Promises are Never Broken

I try very hard to always keep my promises, it’s not always easy but if I make a promise to one of my children then I will move mountains to make sure that I keep it! Promises are built on trust, and my children trust and depend on me, and I sure as hell won’t break a promise and disappoint my children!

When Sophie was born I made 3 promises. The first was that I would always love and remember her… that one is easy to keep because she will always be my daughter and I will always love her; the second promise was that we would find out why she died; this one was slightly harder because the post mortem can back largely inconclusive… she was perfectly healthy which made things harder; however, they were pretty certain that she died from placental insufficiency caused by a blood clot which restricted her oxygen; the third promise was that I would make sure that other people know about her, help to support other mums who’s babies have died and campaign for safer pregnancies and births to try to stop other people going through this… Well… my darling beautiful daughter, your legacy is living on! Your mummy will never break that promise and through the Facebook page, the support group, Twitter, the petition and this blog many, many people now know about you, they know your story and they have also felt supported in their own grief.

I am shocked and humbled by how many people have visited this blog and amazed by how many different countries your story has reached. People from all over the world know who you are and I am very proud to be your mummy. I will never give up and I will never stop fighting to reduce the rates of stillbirth, and I will always help and support the mummies of your angel friends.

Love always xxx

How do Other People React to the News of Stillbirth, Miscarriage or Infant Death?

I have personally found a whole range of reactions; and the reactions tended to be different depending on how far along I was into the pregnancy. When we had our first miscarriage in 2015 I was 10 weeks pregnant; this was classed as a missed miscarriage, meaning that the baby had stopped growing but was still inside my womb; I had to have some medication (misoprostol) and wait for the miscarriage to happen… I found the reactions from others to initially be one of shock, but very soon they started to offer help and support, their reactions were very positive and they ‘kept me going’.

When we lost Sophie there was a lot of shock and disbelief… I was so close to my due date that this news really hit a lot of people quite hard. Even more so as I told them that I was booked to be induced and would have to go through labour to deliver her… everyone was just so shocked at that! I don’t actually know how else I was expecting her to come out, but I wasn’t expecting to have to go through labour! After Sophie was born my family and close friends were just amazing, and they reacted in a way in which they wanted to help. However, not everyone was like this! The first time I walked to the shops was about a week after she was born; and I noticed that people were now avoiding me, trying hard not to make eye contact and one lady even crossed the road so she didn’t have to make small talk! This upset me a lot at the time as it made me feel abnormal! I realise that people often don’t know what to say, but it’s always better to say something rather than nothing!

With my miscarriages since Sophie I have had comments such as ‘maybe you can’t have any more children’ or ‘maybe it’s time to stop now’, some people are supportive about us trying again, and some are not! But I tend to block out the negative ones and these days I don’t let people know if we have a positive test! It’s my way of protecting myself!!

I asked the members of Sophie’s Angels about other people’s reactions; some members would like to remain anonymous and some have said I can use their name. So below is what some of the members of Sophie’s Angels say:

Brittany: When it comes to still birth and infant death it’s something people don’t want to think about happening. When it does happen it makes people uncomfortable. In our case some of my family didn’t agree with me keeping my daughter in the room after she passed and they didn’t want to see her. When I played a video of her pictures at her funeral some people were very uncomfortable. They didn’t even look. I don’t think people know how to react because it’s hard to think about ever losing an innocent child. I don’t think they know how to approach it.

Anon: I get stuck when someone asks how many kids I have. I don’t want to hide Audrey but at the same time people either make a big scene with a very loud “oh my god I’m so sorry” or they get quiet and seem to want to avoid me or the whole topic of kids altogether. I definitely prefer reaction number 1 over the 2nd one. Loss mom’s already feel alone when people avoid us or talk about us like we are not there furthers the isolation!

Laura: Often people change the subject and feel uncomfortable around those who have lost a child. Everyone seemed to just act like it hadn’t happened especially those close to me. People need to know that we as parents to an angel sometimes need to talk about our precious babies.

