Jen's Pregnancy Diary: Week 34

This weekend started off with a trip into town with the kids to see the Chinese new year celebrations. We went to where we thought it was, but the lady told me that is was on further down town. So we walked and walked but couldn’t find anything happening. I was in bits with my pelvic girdle pain and Leon's little legs were so sore. We sat down near the Liffy and had the sandwiches and crisps I had packed. We continued to walk but could not find anything. I started to ask people – eventually one person told us it was on next weekend (if you could have seen my face!) We had been in town about 3 hours at this point...aimlessly walking LOL I put on my Mary Poppins cheery voice - “That’s ok guys, sure we have had a great adventure and it was much better than sitting at home all day” They didn’t look too convinced. We went and had a hot chocolate and cake in a cafe. Then we pottered around some shops. We got a taxi back up toward the Ilac car park (where the car was) as I was fighting back tears with the pain, while trying to remain outwardly cheery. 

To say it was a disaster is an understatement, but I racked up almost 22,000 steps on my fitbit!

On Tuesday I went to my first physiotherapy appointment. I was actually surprised how bad I was when she started her assessment – trying to stand on one leg was near impossible without feeling like crumpling onto the floor. She told me my thighs and lower back muscles were overtight trying to compensate for the weakness in my pelvis. She worked on easing that tension (which was super painful, I was literally sweating) She then gave me exercises to strengthen my hips/pelvis. She also gave me a different belt for the symptios pubis. She had mentioned my pelvic floor was too tight, and that could have had an impact on my previous two births. I have always been very conscious of doing pelvic floor exercisers, as my grandmother has severe incontinence. Apparently I have been over doing it and a pelvic floor that is too tight can cause as much issues as a weak one. I had never heard this so I was grateful for the information. I felt better after the appointment, armed with some tips to help before birth.

Mary doing a Google Hangouts session with myself and Paul on VBAC support and birth options. It was really helpful 

Wednesday evening brought another GoogleHangouts call with Mary. We chat weekly, keeping up the running of DoulaCare. This time there was a difference...it was to chat with myself and Paul about our labour and birth. Mary offered Paul some wonderful tips and explained hospital policy and so on. I was amazed at how little Paul had taken in from me (as we had covered it all before!) He seemed to get really engaged in the conversation when it was coming from our Doula and took away some great understanding of the difference in policy around a VBAC mum.  It was really nice for us both to chat with Mary too, as I spend so much time on the phone/laptop with her ;)

On Thursday I had my 34 week check up in the Rotunda. I was called by the doctor first (normally I see the midwife first) He was a lovely young reg who was open to listening to me. I had my birth preferences with me in the hope we could get them signed off but he told me I needed to speak with Claire Burke at my next visit as she was the consultant.  He measured my belly, which measured 36 weeks. So he did a quick scan, measured baby saying she was measuring a week ahead but I did have a lot of amniotic fluid which is making my bump bigger. He seemed happy enough. I felt things were going well and then, as often obstetricians do...he came out with his random gem... 

So apparently at my 38 week appointment they will check if my cervix is favourable, if it is they would schedule an ARM (breaking my waters to induce labour) I sat shocked for a nano scond. Then I asked why they would intend on doing this, as a VBAC mum ARM is the only induction method I could have so if contractions didn’t begin he would basically be signing me up for a caesarean birth. He was a bit taken back by my reply. He said everything would of course be a discussion with me at the time and it would ultimately be my decision but the reason he would suggest it would be to “avoid another big baby getting stuck” 

He was a lovely young doctor, who clearly wanted to respect my wishes but perhaps was so institutionalised he presumed by offering interventions he would be saving my preference for a vaginal birth. 

After the doctor I waited for another hour to see the midwife to get my blood pressure and urine tested. All was well. I met a gorgeous midwife Jeannine, who is such a warm and caring woman. She is an active advocate for women and midwives – trying to maintain surroundings to facilitate normal birth. We recognised each other from social media and attending workshops and seminars. She was so lovely and listened to me with such kindness, encouraging me to stay strong and voice my wishes for my birth experience. The Rotunda really have some amazing midwives in their semi private clinic and I would encourage everyone to speak with the midwives about any concerns if you feel your doctor had not heard you. 

On Friday myself and Paul had our second antenatal with Mim. It was great to get her feedback on the situation as I know I am too close to see clearly (and probably think rationally) We had a really good chat about Paul's role in the birth and he felt so much better afterwards. She spoke to him about his chat with Mary and helped him to get everything clear in his head. Again, Paul was so engaged with Mim and opened up so much about his feelings around the birth. I was thrilled to have our Doulas facilitate that and allow us to find a balance and to feel prepared. 

That night Paul said he wasn’t sure if he had been brainwashed with all our Doula speak, but he was feeling so much better about the birth and even feels excited now that he knows how to support me while still ensuring both baby and I are safe. It was so lovely to hear – that’s what Doula support offers!

I attended a meeting at the end of the week to plan for World Doula Week. One of our team Lorna has extensive marketing experience and we also met with one of DoulaCare Irelands past client's who is an expert in the field of PR and campaign strategies. It was an amazing morning. We really focused in on what we want to achieve and how to go about it. Mary and I are so grateful for all the support we have surrounding us, helping us to learn and grow. 

