Showtime!

Maternity leave seems to have extended to blogging as well as employment. I feel that this is part of the nesting process, as priorities change and focus narrows as birth approaches.

I came up with the title for this post several months ago. As I was preparing for birth I was concentrating on the natural, instinctive cooperation between my body and baby. As the process of childbirth remains almost indescribable to those who have not yet experienced it first hand, first time mums will I suspect always feel that they don’t have all the facts as they approach this astounding phenomena.

As such, I tried to quell any anxieties I had by trying to focus on birth from the baby’s perspective; of arrival, of action and of his first breath.

For the past nine months he had been flexing in my womb, developing organs, practicing breathing (you can feel them do this by the way). He had been rehearsing.

Now, as labour commenced, this was showtime!

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Understanding Your Triggers

Personally, I think it is really important to try and gain understanding of the underlying triggers of my mental health. Counselling and active listening support is geared towards searching experiences and triggers to try and tackle the root of what makes an individual react to stimulus the way they do. I’m not necessarily expecting to find any answers to ‘why’ certain things make me feel a certain way or experience flashbacks like those I described yesterday and often the trigger itself can be pretty illusive. For me it is about being proactive with my recovery and using these negative episodes towards positively exploring and improving my mental wellbeing.

I have shared several of my coping strategies with you before, especially relating to work and anxiety, and the importance of reflection to help you become aware of how certain stimuli make you feel so that you can understand and prepare for encountering that trigger. Recovery is hard, but finding the strength to keep on pushing and stretching the boundaries your mental illness is trying to inflict and delving into these painful and emotional episodes and experiences is a great step in regaining control when it feels that your mind is invading and imposing itself on your daily life.

Reflections from Yesterday

My latest post stemmed from a reoccurrence of physical and emotional reactions resulting from past trauma. Time had lapsed considerably since I last experienced these particular responses and it came as a surprise, which surprised me more because though I have never expected to not be conscious of this trauma, I had thought that it had stopped encroaching on my marriage and daily life.

Why with the time that has elapsed and with the slow yet steady progress in my recovery am I suddenly back to flashbacks, recoiling and responding as if I were still in that negative situation?

As I said above, the triggers are often illusive, which makes delving into them rather difficult. What I have surmised at this stage it is most likely connected to the pregnancy. It is after all a particularly significant change; physical, emotional and mental.

I hope that unpacking pregnancy as I explore my personal trigger  (for this particular instance at least) will help demonstrate how you can gain understanding, and hopefully begin to feel in control, of  your triggers.

Assessing Triggers

1.Hormones: Menstration, Pregnancy and Otherwise

Mentally during pregnancy there are a whole host of hormones flying around which in turn generate a lot of intense and varied emotions. Beyond pregnancy it is very common to have hormones impact upon mental health. For women especially (although men experience fluctuations of hormones as well) mental health can be strongly affected by their menstrual cycle. Certain contraceptive methods have been frequently discussed in relation to menstruation and mental health, but I have not researched this enough to feel confident to comment on this area yet. My own personal experiences would however lean in favour of this and I would love to hear your thoughts and stories.

2. Intimacy

Regarding my personal experience, intimacy plays a big part. Mental illness to one side, it has been a significant part of my recovery  from that trauma to be confidently intimate with my husband. If I can react so strongly to the man who I married, the first I had encountered to put my needs above his, and who I trust most in the world… it’s not surprising that intimacy can be such a strong trigger.

Again let’s look at this from within and without the context of pregnancy.

For me, pregnancy is the current trigger for recent expressions of trauma and intimacy is a factor in this. I am fortunate not to have a partner who bemoans the decline and physical barriers to intercourse. In fact as someone who experienced coercion and assault for this reason in the past, I don’t even want to contemplate the impact that situation would have on my mental health.

Of course, there are many ways to be intimate during pregnancy that do not involve sex. In fact, intimacy doesn’t need to be physical at all although it is snuggling, cuddling, kissing and so forth that we associate with the term most. These physical displays of intimacy can also be affected by pregnancy as there are many scenarios when being touched and having contact can be uncomfortable.

