Wednesday, July 22, 2015

Pregnancy after stillbirth: completed

The baby lives! It's a boy, he's healthy and fine and feeding like a demon.
Labour was straightforward - I was put on a drip and it took 4.5 hours. For pain relief I had an epidural and gas and air. Got a first degree tear/graze and recovered really quickly - only had a slight bit of swelling and no muscle pain to speak of.

We are now at home and comfortable and relaxed and content.  Don't expect much blogging from me for the foreseeable future :) 

Sunday, July 12, 2015

Pregnancy after still birth: 36 weeks 6 days

I weigh 12stone 3lbs and a quarter. I've put on 2 stone and a quarter pounds. With C, I put on 2 and a half stone.
My bump measures between 36 and 37 cm. With C I don't think I got above 34 or 35, and this baby is likely to be a similar weight, if not a bit smaller.
From 36weeks 0 days i've been expressing colustrum. It takes an hour to get 0.8ml and I've done that 5 times now. I am informed this is good.
I noticed the baby practicing breathing a couple of days ago. It's a rhytmic movement, not as jerky and quick and hiccups,and would look a little like gadpung if the baby was out. At the last scan we saw the baby's abdomen moving, doing the same thing. This is a good sign.
All ctgs are normal and healthy.
At 36 weeks 5 days I had a sweep and this morning my mucus plug came away.  (Edit - the next morning more cane away, on two different occasions, and was bloody).
 With this and the colustrum harvesting I'm hoping induction will be quick, although it could still take 5 days.
My hospital bag is packed and in the car.  I just need to add pilloows, towels and some more snacks.
I've felt a lot heavier this last week and groin is painful, although it's from pressure from the baby's head, not pelvic girdle pain, which I can be grateful for. My indigestion is horrible. My hips hurt more at night. My nose is more sensitive (or there's more smelly people on the bus).  I've been getting Braxton Hicks contractions since 36 plus one. I put all this down to the expressing and the sweep, producing hormones that are getting things going.
My freezer is full of food for us, and a tray of colustrum filled syringes for the baby.  Tonight we clear up the house.
Now to survive the next few days until the baby arrives.

Monday, July 06, 2015

Pregnancy after stillbirth: 36 weeks 3 days

Over the last day or so my moods are very changeable and filled with anxiety. I only feel safe at the hospital. I'm terrified of labour and the few days between now and induction. I have a sweep booked for 2 days before induction and that terrifies me too. I think I've put off grieving for C over the last 9 months and I think his loss is going to hit me like a ton of bricks once I've had this baby and I am now longer pregnant.

I have finally got a prescription for antedepressants for use as soon as I have had the baby and instructions to go see the GP in my second week home, as well as utilise the community midwife and health visitor as much as possible. Apparently paroxetine takes a couple of weeks to kick in for depression and 12 weeks to kick in for anxiety. I don't understand why, but I guess it's because different parts of the brain are affected by depression and anxiety. I just need a crutch to help me cope and keep me caring.

I feel like a burden, like I should be more capable, more calm, more excited. Instead I feel like a liability and I don't trust my own judgement.

When people talk to me about how to look after a newborn I feel a massive sense of rage and bitterness. I can do pregnancy and labour talk, because it makes me feel included, but I can't cope with people telling me how much care newborns need or how much you worry about babies when they're out. Like I'm not worrying now, like they aren't real inside you or like they are safe inside you.

People saying 'you'll learn' as if i'm thinking caring for a newborn will be a doddle, make me really angry.  No one has recently said anything about how hard it is with a newborn. If anyone was to say anything I think i'd flip, because it can't possibly be harder than not having your baby. To imagine that I won't be as worried as every other parent...to imagine I won't be more worried... I had baby resuscitation training last Friday.  Other parents prefer to stick their head in the sand and assume it won't be needed..I know better.  I'm trying as best I can and I don't think it will ever be enough to save this one.

Saturday, July 04, 2015

Pregnancy after stillbirth: 35 weeks 6 days and 35 week care plan

This meeting took place at 35+6, so practically 36 weeks, and a week before my planned induction at 37 weeks.

