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.

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