This week Mary was also invited onto Cork's 96FM Opinion Line as a Mum had contacted worried about her distance from the hospital and how she would manage in labour. Mary had a lovely chat with P.J who was very interested in the idea of a doula. You can listen back here to the interview: 

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Until next time...Jen x

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What Is Happening With Your Baby: 

© 2017 Scot Nelson, Flickr | CC-BY | via Wylio

• Your baby is the size of a cantaloupe this week. 
• Their brain is fully developed by this stage and if they need to be born baby's usually do really well (they may have to go to Special Care for a day or two but most have very few issues thankfully). 
• They are becoming rounder as fat layers continue to develop. These will help your baby regulate their body temperature outside of the womb.
• Your baby's lungs are still continuing to mature. 
• Their fingernails are almost fully formed. 
• If this is your first baby they may have 'engaged' which means they are head down and they are pressed deep into your pelvis ready for the birth. 

Week 34: What Might Be Happening To Your Body

• Exhaustion has probably kicked in again by this week (if it hasn't already!). A combination of hormones, restless nights (with lots of disturbance as you try to get comfortable or breaks to go to the toilet frequently). Your body will want to slow down - do listen to it
• You may have blurry vision. Or your eyes may be extra dry (due to a decrease in tear production). These changes are usually temporary though. Again this is all due to hormone changes which will readjust after baby arrives. Pop into your optician and get some eye drops and don't forget to let your HCP know if you have any issues with your vision so they can check it out. 
• Your breasts may feel heavier. 
• If your baby has engaged any breathlessness you may have been feeling will ease off and you will be able to breathe more freely. 

Week 34: Pregnancy Tip 

Perineal Massage

If you are a first time Mum there is some evidence that that Perineal Massage may help reduce your risk of tearing (have a read of this article for more information). If you are going to give it a try use a plant based oil (try to make sure it is unrefined. Mary our co- owner sells a perineal massage oil blend that you can find over on her website). 

This is a good step by step article on how to do Perineal Massage 

Top Tips on Writing Birth Preferences

Writing your birth preferences is important to do for a number of reasons:  
1. It gives you time and space to think about what you want for your birth
2. It opens communication between you and your birth support team
3. It helps you to familiarise yourself with hospital policies
4. You have time to compare policies with national guidelines, international guidelines and evidence based research.
5. It gives you a tool to remain in control and make informed decisions
 

Key points when writing your birth preferences

Keep your language open and positive. You have a chance to create the atmosphere you wish to birth in. Positivity is key and opens on a good relationship with your team.

Know your chosen hospitals policies. Each hospital has different policies around key factors in labour and birth. You are free to question these and even change hospital if you feel better suited to a different standard of care.

Know the HSE (national) and international guidelines / best practice / evidence. This is key. If you know what the evidence says then you can make an unbiased informed decision, rather than being swept along with a phrase such as “that’s the way we have always done it here”

Keep it to 10 points, or less. Anything more will negate the things that are important to you.

Don’t bother putting things in that are already policy in your chosen hospital (ie drinking water during labour) Again if you are familiar with your hospitals policies then you can avoid this.

Think about the atmosphere you want to birth in. Would you like the lights dimmed, music playing, limit the number of people in the room etc Or are you happy to have lights on, student midwives and doctors in the room etc?

Be firm on the points that are non negotiable for you once all is OK with baby (i.e. if you absolutely do not want an episotomy and would rather have a natural tear if it came to it). Some decisions need to be made in a split second and having discussions around the really important issues before hand are vital.

Create birth preferences for a Caesarean Birth preferences as well. This is a good idea for all the same reasons that are mentioned here. You can have the discussions, make informed decisions and then ‘park it’ to one side. You have your just in case covered, remaining in control. Then you can shift your focus back to the birth you visualise. It can be on the next page so your focus is not necessarily on this outcome if you are not planning to have an elective Caesarean, but it does mean that if things don't turn out as you had hoped you have something written up to help you create a dialogue with staff. 

Create your birth preferences with your birth partner. This is important as they will be your advocate for the day. Being aware of what you want and why will help them be a better advocate for you. 

Bring multiple copies so you have them for shift changes. Make sure your partner is aware they need to ask the team caring for you to read through them and discuss them with you both. 

Finally knowledge is power as they say - but trust in the process is also important. All the above are important and give you the knowledge to discover what you want for your birth. It gets the discussion out of the way before labour begins, as during labour it's important to park the conscious brain as much as you can. You body and your baby know what to do, they are an awesome team, made to work together. Let your advocate voice your preferences and allow yourself to go with your labour journey.

Here at Doulacare Ireland we will always helps our clients draw up their birth preferences after meeting with their birth doula for an antenatal visit. We listen to what is important for our clients and offer information on evidence based care that will enable them to be aware of what they might want to include in a birth preference sheet. We would always encourage clients to have some birth preferences to facilitate improved communication between clients and staff. 

Jen's Pregnancy Diary: Week 29

This week I had my first appointment in the Semi Private clinic. The midwife, Ann, was absolutely lovely. She saw I was a doula on my chart and was full of questions. She was so warm and showed genuine interest in my pregnancy. She mentioned there was protein in my urine but was not concerned as everything else was fine. She ran through my GTT and said I had absolutely no markers for gestational diabetes which was a relief. She did say my iron was a little low – but after 6 months of sickness I’m not too surprised. I said I would up my iron intake to build up stores. 

