I am a Bad Mother: Part 4. In which I feed my baby formula.

Again, a caveat: I am Not That Kind of Doctor, so what follows
is merely a record of my personal experience with infant feeding.
Please don’t take what I write as a substitute for medical advice!
This post may also include words such as engorgement, lactation
and other breast-related things. You have been warned.

 It has taken me a long time to start writing this post, which is due in part to the fact that I still feel rather conflicted about the issues involved. From a medical point of view, I feel somewhat ill-qualified to give an accurate perspective of the breast vs bottle debate, as I simply do not have the time, training or access to data which one would need to conduct a proper scientific survey of the medial and nutritional issues involved. Additionally, I realise that the fraught question of how and what parents feed their babies is inextricably bound up with a variety of societal factors, including class, education, the availability of a support network, body image, bonding, and mental and physical health. These can both increase pressure upon the feeding parent, and act as a confounding factor, making it harder to determine with certainty whether the apparent advantages of breastfeeding are causally related to the breastmilk itself, or merely correlated. Nonetheless, this is something I need to get off my chest (Gah! The pun: it hurts!), and I hope that reading about my experiences might help someone else in the future.

Many first-time mothers have doubts about their ability to breastfeed adequately, typically centred around the concern that the baby might not be getting enough nourishment. Some of those fears may be justified, some are probably not. I, however, knew from the first that I was likely to face problems with breastfeeding and milk supply, as, in 2004, I had had a breast reduction. If you are interested in the details (and you might well be: the type of reduction surgery performed can impact differently on your future ability to breastfeed), I had a Lejour reduction, and I remember the surgeon telling me he had removed at least 2lb of tissue from each breast, which would mean I lost somewhere between 1.5 and 2kg of breast tissue in total. The surgery was performed for free by the NHS as I was suffering from bad back and shoulder pain, thanks to my over-generous frontage. I was still left with large breasts: it took a while for things to settle down after the operation, but eventually I ended up being about a 32E. Considering I had started off as a 30G, though, I could deal with not being a petite B-cup: I may still have been curvy, but things were much more balanced, and I wasn’t in pain any more. My overriding emotion was gratitude: suddenly I could do all sorts of things in ease and comfort: play sports, run for the bus, wear dresses, find underwear in a colour that wasn’t surgical beige… For a while, everything was peachy. Then, in 2011, I had Eoin, and things went a bit wrong.

My first pregnancy: I fail at breastfeeding

If you have read the other posts in this series, you’ll know that I had gestational diabetes during both pregnancies, and that it really knocked me for six the first time. As a nervous first-time mum with an inconvenient history of anxiety, I was very concerned about the impact my feeding choices might have on Eoin, and I was firmly convinced that one of the ways I could attempt to right some of the wrongs I had done him by being diabetic (I know, I know) was to do everything I could to ensure I fed him breastmilk instead of formula. In some cases, mothers are able to feed very successfully after reduction surgery, and I was determined I was going to be one of them. I haunted the BFAR website, I grilled my midwife, I had several pre-natal appointments with lactation consultants. I was delighted when I realised that I was able to produce some colostrum, and, on the advice of the hospital, diligently set about harvesting it. Unfortunately, colostrum-harvesting is a time-consuming, tricky business, and it is certainly not helped by being so terrified about your blood sugar levels that you are essentially starving yourself. For weeks during my third trimester, I sat on my sofa with a bag of sterile syringes, getting hungrier and sadder, expressing until I was covered in bruises, yet producing only one or two millilitres of precious liquid a day. By the time I went into labour with Eoin, I had collected about 30ml: to put this in context, this is roughly the amount that a newborn might be expected to drink in about two feeds in the very early days. I fed this to him from a cup while in hospital, and put him to the breast whenever he was hungry. My technique was assessed by a range of midwives, nurses and lactation consultants, who all agreed everything was going excellently. I was patted on the back and sent home on day three after the birth, certain that I wasn’t going to need those bottles and the box of formula I had bought “just in case”. It was at this point that the problems started.

