The breastfeeding post - a post in three parts

So sorry for the long absence. I’ve been meaning to write about breastfeeding for ages, but the thing about demand feeding a new baby is it’s a bit time consuming, so I haven’t managed to blog for a while!

The diabetes and breastfeeding conundrum

When I was still pregnant I did a lot of reading about breastfeeding and about breastfeeding and diabetes, hoping to prepare myself as well as possible for the challenges of the future. I wasn’t expecting to feed so frustrated by the information that was available to me. Compare and contrast the following:

• ‘The acini cells actually produce milk by drawing the necessary milk-making products from your blood (using osmosis and other processes).’
• ‘The quantity of lactose in your milk is stable regardless of anything in your diet or metabolism. Yes, it is produced from your blood, but your blood glucose is converted to lactose in milk production, and only the amount your body is designed to create is created.’

vs.

• ‘Maternal milk glucose levels rise following an increase of plasma glucose levels with a lag time to the peak glucose level of 40-90 minutes, and return to baseline following the return of plasma glucose to baseline with a lag time of 120-150 minutes.’
  

These two things can’t both be true! Moreover, every published study I read on diabetes and breastfeeding just drove me madder – studies which look at five women or ten women. Where’s the statistical significance in that? Where’s the rigour? Grrrrrrr. Here’s the kicker: ‘The relationship between maternal glucose levels and the concentration of glucose and insulin levels in human milk from diabetic women has not been elucidated.’ The conundrum seems to boil down to this: what do you believe? Respected diabetes researcher Lois Jovanovic suggests that if you are running high you should ‘pump and dump’ and feed your baby with milk which was expressed when your sugars were in range (see Cheryl Alkon’s book: Balancing Pregnancy with Pre-existing Diabetes for more information on Jovanovic’s views, p. 175). Jovanovic believes that if your breastmilk is too sweet then your baby will have reactive hyperglycaemia, and will be irritable, hungry between meals and unable to go more than one and a half hours without a feed.

How do you decide what to believe when the research just isn’t there to back up your decision, or the existing studies are too small to be statistically significant? I want more than anecdote when making a decision this important. My sugars are mostly in range, but my control isn’t as tight now as it was when I was pregnant and I’ve had more highs since I’ve had my baby (since whilst diabetes management is proactive, breastfeeding on demand is reactive and can’t be planned around.) I decided that unless my sugars go really high – 15mmol/l or more (that’s 270mg/dl for my US friends) then I’ll go ahead and feed. On rare occasions when my sugars are higher than that I’ll resort to my stash of frozen milk, or the bottle’s worth that’s tucked away in my fridge. It’s a middle path which tries to balance the risks and it feels like the best I do with the information to hand. Pumping and dumping precious milk that might be fine to feed isn’t a good plan, but neither is feeding your baby oversweet milk… and at the moment there’s no way to really know which theory is right.

The breastfeeding appointment

As I mentioned in an earlier post, I had an appointment with a specialist breastfeeding midwife at the hospital before C was born. I went in to see her on 4 April and spent about an hour getting some specialist advice on diabetes and breastfeeding, and it was a hugely valuable experience (it also gave me a chance to have a sneak preview of the post-natal ward, where I eventually ended up for 10 days after the birth!)

The hospital where I gave birth is a UNICEF ‘Baby Friendly’ hospital, which means that they place great value on breastfeeding and supporting new mums. As a diabetic mum-to-be I was given advice about expressing colostrum antenatally, in order to ensure that there would be some on hand for my new baby if needed (either because of low blood sugars or initial feeding difficulties). The hospital aims for the baby to have skin to skin with Mum as soon as possible after the birth, and to have an early feed (within the first couple of hours) – particularly important for the babies of diabetic women. I was able to ask about the hospital’s hypoglycaemia policy for new babies and was given a copy to take away, which was very reassuring and gave me a good idea of what I could expect when my baby was born. The policy boils down to the following:

• Early skin-to-skin and first breast feed as soon as the baby shows feeding cues. Keep baby warm to prevent hypothermia and observe for symptoms (drowsiness, jitteriness and tremulous movements of limbs, apnoea, seizures)
• An initial check of baby’s blood glucose at 2 hours following delivery. If blood glucose is above 2.6mmol/l (babies run lower than adults) then breastfeed three hourly and re-check blood glucose every 3 hours for the first 24 hours and then 12 hourly thereafter. If blood glucose is below 2.6mmol/l then inform neonatologist (for admission of baby to NICU).

I also received the more standard advice on how to feed, proper positioning and so on, and met my first (but not my last) knitted boob – see picture. [The knitted boobs also made an appearance at both of my antenatal classes, and were in a variety of lurid, and non-realistic, colours, including my personal favourite of purple breast with a massive green nipple! Goodness only knows who knits them – I like to imagine a production line of crazy old grannies…] I took the opportunity to ask M, the specialist midwife, what she thought about the conflicting advice about high blood sugars and feeding. She was of the opinion that ‘pump and dump’ is unnecessary since she believes that the breast’s acini cells only draw what they need from the blood stream and therefore the composition of the milk won’t be affected by the presence of high sugars.

I left the hospital clutching a load of 1.0ml syringes for expressing colostrum, sticky labels and advice to hand express at least three times a day, freeze what I collected, and take it into the hospital when I went for my induction. I could have begun doing this at 36 weeks gestation, but the timing of my appointment meant that I’d missed a few days where I could express and only had about 10 days to produce as much as I could. I diligently expressed, and was only able to manage a couple of drops of colostrum the first time I tried, but each attempt yielded more, and by the time I headed into the hospital I could fill a 1.0ml syringe at one sitting. Apparently the 7.0mls I took in with me at admission was a comparatively good amount, and as you will know if you’ve read my earlier posts, did not go to waste. My baby son, C, had sugars of 0.9mmol/l an hour after birth and went straight to NICU where he was given a dextrose injection and the 7.0mls of colostrum in an attempt to bring his sugars up. This didn’t work, which meant he then had a small amount of formula (150mls over his first 24-36 hours until my milk started to come in, when he switched to my expressed breast milk), and an umbilical line and dextrose drip.

Actually doing it

I firmly believe that the breastfeeding appointment, and the fact that I’d started to express colostrum before C was born, helped my milk to come in sooner than it might otherwise have done. I’d done plenty of research and had bought a really good breast pump (the Medela Swing, if you’re interested) and breastfeeding teats for bottle feeding expressed milk (the Medela Solitaire – pretty expensive, but totally worth it).

