Caroline, an FOM (Friend of Melka) joins High Risk Birth Stories to talk about her difficult experience with pregnancy. Caroline has type 1 diabetes, and had to manage this condition as well as nausea until 26 weeks and placenta previa at 18 weeks through her pregnancy.
“The Triathlon of Pregnancy: Diabetes, Nausea, and Bleeding!” – with FoM Caroline
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Interviewer: Caroline, thank you so much for coming on the podcast. It’s so nice to meet you.
Caroline: It’s so nice to meet you too. Thanks for having me on here.
Interviewer: Yes. So Caroline is a listener and, as I said, an FOM, a friend of Malka, and you basically volunteered to come on. So thank you. Thanks for shooting an email and getting this set up.
Caroline: It’s a really fascinating podcast and it shows the whole range of different birth stories that people can have, which you just realize what a miracle birth is when people can go through so many different challenges to get there.
Interviewer: First of all, tell us, how do you know Malka? This is, you know, your claim to fame now.
Caroline: I am an FOM through TNT. Malka and I met each other through Team In Training, the endurance team to raise money for the Leukemia and Lymphoma Society. So Malka was a coach and I was a teammate and together we ran marathons and raised money for cancer research.
Interviewer: It’s amazing. And so how many marathons have you run?
Caroline: I’ve run nine marathons, a bunch of other half marathons, some several triathlons from sprint triathlon all the way up to starting, but sadly not finishing, a full Ironman triathlon.
Interviewer: Oh, dear.
Caroline: That’s a whole other story. So running triathlon long-distance bike rides, swimming, all kinds of endurance events.
Interviewer: Wow. So how many of those marathons were New York City?
Caroline: I’ve done two New York City Marathons in 2011 and 2013.
Interviewer: That’s ironic. I’ve done two New York City Marathons, 2011, 2013.
Caroline: No way.
Interviewer: Were you supposed to do 2012 but for Hurricane Sandy?
Interviewer: So same. I was supposed to do 2012. I was part of the Achilles Team. I was gonna run with a fellow with one leg, which is pretty amazing. And he also had a pretty good time for someone with one leg. It wasn’t like he had a prosthetic, he was gonna like run with one leg and I think the hand crutches of some sort. Yeah, pretty impressive. And when that got canceled, just me and my idiot friends ran around New Jersey for 26 miles that day. Bergen County replacement marathon. We made a little medals for ourselves.
Caroline: Wow. I was gonna ask what your placement race was, but you made your own.
interviewer: We did. We did our own, which is nice because I was a top 10 finisher. And what was your favorite marathon or most unique? Either one.
Caroline: I have two favorite race experiences. So first was New York City Marathon in 2013. Again, just how emotional it was coming back after Sandy and after the Boston Marathon bombing. And I trained really well. I had a huge PR. I ran it with my father. There was so many other TNT people out there. It was an amazing day. And then my other favorite race was the Lake Placid Half Ironman triathlon in 2017. So that was after I DNF-ed the full Ironman and I came back and this was like my revenge race. Half the distance, but still, you know, trained really hard, had an amazing group of Team In Training alumni with me also fundraising for a group called Riding on Insulin. So I had other diabetic teammates from across the country. And, again, PR and the half Ironman and a really awesome race experience.
Interviewer: Yeah. Well, my 2013 experience was also pretty cool, but I tore my groin at mile 4, but ran the other 26 miles with a torn groin. By the way, painful.
Caroline: I’m shocked [crosstalk 00:03:30.809] you.
Interviewer: Quite painful. But you mentioned diabetes or talk about your pregnancy. A friend of mine is also a type 1 diabetic, and it’s the same thing that it’s quite a science to exercise, to do endurance training, manage your insulin, managing your carbs, you know, not too high, not too low on top of all the other stuff. You know, all the power to you for doing this and managing that at the same time. Not easy, not easy stuff.
Caroline: It’s not, but to me, it’s worth it.
Interviewer: That’s good. That’s why you run with Malka. She could, you know, she’s on it also. She can tell you what to do with your insulin. She could dose it. She’s smart.
Caroline: [crosstalk 00:04:08.610] be like, increase it by half a unit.
Interviewer: Yeah. She’s smart. So, good. So we’re gonna be talking about your birth in March of 2019, your son Daniel. So I guess he just turned 2, right?
Caroline: He did.
Interviewer: Fantastic. How has he now? Is he, like, wreaking havoc on the world, just tearing up the joint?
Caroline: Absolutely. Like every other toddler out there. He really loves doo-wop music right now. So at least 8 to 10 times a day, we will hear him say, “Ooh-wa, ooh-wa,” because he really wants to hear the background singers singing, “Ooh-wa, ooh-wa, ooh.” So we have to turn on the doo-wop music for him.
Interviewer: That’s cool, very nice. And how is he going through this pandemic? Does he even notice? Does he normally go out and, you know, have a job or go to school or see just whatever, it’s nice that everyone’s home?
Caroline: It’s nice that everyone’s home. I think that’s how it is for him. You know, it’s really interesting because he was a very social and friendly baby. And then, you know, 1 to 2, he really got a little shyer and I don’t know how much of that is normal development and toddlers, sort of, better understanding who their caregivers are and who’s strangers are and how much of that is because he’s just not socializing as much from the pandemic.
Caroline: So we’ll see how he comes out of that, but he’s healthy. He’s happy. He’s a very sweet little boy.
Interviewer: Going into that pregnancy, so I guess it was in the middle or so of 2018. Where were you in life? What was your story at the time? Like, either right before pregnancy or right at the beginning of pregnancy.
Caroline: So I was married for about a year and at that time I was working at a community health center network within a big hospital system, not Mount Sinai.
Interviewer: Okay. No one’s perfect.
Caroline: So I was working there, living in Brooklyn where I still am now and, kind of, at a professional and personal crossroads in my life because I knew that we wanted to start trying to have a baby, but I was not particularly satisfied with my job and I wanted to find something new, but I was really nervous about going out and looking for a new job because I knew that not only would it take time to find a job, but then it would take time to be at the job for it long enough to accrue FMLA and then also to really be able to prove myself and, kind of, develop a good reputation before I would eventually become pregnant and have to be like leaving the office all the time for all these doctor’s appointments with type 1 diabetes.