I met my doctor, Claire, who was a similar age to me I think. She was nice but very clinical. I mentioned all the Braxton Hicks (which had continued all through this week too – making me feel pretty drained). She popped me up on the bed and lo and behold baby has flipped again! She is now almost head down (slightly diagonal) in OP position (facing out). The doctor mentioned she would expect baby to be getting into position around now but they are not overly concerned until 34 weeks. 

While going through my chart she said my EDD was now 22nd of March and I nearly dropped off the chair. I said my date has been fip flopping from 30th, 31st march and 1st April but I have not heard 22nd march. She told me that at my 21 week scan the sonographer changed the date to match babies size. I had a long discussion with her about how my early scan is the most accurite. My babies size has nothing to do with how mature her lungs or brain function are. That her gestation is most important. I said from my first early scan and my dates my EDD should be 1st April. I told her both my boys went post dates (40+8 & 40+14) and I would really appreciate as much time as possible to avoid unnecessary intervention at the end of my pregnancy.  She was very helpful and went to speak to a senior consultant, who was happy to change me back to 1st of April. I was very relieved with this as it gives my body that bit more time at the end to go into labour undisturbed. 

Of course I was told all the usual hospital policies. It was mentioned that I would “not be allowed go past 41 weeks”, that I would be monitored very closely during labour and at the first sign of any issues I would be “straight to section”. I decided to just nod as I had one win for the day and didn’t particularly want to have written across my notes “this one is trouble”. So I left knowing I would need to have those conversations at a later date. 

Certificate of Attendance for my Training Day with Cuidiu 

I attended a weekend of training for Cuidiu Antenatal Teachers course. I haven’t been at tutorials for over 6 months as I have been so sick but I have 2 to attend in order to qualify. On the Sunday there was a Study day on Loss, Grief and Disappointment. It was facilitated by the Rotunda Bereavement Midwife, Trish and a Cuidiu Tutor, Niamh. It was the second time I attended this day but I always think these kind of days are so valuable. It was a heavy day but I felt better knowing what is available to parents suffering deep loss such as the death of their baby either in pregnancy or soon after birth. I also appreciated touching base with my own emotions and reactions around the subject and having time to reflect on how to support families in this situation. In my role with Irish Premature Babies, I supported many families who lost their little babies and it is a privilege to be part of that journey with them. 

This week the tightening/Braxton Hicks are continuing so I am resting as much as I can, while still being a mum and running a business. Our cat Shadow is showing me so much love – like over the top. He just wants to be on me all the time, kissing my face and rubbing off me purring. I am thinking he can sense the Braxton Hicks perhaps? Any cat people out there have a similar experience?

My mother in law was admitted to hospital with a terrible gastric bug and is on a drip. I would normally be the first to run around and be by people's side but as they are unsure of the cause I need to avoid just in-case. Plus with all the Braxton Hicks I’m not sure I would be up to it. I do feel really wiped this week. Hopefully this will all pass soon! 

Next week Mary is coming up for an important meeting (for DoulaCare Ireland) We are so excited to spend some time together in person! Then we will have our Team CPD day in Portlaoise, which again I am so looking forward to.

Until next time....Jen x

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Week 29: What Is Happening  To Your Baby

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• Your baby is now approximately the size of a butternut squash and they are continuing to get plumber over the next few weeks as they lay down body fat. 
• Their head is getting bigger to make room for their ever growing brain 
• At this stage if baby were to be born early they would have a much better chance of survival (however, the closer to full term they can get the better for their mental and physical well being and development). 
• There is such a huge increase in brain activity from this week on it is thought that your baby may be capable of dreaming now. 

 

Week 29: What Might Be Happening To your Body

• If you have been suffering from heartburn or consitpation you may find it worsening now for the rest of your pregnancy until baby arrives 
• Some women find they get headaches 
• Your belly may be itchy as your skin here continues to stretch and expand. Drink lots of water and use a good moisturiser to support your skin. Do let your GP know if the itching is severe just in case it's a sign of something more serious
• You may have pain in your back, legs and/or hips as your body manages the extra weight. As well as this your body is also producing the hormone Relaxin to help soften the ligaments and joints in preparation for your birth. Some women find they are in extreme pain with SPD and will need some extra help like a support belt, regular visits to a physio or maybe even crutches. Being in water can be a huge relief so regular visits to the pool might be on the cards to help. 
• You may find you are leaking breastmilk as hormones in your body start to produce colostrum- so stock up on breast pads to help. Washable pads are much better for the environment and in the long term cheaper on your pocket. 
• The hormone that is responsible for producing milk (prolactin) can also make you feel sleepy. So don't be surprised if you need to take naps again. 

Week 29: Pregnancy Tip

You should be looking into applying for your Maternity Benefit payment around now (or the equivalent payment for the country you are living in). Citizens Information is a very helpful place to read up on this payment. You can read if you are entitled to it and when you should apply (at least 6 weeks before you intend to take it). The form may take a bit of time to fill in so it's useful to get started around this point in your pregnancy. The Maternity Benefit Section of the Dept of Social Protection are usually very helpful if you are unsure of anything in particular.  Your local Citizen's Information Centre can also help you fill in the form if you need this support. Your partner can read up on Paternity Benefit on the Citizen's Information website so they are prepared and understand how to apply for their entitlements. 

Jen's Pregnancy Diary: Week 27

This week I am on call for a birth client. One of our doulas in our agency is sick at the moment and  so I have taken over until she feels better. That is the one of the many benefits of the agency model, as we ensure our doulas can take time off if needed and our clients always feel supported. 

