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Discussion Starter · #1 ·
Hello all,

This is my first post and I am eight weeks pregnant today. I am in a little bit of a dilemma.

I still have not found a high-risk ob/gyn, which I am told I have to see because I am a Type 1 diabetic. Two of the doctors I wanted to see required a mandatory U/S before I could even meet the doctor. All I want to do is a meet and greet to see if I even want to work with the doctor.

Now, if I wasn't a Type 1 diabetic, I would have a home birth. I am stressed out because no midwife with take me on as a patient and I don't want ANY U/S unless absolutely medically necessary. I've met with a couple of ob/gyns already and they want me to get an U/S every 4 weeks, I know that I can stand my ground and say no, but I don't want the doctor/patient relationship to get screwed up to the point where they won't take my requests seriously or respectfully. I'm already being told they don't want me walking during labor, must have a fetal monitor on, and to be induced about 10 days earlier than the due date (to prevent a stillbirth). I am discouraged and frustrated. I'm not even being given a chance.

I know a lot of you might not be able to give me some advice specifically because I am a "high-risk" patient, but ANY encouragement and applicable advice to my situation would be greatly appreciated. Anyone have any stories where they were "high-risk" and were successful in having your wishes respected and able to work with the doctor even with fewer/no U/S?

I am VERY healthy, eat organics and lots of raw foods and according to my latest blood work am healthier than the average diabetic. The only thing is that I am working on bringing my blood sugars down even further. I have a A1c of 6.5% so I am working to bring that down in the 5's.

I have ZERO morning sickness, only fatigue and a bit of constipation, so I'm basically sailing through the pregnancy.

Anyway, thanks for letting me vent. It's been an emotional day.

Sierra
 

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There's someone around here who is diabetic and would be able to answer your questions better...let's keep this bumped so she'll see it. Is her name Rikki? Am I remembering that right?
 

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Hi Sierra! I don't have any first hand knowledge for you, but I am the mother of a T1 child who was dx'd as an infant. I also have a friend who is T1 and has 4 children. She was not trying to go the 'natural' route, but I can talk to her about her experiences.

My suggestion right now would be to find an endocrinologist that understands your wishes and then have him/her recommend an OB s/he works with that would fit into your ideal birth. That route may be less needle-in-the-haystack, and you will have to work with an endo regardless of your OB anyway. Maybe you can find a perinatologist who feels has enough experience working with T1 patients that s/he isn't freaked out by diabetes.

Good job on having a low A1c! Are you on the pump? If you're trying to get your A1c in the 5's you might want to consider pumping. Minimed has an integrated CGMS (continuous glucose monitoring system) within their pump which is really helpful in preventing low blood sugars and seeing how certain foods or other issues affect blood sugars. I could see the pump being a huge benefit during pregnancy.
 

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First of all
s! I'm not a diabetic but I *do* technically have epilepsy. And in my first pregnancy was labeled 'high risk' by the initial ob/gyn's I saw. After moving home to Ohio, I ended up seeing a midwife who was initially under the woman who deliverd *me* as a child... and was refusing to let me be seen by the midwife. That only changed when the guy who took over for her (she moved to arizona, thank the bloody gods), was willing to work with me - he, coincidentally was/is the father of one of my best childhood friends. We actually had convos that started as "as your doctor I'm writing X down, but as your friend I'm telling you Y". In the end he allowed me to have the birth that I wanted - in a hospital but with complete freedom to move around, be in the water tub (I chose to birth on a bed as I was just too bloody hot after being in said tub for 2 hours already...). And for all of that, I will always, always be thankful & grateful & respectful of him. Because without him I'd have probably showed up at a random hospital in labor and deal with that...

Anywho, all that to say you *can* have the birth you want. You just have to find the right doctor who will work with you. Be honest, but make your wishes known and clear. There is a doctor out there who will work with you and let you birth as you want. You just have to find him/her!!
 

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no BTDT (been there done that) experience but wanted to offer (((hugs))) & best wishes for the pregnancy, labor & delivery you want & deserve.

Sus
 

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Discussion Starter · #6 ·
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Originally Posted by Pavlovs View Post
My suggestion right now would be to find an endocrinologist that understands your wishes and then have him/her recommend an OB s/he works with that would fit into your ideal birth. That route may be less needle-in-the-haystack, and you will have to work with an endo regardless of your OB anyway. Maybe you can find a perinatologist who feels has enough experience working with T1 patients that s/he isn't freaked out by diabetes.

Good job on having a low A1c! Are you on the pump? If you're trying to get your A1c in the 5's you might want to consider pumping. Minimed has an integrated CGMS (continuous glucose monitoring system) within their pump which is really helpful in preventing low blood sugars and seeing how certain foods or other issues affect blood sugars. I could see the pump being a huge benefit during pregnancy.
I am working with an endo already who understands my wishes but she recommended to one of the doctors that required a mandatory u/s before even meeting with him, so that was a no go.

Yes, I've been on a pump for three years now and works great for me! I travel a lot so it was harder for me to be more disciplined with checking my blood sugars. I actually just started on the CGMS almost two weeks ago (I have Minimed), and that's been a great help. With all the lows and lower blood sugars I've been having lately, it shouldn't be too hard to hit the 5's.

