On Better Miscarriage Care.

You have had two miscarriages and you consider yourself lucky.

Obviously you consider yourself lucky because despite miscarrying you have two live, healthy and handsome children. But you also consider yourself lucky because you had your miscarriages at Chelsea and Westminster Hospital. And Chelsea and Westminster Hospital is pretty good when it comes to looking after miscarrying women.

This is worth mentioning. It is worth mentioning because good care of miscarrying women is not something that miscarrying women can expect. And it should be.

So you feel that Mumsnet’s latest campaign should be supported. They are asking for a Miscarriage Code of Care to be implemented.

They want, we all want, we all should be able to expect:

  • Supportive staff
  • Access to scanning
  • Safe and appropriate places for treatment
  • Good information and effective treatment
  • Joined up care

But what does that mean in practice?

Chelsea and Westminster Hospital has a special ward, somewhat euphemistically called the Early Pregnancy Unit* separate from the ante or post natal wards, so separate it is on the opposite side of the building and on a different floor, for women who have pregnancy of other gynecological or obstetric complications. This means that you were not forced, as others have been forced, to miscarry while surrounded by pregnant women or new mothers. Admittedly, you found out that your first baby had died while surrounded by pregnant bellies, but that was because you had a missed miscarriage which was only discovered when you went in for your 12 week scan. They let you hide out in the scanning room, though, while they booked you in to the early pregnancy unit, which given that the ante natal clinic of Chelsea and Westminster Hospital is busy busy busy was not an inconsiderable favour.

The staff at the Early Pregnancy Unit have clearly been trained in how to react to people who are miscarrying.  For your first miscarriage they provided you with a room to sit in and cry, and when you were admitted to the ward for a D&C** they put you at the far end, drew the curtains, and left you alone as much as possible. For your second, you were even more grateful. You were only six weeks along, but the nurse announced the confirmation of your loss with the same weight and sympathy you would expect in the announcement of any family member’s death. That acknowledgement meant a lot and still does. And yet it is not something that everyone gets.

You also did not have any trouble getting a scan. Of course, you were sensible enough to have your miscarriages midweek, which helps. And since the point of a missed miscarriage is that nothing is happening, a scan for assessment purposes was inevitable. At the time you personally needed it to confirm that the nightmare was real. You were torn between hope that a mistake had been made and that the heartbeat would show up this time and dread that a mistake would be made and a D&C would be performed on a perfectly happy baby if you didn’t check and double check just one more time. The fact that there was no need to fight for that, as some people have had to fight for it, is something you are grateful for.

Given that your second miscarriage was so early that you had only a few days before let your GP practice in on the situation, it seems you were also lucky to be able to phone the unit up on the morning you started bleeding and get an appointment for first thing the next day. You were armed with the promise of a referral from the (sympathetic) on-call doctor at your local surgery, but given that you’d only just put the phone down to him when you phoned them, you were mildly surprised to find they were so accommodating.

The quality of information they gave you in order to help you choose what you wanted to do was similarly without reproach and they were careful, especially in the first instance, to bring the miscarriage support groups to your attention.

Unfortunately, you will say that after you D&C you had not realised, and nobody told you, that you would start getting contractions, and really quite impressive ones, when your body finally caught up with the reality of the situation. They did seem bemused that you were waving away the painkillers as you left, but it has been your experience that Hospitals are often a bit vague about what might happen to you once you are out of their care. It’s something you feel could be improved across the board for all types of health issues. As it happens you were able to ring up NHS Direct, who explained the fact of life patiently and reassure you that nothing had been damaged permanently. Still, a heads up would have saved you some anxiety, and you might have taken the painkillers they offered you home too.

As for the joined up care, for your second miscarriage, despite the trip to the Hospital and the call to the doctor’s, you still received all the letters booking you in for your first antenatal appointment, along with your free prescription card and a magazine-style brochure detailing every week of pregnancy and containing lots of jolly articles about what you could expect over the next 40 weeks.

