TTC With Diabetes

This is a post that I’ve been hesitant to write, because in some ways it feels a bit too intimate. Laying all my cards on the table opens me up to expectations and people asking me if I’m up the duff yet. I do wonder if it would be better to wait, and simply make an announcement when it happens, at a stage in the pregnancy that I feel comfortable to do so. But at the same time, this is something which is very important in our lives right now. It’s a part of our journey with Thomas that I didn’t really record, and this time I want to remember what it’s really like.

So here we are. We’re officially trying to conceive.

Everyone knows what trying to conceive involves. Plenty of frequent bedroom antics in the hope that a single sperm reaches the elusive egg. It’s important for everyone to take the best care of themselves that they can, and take their folic acid to reduce the risk of neural tube defects.

But diabetes has the potential to throw a huge spanner in the works when you want to make a baby. From the moment of conception, higher blood sugars than normal increase the risks of miscarriage and birth defects. The only way to mitigate these risks is to have the best blood glucose control possible.

But that isn’t always that easy. Diabetes is beast that isn’t that simple to tame. Everything that you can think of, from food to exercise, stress to the weather has the potential to affect your blood sugars. And of course blood sugars have the potential to affect pretty much everything in your life. That includes your hormones and hence, your cycles. And the more regular your cycles, the easier it is to conceive.

If you’ve read my entries from my pregnancy with Thomas, you’ll realise that I was quite obsessive about keeping good control, and would have done anything and everything to keep him safe. But back then, diabetes was pretty much my sole focus. True, I also had a stressful full time job, but now I have a stressful part time job and a demanding toddler, as well as diabetes which an be just as stressful as the job, and just as demanding as the toddler.

I have a feeling that things will be a lot tougher this time. But yet, somehow, I want it that much more.

When I was pregnant with Thomas, hearing about people desperate to conceive their second or third child always made me think “But at least they have one child already. It’s not the same as wanting your first child”. I couldn’t understand how the desire could be so great as for a childless person. It’s true that it’s not the same, bu tnot in the way that I thought. Now I don’t just want a child for myself, I want a sibling for my son. And I feel more pressure and in a much greater hurry to get pregnant because I don’t want a huge age gap between my children. To the point that I was ridiculously disappointed not to have conceived in my last cycle as it was my last opportunity to have a second child before Thomas turns two. I realise that two under two would be making life hard for me in so many ways, so please no one point that out. It was just a milestone for me.

The first stage of pregnancy prep for a person with diabetes is making sure that those blood sugars are good enough. In effect we need to be given “permission to try” by our doctors. Of course no one can dictate what you do, and there is no forced contraception, but it’s done for the best of reasons. I’m on board with that. The crucial test is the HbA1c, which reflects control over the previous three months. (For any geeks, it is percentage of haemoglobin molecules which have been glycosylated – or have glucose attached to them. The higher the average blood sugar, the higher this percentage will be. And it covers about three months as this is the approximate life span of a red blood cell.) For non-diabetics, the range is somewhere between 4 and 6%. The advised target for women wanting to become pregnant is less than 6.5%. See above for all the factors that affect diabetes if you think that is remotely easy to do for the majority of women with diabetes. It takes hard work and commitment every single day, and through the night too, since diabetes never sleeps.

This morning we made a trip to the hospital to receive my latest “report”. It’s ridiculous, but I was nervous to the point of feeling dizzy and sick. I want this so much that I was petrified my control would have slipped and we’d have to stop trying. I want this, but I also want it with the minimum of risks. Ian was ever patient, trying to calm me down and point out that I’ve hovered around 6% since Thomas was born, and there was no reason to think that would have changed.

Except the month I spent without my CGM when the transmitter died and i was waiting for a replacement. Except the mild excesses of Christmas. Except the afternoon highs that have plagued me for the last few weeks.

I felt as nervous as if I was going in to an exam. And in a way, that’s what it feels like. I know that the number is just a number. That it isn’t a reflection of my self worth. It’s just a number which doesn’t represent failure. It’s just a piece of information to help me look after myself the best that I can. But even though I know all that, it still felt like so much was resting on this.

