Pregnancy diary: week 38 – midwife appointment and antenatal class 3

And I’m still sitting here with a bump! I usually at least start writing this weekly post quite early in the week, as I can’t always guarantee how long I’ll get to write during Andrew’s nap later in the week, especially when I was at work and only had 3 afternoon naptimes a week. But this week I was less motivated to do that, just in case baby did decide to arrive early and it would have been a waste of time. But as there are no signs yet, I’ll give you a round-up of this week.

The worst part has been having a nasty cough, which Tom kindly passed to me after he caught it most probably at work (where the students all traipse into his office bringing in their start of term germs). It’s very frustrating not being able to take any medicine for it, particularly at night when I’d love to take something that would knock me out and make me sleep through the constant coughing. Overall in this pregnancy I’ve only had 2 cold-/cough-type ailments, which actually isn’t that bad – I remember getting about 5 when I was pregnant with Andrew, probably because my job involved being out in schools every day back then, wheres this year it’s been mainly office-based. I’ve been hoping that baby wouldn’t arrive until I’m over the cough, and I’ve been wondering whether there is some kind of internal mechanism in a pregnant body that prevents labour from starting if there’s any kind of illness present?! It would be nice to think so, but I have no idea whether this is the case.

The best part has been spending time (hours of it, mainly during nap times and some in evenings) finally making decisions on which cloth nappies to buy and where to buy them from. I’ve written about this in a separate post, to spare you all the info if you’re not into cloth nappies (unlike me – I’m hooked!), which I’ll publish when the ordered nappies arrive and I can take pictures of my lovely new acquisitions.

Apparently this bump still looks quite small for 38 weeks according to lots of people I meet who can't believe there's only just over a week until due date!

The more practical parts of this week have been my midwife appointment and third (final) antenatal class. The midwife appointment went well and overall things are fine with baby and me. My blood pressure was fine, my wee had no signs of protein, and I have no swelling of hands and feed (unlike when I was pregnant with Andrew and my wedding ring was getting tighter by now). Bump is still measuring bang on the average line of growth, and baby’s heartbeat is clear and a good fast speed. The only thing that wasn’t so good to hear was the dreaded phrase ‘back-to-back’! At my last appointment 2 weeks ago, the midwife said that baby was half-way between being front-to-back and back-to-back. She suggested some positions and movements that I could do to try and get baby in a front-to-back position, and I have been trying to do these when I can.

What’s the problem with back-to-back anyway? The so-called ‘occipital posterior’ position (or OP that’s now been recorded in my maternity notes) means baby’s back is facing my back, and this can lead to longer and more painful labour than if baby’s back is facing forwards to mum’s tummy. Having said that, it’s a generalisation, and I don’t think Andrew was in a completely ‘front-to-back’ position (the ideal) when the midwife came round for my 40 week appointment and said I was already about 3cm dilated, and he still managed to turn and be born after only 3 hours of real labour. It’s interesting when I look back and think that my instinctual desire during labour was to be on all fours – I’d heard about this position at yoga classes, but when it came to labour my body just automatically stayed in that position the whole time, I didn’t even need to think about it, it just happened! I wonder now whether that was my body’s natural way of encouraging baby to turn into a favourable position for birth. I’ll never know, but I find it fascinating how ‘animal’ labour was for me.

For now, my task is to try and get this baby to turn before I actually go into labour, to hopefully reduce the time it takes for baby to get into position during labour. This means crawling around on all fours, which can easily be incorporated into play time with Andrew who finds it hilarious, sitting backwards on hard dining chairs (leaning onto the back) instead of slumping on the sofa, kneeling on the bean bag, rolling my hips around whilst on all fours, and swimming on my front. Given how much this baby moves, it’s perfectly possible that he/she will move into front-to-back, side-to-back and back-to-back positions quite regularly on a daily basis over however long he/she has left in there. Various people who I have heard from since my appointment have told of different experiences with a back-to-back baby, some slow, some fast, some complicated, some uncomplicated, and some have even said that there baby turned into the back-to-back position during labour, despite being well positioned prior to labour, so there really is no telling what could happen. If I did have a slower labour, it might mean we actually make it to hospital rather than it happening extremely quickly at home. I do also feel as though my general level of fitness from all the walking and swimming I do will stand me in good stead for a straightforward labour, as the midwives commented on how fit I seemed, in looks and behaviour, when I gave birth to Andrew. So my overall feeling at the moment is that I would like to try my best to encourage baby to be in a good position for the start of labour, but at the end of the day, labour can be unpredictable and there’s nothing I can do about that.

Talking of labour, I’m glad that I managed to get along to the third and final antenatal class before going into labour. This class was also for the dads, so it was nice for Tom to come too and refresh his mind on supporting me during labour, birth and the early days with a baby, as well as meet some other dads who will be going through a similar experience. First we split into a mums group and a dads group; we talked about how we would like to be supported in labour, and the dads discussed how they thought they could best support us in labour – we then compared lists of points we came up with and the two groups’ lists matched pretty well.

Next, the dads had a run through what happens in labour with the teacher, to revise this like we did last week, and they also got a demonstration of various ways to wear the baby in a sling (as the teacher is a babywearing consultant). I thought it was a good idea to try and get dads interested in this, and Tom has said that I must show him how to use our new sling. Meanwhile, us mums were discussing strategies for looking after a toddler and a newborn once paternity leave is over and we ‘go solo’ with two little ones (eek!) This was a really useful exercise to share ideas, learning from others in the group as well as inputting our own ideas. Various things were suggested, but one of the main things we all thought of was that we are going to go out to groups and activities a lot earlier than we did with our first, so that the toddler is entertained whilst we can sit and feed the baby and rest a little. We also agreed that we would meet up as a group as much as possible, alternating which house we go to, so that our toddlers can play together and we can share with each other how hard things are. I feel very blessed compared to most others in the group that we’ll have quite a bit of help from family who aren’t too far away.

Then we split into small groups and discussed ways of helping to introduce smoothly a new baby to our toddlers, as well as thinking about potential issues of sibling rivalry and ways to deal with that. I found this very useful, and I feel more prepared for if and when problems arise that I need to deal with coherently. We’re still hoping that with a small age gap and that fact that Andrew is generally a very easy-going child, we won’t have too many issues, but it’s always hard to predict something like this and he may well surprise us.

Finally we came back together as a big group and went through some breathing exercises. These were one of the things that I specifically asked to cover in the class, because I’m sure my breathing in labour with Andrew was one of the reasons, along with being in the pool, that I didn’t need any pain relief drugs at all, not even gas and air. I found the handout from the birth preparation workshop we went to just before Andrew was born, and I’ve been practising the breathing techniques described on there, but it’s always good to go through these with an expert in person (the teacher is also a yoga teacher). I particularly liked the visualisation whilst breathing technique – when a contraction comes, imagine you’re on a walk up a hill, which starts off quite easy, then gets harder and harder as it gets steeper and rockier and you have to scramble up on all fours, but you finally get to the top and the view is worth the effort. I may well use this if I find it helps in labour.

