Weight watchers

That’s what Tom and I have become…. again. It’s not our own weight that we’ve been watching – neither of us need to do that – it’s our baby’s weight that we’ve been watching. Oh and we’ve also been on nappy watch – you know you’re a new parent when you get so excited about the contents of a wet and/or dirty nappy! These are two of the indicators that a baby is getting enough food and is growing healthily.

We’ve been here before, when Andrew was a baby. He lost a lot of his birth weight (nearly 20%) in the first 6 days of life outside the womb. Although he initially put quite a bit back on when we started supplementing with formula as it took about 2 weeks for my breast milk to ‘come in’, it took him until almost a month old to regain his birth weight. After that his weight crept up very slowly for the next couple of months, only gaining an ounce or 2 a week instead of the average 6 ounces a week. This meant that he wasn’t following the curve that is charted on the growth graphs which come in the little red book that each baby in the country is given at birth, so the health visiting team can record their progress.

If a baby is following the curve of the graph, whether that be at the 98th percentile line or the 2nd percentile line, it’s recommended that you get them weighed about once every month. If they are not following a curve, you’re told to get them weighed more often. Andrew was on weekly weigh-ins until around 2.5 months, because he was creeping up so slowly and was lingering around the bottom of the chart. He never lost weight from one week to the next, but he wasn’t putting it on fast enough to follow the infamous curve.

At the time I found these weekly weigh days very stressful. I felt like there was a lot of pressure from the health visitors at the clinic to get his weight up, and I felt like a bad mum if he hadn’t gained enough each week to satisfy them; I used to dread putting him on the scales and could hardly look at the numbers settling down to give the final answer of a weight as he wriggled and cried at having no clothes on, poor thing. Even though my milk was supplemented with formula, I felt as though I was demand feeding as well as I possibly could, with the help of the SNS, so surely if his weight wasn’t going up according to the charts, that was at least partly just his way of growing, even if it didn’t conform to the curve.

This is what a blank weight chart looks like. This blue one is for boys, and girls get a pink one - nothing like a good old bit of perpetuating gender stereotypes.

Once he started eating solid foods alongside breastfeeding, the story changed. He soon started to climb up the curve much quicker, and suddenly made up for the slow start. We went from fortnightly to monthly weigh-ins, and the last one he had (until recently) was at his 1-year health check, as after that I was completely confident that he was putting weight on and growing well, just by looking at him. Out of interest, I had him weighed one day when the health visitor came round to weigh Joel, and he was just over the 75th percentile line.

Fast forward to now, and here we are with our second baby, weight watching again. Joel lost less weight at birth, and regained his birth weight within the 2 weeks that they like them too. A tick in the good parent box for us. He continued to gain well for about 8 weeks, cue more ticks in the good parent box, though he did drop slightly across the percentile lines on the chart. But the GP we saw for his 7 week check wasn’t concerned about this, as he’d always gained a decent amount each week and hadn’t plateaued off like Andrew had by that age. Once I did get quite annoyed by a comment from a health visitor at the weighing clinic when I put him naked on the scales: “He needs to fill out a bit”…. I’m sorry? “Fill out a bit?” I think you’ll find that’s just the way he is, he’s always been long and slim, and you should take a look at his dad!!

But then Joel got a cold with a horrible cough, and thrush in his mouth, both of which meant he was less bothered about feeding, even though I tried to be proactive and offer him as much as possible all the time. He dropped a couple more percentile lines by the next time we had him weighed, which happened to be at the GP because we went back as his thrush had returned (notoriously difficult to shift in babies). This was a different GP from the one at the 7 week check, and he was more concerned; he mentioned referral to a paediatrician if he didn’t regain some percentiles. But I know my baby, and I know there’s nothing wrong with him – well, other than a bad cold and thrush, and that’s enough to make anyone feel grumpy, not eat as much and lose weight (not that he ever lost WEIGHT, just flipping percentiles!!)

It was like Joel heard what the doc said though, and the next day he hit a massive growth spurt and guzzled milk like there was no tomorrow for a few days. Thankfully for me the milk machine, it settled down again, and by the time he was weighed the following week, he’d stepped up a good amount on the chart. Not sure if I got a tick in the good parent box for that, but I felt like I’d done a good job that week at least. A couple of weigh-ins later, and we’re now back to the normal monthly weigh-ins that all babies should get (if their parents listen to the health visitor); I guess we’ve got enough ticks now.

I feel happier now that we’re under less pressure for the time being, as I don’t want this to overshadow my enjoyment of looking after my boys, which I really love. Often I find myself wondering at what age being tall and slim goes from being undesirable to desirable. According to society, babies are supposed to be chubby and adults are supposed to be slim. And why should all humans grow to the same curve? I never thought biology was that exact. Maybe my babies grow to a more step-like graph that starts off with slower weight gain than the average baby – if they are anything like me, and I believe genetics predisposes them to that, they won’t be “normal”, and what is “normal” anyway – average? Not everyone can be average, there need to be some people at either extreme from which to calculate the average.

