The Pregnancy Blog - Part 2 (Birth - 2 months)

This part of the pregnancy blog is harder to write than its predecessor. 

My pregnancy was fairly medicalised because of the early diagnosis of the heart-shaped uterus.. but generally - the nausea and vomiting for the first 16 weeks aside - i felt well during my pregnancy and even when my waters broke, once the initial fear of delivering a 1.2kg baby had subsided - i was fairly relaxed - i honestly think its a lot hard to get worked up about things when pumped full of pregnancy hormones.. emotional yes.. anxious..not so much. Maybe daily HeadSpace app sessions when in hospital post waters breaking helped too.. as my desire to move was somewhat medically restrained. 

Labour

The Vision

I had this wonderful idea of labour in my head. I knew it would be painful - but I looked forward to it - as i would a triathlon - as a challenge to get through.. with the finishing line oh so sweet with a gorgeous bubba ready to nestle to the bosom. 

Discussing pain relief during the NCT classes, my inner hard nut professed the desire to go through the experience using just paracetamol- “pfffft” to gas and air.. heard it just makes one feel sick. I wanted to feel the pain and use my extensively practiced (cough) yogic breathing to get by.

The Reality

Paracetamol - like using an ice cube to put out a forest fire.

Unless this drug normally works well for you - e.g for back ache/headache - i can say with much confidence that it will do bugger all for your labour pain. 

Gas and Air.

Makes you giggle.

Also makes one dissociate somewhat from the experience as if you were watching it happen to someone else. The midwife/nurse/doctor/cleaner/ward clerk will all tell you that you’re not using it correctly… its all in the timing and depth of breathing.. allegedly. 

I was already getting sick (and having to evacuate from the other end too - bowel wants to be as empty as possible for the impending stress of delivery (kinda how you feel on the morning of an important race - magnified)  from my rapidly progressing labour - the gas and air made this worse so i stopped - although held onto the apparatus and my partner (Stuart)’s arm for dear life. 

Epidural

This is the one method of pain-relief which i had not planned into any thought process. 

I was very lucky to have the excellent Dr James Hambly look after the anaesthetic side of my labour from the start. An avid triathlete and runner - we followed each other on twitter so this was a pleasant surprise. I remember him saying that every mother he had given an epidural to, whom went through their first labour without said ‘why the hell did i not do this earlier’.

I saw having an epidural as cheating. No pain, no gain as is the oft repeated triathlete mantra. 

In my case, given that Sophia was still only 32.5 weeks (but of a good weight for her gestation) i was not allowed any opiate pain relief like fentanyl as this can depress breathing in her already undeveloped lungs. 

The midwife checked my cervix and found i had gone from 1cm dilated to almost fully dilated in less than 2 hours. No wonder it hurt so fecking much.

They call this effacing.. The nub of the cervix goes from thick to thin to non existent as the labour progresses… like rolling out a ball of dough.. kind of.. if dough could cry ;)

Just prior to her checking the status of my cervical dilation (i can imagine any male reading this has turned green by now).. the pain was so intense that I had opted - on the sound advice of Dr Hambly to have a ‘low dose’ epidural. The idea being the pain was numbed somewhat but i could still have the sensation of needing to push. 

The actual procedure was a little uncomfortable - first time he hit a blood vessel and a bit of my spine - easily and commonly done - but on second go he was successful & the tube was in to my spinal canal - one can then give anaesthetic directly into the nerves controlling the pain to the pelvis. Typically I wasn’t a standard case and one side numbed up well whilst the other side didn't ... i needed ALOT of anaesthetic to achieve pain control ... i am a fast metaboliser - its the same in the dentist's... i go through local anaesthetic like its water

Labour was progressing very quickly. All of a sudden there was a consultant in the room and (perhaps because it was the middle of the night) she shouted to the midwife “why on earth didn't you call me sooner!!).

This never bodes well for ones anxiety levels.

There were some decelerations of Sophia’s heart rate on the fetal monitoring.

“We need to get this baby out NOW”

OK.. don't panic - yoga breathing - control what you can control and let the professionals do the rest.