C’s first feed was lovely (my new boy held close to my chest, skin-to-skin), but not very effective – with blood sugars of just 0.9mmol/l it’s not really surprising that he didn’t have the energy. Once he was in the NICU I had masses of support to try to feed him, and managed to speak to a couple of midwives/NICU nurses with particular responsibility for giving breastfeeding advice. All mums with babies on NICU are encouraged to express their milk and given packs with sterile breastshields and tubing to connect to the several hospital grade Medela double pumps which they have on the unit for mums to use. There is a room on the NICU where you can wash your kit, collect sterile bottles for pumping into, and store your milk in either a fridge or freezer until your baby needs it. Sticky labels are printed for you so that you can label each bottle, and you have a dedicated container in the fridge and freezer to store your milk. If expressing antenatally started to bring my milk in, then expressing on NICU finished the job! By the time C had been on NICU for 36 hours he was only being given my expressed milk (goodbye formula!) by cup, and I was also given a pager so that the NICU nurses could page me in the night if he showed any feeding cues, and I would be able to hobble down from the ward (courtesy of my C-section wound) and try to feed him the old fashioned way.

C was on NICU for five days, then came back to the ward with me for a further 5 days of transitional care. Once on the ward I was advised to feed him at least every three hours, and to wake him if he was asleep. Although S and I had been shown how to cup feed (see pic) when C was in NICU, and had given him some of his feeds, we weren’t allowed to cup feed on the ward, and we were keen to get him off the cup as soon as possible (even though it doesn’t cause ‘nipple confusion’ like a bottle might, cup feeding is very easy for a baby, and therefore isn’t conducive to breast feeding – in my humble opinion, at least). I had already decided that we would sometimes give C a bottle of expressed milk, since my diabetes means that I could be too hypo to feed him sometimes and it’s important that his Dad should be able to feed him if I’m crocked. Since we already had all we needed at home, S brought the fancy-schmancy breastfeeding teats with him to the hospital so that we could try giving the odd bottle. He also brought my pump, which was compatible with the breastshields/sterile kit I’d been given in the hospital and meant that I didn’t have to queue up in the expressing room with the other pumping mummies (there was only one pump on the ward, in contrast to NICU where there were several).

Initially feeding was a bit of a nightmare. I felt like every midwife in the hospital had handled my boobs and proffered an opinion (and each opinion was different!) C didn’t seem to want to latch, and some of the older NICU night nurses and midwives on the ward had tried to shove my boob into his mouth when he was screaming his head off (tongue up) which was bound not to work. Other midwives, nursery nurses and healthcare assistants seemed to have a real vocation, and were patient, supportive and extremely helpful in identifying things to try. We had a few really good feeds before we were discharged, but also some pretty crummy ones. Whilst the staff in the hospital were really great (one or two exceptions only) the ward was extremely busy, and sometimes staff couldn’t respond quickly enough when I (and other mums) pushed their buzzer for help. This was particularly the case at night, when you might have to wait for an hour (not helpful if you’re trying to latch your baby) – daytimes were easier, not least because S was with me throughout visiting hours (10am to 8pm) each day.

One of the hardest things was having to wake C when he was asleep. No amount of nappy changing, feet tickling, face stroking, bouncing, stripping off and blowing in his face could wake him sometimes, and it seemed that we were getting into a bit of a cycle where he was never hungry enough to exhibit feeding cues, and therefore wasn’t too focused on working hard to get some milk (also my milk had come in so well that it was dripping into his mouth sometimes!) The three hourly feeding advice was relaxed in our last couple of days in the hospital and things seemed to improve, but the three hourly target was re-instituted by our community midwife as soon as we got home. It was only once C showed that he was gaining weight consistently (although still not back to his birth weight until he was three weeks old) that we were able to start feeding on demand. This was when things started to click, and by about three to four weeks of age he was latching much more consistently, my boobs weren’t hurting, and I felt more confident. Growth spurts have been a bit of a nightmare and have shaken my confidence for a day or so – I think my record is probably feeding 13 times in 24 hours (with only one bottle and expressing session for some relief for the boobs), but all in all we seem to have cracked it now.

At 8 weeks and 5 days old C was 11lb 13oz and gaining around 1.25oz per day. He tend to have between seven and ten feeds a day now (unless particularly feedy) and sleeps for 6-7 hours at night, going up to 8 hours between his last feed of one day and his first feed of the next. He has one bottle of expressed milk every night/morning – sometime around 5.00-6.00am these days, although it used to be in the wee small hours. I firmly believe that expressing (both boobs, fully drained) has been really good for me, and has kept my breasts in good condition with no blocked ducts etc (fingers crossed that continues)… oh, and there’s a good stock of milk building up in the freezer, just in case of emergencies. If it doesn’t get used for milk feeds it could always be used to mix with food when we’re weaning our little hungry boy. :)

Breastfeeding has been a real challenge, but I’m really glad that I persisted and didn’t give up. Since I had C I’ve been talking to all the other mums in my antenatal classes, and most of them have found breastfeeding really difficult for the first couple of weeks. Some have persisted and have cracked it, others are doing mixed feeding, and still others have quit altogether and are formula feeding. Some of the advice I was given at my NHS antenatal classes irritated me, if I’m being honest (and irritated a lot of the other mums too). The community midwives can be pretty opinionated (not always a bad thing of course), and we were told in no uncertain terms that expressing milk was a waste of time, and that feeding expressed milk by bottle doesn’t work. Not my experience at all, and frankly not at all helpful (some mums, including me, want to involve their partners in feeding, and it’s a lovely thing for S to be able to give a bottle to our little boy – and quite necessary in any case, as I’ve discussed above). Some of the mums who gave up could have expressed and given some replacement bottles just to keep things ticking over until the feeding was established, especially if the problem was the baby having a tongue tie which could be snipped and would heal, but the advice given in the antenatal classes would have discouraged them from trying. The other thing that frustrates me is that we’re told that breastfeeding is so very important, but there isn’t a lot of honesty about just how difficult it can be. When I spoke to my health visitor she agreed, but said that lots of people wouldn’t even try if they were told how hard it is. I disagree. Many of those mums probably wouldn’t try anyway, as you have to be pretty committed in order to persist and crack it. If you're ambivalent about breastfeeding you probably won't continue through the bumpy times. I’ve not met anyone who took like breastfeeding like a duck to water. However, one thing we all agree on is the fact that if someone had been a little more honest with us, and told us that it’ll be hard, but that it will get better, we’d have known that there was light at the end of the tunnel and for that reason persisting would have been that little bit easier.

This post, which was supposed to be about diabetes and breastfeeding, seems to have gone somewhere else in the writing. But then, frankly this is one challenge where diabetes seems to be a relatively small thing in the scheme of it all!

D-Blog Week – Day Seven: What We’ve Learned

Today’s topic: Last year, Wendy of Candy Hearts made a suggestion for this year. She commented “I think Day 7 should be a post about stuff we've learned from other blogs or the experience of coming together online...” Today, let’s do just that!! What have you learned from other blogs - either this week or since finding the D-OC? What has your experience of blogging the DBlog Week topics with other participants been like? What has finding the D-OC done for you? If you'd like, you can even look ahead and tell us what you think the future holds!

I’ve learned so much from the DOC. I’ve picked up tips and tricks, found out about new technologies, and new ways to use old ones. I’ve met great people, and laughed out loud at their experiences of living with Diabetes, which reflect mine. I’ve marvelled at the way this community advocates for itself, and most importantly of all I’ve learned that I’m not alone, and that I can do this.

