Losing Control

You can buy all the onesies, bathtubs, diaper bags, and nursery furnishings you want, but you can’t control the way your baby comes into this world. Maybe you get lucky and your ideal birth plan runs smoothly. Go into labor, head to hospital, listen to Beyoncé, have some pain meds, push, et voilà, baby! (or whatever it might be, that’s not mine just an example. Except for the Beyoncé part).

On Friday, following a visit to the hospital to attempt an External Cephalic Version (ECV) –a procedure where the obstetrician attempts to manually turn a breech baby into a head down position. We were told by the doctor that our baby was too small to attempt the procedure, and due to some other factors he wanted us to bring him into the world by c-section ASAP. I tell the details below, I follow the timeline from way back to my earlier post about the breech baby up to yesterday. Before you keep reading, I just want to establish that it may be a hard read, but I’m all OK and baby is OK. 

I wrote this post on Saturday, the day after my ECV appointment, following a bit of an emotional meltdown. Writing for this blog really helps me process my feelings, and I’m so appreciative of the support I get from friends and family who read and respond.

Strong Emotions in the Face of Losing Control

Photo by Sydney Sims on Unsplash

I put on a brave face sometimes, I don’t know where that comes from. I guess I’m the type of person who prefers private emotional meltdowns. So private that I’m totally alone. I even sent Steve out to have breakfast with my dad and go to the gym this morning. He needs selfcare too. So, when I started to break down into ugly tears as I sat folding laundry, and that turned into shortness of breath I realized the best way to deal with this was to write. It had helped me before. So after some relaxing breaths, in for 4, out for 8 (I have to work up to the long holds when I’m in a bit of a state), I dried my tears, blew my nose, and grabbed my laptop to write about what was upsetting me. 

So you may have read in a previous post, baby is in the breech position. There are three types, and the one my baby is in happens to be considered the most risky in terms of attempting vaginal breech birth (feet presenting, complete breech, footling). Since that scan on February 19, I’ve been reading A LOT about breech births and c-sections. Apparently 1 in 20 vaginal breech births result in the baby’s death. Despite reading so many success stories on Facebook Groups, like Breech Birth UK, Steve and I realized those weren’t odds we wanted to take. I did consider trying to navigate the midwife care system here to try and find an experienced midwife who was confident with breech deliveries. But it wasn’t something either of us were confident in, so we decided that if the baby was breech, an elective (i.e. planned/scheduled as opposed to emergency/unplanned) c-section was ultimately safest for both me and our baby. However, I figured I still had time, I was only 35 weeks then. I started trying all the spinning babies techniques and continued with yoga, adding in particular moves said to be good for turn encouragement. 

A few days later (Feb 23) I saw an obstetrician, Dr M, who read over the printed report from my scan. She suggested another scan at 36 weeks to see if the baby was still breech and then would be the time to do an ECV.  I had another scan on Feb 27th (a week since the last one, technically right before my 36th week). Still breech. I saw a new obstetrician, Dr B, the following Monday (March 2nd). That’s how it happens in the UK, you see different doctors, with NO knowledge of who it will be when they book the appointment and it was never the same day as the scan. I honestly don’t understand.

We had met with one of our doulas before this appointment. She helped Steve and I understand a little more about ECVs and c-sections and helped us write a list of questions we should ask. Steve came armed with a notebook and all our questions to the appointment, which pleased the doctor! Dr B answered all our questions, and strongly encouraged the ECV. She wanted to book it in ASAP. Unfortunately the Portsmouth Hospital Trust works in mysterious ways and the person she called to book said the next one available was March 28, which was past my due date! She would have to make a formal request which a team would look at and assess the urgency and schedule me in. I thought I’d be called a day or two later and be in there for the ECV by the end of the week. I called a few times to check in, and while at the hospital for another scan (March 4) I asked at the desk. They said it was on the pile and I would hear from them. I waited patiently. 

Side note here, we even talked to Dr B about being referred to a different hospital trust in another part of England, a few hours away. Folks on the Facebook Breech Birth UK group and our doulas, had recommended this particular hospital clinic for having higher rates of success with ECV (which is 50% nationally). But we couldn’t find evidence of their alleged higher success rates, and the doctor was completely stumped as to how to do such a thing, so we dropped it. We dropped it because it would have meant a lot more work on my part to try and figure it out, and I only had hearsay information to go on for it. Also booking things was hard enough for our obstetricians within their own hospital trust! 

