48 hours on the labour ward

I am a walking life support machine. For the moment, this is my only and most important function. It’s a really big responsibility, and, on Tuesday of last week, it looked like I might be breaking down. The diagnosis at 22 weeks of placenta praevia (PP) meant that any spotting whatsoever had to be taken very, very seriously indeed. The issue with PP is that, if you get a bleed, it is usually a precursor to future, more significant and serious bleeds. These are caused by weakening or tears in the placenta, which, if they become worse, can cause it to stop functioning. To manage the risk to both mother and baby in the case of increasingly catastrophic bleed scenarios a decision is usually made, once a bleed gets to about a pints’ worth of loss, to perform an emergency c-section and put the baby in an incubator. The very grave warning to take my diagnosis of PP very seriously indeed was written all over my notes, but no spotting had manifested, and things seemed to be going very ‘normally’.

Until Tuesday of last week, when at 26.6 weeks, with a lack of pain that would almost have convinced me that I had experienced a failure of bladder, I found myself soaked in blood. I was asked for descriptions of how much several times on Tuesday evening, and the best I can do is to say that my underwear was soaked, but it didn’t hit the floor. This equates to about 30ml, apparently. Enough to raise all kinds of alarms.

I was at work, fortunately not teaching (it was the end of lunchtime), and I had gone out of my office to find a student from my tutor group whose birthday it was as I had bought a cupcake for him (a little tradition we have in our class), but had forgotten to give to him in tutor time. Not an especially strenuous activity. Having delivered the cake and birthday greetings, I felt that something was ‘not right’ and went to the toilet next to the school matron’s office. There, I found that I was soaked in blood. I had already given matron the number of the labour ward so that it would be on hand should anything happen such as this, given the PP diagnosis, and I asked her to call it, and an ambulance. I felt surreally calm; I had been warned that this might happen, and now it was happening, and so I had to deal with it. I phoned my husband. There is no way of not sounding alarmist when you tell your husband that, at just under 27 weeks pregnant, you have experienced a significant bleed and are awaiting ambulance transportation to hospital. The same can be said for telling your mother, too.

By the time I had spoken to the midwife at the 999 call centre about the details, the ambulance had arrived and the bleeding had subsided. It was a paramedic and car, rather than a full-blown ambulance, and my blood pressure etc. was taken. Having decided that I could be taken in the car, and after the laying down of an absorbent sheet on the passenger side, I was transferred to Stoke Mandeville labour ward. I was feeling, as usual, some discomfort under my ribs (totally unrelated muscular issue which I have been experiencing for a few weeks), and I kept reassuring the driver that the associated wincing and facial contortions were down to that, and that I was not going into labour in the car.

My husband arrived about 10 minutes after I did, and, from the look of him, was in a much worse state of shock than I was. I was seen and assessed quickly by a midwife who kept calling my husband ‘Dad’ which I could see he found confusing as its not yet a term of address that he has associated with himself. Having been poked and prodded by doctors, we were visited by a team of consultants, the most senior of whom informed me that ‘my maternity leave had just started’ and that I could ‘expect more and heavier bleeds’. I wasn’t going anywhere tonight.

I was installed on the labour ward and my husband dispatched to fetch the overnight bag which we really should have packed when we were given the original PP diagnosis. I was cannulated, given a fish and chip supper, a raspberry pudding and an incredibly painful steroid injection in the backside. My assessment of these developments; if you are in hospital and they cannulate you, you are not going anywhere. If they feed you, they are not anticipating operating on you immanently. If they give you a massive injection, it still has the potential to all get a bit serious. Steroid injections are given when there is a chance that a baby might need to be delivered early. These injections are given, 2, 24 hours apart, to assist with the development of the baby’s lungs in order that respiratory complications after birth are minimised. Better to have them and not need them than need them and not have them. They chuffin’ hurt, though.

Throughout these proceedings the baby was monitored and was active, healthy and apparently completely unbothered by the medical emergency in which is was involved. This was obviously very reassuring.

That night on the ward, I hardly slept and kept imagining that I would find myself covered in blood at any moment. That didn’t happen, though, and I was relieved to be fed again in the morning (so surgery still not immanent). I was told I would be scanned at lunchtime and my husband was going to return in time to accompany me to that. However, a slot became available at about 11am, so I went on my own. The news was good. The PP has resolved, the placenta iss now a good 2cm away from the cervix; a ‘safe’ distance. Even better, it showed no signs of damage or bleeding. In fact, where the bleed had come from was a mystery, with no obvious bleed site anywhere to be seen. The baby, meanwhile, continues to grow well, and seems active and healthy. In the absence of evidence of anything more sinister, the bleed has been attributed to a burst varicose vein. However, the sonographer noted that my cervix has become shortened (thankfully still closed), but this gives us something new to worry about. It seems that we have exchanged the PP diagnosis for the possibility of early labour. It’s less dramatic, but not the ‘normal’ prognosis that I was hoping for.

Back on the ward for a second night, I was fed again (yay!) and the cannula was removed. Red alert had officially been stood down. I still had to endure round two of the pain-tastic butt jabs, but, better done than not done. The consultant has said that the shortened cervix presents ‘no significant clinical concerns at this time’, and I have been released to laze about in my own bed. We have to go in and see another consultant on Tuesday afternoon to find out what the plan will be for the rest of this pregnancy – house rest, bed rest, carry on as normal etc. and I am, of course, on constant vigil for anything else untoward, which would require immediate return to hospital.

The only one who has been seemingly unaffected by all of this has been the baby, which, on Thursday morning gave myself and the duty midwife the proper run around (at 27 weeks, it still has plenty of room to change position) when they were trying to do its obs. It was being very uncooperative; it wouldn’t stay still and kept kicking the doppler probe. I had to literally chase it round my tummy with the machine for an hour and still we couldn’t get a good reading, although it was obvious to all that baby was alive and well in there. I guess that’s the price you pay for giving your baby steroids!

So now its just a case of waiting to see what happens next and hoping that its all normal and non-emergency in nature. Stay in there, baby, not too much longer to go!

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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.