Are London Maternity Services Really That Bad?

Chris turned my eye to this article in Wednesday’s Evening Standard that showcases the inadequacies of London’s maternity services for birth and suggests growing numbers of average pregnant ladies (i.e. non “new age hippies”) now resort to DIY home births for fear of over-medicalized hospital births.

It’s a long, rambling article so to summarize:

• Mothers do not get one on one care: Soaring birth rates, a shortage of trained midwives and clinical-minded, controlling consultants result in a lack of support and choice for women (particularly older mothers). 
• The Association for Improvements in Maternity Services (AIMS) claims London has some of the most interventionist hospitals in Britain.
• A recent investigation by the Conservatives found that more than four in 10 NHS hospitals have refused to accept expectant mothers at least once last year.
• Labour’s women-centric vision of childbirth featuring choice and continuity of care have fallen down; parenting charity the NCT claims just over 7% of women in the capital give birth how and where they want.

Wow. On this basis, I’m shocked that we haven’t seen a mass exodus of pregnant women from the capital. Maybe they are all just giving birth at home instead?

I’m no “new age hippie” but I did plan for a home birth, decide to be a natural birthing warrior and criticize the ambiguity around the closure of the home birth providing Albany Midwifery Unit, cited in this article.

Yet I still feel that there is a huge middle ground between a completely natural home birth overseen by an attentive midwife and a completely medicalized and/or clinical hospital birth with little aftercare and support. This article oscillates between the two extremes. I think that’s a bit misleading.

My birth plan didn’t go to plan: I ran overdue and requested daily monitoring rather than induction; was finally induced at 2 weeks 5 days post dd when my blood pressure spiked; I had some “medical intervention” at the hands of a consultant when LLC’s heart rate fluctuated during birth. Yet I delivered a healthy baby; I felt the midwives and doctors considered my wishes; sure, they could have spent a bit more time post-birth helping me learn to breastfeed but overall, I couldn’t fault my care.

I have met many other new mums whose birth plans have not played out in reality (it seems they rarely do), who have some complaints but overall had a positive birth experience. Yet our voice is glaringly absent from this article. Not to mention the voice of the many women that prefer to give birth in a hospital and have no interest in home birth.

The article shows little discretion for how women can proactively improve their birth experience. Women must ask questions and be their own advocate when it comes to maternity care. If I hadn’t asked for daily monitoring, I would have been induced as a matter of course at 42 weeks. I learned in retrospect I could have given birth in a neighboring mid-wife led birthing unit if I had requested this even though this option was not offered to me. There are definite gaps in ante-natal service choice and information, all the more reason why women must ask or they won’t get.

The article also courts political drama. The Conservative report that women have been turned away from certain maternity units is a problem, but would it not be worse if maternity wards took women into care with no staff to accommodate them?

There may be truth in many of this article’s assertions. The issues run deep and I'm not belittling the problems that exist. But does it take it too far? Are London maternity services really that dire? Have you given birth in the capital and if so, what was your experience?

The Good Doctor, the Madwife and My Second Home

I feel like the hospital has become my second home. And I like my home better. On the way to my daily monitoring appointments, Chris and I scheme about what £5 purchase we can make in the Sainsburys (big supermarket for those in the US) next to the hospital in order to get our £2 parking lot fee refunded.

But then you’re spending £5 rather than £2, you ask? My math skills haven’t totally gone out the window (they were there to start with but never mind) – we decided to pare down our weekly shop so we could continue our purchases throughout the week and not throw away £2 a day on parking fees. You can see we put a lot of thought into this; our days are all too exciting.

Why do we park in Sainsburys in the first place? It’s impossible to get parked in the hospital lot and the minimum, non-refundable fee is £2 for a space. I think it’s out of order, but local government loves pay-and-display (i.e. metered parking) and there’s no break for the sick, stressed or weary.

We chose daily monitoring, however, so who am I to complain? (Even though I just did). But anyway...

The little lady appears to be thriving from her daily monitoring “trace.” Over the weekend when we were monitored on the labor ward, one of the resident doctors, aka the good doctor, decided to perform a 3D scan (sonogram) for us as a spur of the moment thing. He confirmed that all looked well with baby, had a thorough chat about our decision to hold off on induction for now, and also referred me for a full growth scan in radiology, which I was originally told was not an option. I had that second scan today.  It confirmed that the little lady is active, a healthy size with normal placenta flow and amniotic fluid levels.

Knowing that she is thriving supports our decision that nature will take its course when she's ready. I’m more uncomfortable by the day, I have lots of pressure down there, I have frequent Braxton Hicks – all signs things are moving in the right direction. Still, with each day that goes by I am conscious that I don't want to leave her in there too long.... I am booked to meet my consultant doctor for the first time tomorrow (the attending of the good doctor that I saw over the weekend), so it will be interesting to see what he says after seeing me, the scans and baby’s trace.

The good doctor again showed me that not all doctors are keen to push a strictly medical policy route. I am impressed with this aspect of my pre-natal care, as I suspected I would face more push back for policy’s sake. I haven’t. Perhaps many wouldn’t ask for monitoring in the first place, but I have, and I’m grateful that I've been supported and reviewed as an individual case.

The madwife (that’s how she introduced herself to us – haha, not really that funny) proved the one fly in the ointment of my waiting game of late. Buxom and matronly, she busted into my appointment room and interrupted my scan by the good doctor by spouting off a number of frightening statistics about post-date stillborns, crystallized placentas and over-baked babies. I may be hormonal and emotional but her bedside manner really left a lot to be desired.

