I have spent 8 days on a Transitional Care Unit at St James' hospital in Leeds with my premature, jaundiced baby. We're 1-2 days away from going home, pending his blood results today, and it has been one of the most challenging experiences of my life.
The staff are amazing - so supportive and there day and night to help you establish breast feeding if that's your choice, or to help you formula feed through a bottle, cup or nasal tube (even feeding your baby at night for you if you need sleep) if you can't or don't want to breastfeed.
There are different staff every 12 hours so depending on the length of your stay you will get mixed advice, something I've appreciated because I already had strong views and an arsenal of my own research and network of support established so I could take it with a pinch of salt and pick and choose what worked for us. Some of the mums have literally changed tactic with every shift change and are really struggling and frustrated as a result.
It's also the brightest, loudest place on earth. You will find that you and your baby filter out the cries of other babies, the shush-slurp of breast pumps and the humming of jaundice machines but the "unnecessary" noise from the nurses and other mums on the ward will drive you stark raving insane if you need sleep or are trying to settle your baby.
Top noise complaints:
Mobile phones. Some people talk on them too loudly, have the sound turned up so much you can hear the person talking to them, have obnoxious ringtones, have keypad tones switched on loud... you name it. If there are teenagers on the ward then you'll also get to hear them watching stupid videos on YouTube, and if men are watching the football match on their smartphones you'll get to enjoy that too. If you need to make/take a phone call, either speak in an indoor voice or take your phone out to the hall. And whilst having an alarm set for feeding times is fine - your phone is no more than a foot away from you and you're hypersensitive to noise in order to pick up on your child's cues. You can have it on vibrate or low volume - it's not necessary to wake the whole room.
Rustling bags and zips. It's understandable that there will be the odd rustle of a nappy packet or opening sterile syringes and the like, it's a hospital, but never ever ever ever bring carrier bags on a Trans ward. If someone brings you a gift or laundry etc then unpack it during the day and put away in your hospital bag or on your chair/in your locker. At 2 in the morning when you've just settled a baby and someone in the next "cell" starts rooting for breast pads in a Boots bag - trust me. It's not white noise that you or a baby can sleep through. If you don't have good luggage, the BEST bags for hospital are those fabric/hessian bags for life. They carry loads, make no noise and can be stacked under your bed/chair out of the way really easily.
Hazardous waste bins. Hospital bins are made of metal and opened with a foot pedal. DO NOT open it and allow it to bang shut. Depress the foot pedal gently to ease it back down. It is ridiculously inconsiderate to bang it shut when people and babies are sleeping - whether during the day or night.
Visitors. There is a concept called "indoor voices" that you must learn. When someone is sat in your "cell", a foot away from you - you can speak in gentle tones so that everyone else doesn't 1) hear your entire conversation 2) can sleep through your entire conversation. When children come into the ward, if they scream or go mental, take them out in the hall for a bit of a time out, or take them to the day room where there's space and a television. Don't just let them carry on like you might at home. You're not at home - you're in a room of desperately sleep deprived women and sick babies.
Children are not easy to make behave in special circumstances, it must be hard for them to see their parents in hospital and be confusing having a new sibling - especially one hooked up to machines but be considerate of the other people in the room trying to sleep or settle a child and at least make the effort to ask them to be quieter or take them out.
There are number of things that you will need whilst you're here.
Fresh clothes and pyjamas. You will be covered in blood, sweat, breast milk, possibly baby poo and urine and you're trapped in a stuffy room where the windows do not open, full of other people. Have access to as much clean underwear and loose, comfortable clothes as possible. If you're breastfeeding you'll have lots of nakey skin-to-skin time but make sure your pyjamas or nighties are cool and strappy and can just be pulled down when you need to. If you have an eyemask then it will be your best friend - the ward is never dark - it's floodlit during the day and dimly lit at night but you can see the light over your curtains and inevitably someone will be awake in the cubicle next to you with their light on - or there will be jaundiced babies on uv machines that are essentially sunbeds! On day 7 I got a bandana to tie round my eyes and promptly got 4 hours sleep split into 2 hour sessions. Best. Feeling. Ever.
Breast pads, nappies and sanitary towels. More than you could have ever thought possible. Take 5 packets, take 10 packets. They have spares on the ward but don't rely on them filling up the cupboards regularly or there being staff available to fetch you them.
