Monday, December 15, 2008

I wouldn't be me if I weren't complaining

I think after this baby's born, I will be looking for a new OB. I've had some issues with my current practice, mostly due to their stuck-in-the-50s view of childbirth (you will have an epidural, you will like it, you will shut up, grin and submit to any and all interventions that we consider useful, and no, we don't recommend that you have a doula with you at birth, because they tend to think they know more than us), but I haven't switched yet because it seems like their attitude is par for the course in this area. As much lip service is given to things like natural birth and breastfeeding, one definitely gets the feeling in this town that if the medical establishment could schedule every single pregnant woman for an induction and/or scheduled c-section, they would.

But I digress. The managed-childbirth thing, while not my favorite aspect of life down here, is something I can plan for, work around, live with. What I can't live with is discrimination, especially when that discrimination leads to giving crappy medical advice.

As I've mentioned a time or a hundred on here, I'm fat. Now, aside from upping my risk of GD, my weight has (or should have, anyway) little to no effect on my pregnancy. And, while I'm pregnant, I still need to put on a little weight, just not as much as a woman who's at a normal weight to start with. Every book, website, article, etc. that I've ever read (and I've read a lot) recommends that I gain about 10-15 pounds over the course of a pregnancy.

To date (32.5 weeks along), I weigh several pounds less than I did when I started my FET cycle. That's fine and doesn't really worry me too much, since I've been trying to eat well and the baby's growing right on target. What does worry me, though, is the fact that I keep losing weight. Of necessity, my diet is restricted by the gestational diabetes, but I should be at least maintaining my weight, not losing, not after almost 4 weeks on the diet. The fact that I am losing tells me something is a little out of whack and perhaps not the best for the baby.

And if the OB ignored the weight loss, or (as I've mentioned they've done before) merely congratulated me on it, I'd be mildly put out but not that annoyed. At least I have these here intarwebs to help me find information about maintaining a balanced diet. But today, the practice's nurse practitioner went too far. I made some offhand comment about how hard it is to believe that the baby's still growing while I'm losing weight, and she looked at me and said "that's what we want! You should not be gaining weight. The baby will get nourishment from your fat stores."

Excuse me, but bullshit. She has no idea what's nourishing the baby. Neither she nor anyone else is the practice has ever asked how I'm eating. It'd be different, I guess, if the office had ever once mentioned nutrition or exercise or ever said anything to me about maintaining my health (and the baby's) while keeping my weight in check. But no, all I ever got was a handful of prenatal vitamin samples and repeated congratulations for keeping my figure (such as it is). For all they know or seem to care, I could be living on slim-fast shakes and diet coke. As long as my blood sugars are low (and they are) and my weight continues to fall (and it is), there are no questions asked. It was bad enough when there was just tacit approval of my failure to gain, but for her actually to suggest that it would be bad if I did start to gain weight goes beyond the pale. At this point, it's clear that they don't see me as a person or an individual, but merely as a walking sack of fat cells with a uterus.

That's just plain wrong. At the very least, my GD diagnosis should be making them pay attention. They were all-fired to diagnose me in the first place, and they're plenty eager to describe the consequences if I let the baby get too big, but they couldn't care less how I'm actually dealing with the issue. I've mentioned to them at least three times that in order to keep my sugars in check, I've had to adjust my diet to include fewer carbs than the dietary guidelines suggest. Their only advice is that I should up my intake of protein to make up for it.** How very helpful.

Is it really my job to educate my own doctor about things like ketones and the risks they could pose to the baby? And what if I wasn't the kind of person who obsessively seeks information? What if I took the NP's "don't gain weight" admonishment to heart and started actively trying to lose weight right now? Or decided that simply cutting all (or almost all) carbs from my diet was the best way to go about keeping my sugars under control? Wouldn't you think they be at least a little concerned about these issues? But no. As long as the fat chick isn't getting any fatter (despite the baby who's supposed to be gaining a half a pound a week in her body right now), they couldn't care less about the rest of it. That, to me, is totally unacceptable.

And let me be clear -- I do not expect my doctors to ignore my weight or pretend that I'm healthy if I'm not. I would not be offended if they sat me down and tried to give me advice about losing weight or establishing a healthy lifestyle. They have the right (and perhaps duty) to bring up any concerns they have about my health. But to simply ignore my weight for the last three years, then come up with horrible advice during the one time of my life I shouldn't be worried about weight loss is wrong. It points to a serious lack of care and concern on their parts, and that's why I'll be looking for a new practice.

** Oh, wait, that's not accurate. I also mentioned in passing today that I've been eating graham crackers with peanut butter for a bedtime snack (part of a query about whether they have any suggestions for protein snacks besides peanut butter and cheese). It's literally the only "sweet" I've been allowing myself, and it's a snack that was recommended by the hospital's GD counselor. That little mention earned me a stern frown and an admonishment that I should only be eating whole-grain, unsweetened crackers. Even though my fasting numbers have been just fine. Argh.


Anonymous said...
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K said...

Graham crackers and PB sound danged good right about now...

WTF is wrong with your docs??? I was very overweight when pg with Max and was quizzed as to why I wasn't gaining weight. I gained 18 lbs. I was told instead of 30-35 lbs, being the weight I was when I got pg, that my goal was 20-25 lbs. And had the GD too.

I'd be happy to drive over and poke them all in the eye for ya.

Anonymous said...

I lost 13 lbs in only two weeks by obeying this one easy rule

Anonymous said...

I lost 13 lbs in only two weeks by obeying this one easy rule

Rachel said...

I found this post so interesting to read. I really wonder if there have been any good studies on the risks of the GD diet on lower birth weight babies ... clearly an issue on my mind recently. I am so glad that you have been seeking other information than your OB.

The Girl Next Door said...

The small-minded idocy (is that a word? or even spelled right?) of some people/doctors just never ceases to amaze me. And yet you rise above, take care of yourself and your children by going the extra mile and educating yourself (you are one of the brightest people I know and I know you don't even believe me, but hey read your own posts and get back to me, ok?!) and I applaud you. And once Baby is here, by all means, get some new drs!!!