For New Year's Eve I watched Free Willy with Seth (and cried A LOT!!!) 

On Sunday it was New Years Eve. We normally all go to our neighbours for a party but this year we were all wrecked. I was feeling sore and Paul had a cold (plus he was due up at 6am for work!) So Leon and Paul went to bed together at 10pm. Seth wanted to stay up so I stayed up with him. We watched Fee Willy and I of course bawled my eyes out even though I have seen it a good few times.  Then we turned on the National Countdown. We listened to the music and watched the fireworks. The guys on the drums were epic (they played at our friends wedding last year and really got everyone going before the DJ started). Myself and Seth chatted about things we are looking forward to for the year ahead and had a cuddle. Then we both went to bed around 12.30am! Not exactly the rock and roll life but perfect for us this year just the same! 

We had our antenatal with one of my lovely doulas Mim this week. I love her so much and just feel so relaxed in her company. Mim was my mentor over the years and has taught me so much, in my role as a doula, antenatal teacher and breastfeeding counsellor. She is such a warm and calm person and one of the most experienced doulas in Ireland. Between her and Mary we will be well nurtured during our pregnancy, labour and birth! Their combined experience hits nearly 30 years!! We are so lucky to have these two wonderful ladies in our lives. 

The antenatal meeting was really fab as Paul has been a bit in denial about the birth. With both the boys things did not go as planned and both Paul and I carry a lot of trauma. Through all my courses, CPD and training days I am lucky to have worked through a lot of this trauma and have had space and time to debrief. Paul on the other hand has not. So Mim spent a good bit of time giving him room to talk and share his feelings. She pulled more out of him than I have ever managed, but in a very gentle and respectful way. Before this visit, Paul was unsure if he wanted to be at the birth this time, which I would have supported if he truly felt uncomfortable. Now he feels happy in the knowledge he will have either Mim or Mary there as a supporter. 

Mim brought her youngest daughter Juno over to play with Leon while we chatted. I do believe they might be soul mates! They are both cute as a button with innocent little faces, but absolute divils and mad hatters. They had great crack for the few hours and had to be dragged apart when Mim was leaving. 

I then logged on to do a Google Hangouts call with our DoulaCare Ireland doulas on supporting parents with premature babies, as we have a client with preterm twins starting this week. 

I have been getting lots of regular Braxton Hicks this week. Very tight tummy, a little uncomfortable but nothing concerning. I am wondering if my magnesium is low – as this can be a cause of more frequent BH. I also am making sure to drink plenty and rest when I can (again dehydration and doing too much can also be a reason for them as well). 

On Wednesday I had a few client interviews with potential birth and postpartum clients for the agency. I had a lovely evening with the boys and a relaxing shower. I was just about to head to bed and I got the call that our client was in labour. She was a second time mum and had been having surges on and off for days so I had a feeling she would experience a fast labour. Once I heard it was her husbands voice I knew it was time (as mum was unable to talk over the phone). With my bag ready, I made a sandwich for the car on the way, got dressed and headed out the door. It was a stormy night but I made good time. When I arrived 30 minutes later she was ready to go to the hospital. We were only there a few hours and baby was in arms after a beautiful, unmedicated, fiercely strong and positive VBAC. I stayed with them for the first breastfeed and to take some family photos etc. I got home around 6am and fell asleep on a high, feeling so privledged to be part of such a wonderful birth. 

Next week we have our 3d scan booked and are so excited to see babies face!

Until next time....Jen x

Week 27: What Is Happening to your Baby

• This week your baby is the size of a head of cauliflower
• If your baby were to be born now their lungs would be capable of functioning (though they would still not be fully mature). They are inhaling and exhaling amniotic fluid practising for life outside your body. 
• Baby is also showing brain activity this week and will keep developing over the coming weeks becoming more and more complex as the weeks go on. 
• Your baby's taste buds are very developed now 
• If you feel light spasm like sensations in your body - this could be your baby hiccuping 

Week 27: What Might Be Happening to your Body

• Many of the symptoms you have been experiencing will still be around (and stay until baby arrives!). Leg cramps, constipation, backache and haemorrhoids can all be experienced during pregnancy. There are things you can do to help (drinking water can be a huge help with leg cramps and constipation), so it's good to see what might bring you some relief and help make your pregnancy more enjoyable. Some women will sail through pregnancy with none of these issues - let's hope you are one of the lucky ones! 
• If you have managed to escape leg cramps or backaches up to now they may start from this week on as your baby gets bigger and puts pressure on your back and legs. 
• Tying your shoes and bending over is going to become more difficult as that bump expands

Week 27: Pregnancy Tip 

Think about buying a birth ball or exercise ball for yourself this week. They are great support for your pregnancy and during your labour. A birth ball is really just an exercise ball and can be bought in places like Argos, any sports shop and occasionally Lidl and Aldi stock them. During pregnancy they are great to sit on. You can't slouch on them so your posture is improved and they can help balance the ligaments, tendons and muscles in your pelvis. Doing this helps baby as it can give them more room in there and thus encourage them into an optimal position for birth. If you sit in work all day ask can you swap the chair for a birth ball instead. They can help relieve lower back pain

This is a great position to be in on the birth ball both during pregnancy and in labour (some Mums like to have some more support so will add a few pillows for under their knees and on the ball). 

