Pregnant Women and Newborn Babies

How do you cope when you see pregnant women or newborn babies? This is such a hard one for many of us who have lost a child, it’s something that comes up a lot on Sophie’s Angels and other loss groups that I am a member of.

Your Feelings

I would like to start by saying that your feelings are completely warranted. There is no ‘right or wrong’ way to feel in this situation and your feelings will probably vary depending on the time since your angel grew his or her wings, how close you are to the pregnant woman, as well as other factors like how the other children are treated, how long they have been trying for a baby, and their personal situation… I know that this is absolutely none of my business but when you have lost a child your perspective changes, and even though I may not say anything except ‘congratulations’, my feelings are warranted and important… and so are yours. I still find that I get envious of people who seem to fall pregnant very quickly and have an easy pregnancy… It doesn’t mean that I’m not happy for them… because I am! But I am still envious… and that’s ok!

How to cope with your emotions

This is different for everyone, and you need to do what is right for you. It can help to talk about this on groups like Sophie’s Angels as you can talk to people who understand the mix of emotions that you are feeling… without being judged. Some people (and I have done this on occasion) go into self-protection mode and try to ignore their own feelings and emotions; however, by doing so you can end up feeling ‘numb’; this can help in the short term, but when those emotions return (and they will) it is so much harder to deal with it. However you deal with your feelings around pregnant women and newborn babies is right for you, and as soon as you realise, and truly believe that the feelings are completely normal then it will become easier to cope with. It is ok to not be ok.

What can you do to help with these emotions

The first thing, and I can not stress this enough, is to realise that your emotions and feelings are completely valid and totally normal; you are only human and therefore can easily be triggered by something which hurts your feelings. These are some ideas which could help you to cope with seeing pregnant women and newborn babies:

  • Join a few support groups like Sophie’s Angels or SANDS. On these group you will find other grieving parent, grandparents etc, and talking about your feelings with people who understand can be really helpful
  • Cry, scream, shout and vent as much as you need to, because none of this is right or fair
  • Avoid (at least to begin with) triggering situations… I’m sure friends will understand if you can’t attend their baby shower etc
  • Talk to you doctor if you feel that you would benefit from bereavement counselling
  • Talk about your angel as much as you want

What other things have helped you to cope with this? Please feel free to leave a comment.

Trying Again After Loss

Trying again after loss can be a very touchy subject, and can add to the taboo as many people around the couple try to avoid the subject as they are worried about upsetting them. When you do mention the possibility of trying again, everyone seems to have an opinion, and you can find yourself doing what you think others want and expect… rather than what you want for you and your family.

When is the right time to try again? Only you can answer this question and the answer will be different for everyone; it will depend on many factors including:

  • What gestation you were when you lost your angel?
  • Have you healed physically?
  • Did you need a caesarean section?
  • How do you and your partner feel about trying again?
  • Are there any genetic tests which need to be done first?

I have known people who try again straight away, and also people who have chosen to wait a while; whatever you choose has to be right for both you and your partner. There is no medical reason to wait if the doctors have cleared you physically, so the only thing that you need to worry about is how you will feel emotionally going into another pregnancy.

When we told people that we were going to try again we had a whole range of comments, it seemed like everyone had an opinion! Some were good…. And some were not so good! Ultimately, it is down to you and your partner and other people really need to either support you in your decision or keep their opinions to themselves!

After we were told that Sophie has passed away we were sent home for two days while awaiting the induction. This was probably the hardest part for me as I could feel that inside things had changed; my stomach was hard and heavy, Sophie was slumped to one side, at the bottom which made it very uncomfortable, and emotionally just knowing that she had passed away but was still inside me and frightened of what was to come was extremely difficult. Emotions can make you react in a way that some people can’t understand.

During our time at the hospital before we were sent home the doctor was discussing the possibility of trying again and at the time I was adamant that it wasn’t going to happen… EVER! Well, you can imagine Paul’s surprise when the following day I turned around to him and said ‘once Sophie is born I want to try again straight away’ he was very shocked by this and thought that I wasn’t thinking clearly… which I now know I wasn’t! My emotional state at the time was, as you can imagine, all over the place. I remember feeling very guilty for admitting that I wanted to try again so soon, but after speaking to the Midwife I realised that actually, those feelings, are very normal.

