Back starting to ache? Check.
Fast walking starting to become difficult? Check.
Baby kicking around like a nutter? Check.
Body starting to look a bit less bony? Check.

Been there done that.

Now suddenly the bump has started growing and become more visible. And at the same time it’s making itself noticed in daily life. It’s beginning to get in my way when I clip my toenails. And it’s taking up internal space, so there’s less room for food in my stomach. After a normal-sized meal it feels like I’ve overeaten and I’ve got food up to my throat.

Today I had my second appointment with the midwife. I chose her for one reason only: she does planned home births, and that’s a rare thing in this country. Luckily she’s turned out to be a good fit otherwise, too. She’s relaxed and down to earth. “Any idea how much you might weigh now? No? OK, not to worry, it’s not that important. How are you feeling? Any complaints or discomforts? No? Well, in that case, since your blood pressure is looking good, we won’t bother with a urine sample, unless you want to. See you again in a month.”

While I do have a stash of maternity wear from last time, it turns out to not really fill my needs. First, as expected, there’s the climate issue. April in London is a great deal warmer than April in Sweden. Second, my lifestyle has changed. There is hardly anything in my stash for gardening, playgrounds, and other such physical and semi-messy activities.

I need to shop. I dislike shopping at the best of times, and now I need to do it under time pressure. And the shops seem to sell jeans, and clothes in black and white. Depressing.

On the positive side, I am no longer tired, and not unusually hungry either. And I have been feeling movements for the past week or two. First it felt like a little fish fluttering around; now it’s a bit more focused and distinct, like a bubble popping, so I can actually imagine tiny legs kicking around in there.

I’m also releasing some previously-written but hitherto-embargoed posts in the Pregnancy category.

But just like last time, I want cool, light, juicy food above all. Yoghurt and fruit are especially good. Some days I notice a lovely cake or cookie somewhere, and really wish that I wanted to eat it – but when given a choice I’d much rather have some grapes. The best meal is unsweetened yoghurt mixed with some berries from the freezer, and Havre Fras (puffy oat cereal). I’d been wondering what we would use all those berries for (cause we have lots). Now I know: to build a baby!

My body never quite regained its original shape after my previous pregnancy (even though I quickly tumbled back to my original weight). And now my waist is getting rounder again. Most of my “smart casual” skirts are already unusable; the dresses still fit, and some trousers too. Time to unpack the pregnancy clothes again. How lucky that we’ve managed to time this pregnancy to match the seasonality of the previous one almost exactly!

The pregnancy is clearly messing with my blood sugar and digestion. I have to eat every three hours or so, but often when I feel that I absolutely must eat something RIGHT NOW, when I go to the kitchen to actually get food, the only thing I want is a yoghurt or perhaps an apple. The thought of actually eating real food is almost revolting. So the signal of hunger arises from low blood sugar, not from lack of energy.

My blood pressure also seems to be swinging wildly, and standing still for long stretches of time is not good. Several mornings now, while standing on the train – only 11 minutes – I’ve been close to fainting due to low blood pressure. It’s the worst combination: standing still, and being slightly too hot because we’re effectively indoors but with outdoor clothes.

My least favourite pregnancy complaint thus far: gassy stomach. Very uncomfortable, sometimes really painfully so. I fart like a champion. Because of this I find it hard to fit into my clothes at times, even though I haven’t gained much weight yet, so I feel a lot more pregnant than I really am.

Speaking of which… Whenever I think of the English word (farting) I cannot help but remember a business trip, back in 2004 or so. This was while I was living and working in London. There were four of us, visiting a few companies in Stockholm over two days: myself, a colleague, my boss, and my boss’s boss. As our taxi left the airport, one of the others spotted a sign for “Utfart”, meaning Exit in Swedish. And they found it hilarious. So hilarious that for the next two, they would shout “utfart!” to each other about once every half hour. It got old after about 3 repetitions, but not for them. Educated intelligent adults, with jobs entailing significant responsibility over much money – and with a sense of humour at the level of an 8-year-old. And they’ve forever ruined the word utfart for me.

And now I’m entering the tired phase. All afternoon and evening all I can think of is just lying down and closing my eyes. I’m already noticing increasing hunger, too, but I’m clearly not yet in that extreme phase of constant eating.

But of course I myself think about it all the time. When I was trying to conceive, my thoughts kept coming back to the topic of babies all the time. Daily, several times over. I was counting days, and thinking about my pills, and sex, and so on. I have to say, it’s nicer to ruminate about a baby than about wanting a baby. Now I think about the time of year when Blump the Second will be born, and how big I will be in February when we’ll be attending a wedding, and what will Ingrid think, and will I need to buy new clothes again because last time I mostly needed summer clothes, and who will take care of Ingrid while I’m giving birth, and how long will I stay home with the baby, and so on.

