34 weeks of growing you

Well what can I say, the change in me has been so good this week. Though it’s not remained plain sailing on the medical front. Last week I was called several times by the consultant and I felt reassured re the likelihood of a cesarian. Because of my fibromyalgia I don’t recover well from, well anything, and the idea of having major surgery, needing more rest and recovery time without the opportunity to get into rehab for my pelvis, really scares me. The reason being is, at the moment I cannot walk without crutches, and how the hell do I care for you on crutches after major surgery? However these concerns were countered by the consultant who reminded me it was after I had your sister via vaginal IOL that I was diagnosed with fibromyalgia, so recovery for either isn’t likely to be great. Whilst this sounds ominous, it’s reassured me that neither is likely to be worse than the other, for me anyway. I will chat to them again on Wednesday to discuss where we go from here.

The reason I’ve been somewhat pissed off with them again this week, is after complaining about the lack of contact from my midwife I spoke to someone else who was really helpful and arranged a new referral to a physiotherapist- only for my original midwife to phone me on Friday to tell me I couldn’t have physio at the hospital because I’m an out of area patient, they’ve known this since the minute I found out I was pregnant, and I’ve been begging for physio since 16 weeks and was told over and over that I couldn’t be seen face to face because of the pandemic. I was given a glimmer of hope at being seen face to face finally at 34 weeks, only to now be told no, again! It’s frustrating, and I feel like the system in place doesn’t work for pregnant women in physical pain.

Irrespective of the setbacks I do feel more positive in general. As seems to be standard recently, your sister is boosting my mood every single day, making life feel more manageable. I’m still in pain, I’m still without my independence, but I’m not without my family and they, you, are all that matters. Your dad, your sister and I, all went away the weekend and it was amazing. The weather was abysmal, and we spent much of it in the caravan but the change in scenery, the togetherness, was so uplifting it was worth all the exhaustion that is now befalling me upon return. Despite the aftermath I’m so glad that I made the effort. Your sister rode a donkey for the first time, talked about you lots, and before we left for our trip on Friday she even drew on my bump writing baby Cullen I love you xxx

I feel stronger and less weighted by what everyone else might be thinking. Less embarrassed to admit what I need. Less guilty about how I’ve been feeling, more accepting of myself, my limitations and prognosis. We know our journey is tough, we also know some people have it a lot tougher. We know it’s worth it and we know we’ll face whatever challenges come our way together. It’s a startling shift that has taken so long to come I wonder why and how I’ve not been able to pull myself out of the fog sooner – but who cares? I’m here now and I’m thinking more clearly. I’m trusting myself and my ability to get through this, and I’m doing it for you, for us, all of us.

You will be here, before we know it, so soon and we are excited to meet you. Apprehension still resides, and there’s still uncertainty, but I’m trying to focus on the things within my control. Soon we’ll be taking trips as a family of four and we’ll be together, for those days, I cannot wait.

PMDD and pregnancy

April is PMDD Awareness Month and it’s something I’ve not talked about much since becoming pregnant again. PMDD directly corresponds with your menstrual cycle so in theory you should gain relief during pregnancy. However, and this is not fact, merely my personal experience, since PMDD causes an abnormal reaction to normal hormonal changes, whilst you may receive some relief during pregnancy it’s possible you still have a sensitivity to hormone fluctuations. As has been the case for me. Some symptoms are worse than ever before, particularly migraine and feelings of hopelessness.

The first trimester is often the worst for lots of pregnant women even in the absence of PMDD, the severity in hormonal changes tend to happen early in pregnancy and level out as your body becomes accustomed. It’s also thought women who suffer perinatal/postnatal depression may be at further risk for developing PMDD, and I can concur that the dip in hormones post pregnancy deeply affected me the first time around. With PMDD age has been another factor which effects the severity in symptoms for me personally. The older I get the worse my symptoms become. Often it has been the case for me where hormonal therapy such as contraception will provide short term relief only to later stop working with no rhyme or reason. Antidepressant medication can also help manage symptoms but again, long term they often need changing and finding the right type and dosage is a lot of trial and error.

After menarche, my PMDD was prominent, but back then at the age of just eleven nobody took my severe mood fluctuations seriously. At thirteen after attempting suicide I was prescribed antidepressants. It was only later when I started diarising my depression and severe mood swings that often included rage and toxic outbursts that I made the connection between them and my periods. Growing up, soon after enrolling in infants school and before menstruation, I was diagnosed with the hormone imbalance premature adrenarche. Though there is no scientific connection between PA and PMDD I feel this was all part of the same affliction, sensitivity to hormone changes affect me in a major way.

PMDD shouldn’t impact pregnancy in the sense that it alone won’t impact your ability to conceive. However trying for a baby whilst managing PMDD can be difficult, especially if you’re taking contraceptives to manage your symptoms, and or antidepressants. Fluoxetine or Prozac as it’s also known, is one of the more favourable SSRI’s for PMDD treatment. However it’s not recommended for pregnant women and therefore you may be asked to switch to a safer antidepressant or come off of them all together. This in itself can be a life altering (and in some cases life threatening) change that could impact your mental health during pregnancy too.

