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State of the Sprocket

I had my 34 weeks appointment with the midwife on Monday. She says that my iron levels are getting too low; the cut-off point below which they don't allow a home birth is 10g/dl, and that's exactly where I am now (down from 10.8 at the last count). I was taking iron supplements; at my last appointment with the GP he prescribed me some but said to stop taking them if the side-effects got too bad, as my iron levels were "only just below the threshold" so there wasn't much to worry about. However, I stopped after a couple of weeks because of said side-effects (without wanting to go into TMI, they appear to make my digestive system grind to a complete halt). I suspect the GP neither knows nor cares about the requirements for a home birth, though.

The midwife took another blood test (results should be in tomorrow) and suggested a) eating more red meat (fine by me!) and b) taking some 'natural' iron supplements which might have less bad side-effects: she offered a choice of Floradix or Spatone. The chemist at the health centre had never heard of either (and in fact didn't seem very sure what 'iron supplements' were... "Um, maybe try... a bigger chemist?") but Boots did Spatone, which turns out to be sachets of water which tastes of blood. This is very weird, whether mixed with normal water (dilutes the taste slightly) or orange juice (tastes like orange juice that's been sitting in a rusty jar for a week... revolting). The reason for mixing the stuff with orange juice is that vitamin C helps the body absorb iron. I didn't know this so hadn't been consciously trying to keep vitamin C levels up, though I get a decent amount of vitamin C in my diet; but reading the information on the Spatone website suggests that I've also unwittingly been eating/drinking lots of things which inhibit iron absorption, namely milky drinks and cereal. The milky drinks seem to help the heartburn (whereas orange juice makes it worse) and the cereal was supposed to help keep up levels of fibre, to combat the effects of the iron supplements... sigh. I do rather feel like I can't win here. :-( I am determined to try, though, because I really don't want to go into hospital and have to be hooked up to machines-that-go-ping. Anyway, I'll have another blood test next week (for the SPRINT trial), so it will be interesting to see if the supplements (and meat!) make a difference.

The other problem identified by the midwife is that Awkward Baby has turned herself around a bit, i.e. she's more back-to-back than she was. Fortunately a) there are ways I can try to fix this (posture, exercises, etc) and there's plenty of time yet for her to move around, and b) her being the wrong way round doesn't prevent a home birth (it just means it's more likely to be a longer and more difficult labour if she's still facing the wrong way by then).

Baby is also still kicking me all the time, even waking me up in the night with her non-stop activity; once she managed to do something that I swear was a drum roll across the inside of my womb. I tell people she's "very advanced for her age" (but only if I'm confident that they'll know I'm joking!). :-)

Other than that it's just tiredness, aches, tiredness, pelvic pain, tiredness, heaviness, and tiredness. Did I mention I was completely exhausted? Walking upstairs tires me out. Turning over in bed tires me out. Putting my socks on tires me out. I am also fed up with male colleagues who when I say "I'm completely exhausted" reply "God, I totally know how you feel, I had a bit of a rough night once a couple of years ago and I still had to go to work the next day". I have had one unbroken night's sleep since about August last year (and yes, I'm still working, and still cycling into work and back). I'm not expecting some kind of medal, I'm not even really expecting sympathy, but I do get tired of being told "I know how you feel" by people who really, really don't. But "Things Other People Have Said" is another whole rant and one I don't have the energy for at the moment!

A couple of days before I saw the midwife,

addedentry and I had an antenatal session from Lynn Banerji (TalkBabyTalk) -- four hours of talking through everything about birth, labour and breastfeeding. Quite an intense morning but she was really good -- friendly and confident and sensible, and she did a great job of demystifying the whole process and making me feel more positive and confident about it. She also said I had a great attitude and she was sure everything would go really well and she wished she could be there at the birth. :-) (Of course then a couple of days after that things turned out to be going not so perfectly smoothly, as described above, which unfortunately has kind of undone some of my positivity ... but I am still hoping that I can sort myself and baby out in time to be able to do things the way I want to.)

O & I are booked on the NHS antenatal course in a couple of weeks' time, too -- always good to have a couple of sources of information to compare (and the NHS one is free anyway). I've heard very mixed reports of them but apparently it all depends which midwife happens to be running the session you go to -- there's no fixed 'curriculum' or anything.

