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.