We are so much stronger together than we are apart. Keep blogging, reading, commenting and lurking folks!

D-Blog Week – Day Six: Saturday Snapshots

Today’s brief: Today is the only day I’ve brought back a fun topic from last year. Inspired by the Diabetes 365 project, let’s snap a few more d-related pictures and share them again. Post as many or as few as you’d like. Be creative! Feel free to blog your thoughts on or explanations of your pictures. Or leave out the written words and let the pictures speak for themselves.

The diabetes related pic:

(Time to tidy out my diabetes kit? - the tsunami of used test strips is evidence of how breastfeeding can play havoc with your blood sugars!)

Some pics of baby C, as requested by Layne! 4 weeks old today :)

D-Blog Week – Day Four: Ten Things I Hate About You, Diabetes

I'm re-posting this post from yesterday since Blogger has had some kind of major melt-down and it seems to have disappeared! I did post, honest! :)

Today’s brief: Having a positive attitude is important . . . but let’s face it, diabetes isn’t all sunshine and roses (or glitter and unicorns, for that matter). So today let’s vent by listing ten things about diabetes that we hate. Make them funny, make them sarcastic, make them serious, make them anything you want them to be!!

This topic is a little close to home for me right now. I’ve never really hated diabetes before, although it has been a major inconvenience for the last sixteen years! I’ve managed to get my doctorate, spend long periods of time living and travelling in Africa, hold down a pretty intense job and work all over the developing world, and diabetes hasn’t stopped me. It’s always been something that I just get on with – no point in complaining as that wouldn’t change things. However, since having an extremely traumatic childbirth experience within the last month, suddenly I see my diabetes in a different light, and have needed to process some pretty intense feelings…

Ten Things I Hate About You, Diabetes:

• I hate that you are gloriously inconsistent, and that ‘following the rules’ (whatever that means) doesn’t lead me to perfect blood sugars every day.
• I hate that there in fact aren’t any ‘rules’ and that most non-PWDs don’t understand that.
• I hate that you always deliver crappy blood sugars at the most inconvenient time possible (as a new Mum who’s breastfeeding, can I just say that it’s really rubbish to have a hypo just as your baby wants to be fed).
• I hate that you ruled every minute and second of my pregnancy, and that I couldn’t relax and enjoy it, since I was always thinking about blood sugars, insulin doses, what to eat, and how all of this might affect my unborn baby.
• I hate that even though I maintained an HbA1C of 6.6% or less throughout my pregnancy, my baby son spent five days on neonatal intensive care with blood sugar issues.
• I hate that this was probably a consequence of my insulin resistance – thanks for nothing, diabetes.
• I hate that diabetes meant that I had to be induced at 38 weeks gestation – since the induction went horribly wrong and I had an intrapartum haemorrhage, which led to foetal distress for my son, and probably compounded his blood sugar issues even further.
• I hate that diabetes will be my constant companion again when we try to have a second child.
• I hate that diabetes is in my genes, and that my children or their children might one day have to go through all of this too…
• And I hate that so many other people are also having to deal with living with you as an unwelcome houseguest.

**Rant over** – that feels much better, actually! :)

D-Blog Week – Day Five: Awesome Things

Today’s topic: In February the #dsma blog carnival challenged us to write about the most awesome thing we’d done DESPITE diabetes. Today let’s put a twist on that topic and focus on the good things diabetes has brought us. What awesome thing have you (or your child) done BECAUSE of diabetes? After all, like my blog header says, life with diabetes isn’t all bad!

Today’s post will be short and sweet…

The most awesome thing I’ve done despite diabetes is giving birth to my wonderful little boy, C – in fact it’s the most awesome thing that my husband S and I have ever done, full stop.

The most awesome thing I’ve done because of diabetes is to begin blogging, and to find the wonderful support network that is the DOC.

D-Blog Week – Day Three: Diabetes Bloopers

Today’s topic is Diabetes Bloopers: Whether you or your loved one are newly diagnosed or have been dealing with diabetes for a while, you probably realize that things can (and will) go wrong. But sometimes the things that go wrong aren’t stressful - instead sometimes they are downright funny! Go ahead and share your Diabetes Blooper - your “I can’t believe I did that" moment - your big “D-oh” - and let’s all have a good laugh together!!

A short post today... I wasn't sure that I'd have much to say about diabetes bloopers - I've done many daft things in my time, but not many that are laugh out loud funny! The classics include:

• Eating and forgetting to inject
• Getting interrupted during an injection and not being sure if I've had it or not... meaning either a double dose or no dose at all
• Mixing up my Novorapid and Lantus and taking a big whack of the wrong insulin (even worse when you're super insulin-resistant like me)
• Leaving the house with an empty pen, no test strips, or no meter batteries
• Digging in my handbag whilst hypo only to realise that the little piece of paper in the bottom is the empty wrapper from my glucose tablets
• Etc etc etc!
  

Grrrr! All rubbish things to do. However, this morning I managed to top them off with a real diabetes blooper. I dashed downstairs after feeding my little boy in order to feed myself and threw some toast in the toaster, which I then spread liberally with marmalade. Yum, thought I, until I got back upstairs, sat down on the bed, took a huge bite and remembered what my husband had told me yesterday when he baked the loaf... it was onion bread. I have to say that this was not a flavour combination to be repeated, but since I'd already breast-fed, was running a little low, and had bolused, I had little choice but to eat my avant garde breakfast. D'oh! :)

D-Blog Week - Day Two: Letter Writing Day

Today’s brief: In February the Wego Blog Carnival asked participants to write letters to their condition. You can write a letter to diabetes if you’d like, but we can also take it one step further. How about writing a letter to a fictional (or not so fictional) endocrinologist telling the doctor what you love (or not) about them. How about a letter to a pretend (or again, not so pretend) meter or pump company telling them of the device of your dreams? Maybe you’d like to write a letter to your child with diabetes. Or a letter from your adult self to the d-child you were. Whomever you choose as a recipient, today is the day to tell them what you are feeling.

If you've read my blog before you'll know a little about the person I've chosen to write to today. He's the doctor who turned my diabetes management around, not by preaching to me or telling me things I didn't already know, but by inspiring me to do better and supporting me every step of the way...

Dear Dr Inspiring,

Thank you.

I met you for the first time in January 2010, when I was referred to your pre-pregnancy clinic for diabetics. I’ve seen a lot of specialists in my time, and in 16 years of having this disease I’ve rarely had the opportunity to see the same doctor twice – a consequence of the way my previous hospital diabetes clinic was set up. I’ve seen you consistently since I started trying for a baby and throughout my pregnancy. I’ve seen good doctors and bad doctors in my time as a PWD, but you have been the most inspiring. Why? Because you understand. You know that living with diabetes is only part science, and that there’s an art to it too. You realise that whilst there are things I can control – carbs, food, insulin, exercise – there are also things that I can’t – stress, hormones, illness, and the random crap that life sometimes throws at us all. You don’t assign blame, or suggest that I should work harder, you just work with me to find things that I can improve, and support me to do this. You talk with me like an equal and don’t patronise me.

