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Posts tagged ‘epidural’

Nov 26 / Caro

Diabetes During Delivery

What I didn’t include in all my lengthy posts about Thomas’s entrance in to the world is mention of my diabetes. I didn’t really want diabetes to intrude on those memories. To be perfectly honest, I didn’t want diabetes to be a part of it at all, but unfortunately there are no breaks from chronic medical conditions and even amongst all the turmoil of a failed induction and a very much unwanted c-section, my blood sugars still needed to be managed.

When I was admitted for the induction, it was agreed that I could stay on my pump, and monitor my own blood sugars, until I was in active labour. You may recall that I’d already had a frustrating discussion with my obstetrician about what would happen from that point. I’ll admit that I never had any intention of letting the hospital get in the way of what was best for me, but made a conscious decision to take things one step at a time. I was happy that they were happy to leave me to it to begin with, meaning I could save any battles for later. I was, however, told that if my blood sugar went above 8, I’d have to be transitioned to an intravenous sliding scale.

Of course, given that I was responsible for monitoring my own blood sugars, the easy way around this was not to tell them if I went above 8! But equally, I knew that there were good reasons for keeping tight control of my blood sugars at this final hurdle. So I set about managing them with military precision, using the task as something concrete to focus on during all the anxious waiting. Here, I can be honest and say that I did have a couple of blood sugars over 8, but since these were post-food and always came down quickly as the bolus insulin took effect, I wasn’t ready to own up to them. Similarly I stuck to treating lows myself with the stash of Lucozade and Jelly Babies we had amongst my bags. I didn’t trust the hospital not to want to treat low blood sugars with something wholly inappropriate – like milk, or hot chocolate, as I have experienced before, or rush to get me on to IV glucose that could start a whole unnecessary roller coaster soaring up high, and crashing back low.

On the day of Thomas’s birth, things were further complicated by the fact that I wasn’t allowed to eat anything in preparation for surgery. Since a c-section seemed so likely, I was actually made to fast from around 2am. The biggest challenge with fasting is avoiding hypoglycaemia, since treating it requires ingestion of food and so would instead have been an automatic transfer to intravenous glucose and insulin without passing Go and without collecting £200. With birth so imminent, I didn’t want to risk highs either, for a variety of reasons including not wanting to have a raging thirst, or hunger, whilst fasting, worry about healing less well if the surgery was performed at a higher glucose level and of course worry about increasing the chances of low blood sugars for my baby. My new “acceptable range” was between 4 and 7.

I’ll admit that I felt under pressure, if only from myself. With everything else slipping out of my control, I wanted to do something the way that I really, really wanted. By a strange twist of fate however, my body picked that very day to act a little as though I was cured. If it couldn’t do labour “properly” at least my blood sugars were behaving! I actually ran a temporary basal rate of close to or at zero for much of the day leading up to going down to theatre. I bounced along nicely just above the lower limit on the CGM, testing with a finger stick every 30 minutes to confirm. I was also tossed a life line by the lovely anaesthetics registrar who said that consumption of Glucogel was absolutely fine as it was so rapidly absorbed it would not pose a problem even with GA. In the hours before going down, I did consume the best part of a whole bottle to keep myself on the right side of the line. My final stroke of luck was having a midwife who herself had type 1 diabetes, and therefore completely “got” my need to do things my way, and fully supported me in that.

Testing Times

I was due a new insulin pump infusion set on the day of Thomas’s birth and I elected to put this in my arm so that it would be well away from the operating field. The CGM was more problematic. The week old sensor was on the left side of my abdomen, on the front of my hip. Right on the edge of the operative field. I assumed that I’d have to remove it and was nervous about flying blind. There wasn’t time to insert a new sensor and get it working, and since the first day often throws odd numbers anyway, I wouldn’t have felt the same confidence had I done this. To my utter surprise, however, I was allowed to leave the sensor in place, covered by a fresh piece of Opsite tape, which meant I could keep the CGM going throughout. Ian also kept my testing kit in his scrubs pocket whilst I was in theatre, although I can’t recall that we actually used it!