At the March 4 scan, they measured the baby again to estimate his weight. They only do this every two weeks. It was explained to me that they do this because baby’s don’t grow at a steady pace and this could mess with the growth chart. I think that’s important to remember with regard to my experience at the ECV appointment that I’ll get to later. 

The baby had put on some good growth/weight and was no longer at the 10th centile, but above it. This made him a better candidate for ECV. They wouldn’t have wanted to do it if he was on or below the 10th. There were no concerns with the baby. His blood flow through the umbilical cord was good. The liquid around him was good and had reduced slightly, to be expected with the baby's growth.

I didn’t receive that ECV appointment call until a week later on Monday morning (March 9) when I was on my way into another meeting with the first obstetrician Id’ met, Dr M. The hospital scheduled my ECV for Friday, March 13. So much for urgency (10 days after the obstetrician had made the request). When I went into the appointment with Dr M I told her that I didn’t want to wait any longer to schedule a c-section. I was worried that it would take a long time for the hospital to get back to me, that it would be pushed back late in my 39th week and cause more stress waiting. I hate waiting. Dr M agreed to put in the scheduling request right away before the ECV. I asked Dr M if I should bother attending the ECV. I would be 38 weeks and all the healthcare professionals to touch me had been saying it’s hard to feel baby’s position because of my ROCK HARD ABS OF STEEL. She said, if it was her or a loved one she would encourage going because there’s a 50% chance of success which could mean a vaginal birth. And besides, the baby was a good size and it shouldn’t be a risk to him. I thought about it overnight and meditated on it. I decided there was nothing to lose but an afternoon of my time– which let’s be honest already belongs to the baby and will do forever more– I might as well try.

Friday’s ECV Experience

Now, we’re all caught up to March 13, I’m 38 weeks pregnant. The day before the ECV, I received a letter scheduling my c-section for March 24th. That date would be 39 weeks plus 5, only two days away from my estimated due date. 

I took my Mom with me to the ECV because I wanted her there as a supportive and calming presence and could put Steve to work on other projects. The initial part of the ECV process is to hook up to a CTG machine which measures the baby’s heart rate and movements. Can I just add here, this was the first time a midwife touched my stomach and knew straight away where the head was. Perhaps this is because the last manual attempt was by Dr M on the 23rd Feb when I was 36 weeks and since then the baby has grown, pushing him up closer against my abdomen. I’ve certainly felt that truth! 

Every time the baby moved I was told to click a button. This would be alright if it wasn’t for all the noise and the tightness of the CTG monitors on my stomach. I kept thinking, is that a movement or just my discomfort? And not only was my baby’s heartbeat pumping away on my machine, but we were a curtain away from another woman on a CTG. Her machine was much louder than mine and was so distracting! Mom lent me her headphones to help block out some noise and I closed my eyes. The midwife offered me ice cold water and that brought the baby to life a bit more. It was cool to notice how his heart rate increased when he moved and that my click of the button aligned with the graph monitoring the movements electronically. Good, I really did feel that.

The woman next to us was concerned that her baby’s movements weren’t as strong as they had been previously. She was only 30 weeks. But her CTG results and all other tests were coming back positive. Her baby certainly moved more than mine, he tends to be active one day and super chill the next. Friday was a chill day. I did feel for her. I imagined it must be really stressful to worry like that. Before I really recognized my baby’s one day on/one day off pattern I would sit there willing him to move. Every other day, I was thinking, please don't be dead. It’s hard. They told her to come in tomorrow and monday to keep doing the CTG and they can keep a track of it. I hope that everything really is fine with her baby, and that the additional CTG’s put her mind at ease. I reflected, that’s one great thing about the NHS, she doesn’t have to pay for each of these CTG tests. I wondered what insurance coverage in America would be like for all the scans and appointments I’ve had myself. 

