Facing the Fear: Birth After Trauma Part One

No matter what anyone will tell you, cesarean sections are NOT the easy way out. Yes, they might be the best decision for you but we must remember that everybody is different. Your recovery could be a walk in the park or could be a little similar to mine: a small slice of hell with severe abdominal pain, severe swelling from excessive drugs, months of ‘deflating’, months of poor movement and continuous body-confidence nightmares. One of my biggest fears I will have to face this time around is birth and I’m going to try my best to document the process of pregnancy & birth post-emergency cesarean, step-by-step to help any other mama’s out there – whether it’s your first or fifth!

Now, you non-newbies will know I’ve previously talked about my birth story with Rory, my battle with mental health that followed and the ways I’ve tried to face these many demons in the hope of expanding our family –  well the moment has arrived for me to put my money where my mouth is and face ‘The Fear’. I plan for this to be the first of a few blogs following my journey through consultant-lead care and how I make my birth choices.

This pregnancy started off like every other: you make a midwife appointment and meet somewhere around the 8th/9th week of your pregnancy, you go forth and have a 12-week scan and see your midwife at the 16-week mark too – all textbook and running smoothly but it was here I was reminded that no matter how I look at things, this pregnancy will (most likely) result in childbirth – whichever form that comes in! It was at my 16-week appointment that my midwife (coincidentally the same midwife I had for Rory) asked whether I had thought about a natural or assisted birth this time around. I, of course, panicked and jumped straight in with ‘elective C-section is my preference’. WAS I MAD!? Who would think surgery would be a sensible idea? Why and how had I made this decision in my mind already? I worked out that it all boiled down to wanting a better experience than I had. With that, our first consultant appointment was booked and I was ready to fight my corner.

Let’s start off by saying I am lucky. We saw the consultant last week and it was so much more relaxed and successful than I had played over in my over-active brain. You can hear some real horror stories of consultants telling mamas-to-be that they can’t choose a cesarean birth and trying to put them off but I am fortunate not to be in that boat – PHEW! The meeting was calming and I felt listened to. *Worth noting here that we were seen by the consultant and a midwife*. I went in and was checked over as normal. We listened to the baby’s heartbeat, the midwife had a feel for the position and we sat down with my previous birth notes and went through what the situation was and what my choices are going forward. Did you hear that!? CHOICES! Hurrah, the words I so very longed to hear: ‘Whatever you wish to choose, we will support you in those choices‘. Absolute result! I was handed an A4 4-page leaflet on the benefits and disadvantages of both an elective cesarean or a VBAC (‘vaginal birth after cesarean’ for those not aware of today’s lingo!), which I am yet to divulge into, and sent on my way. Now, here are some FAQ’s the consultant answered for me during our meeting:

  • ‘When do I need to have decided my birth preference by?’
    In your second consultant appointment, which will be booked for around 36 weeks.
  • ‘If I chose one, when will my C-section be scheduled?’
    Between the 39th and 40th week mark allowing the baby to be as ‘cooked’ as possible. This means the chances of your baby having breathing issues or needing NICU attention is minimal.
  • ‘What would happen if I go into labour before this date?’ 
    You can either choose to progress with your labour naturally if you so wish OR you can be brought in for an emergency C-section straight away.
  • ‘If I decide on a VBAC how long will I wait after my due date before induction?’
    You will be induced at 41 weeks and no later.

So as mentioned, following on from an initial appointment, you are given a second appointment around the 36th week of pregnancy – so for us, this is around the 28th of November. This will be crunch time. This is where you should have done all of your research and be able to tell the consultant what it is you want. From here, if you wish to choose an elective you will be advised on a date (or selection of dates) for your baby’s big day – again, as mentioned, this will be around the 39th week of your pregnancy to be sure that the baby is fully cooked and ready to be brought earth-side.

