The Hardest Thing

I often help mums who are going through loss and talk to them before, during and after the birth of their sleeping baby, I never tell their stories because whatever they say to me is confidential, and I have too much respect for them to break that confidence! However, one loss mum has specifically asked me to share her story. I was contacted last week via Facebook messenger by Amanda who had just been told that her baby had passed away at 37 weeks… she went for a routine check-up with her midwife, and when they tried to listen with the doppler there was only silence; that is something that I remember… the silence! No heartbeat, no movements and no sounds from the blood rushing through the placenta… just silence. She had felt her son move the night before, but hadn’t felt him that morning; she wasn’t concerned though as he was always quieter in the mornings; this is how her story began, the next chapter in her life, the one where she would have to find a new path without her precious son Daniel.

She was given my details from someone on the ‘Our Angel Sophie’ Facebook page, this person would like to remain anonymous but I would just like to say thank you for suggesting that she contacts me. I always feel very honoured when I’m contacted by people who are going through this, people looking for support, and people looking for a friendly person to help them through it. It’s a very private and sensitive time, but it can also be very lonely, and the fact that I am occasionally contacted to help with support and ideas makes me feel very privileged.

So, Amanda messaged me and explained that she had just got back from the hospital and that they were going to induce her within 48 hours (this seems to happen a lot, they send you home and bring you back 2 days later). She was obviously very scared., upset, worried and angry; it was better to talk rather than message so I called her via the messenger app. We chatted for a long time about her pregnancy, her feelings and what would be likely to happen when she goes in to be induced. We also spoke about making memories, the help in place for after Daniel’s birth and the support that her family have at home. I made suggestions where I could, but I mostly listened.

We kept in touch over the next two days, speaking regularly as she set about packing a bag for the hospital and organising childcare for her other 2 children; while I helped by organising a photographer for her. It is always heart-breaking when I am helping other loss mums… that agony is something that I wouldn’t wish on anyone! But I feel privileged that people trust me enough to let me offer support; as I’ve said before, it’s a very frightening and lonely time, and just having someone to talk to can be really helpful.

I kept InTouch with Amanda via message on the day that Daniel was born, I thought it best to leave her and her husband alone so that they could just ‘be together’. I did say she could ring me any time and left it at that… although she was never far from my mind! She phoned at 11pm to let me know that he had been born and how perfect he was. She sent me photos of her sweet angel and Daniel was absolutely gorgeous.

Amanda went home the next day and she phoned me to thank me… when it should be me thanking her! It is such an honour to help someone through such a devastating time. Amanda has asked me to share her story with you.

I keep in touch with her and I think I always will.

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 Insufficiency

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. HowevPlacental+insufficiency1er, it only passes on antibodies that you already have. Alcohol, nicotine and other drugs can also cross the placenta and can cause damage to your unborn baby.

Placental insufficiency (also called placental dysfunction or uteroplacental vascular insufficiency) is a serious pregnancy complication, and usually occurs when either the placenta does not develop properly or it is damaged.

With placental insufficiency, the placenta is unable to provide the baby with adequate oxygen and nutrients; and without this the baby cannot grow and thrive. This can lead to low birth weight, premature birth, birth defects and stillbirth; therefore diagnosing placental insufficiency early is vital for improving the outcome for both mum and baby.

Causes

It is often linked to blood flow problems. While maternal blood and vascular disorders can trigger it, medications and lifestyle habits are also possible triggers. You are more at risk of having placental insufficiency if you are overdue, have diabetes, chronic high blood pressure (hypertension), blood clotting disorders, anaemia, are a smoker, or take drugs (especially cocaine, heroin, and methamphetamine); it may also occur if the placenta doesn’t attach properly to the uterine wall.

There may be areas of dead tissue, called infarcts, within the placenta which result in reduced blood flow in those areas; often these are caused by a problem with the vessels within the placenta. Certain conditions are known to increase the number of infarcts within the placenta, such as pregnancy-induced hypertension. Infarcts don’t usually affect the unborn baby; however, in certain cases and especially in women with severe hypertension, the reduced placental blood flow may be enough to cause poor growth and even stillbirth.

Symptoms

Regular antenatal (prenatal) appointments are essential as there are no maternal symptoms for placental insufficiency. However, the mother may notice that her bump appears small or her baby may be moving less than expected.