You don’t know when you received it, though, as in an act of great wisdom and kindness, your husband hid all of these things from you and you didn’t find them all until some months later***. You are therefore going to assume that this was just an accident of the timing of your miscarriage so close to your initial GP visit. Certainly, unlike others, you heard no more about it when the appointment time duly rolled round. Still, you do feel that perhaps the notifications of miscarriage to the relevant departments could be given a higher priority.

That was your experience. But it seems that you simply won the postcode lottery this time. To help make the experience as bearable as possible for all women, join the campaign. Write to MPs, to the Health Secretary, to the local NHS trust, and even the local paper.

Mumsnet has some advice about this here.

*The name could do with some work, it’s true.

**Which is what you have if you decide not to let nature take its course, when you have a dead baby inside you showing no desire to leave of its own accord. You are afraid you absolutely refuse to explain the procedure any more than that. You had to explain more times than you care to remember while you were waiting to have it done, as it seems to be standard practice to ask patients what they are in for every time blood pressure or whatever needs taking and you had neither learned the acronym nor thought of a gentle way to phrase it. This could be improved. Unfortunately, you are not sure how as undoubtedly there is some sound reason for checking the patient knows what is being done to her, and the alternative, having the nurse supply the prompt would probably look like this: ‘So you are here for a D&C?’ ‘What?’ ‘[Insert brutal medical description here]’.  Still, advising miscarrying women to memorise the acronym quickly might help.

***It’s all still there, in an obscure corner of an obscure cupboard. I don’t think either of you can bear to remove it.


On mother love.

The thing about having a second baby is that you have already got used to thinking of yourself as a Mama and the way you see the world through that filter of slightly terrified responsibility. So there was less to think about in this pregnancy.

Of course, this time you were having a girl. This did produce a militant resurgence of your inner latent feminist, but luckily you were too busy to post any of the resultant rants here.

You have saved them up.

But one thing that did preoccupy somewhat you was  the constant niggling worry that you had already produced, somehow, a really quite delightful, and inexplicably handsome first child and that in rolling the genetic dice for a second time you were risking turning out an unattractive, stolid lump. And an unattractive, stolid lump that you wouldn’t like as much as you like the Star.

Well, the Comet is two and a half months old now and you needn’t have worried.

Of course, she looks like a goblin. Her ears stick out at the top and are distinctly pointy. Plus she has a really wide nose. She does resemble the Star quite a bit though*, which bodes well for her future prettiness

She’s inherited the smiliness though**. And someone seems to have taught her that peeping out from under her eyelashes is a really cute thing for a little girl to do. She is also lying next to you as you type and blowing bubbles whole making little gurgling noises interspersed with the occasional coo. So that’ll be ‘charming’ covered then.

But essentially none of this matters, and neither does the fact that she has found her hands and feet rather more quickly than the Star did, or that she seems slightly (only slightly, mind) less inclined to be manically active than the Star, or that she stares unblinkingly at you and only you, ignoring all others, no matter how hard they are trying to get her to look at them.**

Right now the Comet could be the dullest, ugliest baby in the world and it wouldn’t matter. Because  at the moment you are in that awful stage of aggressive mother love where it’s you and her against the world.

Well you, her and anything that looks like a baby.

And this sudden expansion of love, which exploded within you the moment the Comet’s slimy little body was passed though your legs for you to hold in the labour ward, is a shockingly odd sensation. It’s odd to realise just how blindingly fond you are of your son, uncritically adoring, to see that emotion reflected off another being.

But most of all it’s odd to have to accommodate another in that special place in your heart where once the Star reigned supreme.

Poor Star. The King is dead. Long live the Queen.

*At 3am you are thankful for the colour coding. If it weren’t for the fact that she is covered in pink, you sleep deprived mind would be very confused at times.

**Except the Star. If it came to a choice between you and the Star, the Star would win. The Comet worships the Star.

On once more with feeling.

Going 12 days over your due date means you have too much time to think.

This is because you were, of course, more or less prepared a good two weeks in advance.

It also gave you too much time to clean. Parts of the house that have never been cleaned before, even. Of course, this is all a distant memory now.