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I am yet to make my ‘final decision’ or even half of it – we do still have 10(ish) weeks to go before I absolutely need to have decided and I am in no rush to put this in concrete. I know it’s going to be a very personal decision and one I am rather unlikely to take anyone’s advice on (in case you were unaware, I can be stubborn!). However, if you are reading this and have had a successful VBAC or a positive elective cesarean second time around, I would LOVE to hear from you. I’m trying to build a much bigger picture and would really like to feel as well informed as possible before I decide. Please head to our contact page if you would like to get in touch!

For the rest of y’all, we will be back soon with more updates!

Love and all,
OCM xo.

Strep In The Wrong Direction!

I have just spent weeks drafting the perfect (and longest) post for you all. Full of information and all the decisions to make when it comes to deciding what to include in your birth plan, I was desperate to share my most in depth post yet. However, in an unexpected change in situation within my pregnancy, I have been stifled by the uncommonly discussed topic of Group B Strep – a bacteria that 25% of people have in their bodies – that has pretty much made some of my major decisions for me. Thinking out loud, some would think that it’s helped me tackle those hard decisions like where to give birth but I beg to differ. Feeling kind of stripped of my breadth of choice, I decided to do some good old research into what Group B Strep is and exactly how it’s going to affect my birth plan now.

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As you’ve probably guessed from my previous posts, it’s very hard to avoid talking about medical topics when it comes to pregnancy. As a natural phenomenon that requires medical care and attention there are always thousands of issues swarming the topic. Having recently discussed vaccinations and the use of dummies, I still feel it’s important to share every high and low step of this wonderful journey I am hazily bumbling along. Throughout my pregnancy, I have chosen to take pretty much all the necessary precautions advised to me by my midwife. I have agreed to have all the offered tests through scans or bloods being taken without question. I chose to have all my available jabs. I chose these to protect not only myself but my unborn baby too. After all of that, at 31 weeks pregnant, I wasn’t expecting to be told I have Group B Strep.

GBS is something I had never heard of. It wasn’t something that was addressed in my appointments, nor was it brought up during discussions for any of my tests. After foolishly turning to ‘Doctor Google’ to do my research, there’s no surprise I was left feeling nervous and worried for my unborn child. Now, at the fear of sounding too dramatic and a little over the top, although harmless for me, GBS can, in extremely rare cases be very serious for your baby. This is because GBS can be passed on to your baby during labour which has the potential to present itself in two ways: Early Onset GBS or Late Onset GBS. In some of the most serious cases, GBS has led to meningitis, pneumonia and sepsis. CUE THE PANIC… but not for me. I made a mature decision and decided to take a deep breath and look for factual information and advice around the subject; I left Doctor Google behind and found a few websites with clear information that made me feel somewhat sane again.

I hope this helps you if you’re in need of some clarity in between all this fog!

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The first website was Group B Strep Support who came to the rescue to calm my nerves and educate my worried little brain. Both helpful and informative, the website clearly outlines what GBS is, how common it is, it’s dangers as well as their support in further research. Once I had read through all the information necessary, I felt so much calmer. Although some of the information on the website can seem scary, especially when talking about the more serious effects, I felt much more informed and educated on the matter.

The most important piece of information I found was that the top medical recommendation made by doctors and midwives to help prevent GBS passing on to the baby during labour is to have antibiotics as soon as labour begins. This is either by intravenously through a cannula (so a drip for about 20 minutes) or through slow injection (estimated to take about 5-10 minutes).  This is recommended to be administered to you at four hour intervals for Penicillin or eight hour intervals for Clindamycin. From a conversation with a midwife last week, it was suggested that Penicillin is more commonly offered whereas Clindamycin is then offered if you’re knowingly allergic. It was at this moment I realised that my expanse of choices had become quite restricted. To have the antibiotics, I need to be on a hospital ward – that means I have crossed off the idea of a home birth (which I didn’t want anyway) and a no for most midwife led units. There are midwife led units that do offer medicine for care but the one at my chosen hospital is not one of them. I had tossed and turned over the idea of a water birth but the idea of all that fluid put me off. I like the ideas of a bath and using water don’t get me wrong but using it as pain relief just doesn’t seem like enough for me. GBS stifles this idea as needing to be hooked up every 4 hours to a drip is going to be a little difficult and unsanitary as you can imagine as the cannula could get wet. However, I believe I am still allowed to use a regular bath and is still encouraged as it can help speed labour along but you must keep you hand out and dry! On the other hand of all this, there is the option not to have any antibiotics. If you should choose not this option, this is where GBS can become serious. As mentioned earlier there are two different types of GBS: early onset and late onset. The information available from the NHS website talks more in depth about both, what each means and the symptoms to look out for.