So at that time I was thinking to myself, “Okay. Well, I’ll stick it out in this job and I will hopefully be able to find something new,” kind of, within the hospital network that I was in, and that way there wouldn’t be as many insurance issues, people would know me, and it might work out. So in the beginning, I got pregnant and it was really within a few months of being like, “Okay. We’re gonna start trying to have a baby.” And around that same time, I also found a job opportunity that was really perfect. It was lined up exactly what I wanted to do. It was with people that I knew and respected and I thought, “Okay, like, if this works out, this is gonna be great.” Miscarriage was certainly a possibility. I knew that it could happen, but I didn’t really think that it was going to happen to me.
And it did. I had a miscarriage at seven weeks. The good thing was that it was spontaneous. It happened on its own. So I didn’t need a DNC, I didn’t need medication, anything like that. But it was really devastating personally and a really sad time in my life compounded by the fact that at the exact same time that all of this was happening, I interviewed for that job that I really wanted and then silence, that I didn’t hear anything, and the time that I was supposed to hear back was really the time in which I was losing the pregnancy. That stretch, those months of experiencing the miscarriage, recovering from the miscarriage, dealing with the simultaneous loss of this big promotion that I wanted was pretty heartbreaking, a real low time for me on the journey to having a baby.
And then there were two things that happened. One was that I decided to talk about it. So I think I felt really fortunate that I knew right away that nothing I did caused a miscarriage, that the miscarriage wasn’t my fault. I knew that because my diabetes team emailed me as soon as I told them what had happened and they said, “Nothing you did caused this,” even though diabetes can increase your risk of miscarriage. But for me, nothing that I did caused it. And I also knew in general that a lot of miscarriages are unexplained. And part of that was because I read blog posts and I found other women talking about their miscarriage. And eventually, I thought, “Okay. I think I would like to talk about this too because this is something that people are talking about, but maybe more people need to hear about it.” And it really helped me to be able to hear other women’s experiences. So maybe this could help someone else.
Interviewer: Yeah. And the fact that you had that insight that you didn’t cause this, so quickly, I would say, is actually quite unusual in my experience. Most people, it takes them a long time to realize that it wasn’t their fault or they never come to that realization and they’re always…I mean, it’s human nature. Something bad happens, you go say, “All right. What was I doing the day before? What was I doing the day before that?” And some of it is just nature and some of it is also the messaging that people hear. And when messaging from pop culture and messaging from us doctors where we always say like, “Don’t do this. Yes, do this. Don’t do this. Yes, do this.” And the thought is, “Well, if I break one of these rules and I miscarry, it’s my fault.”
Whereas having a cup of coffee is not gonna cause you to miscarry. And if you have a cup of coffee and then you miscarry, they’re not related. But when people hear messaging like, “Oh, I can’t have coffee because I’m pregnant,” and they go on to miscarry, they some think, “Oh, I shouldn’t have done that.” And it’s part of the reason that we try to be so clear with what are the things you really shouldn’t do versus what are the things that are like out there but probably don’t matter. And when people have miscarriages, I spend so much more time trying to convince people that it’s not their fault. They didn’t do it. I’m happy that you had that knowledge right away because it’s not typical.
Caroline: It’s hard to hear that. And I think it’s human nature to want to find a cause for something or wanna assign blame to something and so often we turn that on ourselves. So I really hope that more people come to realize that there’s so much that we don’t know and there’s so much that we don’t understand about what causes issues with pregnancy or losses with pregnancy. So I eventually did, kind of, come out and share on social media about it on mother’s day of that year and the response was overwhelming. I was really a little nervous in the beginning because, you know, some people are actively harmful and then some people might say they’re well-intentioned but still harmful kinds of things.
Interviewer: Yeah. And it’s an emotional time.
Caroline: And that was not my experience. It was overwhelmingly supportive and positive. It was like over 100 people between Facebook comments, and text messages, and phone calls, and people sending me private messages. And another theme that I heard was a lot of other women sharing their own miscarriage stories.
Interviewer: Yeah. This happened to me as well.
Caroline: So you probably went through that experience of thinking like, “Wow. This is so much more common than I realized.”
Interviewer: Yeah. When you said you had your diabetes team, how much, sort of, preparation did you do prior to trying to get pregnant in regards to your diabetes? Because so for our listeners, type 1 diabetes is…some of the people can come into pregnancy with, it is complicated but manageable, right? But it takes a lot of effort to get this right in this, it’s a very fine balance of getting the insulin right. Did you, sort of, say like, “I got this, I’m in,” or did you have, like, meetings with your endocrinologist or high-risk doctor and, sort of, to plan for pregnancy?
Caroline: We did discuss planning pregnancy for the first couple of endo appointments before really, kind of, getting to the point where we were actively trying to have a baby. I was lucky in that my A1C was already pretty close to the target or at the target before trying to conceive. And so on that end, I really had done a lot of the work on my own to really fine-tune a lot of the insulin doses and my insulin to carb ratio and a lot of the, sort of, calculations that you need to do in order to set the foundation.
Interviewer: For our listeners who may not know, one of the complications of diabetes in pregnancy is there’s a much higher rate of the baby having a birth defect if, coming into pregnancy, the sugars are out of control. Amazingly, sugar is a very strong what we call teratogen and it can cause birth defects but only at a certain level. So if you come into pregnancy as a diabetic with basically well-controlled sugars, your risk is essentially the same as everyone else, which is what you were saying, that A1C is the marker for that, whereas if you come into the very elevated one, it’s a much higher-risk situation. And so people who are able to have their diabetes under control, or reasonably under control when it comes to pregnancy do much, much better than those who can’t or don’t. I mean, either one, depends on the situation. And then after the miscarriage, how long did you wait until you tried again? Was it like right away or did you need, sort of, time to heal?
Carline: I took time, one, just emotionally to, kind of, like have a break. And also, because, again, since diabetes management is so strict, I really wanted to have some time to, like, shovel carbohydrates in my face.
Interviewer: Go on a bender. Gotta fill up the sugar wagon for a while. Okay.
Caroline: So I, kind of, think to myself, “Well, all right, if this happened, I need a moment to like enjoy not stressing about my blood sugar 24/7.” The other thing that happened during the time when I was either waiting before trying again or actively be trying again after the miscarriage was that I made some big career moves. I was like, “Okay. Well, I don’t have baby. I don’t have a promotion. This is my moment.” So I decided to quit my job and go to grad school.
Interviewer: Oh. That’s a pivot. That’s a real pivot. Okay.
Caroline: It was, kind of, in the back of my head for a long time and then, you know, I looked at the calendar and I thought, “All right. I’m not having a baby in the fall. I could get into school even though it’s still springtime. If I do have a baby, then I can be around to take care of the baby, and let’s make this happen.”
