A Baby Story: Hallie, part 4

And now for a little catch-all post.

Post-delivery is still a bit foggy in my memory, but Brad snapped a bunch of pictures, and I took notes about some things from our hospital stay to help with this part.

Hallie was born at 8:59 am on Friday, August 28. She was 7 lbs 6 oz and 20 inches long. I won't post a picture, but you should know that she had the biggest umbilical cord that anyone had ever seen (literally. There was chatter about it. And my dad concurred.). We realized later that they took her birth weight before they fully removed it, which definitely added 3-4 ounces to that weight. It was unreal.

Brad trains the babies to hold his hand early.

I could just die over this face.

Waiting for me to wake up.

I always try to keep notes on the different nurses that take care of us, as they are a very big part of our first days as a new family configuration and are very important in my recovery process. My post-op nurse was Karen, and she was a hoot. She was super sympathetic to my issues with anesthesia, thanks to some personal experiences of her own. She cracked me up after she got me situated in my Mother-Baby room and was briefing the next nurse on my stats. She said, "Oh, and that pasty color? That's her normal color. She's actually looking much better than she was an hour ago."

That's me that she was calling pasty, guys. She was dead serious, and it was hilarious.

I love this picture so much. Plenty of people joke about feeling sorry for Brad being surrounded by so many women, but I think he's pretty fond of all of us.

I think this might have been my first picture with Hallie (where most of my face is showing).

My first nurse in Mother-Baby was Sarah. She was very sweet and really enjoyed seeing the girls during their first "meeting" with Hallie. We were all bummed about the girls not being allowed to visit us in the hospital. In keeping with this COVID life, we introduced all of the girls via FaceTime, which wasn't ideal but was still fun.

They were so cute! Genuinely thrilled to meet Hallie. Claire just could not handle Hallie's cuteness.

Then Brynnie pulled out the big Mr. Potato Head smile to show her enthusiasm.

My next few nurses were:

Vanessa

Courtney

Brittany

Courtney (again)

Vanessa was my first night nurse and was very attentive to me and Hallie. I started getting a migraine during the night, and she worked very diligently to get a hold of a doctor who could call in some stronger medication for me. She also found me a belly binder to use as I was beginning the process of standing and moving (which is zero percent fun post-Caesarean). 

Courtney was my second day nurse and seemed fairly All Business at first, but over the course of her shift, we had some good conversations, and I was sad when her shift ended (but we had her again for the next day shift).

Brittany was very shy at the beginning of her shift, but the longer she was with us, the more her funny, witty/snarky personality came out and was really fun. Hallie was rather unsettled that night, so Brittany was very helpful during that stretch. 

Courtney was back with us for our last morning and did our discharge work. I really hated that, because of our unexpected timing for delivery, I hadn't gotten to assemble nurses' gifts. And once we were at the hospital, we didn't have a great opportunity to go get anything, so I felt a little bad not having anything for our kind nurses. They were really great, and we were grateful.

Our first family photos! Claire very sweetly told me that my hospital gown was beautiful.

The hospital that I deliver at is not a hospital that our girls' pediatricians have privileges at, so pediatricians from a different practice take care of the babies while we're in the hospital. We saw the same pediatrician both of the days we were in the hospital, and I LOVED her. She liked us, too, and I know this because she told us. :) She was especially taken with Brad and his helpfulness. Apparently, there were some other families on the floor where the daddies were, um, less than helpful and quite unimpressive.

Her first bath was NOT her favorite.

A favorite moment of mine from our hospital stay happened not long after we arrived at the hospital. When I first met Dr. W, I made a comment about how gross the whole water-breaking part of things was. She responded with, "No! It's totally normal and natural. It's not gross." 

A little while later when Dr. S came in and asked about my water breaking, I made a similar comment about it being gross. Her response was, "Oh, it's SO GROSS, right??" I laughed so hard at their different answers.

Thankfully, we were only in the hospital for two days. Hallie passed all of her glucose tests handily, which was a huge relief to me, after such a long time of working hard to make sure my gdm didn't cause any problems for her. My blood pressure was still a bit of a problem (and is still taking its time to regulate, actually), but they let me go home on the second full day anyway (I'm still- almost a month later- checking my blood pressure and watching it creeeeeep back down). 

Overall, Hallie's birth went really well. We were sad that the girls couldn't meet her immediately, especially Claire, who remembers going to the hospital to meet her other sisters. That said, there was something kind of nice about spending time, just Brad and me, getting to know our fourth baby without any of our normal life activities. Physical recovery from a c-section is incredibly difficult, and time in the hospital post-Caesarean/gdm/hypertension means a lot of poking, prodding, and sleep interruptions, so after our few days of just the three of us...we were definitely ready to get back to our own house and bed.

I'm so grateful for yet another safe delivery of another beautiful daughter. So many things came together for her delivery to go even better than I had been hoping for. We are so grateful for all of our family, friends, and the medical professionals who took care of us, our girls, and all of the details that had to be dealt with. We are so blessed with the best people.