Complications

A pregnant lady who has placental insufficiency is at greater risk of preeclampsia, placental abruption, and preterm labour and delivery. However, the risks are far greater to the growing baby and the risks for the baby include:

  • Oxygen deprivation at birth (which can cause hypoxic ischemic encephalopathy (HIE), seizures, brain damage and cerebral palsy)
  • IUGR
  • Learning disabilities
  • Hypothermia
  • Low blood sugar
  • Low blood calcium levels
  • Excess red blood cells
  • Premature labour
  • Death

Diagnosis and Management

Regular antenatal care can improve outcomes as it helps your provider to diagnose placental insufficiency earlier. A range of Tests are used to diagnose placental insufficiency; these include: taking measurements of the fundal height during routine antenatal appointments, pregnancy ultrasound scans to measure the size of the placenta, the size of the baby, and check the placental blood flow, non-stress test to measure the baby’s heart rate, movements and contractions, and sometimes you may have a blood test to check the alpha-fetoprotein levels in the mother’s blood.

If you have high blood pressure or diabetes then treating these can help to improve the baby’s growth. Placental insufficiency can’t be cured but if it’s detected early enough then it can be managed with regular antenatal care. The consultant may recommend looking for any signs of preeclampsia, more frequent appointments, regular ultrasound and foetal doppler scans and if necessary admission to hospital so that it can be continuously monitored. You should also pay very close attention to your baby’s movements and kicks, and any changes in these should be assessed straight away. If there is concern about premature birth then you may receive steroid injections; these dissolve through the placenta and strengthen the baby’s lungs.

Future Pregnancies

In future pregnancies, you are likely to be monitored much more frequently with many more ultrasound and doppler scans and more antenatal appointments. Your consultant may suggest you take low dose aspirin, although you should speak to your doctor first about this, and may also suggest anticoagulant injections such as Fragmin or Lovenox… this will however depend on the reasons for your placental insufficiency. If you have diabetes then this will be carefully monitored and a suggested treatment plan will be put in place; and any bad habits such as smoking or drug misuse should be addressed.

There really isn’t very much that can be done to prevent this from happening. However, careful monitoring and good antenatal should improve the outcome.

placental insufficiency

 

Coping with the Due Date

I have been asked many, many times how I coped with Sophie’s due date; so I thought I’d write a post which may help other people as the date approaches. It was slightly different with Sophie because she was nearly term when she was born sleeping (you can read Sophie’s story here), and therefore I tend to focus more on her birthday than her due date; however, with the miscarriage I had at 10 weeks it was the due date that I focussed on. Therefore, this post is written from the perspective of how I coped with the due date approaching for the baby we lost in the first trimester. 

The Date logo

The first thing you need to realise is that you can’t hide from the date, and that although the date will be imprinted in your mind… not everyone will remember that date that your baby was due. The baby we miscarried was due on 2nd August 2015, we don’t know whether the baby was a boy or girl (although I suspect it was a boy) and that date will forever be a difficult date for us. 

Your Support Networkholding-hands

Speak to your partner, close friends and relatives as the date approaches; they may not actually remember the date and if you speak to them then they will be in a better place to offer support… or at least give you time if you need to talk, or leave you alone if that’s how you need to deal with it.

Create a Memorial Garden707e2d4ab0c0d41b20bf55d041427fc5

We have a small patch in our back garden which I call the ‘memorial garden’, we planted it not long after we miscarried and I am constantly adding new plants to it as the old plants die off… I have perennials there now so all I need to do is weed the area; but to begin with we used bedding plants. I often sit out there and ‘chat’ to both my angels.

Buy Something for Baby-font-b-Kid-b-font-font-b-Toy-b-font-font-b-Car-b-font

If your baby had survived, then you would be buying birthday presents and very often the thought of not buying anything is one of the most upsetting aspects. So… if you feel that way…. Then there is no harm in buying something! I choose to buy things for the memorial garden, but you can also buy something age appropriate for their memory box (if you have one). It can be therapeutic to buy something for baby.

CandlesIMG_0648

I always light a candle for the baby on the morning of the due date; I had a candle holder engraved with my angels details: ‘Angel Baby. Grew wings on 9/1/15. Due on 2/8/15’. You can buy these on Ebay and I find that lighting a candle is quite comforting.

 

A few more suggestionsArticle%20Lead%20-%20wide1001486004gk9k0iimage_related_articleLeadwide_729x410_gk9bjo_png1444867049258_jpg-620x349

These are a few suggestions that helped me to cope with the due date. You could also try taking a long walk, booking some time away, spending time with family, arranging a day out, starting a new hobby, fundraising for The Miscarriage Association or SANDS. There is no easy way to cope with the due date, but the better prepared you are, the less traumatic it will be. If you are struggling and need someone who will listen then please drop me an email via the ‘Contact Us’ page.

 

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