Tuesday, September 02, 2014

Phoebe's birth story - Part 3

At 1:20am on 6 August, I started pushing. It was hard work and not ideal with my legs up in stirrups. But once the epidural’s in, that’s what you have to do. I had trouble visualising where I needed to push. In many ways this wasn’t what  I wanted – on my back, pushing in the classic chin on chest manner. I tried to remember the breathing techniques we’d learned in the NCT class but I couldn’t really work out what I should do. So I followed the midwife’s directions and did the best I could. At this point, the epidural being only half effective was useful. I actually had some feeling left which helped me push. I didn’t feel like I was pushing long, though each push was tiring. After an hour and a half though, the midwife was concerned that we weren’t making enough progress. Her senior colleague decided that it was time for intervention – a trial of instrumental delivery. They would try a forceps delivery and if that didn’t work, they would go straight to a C-section. Oddly, the news didn’t upset me or make me feel disappointed. I think that was partly being somewhat out of it and partly relief at knowing we would be meeting our baby soon. I kept pushing with every contraction as we waited to be transferred to theatre. Rob put on scrubs and grabbed his camera. As I was pushed along the corridor, I was pretty convinced that a C-section was going to be the outcome. I felt OK about this.

Once in theatre, there were many people, bright lights and much equipment. I needed a spinal block – a far more effective anaesthetic. I don’t think it took long to put in, but once I lay down again, I felt very sick. I threw up the blackcurrant squash the midwife had made me drink before starting to push (which was the first sustenance I’d had since 4pm). Once I’d stopped throwing up, my legs were lifted into the stirrups – a very strange feeling. As far as I could feel, my legs were still straight and on the bed, yet I could see them up in the stirrups. I could wiggle my toes and see them move, yet I couldn’t feel them move. I couldn’t feel a thing below my waist (They check this by blowing a cold spray at your body and seeing where you can feel it).

Then it was time to push. I couldn’t feel a thing so I had to follow the midwives’  directions of when to push. I tried to remember the feeling of pushing from before and visualise my body doing it. The senior midwife was pleased with the progress I’d made since she’d last examined me. She said she was more confident now that we could deliver the baby with forceps. (I felt very pleased that the effort I’d put in was worth it).

So it proved. I can’t remember how many pushes it took, but suddenly there she was! Phoebe was delivered, wrapped up, placed briefly on my chest and taken away to be checked and have her cord cut. 


I sent Rob over to take pictures. She cried! She was covered in cheesy vernix and had lots of fair hair. They wrapped her in a towel and placed her back on my chest.





I’m not sure what happened then. I know I’d lost a lot of blood (1.2l according to the notes) and needed a transfusion. I remember asking to see the placenta (a huge bloody chunk of flesh) and being amazed that it had been delivered so quickly (2 minutes after Phoebe). I needed to be stitched up. Rob and Phoebe disappeared. I assume they went straight to recovery. There was nothing wrong with Phoebe – her Apgar score of 9 and then 10 proves that. I was pretty out of it and remained so until lunchtime. My legs were still non-functional and I couldn’t move. At some point, Phoebe was put onto my chest for some skin-to-skin and her first feed. She latched on beautifully and guzzled like a champ. I was so proud of her and happy that she was finally here.


Monday, September 01, 2014

Phoebe's birth story - Part 2

Tuesday was fairly relaxed and uneventful. Rob came in about 11. I spent the day snoozing, reading I Capture the Castle, sometimes going for a walk. I managed to sleep for a while in the afternoon. When I was awake, I bounced on a birthing ball. 


At some point in the afternoon, I was told I was next in the queue to be transferred to the delivery unit. Around 4pm we were finally transferred.


The delivery room was smaller than the induction suite and the windows looked out onto a wall. Not exactly exciting or homely. But it was private and comfortable with a big adjustable big for me and a chair for Rob. Our midwife Laura settled us in. First task was getting the monitor sorted. 


