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  • Writer's picturethesepreciouslittlepeople

#TogetherForChange – Improving Antenatal Care

Updated: Aug 7, 2021

My pregnancy with my first baby was low risk, largely problem free. The thrill I felt at seeing the ‘positive’ result pop up on the pregnancy test was unreal; and the joy I experienced during the time I was preparing to welcome my baby was the greatest that I’d ever known. Our excitement was shared by so many of our family and friends, and we couldn't wait to meet the first Brunker baby. I devoured every pregnancy book going, had already started on the baby manuals, I attended NCT and NHS antenatal classes. I thought I was doing all I could to give my baby the best chance; I don’t think I took it for granted that a positive on a pregnancy test automatically guarantees a healthy living baby at the end of it, but I celebrated every milestone reached as getting closer to the ultimate prize. Seeing our perfect-looking little creation jump around on the screen during our 12 week scan was such a thrilling moment - from that moment our baby became known as ‘the bean’. The anatomy scan went well, then it seemed no time at all before we reached 24 weeks – sometimes known as viability - and with every passing week my confidence grew along with my belly that all was going well, and we were eagerly awaiting the arrival of our first baby just like many other expectant parents before us. Every midwife appointment consisted largely of me passing all the checks with flying colours. Had I felt the baby move? Yes! Our magic little bean would often be doing somersaults inside of me; I imagined I was growing a future Olympian. Any swollen ankles? Nope. Headaches occasionally, and one migraine, but apart from that no issues, and I knew to report any headaches that lasted an unusually long time or caused visual disturbances. My midwife would comment according to the progress of my growing bump and the speed of the baby’s heartbeat whether she thought I was having a boy or a girl – I found it so funny that her prediction would change each time. One week when I said that the baby had been a bit quieter than normal one day recently my midwife remarked that I must have just been busy that day and not noticed the movements so much. When I corrected her that I’d actually been relaxing most of that day, hence noticing that the baby wasn’t moving as much as normal, she repeated her claim that I’d probably just been too pre-occupied to notice them properly, and said I *could* go to hospital to be checked if I was ever worried about movements, but that if I did that more than a couple of times, I would no longer be eligible to give birth on the midwife-led birthing unit like I’d outlined in my birth plan. (As if that was the worst thing that could possibly happen.) I didn’t really think anything more of it – the baby had gone back to its full gymnastics routines on a regular basis since then so I can only guess I presumed that wouldn’t be necessary. When we passed the much-fêted ‘full term’ (37 weeks) we really felt we were on the home straight - what could possibly go wrong now? Our hospital bags were packed. The nursery was beautifully decorated, the brand new buggy, painstakingly chosen from a dizzying array of options, was unpacked and waiting. All that remained was for me (note the emphasis on me – I am ashamed to admit now that I was terrified of the pain of labour) to give birth.

And then at 38 weeks and 2 days our world as we knew it changed forever. I woke feeling very tired. We’d had a disturbed night, as a picture had fallen off the wall in the nursery in the early hours of the morning with a huge crash and our outside light in the garden had turned on almost simultaneously, worrying us that we were being burgled. A peek through our curtains reassured us as we saw a hedgehog toddling around on our decking, and, everything in the house being quiet, we’d gone back to sleep. My husband Mark went off to coach his new cohort of year 7 rugby players in the morning while I went back to bed. I will forever hate myself for falling asleep while half propped up in bed reading; I woke up having napped on my back that morning. When Mark returned home, he asked how the baby was. I replied that I didn’t recall them having moved all morning. In fact, the last I remembered regarding any movement was while I bounced away on my birthing ball watching TV, and when I thought about it some more perhaps the baby had been unusually quiet again the whole of the previous day (hence me remembering that final kick so clearly – I think part of me had been relieved to feel that reassuring movement the previous evening after a day of not experiencing many kicks or wriggles). I was then racking my brains to think if they’d been moving normally that whole week and was horrified to realise that I just did not know – I hadn’t been paying sufficient attention. We tried the tricks we’d heard were sure to get the baby moving - I drank cold orange juice, lay on my side. Nothing. We rang the labour ward and they advised us to try what we had already, we explained that we’d done that and the baby still hadn’t moved. They told us to come in to be checked over. We felt a little nervous, unsure of what this could mean. We took our things in, including the baby’s car seat, in case we had to be whisked in for an emergency c-section (for me at that point that was what we were facing as a worse-case scenario).

