Welcome Phoebe!

She's here! Well, she's been here a week now, but I've been a little too busy to get to the blog.

Phoebe Muriel Gwendolyn was born at 3:49am on Wednesday 6 August via a forceps delivery. She weighed 2.915kg (6lb 7oz), was covered in vernix and had an Apgar score of 9 after 1 minute and 10 after 5 minutes. (10 is the maximum, I was a little proud to discover.)

I lost some blood (1.2 litres) during the delivery and had to have a transfusion shortly after the photo above was taken (by Rob) so I was a little out of it for the next few hours. 

Later that day we were moved down to the antenatal ward and had our first visitors - both sets of grandparents and Rob's siblings. We spent the next day and a bit in hospital and came home on Friday evening. It's been an emotional roller coaster of a week. We've had some problems with feeding and life with a newborn is pretty exhausting for everyone. 

I want to write Phoebe's birth story for the blog at some point. Rob took lots of photos during labour and while they're not exactly flattering, I'm ready glad to have them as a record of what happened.

In the meantime, Rob and Phoebe and I are getting used to life together as the three of us. She is beautiful! Even Rob has to admit she makes cute noises. :) 

Things I will not miss about being pregnant

Turning over in bed is complicated. I definitely have to wake up fully to do it and sometimes I need to get half out of bed to turn over.

Relatedly, not being able to lie on my back. I sleep on my side mostly, but I do generally spend some time relaxing on my back when I first get into bed. I can't do that at the moment!

Being a pin-cushion. With 2 injections and 4 blood glucose finger pricks a day, that's a lot of sticking needles into myself. Fortunately, I'm not squeamish about needles, but I won't miss having to stick myself multiple times a day.

The effort of getting up out of a chair or bed. Usually accompanied by an involuntary "Oof!".

The pain at the bottom of my ribs on the right hand side. Apparently this is common in pregnancy, something to do with the ligaments between the ribs relaxing and the bottom ribs bowing out to make more room. I'm not sure why since my torso is long enough that Zarquon doesn't really reach that high. But the pain is there, most of the time, especially at night when I lie on my right. I hope it just goes once I give birth. (I did ask an obstetrician about it since it can be a sign of something more serious like a liver infection or HELLP, but he was happy that I didn't have any other symptoms of anything serious and it should be nothing to worry about).

Being hyper cautious about what I eat. Not so much the normal diet restrictions of pregnancy (though I do have the occasional craving for Eggs Benedict) but the specific ones for gestational diabetes. I do think it's been good for me to be forced to eat healthily for the last couple of months and I hope some of my good habits (like salad wrap lunches and plenty of veg with my dinner) will stick after the GD has gone. But I do miss muesli for breakfast and sometimes I would love a bowl of ice cream!

Central heating! I'm so hot, all the time. It has been very hot for the last few weeks: 27C most days and sometimes up to 30 or 31C. What with that and the little furnace in my belly, I've been pretty sweaty, especially at night. Of course, once Zarquon's born, her temperature won't be being regulated by mine anymore and we'll have to make sure she stays cool enough/warm enough. But at least I won't feel so overheated all the time. I hope!

Things I will miss about being pregnant

The little kicks and wiggles from inside. I love feeling Zarquon moving around.

The bump. I like being bump-shaped! I feel feminine, fertile and womanly. I'm a little waddly, but I don't feel that enormous, just curvy.

Being looked after. No-one minds giving up their seat to a heavily pregnant woman. People ask if I'm OK, how I'm finding the heat.

Afternoon naps on my schedule! Once Zarquon's here, naps and everything else will be on her schedule, at least at first.

Zarquon is very portable and easy to look after right now. I don't have to think about how to carry her or feed her.

36 weeks, 6 days

So, the decision has been made. I will be induced at 38 weeks.

To back up a bit: I had a 36 week growth scan on Tuesday and saw the obstetric and diabetes teams. The scan looks fine. Zarquon is consistently on the 50th percentile line and doesn't look to be getting too big or too fat round the middle. I've done a good job with keeping my blood sugar under control, but need metformin over night. It's because of the need for medication that I'm being induced early. If I were well controlled on diet alone, I could probably go to 40 weeks. I think this explains the disparity between the first and second obstetrician I saw. At the time I saw the first one, I was controlling my blood sugar by diet alone, but by the second I'd started on metformin.

