Planning for emergencies

Why it keeps happening is unexplained, but it does seem that we can expect it to keep happening.

After week of normality, I experienced another big bleed on Thursday night, in the middle of the night. I had been out for a lovely evening with friends and my husband had been in to London to see a band. He was home, I got up for a glass of water at about 01:30 am. We had a brief chat about what nice evenings we’d both had, and then, whoosh, I was covered in blood again.

We knew what we were supposed to do. I phoned the labour ward and explained the situation. They told us to come in. Since the bleed seemed to have stopped and there had been and was no pain whatsoever, I drove. Whilst my husband wasn’t drunk, he had had a couple of drinks during the evening, so driving would have been unwise. I specifically asked the duty midwife whether it would be OK for me to drive – had the advice been ‘no’, we would have taken a taxi.  I hasten to add that, at 28 weeks, I really don’t think its unreasonable to carry on with some kind of normality. However, under the circumstances of constant uncertainty, we have now reviewed this high risk ‘going out’ policy.

On the way to the hospital we saw an owl, which was pretty cool. But we were rather too preoccupied to really enjoy our Springwatch moment.

Upon arrival we were shown into the maternity triage area and I was treated to the usual procedures of monitoring, blood tests, cannulation, internal exam, showing people the contents of my underwear etc. This time we even got a scan. Was I in pain? No, except for the needles and intimate examinations. This, once again, didn’t seem to be the onset of early labour. Whilst we were being seen, another lady was brought in who was in labour. I think that this was the first time that my husband had ever heard someone in pain like that before (i.e. in real life, not how its portrayed on the telly). I think he found it really rather alarming.

By about 5, it had been agreed that rest and monitoring were the way to go, However, the labour ward was full, so we were put in a delivery suite for the remainder of the night. I had the bed, my husband had a beanbag on the floor. He commented that the beanbag was somewhat lacking in beans. We put this down to NHS cuts. (Bloody Tories!) I was also given an(other) anti-D injection due to my Rhesus -ive status. Apparently you can’t overdose someone on this, so I can expect another jab every time I’m in, as well as the routine one I’m getting next week from my midwife.

We got a couple of hours’ sleep and then were transferred to the Observation ward. This was a private room, which was nice. More monitoring, and baby continues to do well as far as heartbeat and movement are concerned. I was not being fed, which is of some concern, because that means that someone, somewhere thinks that surgery could still be on the table (so to speak). My husband went in search of food (he brought me back a croissant, but I had to wait to get permission to eat it). As we awaited the doctor’s rounds, we realised that we could overhear the phone calls being made at the desk just outside my room. The patient under discussion was me, and there seemed to be some degree of disbelief over the position of my placenta. The doctor doesn’t believe that my placenta praevia could have resolved so much between 20 and 27 weeks. This is consistent with what we were originally told; it might move, but it has a long way to go, so we shouldn’t hold out much hope of that happening. But, according to the scan last week, move it has. She’s not convinced and another scan is required. I am sent, by wheelchair, to radiography. It’s weird being wheeled around. i feel like a bit of a fraud, but I don’t have a choice.

The scan confirmed that the placenta has moved, and that everything is looking good. There was still no obvious bleed site, so, really we’re no further forward, except for confirming something that today’s consultant thought was unlikely, but which was, in fact, true.

After this, I was allowed to eat, and the staff on the observation ward arranged for me to be sent upstairs to the slightly less observationy communal ward. They just needed to check that the bleeding had stopped. I was happy to comply, and sat up, and Gush. The clock started again. I’m not going anywhere for 24 hours. On the plus side, I got to stay in the private room, which is good because I’ve just bled all over it.

Fortunately, the rest of that evening and night passed without further incident, although I did manage to get a couple of hours ‘off cannula’ in the evening. I got a new one before going to sleep, though. No-one wants to have to put in a new one in a midnight emergency. I was told by the evening doctor that no-one knows what keeps causing the bleeding, but that they’re going to treat it as if it is the placenta. Better safe than sorry. It’s a balancing act; as long as the baby is fine, they’ll leave it in as its far better off where it is. However, if the baby starts to become distressed, or growth doesn’t carry on as normal, it could mean that the placenta is failing, and then they’d take the baby out as, at that point, it would be better off in an incubator. Hopefully those things won’t happen, though.

Another morning, another doctor. The same ‘we don’t know so we’re going to be cautious’ message. It was the same doctor that we saw on Tuesday. No, it looks like I can’t keep away, lol. Actually, I do keep running into medical staff when I’m out and about (by which I mean walking between my bed and the toilet), and they greet me like old friends. I’ve been here too long.

So, my current instructions are to take it very seriously, keep as active as I can but don’t go too far from the hospital. I can go back to work (assuming that work will have me) as long as I come straight back to hospital if there is any further pain or blood or anything else that might cause concern. As long as my and the baby’s obs are good on the evening rounds, I will be free.

