Thursday, 18 August 2016

31 Weeks - A Rollercoaster Week

The week began badly. I had a day when I didn't feel the baby move, so, reluctantly, I had to go into the hospital to get checked.

I was a little worried about the baby, but more anxious about going in to the hospital.

It's become a place that terrifies me.

I shouldn't have to feel afraid to go into the hospital. It should be a place of safety and comfort.

When I haven't felt baby move, my worry should be that there might be something wrong with them, not a fear that the need to go into the day unit will be used against me in some way.

Typically, as soon as I lay on the bed to get the CTG straps put on, the baby jumped.

Pilsbury Dough Belly!
Still, I had to lay there for half an hour while  baby's heart rate and movements were monitored. Of course, the little tyke didn't stop moving the entire time, and hasn't since. I've felt more movements since being in, than I have all the rest of my pregnancy!

My blood pressure was normal. My urine was fine. Baby was content. My blood sugar was well within the limits, though when tested on the hospital's monitor it came up much higher than it did on my own. I found that concerning, but have since discovered that different monitors can give completely different readings. The lack of accuracy is concerning, especially when pregnancy levels are so tight. I need to contact the Diabetes Nurse at my surgery to ask to get my monitor checked, just in case.

However, I was still asked to wait around to see a doctor, who, when she arrived, questioned how I knew I had Gestational Diabetes because my sugar levels were so well controlled! I wish they'd all make their minds up. I assured her that I'd had a GTT in my first pregnancy, and that I just have a very good diet.

The doctor told me that they wanted me to come back the next day for a growth scan and to check my amniotic fluid levels. Now, seeing as I had agreed to one growth scan, I said yes, thinking I'd then be able to cancel that one. But it did feel very much like they were grasping the opportunity to get me to have interventions I don't want, simply because I was in the hospital.

I don't think every woman gets called back for scans after one visit for reduced movements.

I'd forgotten what day it was, so when we arrived at the hospital the next day I suddenly realised that the Diabetes Clinic was going on at the same time as my scan.

And I saw my consultant's name up on the board.

The same consultant who has referred me to the Safeguarding Team.

And who my midwife told me has put a note out that he is to be told if I come in to the hospital.

I felt my blood pressure rise massively. I was hot and anxious. The fear of being made to do something I didn't want to do just rushed through me.

The Hubby was fab. He kept me calm.

I was called in for my scan, and the sonographer was the same lady we'd had for our dating scan. Her bedside manner was much improved this time, probably because she had a doctor in with her who was training in sonography.

They had a brief moment of panic when they couldn't find my growth chart, and then another when I told them I had declined to be weighed. It's written on my notes, but, yet again, they hadn't been read.

The doctor commented, "You've had good sized babies."


Obviously, "good sized" means "big." Why do they say that? A veiled criticism. A perceived negative made to sound positive.

You know, I had great sized babies.
Big Baby 1
Big Baby 1

9lb 8oz and 10lb 1oz.

I make big babies.

And do you know what else? I am perfectly capable of birthing big babies.

No tears. No stitches. No interventions.

I come from a family that has had big babies.
Big Baby 2
Big Baby 2

Rumour has it that my own dad was 11lb. And he was born at home. And my Nana went on to have another 3 children after him.

My youngest brother was 10lb 8oz.

God knows what He's doing in giving me big babies. Due to my low milk supply, they lose weight at the beginning, while we work out the right amount to supplement. They can cope with the weight loss, because they started out at a "good size."

My worry when it comes to having a big baby, is the way that I am treated because of the perceived size of the baby before it is born. I knew for both my previous pregnancies that I would be able to give birth to them naturally. I didn't doubt it. My gut told me I would be fine, and they would be fine.

I did my own research, because I didn't trust that I would be told everything I needed to know by the consultants I saw. The consultants who tried to convince me that I needed to be induced at 40 and 38 weeks respectively. The consultants who tried to give me a stretch and sweep against my wishes. The consultants who used the "dead baby" threat as a way to get me to comply.

I was happy with the research I found the last two times. And this time around, I came across Evidence Based Birth's website. Fantastic articles with so much information to support what my own gut had been telling me.

If you're worried about having a big baby, or have been told you're going to have one, then this article is for you:
What is the Evidence for Induction or C-section for a Big Baby?

Firstly, predicting big babies is not an exact science. It's so unreliable:

31 Weeks Pregnant
31 Weeks Pregnant
"In 2005, researchers looked at all of the studies that had ever been done on ultrasound and estimating the baby’s weight at the end of pregnancy. They found 14 studies that looked at ultrasound and its ability to predict that a baby would weigh more than 8 lbs., 13 oz. Ultrasound was accurate 17% to 79% of the time, with most studies showing that the accuracy (“post-test probability”) was less than 50%. This means that for every ten babies that ultrasound predicts will weigh more than 8 lbs., 13 oz., five babies will weigh more than that and the other five will weigh less (Chauhan et al. 2005)."

Accurate 17% to 79% of the time! And that is considered acceptable by healthcare providers.

It's one thing to be told you might have a big baby, but the problem with that is how women carrying these "big" babies are then treated after the diagnosis:

"When a big baby is suspected, women are more likely to experience a change in how their care providers see and manage labor and delivery. This leads to a higher Cesarean rate and a higher rate of women inaccurately being told that labor is taking too long or the baby does not “fit.”