Shayna: My experience was just three months ago . It was my first loss to my second born son. . We went to our 20 week scan and was told there was no heart beat and due to chromosome issues the sexton hadn’t formed . My Dr gave me 2 options , d&e (c) or delivery . My partner only had two days off and they kept saying that d&e was the faster option. I couldn’t do that to my baby so I chose delivery. I scheduled it for those two off days but felt so scared and wasn’t ready to let my child go . I say Fate happened and my oldest unfortunately caught a high fever so I took him to the ER when I should of went to l&d. I waited 2 weeks and finally miscarried on my own then went to l&d when I started bleeding . I delivered a beautiful baby boy who was completely perfect . His umbilical cord had wrapped around his neck twice .
People asked me while I waited what I was going to do and most agreed d&e would be better to get back to my family faster. My mother in law even asked why I would want to go through the pain of seeing and holding the baby. (She had a full term stillborn) but I don’t think I would of done it any different . I wanted my son . I’m grateful for his life inside me and I’m grateful for the chance to have held him and seen his beautiful face . I tell people I have two sons but one just happens to be my angel.
I WOULD LIKE TO TELL PEOPLE DON BE SORRY FOR ME BECAUSE I NOT SORRY TO BE HIS MOM!!

Christina: No one imagines losing your child it’s not something to go through alone it’s very upsetting as of everyday there’s always one little baby’s heart stops beating and I think hospitals should do more during the 9 months of pregnancy

Anon: In my experience people avoid you / the subject when they see you 1st…then they message you apologising for avoiding you because they didn’t know what to say!! I’ve never been offended by anyone’s behaviour EXCEPT that of my father in law, brother in law and grandmother in law……they have not visited, telephoned, text, offered my fella any support…he banned them from attending the funeral ( grandmother had the cheek to ask my mother in law!)

Miranda: Some people don’t know how to respond to miscarriage because they might not have even known you were pregnant. I consider most initial responses to my losses to be from shock. I usually just take hold of the conversation immediately by talking about my angels. I think people tend to be more comfortable if they know how YOU feel about your loss. I’ve lost two beautiful babies and I still struggle when someone has a loss because I never know how someone else is grieving.

Anon: was a shocker when I told my father. I really struggle to talk of it. For me, it’s not one loss, it’s 5. My husband’s family pretended my miscarriages never happened.

Mendy: It’s still so new for me. But I find myself sharing our story at random times. Last time was at my work Christmas party, random ride share moment, but the one that I experience most is, my Boss and I had a “get to know me” conversation. Her mouth dropped and tears formed so fast she alarmed me. I then reactively apologized “I didn’t want to make her sad”. She shares her story of her miscarriage. Even says that her story is still nothing like mine but she can understand the possible mood swings.

Anon: Everyone reacts completely differently. My dad and my brother struggle we don’t do death well in our family we are very matter of fact so losing a baby at 29weeks was a tough one. They are in to protective mode and just want to take the pain away something they can’t do and I can tell they feel helpless. Was so late in the pregnancy we had to tell Facebook as we had already announced that we were expecting. This brought up a number of things. It’s amazing how many old friends offer support and you suddenly realise the amount of people who have lost a child at some point. However one friend who I was very close with in secondary school it annoyed me. She had not acknowledged me being pregnant with my sunshine or any photos of her. She even avoided me at the park. Hadn’t acknowledged I was pregnant with Joshua but when she found out id lost him sent a message starting with “heyyy chick…” for me I felt this was for her benefit and she wasn’t thinking of me at all. Then some of my closest friends have been brilliant just letting me talk and crying with me . But my friend said when I messaged her all she wanted to reply was wtf are you kidding? Obviously she didn’t lol.

