December 15, 2012

Numbers

I had a prenatal checkup yesterday morning. We're just shy of 21 weeks right now, still in the second trimester, so my checkups are still once a month. The standard procedures: I give various samples based on what they need to test/check/verify, they weigh me and get my blood pressure, and then I meet with a midwife to discuss Baby's progress and my overall health.

Ideally, I'd see Tracy (my assigned midwife) consistently, but my last two appointments have been with two different midwives. Both times I asked to be scheduled on a day when I could see Tracy, and both days they've screwed up the scheduling. But I guess you get what you pay for, and being on public aid at the moment, complaining is a useless exercise.

My main frustration with not seeing Tracy consistently is that I felt very comfortable when I met with her, and spent no less than a full hour telling her absolutely everything about my history - about my weight loss, my relationship with Matt, my past experience with depression, and anything else that could even possibly be a concern with this pregnancy. She knows my whole story - the other midwives get the ten second "But! But! But!" version while they make huge assumptions based on my current health.

Which, by the way, is awesome.

  • I had a fasting blood sugar test a month ago - most pregnant women undergo the test in the third trimester, and I will repeat it at the normal time, but given my weight and family history with diabetes, Tracy recommended having an additional test done around week 16 or so. After fasting for eight hours, a person who drinks a sweet drink (glucose-based, I believe) and then tests with a blood sugar level of 200 or higher is considered diabetic. I've seen various positions taken on different websites for what a normal/healthy fasting blood sugar level is - some said under 100, some said under 90, some said under 86. Either way, mine was less than every one of those numbers.
  • My blood pressure is still excellent and considerably lower than the level considered to be pregnancy-related hypertension.
  • My nuchal translucency scan results show that Baby was negative for Down's Syndrome, Trisomy 18, and other intellectual/physical disabilities. He's the perfect size, both in length and weight. His heartbeat is in the perfect range. In fact, the midwife's exact words were "your baby is perfect." And that made me feel incredible.

It all made me feel incredible, really. Until I was told, in not so many words, that I'm actually incredibly unhealthy. Apparently, because I've gained quite a bit of weight since becoming pregnant, even though everything else about my health is in top shape, my BMI is the only number that matters.

I read a statistic recently that said the average general physician only has about 15-18 hours of study in nutrition; I'm guessing it's even less for a midwife, who only needs a Masters and not a PhD. So I'm trying to take with a (very small) grain of salt the seemingly terrible advice I was given at the appointment. Like, when I said I had Greek yogurt for breakfast, and the woman said I should be eating meat with breakfast for more protein. (I'd rather have two yogurts for the same calories and protein - I still struggle with eating meat sometimes, the smell is just too much for me.) And when she immediately assumed my weight gain was due to the fact that I likely don't know about calorie counting, and that I'm "probably drinking all [my] calories and [I] don't even know it." I told her that I only drink water, and her only response was "Well, the calories are coming from somewhere."

She followed that up with one of my least favorite weight loss mantras: saying that "it's really just calories in and calories out." Because even though that is the case, it isn't - at least not always. Not all calories are the same, and the bodies of formerly super obese people (just as is the case with formerly severely underweight people) treat calories differently. My body spent nearly a decade in the 300 pound range. It felt comfortable there, even if I didn't. And the rest of my life, I'll have to watch my calories closely and stay moderately active - not a complaint, I'd rather monitor all the vitals closely forever than spend another day over 300 pounds. But for now, the inability to exercise how much/how often/how intensely I did when I was actively losing weight is a source of distress.

Also worth noting, instead of averaging 1500 calories a day now, I keep it between 1800-2000 - which doesn't seem like a big leap, until you also consider that before, I was also biking daily and running three times a week in California, and still running three to four times a week in Chicago plus walking (upwards of 10 miles a day on several occasions). Now, I walk a little, but the variance in my work schedule can occasionally complicate things. On my days off, I get out and move around as much as I can. But when I spend a shift from 11 a.m. to 7 p.m. on my feet (and it's dark by 4:30, and there's 45-60 minutes of commuting time both before and after the shift), it's hard to find additional time and energy.

I'm really conflicted by what the midwife said, and am trying to see the positives in the bigger picture. My son is healthy and growing as he should. Weight-vs-height comparison aside, every number and measurement says this is a well-cared-for body. Now that I'm over the nausea and morning sickness, I'm able to add more healthier foods back into my diet (the first few months were very bland and flavorless, lots of crackers and pasta to try and avoid becoming stomach sick - any strong flavors or smells could set me off). It's just a matter of finding a healthy balance for myself given my current constraints. I still have days when my eating is imperfect - like days when I'm ravenous and listen to my hunger, or like the night before the appointment when we had not one, but two Hanukkah events to go to ... definitely not ideal right before a weigh-in, but I know that despite occasional treats, my average day is pretty good. There's certainly room for improvement, but I'm absolutely not like some of the other expectant mothers in the clinic, with diets of fast food and convenience store snacks, munching on bags of hot Cheetos and Slim Jims in the waiting room. Talk about a terrible interpretation of what the midwife meant by meat with breakfast...

