KEEP IT IN THE PHAMLY

Last time this orange dress fit.

Around Week 28 at the start of Trimester 3, I had to admit defeat and start retiring my regular wardrobe. I am pretty much exclusively wearing maternity clothes to accommodate the bulging belly for my last 4-6 weeks of pregnancy. Being frugal me, I have tried to keep my maternity wardrobe to a minimum. I want to spend as little as possible on maternity wear because it's only used for a short period in the scheme of things.

I outgrew my work skirts at the start of Trimester 2 and got away with wearing regular tops with these brilliant, bargain-priced Kmart skirts with elasticated waistlines. They were only $25 each and gave me a good 4 months of almost daily wear. However, now my belly is huge I cannot stand having anything on my waist - it's floppy maternity dresses only from here on in. I also bummed around the house in their maternity bike shorts for a while too. 

Elasticated waists for the win!

H&M has a big range of affordable maternity wear called MAMA. The cheaper end of the catalogue has no-frills but comfortable designs, though you can get some dressier items too if you prefer. I browsed the many maternity wear stores but they're expensive for items I may only wear for a month so I opted for cheap, fast fashion for now. 

To try and extend the life of my maternity items, I've looked for dresses where you can free the boobs for breastfeeding so I can continue to wear them after birth. Although I plan to breastfeed there's no guarantee that I will be able to (Mum Pham formula-fed all Pham siblings, and many mums struggle to get milk supply up long-term) so I also don't want to stock up on too many breast-feeding friendly clothes until I know I can breastfeed long-term.

In short, some mornings you'll find me walking around the house half-naked to get freshly washed maternity clothes off the drying rack because I've kept my items to a minimum and if I slack off even for a day or two with laundry I run out of comfy clothes to wear.

Last day in my beloved Beauty & the Beast dress

Our fertility and pregnancy experience

There are so many wonderful things about pregnancy. I wish I had experienced some of them. Unfortunately, I don't carry pregnancy well. In addition to sciatica and gestational diabetes, I started getting cankles at the end of Trimester 1 when a lot of women only start to experience it towards the end of their pregnancy.

I have lived in compression socks for nearly half a year. Doesn't sound so bad until you realise I'm in sunny and humid Brisbane and am having a summer baby and 2023 decided to end the year with a heatwave followed by wild summer storms and 90-something percent humidity day and night. The end of my pregnancy has been a form of heat torture due to the raging hormones and excess blood in my system.

On the upside, I got some really good quality compression socks from a local company on the Gold Coast called Funky Sock Co. I got a 3-pack of funky designs for fun, and then a 3-pack of neutrals (black, white, nude) for work.

I got a cheap pack of socks before finding Funky Sock Co, and they were OK but weren't as firm as I needed. You get what you pay for. Funky Sock Co has an excellent compression progression from the top to the bottom of the sock. On my bloatier days, I need Boyfriend Pham to help remove my Funky Socks at the end of the day and miraculously, my ankles have not become cankles.

I highly recommend Funky Sock Co to any mummas-to-be. https://www.funkysockco.com.au/

Our fertility and pregnancy experience

After my pale and pasty phase of early pregnancy in Trimester 1 where I looked sickly and ready to pass out at any moment, people started commenting on my glow in Trimester 2 even when they didn't know I was pregnant.

I don't remember Little Sissy Pham glowing during her pregnancy, so much as whinging constantly about all the bodily changes and challenges. And I have been the same. I have not felt healthy and glowing at any point during my pregnancy. I do wonder if it's because gestational diabetes put a dampener on Trimester 2 or my sciatica shooting burning pain through both thighs, or my pelvis giving me lower back pain. I was seeing my hospital team and a private physio frequently in Trimester 2 to sort my body out. I imagine women who love being pregnant during Trimester 2 are basking in pregnancy hormones levelling out after a nauseating Trimester 1 and enjoying their cute baby bump. I am not one of these women.