I spent the rest of the afternoon upstairs on the regular ward. The food, which has been good up until now, was rather hit and miss on Saturday and I got an egg salad sandwich in place of the ordered macaroni cheese, but I was hungry, so I ate it. Dinner took its sweet time, too, and by the time it arrived, I was laying flat so that they could listen to the baby’s heartbeat on the monitor. My husband had to spoon feed it to me in bit size chunks. As if this wasn’t a strange enough experience, at the same time the lady in the next bay, separated from me by a curtain went in to labour very quickly after her baby kicked her hard enough in the cervix to break her waters (she was overdue, so they were probably ready to go). Less than metre away, my husband was leaning over all the machines trying not to get ketchup on everything whilst this poor woman was begging for an epidural. It wasn’t funny really, but it was such an odd situation, that, whilst we and I were trying to be quiet and discrete, we were failing because we kept getting the giggles. You couldn’t make it up, but there is a comedy sketch in there somewhere.

I’m back home now, enjoying the comforts that that entails, hoping we don’t have to return to hospital anytime soon.

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I need instructions for normal

We had our consultant appointment yesterday, and we have the all clear to carry on as normal. No bed rest or even house arrest, because apparently all this lying around might lead to blood clots in my legs and the risk of that is now greater than the risk of bringing on any further bleeds or, indeed, labour. On the subject of labour, given the shortened cervix, at 28 weeks we have been advised that the baby is pretty much ‘done’, if small, and, because it’s had the course of steroids, it would have a very good chance if it were to arrive early. It would have to go in an incubator, but it would be considered a better option to let nature take its course rather than try to delay things. The only reason that they would give treatment to delay things is if they needed to move me to a different hospital where there were available incubators.

BUT, all of this is ‘worst case scenario’, because there is every chance that I will carry this baby to term and have a totally normal, emergency free delivery at some point in June. This really is something to get my head around as we had had it in mind for the last 2 months that we would have a planned C-section at the end of May. I have not done any of the mental preparations that the books have been going on about, because I didn’t think it would apply to me. Being something of a control freak, I was quite comforted by the idea that we would go in to hospital at 36 weeks and come out a few days later with a bundle of joy. Job done. Not so straight forward anymore, but normal is good.

The consultant encourages me to take gentle exercise and go swimming, and to take regular stops to stretch my legs in long car journeys. My waking life is now to be treated as if I am on board a long-haul flight; support stockings are on my mind, if not yet on my legs.

My blood pressure was taken (still fine, at the low end), the bump was measured (ahead a little, but I expect that’s down to the growth promoting steroids), and the baby’s heart beat was listened to. We’re keeping the appointments at the end of April ‘just to be extra sure that things are still looking normal’, and we remain on the kind of alert that is normal for women in their third trimester (amazing to think we’ve made it this far!).

Back at home, and in the absence of anything proper to worry about, I decided to read my notes for the day. I was alarmed to see that, under the heading of ‘Hb’ the number 106 had been written. Heart beat of 106? Whose? Not mine! Mine is closer to 80bpm. The baby’s? Should be 140. It was 140 last week! What’s going on?! To add to the confusion, the 106 was written in a different hand writing and a different pen to the rest of the notes from yesterday. Underneath this, in yet more different handwriting, it says ‘x low hb’. This is even more alarming. My husband, upon studying the notes more carefully, notices that the box for ‘fetal heart’ is ticked, indicating that it was heard but not measured today. Looking back, it is this box, not ‘Hb’ where the numbers are usually written. I am reassured that we would still be in hospital if there were any real concerns. After all, they were very cautious with us last week, why suddenly become reckless now? It’s much more likely that I simply don’t understand the notes, he advises. I agree, and bow to my husband’s logic in this matter. Then I secretly google ‘decoding antenatal notes’ and discover that the code ‘Hb’ stands for IRON!!! Not heart beat. What an idiot! (To be fair, heart beat does seem reasonable… maybe I’m not supposed to understand the code?). I have low iron. I mentally note to eat some leafy dark green vegetables tomorrow.

With that panic firmly put to rest, I relax into my new status of ‘normal’ and look forward to remaining ‘normal’ for the next couple of months, at least. Then I awake at 4 am and, realising that I am now 28 weeks and am supposed to no ‘count the kicks’. Unable to get back to sleep, I start counting. I get 10 in 20 mins (apparently you should worry if you don’t feel 10 within 2 hours). More normal, more reassurance. I go back to sleep and have a very vivid dream about blood transfusions…. I think this might be my normal life, now… 🙂

…and a little bit of emotion came out

I’ve been thinking about things. The real-life reality is finally beginning to dawn on me that in about 11 or so week, a baby is coming to live in the house with us. I know, I catch on quick. Being pregnant, it seems, is one thing; I’m enjoying the lovely kicks and rolls (even in the middle of the night), I feel like my lungs are the size of a postage stamp, I no longer bend in the middle, I get a back ache whenever I try to do any work (apparently not sufficiently an excuse to actually not do any work), and, thanks to the placenta praevia, I’m not allowed to lift or shift anything except my own body, which is becoming increasingly difficult. Yesterday, it took me two attempts to stand up from a sofa. Yes, I had an audience. This is the day to day grind, and it’s fine, albeit uncomfortable.

