Dominie

Age at interview: 25

Age at diagnosis: 24

Brief Outline:

I developed pre-eclampsia 6 months (28/29 weeks) into my first pregnancy. I was induced at 7 months (32 weeks) and vaginally delivered my baby. My son, Beau, stayed in SCBU (Special Care Baby Unit) and he was discharged after three weeks.

Background:

My name is Dominie; I am 25 years old and a midwife. I am married and have one son. I identify as White British.

More about me...

Early signs of a problem

I developed pre-eclampsia 6 months (28/29 weeks) into my first pregnancy. As a midwife, I talked to some of my colleagues to get more information about the condition. I remember a time when I felt funny on a nightshift at work and my blood pressure was high. I felt tired and a bit ill, but I wasn’t sure at first if this was just a ‘normal’ part of pregnancy. I was sent home and signed off for a couple of weeks. During this time, I had an overnight stay in hospital where I was monitored and told that I was okay for now but might develop pre-eclampsia later on. I had weekly midwife checks and, by the second week, my blood pressure dropped back down. However, after getting home from a trip seeing family, I started to feel groggy and very tired. I had a routine consultant appointment the next day. My blood pressure was very high and I was sent to stay in hospital. Even at this point and with all my knowledge as a midwife, it didn’t kind of click that the situation was serious or what might happen next.

Being unwell in hospital

I started to have other symptoms of pre-eclampsia such as pain at the top of my stomach (epigastric pain) and overactive reflexes. I also had some panic attacks which I think could have been linked. Before finding out I was pregnant, I had been taking antidepressants. I had stopped the medicine and my doctors thought at first that this might have caused my blood pressure to rise. I went back on the anti-depressants at a lower dose to see if my blood pressure would settle down again. I also started taking blood pressure medicine in hospital – I took one called nifedipine because I have asthma and so couldn’t take the standard treatment of labetalol. I had blinding headaches as a side-effect of nifedipine. I was given magnesium sulphate through a drip to reduce the risk of me having a fit, but the infusion was painful and I had problems with the cannula. Being a pregnant patient gave me a lot of insight into the other side of my job as a midwife. There was some uncertainty about my diagnosis in hospital. I was told that I had pregnancy induced-hypertension but I knew that I was being medically treated as having pre-eclampsia, and this diagnosis was later confirmed.

Giving birth

At 7 months (32 weeks) into my pregnancy, my doctors suggested I have a planned c-section. I didn’t want this because I knew that my baby would have to stay in hospital and I wouldn’t be able to drive for six weeks after the operation. I live in a rural area and it would have been very difficult for me to get to the hospital to see my baby. I persuaded the doctors to induce me and, the next day, my waters were broken. 

I coped well with the pain of labour at first but then I started to feel a need to push when my cervix was not dilated enough. There were no anaesthetists available for an epidural and I didn’t want morphine as I was worried about the effect it could have on my unborn baby. It was very painful and I had a bleed which was frightening. I later learnt that this bleeding was caused by the placenta coming away from my uterine wall. The baby’s heartbeat was lost at one point and it looked like an emergency c-section would be needed. However, a low heartbeat was detected and I vaginally delivered my baby after an episiotomy (when a cut made to increase the size of the vaginal opening) and with forceps. The placenta needed to be delivered quickly to stop me from having a serious bleed (a haemorrhage).

My baby’s health

My baby boy, Beau, was taken to SCBU (Special Care Baby Unit). He was given some support with his breathing. I saw Beau a few hours later but I didn’t get to hold him for a few days. My baby picked up an infection, and doctors thought it might be MRSA at the time. This meant there were even more restrictions on any physical contact I could have with him. Maybe because of my job as a midwife, I was allowed to give Beau a special wash to reduce the infection risk. Doing this helped me feel more in control of the situation. I was discharged five days after giving birth. It was difficult being separated from Beau at home. In the hospital, I had been only a short walk away from him. I worked hard to build up my breast milk supply and after a few days, I was breastfeeding Beau without him needing any extra tube-feeding. Beau was discharged from hospital after three weeks.