When we were called through to be seen, the very first thing I asked, before I even said hello, was “What was the number?”

The minute it took to get the results up on the screen felt like it was going in slow motion. And then came the answer.

Six.

And I turned to Ian with a massive grin, not even caring that he’d won the bet and been closer with his guess.

I felt the kind of elation that comes after finishing exams and knowing that there is no more revision but sudden freedom.

Except, diabetes doesn’t stop. It’s a relentless animal.

I have to keep doing this over and over and over. I have to keep doing it always, but especially whilst we try to conceive. There can be no slacking. No coasting.

While other women obsessively track signs of ovulation and time everything with precision, I’m obsessively tracking my blood sugars in pursuit of not just a pregnancy, but the healthiest pregnancy I can mange with the complications of my chronic health conditions.

That’s how trying to conceive with diabetes is different.

Top Tips For A Diabetic Pregnancy

Plan – Going in to pregnancy with more than 3 months of folic acid behind me and an excellent A1c made the early weeks much less stressful for me than I think they may otherwise have been. Aside from being less worried about potential complications, I didn’t have the problem of trying to drastically adjust what I was doing in terms of diabetes control. I’d already built in lots of good habits, so was free to focus on responding to the changes caused by my new hormonal status. I hated the thought that diabetes could be the thing to stop us trying to conceive once we were ready, but getting everything stable before we started was absolutely worth it.

Sort your hospital care out carefully – This is something I didn’t really do, and I ended up changing hospitals during the first trimester, which made for a bumpier ride than was probably strictly necessary. Think about the logistics of travel to your hospital both for frequent appointments, but also when it comes to actually giving birth. If there is more than one option locally, find out both about the general maternity services, but also what sort of experience they have in managing pre-exisitng diabetes in pregnancy. Ideally, you want to already know your diabetes consultant and DSN, and have a good working relationship with them.

Get used to lots of appointments – It can seem overwhelming. It can seem annoying, especially if you have a full time job to factor in. But all the appointments are there to make sure both you and the baby are well looked after. Try not to view them as an inconvenience and enjoy the unparalleled access to information about your pregnancy. Many non-diabetic women will be bemoaning the fact that they see their midwives so rarely.

However, Don’t be afraid to question what you are told, or what is usual “policy” – A lot of the care for pregnant women with diabetes is based on “one size fits all” policies. It’s essential that you are an active participant in the process though. If something is being suggested make sure you ask why. Ask what the alternatives are and what the risks and benefits of different approaches are. You can’t give informed consent if you haven’t been fully informed. It is often policy to see women with diabetes every two weeks, but in the early weeks, this felt excessive to me, as I was travelling a long way to talk about excellent blood sugars that we could easily have discussed by email. Remember that it is your body and your pregnancy. No one can “tell you” what to do. But at the same time, be sensible and respect the advice and experience of your health care team.

Test, test, test, or better yet, use a CGM – Honestly, I don’t think I have ever tested my blood sugars quite as much as I did during my pregnancy, and I don’t think I could have coped without a CGM to tell me which direction I was heading in at ay given time. The only way to have any chance of keeping your blood sugars as close to normal as possible is to know roughly where they are as often as possible. Testing, and writing down the results, is absolutely essential. You also need to be prepared to act on those results too.

Try to eliminate the lows – When you have the risks of hyperglycaemia drummed I to you frequently, lows can suddenly seem like a friend. Whilst it’s true that mild hypoglycaemia pose no threat to your unborn baby, it can carry risks for you. Frequent lows can lead to loss of the warning signs, which in turn increases the risk of severe hypoglycaemia, which may in turn put your baby at risk. Bouncing back from lows is also a major contributor to high blood sugars and a lack of overall stability. Eliminate the lows and it becomes easier to remain steady. Honestly.

Carb count carefully – eyeballing, or scientific wild guessing are no longer acceptable. The only way you can dose accurately for the food you eat is to know exactly how much you are eating. That means that wherever possible you need to weigh and measure your food. And you need to read food labels.