When my results were looked at by the midwife we got a glowing review. Good heart rate, good movements and no distress. Yay baby. Then we had to wait for another 2 hours before the on call doctor, Dr G, was available. He had been around shortly before my CTG finished but then was called into emergency surgery so had disappeared. Luckily, mom and I had our books to read and free wi-fi. I started to get hungry around 3:30 but the midwife said it was best not to eat anything. Boo!

By 4pm, Dr G was on the ward and ready to go. He reviewed my notes - the past scans, the notes from each midwife and obstetrician appointment, and the CTG results. The first thing Dr G said when I told him I was 38 weeks, was that this should have been done at 36 weeks. NO SHIT. Sorry, but really it’s his colleagues who sent the referral and the admin staff who booked me in. Perhaps the urgency wasn’t made clear on Dr B’s referral form, or there were just other women with higher priority. He said it was low likelihood that it would work. I kind of already knew that so it didn’t bother me. 

He told me the first thing they do is carry out an ultrasound to check that the baby is moving OK and has plenty of fluid around him. If he’s happy with that he would administer a drug to relax the uterus and then manually try to push the baby around. 

He covered my stomach in the lubricant jelly. Like so much of it. It was all over my jeans at the end and in my belly button (what’s left of it!). It was kind of comical. I also thought it odd that he wiped me down after instead of letting me do it myself. He wasn’t efficient so I had to do it again anyway! Haha! 

Unfortunately, the doctor wasn’t happy with the amount of fluid surrounding the baby. He also had noticed that although the baby was above the 10th centile at the last scan, it was still on the small side. This told him that doing the ECV would be “an insult to the baby”, in other words it would cause distress to the baby and more likely result in the need for an emergency c-section. That was fine with me, I had expected it. Alas, a c-section will be my birth plan. Finally, I don't have to feel like I need to keep preparing physically and mentally for a vaingal birth that might or might not happen. That’s a relief.

Because of the lack of fluid, I think he wanted to check more of the baby’s measurements and blood flow. He took measurements to assess the growth and estimated weight of the baby. To do this they measure the length of a femur bone and the circumferences of the stomach and of the head. Then there’s a magical spell/mathematical calculation and they estimate weight. The baby’s weight hadn’t changed much at all in the past week. A one ounce increase. This put the baby below the 10th centile. This concerned him. He checked the umbilical cord blood flow and was happy with that. He checked blood flow in the brain, but this was the first time that measurement was taken so he couldn’t compare it to anything. It was hard to tell if it was good or bad. But all of this told him that we shouldn’t wait until March 24 for the c-section.

He told me and Mom not to panic, but that he strongly felt that my c-section should be moved forward to this week. He also said he wanted me to come in twice a week for the CTG procedure to keep a check on the baby - that was a little concerning. He reassured me that the CTG results today were great, but because of the baby’s small size and limited fluid they want to make sure it stays great. I read his body language to be agitated, he was quite focused on working with the supporting midwife to make sure the c-section got brought forward “ASAP”. 

The scheduling staff had already gone home for the WEEKEND (yeah, apparently you can’t schedule c-sections on a weekend, I’m all for staff having time off, but wouldn’t they stagger it to have at least one person around on weekends? Or at least stay until 5pm on a Friday?!). Dr G asked the assistant midwife to write urgent all over the scheduling request and he took one my patient details and put it in his pocket. He told me he was on call all weekend and if he saw someone from the team he would ask them to schedule it right away. Otherwise I would get a call on Monday. Given my experience with their scheduling, I was not convinced they’d call Monday. I was disappointed. I hate waiting. Luckily, I received a call a few hours later from someone who had the power to rearrange the schedule. They moved my c-section up to this Wednesday, March 18.

Mom and I left the ward and she asked me how I was feeling. “OK,” I said. “He told us not to panic, so I’m not too worried.” “Oh, I’m hysterical,” she said as she burst into tears in the hallway. She was so worried. So I comforted her, and said it would all be ok. I did cry a little, because she’s right, it’s kind of unnerving. I reminded her (and myself?) that if it was that worrying, they’d be doing an emergency c-section right now. She felt guilty for being the upset one out of the two of us. Looking back at it now, I think we just process things differently, I perhaps have a delay to my emotional reaction and worry.