I understand that weight can be one indicator that a baby isn’t thriving, but I really wish that our medicalised society would look at the broader picture – my babies have always been very alert and active, reaching all their milestones at least on time if not earlier than average, and have generally been very happy as far as babies go. Plus, remember what I said about nappies up there? No problems in that department at the moment! Surely these things count when assessing if a baby needs medical attention or more artificial infant milk? To be fair, not all health professionals that we have met have clung so rigidly to the chart culture, and Joel’s health visitor has genrally been very positive when she’s come round to see us – it’s more the ship-em-in-ship-em-out clinics that I’ve found so annoying.

Oh and I think we could save ourselves all the stress by just moving to the moon for the first 6 months of my baby’s life – nobody has any weight there. A rather eccentric old physics teacher of mine once told the class that if people wanted to lose weight they should just go to the moon, and that the dieting brand should really be “Mass Watchers” – not as catchy a name, I know, but more physically correct 😉

Pregnancy diary: week 30 – buggy and blood issues

Before I go any further, I should say that this post isn’t as horrific as it sounds! There’s no gore involved. Just a couple of things that happened at the end of last week that have been on my mind this week, as I think about what I can (or rather can’t) do about them.

First, I discovered last Friday that one of the back wheels on our buggy was dodgy. As I tried to push it to the supermarket, I saw that the wheel was wobbly and making the whole buggy wobble slightly as I pushed it. So I used our ‘spare’ buggy instead – a cheap secondhand stroller that we have for taking on car journeys because it folds up smaller than our usual buggy. There was no obvious reason why it should suddenly have a wobbly wheel, other than the fact that this is the third time in 18 months of use that we’ve had a problem with the back wheels. When we’ve heard back from the manufacturer about getting it fixed, I’m going to write a whole post on this, an honest review post from someone who’s used the buggy for more than a few weeks (that’s the trouble with most buggy reviews online – they are by people who’ve recently bought the product, so not much use for long-term durability experiences). So I won’t name (and shame) here.

When it’s working, I love our main buggy – it’s lightweight, easy to fold, easy to push, parent-facing or outward-facing, and fits in our small car boot (with not much room for much else). The secondhand stroller is pretty good too, but it has no parent-facing option and isn’t as easy to push as the other. But with the warrantee nearly up at 2 years after we bought the main buggy in October 2010, we’ve decided to sell it once the wheels are fixed, and get another buggy, one with more durable wheels, as the current one clearly wasn’t made to be used as often and for as long distances as we use it. I don’t see the point of a buggy that you can’t use as often as we do, but there you go; maybe living in Cambridge has warped my sense of how long is a normal distance to walk each day!

Throughout this pregnancy, our plan has been to continue using the (now read ‘a’) single buggy once the new baby is born, by carrying baby in a sling and Andrew in the buggy. I didn’t get on very well with the couple of different slings we were given when Andrew was little, for various reasons, so I didn’t use them much more than just around the house now and then, especially once he was quite heavy. But since then I’ve learned a lot more about babywearing, and I now know that there are many more slings available than the types we had, which are more comfortable to use. They’re not available in the chain high street shops selling baby products, so I’ve had to do quite a bit of internet research to come to the conclusion on what type of sling I’d like. Finally, about a month ago, I ordered the sling! However, it’s currently not available in the UK, so I have to wait until September for it to be shipped and arrive. That’s why I haven’t mentioned it on here yet – I was waiting until it arrived and could show me wearing it (potentially tricky with bump, but you’d get the idea). But as the topic has come up with the buggy issue, I’ll mention it here anyway. I’ve gone for a Moby wrap. It’s a long piece of stretchy fabric that you tie around you in a specific way that holds baby safely next to your chest. A stretchy wrap is great for newborns up to older babies, and is supposed to be a good starter wrap if you’ve never used a sling that you tie up yourself (rather than a structured one with clips) before. Below is a picture of someone else wearing it! When I saw this lace print design, I thought how pretty it looks, and so went for this design because it’s a bit more unusual than the plain colour ones and as I’m going to be wearing it a lot, I’m thinking of it like a piece of clothing.

Moby Lace wrap - worn by someone who looks like she doesn't have a baby the age of the one she's wearing! She looks far too awake and with it 😉

So the wrap for baby is sorted, but now I feel like we’re back to square one with the buggy for Andrew. By this time in pregnancy with him, we’d sorted the buggy, so I (usually so organised) feel a little uneasy about being 30 weeks pregnant and not knowing what our long-term plan about buggy is. For now I’m happy(-ish) to use the stroller with Andrew, but there will come a point at which we need to decide whether we’d like a double, or another single. I’m currently imagining two options: 1. I’m happy to carry baby in the wrap and push Andrew in the stroller until baby is big enough (about 10-12 months) to go in the stroller and Andrew is a good enough walker to use a buggy-board and walk some of the way (he’d be 2 1/2 years old by the time baby is that age, and is already a keen walker for his age); 2. I find that I’d prefer to push rather than wear baby once he/she gets to a certain weight, and by that time Andrew is not a good enough walker to reliably use a buggy-board and walk some of the way. There’s also the potential situation that I get fed up with the stroller and miss my easier to push single buggy, particularly when wearing baby in the wrap whilst pushing.