Hello woman, you just don’t say that! The real kicker is I’m not even sure why she came into my appointment room in the first place since she left after this diatribe of gloom and never returned. She may have been following up for another midwife who took baby’s trace earlier – I’m not sure.

I’ve read up on post-date risks and the other midwives and doctors I’ve seen of late have discussed them with me. I may stick to my guns but I’m all ears to the medical professionals when they speak objectively and relevantly as they’ve all done but for this tactless scare-mongering madwife.

I bit my tongue during her speech but it was pretty off-putting. Its best that I didn’t see her again as I’m not sure my pregnancy hormones would have remained at bay for one more dose of her medicine!

Going against the grain

Like a hesitant child, I dangle my feet in midair off the side of the hospital bed and feel slightly out of my depth. I’m not a child though; I’m 42 weeks pregnant and in keeping with my decision to go with the flow, am at the hospital for my first session of daily fetal monitoring.

I slowly take in the whir of unfamiliar bleeps, pulses and machinery and hope that I’m doing the right thing. I hope when they hook me up their not going to detect something is awry with baby, who thus far appears good as gold, just a bit too comfortable in her uterine home. I hope that maybe I’ll give birth tonight and this henceforth daily process will be restricted to today.

The midwife approaches and straps me up to two sensors; one records the little lady’s heartbeat, one records my uterine activity. I hope you’re okay with this little lady….and hmmm, I wonder if it might pick up the increased cramping and Braxton Hicks-like tightening I’ve been getting? 

I try to read my book but find my eyes keep straying to the monitor, which is printing out my “trace.” When I think trace I think CSI. Man, my mind is all over the shop. Chris has joined me for this appointment and pops his head around the bed to see how I am and to have a look at the monitor. The little lady gives me a kick; it’s comforting to hear her continual heartbeat thump thumping away.

Half an hour later, the midwife reviews my trace and confirms that I appear to have a very active and contented little baby. She also confirms that I’m having regular uterine contraction-like activity, which has got to be a positive sign. I’ll need to come in for monitoring over the weekend on the labor ward. She reminds me to phone in if I feel any decline in fetal movement, but she says all looks well.

Chris and I leave – we managed to get in and out within an hour – score! I’m on my way home for more bouncing on my ball rather than remaining in the hospital for an induction just because I’ve hit the 42 week mark.

I must reiterate that I’m not opposed to induction but have read it can be distressing for baby, particularly if my body isn’t ripe and ready for birth. We’ll have to assess our situation day by day, but I feel confident that we’ve made the right decision.

The further post date I go, the more it will play at my mind that the time is ticking, that my placenta may no longer be optimal and that maybe I should just book the induction. Still I don’t believe that because I’ve now hit 42 weeks that my body will suddenly morph into an inhospitable home for baby. This is why I’ve opted for monitoring, so we can check up on her day by day and hopefully give my body a few extra days to break up her tea party so she’ll come out and meet us.

Going with the Flow

I may feel a bit more uncomfortable by day (maybe this is a good sign??) but my mantra this week is to just "go with the flow."  I'm ignoring that I'm almost two weeks past my due date.  In a moment of weakness I asked myself if my body is hormonally defunct and not programed for birth, but then I got a grip and reminded myself that all pregnant women are designed to give birth eventually and besides being ridiculous, it was presumptuous to consider myself a special exception.  I'm not nuts, I promise you...

I've been pretty successful at not dwelling on when it's all going to kick off this week, but at the same time have done a few more things to encourage the little lady to flow on out of me.  These include:

• Another curry with Chris - we are taking advantage of our "only us" time while trying to spice up my system.  This meal - a Madras main - was spicier and tastier than the Rogan dish I had last week.
• I ate another pineapple - yum, I do love pineapple
• I went for induction acupuncture - I visited a therapist highly recommended by my yoga teacher in hopes of opening up channels of energy within....I'd never been for acupuncture and don't really understand the science behind it, but I did find the session relaxing, soothing and pleasant.  I could barely see/feel the needles, even when the therapist stimulated them throughout the session.  He explained that his induction technique is more stimulative and less relaxing than other forms of acupuncture, but he was very gentle all the same and no part of the procedure was uncomfortable.
• I went for a second membrane sweep - again, this was more uncomfortable than painful, and generated similar symptoms to my last sweep.  Unfortunately there didn't appear to be many changes down below - baby's head is engaged but not fully, cervix is soft but posterior - but the midwife said she did a thorough sweep and that things could change quickly once my body decides it's ready for birth.
  
• I busted out my high heeled boots for walking - I've been walking a lot but reverted to flats as pregnancy progressed.  With all the snow and ice of late, any type of heel was out of the question.  But now that the roads are clear, I decided some extra clunking and thumping a la heels might combine with gravity to suit my "baby please drop down further in my pelvis" purposes.  
• My butt is totally the shape of my Pilates, now birthing ball - if I'm sitting at home, I'm on that ball.  I may not have used the ball for years but with the amount of time I've clocked on it recently, it is totally worth the investment!
  

Though the NHS policy is to induce labor by 42 weeks, following my midwife sweep today I spoke with the doctor at hospital who agreed that as all appears well with baby/me, I can delay induction provided I come in for daily, 45 minute fetal monitoring.  That means if I don't give birth by Friday, I begin the monitoring. If the monitoring shows all is well, I can continue down this route until I give birth or decide to be induced.  The midwife/doctor answered my questions and listened to my thoughts objectively. 

Maybe something will shift before Friday, but if not I'm going to give my body and baby a few more days to go with the flow before deciding in favor of induction.