I was keen to be on a wireless monitor so that I could move around as much as possible. This was trickier than it sounded. The monitor in the room was missing a piece for the clip on the wireless sensors. A second one was found and some teething problems, it worked. I had a cannula fitted in my left hand – not a comfortable process and a real pain for most of the rest of the time, once it had served its purpose delivering Syntocinin. Laura examined my cervix. I was 1-2cm dilated, open and soft – a good place to start, but some way to go. Then about 6pm, she started the drip. Every 15 minutes she upped the dose and gradually my contractions which had slowed to being almost non-existent and very erratic began to get stronger and more regular.



I had decided beforehand that if I had to have the syntocinon drip, I would want an epidural, but I also wanted to see how far I could get using the TENS and entenox. I think around an hour into the drip, I was ready for gas and air – bouncing on a ball with the TENS and standing for contractions wasn’t quite cutting it. Gas and air is fun stuff. I think the concentration needed to breathe in and out is as much an effective distraction as any painkilling effect. I puffed through each contraction and then felt very lightheaded and drunk afterwards. It helped for a while, but by about 8pm, I was ready for an epidural. 



After that things get hazier. I think the anaesthetist arrived fairly quickly. I continued to puff on gas and air as the epidural was inserted. It took a while to get right. Rob says the process looked painful. I’m not sure if that was the needle or just having to sit still on the bed for it. The position you adopt for having the needle inserted – hunched over and hugging a pillow – is sort of comfortable, but not ideal. There was some fiddling with the dosage and, I think, the position. From now on I wasn’t very mobile. I half sat, half reclined on the bed, fairly out of it, breathing gas and air through contractions when I needed it and saying strange things. (I talked about library books, towels, Rob and his drone). 



The epidural was very effective on my left, but there was one point on my right which still hurt, like a slice through my body which still felt every contraction. Eventually, the midwife and the anaesthetist turned me onto my right side in an effort to move the drugs into the right places. This was my worst moment. I started shivering and feeling very sick. It also didn’t really shift the epidural, if anything the pain on the right was worse once I was back on my back again. I was beginning to feel some pressure in my bottom (only on the right of course). I said “I think I feel pushy”. The midwife checked me again – I was almost fully dilated. By now it was getting close to midnight. The midwife checked with a senior colleague who told her to wait an hour and then another one before I could start pushing. Those two hours are a blur – blame the gas and air! At some point a clip monitor was fitted to the baby’s head to monitor her directly.

Sunday, August 31, 2014

Phoebe's birth story - Part 1

I was booked for an induction on 4 August. I was nervous the night before – would they want me to come in today? I didn’t sleep well. But in the morning, I rang at 8:30 as instructed and was told to come straight in. We arrived around 9:45 and were shown to a bed in the induction suit on Sara Ward. There were 5 beds in a sunny room. My bed was by the window, overlooking a courtyard. The other beds were empty initially, although they would fill up over the course of the day.



After an initial 40 minute period of being hooked up to the monitor to check on baby’s heart rate, I started the induction drugs at 11:20 with a Propess pessary. Getting it in, pushed up past my cervix by Megan, the midwife looking after me, was quite uncomfortable. I had to lie still for an hour and be monitored some more to check that Zarquon was still happy and not being distressed by the process. After that, I could walk around.

Rob got pretty bored. There wasn’t much to do except wait, read, wander about. He took some pictures – the beginning of a series recording the whole process. At one point I went for a walk and he fell asleep on my bed which amused and confused the midwives.



That first day it felt like very little was happening. No contractions, nothing to do but bounce on the ball, read, go for walks. Eventually Rob went home and I went to bed.

Around 11:20pm, I felt some pains in my stomach, then a pop, then another one. I sat up and found myself in a pool of liquid. My waters had broken. Something had been happening that day. I called a midwife who checked the fluids (all clear, just a little blood), cleaned up the bed and found me some maternity pads (mine had got left in the wrong bag and were still in the boot of our car). Then I was hooked on to a monitor again for an hour just to check on baby. She was just fine. I was beginning to have contractions. I could see them as waves on the monitor trace and feel them as tightenings. Not too painful yet, but there, proof of something happening. I texted Rob to tell him what had happened. Neither of us were sure what the timescale would be from here, but the midwife told us we should get some sleep while we could, so I settled down to try to do just that.

