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?! :)

Marseille Trip and Two Huge Pregnancy Landmarks

I have been so bad at posting recently! Since the new year I've been trying to dial things back on the work front and take a few days off here and there, before finally going on maternity leave on 16 March. Great in theory, but as it turns out, difficult in practice. The problem is that I still have to do all the things I usually do, and if I have fewer days I just end up working longer on the days I'm in the office! S and my Mum are both pointing out the silliness of this strategy, and I'd have to agree, but somehow the aspiration and the reality remain poles apart. I have a really intense job at the best of times, and I'm juggling a bunch of projects which I'm really committed to, whilst also trying to set things in order for my handover (the person who's taking over from me for the next year is a good friend, so I want to make her life as straightforward as I can, so that she'll still be speaking to me when I come back and resume my job). Anyway, I'm trying to turn things around now, so maybe I'll have time to blog a little more often.

One good thing is that I've done my last foreign travel before baby arrives. My work trip to Marseille was really great - I got to catch up with some of my favourite people, our conference was fabulous and we've set some new things rolling (just in time for me to wander off into the sunset for a year!) However, it was super-tiring, and I realised that pregnancy is catching up with me a bit now, and I can't do the early mornings and late finishes like I used to (carpal tunnel syndrome and a baby dancing on my bladder are playing havoc with my sleep patterns!) The train journey was a breeze - much better than flying, and once I got onto the Eurostar everything was very smooth (I had a few delays on the UK side, but fortunately not enough to cause me to miss my connection - although it was a close run thing!) The TGV was also great - very comfy, and very convenient. In fact, I think I'll be doing more rail travel in Europe even when I'm not pregnant - anything to avoid the dreaded Charles de Gaulle airport! I have to say though, I'm glad to be home. I had a little scare on my last morning in Marseille when I tripped and fell in the street after getting my feet tangled up in a piece of wire. Although I landed on my side, rather than directly on my bump, it was a frightening experience, and made me feel quite vulnerable to be so far from home and my brilliant doctors. A lovely gallant French chap rushed to my rescue and picked me and my shopping up - there was lots of waving and gesticulating, and he was evidently very cross that 'such a dangerous piece of wire' had been dropped in the street to trip up poor pregnant ladies. My French wasn't quite up to all of the nuances, but I was grateful for the sentiment all the same! I took myself back to my hotel room for an hour or two before I had to head off to the station, and luckily for me the baby obliged with some wriggling, squirming and kicking just to let me know that he/she was okay. I boarded the train relieved to be heading home though...

Here's a snap I took in Marseille of the view from our conference room window - it's amazing that anyone did any work at all! Although the weather looks great, and it was beautiful, it was also pretty cold, and we were surprised one evening by a couple of hours of heavy snowfall.



Since getting home from France I've reached two very exciting pregnancy landmarks. Today is the beginning of my third trimester - I've arrived at the 28-week point, which means I probably only have another 10 weeks to go (eeeeek!) However, my favourite moment of the whole pregnancy came in the early hours of this morning (1 am) as S and I were settling down to go to sleep. For as long as I've been able to feel the baby moving (ie. since Christmas Day), S has been putting his hand on my belly whenever I tell him that the baby's moving, and has been trying to feel it from the outside (so to speak). Last night he felt the littl'un for the first time -which was a magical moment. We went off to sleep full of excitement for what's to come. We're already a family, but baby will seal the deal.

Tomorrow I have another hospital antenatal appointment, and another scan, then on Friday a trip to the physio to discuss my carpal tunnel syndrome, and on Wednesday of next week I'll be seeing the midwife. I'll post again when I've had my appointments...

A Tale of Two Hospital Visits

Visit One:

Last week's hospital appointment - my 24 week visit - was a rollercoaster ride. I started off by having an ultrasound scan to check the baby's growth. S was with me, which was lovely, since we both had the chance to see our little person. The whole thing was over pretty quickly, unlike the anomoly scan, but the news was excellent. Baby's head circumference and abdominal circumference were both at around the 70th percentile, and the length of the femur was around the 50th percentile. The estimated weight of our little fetus was 1lb 9ozs (or 701 grams in 'new money'). It was lovely to see baby's heart beating away, and to know that my placenta's not blocking the exit! My amniotic fluid was normal, and the deepest pool measured 4cm. Finally baby's presentation was cephalic (head down) this time, rather than breech. The midwife doing the ultrasound explained that they're looking for the abdomen to match the head since this suggests that all's going to plan... and our little one isn't suffering from macrosomia, so it seems like my tight control is doing the trick. So far so good. On arrival for the scan I'd been told that they don't do scan photos once you're past 20 weeks, which was a little disappointing, but the midwife who did the scan snuck us a couple of freebies showing the baby's profile. I think they're the best pics yet - here's an example. I love that you can see so much detail of the baby's profile.