I was reading a pregnancy book today and the chapter on week 25 provided a helpful list of baby clothes to buy (the essential ones, not the cute ones that make you make a high pitched noise when you see them). I suppose it is something to think about. I need to clear out a drawer for them, first. Perhaps I’ll leave it a bit longer. 10 more weeks, perhaps…? At the start of this pregnancy (actually since the first loss), I have been quite wary of reading ahead to the next developmental section of the book. I felt that, it was a bit fraudulent to think about what was happening whilst waiting for the next scan which may well confirm the worst. I used to read them retrospectively to find out what had happened, once we knew what was what on the inside. The kicks have eased this anxiety, and now I sometimes read a week ahead. But today’s ‘buy the baby some clothes’ shocker in the cheeky sneak peek at week 25 has accelerated my mind much farther into the future than I was anticipating.

Then, later, something even weirder happened. A very brave lady I know has just had her baby today (she has a similar story of recurrent miscarriage to me), and I have just seen a picture of her, and her new baby boy, on facebook. Amazing, gorgeous boy and proud, exhausted Mum. I’ve usually avoided this kind of thing because it was just too painful to see what I was missing out on (I never promised to have rational emotions), but I was very pleased to see this new arrival. And, something else, new, too. A strange realisation that, soon, that will be us. My nose has gone a bit tingly just thinking about it. My eyes might follow. What is this feeling? Emotional ice, melting. Barriers, softening.

Guess what… I’ve just realised… a baby is coming to live at our house… really soon… our baby.

If necessary use the emergency exit

I am happy to report that baby’s re-scan went well today. Spine and kidneys all present and correct. Baby was asleep when the scan started, but awake by the time it was over (well, so would you be if you were being prodded and poked and blasted with sound waves). Growth is on track, and he or she (we haven’t found out) seems perfect – and looks like a real baby (there is no reason for me to be surprised by this, but somehow I still am).

The less good news is that the placenta is really very low, and, although many low placentas do move up in later pregnancy, it seems that mine has quite a long way to go – 7 centimeters. We saw the consultant and he has officially given me the diagnosis of placenta praevia (http://www.nhs.uk/ipgmedia/National/Royal%20College%20of%20Obstetricians%20and%20Gynaecologists/assets/Alow-lyingplacentaafter20weeksknwonasplacentapraevia.pdf). He is already talking about a planned c-section at 36 weeks or so, which brings the EDD forward to the week of the 27th May. That’s almost a whole month! (!!!!!) I’m not too worried about that, per se, because it’s pretty much term, and they can give me injections to help accelerate the development of the lungs etc., so the baby will be able to manage. To be honest, I just want it to be OK, so I’ll take whatever advice I need to take to achieve that. I don’t think I’ll feel any ‘less of a woman’ if it ends up coming out through the sun roof. It’s not about me, it’s about getting this baby healthily into the world, whatever it takes. I’d rather avoid hospital scares along the way, but I’ll do what I need to do to achieve that objective.

We’ll be scanned again at 32 weeks to see what’s happening and I expect the final decision will be made then. Assuming, that is, that nothing untoward happens in the mean time; we are on alert to go straight to the Labour Ward if there is any spotting of any kind, where I’ll me monitored for 48 hours to check it isn’t a more serious bleed. But hopefully nothing like that will happen. (Please don’t let anything like that happen!).

Apparently, the risk factors (that could possibly affect me – given that I am not a smoker or a cocaine user, I can rule those out as possible causes!) are age (a factor at 38) and previous c-sections (no) and ERPCs (4 + 2 hysteroscopies, including the surgical removal of a septum). Has my surgical history caused this placenta to mis-grow? Even if it has, there’s nothing I can do about it now.

Wish us luck for an incident free path through the next 3-4 months, and getting baby safely into the world in either June or May. Whatever it takes.

Risk

Written 13th December, 2014.

Last Tuesday we had what Professor Brosens described as a ‘highly reassuring’ scan. We are now over 11.4 weeks and the baby was leaping and dancing about, kicking and hiccoughing. As I commented to the consultant who scanned me, we’ve never seen one that big before. Every good scan means that it is just a little bit more likely to happen this time. The odds are, as you might say, increasingly are in our favour. But can we relax? Of course not.

Next Tuesday afternoon is The Scan. The Big One. 12 weeks. And we’ve been there before, and it was not a happy experience. Although we’re beginning to turn our minds to the possibility of there being a chicken, we’re still not quite ready to actually count it.

The 12 week scan comes with tests (http://www.nhs.uk/conditions/pregnancy-and-baby/pages/screening-amniocentesis-downs-syndrome.aspx#close) which we both (think we) want (great if the results are good) and don’t want (what if they’re bad?). The consultant gave us a bit of a talking to to ensure the implications of getting those test results. We have been through so much already. Have we considered what the possibility of high risk results might mean for us? She hastily assured us that she had not noticed anything on the scan that made her mention it, in particular, but that she felt that too many people have the standard tests without really thinking carefully about the implications of the results. The first thing to do is to realise that risk is not diagnosis. Lots of people, apparently, don’t understand the difference. So a risk of 1:150 is considered ‘high’, but, of that, it means that 1 baby in 150 with those results would have a condition such as Down’s Syndrome. 149 babies would be fine. It’s still pretty scary, though. We’ve been through so much to get to this point. Would we make a choice to end it? No. I don’t believe that I would even consent to further invasive tests like amniocentesis because of the 1% risk of miscarriage. But I think that knowledge is better than no knowledge, so we plan to go ahead with the screenig next week.