Interviewer: Grad school for what?
Caroline: Masters in public health.
Interviewer: Oh, nice, an MPH. What does Mike do?
Caroline: He is a pharmacy specialist at health insurance company. So he does a lot of the like pharmacy analytics for medication adherence.
Interviewer: Okay. Got it. And so now you’re gonna enroll in an MPH program?
Caroline: Yes. Yeah. So it was maybe about four months after the miscarriage that I became pregnant again. And that was with, you know, the pregnancy that eventually resulted in our 2-year-old son who loves his doo-wop music.
Interviewer: Right. So spoiler alert, good ending. Okay. Yeah. For anyone who is sick of hearing about miscarriages on this podcast, like, “Enough already with the miscarriages. We get it.” Good ending. Here we go. All right. So you’re pregnant again.
Caroline: So I was pregnant again and immediately becomes a whole set of new issues. Diabetes was not the new issue, right?
Interviewer: I mean, you’re all over it. I mean, you’re checking your finger sticks, what, like eight times a day, five times a day? It’s something…you’re all over it. It’s crazy.
Caroline: Yes. And you are all over it. My endocrinologist CDE said, “We are the first person that you talk to.”
Interviewer: Yes. We’re your first call.
Caroline: Yeah. Not even…I mean, they didn’t explicitly say call us before your friends and family, but it really is like, “Tell your family that you’re pregnant and then tell us.”
Interviewer: Were you seeing an OB-GYN or a high-risk OB like a maternal-fetal medicine doctor?
Caroline: So with my first pregnancy, I went to a regular OB because he was in the hospital system I was working in and he was close by. And then after that, with my second pregnancy, I decided to switch to an MFM. I, kind of, pulled some other friends with diabetes and said, “Who did you work with? Did you like doing MFM versus an OB with MFM consultation?” And one doctor was recommended by a few people who also saw my endocrinologist. So I stayed…my endocrinologist was within Columbia so I decided that I was going to see MFM within Columbia too.
Interviewer: It’s not a necessity to do that, but it’s certainly easier if they’re in the same system, like if you were in the hospital and they have to see you, there are privileges there and people tend to know each other and sometimes the medical records are in the same system and, you know? And it’s not like every diabetic has to see a maternal-fetal medicine doctor. It really just depends if the OB is comfortable or not, and how involved the endocrinologist is. You know, we have endocrinologists who are very involved and so we don’t do as much of the diabetes part and there’s others where we, sort of, take it over and it’s person-specific. Okay. So you have your team set, your endocrinologist, your MFM, and what other issues do you have besides diabetes that you were gonna say?
Caroline: So I had a lot of problems with nausea and vomiting.
Interviewer: Which is not great if you’re a diabetic.
Caroline: It’s really not. You know, it started about six weeks. And at first, it was weirdly a relief.
Interviewer: Yeah. It was a great pregnancy.
Caroline: I was like, “This is viable, blah. This is awesome, great.” And then, you know, I was trying to do different recommendations, not necessarily going on the medication. I was like, “Okay. You got to eat before you even get out of bed.” I tried that, that wasn’t working. You got to do the preggy pops, and the lemon, and the ginger and tried all of that, that wasn’t working. At this time, I am frantically wrapping up all the loose ends at my job for going to grad school. So I printed out a picture of Serena Williams at the Australian Open because that’s the one that she won when she was eight weeks pregnant. And I looked at it every single day at work and I thought, “Okay. Okay. If she can win the Australian Open while she’s pregnant and like throwing up on the court during practice, I can do this too.”
Interviewer: What was your hesitation to take the medicine for nausea? Just, you didn’t wanna take the prescription stuff or…?
Caroline: At first I didn’t think it was as bad as it was going to get. And what was different for me was that I never had hyperemesis. I never had HG because it wasn’t like I was throwing up so much that I could never keep food down.
Interviewer: Right. So it wasn’t messing with your sugars and like…because sometimes with diabetics, we get concerned that, you know, they’re gonna go into ketoacidosis and then, like, all these things are gonna happen, but it wasn’t that bad, you’re saying.
Caroline: It wasn’t that bad.
Interviewer: It was just very annoying, but not medically dangerous.
Interviewer: Fine. Okay. Well, that’s stinks too, but, you know, at least it’s not gonna stink and put you in the hospital.
Interviewer: All right. Fair enough.
Caroline: So what made it annoying, but not medically life-threatening or really serious was that, you know, with type one diabetes, you have to very, very carefully measure out and time your insulin and your food, right? And so it’s really helpful if you eat at certain times of the day, if you know what you’re gonna eat in advance, if you limit your carbohydrate, and if you don’t eat certain foods. And as many people know, in the first trimester, when you’re really sick and nauseated, what do you want? Carbs. When do you want it? You don’t know. It really just depends on how your stomach feels, and it could change within five minutes.
interviewer: Were you on a pump or injections?
Caroline: I was on injections. Still on injections. So I was taking Levemir as my background insulin, NovoLog as my mealtime or correction insulin.
Interviewer: So meaning you take this Levemir once a day and then the other ones as you eat.
Interviewer: So four times a day, give or take.
Caroline: Give or take. Usually a little more [inaudible 00:21:07], right, because you got to give the shots to bring it down more often. So that becomes really challenging to juggle because it’s like, “Okay. I feel pretty sick right now and I wanna eat right now, but I have to check my blood sugar and take my insulin and wait for 20 minutes and I have to figure out how much I’m gonna wanna eat in advance.”
Interviewer: Right. And how much am I gonna throw up after I eat it?
Caroline: Yes. And if I throw up, how much of the insulin was absorbed and how much of the food was absorbed? That was a struggle. There was one time when all I wanted to eat was Domino’s pizza and I tried really hard, but my blood sugar was still going high. And my CDE, I emailed her my logs every week. I kept track of all of my insulin doses, all of my food, all my exercise. And she was like, “I think you really need to not eat pizza or, you know, you really need to, like, tighten things up a little bit.” And I was so upset. I was like, “Please. I’m so sick. I just wanna eat my Domino’s.”
Interviewer: This baby wants pizza. All right.
Caroline: And then the other thing that made it difficult for me was the fact that it just didn’t let up and I heard over and over again, like, “Oh, you know, it’ll get better at 10 weeks. It’ll get better at the end of the first trimester.” Or you hear from people who say, “Oh, I barely threw up during my pregnancy.” And here I was at 8 weeks, at 10 weeks, at 12 weeks, at 13 weeks and it was really…it was almost getting worse.
