Pregnant in the UK–Part 5

A more personal version of this story will be told over the years–in snippets, through tears, in more intimate settings–probably over glasses of wine. This is this version my heart lets rise to the surface, above the precious and private moments, to the world.  

This is the tip of the iceberg.

I often borrow Drew’s Superman sweatshirt–so often, in fact, that it is now mine for all intents and purposes. I even have Superman panties. Those never belonged to Drew. The point is that I must secretly know that I am not as fearless or strong as I intend to be. My mind-over-matter wonder powers are amateurish at best. Superman sweatshirts and panties provide absolutely zero sleep, nourishment, or pain control during birth, but my inner dreamer thought it was worth a try.

I imagined through pregnancy that our birth story would be some beautiful, float-y, Earth-mother song like one of those poems in a Tolkien novel. I was sure that I was unshakeably strong and completely ready to gracefully embrace the most painful and demanding experience of my life in exchange for meeting the most brilliant creature on Earth. Looking back, I feel a bit like I was in a different fairy tale; I looked into The Magic Mirror Gate and stood face to face with a wimpy, haggard, old mama cow.

Sunday, 27 Nov 2011–After weeks of intermittent Braxton-Hicks contractions, and days of random true contractions, the true contractions became regular between 1am and 4am. Drew patiently timed them, rubbed my back, brought me water, and was just generally supportive. From 4am the contractions became irregular again and I went back to normal life for the big chunks of time between them. We went for Sunday roast at The Marksman with Andrea (middle sis) and Jonathan (cousin) and shoved our way down Columbia Road through the Flower Market.

Monday, 28 Nov 2011–The contractions came again as they had in the dark morning hours of Sunday, between 1 and 4am. I stayed close to home hoping that our baby would make an arrival. Baby H stayed snugly inside despite the preparations my body was making.

Tuesday, 29 Nov 2011–The contractions came again between 1 and 4am and I was anxious as we made our way to the hospital for the 41 +1 appointment at 9am, managing irregular but intense contractions. A consultant physician performed an external and an internal ultrasound. The physician judged me to be dilated to 1cm, declared the placenta to healthy, verified that Peanut’s heart rate indicated a happy Nut, and guessed that we would meet our baby within 24 hours. Then we met with a midwife for a manual check; she judged me to be 0.5cm dilated and performed a membrane sweep. We returned home to get on with getting through the latent phase of labour. We filled our bellies first and then Drew took a nap on the couch while I tried to nap through contractions in bed. From 2pm, contractions started to become more regular until 9pm–at which point I began to feel sharp pain with each contraction. The new sensation was more than I thought I should be feeling this early in the process so I told the midwife I was coming in to be checked, even if it meant getting sent back home. The midwife who saw me checked me in to the birth centre (where I wanted to have a water birth) at 3cm. Drew called Andrea to bring our luggage and some peanut butter sandwiches. I weathered some contractions in the shower, getting out to eat half of a sandwich at the midwife’s suggestion.  Until 2am I paced, bounced on the yoga ball, crawled on the birthing mat and just plain got on with it.

Wednesday, 30 Nov 2011–At 2am (-ish) the midwife [#1] decided to send me to downstairs to the labour ward because I was still at 3cm.  She didn’t think I was eligible for a water birth.  (That mean old cow.)  I had a lovely midwife [#2] on the labour ward as well as a sweet student midwife [#2b], another several hour stint in the shower, and some gas and air (laughing gas).  (Gas and air was a joke.  The shower was a happier place.)  At 9am–about an hour after shift change–my lovely new midwife [#3] said I was 5cm.  She had a consultant physician come to apologise that I had been transferred to the labour ward and ask if I would like to be sent back upto the birth centre to a room with a birth pool.  So we packed our bags again and relocated–this definitely meant I missed breakfast in the transfer excitement.  Back in the birth centre, my new-new midwife [#4] said I was still at 3cm.  (That mean old cow.)  Unfortunately, that meant I had three to go before being allowed in the pool.  Shower, pacing, shower, bouncing, crawling, walking, shower, crawling, order lunch, exam.  3cm.  Shower, pacing, shower, bouncing, crawling, walking, shower, crawling, exam. 3cm.  At approximately noon I allowed the midwife [#4] to break my water.  Shower, pacing, shower, bouncing, crawling, walking…  At 2.45pm the midwife [#4] recommended that I go back to the labour ward for a hormone drip because I was still dilated 3cm and the clock was ticking since the time of water being broken; I opted for a side of epidural in anticipation of more fierce contractions (with Drew’s gentle support and the reminder that I hadn’t eaten or slept properly for days).  While we were packing again someone showed up to clear the lunch tray that I never saw.  (In the transfer back downstairs to the labour ward, I missed dinner too, but Elsa [my French BFF in London] did bring Drew dinner before we knew I would miss mine.)  The epidural was in and the hormones were dripping by 7.45pm.  Midwife #4 handed me back over to Midwife #2–who requested to have me again because I was such an awesome patient (bless that sweet woman!) .  Midwife #2 had another student [#2c] of course because she is an amazing midwife…  With all hope of a meal lost, I tried to rest in between the waves of contractions.  (I think my favorite midwife allowed Drew to sneak me some tea and toast.)