Even in breasts which have not been tampered with, it takes a few days for the milk to come in after birth, and, unfortunately Eoin was desperate for more food before my body was in any way ready to give it to him. He was latched on pretty much constantly for the third day and night, but the only thing that happened was that he got progressively more ravenous. It was only at three in the morning, when he was utterly hysterical with hunger, and had lost his voice from screaming, that I recognised I was going to have to give him formula. I fumblingly mixed up a bottle, fed it to him, and was horrified when he just kept screaming. I remember thinking that all I had done was give him the energy to be really furious. It took another bottle half an hour or so later before he finally calmed down and fell asleep; when I woke up a couple of hours later and heard no crying, I was half-convinced that he was dead, so constant had his distress been until that point.

Notwithstanding the two emergency bottles, I was still certain that I could try to feed Eoin myself, and, the next morning, set about latching him on when he woke up. Unfortunately, and unbeknownst to me at the time, I was beginning to feel the first stirrings of post-natal depression. This initially manifested in a rather odd way, although I have since met one other person with identical symptoms: I would be physically sick for much of the time, notably whenever I held Eoin. This got worse very quickly, until I could only hold him for a few seconds without vomiting. The doctor gave me anti-emetics, but I wasn’t able to keep them down. I was then given omeprazole, which, while it stopped the actual sickness, did nothing alleviate the rushes of nausea I would suffer whenever I held Eoin, or whenever he cried. It was only when the PND was diagnosed, and I was able to start taking citalopram, that things got even a little better. In the immediate aftermath of the birth, though, I was really rather unwell: I couldn’t eat, I lost weight dramatically quickly, I was permanently cold and exhausted, and I was pretty much unable to hold my son. Against this backdrop of mental and physical sickness, I was simply unable to continue trying to feed Eoin myself. I did try, but still no milk came in, and still he screamed hysterically until I caved and offered him the bottle. It was only a couple of days after having decided that formula feeding was the only viable choice for us that I finally showed signs of engorgement. I remember thinking how horribly mistimed it was, but in truth it is highly unlikely that I could have continued trying to breastfeed given how ill I was. The whole thing felt like a horrid failure from beginning to end: as I saw it, I hadn’t managed to carry Eoin successfully, I couldn’t give birth to him myself, I couldn’t feed him. The pleasure I should have been able to take in my new baby was entirely sucked away, leaving at worst a depression and at best a flat hopelessness that lasted for around a year and a half.

My second pregnancy: I fail at breastfeeding again, but I fail better

With Ronan, my feeding goals were much more modest: I knew that exclusive breastfeeding would be unlikely to happen, but I decided that I was still going to try to breastfeed him if possible, even if this might ultimately be doomed to failure. The stretch goal, so to speak, would be successful mixed feeding, but, again, I was under no illusions that this might not be possible. I was pleasantly surprised, when discussing my feeding plans with midwives during my antenatal appointments, that nobody turned a hair: I was assured that I would get all the support they could give if I wanted to try to persist with breastfeeding, but that nobody would judge me in the slightest if I ended up using formula. Crucially, I was reassured with the words I had never heard during my first pregnancy, namely that formula is absolutely fine for the baby, and, while breastfeeding is obviously a wonderful thing, it is only best if it works for both the mother and the child. I still prepared myself for both types of feeding, unpacking both the breast pump and the bottles, and stashing an emergency box of formula in the kitchen cupboard. I still expressed and stored colostrum, but, crucially, I didn’t feel anxious and beleaguered about it in the way I had done the first time around. In fact, when I arrived at the hospital for my section, clutching a cool bag full of syringes of frozen milk, the midwife on duty was somewhat taken aback, and told me that they didn’t normally see people being so prepared.