Conclusion

It is obvious from my own experience, and the experiences of others that I’ve spoken to, that just as no two people grieve the same way, no two people react the same way either. We all have different ways of coping, and we all have different was of reacting to bad news. However, one thing remains constant… it is always better to say something rather than nothing!

How to Know When It’s Time to Try Again

This is something that I have been asked a few times recently. ‘How do I know when the time is right to try again?’ This is a very personal question, and the answer is going to be different for everyone. So, with this post I am going to give a very general answer based on conversations that I’ve had with various bereaved parents.

You are the only person who knows how you feel about trying again, and therefore you are the only one who knows when the time is right. However, there are some things to take into consideration.

• How does your partner feel?
• Have you had all the tests available so that you know any risks in future pregnancies?
• Are you happy with your care team?
• Are you confident that you will be well looked after?
• Do you feel ready, emotionally, for another pregnancy?
• Are you physically healed from your last pregnancy?
• Are you taking any suggested medication?

The main thing is that you, and your partner, feel ready. Rainbow pregnancies are not easy; you are no longer naïve about things that can happen, and this can be very stressful. I would urge you to work with your doctor to make sure that you are fit and healthy, and that any concerns are taken seriously; as this will help to ease your mind.

Some people feel ready immediately, others want to wait a while. What I will say (and I’m being a complete hypocrite here as I wanted to try straight away after Sophie!), is that it is best to wait for tests, especially genetic tests, to come back first; this way you can be sure that the care plan your doctor puts in place for you, is tailored to your individual needs.

I wish you the best of luck when you do decide to try again, and I’m keeping everything crossed for you!

Research into Loss

Tommy’s conduct research into miscarriage, stillbirth and premature birth; they have four research centres (London, Manchester, Edinburgh, and the National Research Centre which is the largest in Europe). Hundreds of doctors and midwives work together across the Tommy’s research centre network to improve pregnancy outcomes for both mother and baby.

There are specialist clinics within the centres for women at risk of pregnancy complications, they also have the opportunity for people to join in research trials.

London

The Tommy’s Preterm Surveillance Clinic – This is held at Guy’s and St. Thomas’ hospital, and they have been providing care for over 10 years. Tommy’s states that ‘In 2017, the total number of referrals from women at high risk of giving birth too early doubled compared to 2016. We are now seeing an average of 200 referrals each month’.

The hypertension in pregnancy clinic – This is based in St. Thomas’ Hospital and helps women with high blood pressure. They have helped 150 women since 2015.

The diabetes clinic – This is based at Guy’s and St. Thomas’ Foundation Trust, the clinic helps women with diabetes, women suffering from endocrine disease and other disorders like cholestasis. ‘The research carried out in the clinic has been a driving force for the adoption of universal screening for gestational diabetes’ Tommy’s

Manchester

The Placenta Clinic – This is the UK’s first placenta clinic and was opened in 2009; they work with women whose babies have growth restriction, and study the placenta carefully to reduce the risk of stillbirth.

The Rainbow Clinic – This is based at St. Mary’s and they provide care to women who have suffered a previous stillbirth or neonatal death.

The Lupus in Pregnancy Clinic –Tommy’s is supporting this clinic which helps women with the autoimmune disorder Systemic Lupus Erythematous and related diseases. Tommy’s supports the clinic through access to our research midwives.

The Manchester Antenatal Vascular Service – This is based at St. Mary’s hospital in Manchester, and offers extra monitoring and pregnancy care to women with a history of high blood pressure, and those at risk of related complications. Tommy’s states that ‘MAViS is currently home to exciting research funded by the National Institute for Health Research’. Tommy’s supports the clinic through access to our research midwives.

Edinburgh

Tommy’s Metabolic Antenatal Clinic – This clinic helps women with severe obesity, they have specialists in pregnancy care and diabetes, as well as midwives and a specialist dietician. 25-30 women each week are seen in this clinic. Last year women attending this clinic were 8 times less likely to have a stillbirth than women attending clinics not specialised in helping obese women.