When I told Steve about it, I urged him not to panic. He’s concerned, but not panicking. That was what I told some of our closest friends as they reached out to see how the ECV had gone and I shared the news. My friend Catherine called me immediately, she’s been very supportive and wishes we weren’t so far apart! We talked it through and we were able to laugh about a few things. Before leaving the ward, the midwife had given me a steroid shot that would help the baby’s lungs develop, to reduce the chance he’d need lung support in neonatal intensive care after the c-section. The midwife told me it would be given in my flank, so I turned and dropped my jeans and underwear down, exposing my whole butt. “Oh, someone’s keen, I only need to access the top part!,” she chuckled as she pulled up my jeans for me! It was pretty embarrassing, but you have to laugh! And it felt good to laugh about that with Catherine.

That evening I repacked my hospital bag, and reviewed what clothes I have for tiny babies. I don’t have much in the 5lb-9lb range, so we might need to get more, but we will see. Steve kept assuming we’d have a big baby because his sister had a big baby. My side of the family had smaller 6lb and 7lb babies. Right in the average range I guess. It felt good to do something practical. I have already read a book about cesarean sections that my doula lent to us, and I watched an operation on youtube a few days ago. It was so fascinating to visibly see what they do and the many layers of the body they go through. It hasn’t traumatized me. Yes it was shocking, but I think my brain likes to be informed. I’d rather see that than have a wild imagination. The two things that really blew my mind: they take the uterus out of the body and rest it on top of the tummy to do the stitches, and secondly they use these white cloths to wipe up blood and bits, normal enough, but the doctor actually shoved his whole hand and that cloth inside the body to mop up. I was like, ugh gross. 

Photo by Matthew Henry on Unsplash

Saturday’s Distress, How Anxiety Takes Hold

At 2am I woke up. Porter was drinking a lot of water and I noticed Steve wasn’t in bed. He was in the spare room with a light on. Sometimes he goes to read when he has trouble sleeping. I didn’t disturb him, I figured I’d fall asleep again and he would eventually too. In the run up to this baby arriving we’ve both had our share of sleepless nights. Preparation for sleepless nights with a newborn, I guess. I was hungry though, and I had a splitting headache. I couldn’t fall asleep. I went to the kitchen for a snack and more water. I eventually took a tylenol and put on the Sleep With Me Podcast around 3:30am.

The Sleep With Me host is a man with an amazing voice who rambles on at you enough to distract your mind from anything on it, but not enough to engage you in something worth paying conscious attention to. So you might be able to fall asleep! It’s an hour long, the first ~15 minutes are usually about sponsors and how it works, so that doesn’t help me sleep, I try to skip forward to get to the story if I’m really keen to fall asleep (paying subscribers access story only episodes).  I’ve used this a few times, especially when I have a lot of anxiety. It usually works really well for me, unless I’m super stressed and then it takes a few attempts. He was talking about The Good Place show on Netflix, well I mean rambling nonsense about it. At some point I dozed off, but I woke up toward the end of the podcast when he was rambling about Justin Beiber’s new record. I didn’t want it to end, so I skipped back to where The Good Place rambles started. I fell asleep more quickly and the next time I woke up it was 6:30am, the podcast had been over a while.

My headache still existed and this made me cry. I felt sorry for myself. I was exhausted and did not want to be getting sick. I was worried that I may have caught germs somehow from my niece Emma who has had a string of viruses and was just diagnosed with bacterial strep throat. That was over worrying because I haven’t seen her in weeks. She’s been kept home, thankfully has medicine to help her recover now. 

Yesterday, I had convinced my Mom to host our weekend snack time at our house, instead of McDonalds, due to the coronavirus, and that not being the cleanest establishment! She invited everyone over. Except Emma, we’d take her a muffin later because she won’t have cleared 48 hours on the penicillin. Poor girl missing all the fun! But this morning I texted my mom (who was down the hall) and told her about my hard night, headache, and feeling drained. Right away she cancelled snack time at the house. I don’t know for sure, but bet they moved it back to McDonalds! I think I’m the most coronacerned in my family at the moment. I mean, I’m about to have major surgery and a newborn baby, so it’s understandable. 