You go the extra mile – I’ve never before had a doctor give me their telephone number and tell me to call if I need to, and I nearly fell out of the bed when I was in hospital being induced and you gave me your home number and told me to call you at 10pm with my blood glucose reading so we could assess what doses I’d need! Finally you trusted me to manage my own diabetes whilst I was in labour and didn’t insist that I go on a sliding scale. That meant a huge amount to me, and I hope you feel your trust was borne out since I didn’t go above 8 mmol/l throughout the whole of my ten and a half hour labour, and was mostly in range between 4 mmol/l and 6 mmol/l (what happened during my emergency c-section I don’t know!) The fact that you telephoned the hospital on your day off to see how I was doing during my labour (more than once) speaks volumes about your commitment to your job, and I know that the diabetic ladies of North Bristol are lucky to have you!

Once again Dr Inspiring, thank you. You know that I’ve been blogging about my pregnancy anonymously, and on the off-chance that you ever find this blog and read my letter, I hope you’ll recognise yourself as Dr Inspiring.

My husband, my son and I owe you an incredible debt.

a.k.a Dia…Betty.

D-Blog Week – Day One: Admiring our differences

This is my first time joining in D-Blog week - I was determined to do so, but there is a little something which might make my posts a bit random and a bit short... actually it's a little person - my three week old son, C. So, forgive me in advance for any randomness - it's amazing how pregnancy brain turns seamlessly into mummy brain! Added sleep deprivation from the breastfeeding means I'm a little more off the planet...

Anyway, today's topic is 'Admiring our differences': We are all diabetes bloggers, but we come from many different perspectives. Last year, Diabetes Blog Week opened my eyes to all of the different kinds of blogs (and bloggers) out there - Type 1s, Type 2s, LADAs, parents of kids with diabetes, spouses of adults with diabetes and so on. Today let's talk about how great it is to learn from the perspectives of those unlike us! Have you learned new things from your T2 friends? Are D-parents your heroes? Do LADA blogs give you an insight to another diagnosis story? Do T1s who've lived well with diabetes since childhood give you hope? Pick a type of blogger who is different from you and tell us why they inspire you - why you admire them - why it's great that we are all the same but different!!

I found the DOC when I was reassessing everything to do with my diabetes and tightening up my control in anticipation of trying for a baby, and suddenly there was a brave new world out there of other people who understand what having diabetes actually means. It's a lonely old world if you're type 1 - there are so few of us, and whilst I wholeheartedly agree that all PWDs - types 1, 2, LADA, MODY, gestational and all of the other varieties - need to pull together, it's great for me that there are people out there blogging who totally get what my T1 life is like on a day to day basis. It's empowering to realised that you're not alone, to discover that other people are facing the same challenges that you do, and that [whispers] n0-one's perfect!

For me, the big difference between me and most other DOC-ers is location. Most of you guys are in the States, and there are a few others smattered around the face of the globe - Canada, Australia, NZ. There are comparatively few of us in the UK - people like Becky from Instructions Not Included, Siobahn at Click of the Light, and Caroline Parker at Diabetes Daily - Hi ladies from one of your lurkers! The DOC has given me a real insight into how diabetes care differes in other parts of the world. Pumps are extremely unusual in the UK, although some folk have managed to fight and win the battle to get NHS funding, and as for CGMS... well, they're almost unheard of (and certainly self-funded - oh, for that lottery win!) I'm relatively content to be on MDIs (my HbA1C has been excellent over the last eighteen months, so it is possible to control the D well without a pump), but I would LOVE LOVE LOVE the security that having a CGMS would bring, and the allied opportunity to fine-tune my control a bit more. You know what they say - 'knowledge is power'!

One thing that has fascinated me is just how much someone like me on MDIs can learn and adapt from the pumpers out there - there are tips and tricks which, whilst difficult to completely replicate on MDIs, have certainly changed my D-management for the better. For starters pizza and curry (naughty foods!) now hold fewer fears as I've understood that the fat content will cause my sugars to spike later than I might otherwise expect. Whilst I can't programme a fancy bolus to deal with this, I can certainly test again a couple of times in the hours after my meal and deliver a couple of small insulin doses to flatten out that spike.

The other thing that's been great for me is to follow all of the people out there who have blogged about their pregnancies with T1, and their experiences of parenthood. I don't think that there's another UK based blogger who has written about pregnancy and diabetes (but I may be wrong, and if so, I'd love to read what they have to say on the topic). Whilst I was pregnant I was able to learn a lot from the pregnancy D-bloggers in the US and elsewhere - including Kerri Sparling at Six Until Me, Cheryle Alkon at Managing the Sweetness within, Bethany Rose at Me with D (and previously Life as a Pregnant Diabetic), and Layne P over at Semi Charmed Life. Whilst the US and Canadian health systems might be totally different to the NHS system here in the UK, these ladies have been a huge inspiration, and have taught me things about pregnancy and diabetes that I wouldn't otherwise have know (and which I have been able to discuss with my brilliant doctors).

I believe that it's the diversity of the DOC, and the range of different experiences and opinions that we bring, that really makes us strong. We are not alone, and can learn from and support each other... and laugh with each other too.

My biggest supporter

Just wanted to drop in for a few moments to post something very important to me - a message to my lovely husband S.

You are incredible and have been my biggest supporter throughout this pregnancy (and in life more generally). Now you're proving to be an amazing Daddy, and I just wanted to say how much I love you, and how much you and baby C mean to me.

Love always xx

He's Here!

So I've been absent from this blog for a while now, and I guess people may have wondered what's happened to me/us. Here's the short version, with a promise to post a proper account over the next week or two...

Our son, C, arrived by emergency C-section on 16 April 2011 at 9.17pm. He was 8lbs 10oz. Labour was quite the experience, since my induction went somewhat awry. The drug I was given to induce labour didn't agree with me, and I had some seriously chaotic contractions about ten hours in, with several coming in quick succession and no time to recover in between. I'd managed to avoid a sliding scale during labour thanks to Dr I's trusting me to manage my own diabetes (yay!) but as I spent more time on gas and air I felt more and more like I was deep underwater. About nine hours in I finally capitulated and had an epidural, which allowed me to think clearly again. Fortunately for me it also meant that when the CTG showed that baby was starting to be distressed and we were rushed to theatre I didn't need a general anaesthetic (they would have knocked me out cold if I hadn't already got the epidural on board). It transpires that I was having an intrapartum haemorrhage, and baby's heartbeat was slowing as a result.