Tommy’s Lothian Preterm Birth Clinic – This clinic aims to continue reducing preterm birth and late miscarriage rates, to improve the quality of care for women and to develop expertise in managing complex cases.

Miscarriage centre clinics

Tommy’s National Centre for Miscarriage Research has recurrent miscarriage clinics in three different sites in the UK. All of these offer close monitoring and care during the early stages of pregnancy to women who have previously suffered miscarriages. They are also able to take part in Tommy’s clinical trials, which hope to provide women with reasons for their loss. The clinics are based in:
• Birmingham Women’s Hospital
• University Hospital Coventry
• St. Mary’s Hospital London

If you would like to be referred for one of these clinics, then please visit: https://www.tommys.org/our-organisation/help-and-support/clinical-trials

If you would like to take part in one of the trials, then please visit: https://www.tommys.org/our-organisation/help-and-support/i-would-take-part-tommys-trial

To sign a petition I made to cut the stillbirth rate in the UK, please visit: https://you.38degrees.org.uk/petitions/cut-stillbirth-rates-by-half

HELLP Syndrome

What is HELLP Syndrome?

HELLP Syndrome usually occurs during the third trimester, but around a third of cases occur after the baby is born, rarely it can occur before 21 weeks of pregnancy; it is a rare liver and blood clotting disorder that affects around 1 in 125 women during pregnancy or after giving birth. It is a serious and potentially life threatening condition so please contact your care provider if you exhibit the signs or symptoms.

What is HELLP Syndrome?

HELLP stands for:

H – haemolysis (the red blood cells break down)

EL – elevated liver enzymes (proteins) (a high number of enzymes in the liver is a sign of liver damage)

LP – low platelet count (platelets help the blood to clot)

Symptoms of HELLP Syndrome

The symptoms of HELLP Syndrome are very similar to the symptoms observed with pre-eclampsia (the two conditions are often related). You may experience one or more of these symptoms:

  • Headache
  • Nausea/vomiting/indigestion with pain after eating
  • Abdominal or chest tenderness and/or upper right side pain (from liver distention)
  • Shoulder pain
  • Pain when breathing deeply
  • Bleeding
  • Changes in vision
  • Swelling/weight gain

Your midwife or doctor will check for the following signs during your antenatal appointments:

  • High blood pressure
  • Protein in the urine

The most common reason for HELLP becoming fatal is liver rupture or stroke (cerebral oedema or cerebral haemorrhage), which can usually be prevented when caught in time.

How HELLP Syndrome affects babies

If a baby weighs at least two pounds at birth, they have the same survival rate and health outcome of non-HELLP babies of the same size. Unfortunately, the outcome for babies weighing less than two pounds at birth is not as good; these babies may need longer hospital stays and will have a higher chance of needing ventilator care because their lungs did not have enough chance to develop in the womb. Around 1 in 10 babies born to women with HELLP will pass away and this is often link to their prematurity.

Treatment of HELLP Syndrome

With treatment, the mortality rate of women with HELLP Syndrome is around 1 in 100, although complications can occur in about 1 in 4 women. The only way to treat the condition is for the baby to be born as soon as possible. Many women suffering from HELLP syndrome will also require a transfusion of some form of blood product (red cells, platelets or plasma).

What can I do to prevent HELLP Syndrome?

Unfortunately, there’s currently no way to prevent this illness. Things that could help to make sure it’s diagnosed early are:

  • Regular antenatal check-ups during pregnancy
  • Inform your midwife about any previous high-risk pregnancies or family history of HELLP Syndrome, pre-eclampsia, or other hypertensive disorders
  • Understand the warning signs and talk to your midwife or Doctor immediately
  • Trust yourself when “something just doesn’t feel right”.

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?

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

Foetal Development – An Overview

There are three trimesters in pregnancy and each has different developmental characteristics. The estimated due date (EDD) is set by calculating 40 weeks from the first day of the last monthly period (LMP); which means that when fertilisation occurs the woman is already two weeks pregnant.

