Patient A

I have had this post open in ‘drafts’ for a number of days- the beginning of Finn’s hospital journey and I realised it was also the end of mine.  I want to tell his story chronologically, factually but without the intention of terrifying others. I want you to hold onto the knowledge that there are positive outcomes, even when times are so dark they seem impossible. For me, this still touches a nerve when I attempt to explain it and I think perhaps even more so now, because in those first days, in reality, I was clueless. I have been very lucky that up until Finn’s birth I had never spent any time in hospital, nor had any of my family or friends been in hospital for anything too serious or for any length of time and so I had no first or even second or third hand experience of hospital life. The daily routines, pharmaceuticals, staff change over, food, opening hours, visiting hours, hand washing, bed space, it was all brand new! After Finn was born and then revived on the resuscitare, he was taken directly to the NICU where we were then unable to see him for a number of hours. Interestingly, and I guess quite obviously, at that moment Finn and I became separate patients: I, Patient A on the Labour Ward- at this point to now be treated as a postnatal mother, and Finn, Patient B, on the NICU.  I was moved for bed space on the Labour Ward into a room (or cupboard) further down the corridor with no windows within about 30 minutes, Finn was born at 00:30 after which I think I managed to grab about two hours sleep out of pure exhaustion in my new cupboard before 06:00 came and a nurse told us that Finn had been stabilised and that we were allowed to see him. In addition, though, I was also now being moved up to the Postnatal Ward where they wanted to keep me for an additional night, so, she asked, ‘Could I please gather my bags?’.

I will come to the part of seeing Finn for the first time but I do feel it is of great importance to talk of my experience as Patient A. I was, understandably, not in the right frame of mind, nor was it my priority to contest my room changes x3 in the space of less than eight hours. Being a first time mother, and therefore naive in relation to the aforementioned hospital routines, I was not aware that I, being completely well, was able to discharge myself to focus on Finn. There was absolutely no reason I needed to stay an additional night in hospital; I required no medication except perhaps over-the-counter pain relief, I personally suffered no complications, and with Finn being on the NICU the only time I would need to spend on the ward would be to sleep. Let me tell you, it is quite simply brutal to put a new mother, following a traumatic birth, separated from her critically ill baby (who may never make it), onto an open ward of women and their crying, healthy bundles for the night to ‘sleep’ and recuperate!

I lay in that bed, with my hands over my ears separated only by a curtain from the five other women and their babies surrounding me. I had not cried until this point for the purpose of self-preservation and to try my hardest to be in the right frame of mind to make decisions with the doctors over Finn’s care. I wept, uncontrollably, like a small child struggling to take inward breath. As all of the mothers around me cooed and fussed over their newborns, their partners whispering encouragement, nurses and midwifes popping in to offer support in the darkness, I realised with full force the lack of a bassinet in my own bay. I stayed, my knees tucked up to my chin, behind my curtain- not once did a midwife visit me. Sore and exhausted, I left the bay and hobbled toward the nurses station in the vain hope of a paracetamol, too shocked and exhausted to appreciate the fact that it was quite possibly the cruellest thing I would ever have to endure, and that I had a choice- I didn’t have to be there, to be subjected to that.

To make matters worse, I begged the next morning, to leave, in tears I explained to the midwife on duty that I had not been visited by anybody for pain relief or indeed to check on my emotional state, I also made a point of mentioning that it was not remotely sensitive of the hospital to place me on an open ward full of mothers and their healthy babies. It took another three hours before the discharge papers were processed. I sat in a sterile waiting room on a cold leather sofa while a midwife and, looking back now I assume a student, came to speak to me about my leaving hospital. I am so angry as I think back to this and have to write my next sentence. The pair of them then proceeded to tell me the safety measures of caring for a newborn baby. They asked me if I knew how I should bath a baby. They told me where to hold him, to support his head, how to test the temperature of the water…how to put him to sleep in his cot- to make sure I positioned him so that his feet were at the bottom of the cot so that he couldn’t wriggle beneath the blankets… I sat staring, exasperated, shocked- dismayed at the ignorance! To tell a woman, visually distraught, her notes in your hand, how to care for a healthy newborn when (if at all), it is going to be a very, very long time before she ever gets to take a baby home…I can’t even begin to comment. You might think that somebody would have realised that perhaps it was not the right time to have that particular conversation. It was so by the book, so impersonal, so shockingly ignorant to attempt that dialogue that it broke me. Up until that night in the Postnatal Ward, I had held it together, I had stayed strong, I had with resolution and determination, visited my baby, my thin frail foetus of a newborn and spoken with the doctors about his progress and potential fate, but that conversation with the two midwives who discharged me and the night I endured on that ward I will remember for the rest of my life. I walked with my husband out of the doors of the Elizabeth Garratt Anderson Wing to a fierce blast of freezing February air. My poor father, desperate in his grief, tried to help me into the car, Danny carrying the bags behind me. I was numb.