Snacks and drinks. If, unlike me, you eat hospital food instead of having your own meals delivered then you will find your stay quite easy from this perspective - but if you're breastfeeding you'll need more than 3 meals a day and you'll need good food. I had cereal, both dried and fresh fruit, crackers and healthy biscuits and flapjacky things, nuts... The 11pm and 2am feed are usually the ones you need access to snacks for. ESPECIALLY if you're not sleeping. There are no facilities for you to get your own water so don't rely on them bringing you a fresh jug 3 times a day when they're busy. The ward is hot and if you're breastfeeding you'll need at least 4 litres of fluid a day. Nag them for more water or do what I did and get a litre bottle every day of your own in addition to the jug - and some juice!
Fenugreek and breast stimulation. If you're on a Trans ward, chances are you had an induction or a c-section or an otherwise non-standard vaginal birth and haven't had the luxury of immediate skin-to-skin or even access to your baby after birth for much of the first day. This really delays your colostrum coming in (your actual milk will follow on average about 3 days later but if you want to breastfeed from the get-go without them using formula (very rare that you can give them everything they need straight away - the nurses would still likely top them up through a nose tube with high-calorie formula) you need a helping hand. Fenugreek is a miracle. Take 2 x 610mg capsules three times a day and if your colostrum hasn't started flowing within 24 hours then I'll eat my own cervix. On the first day, they really should advise you to begin massaging your breasts and trying to hand express to get things moving. Don't worry though - I wasn't allowed any skin to skin or told to do this until day 2. The Fenugreek helped enormously to make up for lost time and even if it takes weeks, you can always pick up breastfeeding later. It often feels like you're never going to get anywhere but you will be astounded by how quickly you hit those milestones and how quickly you both learn to work together. The staff should be a great support when you're tired and overwhelmed and need guidance to decide on positioning and suchlike, but preparing beforehand by reading La Leche League's Womanly Art of Breastfeeding and Ina May Gaskin's guide is really helpful. Your baby will decide what position he favours for each breast - as long as their head is in line with their tummy and they can move their neck to breathe you can have them tummy to tummy horizontally, vertically or diagonally in a "rugby ball" hold. Keep your shoulders down and sit up straight to avoid burning and cramping shoulders.
Sleep. The idea of sleeping when your baby is sleeping is the soundest advice that you will ever get. You'll have time for a shower and to eat but shouldn't commit yourself to doing anything else for the first week after they're born. Babies start out on a 2 hourly feeding/changing schedule, then within a few days it goes to 3 hourly and after a week it can go up to 4 hourly, but it's baby-led for breastfeeding.
On a trans unit if you aren't proving that they're weeing and pooing and feeding according to this timetable and your baby loses 8% of his weight then you aint going nowhere and if they need to top him up then it interferes with your breastfeeding routine and can be really disheartening.
I'm demand breastfeeding which involves feeding as often as he needs, but he started out well bedded into a routine and was gaining weight perfectly until he got jaundice. He feeds now for between 45 minutes and an hour and 15 minutes every 2 hours (like clockwork now that he's less jaundiced and has some energy) though one of his feeds is usually 20 minutes of hind milk (if he didn't completely drain my boob before it's time to swap to the next one).
Imagine sitting or reclining in the same position for over an hour, monitoring them to make sure they have a good latch, are still sucking, need burping, stimulating them when they start to doze, gazing into their eyes... it's hard work. Wonderful, but hard. If you haven't slept you're going to struggle enormously and if you're working at establishing feeding on no sleep then hoo boy are you in for a rough time.
Being considerate to those around you will hopefully encourage them to do the same. In a room full of people at different levels of progression, on different routines... it's hard to find an hour to sleep without someone disturbing it and all you'll want to go is get home where you can be as quiet or as loud as you like - as frustrating as it is when you're trying to sleep and someone else is being loud - it's also stressful when it's your baby who does a giant poosplosion and shatters the silence with his screaming.
Build a relationship with the staff. You will never survive without them on your side. I was lucky to have such amazing support, but there was one member of staff that took an immediate disliking to me - refusing to give me my right to skin-to-skin, telling me I'd be no good at breastfeeding (seriously - she was a JOY), ignoring my requests for water (as per my birth story, I'd been sick more than 10 times in 12 hours and recovering from anaesthetic... I needed water) ignoring my request to have my pointless catheter and empty cannula tubes removed on day one because my husband was banned from the ward so I was on my own and I couldn't get up from the bed to pick up my baby or hand express with tubes sticking into my wrists...
