JanB
03-10-2003, 01:15 PM
Wow! I really feel like I made the right decision in going with this team.
For one thing, the appointment was at 9 AM, and I was fully expecting to be out of there by 9:30 at the latest, based on how every other appointment I've ever had with an OB has gone -- i.e., get you in, get you out as fast as possible. But no, we were there until 11 AM! The OB talked to us for awhile and then had his diabetes educator come in and talk to us, and they answered every single one of our questions, patiently and without making us feel rushed. This was a very new thing for us.
As for the substance of the meeting... I came away feeling that this guy and his team are extremely knowledgeable about diabetes. They were able to answer all of my questions intelligently and without blowing me off or making me feel I'd asked something stupid. They took my blood sugar problems seriously and didn't just say, "Oh, those numbers aren't that high, you have nothing to worry about" as my previous doctors did.
The OB told me that what he'd like me to do is monitor my blood sugar carefully for two weeks and then come back, and he'll look at the results and decide whether I need to go on meds (oral meds or maybe insulin) before even attempting pregnancy. At that point we may give an oral medication a trial run to see if it works well for me, and if not, we could switch to insulin -- if meds are warranted at all, which is up in the air. He also said that for his diabetic patients, he likes to see them every other week, or sometimes every week if their blood sugar control is slipping, and that the appointments can be lengthy, as you see him, the nutritionist, the diabetes counselor, etc. I actually really liked hearing that, as I find the typical OB visit ("Hi, can we get your weight? Everything going good? Great, see you in a month") to be pointless and a waste of my time. I also think that while on any kind of diabetes meds, particularly insulin therapy, it is extremely helpful to see your doctor more often than once a month, so every other week sounds pretty good to me.
He also told me that in his opinion there would be no problem for me to see him in conjunction with the midwives. Basically the midwives would handle my prenatal visits and most of my care, and his team would oversee my diabetes control. I like that idea as well.
As far as VBAC, he was initially less encouraging -- he said, "Now, as far as delivery, I definitely think you should go repeat Cesarean, no question." :eek: I think my eyebrows probably shot a foot up off my face. I said, "Oh, really? I shouldn't attempt vaginal birth at all?"
Then he explained himself, which made me feel better: he told me about how they don't do inductions on prior C-section moms anymore (which I already knew) and that the protocol for diabetic mothers is to induce before term. I was about to put up a fight when he further went on to explain that "term" means 42 weeks, so he's talking about scheduling the repeat section at 40 weeks!
I was like, oh! That was actually wonderful news to my ears, believe it or not, because I was anticipating that he would say (as my prior OB had said) that he would want me to have the baby at 38 weeks, which I think is WAY too early. My whole goal in going in for this meeting was to find out what I could do to get him to agree to let me go at least to 40 weeks, and here he is agreeing to that before I've even really said a word -- so that was really fabulous. I loved that he said up front that 42 weeks is full term, not 40 weeks as most doctors would say.
And, I agree on principle that there are risks to babies of diabetic mothers who go past term. I know there are people who are willing to take the risk and go past term anyway, but I'm really not one of those people. If I can just get to 40 weeks (assuming I don't go naturally on my own -- Zeke came 10 days early, after all) I will be happy. This OB also said that if I do go into labor naturally before the scheduled section, that would be "absolutely fantastic" and he sees no reason I couldn't have a VBAC in that case, except of course that Zeke was transverse, so if I had another transverse baby that would be a problem.... but there's no real reason to expect that.
Anyway, I came away feeling very positive about this medical team and the care they are willing to provide me. I feel strongly that they are going to give me the best care for me and my baby, and that I CAN have a healthy diabetic pregnancy! It was so great, because the educator who talked with us is a Type 1 diabetic on an insulin pump, and she had two children of her own while diabetic, so she had a lot of good insight to share.
