It's not you, it's me. Well, no actually, it's you.

I'm going to call my OB's office tomorrow and break up with my dietitian. When I went in for my check up on Monday, we barely spoke. Each time I go there, though, I get anxious about having to deal with her. So I think at this point I just need to give her the opportunity to see other patients. In the last four weeks I've gone to three conferences nearly back-to-back. I understand the cost of putting on a production like that and I also understand that foods high in carbs are much cheaper and easier to provide than those with a lower glycemic value. I am also sick to death of living off of protein bars out of my laptop bag.

At this point, anytime I eat or do something out of the ordinary, I pay for it with very high or very low blood sugars. Mind you, by out of the ordinary I don't mean splurging on a jelly doughnut since everyone else had one. I mean out of the ordinary like eating cereal without pouring it into a measuring cup first or disconnecting my pump for a 15 minute shower or swim. My carb ratios are so low now that the difference between guessing that a food is 30 versus 40 grams of carbs can possibly be the difference between my blood sugar being 50 or 250 from wrong calculations. I'm tired of crying over finding a new painful infusion site, agonizing over what foods to eat and being disappointed in the consequences. And I'm definitely tired of not getting any support about it but just criticism and disdain.

When I went for my appointment on Monday, my dietitian Marilyn came in with some random student. She didn't introduce the student, took my log book from me and started reviewing it on the counter with her back to me. The student smiled awkwardly. Marilyn flipped through my log and then blurted out, "ooOOOoo watermelon! I sure hope you had some protein with that." I was floored. Seriously? She just went ooOOOoo at me? I told her, "I don't remember what I ate with it because you're holding my log book." Marilyn said nothing for almost a minute. Then she mumbled "Well, it doesn't look like your blood sugar went high because of it."

Watermelon is actually not that bad for you because it's mostly water. I just looked it up in my completely compulsive online spreadsheet of all food and medication I've had since FEBRUARY and my blood sugar was 69 before the watermelon and 97 afterward. First of all, can anyone tell me what the hell you had for lunch on February 24th? I had an egg salad sandwich and mushroom barley soup at 12:12pm.

So you know what, Marilyn? Fuck you. I don't have to dread opening my fridge or hear your bullshit about everything I might want to eat either in my head or at our visits. I shouldn't have to create secret codes in my log book for the completely fictitious foods I put in there because I don't want to listen to snarky comments about what I really did or didn't eat if it doesn't bother my blood sugars. I don't want to hear the same line about protein like a broken record and yet get disinterested shrugs when I ask for advice on what could have caused a high blood sugar despite eating cheese with my meal. This relationship has become too much work. You're too controlling. You've driven me to lie and cheat and I don't need this abuse anymore. So I'm leaving.

I thought I could tough it out with you a little longer for the baby's sake but it's just not healthy for me and my son.

Your labor may vary

For the first time in this entire pregnancy, I feel ready. Sure, the only baby item we have purchased thus far is a Halloween-themed baby bib (it has a black cat on it and says "I'm so cute, it's spooky!") but that's not important. I finally feel like everyone is on the same page and we're all working towards the same goal, everyone has a job to do and it's all going to be great. It's a good thing they give women 40 weeks or so to get used to all of this because it's a lot to cover. Bear with me.

When I first got pregnant I knew very little about labor and delivery. Hell, I knew only a moderate amount about pregnancy, based almost exclusively on my friends' experiences. You know that cliche where they say "your mileage may vary"? Yeah, that's pretty much how it is. Pregnancy, childbirth and parenthood are all just basic lessons on taking things with a grain of salt.

When I first told friends that I was pregnant, one friend in particular (actually a woman I haven't talked to in probably 10 years) sent me an email saying how I could have a homebirth as a diabetic and quoting me a myriad of statistics. I admit my first reaction was "uh, what the hell." I wrote back with some generic "we'll see how it all goes" thank you email and got back another four page reply about how breast is best and don't let doctors scare you with "dead baby" tactics. (I shit you not. She wrote "dead baby" several times in an email to a pregnant woman.) I swiftly archived that email and moved right along.

My own mother's labor stories were from the perspective that things were hectic and a bit confusing but it didn't matter because the goal was to have healthy babies. My most vivid recollections are of her telling me the Chinese doctor that delivered me spoke little English and sewed up her episiotomy crooked. (You see where I get my oversharing from. I come by it naturally.) Perry and I were huge babies and Mom did it all without any pain meds. It was no cake walk and from her experience she talked like a cesarean would have been just as easy to recover from if not more so. Like so many things my mother has endured, I got the feeling that childbirth was not joyful by any means, but was what we endured to get the baby we wanted.

I scoffed at women who talked about what music they wanted playing during labor. I may have even said, "do you tell your doctor what music you want playing for your appendectomy? It just doesn't seem important to me." Yeah, I can be a butthead like that.

One of the first visits I had with my OB, I told her that I was not "one of those Earth mother goddess types" and my goals were 1) a healthy baby 2) to not have my lady parts shredded and 3) as little drama as possible. She said that vaginal delivery is still possible for diabetics but that in some cases the head would make it out but a shoulder would get stuck if they were too big. I balked that that didn't sound like low drama to me and mentally started scheduling my induction date and possibly my cesarean.

All of these thoughts went through my head in a time period when I knew I was pregnant but hadn't really interacted with this baby at all. He was a blueberry in my belly, according to BabyCenter.com and I just couldn't focus on how that blueberry was going to be our son or daughter eventually. It's a big thing to wrap ones head around.