Insomnia, vivid dreams, restricted sleeping positions reduce snuggling and by extension not being able to sit comfortably on the sofa, let alone cuddle up watching a film. Then there’s the hot flushes and hot summer days (like this one!), finding your own skin oppressive without the addition of the loving hands of your partner.

Then there’s other people’s hands. I don’t get it… I had people touching my stomach before I even had a bump (not that having a developing human inside you warrants any uninvited anything at anytime).

Short story, someone tried to touch my bump recently, missed and hit my breast instead…

People touching you without cause or consent is not just a pregnancy problem. There are many individuals who are very tactile and there are many who are not and we all need to do better at being aware of other people’s boundaries and respecting them.

3. Consent

Touching of bumps, accidental breast taps and being hugged when you don’t like hugs are just examples that can be swapped for any of an entire plethora of interactions. The topic of consent could provide content for entire blog sites, here I’m going to frame it in the context of control.

I find that control is one of my biggest triggers, in fact it can usually be found a few layers beneath the surface of triggering situations and events that I identify.

Feeling in control is a driver for lots of behaviours, and is particularly relevant to mental illness, especially anxiety. I certainly find that my anxiety is fed by scenarios that I cannot plan for, surprise or sudden events or feeling overwhelmed by the amount of potential outcomes, variables and so on.

In the course of writing this post I have concluded that the factor of control is the trigger for my present experience. At the beginning I mentioned an awareness that the pregnancy was likely influencing my flashbacks. But pregnancy is a very broad subject and whilst for some the physiology of being pregnant can be a trigger for various reasons, I knew for me that it wasn’t the pregnancy itself that was triggering the flashbacks but something associated with it.

Behavioural responses to the flashbacks (and by extension the trigger) began about two weeks ago. So for five months of gestation this pregnancy was not impacting  my mental wellbeing.

What changed?

Over the past couple of weeks I have moved from researching pregnancy, nutrition, exercises and so forth, to focusing on birth. For the first time I am contemplating what my version of a birth plan is and what that entails and looking in depth at the dynamics of delivery.

That’s the key phrase right there: dynamics of delivery. That is not the biology of giving birth, but the interactions and interventions that the majority of birthing women contend with.

Most of these belong (and will feature) in another post, but there is an aspect I want to end with. Whilst there are a lot of women who are content with their birthing experience there are a growing number who are not and from where I am looking, it seems in many instances to boil down to consent and, thereby, control.

As a first time mum labour is a completely unknown entity, and even for women expecting their second, third or fourteen child, the labour and birth experience come with no guarantees. Every woman,  pregnancy and birth is unique which is what makes it beautiful and daunting at the same time, with potential to impact (positively or negatively) upon mental wellbeing.

There are certain interventions in a medicated delivery that are now so routine they have become automatic, challenging notions of choice, consent and control.

Just as I am aware that I have an increased likelihood of postpartum depression because of my mental health history, I am aware that physical examinations may pose as a trigger for me because of past trauma.

I intend to explore both of these aspects more fully over the final months of this pregnancy in preparation for myself and as part of an investigation into mental health during pregnancy.

 

What You Need to Know About Kidney Stones in Pregnancy

It turns out I spoke too soon and ended up with another hospital trip over the weekend.
But, as promised, I’m going to put the past month and a half’s worth of hospital visits, doctor’s notes and NHS time to good use.

When I was initially diagnosed with kidney trouble: renal colic and potential kidney stones on 1st June, I did what many of us with internet access do and started to research online the condition, medication and potential impact on my pregnancy. Whilst NHS Choices (UK) and the National Kidney Foundation (USA) provide detailed explanations of what kidney stones are, how they form, treatment options and comprehensive lists of symptoms, they have little relating specifically to pregnancy.

The reason it is so hard to find out about kidney stones in pregnancy is because they don’t occur frequently enough to be classified as part of a ‘normal‘ pregnancy (which, by the way, does not exist). Most online information revolves around prevention, which is great, as the famous Benjamin Franklin quote says: ‘an ounce of prevention is worth a pound of cure’. But we pregnant women already pile huge amounts of blame and pressure on ourselves regarding what we are doing and experiencing throughout gestation and reading that drinking more water might have prevented this current agony does not help. Besides, in pregnancy, kidney stones are about more than mere hydration.

