30 weeks: Childbirth Classes and More Non-Stress Tests

We spent the weekend in Childbirth classes. Two loooong days of PowerPoint slides and breathing exercises. I am officially scared out of my mind about labor. The pain, the uncertainty, the exhaustion, and then when it’s all said and done, you have to be healthy enough to care for a newborn. And I’m not too impressed with the hospital where I will be delivering, either. I didn’t exactly expect a Ritz Carlton or anything, but a postpartum room with an attached shower would be nice. Maybe I am just spoiled, but I thought my days of shared showers went away when I graduated from college. Heck, even most dorm rooms have fully equipped en suite bathrooms these days!

I’m starting to spend more time at the hospital in the big city than I am in my own home. Between the classes, the non-stress tests, and the doctor appointments, I am there several hours every week. The parking attendant in my go-to garage recognizes me now. As I wander the halls from appointment to appointment, I’m starting to recognize the staff. I’m even starting to get the hang of navigating the crazy hallways and the four different sets of elevators.

This morning I had physical therapy, which helped a ton. My husband had to help me up at one point last night. I was in tears over the whole pain-in-the-rear/pelvis thing. In physical therapy this morning when the therapist snapped those two bones back into place, I immediately started to feel some relief. I hope I can make it until my next appointment on Saturday. I asked about coming in more often, but my insurance only covers 20 visits. So I’ll try to stick it out until Saturday. The therapist did give me some good exercises and seating positions to try to keep everything aligned and strong. We’ll see what happens.

After physical therapy, I drove across town to the hospital where I had a non-stress test and a visit with my high-risk OB. My doctor mentioned that I looked tired. I thought to myself that I am doing pretty well if tired is the best adjective to explain my appearance. I am utterly exhausted. I’m swollen. I’m sore. I’m on an emotional roller coaster. He’s lucky I didn’t burst into tears of frustration and fatigue right then and there.

He says everything looks great … except after he measured my belly, he said with a grin that I am measuring a bit big. Great. I was too distressed to even ask if I should be concerned. I have another ultrasound in two weeks, so I guess we’ll get the scoop then.

In between the physical therapy and the non-stress test, I made a mad dash into a grocery store to to pick up a BG meter. I managed to leave mine on my nightstand this morning. Luckily, they were offering Freestyle Lite starter packs for FREE. It included ten strips and a handful of lancets. It was the highlight of my day.

Tonight it is back to the hospital in the big city for Childcare classes.  We’ll learn how to change diapers, how to feed, and how to bathe Baby NoName, but we’ll also learn tips like when to call the doctor, and what to expect month-by-month. Seeing as neither of us has much experience actually caring for a baby full-time, we’re pretty nervous about it all. Everyone tells you that you just have to figure it out as you go, and we’re trying to keep that in mind, but hopefully the class will give us a little confidence until we sort it all out.

A Pregnancy Update

This pregnancy is really moving along. I can’t believe I’ve made it to 29 weeks and that both baby and I are doing so well. I sure am thankful. Here’s a rundown of the latest news:

Today is our Anniversary!

Today my husband and I celebrate our marriage four years ago. It was a beautiful Easter weekend on the beach in North Carolina and the ceremony, though small and quietly arranged, was wonderful. I’m so lucky to have him in my life. I don’t know what I did before I found him.

Pain in the rear moves to the front

Just when I thought I might be starting to get a handle on the hip pain thing, it threw me a curve ball. Now I have pain in the front, too. It’s like the ligaments and muscles around my pubic bone are out of control. Every time I move, the pain shoots through my pelvis, especially when I move my legs. Putting on my socks in the morning has become an epic struggle. When the baby kicks, or I cough or laugh, the pain shoots right through me. It takes me a good couple of minutes to roll out of bed or to climb into the car. TMI alert: It even hurts when I pee.

The books call it Symphysis Pubis Dysfunction, but I call it torture. Apparently, the pain in the front occurs because that is the spot where the two hip bones come together. They’re held in place by ligaments, which become loose and relaxed during pregnancy, in preparation for childbirth. The result is a wobbly pelvis, misalignment of the bones in the pelvis, and possible muscle spasms as the muscles attempt to hold the bones in place. Here is a really good first-hand account of the condition. I think Kmom is onto something when she says she suspects that the root cause of the pain is the misalignment of the hip bones. I have to admit that she has me a little freaked out about the potential for injury during childbirth when Symphysis Pubis Dysfunction is present. I’m going to need to ask my doctors a lot of questions to ease my mind!

I have my second physical therapy appointment tonight. Hopefully they can offer me some sort of remedy. In the meantime, I’m able to get a small amount of relief from a maternity belt wrapped low around my hips, the exercises that the physical therapist suggested, and an ice pack.

