Saturday 27 February 2010

They're not Terry's they're mine!

Ah pregnancy, a time of dreams...... hypnobirthing, breastfeeding, skin to skin, lazy first weeks with my hubby on paternity leave, getting to know my little bundle, and cloth nappies. Lots of lovely cloth....

As my friend Eminem would say, "back to reality, oh there goes gravity..." Yeah well as previously discussed in my short blogging life, we didn't get all the lovely experiences that often go with childbirth. (but what we did have was precious and special in its own right).

When Joseph came home he was just under 5lb, so I decided to start exploring cloth nappies! An exercise I was planning to do in my third trimester. They could take away my vaginial, natural birth and give me a box of formula, but they can't take away my nappies!

We are very fortunate in Lancashire that we have a generous, green tinged council that gives an amount of cash back towards your cloth nappies, in an attempt to help curb our massive landfill problem. I do have to admit, that my love of real nappies is only partially fuelled by environmental concerns. I just love them! They are fleecy and soft. Colourful and bright. And they look so comfy. If you had to wear a nappy, you'd want one of these, I promise!

Also I was eligible, along with all pregnancy women for the healthy eating in pregnancy grant. Although in my case it was a "we hope you ate healthily in pregnancy grant!"

So after shopping around on the internet, I had a nappy advisor come to the house, and she had lots of lovely options. I finally decided on a lovely green fleece set. It took a bit of tailoring to make it fit Joseph's petite derriere!

Occasionally I do use disposables, for trips to clinic, and when we go away abroad, but at home Joseph is a 100% cloth.

They are easy to wash, no soaking, just a 40 degree wash and a scoop of sanitiser. I don't have a washing line or a dryer, they sit happily on our maiden inside.

I would urge any new mum to just give cloth a go. It's so much cheaper in the long run than disposables, your doing the earth a favour, and I believe they are more comfortable.

Who said its not easy being green?

Friday 26 February 2010

Excuse me doctor, my baby is missing something

One of my friends pointed out something to me yesterday, that her baby, born at 27 weeks, was born without nipples. How odd! Surely I'd remember if my son was born with something, although useless, aesthetically quite important.

I don't remember checking Joseph's chest, I never saw him when he was born, and didn't see him until 10 hours after birth, by which time his poor chest was covered in sensor monitors.

So begun a search through my archive of pictures of Joseph in hospital. All of my photos of him had wires and pads all over his chest. Finally, I remembered, the bath photos!

Yep, my friend was quite right, no nipples. So I have checked on the internet, and yes, babies born before 34 weeks generally do not have nipples and they grow later!

It's really amazing isn't it, that you can see something you would take for granted just appear on your baby!

Thursday 25 February 2010

Please mum, I want some more.....

For all parents, introducing their babies to the world of solid food is nerve wracking. What if my child has an allergy? What if she chokes? What if he refuses everything I make? Should I use jars? Does it have to be organic? Where on earth do I start?

For parents of premature babies it is perhaps even more daunting. The offical UK guidelines for introducing solids are to start at 6 months. However there are no guidelines specifically for premature babies. My Health Visitor expected me to start at 6 months corrected (so nine months old), the Special Care outreach worker said anywhere between 3 to 4 months after Joseph's estimated due date. However the Bliss Guidelines said anything between 4 months and 6 months from the baby's actual date of birth.

Confused? I was. I knew from my reading, start too early, and the baby is at higher risk of stomach problems. Start too late, and the baby may not take to weaning and you've missed "window of opportunity".

I asked other parents, I did research and decided to start Joseph at 23 weeks. 24 weeks is clinically considered 6 months old. I thought if I started at 23 weeks and it all went wrong, we could just pack the weaning spoons away and start again at a later date.

Now what to do? Baby rice? This is the traditional weaning food in the UK. I mixed a bit with Joseph's formula (which I have never bonded with) and it tasted disgusting. I couldn't do it to him. So I carefully mashed up some avocado. He adored it, he seemed to know pretty much what to do from the beginning. I was stunned as his little mouth opened to take each new mouthful.

The next day he had mango. Progressively we worked through a number of different vegetables and fruits. He didn't reject anything.

I have found introducing Joseph to food to be a joy, after my initial terror. We have had some lovely moments, eating together at breakfast is my favourite time of the day. We sit on the floor, him in his bumbo, share his tray, and eat together, planning our day.

Lunch time is lovely too, we often have soup, and eat together. I'm trying to introduce finger foods at the moment, and occasionally we look at each other and laugh as we are covered in bits of mango or papaya!