Once in theatre, diabetes went clean out of my head. I had bigger concerns about the spinal and whether or not I was dying. Ian, however, stepped up to the role we’d always planned for him to have, keeping a close eye on what was going on. We’d clipped the pump to the neck of my hospital gown and Ian diligently checked the DexCom line for me. Either the stress or the Glucogel caught up with me and he informed that I had double up arrows, indicating that I was rising fast. I opted to take a very tiny bolus to head off the high, but switched back to a zero basal rate again, ready to mitigate the effect of the removal of the placenta. I really didn’t fancy a crashing low. I did breach the high cut off, right at that last moment, but by then they were already opening me up and it was really too late to worry about.

I think the fact that I managed to keep such tight control, along with a few helpful healthcare professionals and not drawing too much attention to diabetes is what allowed me to get through with minimal fuss. Getting through with such brilliant blood sugars is a victory I want to claim all as my own, though. I’m still ridiculously proud of this graph form the day of delivery.

A short while after my transfer back to delivery suite, the DexCom sensor ended and needed to be restarted. Once I’d eaten, I commenced the pre-programmed lower basal profile on my pump – a profile much lower than my pre-pregnancy doses with the aim of avoiding hypoglycaemia whilst dealing with a newborn and to balance the possible blood glucose lowering effects of breast feeding.

Beyond this, diabetes doesn’t really feature any more in my thoughts or recollections. I am proud, for I have much to be proud of, but I’m so glad that this is the extent of what I can remember about diabetes on the day I became a mum.

Nov 25 / Caro

Thomas’s Birthday – Recovery

The hour or so between Thomas’s entrance to the world and me being ready to be transferred back to the Delivery Suite felt a lot longer than a normal hour. Ian had been cuddling Thomas the entire time (and been weed on by his son too!) He’d also been weighed in at 7lb and 11oz. Right on the 50th centile, completely in proportion with no sign of an increased abdominal circumference that suggests diabetic macrosomia. All my “big baby” fears  vanished instantly with that news. And I couldn’t help but feel just a little it proud of myself.

Once I’d been stitched up there was a lengthy delay in waiting for a suitable bed to transfer me on to. I had expected to be transferred to the recovery area, but that never happened. Instead they eventually procured a proper bed from the Post Natal ward, which meant I’d only need to be transferred once. Once the bed arrived, I was unceremoniously hauled from the operating table across to it ready to be moved directly back to my room on Delivery Suite. I could not wait to finally be able to cuddle my boy properly, but the moment I’d moved, I knew I was going to be sick. Being sick when your stomach is empty from hours of no food or fluid AND you’re numb from the mid chest down is a very surreal sensation.

Eventually the heaving subsided and finally Thomas was placed in my arms. Until that moment I hadn’t realised that I had a baby shaped hole right there. He filled it instantly, snuggled tightly against my body. I felt spaced out from the drugs and surgery, not to mention lack of food and sleep, but I could not stop grinning as I stared down at my tiny, dark haired boy. As we were wheeled along the corridors to my room, I felt a swell of pride in my heart, to be holding my beautiful boy for everyone to see.

My parents were already waiting in the room as we arrived and I invited them to “Meet your Grandson” through yet more tears.

The next few hours are a bit of a blur. A different midwife came to take care of me and Thomas, which included getting him straight on to my breast and testing his blood sugar for the first time. My heart broke just a tiny bit at the shrill squeal he let out as they pricked is heel for the blood sample. Having kept him safe for so long, I felt guilty that his entrance to the word was being marked with pain because of MY condition and the problems it might be causing for him. Fortunately his level, whilst on the low side, was within normal range for a newborn. And with the midwife’s help, he latched straight on to feed. There was never any need for the frozen syringes of colostrum we’d prepared in advance, as he sucked like a pro and his second and third blood sugar levels were absolutely fine.

I do remember being insanely itchy throughout this time. I was holding Thomas to me with one hand and scratching my skin all around him. It was an absolutely skin-crawling, insatiable itch. Apparently it was a reaction to a drug that I’d been given and once I was given an intravenous antihistamine, the itch subsided. I was also sick again, with a cardboard sick bowl balanced unceremoniously on poor Thomas’s head as he continued to eat!

Family

After a couple of hours, I was allowed to eat. The bendy straws we’d been advised by so many people to pack in my labour bag finally came in handy allowing me to drink a cup of tea whilst feeding Thomas and not being able to move to sit up properly! I also demolished a slice of toast in about three seconds flat. I may not have had a natural delivery, but it’s still true that the first cup of tea and slice of toast following the birth of your child tastes much better than any tea or toast that has ever gone before!

