When I first got pregnant, I’ll be honest: I was pretty sure it wasn’t going to stick. I’m guessing that’s most womens’ experiences — medicine does a VERY good job of focusing on the fragility of early pregnancy.
Being a woman is so strange. You spend decades living in fear of a “positive” on a pregnancy test, sure that a faint dye line has the power to change (ruin? destroy?) your life so completely. But then, when you DO decide you want to get pregnant, that same dye line becomes the weakest, most tenuous grip on this incredible miracle that YOU COULD LOSE AT ANY TIME. The more I researched early pregnancy, the more I learned how little medicine understands it. Last summer was tough. We were in a sea of early OB visits, constant measuring and ultrasounds and scans, constant comparisons of heartbeat rates, constant fear that this little life was going to flicker out. (And I’ll be clear: I didn’t actually have any indication I was going to have a miscarriage–this was just the overall feeling, for me, of early pregnancy.)
And you can’t talk about it! Because the very fear you are tiptoe-ing around dictates that you have to keep your news to yourself until it’s “safe” to tell, so you are alone with your partner, who can only witness your nausea and exhaustion and tenderness, and fret with you over every little symptom and every spot of blood and every cramp.
I think it was once we made it past the first trimester that the reality of diabetes and pregnancy really started to sink in. In so many ways, my body was normalized by this experience — look at me, I wanted to shout, I’m building a baby like any other woman! I feel sick like any other woman, I am starting to “show” like any other woman, I’m experiencing the symptoms and signs of this unique female tradition that has been hardwired into my DNA. I felt connected to my sex in a way I never had before. I didn’t feel so damn different.
Except, I am still different. I still have to perform the job of an essential organ, bumbling through my “best guess” as to how much insulin I’ll need in every. fucking. moment. of my day. Only this time, my mistakes don’t just impact me, they impact this tiny little life that my DNA has hardwired me to value and protect above all others. No pressure.
And then there were the doctors, nurses, medical professionals, who, god bless them, really don’t understand Type 1. Even the specialists best know “diabetes” through gestational diabetes, a particular type of diabetes that affects pregnant women, and which, to oversimplify, behaves a lot like Type 2 diabetes, not Type 1.
Every single doctor’s appointment during this pregnancy, I am asked one question first and foremost. “How are your sugars?” I learned very early on that the best answer, regardless of its veracity, is “good.” Because, no matter who I am talking to, there is a 100% chance I understand diabetes better than they do. There is one doctor who I work with to manage diabetes and pregnancy: my endocrinologist. The rest of them get that 1-word answer: “good.” Were I to say anything else, I would be given pamphlets and booklets about “gestational diabetes,” about counting carbs, about eating every two hours (actually a dreadful strategy for me), about the fact that “I may have to take insulin” (hmm… def have to take it every single second of every day, thanks tho).
I didn’t expect that there would be a huge arsenal of medical professionals at my disposal to manage type 1 and pregnancy, but still, it’s frustrating and disappointing to be confronted by the limits of their experience and knowledge. They just don’t get it. They get gestational diabetes. Not Type 1. My blood sugar doesn’t “settle” or “rise” — it spikes and crashes. Suggestions like “go for complex carbs like oatmeal” are ridiculous. I can’t eat fucking oatmeal because the scant fiber in it “prevents a blood sugar spike.” If I were to eat fucking OATMEAL for breakfast, I’d see a spike the likes of which would make any of them quake.
I don’t need a doctor suggesting incredibly un-useful nutritional advice to me: I need to understand when to move my insulin pump off my growing belly because the absorption is now useless. I need to understand how often to increase my basal rates because the hormones the placenta is pumping into my body are causing my insulin needs to double, triple, over the course of this pregnancy. I need someone to tell me that, in fact, that’s good, and if my insulin needs were to decrease it could be a bad thing; indicate the placenta has stopped working.
I’m lucky: I have an amazing endo who kinda specializes in this. He’s known within the tiny Type 1 community in NYC; other type 1s seek him out when they discover they’re pregnant. Because he’s that good. Monthly, I get to sit down with him and ask all my very real, very specific, very difficult questions. And then my pregnancy questions go to my OB, to the NPs and nurses at the high risk (yes, Type 1 makes my pregnancy high risk) office.