Option 1 means we wouldn’t need to get a new buggy, though possibly another single buggy (rather than stroller) if I miss the easier pushing action. Option 2 means we’d need to get a double buggy. As neither option is clear at the moment during pregnancy – because we need to wait until I actually have 2 children to walk around with to see how they develop – I can’t really do anything about this issue right now. As I said, this makes me feel a little uneasy, but we’ve come to the conclusion that it’s better in the long run to wait. Of course I can do research into single and double buggies, and believe me I already have done lots, but we can’t make the final decision until later in the year or next year. My reasons for not just going for a double straight away are that I’d like to wear baby in the early months because this will be good for my milk supply (with which I had big issues with Andrew) and good for baby (with Andrew I missed out on knowing about the benefits of holding baby so close all the time), plus we don’t have loads of room in or around our flat and, as far as my research so far tells me, double buggies are pretty big contraptions, either wide or long, and heavy, which I’m happy to avoid if we don’t have to have one.

Bump looking bigger all the time. Not sure I'd say that I feel like I'm blooming, but certainly growing!

I think that’s enough on buggies for now! The second issue I’ve been dealing with this week has been my blood. More specifically – the platelets and cholesterol in my blood. The results of my glucose tolerance test last week came back fine in that I don’t have diabetes (yay!), but it was spotted that my platelets are ‘a little lower than normal’, to quote my GP, who has asked me to return for another blood test in 2 weeks to monitor them, in case they drop any further. After some googling, I’ve discovered that this is in fact pretty common in pregnancy, although I’d never heard of it before, and didn’t have this when pregnant with Andrew. Platelets are cells in the blood which help it to clot when necessary, like, for example, if you cut yourself and bleed, the platelets help clot the blood so it stops flowing and the wound starts to heal. As far as I can see from googling, it’s quite common for pregnant mums to have a slight drop in their platelet count during pregnancy, usually the 3rd trimester. Although it’s not certain exactly why this drop happens, there are a couple of factors that may be involved: the body naturally destroys platelets and replaces them with new ones, but in pregnancy this process is sped up, so you have fewer but younger platelets in the blood; the body produces more plasma (the liquid bit of blood) when pregnant, which means there are fewer platelets per millilitre of blood, though they can still perform just as well. As far as I can tell, if they drop a lot more, I’d probably have to have a hospital birth, as I would need treatment if I lost a lot of blood if the birth was complicated or I needed a c-section. So let’s hope it’s just a slight, normal drop, and that they won’t drop any more.

Completely unrelated to pregnancy, I also had a blood test a couple of days before my glucose test, because we’ve applied for life assurance for me. The reason is that I used to have a policy through work which would pay out a large sum based on my salary if I were to die (a policy which Tom also has), but of course with leaving work soon I’ll no longer have this. It’s not exactly a nice thing to think about, but now that we have children, our concern is for them if something were to happen to us. The insurance company wanted me to have a lipid test, although when the nurse came to do it, she wondered why they had asked for this, because it’s not routine for people as young as me. Anyway, it turns out from that my cholesterol is slightly higher than normal, according to the very undetailed letter that the insurance company sent me. So of course I googled again, and lo and behold, it’s pretty common in pregnancy to have slightly raised cholesterol, because my body is producing more of the various types of fat it needs to produce for baby, to build him/her up! Annoyingly though, the insurance company said in their letter that they can’t give me life assurance based on my cholesterol as it stands, so they need to reassess in 3 months – note that they don’t refer to pregnancy anywhere, but 3 months time is when I’ll no longer be pregnant. I’m pretty suspicious now as to why they wanted me to have the test in the first place, as they knew I was pregnant from the application form. So I tried to ring the company to say that this was unfair, because it’s normal to have slightly higher cholesterol in pregnancy and that I have no history of raised cholesterol. However, the call centre agents were unable to help, and said that I should speak to my GP, who would receive the results too (they were posted on the same day as my letter), and ask them whether in their opinion this higher than normal result was purely pregnancy-related, because that would hold more weight in an appeal to the insurance underwriters than my own googling.

So…… I made a GP appointment for three days after my letter had arrived, thinking that this would be enough time to ensure that the results had arrived at the surgery. The letter from the surgery about platelets was also pretty vague, with no info about what platelets are and why a slightly low count is a potential problem, so I thought it would be a good opportunity to discuss both blood issues with a knowledgable health professional, and check that the info I was finding on websites was accurate and applicable to my personal situation. I managed to get an appointment for 11.50 – I thought I would be away from work for about half an hour or so, as the surgery is not far from my office. How wrong I was. When I turned up, the receptionist  warned me that the doctor was running ‘a little late’. It turns out she was running 45 minutes late! So I eventually went in at 12.35. I realised that she was a locum as she introduced herself. I explained about the blood tests, and asked whether it was normal to have slightly low platelets and slightly high cholesterol in pregnancy, and what the implications were in both cases.