The odds are in our favour (mostly – they were more in our favour three years ago when we set out on this journey, but what can you do about time?). How much more can we take? Could we ever do it again, even if it works out? We always thought we’d have more than one child, but it’s been such a a struggle to get to this point, and I’m not getting any younger, and the risks will only increase.

And I know too many stories. My own sad ones, and the sad heartbreak of other women whom have been kind enough to support me on this journey. You think what I’ve been through is bad? I know stories of recurrent miscarriage that break my heart and chill my blood. No-one can keep their innocence about pregnancy after this.

At the end of The Lord of the Rings: Return of the King (the film, sorry, not got my literary hat on this morning!), Frodo says: “How do you pick up the threads of an old life? How do you go on, when in your heart you begin to understand there is no going back? There are some things time cannot mend. Some hurts that go too deep that have taken hold.” We did go back and are in the midst of having another go, but how many times can anyone do this? What has happened to us will stay with us forever. It has made us, in a really fundamental way, different than we would otherwise have been. What’s the cost? ££££ on counselling and cognitive hypnotherapy to try to repair the damage done by post traumatic medical shock. I still can’t look at other people’s 12 week scans on facebook. I think I could be The Old Woman Who Lived In A Shoe, with so many children I didn’t know what to do, and a babybomb scan photo would still turn my blood to ice. This is a terrible learned behavour. I feel sad that I seem to be stuck with it.

What else can I say? Wish us all luck for Tuesday.

Superstition and pseudo-evidence-based hysteria: What recurrent miscarriage has done to my rational mind.

Written 22nd November, 2014.

We keep marching forward, one day at a time. What else can we do? Neither of us are ready yet to think about the possibility that there might be an actual baby at the end of all this. All of our utterances about short, medium or long term planning are qualified with ‘Depending on what’s going on, of course’. I know it annoys him, because he thinks that I think that he’s forgotten that there’s something going on. Or potentially going on. I qualify my qualifications by hastily explaining that, no, I don’t think he’s forgotten or unaware, but, rather, this is my way of not ‘jinxing’ things by foolishly and naively hoping for even one second that it isn’t all going to go terribly wrong again, again. Again.

Rationally, every week that passes means that the chances of success are just that little bit higher. We have now had a ‘good’ scan (i.e. one where the baby hasn’t died) at 8.3 weeks. Anecdotal (perhaps it’s also scientific; the people who I have heard say it say that they have heard it from doctors) evidence says that 8 weeks is a major milestone, as the baby moves from the embryonic to the foetal stage of development. Lots of the things that could have gone wrong have, by now, gone right. Or at least well enough to not shut the whole enterprise of life down. This is encouraging. What’s possibly slightly less encouraging is that that means we’ve had 3 days’ growth in 6 actual days. Funnily enough, I don’t find that I’m too freaked out by this, as I did feel that last week’s scan declaring us to be 8 weeks on the nose was rather over ambitious. I had thought we were more like 7 and a half. Mind you, we were 6.1 only 8 days prior to that. I guess it’s fractions of millimetres they’re measuring, and it’s different people each time making the clicks, so there’s going to be some room for some wriggle room. Everyone seems happy, anyway, and the sonographer didn’t make any mention of ‘slow growth’ on the report. And, actually, 8.3 does fit in almost exactly with my calculated dates. I need to stop looking for things to worry about.

The biggest moment of (post traumatic) insanity came when we realised that we were going to be scanned by The Sonographer Of Doom. I’m sure she’s absolutely lovely, but I can still remember her words almost three years ago when she was scanning me and said ‘Its not good news, I’m afraid.’. I know that there’s no easy was of saying it, but it was like being punched in the guts, and we both remember it, and associate it with her. I silently panic, as if there is, actually, some sort of mystical force at work in the universe (which I don’t believe that there is), and that it’s about to get me again.

Happily, it turns out that it isn’t. The lone magpie I saw on the roundabout on the way here fails again. Quiet my dark superstitious, paranoid mind. She even gave us a photo. He wasn’t too keen on getting it, because, I think, he’s not ready to breathe out and relax, but I thought it might be nice to have (and then immediately thought that it might bring some inexplicable bad luck and wondered whether I was tempting fate by accepting it). Whatever his reasons for hesitating to take the pictre, he says it isn’t because he thinks it’s bad luck. In truth, if we got a scan picture every time we went for a scan, we could have papered the cloakroom toilet with them by now. Given my aversion to seeing the things on social media, I’m not really sure what I’m going to do with it, anyway. It doesn’t even look like anything, except perhaps a potato from space.