Interviewer: Did it ever get better?
Caroline: It did. So first, I finally went on medication. I was taking Unisom and B6. And it doesn’t stop the vomiting, but at least helped me to feel less nauseated during the day.
Interviewer: Right. And it helped you not be awake, you get a little sleepy with those. Okay.
Caroline: So that definitely helped. And then around 16 weeks, it got better. It didn’t go away entirely, but I went from, like, throwing up almost every day to throwing up a couple times a week.
Interviewer: Yeah. I mean, that’s on the farther end of the bell-shaped curve. I mean, most people turn the corner between 10 and 12 weeks. And so 16 weeks is later, obviously. There are some who have it until they deliver, which is really…the poor things. It’s just gruesome. But yes, it’s late. I mean, again, especially because it’s not just annoying, but it really wreaks havoc with what you have to do with your sugar and your insulin and your foods. It’s also, like, just challenging and just annoying.
Caroline: And I didn’t have any triggers for it. I couldn’t say like, “Oh, this specific type of food makes me feel really sick.” So I couldn’t avoid it. I didn’t really stop throwing up until probably like 26 weeks.
Interviewer: It’s pretty late.
Caroline: And then it was like, “Oh, thank God. I’m free.”
Interviewer: Right. Well, you’re free from that, and then it really got interesting.
Caroline: And then it really got interesting in a whole new way. The whole second trimester, I was still undergoing the nausea and vomiting, I was still managing my diabetes. You know, just as the nausea and vomiting was lightening up a little bit, that’s when I went to my appointment and was told that I had placenta previa, at 18 weeks. And I was like, “Okay. Well, you know, I think this will probably go away, but obviously, we don’t know. You can’t [inaudible 00:24:46] recommendations assuming that it will.”
Interviewer: Now, I didn’t ask you before, but in connection to all of your running and exercise, what were you doing up until that point in pregnancy? Were you able to run to exercise? Did they tell you not to? Were you’re physically unable to? And then how did the previa potentially for a wrench into that?
Caroline: So I was working out from the start. In the first trimester, since my first tri was over the summer, I was swimming a lot. And then at the point that I was diagnosed with placenta previa, I was doing mostly pretty slow running at that point. A lot of elliptical, I was riding stationary bike, doing a little bit of strength training. And, again, all of that recommended by both my diabetes team and the OB side, given that exercise really helps to increase insulin sensitivity and help keep the blood sugars under control.
Interviewer: Yeah. Good for you, good for the baby. Everyone wins. Okay.
Caroline: Yes. So when I was diagnosed with placenta previa, I was told to continue exercising, which I think is really interesting because what I’ve heard from other women who experienced placenta previa is that they get told either don’t exercise or like only yoga and walking, like very, very gentle stuff. And even if it’s like a very tiny placenta previa or even if the placenta is not totally over the cervix but really close to the cervix, they still have these precautions put in place. And I can understand why, you know, you need to exercise in abundance of caution in these cases, but for me, I’m really glad that I was able to continue exercising. I don’t know if my OB necessarily thought like, okay, the benefits clearly outweigh the risks, or if she was just a little more lax about those kinds of guidelines, in general.
Interviewer: Yeah. I mean, they’re not really guidelines because there’s a lot of variation in terms of, number one, how far pregnant are you? Number two, is it covering the cervix entirely versus very close to it? Number three, have you had bleeding at all? And then within all of those variables, right, because right there, there’s so many different variables, all the doctors feel differently about this and ranging from you can’t exercise at all versus you can exercise and everything in between, “Well, you can do this but not this, or do this and not this, and this and not this.” And none of it’s based on any evidence, it’s all just…we’re all making this up because…
Interviewer: Well, I mean, yeah, potentially, if you did A, B, and C, you could bleed, but what if you do A, B, and C and you don’t bleed? Like, it’s not dangerous if you don’t bleed and it’s one of these things that you can’t…it’s hard to design a study to figure out exactly what activities will and won’t cause bleeding and then put women in this study, like say, “Okay. Try this and this and that and see if you bleed.”
Caroline: That’s a little unethical.
Interviewer: Yeah. Like, let’s see how far you can go before you bleed and then we’ll tell the next person to back off. So it’s not really done. So people tell, you know, women many different things with this. I think most doctors tell women certainly after a certain point not to have sex because they think that’ll cause bleeding and with exercise, it’s all over the place. You’re gonna hear a lot of different things. But I think that, again, ultimately, if you are exercising and you’re not bleeding, it’s not a problem, right? It’s just an issue that you don’t always know if it will cause it. You can be lying in bed doing nothing and start bleeding with the placenta previa. It’s not like it’s from activity, but the thought is it might increase the risk. And so it makes sense that everyone you know has heard something different because we tell everyone something different based on the doctor.
Interviewer: Yeah. It’s one of our little secrets.
Caroline: We’re all just flying by the seat of our pants.
Interviewer: Well, it’s the same thing, it’s, you know, people have…you know, they have a short cervix, they have pre-term labor. One doctor says strict bed rest, another doctor says run a marathon, another doctor says you could do this but not this. It’s the same thing. It’s very hard to know what the right answer is. And so it’s just, you know, however your doctor feels about it, that’s sort of what you’re gonna get. There’s a lot of variation.
Caroline: So in this case, my doctor said, “Okay, keep exercising but,” as you said, “pelvic rest.”
Interviewer: Pelvic rest. Only doctors can come up with that term. “We need your pelvis to rest, please. It’s been working out too hard. Pelvis needs to rest.” All right. So doctor. That’s wild. Okay. Yeah.
Caroline: So in addition to that doctor speak, I was told not to do any, like, hard running and also not to do weightlifting or, like, intense strength training.
Interviewer: Like I don’t see how being on a spin bike is gonna increase your risk of bleeding or how swimming would increase your risk. I could say that maybe someone just jumped up and down all day, maybe. I don’t know. Again, it’s one of those things. But that makes sense. I think that you got good recommendations. And it’s good because, you know, there’s so many benefits, particularly to you with the exercise.
Caroline: Absolutely. I felt it really helped to increase my energy, it made a difference with weight gain, it helped with the baby to make sure the baby was healthy. And just like when so much of pregnancy is outside of your control, having something that I could control, even if I couldn’t necessarily control what my body could do or how hard I could push on any given day, just the ability to be like, “All right. I can exercise like every other day and I can keep doing this for my own health and sanity,” really gave me a sense of agency during the whole experience.