The scan showed that growth is fine, this will be a small baby, but the growth curve is looking reasonable.  Fluid levels and blood flow through the umbilical cord (measured by the doppler) are in the normal range.

We met with the registrar afterwards, not our named consultant, and I asked for reassurance about growth, whether it was worth bringing the induction date forward (to me, a few days won;t make any difference, surely?), getting a prescription for paroxetine (antidepressant) and about having a sweep a few days before induction.  The response:

Growth and induction date:  They are more concerned with the growth curve, the fluid levels and blood flow through umbilical cord than the size.  If growth had slowed, or remained static, or the other indicators weren't good, they'd bring delivery forward.  But they feel that everything is looking healthy so they would prefer induction to stay at 37+0, as it is planned.  If I notice any change in movements I need to come in immediately.  Like I need telling...

Obviously I'm super anxious about getting to the induction date so the registrar went and got the consultant and they did another scan, where they looked at the blood flow through the baby's brain, and that appeared to be at normal levels.  The consultant said that there is some evidence to show that in the last few weeks this is a more reliable indicator than the doppler blood flow checks, hence why he did it.

He said the evidence shows that we are at higher risk of another stillbirth, but if we deliver pre-term, i.e. before 37 weeks the baby is more likely to get into distress during labour which would lead to an emergency c-section.  Now I don't care about having a cesarean, but I do care about whether they can get to the baby in time.  He also said that if I were to come in 2 days early for induction I'd have to be on delivery suite, rather than the antenatal ward, and the thought of that makes me *extremely* panicky.  I am not willing to stay on delivery suite for 2 days or more to have this baby.  Fuck that with a capital F.  Also, if I was induced pre-term I could only come in if there was room in the nursery for the baby, in case they had difficulties post birth.

The upshot is that I have a provisional induction date for 36 + 5 but in all likelihood I'll keep my date as 37+0.  Unless I have an emotional breakdown between now and then.

Getting a prescription for paroxetine: Like the last registrar I saw she seemed surprised I was asking about this (despite it being in my notes) and said they would normally prescribe one of three other antidepressants.  I explained my reasoning and kept arguing with her until she agreed.  She then said they couldn't prescribe that at the hospital (contradicting what the registrar I saw at the 28 and 30 week scan said) and I would have to see my GP.  Which could be difficult as I can't make appointments in advance with my GP and I'm at the hospital every day until I get induced. Le sigh.  I'll work something out.

Sweep: She said I could have a sweep 2 days before induction which will hopefully make the induction process shorter.  As I'm not expressing colustrum fingers crossed induction won't take days and days.

I wasn't massively impressed with the registrar.  Our consultant took us through the reasoning behind his advice - the most up to date research, the implications, the risks, but she didn't.  She seemed put out when we listened to the consultant more than her and she told us that there were no guarantees this child would be OK, no matter what we did (i'm paraphrasing, I think her words were 'we can't guarantee anything).  You know what lady, we know that better than you!  I can feel it in my bones and we're living with the daily fear of this one dying.  You don't need to tell us nothing is guaranteed.  I don't want false reassurance, though I want facts.  It pisses me off that we have to push to get extra checks and better care and better explanations.

She also wrote nothing about paroxetine in my notes and nothing about the sweep.  I have been told, by my community midwife, that they cannot do a sweep unless it is written in my notes by a doctor.  So I have to go chase that up tomorrow at my scheduled CTG trace. *rage*

I had my last community midwife appointment 4 days ago.  It's my last one as I'm having daily CTGs now so I don't need both appointments.  It was with the one I saw at 12 weeks who I loathed.  She wasn't quite so offensive today, but she was still too excited for my taste,and beause she was running late she rushed me through everything, though she did answer all my questions.  I came out of the appointment pissed off.

I had my last osteopath appointment today, she was lovely.  She and my pilates teacher are getting a card once I've had the baby, they've been a bloody wonder over the last 9 or 10 months.

I've still got a range of stuff to buy and prep.  I need to get on that this weekend.