Lies beget lies, and hiding one thing leads to having to hide other things, too. Since I haven’t told people I’m pregnant, I can’t explain at work why I need to take a morning off (to have that first meeting with the pre-natal care clinic). I can’t mention my flu shot (which I got yesterday, together with Ingrid) because they’re only available for risk groups and children at this point, and I got mine only because I was pregnant. Gah, I wish this month could pass faster.

I’m already thinking of how I will manage two children, where they will sleep, the clothes I will have to buy for myself, what it will feel like to breast-feed again, etc. I wish it didn’t have to take so long!

• … stand on one leg long enough to pull off a sock, or put a leg through a trouser leg opening.
• … reach my toes for cutting toenails.
• … cycle in 3rd gear, and run up the stairs.
• … sleep in other positions than on my left side.
• … feel like I’m sharing a bed with Eric again, without a Chinese wall of a pillow between us.
• … button my jacket all the way.
• … sit right up to the table when eating.

There are some gory details here and there; don’t read it unless you really want to know what labour and childbirth can be like. It’s also quite a long story, but as with my blog posts, I’ve written it more for myself than for anyone else.

Everything went well. The worst of the exhaustion has now passed, but we’re all still quite tired and haven’t quite found our footing yet, so further details will have to wait a while.

Ingrid Johanna, age 90 minutes

This afternoon I walked to the post box to mail a letter, and then to the local clinic to get a repeat prescription renewed. This should normally have taken about 20 minutes, but took me an hour. I think I walked at half my normal pace, on average, but on my way there I forgot myself and sped up for a moment – and paid for it by getting a stitch in the side (at least that’s what I think it was – with a pregnant belly it felt more like a an agonising cramp in the stomach muscles) and having my blood pressure drop through the floor, so I had to sit and wait 20 minutes at the clinic for it to recover.

Then I got home and slept 2 hours out of exhaustion, waking only once to turn to the other side.

No, walking doesn’t work well now. Cycling, however, still works perfectly well for short distances (did yesterday, at least). With hindsight it’s clear that I should have cycled to the clinic instead of walking.

I’ve been cycling throughout the whole pregnancy, both because I always cycled everywhere before I was pregnant, and because I’ve found it more comfortable and/or convenient than any of the alternatives. It’s definitely less tiring than walking and puts less strain on the back. It’s also more comfortable than sitting on a bus – bus seats give me a backache. Above all, it is far more comfortable than taking a taxi, which is what everyone has been suggesting to me (if it costs more, it must be better?). London streets are so uneven and taxis have such strong suspension that a taxi ride here feels like being on a fairground ride or a large trampoline. At the top of each bounce Blump pushes my stomach up to my throat, and at the end of the bounce s/he lands painfully on some internal organs. Not comfy at all. On the bike I can at least see each bump coming and avoid it or compensate for it, but there’s no way to do that in a taxi.

The bike is not really an option for longer distances any more (too tired afterwards) so I’ve been taking the tube for my daytime bookshopping trips etc. The tube has turned out to be a reasonably good alternative, as long as I’m not in a hurry (which I’m not) and can avoid the rush hour (which I can) – a positive surprise, on the whole.

One of the reasons for these high numbers is women’s preferences: half of the Caesareans in the UK are elective. Choosing to undergo major surgery rather than to go through a natural process is an odd choice in my opinion. But I guess those women may have greater faith in modern technology than I do, or be more averse to pain and hard work, or put greater value on convenience. Anyway, that’s not why I’m posting – other women’s reasons for elective Caesareans are relatively irrelevant to me because I’m not even considering that option.

What I find more interesting right now is the other half of Caesarean sections, and why they are performed. It appears that doctors’ inexperience is one major contributing factor: junior doctors are more likely to opt for a Caesarean because they do not have sufficient experience in other assisted methods of childbirth

An article in the New Yorker highlights a related reason: the standardization of childbirth. Teaching all obstetricians to perform one standardized procedure well is easier than teaching them the numerous more “manual” alternatives. And Caesarean section is a standardizable procedure – it is a technical process that doesn’t vary much from patient to patient. Using the forceps, on the other hand, is more of a craft – it requires the doctor to develop a “feel” for using the right amount of force, etc.

The question facing obstetrics was this: Is medicine a craft or an industry? If medicine is a craft, then you focus on teaching obstetricians to acquire a set of artisanal skills. You accept that things will not always work out in everyone’s hands.

But if medicine is an industry, responsible for the safest possible delivery of millions of babies each year, then the focus shifts. You seek reliability.

Whereas before obstetricians learned one technique for a foot dangling out, another for a breech with its arms above its head, yet another for a baby with its head jammed inside the pelvis, all tricky in their own individual ways, now the solution is the same almost regardless of the problem: the C-section. Every obstetrician today is comfortable doing a C-section. The procedure is performed with impressive consistency.

Found via Salon.