Thank you to any of you who also prayed for us and worked to encourage us along the way. It was a long hard journey, and we are just so thankful to be on this side of things.

Our discharge pictures

A Baby Story: Hallie, part 2

After leaving the doctor's office, I called my mom from the car, and we worked out a new plan for her arrival/our childcare needs. My mother-in-law, Barbara, was actually in town at the moment to help with childcare over the weekend for other plans we had, but she needed to head back to Tennessee on Sunday (before the new c-section date on Wednesday). Thankfully, while I had been working out scheduling at the doctor's office, Mom had been working out flights into Durham. That was a HUGE relief; I had felt kind of panicky over the change in schedule, primarily because of Claire, Lily, and Brynna. 

When I got home, Brad and I started working out other details that we needed to deal with. I had so many things that I still needed/wanted to get done before the baby came that I couldn't quite figure out where to start. So, I started a load of laundry and got to work making breakfast burritos.

Yes. Breakfast burritos. 

When I have gdm, I eat the exact same thing for breakfast every day; homemade breakfast burritos that are balanced perfectly for my blood sugar. I figured this out during my pregnancy with Lily and have stuck to it very devotedly while pregnant since then. I had run out of burritos that morning, so making burritos that evening made sense to me.

I also spent some time readjusting our lesson plans for the coming weeks, so I wouldn't feel too overwhelmed about Claire's schooling. With those two things checked off my list, I felt like I could figure out a game plan over the next few days.

We all headed to bed, and I slept TERRIBLY. I generally sleep poorly while pregnant, but this particular night was truly awful. I was up to use the bathroom every half hour and had so much hip/pelvic pain that I could not get comfortable. I remember thinking, during one of my bathroom trips, that I really needed to make a point to wash my hair every day between then and Delivery Day, just in case Hallie decided to come early. 

Well well well.

At 4:00 am, I was getting up to go to the bathroom (again), and MY WATER BROKE.

This is notable for a few reasons, but the biggest reason was that I've never gone into labor on my own. With Claire, I went in for an induction because of pre-eclampsia. With both Lily and Brynna, I went in for scheduled c-sections. I've never, not once, gone into any form of labor spontaneously.

"Brad. BRAD."

"Hm?"

"My water just broke."

"Oh, did it?" said so calmly and not at all in the bewildered tone that I had...

"Yep. It wasn't supposed to do that!!"

We started hustling at that point. We checked in with the midwife on call, Brad started gathering things for the hospital, and I dealt with all that comes along with broken water. I'll spare you the details.

I called my parents to let them know. It was at this point I had the realization that: I didn't have a hospital bag packed, but I DID have a freezer full of burritos. So...there's that.

I got a shower, put a bunch of things in a bag for Hallie and me, and rushed to get the gifts that I had been acquiring for the big girls put in gift bags + write them a quick note before we headed out. 

Brad woke up his mom and let her know the big news: she was now, with no warning, solely in charge of the older three. GOD BLESS HER HEART. She's a great sport and took it all in stride, and she has earned stars in her crown, for sure.

Now for one of my favorite parts of Hallie's birth story:
I had previously delivered two of my babies through this OB practice and at this hospital. Different doctors delivered each of those babies and were the right doctor for each situation. However, the doctor who delivered Brynna is my favorite doctor in the practice. We clicked from the very beginning, and I had such a great experience with her. I very much wanted her to deliver Hallie, but I knew that I didn't get to choose the provider; it would be whoever was the doctor on-call. With both of my c-section dates for Hallie, yet a third doctor (actually, two doctors; the high-risk nature of my pregnancy and delivery meant I had to have two doctors in on my surgery) was the one scheduled. I like her a lot, too, but even liking her, I still really wanted Dr. S. 

While we were talking with the midwife on call and getting my instructions, she looked at the time and said, "Ok, by the time you get to the hospital and get checked in...who will be the doc on call? Let me see...Dr. S. Do you know her?" 

I just looked at Brad and started crying happy tears. God answered a prayer that I hadn't even bothered to pray; I just assumed there was no reason to ask. But WON'T HE DO IT?

We got out of the house a little before 6:00 and made our way to the hospital, wherein we had to wait in line, six feet from the folks in front of and behind us, winding outside the building, while I continued the beginning stages of labor...just waiting to get our temperatures taken so we could actually get into the hospital. 

Oh, COVID. How weird you have made our lives...

But before we move on in the story, let's do a quick "Answered Prayer Count:"
1. Childcare for children: CHECK
2. The exact doctor I wanted: CHECK
Neither of these were ever the original plan, and it blows my mind a bit!
3. Make it safely to 37 weeks before needing to deliver: CHECK. My water broke on the very day I reached 37 weeks.

This entire story is just riddled with prayers answered perfectly- and yet most of them were answered in ways I never thought to ask for.