Messages to others

I encourage other pregnant women to seek help if they are worried about anything. I think medical professions should spend more time explaining about pre-eclampsia to women who have been diagnosed with the condition, as well as giving them information about both the pros and cons of birth methods (e.g. c-sections/caesarean sections, vaginal deliveries).

Dominie was a midwife and her colleagues checked her blood pressure at work when she felt “funny”. She was sent home but started to feel unwell after visiting family. High blood pressure was picked up during a 32 week antenatal appointment.

I think from about, maybe about 28, 30 weeks that’s when I started to develop pre-eclampsia.  I had an episode where I was doing a night shift and I felt really funny. So they took my blood pressure and it was very high, and this was at work. But they couldn’t find anything wrong and they weren't that worried with my bloods and my urine and everything, so I literally just had a high blood pressure, so they sent me home. So I came home; I had a couple of weeks off.

So, I went off to Paris because my brother lives in Paris, and I spent a few days there. I felt awful the whole time I was there; just thought it was being pregnant. Felt really groggy, really just like really tired and weeing loads, drinking loads. And then when I came back, the day after I came back I hadn’t even unpacked because I felt so awful that I couldn’t.

It was the following day that I just had a routine consultant appointment.

So, I went and I saw my consultant. I actually… my husband didn’t come with me that time because I didn’t think that anything was going to be untoward, but my mother-in-law came with me because I was going to have a scan. So, they did a little scan of him and it was then obviously that they did three lots of blood pressures and my blood pressure was very high.

Dominie had her urine output monitored in hospital. She had a catheter fitted at first which she didn’t like and also had her water intake restricted.

I also at one point had to have a catheter much to my annoyance. Because I was…basically as I got in there I was probably drinking about six litres a day and I was probably going to the toilet at least every hour.

I was weeing a heck of a lot. So, I…we… the registrar and I – we know each other – and we had a bit of a kind of, "Oh I don’t want it in." "Well, you need to have it in." Because I was on like the high dependency they needed to keep monitoring my fluid input and output. So I did have it in for one night but the next night I lost all kind of… I think because I'd been awake, I had this headache, I had to hold on to this monitor, I had this horrible burning in my arm, and a catheter, again never realised the pain but that for me was so uncomfortable.

Every time you moved you felt like your whole bladder was just being tugged. So, they did take it out and I had to get up every hour and go for a wee, which I was very happy to do. And the other thing was they then reduced…I was only allowed to have 80 mls of water an hour. So, for someone that…in pregnancy my craving was ice and water, so to only have 80 mls – it doesn’t sound that bad, but when you're drinking so much, like your whole mouth is like, you know and that wasn’t very pleasant.

And just give us an idea about how much 80 mls an hour is.

I think it was something like that in the cup.

Yeah

It was like…it was like a swill on the mouth. And some hours I would just be almost in tears because I just needed something to wet my mouth because I was just so dry yeah.

Dominie took nifedipine tablets as she is asthmatic and labetalol wouldn’t have been suitable.

So, initially they just… they checked my urine, they put a cannula in and took some bloods, and they do kind of blood pressures ten minutes apart; so you get three blood pressures, then they get you an average blood pressure over that time just so you’ve got an idea of whether it's fluctuating or whether it's true high blood pressure and it remains high. So, I think my average was 200 over a 120. So, they couldn’t give me labetalol which is the drug that they regularly use round here. To drop your blood pressure, because I was asthmatic.

And I have had a few asthma attacks, so I think if you’ve got minor asthma you can have Labetalol, but not how severe mine is. So they gave me Adalat retard so some nifedipine, and I had… I think I had two or maybe three lots of dose, and in that time my blood pressure went higher.