Afterwards, we need to negotiate the next scan appointment. The EPU clinic is busy and we are seen to be making good progress. Can we go to 12 weeks? No. I explain that #3 died within days of a 9 week ‘good’ scan, which had seemed perfectly healthy. Worse, the progesterone I was taking (and am taking again), masked any sign that anything had gone wrong and it wasn’t discovered until 13 weeks at the ‘official’ scan. I also explain that I don’t want to have to wait until the ‘official’ scan because the way they have the rooms set up, with large monitors up on the wall in the corner, means that you get an excellent view of your deceased baby (in our case, as a screen grab, left up there even after the scan had been completed) starring down at you from the corner of the room whilst they send someone to fetch the leaflets. This, presumably is in case you forget what’s happened. Oh, and the delivery of the news on that occasion was truly exceptional: ‘Oh, there should be a baby in there.’ No shit?! And me here for my 12 week scan, and all… It’s enough to make you wonder whether they train some of these sonographers in how to give bad news. (Let me qualify this, MOST are EXCELLENT, but when they aren’t, they really aren’t).

I’ve made my case, and the clinic nurse is going to see what she can do. But I do need to book in with a midwife, she tells me. I don’t want to do this, either. More jinxing and bad luck. I don’t like having to text them when it all goes wrong, I plead. You won’t get your 12 week scan in time if you don’t, I am told, in no uncertain terms. Check mate. So, that’s all now booked for Tuesday. It will take about a million years to recount my history. I hope she knows how to ‘manage’ me and my craziness…

All the other signs are encouraging. I permanently feel as though I’ve just disembarked from a Waltzer, and I’m totally knackered. All good, although, as we know, meaningless, really. Still, we must keep moving forward, one day, one week at a time. Baby steps.

Practical Matters – What Happens at St Mary’s and Coventry RMC Clinics?

This post is intended to help ladies (and their partners) get an idea of what to expect if you have been referred for testing at these hospitals. I’m writing for those who have miscarried for a third (or more) time, as you are now officially sufferers of Recurrent Miscarriage, or Repeated Pregnancy Loss. You are probably in a state of grief and disbelief that you have miscarried again, at the same time as being determined to find some answers. You may have a helpful and supportive GP; you may not. Even if they are supportive, you will probably need to chase things up a bit, because although there are a lot of brilliant things about the NHS, sadly admin isn’t always one of them. See this post for more information: https://justonemoretimeagain.wordpress.com/2014/07/04/full-time-administrative-assistant-required/

These are my experience of these two hospitals. Your experiences might be slightly different, but hopefully this will be helpful to you. If you are able to do so, get your local hospital (wherever you had your last ERPC, if you had one), to send away the tissue samples from that procedure, or any tissues you have been able to recover, for genetic testing. If you take them to the hospital yourself, DO NOT allow them to be stored in formaldehyde, as this will make genetic testing impossible. This advice is from Prof Lesley Regan’s 2001 book, which you may find helpful: http://www.amazon.co.uk/Miscarriage-What-every-Woman-needs/dp/0752837575/ref=sr_1_3?s=books&ie=UTF8&qid=1409471375&sr=1-3&keywords=lesley+regan

A note on genetic testing; you may be asked to sign a parental consent form. This may be upsetting, but it is necessary, so it is good to be prepared to be asked to do so. Results from these tests take about 6 weeks and the consultant will normally phone you to tell you the results and follow it up with a letter. This information is very useful in determining what has happened in your most recent loss, and what might be able to be done to help you carry a baby successfully to term in the future. The NHS offers this kind of testing after three miscarriages, although, if there is a reason to believe that there may be a genetic issue in your or your partner’s family (many people live perfectly normally with a balanced translocation of chromosomes: http://miscarriage.about.com/od/twoormoremiscarriages/p/balancedtranslo.htm), then you might be able to get these tests earlier. Some hospitals will let you pay for these tests after 2 miscarriages, others will fob you off (I was told that they ‘didn’t have the right container’ after my second miscarriage, queue hysterical woman in backless gown – I always regretted not fighting harder for that one). You may be able to get your local services to order karyotyping for you and your partner, which will establish whether either of you have a balanced translocation that you may be passing on. Again, the results take about 6 weeks. All of this information will be very useful in determining your treatment plan for your 4th ‘try’, and your RMC clinic will want to take it in to account.

I was seen at St Mary’s last year (October 2013) and for the first appointment you will be scanned, medical history taken and lots of blood drawn. These are for clotting, thyroid and antiphospholipid antibodies.  You will need to go for a hot chocolate or something afterwards. You may wish to take your old notes and paper work copies with you if you have them, they may take some copies for your file. You may be invited to sign up for the TABLET test which is a study involving thyroid antibodies. Many of us donated a sample but were not used for the trial because we didn’t fit the criteria, but you might be, if you wanted to sign up.

If you need anything doing (hysteroscopy etc.) they’ll book that in. I had a septum removed, which was fine, like an ERPC with two coils and HRT for a month afterwards. It was a day procedure and not very painful. Things to consider for St Mary’s; they don’t allow partners on the ward, so you will be admitted and put in bed for the day and your partner sent away at 07:30 am and asked to come back at about 15:00 (they’ll call him). This is unlike other hospitals where you can wait together until it’s your turn. Take a good book. At St Mary’s, they also try to fit in as many operations as possible, which can mean that there is a long wait if someone’s procedure takes longer than expected. When I was there, someone was sent home and given a new date for surgery. This was obviously very upsetting for them. I think this is rare, however, and was caused by an earlier surgery of the day being more complicated than anticipated. It happens.