I did notice my outward glow, but I am certain it's the 2L-3L extra blood flowing through my struggling veins that makes me glow. I am hot and flushed and uncomfortable on the inside; the heat is radiating out of my flushed cheeks. To give context on how hot I run, I am usually the one with cold feet and hands in our relationship but these days I sleep naked on top of the sheets with the aircon on while Boyfriend Pham sleeps in pyjamas under 2-3 layers of sheets and blankets. Silver lining: I don't need to get maternity pyjamas once my belly outgrows my regular PJs since I can't stand wearing anything in bed - the 4 pillows I use to support my body and legs generate too much heat as it is. I'm also wearing compression socks during the days (yes, in Brisbane's summer heat) because the excess blood and fluids gather at my ankles throughout the day if I don't wear socks.

On the inside, my iron levels are dropping/spreading too thin so I am taking iron supplements that make me even more constipated because baby is growing and pressing on my intestines. The muscle-relaxing hormones that make it possible for my pelvis and belly to expand to house a growing baby have also relaxed my digestive system. I have to take magnesium supplements and rub magnesium oil into my calves before bed to try and prevent painful leg cramps waking me up at night. I no longer sleep through the night because I need to wake up and pee at least once or twice a night with baby pressing down on my bladder.

What I'm trying to say is pregnancy glow is surface-level, what's below the surface is a body adapting to lots of changes and challenges. So, yeah, thanks for the compliments, I may look good but I feel like crap. 

Our fertility and pregnancy experience

I don't tell the truth because I want to. I tell the truth because I am a terrible liar, and I know it. I wanted to keep my pregnancy private in Trimester 1 since it's the first time I've been pregnant, and while it wasn't an IVF baby it was an IVF hormones-supported baby so I didn't know if my body would keep up the pregnancy hormones naturally. In short, I didn't want to tell work colleagues in case I miscarried then I'd have to have sad conversations at work.

Typical of me, I caved and told my boss the truth at Week 9 because I kept calling in sick and, well, when I had 'food poisoning' for the third time in two weeks, I decided it was best to confess it was morning sickness and not me making repeated, bad life decisions. He kept my news confidential as requested (he's better at keeping my secret than me), apart from telling his partner. They both already knew I had started fertility treatment earlier in the year.

Anyway, Boss and I agreed that I would host a team quiz and surprise the gang with my news further along in my pregnancy. However, quiz day is Wednesdays and the week I intended to share my news, was EKKA holiday in Brisbane. It's a local public holiday where different pockets of Brisbane and surrounding regions are given a weekday off to look at farm animals at the showgrounds. EKKA is short for Agricultural Exhibition because we're lazy folk who like to shorten all words until they're not recognisable.

The following Wednesday I hosted the quiz but because the teams took so long to answer each question, we ran over time. I spent the whole day sucking in my gut whenever I walked about the office or holding my bag in front of me when walking in or out of the elevator. I don't know how people didn't notice. I was so uncomfortable in my regular clothes by the end. Pictured is the last day I was able to fit into this skirt because it pinched my belly so hard that I found it hard to breathe.

By the third week of trying to surprise my team, I was so big in the belly bump I stopped going into the office because it would ruin the reveal. It was a great relief when I finally shared my happy news and could start wearing maternity skirts with elasticated waistbands (Kmart maternity for the win!) to the office. I am glad to report people were very surprised, and those who saw my belly in person were shocked they hadn't noticed. Sucking in the gut and holding props in front of your belly like you're on a sitcom works a treat!

Our fertility and pregnancy experience

When people find out I'm pregnant, there are one of two questions they will ask first:

1. When is baby due?
2. Do you know what you're having?
   
   

Do you know what you're having?
I know I'm having a human baby that has all its limbs, heart chambers, two kidneys and lungs. I hope it's a healthy baby that has all its senses and brain functions, but I won't know for weeks after I meet them on the outside of my belly.

As for Baby's sex, Boyfriend Pham and I aren't precious about it, which is good because the way we learned our baby's sex was unconventional. My GP doctor, bless him, is not a pre-natal specialist. He didn't even know the process for Non-invasive prenatal testing (NIPT); I educated him on this blood test since the company I work for offers them. With NIPTs, you have an optional tickbox to request the lab check the DNA for gender. I thought I'd learn baby's sex with Boyfriend Pham when we went for results. Not so. In reality, I learned Baby Pham's gender while Boyfriend Pham was in Melbourne visiting friends. My doctor texted me a photo of his computer screen with my NIPT results with the message "Mother of a boy--- C-O-N-G-R-A-T-S."