This is in no way a diatribe on the NHS, but it was an unfortunate, and at the time, devastating oversight on the part of whomever was responsible for moving me along that night, or a fault of the system in general. My care, antenatally on the Labour Ward was exemplary, but this has stuck out to me as a very serious aspect of postnatal care that needs to be addressed- the care of women after birth who are exceptionally vulnerable following either still birth or any birth resulting in the separation of the mother from their newborn child.

Should you ever need to raise concerns with the NHS department or hospital where you have received treatment, every hospital has a PALS office where you may submit complaints, observations or indeed commendations. Let us not forget that this is one unfortunate example, one that I have articulated with the view to raising awareness around preterm care for not just babies but also their mothers. Finn, in contrast, was a recipient of the exceptional.

Transverse

As I sit typing on this rainy May afternoon, Finn’s vest is coffee stained from throwing his arm into my already cold Cappucino, the dog howls along to the repetitive jingle of VTech’s version of “Old Macdonald had a farm” and I’ve thrice had to sprint the length of the bedroom to wrestle my miniature escape artist from attempting to crawl off the top step of the stairs. This, you see, is why this is not a forum through which I seek sympathy, you may read things you find confusing, disgusting, hard-hitting and quite frankly devastating but how lucky am I, despite everything, to have had the morning I just described?

The title of this post is Transverse. For the squeamish, yes, this is a birth story! Once it was clear the baby was not going to shimmy back up the birth canal, the Consultant Obstetricians and the Consultant Neonatologists, in their ways, debated the pros and cons of a C-Section from the point of view of the mother and the point of view of the baby respectively- I was left to decide. “The baby is too small, you may end up requiring a hysterectomy” said the Obstetrician. Twenty-six, first baby, hysterectomy and still birth are not what one ideally should ever have to hear in a single conversation. “A caesarian will give the baby the best chance of survival” said one doctor, “the head is already passing through the cervix” said another.

A vaginal delivery it was, because to call it natural really points out its unfairness.

What I remember really vividly is that despite being given a stack of Tommy’s and Bliss leaflets telling me everything to expect about having an early baby, advice on dealing with bereavement, a list of everything that may very possibly be wrong with my child, there was not one singular moment where I acknowledged that it would happen. In those hours I was my only ally, I could cry and accept my fate, mourn the almost inevitable loss of my first unborn child or I could cling to positivity because that was all I had- I had to align myself with a mindset.

As the Obstetrics team sympathetically offered me an epidural to make it as pain free and calm as possible, I knew they were preparing me for the worst. ‘Will it make the baby any more docile?’ I asked, ‘Potentially, yes’ was the response. So I knew then that I had to do everything I could to give him the best chance! In some sort of determined denial, I gritted my teeth, I breathed, I got on my knees and I pushed with all of my might. Shocked by the speed of it I fought the spasm-inducing oxytocin, the bile rising in my throat, the acidic burning that was Magnesium Sulfate traveling intravenously up my right arm into my chest, my neck, across my face and in some delirious exhausted state with no pain relief I pushed, at times without contractions, until my baby was born. Transverse- yes, sideways, that is: right arm, episiotomy, head, body, blue, floppy, no respiratory effort, no detectable heart rate and placed in a plastic bag onto the resuscitare.

I’d do it all again in a heartbeat.