C's arrival was not what we'd planned, but we were thrilled to have him in our arms, and had no idea at the time of just what danger both he and I had been in. Sadly after an hour together he was admitted to neonatal intensive care with hypoglycaemia (blood sugar of 0.9 mmol/l) and there he stayed for five days, during which time he had a tube running into his umbilicus delivering dextrose, a nasogastric feeding tube, a horrible venflon in the back of his hand and all in all a pretty rough time (despite the amazing care he received). On day three his CRP levels (which indicate an infection) were raised, and he ended up having four unsuccessful lumbar punctures to check for meningitis - before starting five days of IV antibiotics. He also clocked up a night under the bililights, thanks to a bout of jaundice. After another five days on transitional care we finally made it home a few days ago. I also managed to pick up an infection (in my c-section wound), so have also been on antibiotics, and am still not back to normal - apparently there's a risk that the wound will reopen thanks to a large haematoma above the scar. Grrrr. However, we have our marvellous, wonderful, gorgeous, beautiful little man with us now, and we couldn't love him more. We're busy facing some breastfeeding challenges now, but are perservering, and I think we're beginning to turn a corner - more of which in a future post, I'm sure. Speaking of which, time for another feed...

Love to all of my friends in the DOC, and here's a picture of the little man:

A date with destiny...

*** NEWSFLASH ***

I had my last antenatal appointment (36 weeks) on Thursday 31 March, including the obligatory growth scan, and meeting with the diabetes team and obstetricians. Can't quite believe that I've reached this stage!

It wasn't even possible to measure Bumpy's head, since it was so low down in my pelvis (a good sign, I reckon), but the Abdominal Circumference was 329.0 mm and the Femur Length was 74.0 mm, giving an estimated weight of 7 lbs, or 3.175kg for baby, and meaning that our growth was still consistently somewhere around the 75th-80th percentile. Yay! His or her little heart was beating away, the placenta still isn't blocking the exit, and baby's head down with a normal amount of amniotic fluid (3.5cm at the deepest pool).

The next stop was to see the obstetrician, S, who had a trainee doctor with her for the appointment. She was very happy with how things are progressing, and sees no reason for us to opt for a C-section, so went ahead and recommended induction of labour at 38 weeks. This is considered to be the optimum time, since baby will have technically reached term and hopefully have fully developed lungs (full term is anything after 37 weeks), whilst the placenta will still be functioning well (this can drop off in the final couple of weeks, especially in diabetic women, with risks for the baby). S and I had a hundred and one questions (well, not quite, but certainly a long list), which S the obstetrician happily went through with us. Here's the potted version:

Us: What if we go into labour spontaneously before the 38 week mark?
Obs: Everyone cheers, and you call the hospital and come straight in!
Us: Dia...betty had an elevated white blood cell count about a week ago following her routine midwife appointment - is this anything to worry about?
Obs: It can be a consequence of pregnancy, or of an infection, but we'll repeat it and see.
[NB. It was 16.4 when originally tested, and I had a conversation with my GP where he came to the conclusion that it was probably high due to a nasty little viral throat infection I had last week]
Us: Who will be at the birth?
Obs: It will probably start off with just a midwife early in the induction, but there will always be a consultant obstetrician within easy reach should they be needed. Dr I will also be around/on call to manage the diabetes aspects of things. Once labour is established you'll be transferred to the Delivery Suite and when baby arrives there will be at least two midwives there, as well as (potentially) an obstetrician and paediatrician.
Us: What's the exact process for induction?
Obs: Here's a leaflet which lays it all out. Once you arrive on the ward you will be assessed and the baby will be monitored electronically. Basically induction starts with a prostaglandin pessary (a little like a small tampon) which will be inserted into the cervix to soften and open it. You will have to lie on your side for 3o minutes, and then will be free to walk around the ward to encourage labour to start. The pessary can stay in place for 24 hours, during which time it's hoped that your contractions will start and your waters will break. If after 24 hours this hasn't happened you will be examined to see if your cervix has softened and opened enough for your waters to be broken manually (at this point you move from the antenatal ward to the delivery suite). If not, you might be given another pessary. If contractions don't start once the waters have been broken you might be given an IV drip of Oxytocin to kick things off. If all of this doesn't work or if you fail to progress fast enough the doctors will consider a C-Section instead.
Us: How long will Mum and baby have to stay in hospital after baby is born?
Obs: A couple of days, if you have a successful induction, more like four if you have a C-Section. Partly this is to monitor how baby is doing, blood sugar wise, and partly to monitor you, and to allow breastfeeding to become established.
Us: Will Mum and baby be able to stay together on the ward? What are the wards like?
Obs: Yes, Mum and baby will be together 24/7 unless there's a need for the baby to go to special care. The wards have 10-bedded, 6-bedded and 4-bedded areas, as well as single and double rooms. You can opt for a single or double room if you wish, but there's no guarantee that one will be available (as they are first come, first served, and also subject to medical need), and you will have to pay a daily charge for using one (somewhere between c£40 for a double and £125 for an ensuite single).
Us: What happens if baby's blood sugars are low at birth? How is this treated?
Obs: You'll find out more at your specialist breastfeeding appointment, but we will aim for you to breastfeed as soon as possible after the birth and in any case in the first hour. We will use formula milk as a last resort either via syringe or naso-gastric tube.
[Watch this space for more info - my next post will be about the breastfeeding appointment...]
Us: What are the rules about Dads being present for the birth and afterwards? How soon will S get turfed out?
Obs: Whilst you're on the ante-natal ward waiting for the induction to take effect S will be able to be there during visiting hours - 10am-8pm. Once you're transferred to the Delivery Suite he can be there full time. Once you move to the post-natal ward it's back to the usual visiting hours of 10am-8pm. Other visitors (up to two at a time) are allowed between 2pm and 4pm, and again between 6.30pm and 8pm.
Us: What support is there on the ward for breastfeeding Mums?
Obs: Lots, including the specialist breastfeeding midwife, who you will meet at your appointment.

Phew! So, that was the Q&A bit of the appointment. Once we'd finished S headed off to book a date for the induction, and Dr I came in to see us. He was still very pleased with my control, despite my little blip with the throat infection, and was delighted to hear that the growth scan results meant an induction rather than a C-Section. S popped her head around the door to let us know that we'd be aiming for Thursday 14 April. It's a bit mad to know the date in advance, but S and I are slowly wrapping our heads around it! We also had a few questions for Dr I about the birth process...

Me: How exactly will my diabetes be managed? Who will do this? Who determines the sliding scale?
Dr I: Call me when you come into the hospital and I'll be on hand. You're taking a shedload of insulin, so you'll be a bit complicated to manage, but you've maintained excellent control so far. We'll just have to suck it and see! [Sidebar: I've always been pretty insulin resistant, and my TDD now is approx 380 units, up from about 130 before I got pregnant - cue sharp intake of breath from my friends in the DOC who have tiny TDDs!]
Me: When will my usual basal/bolus regime stop in favour of the sliding scale?
Dr I: Only once you're in established labour.
Me: Will I be able to eat/drink/snack/graze during labour, or will I just be on a glucose drip?
Dr I: We'll see how things are going once we get there.
Me: When might my hypo warning signs return?
Dr I: Hopefully soon after delivery, but it's different for different people.
Me: What will my post-delivery diabetes care look like? Will I have follow up appointments?
Dr I: You'll be seen in the combined diabetes/obstetrics clininc twice, once at 3 weeks, and again at 6 weeks after the birth. Then you can stay on under my hospital diabetes clinic if you'd like.
Me: Yes please - I like my GP, but that would be way better! :) Once again, yay!