First she tried to find the results on my profile on the system. It was clear that she had no idea how to use the system, and faffed around for a while before she decided to ring reception as she couldn’t see the ones from my insurance company. Reception talked her through where they should be on the system, but there was no trace of them there or in the post from that day. So that’s the fault of the insurance company, or Royal Mail. Sigh. Still I thought it was worth pursuing the questions of what low platelets and high cholesterol could mean for my pregnancy, because even without the exact numbers in front of her, she could still talk to me about these things, and offer me some reassurance for why I would be monitored. It was at that point that she brought up a web browser window on her computer, and typed the platelets question into Google! I honestly couldn’t believe my eyes!! I didn’t know whether to laugh, cry or say anything. In the end I just kept quiet, and luckily the phone rang again – it was reception confirming that there were no results in the post that day. The GP then said it was probably best if I came back another day to see another doctor once the results were there, and she thought baby would be hungry, so I should go and have some lunch. By this point I was totally in agreement with her – I didn’t want to waste another minute of my day in her room!! I’d already been away from my office much longer than I intended, and ended up being away for nearly 1.5 hours. No lunch break for me then – sandwiches at the desk whilst doing stats instead. I could have just stayed there all morning and googled in my lunch break instead of waiting for the GP to google for me! Incidentally, I’ve written an email with ‘feedback’ to the practice manager about my experience.

As you can see, this week has been quite eventful in one way or another, and none of the issues are particularly enjoyable, though they could be worse – just frustrating more than anything else, not knowing what will happen about the buggy, my blood clotting ability or the life assurance. On top of (or maybe because of?) all this, I’ve been feeling quite tired this week, which I know is normal for later pregnancy, as I felt similar with Andrew and it does mention it in various books/websites that I’ve read. I’m hoping that a nice 3-day weekend with my boys will take my mind off these things and give me some rest. I’ll be back again next week with another instalment of pregnancy news, one week further on the countdown to 40!

Pregnancy diary: week 24 – BOGOF on scans (except I didn’t pay a thing)

Cute little nose showing, as baby looks right at the camera 😉

It seems like ages ago that I sat in the waiting room for our (what turned out to be) 13 week scan and saw a poster asking for pregnant mums to take part in junior doctor training by having an extra scan. Now, 11 weeks later, I’ve actually had the scan. In fact I ended up having two, each on consecutive days! When I arrived for the first on Tuesday, the lady checking me in rather gingerly asked if I might possibly have time to come again later in the week. She looked quite desperate to fill the slots (I can only assume not enough people had signed up, or had cancelled last minute). So I couldn’t resist agreeing to come again – I’ve been there, done that, and bought the desperate person t-shirt myself, trying to get as many participants as possible for my PhD experiments and for the project I’m currently working on in my job. After all, I’d get to see baby again, and I knew Tom was having a random day of annual leave on the Wednesday so I could get to work earlier and take a longer lunch break for the scan. There was a small remuneration and free car parking involved (not that I used it on the second day as I was on my bike), but that wasn’t enough on its own to attract me to help out. This is the kind of thing you have to not mind giving up your time for.

Scan 1

The scans were taking place in a training suite, not at the usual maternity hospital ultrasound department. It was actually a lot easier to find than the usual place, which I still find difficult to find in the hamster maze of corridors that make up the hospital! I was greeted by the above-mentioned lady and shown to a waiting area. A short time later I was called through by a young doctor (she looked younger than me – she probably was, it’s possible, even though this makes me feel old). I was greeted in the scanning cubicle by another junior doctor, two sonographer midwives and a fetal medicine consultant (who incidentally works at the Norfolk and Norwich hospital where I was born – doubt he was there then, again he looked too young…).

After a few basic questions like how many weeks pregnant I was, the first junior doctor got on with the scanning. Her first task was to figure out what position baby was lying in (head down and back to my left side), and showed the consultant what she’d concluded using a Winnie the Pooh stuffed toy. She was right. Then came a good look at the head. They talked amongst themselves about various things, most of which I understood, even though they were tossing about names of brain parts like they were piece of fruit in a bowl: bla bla bla cerebellum, bla bla bla ventricle, bla bla bla mid-line etc. It’s times like that when I’m pleased I work in a neuroscience lab, even if I’m not a neuroscientist by training myself. She established that baby’s brain looked normal and measured the head circumference. All good.

A great view of the eyes (closed), nose and mouth

Then she moved down to the abdomen, and checked the stomach and measured its circumference, which again was normal. A small journey upwards (in baby, so downwards on me – that must be a confusing thing when learning to scan) and she checked the heart, showing its four chambers beating together nicely. Baby was in a good position for viewing the heart apparently, unlike at our 20-week scan when I had to go for a walk to try and shift him/her into place. Not that he/she stayed still you understand – there were plenty of kicks, twists and general fidgeting movements throughout the scan. Poor doctors, I thought, having to learn on such a wriggly baby. Still, if they can do one that active, they can do any!