[Hang on, I think I hear my Mistress’s voice now. 62 words. Something of a record.]

Anyway.  What you were mostly thinking about was childbirth mortality statistics. From a time before modern medicine held sway.

One in four births ended in somebody dying? Was that the mother, the baby or both? You found yourself musing. Did more mothers die or did more babies die?

Were there more deaths of mothers for first babies or was it pretty evenly spread out?

Did the one in four include deaths actually while giving birth or from complications afterwards.

What about animals? Are their death rates comparable, or were some of the deaths due to interference from pre-modern doctors?

Then you would recall that there are depictions? Descriptions? Of Caesarians being performed in Roman times. Which had cheered you up until you were told that, of course, the woman always died.

[Hang on, I think I hear my Mistress’s voice calling. 140 words. Hurrah!]

Anyway. All this goes to explain why you are enthusiastically in favour of hospital births rather than home births. Feeling comfortable is less important to you than feeling safe.

Having an induction, then, suits you down to the ground as it means that you get to spend the entire labour wrapped in the four walls of your own special security blanket. Apart from the bit where they send you out for a walk.

Actually you nearly missed out on the induction. Your appointment was booked for 12 noon, but you woke on the morning of the 2nd at 6am feeling distinct tightenings. Which didn’t go away.

However, neither did they get any worse, and so you ordered your cab for 11am and had a leisurely, if not terribly comfortable, sit in a traffic jam, thankfully enlivened by the chatty driver’s reflections on Russo-Somali relations, women and the best way to drive around the line of cars in order to get you to the hospital on time (he succeeded. You tipped him heavily).

The midwife was unimpressed by your tightenings and so decided to apply the gel anyway.

She was also unimpressed by your claims to have arrived at the hospital last time 9cm dilated. This, on reflection, might have been a mistake. But then how were any of you supposed to know that the miracle goo would succeed so well that while you were on your post-application mandatory brisk walk taking in the sights and boutiques of Chelsea and attempting to make polite conversation with your husband, you were also contending with full on labour? Apart from anyone who had been around for your first labour, of course.

[Hang, on, I think I hear my Mistress’s voice. 300 odd words there. Not bad.]

Well, you assume that’s what it was, as it was only an hour and not much more intensity after you arrived back at the hospital than your waters broke and you were found to be 8cm ready.

4cm is when they are supposed to transfer you to labour ward. And give you access to the gasnair. Childbirth tip number one: never smile politely at midwives when you in labour and they ask you how you are doing. They tend to assume you are not in that much pain really. Even though the only things keeping you sane are feeling your husband’s leg pressed firmly against the small of your back, concentrating very hard on the same two paragraphs of a book entitled Ravished! , squeezing your husband’s hand very hard at intermittent intervals and whispering viciously at your husband when he makes a joke in the middle of a contraction.

B, you will gather, was a very necessary part of your pain management strategy.

Your second childbirth tip is never try to stab a labouring woman with a needle.

Back in the days of pregnancy you had agreed to give certain samples to a tissue bank in order to aid the study of various conditions relating to problematic pregnancies. It seems they had missed getting one vial of blood and so had tracked you down and were actually poised over your vein when you felt that very distinctive gushing from down below.

And then all hell broke loose.

Because GODDAMMIT but it really hurt after that. I mean OW!

You screamed, in fact. Quite a lot. The research doctor ran away*****.

In spite of which, they were still surprised to find how advanced you actually were***, although once they had, they were also quite concerned to get you onto the bed for transfer to the birthing room. They didn’t, apparently, want you deliver the baby in the 100 metres of corridor between the ward and your single bedded sanctuary.

In fact, it was another hour and a half before you gave birth. Thank you once again the gasnair. You didn’t feel it actually made the pain much more bearable this time, but it did help to regulate your breathing. And give you something to bite down on.

You have never previously appreciated how important it is to have something to bite down on when medical things are happening without adequate pain relief. Although you seem to have buggered your jaw up again. Which is a shame as last time you only got rid of the clickiness and tendency to find that your jaw had become dislocated in the mornings by having your mouth comprehensively mauled in order to get your wisdom teeth out.