A Baby Story: Hallie, part 1

Just a little note: I write up all of my birth stories primarily for my own memory-keeping purposes, so I don't even pretend that I'm going to keep them short or concise. I won't go into super graphic details, but I will mention a decent amount of medical situations. There are a lot of those situations involved in this story. So, all of that being said, if you like birth stories, enjoy this little series! If not, I'll be back in a few days with my regularly-scheduled content about the children's shenanigans.

Hallie, as my fourth pregnancy and c-section, was never going to be born on her official due date, which was September 18. Because she was always going to be a planned Caesarean, we knew that she was going to be born around September 11. Planned sections that aren't following a former emergency section are scheduled for 39 weeks; they don't really want you to go into labor on your own when you've had multiple c-sections. Basically, her given due date never meant anything outside of measurement/sizing purposes.

At my 34-week appointment, they went ahead and officially put me on the hospital's calendar. At that point, I knew which doctor would be scheduled to do my surgery (a doctor I like!) and what day to officially work toward for childcare and general planning purposes.

At my 36-week appointment (which was actually when I was 36 weeks, 6 days... Almost 37 weeks), things took a turn. I had spent the entire pregnancy expecting my diabetes to eventually take a nosedive and become much more severe, like it did during my pregnancy with Brynna. In a surprise twist, it never did! It remained entirely under control just through diet the whole time, which surprised and impressed everyone. What ended up causing problems and adjusting the birth plan was actually my blood pressure.

I developed pre-eclampsia with Claire at 38 weeks, so I'm always very sensitive to my BP readings at my prenatal appointments. In my non-pregnant life, my normal BP is naturally very low, and I never get stressed about having it taken. I'm much more anxious about it while pregnant.

Around 32-weeks, I started running quite high numbers. That particular week, I was fighting a migraine during my appointment, so the doctor I saw that week largely attributed my BP to feeling so bad. She did, however, run several labs just to verify that I wasn't actually pre-eclamptic (which I wasn't). She asked me to check my blood pressure at home over the next couple of weeks to check and see if it was becoming a pattern or if it really was just because of my migraine that day.

It proved to be a pattern. Each time I checked it at home, it was high. At my next few appointments, it was even higher. It just kept climbing.

So, at my 36 (+ 6) week appointment, everything changed. I was set to see a doctor that I had never met before (because he joined the practice after my pregnancy with Brynna), and my first meeting with him went like this:

Doc: "Hi! Sorry to leave you waiting in here for so long, but I've been working on your situation. How would you like to have a baby next week, instead of in two?"

Those are the first words we exchanged, guys.

My response?

"Uh... I'm going to need to get some childcare worked out."

(Please remember that we haven't even done real introductions.)

"Yep. You should get on that quickly. We've rescheduled your c-section for September 2nd, instead of the 11th. Your bp is just getting too high, and we're concerned. We need to deliver your baby."

While he was talking, I was shooting off a text to Brad. I was also realizing that the phrasing of "how would you like [to have a baby earlier]?" was, in fact, less of a question about my interest and definitely his way of informing me that they were making big changes.

Brad wasn't texting me back, so I also started texting my mom, as she had been set to be our childcare. Note: I wasn't just being rude and texting while the doctor was speaking; I told him I was trying to let my husband know. He understood and continued to talk details with me: blood work, glucose things, more blood pressure things, scheduling details through the hospital, pre-op COVID test. 

It all came at me FAST. It was so fast...on top of the fact that I was suddenly processing nerves over the information that they found my bp dangerous enough to make these moves so quickly. I'd been nervous about it for weeks at this point, and it was all becoming super real. 

OOF.

Before I could head home, I had to get a blood panel and also make a pre-op appointment. Getting my appointment took almost 20 minutes to hammer out because there was no time to work me in before my new c-section date. The poor receptionist had to run all over the office, tracking down doctors and rearranging schedules. We finally got something worked out, and I was able to head home and start getting my ducks in a row. I got in the car and took a deep breath before starting to make phone calls. 

Before all the craziness set in at my appointment, though, I had a growth scan and got to see this picture of my baby smiling for the camera:

I'm usually a little weirded out by these ultrasound photos, but look! She was smiling! I definitely think she was smiling because she knew that all the "craziness" of the day was about to get crazier. 

Pregnancy and general health updates (it's a lot)

Gentle warning: this isn't explicitly gross or graphic, but I do discuss pregnancy/medical things. Please feel free to skip if that is too specific for your tastes. Please, also, feel free to skip if reading about pregnancy and delivery and babies is just particularly difficult. I don't want to cause any additional difficulties and understand if you'd rather wait until I post the next round of ridiculous quotables.

Ready?

Here we go:

This fourth pregnancy was a surprise to us, and it took a beat for us to wrap our minds around. We are so thankful and really looking forward to meeting our baby...but Erin Pregnancies are always a mixed bag of emotions and complications. This pregnancy is no different and perhaps a bit more complicated in some ways.

