Jen's Pregnancy Diary: Week 25

What a jam packed week this has been. On Saturday it was my good friend Michelles 40th birthday. We went out for a lovely meal in The Dog House, Howth. This is a really quirky little spot and it has a special place in my heart as myself and Paul had our wedding meal there ;)

Another of my friends, Aideen got engaged this week. Her partner Colin went all out and the proposal was the stuff out of a movie with candles and flowers everywhere. She shared a video on our group chat and we were all bawling! Truly delighted for them. Plus this means we now have two weddings to look forward to (as our friend Ruth and her partner Brian got engaged a few weeks ago!) 

My father-in-law got news that he needs more surgery and also that they would need to go deeper this time so he would need to stay in hospital. We were all shook by it but kept a brave face for him. I took time off from my postnatal doula work from Monday-Wednesday to bring Bren and Cindy (my parents-in-law) to the hospital. We went Monday for them to speak with his consultant and get a game plan. This resulted in us waiting around most of the day to see if they could admit him there and then. At 4pm we got the word he could go in fasting the next day for surgery and he would be in hospital for a few days. Bren was happy to get home and we were all tired by then. 

The following day he had his surgery, he was gone for 5 hours so myself and Cindy went to town to pass the time. We did a small bit of shopping and had lunch before returning to James’. Bren was out of surgery and doing much better than we thought he would. We stayed with him for the afternoon and after dropping my mother-in-law home, I crawled onto the sofa around 8pm and conked out! Paul woke me to go up to bed and I had a good sleep. 

After dropping the kids to school the next day I went back to James’, where we had the great news that Bren could go home. The team were delighted with his recovery. They are happy they got all the cancer this time, but he will be back in 3 weeks for more biopsy results just to be 100%. All in all it was fantastic news. Bren looked great, his colouring and everything was so much better. Perhaps it was the relief!

I had a nice afternoon with the kids, sorting out their bedrooms and listening to Christmas FM. The next morning was my GTT (glucose tolerance test). If you follow DoulaCare Ireland on social media you will have seen my posts keeping everyone updated. You can scroll back to 21st December to read them. Our blog on the GTT test is available here . 

After I left the hospital I went straight to my sons school to see his carol singing. It was really lovely and helped bring on the festive feeling. I even collected Leon early so he could come with me too. 

On Friday the boys went to collect holly with my mam and her partner, which they loved. They came back full of muck and fresh faced. It was great as I was due to work a night so I could grab some sleep! I did the night shift and in between caring for the twins and sorting the house, I enjoyed feeling my baby somersault around and kick. She really is a very active baby and I am loving feeling her move so much! Leon is interested watching her move, he thinks its cool seeing my belly. Leon is suggesting Anna as a baby name, Seth really likes Robyn. We still haven’t really felt that ‘wow’ moment yet with any girl names but sure we have loads of time! 

Next week is Christmas! I can’t wait to see the boys faces on Christmas morning. It just makes Christmas having kids :) 

Until next time....Jen x

Week 25: What Is Happening To Your Baby

This week your baby is the size of the cauliflower

• Your baby is the size of a cauliflower this week 
• They are laying down more fat and hair this week 
• As your baby gets more fat, the wrinkled skin gets smoother so they look more like a newborn baby. 
• Your baby is now peeing frequently (and this passes into the amniotic fluid, so that most of the amniotic fluid is in fact sterile urine!)
  • Your baby's brain, lungs and digestive systems are now developed though they are not quite mature yet. 

Week 25: What Might Be Happening To Your Body

• You may notice you are slightly unsteady as your bump grows, this can be due to changes in your centre of gravity. Pilates and Yoga which works on your posture can help give you good balance. 
• Oh dear! Your OH may complain about the noise levels in the bedroom as your snoring gets louder! 
• Frequent urination. As the baby is getting bigger, so is the pressure on your bladder 
• Warm up surges: Also more commonly known as Braxton Hicks contractions. While they usually aren't noticeable until 28 weeks, some Mums will start to feel them from around this time period. They usually go after you change position (so if they don't give your GP a ring). 