Feeding got off to a slightly rocky start: due, perhaps, to the insulin I had needed to take before the delivery, Ronan’s blood sugar levels were very low after birth, and the milk I could give him was not doing enough to bring them back to an acceptable level. For the first two days he was given small formula top-ups on the consultant’s advice, via a nasogastric tube. As you might imagine, he was not best pleased with the tube (he pulled it out himself after 24 hours), but his sugars soon stabilised, and, when we were released from hospital, he was happy, healthy and taking a mixture of breastmilk and formula. Midwives and the health visitor called regularly at the house over the next few days, and I was, proudly, able to show them that I was indeed managing to breastfeed Ronan, at least for some of the time. Latches, positioning and the like were checked, and everything seemed to be going well. I noticed, however, that, no matter how long I tried to feed him for, he never seemed settled. Indeed, he seemed to get more and more dissatisfied as time went on, fussing and pulling away after a couple of minutes, and he only really seemed to calm down after he subsequently had formula. I decided to break out the heavy-duty breast-pump, and see what I could managed to extract from myself by main force and industrial-strength suction. The answer, sadly, was not much. No matter how relaxed I was, no matter how much I thought of Ronan, the most I could ever pump was the foremilk: no let-down ever happened. One particularly prolific day, after spending hours hooked up to the infernal machine, I managed to collect about 80ml. On one hand, I was very proud of this, as I knew it meant that I knew for sure that I was producing something, and that he was getting some form of nourishment from me. On the other hand, when Ronan knocked this back without flinching in a single feed and then looked for more, it was apparent that I was never going to be able to give him more than a tiny proportion of the milk he required myself. Although I did consider persevering with mixed feeding, it soon became apparent that the game wasn’t worth the candle. At fourteen days old, Ronan had his last feed from me, and has been formula-fed ever since.

While I had an immense sense of guilt and failure over my formula feeding of Eoin, my emotions with Ronan were very different. A lot of this was probably due to the fact that I was not horribly depressed the second time, but I think it was also related to the fact that, with Ronan, formula feeding was a decision I was able to make in my own time, with the opportunity to weigh both the pros and cons without the sense of panic, terror and outright illness which assailed me previously. It was also a relief to realise what exactly was going on with my post-operation breasts: although I have no official diagnosis for this, it seems apparent that I have nerve damage following the reduction surgery, a not-unexpected consequence. With Eoin, I couldn’t understand why, when I was apparently able to produce at least some milk, he seemed unable to drink any useful amount. My discovery, with Ronan, of my missing let-down reflex explained a great deal: effectively my body was completely unaware that there was a baby trying to feed from it. While I could make milk, I couldn’t do anything useful with it. While this was frustrating on one hand, it was also immensely vindicating: on some level I had certainly blamed myself for not trying hard enough with Eoin. Maybe if I had pushed on and fed or expressed through the sickness, the dehydration and the fear, I could have managed to Do the Right Thing. But I hadn’t pushed on: I had just taken the easiest option… The self-hating internal refrain went on and on. It turned out, in fact, that there really was very little I could have done: try as you might, you can’t regrow your nerves through sheer force of will, and teaspoonfuls of foremilk on their own are not enough to be particularly useful to a baby. This time, I can honestly say that I felt very at peace with my decision not to pursue trying to breastfeed.

Why is it still difficult to write about formula feeding?

I began this post by saying I was still somewhat conflicted about the issues involved: I should note that this is not because I feel, in using formula, that I have in some way fed my children an inferior food. Obviously, breastmilk is the natural way for mothers to feed their babies: if it weren’t, we would be born with kettles and boxes of Cow and Gate strapped to our chests instead of mammary glands. However, while breastfeeding may be brilliant if it works for you and your baby, it is clear that formula is a perfectly good feeding choice too. The recent Ohio State University study into long-term outcomes from both feeding methods found that neither was appreciably more beneficial than the other. Crucially, this study examined feeding outcomes in relation to siblings, and so was able to eliminate a great deal of the selection bias seen in other studies of the long-term effects of breastmilk versus formula. For what it’s worth, I was myself formula fed as a child: barring the inexplicable gestational diabetes, I have no health problems, I am not obese, and I am bright enough to have managed to collect four degrees in various esoteric subjects. The fact that I was not breastfed does not seem to have done me any harm.

Why, then, do I still find it difficult on some level to be an “out-and-proud” user of formula? I said above that I was at peace with my inability to breastfeed, but note that, even though my chances of successful breastfeeding were very low, I still began by trying to feed Ronan myself. If I were to have another baby, I would do the same thing: mix-feed for as long as was practical, before moving on to exclusive formula feeding. I think the truth is that I now know what my physical and physiological limitations are, and this is comforting. As with so many things in pregnancy and parenthood, all one is trying to do is to regain a measure of control, of stability, of certainty. You want to feel you have done the Right Thing, however that might be defined. Bluntly, it seems to me that the breast-versus-bottle debate is concerned not so much with the nutritional, developmental and sociological benefits of one particular type of infant feeding versus another as it is with the way you define yourself as a mother, as a woman, as a thinking, responsible person. It shouldn’t be this way, but nonetheless your feeding choices invariably seem to brand you: modest/immodest, feckless/overattached, selfish/selfless, martyr, hero or villain. I confess that I feel the need to tick a box here: if I’ve given a baby my expressed colostrum, if I have tried to feed them myself, then I have done all I can, and I can continue to feed them formula with a clear conscience. But – and this is a big but – why do I feel I need this absolution in the first place? Why not feed formula from the first, if you know that, realistically, this is what you will be doing in a few days anyway?