My goal going into the appointment with Tracy was to get advice on how to maintain/lose weight in a healthy way while pregnant, and even though I met with someone else who didn't know my personal story, I did secure the one thing I wanted to come out of the office with: a referral to the hospital nutritional counselors. I'm going to meet with them as soon as possible, and hopefully come away with some good advice and suggestions. On my own, I'll also watch my food intake (quality *and* quantity), and hope for a more positive experience at my next appointment in one more month. As perfect as my and Baby's numbers may be at the moment, I know that the underlying message in the midwife's poorly expressed criticism about my weight is that if I'm not aware and cautious, the results could change in the future, and I need to take excellent care of myself so I can take excellent care of the little one inside me.

10 comments:

Weight Wars said...

I love reading your pregnancy stuff, healthcare is so different for you in the states.

I lost weight during pregnancy (and gained a shit tonne afterwards) and just ate sensibly as I couldn't stomach more than chicken and jacket potato, and craved really fresh fruit.

Midwives aren't all knowing, if you know better then say so! Challenge misconceptions and they will learn and you will feel more comfortable with yourself and your abilities as a parent. Which is completely invaluable.

Sarah said...

Ugh. Forget what they say. You've lost around 150 pounds, yes? You know how to watch what you eat. They're making sweeping generalizations. As long as you aren't diabetic or hypertensive (is that a word?) and your baby is healthy, they need to shut up about your weight.

Frickin' Fabulous at 40 said...

When I was pregnant, many moons ago, my office wanted me to see most of the doctors at my appointments because I wouldn't know who was on call when I delivered. their idea was to have some type of relationship with each doctor, so you're not meeting a stranger at the delivery. It just sucks that you had a bad experience with that midwife. Unfortunately, she stereotyping you. Next time you see Tracy, if you're comfortable, mention to her what you felt was insensitivity by her colleague. She needs to know it's not right.

I'm glad you're doing well! Glucose tests are torture!

Tamara Kasal said...

I keep trying to find the right words to say, but I don't really know what to say, so I just wanted to tell you this.

I had three babies in three years, I was in the 300-350 pound range for all of my pregnancies and all of my pregnancies and births were completely uncomplicated.

I had dounts and chocolate milk pretty much every morning with my first because that was all that sounded good to me. No one at my doctors office said a word to me about my weight until my very last appointment when I was already 40 weeks pregnant, and then it scared the crap out of me.

So even though it sucks to hear and you obviously know more about your body and what it is capable off, it is nice to know that they want the best for you and your baby, even if they maybe don't actually know what that is for you.

You are already a great mom and doing the very best for your baby.

Bethie boops said...

*hugs* I hate BMI! I'm sorry the midwife was negative- your test results look great- way to go! Maybe next appointment you can call to confirm that you get your midwife a day or two before? It's okay to be a little picky!

Une femme en santé said...

Ouf elle a su toucher une corde sensible la sage-femme :-(
Les gens qui n'ont pas eu de problème de poids dans leur vie sont très rapide à nous dire de perdre du poids, ils ne voient pas tout le long et laborieux que nous avons fait et dans une phrase ils nous sensibilisent, c'est pas juste d'être aussi fragile, notre passée d'ancienne obèse nous a rendu très sensible ...

Prends bien soin de toi et de ton mental, laisse pas les gens t'attaquer, souviens toi de ton parcours !

xxx

Bailey @ Onederland or Bust! said...

Thanks for sharing your experience with all of this Mary. I really want to be at my goal weight when I get pregnant and my biggest fear is gaining a lot of weight. I know that there are worse things that can happen in life, but it still scares me. Your honesty in these posts is helpful and insightful and I really appreciate it.

It sounds like you and the baby are perfectly happy and you're taking the right steps and precautions. I think everything will be fine :)

Margot said...

You experience sounds so much like my own. My OB group was very rough on me about weight gain. Being obese when I got pregnant, they immediately jumped on me saying I was a high risk pregnancy. I never had an other risk indicator in either pregnancy. I think weight is something they are getting drilled into their heads about which they have little real training, knowledge or experience.

Always push back and don't let them bully you. Best of luck to you and little Nugget.

Gigi said...

Mary, I am about 8weeks ahead of you in my first pregnancy. I am seeing an OB doc at one of the best teaching hospitals in the country, your mid-wife is full of crud. You are eating good food and taking care of your perfect little one. You know what to do, you know your body. Don't worry about what she said. My doc and I have had the same conversation, he said as long as I am taking care of the baby and not going nuts on junk food, etc... All should be fine.

Tammy said...

I think that she's rude...you know what's best for you & your body. You're going to be a great mom! You have already started!!:) Don't let her bitchiness ruin this for you. I have been heavy for years. I was never THIS heavy when I was pregnant though. Anyway, my ex was in the Air Force at the time & every time I went to the doctor..I had to see a different one.:( I hated it. None of them were very caring. One told me if I gained too much weight that I would have to go to Denver (was living in Cheyenne, WY at the time) to deliver..because they wouldn't have a bed that would hold me!!! WTF? So just hang in there...enjoy every minute of it & tell them that you don't want to see that mid-wife again. You have done amazing & you don't need some woman (who is probably jealous anyway) bringing you down.