Week 25: Pregnancy Tip

The tips this week are aimed at your partner - so they can help you and make your pregnancy a more comfortable one. So get them to read this bit!!! Partners can help out by doing more around the house, running a nice bath, offering to give you foot rubs, lower back rubs or a nice neck and shoulder massage (this will not only be useful for pregnancy but extremely useful during labour). They can also listen to you - this is such a huge time of change and while it may be exciting there can be lots of other emotions involved as well. Keeping up the romance is hugely important during your partner's pregnancy. Surprise her with a trip away or a nice dinner out, and make lots of nice memories together as a family of 2 (if it's your first), before baby arrives. 

Jen's Pregnancy Diary: Week 24

So this week I had a full week of postpartum clients and scheduled phone calls to follow up on. I love that I am feeling better in myself and can still be out supporting families. We have a great mix of clients at the moment (with different backgrounds, ages of children and personalities) So no two days are the same and I really enjoy chatting away with each client, catching up on their news and supporting them with the help they need to make life with a new baby that bit less stressful. 

Picture of the Queue in the Rotunda that circulated on social media around the same week I attended

I had my 24 week check up in the Rotunda public clinic, where I was due to speak with their community midwife team to see if they will accept me. I arrived to an unbelievable queue. Not only was the waiting room to check in full but there was a queue of pregnant women standing all down the hall as far as the clinic waiting room. There was at least 40 women ahead of me.... just to check in!! I really was shocked as some of the women were heavily pregnant and struggling to stand in a stuffy corridor. (It was freezing outside so most of us were bundled up too which didn’t help ;) 

Eventually I made my way to the check-in desk and I was told to take a number and I would be called by consultant. I explained I was due to speak with the team and so she told me to find a midwife at the nurses station to chat to. I did find a midwife and I was told very bluntly that there was no appointment for me to plead my case as there was no point. As Leon was 4.53kg they would not accept me. I then asked about the NBAC clinic and I was told their cut off point was 4kg. I was so stunned by this attitude. I questioned why, in a healthy pregnancy I could not have antenatal care in the community, because one of my babies was over their criteria?? She simply said it was out of their scope of practice, which is absurd. All they do is check my pee, my blood pressure and measure my bump. Surely they could do that and if they were concerned about anything I would happily go to the hospital. There was no talking to them. I did ask why I had to wait until 24 weeks to find this out, as when I spoke with the community midwife team, when choosing which hospital to book, they didn’t seem to have a problem at all. Again very unhelpful, I received an 'it is what it is' type answer. 

I was bitterly disappointed. I wasn’t sure if I was going to cry or boil over with rage, not just for me but for all the other pregnant women using this hospital. Women do so much better with midwifery led care and it is such a shame that a previous “big baby” can put a woman who has a healthy baby and pregnancy in every way into high risk for her antenatal care. I sat another hour and a half waiting to be called, fuming over the system and how women are treated. 

When the consultant called me I went in, still bubbling under the surface. He seemed to think that because the baby is a girl she will be smaller and there is no way she will be 10lbs (surely this is not evidence based at all but interesting to hear a total conflict of their reasoning for not allowing me the care I requested) I spoke with him about my options and he did a similar thing explaining ‘hospital policy’ and so forth.  He did say I had a 90% chance of vaginal birth as I laboured well with both boys and reached the second stage with Leon before a caesarean was required. He reassured me that there would be no pressure on me for a caesarean birth and hopefully everything should go as planned. 

I felt a bit better about this at least, but as I have seen time and time again with doula clients – everything is grand until 38 weeks arrive and then the discussions begin about caesarean, risk with VBAC, big baby and so on. We will just have to wait and see what happens. He said he would like to see me again in 4 weeks so I queued again for 15 minutes and asked for an appointment. The lady was so unhelpful. I was asking about times that I could work childcare and she said I would just get the next available slot.