In a lot of ways, it’s been easy to delineate what my endo helps me with and what my OB helps me with. Questions about blood sugar, pumps, diabetes go to my endo. Questions about the baby, about the placenta and cramping and nausea and exercise and prenatals and all of that go to the OB.
There is one confusing middle ground, though, and that’s questions about all the things that actually put me in the “high risk” group. As a diabetic, I am at high risk for a bunch of pregnancy complications. The big ones are pre-eclampsia, stillbirth, placenta deterioration, and the baby getting too big, too fast. Initially, I understood my actual risk for these conditions to be similar to my actual risk of getting regular diabetes complications: great blood sugar control during my pregnancy will lower my risk, but they can still happen, regardless.
Which “experts” do I consult when it came to questions about any of these risk factors? Initially, I listened to everybody. When I was told that I was at risk for preterm labor because of, well, pretty much everything I listed above, I basically lived my entire second trimester in fear. I have tons of experience with diabetes, but none with pregnancy, so I trusted my doctors when they told me it was a legitimate concern. Every week my body made it with the baby still inside felt like a huge, huge accomplishment. I remember checking them off one-by-one: 21, 22, 23.
In early pregnancy, I used to obsessively google “chance of miscarriage at ____”, filling in the number of days, then weeks, the baby had survived. Once I made it to the second trimester, I started googling “Chance of baby’s survival if born at _____”, filling in those same weeks. I took comfort in statistics. And surely, my high risk status meant that my fears weren’t misplaced. God knows the nurses and doctors talked about it enough, put enough fear in me about it. Type 1 and pregnant felt like a Very Big Deal. I was just the same as any other woman that had been pregnant…but I was also impossibly fragile thanks to my chronic illness.
As of tomorrow, I hit the significant milestone of 34 weeks. If you google “Chance of baby’s survival if born at 34 weeks,” you get the very reassuring statistic of 99%. I realize that I type all this from a position of great privilege—I made it!—but I also feel a teeny tiny bit like I’ve been conned into being as afraid as I was. At no point during this pregnancy has my blood pressure popped above the normal-to-low range. At no point have I been warned that the baby is measuring “too big” or that my placenta seems to be deteriorating (although to be fair, that one’s apparently pretty difficult to assess until it comes out.)
In other words: maybe I haven’t actually had as much reason to be terrified as the many doctors, nurses, NPs, etc., have suggested. Maybe their cryptic warnings about stillbirth and medical emergencies have been ever-so-slightly misplaced. Maybe, when it comes to this body of mine, it’s not quite as different, or as broken, as I have been led to believe ever since February 26, 2014.
I’ll be honest, allowing myself these thoughts at 34 weeks (rather than some point after I have a healthy baby/delivery), is pretty radical. Plenty could still go wrong! I certainly still have time to develop pre-eclampsia, for an emergency to occur. But it’s exhausting, and frankly just difficult, to maintain the constant stream of worry that the world around me seems to have been encouraging for the last 8 months. And there’s a part of me—a big part of me—that just wants to get to know the miraculous but also deeply normal, almost banal, transition my body is currently going through. Banal in its frequency, I mean: women have literally gone through this for as long as we have existed. As much as diabetes wants me to believe I’m cursed and different, maybe I’m not.
For me, that has been the biggest revelation of pregnancy: the beauty of my body’s unremarkableness. Its normalcy. It’s doing exactly what its supposed to do to grow another human inside me—with zero input from me. Pregnancy is, in a lot of ways, your body going on autopilot. I wasn’t consulted when my son’s heart was developed, or when his thumb was. My body didn’t ask for input when it built his nose or his eyes or his ears. It just… took care of it.
I’ve spent almost 6 years feeling like my body has let me down. That it can’t take care of shit: that I have to babysit every little thing it does or I’ll wind up seizing, in the hospital, dead. I’ve struggled to rectify feelings of incredible betrayal. I’ve been so mad at my body, so disappointed, so sad.
Well, when it comes to my son, my body hasn’t let me down. For the first time in six years, I feel like my body has taken the wheel. “I’ve got this,” it’s said, and even though I couldn’t hear it at first over the crush of warnings from medical professionals, I’m trying to listen now. Because it’s fucking beautiful.