I told Steve about my rough night, and said I just needed to stay home and chill. He wanted to go out for breakfast with my dad and then to the gym, so off they went. Alone in the house, I made myself a decent breakfast and read an article in the Times magazine (the british newspaper, not the NYTimes). I’m trying to spend less time on my phone because I end up researching all the things that could possibly be wrong with my baby. Despite this effort, when I went to fold the laundry I just burst into tears. The kind of tears that come deep from within that you really tend to only do when you’re alone. Movie worthy emotional crying. Deep ridiculous sobbing. I was overwhelmed with fear that my baby isn’t actually OK. That something could be wrong with him. That the placenta I raved so much about in an earlier post has stopped working effectively, preventing the kind of growth the doctor’s want to see. 

All these worries and thoughts like I might have done something wrong. Did I miss too many days of prenatal vitamins? Did I exercise too much? (I literally LOL at that one). Should I not have flown to New York and Europe at 29 and 30 weeks, respectively? Do I have my laptop too close to my belly as I write this? Do I use my cell phone too much? 

The truth is this kind of birth reality is so far from what I think I really expected. It's so out of my control. I was so focused on everything going smooth - baby will be in the right position, unconcerning size, and will pop out of my well prepared vagina due to well rehearsed movements and breath work.  I’m going to crush this pregnancy and birth thing, I thought. 

I wasn’t too worried when the breech position was the main indication/reason for the c-section, but Friday’s ECV experience did freak me out a little, honestly. Dr G said, don’t panic. But when you’ve never been through this before and not seen the other side, how could I not! The truth is, I don’t know that everything will be OK. The baby could need to be in intensive care. He might have trouble breathing. He could end up with brain damage. He might already have brain damage? I don’t know. No one knows. 

I think I calmed down when I realized this. No one knows. It’s just out of my control, out of anyone's control. We can only do our best. I can only do my best, make decisions for me and my baby based on the information and research I’ve read, and on the doctor’s advice. I feel a like I have to trust the doctor, though he may be overly cautious than another doctor would be. But who am I to judge? No matter what I’ve read, I am still following his lead. And I am OK with that too. That’s part of my personality. I always want to consult the experts. Dr G is the expert here. I’ll follow his lead. And if he says don’t panic, then I will not panic.

I think that’s how I managed to calm myself down. It’s OK to have those moments of fear and distress. It’s natural when facing something unknown and upsetting. But everything will be OK because life is a total unknown rollercoaster and sometimes bad things happen, but life goes on and other good things will happen. I will love my baby no matter what happens. I hope he survives birth and is healthy. And if he’s not healthy, Steve and I have each other and amazing friends and family to support us as we navigate that situation.

Photo by Faye Cornish on Unsplash

Update from Saturday Evening

Steve and I returned to the hospital for my second steroid shot on Saturday afternoon, and another go on the CTG machine. Today was an active day for the baby, so I imagined we’d have more fun. The midwife still gave me ice cold water and that definitely got him moving. It was also really cute to have Steve yell-talking at the baby and it made the baby’s heart rate go up. He was excited to hear Steve’s voice.  Steve being there was definitely different than my mom. He was playing around and turned on this overhead spotlight I imagine is there for vaginal inspections. He shone the light right in my face and asked me where I was 38 weeks ago, as if interrogating me for a crime. "The baby is yours Steve," I rolled my eyes.

Following the CTG, I asked the midwife to explain the results to us. She showed us where the baby’s heart rate was, average around 125 bpm, and that the increases coincide well with the movements. She said we have a very happy baby, and that it was a textbook result. This felt good to hear, he’s still moving well and his heart is strong. Then Steve asked if she could further explain why the doctor would want to move our c-section up so urgently. In a much more calm and understandable tone she just explained that sometimes the placenta gets to a point where it’s just like “eh I’m done,” and that can cause the reduced liquid around the baby. Since the baby is already at term, he’s just ready to come out. Because he’s breech and small it’s best for the delivery to be by c-section. 

The successful CTG and her explanation really helped us leave the hospital happy, calm and excited to meet our baby on wednesday. So now we can just prepare for that, and I’m sure I’ll post again about our thoughts going into it.