During labour they are a fantastic tool for making you more comfortable. You can use them to sit on and do gentle hip circles or figures of 8 in early labour. They are also great for leaning over when the surges get more intense. This can help encourage baby into a more optimal position if they are posterior, but it also allows your partner access to your back - and so they can give comfort measures to help make your labour more manageable for you (they will learn these tools at a good birth preparation course like GentleBirth or Cuidiu). Having a birth ball with you also helps to keep you upright and off the bed (much better for labour). 

Do make sure you choose a ball that is anti burst (which would mean they deflate slowly if they burst) and you will also need one that suits your height. Your hips should always be higher than your knees when sitting on the ball. Recommendations are: 

Under 5ft 4 inches: 55cm ball

5ft 4 inches - 5ft 9 inches: 65cm ball

Over 5ft 9 inches: 75 cm ball 

Any questions about using a birth ball do let us know here at DoulaCare. Our email is: info@doulacare.ie 

Jen's Pregnancy Diary: Week 21

I started this week off at my local Cuidiu Breastfeeding support morning. As one of the volunteer breastfeeding counsellors it was my turn on the rota to cover the group. There were lots of small babies there, some with a few issues, so thankfully one of the other BFC's - Orla -attended. Everyone left with their questions answered, a few cups of tea and some cake in their bellies so all around a good morning. I love giving back to our community in this way and hope that breastfeeding rates will grow with the support. 

Straight after the group it was off to a postpartum client on the South side. This client was a lovely new mum, a paediatric nurse herself – who just wanted a sounding board and some help with the big ‘firsts’ like bathing and cutting nails! It was a lovely shift. 

After my shift I drove to Drake Chiropractic Clinic in Sandyford, run by the very knowledgable Ros Drake. I had been meaning to try it out as Seth was OT and Leon was OP so I always wondered was there a reason within my pelvis for their positioning. While I laboured to 10cm and pushed, Leon was a caesarean birth in the end – so I imagined with all the pushing and pulling my body was probably in need of some realignment. I know Ros from attending conferences together and I was not disappointed with her care. She was professional and friendly and explained everything as she went. It was the strangest sensation as she readjusted different parts of my body. No pain but as I heard the cracks and my neck/back/hips etc moving that little bit further than feels comfortable part of me resisted. I did feel good after and was happy to hear that things were looking pretty good. On Tuesday I had Leon at the fracture clinic in Temple Street to review his broken toe. There was still a noticeable crack but they were happy with the healing process and said in 3 weeks time he should be 100% again. We don’t need to go back again unless we are concerned about anything (as Leon has been pretty much walking on it as normal since it happened I think we are good!) 

Then of course on Friday we had our anomaly scan! There was a good wait as the Rotunda are starting their online charts system (meaning patients no longer have their paper chart and every department logs into their system on a computer and writes notes there) I feel it’s a good thing as every department has access and there will be no missing charts. It does however mean that we can no longer snoop in our chart and see what they have written about us! I guess I will have to wait for after baba is born when I request a copy of my notes. At least with everything typed I will be able to decipher the doctors writting unlike Seth and Leons charts. 

You can request a copy of your hospital notes for you and your baby under the Freedom of Information Act 2014.

Our little girl at 21 weeks 

At our scan we found out that our baby is doing perfect. Myself and Paul were both so relieved as I have been so sick I was worried baby would have been lacking in the correct nutrients. The sonographer said she hadn’t seen such an active baby in a good while and that baba wouldn’t stay still (sure I knew that with all the movement I have had recently) After watching the chambers of the heart pump the blood, and seeing all babas organs, checking measurements and so on, we found out that we are having a little GIRL!! I couldn’t believe it. I really thought we would have another boy. Paul was very quiet, so when we left I asked was he disappointed. He said of course not, but he was terrified. He said he doesn’t know what to do with a girl – he only knows how to parent boys. So after a good chat he has come around to the fact it is a new adventure and we will learn together. 

Seth was absolutely thrilled with the news as he had decided he wanted a sister. Leon was not so impressed – as he ‘doesn’t want girl stuff all over the house’ LOL! My mother and grandmother were thrilled and Pauls parents cried down the phone. Babies can bring so much joy to a family unit and I am so excited for next year! Now to start thinking of names... Any suggestions will be gratefully received. 

Until next time...Jen x

Week 21: What Is Happening To Your Baby

© 2007 U.S. Department of Agriculture, Flickr | CC-BY | via Wylio

• They are approx the length of a carrot this week
• They are becoming extremely active inside with lots of kicks and nudges as they somersault around your womb. Baby has more control over their limbs so this movement will be more co-ordinated. 
• Your baby now has very clearly formed eyebrows and lids. 
• As their taste buds are now developed there's a good chance that whatever you eat this week - baby will taste it too! 

Week 21: What Might Be Happening To Your Body

• Due to the increase in oil production in your body you may find yourself suffering from acne. Talk to your GP about what you can do. Most over the counter oral acne medications cannot be used during pregnancy. 
• Your heartburn or indigestion may be getting worse
• You might be able to feel warm up surges (or Braxton Hicks as they are often called). This is totally normal as long as the surges disappear when you switch position. If they don't give your GP or HCP a ring. 
• Your skin can develop stretch marks. Despite what the cosmetic companies will promise there is no way to get rid of these if they develop. You can improve the condition of the skin by keeping it moisturised. Mary has a lovely Nourishing Bump Blend which feels and smells lovely on the skin and is completely natural and safe for you and baby. 