The last photo of me pregnant with Esme, the day before we found out her heart had stopped beating

The car journey to the hospital was pretty silent - I don’t think we even had the radio on; me concentrating on my very still womb, and Mark no doubt with his mind racing but trying to drive calmly and not to panic. We were kept outside of the door to the maternity assessment unit for what felt like an eternity on arrival - I remember being eager to find out what was happening when we did head in – but still no thoughts of it being too serious at this stage. The midwife was a little brusque as she asked where our straps were – she assumed we’d been in for monitoring before – we had to explain that this was our first time coming in for a check over. Her manner did soften slightly as she found a new set for us and said these would be ours to keep in case we needed to come in again at any point, and her voice definitely changed once more as she ran the Doppler wand over my tummy searching for the baby’s heartbeat. She was softly murmuring that she couldn’t find it, but that she could be wrong. She said that she’d be back as soon as possible with a doctor. I remember looking up at Mark searching his face for answers, for reassurance, and I could tell he was barely holding back the tears already and was trying to be strong for the both of us as we waited to hear what would be the worst news of our lives. I couldn’t believe what was happening as the ultrasound machine wheeled into us brought nothing but more silence and two very young-looking doctors were muttering to each other – Mark had tears streaming down his face at this point and I wanted to scream at them, “What is happening, why aren’t you talking to us?” I don’t think my brain could quite let me ‘go there’ as I don’t think the seriousness of our situation had yet dawned on me. I felt angry, scared, and confused more than anything. But instead of speaking up all I could utter was the most animal-like howl of despair upon hearing the words that they did eventually come out with: “I’m sorry, your baby has died”. I often describe what happened next in terms of it being like an out-of-body experience. I don’t know if that was how it felt at the time but that’s certainly how I remember it looking back – as if detaching from that most unspeakable pain and horror is the only way I can bear to relive it. In my memories I am an observer watching my world crumble in front of me, like I am watching myself having been shoved violently off a cliff edge and can just see myself plummeting into a dark chasm with no chance of rescue. I know that at some point I was led out of the cubicle, sobbing uncontrollably and barely able to put one foot in front of the other, but I recall still managing to think to myself, “Ah, yes, good, I need to be kept away from the other mum in here, this must be horrible to listen to”. I still wonder now whether that woman remembers having her baby monitored in the cubicle next to us that day and whether she ever thinks about what happened to us.

After we had endured a further ultrasound to confirm that our baby was definitely dead, we were taken through to the hospital’s bereavement suite, the Star Room. It reminded me of a Travelodge hotel room, complete with tea and coffee making facilities and a mini fridge. None of it seemed real. The midwife who first came to speak to us in there sat down next to me on the sofa in the room with tears in her eyes. She spoke to us in the most calm and gentle manner. I can’t remember her full name but there was definitely an Angel somewhere on her name badge and I thought about how apt it was. She said how sorry she was, and answered my questions about next steps. My heart sank at hearing how long the induction process might take because my body showed no signs of being in labour at that time. Neither my brain nor body wanted to believe this was really happening it seemed. I wanted everything to be over with as soon as possible, but resisted Mark’s suggestion that I should have a c-section. I wanted no such thing. I couldn’t bear the thought that my baby would be surgically removed from me, like some kind of tumour. I wanted to do our little bean the honour of at least delivering them the way we had planned, to see it through and know that I’d been able to do that last act for them, and for me. I know many bereaved mothers have the opposite response, and cannot fathom how cruel it is that we make women go through labour with no hope of any happy ending after all of that emotional and physical stress, but to me, nothing could be worse than having been told our baby had died. I almost welcomed the prospect of labour as something to put my focus on other than starting to process the reality we were dealing with. Mark had the unenviable task of breaking the news to our parents over the phone. I truly do not know how he found the words to have those conversations, and I know their cries of disbelief, dismay, and despair will forever haunt him. After I had been given a pessary to prepare my cervix we were given a Sands bereavement support pack to take home, read, and digest before we returned to the hospital the following evening for induction.