And we've had some suprises. There is a rather hideous Annabel Karmel recipe for salmon cooked in orange juice topped with cheddar cheese. I cooked it for Joseph, tried it myself, and then made it for my husband and I, it was lovely!

Joseph adores food, and kicks his little legs with delight every time I bring something out to him. Often he stops eating and just grins, mouth and face covered in food. I have lots of lovely foody grin pics.

Tuesday 23 February 2010

Snakes and Ladders

Title courtesy of Kylie - Llewllyn's mum

When a baby is born and goes to special care, everyone gets "the conversation". A run down about how the ward works, about expressing, and about the peculiar special care "snakes and ladders" phenomena.

Premature babies are, quite simply, not ready for the world. They have no fat and cannot maintain their body temperature, their skin hasn't formed so it doesn't act as a barrier to the outside world and they are incredibly susceptible to infection, they are not ready to breathe, they are not ready to eat. It's all alien and strange, because us, as mothers, should be protecting, feeding and nurturing that baby inside the safety of the womb. But nature (or in my case a consultant team) have decided the baby is safer on the outside.

So the reality is there is a lot that can go wrong. And this scenario is without any underlying problems that even a term baby can face, such as heart defects. Many premature babies develop life threatening problems particularly in their first weeks in special care.

One is warned that the journey will be two steps forward, one step back. One day, you can walk in, the baby is breathing on their own, looking good, maintaining their body temperature. The next day you walk in and they're back on assisted breathing, a funny colour, and the incubator is turned up.

The baby might be feeding like a pro, using a bottle, and then just not able to for a day or two, gets too tired, and you feel like your back in the beginning again. It can be crushing, and so hard to remain positive and stay strong for your baby.

And to a lesser extent, once a baby is discharged this can continue. Weaning (which I promise I will get to tomorrow!) is a case in point.

You have finally got feeding, whether bottle, breast or mixed feeding, down to a fine art. You know when feeds are due, you know how the baby is likely to react, what size teats to use, how much to make, and then you have to add solids.

This can be a frustrating and difficult time for parents, and their babies. It can also be a joy, as its another step in your tiny baby's journey to join the world.

Monday 22 February 2010

Confessions of a Domestic Goddess

It isn't fashionable, but I love being at home. I am not the most wonderful housekeeper, I'm not so hot on dusting, and the hoover and I have a very uneasy relationship. The iron, however is my friend, we get on very well! It makes me feel slightly less guilty about my mid morning Law & Order habit!

My other friend is my kitchen. It's so tiny, it looks like it should be on a boat!.The smaller the kitchen, the less to clean I suppose. There is room for my Kitchenaid Artisan, a large fruit bowl, and my big toaster. What more could I want ?

I am a collector of cookbooks. I have, rather aptly given my title, every single Nigella book. And suprisingly perhaps, her Express is my favourite, despite the lack of convoluted recipes for cakes and slow cooked extravaganzas. Every0ne needs one of those books that give you quick ideas when your pressed for time, or just can't face an hour in the kitchen.

My other cooking hero is Stephanie Alexander, not well known in the UK, she authored the epic Cook's Companion. If you only ever treat yourself to one, huge, encyclopedic cook book, make it this one. Its separated by ingredients, so if you happen to have a glut of one particular ingredient, or if you see something new at the supermarket, or especially if you get a veggie box and get some strange item in it and not sure what to do with it, this book is a lifesaver. As well as long recipes, she has quick short margin ideas. Its an invaluable resource. I love her other books too, especially Recipes My Mother Gave Me, a reworking of her mother's recipe book.

I love baking and I am a sucker for cupcakes. I love them. Partly because they are small, so you can always find a little space in your diet for a cupcake. Nothing is prettier than a nicely decorated cupcake. They also repay you if your fundraising. Out of one batch of mixture you would get one big cake, but 20 cupcakes. You can easily get £1 for a cupcake, but much less likely to be able to cut a big cake into 20 slices and comfortably charge £1 a slice.

I own a few beautiful baking books, but The Hummingbird Bakery cookbook is a current favourite, along with Cupcakes from the Primrose Bakery. My dream would be to own such a bakery here in Ramsbottom or Bury, and bake beautiful cakes to brighten up a dull day (and we have enough of them up here!)

My biggest culinary challenge though, has been weaning Joseph, I will talk to you tomorrow (hopefully) about this delightful and somewhat daunting experience!

Until then, browse Amazon and drool over my favourite books!