Week 21: Pregnancy Tip

Don't forget to leave some time to pamper yourself during your pregnancy. Especially if this is your first pregnancy. You will never have this time again or the luxury of having nobody else to worry about. So book yourself in for a lovely pregnancy massage, or a spa day, or get your nails done - what we find pampering is different for everyone, but whatever it is - make time for it now. Some Mums will enjoy going for regular reflexology or acupuncture - it can feel lovely and also help with the pregnancy aches and pains. Many Mums will attend Pregnancy Yoga classes and these can be a lovely way to meet new Mums, take some time for yourself and pamper yourself as usually with a class like this women say they feel amazing after it. Body work such as going to an osteo may not be pampering but it can be something that helps you to feel better in your body and can also be great for positioning of baby - so this can be helpful to try as well. What you choose of course has to be something that you enjoy, or feel good about going to and gives you a lift. Enjoy yourself whatever you choose. 

Jen's Pregnancy Diary: Week 20

This has been a great week. I am feeling good in myself and coming through the sickness. I am eating a wider variety of food and feeling like my energy is up. This week my herbal remedies from Cork arrived. I have been taking them and hopefully they will help to build me up. 

I have been focusing on growing DoulaCare Ireland and this week I attended some fantastic meetings that will hopefully open up amazing opportunities for us in 2018. I will of course keep you posted once deals are done ;)

I had postpartum clients two full days this week and then my lovely November birth client needed me. She was admitted unexpectedly as at her 39 week check they found her waters to be extremely low, which her care team explained could be a sign of the placenta failing. Her induction began on Tuesday, I spent 6 hours with her helping herself and her partner to get their head around the situation. We all sat and chatted and I was a sounding board. We listened to GentleBirth tracks, joked between us, and ran through questions to ask her care team. Once all their questions were answered my clients were happy to consent to induction. 

Reasons for low fluid (oligohydramnios) can include:

• Mothers waters are slowly releasing
• Being more than 42 weeks pregnant
• Medication mother is taking
• If baby has a medical problem with their urinary system

Other common reasons for induction include:

• Post dates – babies approaching 42 weeks gestation
• Advanced maternal age – women 40 years plus
• Big baby – often a guess weight
• Issues with placenta (coming away from wall of uterus or not working efficiently)
• Waters have released without labour begining

Some of these reasons can be negotiated and navigated with your care team - it can be helpful to be aware of the current evidence surrounding best practise for some of the reasons mentioned above (which is where taking an independent antenatal class can be such a help as these issues are usually covered. Classes that the hospital offer tend to focus on what the hospital policy is rather than what is evidence based care).  

I popped back to my client on Wednesday, after a postpartum shift for a few hours. Again we spent the time chatting and supporting my client in getting into the right head space. On Thursday things kicked off so I spent most of the day with them, and their beautiful baby was born at 6.15pm in such a positive end to what was a long  process. It was very emotional as this will more than likely be my last birth client for a long time. I am getting too big myself in pregnancy and once baby arrives I know I would not be comfortable being on call. It was a wonderful birth to end on and I am still on a high. They are such a lovely family and I look forward to our postnatal meet up in the next week or two. 

During the birth it was so lovely to be welcomed into the maternity unit. On 3 separate occasions midwives came to say hello when they heard I was the doula on the ward. This is just so wonderful to have such good relationships with the staff and it really helps to grow the feeling of a birth support team around parents. When we went up to postnatal ward I was again greeted with fantastic midwives who remembered me from past clients. It was all a really positive experience and I am so thrilled to end things for now on such a high. 

Also one of my good friends Ruth and her boyfriend Brian got engaged this week while on a romantic sun holiday. I am so thrilled for them both and you could feel Ruths joy and excitement bursting through the photos in our whatsapp group! (Ruth was sone of the girls I went away with a few weeks ago, we have been friends a long time) Ruth moved up north to live with Brian so I am unsure if they will have the wedding up there or perhaps even in the sun somewhere fab. It’s always nice to have a wedding to look forward to :) 

My baby has been moving so much and on Thursday night Paul finally felt baby kick :) We were thrilled. I can’t wait for the kids to feel too. 

Next week we have our ‘big’ scan. We are hoping to find out babas gender too. I will fill you all in more next week...

Until next time....Jen x

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Week 20: What Is Happening To Your Baby

Photo by Mike Dorner on Unsplash

• Your baby is the size of a bananna this week
• This is the last week baby will be measured from 'crown to rump' (they were measured like this because their legs are curled up in a foetal position - from next week however measurements will be taken from top of head to tips of toes!). 
• Your baby is swallowing more this week - really helpful for their digestive system 
• Your baby is starting to produce meconium - this is a greenish black sticky substance that will accumulate and be stored in their bowels and you will see it when they first pass this in their nappy (or if you haven't managed to get the nappy on them, it might end up on you or your birth partner!!!). Some babies will pass meconium in your womb or during the birth.
• Your baby is forming sweat glands this week

Week 20: What Might Be Happening To Your Body

• Woo hoo!!! You are now half way through your pregnancy (more or less!! Baby may not arrive until 42 weeks!!!). 
• You could be snoring for the first time ever!!! Blame those hormones again. The increase in Oestrogen can result in the mucous membranes in the nose swelling. It can help to sleep on your side and elevate your head slightly. 
• Sleeping can start to become very challenging from this week. See our Pregnancy Tips below for some ideas on how to help your sleeping. 
• You may find you have a vaginal discharge which is getting more noticeable as the weeks go on. This is normal and you can expect it to keep increasing until baby arrives. It helps keep bacteria at bay. It it becomes green, yellow or starts to smell do let your GP know. 