As we were getting ready to leave, we talked about meeting up and one of the mums volunteered to send an email suggesting a date soon, as I’m due any day and there’s another mum who has a planned c-section date not long after my due date. It would be great to meet up and get to know each other even more than the time in the classes allowed. I’m so glad that this aspect of the classes has worked out, as that was my main reason for doing them. Who knows, maybe the dads will also have a get together or two – I’m sure they’ll be looking for ways to entertain the toddlers at weekends when they are in charge to give mummy some time with just the baby.

Having typed this kneeling upright on the beanbag, I’d better get back to some crawling and hip circling. Maybe I’ll be back next week with news of week 39 of pregnancy…. or maybe I won’t. Watch this space 🙂

Pregnancy diary: week 36 – antenatal class 1 and midwife appointment

This week saw the first of three evening sessions of antenatal classes. You may be wondering why I’m doing antenatal classes at all – I mean it’s my second baby, don’t I remember what it’s like, especially given the relatively small age gap? Well, yes, I do think I remember most things about birth and the early days, but one of the main reasons I’m doing the course is to meet other mums who are in a similar situation to me: they are having a baby when they already have (more than) one child. This course is specifically a refresher course, run by the NCT, for second-time (or subsequent-time) parents.

I was a little disappointed to miss out on attending an NCT antenatal course when I was pregnant with Andrew. Cambridge has a massive NCT branch, one of the biggest in the country, and the courses are always oversubscribed. We tried to book onto one when I was only a few months pregnant, but even by then they were mostly full, and the ones that weren’t, we knew we couldn’t make because we had a regular commitment at church on that evening or we’d already planned things for the weekends (like going to weddings) that they were on. We’d heard that they were a great way to meet a group of people who were all in the same situation, and that often NCT groups would meet up after the babies were all born, and even continue doing that every now and then for years afterwards. Of course this comes at a cost – the courses are not free – but we thought it would have been worth it, if we’d have managed to get onto one.

However, we did attend the (free) NHS ‘Parentcraft’ (!) classes that we were told about via the midwife. These were pretty good at giving us info on birth and early days, but we didn’t feel they gave us much more info than I’d read in the NHS Pregnancy book. I did attend an optional breastfeeding workshop as part of the course, but this turned out to be not particularly useful in our case, because we weren’t ‘textbook’ and they didn’t cover any of the major potential issues that you might encounter breastfeeding. The worst aspect of the course was that the group (about 12 couples) didn’t seem to want to talk and get to know each other. Maybe there were too many of us? (I think NCT groups are generally smaller than that.) Some of the couples seemed to know each other already and formed little cliques, or maybe it’s because they were of the same nationality so just spoke their language in little groups (we were the only native English speakers in the group except one other man – that’s Cambridge for you). This meant that we didn’t get that ‘social group’ outcome like we’d hoped for in an NCT class, despite trying to make conversation with a few couples – it just didn’t happen.

So when I read about the NCT refresher courses online, I decided that it was worth trying to have this experience the second time around. It helps too that all of us in the class have had the experience of a first child already, and will all be looking for ways to cope with a newborn as well as an older toddler/child. We’ll all also be off work at the same time, so we should be able to meet up pretty regularly at least in the early months. And so far, from just one 2.5 hour session, the prospect of this is looking promising. The first session was for the mums only, and I think this helped to get us all chatting and start to make friendships, as none of us knew anyone else in the room. I felt like I had things in common with these ladies, and can definitely imagine meeting up and getting on well with them. There was already a consensus that the teacher should send round our email addresses so that we can get the ball rolling on meeting up.

Apart from the social aspect, which was my main reason for attending, it was good to chat together about our previous pregnancies and birth experiences, and I got a lot of info out of others’ personal experiences as well as the teacher’s input. I felt a bit shy in telling my birth story though, because many in the room had had much more complicated and longer births than my experience with Andrew, but I hope my story was an encouragement that things can go really smoothly and quickly and it’s not all negative. I’m looking forward to next week already, when we’ll be recapping various things like breathing techniques, movements and positions for labour, and different types of birth (e.g. c-section, water birth). Then on the third week, our partners will join us for the last session. Next week I’ll actually get there on time – for some reason (baby brain is my excuse) I thought it started at 7.45pm, but as I was walking into the centre, I got a text from the teacher asking if I was OK, and as I walked into the room, slightly puzzled by the text, I realised that everyone else had obviously been there for quite a while and they’d started doing small group discussions! (The actual start time was 7.15pm.) So I sheepishly made an entrance and joined a lovely group, who welcomed me despite having to do introductions all over again. Ooops!

Still quite a high bump, but baby has dropped a little into the pelvis already.

On to the midwife appointment that I had earlier today. At my appointment 2 weeks ago, she asked again whether I’d thought more about a home birth. My answer to this was the same as it’s always been every time she’s asked (I think she’s on commission or something!) – I’d rather have a Birth Centre birth than a home birth, but I’d rather have a home birth than a car birth, if baby decides to come even quicker than Andrew did. One of my issues with a home birth is that our flat is small (think proverbial cats and swinging motions) – where would we put a birth pool for a start? So the midwife suggested that my next appointment at 36 weeks should be at home rather than the GP surgery, so she could take a look at our flat and see where things could go and what we should have prepared in case we end up staying at home. I agreed that this would be a great idea.

When she arrived, we had the inevitable conversation about the fact that Andrew had clearly grown since she last saw him – I should hope so, he was only 2 weeks old when she last saw him to discharge us from her care! After that she moved straight on to talking through the practicalities of home birth. She said that there was no problem with our flat. The fact that there’s not really room to swing a cat wasn’t an issue; in her opinion there is room to give birth to a baby. She was happy that our kitchen table is a good enough work surface for the midwives to work on, and she even said that we would just about have room for a pool if I wanted one. I don’t think I’ll bother though, because they are expensive to buy/hire, and if we’re at home it means things are happening fast and we wouldn’t have time to fill it anyway. Shower curtains are fine as plastic sheeting, so Tom’s now on the case to find some cheap ones. Other than that, we’re pretty much sorted in terms of things on the list that the midwife gave me to prepare for a home birth. It’s good that my midwife is so pro home birth, given that not all midwives are so keen these days, but I did have to remind her that this was my back-up plan, my ‘just in case’ idea. Of course she understands that if my platelets (which were tested again yesterday, so I don’t yet know the results) drop further, then home birth wouldn’t be an option anyway. It’s just nice to know that we have all bases covered.

After the home birth pep-talk, and in amongst Andrew’s attempts to charm her with various acrobatics, chatting and smiles, we moved on to the usual antenatal checks. My blood pressure and urine were fine, and baby’s heartbeat was as clear and fast as ever. Andrew was intrigued by the sound of the heartbeat on the monitor – it sounded a bit like a ‘choo-choo’ to him, and that’s one of his favourite things right now, along with aeroplanes. I still don’t think he gets what’s happening, even though I’ve tried to explain; he just laughs when I say there’s a baby in my tummy. Baby’s position is generally good, in that he/she is head down and one fifth engaged (dropped into the pelvis) already, so pretty unlikely to turn now. The midwife said it was normal for baby to have dropped slightly by now in a second pregnancy, as I was sure that Andrew hadn’t started to engage until a couple of weeks later. Bump is still measuring bang on the average line of the graph, so growth is progressing well.