I have to say, this is the first time I’ve ever been compared to Homer, in any context!

Helen in muumuu	Homer in muumuu

First problem: it took us 3 tries, on 3 different weekends, to even get to the class. The first time no teacher turned up and we gave up and went home after 15 minutes. The second time no teacher turned up, we chased around the hospital to find out what was going on, were told the class was cancelled because the midwives were all busy, and went home again.

This time a midwife did turn up to actually hold the class. But she was so disorganised, and her way of presenting so confused, that the class was almost useless.

She started by handing out a course plan with a list of topics. That course plan had nothing to do with the actual course. When she spoke, it was almost a stream-of-consciousness presentation: she might be talking about pain relief in labour, in 3 sentences segue into breastfeeding, then moments later be talking about how to raise children, and then back to labour again. Only when someone asked a specific question did she stay on topic for more than a few moments.

Occasionally, when someone asked a question about something I felt informed about (I have been reading, after all) I was very tempted to answer the question myself because then they would at least have gotten a coherent answer. I believe some of the people there may have gone home more confused than they came. Of course, if they knew nothing at all, then this may have been more useful than nothing…

The course was supposed to take 6 hours. 4 hours after we’d started, the midwife obviously thought she had spoken enough and sent us home. Well, she did ask if there was anything more we wanted to hear about. But if we knew what we needed to know then we wouldn’t have been there, would we!

I got the impression that someone had set up this class a while ago – written the course plan with suggested topics in a rational order – and then handed it over to other people to run. Maybe the original plan was put together by a consultant from somewhere, or just a midwife with some planning skills who later left. (The course seemed to be a few years old: many of the printouts and photocopied materials were dated around 2002). In any case, the materials appear to have been taken over and used by random people with no teaching or organisational skills whatsoever.

Maybe the teachers are different on different weekends and we just had bad luck. But the hospital should know that. If the hospital sends someone with so little preparation and so little teaching aptitude to teach a class, they can’t take these classes very seriously. This seemed like a mixture of box-ticking (“each hospital shall provide antenatal classes”) and keeping the parents pacified, rather than an effort to actually provide information or knowledge.

It certainly explains why the antenatal classes by the NCT (National Childbirth Trust) are booked about half a year in advance (which is why we attended this one instead).

Friday evening after work I had dinner, read some, and then pottered around aimlessly for a while. By 9:30 I was barely able to keep my eyes open so I went to bed and slept 11 hours straight.

Saturday I went to Oxford Street for some shopping. Took the tube instead of cycling to give my body some more rest. When I got home I lay down on the sofa to catch my breath and rest my legs a while. Fell asleep and woke up an hour and a half later.

Thus the relatively low frequency of new posts here recently.

Standard medical knowledge expects babies to settle in one position (normally head down) around week 32. I am now coming to the end of week 33, and Blump definitely hasn’t done that yet. It feels like a minor earthquake when Blump turns around from one position to another. It’s hard to imagine two arms and two legs making all that movement! Sometimes s/he sneakily turns around during the night – twice during the past week I’ve woken up to find Blump apparently lying horizontally, with his/her feet kicking out towards one side and the head pointing towards the other side, which was a pretty odd feeling!

With all this moving around, I’ve become curious to understand where and how s/he is lying, and learned to more or less “map out” Blump’s body.

First of all there’s the kicking, of course. Kicks are strong and distinct; arm movements feel smaller and lighter. Where I feel most movement, that’s probably where the legs are. Hiccups – regular “ticking” movements – should probably come from the top half of the baby’s torso, I imagine.

In addition to feeling movements, I can figure out Blump’s position by feeling around the belly. (One of the midwives explained briefly what she feels for, and the rest is just practice and common sense.) It doesn’t work every time, but it is getting easier and clearer as time goes – in part probably because I get more practice, but also because Blump fills up more of the belly.

I find it’s easiest to map out Blump’s position when I lie on my back with my knees bent, so the water flows down towards my spine and leaves Blump more exposed. The parts towards the top half of the belly are easiest to feel – above where my waist used to be, up towards the ribs. I try to feel what’s up there, and assume that the parts I haven’t located are lying down below the waist.

• A broad thing that gives strong resistance and doesn’t yield to pressure is the torso / back. When Blump lies with his/her back towards my one side, I can feel that that side of the belly is “solid” whereas the other side is more “watery” and has more “give” (in the space between and around the limbs).
• A small sharp thing that can be pushed around is probably a foot or a knee – especially if continued poking makes it move!
• A broader lump (but not too broad) that can be moved from side to side is probably the head.
• An even broader thing that moves just a little is probably the bum.

Every body part on its own may be hard to spot, but if I can kind of guess a few of them, the various clues reinforce or clarify each other, until I get a reasonably clear picture of what’s in there.

Right now, for example, Blump seems to be lying with the head down, the torso towards the left, and legs & feet up underneath my right ribs.