Interviewer: And I think that, you know, coming into it as a diabetic, you’re already, sort of, used to having very tight control over things in your body. I mean, to the ability that you can, but, sort of, this idea that it’s up to me to make sure my blood sugar is normal. Like, most people want to think about that. Obviously, it’s always on your mind and then also, you know, you already run a bunch of marathons. You know, we tend to be a very meticulous group, I’m gonna run this many miles at this day, this many times. Like, it’s very like ordered in a sense. And like you said, pregnancy often doesn’t allow for that because all hell breaks loose, sort of, without our ability to control it. And so things you can, sort of, map out, people tend to like, things like that, you know?
Interviewer: Okay. So you’re going along, so no bleeding yet?
Caroline: No bleeding yet, but that’s the kicker. Spoiler alert.
Interviewer: Waiting to come.
Caroline: Yeah. So chugging along, really working hard to manage the diabetes, stay on top of diet and exercise, making the modifications. And then at 33 weeks, I had my first bleed. And it was not a lot of blood, but it was in the evening, and so you had to like call the after-hours phone tree and talk to eight different people and eventually I got through to someone who was like, “Yeah, you should go to the hospital.” I was like, “Ugh.”
Interviewer: Yeah. Did you have a sense at the time that there’s a good chance you’re gonna be parked there for a while, or did that even dawn on you?
Caroline: At that time, it did not dawn on me.
Interviewer: At that time. First bleed.
Caroline: Because that was like…you could almost call that one-and-a-half bleeds. Because at maybe 29 weeks when they checked again and they told me like, “Yeah, you still have a placenta previa,” I had a little bleed after that, but I called my OB and we were like, “Oh, well, you know, they were all up in there with the probe, so that probably caused it.
Interviewer: Your pelvis wasn’t resting that day. Right. Okay. Got it.
Caroline: My pelvis needed to chill out.
Interviewer: Right. You knew you were gonna go in to be evaluated, but your thought was maybe I’ll come for an hour or two and then go home. Was that, sort of, what you’re…? I’m just curious what people are thinking.
Caroline: Yeah. I was really hopeful that they would check me out. You know, bleed one-and-a-half still wasn’t very much and I thought, “Well, yeah, they’ll probably look at it, I feel fine, I don’t feel sick, and it’ll be okay.” So I went over and they were like, “Yeah, this is not okay.” But they only kept me to monitor me. They did give me the steroid shots.
Interviewer: Right. Just in case.
Caroline: Just in case, which was unpleasant. For listeners, you know, the typical pattern of blood sugars with type 1 diabetes is that, you know, you have normal to maybe some low blood sugar in the first try and then the second try your insulin resistance creeps up, and up, and up as the placenta is creating the stress hormones that help the baby grow and so you’re very, very insulin-resistant in the third trimester, taking a ton of insulin, really, really restricting carbs to the point where like maybe you could have a sandwich or maybe you can have like one fist-size of rice. No pasta, forget about dessert. Nothing like that. So then, you know, I come into the hospital and I get a steroid shot, which, of course, is filled with all the chemicals that make your blood sugar skyrocket. And I’m eating hospital food, which is…
Caroline: …delicious. And the hospital’s idea of carb control is 60 grams of carbohydrate, which is like 3 times as much as I could eat at any given meal.
Interviewer: Right. They pay someone, by the way, to organize those meals by carbs. Just so you know, there’s someone who does that, and that’s what they came up with.
Caroline: If only it could taste just a little more flavorful.
Interviewer: Yeah. Word to the wise, grub hub. If you’re in the hospital, order in, you know?
Caroline: Yeah. So I was kept there for three days and at that point, they decided, “All right, you’ve stopped bleeding. We think it’s time to go home.” But at that point, the birth plan was really taking shape. I saw my OB in the hospital and she said, “Okay, you’ve got this previa, you’ve had a bleed. We’re gonna go ahead and plan for a C-section.” We planned it for, you know, 37 weeks when she had it in her calendar. And I was like, “All right. I can wrap my head around this.” I didn’t know for a while whether it was gonna be C-section or vaginal delivery, but I knew that I should prepare myself for C-section.
Interviewer: You knew that it was a previa, it would be a C-section, correct?
Interviewer: Yeah. But you just didn’t know if it would resolve or not.
Caroline: At that point, I knew because, you know, 18 weeks it’s like, “It’ll probably move. You’ll be fine. Don’t worry about it.” And it didn’t move. And then it bled. And so I’m really, like, wrapping my head around this.
Interviewer: When they sent you home at that time after three days, did they change the restrictions on you? Did they say, “Okay. Now, no more exercising.” They, sort of, like tighten the reigns on you a little bit?
Caroline: They did.
Interviewer: I was gonna ask you, but I forgot to. When you came into the hospital and amongst the 65,000 people who see you from when you come in until you leave, did any of them give you crap about exercising before you were bleeding?
Caroline: Nobody did. No. To be fair.
Interviewer: Wow. That’s impressive. Not even the medical students, or residents, some nurse who just said something wayward like, “Well, of course, you’re exercising, you know?” That’s great. That’s good on their team that they were a unified front. Okay. But when you went home, they said no mas.
Caroline: Well, they didn’t even say no mas.
Interviewer: Really? Less mas. Okay. All right.
Caroline: So my OB said, “Okay. Keep exercising, but don’t do anything where you are standing up or otherwise, kind of, putting any pressure.”
Interviewer: Keep exercising but don’t do anything where you have to move. Okay. All right. Yeah. I mean, that’s understandable. All right.
Caroline: So what that meant for me was sitting on a recumbent bike and doing your coming bike rides and also swimming…
Interviewer: Like arm weights or something. Yeah.
Caroline: …pool walking. I was with all the old ladies in the water aerobics class, having fun at the YMCA. So that’s what I did. And I was also told that if I were working, I would have needed to stop work because of, you know, the potential of being up on my feet, going back and forth on the subway. So I was lucky in that I was in graduate school and I had taken that semester off as maternity leave. So that was a big relief. So I was still going to the pool, still riding the recumbent bike, still counting my carbs and being very diligent about diabetes management, again, logging everything, all your food, all your insulin, all your exercise, all your blood sugar checks, and planning for the scheduled C-section at 37 weeks.
