Third Time Lucky

What I learnt from two miscarriages and what midwifery qualifications can’t teach you…

It’s funny being on the other side, especially after a few false starts. Two, to be exact. Miscarriage is something that, being a midwife, I  should’ve been more realistic about, especially with 1 in 4 pregnancies resulting in miscarriage, but I thought, 26 and healthy, there would be no reason to consider the gloomy side of things.
Falling pregnant for us, was easy! 3 cycles = 3 pregnancies, which we were and are very grateful for, but getting the little rugrats to stick was the hard part for us.

Recurrent miscarriage is classified as 3 or more miscarriages, so a lot of the time investigations start after the third miscarriage…but being an impatient Gen Y’er, and lucky enough to be working with, and surrounded by midwives and obstetricians to help with the investigations, I got straight to it to see what was going on/if anything was going on…

One consult with a colleague, 18 tubes of blood later and I had been tested for every weird and wonderful anomaly+chromosomal testing you could consider, I got an ultrasound,my husband got sperm+chromosomal testing, and 3 months later when the results returned, everything was perfectly normal. This was good, but was frustrating – I was almost of the mentality, if something had been there, we could work at it and fix it, but nothing showed up….as a lot of the time it does. We put it down to environment.

I’m a stress-head and love working and keeping busy. I was working a job that required me being on call, working long shifts and keeping bizarro hours – all in all not really looking after myself. My healthy lifestyle choices would fly out the window because the reformer pilates class I was booked into, or the trip to the gym, was now kiboshed by a trip into the hospital, and once I’d returned I was buggered and we’d order takeaway.

When I was newly pregnant, the first time, I pulled a few all nighters at the hospital, and we were particularly busy. I didn’t eat any food/drink minimal water for each of the shifts and we didn’t have breaks…not that I think this was the reason for what eventuated, but it just goes to again reinforce the pace at which I was moving and the fact that I wasn’t putting myself or my pregnancy first.
A couple of days later, I started a new role at the same hospital I had been working at, and as the heaven’s would have it, my first week on the job, I had a miscarriage. Not wanting to take anytime off (group practices rely heavily on being a team player…and I would be buggered if I was going to let the team down week 1!) I worked the whole way through….and did the second time as well, this time pulling a 12 hour shift, doing home postnatal visits, returning to go to the loo and instead ended up running for emergency caesarean… craziness. I ended up in hospital that night with falling blood levels and an operation at 3am. Stupid. Stupid. Stupid.

What’s the point to this article? A lesson of hindsight and how you can learn from my stupid ways.

Things I wish I had done sooner:

Prioritised myself and my health. Working within a big organisation you can be chewed up and spat out without even really noticing it. If you need a day off, you need a day off. Take it. Don’t be a martyr. I’m getting better at this. Third time around, I knew I was pregnant by 3.5 weeks (when I started vomiting all the time)…so I took the week off and veged on the couch watching movies, and as luck would have it (if you call moving interstate and packing up a house lucky when you’re 5 weeks pregnant) I was finishing up in this role a fortnight later. So I didn’t/haven’t looked for midwifery jobs in Brissie yet, I’m studying to educate Calmbirth for the moment and doing some freelance stuff.

Find a good GP. Going to whomever that was available at the local bulk-billed place when you need the quick medical certificate or script had always served me well, but not having a regular GP when it came time to pregnancy related stuff kinda screwed me. Having to show up to get your bloods taken to confirm falling HCG levels mid miscarriages by rando Dr’s that have no bedside manner and answer questions like “do you have any kids?” rather than “are you okay?” or “this sucks” was a kick in the head, twice… Go find one you like, and stick with them.

If you’ve had a couple of miscarriages and you’re wanting to investigate sooner that what a GP would normally recommend investigating or write a referral for, do it if it’s going to give you piece of mind. Even though it was third time lucky for us, just knowing that there was nothing showing up on paper was enough of a confidence booster a few months later to try again. Worth every penny! Be “difficult” and demand it. No harm in investigating, if this is what’ll keep you sane.

 

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Baking until Feb 2018

 

Postpartum Contraception

So you’ve had a baby! Contraception is probably the last thing on your mind, but it’s an important conversation to have with a healthcare provider…know your options!

So you’ve had a baby! Contraception is probably the last thing on your mind but, it’s an important conversation to have with a healthcare provider (Midwife, Obstetrician, GP, Family Planning Services) to discuss what will best suit you- and there’s quite the array!

If you are breastfeeding, postpartum contraception options include:

Lactational Amenorrhoea Method (LAM) – When you’re exclusively breastfeeding bub, the hormonal process can effect menstruation, halting ovulation (voila contraception!). The World Health Organisation accepts this as an effective method of contraception, and is considered 98% effective (the same efficacy as the pill) when used according to the guidelines. These guidelines should be discussed with a healthcare provider (this is very important…don’t want any surprises!)

Three criteria can be used to predict the return of your fertility.

  • Have you had a menstrual bleed? (for the purposes of LAM this is defined as any bleeding, on any two consecutive days, that occurs 2 months after the birth)
  • Are you giving regular supplementary foods or foods or fluids to your baby in addition to breastfeeding?
  • Is your infant older than 6 months of age?

If you answer no to all the above three questions, then you potentially meet the requirements for the LAM.

Progesterone only Pill (POP) – Progesterone only pills are considered safe whilst breastfeeding. POP works by thickening the cervical mucosa making it harder for sperm to penetrate. The important thing to note with the mini pill is that it needs to be taken at the same time each day (so set that alarm clock!)…because if you miss it (by 3 or more hours, that window is considered a missed pill, and extra contraceptive precaution will be needed).

Implanon® – is a progesterone implant, which may be suitable from 6 weeks. A conversation for your 6 week check up, perhaps?

Depo-Provera®/ Depo-Ralovera® – Progesterone intramuscular injection. Commence anytime from 6 weeks postpartum.

Mirena® – is an IUD. Dependent on hospital policy/doctor’s policy, the IUD may be able to be inserted within 48 hours postpartum. If this is not possible, it should be left until 4 weeks after childbirth. Its effective within 7 days, lasts 5 years and is a localised progesterone. If at any point you don’t want it anymore, it can be taken out…no 5 year lock in contract!

Note: women who have had a caesarean section should not have a IUD inserted prior to 6 weeks postpartum due to the increased risk of perforation.3

Side note: I have one of these bad boys, and they’re fab! 5 years contraception…tick…peace of mind.

Condoms – Can be used immediately.

Diaphragms – make sure size and fit is correct, and it is advised to wait 6 weeks.

Combined oral contraceptive Pill (COCP) – Not recommended to be used for the first 4-6 weeks. If breastfeeding is established, and no other methods are deemed suitable, this is an option to discuss with your GP etc.  The reason COCP is not recommended for the first 4-6 weeks, is because the combination of hormones can reek havoc with breastmilk supply establishing.

Non-breastfeeding mamas you really are spoilt for choice! All contraceptive methods are suitable. On average, for non-breastfeeding mamas, first ovulation cycle returns 45 days postpartum. 

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