My history with pregnancy includes several issues that tend to follow from pregnancy to pregnancy, namely: preeclampsia/high blood pressure, c-sections, and gestational diabetes (gdm). I also have debilitating migraines and nausea that stay with me throughout the entire pregnancy. I took the pregnancy test on a Saturday, and the nausea set in the very next night. Once the calculations were done, I realized that I was 5 weeks and 2 days along, which meant that I knew almost as early as I could have known...and that a very long road lay ahead of me.

I've written a decent amount in the past about gestational diabetes (which I'll refer to as gdm), because I dealt with it during my pregnancies with Lily and Brynna (I *somehow* lucked out and did not deal with it during my pregnancy with Claire- I think the Lord knew it would have overwhelmed me too much). With Lily, it was discovered at the beginning of my third trimester, and I was completely diet-controlled. I learned a lot about how gdm works, how to count and measure my carbs/proteins/fats, and how my body responded to food, as well as environmental factors. The gdm diagnosis OVERWHELMED me at first, but my fallback habit when faced with something overwhelming is to learn everything I can about it and make a plan. I did, and it worked! My numbers were fine, Lily was a perfect size, and her blood sugar was perfect at delivery. To read more about my experience with GDM, click the GDM label at the bottom of this post or the tag on the sidebar.

Quick fact about gdm: a mom develops gdm because of the baby's placenta. Some placentas produce hormones that inhibit the mother's insulin production. Once the baby and placenta are delivered, mom's body begins to regulate again. Within a few days to a week, her own insulin is (usually) working properly again. That said, having gdm does increase mom's chances of developing type 2 diabetes later in life. So, while it's only for a short time, moms with gdm should definitely take it seriously.

Because I was diabetic with Lily, I was tested early (13 weeks) with Brynna. My numbers were out-of-range after the 1-hour test, but the test made me so sick that I opted out of the 3-hour test and just began checking my glucose and modifying my diet right away (with my doctors' consent).

Note: I really think it would be better if the medical community eliminated the idea of "failing a glucose test" from the process. During my first gdm pregnancy, the idea that I had failed (myself and my baby) was extremely upsetting to me- even though it had nothing to do with how I was taking care of myself. So, I try to use different language when talking about it. Maybe that's too sensitive, but really? Pregnant women are already hormonal and often overly sensitive. 

I did all of my same eating plans during my Brynna pregnancy that I had done with Lily, and despite following all of the rules, ignoring all cravings that didn't fit in the plan, eating on a schedule whether it was what I felt like or not...my numbers kept climbing and climbing, particularly my fasting (overnight/sleeping) numbers, which I had very little control over. It was very discouraging, to say the least. I started on an oral medication at 20 weeks, which was upped to twice a day around 30 weeks. At 32 weeks, I started insulin shots (in addition to the oral medication) and had appointments twice a week for fluid checks (ultrasound) and non-stress tests- all in addition to a strict diet. It was a lot. (And truth be told, I have a hard time, while pregnant, seeing women post on social media or talk with friends about how they just had to eat ____ because the baby wanted it. I almost never get to eat exactly what I want when I'm pregnant, and I definitely can't do it "because the baby wants it." Again, that's probably overly sensitive, but again, please see "hormones.")

With this fourth pregnancy, there was almost no statistical way that I would pass an early glucose test, so I opted out again and just began checking my own sugars. That was around 11 weeks, and as I write this at 33 weeks, I'm still doing ok. I'm not on any medications and am successfully controlling with diet. That might change before it's all said and done, but I'll take it for now.

During my second trimester, I unexpectedly had an intense kidney crisis. I knew it was fairly common to develop UTI's during pregnancy (that's the only time I ever get them), but apparently, it's also pretty common to have issues with kidney stones. Lucky me, I went through the process of dealing with my very first kidney stone while pregnant. I'm not exaggerating when I say that it was the most painful experience of my life. And being pregnant, I couldn't take anything for the pain. My only pain management option was a heating pad. 

If you've ever had a kidney stone, I think you'll understand that "heating pad as pain management" is an actual joke. After days of writhing in pain, not eating (which, by the way, is bad for a diabetic), vomiting from pain, and general despair, they told me I could take 2 ibuprofen sparingly, if I "absolutely needed it" (pregnant women aren't supposed to take ibuprofen/aspirin). 

I got a renal ultrasound to confirm that I had one kidney stone in my kidney (which wasn't causing any problems) and one that was stuck further down, preventing my right kidney from draining (causing swelling in my kidney- hydronephrosis), which was what was causing all the pain (I also found out later that they found cysts on my kidneys, as well, which I'll get to deal with after the baby is born). 

I had an appointment with a urologist about 9 days into all of my problems. At this point, I had legitimately prayed and begged the Lord to return already and take me out of my misery. The urologist told me that I had roughly a week to pass the stone on my own before she would need to intervene (because of concerns over long-term damage + she had to act quickly before I moved into third trimester, which was about 2 weeks away). PRAISE THE LORD, I started passing the stone in tiny pieces that very night and over the next day. I got almost immediate relief, as my kidney was able to start processing fluid correctly. 