I will be putting a complaint in about her, but everyone else has my eternal gratitude for their support and advice and encouragement. I worked my arse off this week to get feeding established and survive in this hugely challenging environment - not an easy thing when you have OCD, a sick baby and haven't slept - and being told how fantastically well you're doing at 4am when you just want to curl up in a ball and die is very welcome indeed.
Ziggy played guitarrrrrraaaaarrrrraaaarrrrrr.
Title: Survive by David Bowie
The passing of time is a strange thing. On Friday, I drew a star on my tummybump to herald my starchild... and then my waters broke. During labour I drew a star on my tummybump to encourage his arrival (voodoo?), and now that he's here, every night I trace a star on his forehead with my finger and kiss him goodnight.
He's here, he's early and we've been in St James' Hospital for over a week now, with at least another week to go before we're allowed home to start life as a family of three. So for now, here's how it happened.
It’s 8:15pm on 22nd February earlier this evening at 6:15pm, your Daddy and I were in the kitchen putting the finishing touches to our dinner. It’s a new recipe that I dreamed up (I do that) for Everything Goes With Toast - linguine smothered in avocado, lemon and coriander roast courgette and a bit of parmigiano.
No sooner had I dolloped it onto our plates, I felt a trickle of warm liquid run down my thighs and into my rainbow socks. “What is the point in constant pelvic floor exercises? Damnit Darren I just wet myself!” I exclaimed and left your Daddy to plate up dinner whilst I changed my pyjamas from stripes to spots.
“Weird,” I thought “I only had a wee 10 minutes ago...” I came downstairs, took a picture of dinner for the food blog recipe and as we were planning on eating in front of a movie, took my plate through to the living room and sat on the sofa. No sooner had my bum touched the leather, it happened again - another gush of water.
“Not again!!” I yelled and ran back upstairs to change my pyjamas again. This time I had barely got down the stairs when a huge gush came out so I doubled back and sat on the loo until it had finished trickling. “It’s not wee!” I called down to Daddy as we realised it was my waters breaking. Daddy kissed me and thoughtfully brought my pasta up to me. Yes sweetheart, you reduced me to eating pasta on the loo. I am THAT pregnant person.
It was trickling out in a steady stream, completely clear with no blood or mucus so Daddy called the Maternity Assessment Unit and they told us to come in. You see originally you were due on the 19th March but because we got Gestational Diabetes we were booked in to have you induced on 11th March. 11th March is a special date because David Bowie’s new album is being released and it’s been 10 whole years since his last album. We’re naming you after him you know. Michael after my Daddy, your Grandad, and David after David Bowie. Michael David Mease will be your name but we call you Mikey or Starchild. So technically, you’re a month early - I’m only 36 weeks and 3 days pregnant!
Daddy and I have been practising hypnobirthing which is all about being calm and fearless and using visualisation, breathing techniques and light touch massage to breeze through the contractions and breathe you gently out. So that’s the plan OK?
We’re at the hospital now and I’m strapped to a monitor listening to your heartbeat. I have a button to press every time you move which is quite often. Your heartbeat is strong and happy and Daddy and I have been laughing and talking and are really excited to meet you.
It’s 2:42am on 23rd February and I’m really struggling to sleep. The hospital is so loud - nurses talking, phones ringing, doors slamming, machines beeping, trolleys being wheeled round, lights going on and off. I slept for maybe an hour but what I really want is fresh orange juice and to walk around and get things moving. There are no signs of any surges yet and my waters are clear - no bloody mucus - so we’re PPROM. I wish your Daddy was here to help me get the oxytocin flowing. Soon the nurse will be back to put the monitor on my stomach again so there’s no point in trying to sleep really, though I’d love to!
It’s 6:52am on 23rd February. Well little man we did it! The nurse just confirmed our first surge (contraction) so we’re on our way to delivering you. It’s a little over an hour until Daddy is allowed back on the ward. He’s bringing me orange juice and bananas and my razor and deoderant (I did shave everywhere yesterday but I don’t expect you’ll arrive THAT quickly - I need to focus on getting you out safely, not be distracted by what your Uncle Josh calls “crumply armpits”) and fresh knickers because you little man have soaked through 10 pads the size of sofa cushions. I know that they said on Thursday that we had a lot of fluid but goodness me! My stomach is already deflated. Goodness knows what it will look like when you and all the water is out!
