Doctor! Doctor!

From being classed as a 'high risk' consultant led pregnancy to being just a normal run of the mill midwife led pregnancy I've had a few extra appointments with the doctors along the way and I want to share some of the things I have learnt. Which is a lot.





I have questioned whether to do this post for a fair few weeks now and I feel the most important way for me to start this is with a disclaimer: I have absolutely NO medical training and all the information I will write about here is very specific to me and only relaying the information I have been given by my doctors, midwives and nurses. If you're reading this and have any worries or concerns about your health I strongly recommend seeking medical advice. I will be talking about my experience with hypothyroidism, having to have a GTT and more recently an Anti D injection.

I will start at the beginning. When I first visited the GP to confirm my pregnancy one of the first things that happened was a conversation about my thyroid. When I was 19 I had a blood test because I was tired and run down. I expected the results to be that I had low iron levels and should up my intake of spinach or something like that but it wasn't quite that simple. I was diagnosed with hypothyroidism.

Hypothyroidism is a disorder of the endocrine system where your thyroid glad (situated at the back of the neck I believe) doesn't produce enough hormones. The hormones that the thyroid releases control the metabolism of the cells in the body. Basically, it controls how fast the cells do things. Everything just slows right down.
I'm not quite sure what actually causes it, I've googled lots of times over the years, some places tell me its the immune system attacking the gland other places tell me its genetic (which would make sense for me as I have a strong family history of hypothyroidism)

There are lots of symptoms of having an underactive thyroid including sensitivity to the cold, fatigue, depression, weight gain, dry skin and hair..... the list goes on. For me the telling signs at the start were low mood and feeling tired and cold. Sometimes I have not been so compliant with treatment of my underactive thyroid and these symptoms creep back in. I slow right down, I become exhausted, achey and cold to my bones and particularly forgetful and clumsy. Davyd is usually the first one to catch me out and call me up on it but I do really try to take it as the consequences of not really aren't worth it.

All is not lost to have this diagnosis, far from it, I was prescribed treatment in the form of Levothyroxine (replacement hormone to compensate for the hormone my body doesn't produce enough of) to take once a day for the rest of my life. I have had this on repeat for nearly a decade now (dosage has slowly increased over the years but we won't dwell on that!) and I have annual blood tests to check all my levels are okay. I get free prescriptions because of it, which a total bonus and it's really not affected me at all. Until now. Who knew !? (I'm seeing a pattern of saying this!!)

Back to my first doctor's appointment and the conversation about my thyroid. The first thing that happened is my dosage was increased straight away. When you're pregnant your body is obviously supporting two endocrine systems and so it makes sense that more of the thyroxine hormone would be needed. However, this increase in dosage didn't initially work so well for me. While although my body was growing Plum, I was being so sick and my weight had gone down and my mind was all over the place and I felt sure that the increased dose was making my heart beat too fast and making me sicker. So, I stopped taking it completely. (smart move you ass, you feel rubbish so why don't you just slow all your systems down completely, that'll make you feel great!) I would NEVER recommend this to anyone and in hindsight it was a stupid thing to do, I was so frantically trying to stop myself being sick I was blaming anything and everything. Its actually quite unlikely this was contributing to the sickness, I think pregnancy was the main cause of that...!

Initially, having an underactive thyroid meant that I needed to be monitored by a consultant every four weeks. A drop in your hormone levels can be dangerous during pregnancy and the risks are horrible (I googled it, what a mistake!) and the consultant was quite clear how important it was that I attended appointments and was compliant with medication. Terrifying really. I won't write the risks because I don't want to scare anyone (or myself!!) but of course you're always presented with worst case scenario on google aren't you...

After a few appointments and a very satisfied consultant I began to feel much calmer about all this and almost as if all this fuss was a bit unnecessary. My levels were ever improving (funnily enough in line with me starting to actually take my medication around week 16) and then when I changed midwife after moving house a blood test proved that my body was doing a great job of regulating my thyroxine and I could be handed over to the care of the midwives. No more consultant visits! More importantly for me, an opportunity to deliver at a birthing centre! So what happens for me now in regards to this is I have blood tests with the midwife and a consultant just reviews the results. If there was to be a change or the consultant was concerned, I would have to go back to consultant care and this would mean a hospital delivery as hypothyroidism, if not properly controlled, can lead to complications during labour. I'm positive about how my thyroid is being managed and actually, my levels are better than they were before I was pregnant... we got this Plum. Little extra tit bit of information for you all, having an underactive thyroid is commonly known to effect fertility, many women with hypothyroidism have lots of problems trying to conceive and so I already beat the odds on that one!