The first of many!

The midwife and my mum helped Ian to change the original nappy that had been put on – his first ever nappy change – and dress Thomas in the yellow sleepsuit with two little elephants on that we’d chosen especially. We took lots and lots of pictures. Surprisingly I look half decent in a few of them.

Ian looked absolutely wrecked, however. Neither of us had had much sleep since Saturday night. I really wasn’t keen on the idea of an emotionally charged and over tired drive home, even though it wasn’t far. Fortunately my parents were able to take Ian home and we could leave our car in the hospital car park overnight. One less thing for me to worry about. At this stage I was still waiting to be transferred upstairs to the post-natal ward, but he looked so dead on his feet that I urged them to leave.

I have no idea what time I was finally transferred, once again holding Thomas to me. I was still pretty numb and starting to get itchy again. As soon as we arrived in my room on the post-natal ward, the midwife settled Thomas in to his little plastic crib, and he happily fell asleep. I could have watched him all night, twitching and snuffling in his sleep, but I was exhausted myself after what I can safely say was the biggest day of my life. It didn’t take too long for my own eyes to close.

Nov 24 / Caro

Thomas’s Birthday – The Birth Bit: Part Two

The first part of my birth story can be found here.

 

I’ve heard the sensation of a caesarean section being described as like having the washing up done in your stomach. Since no one has ever done the washing up in my stomach, I cannot confirm of deny the truth of this statement. I can tell you however that it’s an odd feeling. A bit like the most enormous baby kicks and rolls of the last few months, magnified a few hundred times.

“Here are your waters.” I had to smile as the waters we’d tried so hard to break were suctioned out with a magnificent slurp.

I heard someone ask Ian if he was squeamish and I was vaguely aware of him, by the left side of my head, standing up with camera in hand. Everything felt very narrow and focused. Music was playing, but I couldn’t tell you what. Time was passing, but it felt frozen. Nothing mattered except the safe arrival of our baby.

And then.

“Here we go. Get ready to meet your baby.”

I looked up as they lifted my baby high above my head, above the blue surgical drape that separated my head from my lower half and I laid my eyes on him for the very first time.

Tears were already running down my face and my voice cracked as I declared to the room “It’s a boy.” I may have lost all control over my birth experience, but it meant so much to me to be the one to announce this, to introduce him to everyone else as I met him for the first time.

Ian was right next to me squeezing my hand. “I knew it” I whispered. “It’s a boy. We did it.”

“You did it.” Ian replied, his own face streaked with uncontrolled tears.

Minutes Old

Minutes old... and not too impresed with this being brn lark!

Thomas’s lusty cry seemed to fill all the available space in the room, as he was not afraid to express his displeasure at his abrupt entrance in to the rather bright, noisy world. “Is he OK?” I asked over and over again, sending Ian to the resuscitation unit in the corner where the midwife and paediatric team were busy cleaning him up and checking him out. What could only have been moments later, but felt like forever, he was handed to me, bundled tightly in a towel, tufts of dark hair protruding at the edges.

“He’s perfect” the midwife told me with a smile. “Congratulations Mummy and Daddy.”

“I’m a Mum” I whispered. I knew it was coming. I’ve had nine months to prepare, but it still took me by surprise and took my breath away.

Hello, I'm your Mummy

Welcome to the world, little man

I wanted to hold him tightly to me, finding it difficult to wrap my head around the fact that after all this time inside me, physical space now separated him from him. But it was almost impossible for me to hold him, laid flat on my back as they worked to put my lower half back together. Instead, Ian sat by my side, cuddling our boy close to him and for the first time getting the opportunity to directly protect the life we created together, but which I’ve carried for nine months.

We really had done it.

Nov 23 / Caro

Thomas’s Birthday -The Birth Bit: Part One

This follows on from my induction story which can be found here and here.

 

Ian was dressed in fetching blue scrubs. In his pocket was a newborn sized nappy and a hat, ready for our baby, and a camera to capture the moment. I was attached to an IV pole and attired in a fetching hospital gown and nothing else. We were as ready as we would ever be to meet our child.

