37 Weeks and getting the PMA back.

I’ve been feeling kind of like an asshole. You see in every pregnancy I’ve had to fight for the birth that i wanted. I’m not naturally a bolshy person, not by any means at all. I’m more the type to silently fume about something or to get upset or to feel like I’m just causing a fuss, but I had such a poor experience with my first birth which I truly believe contributed to the severe postnatal depression that I suffered after. It’s taken a long, long time to heal those wounds (and the scars are still there) and I’m admittedly scared of it happening again. So i start off from a frightened and defensive position.

I’ve been pleasantly surprised, nay shocked, to see the apparent sea-change in attitudes that has come about in maternity services in the last few years. I got the GBS result and I assumed, based on previous experiences, that I was going to be told I HAD to go to labour ward and that I would HAVE to have my labour augmented and HAVE to undergo continuous monitoring as standard. I expected to encounter unhelpful, patronising, scornful and paternalistic attitudes because I have before (it’s very important to note that it hadn’t been my experience with every HCP I encountered in pregnancy, but it did make up a fair proportion and naturally sticks out in my mind as the most upsetting experiences). I was very shocked when the community midwife called me and suggested that I meet again with my consultant to discuss my options. That threw me, i have options??? So I agreed and went long to meet with the consultant.

Wow. Mind blown.

She went through the stats on group b strep, on how low the incidence is, on how low the actual risk is, though it is important to note that for the tiny, tiny proportion of infants who do become infected with it, it’s a very serious disease. She said she actually regretted ordering the swab in the first place, as since little A hadn’t suffered from an actual GBS infection there was no indication to swab me, but she had and we had got back the result that we don’t and unfortunately she couldn’t pretend like she wasn’t aware of that piece of information. My choices were, i could go to the labour ward (with GBS status alone is not an indication for continuous monitoring!) written in very large letters across my notes and the thorough endorsement of Dr X to invoke her name in turning down any intervention that I wasn’t comfortable with, or I could have my home birth but the midwives hands are tied by Trust policy so I wouldn’t be able to receive antibiotics.

I thought long and hard about it. The only reason I received antibiotics within the four hour time frame with little A was because my waters broke before contractions started. If it had been based solely on the amount of time I was actually in labour (1hr and 50 mins) I wouldn’t have gotten them. Squishy’s labour was even shorter at 50 minutes. What are the chances that I’d even get them on time? I may well be barely through the door of the place before I’m delivering (and it’s a looooooong walk from the carpark to the maternity ward). So we decided to go ahead and book the home birth, at least that way my options stayed open with regards to changing my mind and going to hospital if I felt at the time that was the right thing to do.

I called the midwives on Friday morning to inform them of our decision and I think they freaked out a little, as suddenly I was offered the use of the midwifery led unit (with birth pools!!!!) that I had been categorically told was a NO the day before. The MLU is a very, very happy compromise for me, it’s none of the medicalisation of the labour ward but I’d get the antibiotics. I was pleased to accept, i just want it in writing because I’m paranoid of arriving at the hospital and them claiming not to have heard of me and admitting me to the MLU is against protocol etc etc etc. That makes me feel like kind of a suspicious asshole but i’ve been burnt before, and then I feel bad about all my ranting and wailing about how awful they all are because they have been so supportive, respectful and accommodating when all I was expecting was a massive argument and a struggle against a power trip.

I suppose we shall see how it all pans out, but I’m cautiously optimistic.

In other news I appear to be gestating Godzilla. I had a scan on Thursday and Dr X is estimating baby’s weight at 8lbs 3oz already. OMG that’s bigger than Squishy (my biggest by far) was at practically term. I think I may have to take the gorgeous little newborn sized onesies out of my bag and repack it with something in the 0-3 month range. Baby Loki does feel long (well he is a frost giant), as I am frequently simultaneously headbutted in the cervix and kicked in the ribs. I’m terrified of what size he will be, and I know it’s all my fault for eating far too many buns.