Thursday, 01 Dec 2011–In the dark hours between 2am and 4am the Midwife [#2] was coaching the student [#2c] through an exam and tilted her head in a funny way, thinking and then having an ‘aha!’ moment.  At 7cm she said that Baby Huddleston’s head was deflexed (tilted back).  This, she guessed, was the reason for the pain I was describing as well as the slow progression.  Our baby was intent to stare this world straight on.  At breakfast time Midwife #2 (and student #2c) handed me me over to Midwife #5.  I kept trying to rest, quietly begging for food at every opportunity.  Somewhere near 12.30pm a (male) student nurse [#5b] joined the party–just in time for the big push.  For an hour and a half the four of us pushed.  Peanut happily hung out in the birth canal–facing the world and spine rotated slightly to my left.  And that’s when they broke the news that I would need assistance (most likely by way of forceps), though they were going to consent me for a c-section too.  Either way, we were going to have to go to the operating theatre to introduce my lady parts to a room full of new faces.  It is terrible that the operating theatre was tied up for two hours for an emergency case, but I was thankful for those two hours in the end.  By the time we were rolled in and Midwife #5 handed me over to Midwife #6, Peanut rotated into the correct position (spine up) so that the team felt sure that forceps would do the trick to tilt his head into position on the way out if I could manage the pushing.  Drew, Midwife #6, student nurse #5b, an anesthetist, an OB-GYN/Urologist [#7], two students [#7b, #7c], a consultant physician, a pediatrician, and a surgery tech [#8] were with me in those three last incredible contractions.  But everything faded away at 4.04pm when a baby was laid on my stomach–wet and crying.  In a few quick motions Peanut was rotated until I could see that he was a boy.  He was exactly the boy I had been talking to for so many months and the boy whose name we deliberated over and who spiritedly kicked us in the wee hours.  He was the boy I dreamed about and the boy that I was eager for his daddy to meet.  He was the baby that I was aching to see with all of his fingers and toes, completely healthy and whole.  In the moment that he was born, my whole world changed.

In Summary–

This is the birth pool that I did not use:

 

This is why it does not matter:

 

Kenneth Howard Ross Huddleston makes three.

 

Birthdate: 01 Dec 2o11

Birth time: 16.04

Weight: 3.69kg/8lbs 2 oz

Length: 54cm/21.25 inches

Gestation: 41 weeks, 3 days

Active Labour: ~43hours

Delivery: vaginal, forceps assisted (with 2/3 of London present)

Birthday twin: Magnolia Grace Montgomery; Nashville, TN

*[These people in brackets are the lucky ones who got to know me on a pretty intimate basis.]

Post-birth details to follow for those interested in the medical care follow up type stuff.  Please note that Drew may offer his version of events if I get enough of the details wrong or if he is politely begged.  Click here for Parts 1-4.

Pregnant in the UK-Part 3

Here we are. Pregnant in the UK.

elsa konig 40 weeks
Photo courtesy Elsa Konig

I had a fair bit of anxiety taking the second pregnancy test and went through the motions of seeing my GP again. It was a blessing to be incredibly busy in a new position at work while we waited for the first early scan. However, we were lucky enough because of our history to have three early scans scheduled for us although they are not usually offered before the 12 week scan. When all was confirmed to be progressing normally, we were given a ‘booking appointment’ with a midwife from the hospital for 8 weeks. At a booking appointment you fill in your medical notes; these you carry with you everywhere you go because you see healthcare professionals at multiple locations. You definitely carry your notes with you when you travel so that you can always just hand your antenatal record to a medical professional in any situation where you need to see one. All of this documentation is archived by the hospital after delivery.

At your booking appointment the midwife performs a set of routine checks and conducts a lengthy interview. Then she (or he) answers any questions you may have and walks you through what the rest of your appointments will entail, given that your pregnancy is straightforward, and how they are scheduled.