We didn’t get a lot of rest that night, for obvious reasons, and we hadn’t even told all of our family and friends what was happening – we needed time and space to come to terms with the news before telling the world – I couldn’t face having to receive all of the messages of sympathy, fearing that they would make what was happening to us all the more real. We went for a walk in the early hours of the morning and chose a name for our baby: Esme for a girl and Toby for a boy. I was induced as planned on Sunday evening, and after a mercifully quick labour, managed to deliver naturally (with the assistance of diamorphine as the only pain relief) at 5.39am on Monday 23 September. We had a little girl: Esme. There was no obvious reason why she had died - my placenta appeared completely normal, and Esme was perfectly formed - a healthy 7lb 1oz weight and 55cm length. We spent time making memories with her in the Star Room, including taking some photographs, but to me she had already gone – the condition of her body quickly deteriorating being a brutal reminder of that fact. She was still beautiful but her skin had started 'slipping' and fluid was leaking in places, which was very upsetting to see. I knew she would not be suffering as it was likely damage caused by having spent time inside of me after she’d died and through being squeezed through my birth canal on her way out, but it still was so far removed from how I had imagined spending time with my baby after they were born that I soon realised that I didn’t want to linger in that room for too long. It would never be easy to say goodbye to her and I didn’t want my memories of her to be tarnished by how she looked towards the end of our time with her. Some of our family came to meet her, and I am forever grateful that they were brave enough to do so. I wish I had granted their wish to hold her too but I was worried that the blankets she was swaddled in would loosen and that they might not like all they saw. I wanted to protect her from anything less than the pure adoration and affection she deserved. We had Esme's post mortem results delivered to us on 4 November – exactly six weeks after she had been born. The consultant who spoke to us about them was only able to confirm that she was perfect, as was my placenta, so no cause of death had been found, and to this day we are none the wiser why she died. Although of course I have since invented a million and one reasons why it is all my fault. We told our consultant and bereavement midwife that my antenatal care could have been better in hindsight (that wonderful thing!), as although all the check boxes were ticked during my appointments (blood pressure taken, urine tested, bump measured, etc), I was never told about exactly why it was so important to carry out all those checks, and why pregnant mothers need to monitor foetal movements – stillbirth was never an issue that I was made aware of. I am conscious of how midwives must be reluctant to scare expectant mothers and don't want them worrying unnecessarily, but it was agreed in our post mortem results appointment that it sounds like more could have been done during my antenatal care to highlight risks and warning signs.

So, in sharing my story during Tommy’s #TogetherForChange campaign I hope to be able to highlight to everyone everywhere just how vital it is to ensure high quality antenatal care - and we can all play a part in educating and empowering pregnant women to know their bodies and get to know their babies. More can and should be done to help expectant parents know how to keep their babies safe during pregnancy.

For example, Kicks Count's advice on how and why to monitor your baby's movements: Group B Strep Support's information on this very common infection and how it can pose a risk to an unborn baby if undiagnosed:; similarly with the condition gestational diabetes: Tommy’s #sleeponside advice -

We should all know how and why to seek help if any alarming symptoms appear during pregnancy, and have medical professionals willing and able to act quickly if a baby might be in need of assistance.

MAMA Academy have put together some really useful wallets for pregnant women to keep their maternity notes in, with key information about how to enjoy a safe and healthy pregnancy. Information on the MAMA Academy and Tommy’s websites also outlines the antenatal care you should be receiving, and what to do if you are worried about anything:

If any of the following happen you should seek help straight away by contacting your midwifery unit.

Don’t delay if:

· Your baby’s movements reduce, slow down or change

· You have bleeding from the vagina

· You have itching, even mildly (particularly on the hands and feet, but other areas of the body may be affected too). This could be a sign of a liver disorder called Intrahepatic Cholestasis of Pregnancy (ICP, also called Obstetric Cholestasis), which increases the risk of stillbirth

· You have watery, clear or coloured discharge that seems abnormal for you.

· You have signs of pre-eclampsia.

Know the signs of pre-eclampsia:

· Obvious swelling, especially affecting the hands and face or upper body

· Severe headache that won’t go away, sometimes with vomiting

· Problems with vision (blurring, flashing lights or spots difficulty in focussing)

· Severe pain just below the ribs in the middle of your abdomen.

Sadly, I had no instinct that anything was wrong with Esme, but many bereaved mothers report that they didn’t feel quite right before they found out that their baby had died. Tommy’s campaign encouraging us to #AlwaysAsk recognises that if a pregnant woman ever feels that something is wrong, or is concerned about her baby, she should not hesitate to call her midwife or doctor to talk about it.

It is so important to listen to a pregnant woman’s instinct and a midwife should be happy to discuss any worries and act upon them when necessary. Do not rely on advice from family members, friends or even the internet. If you feel that a midwife is not listening, you can ask to speak to another member of the team. If you are still anxious that no one is listening to concerns you might have, contact the day assessment unit (DAU) within the maternity unit or seek advice from the Consultant Midwife - sadly even the professionals can get it wrong - and no-one knows your body and your baby like you do.



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