My online research wasn’t giving me much so I wanted to convert the oral information given to me at the numerous appointments with obstetricians, general practitioners and urologists into a post for the benefit of others.

Why Does Pregnancy Make You More Susceptible to Kidney Stones?

Hydration is of course important at all times and during pregnancy a woman’s body does require more fluid for the changes and creations that are occurring. These changes result in the body working harder, including the kidneys.

1. Increased blood volume during pregnancy means increased filtration for your kidneys as they work to remove waste and return nutrients. With increased water consumption the kidneys ideally have enough fluid to filter effectively and prevent the crystallisation of minerals within the organ which can develop into kidney stones. Yet increased blood volume equates to more work and there are more minerals to filter.

2. There are several different types of kidney stone, the most common being composed of crystallised calcium. In addition to increased blood volume during pregnancy, there is also more calcium in your blood because of the developing fetus. Not only is your body absorbing more calcium during pregnancy, but your kidneys are also extracting more, potentially leading to an increased build up of this mineral either as crystals or, eventually, as stones.

3. In addition to your kidneys working harder for you with increased blood volume and calcium extraction, they are also working for your baby. Although the major organs are formed early on in gestation, the fetus still has no kidney function of its own until 10 weeks. At this time your baby begins to drink from the amniotic fluid surrounding it, produce urine and replenish the amniotic sac.

4. However, despite babies having their own kidneys from 10 weeks onwards, you body is still doing a lot of the work until the very last stages of pregnancy. Although the fetus is producing urine, there is still plenty of waste, excess water and other substances transferred between mum and baby via the umbilical cord. It is mum’s kidneys that are then filtering and extracting these extra materials prolonging their increased workload.

5. As with many medical conditions kidney stones have a tendency to reoccur. If you have had kidney stones in the past you have an increased chance of developing them again, especially during the extra strain of pregnancy.

Should You Worry?

I experienced a brief lull and calm after receiving a diagnosis. However, it didn’t last long as although I now had some comfort from what was causing the extreme pain I was experiencing, my thoughts turned immediately to what this might mean for my unborn child.

This was what fuelled my initial online search for information about kidney stones. Typing kidney stones and pregnancy into a search engine can result in some pretty concerning, yet entirely unrelated, findings. Predominately, the results generated will be to do with kidney infections, kidney failure or urinary tract infections. In comparison, kidney stones are not something to fret about. They can be incredibly painful, but it is mainly an issue that affects mum as opposed to baby. The main problems from kidney stones result from pregnancy rather than the other way around.

1. As I have detailed in another post dedicated to medication, there are very few pain management options available during pregnancy. It is usually this, rather than the condition, that results in the increased rates of hospitalisation for pregnant women with kidney stones, not the stones themselves.

2. Usually, kidney stones are left largely to their own devices. This should immediately reduce the rate of alarm because if there were risks to the fetus you can guarantee that there would be very swift action taken (as there would be in the case of infection). Whilst it is far from a pleasant experience, most stones are small enough to pass on their own.

Particularly large stones can cause blockages and then interventions will be investigated. Treatment of kidney stones is complicated by pregnancy as the most accurate method of detecting them is x-ray, which of course will not be used on an expectant mother. Some doctors believe that the risks are negligible but this is a conversation that you would need to have with the consultant or urologist. Ultrasound is the alternative and is still very accurate for detecting large stones, or their presence if the kidney is swollen or puffy.

In the case of blockage or infection (as with urinary tract infections which can be delightfully frequent in pregnancy) there can be a risk to your baby if your temperature rises or a fever develops for a prolonged period. It is always advised that you contact your health professional in the case of developing a temperature, whatever the cause.

Treatment

In these cases treatment appears to be the same for both pregnant and non-pregnant patients. Ultrasound waves may be used to break down the stone (given the much more alarming treatment term of extracorporeal shock wave lithotripsy – eek!) or surgery. Today, it is rare for open surgery to be performed with a ureteroscopy being the more likely.

Antibiotics will be used to treat infection, opening up an entirely different set of decisions for pregnant women and their healthcare providers. As with pain management the options are limited and it may be decided to administer them in hospital rather than with a take home prescription.