These are some of the questions I asked myself to decide when the time was right for me. However, this was after a stillbirth, when I had gone through labour and birth, my milk needed to dry up, and I needed time to heal physically and have the post mortem and all the genetic testing done; after our miscarriages we tried straight away… so these questions can be adapted depending on the gestation.

When is it right to try again?

This is something that is personal to each couple, and no one else should try to influence them in any way. I am hoping that this post will help to answer this question.

Are You Physically Prepared?

With the physical aspect of trying again it is best to be guided by what your doctor recommends. My doctor recommended waiting until after my 6-week postnatal check-up, but each doctor will have their own recommendations based on your own personal circumstances, the reason for your loss and the method of delivery. They may also recommend that you take vitamin supplements for a set period of time to replenish the stores which reduced during pregnancy.

Are You Emotionally Prepared?

Your doctor can assess your physical state, but your emotional state is just as, if not more important when trying after a loss. In all honesty, no one knows for certain how they will react when they conceive after a stillbirth, miscarriage or infant death; psychologically it can affect you for the rest of your life, and although you move forward, when you conceive these feelings may come rushing back. However, there are a few questions that you could ask yourself when preparing to try again:

  •  Have you had a chance to work through some of your grief?
  •  How would you cope if you were to experience fertility problems?
  •  Are you ready to cope with the stress of another pregnancy?

Talk about your feelings with your partner

Do you both feel the same? It’s important to discuss and listen to each other. I know Paul was shocked and overwhelmed by my eagerness to try again so soon. Women can sometimes become obsessive and carried away, while very often, for the man, it takes time to want to try again. So, you really need to listen to each other in order to agree on a course of action that you are both comfortable with.

Emotions while Trying Again

Trying to conceive can be torturous and frustrating… even for people who haven’t experienced a loss. Women can easily become obsessive as the months go on (charting, taking temperatures, buying ovulation predictor kits etc). Very often people lose sight of the intimacy and sex becomes robotic… this can make things much harder, not just to conceive, but also your desire to be together. For couples who have experienced a loss this can be even more challenging…. You want things to happen, but at the same time are scared of them happening. It is far better to just relax and let nature take its course; and you will then find that you enjoy the process rather than allowing your emotions to get in the way.

What Others Think

It is a fact that everybody will have their own opinions on whether or not you should try again. However, ultimately that is down to you and your partner. Until I decided to write a post about this there were very few people that knew we were trying again… mainly because I didn’t want, or need to hear their opinion! Of the people we have told, we have had a range of opinions… from the supportive ‘we will stand by whatever you decide’ to ‘we think it’s a complete mistake’ but ultimately it is our decision, and with the doctors promising that I will be closely monitored, I think we may regret it if we don’t ‘try’ once more.

How to Know When You’re Ready

This is a really hard one to answer! You will have days when you are obsessed about trying again and really want it to happen asap, and then you’ll have days when fear takes over and you are terrified about conceiving and losing again. These are both completely normal emotions. Most people who have lost a baby ‘just know’ when the time is right; it’s a gut instinct that takes over. However, I am under no illusion that pregnancy will never be the same again, I will worry about every single thing and will no longer be ‘relaxed’ once I hit the 12-week milestone.

Final and Most Important Question

Do the rewards outweigh the risks? This is a personal question that only the couple can answer! Once you feel that the answer is yes, then you are ready to try again

Antiphospholipid (Hughes) Syndrome

Antiphospholipid syndrome, also known as Hughes Syndrome, is an autoimmune disorder which causes an increased risk of blood clots. People with this condition are at an increased risk of developing:shutterstock_53224042_height-400.jpg

  • Deep vein thrombosis
  • Arterial thrombosis
  • Blood clots in the brain
  • Pregnant women have an increased risk of miscarriage or stillbirth

What causes antiphospholipid syndrome? 

With antiphospholipid syndrome the immune system attacks healthy tissue; abnormal antibodies are produced which target proteins attached to fat molecules, making the blood more likely to clot.

Diagnosing antiphospholipid syndrome

Blood tests are used to diagnose antiphospholipid syndrome; these tests look for antibodies responsible antiphospholipid syndrome.

How antiphospholipid syndrome is treated

Antiphospholipid syndrome cannot be cured; however, it can be managed successfully. Blood thinning injections, such as fragmin can be self-administered and aspirin can also be taken to help thin the blood. These medications can also improve a pregnant woman’s chance of having a successful preEIS05000.jpggnancy.