And then a week-and-a-half after being discharged, I woke up in the middle of the night to go to the bathroom, like you do the third tri, and something felt damp. And I was like, “Oh, no.” I went to the bathroom and I turned on the light and I looked down and I was like, “Oh…” You can imagine the form of expletives that pours forth. So I sat for a little bit. I pet my cat because I knew that like, okay. I think this time I could very well be in the hospital for a while. I didn’t know for certain, but I knew I was gonna have to go back and I knew that most likely it was not going to be another, like, monitor you for three days situation. I really hoped for that, but I knew that this was not good news. And so I woke my husband up, I said, “We have to go back to the hospital. I’m bleeding again.” We go at 3:00 in the morning.
Interviewer: Right. No traffic.
Caroline: Yes. And thank God because we were living in Brooklyn and I was going up to Columbia, which is a schlep for those of you who are not in New York City, that is a long ways away. So I showed up at antepartum and they said, “Okay. All right. You’re bleeding again.”
Interviewer: And you’re like 35 weeks now?
Caroline: Thirty-five weeks at this point. And I’m hanging on antepartum. They start the IV. They’re checking out the baby, baby’s okay. I don’t feel great, but I don’t feel, like, terrible. Bleeding seems like it’s slowing down. We’re just waiting. And then the bleeding increases, like I got up to go to the bathroom and it’s not a good scene. And the doctor walks in and says, “Okay. We’re delivering this baby today.” And I was shocked because that was not what I was expecting. Very emotional, start frantically calling my parents. My husband started calling his family and like, saying, “I’m not going to work today because, oh my God, we’re having a baby.”
Interviewer: Right. Did you know you’re having a boy, by the way?
Caroline: Knew we were having a boy, but at that point, we did not have a name picked out. So.
Interviewer: And probably you’re lacking some of the essential is needed at home?
Interviewer: Yes. Okay.
Caroline: Because we showed up totally not expecting that we were going to be having a baby that day. So I was waiting for them to get everything prepared because, you know, it was an urgent situation, but it wasn’t emergent, like, “You’re bleeding so much. We need to do this ASAP.”
Interviewer: Right. Yeah. You weren’t hemorrhaging to death, but they’re just like, “You’re bleeding enough that there’s no upside in waiting.” I mean, it’s the right call, but that’s, sort of, where we were. Okay. I mean, obviously, it’s a whirlwind, but how worried were you, specifically about, A, your own health? You know, you’re bleeding, you’re diabetic. You’re 35 weeks. You gonna have a C-section like, hello? And, B, about your son. Were you worried that he’s premature and he’s gonna be ill or were you, sort of, like, it’s gonna be okay? He’s already 35 weeks. Like, what was going on in your head from, like, a worry perspective?
Caroline: I felt okay. When I was hospitalized at 33 weeks, I was a little bit worried then, but it seemed like the possibility was really low that he was going to be delivered at that point. When I came back at 35 weeks, it seemed like he wouldn’t have a NICU stay or if he did have a NICU stay, it wouldn’t be too long or difficult. That’s what they told me. He’d be the big kid in the NICU.
Interviewer: Yeah. Okay.
Caroline: Yeah. Again, anytime that they monitored his heart sounds, it was A-plus-plus.
Interviewer: Yeah. Yeah. You’re the one bleeding. He really couldn’t care less.
Caroline: He was fine. And, again, I was not bleeding enough that I was really concerned about my own health since health and safety, it was just like…And then the emotional whirlwind continued because the MFM who was on the floor in antepartum that day walked in and he’s got his ultrasound machine and he says, “Well, I always say measure twice, cut once.” So we do the ultrasound and he says, “Your placenta is not where it was before.” And I’m like, “What?” And he said, “We’re gonna need to do more imaging because it’s not over your cervix anymore.” And I’m in shock because all I’ve ever been told is that I have placenta previa.
Interviewer: When was the last time they had…Did they see it when you were 33 weeks? Did they do an ultrasound to confirm it or they did not do it at 33 weeks?
Caroline: They did not do it at 33 weeks.
Interviewer: Got it. Okay. So it’d been about a month, give or take?
Interviewer: Fine. And that’s normally the interval we do it, every month or so. Okay. So he thinks it’s moved and you’re bleeding for another reason.
Caroline: Yes. And so…
Interviewer: Well, that’s a twist.
Caroline: I mean…So I texted my pastor and our minister [crosstalk 00:41:53.410] saying…
Interviewer: Pray for me.
Caroline: “Pray for me. This baby is being born today.” I hit send, I look up at the doctor, and he says, “The placenta is not where it was before.” And I’m like, “Okay. Scratch that, but still pray for me.”
Interviewer: Don’t pray anymore. Yeah. New God.
Caroline: So we went downstairs to the ultrasound tech and at that point, we did not know what was happening. At that point, it was still maybe this baby’s coming out today, maybe not. We’re waiting for the ultrasound tech, my husband and I were like, “We need to pick this baby’s name. What’s it going to be?” We decided on the name while we were waiting for the previous patient to finish up. We go in and they do the ultrasound and the tech says, “Oh. You have had an abruption.” And I was like, “Oh. So okay, no more placenta previa and you’re saying that the bleeding was caused by an abruption, which is a totally different thing.” And she was like, “Yeah, yeah, basically.” And then that was all that I knew for a long time because, to compound the issues, my OB, the day before I went to the hospital, had gone on a jungle cruise in the Amazon.
Interviewer: Oh, how nice. How nice for her.
Caroline: How nice for her. Good for her. Every doctor deserves a vacation.
Interviewer: How wonderful. All right.
Caroline: Very, very stressful to come in and suddenly the whole plan has changed and I have no idea what’s going on because they were like, “We’re admitting you. You don’t have the diagnosis that you have when you came in and we don’t really know what you’re gonna do.”
Interviewer: Right. But you weren’t bleeding heavy enough that they were…I mean, because some people with an abruption we deliver also, they said, “Since it’s an abruption, we can watch and wait and see what happens and probably maybe get another week or two out of the pregnancy,” was sort of their thought, I’m guessing?
Caroline: That was eventually what came out.
Interviewer: Did they give you steroids again or they didn’t?
Caroline: No steroids again.
Interviewer: Because you’re diabetic, probably.
Caroline: They never really talked about this. I figured…Oh, that’s interesting because I thought you would just get them once.
Interviewer: You normally just get them once and then you can get what’s a second course of steroids potentially. I don’t know if they would have done them or not, but not for a diabetic. Not exactly the same thing, but the study about getting steroids between 34 and 37 weeks was a multicenter study. But the person who ran the whole thing is at Columbia. Yeah.
Caroline: Fascinating. Because I remember…
Interviewer: But that was for the first time steroids, not a second time. So I was just curious if you did it. I mean, it’s not clear it’d be helpful, plus since it would wreak havoc with your sugars, it makes sense they wouldn’t do it.