As usual, this post carries the disclaimer that I have no medical training and that any symptoms that are causing concern should be discussed with a health professional and not self-diagnosed on the internet. This post is intended to compile information and highlight options, not to advise.

Medical Update

Friday 13th is perhaps not the most reassuring date for a hospital visit.

I am so grateful for the NHS and medical teams in Scotland. At all my many hospital trips over the past few months the nurses and doctors have been attentive, listened and smiled.

This year celebrates 70 years of the NHS, providing free healthcare to the entire UK. There are funding, staffing and overtime issues, but we are better off with it than without and it is so important to remember all the medical staff who work so hard and such long hours to keep it going. I felt I had to give them a heartfelt mention.

Today’s Update

If there ever was a kidney stone, there certainly isn’t one now.

Thankfully I have had no flank pain for almost a month, and the ultrasound scan two weeks ago showed no swelling and all blood and urine tests have been clear of infection.

The suggestion currently is that baby is lying on a nerve or some other vessel which is what causes the sporadic cramping when I urinate.

Whether baby is responsible for the constant abdominal pain that was perplexing doctors 4 weeks ago is something I am still doubtful about. He would have had to have been lying on the same place for an awfully long time to generate such continual severe pain. (I know he doesn’t stay in the same place for long as, since I have started to feel his movements, I can feel him wriggle around in accordance to the flares up of cramping I am experiencing).

A nurse did scan my bladder and found a little retained fluid, but the doctor explained that the machine can pick up amniotic fluid by mistake. So essentially there is fluid in my abdomen which may or may not be meant to be there…

Fun Facts

As ever though, with each appointment a little more knowledge and understanding is gleaned.

Although you won’t find much information out there about kidney stones in pregnancy (I hope to post up something shortly to rectify this) there is a trend between pregnancy and kidney stones because:

1: your body produces more blood so you kidneys are filtering a higher quantity than usual.

2: more calcium is passing through your kidneys, increasing the possibility of it crystallising and forming a stone.

3: in addition to your kidneys working extra for you they are also working for baby for the first 10 weeks as the fetus has no kidneys of its own at that time.

We all know how important hydration is, especially in pregnancy but it really is the most effective prevention against developing kidney stones.

I also learned a fun fact about kidney ultrasounds today (you can see I have had too many appointments as I am now describing this information as ‘fun’).

I mentioned in a previous post about that ultrasound is considered less effective but of course considerably safer during pregnancy than x-rays. Today the doctor inform me that the ultrasound scan is 90% effective and that what the sonographer is aiming to identify is any swelling or puffiness of the kidney itself, or any signs of blockage within the tubes connecting the kidneys and bladder.

As long as there is no blockage, kidney stones will be left to pass by themselves (I have a whole post on pain management during pregnancy which you can find here) which is usual treatment for kidney stones in non-pregnant patients as well (although they have more options for pain management). It is soley down to pain management that leads to the hospalisation of pregnant women with kidney stones.

If stones are particularly large, there is swelling or a potential blockage, urologists will consider treatment. Ultrasound may be used to break up the stone or surgery may be considered.

The doctor today mentioned (to my surprise) that had swelling been detected at the ultrasound the temple would have considered an x-ray and that the risk to my unborn child is negligible… bearing in mind that I am a completely untrained with no medical background whatsoever… I’m not convinced by that, especially given the information from other doctors I have seen. But I do imagine that there may be extreme circumstances where the risk to mum not having the procedure may be more than the risk the procedure holds for baby.

Conclusions

The matter seems to be put to bed for the time being. We can move forward with the confidence and reassurance that both baby and I are healthy and that everything is functioning as it should.

Now I can relax, hope baby stops elbowing my bladder or whatever he’s doing to cause this periodic cramping and just enjoy the rest of my pregnancy (despite the unabating nausea…).

Disclaimer: I am not a medical professional. I am just relaying personal experience and the information that has been given to me by doctors, nurses and that I have uncovered through my own research. As I could find very little online when I first started this unpleasant process I hope that by creating these posts I might be able to assist somebody else. 