Sorry for the book-long post here, but I wanted to share the progress I've made! I think there are at least a couple people here who are following my long and sordid saga. :)
For one thing, the appointment was at 9 AM, and I was fully expecting to be out of there by 9:30 at the latest, based on how every other appointment I've ever had with an OB has gone -- i.e., get you in, get you out as fast as possible. But no, we were there until 11 AM! The OB talked to us for awhile and then had his diabetes educator come in and talk to us, and they answered every single one of our questions, patiently and without making us feel rushed. This was a very new thing for us.
As for the substance of the meeting... I came away feeling that this guy and his team are extremely knowledgeable about diabetes. They were able to answer all of my questions intelligently and without blowing me off or making me feel I'd asked something stupid. They took my blood sugar problems seriously and didn't just say, "Oh, those numbers aren't that high, you have nothing to worry about" as my previous doctors did.
The OB told me that what he'd like me to do is monitor my blood sugar carefully for two weeks and then come back, and he'll look at the results and decide whether I need to go on meds (oral meds or maybe insulin) before even attempting pregnancy. At that point we may give an oral medication a trial run to see if it works well for me, and if not, we could switch to insulin -- if meds are warranted at all, which is up in the air. He also said that for his diabetic patients, he likes to see them every other week, or sometimes every week if their blood sugar control is slipping, and that the appointments can be lengthy, as you see him, the nutritionist, the diabetes counselor, etc. I actually really liked hearing that, as I find the typical OB visit ("Hi, can we get your weight? Everything going good? Great, see you in a month") to be pointless and a waste of my time. I also think that while on any kind of diabetes meds, particularly insulin therapy, it is extremely helpful to see your doctor more often than once a month, so every other week sounds pretty good to me.
He also told me that in his opinion there would be no problem for me to see him in conjunction with the midwives. Basically the midwives would handle my prenatal visits and most of my care, and his team would oversee my diabetes control. I like that idea as well.
As far as VBAC, he was initially less encouraging -- he said, "Now, as far as delivery, I definitely think you should go repeat Cesarean, no question." :eek: I think my eyebrows probably shot a foot up off my face. I said, "Oh, really? I shouldn't attempt vaginal birth at all?"
Then he explained himself, which made me feel better: he told me about how they don't do inductions on prior C-section moms anymore (which I already knew) and that the protocol for diabetic mothers is to induce before term. I was about to put up a fight when he further went on to explain that "term" means 42 weeks, so he's talking about scheduling the repeat section at 40 weeks!
I was like, oh! That was actually wonderful news to my ears, believe it or not, because I was anticipating that he would say (as my prior OB had said) that he would want me to have the baby at 38 weeks, which I think is WAY too early. My whole goal in going in for this meeting was to find out what I could do to get him to agree to let me go at least to 40 weeks, and here he is agreeing to that before I've even really said a word -- so that was really fabulous. I loved that he said up front that 42 weeks is full term, not 40 weeks as most doctors would say.
And, I agree on principle that there are risks to babies of diabetic mothers who go past term. I know there are people who are willing to take the risk and go past term anyway, but I'm really not one of those people. If I can just get to 40 weeks (assuming I don't go naturally on my own -- Zeke came 10 days early, after all) I will be happy. This OB also said that if I do go into labor naturally before the scheduled section, that would be "absolutely fantastic" and he sees no reason I couldn't have a VBAC in that case, except of course that Zeke was transverse, so if I had another transverse baby that would be a problem.... but there's no real reason to expect that.
Anyway, I came away feeling very positive about this medical team and the care they are willing to provide me. I feel strongly that they are going to give me the best care for me and my baby, and that I CAN have a healthy diabetic pregnancy! It was so great, because the educator who talked with us is a Type 1 diabetic on an insulin pump, and she had two children of her own while diabetic, so she had a lot of good insight to share.
Sorry for the book-long post here, but I wanted to share the progress I've made! I think there are at least a couple people here who are following my long and sordid saga. :)