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Weighing the Decision to Have Children if You Have Diabetes – Diabetes Daily

Trigger warning: this article discusses fertility, pregnancy, and childbirth.

“When are you having kids?” 

The question weighs heavily on any childless person’s mind as they reach their mid-thirties, and if it doesn’t, the pressure reverberates throughout society in the form of well-meaning friends, family, and nosy acquaintances. “You’ve been married nearly four years; I think it’s time we see some cute little kiddos outta you two!” “So, any plans for the following, I don’t know, 10 months to a year?” 

These questions, while seemingly innocent, can send shockwaves through any millennial’s mind. In the average week, I think about whether or not to procreate about 417 times. 

I’m turning 34 this year and my husband is five years older than me, so time isn’t exactly on our side. Given the constant threat of global warming, civil unrest, the widening wealth gap, the exponential and sharp rise in college tuition costs, social injustices, lack of a federal paid parental leave program, and average child care costs in my city topping $2,000 per month, it seems crazy to even want to have a child. But the society and peer pressures exist, and they echo to make it seem like you’re delusional for NOT wanting to have a child, either. 

And then there’s the not-so-gentle reminder of the boulder I’ve been carrying on my back for the past 21 years: type 1 diabetes.

In America and its capitalist society, not much is guaranteed. Our infamous lack of a social safety net shocks other Western industrialized countries: for all intents and purposes, health care here is not a right. Without universal health care, people – often living with either chronic disease or whiplashed by disaster or medical emergency – find themselves setting up accounts on GoFundMe.com to help pay for things like surgery, routine dental care, or cancer treatment.

Nearly two-thirds of people who file for bankruptcy each year state that a medical issue was the key reason for their financial troubles. Insulin is outrageously expensive in America, and nearly 1 in 4 people with insulin-dependent diabetes ration their insulin due to cost alone. Inevitably, that has only increased since the COVID-19 pandemic left millions without jobs and health insurance. The list price of a vial of insulin? $300. That is nearly 8x higher than other industrialized countries charge patients, and people are dying here as a result.

Babies are cute and snuggly, and imagining someone with half of my genes and half of my husband’s is an adorable pastime on lazy days when we think about our uncertain future.

But then a million worries float to my mind: will I always have access to health insurance? What if my health insurer stops covering the type of insulin I’m thriving on? What if I need to take extended time away from work for pregnancy or childbirth complications? How will I pay my medical bills? How exactly are we to survive without any parental leave between our two white-collar jobs? How do we afford $2,000 in child care costs per month in addition to my costly diabetes care? How will we pay our mortgage? How will we pay for anything an actual baby would need in real life?

These questions loom large these days. Like many people with chronic disease, when I was diagnosed as a pre-teen I was thrust into a realm of adulthood and responsibility that I wasn’t quite ready for. I’ve known what an Explanation of Benefits was since junior high; I can recite the difference between a premium and a deductible in my sleep.

I know all about the long-term complications of an oftentimes scary disease, but through education, persistence, and a steadfast allegiance to diligence and my own future, I’ve come to a comfortable place where management doesn’t occupy my whole mind for every hour of every day. It only occupies most of my mind on most days. Adding a child (aka entropy) into the mix to me seems like a recipe for disaster.

And I don’t want this to come across as another spoiled millennial shirking the responsibilities of adulthood. I’m not saying I don’t want children so I can lay on the lanai of a beachfront home listening to episodes of The Daily while sipping homemade ginger juice (although that does sound fantastic). I’ve hustled really hard, often from a place of anxiety, to ensure that I have access to health insurance, insulin, and diabetes care (privilege, checked). I am afraid to mess up the balance.

They say to only do things out of a sense of love, not fear. But it’s also been said that people often regret the things they didn’t do more than the things they did. Am I afraid to have a child, but think I’ll regret not having a child in 30 years more?

Do I have so much love overflowing within that I know I need a baby, but I wonder about the childfree life I could have had? Am I worried about keeping my precarious financial position in perfect balance, when everyone knows that order is an illusion and we don’t really have much control over the future anyway? Am I overthinking this entire thing? Am I not thinking about it enough?

I love kids. I was the neighborhood babysitter all throughout high school, and even nannied in college. I love their innocent inquiries, endless curiosity, and zest for life. I love that they love colors and music and Play-Doh and tea parties and playing in the dirt. Don’t get me wrong, I love children. I’m just not sure I have the time, space, or mental capacity to manage both a child and my chronic disease at the same time.

I’ve had several friends who have difficult experiences while managing the reality of a high-risk diabetic pregnancy. I’ve known people who ration their insulin so their kiddo can get more toys at Christmas. I’ve seen someone’s retinopathy worsen with a natural delivery, and another woman’s insulin to carbohydrate ratio go from 1:15 to 1:1. Dosing 9 units for a carrot doesn’t seem fun nor fair.

It’s hard work, and I get that. Parents, and mothers in particular, are not lauded enough for all of the wonderful, thankless, often backbreaking work they do to raise up the next generation of thought leaders, artists, writers, engineers, and magicians. They are truly miracle workers, and society doesn’t see or credit or support them nearly enough.

The question still looms high and bright in my mind, but until we have a more just, more fair society that offers everyone with chronic illness, and type 1 diabetes in particular, the support they need to adequately manage their condition without financial ruin, anxiety, and stress, let’s be gentler on the women so intentionally weighing this decision.

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