If your PMDD is severe and not responsive to treatment you may have considered sterilisation, which of course can put added pressure on you if you want to conceive. You might feel like you’re running out of time or you might feel forced to make the decision not to have children at all in order to manage your condition.

Though classified as a mental illness PMDD has many physical symptoms including joint paint, migraine and profound fatigue, that can often be mistaken or overlap with other illnesses, in my case my fibromyalgia is much worse when PMDD strikes and I know many other sufferers often get diagnosed with secondary conditions as a result of living with PMDD too.

Looking after your mental health must alway be a priority including during pregnancy, but it’s scary when you’re offered conflicting information and promises of symptom relief aren’t helpful either. ‘At least you get a break from PMDD’ is one of the most useless reassurances I’ve ever heard. Surely we know by now that even those of us with the same diagnoses will experience symptoms differently and bodily changes will impact us all in different ways. Pregnancy is one of the most obvious examples of this. Some women barely know they’re pregnant at all and others (like myself) find the process insufferable.

What’s important when considering all factors is finding a healthcare practitioner that is aware of your diagnoses and if they aren’t up to speed on what it means. They need to be willing to learn. When I found out I was pregnant this time I specifically asked to be cared for by the perinatal mental health team, this has included regular discussions with a mental health consultant that specialises in reproductive health. It’s been invaluable for me to know that I have people on my healthcare team that understand and are knowledgeable in helping me look after myself during pregnancy. My most recent appointment with the consultant included discussions around further specialist referral for PMDD post pregnancy, and also the need for me to be prescribed antidepressants again post natal. Even if I don’t feel I need them I have a prescription ready and a doctor who is helping me monitor the impact.

Pregnancy is hard on our bodies, buts it’s equally as hard on our minds, and when you are prone to mental health problems or live with a mental illness already, specifically ones prone to intensify with hormone fluctuation, the need to receive the right healthcare is critical.

https://iapmd.org/ the international association for premenstrual disorders have a directory that can help you find doctors in your area that specialise in PMDD so do check them out.

Week 22 of pregnancy, carrying you, baby #2

We didn’t know what you’d be. We weren’t sure you’d show up on a scan as healthy. Our twenty week scan was nearly two weeks late and it made us impatient and anxious. We still don’t know what the outcome will be or if you’re truly ok in there. All we know is that you’re wanted.

Now I can no longer walk again it’s difficult to associate pregnancy with positivity. It was the same with your sister, causing me pain so difficult to overcome that I never really know what each day will bring. We’ve been left to our own devices by the health care system. Lots of people told me it happens with second babies. You’re an assumed pro by number two, you don’t need any support. Except I do need support. I do need reassurance. I am not a pro.

You present me, your mum with symptoms similar to the ones your sister did, but it’s different this time. They keep telling us about the risks to you, but don’t really do anything to help us overcome them. Maybe there’s little they can do, or maybe they expect me to know, I don’t. Medication that I need to function, to care for your sibling too, means you might need help when you’re born.

They have offered me mental health support that has been good, but physically I’m in worse shape than ever and I still have to care for your sister, so it’s hard.

We weren’t amongst the chaos of a pandemic when she was on her way. This time our support has lacked and your sister has been home for most of it. Waiting for your arrival with baited breath. With hope, but also with boredom. She longs for a playmate but she doesn’t fully understand the implications of pregnancy and why her mummy has become less fun.

Me, your mum, I have a few health issues already. Ones that were present before you were even a thought in my mind, a seed in my belly. Ones that haven’t gone away, that never really will, but that we’re working hard to escape. We love you already. That much we know, but each and every day that we will you to grow, we are scared that you’ll have a hard start. That your life won’t begin with all of the joys of a hot July summer. We worry that I might not be strong enough to care for you. That the help we need might not be available or accessible. Maybe we should have been more prepared but you showed up with two lines three weeks after my last period and we weren’t prepared, all we knew is that we would keep you.

I’m off work at the moment. Pregnancy isn’t kind to my health or my mind. I was struggling to hold down a job before you came along, but I’m trying. I fall into a category of disabled that isn’t well recognised or even always believed. I don’t get financial help for my disability and your Daddy works very hard but we aren’t wealthy enough that I don’t have to work. We are looking at ways to accommodate my return, and we have to hope that I will be well after your birth. Well enough to care for you. The trouble is I get periods of wellness that don’t really last. They are usually days and not weeks or months. I hope you don’t grow up having to care for me. I hope that I will always be able to give you what you need.

I love you. I love your heartbeat and your tiny feet. I love your kicks and I hope that when you arrive you will know that whatever challenges we face, my love for you will continue to grow.

I hope that you and your sister will always know that Mummy tried. She will never stop trying to give you a good life and will always be there to share it with you.