You might have a non-surgical procedure, or just the blood tests, so please don’t be worried that you’ll necessarily end up in theatre!

You’ll go back for repeat blood tests 6 weeks or so after the first lot and then have an appointment to give you all your results about a month after that. They’ll tell you what your treatment/plan will be and then you ‘go forth and multiply’ and call them when you’re pregnant again so they can do the TEG blood test again and decide whether you need anything for that, too, in a pregnant state, as it can change that result.

Many ladies have also been up for private NK (natural killer) cell testing with Profs Brosens and Quenby at Coventry. This costs £360 and you need to have had 2 periods before you go. They take a uterine biopsy and then advise what to do when trying again. Some people have told me that the biopsy doesn’t hurt. I found it quite uncomfortable both during and afterwards, but nothing that paracetamol won’t deal with. They usually recommend 200mg progesterone from CD21 to CD28, carrying on if you get pregnant, and then Heparin from ‘in uterine’ scan. If you have high NK cells, you may also be offered steroids, but other ladies will know more about that. I do know of at least two success stories from ladies who have been to this clinic.

The results of the biopsy take about 5 weeks and they will email you with the outline results and a time to call for your consultation. After that, you’ll be emailed a letter detailing your treatment plan. If the protocol doesn’t work within three months (as happened with me), they may suggest not using the progesterone until you get a positive pregnancy test.

You will need to not be pregnant for these procedures and tests, and hopefully the break from trying to conceive will help you to get your head around everything and heal emotionally.

I hope this helps some ladies (and their partners) to understand what tests they can expect at these clinics. Remember, 50% of couples never get a clear answer as to why this has happened to them. As distressing as this is (because we want answers), it’s actually good news, because it means that you have a very good chance of being successful without intervention in the future.

Am I Pregnant? An Obsessive’s Guide

Fed up of symptom spotting? Here’s a guide for the ladies who’ve googled it all.

1. Check your calendar, even though you are absolutely 100% certain beyond all doubt where you are in your cycle. If using the one on your phone or any other touch screen device, curse every time your hovering finger touches the screen and opens up a particular date because this makes you lose count. Vow to print off a paper calendar that you can circle and annotate with a red pen.

2. Get paranoid that a friend or family member will find your annotated fertility calendar and hide it in the wardrobe.

3. Unable to make sense of your annotations, switch to a fertility app. Find that it contains old data from a pre miscarriage cycle, which skews this cycle’s data.

4. Consider deleting the old data. Feel very guilty because it’s like deleting the memory of your baby, in your crazy head.

5. Get a grip and delete old data. Find that there is not enough historic data in the app to give you any useful clues about current fertility status.

6. Give up on app and decide to go with gut feeling.

7. Realise you have absolutely no confidence in your gut feelings.

8. Google ‘Early Pregnancy Symptoms’. Find you have hardly any of them. Google ‘Very Early Pregnancy Symptoms’.

9. Wonder whether last week’s hang over was morning sickness.

10. Concentrate on boobs to assess whether they hurt or not. Run up and down a few flights of stairs. Jiggle a bit and poke them when no-one is looking.

11. Become convinced that you are pregnant because your boobs hurt.

12. Review the week when you think you ovulated in forensic detail in your mind. Convince yourself that you a) must be and b) cannot possibly be pregnant.

13. Determine that you are 8 dpo (days post ovulation). You are therefore way too early to do a pregnancy test.

14. Do a pregnancy test. Reassure yourself that the inevitable negative result is only because you tested too early.

15. Decide to take your mind off things by booking a holiday or going clothes shopping. These activities also have the double effect of making you pregnant, because Sods Law is more effective than sex.

16. Take the fact that the cat sits on your lap as a sign that you are definitely pregnant.

17. Take the fact that the cat runs away from you as a sign that you are definitely pregnant.

18. See someone else’s baby/bump, cry and decide that you are never, ever going to be able to have children. Ever, ever.

19. Decide to take another test on 10 dpo. Spend at least 10 minutes holding it up to the light to see if you can see a trace of a line.

20. Pop back to the bathroom, fish the test out of the bin and check it again through out the course of the evening, see an evaporation line. Panic. Do another test. Be relieved that it’s still negative, because actually getting pregnant would scare the sh*t out of you. Repeat steps 19-20 for the next 3 days.

21. Notice some light spotting. Wonder if it could be the fabled implantation bleeding. Become convinced that it isn’t. Test again.

22. Get full period. Become convinced that it definitely is implantation bleeding.

23. Spend 24 hours in despair. Drink (because it doesn’t matter now anyway).

24. Get a hang over. Become convinced it’s morning sickness. Immediately regret that drink.

25. Get signs of new cycle, new ovulation, new hope. Have sex. Return to step one.

Emergency bathroom midwifery ***Birth described***

I have written before about how difficult I have sometimes found it to be around pregnant women and babies. Emotions swing between jealousy, self-hatred (I never used to be such a nasty b*tch) and sadness for what I’ve lost. Self preservation has a lot to do with it, I’m sure. That and the abject humiliation of having to leave a 2 year old’s birthday party because you can’t stop crying (got the t-shirt).