Absolutely honestly, I think my reasoning stems, predictably, from guilt: my reduction, while medically very desirable, was not a life-saving procedure. I could have held on, surgically unaltered, and perhaps then I would have been able to feed my children myself. Perhaps, though, things would still have gone wrong, and I would then be beating myself up for another set of reasons. I don’t think I have managed to deal properly with this guilt yet, absurd as this might seem to other people. What I do know, though, is that for every irrational twinge of reduction/formula-based shame that I feel, another mother is feeling a very similar emotion for another reason. Extended breastfeeding, switching from breast to bottle, exclusive pumping, feeding through reflux, allergies and intolerances: all of these choices involve hard work and soul-searching, and all are likely to incur the judgement of outsiders. This, really, is the nub of the matter: as parents, we place enough pressure on ourselves without having to deal with the hoiked-up judgeypants of the neighbours, the people at playgroup, the staff of the fancy hotel restaurant (I’m looking at you, Claridges), and the Daily Mail. I have never felt so bad about formula feeding, or so angry at others’ thoughtlessness, as the day that someone came up to me in the cafe at Anglesey Abbey and told me that, if I had only loved him enough to breastfeed him, Eoin would have been happy and content instead of crying. This is the kind of nonsense no parent should have to deal with: life and infancy are far too short to agonise over whether a baby’s milk comes out of a breast or a packet. However you feed, you are doing your best. You will be fine. The baby will be fine. Unless there are medical issues at play, your feeding choices are yours to make, and none of anyone else’s business. The most important thoughts I could leave you with are the mantras of both the BFAR organisation and the Fearless Formula Feeder website. The former states that, in attempting to breastfeed after surgery, you must define your own success, whether that be through colostrum harvesting, the use of a pump or a supplemental nursing system, or simply through knowing that you have done all you can for your child. Measuring yourself against an unreasonable standard is not helpful. The Fearless Formula Feeder reminds us that the most important words we can say to any mother about her feeding choices are “I support you“.

This is how I would like to end: if you are reading this post because you are contemplating breastfeeding after a reduction or some other surgery, or simply if you are struggling with feeding in general, however you are feeding your baby, whether by breast, formula or both, you are doing the right thing. Be proud, and ignore the judgey comments: the people who make them are honestly not worth bothering about. I support you.

 

 

 

I am a Bad Mother: Part 3. In which I have a Caesarean section. Again.

Warning: there will be some discussion of childbirth in this post, so,
if you’re only here for the knitting, I’d suggest that you look away now.
It’s also a bit of a long one…

Alright: I realise that most people don’t give two hoots about how I happened to transfer two small human beings from inside my body to the outside world, and my reading of STFU, Parents has given me all too keen an awareness of the dangers of over-inflating the significance of your own birth experience. This is my blog, though, and my introspective pregnancy-woe-venting session, so I’ll write what I like. Less flippantly, it’s certain that my experience of labour and birth the first time around had a substantial negative impact on the way I coped in the immediate aftermath of the delivery, and on my post-natal mental health in general. As such, I think it’s a topic worth addressing.

When I was expecting Ronan, people would ask polite questions about the pregnancy, and how I planned to give birth. How I felt about my answer would depend on where on the emotional and mental curve I happened to be at that point, but I almost always found myself having to defend the fact that I was not going to attempt a VBAC. Sometimes the questions and my responses were both calm and rational, but at other times I felt very judged for having a Bad Medicalised Birth™ rather than the empowering, natural VBAC for which I should have been striving.¹ It didn’t matter that the exigencies of carrying and delivering a baby when one has gestational diabetes put me in a position where a Caesarean was the only realistic option, or that the circumstances of Eoin’s birth led more than one consultant to suggest that it was highly unlikely I could ever have delivered naturally. There was frequently a sense that I was in some manner taking the coward’s way out, or that I was putting myself and my body through a hideous surgical process when I could, instead, have been doing The Right Thing. A Caesarean section is very often perceived to be a failure, an artificial process, and a bad birth, while the natural, low-intervention route is seen as the only way to have a good birth. While I would never wish to judge anyone’s birth practices, and while I am delighted that so many women have empowering, successful VBACs, I would hope that my experience demonstrates that it’s possible for a repeat Caesarean to be empowering and successful too.  First, though, I should explain what went wrong the first time around.