Week 20: Pregnancy Tip

It can be tough to get a good night's sleep when you are pregnant. Some things that can help are: 

•  Listening to the Sleep Sanctuary on the GentleBirth app. It is very soothing and Mums will often find they drift completely off having listened to it. Do yourself a favour and get yourself some SleepPhones if you are listening to the App regularly btw - they can help with the sleep because they are not as uncomfortable as ear buds.
• Mary's Sweet Dreams Essencia Blend is also a great blend of aromatherapy oils to help promote sleep. It's safe to use when pregnant, smells amazing and is especially designed to help you relax and drift off - and works great in conjunction with the Sleep Sanctuary track. A body pillow can help ease aches and pains and make you more comfortable in bed. Switching off the phone at least half an hour before you go to bed can help as well. And trying to grab a cat nap during the day if your sleep is disturbed is important so you don't get too exhausted. 
• Check out this EUMom article from GentleBirth founder Tracy Donegan to get more tips to help with sleep. 

What is the Glucose Tolerance Test (GTT):

Many women will be recommended to get the GTT by their Health Care Provider. GTT stands for Glucose Tolerance Test. The GTT tests for Gestational Diabetes, which is a type of diabetes that develops during pregnancy. With this type of Diabetes,  normally symptoms subside once your baby is born. If a mum has GD (Gestational Diabetes) she is more susceptible to developing Type Two Diabetes later in life. 

Why are some women offered the GTT?

There are certain risk factors that make you more susceptible to developing GD. If you have any of these risk factors, your antenatal care provider may suggest a GTT to screen for markers. 

Risk factors for GD include:

• High Body Mass Index (BMI of 30 or higher)

• Previous large baby (above 9lbs or 4.1kg)

• Women older than 25 years

• Poly-cystic Ovarian Syndrome (PCOS)

• You had GD during a previous pregnancy, or you had an unexplained stillbirth in the past.

• Family or personal health history. Your risk of developing gestational diabetes increases if you have prediabetes — slightly elevated blood sugar that may be a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes.

• Race. For reasons that aren't clear, women who are black, Hispanic, American Indian or Asian are at higher risk to develop gestational diabetes.

So what is involved if you agree to take a GTT? 

Methods can vary slightly from each hospital, but they remain generally the same. The woman is asked eat her normal diet for the days leading up to the test and to fast for 12 hours before the test (this includes no water). She is then asked to attend an appointment with her Health Care Provider early in the morning (usually around 7.30am). 

You will receive a fasting blood test, as well as 2 more blood tests at hourly intervals with a Glucose Tolerance Test

The test then begins with a fasting blood test. After this the woman is given a jug of lucozade or high sugar drink. She is expected to drink this over 10 minutes. The woman is requested not to eat or drink anything else until the test is fully completed. 

Your care provider will then take two more blood tests at hourly intervals to monitor how your body metabolises sugar. You will be expected to stay in the clinic during the testing process so it is a good idea to bring a book or laptop (as I can imagine 3-4 hours sitting there while starving is not fun).

After the test you will be free to head home,  and as you will have been fasting it is probably a good idea to grab something to eat before you hit the road. 

The blood tests are analysed very quickly and you will be contacted the same day if there is any abnormalities showing up. Most hospitals do not contact women if the test is normal so no news is good news in this situation ;) If you are not contacted you continue with you antenatal appointments as normally scheduled. 

What are the pros and cons of agreeing to take a GTT?

Pros:

• If you are found to have GD, it can be carefully controlled to avoid any complications, most women with GD give birth to healthy babies with no complications. However GD, if not carefully managed does carry risk to mother and baby.

Cons:

• It is not pleasant to fast for 12 hours when you are pregnant.

• Drinking a full jug of sugary and processed lucozade is not something most pregnant women would choose to do.

• Blood tests are uncomfortable.

 

Complications that may affect a baby if their mother has uncontrolled GD:

High birth weight – Babies with a birth weight above 9lbs statistically have higher chance of complications during birth. This includes interventions such as ventous or forceps and increased instance of caesarean births. It is important to note that many women can and do give birth to high birth weight babies without complications or interventions (we all know the pressure women are under if they have a ‘big baby’ during scans, GD or not). 

Low Blood Sugar (hypoglycaemia) – Sometimes babies born to mothers with GD develop low blood sugar shortly after birth because their own blood sugar is too high. Lots of regular feeds or in some cases a glucose drip can help to return babies levels to normal. Again it is important to note, many mothers feel pressure to top up with formula if this situation arises, even when their wish is to exclusively breastfeed. These mothers can hand express extra colostrum or breast milk to offer their baby instead. Some mothers with GD choose to express some of their milk antenatally, to have milk for baby after the birth.

Early (Preterm) birth and Respiratory Distress Syndrome – Babies born early may need help with their breathing until their lungs mature. Also, even babies born at term to mothers with GD are at risk of having respiratory distress syndrome. A mothers high blood sugars can put extra strain on babies body as they fight to maintain a normal level. 