It soon became clear that sleep wasn’t going to happen. My contractions got stronger and soon I couldn’t find a position in which I could both lie down and sleep and cope with contractions. I got a midwife to help me attach the TENS machine. I wore it for the next 24 hours and it made a big difference. After a while, I was sitting down bouncing on the ball or in a chair between contractions but had to stand when one started. Circling my hips helped, so did leaning forward against the bed.

I played Monument Valley on Rob’s iPad. It was a good distraction and the music was very soothing, though I had to put it down to stand for contractions. I don’t think I got any sleep, though judging by the moans coming from the other 3 occupied beds, neither did anyone else. I was in too much pain to sleep (and the gaps between contractions were too short to drop of in) but I felt the pain was bearable, especially with the TENS machine’s help. Eventually morning came. I ate hummus and chicken on brown toast in the kitchen (with stops for contractions). My last gestational diabetes friendly breakfast.

Wednesday, August 13, 2014

Welcome Phoebe!

She's here! Well, she's been here a week now, but I've been a little too busy to get to the blog.


Phoebe Muriel Gwendolyn was born at 3:49am on Wednesday 6 August via a forceps delivery. She weighed 2.915kg (6lb 7oz), was covered in vernix and had an Apgar score of 9 after 1 minute and 10 after 5 minutes. (10 is the maximum, I was a little proud to discover.)

I lost some blood (1.2 litres) during the delivery and had to have a transfusion shortly after the photo above was taken (by Rob) so I was a little out of it for the next few hours. 


Later that day we were moved down to the antenatal ward and had our first visitors - both sets of grandparents and Rob's siblings. We spent the next day and a bit in hospital and came home on Friday evening. It's been an emotional roller coaster of a week. We've had some problems with feeding and life with a newborn is pretty exhausting for everyone. 

I want to write Phoebe's birth story for the blog at some point. Rob took lots of photos during labour and while they're not exactly flattering, I'm ready glad to have them as a record of what happened.



In the meantime, Rob and Phoebe and I are getting used to life together as the three of us. She is beautiful! Even Rob has to admit she makes cute noises. :) 



Thursday, July 31, 2014

Things I will not miss about being pregnant

Turning over in bed is complicated. I definitely have to wake up fully to do it and sometimes I need to get half out of bed to turn over.

Relatedly, not being able to lie on my back. I sleep on my side mostly, but I do generally spend some time relaxing on my back when I first get into bed. I can't do that at the moment!

Being a pin-cushion. With 2 injections and 4 blood glucose finger pricks a day, that's a lot of sticking needles into myself. Fortunately, I'm not squeamish about needles, but I won't miss having to stick myself multiple times a day.

The effort of getting up out of a chair or bed. Usually accompanied by an involuntary "Oof!".

The pain at the bottom of my ribs on the right hand side. Apparently this is common in pregnancy, something to do with the ligaments between the ribs relaxing and the bottom ribs bowing out to make more room. I'm not sure why since my torso is long enough that Zarquon doesn't really reach that high. But the pain is there, most of the time, especially at night when I lie on my right. I hope it just goes once I give birth. (I did ask an obstetrician about it since it can be a sign of something more serious like a liver infection or HELLP, but he was happy that I didn't have any other symptoms of anything serious and it should be nothing to worry about).

Being hyper cautious about what I eat. Not so much the normal diet restrictions of pregnancy (though I do have the occasional craving for Eggs Benedict) but the specific ones for gestational diabetes. I do think it's been good for me to be forced to eat healthily for the last couple of months and I hope some of my good habits (like salad wrap lunches and plenty of veg with my dinner) will stick after the GD has gone. But I do miss muesli for breakfast and sometimes I would love a bowl of ice cream!

Central heating! I'm so hot, all the time. It has been very hot for the last few weeks: 27C most days and sometimes up to 30 or 31C. What with that and the little furnace in my belly, I've been pretty sweaty, especially at night. Of course, once Zarquon's born, her temperature won't be being regulated by mine anymore and we'll have to make sure she stays cool enough/warm enough. But at least I won't feel so overheated all the time. I hope!