I have never felt quite as hopeless and scared in my life as I did during those days with my kidney stone. They were some very dark and excruciatingly painful  days for me, and I've spent the intervening days praying desperately that the second stone will just stay where it is- at least until after the baby is born (preferably forever).

Note: I've discovered that I have some more issues going on with my kidneys that will have to be looked into after the baby is born, in addition to the cysts, and would appreciate any and all prayers for those appointments to go smoothly.

Pre-eclampsia is one of those complications that just kind of happens out of nowhere with no real warning. Which is what happened when I was pregnant with Claire. Once you've had it, your chances of developing it again with subsequent pregnancies is ~25% higher.  At my 30-ish week appointment a few weeks ago, I had very high blood pressure in office, both times they checked, so they had me checking my own bp at home periodically. It wasn't great. It was high every time, which caused a lot of anxiety for me (which, incidentally, elevates both blood pressure AND glucose. A vicious cycle.). I became so anxious thinking that I was in the process of developing pre-eclampsia and what it would mean. I was 31/32 weeks, which was far too early to comfortably deliver a baby, and I was terrified at the thought of delivering a vulnerable preemie during a pandemic. It was just nightmarish.

I went for my 32 week appointment and had my highest bp reading yet, which was so overwhelming to me. BUT. There was no protein showing up in my urine dip (gross, I know, but that's how they check), which was a HUGE answer to my prayers. I wish my bp was lower (it's naturally very low when I'm not pregnant, so I'm hopeful it will naturally lower after the baby comes), but for now, I'm so unbelievably relieved that it's not pre-eclampsia. 

So, at 33 weeks (34 tomorrow), I'm still on a strict diabetic diet and tethered to checking my glucose, I'm trying to keep a lifestyle that will help keep my bp low-ish, I'm anemic, I'm migraine-y and nauseated, I'm achy and full-time Braxton-Hicks-y, but I'm so grateful for the small mercies of no insulin and no pre-eclampsia. The baby is moving ALL THE TIME, which is so reassuring and comforting (and also keeps me awake). I know I still have several weeks left, but I'm grateful for where things stand in the here and now. 

I know I have so many people praying for me and encouraging me, remembering me and checking on me. I'm SO THANKFUL for my support system. I have concerns about delivering a baby in a high-risk pregnancy during a pandemic, but I'm working to remember that none of this was my plan; the Lord has orchestrated and timed things from the beginning, and I can leave it in His hands. 

In my past pregnancies, I've never made a habit of taking pictures. I'm usually feeling too lousy to care about it and also never look very cute...which isn't something I've felt very much like documenting. I decided I wanted some documentation for this surprise, final pregnancy. 

18 weeks

19 weeks

also 19 weeks

22 weeks

24 weeks

25 weeks

26 weeks

28 weeks

29 weeks

30 weeks

31 weeks

32 weeks

33 weeks

I've also tried to remember to snap pictures of kindnesses of our friends and neighbors. I never want to forget the ways God reminded me of His nearness during hard times (and this doesn't even cover the daily texts and Marco Polos from friends and family who check in on how I'm feeling/doctor appointments/glucose numbers/the girls/all the things. It also doesn't cover the many days and weeks that Barbara stayed with us, making food, doing laundry, managing children. We have been so taken care of. Also not pictured: the summer survival kit that Kat sent for the girls. It was inspired.).

A very thoughtful friend sent me flowers during my kidney stone saga to remind me that she was thinking about and praying for me. I definitely cried.

A very kind neighbor who loves the girls dropped off this tub of homemade snickerdoodle dough for them to make/to give me an easy activity to do with energetic children.

It was a big hit.

A few days later, sweet friends (both are friends from Duke and church) dropped off Mexican take out. One of them snapped this picture of the girls that I later screenshot. She always gets tickled chatting with our very extroverted children.

A few days after that, some other friends from church dropped off take out from a local Peruvian restaurant that we love. We felt very cared for.

If you've made it this far, well done! 100 points for you. I appreciate the care and questions. I also never have a straightforward answer to "How are you feeling/doing?" It's never straightforward. But always interesting, I think? Bless us...

And then there was insulin.

I've posted several times about GDM recently, so the fact that this pregnancy is fairly eclipsed by diabetes is no secret. I've written quite a bit about my eating protocol, but I thought I'd record a little about all the other stuff that goes into treating my GDM this time around, as it is quite different than my experience with Lily. Maybe this will help someone...maybe it will just be something I show New Baby for the rest of her life when she complains about doing chores and constructively participating in the life of our family. It works out either way.

The tricky part with this round of GDM has been my fasting glucose (the sugar you check first thing in the morning before you eat anything). I tried all the tricks that I used last time plus several other things in order to lower it overnight, and none of it worked. In December, I started oral medication (including many experiments with dosage changes) + careful dietary choices, which worked until I hit third trimester (when the placenta begins producing the complicating hormones in earnest). At that point, there was nothing between diet and oral medication that would keep my fasting glucose within the desired range. So, I was classified as having GDM with IFG (impaired fasting glucose). This led to starting insulin.