Once we'd finished up with Dr I, S headed off for work whilst I waited to have blood drawn for a repeat White Blood Cell count and the usual routine things (HbA1C, Liver function, Thyroid Function, Electrolytes etc). I called the hospital for the results today, and discovered that my HbA1C was 6.7% (up a tiny bit from the last reading of 6.5% but still fab in my opinion!), my Free T4 was down a bit from last time (at 8.9), my WBC was still a bit high (at 16.2), and my calcium and albumin were a little low. If there's anything to be really concerned about in all of that I'll hear directly from Dr I, but otherwise I won't be back at the hospital until Induction Day, on 14 April. Eeeek. It all seems much more real now!

Catching up - hospital appointments, midwife visits, antenatal classes... and Elvis!

The last five weeks have been just packed. Every time I've thought about sitting down and posting to my blog something has got in the way... Feels like I've had plenty to say, but just haven't really had the time to say it. However, here I am, back again!

Since my last post lots has been happening. Here's a quick run down:

Elvis the dysfunctional pelvis - Physio visit, 1 March

After my first visit to the physio I knew that I was beginning to get the early signs of SPD, and by the end of February it was coming on with a vengeance, leading me to nickname my pelvis Elvis (it always helps to personalise these things, I find - that way there's 'someone' to blame!) I think what probably took me over the edge was a work trip to London, involving a 20 minute walk (with little trundly suitcase) from my hotel to a meeting. By the time I got there I was starting to struggle a bit with the pain in my pelvis, and over the next few days resting up didn't seem to help. As a result I got back in contact with the physio to ask if she could see me a second time, and she was good enough to squeeze me into her list for an emergency appointment on 1 March. Since she couldn't find me a slot in her list at the local community hospital I went to see her at the main hospital instead - really this should have involved lots of paperwork discharging me from the one place, and adding me to the list in the other, but instead she just snuck me in, which was very kind.

A few days earlier I'd given in and been to see my own GP* in order to get a letter from him to say that I had SPD, in order that I could get a disabled parking space for my last three weeks at work. The multistorey is eight floors high, and at the time I arrive all the lower floors are full, meaning a somewhat uncomfy trip down the stairs (the lift seems to be out of order more than it functions!) Luckily work were very obliging, which made life much much easier.

My second trip to the physio was also really positive - she agreed that my symptoms were worsening, and gave me some really good advice about how to minimise the pain (posture, pelvic floor exercises, etc etc). Then she surprised me by fishing out an enormous roll of elasticated support bandage and cutting off about 1 metre of it, which she doubled up and showed me how to wear over my bump and hips in order to support my pelvis. Yes, I am now wearing the world's largest tubigrip, and believe me, it's great. I can't believe that something so cheap and cheerful has such a positive effect - it really cuts down on the discomfort, and means I can walk a bit faster and a bit further. Admittedly it's not the most attractive thing in the world, but I can live with that, and since it's not high summer the fact that it's pretty warm is actually a positive (I can imagine that it would be horrible to be so hot in the summertime).

*NB - whilst I was at the GP's he decided he'd have a quick check of the baby, and had me jump on the couch so he could palpate my abdomen and listen to the heart. It was a really nice thing to do, since it was an extra little check up, but it was a good thing that my little passenger was kicking me so hard during the process, since my very lovely GP took rather a long time to find the heartbeat!!

Hospital Antenatal Appointment: 3 March

On 3 March I had another one of my regular hospital visits to the combined diabetes and antenatal clinic. This started off, as usual, with a growth scan. Baby appeared on the screen, little heart beating away, and we settled in as the ultrasound midwife took all the necessary measurements. Baby measured at something between the 75th and 80th percentile, so all in all our growth has been pretty consistent, and the obstetricians and diabetes teams seemed very pleased. The biparetal diameter was 89.8 mm, the head circumference was 311.4 mm, the abdominal circumference was 293.3 mm and the femur length was 64.9 mm - which gave us an estimated weight of 4lb 15 ozs. I hope that we can keep baby's growth this consistent and that we don't drift upwards in the final few weeks - 80th percentile would be perfect, to my mind, and I'd rather we didn't end up with an enormous newborn (I guess I'm thinking of the birth here!)

Once we'd had the ultrasound we saw the usual array of doctors, starting out with a very earnest and very young obstetrician, who was just a tiny bit confused as she bowled into the room and told me I was 24 weeks! No, I said, 32 actually! She checked my notes, agreed, and told me that she was happy with the growth scan, and that was it! The next appointment, at 36 weeks, will be the biggie, with what's called the MOD discussion - method of delivery! I've already been warned to expect an induction or C-Section at 38 weeks, and this will be the decision point for which one, and when...

Dr I had a new colleague with him, D, the dietician, who is covering for L whilst she's on maternity leave. They make a pretty good double act, these two - both very encouraging, and very supportive. D had a look at my monitoring diary and professed himself quite pleased with how things are going, although he suggested upping my dinnertime novorapid a little. Dr I ran through my last set of blood results, and was really happy with my HbA1C of 6.5%. My next appointment for a scan and the obstetricians was set at 4 weeks ahead, but Dr I suggested I might want to come back in 2 weeks to see the diabetes team, since I'm coming up to the end of the pregnancy and insulin doses can change quite a bit at this stage. He was due to be on holiday, but D would be around and happy to see me. Dr I also sat down and calculated my suggested post-pregnancy insulin doses 'just in case' baby should arrive before the next appointment. That was a slightly freaky thing to hear, but I was pleased to have the safety net! I didn't have any blood taken at this appointment, which was a strange experience after all the testing, but Dr I didn't think it was necessary. At the end of the appointment Dr I also mentioned the possibility of me joining his new patient advocacy/research steering group, which sounds brilliant. It turns out to be full for the moment, but my name's on the waiting list, so hopefully I'll get an invitation eventually.

The last part of the appointment involved popping across the road to the diabetes centre for retinopathy screening, since Dr I has just arranged for his pregnant ladies to get the Rolls Royce treatment of retinal photos instead of just having a look in the back of the eyes with a pen-light.
I had only just had my annual screening at the GPs (on 25 Feb) but when I'd mentioned this to the hospital they suggested that I still have the maternity related screening appointment. When I arrived I mentioned the recent test, and the lady who was doing the screening was able to reassure me that I didn't need two appointments and that they'd be able to pick up the photos from my regular screening and use those. It was still worth coming in though, since she was able to walk me through what would happen next: additional post-pregnancy screening at 3, 6, and 9 months after delivery and then a return to the annual GP screening programme after a year. It's great to know that the NHS takes such good care of us.