A Bad Birth

So much of our experience of pregnancy, birth and motherhood consists of striving to do The Right Thing, and to measure up to some hypothetical gold standard of parturition, as nebulous a concept as that might be. When I was expecting Eoin, I diligently went along to NCT classes. Most of the other attendees were planning low-intervention, midwife-led births (a lucky few even ended up getting them), but, having just been diagnosed with gestational diabetes, I was very aware that my experience was likely to be medicalised, and, by extension, compromised from the start.

Particularly at NCT classes, people talk a lot about the “cascade of intervention” in childbirth: briefly, the idea is that any medical practice used to hasten a delivery can and will have a negative impact on the rest of the process. Once some form of intervention has taken place, it is likely that you will need another and another, until you find yourself strapped into a set of stirrups on an operating table, drugged up to your eyeballs, while a team of surgeons gets to work on your nether regions with a set of Kielland forceps. Understandably, this is something most of the other members of the class were keen to avoid, but it was something that I knew I was likely to have to face. Because of the diabetes, and the concomitant gigantic baby I was supposed to be harbouring,² I was to be induced two weeks early. I felt rather guilty as I explained this to the group, and, although they were all extremely supportive and non-judgemental, I already felt as if I had failed.

As it happened, I needn’t have worried about the induction. I unexpectedly went into labour three weeks early: the contractions started on a Thursday as I was, symbolically enough, baking bread with a friend. As we sat in her kitchen, drinking tea and admiring the loaf (which, of course, I couldn’t eat because of the diabetes), I noted that I seemed to be having a lot of Braxton Hicks contractions, but that I was sure it was nothing to worry about. Things got a lot tougher over the next couple of days. On the Friday, I was having contractions every ten minutes or so, and finding it rather difficult to do anything useful, like eating or sleeping. By Saturday, the contractions were every three to five minutes and things were getting pretty serious. Somehow, though, and despite all evidence to the contrary, I was still convinced that they were Braxton Hicks, or at the very least the earliest stages of labour. By 4.00am on Sunday morning, though, I had had enough, and we ended up in a taxi to the hospital. I was still terrified that this wasn’t “real” labour (I didn’t think it was bad enough, which suggests I either have an unexpectedly high pain threshold, or I’m a closet masochist), and was pretty certain the hospital were going to send me home to wait it out for another week before they performed the induction. The taxi driver, however, was pretty firmly convinced that this was the real thing, not least because I was sick twice during the ride to the hospital.³ When we got to the labour ward at 6.00am, I was surprised to be told by the midwife that I was 8cm dilated, and that I’d have my baby in no time. There was some congratulation for the fact that I’d got this far on a couple of paracetamol, a hot water bottle, and a half of mild in the pub on Friday evening. Then, everything went wrong. I kept having the contractions, but no waters broke, no transition happened, no baby arrived. Things got more painful, and I got more exhausted: I had, by this point, been in labour for three days, and I didn’t have anything left to give. Sometime around one in the afternoon they told me to push, and I pushed, dutifully and fruitlessly, for two hours. It became apparent that I wasn’t getting anywhere. The midwife gave me the gas and air mouthpiece back while the doctors tried to decide what to do with me, but by this time it wasn’t having much of an impact on the pain. At one point I must have passed out: I remember dreaming, being brought round by another contraction, and thinking, Father Jack-like, “Oh, God, am I still in this fecking hospital?!” I had a very clear sense that the only way this would ever end was if I died: it wasn’t that the pain was unbearably bad, even at that point, but rather that it had been going on for so long, and there was nothing I could do to get the baby out and make it stop.