Sunday 21 February 2010

Like a Dose of Salts

What follows is my interpretation of the use of magnesium sulphate in the treatment of pre eclampsia. I have done research, however I have not referenced as this is a blog and not an essay. Please do not use what I have written as anything but musings and reflection.

When I was a poor student, and unable to buy treats from the Body Shop (and Lush hadn't been invented yet) I used to buy Epsom Salts for a lovely bath time treat. Nothing relaxes the muscles like a dose of salts. (Its used for constipation as well, however I'd rather have prunes thank you very much)

Little did I know then what an important role Epsom Salts (magnesium sulphate) would play in my medical future.

Just to recap a little, at 26weeks + 6 days I was diagnosed with pre-eclampsia. So just what is it? Eclampsia is a Greek word, and it means "bolt from the blue", eclampsia is a massive seizure, and can be fatal.

Pre eclampsia is the state before eclampsia happens. True eclampsia is rare, partly because of good ante natal care, and the fact that pre eclampsia can be spotted and treated. Pre eclampsia though, is somewhat of a misnomer, as eclampsia can happen without pre eclampsia being present. Also it can appear after eclampsia has occured. In some instances pre eclampsia can occur immediately after birth.

No one is really sure why pre eclampsia happens. Some things put a woman at greater risk, such as a first pregnancy, being obese, and having a history of high blood pressure. But equally, many women without any of these risk factors find that they are afflicted with this horrible condition.

Pre eclampsia used to be known as toxeamia. And that is a good description. Occuring after the 20th week of pregnancy, once the placenta is developed, the body starts treating the placenta as hostile. It can then cause the placenta to stop functioning, and the baby to have problems. In Joseph's case he had severe intra uterine growth retardation (IUGR) he should have been 1kilo at 27 weeks, but he weighed just 680 grams (1lb 7oz)

The only cure for pre eclampsia is delivery of the baby. However this needs to be well timed, as pre eclampsia can cause the mother's liver and kidney to stop functioning, so deliver too early by caesarean section, and death can occur. Deliver too late, and of course, the consequences are obvious, full blown eclampsia, and the loss of baby and mother.

This is where magnesium sulphate comes in. Given by infusion or injection, it causes the internal body systems to relax, the blood pressure to drop, and diminishes the risk of eclampsia.

What happens these days, is that if premature delivery is expected, the mother is given two injections of steroids to improve the baby's lungs. (this also plays a role in diminishing the risk of cerebral palsy in extremely pre term infants)

So the magensium sulphate buys some time, for the steroids to work, to stabilise the mother, and to conduct a safe c-section. In many cases, including mine, treatment continues for 24 hours after birth.

So next time you hear the phrase "like a dose of salts" just think how amazing simple Epsom Salts really are.

Saturday 20 February 2010

The Battle of the Boob

When I was dreaming of being a mum, and all through my rather brief pregnancy. I knew I would breastfeed. To me it just wasn't a choice, it was the natural thing to do. Its free, its portable, and its nutritionally sound. Also being a lifelong asthmatic I was aware of research stating that breastfed babies have some protection against asthma (although the research is not conclusive)
When I was told I would be having Joseph at 27 weeks, I was still determined that I would breastfeed. I knew I would be asked to express milk for him and later we would be able to try and establish breastfeeding, once his suck/swallow reflex had started to develop. A consultant came to see me in special care and asked if I would consider expressing. I looked at him and said "I am completely committed to breastfeeding my special care baby" He ran through how many extra calories I would have to eat, and gave me licence to eat as much dark chocolate as I wanted!!!! Bliss!!!
12 hours after he was born, two midwives came to see me to start expressing. (I know I'm a big lady, but I didn't think I was a two person job!) As I was so weak and covered in rather large needles, they milked me like the proverbial dairy cow. They were very apologetic "we are so sorry this isn't really dignified for you", my sense of humour remarkably still intact I grinned "for someone who has been pregnant and produced a baby there has been suprisingly little interest in my cervix, so this is certainly preferable!"
I was then given a pump (you can see me expressing my Joseph's incubator at 3 in the morning in special care in the photo above) and for the next 9 weeks, expressed every 3 hours.
Unfortunately my milk supply went to nothing at around week 8. I struggled on. Joseph was still under 4lb and just couldn't manage to suck. We continued to struggle. At this stage he was still in hospital. I later learned that magnesium sulphate (which I will discuss in another post) can harm your ability to lactate months after the treatment.
One teary night, I knew I had to make a decision. To keep trying to express and establish breastfeeding, or to give up and go to formula.
I cried and cried, I felt an utter failure, I couldn't keep him inside long enough, and now I couldn't even nourish him from my own body. All my dreams were disappearing in front of me.
However, the day I gave up my dream, discharge planning was put in place. Joseph tolerated the formula, bottle fed like a pro, and 2 weeks later he was home where he belonged.
Breast is best, and I will always believe that, however, sometimes, formula is just as good, and completely necessary. Perhaps its coincidence, but on my milk, Joseph stubbornly stayed under the 0.4th centile for weight. Once I gave up and he went on formula, he started to make a climb up the centile charts. Now he's eating a full mixed diet, that I prepare, so I am now providing his nourishment, not some nameless, faceless, multinational conglomerate milk firm!
But poor old Green & Blacks might have to call in the receivers!