I had just woken up from a nap on Friday night after work. I was sad Boyfriend Pham didn't get to learn at the same time as me. I called him straight away and interrupted his game of Dungeons & Dragons to see if he wanted to know the baby's sex. He said, "Oh - okay...? Yeah." So I told him and he shared it with his friends who cheered in the background. They were shocked that you can casually find out your baby's gender on a Friday night. 

I had enough trouble keeping my pregnancy a secret from the work crew during the first trimester, I couldn't be bothered keeping more secrets after I could finally talk about it so the closest I got to a gender reveal 'event' was getting the work crew to guess what I was having.

I hosted a team quiz where I revealed I was pregnant and got the team to guess whether I was having a Barbie or a Ken. As much I adore Ryan Gosling's Ken, our baby will look more like a Simu Liu Ken since neither Boyfriend Pham or I are blonde and blue-eyed.

Our fertility and pregnancy experience

When people find out I'm pregnant, there are one of two questions they will ask first:

1. When is baby due?
2. Do you know what you're having?

When is baby due? Well, nobody really knows because estimated due dates based on the start of your last menstrual period are based on a very non-inclusive formula some German obstetrician named Franz Nagele concocted hundreds of years ago, assuming all menstrual cycles are 28 days long and you conceived on day 14. This excludes most pregnancies because menstrual cycle lengths vary and you can conceive on a number of fertile days each cycle. In short, this method is stupid and I don't understand why we still use it.

Healthcare professionals realise this, which is why some medical practitioners use your Week 12 growth scan to estimate a new due date that they deem more accurate. But this method is also flawed because the angle the sonographer decides to take the measurement on any given day changes, your fetus's position could also be tricky to measure and you end up with a measurement that can be a little or a long way off the reality.

Lastly, we started the IVF process and my hormones were all over the shop when we became pregnant naturally. My menstrual cycle was a whopping 49 days or so the month before we became pregnant as opposed to my usual 28-day cycle. I tracked my body's symptoms and knew when I had spot bleeding, which I thought was my period coming in a few days, but it turned out to be Baby Pham in embryo form embedding into my uterus lining so if I use another formula that assumes the embryo implants 6-7 days after fertilization then my current estimated due date is off by over a week.

So when people ask me when baby is due, I say it'll be a summer baby.

This turned into a long rant, so I will talk about gender reveals in my next post.

Our fertility and pregnancy experience

There are three main ways that gestational diabetes seems to be managed:

1. Not at all - pregnant woman ignores medical advice, goes rogue and eats whatever she wants and doesn't test her blood glucose levels.
2. Diet-control and exercise - Moderating blood glucose levels through balanced meals and snacks, with moderate movement/exercise after each main meal to help process the blood glucose.
3. Diabetes medical intervention with insulin injections or Metformin pills, or a combo of both.

So far, I have been on Option 2: Diet control and movement. On bad days, I wish I could do option 1 and indulge in hot chips and ice cream without the crippling guilt I know I'd feel after. On exhausted days, I consider asking my diabetes team to stick me with multiple daily needles already so I can be less strict with my diet. Then I remember that I am doing option 2 for baby and get back to it!

Going on insulin, I'm told, risks placental deterioration while taking Metformin pills passes through the placenta and impacts baby's insulin production and growth. Both are safe enough to be used on pregnant women, obviously, but diet-controlled is what the medical teams prefer if you can to avoid further medical interventions that come from going on medication. Diet control doesn't always work especially towards the end of your pregnancy because of wild pregnancy hormones produced by the placenta.

I am writing this at Week 30 when the placenta starts to kick up its insulin-resistant hormones so I may write about insulin and metformin experience in future. But for now, I am diet-controlled.

I went from two meals a day, and an afternoon snack of fruit to:

1. 3 main meals a day - breakfast, lunch, dinner - 30g-45g carbs
2. 2 snacks - 2-3 hours after breakfast and lunch - 15g-30g carbs
3. Supper right before bed - 15g or less carbs

I focus on low-GI carbs that take longer to break down into blood glucose, and adding lots of veggies and protein will also help slow the conversion to glucose. Some women find it easier to go low-carb because there's little to no risk of spiking your blood glucose levels (BGLs), but my dietitian recommended 175g minimum a day for baby's development so that's what I target.