It's quite hard finding good information on why early induction is better for GD. The NICE guidance, as far as I understand it, looks at the numbers of early inductions (typically 38-39 weeks) and the outcomes but doesn't really address the underlying reasons for early induction. It's more a case of this is what happens and it seems to be safe. A relevant passage says:

"The NICE induction of labour guideline recommended that women with pregnancies complicated by diabetes should be offered induction of labour before their estimated date for delivery. Although the guidelines reported that there were insufficient data clarifying the gestation-specific risk for unexplained stillbirth in pregnancies complicated by diabetes, the GDG [Guideline Development Group] that developed the induction of labour guideline considered that it was usual practice in the UK to offer induction of labour to women with type 1 diabetes before 40 weeks of gestation."

http://www.nice.org.uk/guidance/cg63/resources/cg63-diabetes-in-pregnancy-full-guideline-reissued-july-2008-2 p120

Early induction for macrosomia (baby over 4kg or 4.25kg depending on who's defining it) is the most commonly cited reason, because of the associated risk of shoulder dystocia. That doesn't seem to be the case for me and Zarquon. There is still a risk of still birth (one study found a rate of 26.8 stillbirths per 1000 live and still births for women with all types of diabetes, not just GD, versus a national rate of 5.7 per 1000 live and still births), although it's unclear if it's actually a larger risk for well-controlled GD.

I have the impression if I ask an obstetrician pointblank why I should be induced early, they're either going to say "because that's standard practice for GD" or say something about the increased risk of still birth, which is probably scary enough for most women to agree to an induction on that basis. But I need to remember I am not an expert at interpreting scientific evidence and medical guidance.

Anyway. I am being induced at 38 weeks or soon afterwards. I am OK with this. I'm not completely convinced it's necessary, but I'm willing to trust the obstetricians' judgement. It did help that the last obstetrician I saw was helpful and friendly, explained why the previous two gave different answers and gave me a thorough explanation of the process of induction, with all of its if-thens and what happens if steps.

Of course, I'd love to know how long it will take to get labour going, but that really is something no-one can tell me. It all depends on how I respond to the drugs. I'm hoping it's fairly straightforward, that the prostaglandin pessary and gels work for me and I don't need syntocinon to get things going. I will have continuous fetal monitoring. I may need a glucose and insulin IV once I'm in labour if my blood glucose doesn't stay in my target range. I'd like to get through labour with my TENS machine and gas and air, but I'm open to the idea of an epidural if I need one. Especially if I do have to have syntocinon. I think I'm more open to having an epidural than to pethidine, because the latter seems to have more side effects for the baby. All these unknowns! And I might still manage to go into labour spontaneously, you never know. We will find out soon.

35 weeks, 2 days

Oops, how did that happen? I've been neglecting the blog again. So, what have you missed?

Zarquon is a girl. Pretty definitely. She wasn't exactly co-operative at her 20 week scan though. We had to go away for half an hour in the middle and do some walking around to get her to move so that the sonographer could get a measurement on the blood vessels of her heart. Then, finally, I had to empty my bladder to get her into the right position to see her gender. But Rob was right all along. She is a girl. :)

Things progressed pretty uneventfully for a while after that. I got bigger, the bump showed more, I needed more actual maternity clothes (planning a post about my favourite places for buying those). Then, at 28 weeks I had a glucose tolerance test (GTT) which is standard practice for someone with a 30+ BMI. Women with a BMI below 30 get a glucose challenge test, which takes an hour. GTT takes 2 hours, but essentially both are measuring similar things - overnight fasting blood glucose and how well your body processes sugar.

I didn't expect it to show anything unusual. After all, I didn't feel unwell, or extra thirsty or like I needed to wee a lot. I had no reason to think I might have gestational diabetes. But, according to the test, I did. My results were borderline, only just into the range where they flag you for follow-up. But it was enough to need monitoring.

I was pretty upset the first day I found out. This was the last nail in the coffin of my ideal birth preferences. With GD, continuous monitoring during labour is standard practice and induction at 38-40 weeks is also standard. There's a risk of the baby being large (macrosomia) and of shoulder dystocia, where the baby fails to once the head is born, resulting in her getting stuck in the birth canal. Basically, zero chance of a water birth and a pretty high chance of needing further interventions. Plus I was worried about flying to Cyprus at the end of June. I already needed a fit to fly letter to say I was safe to fly and had no complications and here was another complication.

The midwife I saw that day was reassuring. The GD was controllable, whether with diet alone or with medication. I should be ok to fly, at least. And my birth plans? Well, I had a while to think about them and get used to the idea at least. And knowing there was something wrong was the first step to making it right.

So, since then, I've had an awful lot of hospital appointments. I have extra scans, the first at 32 weeks, the next at 36 and one more at 40 if I get that far. Every couple of weeks I see the obstetric diabetes team and an obstetrician. I had an assessment from an anaesthetist, who talked me through what an epidural would involve if I wanted one. (Right now, I don't think I do, but I've never given birth before, induction has a reputation for making labour more painful and it's good to know the option is there if I need it). Not forgetting the haematology clinic I've been going to every 8 weeks or so since the beginning. It all adds up to a lot of time at the Rosie, mostly in the antenatal outpatients clinic.