 

Signs My Body is No Longer My Own: A Draft

Let me begin by apologising for how barren my blog has been of creative thought recently.

In my post about blogging and creative writing, I talked about the connection between my writing and mental health. Thus, my poetry has always been inspired from strong emotions, the numbness of depression meaning that before starting this blog I hadn’t written a thing for two years.

For those of you who have been following my journey into writing, you will be aware that other than my first efforts (which were essentially homework) my poetry has come from a place of uncertainty, illness, pain and grief.

There are still some earlier pieces that I hope to share with you, but it has been far too long since I produced anything new, that I liked. I wanted to change my creative drive from a place of darkness to one of positivity.

That is at the heart of everything I feel throughout this pregnancy, even with all the recent unpleasantness, I feel incredibly positive and uplifted by being pregnant.

With the awareness and deep appreciation that not everyone finds joy and security in their pregnancies, I wanted to capture how I feel about my situation.

I have received criticism in the past for being too personal in my poetry, but I was so thrilled to have written something this morning that I was too excited not to share.

It is essentially a piece of free writing, my favourite, and I do hope that in some way it will resonate and perhaps bind the two different aspects of this blog; the public and the personal, together (#Idonthaveaniche).

As always, your thoughts and feedback are greatly appreciated, I look forward to reading them in the comments!

Signs

I feel nauseous
As my organs
Shift, squeeze
Into the narrowing space
Around my womb.

I am weary
With a tiredness I have never known
Physical, mental, emotional
It feels eternal;
Pregnancy’s constant companions.

I vomit
Retch
Rinse and repeat,
But whoever said that
Miracles came easily?

The midwife called him a parasite
But this is not a hostile take over
My body is a vessel
A cradle
Carrying a new life forward.

The marks on my body
Are not weakness.
They are not cracks or fractures
But glaze on my porcelain sides,
They bare the truth of my task.

 

 

Prognosis, Prognosis, Will We Get a Diagnosis?

Since my last post, there have been no more surprise hospital visits, but a lot has been going on.

In addition to having an anatomy scan, with everything that has been happening we decided we wanted to know if there had been any effect on the pregnancy. Although we would have gone to term regardless, it gave us peace of mind, and just as the baby kicks had done, it made the pain of the past few weeks, disappear from my memory.

It is often banded about that you forget the pain of labour and discomfort of pregnancy once you have delivered your beautiful baby, and clearly that can happen during the pregnancy as well.

Upon feeling my baby kick for the first time, I couldn’t remember the intensity of the pain I had been feeling for weeks before.

At this time, I have been off sick from work for a month. I had a kidney scan last week, an ultrasound is the only safe way to view the kidneys during pregnancy, as I detailed in my posts on pain and medication in pregnancy.

Good news! There was nothing visibly concerning about my kidneys, so despite being in hospital with severe pain within my renal system a month ago, the cause (whether it was a kidney stone or not) seems to have passed and left no impact on these vital organs.

Where Does This Leave Us?

On Friday, I have another hospital appointment, this time at the urology unit.

The pain has thankfully decreased in frequency and intensity, but I still have seemingly random flare ups.

In addition to the obvious relief that two of my vital organs are functioning as they should and have come through unscathed, the results of the kidney scan mean that I can know park that suggested cause at the hospital door.

The aspect that has caused most confusion (and thus distress for this mum-to-be) is that with a kidney stone (as was first assumed) there is the intense pain that I experienced during my first hospital trip and then the pain decreases and passes along with the stone. What it does not do, is sit, constantly in the centre of your lower abdomen.

This is what was happening for the first 2 weeks, between our two midnight visits to hospital. As I mentioned, it has lessoned since then, from being constant to arising every few days.

This past week especially, it appears to have been most intense when urinating, as an acute cramping sensation. This has not been accompanied by any of the usual symptoms of a urinary tract infection (UTI), a burning or stinging sensation whilst passing urine.

So, whilst UTIs are really common in pregnancy, I think you can sense the scepticism I am feeling towards that prognosis.

We’ll see if we can get a more concrete idea of what is occurring on Friday…

Pain in Pregnancy: It Isn’t Always Wind!

Late Friday night I was admitted to the maternity ward with severe abdominal pain.