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Early Onset, which develops within 24 hours, carries symptoms such as ‘being floppy and unresponsive, not feeding well, grunting, high or low temperature, fast or slow heart rates, fast or slow breathing rates and/or irritability’. IF your baby is to become infected there is a chance that ‘even with the best medical care the infection can sometimes cause life-threatening complications’. The information leaflet goes on to discuss the chances of it becoming serious. One in ten babies born with GBS will die and one in five babies born with GBS will develop issues such as ‘cerebral palsy, deafness, blindness, and serious learning difficulties‘ but there are still chances that a baby born with GBS can make a full recovery and survive with no complications. Late Onset is a little different from Early Onset. It’s only classed as ‘Late’ if it develops in the baby after seven days or more. This then suggests that it is not linked to pregnancy and an infection could have been picked up from someone or something else. This will be handled with care and your baby will be tested and monitored to determine whether GBS is or isn’t present.

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There’s a lot of reading here and it renders a very uneasy feeling with me. As commonly untested and therefore untreated, this can leave a lot of your baby’s health to chance but spreading the word is easy and could be the difference between making that doctors appointment for a swab or not bothering. The topic was this week discussed on popular morning TV show This Morning – in my eyes a very good step in the right directed to see GBS starting to emerge into the mainstream media. The six-and-a-half-minute clip shows an interview with a bereaved mother, Fiona Paddon, and medical professional, Dr Chris. They began the discussion with the heartbreaking story of how Fiona lost her son at just 9 days old. Like myself and I’m sure many others, Fiona had no idea that GBS even existed or that she was a carrier of the bacteria. There was no mention of it during appointments, tests or NCT classes. This is where Dr Chris steps in to talk about the many petitions over the years that have been signed and repeatedly ignored. For the sake of a small swab test carried out between 35 and 37 weeks, so many babies could be saved from contracting life changing illnesses or meeting death just by mothers, midwives & doctors knowing that GBS is present. It’s that simple.

Since mentioning it to a midwife when I was recently in hospital for monitoring, I now have a big square sticker on the front of my maternity notes to help whichever midwife I have when I go into labour – the sticker is a bit like the one at the top of this post. With this in mind, I think my personal decisions will all become a bit more final after my next midwife appointment when I will be able to talk and come away with as much information as possible to go away and write my birth plan. I already have an idea of how I will plan this already. It’s been decided for me that I will be heading to the delivery suite, accepting the antibiotics provided, having any pain relief I can have whilst on the antibiotics, using the bath (if not too traumatised by the thought of a water birth) and eventually when little one makes his grand entrance, I will be staying in hospital for 24-48 hours for observation… or something along those lines!

GBS has definitely been one of the more difficult subjects to tackle and I want to thank you (again and again) for having a read. Now let’s do our bit spread the word and make more and more women aware of GBS and how it can be handled!

One Curious Mother x

Sources:
http://www.gbss.org.uk
http://www.nhs.uk/chq/pages/2037.aspx?categoryid=54
http://www.itv.com/thismorning/health/group-b-strep-why-dont-we-test-for-it
(header image) https://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwjbz9z9j-LRAhWE6xQKHWH_BRMQjRwIBw&url=https%3A%2F%2Fuk.pinterest.com%2Fpin%2F236157574190265969%2F&bvm=bv.145393125,bs.2,d.ZGg&psig=AFQjCNG92g6XdbZaos7F7tsfisv2fXlfNQ&ust=1485599612550243