The Finish Line

At approximately 10:30pm on Wednesday 24th February, at gestation of 37 weeks and 4 days, my water broke. As it was late in the evening, and everything appeared normal, I did not phone my midwife until the next morning. This is standard practice so that they can be at their best when they need to be later in your labour, as they are likely not needed until at least the next day. The advice if early labour starts at night is to try and rest, and monitor any contractions. While I didn't get much sleep due to my brain running overtime, I did not experience any contractions overnight.

After speaking to my midwife on Thursday morning, and them learning that my water had broken but I still had not felt any contractions, they asked me to meet them at the maternity ward of the hospital for an examination. On arrival they hooked me up to a monitor consisting of probes strapped to my stomach, one that measures the baby's heartbeat, and one that detects contractions. After 20 minutes of continuous monitoring, no contractions were noted, and the heartbeat was healthy. My midwife then performed an examination of my cervix, which was still closed, and took swabs of the fluid still leaking to confirm that it was amniotic fluid and that therefore my waters had broken (apparently sometimes urinal incontinence can confound things, but thankfully that hasn't been an issue for me). The initial swab test came back as a weak positive, and subsequent a test confirmed this. The concern with the water breaking before labour commences is that the amniotic fluid is sterile, and is what protects the baby from infection. If the baby is not born within 24hrs of the water breaking, then IV antibiotics are administered to the mum to protect the baby. I was advised to return to hospital that evening if nothing had changed, to be admitted to receive antibiotics and to begin the process of inducing contractions.

Upon admission to hospital, I had an IV inserted and a midwife performed another examination of my cervix, and assessed my readiness for labour (I wasn't; cervix still closed, baby not in position, but still leaking amniotic fluid). She applied a prostaglandin gel behind my cervix, the purpose of which is to help soften the cervix ready to thin and dilate for birth. This alone can sometimes be enough to bring on labour, but more often is used as a precursor to a synthetic oxytocin IV drip, oxytocin being the hormone that drives labour. The next morning, after being seen by the obstetrics team and discussing the plan, I was moved to a birthing room and once again hooked up to the monitor. Following a continuous half hour of monitoring to check on the baby and confirm there were no contractions yet, at around 11:30am the midwives looking after me began the drip. I was also given the first dose of IV antibiotics, which were to be given every 4 hours until the baby was born. As the monitor showed no contractions, and I wasn't feeling any, the oxytocin dose was increased every half hour.

My midwife, who had been busy with another woman she was caring for, popped in and established that even though I couldn't feel anything, if she palpated my abdomen she could actually feel that I was undergoing some contractions that the monitor had not been picking up. With some adjustment they managed to get the monitor to work, and even though I felt nothing I was apparently having  6-7 mild to moderate contractions per 10 minute period. This was not ideal, as this can be indicative of hyperstimulation, where the contractions were too many and too small to actually progress labour, and can begin to cause distress to the baby. Thankfully my baby was not showing any signs of stress at all. The decision was made to reduce the oxytocin dose again, with the intention of reducing the frequent contractions before increasing the dose to hopefully bring on fewer, stronger contractions to dilate my cervix and bring about labour. After nothing really changing despite reducing the dose for a couple of hours, the midwives upon consulting with the obstetricians decided that since there were no signs of distress to the baby, to just continue ramping up the oxytocin dose for a few hours to see if they could just bring about bigger contractions. During the course of the day, I was advised not to eat, and to limit fluid intake 'just in case'. After several fruitless hours, and a further check confirming no change to my cervix, at around 7:20pm the call was made to perform an emergency caesarean section. The baby was still not in distress, but since it had now been almost 48hrs now since my water broke, they had to get her out somehow! Thankfully my lack of pain and the fact that the baby was still doing well meant that I wasn't feeling particularly stressed about how things were going, just getting frustrated at the long day of waiting to see when and how my baby would arrive.

