Do you have kids

“Do you have kids?”

I’ve been ready for this question. As a midwife, who chitchats a lot during exams, I’ve been on the receiving end of the questions many times. I remembered being pregnant and thinking how excited I was to finally be able to say yes! Obviously there were many things I was excited about, but having the experience of pregnancy, of birth and of raising kids gave me yet another thing I could relate to my patients about.

When we learned Mabel’s kidneys weren’t working, making her fluid low and affecting her lung development, we were told she might die. I remember asking my midwife, “What do I say if she dies and someone asks me if I have kids???” I couldn’t imagine a more distressing question, but here I am living it. I had one hairdresser and one patient ask me so far. I’ve actually been surprised I don’t get asked more, but I attribute that to the sign I put up about Mabel for patients to read. My responses so far have been “None living,”  which didn’t feel good, nor did it get a good response and “I had a daughter,” which felt okay and got a much better response.

So when I was asked this hallmark question again, I was ready to try a different answer, one inspired by what another bereaved mom uses in these kind of situations.

“I had a daughter but she died shortly after birth.”

“Oh.”

The tone in the room changed. The patient was pregnant and not dealing well with the physical discomforts of the third trimester. When I met her the last visit, I suggested she reframe her thoughts on pregnancy because she had three more months to go and, no, I would not induce her 27 weeks because she was tired. I also had to let her know that by not doing her diabetes screening, she was risking the life of her child. “If you have gestational diabetes and we don’t know it and your sugars are uncontrolled, you could have a stillbirth.” I was exasperated already with what I perceived as her lack of gratitude.

And when we broached the topic of the diabetes test again, which she still hadn’t done, she changed the subject and asked me about kids.

In my head when talking about the diabetes test, I wanted to scream “you don’t know how lucky you are! You don’t understand how precious that life inside of you is! Why would you risk it just because you heard the glucola tastes gross??” But I didn’t. I calmly explained to her the repercussions of refusing the test. And when she asked about my kids, she got more than she was intending. It took all my effort to not say “Listen, my baby died and I would have done anything to keep her safe. Can’t you please just do the test so I can just know that your baby won’t die because you had undiagnosed gestational diabetes?” But I didn’t

I simply said, “I did my diabetes test.” I looked at her with raised eyebrows, my facing telling her that I would only ask her to do what I have done myself.

I’m hoping she does her glucose test. If Mabel can help her see the light, then I’m glad she was brought into conversation. I know this woman has her own struggles, I just wish the glucose test wasn’t one of them.

What’s your response to this question?  What kind of reactions have you gotten?

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14 thoughts on “Do you have kids

  1. Thanks for the medical end of why the GD test is important. I did mine but wondered, “why?” Yeah, I could have or researched, but I trusted, acted, and wondered. Thanks!

    The medical info you naturally sprinkle here is awesome…just right.

    • thanks! I’m glad you trusted your providers. I like to think that a good relationship will help foster that trust and I dont have to shove the scary stuff in their face. I’m working on building that relationship in this case.

  2. I’m surprised to read about the increase in stillbirths in GD moms – is that really supported by the medical literature? It wasn’t mentioned as an increased risk by my midwife – she talked about macrosomia and dystocia though. Curious what the absolute or relative risk increases are?

    • the key is uncontrolled diabetes. well controlled GDM is relatively low risk. also whether insulin is needed or not, affects risk. in addition uncontrolled GDM can lead to a macrosomic baby and shoulder dystocia, which can not only cause significant injury to mom but birth injury and hypoxia to baby in severe cases- and can be life threatening. These are all things I’ve seen in my career and they are rare, but scary from a provider point of view. I dont like to use fear to motivate, but understanding the risks of not testing is so important. All I want at the end of the day in as healthy a baby as possible.

      Shoulder dystocia is 6 to 10x the risk in moms with GDM than not. and stillbirth is about 2x the risk in GDM than with not. poor blood sugar control is the key factor in both.
      “Sudden fetal death in women with well-controlled, intensively monitored gestational diabetes.” by Girz et al in Journal of Perinatalogy
      and Nesbitt TS, Gilbert WM, Herrchen B. Shoulder dystocia and associated risk factors with macrosomic infants born in California. Am J Obstet Gynecol 1998; 179:476.
      (those are just some of the sources in my quick research. but there are plenty more)

  3. I do the “I had a son but he passed away last year” line. It does change the tone but it’s the most honest I can do. And seriously, I don’t know HOW you refrained from not going ballistic on that woman. I’m furious and I’m just reading about it!! Why WOULDN’T you do something so simple to keep your baby safe?! If you can’t do THAT, how are you going to make decisions in the best interest of your child after he or she is born?! ARGH!

    • I like the one liner like you have- it made me feel the best, despite the tone change. but hey, thats life, right?

      Most people think about the inconvenience of the one hour test or the gross tasting glucola. I was trying to help her understand the repercussions. Though this woman may have many unknown struggles- her life is very different from mine. I did my best to remain professional, though I had many thoughts racing through my head!

    • thank you. I just try to tell myself, her circumstances are different than mine. she may have many unknown obstacles. like people dont know I lost a baby, maybe people dont know she’s terrified of the diagnosis of diabetes. maybe her good friend died of complications from DM and thus she’s terrified of being diagnosed. maybe she cant afford gas to get there. Ihave no idea. or maybe she just doesnt understand the repercussions. if she would just tell me, maybe I could help her.

  4. I have tried to answer it in different ways. None made me satisfied. I did not want to shock the others and say, “he died.” or did not acknowledge he existed, “no, I do not have one.” which has been my go to answer, especially to strangers. I have been testing on different people. One time I even said, ” mine is not with me now.” Of course, it created more confusion and more followup questions I did not want to answer. This is a sore spot. I struggle with an answer, to say the least.

    • testing- thats what I’ve been doing. such a sore spot. but finding one that validates her existence without making it more complicated has been my goal. working on it! keep me posted if you find more responses you’re comfortable with!

  5. Pingback: A little glucola, a little Mabel | Expecting the Unexpected

  6. It’s difficult as it’s not that I haven’t experienced the excitement of pregnancy, the overwhelming feeling of remaining informed on all the decisions to be made or the process of childbirth. I was talking about childbirth to someone who’s wife was going into labor very soon, and with the answers I gave he looked at me as if I knew this from experience but he looked confused about it. He causally asked ” do you have kids?”. How to answer this by validating my opinion on the matter and by acknowledging my experience and our baby without making him feel awkward he asked — as most people get. I fumbled on my answer and ended up saying “Well no .. My fiancé and I were pregnant and found out at 5 months that I had to deliver early because our baby didn’t make it to full term. ” and it carried on from there but I diverted the conversation right back to the excitement of the whole process for both parties. I always feel I need to save the person that is asking from feeling award and it takes away from me being able to truly pay attention to how I feel about answering the question. The answer isn’t no but it isn’t yes. We will have to keep answering to the best of our ability in each given situation. Thinking of all of you!

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