Pregnancy 

Antiphospholipid syndrome can cause recurrent miscarriage or stillbirth, as well as other pregnancy complications. At least 15% of recurrent miscarriages occur as a result of antiphospholipid syndrome, and with prompt treatment, the pregnancy success rate has risen from 20% before 1990 to over 80% today.

Pregnant ladies are usually treated daily with low dose (75mg) aspirin, and if a previous loss has occurred in the second or third trimesters they may also be given fragmin injections.

Pregnancies can be affected in a number of ways:

Early pregnancy loss

Most miscarriages occur during the first 13 weeks; antiphospholipid antibodies can cause early miscarriages by preventing the embryo from embedding properly in the womb. Early miscarriages are common, and there are many possible causes. Therefore, women will not be tested for antiphospholipid antibodies until they have three consecutive early miscarriages.

Late pregnancy loss

In most pregnancies foetal death in the second and third trimesters is rare; however, it is strongly associated with antiphospholipid syndrome and therefore women with a late pregnancy loss should be tested for antiphospholipid antibodies. Women with antiphospholipid syndrome can develop clots in the placenta or around the cord which reduces the baby’s oxygen supply.

Pre-eclampsia 

Pre-eclampsia is twice as likely to occur in women with antiphospholipid syndrome.

Intrauterine growth restriction 

Intrauterine growth restriction (IUGR) are babies with a very low birthweight and they usually weigh less than 90% of babies at the same gestational age. With antiphospholipid syndrome the reduced blood flow to the placenta can cause the baby to be small for dates.

Research

What is being done to treat Antiphospholipid (Hughes) Syndrome? And what research is in place to find things to help someone with this condition? I recently came across ‘The London Bridge Hospital’ website, they are a private hospital which specialises in treating Lupus and Hughes syndrome as well as conducting clinical research.

From The London Bridge Hospital website ‘In 1983, our group described a condition in which there was an increased tendency to blood clotting. Such clots can occur at any time, and can affect veins or arteries anywhere in the body. During pregnancy, clotting of the placenta results in a tendency to miscarriage – some women suffering a dozen or more miscarriages before correct diagnosis and treatment. Features include leg and arm clots (DVTs), headache and migraine (leading in some to stroke), memory loss, chest pain, cold circulation. We initially reported the condition in a group of lupus patients but soon recognised that it could occur in individuals without any evidence of lupus’

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Clinical Studies for Antiphospholipid (Hughes) Syndrome Research

Units throughout the world are researching Antiphospholipid Syndrome; The unit at St Thomas’ obtains some funding from the Hughes Syndrome Foundation and publishes up to 40 research papers each yeaaps3r; and The London Bridge hospital is now carrying out studies with groups in America, Argentina, Brazil, France, Italy, Japan, Portugal and Spain. The International Antiphospholipid Syndrome meeting (Dr Hughes first started this in 1985) is now in its 12th meeting, and it attracts up to 1000 doctors and researchers. The discovery of Antiphospholipid Syndrome in obstetrics has meant that the odds of carry a baby to term has increased dramatically; before the discovery patients only had a 20% chance of a successful pregnancy but treatment patients now have an 80% chance.

General treatments

The aim of treatment is to ‘thin’ the bloody so that the tendency to clot is reduced, this is achieved with anticoagulant medication. There are currently three main anticoagulant medications (aspirin, heparin or warfarin) and for most patients one low dose aspirin (75mg) a day is enough to stop the blood from clotting. Heparin (such as Fragmin) is a very effective anticoagulant and is offered in injection form. It cannot be used for long term treatment due to an increased risk of osteoporosis. It is, however, used in some Antiphospholipid Syndrome pregnancies, as warfarin is potentially toxic to the developing baby.

Aspirin 

  • aps5Low dose aspirin (baby aspirin) – at a dose of between 75mg to 100mg a makes the blood platelets less sticky.
  • Side effects are rare (indigestion; allergy especially in asthmatics)
  • Safe in pregnancy

Heparin

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  • Newer “low molecular weight” heparin (such as Fragmin) has replaced older preparations
  • Only available as injection
  • Used to treat thrombosis, prior to warfarin use
  • Safe in pregnancy

Warfarin (Coumadin)

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  • Warfarin is a safe and effective medicine; despite being dismissed as ‘rat poison’ by some journalists
  • Side effects are rare – the only vital issue is to keep the dosage correct
  • The thinning of the blood achieved by warfarin is measured on an ‘International’ scale called ‘INR’ ‘Normal’ is “1” – half thick blood is “2” and one third blood is “3”
  • Not allowed in pregnancy

