A change of [birth] plan…

As we say in the UK, there’s been a slight technical hitch…

No sooner had I gotten my head to that zenlike state of pre-birth blissful ignorance calm excitement (based on doing it all naturally, or as far as possible, pending any surprises) but I had a hard knock back down to earth.

Long story short: Turns out I’m not going to get to give birth in the lovely Birth Centre, which just about broke my heart (if it wasn’t a stone cold British heart). 

Damn you, gestational diabetes!

The way I found out was particularly shocking. By which I mean, it wasn’t really that shocking but now I’m on wind down from the professional world of work, I’m sort of in a state of blissful relaxation and it was a bit of a shock to discover that everything I’d been visualising in my head wasn’t actually going to happen.

The basic problem is that if you have diabetes (including gestational, including diet-controlled and not insulin-dependent or medicated in any way), you have to be treated by a consultant. And if you’re under consultant care, you have to give birth on the delivery ward. The reason is, if you have diabetes then the protocol during birth is to be monitored continuously. They can’t monitor continuously in the Birth Centre as it’s a midwife led unit.

So instead of giving birth in the place I’d envisaged (huge, softly lit, nicely paint-jobbed pseudo hotel room), I have to give birth in a standard hospital room – with a bed with bars on, and medical equipment beeping and nasty bright light white roomed paper curtained yuckiness.

Now, someone could have told me this weeks ago when I was diagnosed with gestational diabetes but they didn’t. Mainly because the diabetes people are a bit sh*t and don’t operate in a joined up way at all. (I really do not see eye to eye with the diabetes people and now I especially don’t.) So the way I found out was from my midwife (the lovely, lifesaving L) when I asked if I could take a picture of the birth suite for T, as he hasn’t seen it (he figures he’ll see enough of it by the time I’ve given birth and I’m inclined to agree) and instead of being led to the lovely hotel-room-like birth centre room, she led me down the horrible hospital corridor to a yucky hospital room with wires and stuff hanging all over the place.

Naturally, I didn’t look happy at this – L realised there’d been a massive misunderstanding and told me I should have been told there was no frickin’ way I could use the Birth Centre if I was “diabetic”, and clearly I was beginning to change my mind about the whole thing and considering how I could do a home birth! And swiftly took me to the hospital cafe to talk it all out…

The thing is, it’s taken a vast amount of psychic energy and general emotional thought to get myself to a space where I felt okay with the idea of childbirth and was largely managing my emotions and anxieties concerning pregnancy loss fears and fear of pain etc. I was actually completely fine about the whole thing, and now I feel like I have to unravel all of my mental preparations and change my idea of what the birth is actually going to be like. And this is all for something that could happen any time.

It’s frustrating, for sure. And thing is, I realise that everything could change on the day and I was prepared for that (eg If I have to have a caesarian rather than vaginal birth) but this is changing the entire birth plan I’d envisaged before my waters have even broken.

I asked if there was anything I could do, but L said that the protocol at our hospital for those who’ve been diagnosed as diabetic (using the goddamn Glucose Tolerance Test) even if well controlled by diet mean that patients have to have continuous monitoring during birth. This is because of the NICE guidelines which say that for controlled diabetics, they should be allowed only to get to 40+6 (ie 41 weeks gestation, one week overdue) before being induced, and they should also be subject to continuous monitoring during birth because apparently they’re more at risk of the baby being in distress.

Now, the NICE guidelines apply to insulin controlled diabetics. I am not on insulin or metformin. Quite frankly I am not inclined to believe I am diabetic but allegedly because I “failed” the glucose tolerance test, I am now classed as diabetic. (Based on my body’s ability to metabolise a syrupy glucose drink over two hours of inactivity. Which is something I do every day… NOT.) By all accounts it’s likely it’ll go away after the baby’s born, and anyway, my private doctor said these tests do not account for racial differences (I am not white) and in his opinion, the normal glucose levels for different races are different and it should be expected that my race has a higher baseline level of blood sugar and can still be healthy / non-diabetic. Which just makes my blood boil. (I’m already mad that the diabetic dietician tried to make me eat more carbs that I don’t even usually eat – such as diet fizzy drinks, more bread – so they could then put me on metformin. WTF?)