The Big Swell Returns

My ankles have started their swelling tendencies again. Even with the compression stockings, they’re still fairly fat and feeling a bit achy by the end of the day. Luckily, the swelling has not spread to my face or hands (I’m even still wearing my rings) and a couple of hours with my feet up does wonders for the bulges around my ankles.

Wishing for a Plan

I’ve been pestering my High-Risk OB for an inkling of what to expect during the birth of my son for a while now. I am a planner, and when things are uncertain, I start to worry. Last week, I pressed for information again and this time I got a little, but not much. He says that we will try to get me to 37 weeks before we deliver. This sort of shocked me when I realized that 37 weeks is only 8 weeks away. Wow.

I pressed for information about the mode of delivery (will Baby NoName use the vaginal route or the uterine, aka cesarean, route?) He sort of put me off on this one, although, it seemed that he was leaning toward the vaginal plan. I’m guessing it’s because my pregnancy, despite the diabetes, has been pretty “normal.” Again, I am freaking out a little (OK, a lot.)

As my belly has gotten bigger and bigger, I’ve begun to realize that this baby has got to come out of me somehow and none of the options sound especially pleasant. I think my preference might actually be for a c-section. At least I’ve had (minor) surgery before, so I could have an inkling of what to expect. Plus, the controlled environment makes me feel better about my diabetes management during the procedure – one less variable, you know? It doesn’t hurt that I’d be likely to get another two weeks of Short Term Disability pay out of the deal.

When I started to freak out a little in the appointment, the doctor just smiled at me, and continued the exam. Sigh. My husband and I attend childbirth classes this weekend. I’m sure I’ll be a worried mess by Monday.

PT for my Pain in the Rear

Saturday I went to the local Physical Therapy practice to see if they could help me with my Pain in the Rear. I’d never been to a physical therapist, so I did not know what to expect and was even  a little nervous.

The visit was pleasant, though, and I felt like the physical therapist actually wanted to help me. She commented that the pregnant population is greatly underserved by physical therapists and the she thought a lot of us could get through pregnancy more comfortably if we were referred to people like her.  If my first experience is any indication, I think she is right.

First she explained that during pregnancy the ligaments that surround the pelvis loosen to allow the bones to expand for the growing baby and for birth. Unfortunately, when this happens, the three bones in the pelvis no longer have the same support that they once did and they start to move around. In an attempt to stabilize the pelvis, the muscles in the region tighten up. This tightening can cause muscle spasms which are painful on their own, but can also cause the inflamed muscle to put pressure on the sciatic nerve, which leads to the sharp pain in the lower back and the pain that radiates down the thighs.

She started by asking me to bend this way and that: forwards, backwards, side to side. Then she checked out the alignment of my hips, which she said were severely misaligned. She pressed on the tops of my hip bones, which were pretty sensitive, and then she grasped my ankles and pulled on my legs. The pulling seemed to help a decent amount with the pain, although the relief was short-lived.

Next she had me lay on my side and she massaged my hip muscles. She commented that they were definitely in spasm at the moment, and I thought to myself that they have probably been in spasm for the last four weeks. She said she would just do a little bit of massage because the muscles were just too tight at this point for a full massage to work. The massage was extremely painful, but when she was finished, there was definite relief. Unfortunately, this relief was also short-lived.

Lastly, she showed me how to do some stretches that should strengthen my thigh, abdomen, and back muscles and stretch out my hip and back muscles. I’ve been doing them once a day, although she suggested that I do them twice a day. I need to find the time, because everything feels better for about 15-20 minutes after I do the stretches.

She said that she could not do a lot on Saturday because I was in such bad shape, but with the starting massage and the exercises, I should see some improvement, and once the hip muscles loosen up a little, the massage will be more effective. I’m scheduled for bi-weekly appointments for the next couple of weeks, in which she will realign my hips and massage the muscles. We will reevaluate at that point. I don’t want to get too excited, but so far, this is looking promising.  I am so grateful to all of you who commented on my previous posts about my pain in the rear. I would not have thought of physical therapy if it weren’t for you – thanks a ton!

Tomorrow I am off to the “Fetal Evaluation Department” at the hospital where they will monitor the baby’s vitals for the first time.

Even More Pain in the Rear

I was up bright and early yesterday morning for a 7:00 AM appointment with the orthopedic specialist. As you might recall from my previous post , I considered cancelling the appointment, but at the last minute, decided to see what he had to say about the less-than-impressive results of the steroid shots.

Surprisingly, this visit was much more pleasant than the last. He did a lot less poking and prodding (although there was still a fair amount of jabbing into my aching rear, lower back, and thighs,) and there were no completely-not-funny jokes about the reflex hammer.