I have this with low GI brown rice that's not pictured

For those on diet control, this generous Melbourne dietitian is a godsend - Robyn Compton shares her GD expertise and I couldn't have figured out my new, balanced diet without her. Even my hospital dietitians recommended her to me after I'd found her through an online support group: https://www.instagram.com/gestationaldiabetes_dietitian/ The hospital dietitian's few pages of info on carb portions and whole foods vs processed foods is not enough to build meal plans for however many months until baby arrives. But with Robyn Compton here to save the day, I have plenty of meal and snack options from here until I deliver.

The Gestational Diabetes Australian Support Group on Facebook is also really helpful:  Lots of women sharing their personal experiences and supporting each other through this often baffling diagnosis and treatment. I don't normally have a good time with Facebook groups because I find people get catty, judgemental or sarcastic when they're allowed to post anonymously. But this group is full of pregnant women who genuinely care and are trying their best to navigate the murky areas of gestational diabetes management.

I also binged the Gestational Diabetes Club podcast by nutritionist, Helena. There is one particularly helpful Q&A episode with a GD educator that I wish they'd recorded a couple months earlier when I was starting my GD learning. It's super helpful: https://open.spotify.com/episode/1AaAKDKl7kOC1hOWQzzoLh?si=e0a1418b664b452b  

I've found my 'safe' meals after about 4 weeks of a crash course on how my body processes different food combinations. I'll occasionally try something new now I'm 11 weeks into my new diet but often I don't want the anxiety of eating something different and waiting two hours to test my BGLs to see if it's within limit. My diet is getting boring and I have another 9-11 weeks to go if baby arrives around the estimated due date, but better safe than sorry. I talk Baby Pham through our daily menu each morning so he's prepared for yet another bland day of eating.

I have a few 'cheat' meals coming up for Babymoon and over the holiday season where I'm pretty sure I'll spike so I want to avoid having too many spikes now. Consistent spikes over time is the real danger to baby whose body then gets used to producing more insulin to compensate for my high glucose diet so I don't feel so bad about the odd cheat meal I have coming up in the next couple months.

Our fertility and pregnancy experience

Not fun fact: There isn't a national standard for diagnosing gestational diabetes (GD), as stated on the Royal College of Pathology Australia's website and also by my gestational diabetes educator. She opened our education session by stating, "This won't help you ladies, but if you were having your baby next year you may not have been diagnosed with GD because they're easing the diagnostic levels." Great. Just great!

It gets dumber. Each hospital has varying blood glucose limits and guidelines. So you can be in the same city as another pregnant GD mumma and get different medical advice. For example, I am trying to keep my levels within:

1. Fasting - 5.0 or under

2. 1 hour after meals - 7.6 or under (only if I know ahead of time I can't test at 2 hours then I should test at 1 hour if I can)

3. 2 hours after meals - 6.7 or under

Other women's fasting numbers range in the 5.3-5.5 range that I've seen. Some women are told to test at the 1-hour mark, while others are told to test at 2 hours. Gestational diabetes guidelines are a bit of a joke, yet it impacts many pregnancies in Australia. I can see why they're loosening the GTT gestational diabetes diagnosis guidelines because it puts more strain on pregnant women who are already struggling with all the quick bodily changes. Though, let's face it - the motivator for diagnosing fewer women with gestational diabetes is probably the cost to the healthcare system. The number of appointments I had scheduled more than doubled when I was diagnosed with GD. 

Anyway, it's 2023 and they haven't changed the Glucose Tolerance Test (GTT) gestational diabetes diagnostic ranges yet so I am being treated for gestational diabetes. You can read about my GTT experience and results for a bit of background.

In my early pregnancy, I was counting down to Trimester 2 in the hopes that I'd feel less nauseous and fatigued. Though, once Trimester 2 arrived so did my gestational diabetes diagnosis. This has taken over my pregnancy and overshadowed sciatica and pelvic pain that seem like molehills compared to the mountain I'm now climbing learning how my body's insulin and blood glucose levels relate to the foods I eat, the exercise I do and stress factors like work, hot weather and poor sleep.