Thank you all for your encouragement! I made a few more phone calls to some other doctors for some appts., so I am still hopeful.

Happy to be on this board!

Sierra
 

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I would suggest you check out ICAN, esp your local chapter, but the national forum may be able to help you, too. Lots of very educated women when it comes to "high risk" birth. (personally, I don't see diabetes as particularly high risk if one's sugar is under control. but I could be wrong.)

Also, you can call an ob office to make an appt for a meet & greet w/o mentioning the type 1 diabetes. If that's not possible, get your endo to call and talk to that dr's nurse to get you in w/o an U/S.
 

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Have you also checked with diabetic communities, either your IRL area or online? I have a dear friend who is T1 diabetic and planning to TTC this summer. From talking to her, it sounds like she's been given a pretty positive outlook from her provider on her chances to have a "normal" pregnancy and birth. She has an awesome, supportive endocrinologist who has apparently has a special interest in diabetic pregnancy care...if, by chance, you are in Northern California, I'd be happy to ask my friend for her name.

Maybe also see if you can get your endocrinologist on-board as a resource/care collaborator for the OB provider you find -- you are one person, and it makes sense that your providers should not have your care divided into separate bins based on what internal organs they are interested in. Maybe your endocrinologist also knows an OB provider who might be more willing to work with your wishes too...
 

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Someone PM'd me to come see your thread.


I'm a T1 diabetic, coming up on my 20th anniversary. I have 5 children and am pregnant with #6!

Firstly, you're going to *have* to submit to u/s, unless you want to go the UC route. There is *no* doctor in the country who will not force you to have at least the 20 week u/s, you will also be required to have at least one fetal echocardiogram, since babies of T1s can get thickened heart walls and they can treat that before the baby is born.

I don't know where you live, but here in WA I have an awesome perinatologist whom I work with instead of my endo. My endo has never been helpful, I'm used to my online community and my own experiences. I go to my endo for script refills and my A1c.

All perinatologists and OBs will tell you that you need your A1c in the low 6s, preferrably 5s. You also need to have your fastings/premeal below 95 and 2 hour post-prandial below 120. It's difficult and sucks. They think we're T2s or something! I was in the hospital a few weeks ago due to a severe stomach bug and they had me take off my pump. I protested, but ended up going with their rules... Then no doc ordered a basal insulin, so I woke up in DKA. They let me put my pump back on!


So, all of this to say that there's no way you're going to get out of routine testing...lol except the GD test.
Unless, of course, you decide to go UP/UC. The only one you won't have to do is the quad-screen since T1s blood skews the results. They will want a nuchal fold scan at about 12 weeks, then the normal 20 week scan and usually at the same time you'll get the fetal echo, then another at 28 weeks, then 32 weeks, then most likely NSTs until you're due.

Now, one thing you can count on is if you have a more progressive (I mean *younger*) perinatologist, they'll *let* you go to 40 weeks before they push induction. But be assured, they will induce you on your EDD. They won't let you go further than 40 weeks.


I know it's not the news you want! At least you do have the Paradigm system now. I have it too and am so glad my insurance covers it. It's still not covered by a lot of insurance companies.
 

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Discussion Starter · #11 ·
Quote:

Originally Posted by Rikki View Post
Someone PM'd me to come see your thread.


I'm a T1 diabetic, coming up on my 20th anniversary. I have 5 children and am pregnant with #6!

Firstly, you're going to *have* to submit to u/s, unless you want to go the UC route. There is *no* doctor in the country who will not force you to have at least the 20 week u/s, you will also be required to have at least one fetal echocardiogram, since babies of T1s can get thickened heart walls and they can treat that before the baby is born.

I don't know where you live, but here in WA I have an awesome perinatologist whom I work with instead of my endo. My endo has never been helpful, I'm used to my online community and my own experiences. I go to my endo for script refills and my A1c.

All perinatologists and OBs will tell you that you need your A1c in the low 6s, preferrably 5s. You also need to have your fastings/premeal below 95 and 2 hour post-prandial below 120. It's difficult and sucks. They think we're T2s or something! I was in the hospital a few weeks ago due to a severe stomach bug and they had me take off my pump. I protested, but ended up going with their rules... Then no doc ordered a basal insulin, so I woke up in DKA. They let me put my pump back on!


So, all of this to say that there's no way you're going to get out of routine testing...lol except the GD test.
Unless, of course, you decide to go UP/UC. The only one you won't have to do is the quad-screen since T1s blood skews the results. They will want a nuchal fold scan at about 12 weeks, then the normal 20 week scan and usually at the same time you'll get the fetal echo, then another at 28 weeks, then 32 weeks, then most likely NSTs until you're due.

Now, one thing you can count on is if you have a more progressive (I mean *younger*) perinatologist, they'll *let* you go to 40 weeks before they push induction. But be assured, they will induce you on your EDD. They won't let you go further than 40 weeks.


I know it's not the news you want! At least you do have the Paradigm system now. I have it too and am so glad my insurance covers it. It's still not covered by a lot of insurance companies.
Thanks for your reply, Nikki! I really appreciate it....Congratulations on #6!

