expected to maintain lower sugar levels than the diabetic individual). I also don't see the sense in making a blanket rule that every pregnant women be tested for gestational diabetes (but I rarely think any medical protocol is appropriate across the board - humans are individuals and their medical care should reflect that). Also, if one does have the markers for getting gestational diabetes, there are alternative methods of testing versus drinking a glucola drink - if you think someone has diabetes, don't stress their body out with sugared-up orange soda! Many many of the gd concerns are based on concerns around diabetic women who are pregnant - and most of these issues are concerns in the first trimester; gd moms don't get diabetes until well out of the first trimester, so the concerns are irrelevant.

** the risks immediately at birth are a baby with macrosomnia (large baby) and a baby with low blood sugar having suddenly lost its access to the overabundance of sugar it has been processing for me (this happened with both of the older two, and generally immediate breastfeeding levels things out).

The 15th goal: birth a baby

I don't remember being so nervous when pregnant with Del. I knew our baby would survive and be healthy and birth would go smoothly.
This time I'm a little more hesitant. This feels like I got a nice surprise that feels too good to be true.
So what if we miscarry?
What if being 31 yrs old increases the chances for things like down syndrome ... but actually, do I care?
What if all my strong talk about homebirths and breastfeeding leads to a c-section and formula?

I try to think more positively. I've done this twice in the hospital and both experiences have been impressive natural births. Any birth is impressive. Natural births are challenging, but we've been designed to birth naturally. The hospital adds its own layer of challenges - but we chose our team carefully and we're clear with our expectations and what we were willing to compromise on.
This time, the hospital is not an option. We don't live in an area where there are options any more and I've heard that it's a challenge to birth naturally in this area.
Having said that, I'm not too worried about making it happen, if it was needed.
But among the reasons for birthing for a third time was a homebirth. And I don't want to not have that. I don't want the car ride to and from the hospital. I want our children to be present at any point before, during, or after the birth that they want to be present. I want to be able to go outside during labor. I want a gentle birth for this baby, and the most gentle experience is going to be at home (familiar sounds and smells, minimal separation from family (that car ride), etc).

The only trick is going to be keeping that gestational diabetes under control. I was getting really frustrated because fasting numbers were creeping up - even if my post-dinner number was excellent. Last night I had a handful of peanuts before bed ... back to low numbers at fasting. Phew! Hope this trick keeps working.
My other frustration about this is that I can test three different fingers in a row and get a range of 50 points. Which is the difference between diet controlling your gd, and not. So this test that this whole birth rests on seems very faulty.