In extreme cases untreated gestational diabetes can result in the death of a baby.

 

Complications that may affect a Mother from having uncontrolled GD:

• High Blood Pressure and Pre-eclampsia – Gestational Diabetes increases your risk of high blood pressure. It can also increase a mothers risk of preeclampsia which can be life threatening to both mother and baby and usually requires birth by caesarean even before term.

• Future Diabetes – Having Gestational Diabetes increases a mothers risk of getting it in future pregnancies. It also increases risk of developing Type Two Diabetes later in life. Making healthy life style choices such as eating well and exercising can decrease instances. Breastfeeding your baby is also shown to reduce both mother and baby's risk of diabetes later in life.

You do not have to consent to a GTT. It is your choice to make an informed decision – weighing up the pros and cons and deciding what is best for you and your baby. I hope this blog has helped you to understand risk factors and the process of the test itself. 

Doula Jen 

Jen Crawford, Co-Owner & Founder DoulaCare Ireland.

REFERENCES AND FURTHER READING: 

HSE https://www.hse.ie/eng/health/az/D/Diabetes,-gestational/Testing-your-glucose-levels.html

AIMS http://aimsireland.ie/the-glucose-tolerance-test-gtt/

NICE guidelines https://www.nice.org.uk/news/article/new-thresholds-for-diagnosis-of-diabetes-in-pregnancy

WHO guidelines http://apps.who.int/iris/bitstream/10665/85975/1/WHO_NMH_MND_13.2_eng.pdf

Irish Health http://www.irishhealth.com/clin/pregnancy/conditions02.php?con=574#pregnancy

Jen's Pregnancy Diary: Week 9

So another busy week working in DoulaCare Ireland.  As mentioned I have pulled back a little on night shifts while the first trimester tiredness engulfs my being. This week I am starting to come through it a little. I feel less likely to fall asleep while walking down the road LOL. 

I am finding baby brain is making paper work last about twice as long and my ability to do mental maths while calculating shifts for our team is not what it once was! I am taking my time and using the calculator on my phone just to be sure, but find myself needing to use my hands to count out even small amounts of time (10am-2pm = 1,2,3,4 hours) Tell me this is normal and my poor brain will recover?! 

© 2008 jess2284, Flickr | CC-BY-SA | via Wylio

This week I feel I am starting to come through the sickness. I’m back eating dinners now and once I snack regularly I am not gagging (touch wood). I still can’t handle the smell of the fridge – any fridge – and have to hold my breath while searching for items for the kids. This does still set me off and the kitchen sink has become my saviour. I find I am going off food and drinks pretty quickly. 7Up was my best friend for the first few weeks but I can’t stand it now. Perhaps my body knows it won’t be helping the terrible bloating and ****TMI alert****...gas. 

I am feeling more aware of my tummy and feel a ‘heaviness’ low down. I know my body is telling me baby is there. I haven’t found I need to pee all that much more but when I need to go I do not have the ability to hold it for 4 more hours (working as a doula helps to create a super human bladder - one of the perks!). I am also getting the odd pain, which I am presuming is all the ligaments stretching to accommodate my growing peanut. 

My oldest boy Seth has been asking me a lot why I am sick all the time. We have decided to tell the kids next week about baby. It is my father-in-law's 60th so we will tell him then, as he has been begging for another grandchild for years and we know he will be thrilled. So close family will know and then perhaps we will start to spread the word. 

I am unsure how the boys will react. They are both old enough to understand and we hope the gap is big enough they won’t feel shoved out. I will fill you all in next week. How did you tell your other children about your pregnancy?  And how did they react when you did? 

Until next time...Jen x

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Week 9: What Is Happening With Your Baby

© 2010 Dennis Hill, Flickr | CC-BY | via Wylio

• Your baby is the size of a Grape this week
• All of baby's essential body parts have formed now. 
• Your baby's head is beginning to look rounded and there is a clearly defined neck.
• Your baby's limbs are developing rapidly and you can see clear fingers and toes.
• Your baby's eyes are fully formed now, but their eyelids are tightly shut (and won't open until 27 weeks). 
• Your baby's teeth are developing and their heart has divided into 4 chambers 

Week 9: What might be happening with your body

• Your hCG levels are at their highest this week - so all the changes to your body that have been happening over the last few weeks can be at their most intense this week (nausea, fatigue, vomiting, frequent urination etc). 
• Your gums may be softer now with pregnancy hormones - be careful with dental hygiene
• Those pregnancy hormones can give you lovely skin BUT they can also give you very intense mood swings - so be gentle with yourself and know that these will ease off over the next week or so.
• Your nose may be very congested - your body often produces more mucus when pregnant, leading to a constantly blocked up nose. 
• You may be finding it hard to button your trousers or skirts this week as your uterus expands. 

Week 9: Pregnancy Tip

You can try the GentleBirth app free for the first week. 

The GentleBirth App is a fantastic tool for pregnancy and birth, with tracks for early pregnancy and mindfulness to help you have a positive pregnancy and birth experience. It's such a  nice way to connect in with your baby throughout your pregnancy. You can try it for free for the first week and there's a fantastic GentleBirth Facebook Group that you can join for support as well (and it's a closed group as you may not want to announce to the world yet that you are pregnant! But to be on the safe side - if you have friends in the group and you don't want them to see you are pregnant yet, you can always join under a fake profile). Get more information on the GentleBirth App