Sweep, Sweep, Sweep but Still No Peep

I had my first membrane sweep today – I say first because I’m booked in for a second on Wednesday of next week. Maybe I won’t need that, but from today’s prognosis it appears that labor is not yet directly around the corner for me. As you can imagine, this was not the news I was hoping for. Let’s hope that appearances are deceiving in this instance!

Without going into TMI overload, as of this morning my cervix was still posterior and it took three attempts for a midwife to reach it to perform the sweep (though one midwife said her short fingers didn’t help the situation). On a positive note, it was also very soft and cooperative once the sweep got underway. I didn’t find the procedure painful; more uncomfortable but I never imagined that a midwife rummaging in my inners would feel like a treat.

Following the procedure I had a some show (also positive) and was sent home with instructions to eat more curry and pineapple, to bounce on my ball, walk but not tire myself and to have sex. The midwives are not shy and retiring – they tell it like it is.

I’m trying to keep my chin up. I would have loved to hear that I looked ripe and ready for labor imminently, but it sounds like I’m moving in the right direction so I need to focus on that.

I have one more week on the NHS to attempt a home birth.  Though I'd like to do this, I've always prepared myself that this plan might not come off.  What I'm struggling with more is that once I hit 42 weeks the standard NHS procedure is to induce labor.  I'm not looking to fight medical advice, but if all is well with baby at that time I can't help wondering if that's an indication that my body isn't ready.  My first priority is to bring our daughter into the world safely and I would not turn a blind eye to induction in the case of any health concerns for baby/me. Yet if all appears well, the push to induce "just because you are two weeks past your due date" when due dates are known to be a faulty science frustrates me.

I don't know if I sound like I'm losing site of the bigger picture....it's just after preparing to attempt labor as naturally as possible, induction means using intervention to kick off the very event and that's not something that appeals to me.  But we'll cross that bridge if I come to it and hopefully I won't.  As of now I am grateful that all is well with our little one.  Come on out baby - we want to meet you!

Rear Views can be Deceiving

In tribute to Baby of Dirty Dancing, “I am now carrying a watermelon.” Yes I am.

Yesterday the midwife said the not-so-little melon appears to be dropping in my pelvis but probably has more progress to make from the position of her heartbeat. She told me all looked well and to go away and chill out. I’m trying.

Since gravity is my friend and I’m trying to stay as active as possible, I took advantage of today’s bright sunny morning to do my power walk around the neighbourhood. The cool air felt refreshing, helped clear my head and gave me an extra spring in my step.

Then, to top off my “see-saw up” mood came a cat call and honk from....can you guess...no other than a young guy in white van! I was pleased for such attention with a tiny bump at 17 weeks pregnant so you can imagine my delight at this late-pregnancy honk. I’m not sure whether I took more pleasure in the compliment on my rear view or the look that must have crossed that dude’s face when he kept driving and caught a glimpse my watermelon! I bet that was priceless.

Is it sad that I am excited to still be deemed worthy of cat calls by men in white vans? Probably, but I’ll take what I can get now. Chris says I’m still attractive but he’s my husband and that’s his job :)

I’m Off to see the Midwife, the Wonderful Midwife of Oz….

Okay, it’s not the Wonderful Midwife of Oz….it’s my Wonderful Midwife of London who I’m hoping will tell me the little lady is nicely engaged and will be making her out of womb appearance shortly!

I’m 39 weeks pregnant. I’m starting to feel more uncomfortable. I feel like a beached whale in bed – it really is easier to turn over by flipping on all fours instead of hauling the weight of my body from side to side. I have a sketchy stomach, possibly a sign that things may kick off soon though this could be wishful thinking on my part.

I’m also getting lots of pressure down below, though the baby is still managing to kickbox like a prize fighter under my bust line. Chris and I have taken to watching my belly ripple in waves on a daily basis. I guess she feels cramped too.

Here’s my week 39 picture, taken in the last moments of 2009 before bed. We stayed up for the strike of midnight but we were in bed, worn out by but a game of scrabble.

So I’m hoping Midwife L, who has been extremely supportive to me throughout my pregnancy and who I haven't seen for two weeks (in the US by this stage I'd be having weekly checkups but here in the UK they are bi-weekly) may be able to offer some words of solace and confirmation of progress. Keep your fingers crossed please.

My Hectic Chill

Are most women swimming at the gym at nearly 39 weeks pregnant? Are most still plodding away, slow but steady, on the cross trainer or taking power walks on the beach? Do many subject themselves to one last pre-baby retail therapy session involving Ikea, John Lewis, Sainsburys and horrendous traffic in torrential rain during half term in the week after Christmas? Maybe so….I expect more often not….but I am not most pregnant women but just little old active me and this is my hectic chill in the run up to my “last” week of pregnancy. Hear me roar!

If you’re shaking your head and thinking I should slow down, I don’t feel like I’m wearing myself into the ground. Plus, I just had a lot of rejuvenating down time with family over Christmas. If you’re of the similar “I can’t sit at home alone all day, especially when everyone is telling me make the most of my last week pre-baby before my life changes forever” then you may have a sympathetic hug to offer.

Since going on maternity leave I’ve made time to put my feet up in front of day-time TV but there is only so much Come Dine With Me that a person can take. I can’t stand Jeremy Kyle and Loose Women is just not my thing.  I expect it's a whole different ball game when you have other little ones to tend to, but I don't and it has been an adjustment not to get up for work each morning when the daily grind was all I knew.

I’ve done nesting. Maybe I’m still nesting. Chris says I’m always cleaning at the best of times, and I’ve tidied the house, washed the baby clothes, cleaned out cabinets, rearranged drawers. But there is only so much nesting I can do before I go stir crazy and need to get out of the house. Plus, with all this rain and mud what’s the point of mopping a floor as clean as a dinner plate only to have some inevitable muck tracked in next time someone emerges from outside, even if they do take their shoes off? Plus, I keep hearing once the baby comes I’ll have no time to clean my house so why set an extra anally high bar of cleanliness now?