So the Comet, when she did arrive, arrived very quickly. Total official labour time, 2 hours and thirty minutes (which is when you returned to the hospital from your walk and mentioned that you thought, tentatively, you might be in labour). Total actual labour time, five hours. Total time since any evidence of any kind of contractions, 13 hours.

Which definitely beats the 48 hours you spent on the Star.

And that difference, in the endgame in particular, is curious. Because you have always rather assumed that the reason why the Star had to be hoiked out ignominiously by the doctors is because you didn’t realise how hard you had to push. Until someone in a white coat came and shouted “PUSH!” very loudly in your ear.

Whereas this time, you hardly pushed at all. Once, in fact. To slither the body out after the head had emerged*, which it would have done at that point whether you wanted it to or not. At this moment** you understood how it is that women end up caught short on the toilet.

In fact, looking back, you wonder whether you went into the final stages of labour at all with the Star. Because it simply didn’t hurt that much with him.

[Hang on, I think I hear the doorbell. That’ll be my mother then.]

But on balance you will take a short labour over a gentle labour any day. It makes the post birth euphoria that much more satisfying. Nothing whatsoever to do with the fact that you had at the gasnair again while they stitched you up****, but definitely to do with being able to properly enjoy the buzz of quietly chatting with B as he carried your daughter around the room, although the dinner jazz segment he found on Jazz FM was also particularly soothing. You were also uplifted by the artwork and would like to commend the subconscious of whoever commissioned the very vagina-in-flower like portrayal off strawberries nestling on a hanky that sat opposite you while your legs were very much akimbo in the stirrups.

But a short labour also means that when that wears off, which is sometime around the moment that you notice that your toes are still, a number of hours later*******, covered in blood and you really need to piss, you still feel remarkably spry.

A bit too spry, actually, given that when you finally made it onto the ward you were not nearly tried enough to ignore the five women who had had Caesarians and whose babies, therefore, were not as tired out as yours was and therefore cried all night. Not to mention the fact that you were right next to the birthing rooms, and could hear every yell. Especially from the woman who has only just made it to the hospital and who had, apparently, collapsed just inside the front doors and was subsequently wheeled, howling with a particularly disconcerting Doppler effect, at a brisk trot through the entire length of the hospital five minutes after you had finally managed to drift off.

[Hang on, I think I hear my Mistress’s voice. No idea how many words that was. Thought I had it there]

But in the end, you darkly suspect that the problem you would have with a third child****** is not whether to go for long and gentle or short and sharp, but being confronted by a choice between birthing at home without the aid of a midwife, who will have come and gone away again when she sees you are not in sufficient pain to growl at her when she asks you how you are and giving birth in a taxi. Or on the bus. As you will again have misjudged how much pain you are in until it is too late.

Better keep the third child hypothetical then.

*TMI yet?

**Well, ok, perhaps not that very moment.

***Really, I mean it, do not smile at the midwives while in labour. Although at this point you really really weren’t.

****Childbirth tip number three. Never ignore the bit of the antenatal classes which involve perineal massage. Regarding which, isn’t YouTube a wonderful thing?

*****For the record, though, you had her paged the next day and she came and got her blood from not only you, but also B, so that’s your bit for medical science completed then.

*******Childbirth tip number four. Do not try to hurry the woman stitching up your delicate undercarriage. Remember what you might be wanting to use it for later and appreciate her artistry.

[So at 12 hours that only took nearly as long to write as it did for you to actually give birth.]

On sibling interaction.

You are not the only one eagerly awaiting the arrival of the Comet.

The Star is getting impatient too.

For months now he has been excitedly talking to the bump. He puts his head on your tummy and has conversations with his sister. You do her voice, when she manages to get a word in edgeways, which isn’t often. She’s quite squeaky. The Star tends to shout.

Mostly it goes something like this.