For the first half of this pregnancy, I went along my merry way. I figured we would take one of those day long birthing classes and get a tour of the hospital. Then around week 21, I started feeling this person inside me.

At first they were just tentative movements. But as he started to grow, our son developed a personality as well. On the plane to BlogHer, I sat in the window seat looking out and humming an old bluegrass gospel tune stuck in my head. From the moment I started humming, the little guy started swimming lazily back and forth in my belly. It was very comforting. I landed in Chicago, dumped my stuff in the hotel room and headed down to the pre-conference party where people were stacked like sardines and yelling over the un-chu un-chu un-chu of pop music at volume 11. And as I sat down in one of the only available seats and felt the crush of humanity around me, my unborn son started freaking out in my stomach as if to say "WHERE HAVE YOU TAKEN ME, WOMAN?!" I cut that evening short and headed back to the peace and quiet of the hotel room.

As all these experiences were happening, my attitude about bringing a person into the world started to change. I wasn't thinking about how labor was going to be like all my other hospital experiences where I just wanted to get the hell out of there and more on how I wanted to know everything I could about how my body was going to successfully introduce this person to the world in the best way possible.

Unfortunately, every book I read talked about all these options for "most women" and "low risk pregnancies" and I wasn't really feeling like they were speaking to my demographic. But as I sat in the waiting room at EVMS amongst some morbidly obese pregnant women or ladies who didn't look like they could withstand the stress of a brazilian wax, I didn't really feel at home there either. As Rich has said before, "not everyone is like me."

Faced with these challenges, I turned to the Internet for help. I read up on natural childbirth. Rich and I interviewed several doulas. I made Google documents called "Questions for OB" and "things to worry about" and updated them regularly. And in the beginning I felt very much between the rock of medicinal "high risk" birth as a type 1 diabetic and the hard place of adversarial "keep your dirty paws off my womb" philosophies.

In the last week or so, though, things have started to fall into place. We hired a wonderful doula who will come to our house and help me labor at home for as long as I'd like. She will be a wonderful middle ground between my housecat instinct to try and birth this child in a pile of laundry at home and Rich's protective instinct to rush me to the hospital if I so much as fart with gusto after week 38.

Our doula gave us a list of birth instructors to contact and one of them was starting a class this week. We managed to switch to an 8 week course on unmedicated childbirth. The first class was last night and everyone was great. Best of all it has given Rich and I a common experience and list of topics to discuss before we are in a hospital room with a bunch of strangers. Even after the first session, I already feel like he and I are very much on the same page.

The final piece of the puzzle was to get my OB on board with our game plan. Our previous visit three weeks ago was alright except that there were quite a few mentions of epidurals and inductions. But today I had a very candid conversation with her. I can't stress enough how much having this particular doctor and her campaign to let me manage my own blood sugars throughout labor (which is a major control issue for me that has caused epic fights in previous hospitals) is a huge deal and something no other hospital would let me do. She said that my decision on if I'm induced is completely up to me and that she believes strongly in a mother's instinct to know what's best for herself and the baby. She also said no one would pressure me to do something I didn't want to do but just give me all the data and let me decide.

I could have hugged her right then. That's all I wanted. I just wanted to know that going into the hospital was not going to be going into a war zone and that I would end up throwing down with every medical professional around me while in a very vulnerable state. I just wanted to feel like we're all on the same team.

I am not like most pregnant women. I have a very particular disease that adds additional risk factors to my pregnancy but is relatively easily managed. I also have a birth instructor, a doula, an OB, my kick ass husband, ridiculously excited grandparents and a cast of thousands out in Internet-land to all cheer me on. With all that support, I feel downright invincible these days.

Living by the numbers

I have changed my diabetic basal rates, bolus ratios and correction numbers as of yesterday. As a reminder, the basal rates I take are the insulin I need for just walking around. The extra insulin I take to counteract food is a bolus. And if my blood sugar is too high, I need to know how much my blood sugar will lower for each unit of insulin I take. All these settings are stored in my insulin pump but I have to set them up in the first place. I also have to tell them all to my doctors with each visit (which most of the time involves my stammering and looking them up in the pump, particularly now as they change over time).

Since this little guy in my belly has been making my blood sugars crazy for about a week, I had enough data to try to fix them. I've changed my basal from 1 unit of insulin per hour to 1.3 units of insulin per hour. I changed my bolus ratio from one unit for every 13 grams to one unit for every 10 grams of carbohydrates. And I changed my correction settings to give one unit for each 40mg/dL I want my sugar to drop down from 50. It's a lot of changes and I'm a bit tentative I may have overdone it. But those numbers were conservative considering how many corrections I was having to take all day.

So far my sugars have been much better today. It's barely crested 150 all day and only a smidge low after a huge dinner. It was a little creepy, though, to dial up what seemed like a huge amount of insulin compared to yesterday. Sometimes I have a hard time trusting the technology.

This afternoon, my sensor alarmed in a meeting, telling me I was at 204 and climbing. I checked my blood and it said I was only 130. Hmm. I calibrated the sensor and went about my business. An hour later, I felt a little fuzzy headed and the sensor said my sugar was 120 and dropping. Figuring it was off earlier, I wondered if I was low. I checked my blood at it was 183. Hunh?! I checked immediately again (using blood from the same finger and needle prick) and it said 153. Oh for Pete's sake!

I just put the meter away and told the sensor to shut up and trusted how I felt. And today, I feel pretty okay.