Next she moved down to the femur (thigh bone) to measure it. At that point the sonographers advised me to look away and they turned the screen around out of my view, in case I happened to catch sight of whether baby is a boy or a girl. After the leg was successfully measured (it took several attempts as baby was moving so much), she moved on to what they were calling the ‘AFI’. It became clear from the fact that they were measuring the amniotic fluid around baby that the ‘AF’ stood for amniotic fluid, and the next day I learned that ‘I’ stood for index.

That was the end of the first doctor’s turn, and the second one took over and did exactly the same thing. By the time she was on her last measurement, after 45 minutes of lying on my back, I was starting to feel a bit lightheaded – this is quite normal in later pregnancy when you lie on your back for long periods, because baby presses down on blood vessels so restricts the blood flow. I mentioned it and they were very good, flipping me over onto my left side straight away, as this is the best position to be in for blood flow when lying down. I soon started to feel better. The next question I was not expecting….. the consultant asked me whether I was feeling well enough to lie on my back for a 3D scan! Was I well enough?! Of course!! It wasn’t like I was about to faint, and I wasn’t going to pass on a free 3D scan!

Looking upwards at perfect little fingers

So he took over, showing the doctors how to change the probe to the 3D one and scan in 3D. It was incredible. He focused on baby’s face, and the detail and definition that we could see were amazing. The pictures on here, although good, don’t show it as well as on screen, where the sepia colouring and movements seemed to give the picture an even more lifelike quality and definition. At first it felt slightly odd and freaky to be seeing my unborn baby in this much detail, but soon I was just filled with an amazing feeling of being in awe of the fact I was seeing this! Baby had one of his/her hands constantly up by the head, and this is what was captured in the pictures that the consultant printed out for me. All five of them in the cubicle agreed that this was one very cute baby. I guess they have to say that though, I mean you wouldn’t tell a pregnant mum that her baby is ugly before it’s even born.

After about 10 minutes of 3D scanning, the session came to an end and I was thanked several times, given my photos to take home, and handed some tissue to wipe the sticky gel off my tummy. What an amazing experience, I thought, and couldn’t wait to go home and show Tom, Andrew and Granny the pictures. I was also looking forward to doing it all again the next day.

A bit shy, looking down to the left, hand in front of face

Scan 2

I don’t think it would have been possible to beat the enjoyment of the first training scan, so I wasn’t bothered that the second one didn’t quite have the same ‘wow’ factor. This time I was in a cubicle with just three people – two midwives who were training to become midwife sonographers, and one midwife sonographer doing the training. I had thought it was doctor training, but it made no difference to me who they were, I just got to see baby again. Interestingly I met a male midwife for the first time; I knew they existed in small numbers, but it was nice to actually meet one in person.

Today’s trainer obviously had a very different approach to teaching compared to the trainer the day before. She was much more hands on, literally, as she was quick to grab their hand on the probe and move it how she wanted them to, whereas the consultant had done much more verbal explaining, with the odd occasion of doing it for them by directing the probe himself. She was also very talkative, and engaged more with me (than the consultant had) as well as with the trainees, who were very quiet and kept their eyes on the screen for most of it. I’m not sure whether they were just concentrating, or trying to avoid interacting with her too much, as she was very enthusiastic and keen to show them everything she knew about what they were doing. It was hilarious, being a kind of fly on the wall (OK, not quite such an inconspicuous one!) witnessing this interaction between a slightly eccentric, but eccentric in a lovely way, trainer and her trainees.

So this is baby's head on the left (the skull bone of the forehead is showing bright white), and the blob at the top right is the arm and hand near the mouth, just as in the 3D photos. In fact if you imagine looking down on this picture from the top, that's what the 3D scan was picking up.

Of course I made the mistake of warning them that I had felt a bit lightheaded towards the end of yesterday’s scan. This provoked a reaction from the trainer of constantly asking me if I was OK and turning me onto my side frequently, and also praising me several times for giving so much of my time by coming twice and repeating how grateful they all were. She said it was good for them to learn to scan a woman on her side, so I shouldn’t worry. I wasn’t worried, it wasn’t that bad, but I let this slip before I’d had chance to experience her personality.

The trainees basically did the same measurements as the ones the day before had done, so by the end I felt like I could have a good shot at measuring if I’d been given the chance (no not really, it looks incredibly difficult to scan!) Again there was lots of wriggling, but the trainer was keen to point out that this was a good experience for them. This time baby was in breech position, which helped to explain all that wriggling the evening before. I think this baby must turn around all the time, and I just hope he/she gets in to the head down position and stays there before it gets too tight on space in there.

There was no 3D scan on offer at the end this time, but the hilarity of the printer breaking down kind of made up for it! I tried to explain that it really didn’t matter if they couldn’t give me pictures today because I’d had such good ones yesterday, but the trainer, as you might have guessed, was not having this as an option. She pressed the print button several times, 11 in fact (that’s how many photos eventually spurted out when it was fixed), and fiddled about trying to get it to work, whilst making lots of noise about this technology failure, complaining that this machine wasn’t as good as the one she normally uses, and generally making a big fuss. She figured out that she could save them onto the hard-disk, and insisted that the administrator would sent them to me. But just in the nick of time, before I was about to be brave and try and leave, a technician arrived and sorted it all out using the reset button. Again I got a flood of thanks, and of course apologies for the hardware failure, and at last was on my way back to the office.