I decided there was no way on Earth I would do that queue every appointment, so I walked over to the semi-private clinic to see would they take me on. The receptionist there was so lovely. She couldn’t have been more accommodating. Booked me in for a date and time that suited me and cancelled my public appointments. She even moved my GTT to the semi private clinic so I could "relax there, as the rooms are much quieter" -  I wanted to hug her! 

So I left feeling deflated but glad to have the public system behind me. I will think about my options over Christmas. I may make a few phone calls to the Coombe and see what is available there. 

After a crazy week it was wonderful to get out for the weekend. Paul and I took the kids to Causey Farm Santa Experience. It was really amazing, they made it such a special experience and the kids loved it.  We left feeling very festive and even got a take away as a treat on the way home. We all snuggled up after to watch a movie and I for one so needed this day to just switch off and remember what is important. 

The kids went to Butlers chocolate factory with my mam and her partner on Sunday, which they loved. They came home delighted with their chocolate santas. While they were at that I did a mad dash to Blanchardstown shopping centre to get some Christmas shopping done. My tummy has been a bit sick the last few days so I had to keep stopping for breaks but I got the bulk of it done. 

Baby is moving around lots and you can now see my tummy moving with her. Paul gets a little freaked out by this which I find hilarious - he thinks it’s like an alien LOL. He likes to know she’s moving and doing well but doesn’t want to see it!

Until next time... Jen x

Week 24: What Is Happening To Your Baby

Your baby is the size of a cantaloupe melon this week 

• Your baby is really starting to put on weight and fill out this week and they are about the size of a cantaloupe now. 
• Their lungs are developing branches in the respiratory tract as well as cells that produce surfactant, a substance that will help his air sacs inflate once they are born and start breathing in air. 
• Your baby's skin is becoming much pinker and less see-through as they develop.
• Your baby's brain is also growing rapidly now and will continue to develop at a enormous rate over the next few weeks

Week 24: What Might Be Happening To Your Body

• If there are any concerns about Gestational Diabetes you will usually have your Glucost Tolerance Test around this week. You can read more about it in our blog post here
• You may have lots of backache now as your muscles are having to work harder to carry the extra weight. You could try getting some body work done with a physio or osteo, or treat yourself to a nice massage (just make sure the therapist is trained in pregnancy massage and can accommodate you). 
• Dry eyes can be a symptom some women suffer from in pregnancy. This can be accompanied by irritation and a feeling of grittiness. Talk to your optician about how you can make this less uncomfortable 
• Some women will suffer from Piles/Haemhorrhoids during their pregnancy - they can be the result of becoming constipated and increasing the amount of fibre and fluids in your diet can help. It can also help to avoid sitting for long periods of time. Talk to your GP if they are severe as you may need some medication to help relieve the pain. 

Week 24: Pregnancy Tip

There is a huge amount of breastfeeding support around Ireland - find out where you can access support before baby arrives 

Are you hoping to breastfeed? If yes start looking around for a good breastfeeding class you can attend. You may find your hospital run these but they can book up fast, and it's really helpful to take a class before baby arrives. It's also useful to find out where your supports are and get in touch with them beforehand as well - this way you will know who to contact if you should need some extra support after. Friends of Breastfeeding offer a Buddy system, whereby a trained Mum will come out and support you in the early days of breastfeeding. It's such a great idea and completely free - so definitely worth booking. Cuidiu have regular breastfeeding support groups around Ireland as well as trained breastfeeding counsellors who are available by phone to provide support and a listening ear. (Both Mary and Jen are Cuidiu Breastfeeding Counsellors). La Leche League also run support groups around Ireland have their Leaders are available to offer breastfeeding support as well. So do make contact and if you can at all once you are on maternity leave, pop into your local group and say hi. Pregnant women are always more than welcome along and it's nice to meet other Mums who are breastfeeding before your baby arrives. 

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