You should know that I had been dreading starting insulin for a couple months before it actually happened. Insulin is administered via injection, so I was reluctant to be put on daily injections. I mean, no one looks forward to that, right? In addition to all the finger pricks, to boot. To say that I was determined to try everything I could before starting insulin would be an understatement. Starting insulin also puts pregnant gals into a higher risk category, which I also wanted to avoid. Every time I went for an appointment, I held my breath until they put it off once again. 

Eventually, though, they just kinda ran out of other options and had to pull the insulin trigger. Funnily enough, I had been dreading it/thinking about it for so long that, apparently, I'd made my peace with it. I started wrapping my mind around what my new nightly routine would look like.

Does anyone reading this remember way back when I was expecting Claire and had to have the initial tests run for preeclampsia? I ended up with this story where I had the weirdest conversation with a health care professional about what supplies I would need to a 24-hour urine collection. And where I wasn't given a hat for said urine collection.

I had another weird "how do you expect me to know what I'm doing" experience with insulin.

First note: I was given zero instruction by the office staff on how to administer these injections. I assumed a nurse would come in after the doctor to explain the process or that the pharmacist would explain at pickup.
Second note: I was told nothing about what supplies I would be receiving at the pharmacy. Once again, I assumed the pharmacist would know all the things and would provide me with that information.
Third note: Should you find yourself given an insulin prescription, do yourself a favor and learn from my assumptions. ASK BEFORE LEAVING THE DOCTOR'S OFFICE.

Otherwise, you might end up with a sack full of 100 empty syringes and nothing else. 

No instructions from the pharmacist, no INSULIN to put in said syringes, and no idea of what you don't know.

Brad stopped by to pick up my prescription and was hurried along with no information from the pharmacy. When he got home and I opened the gigantic sack, expecting pre-filled syringes (which is what my doctor said she was going to try to get for me) and a detailed sheet of instructions on how to administer my injections, I was a little confused that all I found was 100 empty syringes. 

I called the pharmacy:
"I was just prescribed insulin injections today and don't exactly know what all that entails...but there was no insulin in my bag, and I'm pretty sure I need that."

Pharmacy: "Uh, what kind of insulin do you use?"

Me:"Well, I was just prescribed insulin today, so I know almost nothing. Is that information not included in the orders from my doctor?"

Pharmacy: (deep sigh) "Let me check...oh...yeah, we don't have that in. Do you need it today? Are you out of insulin?"

Me: "Ok, I was just prescribed insulin today, so I currently don't have ANY, and I'm sure they want me to start today."

Pharmacy: (impatient sigh) "Well, we won't have it until tomorrow. Can you pick it up from a different pharmacy? It looks like they have some at [a different nearby CVS]."

Me: "Yes, I can get it from there."

Pharmacy: "Ok, they should have it for you in an hour or so."

Wow. Really?

I got a text from the other CVS not long after, indicating that my order was ready. Brad went to pick it up, and I called my brilliant and informed father who is an ACTUALLY HELPFUL HEALTH CARE PROFESSIONAL (if you happen to be reading this and don't know my dad, he's an incredible pediatrician, a fact I for sure took for granted until I was in my 20's) to ask the questions I should have asked earlier.

I started with just asking..."um, so how do I give these shots?"

Dad: "Did the nurse not give you instructions?"

Me: "No..."

Dad: "Or the pharmacist?"

Me: "No...the pharmacy actually only gave me 100 empty syringes." (filled him in on the above story)

Dad: "Ok, well, the basic process is to start by wiping off the insulin bottle with one of the alcohol pads."

Me: "Alcohol pads?"

Dad: "They didn't give you those?"

Me: "No, just the syringes."

Dad: "Make sure they give you alcohol wipes when you pick up your insulin. Use those to wipe the bottle before you fill the syringe. Before you puncture the bottle with the needle, pull the plunger down to your prescribed unit so you can push that air into the bottle, otherwise, there's a vacuum when you try to fill the syringe. Pinch a fatty area of your thigh or back of your arm. Then, use alcohol to wipe your skin. When that's dry, just breathe out and give yourself the shot."

Me: "And what do I do with the used syringe?"

Dad: "Put it in the Sharps Container."

Me: "100 EMPTY SYRINGES, Dad. I know nothing about this container of which you speak."

Dad: "They just failed all the way around, didn't they? Make sure they give you a Sharps Container."

Brad walked back in near the end of my conversation with Daddy and said, "Well that first CVS failed all the way around. This pharmacy gave me these alcohol pads, insulin, and this container for you to collect your used syringes in. The pharmacist also told me about how you need to fill the syringe with air before you puncture the insulin bottle..."

Guys. What in the world?? How do these things happen?

Despite all these little setbacks, I successfully started giving myself insulin injections and have been for almost a month. I'm a survivor of incompetently-handled situations. 

I've had to have my dosage increased several times to find the right amount, but it seems that, with 2 weeks to go, we've landed on the right combo of dieting and medication.