Friday 19 February 2010

God Help Me.....

What follows is my experience of post traumatic stress disorder. It is not clinically informed, and purely my own interpretation of what happened to me. If you think you (or a loved one) is suffering from PTSD please speak to your GP or health visitor

And can you tell me doctor why I still can't get to sleep
And why the Channel 7 chopper chills me to my feet
And what's this rash that comes and goes
Can you tell me what it means......
God Help Me.....

I was only nineteen, Redgum

Trauma and loss are common experiences for anyone who has been through a premature birth, whether your baby makes it, or sadly does not. You grieve for the birth experience you dreamt about, for your baby's first weeks, for all sorts of things.

For me the post traumatic stress disorder did not start until over a month after Joseph came home. It made no sense to me. I was feeling dreadful yet Joseph was well.....

Sometimes, something stops the grieving process. Post traumatic stress disorder, to me, is like a computer virus. A worm, a trojan. The traumatised part of your conscience fragments, and it weedles its way through your brain, your memories, dragging out files and corrupting them, in an attempt to make sense of what has happened. It stops you from following your thoughts, from having insight, from making sense of what has happened, and letting go.

For example, the stanza of the song I have quoted, kept coming to my mind. I haven't heard the song in well over ten years, yet it played through my head over and over again. This virus dragged up all sorts of memories, mainly traumatic ones, and linked them to Joseph's birth.

I was having nightmares, nightly. It got to the stage where I was avoiding sleep because I was scared of the nightmares. I had flashbacks in supermarkets, in the park, at home, everywhere. Here I was with a baby who slept well at night, yet I was awake all night, waiting for the next drama.

It wasn't until I broke down in our baby massage class that I realised I had a real problem, and it was not going away, it was getting worse.

I felt so confused, as I wasn't depressed. On the good old Edinburgh scale of post natal depression, I scored low. I couldn't really comprehend what was happening. I thought, like in my song, post traumatic stress was something that happened to war veterans, not mothers of small babies.

I went to my GP, and started receiving treatment. Suddenly, the world seemed a kinder place. I could finally see outside my own grief and see that of others around me. And I could see Joseph. As a bonny, growing, funny, clever little boy. And it's taken a long time, but I finally saw myself as a mummy, a good mummy doing the best she can.

And finally I could let go of my little tiny translucent skinned fragile being in an incubator, and focus on the future.

Thursday 18 February 2010

My Precious 'Bag of Sugar'

Meet Joseph. Lovely isn't he. Not even a bag of sugar! In this picture he weighs just 652 grams. Take a bag of sugar out of your pantry. Yes, now. Hold it, look at it, marvel at just how tiny a human can be.

This picture was taken in May 2009, dreadfully hot, an early English Summer. That's me in the picture, the first time I held my darling son, at just a week old. The bruises aren't from a bar fight, they're from my friendly anaethetist. I had severe early onset pre eclampsia. Not. Fun. At. All.

I've spent a good many months thinking that pre eclampsia, and the early birth of my son was the most horrendous thing that could have happened to me. I had a six month pity party. Balloons, cake and everything.

Until I woke up. Joseph is the greatest thing in my life (apart from my husband of course). He is a precious gift. Ok so childbirth was not how I expected it. And I expected Joseph's first bed to be a nice cosy crib, not a cold hard incubator.

But I have learnt over the past months that things could have been so much worse. Women in 21st Century England still die of pre eclampsia, babies are still lost.

So my not even a bag of sugar is now many many bags of sugar! A pallett!

Joseph has inspired me to blog, not just about premature babies, and my experiences, but everything that touches me. Especially baking, now that takes a bag of sugar!