Thursday, July 02, 2015

Parenthood after loss

I wrote this with the intention of submitting it to The F Word blog, but since writing it I haven't gathered up the guts to submit it, and since I'm due so soon I also can't handle the editing and feedback process as I'm getting rather stressed about what will happen over the next couple of weeks.  So I'm going to publish it here and ask The F Word to link back to it as part of their weekly round up.

Talking about stress, I think I might have another post in me about the physiological and mental effects of extended stress.

---------------------------------------

What makes a mother?  Or a father?

I used to think that you became a parent once you'd given birth.  Once the baby was outside of the mother, and breathing.  But recent events have changed my opinion on this.

My first child died at full term, for no known reason.  According to conventional wisdom, I am not a parent as I have no child at home to care for.  According to conventional wisdom, the 8-9 months I grew him and carried him aren't enough to make me a mother.  From my pre-pregnancy understanding, once my son had died, I wasn't sure if we were still parents.  We had no physical, moving, breathing, child to show and talk about and cosset.  I have the evidence in my body that I carried him to full term - the stretch marks, the linea nigra, the post labour pains, the recovery period, the dodgy knees, the sore back.  Everything about my body screamed that I was a mother yet I was missing the vital proof.

Losing a baby is likely to be the most horrific experience a parent will ever go through, and denying their experience as parents is damaging.  I am still a mother even though my son isn't here.  I ate the right things, went to the ante-natal appointments, saved the scan photos, planned and decorated the nursery, bought all the right stuff, read all the right books and took as best care of him as I could.  If that's not being a mother what is?

Louise who runs the Duck in a Dress blog wrote about infertility and mothering sunday, and came to the conclusion that you become a parent when you feel like one.  I agree with this.  It might be when you discover you are pregnant, when you accept you are pregnant, when you have the first scan, feel the first movements, or when you have their baby in their arms.  Or it might be when you decide you desperately want kids.

Leigh Kendall over at Headspace Perspective recently wrote about whether she is a mummy blogger, given that her son lived for just 35 days.  Just because Hugo isn't with her now does that make her less of a parent, does that give her less of a right to be part of the parenting blogging circles?

Still Standing magazine has an article on just this subject, the writer argues that "a mother isn’t born when a child is born. A mother and father are born when the dream of a child is conceived".

I believe that it doesn't matter whether your child died due to a cord accident, placental failure, intrauterine growth restriction, pre-eclampsia or Hellp, or if their heart just stopped.  You are still a parent, if you want to be.  Even if you choose to have a termination for medical reasons you are a parent, making a decision in the best interests of your baby, the same way as parents of living children would decide whether to turn off life support should there be problems after the child is born (at age 1 or 26).

For those of us whose babies have died, if we are no longer parents, what does that say about our experiences of pregnancy and delivery?  If your baby dies in utero, after about 14 weeks, you still have to give birth, whether that is by labour or cesarean section.  The labour process is the same as that with a living child.  I know what the difference between early and active labour and I know what ring of fire refers to, and what it feels like to pass the placenta (gross, since you asked).

I think for second trimester losses, there is even more of an inclination to dismiss the baby as not real, and the parents as not parents, and that's damaging.  Baby loss parents have pregnancy symptoms and delivery stories, the same as every other mother out there, because it's the same process, but not if others don't recognise us as parents.  Not if they treat us, on later pregnancies, as first time parents.  Dismissing our children is a crushing experience.

We are still parents and it's about time the rest of the world recognised that.

Some notes:
Baby loss, through second trimester miscarriage, stillbirth (in the UK this is classified as death of a baby after 24 weeks gestation and prior to birth), is vastly unknown and misunderstood.  People think it doesn't happen, or that it's preventable, or that you'll get warning of it.  That's not always the case.  In 2013, over 5700 babies died just before, during or soon after birth.  That’s over 100 babies every week. Sometimes reasons are found, more often they are not.  Dealing with the death of a baby, whether you are the parent, other relative or a friend, is a hugely complicated and emotional thing to do.  If you then go on to become pregnant again, it's even more messy.  However there is support available:
Sands - providing support for those affected by late miscarriage, stillbirth and neonatal death, as well as promoting research around babies dying.  June is Sands awareness month, find out more here.
Tommys - funding research into stillbirth, premature birth and miscarriage, and providing information for parents.
Miscarriage Association - UK site giving information and support for all stages of miscarriage.
Movements advice from RCOG
Still Standing magazine - online magazine dealing with child loss and infertility

Wednesday, July 01, 2015

Get to know me questions

I'm bored and found this on tumblr so thought I'd do it here.  Cross channel memes, yeah.