Hello! How you? I waiting for you! I play with you! I gentle! You play my cars! Where you? You coming out? I brother. I big boy. You baby! You small!

Please do be impressed by the Star’s willingness to share his toys. That took a couple of weeks intensive coaching. In the original version, when his sister suggested that he give up his cars, the Star sat bolt upright and said, flatly, and with considerable outrage, ‘MINE!’ You have also been getting all the books out of the library which emphasise the importance of careful play with small and fragile beings. You are not convinced any of this will help when reality sets in, but nevertheless you feel smug that you have tried.

Sadly, in the last week or so, the Star has clearly picked up on your despair of seeing your daughter before she turns 18.

He now only occasionally wonders listlessly over to enquire ‘Why you not coming out?’

And then you both sigh.

On waiting for Godot.

Once upon a time, a long time ago you were on the pill.

It was the most boring six months of your life, which was a shame since you were at university at the time. Your grades, in particular, took a complete nosedive.*

You only realised this after you had stopped taking it. And all your creativity and inspiration, your amusement in small ridiculous things and your zest for life came flooding back. Admittedly so too did your capacity to get thoroughly enraged, occasionally depressed and slightly hysterical, but if this was the price you needed to pay in order to feel sheer joy, then you decided it was worth it.

You were quite surprised to find that the hormonal mood swings so often trotted out as the reason why women are the inferior sex were not a myth, not really limited to a particular week of the month, and, most importantly, far far more integral to your basic make up than you had previously realised. Especially interesting was finding that your intellectual capacity seemed to rely on them too.

Looking back, this was probably when you really decided to embrace womanhood. Of course, presumably, you reasoned, men have their testosterone driven moments too. But what if it doesn’t work in the all-enveloping way that oestrogen and progesterone do for you? What if men feel much like you didn’t during those six months all the time? The very possibility made you feel quite horrified, and very very relieved to be the sex you are.

Pregnancy, mind, is something of a test of this.

A lifetime learning to expertly surf the hormonal waves dis not really prepare you for the humongous rip-tide which submerges you in exhaustion and forces you to eat an avocado every day for the first twelve weeks, gives you great hair and a disgustingly positive outlook for the next three months and then forces you into a state of unaccustomed zen-like calm, which only gets worse the closer you get to the end of the final trimester. You particularly resent the zen-like calm. Have to get into a fight with your husband in order to manufacture enough adrenaline to get anything done isn’t the most ideal way to work up the energy  for paying the phone bill.

But worst of all is what happens when you go over your due date.

Presumably your body is trying to find the right combination of chemicals to trigger contractions.

All you know is that you spent Saturday and Sunday frantically cleaning the house.

On Sunday night you slept 12 hours, then another four hours in the day on Monday, and then went to bed early that evening too.

On Tuesday you woke up feeling energetic, but liable to burst into tears at any moment. You spent the whole day in the park with the Star, who was being wilful. To be fair, this might have been the source of the weeping.

Yesterday, on the other hand, it took you three hours to clean the bathroom, so sluggish had you become and today, well today, you have been told to go and lie down after you came over all faint whilst making the breakfast. Eating constantly seems to be helping with this.

You would like to think you will find the trigger soon – and yes, thanks, you have also tried curry, baths and, y’know, that other thing. Repeatedly – but you are not holding out much hope. Giving up on pregnancies is not something you do gracefully**. You suspect the Star kicked his way out.

Clearly even hormones, even female hormones, even your female hormones have their limits.

So your personal prediction for the revised due date is Saturday 4th June, 42 weeks into the pregnancy and after massive doses of chemical inducements.

*Likewise your libido. As a contraceptive, the pill was completely effective

**This, of course, is a good thing overall.

On the fast approaching Comet.

You haven’t written much about the Comet so far.

This is because there isn’t much to say at the moment. Which is good.

In fact your only issue is counting her kicks, and you are only doing that because you unwisely commented to the midwife that you were feeling quite smug that she seemed to be somewhat less kicky than the Star was and you were hoping for a slightly more placid child this time round. After you had both watched the Star hop across the room, climb on a chair, climb off, crawl under the examining table, bustle importantly towards the door, whirl unexpectedly and start to investigate the contents of the sharps drawer for 30 seconds or so, she turned back to you and reminded you that it is important to feel at least ten movements every day.