It’s 7:50am on 23rd February and I’ve been bouncing on a birthing ball and walking around the ward, stretching and keeping active. It’s been wonderful to have no SPD pain for the last day or two so I’m making the most of having this range of movement and trying to get your head pushing down and these surges going properly.
It’s 12:07 on 23rd February and I have nothing much to report. You’re doing fine on the monitor and so am I. Daddy brought me a fabulous brunch from The Greedy Pig (you’ll enjoy this on Saturday mornings with us when you’re out - what an incentive to emerge!) after he’d made a few preparations at home like washing the sheets for your moses basket and getting the camera charged. Then I had a bath, washed my hair, moisturised and got back on the birthing ball for more bouncing because I’ve been told if I don’t start having proper contractions and progress to labour then you’re going to be induced at 6:15pm. So we have about 6 more hours to do this naturally. Come on pudding - let’s show them! We have a chance to have the natural birth we wanted, and not have to face the Induction of Doom.
It’s 2:20pm on 23rd February and aside from a few mild contractions and more flud trickling out, nothing is happening. Daddy and I have been exploring LGI - going on long walks around the old part and to check out the art and the treasure hunt. We found chickens. CHICKENS!
I’ve had a bit of pressure in my cervix but despite climbing All The Stairs for hours and hours, we’re still at base camp.
It’s 6:00pm on 23rd February and we have been transferred to St James’ Hospital as there were no beds in the Neonatal Unit at LGI which you may need because you’re early. They did an exam and my cervix was completely closed so we’re definitely being induced.
We had wanted to go out for a spicy curry to see if that stimulated my bowels, and then of course kicked off labour but The Aagrah doesn’t open until 5:30 and they recommended that we didn’t have a big meal before the induction as it might make me sick, and if anything goes wrong and I need a C-Section to get you out quickly then it’s better not to have a full stomach, just something small.
I have a cannula in my left hand for the oxytocin drip which will bring on the contractions after they turn it on at 6:15. We are in a dimly lit room so you can be born in a calm, soothing environment (the light is lavender coloured, how perfect!) and they’ve found me a wireless monitor so that I can change positions whilst they monitor you - sadly I’m not allowed to be off the monitor for even a minute so there’s no chance of having a bath or sitting in the shower to get me through the contractions. I know they’re going to be intense because they’re artificial but I’m not afraid, I know that I can cope. Part of me thinks that I shouldn’t have tried so hard to bring on labour naturally, because I could have slept and been rested in preparation for labour - I’ve had no more than 3 hours sleep in the past 2 days...
It’s 6:55pm on 23rd February and my blood sugar came back at 8.1 which is unusually high. I explained that it will be - all there was to eat at The Hospital was a pannini in Costa Coffee - so white bread is not very GI friendly! THIS is why I make all my own food or eat at lovely local places, not nasty chains!
They wanted to put me on an insulin drip but I asked them to wait an hour and test my sugars again, I have no intention of having a cannula in both hands - how can Darren stroke my hands, hold my hands, how can I grip a bed to hold myself up etc? It’s bad enough having one hand incapacitated!
So far I’m hooked up to 1ml/hour of Oxytocin.
7:15pm 2ml/hour of Oxytocin
7:45pm 4ml/hour of Oxytocin
8:15pm 8ml/hour of Oxytocin - Tingly cervix!!
9:00pm 12ml/hour of Oxytocin
9:30pm 16ml/hour of Oxytocin
It’s 9:30pm on 23rd February and my surges are starting to intensify and regulate. I’m feeling some pressure in my cervix and tightening across my back but I’m completely comfortable.
It’s 10:30pm on 23rd February and I had a really strong surge, felt a popping and waddled to the loo to find that my mucus plug has gone - quite a bit of blood came out, and then I needed a poo too because of the pressure. Everything is progressing nicely.
11:15pm 20ml/hour of Oxytocin
It’s 12pm on 24th February and I have vomited twice so they’ve given me an anti-emetic. The surges have been a lot more intense for the last hour but I’m breathing through them well.
It’s 2:35am on 24th February and I’ve been in labour for 7:15 hours. The surges are really, really intense. For hours and hours I’ve been sat on the birthing ball breathing through them and Darren has been doing light touch massage on my lower back for the duration of each one which I would recommend to anyone. We have a good routine going. As soon as he hears my breathing change or sees the surge ramping up on the monitor he leans forward to stroke my back, then stops when it passes. It’s repetitive but I find that soothing. Every so often I can sense him tensing and panicking because he knows that it’s painful but he’s been wonderful at not letting it show and he’s so patient if I snap a little occasionally because he’s not got me a sip of water fast enough when I feel sick.