8-14 weeks– booking in (and dating scan if required, to determine the due date)
12 weeks–Down syndrome screening scan
16 weeks–routine midwife visit
20-22 weeks–scan to assess baby’s growth and mum’s health (placenta, cervix, etc.)
25 weeks–routine midwife visit
28 weeks–routine midwife visit
31 weeks–routine midwife visit
34 weeks–routine midwife visit
36 weeks–routine midwife visit
38 weeks–routine midwife visit
40 weeks–routine midwife visit
41 weeks–routine midwife visit

Routine visits include blood pressure and urine checks as well fetal heart monitoring and a manual check of the position of the baby. At each visit there are unique items to discuss and sometimes blood tests which are recommended to be performed. If there is a complication at any time, you are referred to a specialist. For example, when I complained of a serious spike in migraine activity, I was referred to an obstetrician and a neurologist as well as a midwife acupuncturist. I was lucky that the migraines subsided naturally after 20 weeks and I have only had a small handful of related symptoms since then.

Ultimately the philosophy seems to be that pregnancy is a normal, natural occurrence and requires minimal medical intervention in straightforward situations. I have heard the argument that the approach that the NHS takes is centered around being cheaper, not better for me. Having been a recipient of care in this model I can understand where this argument gets its basis, but I can argue from personal experience that routes of escalation are in place and physicians are available when a midwife reaches her (or his) limit of responsibility. I have also witnessed the expertise of the midwives; it should be pointed out that they attend far more births than physicians. Ask any nurse, the people who provide care day in day out catch things, see things, and usually engage in a more personal way with the patient. An obstetrician is essentially a surgeon (many train in gynecology, especially in the US where midwifery is not standard in the care model, in order to be able to provide more well rounded care to women). Due to the way medical professionals specialise in the UK, there isn’t a need to involve an obstetrician in routine antenatal care.

I am not interested in opening a debate or changing anyone’s mind about whether the system in the UK is better or worse than the care I would have received in the US, but I do want to share what I am learning as well praise the caregivers who have been looking after us. I would like to give our loved ones comfort that we have in fact been looked after though rumor may have had it we were left to the wolves. For my own way of thinking, I am thrilled to have been given the opportunity to experience care from this side of the antenatal philosophy. My GP had a point back in those early days; in some cases, the US care model introduces treatments and interventions that are more costly (some potentially introducing unnecessary risks) due to the way the system operates. Surely there is some middle ground where we could all meet…

Coming next–Birth: preparation, the big push, and the baby’s first month
Followed by–our own personal birth story

Disclaimer: I am given to understand that there are some differences in the care offered by different hospitals based on the needs of the region they serve and due to way that services are managed by trusts in that region.

Pregnant in the UK–Part 2

First things first… I got ‘booked in’.

Booked InRegistration with a particular facility, declaring your intent to present for treatment under the care of the staff of that facility. In this case, my GP booked me in at University College Hospital for antenatal care and for the birth.

Being booked in means that my first point of contact for antenatal care is a team of midwives based at the hospital of my choosing. As needed, a full medical staff is available to me as well.

MidwifeA medical professional with an academic and professional qualification to provide antenatal care, including birth and newborn baby care. Typically, full time courses take 3 years to complete and are comprised of 50% course work and 50% practical based experience. The NHS only employs midwives who hold a midwifery degree and who are registered with the Nursing and Midwifery Council. (My midwife team holds a weekly clinic in my GP’s office for my convenience; that’s where I have my regular check-ups.)

Though the midwives perform the routine checks, ultrasound scans and treatment of complications require hospital visits and are handled by doctors and/or specialists. A full range of medical services is available for any non-routine situation and your case is triaged.

It was a little strange (ok, maybe a lot strange) to be booked in to a hospital and assigned to a team of midwives without really understanding what to expect of those two things. It was more shocking to need emergency care before I had wrapped my head around routine care. We don’t like to dwell on the loss we experienced in January but you have to know, to get the full picture, that we were handled quickly and carefully. Not every staff member we met was incredibly pleasant, I didn’t mistake the hospital for a five star hotel, and I did need to be clear about what I was experiencing and what I wanted.

I can’t tell you how many times I was seen by the emergency staff in the antenatal unit, though there was one Ambulatory and Emergency visit (A&E, like the US ER). The point is that the care I needed was given to me. I didn’t pay a single co-pay or fee and received medication completely free (not all medications are free all the time). For more routine type follow up appointments my GP fit me in on short notice; if my GP was not available another GP at my practice was. (It should be noted also that my employer treated me with the utmost kindness when I needed medical leave.)

I didn’t have time or energy in January to assess whether the care I received was what I expected–it was all so much… We were offered free counseling. We were assured early antenatal scans in the event of another pregnancy. I was seen as a priority at my GP’s office. My initial confusion and discomfort with the workings of the NHS system took a backseat to finding a groove of honest and open communication and then participating in my care. This was a very powerful thing. Perhaps that’s when the change in my perspective began…

elsa konig 38 weeks
Photo courtesy Elsa Konig

www.drewandjengotolondon.com