The only slight issue was that this morning baby was lying slightly posteriorly – not completely ‘back-to-back’, which would potentially make labour longer and more complicated – but with its back to one side instead of pointing outwards. But the midwife reassured me that there was still time to move, and I know this baby moves a lot, so it’s perfectly possible. She also advised me to sit as upright as possible, on hard-backed chairs, no slouching on the sofa, or better still, spend lots of time on all fours wiggling my hips. I used to do this more in pregnancy with Andrew because I did yoga, so I’ve decided that I’ll start doing some of those moves in the evening when Andrew is in bed. Now I have no excuse not to be the one who clears up his toys at the end of the day, as that is basically 5-10 minutes of being on all fours!

At the end of week 36, I’m feeling very positive and I’ve enjoyed my first week (since maternity leave ended) looking after Andrew every day. I feel less tired today than I did on the Friday of the last few weeks of work. This week has also been very exciting because several family members and good friends have made exciting announcements. For example, I’m now an aunt to a lovely little niece, and my brother-in-law and his girlfriend are now engaged. My Facebook status today carried a warning: any more exciting announcements this week and it might just tip me into labour! I need a weekend to recover 🙂

Pregnancy diary: week 35 – birth plan

As yesterday was my last day at work (I’ll come back to that in a mo….), all of a sudden giving birth seems like a much more imminent event! So I thought it was about time that I write my ‘birth plan’. I thought I’d saved a copy of my birth plan for Andrew’s birth, but I have a feeling I didn’t back it up to the server (unusual for me, Little Miss Paranoid Doer of Back-ups) and annoyingly my laptop hard-drive died a few days after Andrew was born. The birth plan must be forever lost in an irretrievable gobble-ti-gook of 1s and 0s. But nevermind. I managed to find a great resource on the NHS choices website, which runs through the various points you might like to include in a birth plan. It even lets you save an online version of a birth plan that you create by ticking various multiple choice option boxes and then printing off a PDF, but I found this a little restrictive and preferred to write my own using ideas from the website.

Not much to say this week, other than it's a bump!

I’m not a massive fan of the word ‘plan’ in this context, because I don’t think labour and delivery are really things that you can ‘plan’ in the sense that I normally plan things (like what I’m doing next Monday morning at 10am, or when we will go on holiday next year, or what we’ll eat for dinner tonight, for example). Yes I have an image of what would be an ‘ideal’ birth, and actually I came pretty close to this with Andrew (lose the vomiting after the syntocinon injection and it would have been perfect), but I’m not so naive to think that there is no possibility of complications that might cause my ‘ideal’ birth to fly out the maternity hospital window. I’m optimistic that, given previous experience, the birth will go smoothly, but realistic that I have no control over the fact that it might not.

I remember when I came to write my birth plan for having Andrew that I didn’t know where to start. Although I had some ideas about what I wanted and didn’t want, I also had no idea how I would react to and cope with the pain once I was in labour, having never experienced anything like it before. So most of my points were couched in a ‘I’d like it to be as natural as possible but if I scream for drugs then please give them to me’ kind of tone. This time, of course, I know what it’s like, so I found it easier to write down what I hope for, complications and long duration notwithstanding.

This sets the scene for my birth plan, which I’ve set out below. I will print this out and keep it with my maternity notes, so that whichever midwife gets the job of helping us through labour will see it when she looks at my notes – this worked well last time, and she was keen to read what I’d written before doing much else with me. I’ve probably forgotten some important points, so if you think of anything I might like to mention, I’m all ears. Next week I have another midwife appointment, so I might have chance to go through it with her too, particularly as she’s coming to look at the flat in case of home birth necessity!

Ruth Cumming’s birth plan

This is not so much of a ‘plan’, because I’m not sure you can really ‘plan’ labour and birth, but rather it’s a list of things that I would like and not like to happen, if at all possible.

Location

My preferred place of birth is in the Rosie Birth Centre, because I had my son at the former MLBU, and I liked the relaxed atmosphere and received excellent care from the midwives, who helped me but did not take over.

However, if baby comes even faster than my son did (which was pretty fast), I may decide that I’d rather stay at home, because I’d rather not risk being in advanced labour in the car – I’d rather have a ‘home birth’ than a ‘car birth’!

Of course if there are complications, I understand that going up to the delivery unit in the main Rosie hospital would be necessary.

My birth partner is Tom, my husband, and I would like him with me at all times during labour, no matter what happens.

Labour and delivery

I would like to be in a birth pool during active labour (another reason for choosing the Birth Centre); this helped me a lot for my first labour.

If possible I would like to deliver the baby in the water. Last time the midwife could tell that being in the water was relaxing me too much and she was concerned that I wasn’t pushing as hard as I could during the final stage in there, so she suggested I got out for delivery. She was right, because I gave birth within minutes of getting out, as I pushed much harder ‘on land’. If this happens again, I’m not against getting out of the water if necessary, but would rather have a water birth if possible.

Last time I used a birthing stool for the final pushes – this worked well and I would like it again if ‘on land’.

I am happy for baby’s heartbeat to be monitored like it was last time – with a detached probe device every now and then, i.e. I’m not constantly hooked up to a machine so I can move around freely.

I will move around during labour before the pool is ready, and get into positions that I find most comfortable at each point. This could include getting on all fours (possibly on the bed) and walking around. But I hope to spend most of the time in the pool.

I hope to deliver in the water, squatting or upright in some other way, or if I’m on land, squatting on a birthing stool worked well last time. I do not want to be on my back, lying down or completely horizontal in any way.

If I am in the water for delivery, I would like to pick baby up myself from the water, and sit there skin to skin for a while until I feel I’d like to get out.

If I am on land for delivery, baby should be delivered straight onto my tummy, without being cleaned, so that we can have skin to skin time. This worked well for my son, and he latched on for a breastfeed almost straight away. I would like this to happen again if possible.

I would like the midwife to cut the cord (Tom is not particularly keen to do this).

I do not mind if there are trainee midwives in the room.

Possible drugs/interventions

For pain relief, I would like to try and use just natural methodsbreathing, movements, and the water of the pool. This worked for my first labour and I didn’t need any drugs.

However, if labour goes on for a lot longer than my first labour, I may decide on other pain relief methods. Gas and air would be my first choice. I didn’t find a TENS machine helpful last time, so I won’t try it again.

I would prefer not to have an epidural, but I can see that if I’ve been in pain for several hours and I’m exhausted, that this would be something I would consider and would want to be given if I decided on having it.

I had a 2nd degree tear with my son, so I’m prepared that this might happen again. I’d rather not have an episiotomy if at all possible, but would consider it if the midwife thinks it is necessary if baby was in trouble.

I would rather not have an assisted delivery with forceps or ventuose. But if baby was in trouble and therefore it was advisable to have these interventions, I would consider them.