It had begun on Thursday, and I assumed that it was the usual pregnancy fun; bloating, trapped wind and the general nausea trend. During the second trimester you can also experience the gradual reduction of your stomach capacity as your uterus increases with size.

So discomfort after eating was not a huge surprise or of noted concern.

‘It’s Just Wind’

I woke up on Friday morning with the same discomfort, still assuming that it was attributed to ‘normal’ (we discussed how inappropriate that term is in my last post) pregnancy effects.

I went to work as usual, guiding tourists around the city. This appeared to escalate the discomfort to intense pain, shooting up my left side from my lower abdomen to under my ribs. After almost vomiting from pain, I finally limbed my way back to the tour office.

Almost in tears, I entered the staff room and was met by concern from some of my colleagues enjoying a cup of tea. As I told them what was wrong, I started to cry. They lovingly reassured me that ‘it’ll just be wind’.

Trapped wind is very common in pregnancy and really can HURT! But I still felt embarrassed and silly for making a fuss about something so typical and that I had experienced on many occasions.

This sense of shame worsened as the pain failed to abate, even with peppermints, ginger tea, and reduced movement. I was observing trainees on tours in the afternoon, but even though this is considerably less effort than delivering a tour, the pain continued to worsen, accompanied by severe nausea.

I had assumed that once I got home, I would be able to relax and finally get some relief. However, the pain continued to increase until I was finally in tears. This is not a usual response from me, it alarmed my husband and made us wonder if it really was ‘just wind’.

A Midnight Trip to Hospital

After a call to NHS 24, we were given an appointment at the Out of Hours clinic, were two lovely doctors examined me and concluded that it defiantly wasn’t bloating or wind, but an infection of some kind.

They considered it best that I get seen by an obstetrician to be on the safe side, and get confirmation that baby was absolutely fine. To be honest, I was reasonably confident that this pain was occurring around the baby, and not actually related to it, as I had no cramping pains or spotting.

We were at the Maternity Unit for almost 4 hours, with a series of urine and blood tests. It was concluded that it was likely that rather than an infection, I had a kidney stone and the immense pain I was experiencing was the resulting symptom. The official term for this pain is renal colic, which sounds about as pleasant as it is.

Kidney Stones in Pregnancy

The risk of developing a kidney stone is apparently increased during pregnancy. Given the increased workload for the kidneys during gestation, due to the mother’s increased blood volume and the fact that the baby has no kidneys of its own until about 10 weeks. The amount of fluid you need to intake is increased as well, which makes hydration increasingly important to ensure that the kidneys are filtering your blood effectively.

You can get more information about kidney stones here and of course on the NHS website.

A New Lesson

To be honest this post is a little more personal than I was envisioning when I started blogging. I never intended to be sharing hospital trips on the internet. However, I felt that it was important to share this particular experience because although my colleagues are right and a lot of the time the discomfort you are feeling is part of a ‘normal pregnancy’ experience, sometimes it isn’t.

A lot of the time pregnant women will be told that how they are feeling is just part of being pregnant, to grin and bear it, and it can feel that your experience is minor to someone else’s. But as I stated in my last post, Samuel’s aunt gave me great advice: not to diminish how you feel because someone else is feeling something else.

It is great to share experiences, they can be reassuring and beneficial, but never take someone else’s opinion or advice over your own instincts.

The other thing that pregnancy women are told, usually in preparation of birth, its to know and trust your body.

I have experienced bloating and wind A LOT during this pregnancy, and deep down I could tell the difference. Although my colleague had originally reassured me that it was ‘just wind’, she also could see that by the end of the working day, my condition was not improving and suggested that I seek medical advice.

I delayed in doing this because I was worried about being embarrassed again, of calling out of hours and being told it was ‘just wind’. No one likes to feel that they are making a fuss over nothing, or that they are overreacting. My colleague had not given any impression that she thought this, as I say her reassurance was very lovingly given, but it didn’t change how I felt about myself.

So that’s my lesson, especially to first-time mums. Know your body, trust your body, and have the confidence in your conviction that your body is reacting differently, or more intensely, because it is reacting to something new.

You can follow my medical adventures here.