Placenta Previa

The placenta is the baby’s lifeline during pregnancy, it’s an organ which grows in the womb and is connected to the baby via the umbilical cord; it provides baby with Oxygen and nutrients which pass from your blood supply into the placenta and are then carried to your baby via the umbilical cord; carbon dioxide and other waste products are also carried away from the baby by the umbilical cord to the placenta and then into your bloodstream for disposal. Hormones produced by the placenta help your baby grow and develop; It offers your baby protection against bacterial infections while in the womb, and towards the end of pregnancy it passes antibodies from you to your baby which should give him or her immunity for about three months after birth. However, it only passes on antibodies that you already have. In most pregnancies, the placenta attaches at the top or side of the uterus. Placenta previa occurs when a baby’s placenta partially or totally covers the mother’s cervix, which can cause severe bleeding during pregnancy and delivery.

If you have placenta previa, then you may bleed throughout pregnancy and during delivery; and your doctor will probably recommend that you avoid certain activities, such as, having sex and running. If the placenta previa is diagnosed early in pregnancy then there is a chance that the placenta will move as the uterus grows, however, If the placenta doesn’t move then you will need a caesarean section. You should call your doctor if you have vaginal bleeding during the second or third trimester, and if the bleeding is severe then you should seek emergency care.

Diagnosis

An ultrasound scan will be used to diagnose placenta previa, and you will probably need extra ultrasounds throughout your pregnancy to check the position of the placenta.

Treatment

There is no medical treatment for placenta previa, however there are ways to manage the bleeding; the recommendations will depend on various factors:

For little or no bleeding

  • Pelvic Rest – avoiding activities that can trigger bleeding, such as sex and exercise.
  • Seek emergency care if bleeding starts.
  • If the placenta is low lying but doesn’t cover the cervix, you might be able to have a vaginal delivery. Your health care provider will discuss this option with you.

For heavy bleeding

  • Seek immediate emergency help, Some women with severe bleeding may require a blood transfusion.
  • A Caesarean will be planned for as soon as the baby can be delivered safely (ideally after 36 weeks of pregnancy)
  • If bleeding persists you may need an earlier delivery and you will be offered steroids to mature your baby’s lungs.

For bleeding that won’t stop

  • If your bleeding can’t be controlled or your baby is in distress, you’ll need an emergency C-section — even if the baby is premature

Risk Factors

Although the cause of placenta previa is largely unknown, there are certain things that have been found to increase the risk. These are:

  • Have had a baby before
  • Have scars on the uterus from previous surgery (caesarean deliveries, uterine fibroid removal, and dilation and curettage)
  • Had placenta previa with a previous pregnancy
  • Multiple pregnancy
  • Are age 35 or older
  • Smoking

Complications

You will be monitored to reduce the risk of serious complications such as:

  • Severe bleeding (haemorrhage) which can occur during labour, delivery or in the first few hours after birth.
  • Severe bleeding may prompt an emergency C-section before your baby is full term.

Have you experienced placenta previa? What was the outcome? What support did your care provider offer you?

Flashbacks

One of the hardest things for me to deal with at the moment are the flashbacks I seem to be getting. I can’t control them and they are never the nicer memories… ‘It doesn’t look good guys’ is what the doctor said when he told us the news, ‘what will she look like’ I asked a different doctor, to which she replied ‘she will look like a baby’… this last one has stuck with me, because although comforting at the time, she will not LOOK LIKE a baby… she WAS a baby… MY baby!!! She was loved, wanted and cherished and she always will be! I will always have a piece of my heart missing, and it will never be complete again. I understand that now… I don’t like it and I can’t accept it… but I do understand it.

One of the biggest flashbacks I’m getting is of Sophie being wrapped in a towel and me being taken to theatre to remove my retained placenta; when I got back from theatre Sophie was bathed and dressed. I asked Paul if he had washed and dressed her, and he said ‘no the midwife did it’… this I accepted at the time (I had just given birth to a stillborn daughter and didn’t want to make a scene!), but it has affected me… really affected me! I can visualise every single part of Sophie, except her feet! I never saw her feet so I have no idea what they looked like! I should have bathed her, I should have washed her, and I should have told the midwife not to do it… but I didn’t, and now I never will be able to… and that crushes my heart sometimes.