The frustrating thing is, it is not a decision for me or for L and I don’t have much choice. Basically that’s my hospital’s protocol so unless I start looking for someone else to give birth (bearing in mind this could happen any day now – I’m now at 38 weeks) I have to accept that. L said this was just how it worked in this hospital and whilst she sympathised with me, she would not feel comfortable looking after me (as my dedicated midwife) against the consultant advice / hospital protocol (for continuous monitoring). Which I can completely understand from her point of view.

My only option really is to appeal to the diabetic obstetrician (who is very nice and an advocate of natural childbirth and minimal intervention) to see if she thinks I need continuous monitoring. But… I also feel like things like this make us doubt our own opinions. I mean, if doctors tell me my baby needs continuous monitoring and this is my first baby to make it to childbirth then I don’t feel in a confident position to tell them I don’t want that. (In a midwife led unit, the most monitoring they can do is doppler in between contractions, which doesn’t tell you if the baby’s in distress during the contraction, during which the oxygen is cut off and he’s relying on oxygenated blood reserves in the placenta, from what L explained to me. Which are apparently considered lower in certain groups of people including diabetics.)

In short, I’m not in a position of confidence to say, “I don’t want continuous monitoring” because we are made to feel we are basically endangering our baby if we don’t have it. And I don’t want to endanger my baby. Of course. I can have a feeling that it’s not necessary but then a voice in the back of my mind says, what if it is necessary? What if you refuse it and he dies? So of course I’m not going to go against what they say.

L thinks it’s just about me wanting “the nice paint job” (her words) and it’s true, the Birth Centre room is like a hundred times nicer than the delivery suite room. But it’s not just some stupid vanity or whatever or wanting to be in a hotel room. It’s the difference between wanting a relaxed home-type birth versus a medicalised, all white bright-light smelling-of-hospital whilst other women scream in the background birth. I mean I really don’t like hospitals and the only reason I was so chilled out about the birth was specifically because I’d seen the Birth Centre, which is totally un-hospital-like.

Argh. So L tried to make me feel better. She said she would “de-medicalise” the room. We could turn the lights off and have fairy lights / tea lights (all battery operated of course) and I could use the birth pool and also use the continuous monitoring that is wireless so I could move around and get in and out of the pool. So I wouldn’t be tethered to the bed, which is completely what I don’t want. (I know this sounds odd when I had initially wanted an elective caesarian but it’s precisely because of my fears about lack of control which are now coming true!) I am also absolutely averse to going on the ward after birth. It’s like my worst nightmare. I don’t want to be around other people. I want it to be just us.

L also said that she would make a concession and other than trying to de-medicalise the delivery room – and also that she would be the gatekeeper and not let anyone in without agreeing it with me (and I refused the consent for the medical student to be there as well) – that if I have a “normal” vaginal delivery without intervention or complication, that I can go recover in the Birth Centre. So if I don’t lose loads of blood and need further treatment or whatever, or have a caesarian, I can go to the original place I wanted to be rather than on the ward.

I’m getting my head around it, and T thought I was doing well as he said they should have told me ages ago so I’d have had time to get accustomed to the idea. I feel like I don’t have much choice in the matter. I mean, realistically I can’t have a home birth (and I don’t feel up to that, quite aside from our flat is tiny) and if I want to be looked after in hospital, I have to go along with what they say. I appreciate L trying to make it better for me, but it’s quite a big shift in what I’ve been gearing up to. So I’m just going to have to work on being all zen and accepting and stuff.

I think one of the big things is that I’ve done a lot of work on myself to get to this calm state, so when there are things that are knocking me out of it, they make it difficult for me to stay so relaxed. Actually one of the things completely doing my head in is one girl in my NCT group. We have a Whatsapp group and she always posts about how anxious she is and how much pain she’s in yadda yadda and I just want to tell her to shut up. She’s like super insipid and whines about everything and keeps talking about how she wants it to be over. I actually said to her today that she should try and enjoy it because some people (like me) are grateful for being pregnant as we never thought we would be. 