Caroline: Right. And they told me when I was hospitalized the first time that, “Okay, because you’re coming in before 34 weeks.” After 34 weeks, they would have said, “Okay, you’re fine.”
Interviewer: Right. Because you’re diabetic. They would have given you steroids otherwise.
Caroline: Oh, okay.
Caroline: Okay. That’s interesting.
Interviewer: Yeah. Okay. So new plan. Here we are.
Caroline: New plan.
Interviewer: Did the doctor make it back from her exotic vacation before you delivered?
Caroline: She did. Until then, I was hanging out in the hospital. Thank God I pet my cat because I was there…
Interviewer: And the bleeding slowed down?
Caroline: It did. It slowed down and eventually stopped maybe a few days after I was admitted. My poor beleaguered husband was working all day and then schlepping up, you know, usually taking a taxi from Brooklyn to Manhattan, which still is like 45 minutes, but it’s better than an hour-and-a-half on public transit. Seeing me, bringing me, you know, as you said, the husband version of GrubHub to replace the terrible hospital food and then going back home, not getting home until 11:30 at night. And I was just waiting. I knew that, “Okay, there’s no more placenta previa, which means that I can do a vaginal delivery. It’s just a question of when.”
Interviewer: Right. Was that the plant induce your labor?
Caroline: Yes. So everyone who was on the floor at that time agreed. It’s like, “Okay, let’s do an induction. Now that we know that the placenta has moved and like the bleeding has slowed down, we can do an induction at some point.”
Interviewer: Right. Is that what they did?
Caroline: That was what they did. So at the tail end of 36 weeks, I was induced and had a really overall positive birth experience.
Interviewer: That’s great. Did you get an epidural?
Caroline: I did. I was…maybe like 24 hours after induction started.
Interviewer: First baby. That’s usual.
Caroline: Yeah. It was, like, pretty cool. And then things were going, kind of, slowly and they were like, “We’ll break your water.” And I was like, “Okay. Okay.” And then they did, and then it was terrible. I got the epidural and it was much better after that.
Interviewer: How long did you have to push?
Caroline: For about an hour.
Interviewer: Okay. That’s pretty standard. That’s average. It’s a long time to push, but it’s normal to push that long for the first baby. I mean, it’s long on your end because you’re working for an hour, but that’s not unusual. And then birth, what was that like when this kid came out of you?
Caroline: When the kid came out, it was incredible. I felt…you know, I was really working hard while pushing as anyone is, but working hard in the sense of like, again, like a marathon. It’s like the last miles of a race where you…
Interviewer: You’re an athlete.
Caroline: …feel terrible and you’re really working as hard as you can, but you’re riding like the edge of your limits and you know eventually, you’re gonna get to the finish line and you can do this.
Interviewer: Did Malka come in with, like, a cowbell and an air horn or something like that and start yelling at you and offer you hamburgers and beer at the end to get you all motivated?
Caroline: Maybe the baby would have come out faster if she did that.
Interviewer: Good. She’s good with the cowbell. More cowbell. And then in the labor, your sugars were fine, they managed it either with insulin or with a drip or something like that? They…
Caroline: You know, overall, the whole time that I was hospitalized and even during labor and delivery, I was really pleased that they of let me take over the reins in a lot of ways.
Interviewer: Well, you know yourself better than they do. You know what works for you and what not.
Caroline: Exactly. But not every medical professional is like that, right? And I’ve heard a lot of stories about other women with diabetes who come in and…
Interviewer: Well, the good ones are.
Caroline: …somebody inpatient tries to change everything on them.
Interviewer: It’s only hard if there’s a pump because then it’s like, well, now it’s like this like secret thing that no one knows what’s in it, but like if it’s like injections and how much to use and this or that, it should be collaborative because, again, you know. You’re like, “This is what’s gonna work.” Like, “I’ve been doing this for a long time.” And so smart people are gonna listen to you in that circumstance. All right. So he comes out, got a son.
Caroline: Comes out, I have a son. Just this, like, amazing feeling of physical, and emotional, and spiritual relief that he’s out and he’s good. His blood sugar went a little bit low right after birth, which, of course, happens in a lot of diabetic patients, but not enough that they were really concerned about him.
Interviewer: What was his birth weight?
Caroline: Seven pounds, 11 ounces.
Interviewer: All right. Good. Yeah.
Caroline: So like a nice chunker for 37 weeks. So, yeah. I was induced at the very end of 36 weeks and then he was born…
Interviewer: At 37.
Caroline: …exactly 37 weeks.
Interviewer: Full term.
Caroline: Yes. The first day he hit full term. So thank goodness. And then we got home and I thought things were gonna be like, okay, this is done. I’m done with the hospital until three days after we were discharged. So I guess six days after he was born, we take him back to the pediatrician and she’s like, “He looks kind of yellow.”
Interviewer: Yeah. Your baby’s yellow.
Caroline: Yeah. And I had a lot of risk factors for jaundice. I had jaundice when I was a baby. My husband is Asian and I know that Asian people have a different risk profile. And I was having issues with breastfeeding too. It was definitely difficult at first to get him to latch well and to nurse well, and…
Interviewer: He was a little bit early.
Caroline: Yeah. And I did read an article that someone I know sent to me about the difference between early-term and, kind of, later full-term babies.
Interviewer: Yeah. Things like jaundice are more likely 37 weeks, things like low blood sugar. Again, it’s a little bit more, and it’s, you know, not often a deal-breaker, but you do have a higher chance of a longer admission to the hospital for the baby or getting readmitted. It is slightly higher at 37, which is why we don’t routinely deliver people at 37 weeks. There has to be, like, a good reason. Having an abruption is a good reason.
Caroline: I was just about to say.
Interviewer: It’s a very good reason because things can really go crazy the longer you wait. You can just start hemorrhaging and it’s just not worth the risk. But we don’t do it like electively at 37. Even though it probably wouldn’t matter for the majority of babies, like why take an extra 5% of babies and, you know, park them in the NICU if you don’t have to.
Interviewer: So he got readmitted for jaundice?
Caroline: He did.
Interviewer: For how long?
Caroline: He was only there for two days.
Interviewer: That’s stressful.
Caroline: It was very odd because on one hand, I knew he was gonna be totally fine and they were just helping to get his levels back to where they should be. And on the other hand, it was so awful because I had just spent the past several weeks in the hospital between the two different admissions and now I was back in a different hospital and, you know, just the distress of seeing your newborn get an IV fluid.