The anaesthetist and obstetrician both met with me briefly to go over the procedure, risks and consent paperwork. Since I hadn't required an epidural, I was to have a spinal for the c-section, where anaesthetic and morphine was injected into my lower back, bathing the spinal cord and numbing my body from that point down. We were prepped for theatre almost right away, and at 8:17pm on February 26th 2021 our beautiful baby girl was born. My abdomen was obscured from my view with a curtain during the surgery, but they showed her to me as soon as they pulled her out, all shrivelled and purple, before briefly taking her aside to perform checks, and let Dave cut the remaining section of umbilical cord. They administered a vitamin K injection, which is standard procedure as babies are born with low vitamin K, which can put them at risk of a bleeding disorder. They put a nappy on her, then placed her on my chest for skin to skin contact and covered her with a blanket. It sounds cliché, but the moment she was given to me, I had the overwhelming feeling that everything was going to be ok. My heart rate, which had increased when they announced they were ready to start the surgery (mostly because it finally hit me that we were about to have a baby), immediately dropped to closer to normal as I relaxed. 

Dave and I could not be prouder or happier that two years since starting this journey, our baby girl is finally here. Perfect, healthy, and free of the SCA3 gene.

Our wee family of three

Nerves (not that kind)

 Incredibly, today marks one year since my egg collection procedure, and I am now 37 weeks pregnant. While estimated due dates are set for the 40 week mark, a baby born any time from 37 weeks onwards is no longer considered premature, and is full term. 

Over the last month, I have continued with the routine fortnightly midwife check ups, including one where I met my midwife's practicing partner, in case she ends up being the one on duty when I go into labour. At 36 weeks I had a follow up blood test, and now that I am taking supplements daily, my iron levels are now within the normal range. Dave and I also attended a weekend of antenatal classes, which both consolidated information we aleady knew and provided further information around pregnancy, labour, birth and caring for a newborn. 

Following recommendations from the antenatal classes and my midwife, I have also attended a brief group training session with a physiotherapist at Nelson Hospital to learn how to use an obstetric TENS (Transcutaneous Electrical Nerve Stimulation) machine so that I can hire one should I want to use it during labour. Basically, this device emits an electrical signal through each of four adhesive electrode pads that you stick in position on your lower back. The idea is that the electrical signal confuses and helps ease the pain signals from the contractions, particularly during early labour. I have hired one from the hospital so that I have one available should I choose to use it - it's only $30 and this is just to cover the cost of the adhesive electrodes which are replaced between each patient.

The TENS machine and wrist splints on loan from Nelson Hospital

I have also had another appointment with a physiotherapist, this time because I have developed pregnancy-induced carpal tunnel syndrome. While this presents the same way as those who develop it from overuse (tingling and numbness in the fingers and hands, shooting/burning pain up the arms), pregnancy-induced carpal tunnel is caused by the build up of excess fluid in the wrists pressing on the nerves, rather than swelling of the tissues around the nerve. I often wake up being unable to flex my hands properly until the fluid has a chance to redistribute as I move around. The good news is that it should hopefully rectify itself in the weeks or months after birth. The physiotherapist has also given me wrist splints to wear overnight, which should help keep my arms in a straightened position, limiting the build up of fluid, as it's usually worst at night and first thing in the morning. The bad news is that it can take months to resolve after the baby arrives, so I may have to care for my newborn without the full function of my hands. Fingers crossed it dissipates quickly.

All in all, besides the carpal tunnel syndrome and feeling increasingly tired, I still feel pretty good and think I am thankfully getting off lightly so far.

Perfectly Average

This week I had another routine midwife visit, with the usual measurements (blood pressure, urinalysis, foetal heart rate) all checking out as normal. Routine checks with my midwife have now progressed from monthly to fortnightly as my pregnancy advances. My midwife is now also measuring my fundal height (length from the top of my bump down to my pubic bone) each visit to help track the growth of my baby. Fundal height should roughly correlate with the gestational week. Last visit my measurement was slightly above average - 30cm at 29 weeks. This week I am 33cm at 32 weeks - so still a little above average in measurement, but growing steadily at ~1cm per week, which is ideal. Overall, my midwife seems happy with my progress.