So, it wasn’t actually doing anything. So, my mum lives in [city] about ten minutes away from the hospital, so I'd phoned once I'd got in there, but by the time that she arrived I was already up on labour ward because they just… my blood pressure was just wasn’t going down how they thought it should be. And the next drug they had to give me was an IV drug that they have to monitor me on so yeah.

Dominie didn’t want to have a caesarean section as she knew she wouldn’t be able to drive for six weeks after the operation and this would make visiting her baby in hospital difficult. She opted for an induction and had a vaginal birth.

So, on the Friday morning… I'd spent Thursday night there. The Friday morning they did a ward round, so my consultant came in especially and the consultant that was on, and they decided that they were going to section me on Friday morning.

That I was the top priority and I was going to be the first on the section list. And they were kind of talking about it amongst themselves, and they said, "How do you feel about that?" and I said, "I don’t want to have a section." For me it was because I lived too far away.

And I knew that he was going to be in special care and I knew I wouldn’t be able to drive for six weeks, so how was… that was all going through my mind – how was I going to get in and out from hospital to see him. So, I begged and they agreed to induce me. So, the hospital that I work at we use a drug that you… it stays in the cervix for 24 hours and after 24 hours they take it out and then they kind of reassess. So, I was given four hours with this drug on the Friday morning. So, they put it in for four hours, and then they had obviously gone out of the room and had a discussion, and they decided that at that point my blood pressure was under control, and that they would see what the 24 hours would do. So, I was really pleased about that.

And I'm really pleased with my decision because then on the Saturday they took it out, they managed to break my waters and within about four hours I'd had him.

So, I do believe that if I wasn’t a midwife and I didn’t know what I was talking about, that I would have had a section regardless, which I think is major surgery for, you know someone of my age that isn’t… wasn’t… it wasn’t necessary. I mean, if my blood pressure was amazingly dangerous at that point, and they were really worried about him, I would have done; I would have done anything. But in my mind, and through discussion with the midwife I felt like I was… that was the right path to go down. But I had not been a midwife things could have been very different yeah.

Dominie came close to having a caesarean section. Her baby was born following an episiotomy and forceps, which was a bad experience because she hadn’t had sufficient pain-relief.

So yeah, so they turned off the hormone drip, and I think it was at this point that my husband said like… not that I remembered, but he said to me that he had said to the midwife, "Is it normal that there's blood on the floor?" and she went, "Oh no, that’s normal." He was like, "No, it's all over the floor," and she looked down and she could see all this blood. So, they pulled the emergency bell and the consultant came in, and again I still couldn’t stop myself from pushing, and they did a quick scan because they hadn’t heard his heartbeat for quite a while. They did find his heartbeat but it was only about 60 beats per minute which is very low. So they decided for delivery then and there and it looked like I was going for a section because 30 minutes prior I'd only been three centimetres. She did a quick examination and I was fully dilated. So, I had a very nasty episiotomy which I do remember her saying, " These scissors are blunt, has anyone else got another pair?" and that to me just makes me cringe. And then I had a forceps delivery and he was born, and I don’t really remember anything about him being delivered; I don’t remember seeing him. It turns out that I had an abruption at the end so that’s why I was bleeding and everything, and that’s probably why it was so painful.

Dominie explained CPAP and how this is different from being on a ventilator or intubated.

He needed CPAP.

And what's that?

So, that’s like pressurised air. So, they didn’t intubate him which is putting a tube down his throat. They kept oxygen under his nose.

Yeah

Which basically is like pressurised air to keep his lungs open. And they give him a bit of oxygen with it, so they're just assisting him with breathing, they're not doing it for him.

Yeah

So, they're doing a bit… so he had to have that; he had to be in an incubator. And he had to have some like drips, like I can't remember what it was called, but not food but as in like sugary…like a bit of like glucose and things yeah.

Dominie sometimes found the dynamics in SCBU difficult. But she kept observing and asking the nurses questions. She thought that this, along with her background as a midwife, meant she was allowed more a role in caring for her baby.