Wednesday, July 30, 2014

Things I will miss about being pregnant

The little kicks and wiggles from inside. I love feeling Zarquon moving around.

The bump. I like being bump-shaped! I feel feminine, fertile and womanly. I'm a little waddly, but I don't feel that enormous, just curvy.

Being looked after. No-one minds giving up their seat to a heavily pregnant woman. People ask if I'm OK, how I'm finding the heat.

Afternoon naps on my schedule! Once Zarquon's here, naps and everything else will be on her schedule, at least at first.

Zarquon is very portable and easy to look after right now. I don't have to think about how to carry her or feed her.

Tuesday, July 29, 2014

36 weeks, 6 days

So, the decision has been made. I will be induced at 38 weeks.

To back up a bit: I had a 36 week growth scan on Tuesday and saw the obstetric and diabetes teams. The scan looks fine. Zarquon is consistently on the 50th percentile line and doesn't look to be getting too big or too fat round the middle. I've done a good job with keeping my blood sugar under control, but need metformin over night. It's because of the need for medication that I'm being induced early. If I were well controlled on diet alone, I could probably go to 40 weeks. I think this explains the disparity between the first and second obstetrician I saw. At the time I saw the first one, I was controlling my blood sugar by diet alone, but by the second I'd started on metformin.

It's quite hard finding good information on why early induction is better for GD. The NICE guidance, as far as I understand it, looks at the numbers of early inductions (typically 38-39 weeks) and the outcomes but doesn't really address the underlying reasons for early induction. It's more a case of this is what happens and it seems to be safe. A relevant passage says:

"The NICE induction of labour guideline recommended that women with pregnancies complicated by diabetes should be offered induction of labour before their estimated date for delivery. Although the guidelines reported that there were insufficient data clarifying the gestation-specific risk for unexplained stillbirth in pregnancies complicated by diabetes, the GDG [Guideline Development Group] that developed the induction of labour guideline considered that it was usual practice in the UK to offer induction of labour to women with type 1 diabetes before 40 weeks of gestation."

http://www.nice.org.uk/guidance/cg63/resources/cg63-diabetes-in-pregnancy-full-guideline-reissued-july-2008-2 p120

Early induction for macrosomia (baby over 4kg or 4.25kg depending on who's defining it) is the most commonly cited reason, because of the associated risk of shoulder dystocia. That doesn't seem to be the case for me and Zarquon. There is still a risk of still birth (one study found a rate of 26.8 stillbirths per 1000 live and still births for women with all types of diabetes, not just GD, versus a national rate of 5.7 per 1000 live and still births), although it's unclear if it's actually a larger risk for well-controlled GD.

I have the impression if I ask an obstetrician pointblank why I should be induced early, they're either going to say "because that's standard practice for GD" or say something about the increased risk of still birth, which is probably scary enough for most women to agree to an induction on that basis. But I need to remember I am not an expert at interpreting scientific evidence and medical guidance.

Anyway. I am being induced at 38 weeks or soon afterwards. I am OK with this. I'm not completely convinced it's necessary, but I'm willing to trust the obstetricians' judgement. It did help that the last obstetrician I saw was helpful and friendly, explained why the previous two gave different answers and gave me a thorough explanation of the process of induction, with all of its if-thens and what happens if steps.

Of course, I'd love to know how long it will take to get labour going, but that really is something no-one can tell me. It all depends on how I respond to the drugs. I'm hoping it's fairly straightforward, that the prostaglandin pessary and gels work for me and I don't need syntocinon to get things going. I will have continuous fetal monitoring. I may need a glucose and insulin IV once I'm in labour if my blood glucose doesn't stay in my target range. I'd like to get through labour with my TENS machine and gas and air, but I'm open to the idea of an epidural if I need one. Especially if I do have to have syntocinon. I think I'm more open to having an epidural than to pethidine, because the latter seems to have more side effects for the baby. All these unknowns! And I might still manage to go into labour spontaneously, you never know. We will find out soon.