Once the scan was complete S headed off to work, and I headed back to the waiting room to wait for my appointments with the diabetes team and obstetricians. When the nurse collected me from the waiting room I was asked to provide a urine sample. Feeling a bit dehydrated, and not really needing the loo, my sample was pretty dark in colour, of which more later. First of the doctors to see me was Dr S, one of the obstetricians, who sat down with me, went through the scan results, and then talked me through some of my questions. I mentioned that I felt I was having to work pretty hard to stay hydrated, and she advised me to keep drinking throughout the day and try not to get too thirsty. We also talked through the fact that I'd had a very peculiar rash on my hands (red, prickly and swollen) on Christmas Day. I showed her the remnants just as Dr I stuck his head round the door to say hi, then came in to join us. Dr S concluded that the rash wasn't pregnancy related, just a bit of dermatitis (probably contact dermatitis) and nothing to worry about, which really put my mind at rest. I also mentioned that I've been getting pins and needles in my hands (fingers and thumbs) in the night, and keep having to change sleeping side and shake like crazy to get the blood flowing again. I was wondering if this was carpal tunnel syndrome. Dr S concurred, and gave me a referral to the physio department, who might be able to help. Apparently they could give me splints to sleep in if they think I need them. We also discussed the fact that I have a work trip coming up in a week or so, and I wanted to hear the team's advice. I'm travelling down to the South of France for a conference, and have decided to take the train rather than flying. In the scheme of things it doesn't seem to make much of a difference time-wise (a couple of hours) and I'm told that the Eurostar is much more comfortable. I've travelled by TGV before and been very impressed with the convenience and level of comfort, and I've had some horrible experiences at Charles de Gaulle airport, so I'll be glad to avoid changing flights there. Dr S agreed that the train might be more civilised, and advised me to keep well hydrated, wear flight socks, and keep mobile throughout the journey. Otherwise she thought it was fine to travel, and reminded me to take my yellow pregnancy notes with me. She also wrote me a prescription for the compression stockings, to save me a bit of money.

Dr I went through my log book with me whilst Dr S went off to find my urine results. He was really pleased with how things have been going - my HbA1C was 6.6% at my last appointment, and I'd managed to get my meter averages down since then, even taking into account the excesses of the Christmas period. I'd been a bit worried about my thyroid results, since I'd been told they were borderline when I called to get my blood results after the last appointment, but Dr I felt that they were still okay, if a little on the low side of normal. Another bit of good news.

At this point my urine results found their way into the room - apparently I was showing +1 for protein, +1 for ketones and +3 for glucose. I'd had a massive hypo in the night, so wondered if I'd overcorrected a bit too much, but it seemed a little strange, since my sugars had been great in the morning at 6.0 mmol/l. Not such good news. Dr S also took my blood pressure, and it was quite a bit higher than it's been at 150/90. Hmmm. Dr S told me I'd need to come back to the hospital two days later (on Saturday) to visit the Day Assessment Unit and have the tests repeated. She explained that she had slight concerns, but that it could just be a blip. She didn't mention the words pre-eclampsia until I did - as a big reader/researcher I knew that this was a possibility based on the symptoms. Dr S explained that it was pretty early in the pregnancy for such a development, and not to worry (but that's easier said than done, of course). Otherwise Dr S and Dr I both thought that everything was going pretty well, and agreed that I wouldn't need to return for another routine appointment for four weeks.

The next stop was to have my bloods taken by S, the diabetes midwife (I've just realised how many S's there are in this post - S my hubby, Dr S the obstetrician, and S the diabetes midwife!) After the usual struggles to find a decent vein (a theme of my hospital appointments, since I have rubbish mobile little veins!) I had blood taken for another HbA1C, as well as electrolytes, kidney function tests and to re-check my thyroid function. Whilst I was having the blood taken S and I had a little gossip and catch up, and I explained about my upcoming visit to the DAU. S explained that I just needed to turn up, as they don't make appointments in advance, and that I might want to consider getting there pretty early (9am) since it can get very busy. She asked if my blood pressure had been taken with the cuff that was in the consulting room, and when I said yes, she mentioned that it was a pretty small cuff for my arm, and that they usually use a larger cuff for me. She explained that might have affected the reading. She was going to try again with a larger cuff, but before she could do so she was called into another room, leaving me to head back to reception in order to book my next visit.