After my son was born I opted to have the syntocinon injection, but in a reaction to this drug I vomited several times and felt nauseous for about 6 hours after the birth. I would rather not have the syntocinon injection this time, but if the midwife thinks it is necessary because I am bleeding a lot (and I know I’ve had a slightly low platelet count that might not help the situation), I am prepared to have the injection. I would like Tom to be able to stay for as long as possible after the birth this time if I am feeling sick.

I would like my baby to have the vitamin K injection or oral drops.

Breastfeeding

I am going to breastfeed and this is extremely important to me. I struggled with breastfeeding my son in the early weeks, but eventually got on track with it and have continued to feed him until now – I plan to tandem breastfeed if he still wants to continue after the baby’s birth.

So I would like my baby to stay close to me at all times and not be swaddled – I would like to remain in skin to skin contact for several hours after the birth, so that baby can feed off and on whilst lying on me.

If complications arise and I need to be separated from him/her, I would like Tom to be able to have skin to skin with baby whilst I am out of action. I would like baby to be brought to me as soon as possible if we are separated, and have help with positioning baby on me for feeding if I am in pain from a difficult delivery (e.g. c-section).

Pregnancy diary: week 34 – midwife appointment and baby/toddler transport finally sorted!

Really starting to stick out now, and I'm definitely feeling shorter on space inside 🙂

There’s something about 34 weeks that all of a sudden makes it sound like we’re nearly there. I think it’s because I’m thinking of it as 6 weeks to go, and 6 weeks doesn’t sound that far off, though of course I know it could be anywhere between 3 and 8 weeks, and the nearer end of that range, just 3 weeks, sounds incredibly close! This week involved a midwife appointment (my last was at 29 weeks). According to the NHS Pregnancy book, at this appointment my midwife should: give me info about preparing for labour, including how to recognise active labour, ways of coping with pain in labour and developing my birth plan; measure the size of my uterus; measure my blood pressure; and test my urine for protein.

She did the latter points in this list, and all is fine – no signs of high blood pressure or protein-filled wee, and bump is still bang on the average line for size at this stage in pregnancy (it’s nice to think we’re ‘normal’ in some way at least 😉 ). Baby is also currently the right way up (or down I should say – head down), so that’s positive, though of course he/she still has time to move, but hopefully not. We didn’t talk specifically about labour, though I presume she thinks it’s not necessary to tell a second-time mum about these things, and I agree, I can certainly remember how I recognised active labour – it blimming well started to hurt a lot more all of a sudden! I came across the handout from the work preparation workshop that Tom and I attended, run by the lady who did the antenatal yoga classes I went to with Andrew as a bump. It went through the various natural techniques for coping with pain, like breathing and movements, and I know that these definitely helped me last time. Unfortunately, because the lady has recently had another baby herself (fancy that!), she doesn’t offer antenatal yoga classes anymore, which I would go to if she did, but she does do one-to-one sessions for birth prep still, so I’m thinking of booking her for one, as I believe that was money well spent last time and would like a refresher session to remind me exactly what to do.

Anyway, back to the midwife…. she did, however, talk about home birth (AGAIN!! – Tom reckons she’s on commission or something the amount she’s gone on about it in my appointments). I told her my thoughts are still the same, i.e. plan to go to the Birth Centre, but if it all happens quickly and smoothly then stay at home. She sounded pleased and said that in that case, she would do my 36 week appointment at home so that she could assess the flat and help us by going through what we need to prepare. This sounds like a good idea to me, as I need to ask her some questions that arose from the home birth leaflet I read, like do we have a big enough work surface and what kind of plastic sheeting is good (a friend suggested old shower curtains, which sounds good to me, but the home birth leaflet I have talks about ‘non-slip’ sheeting). So I’m looking forward to that appointment, to get things clearer in my head about what would happen if I decided to stay at home. I also can’t believe that I’ll only have one routine midwife appointment after that, at 38 weeks; only if baby stayed in until 41 weeks would I get another appointment to sort out induction (hopefully it won’t come to that).

I also wanted to talk to her about the results of my last blood test; this was an extra one due to my slightly low platelet count and slightly high cholesterol level, which I wrote about at 30 weeks. I received a letter in the post from the doctor last week, but it was very vague and didn’t tell me anything other than she wanted me to have another test in a month’s time. I guessed from this that neither the platelets nor the cholesterol are a big issue, otherwise they would let me know, but still I’d rather talk these things through with someone, not just rely on assumption from a vague letter! And I was right, there’s nothing to worry about in terms of platelets. My first count at 28 weeks was 129 (thousand per ml of blood), and three weeks later at 31 weeks it was 130; the normal range is 150 and above. The fact that it hasn’t dropped further is great, and the midwife said that as long as it stays above 100, I’d still be allowed to have a Birth Centre or home birth. That’s good news. Annoyingly the cholesterol issue is still in the air, because for some reason (admin error I presume) a glucose test was done instead of a lipid test on my fasting blood sample. So if I want to pursue that, I’ll have to have another fasting blood test and hammer home to them that it’s a lipid test! On the plus side, my fasting glucose was completely normal, so that’s another check to say I definitely don’t have gestational diabetes.

Things other than the midwife appointment that the NHS pregnancy book mentions for week 34 of pregnancy are: make arrangements for where you will give birth, including childcare for any children you already have; ask about tours of maternity facilities for birth; think about who you’d like with you in labour; get your bag ready; attend antenatal classes now if you’re doing them; you may feel Braxton Hicks contractions (tightenings that aren’t painful); you may feel quite tired so make sure you get plenty of rest. Well I think I’ve got most of that covered, including the tiredness! I know where I’d like to give birth if possible – the Birth Centre – and handily I got to have a sneak preview tour of the brand new building a couple of months ago as part of my role as Editor for our local NCT branch magazine. We have a few options for childcare for Andrew – Tom’s mum is coming for half-term week, which is the week before baby is due, so if he/she arrives early, Grandma can toddler-sit whilst we go to the hospital. If baby doesn’t arrive in that week, Andrew’s Godmum has kindly offered to come round when we need to go into hospital – she lives about 10 minutes away – and my parents will be prepared to come and take over when needed – they live about an hour and a half away (in good traffic). Like last time, I’m only planning on having Tom with me during labour (and of course the midwives!); I got so ‘in the zone’ when giving birth to Andrew that, to be honest, I didn’t really notice who was there with me! Regular readers will know that I got my hospital bag ready last week. We have a refresher antenatal class booked for three weeks in October, the last night of which is quite close to due date, but it was either that or do the course in July, and I didn’t want to forget it all by October. We’re doing the course not so much for the info about birth (I think I can remember what that was like and how I got through it), but more to make friends with others who are also expanding their families – it’s a course specifically for expectant parents who also already have a child or children.

Me and Manfred in the Moby 😉 (Manfred is the name he came with on his label.) I love the feel and look of this gorgeous fabric and can't wait to wear baby in the wrap. It's of course tricky to get it fitting right at the moment because bump is in the way, so I know the horizontal length of fabric should be higher than it is here, but bump sticks out too far!