Midwife Appointment: 14 March

14 March saw another midwife appointment. It was a relative quickie, since everything has been going pretty well. My BP was 136/74 (a little higher than some of my 'at home' measurements, but nothing to raise concerns). No protein in my urine (which I knew already since I have my own protein sticks), and +1 of glucose, as a result of overtreating a night-time hypo. My fundal height was 36 cm (about 2cm over what would be expected, but consistent with an 80th percentile baby) and we had a little listen to baby's heartbeat on the doppler, which is always a lovely thing to hear. J gave me a slip for having some routine blood tests taken, but didn't risk trying to get them herself, since I have such difficult little veins. I need to go back into the surgery early next week to get them taken (must. not. forget.) J didn't book me another appointment at the end of our consultation since I already have a hospital appointment booked for that week. She told me to ask them if I should see her again before the baby's born, but thought that we might not see each other again until afterwards, if all happens as planned. Scary!

Starting Maternity Leave: 16 March

On Wednesday 16 March I finally finished work. Although my maternity leave doesn't officially start until Monday 21 March, I took a flexi day and a day's annual leave on Thursday and Friday to shorten my last week in the office. Monday was a busy one, working from home, with a long teleconference in the morning (at least I decided not to go into London one last time), and then an antenatal class at my GP surgery in the afternoon (of which more below) and a midwife visit (see above). Tuesday and Wednesday I was in the office, finalising my handover notes, meeting with colleagues to explain said handover notes, and packing away my desk (the team's moving locations whilst I'm off, and in any case, someone will need to sit in my seat whilst I'm away). I had half planned to work two relatively short days, but... epic fail! I was, in fact, 'thrown out' of the office at 7.59pm two days running. Grrrrr. Why is it that we always think we can do this sort of thing faster than we actually can?? It's a strange sensation to have finished at work, and even stranger to think that I won't be going back in for a year (26 weeks on full pay, 13 weeks on statutory pay and 13 weeks unpaid - the UK system is pretty generous compared to the experience of some of my friends who are pregnant at the moment and working in the US). I'm not sure that it will hit home until Monday. I'm really tired now, and do feel that it was the right time to finish, but I have to say that I'm feeling a little lazy - especially when S has to leap out of bed in the morning to go to work. Still, I know that my job now is to rest, relax and grow our little person. I'll miss my colleagues though - my team took me out for lunch on Tuesday, which was lovely, and the whole organisation crept up on my desk for the traditional ritual humiliation and present giving on Wednesday - I had some gorgeous gifts, both for baby and for me, which was very touching (especially as I'd also received a very thoughtful 'care pack' from my brother and his girlfriend the day before, containing pampering foot soak, pregnancy balm, books, knitting patterns and wool - I feel very spoilt indeed!)

Hospital Antenatal Appointment: 17 March

Thursday 17 March saw my most recent hospital antenatal appointment, which was just a quick review with the diabetes team - specifically D, the dietician. The tweaks I've made to my insulin since the last appointment seem to have done the trick, although I'm back in hypo-land more often as a consequence. D suggested watching things closely now that I'm not working (and therefore not running around like a headless chicken), just in case I need to tweak things again. D also arranged for me to have a specialist breastfeeding referral, since having type 1 can complicate the process more than a little - hopefully I'll get a call with an appointment sometime in the next couple of weeks, which would be great.

Other features of the last month:

Nesting:

Yep - I've finally capitulated and started buying things for the baby! I was quite superstitous to begin with, and didn't want to buy anything until I was thirty-something weeks, just in case something went wrong. Daft, I know, since owning a babygro isn't ultimately going to change the outcome, and if something bad happens, having baby stuff in the house isn't going to be the thing that breaks your heart, but still... Anyway, since the beginning of March (about week 32) I've relaxed a little. S and I went to IKEA to buy nursery furniture, and to Mothercare to get a few essentials (including the odd babygro!), as well as to pick out a pram/buggy/carseat combo. S's parents paid for the nursery furniture, and mine paid for the travel system. I spent a few happy hours erecting the furniture, and now it all seems a little more real. The most exciting thing for me is that we're going to have the family crib. My aunt, who currently has it at home, has washed all the drapes and even erected it so she could send us some photos. It means a lot to me, since it's 72 years old (made either by my grandfather or great-grandfather), and my uncle, aunt, Mum, three cousins, me, my brother, and my cousin's little girl have all slept in it over those 72 years. Our little person will be number 10! Here's a picture:



It will only last us until baby is about three months, but we already have the cot for when baby's too big for the crib.

Antenatal classes: compare and contrast

This week also saw the start of our antenatal classes. I'm doing two different ones, whereas S is just coming along to one set. The first is free through our GP surgery, and thanks to government cuts it's been slashed from four sessions of two and a half hours each, to just two. The first session was on Monday afternoon, before my midwife appointment. There are two GP surgeries sharing the same premises, and the two midwives run the class jointly - the first session was led by my midwife J, who ran us through labour, delivery and pain relief. She's a very forthright Scot and 'tells it like it is', which had some of the men in the class blanching a little! There were 15 women all together and 13 partners came along with them (S couldn't manage it since he was at home waiting for the gas engineer to fix our boiler!) The class was good, and it was nice to be in a room with so many other bumps, but it was difficult to get to know people with so many of us in the room. This is a big contrast with our other antenatal class which is through the NCT (National Childbirth Trust), a UK parenting charity. The groups are smaller, with up to seven couples per course, and the classes are more detailed, with much more time to get to know each other. In fact, some people have nicknamed the NCT the 'mummy mafia' since people often make lifelong friendships through the classes. We've been to two sessions so far, and have really enjoyed them. There are seven couples in the class, most local to our area, and no-one from more than 6 miles away, which is great. The other great thing for me is that there's another 'high risk' lady in the group, which makes me feel less of an outlier - she's expecting twins, so is also in line for a more 'medicalised' birth experience, and probably either an early induction or c-section. So far we've covered labour and childbirth, and had a sessions on managing pain through promotion of 'good hormones' including things like listening to music, 'customising' your birth environment, and massage. We've also started thinking about the first few weeks post birth, and how to manage them. All pretty good fun, and the group has a good dynamic - there's been lots of laughter (and one or two highly 'inappropriate' comments from a couple of the men have caused us all to crease up!) Four more classes to go - 17 hours in all over a three week period, with a mix of evening and Saturday morning sessions. Hopefully we'll all see each other again after the end of the course, with reunion sessions planned. I wondered if it might be a bit cringey in places, but actually the whole group has quite a similar, humorous attitude to the course, so it's been great so far...

********

I'll leave you with my latest fruity update - it's a honeydew melon! As baby gets bigger and therefore more cramped, I'm finding that his or her movements are very different. More of the whooshing, flumping type movements, and less of the old style kicks, although when I do get one they can be pretty powerful. The newest feature is the stretching, which can either be up-down (in which case a little foot reaches up into my rib cage) or side to side, which is very weird indeed (and just slightly uncomfy - S can always tell when it's happening thanks to a sharp intake of breath from me!) Can't quite believe it, but here I am in month eight, and our little person is likely to be with us in less than four short weeks... :)

A week of appointments

I had a very busy week for medical appointments last week!