I spent the rest of the day at work, trying not to worry too much, and came home in the evening determined to do a little bit of research. I found out three things of interest:

1) If you're dehydrated and your urine is concentrated, you can have higher levels of protein show in your urine than if you're properly hydrated. (See this factsheet).
2) The wrong size blood pressure cuff can have a significant effect on readings, and can lead to mis-diagnosis of hypertension in larger pregnant ladies: see this website, and this one (for more general information).
3) Pre-eclampsia is scary, but not untreatable. Here are three resources which I found reassuring: patient.co.uk, Mayo Clinic, and NHS Choices.

All of this made me feel a little better. I bought a new home blood pressure monitor that same evening (a clinically validated wrist one, which is perfectly accurate if used properly, and in any case better than the one I currently have, which has a cuff too small for me), and to self-monitor in order to feel more in control of the situation. My BP when I got home was super high - 160/96, but it fell back to 123/76 later that evening, once I'd chilled out a bit, stopped worrying so much, and had a good chat and cuddle with my lovely hubby. It's been at good levels ever since!


Visit Two:

Saturday morning's excursion to the Day Assessment Unit at the hospital was much more reassuring, and in a funny way it was nice to see inside the Maternity Unit and meet some of the people there, even if I did have to go through a little scare first!

We arrived at 9am, and had to wait for security to unlock the door to maternity reception before we could even get in! I'd been scrupulous about drinking plenty of fluids over the prior 24 hours, in order to avoid the possibility of dehydration, and when the admitting nurse checked my pee sample it came up negative for everything - protein, ketones, glucose, the lot! I was shown to a bed, and my temperature and BP were taken. My temperature was up a little (I did feel a tad hot, and since then I've had a bit of a sore throat), and my BP came in at 140/80 - with the large cuff :) The nurses checked my notes, and spoke to the duty obstetrician (Dr M), then came to explain that they'd take some bloods for analysis, and would do serial blood pressures every half an hour (four in all), which meant that I'd be in the unit for a couple of hours at least. Well, we'd come prepared - both S and I had books with us, and my resourceful husband had even brought a flask of coffee (unneccessary, as it turned out, since we were invited to help ourselves to hot drinks from the day room!) My second BP reading was lower than the first, at 134/68, and the midwives were so surprised that they double checked it! Between my second BP reading and the third one of the midwives came and measured the height of my fundus (26cms, about 1-2 cm over the expected reading), and then as a treat let us listen to the baby's heartbeat using the doppler. So exciting, since it was the first time we'd heard baby's little heart chugging away. It was rattling along at 158 beats per minute, which is within the normal range. My third BP was 116/62, at which point Dr M stuck her head round the curtain for a chat. She was happy with my BP results, and told me that all of the blood tests had come back normal, so she was happy for me to go. She agreed that dehydration and a small cuff could have been the problem, and in any case, I was fine according to the DAU's tests. I mentioned my up-coming travel plans, and Dr M thought it was absolutely fine to go ahead with the trip. I asked if I should procure some protein strips for checking my urine at home, and she said they don't usually provide them to ladies unless they've had significant and ongoing problems. (Being a control freak I bought some from Amazon when I got home - they're identical to the NHS ones!) We left the hospital about two and a half hours after we arrived, and both S and I felt much much happier. Definitely better safe than sorry!

Postscript:

Today I had my 25 week appointment with J, the community midwife (and her trainee student K). My BP was 122/64, my urine sample was negative for all the nasties, and my fundal height was 27cm (still 2cm over!) We also listened to baby's heartbeat, which was around 150 bpm. I think I could listen to it all day every day! I also collected my MAT B1, which will allow me to complete the paperwork for my maternity leave at work tomorrow. All in all it was a pretty routine appointment, and I've booked another for four weeks' time. So, I'll be at the hospital next on 3rd February, and then I'll see the midwife again on the 9th.

Last, but not least: fruit and veg. Since my last fruity update my little passenger has graduated a couple of levels...

I've been feeling something new...

I can finally feel my little passenger wriggling! As the weeks ticked by I was starting to worry just a tiny bit. I know that it can take longer to feel movement in a first pregnancy, and it can take longer for the larger lady (ie. me), but I was kind of working towards the 18-22 week target that all the pregnancy books and websites seem to agree on. As it was, my little passenger was saving up for something special. I felt baby's first little flutters on Christmas Day (at 22 and a half weeks) when we got back to Mum and Dad's after spending the day with my aunt. At first I wasn't entirely sure if I was imagining things, but throughout the week between Christmas and New Year I felt more and more little wriggles, squirms and flutters. Yesterday, New Year's Day, was the best so far - we were out for dinner with some friends and I swear the littl'un actually did a somersault! What a Christmas gift. S and I have had a wonderful time seeing family and friends, and the last few days we've been hanging out at home together, enjoying just slobbing about, but the best thing of all about this Christmas has been the reminder that soon there will be three of us - a proper little family.

Happy New Year to all - I think 2011's going to be some kind of wonderful!