Ready

It was about 2pm when an entourage arrived to escort us to theatre. I walked myself there, gown flapping open in an undignified manner. Not that I cared, and I was clasping Ian’s hand far too tightly to allow him to do anything about it. It was my final pregnant waddle, because the next time I stood up, the baby would be on the outside. As we passed through the anaesthetic room right in to the theatre itself, and I caught sight of the waiting bed, my stomach rolled involuntarily. My instinct was to turn and run, but at that moment my baby gave me a hefty kick. The thought of finally meeting him or her after all these months, and all this hard work to keep them safe and healthy proved to be a more powerful motivator than fear of what was about to happen. Without much persuasion, I found myself hauling my heavy bump up on to the edge of the table in preparation for the spinal block.

A consultant anaesthetist had been specifically called in to administer the anaesthetic, in view of my history and fears.

“So, do you know what you are having?” was his first question. “Do you have a name ready?”

We confirmed that we would be finding out the sex for the first time today and that although we had a shortlist of names, nothing was definite until we met our baby.

“Well I can highly recommend the name Paul for a boy. It’s a fabulous name. Just so happens to be my name in fact.”

I had to laugh a little.

Before I knew it we were talking about dentistry and teeth and anything but what was about to happen.

I was so grateful that Ian was allowed to stay with me whilst the spinal was administered. I hung on to him as though my very life depended upon it, trying to focus on what we had been laughing about just a moment before. The local anaesthetic went in with a sting. I could feel pushing and then… pain. I cried out in fear more than because of the pain itself. I didn’t want this to go wrong in any way. I wanted it to work, but without causing me any harm. Ian forced me to look in to his face as they topped the local up and tried again.

“I can’t.. I can’t.. My legs.. They’re numb…” The words came tumbling out of my mouth at top speed as I convinced myself they’d hit a nerve and I was losing the feeling to my foot.

“Brilliant” The anaesthetist’s voice cut across mine. “That’s exactly what is supposed to happen. I was so tense I’d completely forgotten that going numb was exactly what we were aiming for.

Several people helped to move my legs up on to the bed and lie me down. A screen was put up and Ian reappeared on a stool next to my head. I felt very vulnerable all of a sudden. Completely numb from the waist down, exposed to the entire room. The preparatory stage seemed to take forever. They tested the anaesthesia using a cold spray, working it gradually up my body until the point that sensation returned, well above the operative field. I was aware of lots of pushing and tugging as they inserted a catheter. My chest felt heavy, the anaesthesia seeming to interfere with my ability to take a proper deep breath. My head began to spin and I started to feel hot and detached from the surroundings. I felt a suffocating sense that something terrible was about to happen. Nothing was in focus, and my ears echoed.

“I’m dying” I said, with absolute finality. “Help me?” And then more urgently “Oh no… I’m dying…. I’m going to die.”

“You’re not dying” the anaesthetist cut across my irrational thoughts for a second time. “Don’t worry, I can see everything on the monitors. I’ll know if you’re dying long before you do.”

As he spoke he was already busy administering something through the cannula in my hand. It took just moments for some clarity to return. The crushing sense of doom diminshed and the room came back in to focus.

I had to smile at how ridiculous I must have sounded.

“We’re almost ready” a voice came from behind the drape.

Nov 22 / Caro

Induction Story: Part Two

This is the second part of my pre-birth story: the induction of labour that wasn’t an induction of labour. The first part can be found here. If you want to read about Thomas’s actual birthday, then hang on in, because it will be coming up.

 

“Your induction isn’t working, so you’ll be having a caesarean later today.”

That was how I was greeted shortly after midnight, first thing on Wednesday morning, when I was woken from my dozing by a midwife bustling in to the room. With hindsight, this was so inappropriate that I have no idea where to begin. It had not been discussed with me. I’d had no consultant visit and it was the middle of the night! This is all aside from how very much I did not want a c-section, which I was beginning to realise was obviously not clearly documented in my notes. I’ll freely admit that once again I didn’t respond in the finest fashion, but went in to pretty much complete melt down. A different midwife overheard me crying and came in to the room. She did her best to reassure me that the decision would be reviewed in the morning, but in the end had to call Ian at 4am to come in to calm me down as I was so distraught. What Ian must have thought when he was woken by the phone at 4am…. For a moment at least, he must have thought this was it! With Ian’s help I finally calmed down and fell asleep at around 5am, whilst the poor guy tried to nap on the floor!

