Notes from the beginning of viability

The unexpected mental strain upon reaching the stage of pregnancy where life is given every chance.

I wear unitards now

I have reached 24 weeks gestation.

As an ex-midwife this was my next goal after my 12 week scan — to get to the realms of external survival if anything untoward was to happen. Simply put, my baby is now old enough to warrant full medical intervention if his birth was a necessity or a spontaneous unstoppable event.

The arrival at this hugely momentous point of pregnancy has been a long-awaited relief, but I am starting to notice how this milestone actually marks the beginning of a fresh anxiety for me.

How it is in fact, surprisingly difficult to move from the part of pregnancy where ‘nothing can be done’ to ‘everything can be done’, which seems contradictory. Surely, I should feel safer at this stage? In many ways I do, but the enormity of a viable loss, one where survival was an option is playing on my mind.

To make sense of the change to my level of anxiety, I’ve cracked out a Venn diagram, naturally :)

Pregnancy-after-loss-as-an-ex-midwife-now-at-viability brain mush

Professional vs Personal Pregnancy Experience

I have no personal experience of what a premature problem or labour feels like within my body, but I do know in clinical detail how hundreds of other people’s pregnancies have been affected by the myriad of adverse pregnancy events that are unforeseen and unwelcome.

I know how quickly things can change.

How seemingly normal pregnancy symptoms, like back ache or an upset stomach can actually be a sign of premature labour, and sometimes be the only indicator of a problem. I remember patients who ‘surprised’ staff by appearing to not be in labour at all, but were actually nearing premature birth on examination.

That’s why I recently found myself being checked at hospital in the early hours. I’d woken at 3am (which is strange in itself) and couldn’t get back to sleep. I was reading in bed and suddenly realised I was tightening. I’d felt Braxton Hicks a few times in the weeks before but this was different. I started timing them and noted they were coming every 5-10 minutes. The panic started to rise. Memories of what babies born at such early gestations look like and feel like to hold, alongside the agony of the parents I had supported through such harrowing events flooded my nervous system.

I tried to focus on facts. I knew the baby was ok moving around and because I have a home doppler to listen to his heartbeat. I knew I wasn’t in pain, but like a stubborn dog determined to go one way on a walk, I had to forcibly move my thinking away from the unlikely scenario of being a ‘silent labourer’ at nearly 23 weeks —and let my professional knowledge land upon the most likely reasoning. My old foe, the UTI. It had to be that.

I went in to be checked and found no UTI, no labour and that nothing was wrong. The tightenings had also slowed down. After a chat with the doctor we worked out that they must be Braxton Hicks brought on by the active day I had had before. I say ‘active’ but it was about 2 hours of sustained movement in a rare window of energy — a 30 minute gentle online pregnancy Pilates class followed by cleaning the downstairs of the house.

It’s safe to say the exercise mat has been rolled away and I clean in shorter bursts now, but I also know that the only reason I probably noticed my Braxton Hicks is because I know too much. My fingers are trained to feel the sensitive difference between various states of the uterine muscle. Also, my days are not packed with places to be, meetings, deadlines or school runs. I have little distractions in day to day life, so in turn notice every little thing.

The combination of pregnancy after loss and my previous profession feed into the main change I have noticed since entering viability — the increase in my sense of personal responsibility.

Responsibility

I view my previous losses as out of my control and, in all honesty, I never blamed myself. But, I can sense how this stance has completely altered now I’ve entered gestational viability. There is a new level of personal responsibility upon me to recognise and seek appropriate help if I am concerned, because life-saving care is now on the table.

I am his first responder.

I am now his advocate in ways that I didn’t realise would challenge the peace of mind I had enjoyed after my 12 week scan. All of the early weeks up to that point were a nervous statistical countdown. Each week moved me further away from the chance of a miscarriage. It feels like I have now started another nervous statistical countdown, with each week bringing an increase in the premature survival rate.

I’m anxious to move on past this part, which has been hard to sit with, having so far, not really felt fearful of my pregnancy. I was just so happy to be pregnant I was determined to enjoy it and had been — but suddenly this is much harder to do. I feel like I have no excuse to miss something. I am mother and midwife. As much as having expertise is helpful, it is a draining place to be. I’m on shift with myself 24/7.

I’ve decided to focus on my next goal to help me relax — reaching 31 weeks. This is when the chance of survival is 95%. I’m also moving into the part of pregnancy where I will have more regular appointments and I’m looking forward to my scan in a few weeks time. As for the little boy this anxiety is all for, well he’s oblivious of course and thankfully moving a lot each day so that I can feel more reassured.

Although the increase in my anxiety is challenging I’m all too aware of how much it is a blessing to be worrying about any of this at all.

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I have been horrified to think of the pregnant women within Gaza right now. I have set up a monthly donation to the United Nations Population Fund who are supplying emergency supplies and support to the estimated 50,000 pregnant women caught within the conflict.