Don't get me wrong.  I'm thankful for the time I've had to get organized for our little lady.  I'm grateful to be able to lay in bed past 7am and sit down when I need to.  But I'm still, in the words of Chris and in my usual on-the-go style, actively moving and using. Swimming and shopping; walking and errand running; reading and Internet browsing; preventing my days alone from dragging or my mind from idling over “Is she coming, is this it?” through this home stretch of pregnancy.

Pregnancy Courts Debate

Pregnancy is smitten by debate. Pregnancy is a sucker for debate. Pregnancy just can’t get enough of debate.

And that’s usually okay with me, for as pregnancy courts debate I am encouraged to think laterally and broaden my perspective. Only occasionally when the debate in question concerns copious baby retail options (i.e. what are the relative merits of baby mattress types?....gag me and fast!) or the sweeping scythe of the nanny state do I want to bang my head against a wall and renounce all deliberation as painful and/or confusing and/or insane.

Today debate was so “hot to trot” that pregnancy managed to finagle two dates. I’d like to share the details and my take:

Debate #1: A Council in Wales hands out pink badges to heavily pregnant ladies so they can bag favourable parking spaces. An online news blogger decries this as yet another policy that will be abused. 

My father-in-law brought my attention this afternoon’s BBC Radio 2 report. I can’t find anything in print on this story, so please let me know if you can. Without more information it’s hard to pass judgement, but my gut instinct is that walking an extra 50 extra feet might do a pregnant woman good. Badges like this most likely would be abused unless monitored, which I don’t see as the best use of Council resources.

Debate #2: Are Doula’s “helping hands or stepping on toes?” The BBC today reports anaesthetist Dr Abhijoy Chakladar’s view that the increasing trend of women hiring doulas (birth assistants that offer emotional support before, during labour and postnatally) is a side effect of lapses in midwifery care that often hinders clinical decisions by disturbing the relationship between the mother and medical team.
 
I beg your pardon? My understanding is that doulas offer mothers and their birthing partners emotional support and encouragement in preparation for and through birth, as well as during the early days of parenthood. Doulas are not medically trained and unlike midwives, are not responsible for the physical care of the woman through her birth. While it’s important that doulas don’t overstep this boundary (and perhaps some do), to suggest that their presence upsets the clinical side of birth wreaks of practitioner speak to me! Many women hire doulas to develop firm emotional support and coping strategies that help them approach labor as naturally as possible and don’t want a clinical birth. Doulas should not be berated for helping women participate actively in their birthing experience - having said that, should medical care be needed, it is not their place to argue with practitioners but to support their client through whatever shape the birthing experience takes.

Dads in the Delivery Room: Delightful or Disastrous?

Today the BBC brings to light French obstetrician Michel Ordent’s view that dads should NOT be in the delivery room during the birth of their children as they are likely to be more of a hindrance than a help in the birthing process. The French doc shuns the notion championed by US doctor Robert Bradley that a husband’s presence during labor provides his wife with much needed support and solidarity. He even suggests that an anxious male partner will make a women tenser and increase her likelihood of ending up with an emergency Caesarean section!

Oh ye of little faith Dr Ordent! While not all men want to be present at the birth of junior (celeb chef Gordon Ramsay for example) there are loads out there who want to actively participate in the life changing experience that is birth to the extent that they can. And although the c-section rate has risen over the last several decades, this is more likely a side effect of our increasingly litigious and medicalized society that features older moms and women who struggle with obesity.

On Babyworld, midwife Catharine Parker-Little suggests that women talk openly with their partners during pregnancy to gauge their true opinions about attending the birth - and not to lay on a guilt trip if they decline. I couldn’t agree more. Rather than make sweeping generalizations about whether men should be in delivery rooms, we need to talk it out with our guys. Do they want to be there? If so, do they want to be down “the business end?” If not, who can better offer moms support?

Chris can’t wait to be there for the birth of our daughter – look at him with Rico – he’s a natural! But since I’m one to lay things on the table, we’ve had the birthing “talk” to different degrees over the course of my pregnancy. I’ve tried to condition him to the idea that he’ll see me in pain, that we’ll both ride an emotional rollercoaster, that he may be subjected to some grim and gore like blood, poop, placenta and stitches.

Yesterday we went to our NHS Labor and Birth ante-natal class that featured a short film showing a labouring woman taking gas and air on a birthing ball. Afterwards one of the husbands admitted that the image made him feel nauseous, and that he was “going to take some quiet times to come to terms with all that labor may entail.” We shared a laugh about this, but props to that guy and his wife for preparing for birth as a unit. He might decide to attend his child’s birth, he might not, but they were in the learning together.

From our chats, Chris is on board and prepared to be my labor partner, coach, advocate and rock. He hopes to cut the cord and be as active a participant as possible, partly why we’ve opted to attempt a home birth.

Tonight we had our first couples NCT class, which also featured the first stage of labor, including the need for a woman to relax and let her oxytocin (hormone of “love” that causes uterine contractions) flow while in labor. As a birth partner, the man is instrumental to this process; if he gets in a flap, it’s likely to kick off his wife’s adrenaline, which counteracts oxytocin production and slows labor. I hope Chris is by my side throughout labor, but learning like this helps us both recognize that it depends how he feels in the moment and if he’s able to give off positive energy in the face of his own apprehensions. If it all gets too much and he needs a breather, we accept that.