Diagram illustrating measurement of fundal height.
From: https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/multimedia/fundal-height/img-20008049

I also had my 32 week scan, which was primarily to check position of the placenta relative to my cervix, as it was quite low in my 20 week scan. Today it was deemed to no longer be low-lying, which is good. They also checked the level of amniotic fluid, and took several measurements to check on the growth of the baby. Everything is thankfully looking very normal at this stage, and the baby's weight is currently estimated around the 2 kilogram mark, which is perfectly average for this gestational age. As the ultrasound technician pointed out - this is one of the times you actually want your child to be average! She is currently positioned with her head down, her back along my right hand side, and her backside up near my ribs. This explains why I tend to feel the most movement in my lower left abdomen - that's where her limbs are as she moves them around.

During my next midwife visit I will meet with my regular midwife's midwifery partner, so that I can get to know her in case she ends up being the one attending the birth. We also have antenatal classes coming up, so we are already getting used to much of our time already revolving around the baby - a sign of things to come.

Testing, testing

Nothing much to report (at this point no news is good news), but I thought I'd write a bit of an update of the appointments and tests I've had lately.

Midwife checkups
Routine 4-weekly appointments with my midwife have been thankfully uneventful, with my blood pressure, urinalysis, and the baby's heart rate all checking in as normal each time. They use each appointment to discuss any concerns, pass on information on what to look out for during pregnancy, when to call them, and when to arrange any upcoming tests. From here, my next appointment is 3 weeks following the previous, and then the checkups will move to fortnightly as my pregnancy is further along.

Anaesthetist
Four years ago I had a serious of four surgeries on my lower spine within the space of about five weeks; the first to remove a piece of prolapsed disc, and the subsequent surgeries to address complications I experienced. I mentioned this to my midwife, particularly since I was wondering if the scar tissue I likely have would affect my ability to have an epidural or spinal should I want or need one during the birth. They referred me to the hospital to discuss this directly with an anaesthetist. Incidentally, when I arrived at my appointment the doctor was the same one who oversaw my anaesthetic for my first spinal surgery. They asked me some questions about the surgeries, my recovery and current health, and performed a quick examination of my back to assess how easily they could feel and visualise my vertebrae. They had no concerns regarding administering an epidural or spinal should I require either, and discussed the risks and benefits of each as is routine before such a procedure.

Physiotherapist
A few weeks ago I was experiencing some referred sciatic pain in my leg, which while a very common pregnancy symptom, is also a sensation I am all too familiar with from the prolapsed disc I mentioned above. This time thankfully I only experienced the pain intermittently for about two weeks, but during that time I asked my midwife if I should see a doctor or physio, especially given my history of back problems. They referred me to the physio team at the hospital, and I had a very reassuring and helpful session with a physiotherapist who showed me some stretches that can help alleviate sciatic pain, assuming I'm likely to experience it again during my pregnancy as the baby grows and shifts around. I also experience some fatigue in my back at the base of my shoulder blades most evenings, and she gave me an elastic body bandage that I can wear around my middle for extra support to alleviate this.

Diagram explaining sciatic pain caused by pregnancy from https://www.cantrellcenter.com/is-your-baby-getting-on-your-nerve/

28 week antenatal blood test

At just over 28 weeks I had the routine 28 week blood test, which includes a complete blood count (CBC), iron levels, and glucose tolerance test. The CBC was normal, but my iron was low so I have started taking supplements prescribed by my midwife. My glucose was high, so I had to take the subsequent test which checks for gestational diabetes, and requires a fasted blood sample followed by another sample taken two hours after drinking a 75mg glucose solution. For this you have to remain in the waiting area for the full two hours, and as my appointment was just before christmas, the staff were playing christmas songs and singing along the whole time! Thankfully the subsequent glucose test came back normal. 