Breech position (this is not Sophia )

I pushed AS hard as i could muster only being in pain on one side … i couldn't really tell what i was doing so followed the encouraging expressions from my partner and the medics down the bottom of the bed. It didn't work. All i could think of was that I was a failure. I had succumbed to the epidural because the pain was so excruciating (maybe my willpower pot had been drained by the experiences of the past weeks - studies show this reduces pain tolerance).
I was a fit athlete yet I couldn't push my 1.2kg baby out - this was the thought process.

Despite previous scans showing she was in a normal head down - ready to come out - position - Sophia had in fact turned herself slightly around so was in a breach position with her feet up around her ears... not so easy to push out.

I needed an epiostomy (cut through the muscle/fascia between the pee hole and the poo hole - and forceps to assist the delivery.

At that point i think i would have agreed to anything. 

And then there was a slippery mucus covered squirming baby on my chest.

She was tiny… and so skinny.

I could not hold back the tears.

But it was not the romanticised birth one pictures or sees on tv.. where mum and baby are united in bosom bliss. I could not hold her for more than a few seconds before my instinct spoke through tear-streaming eyes “just take her and make sure she is ok”

At this point there were about 10 people in the room. Different types of medics/students/midwifes.. and an incubator. I just wanted to know she was ok, but wasn’t given a firm answer. I heard some faint squealing which gave me a moments reassurance..but then she was gone.

I’m not sure i ever pictured what would happen next.. despite all my medical training .. 

Labour is over .. you put your feet up and have a cup of tea cuddling baby to bosom.

My placenta would not deliver. 

Thank goodness i had that epidural the doctor said as she proceeded to tug at the upper right quadrant of my uterus. The design of the placenta as such it wanted to be there for the full 40 weeks. I was loosing a lot of blood by this point.

“We are going to have to move this to the operating theatre”

All of a sudden the room was empty and Stuart was left alone sitting surrounded by pools of blood dotted with gauze.

I cannot imagine how despondent he must have felt.

The epidural was converted to a full spinal anaesthetic and the procedure to remove my placenta continued. I was given drugs to stop my uterus contracting and goodness knows what else. I remember the whole experience very vividly and talking to the medical staff to take my mind off the very uncomfortable feeling of having my insides ripped out. It wasn’t painful just a pulling…tugging and the placenta still wasn’t coming. An anxious phone call with another consultant on the phone for advice and she started to remove the placenta piece by piece. It took over 2 hours. 

The drive to hold my baby - to even hear how she was - was overwhelming. 

As I lay in the recovery ward surrounded by mothers feeding their newborns with the meshed squeals of hunger, frustration and exhaustion - I felt suddenly very scared.

Stuart had been told the operation would take 10minutes - he waited 2.5hrs with no news - until I came out then went home to get some rest. 

The drugs were wearing off and the feeling of dysphoria overwhelmed me. I was alone, I could not feel let alone move my legs and no one answered the pressed nursing bell for a good while.

When a health care assistant did come and I asked her if someone could let me know how my baby was - she was unable to let me know - she was about to finish her shift and the other nurses were in handover - her english was poor. 

I spent the next two hours in tears, summoning up every ounce of mental fortitude I could muster to move my legs - so the spinal anaesthetic would wear off and i could get up and get myself to the neonatal intensive care unit. 

8am - I had not seen or heard any news about my baby from 2.30am the night before in the operating theatre. Nursing staff said I must eat and drink something before i could get up so I swallowed some sweet tea, scooped half a weetabix into my mouth and rose to my feet like a newborn lamb wobbling on unsteady pins. 

I made it to the NICU and asked for Sophia. And there she was in her incubator covered in tubes.. face puffy with the overnight positive pressure airway support. It was all i could do to hold the sides of the incubator and let the tears flow. (as they do now writing this).

She weighed 1.79kg at birth just around 4llbs. This is tiny. She is not meant to be here…. she needed longer… what could i have done differently… why me… all those thoughts.. followed by a relief that she had all four limbs and according to the staff was doing well. 

I was given steroids when my waters broke to help develop her lungs and they had helped. She was on ventilation support for 8 hours but then was able to breathe well alone. 

Thoughts quickly turned to how could I feed her? The nursing staff said that I could try to hand express and i was showed how to do this.

