The Savannah

When Zach was born, we were in the neonatal intensive care unit and then the HDU neonatal unit at St Thomas’ Hospital. We then moved over to the HDU on the Savannah ward at the Evelina Children’s Hospital. Its very confusing, but the first HDU is next to the labour wards so parents are next to their babies. Savannah is a part of the Evelina hospital – in a whole other building!

We were moved to the Savannah ward late one evening in the first week of being at the hospital. Myself and Emmanuel call the Savannah ward, The Jungle. It is pretty wild. Imagine a large room with six cots all containing tiny babies. Next to the cots are the worried parents and walking back and forth between them are the nurses and doctors. Each bay has a blue curtain that pulls around your allotted little space. Inside that space, that is perhaps the size of a small shed, are two chairs a storage cabinet, a table and a mountain of medical infusions and monitors. Plus, two suitcases, three bags, breast pump equipment, shoes and a coat. Then imagine living in that space whilst trying to breastfeed your brand-new baby. The nurses have their desk area right next to the first cubicles. There is also the doctor’s office, scanning room, toilets and shower. It was as Emmanuel called it ‘The wild, wild west.’

When it was time to move across, we were walked from St Thomas’ to the Evelina with our two nurses and a student nurse. It was the first time Zach had seen the outside world. He looked around from his cot as we passed through glass corridors, taking in the blue sky, before falling asleep. He then slept for the rest of the walk. We were taken through the old part of the hospital where they have the teaching areas. There is a display case of old medical equipment. ‘The iron lung’ and other old ventilators. They looked like torture devices and sent a shiver down my spine. It made me think that medicine had a pretty brutal history. Street doctors that hacked off limbs and dentists that pulled out teeth with big metal plyers. What about the people that had been hooked up to those old machines, had they lived? Had any of this horror movie looking stuff worked? A movie scene popped into my head; the man had been strung out by his organs but he was being kept alive by machines. His intestines hanging on hooks. His heart beating out in front of him. I physically shook my head and tried to concentrate on Zach. He looked peaceful in his cot. Like an emperor on a travelling throne being brought across his land. All these people here for him and he was blissfully sleeping.

We arrived at the Savannah. As Emma and Emily dropped us off, I hugged them both. I had grown very attached to them in my days in the HDU. Our Savannah nurse came over to introduce herself. The HDU nurses were explaining to her about Zach’s medication and infusions. My heart quickened. Why didn’t she know this stuff? Were we safe here? Was Zach’s careful care going to be messed up? I started asking questions. My anxiety started to rise. In HDU you have two babies per one nurse. Here the nurses can have three babies at a time and there are six bays. I was so scared that something was going to go wrong. I was becoming prickly; I didn’t know how things worked here. A heath care assistant came over to help us ‘move in’ and when she started to move the breast pump machine out of the way to get to the plugs behind it I started almost yelling at her.

“I NEED THAT, you can’t take it!” So, I wasn’t quite yelling, but I certainly wasn’t nice to her. She explained that she was just moving it. I thought she meant moving it away from my area so I continued to tell her that she can’t. Emmanuel stepped in to explain what the lady meant. I stood back and let her finish. I felt awful. She was only trying to help me. The next day when I saw her again I apologised for how I had spoken to her. I explained that I was really unsettled being moved across and I was just feeling really anxious. She was lovely and thanked me for apologising. We actually got on quite well and started joking with each other about miscommunications. I didn’t see her much after this, but I would smile at her when she was around and she to me. “Well done.” My mum said to me after I apologised to the woman. It doesn’t matter how old you are but hearing well done from your parents always means something. “Thanks mum, she really didn’t deserve how I spoke to her. It was only fair.” Yes mum, I am a grown up after all!

Each bay has a pull-down bed next to the patient’s bed for a parent to sleep on. It is tucked into the wall. It is a few wooden slats with a thin foam mattress on top. It reminded me of the mats that you get in sports halls for PE. Where you line them up and do forward rolls and cartwheels across them. They are great, but not for sleeping on.

When the nurses switched over and our night time nurse came over she offered me a proper hospital bed in the bay next to Zach’s. There was nobody in there and she knew I was just a few days post-surgery myself. I could have kissed her. She pulled the curtains around us to make one big giant bay. For the first time I got to sleep next to my baby boy. The hospital beds elevate at the head end so that I could sleep sitting up. After a C-section it is extremely difficult to sleep laying down. It’s difficult to do anything to be honest, but laying fully flat is agony. So, there I was a new mum sleeping next to my baby for the first time surrounded by four other mums and babies all cocooned in blue curtains. The thing about the blue curtains is that they don’t block out any noise. So, all night long you can hear the nurses, the other babies and parents shuffling around. Of course, when one baby cries in the night so do all the other babies. It’s like they play tag with each other. ‘You start crying first this time and I will for the next round. Then we can take it turns like a dawn chorus so that nobody gets any sleep.’ I imagine this is what the babies were up to. So that first night I managed about an hour. 