The good news is we got my blood sugar levels (which I have to measure 4 times a day with a finger prick blood sample) under control fairly quickly with diet and metformin. The day time ones were pretty easy to get right by changing my diet - limiting sugar, cutting out refined carbs and replacing them with wholemeal bread and pasta. I've had to forgo my usual bowl of muesli for breakfast, which I miss, because I can't cope with oats and milk and yoghurt and banana first thing in the morning. Instead I'm having scrambled eggs on wholemeal toast, which is nowhere near as good, but doesn't do bad things to my blood glucose. Over night took longer to stabilise. I'm now on 2 tablets (1g) of metformin, which makes my body more sensitive to insulin, so the amount my body makes can work more efficiently processing stored glucose overnight. I got a bit frustrated when I had to increase the dosage (and worried about having to go onto insulin if it didn't work) but the diabetes team reassured me that really, there wasn't anything else I could do if my daytime control was good, apart from take medication at night. I am controlling my levels well with diet during the day. Also, my weight gain is good (7.5 kg above my booking weight) which helps. I've not put on any weight since I changed my diet to control my blood glucose. I lost a little (maybe 0.5 - 1kg) initially, which worried me, but it soon stabilised.

The bad news is I don't yet know if I'm going to be induced early or at 40 weeks, or not at all. The first consultant I saw on the day of my 32 week scan was happy that Zarquon's growth looked normal, particularly her head circumference to belly circumference wasn't large and because of that, he was happy for me not to be induced early and have the offer of induction at 40 weeks, though the choice was up to me. The evidence for early induction in my kind of case - borderline GD, well controlled by diet without insulin, baby not looking large - is inconclusive. It happens to lots of people since the standard route for GD is early induction at 38 or 39 weeks, but it's possible women who are well-controlled don't need it. Though of course, it's possible they do. (Also, growth scans are notoriously unreliable for predicting birth weight. I'm therefore not sure why they bother measuring so much, but I suppose having a look and trying might tell you something?)

Then, at my last obstetric clinic appointment I saw a difference obstetrician who said they wouldn't let me go to 40 weeks and I'd be induced around 39 weeks. I challenged this by repeating what the previous obstetrician had said (though, annoyingly, he hadn't put any of that in my notes) and pointing out that I was well controlled, not on insulin and the baby wasn't looking big. She did back down a bit after asking colleagues about my results and we agreed we'd make a decision at 36 weeks, after my next growth scan.

I think I basically ran into the problem of varying degrees of risk-averseness among medical professionals. I think the first man was more senior, with a better understanding of the evidence and the second women was going by standard procedure. The potential complications associated with GD are serious - placental abruption, still birth, foetal death because of getting stuck in the birth canal, though the absolute risks are small and hard to calculate accurately. It's easy to be scared by the prospect of still birth and I don't want to put my daughter at unnecessary risk. But it's hard to quantify risk exactly. I would rather not be induced because of the increased risk of further interventions. But I'm not completely sure that I'm not being selfish, trying to avoid discomfort for me at the expense of increasing the risk of damage or death for my baby.

Right now, I hope I'll be booked for an induction at 40 weeks, but actually go into labour spontaneously before that. Unfortunately, there's nothing I can do to make that happen! I don't want an early induction. Maybe if I can convince the hospital to book me for induction towards the end of week 40, have a membrane sweep at my 40 week appointment and hope that starts things off? I don't know. We will see what my 36 week scan and appointments bring next Tuesday. I am trying to remain calm and trust God.

20 weeks, 2 days - halfway, baby!

How did that happen? Somewhere we're halfway through the 40 weeks of pregnancy. Of course, for the first 2 weeks, I wasn't pregnant, and for for the first 4 or 5 weeks, I didn't know. And babies can be late or early, so it's hard to know exactly when the halfway point is, but we'll call it now.

Next scan is on Thursday next week. I'm excited already! We want to find out if Zarquon is a boy or a girl. I hope (s)he co-operates!

It's time we started getting the flat ready. Rob wants to put about half our stuff in storage or get rid of it entirely. (!) Which is a good idea, I'm just not good at letting things go. But it's a small flat and right now, there's nowhere to put baby things like clothes, nappies, a cot, a baby bath, a buggy. We're planning not to buy much, but lots will come from family and it needs to go somewhere.

19 weeks and 6 days - Mothers' day

Today is Mothering Sunday, my first ever as a mother. I am so grateful.