So Dr Ordent, you can take your study and shove it! Whether a dad is a birth partner should be an individual choice – not a given but not ruled out either. It’s up to couples to do their research and make the best decision for them.

Pineapple Anyone?!

Oh wait, sorry, you can't have any pineapple because it's in my belly or rather, my uterus.  That's right folks, this week our hefty little one should be weighing in at just over 4 lbs and is about the size of a pineapple.  My spirits raised that my 33 week fruit comparison is one that I enjoy so much; then they dipped a bit when I started picturing myself birthing something the size of a pineapple - and I still have 7 weeks to go if I'm on time!

Here's my 33 week photo - as you can see, bump is blooming more than ever.  I'm experiencing a lot of movement right below breast level.  These must be kicks since she is now in a cephalic, or head down, position according to my midwife at my appointment this afternoon.  This is the preferred position for birth so let's hope that she chills out and stays that way so she can engage in my pelvis with greater ease over the coming weeks.  Fortunately the more she fattens out, the harder it will be for her to shift.

I witnessed an example of how this "pelvic engagement" works at my first NCT ante-natal class this morning a la doll in sample pelvis so this is fresh in my mind as I write.  There are six other girls in my class and I can tell already that I'm going to enjoy them - even though I knew I was not the only one with a million questions, it is comforting, fun and supportive to chat with others at a similar stage of pregnancy in our area.  This morning was women only session and everyone was lovely; next week we have our second meeting and the guys come on board!  Classes like this and more intimate/grim pregnancy chat come a bit more naturally to women in my opinion so it will be interesting to see how all the men fare!  Hopefully Chris will not have the urge to laugh like he did at our home birth talk.

My missions for progress this coming week - start to wash her clothes in non-biological powder for sensitive baby skin (I only just learned that you are not supposed to use biological powder to start with) and pack them away in our newly acquired baby drawer unit and secondly to stop bumping into things.  I'm used to be able to squeeze through tight spaces and I just can't do it anymore without jostling someone or something with my bump!

The Doctor Says the H1N1 Flu Vaccine Decision is Mine

I decided to see the doctor to discuss my H1N1 aka swine flu vaccine dilemma.  I made the appointment on Monday, and by the time this morning arrived I felt fairly decided that I would NOT get the vaccine.  If I'd already had our baby, maybe I would, to be on the safe side.  But as she's inside me and the potential side effects of this vaccine are still unknown, I just don't feel comfortable taking the plunge.  Although I have not always seen eye to eye with my doctor (see running in pregnancy advice), I do respect his opinions and advice.

He explained that it was my decision as to whether to get the H1N1 vaccine; he also seemed to understand my concerns with taking it.  Although the official government health advice is for pregnant women to get the vaccine, I appreciated that he considered my personal situation and did not push the medical solution.  Don't get me wrong; he didn't advise me not to take the vaccine but instead didn't press me to take it.  

If his expertise and assessment of me indicated disproportionate risk, I expect he would have given different advice.  This has sealed the deal for me; I will not be getting the H1N1 vaccine (unless I have a major change of circumstance or change of heart).

I did have a hot water and lemon when I returned home from the surgery....just to be on the safe, un-vaccinated side.....

Up to My Eyes in Hormones

Rightly or wrongly, women are often accused of being overly hormonal, particularly at that certain time of the month.  I don't think that I usually suffer from any serious PMS symptoms but now that I'm pregnant, I'm constantly reminded that the influx of hormones raging through my body may turn me into a weeping, wacky wild woman or a clumsy oaf with heartburn, stretch marks and varicose veins.

Please join me in knocking HARD on wood that I haven't yet fallen victim to these unfortunate "badges of pregnancy" aside from my dear, occasional moments of madness.  Saying that, last weekend my right eye was really bothering me.  It wasn't red, swollen, bloodshot or giving me double vision but just prone to random bouts of sensitivity where it would suddenly burn and then spontaneously start to tear.  I didn't know what the deal was and ironically didn't even consider that this new ailment could be linked to those fateful pregnancy hormones until I stumbled upon dry eye syndrome in my pregnancy newsletter.  My sporadic tearing had ceased by then - it stopped as suddenly as it started - but it looks like those pregnancy hormones were yet again making themselves known.

I'm now 30 weeks pregnant and our daughter is the size of a cabbage, weighing in at about 3 pounds!  It's hard for me to imagine that I now have a real, nearly developed baby in my belly and that in about 10 weeks she'll arrive here with us.  This may be what we've been working towards and waiting for but it's still mind boggling all the same.  Chris and I still have plenty prepare and take on board during this home stretch but ultimately we are ready and know the real learning will begin when she is here with us.  I'm excited!

Our great friends T&D just spent the weekend with us and it's been a fabulous, relaxed couple of days.  I will share 30 week pictures tomorrow.

Fruit Photo Credit: Babycenter.com

Let's Talk Therapy

Running late, Chris and I stumble into a cozy living room full of unfamiliar faces. The lighting is soft and comforting and there are cookies on the table. The atmosphere isn’t quite strained but not entirely comfortable either. There is an expectant vibe in the air.

We take our places on the sofa with a sheepish smile and an apology. Smiles and nods abound. Have we been transported into a comedy sitcom? No. Have we arrived for a group therapy session? No again. We’re attending the monthly NCT home birth talk in our area.

By now you probably know I’m interested in exploring home birth and I learned about this class from my area NCT bulletin board. Hosted by a woman who has had 1) a planned home birth that transferred to the hospital, 2) home birth and 3) planned hospital birth, it promised to be an informative and open forum from someone who has been there done that.