For a detailed view of foetal development week by week – with pictures! Please click here.

In the first trimester, when an ovum (egg) is released it travels down the fallopian tube towards the uterus; the corona radiata (outer layer of the ovum) contains follicular cells that are difficult to penetrate; spermatozoa (sperm) must then secrete a digestive enzyme in order to weaken the corona radiata. Once the sperm have penetrated the egg the chromosomes combine to form a zygote (a one-celled body which contains 46 chromosomes); hCG is then released to increase progesterone levels and stop your period. The zygotes’ cells divide rapidly until there is a cluster of 16 cells (a morula); fluid collects within the morula creating a separate outer layer which encapsulates the inner cluster of cells, the inner layer will eventually become the embryo and the outer layer will form the placenta; there are now 58 cells in the structure and it is now called a blastocyst.

The blastocyst then burrows into the uterine wall (implantation). During the embryonic period (weeks five to ten) the major structures begin development; there are three layers to the embryo; the outer layer (ectoderm) forms the outer layer of skin, nervous systems, eyes, inner ears, and connective tissues; the middle layer (mesoderm) forms the heart and circulatory system, along with the bones, muscles, kidneys and the reproductive system; and the inner layer (endoderm) becomes a tube lined with mucous membranes ready for the development of the lungs, intestines and bladder.

While the placenta is forming the embryo is nourished by the yolk sac. The brain forms and the heart is starting to pump blood through the main blood vessels; the tissue which will become the spine is growing and has developed somites; the eyes are beginning to form, and arm and leg buds are developing. The neural tube then closes and the ears and nostrils begin to develop; the lungs are also forming. By the seventh week the arm buds look like paddles which will develop into fingers. The spine eventually begins to straighten and as the arms continue to grow they can bend at the elbows; toes then start to form and all of the essential organs have begun to grow. The eyelids then fuse shut, and the intestines rotate. At the end of week ten the embryo is termed a foetus. Red blood cells begin to form in the liver, tooth buds appear and the external genitalia starts to develop into either a penis or clitoris. By the end of this trimester the embryo has the appearance of a miniature human.

During the second trimester the intestines (which have been growing in the umbilical cord) return to the abdomen and bone tissue is developing. The ovarian follicles start to form in females and the prostate appears in males. Red blood cells are developing in the spleen and bones have also begun developing, with movements becoming better coordinated; the ears move near to their final position and the foetus can hear sounds outside of the womb; the mouth now makes sucking motions. Fat stores form under the skin, and vernix (a greasy coating) covers the foetus offering protection from abrasions and chapping due to the amniotic fluid. The next stage of development is the swallowing reflex; the foetus swallow’s amniotic fluid and then urinates before swallowing again, this helps to mature the lungs; lanugo (soft, fine hair) covers the foetus helping to keep the vernix in place; and meconium is now made in the intestinal tract. The foetus begins to show signs of rapid eye movements, fingerprints are starting to form and taste buds are developing. In females the uterus and ovaries which contain a lifetime supply of immature eggs are in place and in males the testes have started to descend from the abdomen. Bone marrow is now making blood cells and the startle reflex is developing; the foetus may respond to sounds with movement. Surfactant is now being produced in the lungs, allowing the air sacs to inflate and deflate. 

In the third trimester the foetus rapidly gains weight; the bones are fully developed although still soft, and red blood cells have formed in the bone marrow. The eyes open and the pupils can now detect light; the brain is growing rapidly and during the thirty-first week the central nervous system can control body temperature. The lungs begin to practice breathing, lanugo starts to disappear and the foetus begins to absorb minerals (iron and calcium) from the intestinal tract. At thirty-seven weeks the foetus is classed as early term, all organs are able to function and the head may begin its descent into the pelvis. The foetus is considered full term at 40 weeks.