I'll be honest. Gestational diabetes management has put a huge dampener on my pregnancy. I can't sit back and enjoy not feeling nauseous for a few months before reflux and indigestion take over in Trimester 3. Instead, I have a tonne of daily logistics and duties to try and prevent my glucose levels from spiking and causing baby harm. I am juggling 3 meals, 2 snacks and 1 supper each day and testing my blood glucose levels (BGLs) 2 hours after every main meal, and my fasting level first thing when I roll out of bed. This is the most discipline I've had around body and health since... well, ever.

The diet isn't really a diet. It's basically healthy eating with a balance of protein, veggies, fruit and carbs that is recommended for all adults. The difference is I actually have to follow it strictly because straying into simple carbs and highly processed foods like white bread or hot chips spikes my blood glucose levels. Why is this bad? Because if I can't keep blood glucose in check, then my baby overproduces insulin to compensate for my high blood glucose levels. Why is that bad? Because insulin is linked with weight gain in adults and babies leading to macrosomic babies.

Why is big baby bad? They may be harder to birth vaginally, though I've heard of plenty of women birthing big babies who didn't have GD so I'm not worried about that. The main problem with having a big baby in our medical system is the hospital policies. They will want to induce you early (Week 38-39 at my hospital) instead of letting you go into labour naturally when the baby is good and ready to come out. What if they don't want to come out until Week 40-41? Women in my GD support group also seem to feel pressured into elective C-Section to avoid risks. In case you can't tell from my language, I plan to decline offers of early induction or elective C-section unless a good medical reason arises such as I develop preeclampsia or placenta deterioration or baby has health issues. I'm not scared of trying to push out a big baby.

What I am scared of is what could happen after birth if I don't control my BGLs and baby gets used to over-producing insulin. Once bub is earthside, they'll no longer have my blood glucose passing through the placenta to them, and could end up a severe blood glucose level crash, end up in NICU and we won't have skin-to-skin time in our first days together-apart. I want to do everything I can to be able to hold my baby even if it means going on insulin injections or taking metformin tablets. There's only so much you can do to manage your BGLs with diet and exercise. If my placenta decides to produce lots of insulin-resistant hormones as my pregnancy progresses, then medical intervention will be the way forward. 

So... this fear is how I am getting through the monotony, strict schedule and firm diet of gestational diabetes. Any time I've slipped up like eating mango, or having a late meal, my BGL has spiked to remind me to get back in line. On days when I don't feel like jabbing my finger for the two hundredth time or meal prepping yet again or eating another hard-boiled egg for supper, I either say my affirmation out loud or loudly in my head, "For baby!" I'm doing it all to give Baby Pham a chance at being as healthy as possible.

My dreams of an easy Trimester 2 before I got extra bloated in Trimester 3 is long gone. I'm now dreaming of Trimester 4 once baby is out and I can bite into a banh mi. Soft, fluffy, crunchy white bread and all the things I don't currently eat for risk of salmonella or listeria - deli meats, raw egg mayo, liver pate. Oh man... I haven't told The Phamly yet but whoever visits me from Brisbane's southside first has to bring at least two banh mi for me and maybe one for Boyfriend Pham.

I have roughly another 250 finger jabs to go before our due window. Sigh... For baby!

Our fertility and pregnancy experience

The glucose tolerance test (GTT) is a stress test on your body to see if your insulin is managing your blood glucose levels well when you consume 75g of glucose syrup on an empty stomach. All pregnant women are offered the GTT around Week 27-29 when the placenta produces more of the hormones that cause insulin resistance. High risk women like me who have a family history of Type 2 Diabetes and Chinese-Vietnamese descent are given the GTT around Week 14-16 once the placenta has formed. From what I've gathered, women who had gestational diabetes are given the GTT in Trimester 1.

If you're going for a GTT, make sure you follow the preparation guidelines carefully so you don't accidentally skew the results and get misdiagnosed. Your pathology lab should give you an info sheet specific to their testing requirements, but here is a general guide if you want to learn more: https://www.healthdirect.gov.au/blood-glucose-test

The irony is I was working in a product team building a pathology booking system when I got pregnant. Pregnant women are treated like pin cushions we are sent for so many blood tests in Trimester 1. I went from researching what pathology patients need to being a regular pathology patient.