The positive part of my midnight melt down was the fact that they finally seemed to get the memo that I was petrified of having a caesarean. On the basis that the baby was still completely happy, a decision was made to try one more round of induction. This time I was given Prostin without being moved round to Delivery Suite – I think they’d finally cottoned on to the fact that nothing very quick or dramatic was going to happen! This time I did begin to have fairly regular contractions throughout the afternoon, which was once again spent pacing the hospital corridors and bouncing on a birth ball. It was hard not to let myself begin to hope that things might be moving in the right direction.

Wired up

Excuse the crappy phone photo!

In the evening, I was due to be examined again and either scheduled for membrane rupture or to have my final lot of Prostin. I was put on to the CTG monitor ahead of the examination, but as usual, the baby wriggled away and the signal was lost. When I pressed the buzzer to get a midwife to come a re-site the monitor pads, a male midwife that I had not yet met came in. He sorted the trace out and then went to find out what was happening with me. When he went out of the room, I joked to Ian that I had noticed he had large hands and maybe that was what I needed to really get things going! A few minutes later, the male midwife returned ad explained that the midwife who had been coming back to examine me had got tied up. He asked if I would mind if he performed the examination. Of course in light of what I had just said I had no objections, but couldn’t suppress a laugh!

I felt much more positive immediately after the exam when he said that he could actually feel my membranes and the bag of waters. Surely, I thought, that meant it must be possible to rupture them, but the midwife seemed quite negative. I couldn’t really understand when he tried to clarify why things still weren’t progressing, and it became obvious that he didn’t really know anything about my history or my fears. Nonetheless, the final lot of Prostin was in and I was determined to try and remain positive with the next examination scheduled for 6am, despite being told that I would have to fast from 2am in preparation for a likely caesarean.

I didn’t sleep particularly well again as I was contracting on and off all night. Ian arrived at the hospital at 6am by which time all the contractions had died off. I’ll admit to holding my breath when I was examined, desperately hoping for some progress. For a split second, I thought it was going to happen, when the doctor announced that it could well be possible to break my waters. The split second of hope was dashed when he went on to add that it would only be with an epidural on board, as I was now so irritated from all the Prostin and so many examinations. Of course, having an epidural was really the main thing I wanted to avoid and a major part of my fear about a caesarean was the placement of spinal anaesthetic. A natural labour but with an epidural was as bad in my mind as a caesarean. The plan was to take me to Delivery Suite, get an anaesthetist in and go from there.

This is the point at which I lost it and went a bit crazy. In my defence I was extremely tired having slept very little since my admission. I had horrendous reflux that was exacerbated by being ‘Nil By Mouth’ in preparation for a possible section, and being refused any medication to help. Added to that I was frustrated at my body once again failing to do what other people’s bodies seem to do naturally, and feeling guilty and regretful that I’d consented to starting this whole process. I was finally facing what has been my biggest fear throughout pregnancy – an epidural or spinal anaesthetic and a caesarean section. And I was left sitting there with no information on how long I may have to wait, stewing on all of these thoughts and desperate to be anywhere else.

So I did what anyone would do in that circumstance.

I panicked.

And I begged Ian to take me home. I packed everything up and got dressed, although Ian wouldn’t allow me to have my shoes. I cried, a lot. And pleaded. But Ian wouldn’t budge.

So I left, in my slippers. I rushed past the midwives on the ward telling them that I was off home and I wasn’t going to do it. Definitely not my finest moment.

Ian caught up with me at the lift. It took all his powers of persuasion to stop me getting in, but he couldn’t manage to get me back to the antenatal ward. Instead I sat crying in the corridor, where we were found by both the midwife who had been taking care of me earlier, and my parents, who had decide to hot foot it to the hospital following a phone conversation with me earlier from which my mum “could just tell” that I was on the edge.

It took all of them to get me back to my bed. I did finally get some medication for reflux and a promise that things would get moving as soon as possible. I was trapped really, and had to admit defeat.

To give the hospital their due, they did get things moving swiftly after that. I guess they felt they needed to get the baby born before I tried to abscond again. I was taken to Delivery Suite with all of my bags and told that this time I wouldn’t be going back to antenatal. It was baby or bust.

I was taken back to Room 5 on Delivery Suite, the same room I had been in two days previously. It had a fantastic view of the hospital car park (!) so I kept watching the cars moving around the car park again in an effort to distract myself.

