The complications keep mounting :-(

Today I went to see the obstetrician to talk about how to manage my dangerously short cervix. He wants to start steroid treatment right away in the event that I go into labour in the next week or two. He has no way of knowing whether it will happen or not, just wants to play it safe.

Its a tricky decision because the effects of the steroids wear off after a week or two, and its thought that giving another course can possibly affect the baby's brain. So if E3 doesn't come out in the next two weeks, the steroids won't have made a difference. They are only really effective up until 34 weeks anyway, since the baby does the job itself after that.

The steroids will help to develop surfactant in the baby's lungs so that the sacs that take in the oxygen don't collapse so easily.

I'm happy with the doctor's decision. Hopefully E3 won't come in the next two weeks, and it won't have been necessary but its better to be safe. The baby really needs the help with its lungs at this early stage, much more so than in a few weeks so I think we are doing the right thing.

And just to really make my day, I also had my oral glucose tolerance test this morning, and it turns out I do in fact have gestational diabetes. My blood glucose was 9.3 mmol/L so there's no doubt. I've had so many setbacks lately that I'm not even feeling too upset about it. I was forewarned as well, from the results of the screening test.

As I wrote in an earlier post, I'm still gobsmacked that GD has happened to me. I've always had this perception that only fat women got gestational diabetes, and that's not me. Serves me right for being so smug. Nor am I from the racial groups that are more prone, and I've never been overweight. I am an old mother though, and that's a risk factor I can't ignore.

I guess I just have to face the fact that there's just something about my metabolism that has meant my pancreas just can't cope with the load imposed by pregnancy. It will go away as soon as I deliver, but my risk of getting Type 2 diabetes, and therefore heart disease later in life, has just shot through the roof. It means I am committed to maintaining a good weight and doing lots of exercise for the rest of my life. That won't be a stretch - its what I've always done. But I guess I feel a bit confronted with getting old and what might possibly kill me one day. Perhaps that's life over 40.

Anyway, because the steroid injections can mess with my blood glucose levels, I will need to be admitted to hospital so they can monitor me, rather than just going to outpatients for two injections over two days. I guess they may give me insulin to make sure I don't go hyperglycemic.

The other thing that worries me is how we will control the gestational diabetes. Standard first line treatment is the same as for Type 2 diabetes - diet and exercise control. The diet thing is fine. I'm prepared to monitor exactly what goes in my mouth to get those glucose levels down and also to measure my levels as many times a day as it takes.

Its the exercise, or lack of it, that worries me. I just won't be able to do any because of the enforced 'bed' rest. I don't know how they will deal with this. Perhaps the diet will be enough to get things under control, or maybe I will need insulin injections. Oh well, to look on the bright side, at least I've got plenty of practice giving injections from the IVF cycles :-)

So the plan is - my doctor said I can't go back to work at all and need to keep resting for the duration. Yippee - I'm so glad he's taken that decision out of my hands and I was just stressing so much about telling them I can't come back and whether it was a reasonable decision. I was also dreading they would ask me to work from home. Work is just one extra stress I don't need at the moment. I've already called them to break the news and I've got the doctor's certificate to sign me off. Of course it means less money for us than we expected, but all these other things are just more important than that.

The next plan is that I am to see an endocrinologist at RPA tomorrow. Dr I said she would call to make a time but she hasn't done yet. She will be monitoring my blood glucose when I am having the steroid injections.

Dr I said his secretary would try to get a bed for me at RPA for Wednesday and I would be in for about two or three days. She hasn't called me about that yet either. I guess the wheels of the health system have now been set in motion and I just need to do as I'm told.

Lovely husband is in New Zealand for a couple of days but he will be back before I go to hospital. He called a little while ago and I told him about the steroid injecting plan and the possibility of going to hospital for a few days. He doesn't yet know about the gestational diabetes.

Overall, amazingly enough, I am feeling quite calm and positive about the latest developments. Perhaps its because there's now a plan on how to manage me and knowing what the next steps are has really helped to calm me down. And I don't have the strain of work hanging over my head anymore, which is a great relief.

I'm determined that we will get to 37 weeks. I know this is a bit mad because I can't control my recalcitrant cervix, but I will do everything in my power to get E3 to that goal. I also firmly believe that me being calm is important for E3 and getting stressed and worried won't help at all. All of these issues can be managed and I just need to trust in the doctors to get me through it.

LH and I have planned our emergency route to the hospital and we can do it in 8 minutes - pretty good I think, and probably faster than an ambulance. My hospital bag is packed and waiting by the front door, so everything is in place. E3's room is organised and we've got everything we need for when he comes home to live with us.

We are doing everything we can and now the rest is in the lap of the gods.