I thought I should include some of the 2D photos too in this post, given the faff of the printer failure - I feel I owe it to the midwife sonographer who was desperate that I had them!

So here we are at the end of week 24….

…and as you can see, it’s been an exciting week of seeing baby. This should be the last time we’ll see baby before he/she is born, unless there are any complications that require more scans. I’ve tried showing Andrew the 3D pictures and explaining that the baby in the picture is inside my tummy (pointing to tummy), but he looks at me as if to say ‘are you crazy Mummy?’ He’s still too young to understand, and we’re hoping that this will be a good thing when baby is born, that he’ll just accept that this is what has happened without being old enough to think about it too much.

Outside the bump - not such an interesting view as inside!

When tongue-tie is more than being stuck for words

Once again I seem to be blogging about the same topic twice in a few days (obviously not including pregnancy – the last time this happened swimming was the thing on my mind) This week it’s been breastfeeding, which I guess isn’t surprising given that I’m thinking ahead to a new baby. So, apologies if you’re not interested in hearing about breastfeeding, but here’s another thing that’s been on my mind.

We found out, the hard way, after nearly 10 weeks of Andrew struggling to gain weight as a newborn, that Andrew was born with a tongue-tie. ‘What’s that?’, you might say, or ‘I’ve heard of it – doesn’t it just mean when you’re put on the spot and can’t come up with the words to say?’ Personally I used to associate the term ‘tongue-tied’ with the (slightly geeky and cult) comedy series Red Dwarf (some of you may know what I mean; see here if you don’t!) Basically it means a tongue which is anchored to the floor of the mouth to a greater or lesser extent by a piece of skin called a frenulum. A more technical term for tongue-tie is anklyoglossia (anklyo – anchored; glossia – tongue). It is sometimes measured (roughly) as a percentage, so a 100% tongue-tie is where the frenulum goes all the way to the tip of the tongue, and in a 50% tongue-tie (for example) the frenulum goes about half way to the tip.

Example of a tongue-tie (about 80%) (yes, this is my mouth - the mouth of a breastfed baby all grown up) Note the frenulum, the thick piece of skin anchoring the tongue to the floor of the mouth behind the lower front teeth.
Example of a tongue without a tie (thanks to my lingually superior to me husband 😉 ) Note there is no frenulum anchoring the underside of the tongue to the floor of the mouth, so it is free to stick up this far.

‘What’s this got to do with breastfeeding?’, you might well ask. It shouldn’t be too hard to imagine that the physical state of the tongue can affect a baby’s sucking action, because that’s what they suck with. The problem with this for breastfeeding is that a tied tongue is unlikely to be very efficient at removing milk from the breast, and therefore the mum’s supply will suffer, because the process of breastfeeding is such that the more milk that gets removed by baby from the breast, the more the breast produces. Poor supply leads to less milk for baby, and so poor weight gain in the baby.

However, I should point out that it is not an absolute fact that all tongue-tied babies will have problems breastfeeding and gaining weight. I found out on the same day as we found out with Andrew that I have a severe tongue-tie (more severe than Andrew did), and yet I was exclusively breastfed as a baby and my mum had no major problems doing that. There are clearly many factors involved in each individual breastfeeding relationship between mum and baby, and what causes an issue in one may not cause an issue (or the same issue) in another. But my point is that tongue-tie CAN have a big effect on breastfeeding, as Andrew and I (as well as many others) can attest. For that reason, I’d like to do my bit to try and raise awareness of this.

In my experience, one of the most important places to start with raising awareness of tongue-tie is with medical professionals, believe it or not! Of course there are exceptions to every rule, and I’m sure there are doctors, midwives and health visitors who are very clued up on this, but that was not the case in our story. I won’t go into details of our tongue-tie story here, as you can read in a separate post that will follow this one, but we were wrongly advised by two GPs about what to do about tongue-tie. I understand that they are general practitioners, and so I wouldn’t expect them to know everything there is to know about tongue-tie, but I would expect them to refer us to a specialist, given the symptoms that we were displaying as a breastfeeding pair. In the case of these GPs (and others in Cambridge that I have heard about through mums having had similar experiences), the problem is their ignorance of the potential effects of tongue-tie on breastfeeding and, to some extent, ignorance of the importance of breastfeeding itself.

But it’s not really the fault of these individual medical professionals, rather a wider cultural issue resulting from the fact that breastfeeding lost its status as the norm of infant feeding to bottle feeding, though this is currently in the process of being reversed again. Tongue-tied babies can still suck a bottle teat and drink all the milk in the bottle (but they might be slower or messier than a non-tongue-tied baby). Knowledge about tongue-tie and how it potentially affects breastfeeding has dropped off the radar in the training of medical professionals, because it was not an issue for bottle fed babies. So it’s not surprising that our GPs weren’t clued up on tongue-tie – it was probably covered in just a line or two in their massive textbooks that they read once whilst cramming for exams! I read somewhere (but I can’t find it now I’ve come to write about this, so it might be an urban legend or old (mid!)wives’ tale) that midwives used to keep one of their little finger nails long and sharp so that they could inspect the baby’s tongue when it was born and sever the frenulum quickly using the nail if the tongue was tied.