To finish with, I’ll just mention that we made a decision on the baby/toddler transport situation for now. We’ve bought a second-hand single buggy, a Bugaboo Cameleon, which has great reviews for being robust, and we’re in the process of preparing our iCandy Cherry for selling. I’ve already used the Bugaboo this week and I’m really impressed with how easy it is to push and manoeuvre, as this was my main issue with our compact stroller that we leave folded in the car. I can imagine that it will be easy to push when I have baby in the sling too, as it just glides in front of me really. Andrew loves it too, especially because he can climb in and out on his own. I’ve been practising with the new Moby wrap for baby that arrived last week, and it feels so comfortable with a (weighted) teddy in compared to the slings I used with Andrew as a baby. So I feel like we’re sorted for now. That’s not to say that I’m ruling out the possibility of a double buggy when baby is bigger. But Bugaboos seem to keep their secondhand selling price pretty high (though we got a real bargain, thanks to my mum’s hawk eye on eBay 😉 ), so we could sell it later and get a double if necessary, or if we only need a double occasionally, I’m sure we can pick up a cheap bargain double that folds small enough to not take up too much room in our flat as well as keeping the single. As I mentioned before, I’ve almost finished writing a post about how unimpressed we are with our iCandy buggy, but I’m not going to post it until I feel the time is right in terms of our complaint process.

Next week I think I should write about (or indeed just write) my birth plan. And next week is my last week at work, so I think after that it’ll really start to feel like baby could come soon. Having sorted out all of Andrew’s newborn and older baby clothes this week, and got various bits of equipment like the baby carseat and rocker chair down from Mum and Dad’s loft, I do feel much more organised and prepared for when baby decides to arrive. Exciting times 🙂

Pregnancy diary: week 29 – midwife appointment and glucose tolerance test

After our lovely holiday, it’s been hard to get back into the reality of everyday life this week. I felt like I had a good rest, but I guess going back to work and having to do all the usual stuff around the flat have been difficult because I had a nice week without them. I think this is probably partly due to being pregnant, and being more tired than usual anyway. Some people talk about ‘blooming’ in these weeks (about 20-30), but I can’t really say that I feel like I’m blooming. ‘Growing’, yes, but ‘blooming’ suggests something much more positive to me. Not that I want to give the impression that it’s awful being pregnant, it’s just that I don’t think I’m enjoying it as much as some mums say they do. Now that I’m generally not feeling too sick (just in the evenings before bed when I’m really tired, and when I smell food cooking), things are a lot better than before 20 weeks. But still I get tired, I think mainly due to having a toddler to run around after, because I’m sure I feel more tired this time than last!

As I said last week, I was supposed to have a 28-week appointment with the midwife and have my glucose tolerance test last week, but this was impossible as we were a few hundred miles away! So I had these appointments a week late – not that it has to be so precise anyway. You might be wondering what a glucose tolerance test (GTT) is. In our area, all pregnant mums are offered a GTT at about 28 weeks of pregnancy. As far as I can see from some googling, it’s not the same in all parts of the country – in some areas, only ‘at-risk’ mums are tested. At risk of what though? A GTT is used to diagnose gestational diabetes, by checking how your body regulates its blood sugar (glucose) level. Gestational diabetes results when a pregnant mum’s pancreas doesn’t produce enough of the hormone insulin to properly regulate her blood sugar level, when it needs to produce extra to the normal amount once the baby is growing rapidly in the second trimester. If it is left undiagnosed or untreated, both mum and baby are more at risk of complications, a major one being that baby can grow very large and this can cause problems with a natural birth. The condition is usually treated by managing the mum’s diet (including eating less sugar), or, in some cases, insulin injections.

Even if I wasn’t offered this test routinely, I’d probably be offered it anyway, as I have a family history of diabetes. My dad has had diabetes since he was 30, and my mum had gestational diabetes. Thankfully, this is the only factor of increased likelihood of gestational diabetes that I have. Others include: a BMI of over 30; previously given birth to a large baby (9.9 lbs or more); previously had gestational diabetes; family origin with a higher prevalence of diabetes, e.g. South Asian, Middle Eastern, African-Caribbean.

This test is slightly more complicated than the other routine blood tests that I had in early pregnancy. It involved drinking 273ml (precisely!) of Lucozade, and then waiting 1 hour without eating or drinking anything (except water). After this hour, the nurse took a sample of my blood in the usual way (vein in the arm) and sent it off to be analysed. I’m pretty sure this is only the second time in my life that I’ve drunk Lucozade! The first was my GTT when pregnant with Andrew. I can’t stand sweet drinks, and it wasn’t a particularly pleasant experience having to drink it all in one go. But I managed it, and hopefully I won’t have to do it again in this pregnancy.

Wearing my new, very comfy trousers that I got for my birthday. Bump looks like it's growing more week by week now.

Conveniently, I managed to get the nurse appointment for the blood test directly before my midwife appointment. According to the NHS ‘Pregnancy’ book, my midwife should do the following at this check-up: use a tape to measure the size of my uterus; measure my blood pressure and test my urine for protein; offer more blood screening tests; offer my first anti-D treatment if my blood type is rhesus negative. As my blood type is rhesus positive, the last one wasn’t applicable, and also I don’t think I or baby are particularly at risk of other conditions or complications that would be screened for, so I wasn’t offered any more screening tests. The midwife did measure my bump – 28cm, which is bang on the average size for 29 weeks, according to the graph that’s in my notes (I love a good graph, as you’ve probably seen from previous posts). Whilst I was lying on the examination table she also used a little machine to listen to baby’s heartbeat (a probe a bit like the ultrasound scans, but sound only, not pictures), which was 150 beats per minute – that might sound fast, but it’s a good healthy speed for a baby in the womb. My blood pressure and urine were also fine.

We had a chat about various general things, like how I’m feeling and what life is like at the moment being pregnant, working and looking after a toddler. I guess it’s the midwife’s job to tell me to rest whenever I can, but still be active enough. I’d like to think I’m getting a good balance where possible! The topic of where I’d like to give birth also came up, again. She seems very keen on home births. I can understand that as my first labour, which took place in a midwfie-led birth centre rather than the main maternity hospital, was pretty fast and uncomplicated, I’m a good candidate for a home birth this time. I’m still not entirely sold on this prospect, but as I said to her, my current thinking is that I’ll plan to go into the birth centre again, but if it looks like baby is coming even faster than last time, I would probably prefer to stay at home, because I’d rather have a home birth than a ‘car birth’! She gave me a leaflet on home birth, and when I get chance, I’ll sit down and read it properly – from a quick glance I can see that it tells us the kind of things we would need to prepare. Once I’ve thought more about this properly, I’ll write a post about where I’m planning to give birth.

