midwife's muse

Larger than life

I've mentioned before how large pregnant daughter is, well the growth seems to be accelerating. I have attempted to 'step back', and so her last two antenatals have been done by other midwives. For the past week though I have been looking at her, and worrying. She just makes light of her hugeness, 'I'm going to explode if I get much bigger', being her latest observation. I've been lying in bed trying to organise my thoughts and banish my fears, but then on Thursday she came round and mentioned the pain she was experiencing at the top of her tummy. I couldn't sit on my hands any longer and asked if I could have a listen to baby bean, but this time out came the tape measure and her lump was given a good prodding. I was horrified. She is now 31 weeks, so she should measure 29 - 33 cms, this is the allowable variation before we request further investigations, she measures 35cms, three times I checked, three times I got the same result. We had a listen, and Baby Bean sounded happy enough so I said that I thought she was a little large so I would make a scan appointment for about 10 days time, measure her again in a week and decide then if I should cancel it or keep it. She was happy, I wasn't.

Three years ago I was caring for a friend, who is also a midwife. At 34 weeks I thought she was large and also that there was a lot of fluid (polyhydramnios), I sent her in for a scan. There was a huge amount of fluid, she was seen by the consultant, baby was scanned for problems, none detected, and she was referred back to me. Labour went well, apart from flooding the delivery room with a huge amount of liquor, all went wonderfully, and a baby bay was born. Immediately I knew there was something wrong, he tried to breath but his chest just collapsed, emergency staff were called and he was rushed to Special Care. We all tried to be very positive, his Mum and I had seen babies all the time who would appear poorly initially but perk up within a couple of hours. This was not to be. He was put on a ventilator and then transferred to one of the specialist London hospitals. Still no dignosis. During this time I was in pieces, what had I done wrong, what had I missed in labour? Later her husband phoned me a said they had discovered that baby had a diaphragmatic hernia, a congential defect where the diaphragm has a hole in it which allows the abdominal organs to enter the chest, where they fill the space and prevent the lungs from developing. At it's severest it is incompatible with life outside the womb, and this was severe. Three days later they decided to turn off the life-support, my friend phoned me and asked if I would be there, I had been there at the beginning, please would I be there at the end? I accepted and stayed with this little family whilst baby died peacefully.

Too much fluid is an indication of diaphragmatic hernia, and several other congenital abnormalities. After a sleepless Thursday night I decided to pick colleagues brains. I gave them the clinical details, not mentioning it was my daughter, and asked them what they would do. Request a scan. Down I went to scan and said 'earliest scan please', 'April'. I indicated I needed it sooner, like next week, 'you'll have to speak to the ultrasonographer, she's not in until Monday lunch-time.'

At clinic yesterday I saw 8 women who were all at the same stage, or further on, as daughter, and all were half her size. I went back to the unit and had a chat to the midiwfe in charge of the Day Unit, 'Send her in Monday' was her verdict. 'It's my daughter' I said. 'We'll see her Monday' she said, whilst putting her arm round me, 'Will you be there?' I am going to be there. I shall be so relieved when they say there is nothing wrong, I won't mind that they think I'm neurotic, at least I can stop worrying.

5.3.05 11:12