Note the 'heart shape of this tied tongue - the frenulum is pulling it down in the centre when I try to lift up the tongue. Sorry for slight blur - it's actually really hard to take pictures of tongues as they are hard to keep still!

‘Wouldn’t that hurt the baby? Sounds a bit cruel to me?’, you might say. Actually in very young babies, the frenulum has little blood supply and nerve tissue, so they don’t feel much, if anything, when the frenulum is snipped. The younger the better, because as the baby grows, the more the frenulum develops blood supply and nerve tissue, and by the time you get to my age, it would be a major operation under general anaesthetic if I were to get my tongue-tie snipped (which I won’t because I don’t need to, thank you very much!) These days, when tongue tie is actually treated in babies, it’s done with a sterile pair of blunt surgical scissors, without any anaesthetic, not even local. ‘OK, that does sound cruel’, you might say. Well, it’s no more cruel than sticking a needle in their thigh for their immunisations. In fact in Andrew’s case, he cried less (loudly and long) for his tongue-tie snip than he did for any of his injections, and quickly calmed down whilst feeding from me, during which the action of sucking helped to close up the cut effectively. I’ve heard from other mums who had their baby’s tongue-tie snipped at just a few weeks old that the baby didn’t even wake up from their sleep when it was done. So overall I would say that the small amount of pain is nothing compared to the long term benefit of having an efficient tongue suck for breastfeeding, just like the short term pain of immunisations is nothing compared to the long term gain of not catching life-threatening illnesses. Both are choices that I as a parent have had to make on behalf of my child.

Look at how near the frenulum comes to the tip of the tongue! Sadly this is about as high as I can lift my tongue in my mouth when it's this far open, and I certainly can't stick it out very far at all.

With a second baby, I’m sure there are many examples of things that will be easier because we’ve encountered them before (of course there will be new things that didn’t crop up with the first too!) Tongue-tie is one thing that I will definitely be personally more aware of with our new baby than I was with Andrew. As I said, my experience of tongue-tie was once limited to a comedy series, so I can’t stand in my greenhouse and throw stones at people who don’t know about tongue-tie – I don’t fancy getting covered in smashed glass. What I do know is that this time I will be more persistent in getting specialist advice as soon as possible, because it is quite likely that this baby will also be tongue-tied to some extent, as it runs in families and mine is so bad, though thankfully Tom’s tongue is not tied at all. I will have more  knowledge myself to try and impart on anyone who is involved who does not seem to have it themselves. If we catch and snip a tongue-tie early this time, this might help to build up my supply more in the early days, and might mean I can breastfeed with less (or no) formula supplementation.

The follow-up post to this intro on tongue-tie contains the letter that I recently wrote to our GP practice, as feedback on our experience of advice on tongue-tie. I’ve anonymised it: my point is not to name and shame, as this practice is not alone in the way they deal with this condition. I thought it would be useful to share, to complete this bit on raising awareness of tongue-tie. In the meantime, I’ll leave you with a very helpful website, which (in its own words) aims to dispel the myths and reveal the facts about this little-understood condition, just in case you’re interested in finding out more: www.tonguetie.net (need I say more….)

Pregnancy diary: week 14 – hummus and med school

I promised more ramblings about pregnancy, and ramblings there shall be! Here are my baby-brained thoughts about what’s gone on in my life as a pregnant mum this week. Well the bad news is I’m still feeling very sick and tired (and also feeling very sick and tired of feeling very sick and tired). But the good news (for me) is that actually being sick seems to have stayed at low frequency for a whole week now, so I’m hoping it won’t get worse again; and the good news (for you) is that I’m not going to go on about sickness any more this week – I’m trying to be positive and boost my mood about it by writing funny tales on here.

Homemade hummus - my staple diet for week 14 of pregnancy - usually eaten in a wrap or sandwich, but shown here just with salad garnish so you can see it in all it's hummusy glory!

So my words to summarise pregnancy this week are: hummus and med school. Odd combination, I know. In fact they aren’t related at all, but both have featured prominently since I last wrote a pregnancy post. Let’s start with hummus. Or shall I be more precise and say ‘homemade’ hummus. I haven’t eaten any hot cooked food since the middle of March. I’ve been surviving on (as much as I can keep down of) things like cereals, sandwiches, crackers, salad, and selected fruits (totally gone off bananas again, as with Andrew). A few weeks ago I walked past hummus in the supermarket, and thought to myself that I quite fancied it, and it would make a nice sandwich with some salad, so I popped it in my basket. However, when I actually ate some later that day, I really did NOT like the taste of it and was almost sick (ooh sorry, I mentioned the ‘s’ word again; last time!) So I carried on with my staple sandwich filling of cheese.