We're also making some small progress on getting the house in order -- with two superfluous desks out of the way we're halfway to having an actual room for baby (there is at least now space for a cot), and in a couple of weeks we're getting shelves built in the front room which will allow us to make lots more space and, crucially, not have so many free-standing bookcases which could easily and dangerously be pulled over by an inquisitive toddler. If we carry on with this kind of efficiency we may even manage to get curtains put up in the bedroom eventually (only 18 months after moving in!), though the first two attempts at that have been stymied by the presence of an infuriatingly un-drillable concrete lintel over the window.

I realise, with... well, with mixed feelings, that I've only got another 3 full weeks left at work (and about 3 months' worth of stuff to do in them). It's very strange to think that I won't be going into work for a year -- the longest I've been away from work/study since I started school. I'm looking forward to being able to rest, but in other ways the thought of leaving is upsetting me quite a lot; it's useful to be reminded that work will get by just fine without me for a year (and that I'll carry on existing without it, that it doesn't actually define who I am), but I have irrational worries that they won't really want me back after that (and slightly more rational worries that my brain will have completely evaporated by then and I won't be able to do the job any more). Fortunately the timing works out such that I should be able to have my Annual Review just before leaving, so hopefully I'll be able to have a constructive conversation about how coming back might work, and what sort of things I might be able to do on my 'Keeping In Touch' days (up to 10 days of paid work while on maternity leave). And if I actually have any spare brain capacity at any point during the year out I do want to try to use the time to think a bit about where I want to go in the future, work-wise.

And yes, I do realise that -- especially in the current economic climate -- I am lucky to have a job at all, never mind one with a generous maternity leave policy. That's why I want to do it justice rather than just treading water.

So that's where things are at the moment -- sorry this has been a bit of a long and rambly update. I just wish I could stay awake long enough to think more clearly about things and write more eloquently about them!

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Uhuru sells Floradix and it does taste slightly less of watery blood as far as I recall - but then it's been a while since I had it (I took multivitamins designed specially for pregnancy & therefore inevitably pink, the buggers).

Go you on getting the house in order! Don't worry too much about the toddler-proof-ing as you have a fair amount of time before you need all that in place - ours is massively un-toddler-proofed still. Even a cot is not crucial at first unless you mean a space for a cot in your room.

When I went back for my KIT days I was pleasantly surprised to find that my brain did indeed still work properly as before, and I could remember what I had been doing before!

PS work's payroll had this helpful suggestion - I don't know whether it applies to all companies but it might do - that if you're planning on doing a couple of KIT days in a short space of time you should try to do them in the same week. This is because the payroll calculation goes:
* daily rate x number of days worked as KIT
minus
* SMP rate for the week(s) in which you had a KIT day.

So if you have two KIT days in the same week you get one lot of SMP deducted, but if you have two KIT days in consecutive weeks you get two lots of SMP deducted.

Gosh, I didn't realise the KIT days were so complicated. Thanks for the tip!

I know we've got lots of time for toddler-proofing but I'm guessing it's going to be much harder to do when only one of us can use our hands at any one time (and when we have no money). Hence trying to get the big bits of work done now (we really should have started this last summer of course, but too late for that now!).

We're just starting to find now that A can be left to her own devices slightly more: she will accept sitting in her chair for five or ten minutes at a time, and she naps for maybe as much as nearly two hours at a time. There's also parental baby-sitting possibilities. But it's true that the larger tasks are better off being done in advance if you can, without overdoing it...

Floradix tastes much better and has a better iron content. I've found it in holland and barret and in waitrose.

Ah, H&B is very near Owen's work, I will send him out foraging for Floradix - thanks! :)

BTW, where do you get the figures on which has better iron content? (Does it have more iron, or is it absorbed better?)

If memory serves, it said it had more milligrams?? (But memory is not one of my strong points) I believe in terms of digesting, they are both chelated.

Vit C pills will be easier on your gut by a long way. So will high C leafy greens. Y o y do You Brits always and only think "orange juice = C even if it gives me heartburn!"