In fact, research has consistently shown that the care provider’s perception that a baby is big can be more harmful than an actual big baby by itself.

Overall, a total of nine different studies from 1992 to 2015 have all shown that it is the suspicion of a big baby—not big babies themselves—that leads to higher induction rates, higher Cesarean rates, and higher diagnoses of stalled labor (Levine et al. 1992; Weeks et al. 1995; Parry et al. 2000; Weiner et al. 2002; Sadeh-Mestechkin et al. 2008; Blackwell et al. 2009; Melamed et al. 2010; Little et al. 2012; Peleg et al. 2015)."

And therein lies my reluctance to have growth scans. I'm already treated worse because I'm obese, and because I have Gestational Diabetes. I don't need my care to deteriorate further because they've decided my baby is big. I also don't need a growth scan to tell me I'm having a big baby - that's pretty much a given, judging by the last two.

But, there I found myself, lying on a bed, covered in gel, having my baby measured. 

As I expected, baby was measuring a bit ahead, and was on a higher centile. No surprises there. 

However, I also got told that my waters were raised, so I was sent to the Day Unit to be seen by a doctor.

They were busy. No one told me what raised waters means. I had to have my urine tested again. They took my blood pressure, which while fine, was understandably higher than usual. And I had to have another CTG, this time with a handheld clicker to press whenever I felt a movement.

All was fine. 

I asked what raised waters meant, and a midwife reeled off a couple of risks, speedily, and was gone again before I could ask anything else. 

A doctor was consulted, but never came to see me. I was merely informed that I would need to come back every 4 weeks for more growth scans.

I was scared and upset. I cried in the toilet.

My biggest fears about labour - induction and caesarean - are in danger of becoming my reality. 

I think my midwife is away on holiday, so I've had to rely upon my own research to find out what "polyhydramnios" means for me. 

I haven't found anything positive. Even midwives who are fully supportive of homebirths appear reluctant to support homebirth with polyhydramnios.

Risks of cord prolapse and haemorrhage.

Baby death.

I've discovered some homebirthers who have gone against medical advice and birthed at home with excess waters, but there doesn't seem to be any positive research that I can lay my hands on.

I felt desolate.

Last week I was wondering whether I was sure I wanted a homebirth again. This week, after spending 6 hours in the hospital, I am more convinced than ever that I don't want to give birth there, and yet it is now more likely.
I don't like rollercoasters

That evening we had our first NCT Refresher Antenatal session. Our teacher is fabulous. She and I see eye to eye. She believes in research and evidence based care, rather than following protocol simply because that's what has always been done. We chatted after the class, and I came away feeling somewhat calmer and reassured. 

We'd also met the other three couples in our group. Bizarrely, of us all, my labours had been the most positive. I was so sad and angry for how the others' experiences and treatment had been. 

Fast forward a few days, and finally, I had some good news.

We got back from a day out to find a letter on the doormat.

From the hospital.

The Hubby opened it and read it first.

It was a letter to the Barrister from Birthrights who had written to complain on my behalf. I'd been copied in to the response from the Hospital Chief Exec Team.

It contained an apology for the threat to refer me to Safeguarding.

"I would specifically like to sincerely apologise for the remark regarding a referral to social services..."
An apology
"I would specifically like to sincerely apologise for the remark regarding a referral to social services, as we would have no reason to do this unless we had proven concerns regarding parenting, which we did not."

"It is very important, when things do not go as well as we would expect, that learning is identified and action taken to prevent the situation from happening again."
My Consultant's Education Plan
"It is very important, when things do not go as well as we would expect, that learning is identified and action taken to prevent the situation from happening again. I would like to offer my assurance that your complaint has been taken seriously and learning has been identified as follows."

And the assurance that the Consultant would be educated in how to deal with patients better.

It was a real vindication to read that the complaint has been taken seriously. And to see that they acknowledged my thoughts and feelings. That, "...just as we have our plan of care, the woman has a right to what she chooses, and as Mrs M. had no problems with her previous two babies, she may well have considered the approach of scans every four weeks and frequent clinic visits to be excessive."

I was also offered the opportunity to meet with the Clinical Lead for Obstetrics and Gynaecology to discuss the way forward. She is the consultant I had for the first half of being pregnant with M. She was the only consultant I've had who listened to me, who read my notes, who treated me like a person. It was when she stopped coming to my appointments, leaving me with registrars, etc. that my care went downhill last time, and that was why I refused further consultant care and a hospital birth at 38 weeks with M.

I think I will meet with her, especially as I now find myself in a situation that increases risks, and because I have said all along that I would see a consultant when it is necessary.

A real rollercoaster of a week, but at least we have finished on a high point. But does that mean that we have another fall to come? If you pray, I would very, very much appreciate your prayers for this situation.

Baby is the size of a small-clawed otter.
Or a bit bigger in our case.
Weekly Statistics
 Average after meal sugars: 4.7 mmol/L
Average fasting sugars: 4.3 mmol/L
Weight:  +1 lb

Catch up: 30 Weeks
Next: 32 Weeks


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Images: Pixabay

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