Until one day last week when I decided that I hadn’t made homemade hummus for Andrew in a while, and that it would be a good thing for him to have for tea (lots of protein in the chickpeas and no salt, unlike lots of processed food that I was tempted to buy having no will or energy to prepare things myself). Tom, who is always willing to do what I ask of him at the moment (amazing man!), happily set to and followed my rather garbled instructions on how to make it. I never measure things, so my ingredients list was something like ‘chick peas, a bit of yoghurt, and a glug or 2 of olive oil’ – Tom prefers to have internationally recognised units of measurement when cooking! You just whizz them all up together in a food processor and voilà, hummus. The difference between this and the shop-bought stuff is basically no garlic or tahini paste (sesame seeds), but great for Andrew as I know exactly what’s in it. Anyway….. as I was serving some up for him, I got a blob on my hand, and without thinking I licked it off. It flashed through my mind that I wouldn’t like it right now, as I suddenly thought about my previous encounter with hummus, but that was soon followed by a feeling of ‘oooh I actually quite like that!’ So I tasted a spoonful myself and confirmed that it was definitely in the ‘foods I can currently tolerate the taste of’ category.

I liked it so much that I had a hummus wrap for tea myself that day, and the next, and the next…. in fact I’ve eaten homemade hummus for at least one meal if not two every day since the discovery. I don’t know what it is exactly about it, but somehow the combination of ingredients is perfect for my taste-buds at the moment. Maybe it was the tahini or garlic in the shop-bought stuff that was a no-no. So is this a craving? I wouldn’t go that far (yet) – I can’t say that I actively long to eat it, as I don’t really want to eat anything, I just eat out of the fact I know I need to and to some extent eating little and often helps to keep the ‘s’ word at bay during the earlier part of the day. Oh, feeling of hunger, please come back and send the feeling of nausea packing! That’s how hummus has dominated my week, and I have no inclination that this will stop any time soon.

Moving on to med school….. Don’t worry, I haven’t signed up for any more studying! I told Tom during my PhD that if I even looked like I was going to apply for any kind of course to get another degree/qualification then he had my permission to do whatever it took to stop me. But since I am a researcher, I’m always willing to help out others in their quest to find participants for research or training studies; and as we live in Cambridge, where there’s a big medical school and the teaching hospital includes a maternity unit, there’s always stuff that needs signing up to. When I went for my scan, I picked up 2 leaflets about volunteering to help medics (of the student or qualified variety).

The first was something I already took part in when I was pregnant with Andrew. It’s called ‘Preparing for Patients’, and it’s a course that all 3rd year undergrad medical students complete, in the hope that it will help them relate their theoretical work to real patients’ experiences. For this they visit a pregnant mum (and her family) in her home, twice before the birth and twice afterwards, and ask her questions about pregnancy, birth and early days with a baby. I love to talk (as if I need to point that out), and with Andrew I was happy to share my experiences in the aid of a good cause (or course! ;)) So I was keen to help out again. The only potential problem was that the leaflet was advertising for mums due between ‘November and early March’, and my due date (if you believe in such things – I don’t) is 30th October. I thought it was worth a quick email anyway, making it clear that I understood if I couldn’t be useful being due 2 days before November. Within half an hour, the course admin had emailed back saying congratulations on being the very first volunteer for this year! (That is if I didn’t mind having my antenatal visits close together right at the start of term – which I don’t.) I know I’m a keen bean for these things, but I don’t think I’ve ever been anyone’s first participant – someone’s gotta be it! They need 150 volunteers altogether, so if you’re pregnant, due November to March (well, Feb-March babies won’t have been conceived yet), and live in Cambridge or the area, why not offer your time if you can? (Disclaimer: I have not been paid/persuaded by other means to write this, it is merely a suggestion from my inner keen volunteer!)

The second thing to sign up for was an hour being ultrasound scanned by a junior doctor or two, who are training in foetal medicine. Of course they need to practice using the fancy equipment and figuring out what all the bits of a baby look like in black and white ‘magic-eye’ style! The criteria for taking part were: 1) between 11 and 32 weeks pregnant in the week beginning 9th July; 2) a singleton pregnancy; 3) a desire to help junior doctors in their training. I fit that bill nicely, and anyway it sounded like fun – mainly because it means I get to have a free scan, complete with take-home pictures, extra to the routine one at 20 weeks that I get from the NHS. I even get my parking paid, so I can travel in four-wheeled luxury (or our Corsa) rather than struggling there by bike (I won’t be brave enough to cycle with a bump, unlike many pregnant ladies in Cambridge). They’re doing this for one week only in mid July, when I’ll be 24 weeks. All I had to do was sort out childcare for Andrew (thanks, Granny), otherwise the doctors would get more than they bargained for – I can just imagine Andrew’s fascination with pressing buttons and pulling things out of holes getting the better of him, and the scan ending in technological disaster.

That brings me, finally, to the end of my ramblings about week 14 of this pregnancy. I hope you had fun reading it and will come back for more next week. Right, I’m off to get some sleep now, at the fine hour of 19.30. Night, night!