I am so ready to give birth now. I went to Ikea with my sister yesterday to get the last few bits and pieces that we need. I sort of hoped long drive plus long walk might equal some baby action but all it left me with were a lot of Braxton Hicks and crippling new levels of SPD pain. My poor sister also suffers horrendously from endometriosis, so by the time we were in the Ikea warehouse we were both hobbling and groaning like some kind person should really come along and put us both out of our misery. On the plus side though I got a baby bath for a bargainous £6. I also got a new cot mattress for when we get around to re-rigging the co-sleeper. I’m just waiting on the new car seat I ordered to arrive and the replacement axle for our iCandy pram and we should be good to go more or less, though I’d quite happily go right now while I’m definitely in the less camp because oh my god the last weeks of pregnancy are beyond tedious and uncomfortable. I just want to have a working pelvis back. Chronic pain is zero fun. i know that i am incredibly lucky that i will escape this chronic pain within a few weeks, i’m just impatient for it to happen.

Generally though i’m feeling much more positive, if not very impatient.

Gutted

My sister just called me with the results of the second swab, oh irony of ironies, it’s actually come back worse than the first one. Now we have heavy growth. I had a few days there of fantasising about my options, thinking that I actually had some and it’s all just been ripped away from me. I’m just sitting here in tears at the thought that I have to go back to that horrible labour ward.

I am absolutely gutted.

In which we discover you can’t buy a douche in this town….

Yesterday was a pretty busy day. I was running about picking the kids up from school (they all helpfully have different finishing times), doing an emergency “mum! my reservoir of insulin is running low I need more!” run, picking the husband up from work, taking my sister in law to hospital etc. I was exhausted when I finally got back to the house, only to discover there was a midwife sitting waiting for me. It turns out that they had the wrong due date written down for me (they thought it was the 5th) and they hadn’t got the results of the GBS swab so didn’t know if we were go for a home birth or not (and based on the wrong date they had they’d need to have everything in place by tomorrow).

So… we discussed options a little. I told her about the result of the swab and that I had been waiting to see my GP before I went back to them. I wanted to see if she (my GP) would agree in principle to prescribing the antibiotics if I was to labour to home, apparently this will only work if she’ll willing to administer them as well as the midwives aren’t allowed to. Well that’s not going to happen, my GP is lovely and accommodating, but she’s also award winning and exceptionally busy. Who knows what time of the day or night my labour could start? I’m not even willing to put her in the awkward position of having to say no to me and it’s just unfair. The next option we discussed was retaking the swab, since technically I was swabbed early at 34 weeks instead of 36. Well they seem open to that and they’d like me to come in on Friday morning for a repeat swab.

This has opened a window of opportunity for me (I didn’t discuss this bit with the midwife). I could theoretically try a chlorhexidine (hibiscrub/hibicleanse) rinse before the swab. This could result in a negative result freeing me up for a home birth that I so desperately want.

Update – so I went this morning to see the midwife and get the repeat swab done. In the end I did decide to try the hibiscrub regime, so last night and this morning I douched with 4 fl oz a mixture of 2 tbsps of 4% hibiscrub to 20fl oz of cooled boiled water. I will find out the result of the swab on Monday or Tuesday. I have really agonised about this decision, it’s probably not something I would have went for if I’d had GBS present in my urine or if the initial swab had shown anything more than scanty growth. I guess to be on the safe side I should probably douche again with the hibiscrub when labour begins, though that opens up a whole other can of worms about disrupting the normal flora of the vaginal canal and potentially depriving the baby of a once in a lifetime opportunity to be seeded with a good micobiome and opening us both up to yeast infections. I intend to go buy a good probiotic later. I’m sure there are people out there who will disagree with my decision but I am taking this very seriously and will happily go for antibiotics if there are any developments to suggest that I need them.