The reality is that you’re going to have to face pregnant women (and all their worries and complaints about their aches and pains) at some point; whether at work or out and about, they’re everywhere (are they breeding?!). You can either get on with it, or let in ruin your day. I’ve opted for a nice balance of both.

I knew that my sister and her husband wanted a second child, and I knew that they were tying (the loaned What to Expect books had made the return journey from my shelf to her’s). When she told me that she was pregnant again, I was pleased, but also envious (and guilty because of feeling the envy). I wouldn’t be able to avoid her for 7 months, and I wouldn’t want to have to try; I love my family, and there’s no way I’d want to make things difficult or awkward. You’d have to ask them if I’ve managed it!

It was very exciting when I fell pregnant again myself a couple of months later, and we discussed the baby things we could share (I believed at that point that I would be facing something of a financial crisis due to being in the middle of moving jobs and there being big question marks over my maternity pay entitlement). I had a few scares with bleeding etc. and I am sure that my sister’s heart was in her mouth every time I went for a reassurance scan, being pregnant and emotional as she undoubtedly was. She was having the most dreadful morning (all the time) sickness and had a demanding toddler already, so was exhausted. Everyone was tired and emotional, all the time.

Then I found out that my baby had died at the 13 week scan.

Awkward!

No need for hand-me-downs anymore. And yet, I could not have predicted then that the sisterly bonding over babies I had imagined would be more powerful and visceral than any amount of hand-me-downs and baby talk could ever have facilitated.

Three months after my third miscarriage and two weeks before my sisters due date, she texted me to say that her waters had broken. Her first had taken several days to put in an appearance, so no-one was rushing to get warm towels just yet. I decided to go over to her place and have a cup of tea while we waited for her husband to come home from work. No problem. My niece was with our parents, we could have a natter in peace.

When I arrived, everything was fine. The things for the overnight bag were laid on the bed, her notes were in a file by the ‘phone. I thought she seemed uncomfortable. I made her some beans on toast to keep her strength up for the task ahead. She couldn’t eat them. She said she was fine. I suggested she ring the midwife. The midwife said that, if we were worried, we should drive down to the hospital and her husband could meet us there. I have a very tiny little sports car, and was slightly concerned about my sister’s ability to get in to or out of it. “No, you can’t have an ambulance, it’s not appropriate,” came the midwife’s reply. Fair enough; if you don’t ask, you don’t get.

I packed the overnight bag and put it in the car. My sister went to use the loo. I heard her shout to me from upstairs that she couldn’t move. I know a contraction when I see it; by the time I got upstairs, she could hardly speak. In an act of desperation and futility, I brought her two paracetamol. She barfed them on to the bathmat. I fetched the overnight bag back into the house and phoned 999.

If you’ve ever had to make a call to the emergency services, you will know that they keep the coolest heads in the country. The operator talked to me calmly, but with extreme authority as I helped (forced) my sister on to the bathroom floor (she waned to stay on the loo – “absolutely not allowed,” said the operator. “Get her on to the floor. Now.”) Could I see the baby’s head? “I’m sorry, I’m going to have to look.” I’ll take that scream of agony as a ‘yes’, then, shall I? “No, I can’t see the head, yet.”

“Help’s on it’s way. Can you hear the sirens? Don’t worry. Help’s on it’s way.” I rubbed her back as she knelt on the floor. Contractions were about two minutes apart.

“Have you got clean towels?” said the operator. “They don’t think they’re going to make it,” I thought, but didn’t say.

No-one tells you this, so I’ll tell you now; if you have had to call an ambulance because you are having to deliver a baby at short notice at home, take a moment to go and open the front door. It’s a small, yet essential detail. I dashed downstairs to answer the banging at the front door. I have never been more relieved to see a paramedic in my life. My sister, by this stage, didn’t care. She’d gone primal. Her labour cries came from the earth itself. I texted my mum; “It’s happening. The ambulance is here. Don’t worry.”

The bathroom was too narrow for me to get to my sister to hold her hand, so I held her knee instead. All attempts to try to transfer her to hospital had now been abandoned. Nature was going to take its course; it was unstoppable.

My nephew was born less than 10 minutes after the ambulance arrived. It was extraordinary. My sister’s husband arrived about 15 minutes later, and did manage to find a space to stand, cradling his new-born son in the shower cubicle. Paramedics tended to my sister, one from in the gap between the toilet and the sink, another crouching in the bathtub. Midwives ran up and down the stairs. I made a few phone calls. Mum, dad and new baby were taken off to hospital in the ambulance. I followed on in the car, with the now overlooked overnight bag. “Don’t let that baby out of your sight,” texted my mum.