The doctor that came to examine me and hopefully break my waters seemed to have missed the memo yet again, as he did not know about the epidural plan, or the fact that we were waiting to discuss with an anaesthetist. I saw an opportunity to have a go at getting my waters broken without the epidural though, so I consented to yet another examination. The plus this time was that the lovely midwife who’d been assigned to take care of me handed me the Gas & Air mouthpiece and told me to go for it.

Even with G&A, this examination was agony. I have no lingering doubt in my mind that he tried his absolute hardest to stretch my cervix. The crushing news was that, despite all the contractions the day before, I was no longer dilated at all and there was no hope of breaking my waters, epidural or none. I suppose this is the point at which I surrendered to the inevitability of a surgical delivery.

The anaesthetist who eventually came to see me was absolutely lovely. His bedside manner was brilliant and he managed to reassure me that the risks associated with a spinal block were less than those with an epidural or even a lumbar puncture. The desire not to miss the moment that my first child enters the world was so overwhelming, that I agreed to have a single attempt at a spinal block, but if this failed, we would move straight to a general anaesthetic. After all the panic and distress of just a few hours earlier, I felt strangely calm and accepting at this stage. My obstetrician even popped in to see me, and I assured her that I was fine with it. At that moment I think I truly had accepted it, because everything else aside, I was desperate to meet my baby. I felt happier to focus my nerves on becoming a new mum than on how the baby was going to get here.

It was finally time.

Nov 21 / Caro

Induction Story: Part One

Almost every blog about pregnancy and parenting has a birth story, but before I can add mine, I need to share my induction story. You may already have noticed that I have a lot to say and brevity isn’t my strong point, but the length of this will surely top them all. After all, I was in hospital for a whole week! I need to write this down though. For my own records and as a way of dealing with the fact that things did not go in any way how I would have liked. As such I can make no apology for the unedited detail, or the fact that I’ve decided to write this in more than one part. If you’re interested in the actual birth story, or in how I handled diabetes during this epic adventure, then those things will be coming up next. Onward…. To the non-birth story of the boy who was not ready to be born.

I arrived to be induced on the evening on Sunday 8th November . Things did not get off to great start. There seemed to be a lot of debate about various aspects of my medical history and their impact on the induction. No one seemed all that sure what to do with me, as I was told I was “as high risk as they come” and “too high risk to be induced on the antenatal ward” so I‘d need to wait for space to open up on the delivery suite. For someone who didn’t really want to be induced at all, all this indecisiveness was agonising. At one point I even asked if I cold just go home and come back in the morning as it seemed apparent that noting was going to really happen that night. I was persuaded to stay put so that the anaesthetist could come and see me and we’d go from there.

Looking hot!

Waiting… in hospital

I eventually saw the anaesthetist at around half past one in the morning. He was a truly obnoxious man who began by quizzing me on the merits of different pain relief options and clearly had no idea about my anxiety surrounding an epidural. He also told me that there was “no way” I should “let them” induce me at night, due to less staff being around. Of course this completely neglected the fact that induction was unlikely to start labour instantly, and even if I was induced in the morning, it could take until night time for things to get going. You’d think that an obstetric anaesthetist would be familiar with the unpredictability of birth! Whilst butchering my hand in an attempt to insert a cannula in to my rubbish veins, he put the cherry on the cake by telling me that “labour is pretty horrific, you know. You probably won’t cope without an epidural so you should start getting your head around the idea of having one.”

To this moment, I still can’t believe I didn’t slap him. It was the middle of the night. I did not want to be in hospital, or to be induced. I have a serious phobia regarding epidural anaesthesia. My husband was at home – our first night apart since we married – and he thought this was an appropriate thing to say! A lovely midwife found me in tears about 15 minutes later and reassured me that anaesthetists only see women who aren’t coping in labour and forget about the many, many women who don’t need an epidural. She also added that she’d have slapped him for me if she’d been in the room when he said it, which certainly helped lighten my mood.