I figured as much that if I go to a high-risk ob/gyn, they will mandate U/S along with some of those other tests. Did you comply with all the tests? Were any of your births U/C (What is U/P, btw?)? At this point I am so tempted to do just that....I probably won't but I am VERY tempted....I've been checking out the www.unassistedchildbirth.com website.

What were your A1c levels throughout the pregnancies? I've been able to get my fasting numbers below 90 (more like in the 70s), but am struggling with the p/p numbers....I tend to have a delayed digestion (especially with dinner), so I chase my highs (150-200) in the middle of the night. I'm working on it though. I tend to not give myself as much insulin at night because I LOATHE getting lows in the middle of the night, but I know I need to bump up the insulin a bit more.

Thanks again for your reply and honesty.
 

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Discussion Starter · #12 ·
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Originally Posted by kcparker View Post
Have you also checked with diabetic communities, either your IRL area or online? I have a dear friend who is T1 diabetic and planning to TTC this summer. From talking to her, it sounds like she's been given a pretty positive outlook from her provider on her chances to have a "normal" pregnancy and birth. She has an awesome, supportive endocrinologist who has apparently has a special interest in diabetic pregnancy care...if, by chance, you are in Northern California, I'd be happy to ask my friend for her name.

Maybe also see if you can get your endocrinologist on-board as a resource/care collaborator for the OB provider you find -- you are one person, and it makes sense that your providers should not have your care divided into separate bins based on what internal organs they are interested in. Maybe your endocrinologist also knows an OB provider who might be more willing to work with your wishes too...
Yes, I've looked online and in my area....no such luck yet. I'm still looking! So far, the OBs I've met have more of a negative than positive outlook - meaning they are anticipating problems rather than being encouraging. I live in Laguna Beach, CA, so Nor Cal is a bit far away....I want to live up there someday, though. Thanks for the offer!

My endo knows what my wishes are but the OB she referred me too is not what I'm looking for so I will be searching on my own.

Thanks for your advice!
 

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Discussion Starter · #13 ·
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Originally Posted by mamatolevi View Post
I would suggest you check out ICAN, esp your local chapter, but the national forum may be able to help you, too. Lots of very educated women when it comes to "high risk" birth. (personally, I don't see diabetes as particularly high risk if one's sugar is under control. but I could be wrong.)

Also, you can call an ob office to make an appt for a meet & greet w/o mentioning the type 1 diabetes. If that's not possible, get your endo to call and talk to that dr's nurse to get you in w/o an U/S.
I checked out ICAN, thanks for your recommendation! I will be contacting the chapter that's in my area.

It's actually better that I mention the diabetes. I set up an appt. with an ob w/out mentioning the diabetes and it turned out to be a complete waste of both of our time since she didn't even work with type 1 diabetics. That's a good idea to get my endo to talk to a doctor to let me in w/out the U/S. Thanks!
 

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I just thought I'd mention that you could try posting in the "Finding your tribe" area for wherever you are. The ladies there might have recomendations for you on good, natural, high-risk ob's. Maybe not actually on dealing with diabetes, but it could be a start.
 

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Discussion Starter · #15 ·
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Originally Posted by Julia'sMom View Post
I just thought I'd mention that you could try posting in the "Finding your tribe" area for wherever you are. The ladies there might have recomendations for you on good, natural, high-risk ob's. Maybe not actually on dealing with diabetes, but it could be a start.
I will check it out, thanks!
 

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I have no advice for you but wanted to wish you good luck in finding the right care provider for you. It's still early (I switched to the care provider that was right for me at 28 weeks!). I am sure there's got to be somebody out there who is willing to work with you the way you want to.
Hope you have a wonderful pregnancy and a joyful birth!
 

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Discussion Starter · #17 ·
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Originally Posted by KBinSATX View Post
I have no advice for you but wanted to wish you good luck in finding the right care provider for you. It's still early (I switched to the care provider that was right for me at 28 weeks!). I am sure there's got to be somebody out there who is willing to work with you the way you want to.
Hope you have a wonderful pregnancy and a joyful birth!
Thanks so much for the encouragement!
 

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I just wanted to offer my sympathy - I'm considered high risk due to a uterine birth defect that was surgically corrected. Risks include uterine rupture and incompetent cervix. Fortunately my goal of being my doc's most boring high risk patient is very close to completion


I spent a lot of time and energy looking for a doc who would be willing to treat me as "normal" and I eventually decided to stop the quest and settle for a doc I like and feel comfortable with, even though he does more interventions than I prefer.

It has been a process of compromise and the pregnancy has been a far cry from the midwife/homebirth experience I had always expected I'd have. In case you do end up with more interventions than you'd like, I just wanted to say that for me it's been a process of letting go and trusting that our little one came in knowing that he/she is going to have a different experience. Not that a doc is god or never to be questioned, but it can still turn out ok even if it doesn't look like what you had hoped for. You might also consider various energy/bodywork techniques that can help you and baby feel more at ease in spite of your prenatal care being different. I have gotten a lot of benefit from doing that.

Best of luck to you on your journey
 
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