The Happy Baby Project

A happy baby needs a happy mum


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A medical update & thoughts on dealing with obstetricians

As some of you may know, I was recently sent to an obstetrician to see whether I might have obstetric cholestatis (OC), in which case they may have induced me early (around now actually!) due to possible harm to my baby. This led to a dramatic turnaround in my original birth plan and was a real eye-opener in terms of learning to expect the unexpected.

Well, the good news is that it is very unlikely I have OC as my bile salts are fine and my symptoms aren’t very suggestive of it. But the original tests still show a high ALT (liver function) test which is abnormal, and the weight of medical science suggests that this is a bit odd. That’s pretty much all I know, but I’m beginning to think its just a wierd symptom of pregnancy, of baby causing all sorts of problems. But in terms of hard, cold facts (which, as a risk-averse control freak I always like to be in possession of), I’m yet to know why I have this or what it means to me or my baby, so until we know more I am in a state of limbo, not knowing whether I will be able to have the natural birth I want, and worrying that things will get worse.

Note I have nothing against induction for medical reasons, I know how common they are, and I know that many inductions can lead to wonderful, natural births. Although I also know that something like 70% of inductions lead to epidurals (many are done at the same time) due to the sudden, quick contractions that don’t build up gradually as they do in natural labour, making you work super hard to cope. I also know you need to be monitored in hospital so my prefence for privacy at home for as long as possible, for active movement, would be reduced. Although as I say, I’ve heard some wonderful stories about brilliant induced births where mums managed to move around and have lovely, natural (and blessedly very quick!) births.

The obstetrician started by telling me: “Its my job to worry; and I get worried about heavily pregnant women with abnormal liver functions walking around in late pregnancy.”  Which hinted to me that he was thinking about induction. At this, I burst into tears, and when he asked me why I was so against induction (he seemed genuinely surprised), I explained I’d just rather things happened naturally, given all I’d read about the body’s natural production of oxytocin, and my hypno-birth/active birth preparation, although of course if there was any chance my baby could be harmed I’d induce at the drop of a hat.

I also asked him what was causing the dodgy liver function, and what harm it could do to me or my baby, and it transpires that he didn’t have a clue. It was an anomaly. It could be anything, possibly a virus that I’d picked up, but it was unlikely that we’d find out what it was. I suggested a liver scan (thanks to some great advice, as always, from twitter mums) to see if it was something as simple as the baby kicking my liver, and he proposed a raft of blood tests to check for things like hepatitis.

So, subject to the tests showing up something specific (unlikely), or the ALT levels increasing to a worrying level (fingers crossed), or me starting to feel ill (I feel great), or the baby stopping moving (baby appears to be doing a daily marathon inside me so no worries there), then I suppose I can carry on happily until labour starts naturally. Which is great news. The consultant isn’t seeing me again for another 2 weeks which shows he can’t be that worried. And I’m doing all the natural things to induce in the meantime – long walks, gardening on hands and knees, raspberry leaf tea.

However, I’m not sure we would be here in this relaxed “lets wait and see” situation if I hadn’t made it clear that I was against induction, and hadn’t asked a raft of questions about why my wierd liver results were a problem. So my tips if you find yourself in a similar predicament are:

  1. Find out as much as you can before you see the consultant. Ask your GP for information, speak to your midwife, ask twitter and find out what you can from the internet (although don’t panic if you read anything bad).
  2. Be clear about your personal choices for birth – you shouldn’t be pushed into something you don’t want to do if it isn’t necessary. If you’d rather only induce if absolutely necessary, make this clear as it won’t be assumed. I’m amazed at how many women I’ve seen on mummy forums saying they actively want to be induced even if its not clear that there’s anything specifically wrong.
  3. Ask lots of questions – if they want to induce then WHY – why are you or your baby at harm? What is wrong? If they don’t know, the next stage should surely be more tests – blood tests, ultrasound scans of your organs.. If you don’t know what you’re dealing with, how can you properly evaluate the risk?
  4. If you do find out you might need an induction, don’t panic or get upset, speak to other women in your NCT group, or email Natalie at Tell Me A Good Birth Story, to put you in touch with other women who have had happy, successful inductions, to hear some positive birth stories. It may not be what you planned, but with a little mind-change and some planning you can still have the birth you want.


