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.

Pregnancy after stillbirth: weeks 28 to 30 plus 2

Ah, I have not felt capable of writing these last couple of weeks.  They haven't been good.  Emotionally, I've not been well and it's taking a lot of effort and a long run up to write this post.  There's not too much detail, but there's a lot to say, a lot to record.

At 28 weeks plus one I had visits from my family, a couple of them one weekend, and then the other one the next weekend.  They are visiting because I can't bear to leave Norfolk and be that far from my  hospital.  Remember how about 6 weeks ago I talked about how I just needed to grow up and stop being such an arse?  Well it turns out that I don't deal with seeing family, not right now, and I had a meltdown, as we affectionately call it, using that word to try and downplay and poke fun at a very bad time.  I flew into a rage and sent some rather nasty emails which I am not proud of.  I apologised, but that doesn't make it OK.  No matter what people have done, and no matter what I think of their behaviour, there is no need to send nasty, spiteful, rage filled missives.

I wasn't very well.  Things were getting on top of me, I was hurting, I was lashing out and I wasn't thinking straight.  I had a midwife appointment on the Monday and cried through most of the appointment.  Then I had a counselling session later, which was OK, I guess.  Then a pilates 1:1, which was a distraction.

I came home from work one evening, Tuesday I think, and spent the evening in bed, not caring about anything.  There were a lot of self harm thoughts (I haven't had those, in such a high frequency and strength, since probably October last year).  I didn't do anything to hurt myself (because I understand that when you're pregnant that sort of thing is frowned upon) but I wasn't well.  I managed to facilitate/run an all day workshop at work the next day, but still wasn't right.  I had my 28 week scan the day after and talked to the doctor (a registrar, not my consultant) and she suggested anti-depressants, which I'll go into in another care plan post.  I declined the anti-depressants, not because I have a thing against 'popping pills' as so many people rather naively put it, but because when I'm this way I don't make quick decisions and I wanted to be able to research the drugs first.  I didn't go into work that afternoon, but I also didn't take to bed.  I functioned.

The next day I did go into work, but left a bit early to go to the hospital for my second emergency CTG trace.  I had no idea whether I needed to go or not, but because I wasn't rational enough to make a decision I thought I'd be best going in.  When I got there the midwife agreed I'd done the right thing.  However, I did have to sit in the waiting room for about 5 minutes waiting to be called through.  The same waiting room where we were kept for about an hour when we went in to check C's movements and were told he'd died.  So that was pretty horrendous.  Or would have been had I allowed myself to feel stuff.

Since then I've been improving.  I'm not right, not like I was before this 28 week mark, but I look fine and I'm doing normal life stuff and to everyone else I'll be fine now. But I feel like I've packed my emotions and fears into a little box and I've pushed it down deep inside me.  I feel brittle.  That Tuesday scares me, if I allow myself to think about it, because it was a reminder of what depression is like, and I haven't felt that way in a long time.  I'm used to managing stress and anxiety, but not used to feeling like that.  So I push it down and pack it away and I'll deal with it at  later point when I have more time and space.

I do have to remember that in the third tr with C my mood crashed, completely.  I just started crying for no reason and feeling low.  I never really brought it up with my midwife because I'm not good at talking about this stuff, but it was a significant difference to my second tri mood where I was comparatively bouncing along, and the change happened overnight.  So I suspect that this week is a combination of grief, pressure, fear and hormones.

A friend at work (when talking about something completely different to the above) said something like 'you don't want to be defined by your loss at work', and my instinctive reaction was yes I do.  But now, I'm not sure if that's the 'right' response, or what I want.  I need to reconcile my status as a mother with other people's understanding of being a parent, and somehow fit all that into the rest of my life.  Which is kind of what these blog posts are about, a bit.  The purpose of them has changed, I think, since I started writing at what, 5 weeks (?) gone.

So, I guess I should also talk about the physical stuff.  At around 27 weeks I got a growth spurt, and jesus my hips and pelvis started hurting.  So I made an appointment to see the physio (at 29 weeks plus 3) and she gave me a support belt, which is bloody amazing.  Of course the departments at the hospital don't talk to each other, or read historical notes in their department, so she asked how old my child at home was and I curtly pointed to my Sands sticker on my maternity notes (the notes I bring with me that she wouldn't have seen beforehand).  She went ahh and it was fine, but for fucks sake. She saw me for about 50 minutes and gave me exercises to do to help with other pain, and on the whole was pretty good.

Speaking of pelvic girdle pain (PGP), the ways I manage it are:

• When standing or walking for long periods, wear the support belt.  I did get given one with C but it hurt more so I never used it.  This time round my bump is flatter and lower (my torso muscles have little to no tone due to the short pregnancy gap) and the belt works a treat.
• When lying down, put a pillow between your knees, a pillow against your back and a pillow underneath your bump.  You can buy maternity pillows which do all these things or you can use separate ones.  I use a mixture of 4 maternity and non maternity pillows.
• Pelvic tilts can be done sat on an exercise ball, leaning back against an exercise ball, on your side at night or standing up.  They really, really help loosen up painful lower back muscles, which while not strictly speaking are part of pgp, nonetheless don't help.
• Doing pregnancy pilates every week.
• Seeing an osteopath (experienced in treating pregnant women) every 3 weeks to realign my pelvis.
• Sitting on an exercise ball at home, not on the sofa.
• Not pushing myself.  If something hurts, stop doing it.

