30 May 2013

more changes

Brown rice, picture from http://www.tylermcpeak.com/wp-content/uploads/Brown_rice.jpg
The last few weeks have been more than a little fraught, but things are settling again. Earlier this month, I went in for the blood sugar testing that is recommended for pregnant women. You fast for at least 8 hours prior to the test, then they take a blood sample, make you drink a weirdly sweet fizzy orange drink, and  test your blood at one and two hours afterward. I woke up nauseous on the day and threw up the water I was allowed to drink on the way there, and felt nauseous through most of the test. Then I went home, figuring that I'd be fine. Several days later, I headed back to the hospital for my regular prenatal appointment, where my least favourite doctor at the practice informed me that I had gestational diabetes. Then she measured the height of my uterus and proceeded to inform me that the baby was too small and lectured me for not eating enough protein. Because my numbers were borderline (as in, my fasting number was just on the line) and because she was concerned about the baby's size, she told me she wouldn't send me to the dietician, but I needed to increase my protein intake.

I went home and cried the rest of the day. I cried at the drop of a hat off and on for the next few days, one of which was, unfortunately, Mother's Day. I nearly lost it at church and was about ready to punch the next person who told me "Happy Mother's Day." I'm not fond of greeting card holidays to begin with, and it's a holiday my mother especially has always played down, because she doesn't want it to be a source of guilt for her kids like it often was for her. So I've inherited a dislike of the day. I managed to get myself moderately composed by the end of the service, and then we went to see Star Trek, which helped a lot.

Then the doctor's office called again. Someone else had looked at my chart and decided I needed to see the dietician after all. I hung up and cried some more, furious that my body couldn't make a baby without reacting weirdly to food. Then I called them back and tried to find out why one doctor had told me one thing and the other had told me something else. The poor receptionist told me to call the dietician and talk with them, since she couldn't do anything. So I did. The dietician's receptionist was actually helpful. She suggested that I come to the appointment, that it would be helpful, and it seemed like she was actually interested in listening to me. So, off I went to the appointment.

Gestational diabetes is usually a temporary condition, where, for some reason or another, the body during pregnany either does not make enough insulin or does not process insulin normally. It can happen for a number of reasons--hormone levels, position of the baby (for example, if it's squishing too much against the pancreas), or probably a few other reasons I don't know about. The information sheet I was given said something like 3-15% of pregnant women develop it, which sounds like a crazy statistic. There are predisposing factors, such as ethnic background, weight, and a family history of diabetes. I'm a tad overweight and my mother had borderline gestational diabetes when she was pregnant with me, although not with my brothers, so it's likely that those, combined with my body's reaction to all the hormones (like with the morning sickness) were what tipped the balance. One of the biggest concerns with the condition is that, exposed to unchecked blood sugar levels in the mother, the baby may grow much larger than it would have without that exposure. This can, of course, lead to complications during delivery, and after birth, the baby can develop jaundice from the sudden drop in its blood sugar levels after being separated from the placenta. The mother may develop high blood pressure in late pregnancy and is now at increased risk of developing Type 2 diabetes later in life. Gestational diabetes usually goes away within the first few weeks after giving birth, once hormone levels return to normal. It's typically controlled with diet and exercise, and only severe cases require the administration of insulin.

When I came out, I had learned that I need to lower my carbohydrate intake for the moment and that I was now required to test my blood sugar three times a day. This was upsetting, too. I love carbs and I've avoided dieting on purpose for most of my life, because I didn't need to add to my body image issues. I'm unused to checking calorie and carbohydrate contents and have very little real idea of the caloric content of most foods. Additionally, after spending most of my pregnany puking my guts out, any food that stayed down was good. I'd thrown up several days in a row prior to my appointment with the dietician, and had been sick right before the appointment, which didn't help my state of mind.

Two days later, at my next prenatal appointment, I found out that I'd lost weight again, probably due to lowering my sugar intake and the morning sickness. Fortunately, the doctor who was in that day was not the one I'd had the time before. His attitude was that the gestational diabetes was an annoyance for me, but as long as I was careful about what I ate and made sure to exercise, I'd be fine. I mentioned the baby's size, and he checked again and told me that the baby's heart rate was fine, and that as I'm a small person, a large baby wouldn't be a good thing. He wasn't concerned. I got my Rhogam shot at this appointment, so now the concern about my blood-type going crazy on the baby isn't a problem (this is a whole different issue. I'm O-negative, which means I lack Rh-factors in my blood.  Most of the world's population has a positive blood type, so odds are that J. has contributed a positive blood type to the baby, and that she's also positive. If her blood crosses the placental barrier, my body could form antibodies to the Rh-factors in her blood. The nice thing about this is that there's a simple treatment for it that prevents my body from forming antibodies. At six months, the mother gets a shot for the problem, and then the baby's tested right after it's born. If its blood type is also negative, there's no worries. If it's positive, the baby gets a shot, the mother gets another shot, and then they're good. This is one reason for the early blood tests in pregnancy--this is an issue that needs to be identified early so it won't cause problems later).

After a week of monitoring my blood sugar levels, I was back at the dietician's. My levels are good, and I'm allowed to eat more than I thought I was, but I really need to avoid white flour most of the time, since that spikes blood sugar way more than most things. So it's whole grains for us, which I've already been doing more of because of the increased need for fibre in my diet (yay pregnancy). But for the most part, it's looking good. I don't have to jab myself in the finger quite as many times in a day now, and that's also reassuring. I'm getting used to it, but I'm not a medical professional, and never intend to be one.

I'm still wondering how pregnancy as a whole is going to redefine my relationship with food. I've never had an eating disorder, but I have struggled with eating enough vs. eating too much, eating more healthily, and body image. For the first half of my pregnancy, it was all about keeping food down, and to an extent, that's still a concern. It's not entirely normal to weigh less at the beginning of the third trimester than I did when I got pregnant. Now it's not only about eating enough, it's about eating enough while keeping my blood sugar levels from going too high. Of course, my immediate craving is for the starchy foods that are the kind of thing I have to eat in much more moderation. As I write this, I really, really want Chinese food and I'd have to have fairly small portions of most of what I'm wanting (although smaller portions are probably a very good idea).

When I was at my worst points while reacting to this, I felt so tired of pregnancy being about what I could and could not eat. I'm still tired of that. And after the baby's born, after my body's handling insulin normally again, I'm looking forward to being able to have a few more carbohydrates and not having to worry quite as much about white flour. At the same time, I hope that some of the changes will be permanent, that I will grow more thoughtful about what I'm eating. I think that would be good for our family as a whole. Although I am planning to have sashimi with white rice sometime after the baby's born. White short-grain rice is on the list of "worse for the blood sugar" so I have to avoid it for now. Long-grain and/or brown rice it is. Two and a half months to go.

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