1) The hospital antenatal appointment

I had my regular hospital antenatal appointment on Thursday 3 Feb. S came along with me for the ultrasound, which was quick, but great. Baby's doing fine - he/she is at about the 70th-75th percentile for growth, and weighed in at 2lb 15ozs (or 1326g in new money), according to the prediction. The head circumference was 276.8mm, the abdominal circumference was 245.0mm, and the femur length was 54.7mm. After the scan S headed off to work, whilst I went in to see the various docs.

Dr I had a new trainee registrar with him, and introduced me as a star pupil (which was nice). After checking my blood results from last time, and looking over my monitoring diary he pronounced himself very happy with how things are going, and told me to keep on keeping on! Next time, (4 weeks) I'll have my third trimester retinopathy screening, and Dr I explained that he's trying something new for this. Instead of doing the screening himself, he has convinced the local screening service to do a trial run of coming into the clinic with their camera equipment, which should improve the accuracy of the screening compared to the 'old-school' version. The only hitch was that since this is so new, it's not quite clear how to book the appointments so that they line up with the antenatal ones. I'm quite the guinea pig (!) and have been asked to call the screening folks in a couple of weeks to confirm that all is going to plan with the appointment!

After Dr I, I saw S, the obstetrician, who checked my scan results and asked how things were going (including the trip to France, and the carpal tunnel). I explained that France had gone fine, although I'm glad to be back and close to the antenatal clinic for the remainder of this pregnancy, and that I still hadn't seen the physio, although I was due to go the next day. My bloods, scan and urine were all fine at this appointment, and my BP was 100/60, so S was also happy to see me again in four weeks for a repeat scan.

After heading off for the usual round of blood tests I left the clinic about an hour after I'd arrived (which must be some kind of record - and thank goodness, since I had to hurry straight to London to speak at a conference. Arrived in the nick of time!)

** I called up for my blood test results a few days after the clinic appointment and apparently all is fine. My HbA1C was 6.5%, TSH was 2.0, Free T4 was 9.6 and Free T3 was 4.7. Liver function and Alb/Creat also normal. Hurrah. That means my HbA1C has been 6.5% or lower throughout my whole pregnancy.

2) The physio

Next stop was the physiotherapist, who I saw on Friday 4th. I had a little scare when I arrived at the local community hospital in my neighbourhood, which I've never had to visit before. It was being redeveloped, with big 'hospital closed' signs at each entrance. WTF? Rather than freak out, I parked and wandered around the side of the hospital, where I found a tiny sign pointing towards the physio department, which is apparently the only part of the hospital currently open. What? They couldn't have put a note in my appointment letter explaining this?! Ah well. The physio was a lady called P, who was very quick to confirm that I have carpal tunnel syndrome and to agree that wrist splints worn at night are the way forward. She also suggested some exercises that might help relieve it (aside from the frantic hand-shaking, which she agreed is very effective!) The two which stick in my mind are sitting with your hands out in front of you above heart level, and doing the 'windscreen wipers' with both arms (from the elbows), which apparently helps to mobilise things. She tried to fit splints then and there, but had run out of the larger sizes (she only had small with her), so promised to send me some in the post once she got back to her main office.

Whilst I was at the physio I also took the chance to ask about some pains I'd been having in my pelvis the last few days. Right down low, near my bikini line (but inside), quite sharp muscular pains. I'd worked out that doing pelvic floor exercises and resting a little helps relieve the pain, but wanted to know what it was, and if there was anything else I might do. P explained that this could just be bad pelvic girdle pain, although it might also herald the start of SPD (Symphysis Pubis Dysfunction) which is more severe, and is where the bones of the pelvis, the symphysis pubis, open too wide - they open by a couple of milimetres in any pregnancy, but more can be very painful. She explained that good posture is key (and told me I'm pretty good anyway - must be all those childhood ballet lessons), and that I should listen to my body and not overdo the walking or stair climbing (although keeping mobile within those limits is good). If/when I feel pain I should slow down (seems to be after about 15 minutes of walking), and I should also make sure that my work chair and car seat have good lumbar support. I should also try to keep my knees together when climbing in and out of the car - imagining I'm wearing a miniskirt! - to stop any strain. Pelvic floor exercises a couple of times a day (5 x 10 seconds) should also help. I was really glad I'd asked the question. P also told me at the end of my appointment that she'd leave me on an 'open appointment' until I'm 6 weeks postpartum, which means that if I have any problems and would like to see a physio again all I have to do is call.

** The wrist splints arrived on Thursday of this week. They fit fine, although they're not exactly stylish or elegant (or god-forbid sexy!) I've slept with them for two nights, and I have to say that whilst they've banished the carpal tunnel syndrome very effectively they take some getting used to. It's a bit like sleeping in boxing gloves, I'd imagine (having never tried that!), and I find it hard to get comfy. I slept pretty poorly the first night, but did a little better last night, although I took the splints off this morning at about 6.30 and then curled up again for my precious Saturday lie-in. It was heaven to get them off! :) I'm going to persevere for a while though, and see if I can get used to the splints. S hasn't been clonked on the head yet, so he's being very sweet about it!



3) The community midwife

My final appointment of my busy week was this Wednesday (9 Feb) when I saw the Community Midwife. Instead of seeing J, the midwife connected to my surgery, I saw the midwife from the surgery that shares the same premises, another lady called J! My BP was 120/66 and my urine was fine, except for +1 glucose (which probably came from overenthusiastically treating a hypo in the night, since S was away and I was a bit nervous to be sleeping alone). She asked about fetal movements, and I explained that I'm feeling plenty, although they come at specific times of the day - a couple of hours after meals, and just as I'm going to bed (S tells me that he sometimes puts his hand on my belly in the middle of the night and can feel my little passenger squirming then, whilst I'm sound asleep!) I did explain that I certainly don't feel 10 every hour, which is what some of the books tell you is normal, and J explained that this is new guidance. She prefers the old rule of 10 in 12 hours, which I can certainly tick off! :) J also gave me an new leaflet at this appointment which deals with the '28 weeks and beyond' part of pregnancy. It's an interesting read - it explains more about pain relief options in childbirth, and some of the things that you can expect when you're in labour. After talking me through the leaflet she listened to the baby's heartbeat with a sonic aid (it was good and strong at 130 bpm, and I never tire of hearing it!) and then measured my fundal height and felt for the baby. It turns out that baby was in a slightly bizarre position - head down, yes, but seemingly doing a handstand, so carried quite high. This made the fundal measurement large for dates at 33cms, but given the growth scan last week J wasn't too worried. She said baby will probably be back in a normal spot by next time. We made an appointment for me to see other J again in 5 weeks, when I'll also be attending the two Js parentcraft class and coffee afternoon for local mums to be.

Well, I think that's it for the update - except that we've moved into new veg territory since last time I posted. Could I really have one of these inside of me? Might explain why my centre of gravity has shifted so much?! :)