Interviewer: Did you stay overnight with him, or you went home in between?
Caroline: I did.
Interviewer: You did. Okay.
Caroline: Going home for like breaks and stuff, but I stayed overnight.
Interviewer: Right. You were allowed to stay with him overnight. Was he admitted to the NICU or the PICU?
Caroline: He was admitted to the PICU.
Interviewer: Right. So that’s the difference. When the babies don’t leave the hospital, they’re in the NICU, the neonatal intensive care unit, and they usually don’t let parents sleep there. But if babies go home and come back, they’re no longer in the NICU. They’re in the pediatric unit, the PICU, and there, parents stay with their kids. I don’t know, each hospital might be a little different if babies readmitted can enter into a NICU but often they don’t. Often like NICU is only if you’re born.
Caroline: That’s what I was told because I had a friend at the time who was a NICU nurse at the hospital where we took him to and I said, “Can I bring him to the NICU so that you’re there?” And she said, “Well, no, because he wasn’t born here.” But she came and visited. So that was nice.
Interviewer: So he came home a few days later. How was your recovery from birth?
Caroline: Recovery, thank God, was smooth sailing. I was enormously lucky. No baby blues, no tearing, no pelvic…
Interviewer: No tearing. Nothing?
Interviewer: Holy smokes.
Caroline: Yeah. Maybe all that pelvic rest was something.
Interviewer: I don’t know if it’s the reason, but it is absolutely true that if you are exercising in pregnancy, your recovery is more likely to be easy. You can exercise all pregnancy and have a horrific recovery, you could sit on a couch all pregnancy and have a great recovery, but statistically, you’re gonna have a better recovery if you’re in shape throughout the pregnancy and as you get to deliver. There’s no question about it.
Caroline: That was absolutely my experience. As you say, individually, it can vary, but I felt really good. I had good energy. I was not, like, going crazy from fatigue and, right, I felt good, like, picking him up and holding the baby and walking around and…
Interviewer: Did you get back to exercising quickly or did you wait a while?
Caroline: So for the first two weeks after birth, I didn’t do anything. Then two weeks after that, two to four weeks, I was walking, and then four weeks, I went back to the gym, really gentle. And then yeah, after six weeks and, kind of, started escalating more.
Interviewer: Looking back on this now, you know, two years later, what have you learned about yourself this whole experience? I’m just curious.
Caroline: I think what really stood out for me was the duality of different experiences. I mean, through the whole journey, right? I can be really sad that I had a miscarriage in the beginning and also really grateful that it opened up some new avenues professionally and, of course, got me the eventual baby that I have now. I can think that pregnancy was the hardest thing that I’ve ever done, including training for all of those marathons and triathlons and stuff, and still know that it was worth it and my son is amazing, even if I hated pretty much everything about being pregnant. Yeah. It really helps me to believe in resilience and my ability to, kind of, push through a whole host of different challenges.
Interviewer: That’s amazing. And for people listening to this story, what is it you want them to know for themselves that they might be able to take away from this story other than how fascinating it is?
Caroline: Obviously I’m a big believer in the power of exercise. I see it in my own life and the benefits that it has given me, but I’m like kind of a weirdo in that I like doing it and I’m one of those people, like you, who willingly gets up at 6:00 on a Saturday morning and runs for 15 miles. And not everyone feels that way. Being able to work out or at least do something to move my body throughout all pregnancy did help me physically, it helped me mentally, it helped keep the baby healthy and safe. And that was really important. On the other hand, again, going back to the duality of things, I do think that there are some women out there who are really concerned about weight gain and probably some doctors out there who are really concerned about weight gain. And I think there are some cases in which we don’t need to stress about weight gain as much.
You know, you hear a lot of stories from people who ate a lot during pregnancy and gained more weight than they wanted to and then had issues losing weight after pregnancy. And I’m on the opposite side of that. And since I had a restrictive diet and was very, very careful about what I ate, I did not eat as much as I want to. I did not gain as much weight as I wanted to. Like, it was perfectly healthy, but it was not even the recommended amount of weight gain. And I really, really wish that I could have eaten more and just like had the extra 10 or 20 pounds on the other side of pregnancy and deal with losing that later. And even with my very strict eating, there were times when I went into appointments and got scolded for gaining six pounds in four weeks.
Interviewer: Scolded. Whoa.
Caroline: Scolded might be a little harsh, but…
Interviewer: Well, that’s how you remember it. I pretty much personally, almost never comment on someone’s weight, whether it’s too much or too little if they’re holding one baby. Twins is a different story because there’s different ramifications, different evidence, this or that, but generally, because also, women don’t have a control over what weight they gain. They have control over if they eat healthy and if they exercise, right? So if someone is eating healthy and exercising, I don’t care what the weight gain is because what else are they supposed to do? Like, are they supposed to eat unhealthy? I mean, like what…like you just, you eat well, you exercise, and your weight gain will do what it does. And also, like, that’s it. And so I ask them, I said, “What are you eating? What are you doing? Are you active?” And if it sounds good, I’m like, “All right. Great.”
And people sometimes ask me, like, “What do you think about weight gain?” And I’m like, “I don’t know.” I’ll look if you want. Weight gain’s what your body does. It’s not so much, like, you can’t say, “I’m gonna gain four pounds this week.” It doesn’t work like that. You don’t have control over that part. So the focus is more on the nutrition. And no one eats perfectly. Obviously, everyone’s gonna have junk at some point. Like, it’s not about being perfect, but if overall the diet is well balanced and healthy and, you know, you’re moving and you’re active and doing some form of exercise, that’s really all you need to have a healthy pregnancy. The stuff on how much weight you’re supposed to gain is actually based on how much weight most people gained. It’s not based on saying, “For sure, if you do this, you’ll do better.” It doesn’t work like that. I wish it did, but it doesn’t work like that. So, yes, I would not have scolded you. I would have congratulated you on a job well done managing all this in your life. So, yeah, these mean doctors.
Great. Listen, Caroline, thank you so much for coming on the podcast or coming in. It’s great to meet you. Great to know another FOM, friend of Malka, and your story is amazing. I’m glad, obviously, it worked out wonderfully. And so much of that is obviously just a blessing, but a lot of it is also you. I mean, you did have the ability to screw it up, you know, with diabetes. There’s no question. And being on top of it and being so conscious of your sugar, and your health, and what’s going on, it absolutely led to a better outcome. And so, good work.
Caroline: Thank you.