The flashbacks are so hard, I had a dream 2 nights ago that I gave birth and the doctors were wrong and Sophie was alive… then I woke up and cried! I have had dreams where I’m in labour and Sophie is born with a smile on her face, waving as she flies into the air to be with the other angel baby’s… and I just try to pull her back. Dreams can be very upsetting sometimes.

 If you are experiencing flashbacks then please write a comment.

 

Bereavement Midwives – Experiences and Opinions

My own experience with the hospital bereavement midwife wasn’t a very positive one and I wanted to discover whether more can be done to ensure that people are more supported by the bereavement midwives after they leave the hospital. I went about asking for experiences and opinions from other loss parents; and to be honest it is completely mixed! Some had amazing support, while others had awful, or non-existent support!

My Experience

After we lost Sophie we were assigned a bereavement midwife by the hospital; she wasn’t working the day that Sophie was born and therefore we didn’t meet her before the birth; however, we were induced two days after we were told that Sophie had died so she really could have made contact during that time to offer support and explain what would happen… it’s a very scary time and that would have been helpful! She was working the day after Sophie was born, but she still didn’t come to the bereavement suite to meet us before we left as she was ‘really busy’, so the hospital chaplain came in her place.

In fact the first time I spoke to her was the day after we got home when I wanted to go back to the hospital to see Sophie before she went for her post mortem; I telephoned her number and left a message for her to call back… which she did and then she met me at the hospital. The first time I met her she seemed pleasant, she asked how we were coping and if there’s anything we need help with. I asked for a referral to bereavement counselling for my son (I am still waiting for her to do this and ended up going through my GP!). After I visited Sophie she explained about how long the post mortem would take etc, and said that she would keep in contact to see how we were; and to please phone if I need to talk to someone as that’s what she’s there for.

I did telephone a few times (always got the answering machine!), and it always took 24 – 48 hours to receive a call back, and then she was nice on the phone but didn’t action anything she said she was going to!, she has never once visited me or invited me to any appointments, she did not attend Sophie’s funeral and she has not acknowledged Sophie since… I have heard from some people who, for instance, received a letter or a ‘thinking of you’ card on their baby’s birthday… we didn’t even get a phone call! I personally think she’s in the wrong job!

Experiences by others

I asked members of the Sophie’s Angels support group for their experiences and opinions, and the comments were completely mixed! Some positive and some negative. I thought this would give an idea as to what more can be done to support families who have lost a baby.

Positive

I’m always pleased to hear positive experiences about bereavement support… these are some of the comments that were made:

‘So far… AMAZING. I had a side room and the same 2 lovely nurses who looked after me from being admitted to being discharged. Nothing was too much trouble, pain was well managed. Small acts of kindness like letting my husband come/go and stay as much as I/he wanted without restricting us to visiting hours. Giving him a pass to the car park so we didn’t rock up a huge parking debt. They fed my husband and brought him cups of tea/coffee. The way they were with Dexter, how they dressed him and complemented him, the gorgeous memory box and ‘birth certificate’ (not an official one as he was born at 20 weeks), the way they brought him to me as many times as I wanted, the pass they gave me to come back to the ward to come and see him as much as I liked after I was discharged. The photographer they got to come and take pictures of the 3 of us, the chaplain they arranged to come and see us, the bereavement midwife who came to see us… if it’s possible to have a ‘positive’ experience whilst going through this I certainly did’

‘My son died at the children’s hospital where they had a group of people specialist in bereavement. They took hand and prints as well as a foot cast of my son, gave us a box with a candle, an angel, seeds to plant a flower, a box to put some of his hair in. The phoned every so often to check on us and they were wonderful’

‘I could write so much about all of the amazing care I received especially my amazing bereavement midwife Nikki. She was my rock when we lost Amelia last year. This time when we lost Sophia in June The care at the hospital was fantastic again. We were in the snowdrop suite again which is nice, my husband never had to leave they set up a bed so we could sleep together. They gave us our beautiful memory box and took hand and footprints for us. Nikki the bereavement midwife came straight up to the snowdrop suite to see me when she heard I was back. I could tell you so many things she’s done for me. She has gone above and beyond. Today she came to visit me and she knew I wanted to go back to the hospital to hold my baby as I didn’t have chance when she was born. My husband didn’t want to see her again and as she didn’t want me to go alone she took me. Sat with me when I cried and hugged me when I needed it the most. She then took me for a hot chocolate and a chat’