Instead, he agreed with me that because the first set of shots did not give me much relief, there was really not much value in a second round. So we decided on a new course of action: Lidocaine patches, and physical therapy. The Lidocaine patches provide numbing and pain relief. You simply tear off the plastic over to expose the adhesive and stick the patches on your skin where you have the most pain. The down side is that you can only use the patches for 12 hours at a time. Then you have to leave them off for 12 hours before you can apply a new patch. On the plus side, they don’t add to the pain and they don’t screw with your blood sugars.

I stopped by the pharmacy last night after work to pick up the patches. By the time I got home, I was in quite a lot of pain. Per the doctor’s advice, I cut one patch in two and slapped half on each butt cheek. The relief was not immediate, but by morning, the pain had subsided considerably. For the first time in nearly a month, my sleep was not disrupted by the hourly need to find a more comfortable position. Sadly, the pain started to return almost immediately upon removing the patches. Also, I seem to have developed a red skin irritation at the site of the patches. Luckily, I don’t seem to have any other signs of irritation (burning, itching, etc.) Hopefully the redness tapers off before it’s time to slap on the next set of patches.
My next task is to find a physical therapist near either my home or office. The orthopedic specialist was not much help on this front because I live and work so far from his office, so I have a call into my family doctor.

In other pain news, I’ve also developed some ligament pain in my belly – it’s on the sides and it feels kind of like the side cramp you get when you run too long and you’re out of shape. This pain is manageable, though, and does not keep me up at night.

I’m starting to feel like my body is falling apart. I hope it can hang on for another three months!

27 Weeks and an Ultrasound

This morning my husband and I visited the High-Risk OB for my 27 week checkup and for an ultrasound. Now that I am an old pro at navigating the crazy, unmarked streets in the “big city,” I had no problem arriving on time, even though I left after my husband. He, on the other hand, got lost and arrived late, despite the directions he printed out before he left (perhaps it’s time we finally join the 21st century and purchase a GPS …) The nurse admitted that even though she has lived in the city forever, she still gets lost from time to time.

The appointment took about an hour, all told. First I did the standard pee-in-a-Dixie cup-and-then-stand-on-the-scale routine. Let me tell you, it’s getting harder and harder to aim for that little Dixie cup. I won’t give you the gory details, but when the cup disappeared below my belly, I had to take it on faith that my sample would make it in there. Luckily I made it another week without any accidents.

Then the nurse checked my blood pressure, which was a little higher than usual at 126/86. She said we will just keep an eye on it. I mentioned to her that the blood pressure cuff I bought seems to giving me low readings, and she said I can bring it in so that we can figure out what the deal is. At the very least, we can see how far off it is from the one in the doctor’s office and then I will know what my reading really is.

The ultrasound went very well. Baby NoName was wriggling and bouncing around in there like crazy. The technician kept saying things like, “Now where are you going” and “He just wriggled right out of my picture!” Luckily we got two great shot of his face and confirmed, once again, that he is definitely a boy. Even though the pics are just fuzzy black and whites, I am already convinced that he is going to be a heartbreaker. He’s just SO cute! More importantly, he is measuring right where he should; Everything is at 26 weeks and a few days, which is just a few days short of his actual age. His tummy measurement is actually 27 weeks, but the doctor says that, while it’s slightly bigger than everything else, it is close enough that we don’t need to be worried. He weighs 2.2 pounds.

Diabetics are at a higher risk of growing bigger babies due to the higher level of glucose in our blood. This is why we have to try so hard to keep our BGs in the “magic” range during pregnancy. You see, when my BG is high, Baby makes extra insulin to compensate, which makes him gain weight (fat.) This weight is seen most obviously in the torso/tummy. Luckily, my awesome A1Cs seems to be paying off. I’m thinking his big belly is just genetic 🙂

The doctor is not at all worried about my swelling, so my worry-fest was pretty much for nothing. He says every pregnant woman swells, and what I am experiencing is just plain old pregnancy-induced swelling. He said the compression stockings were a great idea, though, and that I should keep wearing them if they make me more comfortable. They really do help with the achy, tired feeling, so I will keep it up. He also encouraged me to get back to the pool (this has been difficult given my aching hips,) and even said a hot tub would be fine as long at the temperature was turned down. Apparently the weight of the water helps push the fluid out of my swollen limbs.

We talked a little about my BGs, which seem to be pretty stubborn lately. Numbers in the 150s and 170s are hanging around a lot, despite my best efforts to bolus them down. He suggested an increase in my basal rates of .1 around the clock, and said that this is right about the time that he expects my insulin needs to start really creeping up. I see my Endo next week, which is good because I’m sure that some hard-core rate tweaking is in order.