I was amazed when droplets of thick golden liquid came out and then next hour was spent with Stuart syringing whilst I squeezed. We filled 10 x 1ml syringes.. suddenly my mood lifted. I could feed Sophia.. even if it was through a tube through her nose. 

She started to open her eyes. 

I was amazed when droplets of thick golden liquid came out and then next hour was spent with Stuart syringing whilst I squeezed. We filled 10 x 1ml syringes.. suddenly my mood lifted. I could feed Sophia.. even if it was through a tube through her nose. 

She started to open her eyes. 

Then the first blow. 

She was unable to take on enough milk via the tube into her stomach without it coming back up - common in premature babies when the gut is under-developed. 

I had to consent to giving a central line so they could feed her nutrition directly into the blood stream. This procedure and feeding method is not without its side effects of infection and other nasties so I was reluctant - but persuaded that it was in her best interests. 

Seeing your tiny baby wailing in an incubator whilst well-intentioned doctors attempt to stick needles into their neck and minuscule hand is one of the most heart wrenching experiences i have ever known. Everything in my body wanted to run in - scoop baby up and run out of the hospital and not stop. But reason prevails - eventually - given the hormone shifts in those days post birth. There were a lot of tears.

I wanted to avoid Sophia having antibiotics given their propensity to wipe out the very fragile and developing bacterial ecosystem in the gut. Thankfully we managed this successfully.

Of interest studies show that babies born by Caesarean section have their guts populated by skin bacteria - usually from the hands of the nurses whom handle them first - these are less beneficial and contribute to reduced diversity of gut bacteria - which can give rise to a host of illness, and even an increased propensity to obesity as one ages. Being born naturally means that gut is populated by bacteria from the mothers vaginal canal (which change slightly pre labour) and also a small amount of mums poop as baby emerges. These bacteria create a healthier ecosystem in the gut. 

If you can have a natural birth - please please do. Elective C-Sections are on the rise - those which mums chose to have even those not medically necessary. This is a potentially dangerous trend.
Read more about this here

I became acquainted with a hospital grade breast pump and spent every 2 hours hooked up. There was a designated room in the NICU and mothers of tiny babies would coalesce to pump.

Its very difficult not to compare milk production with those around you.

Some mums had babies whom had been in the units for months and whose milk supply was dropping as they were unable to put their babies to the breast often… some had older babies who had medical issues - these mums seems to have better milk production. I became quite competitive.. I saw one younger woman produce 5 full bottles of milk in 20minutes - I was really envious… The ensuing weeks partially became a challenge of how i could produce more milk. I read everything I could, took on board most of the advice, but perhaps ignoring the fact that stress and anxiety would negatively effect milk quality. I was determined that Sophia would not have formula given all i had read on the effects of formula on the gut micro biome.. However - there were a few days later on in her time in the NICU that my milk supply fell short by 30-50mls and she would have to have some SMA. I felt like a failure once again.

I did not stay in hospital during Sophia’s time in the NICU as i was discharged the day after the birth - despite my traumatic surgical experience post birth. They need every bed they can in one of the busiest maternity units in the country. This meant I spent from 8am to 8pm most days in the NICU alternating breast milk pumping with hours spent with Sophia sleeping on my bare chest (to bond and encourage milk supply - she was too tiny to latch on to the nipple - but we did keep trying). I would go out at lunchtime and walk to the gym, or to Richmond Park, or when the bleeding had stopped - to the pool. This cleared my head and meant i got some fresh air.. the NICU is very dry and warm. Often during this time away from the unit I was a little emotional and the desire to be holding Sophia was great. The nursing staff made it clear, however, that she needed deep sleep (in the day as well) in order to grow - and told me she would not get this if she was sleeping on me. I think they were just fed up with me hanging around so much.

An ongoing theme, it is maternal instinct to want to care and nourish your new born. However, I had to submit to the authority of the medical staff who controlled when I could hold and feed her. As well-intentioned as this is - it is not easy or intuitive.

A few days post birth one of the Consultants asked to speak to me. This immediately sends a bolt of fear. He told me that he though Sophia may have a genetic syndrome - like Downs or Turners - based on a few physical features she appeared to have.. she did not look like me - but certainly has her dads eyes which I guess are slightly pigmy like if viewed with a biased lens. 