Also, she’s a bit creepy towards me… We are the same race and I kind of feel a bit like she is a potential stalker. She has no family in this country, which I’m sympathetic about, but she really annoys me so out of everyone in the group she’s the one I least want to be friends with. (I did on first meeting until I realised how whiney she is. As an example she’s usually the last person to post on Whatsapp chats because she’ll write a load of stuff and nobody will respond.)

For example re the creepiness: she lives the closest to me out of the others in the group, but not on my estate, but pretends to everyone she lives on the estate (which is more upmarket than where she lives – outside – just to sound snobby!). She’s already told me she walks past our block of flats every day and “wonders which one yours is?” (Ummmm creepy. Glad there’s a big gate around it and she can’t get in.) She is always hanging around our estate and making out she lives there and posting on the Facebook group, like she doesn’t get that she doesn’t actually live here. 

Other creepiness is she literally keeps on buying the same stuff as I have bought for our baby. Like we discuss stuff on the group and people ask what others have got and then she just buys the exact same thing I’ve already bought. It’s like she wants us to be the same race and have the exact same stuff for our babies?! I am just not comfortable with her ways. I think she wants to keep emphasising similarities or something and we are not similar!

And also doesn’t seem to take the hint that I am never inviting her round, and keeps angling for an invitation. The other day she even posted to the group, addressing me: “I think I want to get a sling like yours – do you know where I could try it out?” Clearly asking if she could come round and try mine out. Umm no. I am one of those people (British!) who don’t invite people round unless we are friends friends. And why would she think I’m going to open my brand new sling and let her try it on? Just nope. Why can’t she go to a shop and make up her own mind? She even said it again in person when we met up as a group (I tried to sit far away from her and not talk with her) and I was just like, that’s nice. I mean, if you want to buy it, buy it. Don’t expect me to use my new stuff for you!

Hmm maybe I’m just getting to grouchy pregnant state? Weird thing is, apart from this annoying girl and the whole “You have to give birth in a nasty hospital environment” thing I’m super chilled out. The others in our group were saying how I seem to be the most okay with everything and calm and stuff. I honestly think it’s because I never thought I’d get to this stage and I am grateful. I can remember this time last year feeling hopeless and depressed and thinking I’ll never get to have a child, so I’m not going to feel bad about this, or whine about the pregnancy aches and pains (okay, not that much!) and so on. I’m feeling much better now I don’t have to go into work again until after maternity leave. I’m working from home and lying around with Dog and nesting with T and I am just not going to feel bad about that, because whatever happens, everything’s going to change in a few weeks (or less!).

Anyway the next steps are that L has even had to book me in provisionally for an induction at 40+6. This is something I did know about as with GD the doc said she wouldn’t let me go past 41 weeks. L said it’s better to get a slot rather than wait until the time and then have to fit in around the availability. I’m hoping it won’t be necessary and B will arrive before then (but not early! Ideally on time / a couple of days late!). I see various docs the week of my due date and so there’s the opportunity then to revisit their recommendations around induction, delivery location etc… I’m thinking the most likely outcome is going to be a fairly medicalised birth at 41 weeks though. 

We went through all the birth plan questions (which mainly consisted of me saying I don’t want intervention if I can do it naturally) so L and I are meeting next week to go through the plan. And also she said she’d try and de-medicalise a room for me to try and talk me round and get me feeling better about it! I can be kind of upset about it but ultimately I just have to accept it I think and try and get myself in a good headspace to have the kind of birth I want (even if in a nasty hospital room).

In other news, my sister had her 9+ week scan today and it was great! So I’m feeling hopeful for her. It means by the time I give birth (all being well), she will be around 12 weeks. Maybe this will be easier on her. I know it took a long time for my anxieties to reduce, but equally I feel some selfishness creeping in and wanting to be able to be happy. I feel like for the first half of my pregnancy I was anxious and worried, and then for this latter part, it’s almost been hard to feel happy because of stuff going on with my sister and my brother (which I haven’t talked about on the blog but he’s dealing with something huge). So just to be able to celebrate B’s safe arrival, that would be a big thing. My main thing is I want him to get here safely. And the second thing is I want my family to be able to be happy for me. And not in a way that negates what they are going through – I want them to be happy because they are genuinely happy… I hope that is possible.