So, obsessive and slightly resentful counting has begun. Except today where you knocked off early as she kicked the shit out of you all morning and then again all afternoon.

Other than that, you are sleeping rather a lot. Thank goodness the Star still has an afternoon nap is what you say.

But the tiredness is nothing to the utter exhaustion that overtook you in the first twelve weeks. Which is fantastic. You are also not feeling sick all the time, but having to eat constantly to make sure you don’t feel any sicker or faint, due to crashing blood sugar. You! The woman who can go a whole day and forget to eat was suddenly chained to the half hour apple. You very much resented being at the mercy of your stomach.

Especially because true to previous form, the Comet refuses to let you eat junk. Especially cream. The Comet has a particular hatred of cream.

Of course your first trimester misery was probably compounded by the fact that the closer the 12 week scan gets, the more you freak out. This is what happens when your first baby is discovered to be what they call a missed miscarriage when they fail to find a heartbeat with the scanner. Unfortunately you have discovered that you are unable to relax until you have the second 20 week scan over with too, particularly as now you are left on tenterhooks until the full scan results don;t come back to you until they have combined them with the blood tests to give you the more accurate Down’s Syndrome risk assessment.

Which irritates you no end, because you have no reason to suspect that there will be problems. You’ve had two miscarriages, but both of those were, after all, relatively early, and your pregnancy with the Star was utterly, blissfully, uneventful. You have no reason to get so worked up, other than raging paranoia. And yet you do. Still, at least the scans mean that you are not on complete tenterhooks for the whole nine months. Although really you wonder if it would matter all that much anyway if they revealed something (non-life threatening).

Anyway, all you have to look forward to now is a bout of carpal tunnel syndrome and continuing indigestion if you so much as look at a cup of coffee. So you are afraid you are rather ignoring the pregnancy.

Except to prime the Star. He knows there’s a baby inside. It was a little confusing at first. He would compare his quite rotund middle with Mama’s increasing roundness and declare that he too, was pregnant, although he seems content now with the explanation that no, his tummy is just because he had eaten an adult sized portion of salmon and broccoli pasta.

He was quite excited about listening to the heartbeat.

He knows it’s his sister in there.

He doesn’t actually grasp what a sister is, mind you, apart from something female. He has a tendency now to ask random ladies if they are sisters. His, someone else’s, it’s all a bit unclear.

He will, in tender moments, stroke the bump. In less tender moments he tries to sit on it.

He remains excited about babies he meets out and about. It’s all very positive.

You are tempted to take bets on how long this will last once he has his own bundle of scream ousting his precious place as centre of the universe.

On great expectations.

So this time around it’s a girl.

You were oddly disconcerted by this news.

Of course, it took you a good year to get used to the Star being a boy.

Oh, you thought you were prepared. You had stocked up on an entire wardrobe full of little blue clothes after all.

But babies are so very unformed really.

And despite his little pipiska, not once did the Star ever piss in your mouth when you were changing him, which you understand is a practically obligatory rite of passage for parents of boys.

Mostly it was the fact that whenever you imagined how parenting would go, you kept imagining things which would have done with yourself, had you, in a very Heinleinesque way, been your own mother.

You, of course, are female. Not a very girly female at times, but still.

So it wasn’t until the Star’s personality kicked in that your really started to believe in his masculinity. Nowadays, it’s hard to deny what with the obsession with cars, fire engines, trains, cranes, dirt, dogs and his cheerful hooliganism.

Although his favourite colour is pink.

And so now you can’t imagine how a girl would be. Or how you would be with a girl. Even the nappy changes are going to be… different.

You don’t even have any pink clothes. Except for the tights you bought the Star to make him happy.

It’ll take some getting used to. You are quite looking forward to the cute little dresses though.

Due date 21st May. Working title, the Comet.