A date with destiny...

*** NEWSFLASH ***

I had my last antenatal appointment (36 weeks) on Thursday 31 March, including the obligatory growth scan, and meeting with the diabetes team and obstetricians. Can't quite believe that I've reached this stage!

It wasn't even possible to measure Bumpy's head, since it was so low down in my pelvis (a good sign, I reckon), but the Abdominal Circumference was 329.0 mm and the Femur Length was 74.0 mm, giving an estimated weight of 7 lbs, or 3.175kg for baby, and meaning that our growth was still consistently somewhere around the 75th-80th percentile. Yay! His or her little heart was beating away, the placenta still isn't blocking the exit, and baby's head down with a normal amount of amniotic fluid (3.5cm at the deepest pool).

The next stop was to see the obstetrician, S, who had a trainee doctor with her for the appointment. She was very happy with how things are progressing, and sees no reason for us to opt for a C-section, so went ahead and recommended induction of labour at 38 weeks. This is considered to be the optimum time, since baby will have technically reached term and hopefully have fully developed lungs (full term is anything after 37 weeks), whilst the placenta will still be functioning well (this can drop off in the final couple of weeks, especially in diabetic women, with risks for the baby). S and I had a hundred and one questions (well, not quite, but certainly a long list), which S the obstetrician happily went through with us. Here's the potted version:

Us: What if we go into labour spontaneously before the 38 week mark?
Obs: Everyone cheers, and you call the hospital and come straight in!
Us: Dia...betty had an elevated white blood cell count about a week ago following her routine midwife appointment - is this anything to worry about?
Obs: It can be a consequence of pregnancy, or of an infection, but we'll repeat it and see.
[NB. It was 16.4 when originally tested, and I had a conversation with my GP where he came to the conclusion that it was probably high due to a nasty little viral throat infection I had last week]
Us: Who will be at the birth?
Obs: It will probably start off with just a midwife early in the induction, but there will always be a consultant obstetrician within easy reach should they be needed. Dr I will also be around/on call to manage the diabetes aspects of things. Once labour is established you'll be transferred to the Delivery Suite and when baby arrives there will be at least two midwives there, as well as (potentially) an obstetrician and paediatrician.
Us: What's the exact process for induction?
Obs: Here's a leaflet which lays it all out. Once you arrive on the ward you will be assessed and the baby will be monitored electronically. Basically induction starts with a prostaglandin pessary (a little like a small tampon) which will be inserted into the cervix to soften and open it. You will have to lie on your side for 3o minutes, and then will be free to walk around the ward to encourage labour to start. The pessary can stay in place for 24 hours, during which time it's hoped that your contractions will start and your waters will break. If after 24 hours this hasn't happened you will be examined to see if your cervix has softened and opened enough for your waters to be broken manually (at this point you move from the antenatal ward to the delivery suite). If not, you might be given another pessary. If contractions don't start once the waters have been broken you might be given an IV drip of Oxytocin to kick things off. If all of this doesn't work or if you fail to progress fast enough the doctors will consider a C-Section instead.
Us: How long will Mum and baby have to stay in hospital after baby is born?
Obs: A couple of days, if you have a successful induction, more like four if you have a C-Section. Partly this is to monitor how baby is doing, blood sugar wise, and partly to monitor you, and to allow breastfeeding to become established.
Us: Will Mum and baby be able to stay together on the ward? What are the wards like?
Obs: Yes, Mum and baby will be together 24/7 unless there's a need for the baby to go to special care. The wards have 10-bedded, 6-bedded and 4-bedded areas, as well as single and double rooms. You can opt for a single or double room if you wish, but there's no guarantee that one will be available (as they are first come, first served, and also subject to medical need), and you will have to pay a daily charge for using one (somewhere between c£40 for a double and £125 for an ensuite single).
Us: What happens if baby's blood sugars are low at birth? How is this treated?
Obs: You'll find out more at your specialist breastfeeding appointment, but we will aim for you to breastfeed as soon as possible after the birth and in any case in the first hour. We will use formula milk as a last resort either via syringe or naso-gastric tube.
[Watch this space for more info - my next post will be about the breastfeeding appointment...]
Us: What are the rules about Dads being present for the birth and afterwards? How soon will S get turfed out?
Obs: Whilst you're on the ante-natal ward waiting for the induction to take effect S will be able to be there during visiting hours - 10am-8pm. Once you're transferred to the Delivery Suite he can be there full time. Once you move to the post-natal ward it's back to the usual visiting hours of 10am-8pm. Other visitors (up to two at a time) are allowed between 2pm and 4pm, and again between 6.30pm and 8pm.
Us: What support is there on the ward for breastfeeding Mums?
Obs: Lots, including the specialist breastfeeding midwife, who you will meet at your appointment.

Phew! So, that was the Q&A bit of the appointment. Once we'd finished S headed off to book a date for the induction, and Dr I came in to see us. He was still very pleased with my control, despite my little blip with the throat infection, and was delighted to hear that the growth scan results meant an induction rather than a C-Section. S popped her head around the door to let us know that we'd be aiming for Thursday 14 April. It's a bit mad to know the date in advance, but S and I are slowly wrapping our heads around it! We also had a few questions for Dr I about the birth process...

Me: How exactly will my diabetes be managed? Who will do this? Who determines the sliding scale?
Dr I: Call me when you come into the hospital and I'll be on hand. You're taking a shedload of insulin, so you'll be a bit complicated to manage, but you've maintained excellent control so far. We'll just have to suck it and see! [Sidebar: I've always been pretty insulin resistant, and my TDD now is approx 380 units, up from about 130 before I got pregnant - cue sharp intake of breath from my friends in the DOC who have tiny TDDs!]
Me: When will my usual basal/bolus regime stop in favour of the sliding scale?
Dr I: Only once you're in established labour.
Me: Will I be able to eat/drink/snack/graze during labour, or will I just be on a glucose drip?
Dr I: We'll see how things are going once we get there.
Me: When might my hypo warning signs return?
Dr I: Hopefully soon after delivery, but it's different for different people.
Me: What will my post-delivery diabetes care look like? Will I have follow up appointments?
Dr I: You'll be seen in the combined diabetes/obstetrics clininc twice, once at 3 weeks, and again at 6 weeks after the birth. Then you can stay on under my hospital diabetes clinic if you'd like.
Me: Yes please - I like my GP, but that would be way better! :) Once again, yay!

Once we'd finished up with Dr I, S headed off for work whilst I waited to have blood drawn for a repeat White Blood Cell count and the usual routine things (HbA1C, Liver function, Thyroid Function, Electrolytes etc). I called the hospital for the results today, and discovered that my HbA1C was 6.7% (up a tiny bit from the last reading of 6.5% but still fab in my opinion!), my Free T4 was down a bit from last time (at 8.9), my WBC was still a bit high (at 16.2), and my calcium and albumin were a little low. If there's anything to be really concerned about in all of that I'll hear directly from Dr I, but otherwise I won't be back at the hospital until Induction Day, on 14 April. Eeeek. It all seems much more real now!