Women in preterm labour are given steroids to help mature the unborn baby’s lungs and this can reduce the risk of dying by 40%. Magnesium Sulfate, which is a terrifyingly painful drug, is delivered in two doses intravenously for a time slowing down contractions, its administration also reduces the risk of Cerebral Palsy for babies born too early. If you’re wondering, or are confused about my mention of oxytocin, oxytocin is actually a hormone naturally produced by the body to start contractions and a drug form is used to induce labour.  Odd then isn’t it, that I was given it? Once it becomes clear that the baby is better off out than in, so to speak, oxytocin is administered to speed up the labour, causing painful, strong and very frequent contractions. So painful and frequent in fact that having already been contracting regularly for two days with virtually no sleep and having to use a bedpan for a week as the doctors were doing everything they could to keep Finn in,  the administering of oxytocin meant that Finn was born within two hours, and as you’ve read, quite dramatically.

You might also be interested to know that up until the day that Finn was delivered, my waters still hadn’t broken. Some preterm babies are actually born in the waters intact. The sheer force of the contractions sped up artificially through hormones caused my waters to burst at the pushing stage, followed then by a placental abruption which meant Finn was not receiving oxygen via the umbilical cord and the delivery room on the labour ward suddenly filled with what felt like one hundred people in a state of emergency. My mum, I think, was screaming and that’s why I was forced to push without contractions; the longer Finn was deprived of oxygen, the more likely… well the rest hardly needs to be said.

Truly though, despite all of this, facing labour with all of the heartbreaking possibilities that could have been our outcome. Danny and I were the perfect team! He was an unwavering motivator: hopeful, encouraging, excited and then ecstatic at the knowledge of hearing we had a little boy for the first time! He never once showed me he was scared. And the pain? I joke sometimes that I only had to push out half a baby, weighing less than 2lbs- he was minute but being transverse, the pain at the final hurdle is just indescribable. I do know though that I got into a rhythm, you can work through contractions, you can find a way to cope because once it’s all over all you really need is a strong sugary cup of tea and a good night’s sleep and at the end of it, regardless of the outcome, you know you have tried your very best for you and your baby, and that, quite simply, is the only power you have.

The Beginning

I pondered with the view of starting this post with the statistical chance that I had of going into ‘spontaneous preterm labour’ but then I have just returned from Finn’s 1 year corrected development check and I have been firmly shunted into the realisation that it’s not the statistics that matter but on which side of them you fall.

I do know that 1 in 9 babies in the UK are born early; it is less likely to happen at the point of viability (you’ll notice that the UK abortion limit is 24 weeks gestation where it is believed that a foetus becomes viable, that is, able to potentially survive outside the womb); less likely to happen to healthy young Caucasian women; but to be young, white, middle class, healthy and to go into labour at 23 weeks the night before one’s wedding is virtually unheard of.

Survival rates of 23 weekers are also sickeningly low at approximately 15%. Of those 15% who survive the birth itself, many die soon after or may have life long significant health problems: lung disease, poor hearing, blindness, neurological or developmental disorders, Cerebral Palsy.. the list is endless. And so part of writing this blog is not to terrorise with a fact list about that which awaits if you go into early labour, but to educate, offer some comfort to those who might be going through something similar, or have had in the past. Writing it down is something that I have thought about for a while, but feeling that I have for the past year, been living in a state of, I suppose, trauma, I have not felt able until now, to open the laptop and start.

I remember being desperate to seek some support from anybody who had the slightest inclination of what I was going through, desperate to read success stories about terribly sick babies now bouncy toddlers with a medical history as long as their arms but a future unaffected. I craved this but also feared typing #23weeker, #24weeker, #premature, #preemie (a word which for some reason I hate) into Instagram for fear of what I might see that I didn’t want to. So I hope that, whomever this reaches it might give just something, words from somebody through the other side, that I so desperately needed, myself, to read.

Prematurity is a subject about which most know very little. Before it happened to me, I remember knowing that babies were born early, that they had to go into incubators until they were big enough to go home- but that was the extent of it. But if you think about the reality of an early birth, a birth as early as mine for instance, my baby, Finn, missed the entire third trimester. Luckily (if that’s the right word) after a ‘spontaneous maternal PV bleed’ (as I have read so many times about myself in Finn’s medical notes) which caused my going into preterm labour at 23 weeks gestation, I was bluelighted to UCLH London, put on bed rest, tipped backwards almost upside down to counter gravity and given a cocktail of drugs to prevent my labour progressing, Finn was born at 24 weeks and 6 days gestation weighing 730g or 1lb 10oz. This extra week gave Finn an additional 9.5% chance of survival. Little did I know, surviving the birth was just a tiny part of it, for all of us.