All my maternity genetic screening tests were normal so this was a shock.

The test results would take around 2 weeks to be returned. I was not reassured, despite some of the nursing staff telling me that they tested a lot of the babies and she did not appear to be syndromic. The next 17 days were filtered with a undertone of anxiety.

How would I cope if Sophia had Downs’ syndrome or Turners Syndrome? I tried to convince myself that she did not have any of the features really… but once that seed has been sown… 

The tests were negative. More tears. Relief.

6 days post birth.

30mins on Wattbike (100-140W)and some light seated leg weights. 

As I am sure the reader will tell…

I felt a little wobbly these days post birth. 

My Haemoglobin had dropped from 14g/dl to 9g/dl.

This is quite a lot of blood to lose. Any benefit from that blood volume expansion and extra EPO during pregnancy had been lost.. yes this did cross my mind briefly - followed by how much iron do I now need to take to get back up. 

We walked into Kingston from the hospital - around 1 mile the day after the birth. 

Leaving the hospital after just under 4 weeks in NICU

I lost control of my bladder crossing the road to Boots - i just could not feel the sensation of needing to pee and next thing i knew my trousers were soaked.. I didn't know if this was normal or not - but thinking about it - it was completely normal.. I had spent the previous night being stretched and pulled and pushed and forcepped. Bouncing back together ain’t so quick despite being fit when you’re 36 and your placenta is stuck.

Still i asked the ward doctor to have a look when I returned to the ward and she ruled out infection and reassured me that things would take time and that the nerve supply to the bladder had probably been damaged slightly during the birth and ensuing surgical procedure.

The emphasis on pelvic floor exercises was stated and as anyone who is or has been pregnant will know this becomes an oft chanted hymn. 

One can never do enough pelvic floor exercises as boring as they are.

First Bath

The next few months were to be some of the toughest i have experienced.

Below are some of thoughts

Newborn babies are noisy during the night… they grunt, whine and an whimper in their sleep - hence you spend whole night staring at them wondering if they are in pain or are hungry.

Don’t assume baby has colic - he/she maybe overtired.

Sticking a plastic tube (Windi) per rectum to relief tummy distension ?Colic was slightly disturbing - but baby didn’t mind in the slightest & it worked.

All baby clothes have hundreds of poppers - it is night on impossible to do these all at 3am with crying/squirming baby. And as for putting on a nappy the right way...

It is an overwhelming time - working out why your little one is crying - there were a few nights when i would sit in tears in the bed/bathroom - exhausted but unable to work out what she needed- and thus feeling like a failure. She slept in a SleepyHead in the bed next to me for 5 months - so i could feed, wind, pat, repeat through the night. 

Stuart was working 12 hour days, so he was unable to help at night but would occasionally do the 6.30am feed and go into work a little late so i could sleep. Without this and without my mum driving 4plus hours from Devon every couple of weeks - i honestly don’t know how i would have got through these months. Sleep deprivation, plus huge drops in hormone levels on a sensitive brain can wreak havoc.

The Health Visitor suggested i see my GP as she raised the question of post natal depression - but my very frank and wonderful GP said `to invest in a night nanny for a few nights and that sleep would solve all. We couldn't quite stretch to £250 a night for the night nanny but did have a local nanny help out once a week and she would come at 5.30am so i would sleep from 5.30am to 10.30am. Some people manage to sleep well between feeds at night - but often i’d be mostly awake the whole night listening for sounds and worrying about the next time she would wake - my cortisol levels were sky high - so even when i could sleep 3-5am for example - i would be awake worrying about the fact i couldn't sleep - or had i fed Sophia enough, did she have tummy ache etc etc. Sophia still wakes every 3-4hours even now at 7.5 months. I have given up being envious of my NCT mums who’s babies slept through the night from 6 weeks.

BreastFeeding: There is nothing more wonderful than being able to feed and nourish your baby and i loved this.. it was very time consuming as Sophia so small. The health visitor told me to establish my milk supply i should stay in bed for a week with baby. However, this was now a month post delivery so not straight forward. Plus as you can imagine, i find it difficult to stay in bed. 