I’ve swayed back and forth on the merits of home birth, my main concern being that something may not go to plan that could harm our baby. This has been a major sticking point for Chris, who wasn’t at all convinced by this potential plan. I also had the impression that women often consider home birth for later pregnancies once they have a better understanding of how they will cope in labor and birth. So the pendulum swings between reservations and opportunity, though recently I am moving in favour of going for it. Once got over the somehow amusing shock that we were sitting in a session such as this, we both came away feeling encouraged about home birth for the following reasons:

• UK hospital midwives may care for up to 5 women simultaneously; at home birth you have one dedicated midwife who monitors you throughout established labor
• Hospital transfers can be quickly arranged for any home birth not proceeding as planned; in fact, because of your one to one supervision at home it’s more likely that a midwife will identify any issues “sooner” than she might in the hospital
• If being at home makes you feel more relaxed and at ease, this is likely to speed up and progress your labor, all in the interest and health of the baby
• If more relaxed, there is less chance you will need medical interventions during birth; if you do, the midwife is able to perform an episiotomy, use forceps and give you an injection to deliver the placenta at home
• Home birth is conducive to natural forms of pain relief: TENS, water birth, upright positions and gas and air (no epidurals)
• If you decide you can't cope with labor at home, a hospital transfer can be immediately arranged
• At home your husband/partner may feel less of a spare wheel and better able to get involved by virtue of it being your own home
• After birth there is no risk that your husband/partner will be dismissed from the post-natal hospital ward because it’s outside visiting hours
• Should any sudden, horrible, unfortunate incident occur, it is just as likely to happen in the hospital

Some of these points may be more specific to my area (i.e. we live 10 minutes from the hospital so if we needed a sudden transfer it could easily be arranged; home birth is an available birthing route through the NHS in my area so admin arrangements with the local hospital should a transfer to hospital be needed aren't a complicated issue as could be the case if using a private midwife; there are not the same insurance issues you may run into in the USA where home birth isn't always covered by insurance) but they are all food for thought if you think home birth may float your boat.  I'm not saying it's the way forward for all, but it may just be for me.

"Tub" Trucking at 23.5 Weeks

Chris and his brother have been calling me "Tubs" for some time now. I'm pretty sure it's a nickname given with affection, thus I've not let it damage my self image too much and have overlooked that the name originated from the cannibalistic shop-keeper's wife from The League of Gentleman. But anyway - now, as you can see, at 23.5 weeks pregnant, the name is actually pretty fitting for the little tub at my front.

This week our baby is the size of a large mango. She is ducking, diving and kicking with regularity. I guess she's small enough that there is plenty of room to groove in my womb but large enough that I can really feel her. My weekly Babycentre update says the blood vessels in her lungs are developing in preparation for actual breathing, and at the end of this week she will be considered "viable" for birth (though she'd still need pretty in depth medical support to function). Other developments this week....

A huge shout out is in order to our fab friends E&L who are also expecting and due just about 10 weeks after us!! It's really exciting to have another good friend jump on the pregnancy bandwagon at the same time. E&B have been so helpful to me with their pregnancy tips and chats and I hope I can be of similar support to L on her journey. I'm sure we'll have plenty of insights to exchange - very exciting!!

Friday I had my third midwife appointment and was re-introduced to the kind and calming midwife that I met at our hospital open night a couple of months ago. She confirmed that "all looks in order" and our missy's growth is on track. I also spoke to her about my interest in natural birthing and exploring home birth. She suggested Chris and I attend the home birth night at our hospital next month to learn more; she was very encouraging, not at all dismissive or judgmental, and made me feel at ease about exploring our options. I'll keep you posted on what I find. But all around, it's all go!

Speaking of "going," every time a pregnant lady has a midwife appointment, you need to bring a urine sample in a little test tube thing so they can check your pee for glucose and protein. Being that peeing in a cup, or tube, has become a popular pastime by default, you'd think I'd be a bit better at it! Does anyone else have issues peeing in a cup or am I the only one with a sheepish hand raised here?! When I had my booking in appointment at the doctor they literally gave me a huge beaker to pee in that I couldn't fit between my legs. That led to some cool half squat crouching moves.... Now I need to regularly pee into this small test tube thing that is challenging with my urinary aim or lack thereof. Once I do hit the jackpot the tube fills really fast and is prone to splashing out at me. Gross. Maybe this is TMI, but I'm hoping I'm not the only one who has been embarrassed at the hands of this ritual!

Enjoy the 23.5 week close ups!

Birthing Warrior

I’m nearly halfway into my pregnancy and am starting to think about the miracle of birth and mission that is labor. Actually, I’ll be honest – I’ve thought about labor and birth on numerous occasions since conceiving. As I’ve said and you may realize, I’m a thinker for better and for worse. I haven’t been to any of my pre-natal classes on this topic yet, but I’ve done some reading, asked around and formed some opinions. Who knows if these will change as hormones continue to wrack my body and my due date approaches; who knows if I’ll stick to my guns in the throws of squeezing a baby out of my lower regions…. But for this moment, this is where I am.

I always pictured birth as you see it in the movies: lying spread eagle on a hospital bed, pushing with all my might. I also promised myself that I wouldn’t shout nasty things at Chris like, “How could you do this to me?!!” Plus, I’d be comfortably numb by a wonderful, soothing epidural. With medical pain relief practices like epidurals now common place, why would I take on body splitting pain? Those natural birthing ladies had to be mental…

So I thought, until I started exploring and my initial perceptions on labor and birth came tumbling down, down down…

I was surprised to learn that many women don’t give birth in a hospital bed, but instead from an array of upright positions ranging from kneeling to squatting to down on all fours. Maybe I was naive here, but I really didn’t have a clue. Aided by birthing balls, floor mats, steady relaxation breathing, pelvic rocking and most importantly gravity, women who birth upright often deliver with shorter labors and less medical intervention like forceps, ventouse and episiotomy. Epidurals, on the other hand, leave you immobile from the waist down in a hospital bed, catheterized and with greater chance of distressing your baby and needing delivery interventions since the drugs slow your labor and reduce your urge to push!