The induction finally got going sometime around 5am on Monday morning, by which time ‘d had virtually no sleep and was not really in a frame of mind to think about giving birth. With hindsight, I really wish I’d never stayed in hospital on Sunday night, or that having done so, I’d gone home on Monday and started again the next day when I was calmer and more rested. But instead I allowed them to insert the 24 hour Propess. I was 38 weeks and 6 days and at that point my cervix was still fairly posterior and fairly thick, but was 1-2cm dilated. The way it was presented to me sounded quite positive, but again with hindsight I wish someone had actually spelled out how low my Bishop’s Score actually was and what that meant for the chances of the induction being successful

I spent the day pacing around the hospital corridors, and even walking around outside in the hospital grounds as it was a beautiful, clear day. Ian and my parents took turns to keep me company I drank hot chocolate in the hospital’s branch of Costa Coffee. Ian and I played cards. I tried to watch television, but the one in my room would only show BBC1 and I was not desperate enough to watch David Dickinson cavorting around a car boot fair!

I had no contractions. No prostaglandin pains. No show. Periodic sessions on the monitor showed mild tightenings that I couldn’t really feel. The baby was completely happy, still moving around. The most I had was a little back ache, but that was more than likely from all the walking and the lack of pillows on the bed! Ian headed home at around 10pm, and I settled in for my second night.

On Tuesday morning I was told I’d be taken to Delivery Suite to have my waters broken and be started on a Syntocinon drip. “This is it” then I thought. Today, I’m going to actually go in to labour. With luck, the baby will be here by tomorrow!” My obs registrar then explained though that they didn’t know how long I wold have to wait for a space on Delivery Suite and there was a possibility that I’d need more Prostin if my waters could not be broken. I suppose at this stage I assumed the 2 cm I’d been dilated the day before meant that it was very likely that my waters cold be broken. Now I was being told otherwise. So I consented to an exam on the antenatal ward, so that I’d at least know if we were waiting for membrane rupture or Prostin.

This exam, in comparison to the one the day before, was agony. I was told later in the week this is common after Propess as it irritates the soft tissues. And it was disappointing news. My cervix had not changed at all. If anything it was even less favourable and there was no chance of breaking my waters. I was pretty disheartened. To be honest – and this is one of many moments I cannot claim as my finest – I begged to go home. At this stage I was really regretting consenting to induction. I was fed up with staff members who treated me like some sort of major headache for having a complex medical history, and staff members who had no clue of my history and no empathy for my anxiety about epidurals and c-sections. But I was told quite firmly that the only way out was through. Now that we’d started the risks of stopping were apparently too great. In clearer mind now I wish ‘d asked exactly what the risks were given that the Propess had had exactly no effect on me or the baby at all.

Nevertheless I allowed them to insert the first lot of Prostin gel at around 11am and whiled away my time on the monitor in Delivery Room 5 watching cars coming and going in the car park. I spent the rest of the day again wandering around the hospital, walking as much as possible to encourage my body to get going.

At around 5pm, I finally began to get some pains coming at fairly regular intervals. They weren’t painful, but mildly uncomfortable, but there was also a continual background pain which never went away. I felt like I couldn’t keep still, a bit like when you are desperate for the loo. I spent some time bouncing on a birth ball, but disappointingly a session on the monitor seemed to show less contraction activity than the previous day, and the previous week when I hadn’t been able to feel anything at all! I was starting to suspect that my body, as with so many other things, didn’t want to do what was “normal” or expected. Finally, in the late evening, I was examined again to the crushing news that my cervix still had not changed. Ian went home and I tried to settle. I’d had so little sleep since Sunday by now, that I was starting to feel a bit loopy, but I now had to contend with regular pains for which I could have no pain relief as they weren’t actually contractions!

Two days in, and I was still very determinedly pregnant. Absolutely no closer to giving birth at all.

Nov 4 / Caro

Am I Right to Accept Induction?

I can still say no to this. Right up to the moment that they actually start the medical process, I can decline to be induced. With forty-eight hours to go, it’s something that my mind still keeps returning to.

I know that I’ve had the best blood glucose control of my diabetic life in the last nine months. I know that my blood sugars have averaged similar to a non-diabetic, with very few major spikes. I’ve essentially had an uncomplicated pregnancy. I feel like I’ve mitigated the risks from being diabetic far better than I could ever have imagined, and the numbers suggest that my chances of problems at this late stage cannot far exceed those of a “healthy” woman. If I’m honest, I feel I deserve a straightforward birth experience as much as any one else.

I know that many women don’t get anything like their ideal, or straightforward birth. But I can’t help feeling that by accepting induction, I’m not giving myself the best chance.