Last year, I dreaded Mothers' day. We'd been trying for a baby for over a year, with nothing. I was pretty down about it, feeling like I'd never get to have a baby and sad and angry with God. This year, here I am, pregnant and almost halfway to my due date.

I wish I could guarantee such a happy outcome for everyone who yearns for a baby. I know I can't. All I can offer is hugs and prayers and the knowledge that God is good.

19 weeks and 4 days

Lately, I'm enjoying pregnancy. My back has settled down and isn't keeping me awake. I haven't worn the back support for a week or two, but I'm glad I've got it if I need it. I have had cramp once this week, which I do not like at all, but that seems to be normal for pregnancy.

As far as I know, all is well with Zarquon. After not being able to get a nucal fold measurement, I had a blood test done. That revealed a less than 1 in 10,000 risk of Down's syndrome and a low risk of spina bifida, which is great news. I'm not sure I've felt her move lately, but I've never been entirely sure if the movements I feel are baby or digestive system, so I'm not too worried.

The next scan is in just under 2 weeks. We plan to find our whether Zarquon is a boy or a girl, providing he or she co-operates. :) Rob is convinced she's a girl, so much so that we tend to talk about her as 'our daughter', but we'll see!

Last week, we were on holiday in the Lake District, with our friends J and J who are expecting a baby about 5 weeks before ours. It's fun to have someone to compare notes with and they're both doctors, which means they actually know stuff. :)

Life is fairly baby-dominated for me. We've not done a lot in the way of preparation, but soon we need to start tidying and making room for baby things. I suspect a lot is going to have to either be got rid of, or out into storage somewhere. It's not a big flat and babies, for all they're small, seem to need a lot of stuff - cot, clothes, nappies, maybe a baby bath. We're not planning to buy a lot, as there are lots of hand me downs from Hannah and Debs' babies, but still, we need to find some room.

17 weeks

I was enchanted to find out this week that Zarquon now has eyebrows and eyelashes. I wonder if they're the same beautiful golden ginger colour as Rob's?

I think I felt the baby move last night. I got up to go to the bathroom at about 3am and when I came back to bed, I could feel little bubbly, fluttery movements in my stomach. Was that my baby? I hope so. I we heard the heartbeat for the first time too. We've been lent a little heart rate monitor and though it's tricky to use, I think I heard a little, fast heartbeat that wasn't mine. I made Rob listen to it too, though I'm not sure I knew what he should be listening to.

At the weekend we met up with a couple whose wedding we will be photographing and took some photos of them. I love doing that. It's something Rob and I can do as a team. By the time of their wedding, I'll be 28 weeks pregnant. It'll be the last wedding I shoot before Zarquon is born. I hope I can manage it! There'll be quite a bump by then and I won't be up to carrying much equipment around. Rob can do the running around and climbing things and I'll have to be more static, I think.

16 weeks

I've been pretty tired this week. My back hurts a lot. Yesterday I picked up a pelvic support band from the physio. I think it helps a bit. I need to keep doing my back exercises. I also woke up two nights in a row with leg cramps at night. So really, I've not been sleeping well. I suspect carrying heavy camera bags several days in a row is the main problem. I do hope the cramp doesn't happen every night. It's really horrible.

At the weekend Rob and I went to a photography trade show at the NEC and then to see Rob's family. My mother in law, Julia is very excited about becoming a grandma. She gave us a baby journal and a kit for making casts of baby hands and feet. Rob's siblings are fun and the dogs - three little bichon frise - are as crazy and barky as ever. I wonder how they'll react to a little person?

13 weeks and 2 days. Or is 13 weeks and 4 days?

Baby Zarquon!

Yesterday we got our first look at our baby. There's just the one in there, but he or she is alive and well and wriggly. She's buried deep; my uterus is tipped back, so she's well inside the pelvis. There's a fair amount of padding there too, so the sonographer couldn't get great pictures. But there's a baby in there! And he has all his arms and legs and a head and a spine and a heart and a stomach.

Ideally, baby would have flipped over (she's actually standing on her head, hence the upside picture) so that we could get a measure of the nucal fold (on the back of the head. It's an early test for Down's syndrome). But Zarquon (named by Rob) refused to flip, so upside down it was.

The sonographer did get a measurement from crown to rump of 72.6mm, which would make me 13 weeks and 4 days pregnant and gives us a new estimated due date of 18 August. But, babies come when they're ready, so who knows.

I am feeling a little less sick then I have, so I feel like I'm beginning to get to the second trimester glowing stage! I hope. Still quite tired though, and I'm fighting a cold/viral thing which keeps coming back. But when large swatches of the country are covered in water, with the threat of more to come, I am grateful for shelter, warmth and a tiny little wriggly jelly bean growing inside me.