In addition to the insulin update, my number of visits to the doctor increased A LOT around 33 weeks. Because of my new, higher risk classification, I earned Frequent Visitor Status with twice weekly appointments until the end of the pregnancy. I go either Monday/Thursday or Tuesday/Friday, and each time, I have a non-stress test (NST), an amniotic fluid index (AFI), and a check-in with an OB to evaluate my glucose readings and medication dosages (I'm still on an oral medication in the mornings, as well as insulin before bed). I spend a big chunk of time there these days. 

For anyone who may not know, an NST means I recline in a chair with monitors wrapped around my stomach, and I click a sensor every time I feel the baby move. NST's are supposed to last 20 minutes, but I regularly get left in there for 30-40 minutes, depending on when a doctor or midwife can come read my measurements. Before my first NST, I thought, wow, I can get reading done while I just sit and chill. Then I learned that I have to track her movement. Can't really read and track at the same time. So, I listen to podcasts instead (which works out, given that my reading motion sickness is back in full force).

An AFI is a quick ultrasound to check and make sure the baby's fluid levels haven't gotten too low. Apparently, that can happen really quickly with GDM babies and can be really dangerous if it does. I'm becoming good friends with the Ultrasound Tech. She's lovely.

So that's my Diabetes Update this week. Kind of a long one, but a lot has transpired, it seems. 

I'm less than 2 weeks out from my scheduled c-section, so there's not too much longer of insulin and Metformin and NST's and AFI's...

My diabetic go-to snacks and meals

I've mentioned a few times that one of my big frustrations after meeting with the nutritionist during my first round of gdm was that I didn't feel like I left that meeting with a lot of practical food options that didn't include foods with artificial sweeteners (which aggravate my migraines and headaches). I thought I'd make a list of some foods that I've found work for me while on a diabetic diet (remember: this is NOT prescriptive or exhaustive, and I am NOT an expert. This is just some stuff that works for me.). If you find yourself needing some ideas for a diabetic diet, maybe this could give you a place to start?

A normal eating schedule for me (and my allotment of carbs-per-meal/snack) looks like this:
1. Breakfast: 2 carbs
2. Snack: 1 carb
3. Lunch: 3 carbs
4. Snack: 1 carb
5. Supper: 4 carbs
6. Snack: 1 carb*
7. Pre-bedtime snack: 1 carb
*This snack isn't officially on the usual recommendation for diabetics, necessarily, but I find that I usually need it. 

Breakfast ideas:
1. Homemade freezer breakfast burrito ("recipe" at bottom of post- I literally eat this every single morning because I know exactly how my sugar reacts to it)
2. "Egg McMuffin": Thomas whole wheat English muffin + egg + cheese + sausage or bacon
3. Yoplait yogurt (I think the 6 oz is around 1 carb serving- but you have to check labels), bacon, one slice of whole grain toast with butter (real butter- it's a good fat)

4. Greek yogurt + cup of berries + sliced almonds on top (I like the Chobani Greek yogurt that has fruit on the bottom. It's got a good carb-protein ratio.)

5. Peanut butter or avocado toast (one slice whole wheat bread) + sausage or bacon or egg + fruit that equals one serving of carbohydrate (half banana, half apple, cup of berries, 10-12 grapes, or a clementine)

Lunch (I usually rotate through the same options for lunch because it's convenient)
1. Crispy chicken salad wrap (recipe at bottom of post) + large side salad
2. Pimento cheese sandwich + salad/green veggie
3. Large cobb/chef salad with plenty of chicken and veggies
4. Tuna or salmon salad sandwich or wrap + low sugar cole slaw
5. Large taco salad (ground beef, cheese, sour cream, salsa, avocado on lettuce, careful serving of tortilla chips- usually 8-10 chips)

You can do a lot with sandwiches/wraps. It's best to use whole wheat bread/pitas/tortillas (again, read the nutrition label, remembering that one serving of carbs is around 15g). If you want to eat deli meat (even though it's not generally recommended for pregnant women), put it under your broiler for a few minutes to heat it up/melt cheese over it, and that will help kill off any listeria bacteria. You can do a lot of sandwich (or wrap) variations which are pretty easy and can keep you from getting too bored (you still might get bored...fair warning).

