Tuesday, 19 April 2016

14 Weeks - Booking In & Dating Scan

I am never more aware of being fat than when I am pregnant.

A time that should be full of hope and excitement and joy can be reduced, in the blink of an eye, to one of fear and worry and stress, just because of a number written on a form. I have found, in both of my previous pregnancies, that as soon as my weight and BMI were taken and recorded on my maternity notes, I was subject to scaremongering, patronisation and poor medical practice. 

The standard practice in UK antenatal care is to place anyone with a high BMI under consultant led care. Weight in itself is considered to make a high risk pregnancy, regardless of maternal health. And from thereon in, the stress and interventions just pile up.

Troll doll 14 weeks plus size pregnancy
14 Weeks - Baby is the size of a Troll

During my first pregnancy I was diagnosed with Gestational Diabetes, which, as a PCOS sufferer, should not have come as a surprise. Though, having been told by my doctor that as I had achieved pregnancy there was nothing that needed doing about my PCOS, it is no wonder that I was unaware of the other issues of the Syndrome apart from infertility. 

PCOS sufferers often have Insulin Resistance, and a higher risk of developing Type 2 Diabetes in later life. Insulin Resistance, when unrecognised and untreated, can lead to weight gain, which in turn can increase Insulin Resistance, and so on and so on. Much of what I have read has pointed to the fact that it is Insulin Resistance that causes obesity, and not vice versa. 

People don't get Diabetes because they are fat - they get fat because they are already headed towards Diabetes. And with Insulin Resistance comes a propensity for Gestational Diabetes, which is often considered a pointer towards future Type 2 Diabetes, and low milk supply. 

My GP should have known, and informed me, of the problems caused by PCOS. I should have been prepared. But considering it took them 15 years to diagnose me, again I shouldn't be surprised.
And, as ever, it seems that symptoms rather than causes are dealt with. 

And fat people are blamed for everything that happens to them healthwise.

I managed my Gestational Diabetes (GD) by diet and exercise. When I say diet, I don't mean that I changed my diet in any way. I continued on the low GI diet I was already following. The Dietitian I was sent to had no advice for me, because my diet was fine. The Diabetes Clinic Consultant didn't read the Dietitian's notes and presumed, just because of my weight, that I must have had a poor diet to begin with, and praised me for changing it to control my blood sugar levels.

And that has been the problem with consultant led care through both of my previous pregnancies. Presumptions based around my weight, rather than looking at my notes and treating me like a human being. 

It was only when seeing my midwife, Mandy, that I ever felt excited and positive about my pregnancies. With both I was always measuring correctly. I had perfect blood pressure. My urine was always fine. 

My only complication was a too high blood sugar after drinking a litre of Lucozade for the Glucose Tolerance Test. A test that isn't entirely accurate, is difficult to get the same score on when repeated, and is more likely to be failed by someone who has a low sugar diet already. My body didn't know what to do with that amount of glucose hitting it, and even so I only just hit the cut off point. 2 minutes longer before the second blood draw, and perhaps I would have been just under. 

Still, it doesn't help to think about what ifs, and having to test my blood sugar daily was interesting. Without the diagnosis, I wouldn't have done all the research I did, and I wouldn't know what I know now. 

My Lead Consultant during my second pregnancy told me she would not send me for the GTT - which I was declining anyway - as the assumption would be that due to GD in my first pregnancy I would probably have it again. I monitored my own sugars and kept them well below the maximum. 

As much as I hate it, the truth is that I had Gestational Diabetes, and I will have it during this pregnancy. What that diagnosis doesn't mean though is that I have to put up with the treatment I received in my previous pregnancies. I deserve evidence-based care, not the routine care that leads to interventions.

I had quit consultant led care at 38 weeks pregnant with M because I was bullied and pushed into having an induction. I declined, despite being told, "We will induce you at 38 weeks, because we don't allow women with Gestational Diabetes to go over 38 weeks." Now, having done all my research, I knew that what he said was unacceptable. Health Care Providers are allowed to advise on medical care, but they cannot force a patient to do anything against their will, and they must support the patient's informed decision. 

Unfortunately, too many pregnant women are patronised and given scaremongering "advice", and allow their HCPs to be in control. There is a lack of easily located research and statistics, and so women are not as informed as they should be. We are kept in the dark. Again, a lack of evidence-based care that leads to interventions and births that are not the way they should be.

I decline Consultant Led Care plus size pregnancy
This might be the best method of declining

And so, we come to this, my third pregnancy. I put off going to my GP for several weeks, because all those feelings of anxiety and stress came rushing back. I knew that I would have to be weighed and then that number would go on the form and then I'd be referred to a Dietitian and put straight under a Consultant and we'd be back to excessive hospital trips where I would be patronised and measured wrong and told that I'm too fat to find the baby's heartbeat. Funnily enough, I have not yet met a midwife who was unable to find a foetal heartbeat - that seems to be the domain of the Consultant. That, I believe, is because Midwives are used to looking for, and seeing, normal, while Consultants are always looking for a problem. 