Negative

Unfortunately there are also many negative experiences, and more can most definitely be done to help with bereavement support; either before, during, or after the birth:

‘My experience wasn’t so good I was on labour ward for a whole week and I wasn’t allowed in the quiet room till the last night. The midwife’s where lovely, gave me a memory box hand and foot print had a cold cot were really respectful of him asked his name etc and talked to him which was comforting. I can’t fault the midwives, they gave me a lot of emotional support while I was in the labour wars for 7 days hearing births; another lady came in during that time at 39 weeks to deliver a stillborn baby which was heart-breaking all the more. I was given some leaflets and that was it when I was discharged, SANDS send me a letter to attend a candle lighting event every 6 months, but that’s all aftercare I have received’

‘My bereavement care was so poor. The whole care from admission to discharge was disgusting actually. Felt really let down and totally robbed of all the things, the little memories I never got to do that I will never get back. They only had 1 bereavement midwife for the hospital, and whilst she was off the week I was admitted no one stepped in and took her place to guide me and my partner through the process of it all. I had a different midwife and Dr every day and night literally no continuity of care what so ever. The memory box was left outside the room, they all avoided the room like the plague avoided all the questions I had. The midwife who delivered my angel was nice but she didn’t do the care to her full potential, she covered my baby with a towel as if she was a bit of trash, I was totally rushed with my baby, I was given 8 hours with her which I will forever treasure, but I was kept in that night and my baby sent to the mortuary even though they had a cold cot there. Also I wasn’t offered to see my baby again by the hospital, the bereavement midwife txt me and called me when she got back off holiday and explained that the staff hadn’t given me a bereavement info pack that I should’ve got which I later got posted out to me. Also I had to figure a lot of things out on my own. The staff were all so under trained with bereavement care (and I wasn’t even a difficult patient). I was 37 weeks pregnant when I had my little girl who was born sleeping, with no complications what so ever and no cause of death from a full post mortem’

‘I never had one. Wasn’t even offered one. I’ve just struggled through on my own’

‘My care was horrific! My bereavement midwife was none existent. Counselling was a great help but wasn’t offered until 12 weeks after, and by that time I had already attempted suicide! Nothing got explained, because of this we missed out on a lot of memory making’

‘Mine was terrible. I lost my daughter on the 8th April at 17+2 and I’m still trying to get help. I have taken an overdose too. I was assigned a bereavement midwife but only spoke to her once and that was to tell me Elsie had had her post mortem. I’m still waiting for the results. The care I received whilst suffering my miscarriage was on another level of shocking. I’ll never go back to the hospital concerned if I’m ever lucky enough to have my rainbow’

Conclusion

As far as I can see there are some bereavement midwives who go above and beyond to really support the families, while others could do with retraining so that people feel supported and cared for. Small gestures make all the difference… phoning or visiting to see how you are, offering help and support, referring to outside agencies who may be of benefit, attending the funeral, becoming a friend, being approachable and easy to talk to, returning telephone calls, visiting before the birth, organising the birth photographer, hand and foot prints etc, offering to help with any arrangements, recommending funeral directors… there are many things that can be done to help the grieving family and as a bereavement midwife or support worker they really should be doing everything that they can to make this difficult time slightly easier.

Please feel free to join Sophie’s Angels, it can really help to connect with other parents who are going through loss.

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Placental Abruption

Overview

The placenta is the baby’s lifeline during pregnancy, it’s an organ which grows in the womb and is connected to the baby via the umbilical cord; it provides baby with Oxygen and nutrients which pass from your blood supply into the placenta and are then carried to your baby via the umbilical cord; carbon dioxide and other waste products are also carried away from the baby by the umbilical cord to the placenta and then into your bloodstream for disposal. Hormones produced by the placenta help your baby grow and develop; It offers your baby protection against bacterial infections while in the womb, and towards the end of pregnancy it passes antibodies from you to your baby which should give him or her immunity for about three months after birth. However, it only passes on antibodies that you already have.

In 2013 the NCBI (National Center for Biotechnology Information) published a study which found that placental abruption affects 0.7% – 1% of pregnancies; however, according to Tommy’s it is suspected that this figure may be higher as abruption isn’t always diagnosed. This is a serious condition in which the placenta begins to detach from the uterus, meaning that the baby can become starved of oxygen and nutrients.