With… it took probably about a week and I think more so because I was like, 'Ooh what you doing now, what you doing now, what you doing now?' that…then they were like, "Well you could do this." Because it was like changing a nappy. I watched them change so many nappies that I could have done.

And by the end, you know I was giving him… because they thought he had MRSA which he later on turned out not to, he had to have this special wash every day, so I used to have to strip him off – get him out of the incubator but I'd have to get him undressed in the incubator. Put him in, get him properly washed with this like thick like soap and then dry him out, put all his tubes back on and things like that. So, that made me feel more like in control and yeah. And they would often when they accepted handover though, they would say, "Oh well she's a midwife so she knows what she's doing," so that was quite nice that they did let me kind of loose, but I don’t know that every mother gets to do that.

There was a delay before Dominie was able to see her baby. It was a very exhausting time both physically and emotionally.

So I think that I delivered him at about twenty past eight in the evening and I couldn’t get to see him till about two in the morning I think it was. So, normally we would want mums to like express and everything like that, but for me I just, like I said, I was just so tired and out of it, I kind of… I slept for a few hours; I then had a shower, got myself a bit sorted, and actually my husband and my mum went down to see my son at about ten o'clock, so a couple of hours afterwards. And then I went to see him at about two. It was just very weird because you’ve got this child that’s in a plastic box and you know them but you don’t know them - it's a very strange feeling – and I didn’t get to hold him until the Monday morning, and I didn’t even ask really; they just went, "Do you want to hold him today?" and I was a bit shocked and so it was, yeah Monday like 11 o'clock, and I remember being really hungry because I hadn’t had breakfast, and I'd missed lunch because I just… I just want to hold him for hours, and I cried… I just cried because that for me then was when I met him, and you know that was the realisation then that I'd had a baby. And unfortunately my husband had had to go back to work, he couldn’t… because we were going to save his two weeks paternity for when I had come home with my son. So, that was really hard because I sat there and I cried and it was an emotional time, but I was on my own and so I couldn’t really share it with anyone, whereas I imagine that if you have your baby and you get given your baby you get to have that connection as like a family but we didn’t get that for, you know, until later on that night when my husband then got to have a hold. But yeah that was… it was really hard yeah.

Dominie was a midwife and had good knowledge about breastfeeding. She described what worked well for her.

OK, so you can hand express which is basically where you use your hand to express your milk off. Or you can… a single pump which is using an electrical pump, or you can double pump – so you can pump off both breasts at the same time.

OK 

And the hospital where I gave birth they have a special pump that you can… it's got like a premmy setting. So, it's like a fifteen minute cycle and it goes through the different sucks that they will do. So, the flutter sucks, the long drawing sucks, the pauses, things like that. So, you… so I was that… initially when you're first starting, hand expressing is the best.

And then double pumping is amazing to then get your milk going. On this side I couldn’t get very much milk off, so… especially on the pump, so I used to have a do a lot of hand expressing. 

I think some people just think that hand expressing is just pointless but actually I think it's one of the best things to really stimulate your milk. To get volume it's better to double pump, do you get what I mean?

The other things that I did are looking at pictures of your baby.

Yeah

Things that smell of them, things like that. So, yeah… so I did that until… so he was about five days old and I… before I delivered I met with the consultant, to his consultant, and I explained to her that I didn’t want him to have any formula because again, from my experiences and things like that, I know the benefits of breastfeeding and the disadvantages of formula feeding. So, I know it's very expensive but I asked them if they needed to give him milk that he would have donor milk. She explained to me that until my milk had come in they weren’t going to give him any food. So, he would just have a glucose drip until that point. So, I… on about… so, it was quite disheartening because the first few months they give… you give them they just put it in their mouth for mouth care, so just almost like just to wet their mouth really.

And then it wasn’t till about day three or four that he then started to having little volumes of my milk. And on day five I managed to have a breastfeed with him which is like amazing because at that point he was about 33 weeks.