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My Anti-Plan Birth Plan

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At 36 weeks, I’m now contemplating the realities of labour and birth and, for the first time, getting really excited about what lies beyond – the adventures of babies and crying and breastfeeding and what on earth are we doing?

But for now, I’ve written my birth plan and shown it to my midwife. It describes the ideal birth of my dreams, mirroring the ones I’ve read about from Ina May Gaskin, in Maggie Howell’s fantastic Birth Preparation book and from stories read out at my Active Birth yoga class. This means:

  • Staying at home for as long as possible, using homeopathy, movement and massage
  • No inductions / sweeps unless medically necessary (and I will pester them to tell me why so)
  • A water birth
  • No pain relief (although I am tempted by gas & air)
  • No interventions unless medically necessary
  • Staying in control of the process, asking for full information and time to assess risks and make decisions
  • Privacy, music and candles, dim lights, encouragement but no time pressure
  • Letting the cord pulse until it stops
  • The moon on a stick.

So far, so unrealistic?

Maybe not. But we all know life does not always go to plan and only a very small handful of my friends had a blissful, empowering birth experience. Most had surprise illnesses and complications, some had real horrors. All seem pretty unfazed by the whole thing, which shows as long as you have a happy healthy baby at the end of it then how you got there probably doesn’t matter.

Add to this the fact that we also know that pregnancy has a lovely way of throwing spanners in the work and lo and behold, at 35 weeks I was diagnosed as having possible OC (obstetric cholestatis) from tests done after I mentioned that I had been itching. OC is basically where your liver doesn’t work well and doesn’t filter out bile salts properly, which stay in your body causing incredible itching. The bile salts in turn can harm baby by increasing the risk of late-stage stillbirth, so you are normally advised to induce at around 37-38 weeks.

To sum up, therefore, my peace n’ love hippie birth – all surges and turning down the pain dial and breathing in golden light – may well now turn into an induction-cranked chemical fest which has all the potential of turning into an intervention-filled nightmare.

Thing is, I’ve been itching since day 1, given my hives and excema (lucky me) but it’s never been the on-hands-and-knees-ripping-off-skin-til-4am type of itching – mainly on the palms of the hands and soles of the feet – that OC sufferers describe and I actually feel really, really good right now. So the fact that my body might be letting me down is annoying. While my bile salt tests are normal, my liver function test (ALT) is high so they still worry I may have it and need to monitor me carefully. I have accepted that I can’t do anything to stop it and obviously if the baby is in danger (and as long as I’m sure I have all the information to allow me to weigh up the risks myself) then we will induce and intervene to get baby out safe.

But something interesting has happened since I’ve found all this out. After initial panic, worry and tears (heaven help a hormonal lady with a google search button), and taking several days to get my head round the fact that I could be induced several weeks before I thought I would have my baby, I found an acceptance, a letting go of expectations and plans, which has actually made me feel liberated, calm and in control. So back to the theory behind my original birth plan.

Yes, for a planner like me, the idea of things happening sooner than I expected, at a time when I can’t control it, was at first terrifying. But I moved important appointments forward to my 37th week (well – my hair won’t colour itself), leaving week 38 and onwards entirely free. I wound down at work so I could leave promptly if required. I washed all the baby stuff, had a lovely lunch with my best friends, finished all the odd jobs round the house (or rather got The Chef to help). I read the birth stories I wanted to read, played the hypno-birth CD on repeat, packed the hospital bags.

So now, I feel ready. And more than that, I have discovered a new sense of purpose, a new open-mindedness that I didn’t have before and which I believe will make me stronger for what lies ahead. A very clever friend of mine said to me that all this OC stuff was actually a good thing because it was teaching me perhaps the most important lesson of motherhood:

That nothing can be planned. Expect the unexpected.