In the United States, epidurals are a very common form of pain relief – probably why I’d always associated them as given for birth. In the UK, they are also widely available but perhaps not pushed as much as less invasive pain relief options like gas and air are popular (which doesn’t appeal to me either since I don’t want to feel giddy or drunk when laboring). But I’m not picky or nuts...I’ve just decided that I’m going to be a Birthing Warrior. I want to be upright, I want to use my “in for four, out for four” breathing and I want to get in a zone and deliver naturally. I’m also curious to learn more about those TENS machines. I can’t imagine how exactly birth is going to feel but I am preparing myself for pain – “good” pain, that I am going to power on through like a Spartan and triumph over in order to bring my baby into this world. Cue glory music.

Shock of shocks, there are an overwhelming wealth of resources out there on natural birth that I just don’t have time to sift through. For a good overview, check out My Best Birth, a website associated with Ricki Lake and Abby Epstein’s documentary film ‘The Business of Being Born.’ My friend SH suggested this film to me, and though I haven’t got my hands on it yet it promises insightful observation into the “medicalization of pregnancy” in the United States and the more natural birthing options and venues that women can consider. More on that when I’ve watched the dvd. I also happened across this Giving Birth Naturally Site, which has a lot of information on the subject. Encouragingly, when I asked midwife at my hospital about natural birthing, she was very supportive.

While I’m on a roll here, I’ll also throw in my new found interest in exploring a home birth. I like the idea of avoiding the germ infested hospital and giving birth in my own domestic bubble of bliss. The neighbors might think a wild fox got trapped inside our house, but I’ll get to recover from labor in my own bed, with my own nice food, safe and sound with my family. Ideal. Unless, family and friends remind me, I face any complications in which case “Isn’t it better to be in the hospital?” Hmmm.

Interestingly, the American College of Obstetricians and Gynecologists does not support home births while the Royal College of Obstetricians and Gynaecologists/Royal College of Midwives does for women with uncomplicated pregnancies. Then again, pregnant B shared this NHS article with me, which discusses how home birth risks are still unclear. So as usual, there is not clear or right answer. Weighing up all the factors, I’ll probably end up choosing the hospital but I am still going to talk to my midwife about home birth...

I know that each labor and birth is different and birth plan and all, I can’t over-plan and will just do what is best for baby and me in the thick of it. I'm not knocking any form of pain relief because if you have a choice you need to do what's right for you, but my mental plan of action is to go as natural as I can – and the mental part of it has to be half, if not a little less than half, the battle.

And the Doctor Says...

NO!

In my previous post, Bump on Board: Running in Pregnancy, I mentioned that I was going to contact my doctor/midwife to discuss my second trimester running in relation to the strength of my cervix. Don't worry, I won't get more graphic than that.

I read about this on US sites and it seems like a fairly common, encouraged, question that pregnant runners ask so I thought I'd give it a whirl here in the UK.

Swallowing my pride, I called my local surgery (for those in the US that's the doctor's office) and left a message for the doctor asking if I should come in for a quick cervical check up and hopefully get his blessing to continue running. It was fun explaining all this to the receptionist...

I can't say I was shocked when the receptionist called me later that day and said, simply: "We've passed on your message to the doctor regarding your running and he said you'd better not."

I'd better not. That was it. No check up. No reason in relation to me. Stock advice. From my initial encounter with the midwife I expected this might be the response I got, but I still felt disappointed. I really like my doctor; he has always been lovely and patient with me through any odd little ailment I've had. But I've done my research on running and believe I should be able to continue at this stage. It's slightly aggravating that since the general UK advice on the matter seems to be "don't do it," the one precautionary check I'd like done doesn't appear to be an option due to differences in US/UK pre-natal culture. I'm not knocking the UK system - I think it has a lot of benefits the more I learn - but in this instance, I'm not a fan.

So truthfully, what am I doing? I've made the executive decision to continue my weekend 5k run at an easy pace. If I feel anything is out of sorts, I'll stop. I'm not looking to be stubborn or doing anything that will be unhealthy for our baby, or me. But I don't think I am based on my research and the fact I'm treading carefully and have not experienced warning signs. Maybe at my 20 week sonogram they'll be able to comment on my little ol' cervix. I'm not sure though. I'll keep you posted :)

Bump on Board: Running in Pregnancy

I’ve always been a runner. In school I took pride in being able to outrun some of the boys in my class. I played midfield in soccer which required a lot of stamina, and I kept up running for fitness through college and as I moved into “the real world.” Last year I even knuckled down and ran the London Marathon! So now I’m running while pregnant, which you’ve probably picked up on.

When I mention that I’m still running, I often get one of two reactions: Cue furrowed brow and concerned tone: “Is that really a good idea for you and the baby?” OR a perplexed grimace that suggests I might as well be bungee jumping or throwing myself into a rugby scrum. So I find myself justifying my actions, and explaining that there is no reason for concern. “I’m only running a couple of 5Ks a week, nothing too taxing for baby or me!”

This approach was not condoned at my first “booking in” midwife appointment around 11 weeks, where I was told plain and simple, “don’t run, we don’t advise it.”