I think that’s covered what my antenatal care was like this week. The next time I see the midwife should be at 34 weeks, so not so much of a big gap between appointments once we’re in the third trimester. Incidentally, just something else I read in the NHS ‘Pregnancy’ book for this stage in pregnancy: it says that if I have young children already, it’s good to talk to them around now about the new baby. I think Andrew is still too young to understand what is going on. I’ve tried to explain to him that there’s a baby in my tummy, even with the 3D photos that we got from the extra scan. But even if he understands the concept, which I’m not sure that he does, I don’t think there’s much I can do to prepare him for what it’s like to live with a newborn baby. There are only 18 months between me and my brother (there’ll be 21 between Andrew and baby), and my parents said that I was too young to really understand what was going on, and I just sort of accepted my brother because I wasn’t old enough to think or do anything much different. I’m hoping this smallish gap will result in the same acceptance for Andrew.

I can’t believe that next week we’ll have reached the big 3-0! That really makes it sound like we’re on the homeward straight. Also, with only 6 weeks left at work, I’m starting to realise that our time as just the three of us is coming to an end, and I’m getting more and more excited about meeting our new addition 🙂

Pregnancy diary: week 25 – what is baby upto?

As we’re approaching the end of the second trimester (where did that trimester go?! ….the first seemed longer!), I thought I’d do a bit of research into what baby is upto at the moment in terms of growth and development at this stage of pregnancy. I say ‘research’ – this consists of me reading the NHS ‘Pregnancy’ book (for the first time in ages) and a few other pregnancy websites. I used to follow Andrew’s progress in pregnancy much more regularly, as I found it interesting to know what was going on inside me at each stage, but this time I’ve had fewer opportunities to catch up with where we’re at.

So, apparently I should really look pregnant now. Check. Apparently I may also feel hungrier…. I feel less nauseous, does that count? I can’t say that I’ve really got a sense of ‘hunger’ back. In the morning and afternoon, I do feel more like eating for the taste of the food itself rather than because I know I have to (though still no smelly cooking allowed in the flat), but the evenings are still not great. Still, I’m generally feeling much better than in early pregnancy 🙂 Both the ‘looking more pregnant’ and ‘feeling hungrier’ things are of course to do with baby starting to grow more quickly per week than in the earlier weeks which involved a lot of laying the foundations of growth. The BBC pregnancy calendar tells me to make sure I eat well and put my feet up when I can because my body is working hard. Bless it, it clearly doesn’t know I have a toddler to look after! Feet up is a thing reserved for evenings, when I just lie horizontal anyway.

Apparently baby is moving around ‘vigorously’ now. Check – definitely! That’s a good word to describe it actually. He/she also responds to touch and sound, and a loud noise close by make make him/her jump and kick. That’s definitely the case, like when my tummy was being prodded and poked in various ways for the scans I had last week, baby moved in reaction to touch, and when we’re in church, baby is always very active during and after the worship sessions (which feature drums, keyboards, guitars, and of course my singing).  Daddy and Andrew are also starting to get reactions out of baby, either intentionally in the case of Tom talking to the bump or unintentionally in the case of Andrew boofing the bump as he feeds or plays with me. It’s amazing to think that baby is starting to experience bits of family life even in the womb.

Looking bumpy! This is the last time I wore these trousers - when I took them off I discovered a rip right over my bottom! Apologies to anyone who saw me that day, whenever it happened. Nobody was brave enough to tell me though. Although they weren't particularly tight, they were wearing very thin across the bottom, and I did brush past a bike handle that day whilst locking my bike up and trying to get out of the space between my bike and the next (bike racks weren't designed for big or pregnant people!), so I think it must have torn then.

Something that I can’t say whether it’s happening from the outside is that apparently baby is swallowing small amounts of amniotic fluid and passing tiny amounts of urine back into the fluid. That doesn’t sound particularly nice, but it’s a good thing I guess to get the system used to working before it has to do it ‘for real’ once baby is out in the real world of being unattached to me through the umbilical cord. Baby may also get hiccups; I haven’t felt this yet, but I do remember Andrew getting hiccups quite a lot in the womb (and, incidentally, I know now that frequent hiccups in a newborn can be a sign of tongue-tie….) By now baby is covered in a greasy substance called vernix, which is thought to be there to protect the skin as it floats in the amniotic fluid. The skin isn’t as tough as it will be at birth as it’s still developing – this is why premature babies often look redder than full-term babies who have their natural skin pigment colour. The vernix mostly disappears before birth, but I do remember Andrew having some bits left on his back when he was born.

It may be that baby starts to follow a pattern for waking and sleeping. I haven’t noticed this yet, but then I’m not sure I will without really paying attention and making notes, because I’m so busy doing everything else that I don’t really think about when exactly I feel kicks or not. I do know that I would notice if I suddenly felt far fewer kicks over the course of a day though, and this is something I would need to contact my midwife or GP about. Apparently it’s quite common that baby sleeps more in the day when mum is up and about, and then decides to wake up and wriggle as she is slowing down and going to sleep herself. I don’t remember this being a particular problem with Andrew; I think I just slept well generally in pregnancy, until the end when I was so big and then felt him moving a lot all the time! Let’s hope this will be the case this time too 🙂

At this stage of pregnancy, it’s relatively easy to pick up baby’s heartbeat with a stethoscope or ultrasound probe. As this is my second baby, I don’t get a midwife appointment this week as I did with Andrew, so I don’t get to hear that amazing sound of the heart beating on the ultrasound machine. I’ll have to wait until 28 weeks for that pleasure. Apparently it won’t be long before Tom (or anyone else who’s invited to get that close to bump!) can possibly hear the heartbeat just by putting his ear to my tummy, but only if baby is in the right position. I don’t hold out a lot of hope for that!

With most of baby’s vital organs now developed and in place, most of the work left to do is just increasing everything in size. Baby is basically an even mini-er version of what he/she will be when born in about 15 weeks. The brain and nervous system are still getting there, however, and are developing intensely around this time. Although the brain needs to reach a certain level of development in order for baby to survive outside of the womb, it doesn’t stop developing at birth. In fact baby’s brain will continue to change as he/she experiences things in the world right throughout childhood and into adulthood. This is what happens as we learn new things – the brain makes new connections within itself, and is constantly doing this in the first years of life. Fascinating!

So as you can see, that’s a lot of stuff going on with baby right now, some of which I’m aware of from the outside by observing his/her reactions, and some of which isn’t obvious but is interesting to think about and imagine going on inside me. Next week sees us counting down to 30, in more ways than one, as I’ll be 26 weeks pregnant and celebrating my 20-something-th birthday 😉

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!

Breastfeeding support: accurate info, practical help, listening ears

I am absolutely convinced that every mum needs support if she is going to reach her breastfeeding goals. Breastfeeding involves many factors (physical, hormonal, emotional, social, psychological etc.) that come together to create the unique journey of a breastfeeding pair comprised of mum and baby; the same mum can even have a completely different experience with two (or more) different children. Sometimes these factors create a very favourable situation, making the breastfeeding journey relatively straightforward, but in other cases these factors cause issues that make the journey a very difficult one.

