Tuesday, August 20, 2013

Drink me

I guess it was in the milliseconds after the phlebotomist handed me a bottle of lime-flavored liquid with 50 grams of glucose in it and then told me I should sit for one hour -- "no walking around!" -- that I became extremely irritated.

Yes, today was Ye Good Ol' one-hour glucose test, to determine if I have gestational diabetes. And I gotta say, I kind of think this test is bullshit. Because it's not testing you in a real-life situation. In real life, I would have eaten breakfast, and it wouldn't have been loaded with sugar. So having me drink 50 grams of glucose on an empty stomach in under five minutes and then simply sit there for an hour is completely ridiculous.

Which makes me feel that pregnant women are sort of set up to fail this test. It's obviously unnatural. As soon as you drink it, it hits your system like speed. I felt shaky and wired for about ten minutes, and then I crashed hard and wanted to sleep, eat, and vomit at the same time. Some other poor woman was in the midst of a three-hour test (which they force upon you if you don't pass the one-hour test) and she'd become so faint she needed to lie down.

I just want to know: Where are the tests that are grounded in real medical science? Where is the medical care based on scientific results rather than fear, unproven beliefs, and cover-your-assism? I worry that it's too late for standard medicine -- liability will always be the greatest concern, and the best way to reduce liability (at least in the eyes of medical institutions) seems to be to run a variety of unnecessary tests in order to prove that everything possible was done to help the patient. When, in fact, everything possible ought to include only those tests actually proven to help patients.

Today's test comes on the heels of the release of a new book by Emily Oster called Expecting Better: How to Fight the Pregnancy Establishment with Facts. In it, Oster debunks what I'll just go ahead and call myths -- that you can never drink alcohol or caffeine or eat soft cheese or deli meat during pregnancy. In excess some of these things are obviously not a good idea, but the actual facts as Oster discovered them are that women who drank the occasional glass of wine and a couple cups of coffee every day had perfectly healthy children who, years later, often scored higher on IQ tests than children of women who abstained throughout pregnancy. (Color me bitter -- I've abstained this entire time)

I haven't read Oster's book yet, but you can bet it's at the top of my list. What whet my interest was this article she wrote that appeared in the Wall Street Journal.

I hope her book addresses a number of questions I have. Is it entirely necessary to check for dilation in the final weeks of pregnancy when doctors themselves have said it's not at all an indicator of impending labor? Are internal fetal monitors at all necessary during labor? (pretty sure I already know this one is total bullshit) What is the deal with kegels? Please, I need hard evidence here.

It's a bit irksome to have to rely on outside information during pregnancy, when in theory, doctors know best, and they ought to have the latest and greatest information. And I really do like my doctor, but even doctors who don't necessarily believe certain tests are necessary are obliged to follow protocol. So I take everything said and done to me with a bit of a grain of salt.

And I know if I wanted to be a militant anti-medicine hippie I could have simply hired a midwife and I know she would be completely on the same page with me. Except for the pain management page -- I am 100% certain an epidural is in my future. I've done the research on natural birth and read several books and I think vaginal is the way to go, if possible, but the benefits of reduced pain outweigh the risks for me. I mean, modern medicine's got to be good for something, right?




13 comments:

  1. Ugh, I'm uncomfortable and annoyed reading this. And I'm not pregnant.

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    1. Girl. I'm uncomfortable and annoyed, too.

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  2. Oh man, you think the one-hour tests are bad, the three-hour ones are complete torture. I remember wanting to kill the poor guy drawing my blood, I was so hungry at the end of it.

    And if they make you stay there that long, they need to have more comfortable chairs in the waiting room!