While hypothyroidism has been a constant topic through my pregnancy a couple of other little extras have popped up along the way. One of these being the requirement of a Glucose Tolerance Test. This one was a killer. I think the reason I had to have this was because I have a family history of type 2 diabetes but I still don't quite know why. Even so, I did. A few weeks ago on a cloudy morning hubs and I trundled off for the glucose tolerance test. I wasn't allowed to eat or drink anything except water from midnight the night before and I was feeling ROUGH. Before pregnancy I could go all day without eating anything but this is a thing of the past, I've talked about my eating and breakfast has proved to be imperative to survival these days!
So, I got there and this poor HCA dug around in my arms looking for a vein. No such luck, no food and limited drink was making everything a bit flat. By the time this chick found a vein I was feeling so doomy and ready to just lay down and close my eyes and swear profanities under my breath.
After the blood test I had to drink some glucose liquid. Heres me thinking, oh this will be alright, this'll probably perk me up a bit and just taste like Lucozade. WRONG. It tasted like bread. Sweet, laggy ready liquid. Awful. It didn't perk me up, it pissed me off.
Then I was allowed to go home for two hours (but still not eat or drink anything other than water) and then back to the clinic for another blood test. What fun!

By the time I was on my second visit I already had dark bruises tracking up the inside of my arms and a pounding headache. I was aggy, tired and needed to eat. I was relieved that the HCA managed to get blood first time and then I just ate a handful of chocolate buttons to just sort me out until I could eat a proper meal. By this point it was nearly 1pm and I felt like it was the end.

A couple of days later a voicemail told me all my glucose levels were fine and no further action was needed. This GTT test was so baffling for me. It made me feel like shit (it was painless, I just felt awful) and I don't really know what it all meant or the point of it. I have read that its all related to gestational diabetes and I get that but I just don't know why all that testing happened to me really.

The last intervention I will tell you about is the AntiD injection. This was a much simpler situation, a simple injection in my arm, but the reasoning behind it I find really interesting. My blood type is O-Negative. This is a rhesus negative blood type. When women have a rhesus negative blood type and fall pregnant they need to have a special little injection in case their baby is rhesus positive blood type. As a rhesus negative pregnito, if Plum was rhesus positive, my body would treat its blood as a foreign invader and my body will make antibodies and destroy the baby's blood that's in mine. This is called 'being sensitised to Rhesus positive blood'. The antibodies won't actually harm Plum but if I had another baby (easy now, I've barely recovered from the shock of this one!!) this sensitisation can be a much more of a problem. This is because those antibodies are already there in my system and will react much faster next time and cross the placenta and cause problems for the baby. So dark but actually, not the end of the world and so easily treatable. The AntiD injection stops the disease that makes new babies poorly as a result of this, it stops my body from becoming sensitised and thus, stops those pesky antibodies in their tracks! There could be more science to it but this is how I've worked it out.

Interestingly, Dav is (we think) rhesus positive so there is 50% chance Plum is rhesus positive so this injection was particularly important for me, though they make all rhesus negative women have it, just in case. My Nan was rhesus negative and my Grandpa was rhesus positive and going back 50 odd years it was a different medical time and some of her babies were poorly when they were first born as a result of this positive negative thing but these days AntiD swoops in and saves the day!

This post has been long, and maybe not as light hearted as some of my previous, well done if you've made it this far! I just really wanted to share some of my learning. I never knew any of these things would happen to me during pregnancy and I know there must be other people out there who get caught out by these interventions that crop up. I haven't felt scared of any of these things and I have felt really well cared for. Even if I don't always know why things are happening, I have more recently maintained that I want to try keep things as low key as possible and not panic about things. I am hopeful now that as I sit here in week 30 I'm hoping I can mostly just be left alone now and carry on this growing business on my own. I'll keep you updated!

Mantra