Being taken for the emergency Caesarean section was a bit of a blur: the midwife, who had been monitoring Eoin, lost the trace on his heart, there was a bit of a commotion, and suddenly my bed was being pushed down the corridor into an operating theatre. I wasn’t even aware of the section itself happening: it seemed as if one minute I was being prepped, and the next, Eoin was being lifted out, fist-first like Superman. In many ways, though, the operation was the best part of the whole business. I was exhausted, stunned and, I think it is fair to say, somewhat traumatised. I was convinced that, somehow, I hadn’t really given birth to Eoin at all, rather that something had been done to me while I wasn’t really aware of it, and now, suddenly, there was this angry, hungry creature to deal with. I had enormous difficulty bonding with him: the guilt of this disconnection, combined with the guilt of having had the section in the first place, of having been diabetic, of having failed to breastfeed him, all piled on top of the other mental and emotional issues I had in the postnatal period to tip me into a very lengthy bout of depression. For a long time I was too scared to contemplate having another baby, and, when I was pregnant again, I was terrified of facing the same situation.

Eoin, a few hours old and none the worse for having been delivered by EMCS. Photograph by Stephen Lynch.

A Good Birth

Fortunately, my experience with Ronan couldn’t have been more different. I suppose I should be thankful for being diabetic in my second pregnancy, because it took the responsibility for making a decision about the method of delivery entirely off my shoulders: it is NHS practice to induce mothers with gestational diabetes early, and, as a (temporarily) insulin-dependent person with a history of previous Caesarean delivery, such an induction would not have been recommended for me. The best advice was that I should prepare myself for an elective section, and the doctors hoped I was not too upset at not being able to try for a VBAC. Upset? I was so relieved I could barely believe it.

I was, understandably, far more aware of what was going on during this second delivery, and, inevitably, I have to admit that it wasn’t a particularly private experience. I think there were probably twenty people in the operating theatre along with me, many of them students, and there was a slightly comical moment in which everyone in the room, including me, had to introduce themselves to the others. In the blur of the emergency section, I don’t think I had registered that the operating theatre was just a small room in the middle of the delivery unit: in my mind, it seemed much more separate and strange. This time, being taken for the operation was almost alarmingly prosaic: I walked down the corridor in my hospital gown and slippers, thorough a door that looked much the same as all the others, and spent a little time having a chat with the medical staff. The only jarring thing was the presence of the very large operating table on which I was shortly to be sliced open. Of course, a Caesarean is never going to be comparable to a water birth in a candle-lit room with soft music playing, but frankly I don’t think anyone would expect it to be. Yes, there was an operating table, and yes, there was a huge tray of ominously sharp-looking sterilised instruments. Yes, it did feel a bit as if the world and their dog were in the room with you. But I can say with complete honesty that my procedure was relaxed, calm and, believe it or not, thoroughly enjoyable. People were friendly and informative, and explained every step of the operation to us. I wasn’t particularly bothered about having music playing, but this would certainly have been possible if I had wanted it. In fact, the only thing I was determined I did want was as much skin-to-skin contact with Ronan as possible, as soon as possible after he was born. Fortunately the medical team were quite happy for this to go ahead, so, unlike the first time around, I was put back together again while holding a small, warm and slightly confused person against my chest. I really can’t underestimate the importance of this skin-to-skin contact: I understand that sometimes, when there are serious medical complications, it isn’t possible. But Eoin, notwithstanding his somewhat early arrival, was perfectly healthy at birth, and I really wish I had pushed harder to be allowed to hold him this way too. I had a great deal of difficulty bonding with Eoin, and this in its turn exacerbated the problems I had with depression and anxiety. With Ronan, again, it was completely different: as I held him in the operating theatre, it would not be too much of an exaggeration to say that I could feel myself bonding with him, minute by minute.

Ronan, one day old, and also quite happy to have exited through the sunroof.

If you have spent any time reading around the topic, you will no doubt have realised that there is a very unhelpful rhetoric surrounding childbirth, along the lines that we can control our experience almost perfectly if we are knowledgeable, prepared and driven enough. Now, I am not for a moment suggesting that knowledge and preparation are a bad thing, but ultimately, however many books you read, and however many hypnobirthing classes you attend, they aren’t going to outweigh physical factors like the shape of your pelvis, or the size of your baby’s head. I have two friends who planned for drug-free home births. Both were similar ages, fit and healthy, well-informed, and thoroughly prepared. One was lucky enough to have the natural home birth she wanted. The other, however, ended up with a lengthy and traumatic hospital birth. What did those two women do differently? Nothing. The mother with the hospital birth: did she just not try hard enough? Did she somehow not deserve the birth she had prepared for? If she had only wanted the home birth a bit more, she could have made it happen, right? Nonsense!