I felt a little cheated by this response. Yes, it wasn’t what I wanted to hear, but mainly, it conflicted with advice I’d read elsewhere. I’m sure the midwife had a duty of care to echo the advice in the NHS Handbook that gave she me, but this “blanket advice” didn’t account for my history running, fitness level, medical history, etc. It seemed more of the “cover our backs with catch all safe advice” family. So I dug a little deeper…

Now I’m no medical expert, and the following is my understanding and NOT official medical advice (disclaimer, disclaimer, etc). but herein lies the skinny on running while pregnant:

If you haven’t run before you were pregnant, don’t start once you are. It is generally safe for seasoned runners to continue at a lesser distance and intensity; you will need to slow down as your pregnancy progresses and your bump grows. It’s important to stay hydrated and not to overheat, especially in the first trimester while your young baby is developing its vital organs. You may be more prone to injury as your body has higher levels of relaxin, a joint-relaxing hormone, so tread carefully over uneven ground and to wear supportive footwear. A sturdy sports bra is also a must, and a maternity support belt could help support your bump. Try to engage your pelvic floor as you jog since extra strain is put on these muscles. Listening to your body is most key: if you feel nauseous, dizzy, out of breath or experience chest pains, blurred vision, a headache or vaginal bleeding, STOP! If anything feels uncomfortable or not right, STOP! Don’t push yourself and don’t go for the “burn.” Think in terms of your fitness, not keeping up your previous level of training.

Across the board, advice suggests that women with pregnancy-induced high blood pressure, gestational diabetes, placenta previa (low lying placenta), a weak cervix and others, particularly a history of pre-term labor or miscarriage should avoid running; if you are at all concerned, have a discussion with your doctor or midwife.

This article from Runners World suggests that women entering their second trimester should have an internal with their OBGYN to check the strength of their cervix. I’ve read more about this from US sites, and think my midwife might look at me like I have two heads if I ask her for an internal considering the advice I received previously, but maybe I should ask. I haven’t had any signs out of the ordinary, but this looks like an extra and sensible precaution runners can take. In fact, many US sites suggest getting the “all clear” from your doctor regarding your plan to run pregnant.

As with many things in pregnancy, a cautious and sensible approach to running looks like the answer. Many runners pay testament to their trade as a means of staying fit and healthy throughout their pregnancy and preparing them for labour. Here’s an excerpt from a Babyfit article on the topic:

“When I became pregnant with my first child, I decided that as long as my doctor said it was okay (and I felt good), I would continue running for as long as my body would allow… I'd been a runner for years and loved both the physical and mental benefits. So I was relieved that when I went in for my first OB appointment, the doctor said I could continue running as long as I felt good and didn't push myself too much. Running helped alleviate the constant morning (and afternoon and evening) nausea I couldn't seem to shake, kept my weight gain at a healthy rate, and prepared my body for the toughest race I'd ever have to run-labor and delivery. As my belly expanded, I went from a comfortable jog, to a slower jog, and finally to a waddle the week before my daughter was born. I was quite a sight to the neighbors I passed on my running route! But I wouldn't trade that for anything. For anyone whose health care provider has given their okay to continue running, I highly recommend it.”

Some other useful articles about running pregnant are at Babycentre and Pregnancy Today.

So come on fellow running ladies, let’s lace up our sneakers, give our bodies and minds a work out, our bumps a ride and those passers by something to gape at!

'Baby Gaga' for me

I had to laugh this morning while I slogged it out on the stationary gym bike watching Lady Gaga's 'Paparazzi' music video and Ciara "driving her body" around Justin Timberlake in 'Love Sex Magic.' I was out of bed before work, faithfully trying to do my expanding body good and ironically seeking motivation through the music and gyrations of these two lithe and ostentatious superstars.

I don't have illusions, delusions, aspirations, whatever about trying to look like the toned and primped celebs of today, but I've always secretly wanted to star in a music video. How cool would that be? It wouldn't be saucy and I'd be fully clothed, but it would tell a good story and feature me dolled up for the camera. Maybe I'd even dance in it....

How could my bump and I ever compare to the glamorous musicians before me? You know what - I can honestly say I didn't give a damn! There's so much pressure put on women to "look the part." While I'm never too concerned with this and think I have my own style, pedaling away I felt fit and blossoming.

They say some women feel unattractive as their pregnancy progresses and others feel extra sexy; I wouldn't say that I fall cleanly into either category and I still have a long journey ahead, but I'd have to say I'm leaning toward the latter. Pregnant ladies may be growing out, but we're growing babies and that is a beautiful thing. I plan to stay healthy and active for general fitness, but I hope my transformation makes me all the more attractive. I mean who really wants to parade in a leopard catsuit or look like a half naked droid on crutches anyway? Maybe I can star in some classy video featuring a pregnant girl :)

I'm 17 weeks today and I my little bump is on the rise. It's satisfying. Apparently the baby is now the size of a turnip - 5 ounces. I had my second midwife appointment this afternoon and she said baby's growth looks on track. I heard his/her heartbeat (150 beats/minute) and was sent on my merry way.

I'm a little conflicted about the community midwifery approach here in the UK. On one hand, people have been giving birth since the start of time before organised care and continue to do so in many places around the globe. On the other, I do like idea of the American personalized experience of choosing an obstetrician that cares for you over the course of your pregnancy. There is no choice on the NHS, but there is also no cost. I guess as long as I do my research and know what I want, it's my responsibility to communicate my questions/wants/needs to the midwives I see so that my maternity notes tell my story. And then hope when I do give birth that the midwife on duty actually pays attention to them! Though that's also why it's important to have a supportive, firm and knowledgeable birth partner - I'll have that in Chris (no pressure).

My 17 week picture will soon follow!