Rant over...

Liver is quite acceptable now and again if you would eat it when not-pregnant?

Liver is advised against due to the Vitamin A content these days.

Liver every week is too often. Every now and again is fine. There are silly people who take 10,000 IU a day and turn orange, but in utero critters aren't hurt by the occasional nontoxic spike in placental vitamin A dosage.

I read something recently-ish suggesting that this advice was based on just one study where they fed bucketloads of liver to pregnant rats. Will try to dig out a more reliable reference than "I vaguely remember reading this"...

Also, I know anecdote != data, but my mum said when she was pregnant with me she was advised to eat plenty of liver because of the iron...

When I did mammalian toxicology back in the days of the pyramids, yes, it was a rat study. Honestly, you cannot harm the sprocket by eating liver now and again at this developmental stage. The window for damage by A toxicity is pretty well over now. A small slice, say, 4 oz, once a week even, cannot harm anyone.

Gah....

I went for OJ because that's what it recommended on the iron supplements, not because I'm British. :-}

(Personally I'd always prefer food/drink to pills anyway... not that I think they're better, just that I've got to have the food/drink anyway so it makes more sense (to me) to kill two birds with one stone!)

Handwavily: it's /very/ British to do something one thinks is good for one even if it hurts. ;-}

I has done it. Spinach and other leafy dark greens will give you fibre and vit c and a bit more iron, too -- orange juice too acid for me, actual oranges (tiny tangerines if you can get them) are better, or even moreso blueberries.

I also feel compelled to plug Cafe Nour's Shawarma -- massive plate of iron loading, put some tabbouleh on the side for the vitamin c, wash it all down with some stomach-kind mint tea

P.S. Cereal is still fine, just don't take it at the same time as the iron

Mmmm, Cafe Nour. Any excuse. :-)

Mint tea, bizarrely, seems to give me really bad wind, even though everybody keeps telling me it will fix the wind. Sometimes I wonder if bits of my digestive system just got put in the wrong way round. :-/

I think they do ginger tea, too -- might suit your stomach better? I'm quite fond of that (basically just fresh ginger grated into hot water -- although you can faff with lemon and other spices if you want) and that's supposed to be a stomach settler, too

Unfortunately the taste of ginger is now so firmly associated with morning sickness for me that I'm not sure I'll ever be able to enjoy it again. :-{ I used to love peppermint-and-ginger tea, too (peppermint leaves, chunk of ginger, hot water, mmm).

Bah, sorry for whinging. I hate being whiny & fussy about food. I really really want to be able to go back to being able to eat/drink anything and everything.

I think that you have carte blanche to whinge about food at the moment, what with having to deal with an extra immune system, etc.

On another note, this weekend for drilling and career discussion (so wild our lives) sounds good, what day is better?

I think either day is OK with us (Saturday evening is busy, but presumably for you too, for the same reason!) -- when's best for you?

Sunday afternoon suit? 2pm-ish

Fine by us - it's a date!

I just went to Café Nour today - they have a lovely lemon & honey tea, but I didn't spot any ginger one on the menu.

Sometimes I wonder if bits of my digestive system just got put in the wrong way round

Ah, you've probably got a positive earth body. This can be fixed by applying a current briefly across your dynamo.

Get an SDS drill (http://www.homebase.co.uk/webapp/wcs/stores/servlet/ProductDisplay?langId=-1&storeId=20001&partNumber=449329&c_3=3|cat_14418763|Corded+Power+Drills|14418780&c_2=2|cat_16849334|DIY+Power+Tools|14418763&c_1=1|category_root|Tools|16849334), or alternatively borrow mine, or ask me to come round and drill it.

SDS drills will deal with undrillable concrete lintels (http://waistcoatmark.livejournal.com/233308.html).

Edited 2011-02-24 01:37 (UTC)

Cor! In that case... Dear

timscience, please can you come and visit us with your +2 Drill of Lintel-Buggering and make our wall full of holes? :-) Honestly, Owen & I have faffed around failing to do this for so long that we'd be happy to pay you to sort it out -- whether that's payment in actual cash or just buying you dinner or something.