1. If someone wanted to really understand you, what would they read, watch, and listen to?
Read - the Discworld books, particularly the witch and watch ones.  Supergirl: Many Happy Returns.  Elizabeth McCracken's An Exact Replica of a Figment of my Imagination.  Alternatively, they could read this blog and New readers...start here!.
Watch - the Buffy telly show.  Listen to - 90s britpop, metal and punk albums, with a dash of Shampoo, 5ive and Steps.

2. Have you ever found a writer who thinks just like you?  if so, who?
No, but some of Terry Pratchett's creations make total utter sense to me - Granny Weatherwax and Vimes in particular.

3. List your fandoms and one character from each that you identify with.
Discworld - Granny Weatherwax
DC comics - Linda Danvers Supergirl
Buffy the Vampire Slayer - Tara

4. Do you like your name?  is there another name you think would fit you better?
I like my online name, I think it suits me just right.

5. Do you think of yourself as a human being or a human doing? do you identify yourself by the things you do?
Wanky question.  Human being.  I identify myself by the things I am.

6. Are you religious/spiritual?
Not any more.

7. Do you care about your ethnicity?
I'm white.  No I don't care about it, I don;t need to care about it, I live in the UK and being white affords me the privilege to not have to care about it.

8.   What musical artists have you felt most connected to over your lifetime? 
Manic Street Preachers and the Wildhearts.

9. Are you artist?
I can do some origami and some crafty stuff.  I can put together costumes, following tutorials, but I don't think that makes me an artist.

10. Do you have a creed?
No

11. Describe your ideal day.

12. Dog person or cat person?
Kitties all the way.

13. inside or outdoors?
Both.  The home comforts of indoors with the freedom to go outdoors whenever I like.

14. Are you a musician?
Hell no.

15.  Five most influential books over your lifetime.
The Discworld series.  All 30 plus of them.

16. If  you’d grown up in a different environment, do you think you’d have turned out the same?
Nope.

17. Would you say your tumblr is a fair representation of the “real you”?
Nope, my tumblr is just comic stuff that makes me happy.  My blog isn't all me either, it's what I choose to write about and put on here, but that's not all I am.

18. What's your patronus?
I found this definition of a patronus: The Patronus Charm is difficult, and many witches and wizards are unable to produce a full, corporeal Patronus, a guardian which generally takes the shape of the animal with whom they share the deepest affinity.
I have no idea what my patronus would be.  Something that likes pretty things but doesn't really exist, I guess.

19. Which Harry Potter house would you be in? or are you a muggle?
Hufflepuff - values hard work, patience, loyalty and fair play.

20. Would you rather be in Middle Earth, Narnia, Hogwarts, or somewhere else?
Of the list, Narnia.  Elsewhere, the Discworld.  I would like a world with narrativium.

21. Do you love easily?
No.

22. List the top five things you spend the most time doing, in order.
Checking for movements.
Thinking about my babies.
Thinking about my partner.
Thinking about my next set of appointments.
Thinking about my physical state.

23. How often would you want to see your family every year?
Discounting my partner and kids, I can happily see family just every few months, with a bit of contact over phone, email or skype between that.

24.  Have you ever felt like you had a “mind-meld” with someone?
Don't be ridiculous.

25. Could you live as a hermit?
With adequate maternity care, yes.  So perhaps I mean no.

26.  How would you describe your gender/sexuality?
Gender - female, but had my life gone a different way I can see how I would have become more masculine identified, but never male identified.
Sexuality - bisexual.

27. Do you feel like your outside appearance is a fair representation of the “real you”?
Well, I'm very visibly pregnant now so I look like a mother, so yeah, I guess?