On a side note it was impossible to find either a douche, a large bulb syringe or even an enema kit that would do the job in this town. I had multiple embarrassing experiences yesterday going into pharmacies and asking for them. Then I thought…. well maybe I’ll try a turkey baster. I couldn’t even find one of those! What I ended up getting was this

silicone easy squeezeIt’s a silicone easy squeeze icing pen, you know… for decorating cakes, not for squirting chlorhexidine up your lady parts… but needs must and all that. It did the job (after a trip in the microwave steriliser). Let me reassure you right now that this piece of equipment will never go near a cake.

 

 

35 weeks and group b strep

So I have found out I have group b strep again. I’m pretty devastated to be honest because I cannot imagine any scenario going forth where I won’t have to fight and stand my ground in the face of immense pressure/resistance from HCPs.

When I went into hospital to have little A, I genuinely went with an open mind. I thought things must have moved on in the last ten years, it doesn’t have to be some horribly medicalised birth where they will strip me of my autonomy and treat me only from the neck down. I was wrong, the minute I stepped through that door they were insisting on continuous monitoring, refusing to believe me when I told them I was contracting (because as it turns out their machine was broken, and why would you ever listen to a person over a machine?) And they were putting me under immense pressure to get on a synto drip to speed things up. I had a literal succession of doctors and midwives parade through the room for two hours to tell me how wrong I was, and how I was putting my baby at risk and that I needed to make a decision now. Let me tell you, it had NOTHING to do with what was right or best for me and my baby. It had everything to do with the fact the wards were bursting at the seams and they wanted to get me through as quickly as possible. I have zero faith in the staff on that ward. I don’t expect them to be honest with me and I don’t expect them to respect me. What I do expect is a patronising, paternalistic attitude and an argument.

So what are my options?

Well… what they will tell me is my only option is to go to hospital at the onset of labour to get IV antibiotics. This will involve continuous monitoring (so restricted movement) and if my waters break before contractions begin they will push me to have my labour augmented. After the birth they will require the two of us to stay in hospital for 24 hours for monitoring, and if I happen to give birth at night they will chuck the husband out as soon as they want to move me to the postnatal ward. Sounds f**king horrid right? If I don’t want to submit to all of this I will need to fight them over it, and split my attention and energies at  time when I really should be focusing at the task in hand. 

Alternatively I can go in there and tell them I intend to have a home birth regardless, they will no doubt tell me that I can’t, that they can’t provide antibiotics at home, that no one will be wiling to cover it, that there are staff shortages etc. I can argue with them about it, I can start a letter writing campaign right now, contact the Supervisor of Midwives, the director of women and children’s services for the trust, my local MLA etc. 

I absolutely resent that in my first birth when I meekly went along with everything they told me that I must, I ended up genuinely feeling like I had been sexually assaulted, totally disempowered and humiliated and I honestly believe this contributed to the severe postnatal depression I experienced afterwards. In each subsequent birth I have literally had to fight to get the births that I wanted and to keep my sense of personal autonomy intact. It is utter bullshit that it has had to be this way. I have never felt supported or respected for my right to exercise decisions over my own body. I feel completely sick at the thought of having to speak to another midwife, never mind submit to their way of doing things. 

I couldn’t sleep last night because it just kept tumbling over in my mind the stress and the arguments that are to come. I don’t want to fight anymore, but I’m too damn stubborn to just give up and let them take my birth from me. 

This isn’t about me putting the birth experience before the baby. I’m okay with taking the antibiotics, despite the latest Cochrane review concluding that prophylactic antibiotic treatment of GBS is not evidence based and does not have a statistically significant effect on outcomes. I am okay with intermittent monitoring. I’m okay with most things if there is a medical need for them. What I am not okay with it is doing things a certain way because “that’s how it’s done” or because it suits the institution rather than it having the least bit of connection to what is best for me or my baby. 

Of course the other option is to disengage from services completely, which I’ll admit I am very tempted to do. I’ve already cancelled the midwife appointment I had booked for next week, in theory it is to give me time to think, but I’m not sure I can bring myself to book it again and put myself through this level of stress. Is it really too much to ask for to have the last month of pregnancy not to be a stressy mess? 

I really don’t know what to do, but I’m heartbroken to be sat here having to contemplate all of this.