The mums who do have a difficult time obviously need support, and I’ll come on to where you can find this in a moment. But even those who have no major issues need a certain amount of (perhaps subtle, in the background) support in the form of, for example, a helpful partner and/or family who understand why breastfeeding is important and how it works. As a society, we can all give moral support to all breastfeeding mums by making them feel welcome and normal in public places, not making them feel self-conscious and like they have to hide away. This is one of the most fundamental ways of supporting breastfeeding mums in general.

But on an individual level, what if you do encounter problems? What can you do about it, and where can you go to get support? The first thing to remember is that you are not alone – many mums experience issues ranging from relatively minor/temporary/easily fixable problems to more overwhelming/long term/unbearable problems. The second thing to remember is that there are sources of support out there, even though you might have to be quite pro-active in searching them out at a time when you’re already feeling exhausted. Our experience of breastfeeding could have been a lot worse and a lot shorter if we had not been lucky enough to find the right support at (more or less) the right time. I see breastfeeding support as encompassing three different aspects: accurate information, practical help, and listening to emotions.

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The obvious place you might think to look for support would be your midwife and/or health visitor. In our experience they were mixed in how helpful they were, and I know that this very much depends on the individuals and how much breastfeeding-specific training they have had and how recently they completed it. I gave birth in a midwife-led birth centre, and it was a very positive and empowering (as is currently the buzz word in birthing) experience. I cannot fault the support of the midwives there to get breastfeeding off to a good start: they allowed me to have a completely natural birth with no pain relief except a pool; Andrew was delivered straight onto my tummy and breastfed almost straight away by latching on of his own accord; we were not hurried onto the post-natal bay and were allowed lots of skin-to-skin time; they checked on us a lot during the night after he was born, constantly asking if I needed help with feeding, and even suggested I wake him after he’d slept so long without a feed – this was really important to stimulate my milk supply.

But we were only in hospital for about 12 hours after the birth. The problems came when I went home and we were in the care of my community midwife. She was (unfortunately) on annual leave during Andrew’s first week. Of course everyone needs a holiday and I’m not complaining about that, but when we rang her team because we were concerned that feeding wasn’t going well, we did not get the support we needed. Later that week he was admitted to hospital with dehydration and significant weight loss, and I felt let down by the community midwife team care.

When we came out of hospital the second time, and I was trying my hardest to give breastfeeding a go as well as continuing the formula supplements that the paediatricians had started, my community midwife told me that I should only keep him on the breast for 20 minutes at a time every three hours and then top-up with a bottle, to give my breasts time to ‘fill up’ again. At the time I believed her, but having read more about how breastfeeding works from La Leche League (LLL) resources, I know that this is rubbish! Breast milk is constantly being produced as soon as some leaves the breast – it’s more like a continuous stream than a bucket you have to fill, then empty, and then wait for it to fill again before taking any more out. Our health visitor wasn’t much better – with her it wasn’t so much the inaccuracy of her advice rather the lack of her visits. She came a couple of times, checked I was in a fit state to look after my baby, and then left us to get on with it. I could have made the effort to ring her, but by that time I had started to get support from my local LLL group and thought that was much more worthwhile than keeping in touch with a busy health visitor – these mums had time for me whenever I wanted advice (more on this in a moment).

However, the most crucial support we received in the first week was from the infant feeding specialist midwife at the hospital when we were on the paediatric ward. Looking back, it was, ironically, good that we went back into hospital. She introduced us to the SNS (at-breast supplementer that I talked about in my last post). Without this way of supplementing, with Andrew still getting as much breast milk as I was able to produce, I don’t think we’d still be breastfeeding today. This midwife’s support was helpful and, most importantly, she gave us accurate information.

So the moral of the story with health professionals is, in our experience, don’t be afraid to question their authority and seek a second opinion – in many cases their training on breastfeeding is very basic and often out-dated because it does not feature prominently in current training (even for midwives and health visitors). If you’re anything other than a perfect textbook case, you might find they give, out of ignorance, inaccurate or downright misleading information.

As I just mentioned, I got amazing support from my local LLL group. This is an international organisation represented in many countries across the world. In Great Britain there are groups who meet in various cities, towns and villages across the country. The mission of LLL is ‘to help mothers worldwide to breastfeed through mother-to-mother support, encouragement, information, and education, and to promote a better understanding of breastfeeding as an important element in the healthy development of the baby and mother.’ This is exactly what I found when I went to my first coffee morning, after I was lucky enough to meet one of the volunteer leaders at a breastfeeding drop-in clinic who encouraged me to come along as she knew I was struggling.

A flyer for our local LLL group, with lists of meeting and coffee morning dates inside, hanging on our notice board so I know where to meet each week 🙂

From what I’ve heard said by others, breastfeeding support organisations like this and others (e.g. NCT) in the UK can be seen as an exclusive group of well-off ladies who bang on about ‘breast is best’ and look down on those who feed their babies formula without persevering through difficulties. In my experience, nothing is further from the truth! I took formula (in the SNS) to meetings and was not shunned; I’ve seen mums take bottles to meetings and were not shunned. In fact it is mums like me that are made to feel particularly welcome, because mums at LLL meetings who have overcome problems themselves know exactly how it feels to be under all the different pressures and prejudices associated with how you feed your baby. All these mums wanted to do was help me in how I chose to feed my baby, by giving me accurate information, practical help and a genuinely interested listening ear when I was in floods of tears. At no point did I think that I would have been thought less of in that group for bottle feeding Andrew. Now they are some of my most respected mummy friends. I always look forward to seeing them once a week for continued support now that we’ve overcome our initial breastfeeding struggles and are into the toddler feeding stage, which comes with its own difficulties, such as the judgement from others that it’s not normal (it is normal – I’ll write more about this next week).

So the moral of the story with breastfeeding support groups is don’t be afraid to go – whatever your circumstances, your age, your income, your background, your breastfeeding journey (or lack of) so far, there will be other mums who would feel privileged to be able to help you in the way you need it most to meet your breastfeeding goals. It’s not just LLL groups (that’s what I had access to here in Cambridge); there are all sorts of other local groups run by mums for mums. Other organisations with such groups are the NCT and the ABM. Children’s Centres are a good place to look for these groups, as many of them meet there, or have links with the centres who put their leaflets/posters out. A google search would probably bring up a few hits in your local area. Or your midwife or health visitor might be only too pleased to pass on information about such groups if they are rushed off their feet with a huge caseload!

Last, but not least, I could not write a post about breastfeeding support without giving pride of place to Daddy and grandparents. I definitely could not have got through the hard times without Tom, my amazing husband. He has done everything possible to support me whilst breastfeeding, including practical help like making sure I had drink and food in the early weeks when I was constantly feeding, and emotional support by being my person to cry on at any time of day or night (he got very wet in the early weeks!) and making it clear to me every step of the way that he would be behind me 110% with whatever decision I made about feeding, whether I chose to persevere with breastfeeding or switch to bottle feeding. He never pressurised me either way, and has found many ways to help me and bond with Andrew without doing the feeding, for example bath time has always been Daddy and Andrew time. He understands how breastfeeding works (mainly from how much I rabbit on about what I’ve read about breastfeeding!) and is happy that I still feed Andrew now at 16 months – he knows it’s a natural thing because he sees on a daily basis how much Andrew and I get out of it. He also knows that I am now very passionate about sharing our experience of breastfeeding and supporting others, and doesn’t complain when I talk at him about it in the evening after a hard day at work 😉 Basically, Daddy is the best! He’s the most important source of support that I had and still have for breastfeeding.