(In fact, are you around this weekend at all? Maybe we should take this to email...)

am around, although Computer Doom makes email problematic (turns out to be power supply, ordered new power supply, new power supply arrives, computer fails to boot, turns out brand new power supply is also faulty.....).
am thinking possibly saturday sometime, not evening obv, I believe J is sorting out a time, whatever she sorts will be OK.......

I found, with a little jiggling, that it's possible to type while on "hands" (something to prop one up on one's upper chest) and knees. Alex turned after 2 weeks on hands/knees where possible, not leaning or lying back (so sit forward on chairs etc - birth ball best) and lots of walking.

I chose to have a hospital midwife led birth with my first, as I'm not a home birth person (I personally am more comfortable with hospitals than home births.) I didn't get any machines which go ping during my first labour. (A couple of listens in to the heartbeat with the doppler they use during antenatal appointments.) Are you making assumptions or have a firm basis to expect them? I found that the midwives tend to try for a minimal monitoring unless there's serious reason to do more, and if that's the case they'd probably be recommending being shipped in if you were at home.

With my second "consultant led" induced labour, I had foetal heart rate monitoring which DID mean being strapped to a bed for what felt like hours while they tried to get 40 minutes of awake monitoring of my wriggle before and after the inductiony bits, while she wriggled out from under it or fell asleep, but it honestly wasn't that bad, just boring - I read erm 3 long good novels and a couple of trash. The boringness was contributed to by being shoved in the end bay of the ward and left for 3 hours while they dealt with people who needed them more. The actual monitoring itself was quite interesting, as you can watch the screen and see the kicks and wriggles and contractions and feel them at the same time, just after having it weekly/twice weekly for the last month of pregnancy and then for hours before the birth it got tedious.

I am doing the hands/knees, sitting forwards, walking, cycling... I even have a birthing ball thanks to

jinty. We'll just have to see if she co-operates -- I gather there's only about a 50% success rate for this sort of thing.

I chose to have a hospital midwife led birth

Unfortunately the midwife-led ward at the JR has exactly the same criteria as the midwives have for home birth -- ie if my iron drops below the magic number so I'm deemed too high-risk for a home birth, I won't be allowed to deliver in the midwife-led ward either.

I'm really glad you had such a positive experience with hospitals, but personally I'd much rather stay at home.

Child didn't get in position until he was damn well good and ready. Can't think where that attitude came from. The GP's midwives were all quite good about nudging the Critter about the last two weeks before delivery, though.

Lots here in your circle of concern, less within your circle of influence, though.

She has time to shifty about. It'll be fine.

Ani (now at 38 weeks so just ahead of you) is having both the iron problem and the back-to-back baby problem as well, so I've been doing some reading up on both for her! Http://homebirth.org.uk has a useful page on iron deficiency & its implications, if you want to read it. They quote some evidence that low iron in very-pregnant women is in fact normal & shouldn't be treated as concerning in the same way as it would in non-pregnant women (which is what tends to happen).

The NICE guidelines only count it as "low iron" & thus recommend a hospital when it's below 8.5; between 8.5 and 10.5 they recommend an "individualised assessment". Different trusts policies vary, of course (Southampton says below 10 they're unhappy with a home birth too). They can't actually refuse you a home birth if that's what you want - if you just stay home they are obliged to send someone - but whether you want to do that is a matter of personal preference, risk assessment, how strongly you want to be at home rather than in hospital, whether you (well, your birth partner!) is happy insisting... & so on. (A very strongly does not want to be in hospital, but she has a handful of specific personal reasons for that.)

Apparently 87% of babies who go into labour back-to-back turn during labour; lots of upright & forward-leaning positions in early labour seem to be the recommended option!

I have ongoing (since my teens) low-iron problems (obv not pregnancy-related) and have found that liquid Floradix works better than Floradix tablets and much better than regular iron tablets; also actually tastes quite nice (sort of fruity) and didn't give me any side effects. YMMV. Never tried Spatone (A has; no side effects but didn't make a difference either; she's now onto high-heam content fish & shellfish, so if you eat those you could try that?).

Good luck with the next few weeks!

