Pregnancy is usually a time of huge excitement and anticipation as parents-to-be look forward to meeting their little bundle of joy after, hopefully, a non-eventful nine months. But while pregnancy is a straightforward affair for many, there are those who experience complications and stressful times and who are left feeling bereft and traumatised by their unpreparedness.
"Many parents find themselves utterly overwhelmed by parenthood and unprepared for all that is involved in pregnancy, delivery and caring for a newborn," explains Prof Fionnuala Breathnach, consultant obstetrician gynaecologist and associate professor at the Rotunda Hospital, Dublin.
“The hope and expectations that define pregnancy are such that expectations for a wonderful life-changing outcome are high, and so they should be. But equally, there needs to be an acceptance that parts of it all are really tough. I think prospective parents are well-versed in what can go wrong, but we are all programmed and conditioned to expect everything to work out well.”
“The first ultrasound is a real milestone,” Breathnach continues. “If a pregnancy is identified at eight weeks on ultrasound and is a normal size, the risk of miscarriage drops to 2-3 per cent.”
There are several conditions in pregnancy that prenatal care is focused on, including pre-eclampsia, which affects 3 per cent of pregnancies, most commonly first pregnancies. Although pre-existing conditions such as “diabetes, chronic high blood pressure or kidney disease increase the risk of developing pre-eclampsia, most affected women have no risk factors and no symptoms”, Breathnach explains.
Ireland doesn't run a universal screening for gestational diabetes and much of the third trimester screening carried out in the Rotunda Hospital is based on family history or risk factors such as obesity.
“This approach has resulted in one in eight pregnant women at the Rotunda Hospital screening positive for gestational diabetes. There is no question but that urgent investment is needed to tackle a problem that impacts birth injury and long-term maternal health,” Breathnach adds.
Amniotic fluid levels can give a health-provider some insights into how baby is doing. “The amniotic fluid that surrounds a baby, within the amniotic sac, is made predominantly of baby’s urine. If the amount of fluid is considered excessive, then this is referred to as polyhydramnios. For the vast majority of pregnancies where excessive fluid is identified, the pregnancy is perfectly healthy and no problem exists. For example, a big baby will often have a lot of surrounding fluid because big babies have big kidneys that produce a generous volume of fluid.”
Amniotic fluid
Where low levels of amniotic fluid are present it can be “that the waters have broken. Although this is usually obvious to the women, it can occur in a very subtle way either very early in the pregnancy or at the very end. More commonly, low fluid can be an indication that the placenta is not working optimally,” Breathnach says
“Rarely, extremely low fluid or absent fluid around the baby can be an indication that the baby has no kidneys, or has severely malfunctioning or blocked kidneys. Unfortunately in these circumstances, the baby is not expected to survive.”
Breathnach believes when it comes to parents experiencing complications in pregnancy, that reassurance may be overrated. “I think that women are smart, and rightly recognise that while things work out well most of the time, that is not always the case and that nature is indiscriminate and sometimes downright malevolent when it comes to the fraught path to parenthood.
“Reassurance is only meaningful if it has a sound basis; otherwise it’s just false reassurance, aimed at telling a woman what you believe she wants to hear. Rather than seeking serial assurances that ‘everything is absolutely fine’, it is much better for prospective parents to know where they stand when it comes to any given pregnancy complication, and then figure out how to re-programme their expectations for how best to deal with it.”
Mum of one Addi Wood’s pregnancy began as she expected it might, with some light morning sickness. Although early scans indicated her baby was on the small side, Wood was not initially worried. It was only when she was sent for a second opinion that her fears began to increase.
The doctor “told us that the thighs on our baby were measuring a little small which would be one of the soft markers for Down syndrome”, she explains
Wood and her partner John were offered blood tests which they were told couldn’t give a “definite” answer or an amniocentesis, which carries a 1 per cent chance of miscarriage. The couple didn’t want to risk the amniocentesis and John didn’t want the blood tests. “The outcome made absolutely no difference to how we felt about our child so he didn’t see the need for us to have it,” Wood continues. “I just felt I didn’t want any surprises and wanted to give myself the best chance to prepare.”
Further complications
The blood tests returned a 1 in 10,000 chance that the baby had Down syndrome. However, further complications arose down the line for Wood.
“My birth experience was nothing like I expected it to be and in all honesty I still ‘mourn’ the ideal I had in my head of how it was going to be. I feel I was robbed of the experience I had imagined,” she says.
A partial breaking of her waters at 34 weeks saw Wood admitted to hospital. “I felt absolutely overwhelmed knowing that I wasn’t going to be leaving the hospital without my baby – I hadn’t packed a bag, the house wasn’t completely ready, I hadn’t even finished work yet. I kept crying because I felt so out of control with what was happening to me.”
Baby Aidan arrived five weeks early and Wood says it was only when she went home that she realised how much the whole experience had affected them.
A post-C-section infection saw her re-admitted to hospital and the sense of losing control resurfaced. “I kind of already felt I’d failed with how I bought him into the world, then I failed at breast feeding and then I left him because I went back into hospital. The guilt and pressure you feel as a mother is extreme – there is nothing worse than the thought of letting your new little beautiful baby down.”
Wood says if she was to have another baby in the future, she’d do things differently. “Knowing myself and how anxious and worried I can be about things I would try hypnobirthing. I think following that method gives you mechanisms to cope with whatever birth situation you end up in. I would also not be so hard on myself and put so much pressure on myself with everything. I would also start the preparations extra early – just in case!”