FYI, my pgp hurts when I walk for more than 10-15 minutes, when I roll over in bed at night, when I sit on the sofa for too long and when I stand up from the sofa I get shooting pains down my leg.  That last bit probably isn't pgp, its just general pregnancy tightness.  It all needs treating though.

Right, what other physical stuff?  I had the whooping cough vaccination at 29+3.  It made my arm hurt.  2 days later I started getting a cold and now nearly one week later the cold is still lingering. It's not that severe, but bloody hell it's knocked me out.  I feel like I've been asleep for most of the week.  Considering that and my near breakdown the week before I've done fuck all at home and the boyfriend has had to take up all my chores, as well as the redecorating job he's doing.  It's not very fair on him so now I'm better I'm determined to start pulling my weight again.

Pregnancy after stillbirth: notes on CTGs and UTIs

Recently I've been thinking about CTGs and I also mentioned UTIs.   I wanted to put a few words about them on these here posts.

A UTI is a Urinary Tract Infection, like cystitis.  They are uncomfortable/painful at the best of times, causing pain (burning) when you urinate, making you want to pee more often than normal (and crucially, not having anything to piss out when you do go), and can make you feel grotty and under the weather.  In older people (pensioners) they can make you seriously unwell.  When you're pregnant an untreated UTI can cause premature labour and the infection can travel up your vagina, to the womb and infect the baby.  This can cause illness in the baby and can be fatal (to the child).

Hence why my midwife was concerned about the leukocytes and ketones as they can indicate an infection.  However, I did as she told me and the following Monday when my urine got tested again it was all clear.  So that's fine.

CTGs, or Cardiotocography traces, are used to monitor the baby's heartrate and uterine contractions.  It's done through putting two monitors on your bump, one at the top of your uterus (your fundus) and one roughly where the baby's heart is.  The machine my hospital uses gives the uterine contraction rate in a green number, and the baby's heartrate in a red number.  If you ring up your hospital concerned about movements and they ask you to come in they'll put a ctg trace on you.  At my hospital you go into delivery suite to have this emergency check done.  I've been in twice now, it's not pleasant.

Anyway, the point of this post is for me to explain about the baby's heartrate and what the ctg trace is picking up.  I asked a couple of fellow Sands ladies about this and they, along with my midwives, gave me the following information.

My midwives have all said that a normal baby's heartrate is between 110 and 160 beats per minute. When the baby moves, it is expected that the heartrate will go up to to 180 beats per minute (just as yours and mine heartrate would go up if we exerted ourselves by going up stairs, for example).  On a ctg trace, which records the heartrate on paper, a la the top line on this image:

You will expect to see at least two spikes occurring at the same time as movement.  The mother is given a beeper thing to press when she feels movement and this is also recorded on the trace.  These increases are called accelerations.

I believe that the lower line on the above image measures baseline uterine activity, i.e. contractions, and is normal.

The ctg tracking the heartrate will pick up when decelerations, i.e. when the heartrate dips below 110.  If more than two of these happen in a 20/30 minute period for more than 15 seconds at a time your midwife/consultant should be concerned and further monitoring is needed.

You have to meet set criteria for the midwife and doctor to be happy with the traces.  A normal CTG needs 4 features - baseline rate to be between 110 and 160bpm, variability has to be 5bpm or more, at least 2 accelerations in a 20 minute period and no decelerations.

For a non-reassuring trace, you need to meet just one of  the following criteria: baseline heartrate below 109bpm or above 160 bpm, variability less than 5bpm per 40 minutes or more than 5bpm for 90 minutes, unprovoked decelerations, decelerations related to uterine tightenings when not in labour.

A baby's heartrate is expected to vary from second to second, like humans out of the womb but there will be a baseline, which is not the same as a deceleration.  I have been told that decelerations are very obvious on ctgs, and that experienced midwives can hear a deceleration without having to have it checked by technology.  This applies when you have your heartbeat checks at regular antenatal midwife appointments and even the parents attending the appointment can hear it.  Having now heard this baby's heartrate weekly since 16 weeks, I would agree that it is obvious what a normal heartrate of around 140 to 150 beats per minute sounds like.

Note: fellow Sands women who are also midwives have told me that a normal heartrate is between 110-160 beats per minute and they expect accelerations with movements to go up to 180 beats per minute.  They have said a deceleration is classified as being at least 15 beats below the baseline for at least 15 seconds.  Which to me says it comes back to being what it normal for your baby.  One off decelerations can be fine, but the baby should always be monitored with a ctg and/or scan if one is suspected.

Another Sands mother says that when she had hours of CTG in the last 5 weeks of her pregnancy, her son only had decelerations in the day before being delivered, and that they were really really obvious on the CTG feed.  She says that movements led to a raise in heartrate, which then came back down, sometimes with a little valley below the average heart rate.  The deceleration was "massively and very distinctly different, with a marked downwards tench with no movement before it".  I'll add that although the mother might not feel every movement, on a ctg trace and a regular heartbeat check, you can hear movement as the baby pushes or shifts against the uterus.

I also asked Sands women about what they can pick up at scans regarding heartrate.  Most scans don't take 20 minutes.  They might take just ten or less.  I have been told that during a scan the sonologist looks for normal movement patterns and they can see if the heartrate is slow - they check it by eye.  if you have a doppler scan they can record the blood flow through the umbilical cord - the print out looks a bit like the ctg trace.

That's a rather long post, but I feel better for getting it out there.  I'm a huge believer in the more information available to parents the better.