Causes and Risk Factors

Very often the cause of abruption is unknown; however, there are factors that can increase the risk. These are:

  • Abdominal trauma – maybe from a fall or a car accident
  • Previous placental abruption
  • High blood pressure
  • Smoking
  • If your waters have broken prematurely
  • Blood-clotting disorders
  • Multiple pregnancy – the delivery of the first baby can cause changes in the uterus that trigger placental abruption before the other baby or babies are delivered.
  • Maternal age – women over 40
  • Using drugs (especially cocaine) in pregnancy
  • Previous caesarean birth
  • History of recurrent miscarriages

Symptoms

Placental abruption occurs most frequently in the last trimester of pregnancy (especially in the last few weeks) and symptoms include:

  • Vaginal bleeding
  • Abdominal pain
  • Back pain
  • Uterine tenderness
  • Rapid uterine contractions, often coming one right after another

Abdominal pain and back pain often begin suddenly and the amount of bleeding can vary. If the blood becomes trapped inside the uterus by the placenta it is also possible to have a severe placental abruption with no visible bleeding. In some cases, placental abruption develops slowly. If this happens, you might notice light, intermittent vaginal bleeding. Your baby might not grow as quickly as expected, and you might have low amniotic fluid (oligohydramnios) or other complications

If you notice any of the symptoms then please get medical help immediately because they may signify an emergency.

Treatment

The treatment for placental abruption will depend on the severity and gestation. Women under 34 weeks with a minor placental abruption are usually monitored closely in hospital, your care provider will ensure that baby is growing correctly, and will also look for any signs of preterm labour. If there is a risk of your baby not growing properly then labour may be induced. If the abruption is more severe, you are losing lots of blood and the baby is in distress or at risk of not growing properly you may need to have your labour induced or have an emergency caesarean.

Complications

Placental abruption can cause life-threatening problems for both mother and baby.

Mother

  • Shock due to blood loss
  • Blood clotting problems (disseminated intravascular coagulation)
  • The need for a blood transfusion
  • Failure of the kidneys or other organs
  • Hysterectomy

Baby

  • Oxygen and nutrient deprivation
  • IUGR
  • Premature birth
  • Stillbirth

The study showed that:

19% of cases were stillborn, 11% of new born baby’s had an apgar score under 7 at 5 minutes, 34% of newborn baby’s had weight less than 2500g (2.5kg or 5lb 8oz) and 40% of newborn babies were admitted to NICU.

Have you suffered with placental abruption? Please feel free to share your story

Multiple Miscarriages

So here I am writing about a subject that, until recently, had never crossed my mind; while awaiting a call from my consultant which never seems to come!

1 in 4 people will miscarry before 6 weeks of pregnancy, 80% of pregnancies fail in the first 4 weeks, and most people never knew they were pregnant as it happens before the period is due; but these are just statistics right??? Wrong! Miscarriage is another taboo subject that should be spoken about, these families deserve to have their baby remembered just like any one else, and they should also be allowed time to grieve their loss.

Since Sophie passed I have had multiple early miscarriages, the NHS don’t test for reasons until you have had more than 3 consecutive miscarriages and they have finally agreed to test for reasons, I will keep you posted! I have actually had 5 early miscarriages but because they weren’t consecutive I didn’t qualify for testing. We only have until the end of the year and if we’re not successful then at least we tried! A few people have said that maybe we shouldn’t try anymore, that it’s fate…. thank you for your concern but fate can kiss my backside right now! If the doctor is happy then we’re happy!!

I will be starting a series of blogs about what can cause early miscarriages, but please, if you’ve suffered a loss at any stage then please don’t stay silent, my email is always open

VBAC – Facts and Statistical Information

It used to be said that ‘once a caesarean, always a caesarean’, this is no longer the case and in the UK VBACs are becoming more encouraged and more common. I am slightly biased on this topic as I have had two caesareans, followed by two VBACs; however, I will try to write from a non-biased view to allow you to make an informed decision. I have researched from RCOG (The Royal College of Obstetricians and Gynaecologists) to ensure that the information is accurate and current.

Are you a good candidate for a VBAC?