Fortunately, after a discussion on a Facebook group, I was reminded that everything is optional. 

I do not have to be weighed. 

I do not have to see a Consultant. 

It is my pregnancy. 

I am in control. 

And so I went to the midwife at 10 weeks. I was prepared to fight, to explain, to be strong. I hoped it would be Mandy I would see. She had been my midwife through both my pregancies. I know her and I trust her. And she trusted me and treated me fantastically. But it wasn't Mandy who called me in, and I was told that there had been a swap around of the Community Midwives and she was now at another surgery. So I steeled myself and explained my decision not to be weighed. And I told her why I would not going under Consultant Led care. I told her everything. And she listened. And she didn't argue with me. What a huge relief. 

She did ask me if the promise of extra scans would tempt me into seeing a Consultant, and - without laughing out loud! - I said no. We made an appointment for my Booking In, and I left the Midwife feeling a huge weight off my shoulders.

Fastforward to Booking In. Sharon (my midwife) turned up at our house, much to B and M's excitement. We began to go through my Green Antenatal Notes, and then she broke it to me. 

She had discussed me with her manager, and had been told that she had to recommend me for Consultant Led Care. 

I held back the tears, and nodded as she explained that she has to do her job, which I know often means covering one's own backside. And then she said that at my scan, later that day, I would be asked about being weighed, because they would assume she hadn't written it down. And they would keep my green notes until my 20 week scan. Like last time, when I was told that I couldn't have my notes back unless I came to my Consultant appointment! 

That's when I cried. I had naively thought my fighting was done, that I had made my decision known and it would be respected. 

But - in my experience - fat people aren't respected. We are looked down upon; we are stupid and greedy and lazy, and our size gives others "permission" to treat us poorly. 

Here I was again, with the anxiety and the stress that I shouldn't have to experience. 

Sharon apologised, and nodded understandingly, but the person I thought was going to be my supporter had let me down. It was back to me and the Hubby fighting our corner. 

She tried to give me a "Healthy Weight in Pregnancy" leaflet. I suggested it go in the recycling, as even if I consistently lose weight during this pregnancy, as I did when pregnant with M, I will not reach a healthy weight. 

We still managed to get Home Birth written on the front of my notes.

fetus plus size pregnancy
Artist's Representation of our unborn child

And so we head to my Dating Scan. Waiting for ages in the hot waiting room, bursting for a wee because you need a full bladder for the scan and I had mistakenly drunk a litre rather than a pint of water prior to my appointment. 

The Hubby and I kept ourselves going with quiet conversation and deep breathing. We were psyching ourselves up for the fight ahead. 

We spotted a number of larger ladies on the staff, and joked that if needed I could have plenty of support. We plus size ladies should stick together, right? 

Added to the nerves about the weighing issue was the anxiety over what we would find at the scan. Was I really pregnant? Could it be twins? 

Finally, we were called in and I hopped onto the bed and bared my belly. The Sonographer got to work and we saw the tiny dancing person up on the screen. 

I always tear up at that point. 

No.3 was jumping and wriggling and waving. Such a clear picture, despite the difficulties of scanning through fat. Of course, the photo we got was nowhere near as clear as what we saw on the screen, and I am sad that children are not allowed to go to the scans at our hospital. B and M would have been awestruck by our baby on the screen. The picture hasn't inspired much excitement in them, though they still want to kiss and hug my belly all day, every day. 

We declined all screening tests. 

The scan put me 10 days ahead of what my own calculations had. So, the push to induce will come much sooner than I was anticipating, but that fight is for a later date.

We were sent back to the waiting room to wait for someone to go through my notes with me. Joy of joys! When we met the midwife who called me in, she told me Sharon had spoken to them already, so they knew my issues.

"I understand you have an issue with knowing your weight, so can we weigh you to make a growth chart for the baby, and then scribble it out so that you don't have to see it?"

"I don't have an issue with knowing my own weight. I have an issue with my weight being recorded on my notes because once that number is written down, I will no longer be treated as a human being."

Sympathetic nod, followed by, "We understand that you don't wish to be under Consultant Led Care, but we will have to pass on your information, and you will receive an appointment in the post."

"That's fine. You can send the appointment, but I will be cancelling it. I am declining Consultant Led Care."

"Not even just one appointment?"

"Not even one."

"What about if we could assure you that you would see the same Consultant for every appointment?"

One of my previous issues with Consultants is that I never saw the same one twice. Every appointment I had to go through my notes again. No consistency of care; no knowledge of me. This offer could have been tempting.

"No. I am declining Consultant Led Care."

She eventually took the hint, and wished us a good evening. We stood up and left without my green notes.

As we were about to exit the department, the midwife called my name and waved my notes at me. "You forgot your notes!"

Wow! One fear was not realised - I have my notes. I'm in charge of those. This is my pregnancy.

Catch Up: 13 Weeks
Moving On: 15 Weeks 


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