The GTT is a 2 hour+ test. When you arrive, usually first thing in the morning as you need to fast for 8-12 hours. If you fast for longer, your body may do a glucose dump and cause you to fail the fasting blood glucose level test and be diagnosed with diabetes, pre-diabetes or gestational diabetes depending on why your doctor sent you for the test and your medical condition.

Some people abhor the test and feel sick from the glucose syrup. I was thankfully not one of these people. After my fasting blood vial was taken, I sipped my 75g of glucose in a 10 minute window without issue. The pathology collector set a timer for 1 hour from my fasting test and at the one hour mark, another blood vial was taken. Another 1 hour timer was set and at the 2-hour mark from drinking the syrup, my third blood vial was taken and after checking I was feeling OK, they sent me on my merry way with cotton balls taped to both arm nooks. They rotate arms for the GTT so one arm gets pricked twice at the fasting and 2 hour mark, and one arm gets pricked once at the 1 hour mark.

I failed my GTT at 16 weeks pregnant, and have been diagnosed with gestational diabetes due to my 1 hour test results based on the diagnostic criteria below, as I had a 10.7mmol/L result. My fasting and 2 hour results were fine.

International Association of the Diabetes and Pregnancy Study (IADPSG)

• 0 h ≥ 5.1 mmol/L
• 1 h ≥ 10.0 mmol/L
• 2 h ≥  8.5 mmol/L

Our fertility and pregnancy experience

When people say you're glowing in Trimester 1, it's the sheen of sweat that is reflecting light off your nauseated forehead. The good news is that for some of us, including me, this sweat does actually become a glow in Trimester 2 once you stop feeling sick all the time and are instead flushed with the 40%-50% extra blood circulating around your body, making you feel overheated, and putting you at risk of varicose veins, high blood pressure and other fun, potential pregnancy symptoms.

My early pregnancy symptoms in brief:

1. Sore boobs - a constant dull ache and they keep on growing
2. Sleep deprivation - I used to sleep like a log but no more
3. Frequent peeing - including at night, which added to lack of sleep
4. Fatigue - the most tired I've ever been in my life. Pulling all-nighters and 6-day camping music festivals have nothing on pregnancy fatigue
5. Gas - constantly bloated and gassy. Farting myself awake was a fun, new experience
6. Nausea - constantly needed plain carbs to settle my belly
7. Pimples - a smattering of hormonal pimples along my chin line
8. Sciatica in both legs - this is why they recommend sleeping with a pillow between your knees to alleviate pressure on the hips during pregnancy. Learned the hard way. D'oh.

I only vomited twice and that was before I knew I was pregnant. The first time I threw up was during a Diablo 4 gaming session. I don't normally get tension headaches but Boyfriend Pham does so we assumed I'd just been tense at the computer for too long. The second time I threw up was the night I found out from the GP via an email that we were pregnant. I went out to dinner for Girls Night, ate pho, had indigestion all night then finally threw up in the morning and took the next day off work.

This is what I craved early on:

1. Breakfast - must have cereal as soon as I get up to combat nausea
2. Oranges - 3kg bag nearly every week
3. Bananas
4. Kiwi - out of season so that was an expensive phase
5. Strawberries
6. Vegemite on toast
7. Eggs and toast
8. Plain crackers
9. Crackers and cheese
10. Hot chips
11. Cheese and butter sandwiches, later I craved pickles and cheese sandwiches
12. Vinegar - on salads mostly, but sometimes I'd drink a mouthful
13. Could not stomach red meat for 2+ months

Of the girls night crew, I had the worst Trimester 1 experience. In hindsight, I think it was the gestational diabetes / pre-diabetes because my pregnancy cravings were all high GI, mega blood glucose spiking foods like plain cheese sandwiches with butter and white bread, or plain hot chips soaked in tomato sauce. Fatty foods made me feel sick, flavoursome foods like curries made me feel sick. I somehow managed to not throw up, though, even when I thought I might. I was mega nauseous and plain carbs seemed to be the only thing to settle my stomach. But then I'd feel tired and exhausted after food and need a nap.

Our fertility and pregnancy experience