More Pain in the Rear

I went to the orthopedic specialist yesterday to see about my pain in the rear. Surprisingly, the pain had subsided a fair amount since the last time I reported. In fact, I have managed to avoid sleeping in a chair for the last three or four nights, which makes for a much better night and much more rested Nici. I decided to keep my appointment anyway in case the pain gets worse again. At least I would have an “in” with the only guy in town who would care for a pregnant woman with a pain in the rear.

I arrived for my appointment early, even though the office is all the way across town. The nurse took me right back to a room, but I waited for the doctor for what felt like an eternity. After sitting on that hard exam table for so long, my rear was starting to complain again.

But that was nothing compared to what he was about to subject me to. He twisted my legs this way and that. He asked me to bend backward and forward at the waist. He made a lame joke about his weird-looking reflex hammer being for a rectal exam. SO NOT AMUSED. And then he got crazy. He jabbed his thumbs into my butt cheeks so hard that I thought I might die. OMG. The pain was immediate and intense. “That must be where the problem is,” he says. No shit. For good measure he did it another couple of times all over my butt cheeks. Holy crap. I wondered if it would ever end.

In the end, he suggested the steroid shots and I gladly took them. Just before he injected the steroids, he poked around on my cheeks again. It felt a bit like he was shoving a hot fireplace poker into my flesh.  “Is that the spot?,” he’d ask with each jab. How could I tell, every poke was pure agony?!

Through the pain, I only managed to remember bits and pieces of his explanation of the condition, but it was something like this: The muscles in my rear are tight (maybe he said inflamed?) and they are probably pressing on my sciatic nerve which is causing the pain in my hips and thighs. The steroids would actually make the pain worse for two days and then it should get better as the inflammation subsides. My BGs would spike about 12 hours after the shots and the highs will last for about two days. I have to go back in two weeks and he might do more shots then, depending on my condition.

He was right about the pain getting worse. Three hours after I had the shots, the pain went from manageable to OMG-I-Can-Hardly-Think-Straight. By evening I was a wreck. The doctor said to avoid heat for one day, but that I could use ice for a measly 15 minutes every three hours. I ended up using ice all night long. It was the only thing that could give me enough relief to fall at least partially asleep.

My BGs rose steadily all evening until they reached a high of 193 around midnight that would not budge, even with a generous correction. Per my Endo’s advice, I doubled all of my insulin rates, but even that was not enough. I rang in at 194 at 2AM and at 199 at 4AM. By morning, I had it down to 174, but that was the best I could do, so I changed my basals to 250% and increased my correction rate, too. Breakfast, with a double bolus rate, was a disaster, resulting in a 211 at one hour postprandial and a 243 two hours postprandial. I am going to try a 250%  increase in my bolus for lunch, but I am also really restricting the carbs. Lunch has about 15 grams, or one exchange. We’ll see how that goes.

So I’ve got another day of this pain and suffering to deal with and then I should have relief. I’m starting to wonder if it will be worth it.

Pain in the Rear, Part 2

You might remember the pain in the rear I described a month or two back. It turns out that it mostly resolved itself with a little exercise and with a shift to sleeping on my side. It still comes and goes, but it is mostly manageable.

Now I have a new pain in the rear. And this one is intense. Instead of the sharp, shooting pain on the one side, I have an excruciating hip pain that radiates throughout my whole pelvis and even down into my thighs. The pain is not superficial — it’s deep inside my hips and rear.

The pain is continuous, and it gets worse if I sit or stand or lay in any one position for more than about an hour. And it’s worse at night. I’ve barely slept for nearly a week now. I’ve tried everything from pillows between my legs to sleeping in a chair. When I find a bearable position, the relief only lasts an hour or two.

In a desperate attempt to alleviate some of the pain, I bought a pregnancy support  brace. It is helping the minor lower back pain I’ve had, but it does not touch this hip pain. Neither does Tylenol.

The book says that the pain is likely a result of the hormone relaxin, which is relaxing the ligaments in my hips to prepare them for childbirth. Oh joy.

Luckily, I had an appointment with the high risk OB yesterday morning, so I asked (OK, begged) for some relief. He referred me to an orthopedic specialist who, unfortunately, is ON VACATION until next Monday. Apparently he is the only orthopedic specialist in the whole area who will take pregnant patients. So I have to wait.

The OB says the orthopedic specialist will probably give me cortisone (steroid) shots. Those should just do wonders for my BGs!

So I am in waiting mode now. I’m sitting on a heating pad as I type this. Does anybody have any ideas for alleviating this pain at least until Monday? What about experience with steroid shots? What did they do to your BGs? How long does the relief last? Do they hurt?