What's next?
At 32 weeks I'm due my next scan, which is to check the position of the placenta relative to my cervix. In my 20 week scan it was quite low, so they usually scan again at 32 weeks to check for placenta praevia, where the placenta lies across the opening of the cervix, and can get in the way during birth.

Otherwise, so far I'm feeling pretty normal, just tiring easily. My belly is getting bigger, and I can feel the baby as she is moving on and off all day. I'm still working part time, walking the dogs daily and swimming laps a couple of times a week. It remains to be seen how long I can keep this up.

It's a...

 A couple of weeks ago I had my latest midwife appointment. Once again they checked my blood pressure, conducted a urinalysis and used the doppler to listen to the baby's heartbeat. Everything checked out as completely normal, and this time they found the baby's heartbeat the moment the probe was placed on my stomach, where in the previous visit it took a few moments of moving it around to pinpoint the sound. They asked again how I've been doing, and I was able to tell them that I feel pretty normal these days, which is a welcome change from feeling sick. I did have a question about a muscular-type pain I felt in my abdomen one night when I tried to roll over using my stomach muscles. I wasn't too worried as the pain subsided the second I stopped, and used my whole body to roll over rather than just my stomach muscles. I said that I suspected from my online research I just over-stretched my round ligaments - these are the ligaments that wrap around your uterus, and so are very tight as it grows with your baby. My midwife agreed that it was most likely muscle or ligament pain, as these are very common throughout pregnancy. I have already had a flu vaccine this year, but I was advised that any time between now and 38 weeks I need to have my whooping cough vaccine, so that the baby will have some protection passed on from me until it can have it's own vaccination at 6 weeks of age. We then booked my next midwife appointment for early November, and my next scan for mid-October.

So today at 19 weeks and 2 days we had our next scan, which they term the 'anatomy scan' as they continue to check and measure many aspects of the anatomy. It is also the earliest scan at which you can learn the sex of your baby, if you would like. I found the scan really fascinating, it was amazing the level of detail they can see over the course of about half an hour. We were able to view and measure the heart, including visualising the four chambers and you could even see the valves moving as it pumped blood. They checked each of the blood vessels entering and leaving the heart, as well as several blood vessels elsewhere in the body including to the lungs, brain and kidneys. Measurements were taken of areas of the brain, including the circumference, the cerebellum and of the ventricles in the brain that secrete the cerebrospinal fluid. They looked at the hands and feet counting the digits - four fingers and a thumb on each hand, five toes on each foot, and counted the number of bones in the arms and legs. The stomach was measured, and we looked at the spine to check for normal shape. What we could see there looked normal, but unfortunately the baby was fairly uncooperative once again, and had by this time rolled from their side onto their stomach, where they were essentially curled into a little ball  upside-down with their bum sticking up. This meant the sonographer could not complete their measurements/check of the spine, nor could they check facial features (they check the eyes, nose, lips and profile) so we are going back for another appointment later in the week. They were able to get a look at the genitalia of the baby though - we're having a girl!

Stock photo of 19 week old foetus from: https://www.gettyimages.ae/detail/photo/my-babys-19-week-scan-royalty-free-image/139538366

They assured us that so far, everything they could see looked normal, and measured within a normal range. The only except to this was that the placenta is still sitting fairly low close to my cervix, so they will do another scan at 32 weeks to check it's position again. This does not affect her development, but can affect the birth if the placenta lies across the cervix (a condition called placenta praevia) as it can essentially get in the way, and also increases the risk of bleeding. They re-scan at 32 weeks because as the uterus stretches, the placenta may move away from the cervix and this self-rectifies the problem. If it was still low towards the time of birth, my understanding is that a planned caesarean section would be advised to minimise the risk to me and baby. This is not something that worries me, as at least it is something they can monitor closely, and they can then take appropriate steps to keep us both safe.