The problem is that I haven’t slept for more than 3 hours in 3 days now and in between the surges I’m nodding off and then being woken up 30 seconds later by another one. It has got to the point where I am beyond exhausted and can’t hold up my own body weight on the birthing ball, which is the only comfortable place for me to be during contractions. They weren’t going to check how dilated I was for another hour, but as I am so exhausted they checked me early. Because I am only 3-4 centimeters dilated and have hours of more surges ahead of me, we decided to have a low epidural so that I can sleep for a couple of hours, and then be mobile again by the time I’m fully dilated and ready to push.
It’s 4:20am on 24th February and I am fully dilated! Unfortunately because I have been ridiculously and obscenely sick (despite the anti-emetic I have filled 10 kidney dishes so far!) which I think is a combination of the anaesthetic, the sliding scale of insulin they put me on (my blood sugar kept getting higher weirdly despite my not having eaten and despite my being violently sick!) and the fact that I’ve been slightly reclined on the bed so that I could sleep) they missed that I was fully dilated. I told them that during the last few surges I felt a lot of downward pressure and have had to work really hard not to push, but it was dismissed.
It’s 6:45 on 24th February and I am finally allowed to start pushing. There’s a Foulds clip on your head to monitor you as they’re not picking up your heart rate properly. After getting some sleep, I’m coping well with the surges and pushing is easy. The down breathing from Hypnobirthing wasn’t working for me - I don’t really have the luxury of gently breathing you out, they are only allowing me to try for an hour before they threaten a C-Section so I have been using Kelly (my lovely midwife)’s technique of holding my breath whilst I push. I’m making sure to keep my tongue resting softly on my palate and not tucking in my neck so the sphincter law isn’t being violated!
It’s 7:45 on 24th February and they think you are facing upward. They let me have an hour of pushing you down the birth canal and out out of my cervix but unfortunately I'd just started to make progress when the hour was up and they said they couldn't take the risk that you were going to get out easily so now they’re going to rush me into theatre for a forceps delivery. Daddy looks very cute in his scrubs and I am a hot mes because unfortunately they gave me so much epidural that I am completely paralysed. They flobbed my legs into stirrups and I could barely lift my head to speak let alone lift myself from my bed onto the operating table. It took 4 of them to lift me over because they couldn't keep me stable.
I feel completely helpless because I’m not in control of my body, but Daddy is hovering somewhere behind my head so I feel safe and calm. He's remained at the head end as promised.
It’s 8:56 on 24th February and I just gave birth to you!! You weren't facing upwards at all, you were exactly where you needed to be. They gave me an episiotomy and got you out with special forceps - I gave one push and got you right out - told them you were right there and ready!
As soon as all the fluids they pumped me full of (and therefore bloated you out with) had passed you became this teeny tiny fragile looking thing.
Alison, the midwife that came on when Katie came off was also lovely and brought you in to me for some skin to skin time and to try to establish breastfeeding before they took you off again. She thought at the time you’d drawn a bit of colostrum but now I’m not so sure because all day Monday I had soft, empty breasts. They moved me to the Transitional Wing and for the first day I barely saw you because they were monitoring you, giving him special formula through a nose tube to get you sugar regulated and trying to get your temperature regulated too.
You barely cry, just sleep or gaze at me. You're a real flirt with the nurses too - everyone is in love with you!
On the day you were born, Daddy went home to pick up a few things for us to have on the Trans ward overnight, but then called me crying to tell me he had diarrhoea and obviously wouldn't be allowed on the ward untul 48 hours had passed following his last attack of it. We didn't see him again until Thursday and he is the bravest man I have ever met for coping for 4 days being separated from his wife and brand new child. The day you, Daddy and I were reunited was FANTASTIC - that was the day my milk came in properly and you started feeding.
Despite all the drama of you coming early and the unfortunate induction, I feel completely positive about the birth. Despite it not being the way I wanted to happen, it was still a truly empowering experience that brought you into my life. Who wouldn't melt looking down at your little face?
Ziggy played guitarrrrrraaaaarrrrraaaarrrrrr.
Title: Thursday's Child by David Bowie