It wasn’t exactly the circumstances I would have imagined for my first visit to a maternity ward, but I had one job to do, and that was to look after my nephew. My sister needed surgery, and her husband went with her. I was left, alone, in a side room, literally holding the baby. A nurse made a comment that made it clear that she thought I was my sister’s mother. I’d had a stressful morning, but had it aged me that much?!

I spent the day sitting by my sister’s hospital bedside, getting snacks from the canteen and waiting for her belated epidural to wear off.

Was it better for me, and for her, that I have coped in so many crises before that I could keep a cool head in that one? I will say this; someone’s got a wicked sense of humour.

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Extra special thanks to my sister for agreeing to let me write about this.

 

 

Blood bath ***Caution. Contains graphic descriptions***

There is little more alarming that a spot of blood when you go to the loo, if you’re pregnant. Everybody knows that your periods are supposed to stop, and, although we probably all know someone who has had break through bleeding or spotting early on in their pregnancy, it doesn’t make it any less scary if it happens to you.

The start of my first pregnancy was characterised by several episodes of light spotting. This, although never accompanied by pain (which is the scariest sign of all), was worrying enough to result in two separate ambulance rides (once from work, once between hospitals), a day in a bed on Ward 4, several hours in A&E, three trips to the EPU (Early Pregnancy Unit) and more than one out of hours doctor’s appointment. Hysteria will get you a long way.

My second pregnancy was just as short as the first, but much less bleedy, lulling us both into a false sense of security that the outcome might be better. It wasn’t. So much for that theory.

But, for all of these minor episodes of spotting, nothing could have prepared me for what happened at the start of my third pregnancy. We had gone out for the evening and were in a local pub with friends. I was driving, so no need to fib about why I was off the sauce. I was faithfully taking my cyclogest (progesterone), and was (thankfully) wearing a pad, since that can be a rather ikky, messy business. Suddenly I felt what can only be described as a ‘gushing’ sensation. I excused myself and, upon reaching the ladies room, found that I was covered in bright red, fresh blood from the waist down. I cleaned myself up as best I could and asked a passing friend to fetch my husband. I felt strangely calm and detached. Oh well, here we go again. That’s that, then.

We stood staring down a toilet that looked like it had just played a starring role in a slashser movie, wondering whether to flush. We thought that our baby might be in there, somewhere, but there was just too much blood everywhere to tell. I knew that one of the best chances we had of finding out a cause would be to recover it and have it sent away for genetic testing, but, in the end, neither of us could do it. So we flushed.

If you have suffered a serious bleed during pregnancy, and miscarriage seems immanent, you are advised not to drive (in case you faint). My husband had already had a beer or two and I was the designated driver, but now I couldn’t safely drive, either. A friend kindly drove us the 20 minutes to the nearest A&E and dropped us off.

We waited.

And waited.

And waited.

9, 10, 11 o’clock, 12 o’clock rock.

Having arrived at 21:00, we were seen by the triage nurse maybe an hour later, and I was cannulated. My theory is that they do this so that you can’t escape if you get fed up of waiting the further three hours after you’ve been triaged. Targets met; everyone’s a winner! It was almost 2 am before we were seen by a Doctor, 4 by the time we were discharged.

The whole time we were there (sustaining ourselves on chocolate and fizzy drinks from the healthy choices vending machine, having ascertained that I didn’t need to be nil by mouth), at no point were we offered a scan. We were given an appointment at the EPU three days later. Point 2 of the Mumsnet Miscarriage Care Campaign (http://www.mumsnet.com/campaigns/5-things-that-need-to-change-in-miscarriage-care) states that scanning should be available. The reality is that if you present at A&E with bleeding in early pregnancy, there is a good chance you will be waiting several days to find out whether your baby is alive or dead. It is my strong belief that this fact puts appalling mental strain on women and their partners in a, frankly, oppressive ’12 weeks of silence’ (or is that isolation?) culture. More steam to vent on that one another time!

We got home at about 4:30 am, I emailed work to let them know I wouldn’t be in (and set my cover lessons! How’s that for dedication!), and we went to bed. No alarm clocks. We would deal with the morning in the morning.

Tuesday was spent watching day time TV and eating fish and chips. There was a program about cats on. It was nice. Invariably, when we’ve had pregnancy related issues, it’s felt like all that’s on TV is One Born Every Minute, or a character in a favourite show is getting a scan (Bones, Breaking Bad, Homeland, all had story lines featuring scans right after I’d MC’d). The scan was booked for Thursday. We decided to be proactive so we got up and went down to UCLH’s walk in EPU first thing on Wednesday morning and waited.

There, against all odds, we saw a tiny little flicker of a perfect heart beat; 6 weeks, 5 days.

I believe that we experienced the full range of emotions over the course of those three days. It’s not a roller coaster ride I’d care to repeat.

And I know it didn’t, ultimately, end well for baby number 3. But it wasn’t anything to do with what happened that night. In fact, we were told that the combination of progesterone and aspirin can lead to these kinds of sudden, heavy bleeds. As far as this part of the story goes, it may not have been a happy ending, but I’ll take a happy middling. It’s a close as we’ve got, so far.

If you like, or feel you have been helped by what you have read here, please share it. If you want to see more, why not follow me? Thank you for reading!