They can't actually refuse you a home birth if that's what you want

Yeah, but I don't think a home birth would be much fun either if the midwives were resenting me & thinking I was an idiot for insisting on my entitlement to a home birth against their expert advice... :-}

Annoyingly, my GP (as I'd correctly guessed) didn't know that there was a cut-off point for a home birth -- he certainly doesn't think 10 is worryingly low though. I wish they had some kind of joined-up policy here!

I do strongly want to be at home, but part of the reason for that is that I don't want to have to waste all my energy fighting with doctors all the way through. :-( I wouldn't know how to begin insisting.

lots of upright & forward-leaning positions in early labour seem to be the recommended option!

Yes -- that's one reason why I really don't want to have to stay lying on my back while doctors prod at me... I just fear that if I'm forced on to my back then the baby won't turn and the labour will go on for far longer, I'll run out of energy and/or time and they'll just say "oh well, time to fetch the knives, can't have you taking up this bed any longer" etc. I know it needn't be like that, but there does seem to be evidence that every intervention just increases the likelihood of needing the next intervention.

high-heam content fish & shellfish

I thought you were supposed to avoid shellfish altogether in pregnancy because of, er, whatever it is. Though I'd be very happy for an excuse to start eating it again! I will try the Floradix since a few people have recommended it now...

Thanks for all the info & good luck to you & A.

I know quite a bit now about how to go about resisting pressure (of various sorts) to go into hospital; so if you do want any of the stuff I've dug out about it, let me know. A's and my attitude has been that she gets to make (informed) choices about her own body & baby & labour, & once she's done that, I get to be gatekeeper & deal with any external pressure against that (without distracting her, as she will be busy!). But yeah, it can be a bit of a balancing act & certainly *you* don't want to feel put under any extra stress. I'll let you know how it goes!

There is also the option of refusing further blood tests (if you're happy that you feel healthy enough etc). If they haven't got anything saying you're below 10, they can't act on it :)

Shellfish just has to be cooked thoroughly. And there might be a maximum amount you're supposed to have each week in order to avoid toxins that accumulate in filter-feeders, but I'm not keen enough on well cooked shellfish to have had to worry about that!

On the positioning side of things, my understanding is that it's much more important to know what to do about position once you are in labour - babies move a lot in labour and babies that aren't posterior can suddenly turn posterior and vice versa. Owen was ROA which wasn't ideal, but realised after a while that there wasn't any way he wasn't going to move, however much I did all the things that I was supposed to get him 'optimally positioned' and trying to do so was just not worth the effort.

I didn't really have choice for a home birth as I was classed high risk for labour from the start annoyingly (due to my height) and eventually decided that the stress of trying to persuade them let me have a water birth in hospital wasn't worth it, but could move about as much as liked during labour in hospital and wasn't on my back right until the last few minutes when I needed to be for various reasons. In fact I was quite impressed how much the midwives contorted themselves in order to do the periodic monitoring without disturbing me! So even in worst case scenario it might not be as bad as you imagine, though can understand why you would want a home birth.

I hate liver and am allergic to shellfish so didn't have the same dietary dilemmas as you. There was a blog called 'bumpology' that New Scientist ran last year written by one of their journalists who was pregnant that I seem to remember looked at whether there was actually any evidence for various of the recommendations, so could be worth looking there.

I've been attempting to tackle non-pregnancy-related low iron with dried apricots - they come with their own vit C! If nothing else, they're pretty nice to eat anyway. I haven't yet had my iron re-checked so I don't know if it's doing any good.

Not being well up on this pregnancy business, I'm not familiar with back-to-back babies, but assume it is something a little like wall-to-wall babies, ie your life is becoming increasingly full of baby with little space for anything else!

Mmm, dried apricots. The iron-rich foods do seem to be the tasty ones at least!

wall-to-wall babies

Eeek, no, there's still just the one, thank goodness... :-) Though it is filling me up rather thoroughly. I am approx the size of a whale.

(Back-to-back just means baby's back is towards my back. This is apparently sub-optimal for getting baby out. I suppose I shouldn't be surprised that a child of mine is turning out to be awkward already, though. ;-)

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State of the Sprocket

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iron loading

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aw that's bad

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the lintel

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