Daddy with Andrew (aged 6 months)

But if your baby’s dad isn’t around for whatever reason, there’s no reason why you can’t have another person, for example your mum or another family member or close friend, to be that rock of support. I am also blessed to have very supportive parents who have been behind my decision to breastfeed despite tough struggles every step of the way. I guess they know me so well that they know there’s no point getting in the way when I’m determined to do something. In the early days and weeks they helped by doing lots of practical stuff for us, like housework, shopping and cooking, and they still do these things when they come to visit every few weeks on average. They too understand how breastfeeding works – it helps that my mum breastfed my brother and me at a time when there was much less support for it than there is now. This was particularly important in the early days: they weren’t the kind of family members who would come round and insist on constantly cuddling baby and questioning when I knew he wanted feeding; instead they of course enjoyed cuddles, but respected that I was the primary person who Andrew needed access to, to stimulate my milk supply and feed him as much as necessary. They knew that doing the housework themselves was more helpful than taking Andrew off my hands so that I could do it. Having people around you who understand these things is very important. Support is only helpful if it’s the right kind of support.

Granny and Grandad with Andrew (aged 14 months)

I hope that this post based on our experience of support for breastfeeding has been informative. Why not hop over to some other blogs and read about other sources of support that mums have found helpful? There are some links below, and more on the main website, where you can also find out more about the Keep Britain Breastfeeding Scavenger Hunt 2012. Don’t forget to enter the competition below to have a chance of winning the grand prize.

Breastfeeding in England – Breastfeeding support groups

Mama Geek – Breastfeeding Support – Why it’s important and where to find it!

My gorgeous boys – Breastfeeding: Where to get support

Breast 4 babies – Ten Things My Midwife or Health Visitor Never Told Me About Breastfeeding

Diary of the Milkshake Mummy –  Together everyone achieves more

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Pregnancy diary: week 16 – it’s all about the ‘M’s – midwife & maternity clothes

The last time I saw a midwife (excluding the sonographer variety at the hospital for the scans) I was only about 7 weeks pregnant. It was a bit of a polava, because the community midwife at our surgery was off sick on the day I had booked to go, so I ended up having to see another midwife at a drop-in clinic in a local children’s centre about a week later. She was very nice, though got confused with dating the pregnancy as she didn’t seem to listen to my explanations about how I know my own body better than she did – cycles and all that. But the 13-week scan sorted out that minor blip. So this drop-in visit meant I didn’t get to meet my community midwife until 9 weeks later, at my 16-week routine appointment this week.

According to the pregnancy guide from the NHS that we were given at the start of Andrew’s pregnancy, at this appointment the midwife should: review, discuss and record the results of any screening tests I had; measure my blood pressure and test my urine for protein; give me info on the 20-week anomaly scan; let me listen to the baby’s heartbeat using an ultrasound detector. Well, she ticked all the boxes, and we did all that stuff. It was particularly lovely to hear baby’s heartbeat so clearly. When the probe was first put on my tummy all you could hear was whooshing noises, but pretty quickly she moved it to the right position to pick up a very fast little heartbeat – fast is good for such a little heart by the way! Then this was interrupted quite a few times by a crackling sound, which the midwife informed me was baby moving around. Great, I thought, we’ve got another wriggler on our hands! Andrew was exactly the same – never stayed still for scans or heartbeat monitoring, or just in general every day living in fact. This is a good thing; it’s reassuring to know he/she is healthy. It just makes me tired even thinking about what it’s going to be like with two active toddlers – fun but tiring 🙂

Anyway, it turns out I had already met my midwife before, as she was the same community midwife whom I saw when pregnant with Andrew. I thought this might be the case, but I also thought that they might swap around within their team between surgeries or change to being based at the hospital or something. But as I’d had very good antenatal care with this midwife, I was happy to see her friendly face again. (I wasn’t too impressed with her breastfeeding advice post-natally, but now I know where to go for useful advice and help, this doesn’t concern me too much.) We also talked about where I’m thinking of giving birth. I should probably write a whole post on that at some point, so I won’t go into detail here. She was good at her job in that she reminded me of the option of home birth, given how uncomplicated and fast labour was with Andrew, but respected my explanation of why it probably wasn’t for me and didn’t try to persuade me otherwise.

As the appointment drew to a close, she told me that my next routine appointment wasn’t until 28 weeks. This seems like ages away, but apparently I get fewer routine appointments as I did last time because this is my second pregnancy, and it seems like they think you’re a pro at it by now! Of course I can always ring up if I have any problems, but I imagine that time will fly by and it’ll be July before we know it.

I was thinking of taking a photo to illustrate the fact that I'm wearing maternity clothes (see below for ramblings about that), but then thought that it would be interesting to take a picture of the bump each week to see how it's changing, so I got Tom to take one focusing on the middle part of my body. As you can see there's not much of a bump at the moment, but it's more comfortable in these nice and stretchy black maternity trousers, and the grey of the maternity jumper, with room for expanding bump, matches my sea bands very nicely 😉

Apart from this midwife visit, the other event of note in my pregnancy diary this week has been the extraction of maternity clothes from storage and entry into wardrobe! My bump isn’t really that noticeable yet – maybe it is to those who know me, but to the average person on the street I probably just look like I’ve eaten a few too many chocolate bars 😉 I’ve just begun to notice that my clothes (bottoms really) are getting a little tighter, and as I’m still feeling sick (not bad going to get this far in the post without mentioning the ‘s’ word I think), it’s nice to have something a little looser and stretchier around my tummy/hips region. Plus we had Granny help on Tuesday this week, so I took advantage of 10 minutes of that time to do the removal from storage and exchange with some of the clothes from my non-maternity wardrobe.

Although this pregnancy is at a slightly earlier point in the year relative to the last one, I reckon I’ll be fine with the clothes I had before. I didn’t get that many, and managed to wear some looser fitting non-maternity clothes, mainly jumpers, cardigans and empire-line tops. I probably won’t need my coat as much this time (well, who knows with the current state of the weather, but if we actually get some semblance of summer, I shouldn’t need it for as long this time). Last time I deliberately went for layers, so I could, for example, wear a t-shirt or vest under another top or a short-sleeved dress in colder weather. This should work well this time too.

So that’s my round up of the ‘M’-related week of pregnancy that I’ve had. Just to chuck a bit of linguistics in before I leave you, did you know that the word ‘midwife’ comes from Old Engllish mid ‘with’ wife ‘woman’? Unsurprisingly this describes someone (usually another woman, though not always) who is trained to be with and help a woman in the process of labour and birth. I know that next week’s post is also going to talk about a word beginning with ‘M’, which I could have talked about this week, but I’ve already rambled on enough, so I’ll keep you guessing…. any guesses anyone?! 🙂

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….)