Low carb can be your friend – Eating low carb is a sure fire way to reduce or eliminate post-prandial glucose spikes. Low or no carb foods are also fantastic when you are hungry at a less than ideal blood glucose level. But don’t go mad. I had ideas pre-pregnancy that I would stick to low carb, and a limited range of foods whose effects I knew, for most of the pregnancy. This isn’t necessary and will make your pregnancy seem to last a lifetime. There is also some evidence that restricting carbs too much can be bad for your unborn baby.

Superbolus is definitely your friend – Minimising the post meal spike is one of the most challenging aspects of good control. The superbolus is a pump technique whereby you take some of upcoming basal along with your pre-meal bolus, and then reduce your basal rate to prevent a later low. This is much more difficult if you are not on a pump, but taking a larger bolus and then eating some of the carbs much later on is also a rough approximation. Bolusing 30 minutes before eating, especially in the morning, also gives your insulin a head start to increase the likelihood of its action matching the absorption of your food.

Don’t panic about occasional highs – this is so much easier said than done. I remember having a full on, tear soaked and snot-ridden melt down the first time I had a high blood sugar. People will throw around all sorts of analogies that are cheesy, but true: the occasional visit to the sweet shop for your baby won’t do them ay harm. It’s a fact of diabetes that highs happen, and you won’t be able to eliminate every single one. Just do your best to minimise them – with frequent testing, accurate carb counting and regular adjustments. Look at the bigger picture when faced with a high number. Frequent and sustained highs are much more of a problem than occasional spikes. It’s also easy to focus on the highs, so writing down all your results can help you to see that they probably aren’t as frequent as you think.

Night times really matter – If you can get your night time basal insulin sorted to keep you steady and in range all night, this not only gives you almost a third of the day within target, but also gives you a good waking blood glucose level which starts the day off much better physically and psychologically than a high or low number. It’s worth making the effort to test overnight frequently. This gets easier in later pregnancy as sleep gets harder!

Get comfortable making adjustments yourself – If you are the sort of person who tends to rely on medical staff to make the bulk of the changes to your insulin regime, get ready to change. The adjustments needed in pregnancy are too frequent to wait between appointments, or for someone to keep calling you back. By all means seek advice as often as you need it, but get used to trusting your own instincts. You live your diabetes every day, so you really do know it best.

Remember that the old rules don’t always apply – Four will probably not be the floor, unless you have severe hypoglycaemic unawareness. 3.5 will suddenly become an acceptable fasting level. Correction doses are no longer reserved only for numbers above , or 10, or whatever you used to use. 6.5 is now a number you can and should correct. You no longer have to wait 3 days to see a pattern. It’s OK to make changes on the fly.

Don’t be afraid to ask for medication for morning sickness – even if it doesn’t seem “that bad”. The effect of morning sickness for women with diabetes is very different than for women without. Whilst there is no doubt it’s unpleasant for everybody, trying to deal with bolus insulin and not knowing whether your food will stay down is an extra challenge you don’t need. If morning sickness is interfering with your efforts for good control, then taking medication is the sensible option.

Don’t expect non-diabetes staff in hospital to have a clue about diabetes – Be prepared to be your own advocate. Be prepared to take care of your own needs possibly throughout labour if you want – but certainly during early labour or if you are admitted for induction. Take plenty of your own test strips and medication. Also take plenty of food and treatments for low blood sugars – don’t rely on the hospital to have what you need when you need it, no matter how shocking that sounds!

Remember to enjoy your pregnancy too – Remember that there is more to this than just blood glucose levels, carb counts and estimated fetal weights. Try to set aside the focus on diabetes at least some of the time and enjoy your changing body shape, shopping for your new addition and feeling them kick and move inside you. Remember that you are a mum-to-be, not just a medical machine.

Remember, it’s only 8 months of your life – By the time you find out you are pregnant, there are only eight months to go. The obsessional focus on everything diabetes is finite. And you have the biggest motivation you’ve ever had. Once the pregnancy is over and you have your child in your arms, it will all seem more than worth it.

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.

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.

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.

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.

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.