The majority of women in the UK are offered to attempt a VBAC, as long as you fit the criteria then you have a fair chance of having a VBAC:

  • A low-transverse caesarean scar
  • No history of previous scar rupture
  • Baby is in a head down (cephalic) position

This risks of VBAC increase when:

  • The woman has a classical caesarean scar
  • The woman has had placenta praevia
  • Woman who’ve experienced previous uterine rupture
  • Women with a previous classical scar (high vertical incision)
  • Women with a T or J incision
  • Less than 12 months since last delivery
  • Post-date pregnancy
  • Maternal age of 40 years or more

Can women with two or more caesareans attempt a VBAC?

Most obstetricians in the UK will offer women with two previous caesareans the chance to attempt a VBAC; an analysis of the NICHD study showed that there was no significant difference in the rates of uterine rupture in VBAC with two or more previous caesarean births (92/10 000) compared with a single previous caesarean birth (68/10 000), and successful VBAC rates remain the same (62-75%). RCOG states that women with two previous caesareans should be told the following information:

  • VBAC success rate (71.1%),
  • Uterine rupture rate (1.36%)
  • Risk of hysterectomy (56/10 000)
  • Risk of blood transfusion (1.99%)
  Planned VBAC Planned Caesarean
Maternal Outcomes 72–75% chance of successful VBAC Able to plan the delivery date
  Shorter hospital stay and quicker recovery Virtually avoids the risk of uterine rupture (less than 0.02%)
  Approximately 0.5% risk of uterine scar rupture Longer recovery
  Increases likelihood of future vaginal birth Reduces the risk of pelvic organ prolapse and urinary incontinence
  Risk of anal sphincter injury Can be sterilised at the same time if that’s what the woman wants (although this needs to be agreed 2 weeks before the procedure)
  Risk of maternal death is 4/100,000 likely to require caesarean delivery in future births
    increased risk of

placenta praevia/accreta and adhesions

with successive caesarean deliveries

    Risk of maternal death is 13/100,000
Infant outcomes Risk of transient respiratory morbidity of 2–3%. Risk of transient respiratory morbidity of 4–5%
  10 per 10 000 (0.1%) risk of stillbirth <1 per 10 000 (<0.01%) risk of delivery related perinatal death or HIE
  • 8 per 10 000 (0.08%) risk of hypoxic ischaemic encephalopathy (HIE) 4 per 10 000 (0.04%) risk of delivery-related

perinatal death

This post has given the statistical information for VBACs; on my next post I will discuss your options during your VBAC labour.

The Menstrual Cycle

The menstrual cycle is on average 28 days, although this is only a guide and often varies. There are four stages to the menstrual cycle: menstruation, the follicular phase, ovulation and the luteal phase.

MenstruationIllustration of Menstrual phase lasts from day 1-5 showing uterus shedding its inner lining and menstrual fluid flowing out of vagina - Menstrupedia

The thickened endometrium (lining of the uterus) leaves the body through the vagina; the menstrual flow contains blood, endometrial cells and mucus. This usually takes 3 – 7 days to complete.

 

Follicular phaseIllustration of Follicular phase lasts from day 1-13 showing an egg cell maturing in a follicle in one of the ovaries and endometrium begins to develop in the inner surface of the uterus - Menstrupedia

This phase commences on the first day of menstruation and finishes with ovulation. The pituitary gland releases the follicle stimulating hormone (FSH) which stimulates the ovary to create several follicles containing immature eggs; one of these follicles will mature into an ovum. The endometrium thickens in preparation for pregnancy. The level of oestrogen also rises due to the developing follicle.

OvulationIllustration of Ovulation phase day 14 showing an egg being released from the ovary and enters the fallopian tube. Fimbriae of the fallopian tube is labeled - Menstrupedia

Two weeks before the period is due the mature egg is released from the ovary; stimulated by the rise in oestrogen, the hypothalamus releases gonadotrophin-releasing hormone (GnRH) which prompts the pituitary gland to produce FSH and luteinising hormone (LH). High levels of LH then trigger ovulation; the egg ruptures the follicle, leaves the ovary and travels down the fallopian tube towards the uterus.

Luteal phaseIllustration of Luteal phase lasts from day 15-28 showing a fully developed endometrium in the uterus. If the egg cell is not fertilized, this phase leads to the menstrual phase of the next cycle - Menstrupedia

The ruptured follicle develops into a corpus luteum. The corpus luteum then begins to release progesterone and small amounts of oestrogen. These hormones maintain the thickened endometrium in the hope that a fertilised egg will implant. If an egg does not implant, then the corpus luteum dies and progesterone levels drop which triggers menstruation.