28. On a scale from 1 to 10, how hard is it for someone to get under your skin?
Very, very easily.  I'm a moody bastard.

29. Three songs that you connect with right now.
I am not connecting with any songs right now.

30. Pick one of your favourite quotes.
"...And that's what your holy men discuss, is it?" [asked Granny Weatherwax.]"Not usually. There is a very interesting debate raging at the moment on the nature of sin. for example." [answered Mightily Oats.]"And what do they think? Against it, are they?""It's not as simple as that. It's not a black and white issue. There are so many shades of gray.""Nope.""Pardon?""There's no grays, only white that's got grubby. I'm surprised you don't know that. And sin, young man, is when you treat people like things. Including yourself. That's what sin is.""It's a lot more complicated than that--""No. It ain't. When people say things are a lot more complicated than that, they means they're getting worried that they won't like the truth. People as things, that's where it starts.""Oh, I'm sure there are worse crimes--""But they starts with thinking about people as things..."--from Carpe Jugulum, by Terry Pratchett.

Tuesday, June 30, 2015

Pregnancy after stillbirth: 33 week scan and a bit after

My 33 week scan went OK.  The baby is growing and blood flow etc is fine.  I agreed to being prescribed antidepressants after the birth as I think it's a good precaution.  They'll take a couple of weeks to kick in, so won't save me from the baby blues that I have been told kick in 3 or 4 days after birth, but they should stop me from giving up after that.  I have requested paroxetine as that seems safest for the baby, if I can breastfeed.  I'm planning to try to breastfeed, but if I can't I won't beat myself up about it (hopefully).  I'll get a carton of formula in just in case.  At least I know I can express colustrum so the baby will be alright for the first few days.

The day after the scan (at 34 weeks exactly) I decided I needed more checks, to keep my anxiety down.  So I booked CTG traces for that day, and more for the following week, with the end result that I have medical appointments (community midwife, growth scan, CTGs) booked for pretty much every day between that 34 week point and when I'm booked in for induction.

My mistake was in not making appointments for the weekend directly after the 34+0 point, because I spent that weekend super anxious.  Saturdays and Sundays have bad associations for me.  So now I'm going in on the remaining two weekend between now and induction, and conveniently enough CTGs on the weekend are done on the ward where I'll be induced.

I ended up having an emergency check at Delivery Suite (it's still vile visiting there) because the baby was moving far too much - increased movements are as concerning as decreased movements.  But at least when they are moving you know they are still alive.  Anyway, the check was a ctg trace and in total I was in there for 2.5 hours, which is pretty quick.

I'm now 35 + 1 and I went to the hospital today and it was pretty horrible walking into a new hospital setting, to a bay to be checked over.  I've never stayed in a hospital bay, but my partner did have a couple week stay a few years ago as he was hit by a car, and it wasn't a pleasant time.   The midwife who did the trace did tell me that for people in our situation they try to put us in a private room, which would be preferable.  However the private rooms may be being used by families in more dire need than us.  We'll see.

Physically, the baby is dropping and jeez I can feel it.  Actually I think the drop started a few weeks ago, I remember a day when I felt really heavy,  Since then I've been getting more groin pain, lower back aches and shoulder blade aches, and it's more difficult to get my legs and hips comfortable at night.  I have woken up with pins and needles in the arm I've been lying on, and it can take a couple of hours for them to stop.  My knee is playing up again.  There's a muscle on the side where it gets swollen and is painful to bend.  I think my foot arches have fallen even more as my feet ache in a new way when I walk.  When I leave the house in the morning, to go 10 minutes to the bus stop, my calves are awfully tight and I can't walk at any speed, it's pathetic.  However I'm not getting cramps at night, thankfully.  This hot weather is a shit because my feet heat up ridiculously, but at least they aren't that swollen. I guess that's all the water I drink and the sandals I'm wearing.

I've finished work now, and that's really helped with the physical stuff and my anxiety.

I can see the baby wriggling away under my belly, it's reassuring.  Even the thumps in the groin and the shifts onto my bladder are reassuring.  I got to show a friend the movements in my belly the other day, and she got to feel the baby too.  I'm glad I could show her.