Wednesday 19 February 2014

Size Matters: Part 1

Size Matters: Part 1

December 2008

I was well into my second trimester and the morning sickness hadn't stopped. I was feeling exhausted.  I was struggling to eat properly and hadn't gained any weight in the way that you're meant to when you are pregnant.  I envied women who bloomed in pregnancy but every time I looked at the scan photograph I knew that every bit of tiredness and sickness would be worth it.  Work was incredibly busy and I put my exhaustion down to this.  I tried to rest as much as I could outside of work but the feeling of illness and exhaustion didn't go away.  

At 28 weeks I had a routine midwife appointment.  My blood pressure was checked and my urine was checked for protein.  Both were fine.   The midwife located a heart beat quickly and I lay and listened to the sound.  I was certain, at the time, that it was the most beautiful sound I'd ever heard - the sound of my baby's life. When the midwife measured my bump, however, she was concerned about the size.  She made a note of it and reassured me saying that as I am slight she wouldn't expect me to have a huge bump and that every woman and baby grows at a different rate.  Just to be on the safe side she wanted to see me again the following week.  I wasn't especially worried.  It played on my mind but not enough to cause concern.  I went back to work, had a quick chat with a colleague to try and dampen my worry, and tried to put it out of my mind.  

The following week my bump was measured again and growth had been a lot less than they would have expected.  It was a couple of days before Christmas and the midwife advised me to rest and to come back a few days later - my blood pressure and protein levels were still fine.  We went home and enjoyed Christmas as much as we could.  My sister in law was also pregnant with her second baby - not much further on than me - and for the first time I could see that there was a big difference, not only between the size of our bumps but also in the way she felt.  She was blooming and I was exhausted, run down and frail.  We didn't tell our families about the growth issues.  We didn't want to worry them but it was having a definite strain on us.  On 29th December we returned to the midwife and heard the heart beat again.  I had tried so hard to rest over Christmas and was feeling positive - especially since my whole family had suffered an outbreak of gastric flu yet i had remained unaffected and had been able to eat normally.  I was certain I was getting stronger and even went alone to see the midwife.

I lay on the bed while the midwife took out her tape measure to measure my bump.  She measured once, readjusted the tape measure and measured again for certainty.  She explained that there had still been no growth. "I don't want you to worry", she began to say, "but I'd like to refer you to the women's for a growth scan as you seem a lot smaller than you should be for this gestation".  She reassured me as best as she could but there and then called the hospital to make an appointment for a growth scan for me the following morning.  As I was leaving she said, almost as an afterthought, "try not to worry too much.  They'll probably just want to monitor you - they won't just whip in and deliver at this gestation".  I drove home in a daze - the thought of premature delivery hadn't even entered my mind.

The next month is a bit of a blur of appointments and monitoring.  My growth scan revealed that our baby hadn't grown as much as he should have done.  It also confirmed that there was resistance in the blood flow through the placenta meaning that the baby wasn't getting the sustenance he needed.  An appointment was made for me to come back a couple of days later.  

At the second growth scan things still weren't looking great and we were asked to wait to see a consultant.  No appointment had been made for us, instead we were asked to hang around and wait until the consultant was free to see us.  I felt awful.  Something was wrong with my baby and it was serious enough for us to be slotted in to the schedule of a busy consultant.  The scan that the consultant did confirmed what the sonographers and midwives had found.  There was resistance of blood flow through to the placenta and 'absent end diastolic flow' through the umbilical artery.  My baby wasn't getting enough blood and would be delivered early at a time that was considered safe - at a time when his internal organs had had as much time to develop as possible, but before the restricted blood flow became critical.  I was given steroids to boost his lung development and my notes now read 'IUGR', intrauterine growth restriction, a term that I would become very familiar with over the coming years, as I would with the consultant. The plan was to deliver by 34 weeks.

Over the next couple of weeks I went into the hospital for daily monitoring and CTGs.  By now I was on bed rest at home as much as possible and felt awful.  The baby's movements had slowed down significantly which, I learnt, is a way that babies conserve energy in utero.  I had to keep a kick diary to monitor his movements.  It was very unnerving and I even considered the possibility of the baby not surviving and ran through different scenarios in my mind wondering how I might cope if the worst happened.  At 33 weeks his movements had slowed so much and his heart rate was not what they wanted it to be.  The medics hadn't been happy with the CTG readings for a couple of days.  Once again I saw our consultant.  She ran another growth scan which confirmed that the baby was showing signs of 'brain sparing' - where oxyganated blood is sent to the brain at the expense of the other organs in order to protect it.  My initial worry was the fear of my baby having cerebral palsy - something that they couldn't deny could being a possibility.  An appointment was made for me to have a Caesarean section the following morning.  We were advised to go home and have a nice meal before I had to come back to the hospital that night for admission.  That night we settled on the name Samuel meaning 'God has listened' and 'asked of God'.

Once I was admitted to hospital I had a series of CTGs through the night and didn't sleep at all.  I was excited at the prospect of meeting my little boy but was terrified at the thought of what could potentially go wrong the following morning and in the coming weeks.  I tried to keep myself occupied by reading books and listening to music through the night but my mind was in overdrive.  The following morning I got up early and had a shower, trying to bring some sense of normality to the day.  The morning seemed to go on for ever.  We found out that, at that present time, there wasn't a bed available in special care and the neonatoligists were having a meeting to decide what to do for the best.  I was terrified at the prospect of having to be transferred to another hospital not as close to home where I was feeling isolated.  Eventually, another CTG showed that Samuel was tachycardic and it wasn't safe to leave him any longer.  I was very quickly prepped for theatre and sent down to have my c-section.

A canula was placed in my hand and I was give a spinal.  Everything seemed to happen so quickly.  John was brought into theatre to sit with me and the operation began.  Within minutes Samuel was born.  We waited for the cry but there was deafening silence.  There was a screen up that obstructed our view but we knew that the neonatoligists were working on him.  The silence went on for many minutes and in that time the technician kept popping to see what was happening.  We asked him what was going on but he couldn't tell us anything.  There was only one thing that we wanted to know - was our baby alive.  It became clear quickly that he was just filling time in going backwards and forwards while he checked on the progress being made. The thought of losing Samuel crossed my mind again and I began to panic.  John's body language and expression mirrored mine as we both began to fill up. Finally we heard a tiny, mouselike squeak.  It wasn't the gasping for air cry that new born babies normally make but it was a sign of life none the less.  He was brought round to the side of the operating table for us to see him for a couple of seconds before he was whisked away to special care.  I remember the shock I felt when seeing how tiny and delicate he was.  I was overwhelmed by how beautiful I thought he was but I can barely look back at photographs of him now due to his fragility.  We weren't able to touch or hold him as he was taken away so quickly.  I longed to be able to hold him.  I was taken into recovery where I had to wait for a while as my temperature had dropped quite significantly.  Once Samuel was stable, John was able to go and see him but I had to go back to the ward until I was stable too.  It was confirmed that he weighed in at a tiny 2lb 13oz - very small for his 33 weeks gestation.


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