I don’t want to be induced because I know that it carries risks. Chief amongst them, the increased risk of needing a caesarean section. And we know that I don’t want that . In fact several studies have suggested that increased induction rates are the single biggest reason for the rising caesarean birth rate. Even if caesarean is avoided, there is a greatly increased chance of other interventions including episiotomy, ventouse or forceps delivery. Induced labours generally require continuous fetal monitoring, which restricts the options for active birth, further increasing the risks of needing assistance.

These are all things which don’t sit well with my ideals for birth. And then add to that the fact that induction can also lead to breastfeeding difficulties and you can probably understand my personal apprehension. Furthermore, yet more evidence is also beginning to come to light that babies born between 37 and 39 weeks gestation are at risk of more health, developmental and behavioural problems than those born after 39 weeks. Unsurprisingly, the internet is littered with articles urging women not to be impatient and to let labour start of its own accord.

But…. I’m not doing this for convenience reasons, or solely because I’m impatient to meet our baby. I’m doing it because its what my medical team have advised me is the safest thing.

And the medical reasons to induce are, at least at first glance, extremely compelling. And particularly now I’ve managed to carry this little life safely inside me for almost nine months. I’d obviously never forgive myself if something went wrong right at the end that could be avoided. The bottom line is that if I decline induction, anything that goes wrong after that point will lead to me wondering if an induced labour would have avoided that problem. Ergo I feel somewhat obliged to go with what is, after all, the medical standard.

It’s the medical standard for a reason. Contrary to popular belief, big babies  are not the primary reason for early induction, although it does follow that delivering a big baby early avoids the opportunity for it to increase yet more in size and so decreases the chance of delivery complications including shoulder dystocia.(In reality, this is still questionable.) The most important reason, however, is the increased risk of stillbirth.

Yeah, that’s something that doesn’t bear thinking about.

Pre-existing diabetes in particular, and especially that which has been long standing, is associated with vascular changes that can lead to more rapid deterioration of the function of the placenta. If the placenta fails and the baby is not born within minutes…. Well, you get the picture.

And of course if you start asking questions about whether the risk is correlated with glycaemic control during pregnancy, or what the actual percentage risks are of stillbirth if waiting until 41 weeks, no one can tell you. Because early delivery is the standard of care. Because the potential risk exists, no one is going to give ethical approval to a study to quantify it which would mean putting women and babies at that risk. In fact, a recent systematic review of the evidence to support reasons for induction conspicuously excludes type 1 diabetes, mentioning only gestational diabetes, which it puts in the category of having no solid evidence to support routine induction. In fact, it concludes that there is little evidence for the majority of reasons given for induction.

But even if a study were carried out which proved that the risk of stillbirth in women  with type 1 diabetes waiting until beyond 40 weeks was, say 10%, that’s meaningless if you’re the one in ten and your world comes crashing down. To be honest, once you’re aware of the risk, it’s hard to do anything but contemplate getting the baby born safely as soon as possible.

To look at it another way, though, as an individual you’re still extremely unlikely to suffer adverse complications. As one article puts it:

“Fortunately, it is uncommon in this day and age for a baby born at full-term to die around the time of birth or experience serious illness or injury. However, these outcomes still occur despite advances in obstetric and neonatal care. Doctors or midwives may recommend inducing labor as a way of lowering the chance of these problems happening. However, it is impossible to know which women should be induced because injury and death are often unpredictable. As a result, thousands of women may have labor induced to prevent just one injury or death, and all of those women and babies will be exposed to the risks of labor induction, which may include cesarean surgery, instrumental delivery (assisted by forceps or vacuum extraction), and newborn breathing problems.”

I wish there were more definitive tests to establish individual risks. I wish that this process of giving life weren’t so fragile and precarious. I wish I could just let it go and accept that what will be will be, rather than continuing to agonise over choices that don’t really exist. It was different before I was pregnant and I could indulge in being idealistic, with my image of a “normal” pregnancy and natural, spontaneous labour. I naively thought that so long as my control was good, I could be managed like a healthy person, rather than an ill person.

That was before I had a second heart beating inside me. Before I knew the kind of love and powerful, instinctive protection you can feel for someone you’ve not yet met.

My reasons to decline induction are largely selfish, and now that I’m about to be a mum, I can’t be selfish anymore. I don’t want forceps or a caesarean, but the risks of these procedures to my child seem less than the potential risks of not getting labour going sooner rather than later. I don’t want anything bad to happen to my baby either way.

Am I right? I’m right, right?

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