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  3. I'm pretty sure the glucose test is based on good science. It's putting your pancreas in a controlled, worst-case-scenario situation and making sure it can handle it. Otherwise, it would be taking a reading based on whatever was happening to it during the day, and might miss its cries for help. Gestational diabetes is bad juju. I haven't read this book you are mentioning, but everything you said about it sounds pretty right to me. All of that stuff... caffeine, moderate alcohol, deli meats, is prohibited based on some science, but not to the point that it has been taken. Caffeine was shown to be harmful in one study when it was consumed in huge quantities during a time when most people don't know they are pregnant. Well, that's helpful! In Ireland a few years ago, the national health people were telling everyone that five units of alcohol a week was a safe amount to drink during pregnancy. They changed it to zero, and it was a kerfuffle, and when people interviewed on ITV (national station) in Ireland were asked, they straight-up admitted that the reason they were banning it altogether is because they were dubious about people's self-regulation with five units. Not because the only amount of alcohol you should consume is zero if you want to have a baby without FAS. Well, if a little wine a few times a week caused FAS, France should be crippled with it, and they aren't.
    Dilation determines nothing; some women want to know just because they do, and doctors check. Effacement matters more, but it is not a reliable indicator either. Even checking a lot during labor is not that helpful if the person is unmedicated (there are rare times when internal fetal monitoring is absolutely the best way to go, mostly when the baby has been in distress and they can't get a reliable tracing through external monitoring... these cases are rare and I haven't had a client with an internal monitor in seven years, which is hardly a serious sampling, just an anecdote). I will see if I can find the caffeine study for you, and something on glucose. I love evidence.
    There are doulas out there who are fans of epidurals and know that they are both necessary and awesome for people who want need them (I am one!).

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    1. yeahhhhh.... I'm still torn. Like, that is a worst case scenario, and I never put myself in that scenario. But I'll go with it. :)
      And oh yes, Europeans are generally more lax about the alcohol during pregnancy, aren't they? Smart folks. ;)
      Epidurals FTW!

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  4. Hated that stuff... you can always decline the glucola and try to eat less sugar while preggers... probably good to have an occasional random glucose drawn just to observe, though. You don't really need to he checked for dilation when full term unless you feel you need to poop with contractions or if for some reason you are induced... need to know what method to use for induction by how dilated and effaced you are. Sigh... internal monitors. I place them all the time, usually if I feel baby is in critical distress and can't get a heart rate externally. I also help place internal contraction monitors... sometimes a decent idea when it's for the right reason. If you really want more info just let me know.
    Good luck-wishing you a lower number so you don't have to do it again!!

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    1. It's funny how many nursey types and doulas I "know"! I get that sometimes internal monitors and such are medically necessary, just not generally necessary. Fingers crossed on the glucose, ugh!

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  5. Kris is right on the money. I know these test suck! But! As someone who has Gestational Diabetes I have to say they are based on sound science. Here's the principle: You should have a fasting blood glucose level of less than 95. Then, your blood sugar should only rise a certain amount on 50 grams of glucose. If it rises more than that, then it could be an indication of GD, and that's when you go in for the 3 hour. During the 3 hour, they take your fasting levels, then see how you react to the glucose over time. It's a far more exact indication for GD, and a lot of women fail the first only to pass the second. But they give you the one hour test to start so that you'll be able to avoid the three hour if you can. They tell you to sit still during the test because physical exertion can effect your blood sugar levels, and therefore give a false picture. GD can be a nightmare if it's left untreated. Better safe than sorry!
    On the other hand, I've been all about the caffeine, soft cheeses, and deli meat during this pregnancy. On that I totally call BS.
    All in all, I think it's a matter of doing your research - but making sure that your sources are reliable.
    Here's hoping you passed the one hour and all is well!

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    1. HOLY CRAP where have I been? You're pregnant?!!!!! And about to pop! I have some major reading to do.

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  6. hope your glucose comes back as it should!

    i had a cup of coffee everyday i was pregnant. it wasnt until i was breastfeeding that i switched to decaf! i also had my fair share of deli meats and questionable cheeses. the NP at my OBGYN said she had been working there 30+ years and never had a patient that got sick from meats, hot dogs, cheeses, etc. ha!

    however, i DO think there is truth to the KEGALS! not from personal experience (thank god) but i think its more a problem of women in their 40s+. from what i have read, pelvic floor strength is EVERYTHING. i go to the women's health center weekly for mommy and me classes and the lady that runs it says that of all the classes they offer there (100s) the pelvic floor strengthing classes are the fullest and fastest to sell out. and then she told us to do our kegals. :p

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  7. Mmmmmm lime-flavored sugar. Also alcohol! Yeah! Get on that!

    But wait, why are we debating kegels? Most of what I've accomplished while unemployed has been kegel-related.

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