Update from follow-up scan

I had the follow-up anatomy scan at the end of the week. They were able to see the baby's face this time, and check her eyes, nose, mouth and facial profile. They were also able to see her lower spine. Everything looks normal, so my next scan will be at around 32 weeks to check the position of the placenta.

Wiggly little fish

 At the end of August, at 12 weeks and 2 days we had our 12 week scan. The purpose of a 12 week ultrasound is routine screening to check the baby is developing normally. Together with a maternal trimester 1 blood screen, the scan is used to assess the risk of chromosomal abnormalities such as Down Syndrome (trisomy 21), trisomy 13, and trisomy 18. 

The sonographer had a little difficulty getting a clear view of the baby, saying it was quite deep in my abdomen. After positioning and re-positioning the probe, we managed to get a few grainy views where he was able to take some measurements including length (61mm), heart rate (150bpm) and checked the position of the placenta. During this time, the baby was very active - more so than I knew they could be at this age. They kept moving up and down like they were swimming, wiggling about like a little fish! They were also on a slight angle, which meant that the sonographer couldn't take one key measurement - the nuchal translucency. This a a measurement of a fluid pocket at the back of the baby's neck, and is one of the factors used to assess the risk of Down Syndrome. After asking me to repeatedly move positions and get up and walk around to try and move the baby (unsuccessfully) they rescheduled us for a follow up scan the next week.

The day before my next scan I had my next midwife appointment. They asked how I was doing, checked my blood pressure and we were able to hear the baby's heartbeat through a doppler (151bpm). They also conducted a urine test to make sure I wasn't passing an excess of protein or glucose, which can be indicative of health issues. Everything checked out as normal, and my next midwife appointment is to be at 17 weeks.

At the follow up ultrasound at 13 weeks and 3 days, the sonographer was able to find the baby more easily and images were much clearer - but this time the baby was upside down! After repositioning the probe a few times, they managed to get a clear view and were able to skillfully take the nuchal translucency measurements upside down. At 1.9mm the measurement was well within the normal range - anything less than 3mm is no cause for concern. Our next scan is to be at 20 weeks.

Stock image of 13 week old foetus. Ours looked more-or-less like an upside-down version of this.
From: https://www.sciencephoto.com/media/79609/view

When the risk assessment results came in from the scan and blood test, they reported that the chance of Down Syndrome is 1 in 4500; trisomy 13 1 in 100 000, and trisomy 18 1 in 100 000. The reference given for all of these was that the cutoff is 300 - so a chance of 1 in 300 or greater would indicate high risk. The analysis concluded that there is a low chance of our baby having any of these conditions. (the chance of Down Syndrome is only higher because it is a more common condition than the other two, these results are well within the range of normal and low-risk).

At 10 weeks, I was able to wean off both my Progynova and Utrogestan over 4 days. At 12 weeks, folic acid supplements are no longer necessary. The only thing I am currently taking is the daily iodine supplement. After consistently feeling pretty sick up until around 13 weeks, I am now mostly feeling a lot better, with the odd period of nausea becoming less frequent. I'm still generally exhausted, but I've had my busiest couple of months work/study wise, and should be able to get some more rest soon which will hopefully help. In the meantime, we will look forward to our next scan.

A Little Lizard Thing

It's been a busy couple of weeks! The week following my last post we met and signed up with a midwife, who sent me for my first antenatal blood test. While we will be in contact and I can get in touch if I need anything, we will not need another visit until after our 12 week scan.

Later that week we had a bit of a scare, as I discovered I was bleeding. I called Fertility Associates, and the nurse assured me that some spotting/light bleeding can be very normal at that stage of pregnancy, and for someone who has gone through the type of treatment cycle I have. Regardless, they ordered a blood test to recheck my hCG. It came back at 24300, so had still been at least doubling every 2-3 days, suggesting that everything was still ok. The bleeding also stopped after just a couple of hours, which was reassuring. I had been feeling a little nauseous, and that also hadn't changed, so it looked like we were still on track. Bleeding at this stage of pregnancy can be caused by the embryo implanting into the uterine lining, so hopefully it was just making itself at home.