Unless you are very lucky, childbirth can entail a loss of control over what happens to you and your body. For many people, myself included, an emergency Caesarean might be a life-saving procedure, but it can also be traumatic and can leave you feeling as if you have lost all power and agency. For many mothers, a successful VBAC can be the experience which allows them to exorcise some of the demons left behind after such a difficult delivery. However, an unsuccessful VBAC can pile one failure on top of another: given my diabetes, and the long, difficult and ultimately fruitless labour I had had with Eoin, this was simply not something I was prepared to attempt. After a difficult birth, the main thing you are tying to do in a second delivery (apart, of course, from ensuring everyone is safe and healthy) it to regain some of the agency which you lost the first time. A VBAC can be empowering, of course, but, properly handled, a Caesarean section can be too. I wouldn’t have changed my experience of Ronan’s birth for the world, and I am very grateful to have had one birth on which I can look back with happiness, even if that birth was not the one that conventional wisdom told me I should have wanted.

¹It’s important to note that, in the vast majority of cases, the critical judgements came from people who didn’t know me and my situation well.
²I was told that, at 36 weeks gestation, Eoin was already well over ten pounds in weight, and generally off the top of the scale as far as size was concerned. Born at a pretty average seven pounds, he turned out to be a small baby with a ridiculously big, heavy head. Those ultrasounds don’t always give you the whole picture…
³Don’t worry: I had brought a bag with me. The taxi was unblemished at the end of the trip.

I am a Bad Mother: Part 2. In which I have Gestational Diabetes, and don’t handle it well.

As I said in my last post on this subject, it doesn’t seem as if either my body or my mind likes being pregnant. I can certainly pinpoint the stage when things all started to go wrong the first time around, though: it was when, completely out of the blue, I was diagnosed with gestational diabetes at around 29 weeks. The whole situation was a bit of a mystery. I had no family history of diabetes. I was pretty active, and eating healthily. I hadn’t shown any of the usual symptoms, and indeed I had barely put on any weight at all. Nobody would have had any idea about my underperforming pancreas had it not been for the hospital’s policy of screening all pregnant women for diabetes, whether they were showing symptoms or not. I can’t say for sure whether or not it was a good thing that I was diagnosed. I have to hope that the whole rigmarole was worth it for the boys’ sake. And, who knows? Maybe I would have had the peri- and post-natal depression anyway. What I do know is that it was with the diabetes diagnosis that I started to lose control over my pregnancy, and, to a degree, my sanity.

I think much of the problem the first time around stemmed from the hospital’s “one size fits all” approach to treating the condition. I had gestational diabetes, which, obviously, I must have caused by being grotesquely overweight and persistently gorging myself on chocolates and cheeseburgers. When the diabetes got worse, week-by-week, to the point that I needed insulin to control my blood sugar, well, that meant I clearly wasn’t trying hard enough. The fact that I needed insulin during pregnancy was also clearly an indicator that I was well on the way to type 2 diabetes after the delivery. Why couldn’t I just put some more effort in? Didn’t I have any self-control? Did I actually want my baby to die? Oh, and, by the way, the consultant happened to be running a study of obese mothers with diabetes: did I want to talk to a social worker about my bad food choices and how they would affect my unborn child?

As you can imagine, this was not the most helpful approach for them to have taken.

What was in fact happening was that I started out eating a fairly normal, balanced diet (cutting out, of course, any obvious sugary items), but, in response to the constant criticism from the hospital, I began cutting more and more foods out entirely: not just starches, but all fruit and most vegetables too. By the end of the pregnancy, I was really only eating fish and leafy greens, and I was getting so fixated on my apparent failure to control the diabetes with diet that I was pretty much terrified of eating. As for the weight issue, well, this is me about a week after Eoin was born: you can judge for yourself. I’m afraid I have absolutely no idea who took the picture, and I do look a bit of a state: I was already getting fairly unwell at this point. I think it’s fair to say, though, that I was not obese.