At our first NCT class (more later – actually really enjoyed it), we were shown a photo of a doctor-led medical labour ward room – as opposed to the midwife-led nest we’d all come to want – and asked how we would feel about that being the place we were told we had to give birth in. While most of the couples appeared to hate the thought of such an industrial, medical environment, choosing words like “anxious” and “worried”, I went straight for a card that appealed to me. It read:

IN CHARGE

And on the back of this was marked the hormone that I’m aiming to harvest more than anything – OXYTOCIN – the hormone of love and labour.

Straight away I realised my mind set had changed. That, having first embraced a natural, instinctive birth, I now knew that if I need an induction, an epidural, hell if an entire team of scrubbed up consultants came in and told me I had to have an emergency caesarean, then I would probably be able to stay in control, to make this birth the way I wanted it to be.

So that’s my birth un-plan. Wish me luck!

For More Information…


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A preggie girl’s guide to being “a bit hormonal”

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As I approach 27 weeks and the third trimester with a certain joy at knowing me and my baby will meet each other before I know it, a raft of new symptoms appear.

My body is swelling all over. The bump feels enormous, and with its new curves and weight comes surprising, uncontrollable physical symptoms. The sore back, the swollen ankles that threaten to make knee high boots a thing of the past, the new-found clumsiness, bringing an impromptu “oof” when doing up shoes or having to pick something up off the carpet. The heat and hot flushes that make me thank my lucky stars this isn’t the height of summer. There’s bleeding gums and spots, hiccups and heartburn and constipation. There’s the fact that, like many of the women in my pregnancy yoga class, I have been known to let out an unexpected burp after eating. I don’t feel beautiful or voluptuous now, I feel creaky and ancient, like an old dusty bookcase.

And then there’s the emotional stuff. I’ve been told – oh don’t worry, you’re probably “a bit hormonal” – which suggests a bad case of PMT or teenage heartbreak. But I’ve been reading up on what these hormones are doing, what they will do in future, and am frankly amazed we pregnant ladies manage to get our shoes on the right feet in the morning, let alone do a full day’s work*:

  • There’s progesterone that basically stops the baby falling out. And if you imagine it sending waves of stupor to do so, you can also envisage it being responsible for that sluggish feeling, that slow heaviness, and with it constipation, heartburn (and also spots, aching bones and bleeding gums).
  • And we have oestrogen which stimulates blood flow, giant boobs, and is responsible for that attractive “glow” (bright red sweaty puffy look).
  • There’s relaxin that makes your hips expand, your pelvis grow, and I am personally blaming for my giant bottom.
  • As well as oxytocin to trigger contractions and prolactin to make milk and unwanted hair, and which is also bizarrely linked to sexual satisfaction – seriously, look it up.
  • And finally there’s adrenalin to help you push and endorphins that will be secreted during labour – your own natural pain-relieving happy pills – that some say, perhaps optimistically, can make the process enjoyable…

So, hang on a second.

If I’ve got this right then, left to go about its work unhindered, and without help from man or science, my body can hold in a baby for 9 months then push it out by summoning up super-human strength, while pumping me full of pain-relieving chemicals, and others which put me in such an animal-like trance that I will barely know my own name, and might even make the whole thing pleasurable?

A little idealistic perhaps. But while I still don’t understand why I find myself flying uncontrollably from clingy affection, to red-mist rage, to pathetic sobs, and back to boundless joy within a manner of minutes, I expect its something to do with these powerful chemicals inside me. And though I can’t use them as an excuse for bad behaviour generally, it does allow me to give myself a bit of a break, to respect what my body is doing and allow myself a bit of rest and relaxation.

For me right now, this involves massages, chocolate, sofa time, comfy PJs, cuddles, yoga and reflexology. And a very understanding Chef.

* please note this is based on no medical or scientific knowledge whatsoever