Supper
1 Cup-cup and a half of homemade chili + half of a grilled cheese sandwich + large side salad
2. Pot roast + veggies (roasted brussels sprouts, 3/4 cup roasted sweet potato, spinach salad) + 1/2 cup cooked brown rice
3. Meatloaf + broccoli + sweet potato
4. One slice of pizza (preferably with meat) + roasted veggies (go light on carrots- they have a higher sugar count. Try broccoli, brussels sprouts, squash/zucchini instead.)
5. Mexican restaurant: fajitas (only one tortilla but you can eat basically as much meat/veggies as you want) + one serving of chips and salsa (about 8-10 chips) + plenty of guac
6. Chick-Fil-A 4-count chicken strips + superfood side (I was so excited to realize I could still eat CFA!)
7. This grilled chicken and balsamic tomatoes with grilled veggies or a salad side

There are lots of meals that can fit into a diabetic diet, as long as I am mindful of portion sizes. For example, my mother-in-law made a spaghetti pie for us last week. I measured out a little less than a cup of spaghetti and filled the rest of my plate up with vegetables (and 2 deviled eggs). I've learned not to stress about not preparing my own meals, especially if it's at someone else's home or out at a restaurant; before I fill my plate or order, I put options into the My Fitness Pal app, and it calculates the carbs of what I'm thinking of eating. I then determine what/how much I can eat. Measuring out smaller-than-usual amounts of food can seem restrictive at first, but in reality, it untethers me from having to eat at home for every meal.

Snack ideas
Chobani Greek yogurt (with fruit on the bottom) + sliced almonds
Sargento Balanced Breaks packs (or make your own version of this if you're not struggling through pregnancy...)
Berries + nuts

Babybel cheese rounds/Cheese stick + serving of fruit
Cheese toast
Avocado toast
Hummus + veggies or pita chips
Caveman bars

Graham crackers + peanut butter

Good protein options to pair with a carb
Nuts
Whisps (I buy these little cheese "crackers" at Costco. They are not cheap, but they are HIGH in protein.)
Hard boiled egg
Deviled eggs
Peanut butter
Babybel cheese rounds/Cheese stick

For "desserts," Breyers makes a carb control ice cream line that is quite good. I can eat a half cup, based on the serving portions, and that usually works for me. I also eat a reasonable amount of dark chocolate (not only is it allowed, there is some research that dark chocolate actually HELPS diabetics with their sugar control!). I crave sweet stuff while pregnant, so if everyone else is eating real dessert and I just really want a taste of what they're eating, I'll let myself have one bite. That usually won't ruin anything for me, but it does take self-control. So, if you can stop yourself from eating more than 1 or 2 bites, that's an option, too. I don't usually do too much with sugar-free dessert options from the store, but that's personal preference. 

For beverages, I mostly drink water, but I do like to drink unsweetened tea + Chick-Fil-A diet lemonade mixed together if I need caffeine. While I miss sweet tea terribly, this is a really good stand-in, guys. I will also have Brad make me some of his cold brew coffee sometimes, using a little sugar-free syrup (I like the Torani English Toffee).

These are some of the things that I eat on a regular basis and have good results with. Sometimes they can become repetitive and boring; I try new things periodically, but it's also just nice to have a bunch of fall-back things that I can trust. As a rule of thumb, ALWAYS read labels and check serving sizes until you have a good repertoire of food that you know works for you and your sugar (your glucometer will let you know, for anyone sticking their fingers multiple times a day). Use My Fitness Pal liberally to check on carbs when you're out and about. This awareness of portion sizes and carb counts is key to sticking to a successful diabetic diet. Knowledge really is power. 

Is this a helpful kind of post? Would anyone out there be interested in my keeping a food diary for a while and recording it for ideas? Let me know in the comments! (or email or text if you have my contact info!)

I'll do an update soon on my current diabetic status. Hint: it currently involves daily injections. :/ But, I'm still learning a lot, so there's something in that.

A few recipes (/methods) I use:
1. Chicken salad wraps
2. Salmon salad
3. My freezer burrito method:

24-ish eggs
1lb cooked, crumbled breakfast sausage
2-ish cups shredded cheese (I use sharp cheddar)
15-ish tortillas (depending on how full you fill your burrito
plastic wrap + gallon freezer bag (or 2) OR snack size ziplock bags

In a LARGE, greased pan, add all eggs (beaten), sausage, and cheese. Scramble until eggs are fully cooked. Allow egg mixture to cool. Spoon several spoonfuls of egg mixture into the middle of a tortilla, fold two sides of the burrito in toward the middle (sort of envelop-style) before rolling the tortilla up into a burrito. Ensure that the tortilla is fully encasing the egg mixture so that nothing slips out. Wrap burritos individually in plastic wrap (or zip up in snack-size bags) and store in gallon-size freezer bag in the freezer. When you're ready to eat one, unwrap the burrito, re-wrap in a paper towel, and heat in the microwave for 1.5-2 minutes. I eat one every single day.

Salad ideas to help fill up your plate:

1. cup (or more) of lettuce (or spinach) + 4 or 5 sliced strawberries (or  blueberries) + sprinkle of feta + sprinkle of sliced almonds + raspberry vinaigrette

2. cup of lettuce (or spinach) + shredded cheddar + bacon bits + tomatoes + balsamic vinaigrette

You can also trade in a few chopped carrots, red bell pepper (this is a good veggie for diabetics), avocado on these salads. Or you can turn them into entree salads by making it bigger and adding chicken/turkey/salmon. When you are carefully portioning your carbs, it can often seem (to our traditional American diets) that our plates are kind of bare. A salad that takes over half of your plate will help. :)