Over the last couple of weeks I have found that instead of feeling hungry, I start to feel sick. While I haven't actually been sick yet, it's not a great feeling. I also find I get hungry a lot, so I'm basically feeling sick on and off most of the day at the moment. Nothing debilitating, but not fun either, especially as I'm also feeling tired most of the time. Also helpful is that I am experiencing the heightened sense of smell that often accompanies pregnancy, as well as food aversions. Some days I feel sick at the thought of certain foods, the next day it's one of the few things I can face eating. I can barely keep up! At least I can eat I suppose.

Today we had our 7 week scan. They advised me to go with a full bladder, but they couldn't get a very good view through the external probe so they asked me to empty my bladder so they could use the internal one. They were able to get a good look at our embryo, and take some measurements. We could see the embryo itself looking like a little lizard thing, and the yolk sac through which it receives its nutrients until the placenta forms. Normally, for non-IVF babies, the measurements from this scan are what they can use to calculate the estimated due date from. Today, known to be 7 weeks 3 days of age, it measured 13mm long and was calculated to be 7 weeks 4 days based on the length, so the measurements are pretty accurate. We could see its heart beating, and the ultrasound technician recorded it at 150 beats per minute, which they said was within the normal range for this stage. Since our appointment was late in the afternoon today, I expect Fertility Associates to call and discuss the scan with me tomorrow. If they're satisfied, they will discharge me into the care of my midwife.

Stock photo of an 8 week ultrasound. This is more or less what we saw (once again not posting our images out of respect for any potential future person).
From :https://www.itnonline.com/article/fetal-pictures-ultrasounds-gallery

While things are still very early, it was reassuring that things are looking ok so far. The appointment today helped things feel a bit more 'real', and it was nice to confirm that there really is something growing in there.

Player Two is Still in the Running

Today I had a blood test to measure my hCG (human chorionic gonadatropin), which is the hormone produced by the cells that surround a growing embryo. This is the hormone that is used in tests to confirm pregnancy. Ideally, I would have had this test over the weekend as this would have been 10 days following embryo transfer, but it was scheduled for today (Monday) so that we could get a same day report of our results. Just before 4pm today Fertility Associates called me, and after checking my identity details, gave me my results. Had the test occurred on Saturday, they would have been looking for an hCG ≥50, and the reference doubles each day, so by today they were looking for hCG ≥200. My level today was 410! So I am currently 4 weeks and 2 days pregnant, with very encouraging levels of hCG. 

We still have a long way to go!
From:https://www.healthline.com/health/pregnancy/pregnancy-week-4#your-body

I am to continue taking the Utrogestan and Progynova, and have a follow-up blood test on Wednesday to check my hCG is still climbing at an appropriate rate. If things are still looking good, I am to continue my medications until around 12 weeks, all going well. I am also to continue taking folic acid, and to start taking 150μg of iodine per day. I was also advised to contact a midwife, as although visits wouldn't start until around 7 weeks, they can book up really quickly. Pending a good blood test result on Wednesday, I will have an early scan at around 7 weeks (so in late July) to check how things are going. 

We are relieved and excited, but also mindful that things are very early (most people would not yet have announced) and we have a long way to go yet.

8/7/20 Update:

Today I had my next blood test, and a Fertility Associates nurse rang me early this afternoon to report my results. My hCG today was 1350, which is very encouraging given they said it should be doubling every 2-3 days at this point. They then checked the medications and supplements that I am taking, and organised to courier me some more Utrogestan. They sent through a referral to Pacific Radiology, and I have since arranged my 7-week scan for the end of the month. Until then, we're just crossing our fingers and taking it one day at a time.