[Edited to add: a Trackback to Jo's post about her impending test]
So after reading Michelle's latest comment about her pregnancy, specifically her 1 hour GCT, my head exploded and I hijacked her comments with my sad, strange tale about my experience with gestational diabetes (GD). I really don't mind if people write long comments on my blog (I am pretending that people actually do comment on this blog, which they don't), but it bothers some people. I probably should have written an article here first and just posted it in her comments, but it's too late now.
Unfortunately, writing all of that in her comments has set off that whole experience in my head again, and I just have to write some more about it. These events happened to me over two years ago, and I am still not over it. What can I say? I obsess. It's in my nature.
I worked nights throughout my entire pregnancy. For some reason my OB never internalized this fact. I always made my appointments first thing in the morning after work. I was usually waiting outside their door when they came to open up. I really have no idea why they didn't just make a note in my chart: PATIENT WORKS NIGHTS, but they never did. We went over the fact that I worked nights at every appointment.
My OB's office forgot to tell me that I shouldn't eat breakfast on the day of the GCT. I guess they just told people verbally. The problem is that I was working for the previous 10 hours before I had the test, and I had eaten a bunch of food all night, and I'd had a coke and a candy bar as I was driving to my apartment, where the glucose solution was. I got home, drank the solution, and went to my appointment. Now, I am not a doctor, or a nurse, or any other type of medical practitioner, but I do have common sense. And my common sense tells me that because I ate candy right as I was taking the glucose solution, there might have been a wee bit more sugar in my blood than they were expecting. I mean, one variation of the test is to have the patient eat 18 jellybeans instead of drinking the glucose solution. I didn't know this at the time of the test however, so I didn't mention it. I was very surprised when the result came back high, since I'd had such a an easy and complication-free pregnancy up to that point.
I also didn't know what to expect from the three hour glucose tolerance test. When my OB office called me to tell me that my 1 hour GCT had come back high, they also said I had to have the test the following day. I had to work that night, and I asked if I could schedule it another time, and they said no. I asked if they would provide me with a place to sleep, since I would have been up for some time, they said yes. They did not tell me to follow any special diets. Apparently this isn't done in some offices and is done in others. This is a big problem, because it means that the results will be mixed, and the experiment then becomes empirically incorrect, with some people doing one thing, and some doing another. That's voodoo medicine, in my opinion.
So I spent that whole night at work starving while everyone around me ate pizza and doughnuts. I was in a rancid mood, and dog tired by the morning. I drove to my OB's office and the first thing that the receptionist told me was that I couldn't have the test done at the office because my insurance wouldn't cover it. She said I had to go to an independent lab about two miles away instead. I was livid, and pregnant, and hungry. I also had not slept in a long time. I fought with the receptionist for a while, but then I just went to the other lab.
When I got to the lab and told them why I was there, they asked me if I'd made an appointment, and I said that I had, with my doctor's office. They told me I hadn't made an appointment with them, so they couldn't do my test that day. I immediately broke down and started crying. I mean really crying, sobbing, with tears streaming down my face type of crying. The lab people felt so bad that they made an exception and did my test anyway. I was really having a hard time. Tired, and extremely nauseous after drinking the 100g glucose solution, I had to fight the urge to puke my guts out for the first hour of the test. I finally calmed down after about an hour. It didn't help that the technician use the same place to take the blood three times. I cried on the second and third blood draws, and I never cry over blood draws. I managed to talk them out of using the same place for the fourth blood draw, they used the other arm.
By the time the test was over I was so dizzy and sick that I had to walk to a Jack in the Box in the parking lot of the shopping center where the lab was located to get something to eat, because I couldn't drive in that condition. I had been awake for almost 24 hours, and I hadn't eaten in 15 hours.
The results? I was sky-high on my first reading, two points over their goal value on the second hour, and I crashed big time on my third hour. War ensued.
The first office visit I had after my three hour test was with a different OB, and she said that I didn't have GD, I just had a bad test because of the above factors. She gave me a booklet on GD anyway, and sent me on my way.
I went on the diet for the two weeks until my follow-up appointment with my regular OB. He was dead serious about the whole thing. I'd lost 4 lbs in two weeks following the diet and I was starving. I agreed with his partner - it was a borderline case at best, and didn't warrant special treatment. He said that since I had two elevated values, by definition I had GD. I pointed out that one value was barely above their target. He was convinced that I had it. He told me that my baby was going to be huge, and I might need a C-section, all that jazz. I told him I thought he was wrong, and he offered to send me for the test again. That was the stopper. I didn't think I could prove them wrong unless I went to another 3 hour test, and I was really unwilling to do that.
We finally worked out a plan where I would do a glucose test every time I came in for an office visit - that was every two weeks, people - I would follow the diet at home, and starting at 34 weeks, I had to have special monitoring to make sure that my gargantuan fetus would live if they had to induce labor. I never followed that diet, and I never had an abnormal finger stick test. In fact, at one point the intake nurse at the OB's office thought they were testing for hypoglycemia, because my readings were so low.
I ended up getting pregnancy induced hypertension about two weeks before I was due. At my final fetal monitoring appointment, the OB estimated that I would have a 9-10 lb baby.
I was induced a week later and gave birth to a 6 lb 11 oz baby. That's three pounds under the OB's estimate. They had a pediatrician on hand during the birth, because he was a GD baby, and they took him away right after the birth for special monitoring. I didn't see him for four hours. When they finally brought him in, the first thing the nurse told me was that they'd given him formula without my permission, and in a bottle with a rubber nipple. I was breastfeeding, and I had specifically requested that he get no artificial nipples and no formula. I was livid, and asked her why they'd given him formula without my permission. She said because he was a GD baby, they had to, by hospital policy. My breastmilk wasn't good enough, apparently. I was so mad.
The Moosh never had a drop of formula after we left the hospital.
I am still not convinced that I had GD. My baby's weight was less than the average newborn. By definition (take that stupid OB) GD babies are over 4000g. My son was 3000g.
This is a big deal for me. I trusted my OB, and stuck with him even after I thought he'd made an incorrect diagnosis. I think this is a clear instance where he should have looked at the patient, not the lab results. I still don't know why he said my son would weigh 9-10 lbs at birth. That's 2.5 to 3 lbs of error. Are ultrasounds that inaccurate? Or was he just inflating it so that he could stay in line with his diagnosis?
I never confronted him about these issues after the Moosh was born, I just ended up leaving his practice. I am unsure about what to do for any future pregnancy. My idea right now is to have any future babies at a birth center, with a midwife. That wouldn't necessarily solve any GD problems, but it would solve the pediatrician taking the baby and the formula problem.
It's been two years, and I'm still not over it.
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