A good breast pump is essentialI rented a hospital grade one from AnaWiz— esp. if like me baby was pre - latching onto the breast is often difficult & often she would just nibble away for an hour and fall asleep - not conducive to gaining weight. My obsession with producing enough milk continued. I would pump 4-5 times in the day with some additional breast feeds and 1-3 times at night. Many a night was spent with one boob in a pump with baby on other then after 30mins i would pour pumped milk into a bottle and feed. I tried all the techniques advised for increasing milk production - possible with the exception of ‘eating for milk’ - i.e eating cake/carbs..but as my sleepless nights continued and i forced myself out on short runs/swims most days to clear the brain fog from no sleep - my milk production did wane. I tried the herb fenugreek and it did increase milk - but at the expense of creating a lot of wind in both of us.

Many people give up breast feeding early because they have problems with supply, latch or any number of problems. My advise would be to try everything possible and get specialist help - it really is the best start you can give your baby - esp. if premature or born via C-Section for reasons discussed above. Yes the formulas claim to be advanced and contain all the nutrients, but they don't contain antibodies and only a few address the good bacteria balance - Aptamil has prebiotics (which feed good bacteria).. a couple of French brands and US Brand Eptamil offer some probiotic support. This made Sophia even more windy - so we went back to SMA - which is what she was first offered on the NICU on the days i couldn't quite produce enough milk. I was offered Aptamil and SMA on the NICU but because SMA was packaged on in glass bottles as opposed to plastic i chose SMA.

I lasted 4 months breast feeding/pumping before I - with a heavy heart - decided to give it up.

Although would then get emotional and try feeding/pumping again… feeling like a failure.

Sophia had ongoing problems with reflux and colic and I wanted to make sure nothing I was doing was contributing. I craved a lot of dairy products whilst breast feeding. Goodness knows how much full fat greek yoghurt and decaff lattes i drank.. i tried a week dairy free to observe for effect ( i tolerate dairy very well) but Sophia still suffered with the same symptoms. 

 We tried about 6 different types of formula -including lactose free/easy digest/anti-reflux/extensively hydrolysed - never soy (most soy beans are genetically modified). 

Nothing helped. I gave in to the paediatricians ant-acid medication reluctantly (Zantac - Ranitidine) as I couldn't bear to see Sophia in pain and bringing so much milk up - if you've ever had heartburn - imagine how this feels to a baby - they start to associate feeding with pain - not good.

So for one month the anti-acids did their thing but then constipation set in and boy did her poo start to become icky/dark green/horrid smelling. Formula milk generally isn’t great for their developing micro biome and neither are ant-acids - allowing nasty bacteria to grow - i could see this in the change in her poo. Upsetting, but i kept thinking - just short term. 

Finally we settled on NannyCare - formula made from New Zealand Goats. 

They now have all the necessary additional vitamins required by law to market as formula.

And no added whey protein which all cow’s milk derived formulas have.. making it easier on the tummy. I also am rather fond of goats - as anyone who has ever climbed mountains in Morzine will know - goat village is a joy- goats are happy, playful animals - perhaps some of this is down to their early diet ;)

I also began to give a powdered probiotic in her milk from 3 months - Bifidobacteria is one of the friendliest bacteria and is found in breast milk but not in formula. I use Biocare (not cheap - and needs to be in the fridge - i like to think it helps. 

Exercise wise in these first few months - I tried to do one thing every day - be this a 20-60min run. An hour or two's bike ride or a 30min swim/sauna/stretch. Some days when I had been up all night - it was all i could do to get out of the door - but never did exercise make me feel worse - if it does at this stage..  back off or seek advice.

The 6 week check - the standard advice being don't do anything until you have been through this. For most fit types who have had uncomplicated deliveries this is probably 3 weeks later than needed. I had been running/jogging.. from 2 weeks and at the 6 week check i was asked about bleeding (this stopped within a week).... pain (nope)... my episotomy stitches and that was it. My consultant knew i would have been exercising for some time already - it didn't seem to phase her. 

In Part 3 of this blog i will go through exercise post pregnancy/getting back into shape. in more detail.

 

Coming Soon!

I also began to give a powdered probiotic in her milk from 3 months - Bifidobacteria is one of the friendliest bacteria and is found in breast milk but not in formula. I use Biocare (not cheap - and needs to be in the fridge - i like to think it helps.