Perhaps if I had been more blasé about the whole thing, it would have been better. However, I was far too determined to do the right thing, and was desperately trying to measure up to the consultant’s impossible standards. Instead of being supported, I was left feeling that everything I did was wrong. I didn’t realise at the time that gestational diabetes inevitably gets worse no matter how carefully you eat, or how much exercise you do: it is your placenta that makes you insulin-resistant, and the only sure way to ameliorate the condition is not to be pregnant any more.

Fast-forward three years, and, having moved cities and now pregnant with Ronan, I was again faced with the likelihood of diabetes. Thinking about how badly the diagnosis had affected me the previous time, I was, understandably, pretty worried about how I and the medical team in this hospital would deal with the situation. At first, things seemed to proceed along the same lines: I had no symptoms whatsoever, and all early tests were clear. Suddenly, around 28 or 29 weeks, I was again diabetic and bracing myself for the anticipated misery. I am incredibly grateful to be able to say that I couldn’t have been more mistaken: the entire medical team was supportive and understanding, and, more to the point, they actually listened to my story and took on board the details of the situation. When I described the meals I had eaten, they didn’t accuse me of lying. When I worried about the severe restrictions I was going to have to place on my diet, they kindly pointed out that this was a temporary condition, and if I needed to take insulin in order to be able to eat a balanced, healthy diet including the occasional piece of fruit, then so be it. When, as was inevitable, my blood sugar started to get harder to control, they didn’t immediately accuse me of illicitly eating chocolates and chips, but rather reviewed my diet and discussed insulin dosage in a measured, sensible manner. They were thorough and caring, but notably absent was the overwhelming sense of blame which had pervaded my first experience. With Eoin, starting insulin was seen as the final confirmation of my absolute failure. With Ronan, it was very definitely a necessary short-term measure, one which would enable me to go on leading a normal life. It might be interesting to note that, while my mental health was so much better during my second experience of diabetes, the physical impact on me was almost identical: again, I put on very little weight (about 2 kilos) up to the point of diagnosis. Again, I promptly lost it immediately I stopped eating any and all cake. Barring my blood glucose levels, I never showed any symptoms of diabetes, and my HbA1c, when I’m not pregnant, is totally normal. Ronan was, like Eoin, not the macrosomic monster-baby you might expect, but rather smack-dab in the centre of the size bell curve. Really, the only difference with my second pregnancy was that I didn’t spend my final trimester hovering between blind panic and a crushing sense of failure.

Again, I have to underline the fact that I am not that kind of doctor. This post is not intended to be a substitute for proper medical advice. What I do want to say, though, is this: if you’re reading this, and you’ve recently been diagnosed with gestational diabetes, please learn from my mistakes. Firstly, it’s honestly quite likely that there’s nothing you could have done about it. People do like to play the blame game when you’re pregnant (and get used to it, because it doesn’t stop when the baby’s born), but it’s entirely possible that you would have been diabetic whatever you had done. While it’s probably not a good idea to prepare for pregnancy by putting on a pile of extra weight, it’s important to note that being large doesn’t inevitably mean you’ll develop gestational diabetes. Other significant risk factors are your age, and whether or not you have a family history of diabetes: there’s really not a great deal you can do to change these. Don’t panic about food, like I did: once you cut out the obvious problem foods (sugars, processed stuff), there’s really nothing to be gained by starving yourself. A low-GI diet should work, but, for heaven’s sake, don’t try to eat a low-fat diet too: get plenty of nuts, avocados, full-fat yoghurt, eggs, cheese and oily fish into yourself. They’ll help to balance out the overall GI of your meals, provide valuable nutrients, and, crucially, keep things tasting good. If you need insulin, make your peace with that. Be grateful that you’re unlikely to need it forever. When you’re pricking your fingers to check your blood glucose, or looking for a new spot in which to inject, remember that there are an awful lot of people for whom this is daily life, not just a frustrating side-effect of a biological process. Understand that, while this may mean you are more likely to develop diabetes later in life, it is not a foregone conclusion. Be sensible, be cautious, but don’t be paralysed by fear, and don’t ever feel that you’ve failed. Take it from me: it isn’t worth losing your mind over.