The best thing about Savannah ward is the breakfast. When hand over is just finishing and all the curtains are being opened, the breakfast lady comes around and she says these magical words “Toast or cereal?” I always had toast and a cup of tea. The toast was cold and the little pots of butter and jam were those plastic kinds that taste more like sugar, but it was delicious! After hardly any sleep and facing a day of uncertainty on the ward, tea and toast just made the world better for a brief moment. In fact, tea and toast become something that I relied on. When Zach was awake at 3am and not settling. Or they came at midnight or 5am to take yet more bloods from his poor feet. I knew in a few hours that I was going to have five minutes where I could eat some jammy toast and drink some very strong milky tea. I often ate it one handed whilst holding Zach. Or Emmanuel would feed it to me if I had no hands free and he had arrived early. It’s the small things that become crutches. It’s the small details that make the long days and weeks bearable. They also fed the breastfeeding mum’s lunch and dinner. I didn’t always eat it but it was a small comfort to know that I would have hot food there at 8am, 12 noon and 5pm.

The only other thing that’s better than the tea and toast in the morning is when you have had a particularly bad night or early morning and one of the nurses brings you tea and toast accompanied by a listening ear.

The first day on the ward my mum was still in London so she stayed with me all day. She was there as I fed Zach constantly. She helped me as I cried because he just wasn’t getting enough. She listened to me moan all day long. There really wasn’t much she could do but at least she was there. Emmanuel had to go and sort out a big food shop for us and take It back to our accommodation. He also had to unpack all of our suitcases and organise our room where we were staying. I am so glad I had my mums’ company that day. But at the same time, I felt so bad for just being this big mess. This definitely wasn’t the happy day with their grandchild that most grandparents dream off. It was so handy having her there though. When I needed to go to my own appointment the day after. Mum and dad sat with Zach whilst Emmanuel took me across to St Thomas’ hospital so that I could see the midwifes. They sent a picture in the family WhatsApp group of Zach in his cot. ‘First babysitting duties’ was the caption. Mum and Dad stayed for a week in total. It was perfect, they were there when we couldn’t be. They sat with Zach we had to do other things. My mum was a friendly face in the sea of nurses when I was trying to feed and change him. Sometimes you do just need your parents. Myself and Emmanuel soon felt ready to do this with just the three of us, as a family. When Mum and Dad went back home we were ready to try to handle this all ourselves. I will always be grateful that my parents got to see Zach when he was so little. Soon his other grandparents would meet him as well. It really meant so much to me for them all to come to the hospital to be with us.

Alone To Recover

The nurses checked on me every half an hour after my C-section surgery. I was in a private room with a view across London. Emmanuel was with our baby. I was so alone at that moment. Yet I still felt full and happy, not sad. I felt like I had accomplished something. Something with a nine-month build up.

Emmanuel came to my room and gave me my phone. He had kept hold of it for me after Bethany (the Anaesthetist) had taken our wonderful birth photos for us. I had been alone with no phone for almost thirty minutes. I think that feeling was more bizarre than the numb legs were. He bowled into the room with the biggest grin on his face. He was a father. No matter what, from this point onwards he was a Daddy. I had had nine months to get used to the idea of having a baby every time I felt him kick. Emmanuel had this moment. It was written all over his face and his navy-blue scrubs. I am a Daddy. He looked like he might burst.

“How is he?” I asked.

“He’s good. The doctors are just sorting him out now.” He beamed at me with such joy, I couldn’t help but feel the same way.

“Go. Go be with him.” I would have pushed him out of the door if I could have.

“Are you ok?” he asked.

“I’m fine. Just go.” I was again left alone.

I looked through the pictures on my phone. Seeing it all captured made me so happy. I zoomed in on Zach’s face, his wide-open screaming mouth. That beautiful squashy nose. In one picture his face was next to mine and his hand was reaching for me. I couldn’t stop staring at it. Then my phone pinged and Emmanuel sent through pictures of him now. His bottom half was tightly wrapped up in a hospital blanket. He was wearing a hat with a white and grey star print on it that I had picked out as his first outfit, He didn’t need the baby-grow that matched as he was on a heated bed. His chest had three little wires attached to it with different coloured sticky pads, a red, a green and a yellow. These were to measure his heart. But I didn’t know that at the time. I barely saw them. I just saw his face. His beautiful fluffy new-born face. My son.

My parents had booked a hotel room in London near to the hospital. As soon as we gave the go-ahead for them to visit, they appeared in my room in a nanosecond. Armed with a gorgeous teddy and a card. It was so surreal to see them there. I had just briefly met my son and now my parents were about to as well. They came to me at my bedside, because of course I couldn’t move, and gave me hugs. I told them right away to go and meet their grandson. It didn’t take much convincing before they left to go and find him.

Again, I was alone. A nurse came in and took my blood pressure and observed my bleeding. Which involves lifting the sheet to peek at you and see if you are bleeding on to the giant pad sheets.  At the time I did not care a dot. Looking back, it was really humiliating. I asked when I could go and see my baby. As soon as you can get into a wheelchair was the answer. Over the next hour and a half, I sat there trying to wiggle my toes and get my legs to move enough to be able to get into a wheelchair. They offered me morphine and I accepted. Anything to make it easier to get off this bed and into that chair. By 3.30pm just over two hours after I had been stitched up, I was calling the nurse.

“I can do it. I can get in the chair.” I was so determined that I didn’t care if I actually felt ready or not. She wheeled in a chair with a humiliation pad on it. And a big sheet to wrap around me so that I wasn’t flashing my butt to everybody through the back of the chair.

I used every piece of strength I had to heave myself into that seat. I could move my legs but not properly. I was using my arms to get off the bed and closer to the wheel chair, closer to him. I stood one foot on the ground and lifted, exposing my naked back to the nurses. I did not care. I swung around and placed my butt down into the seat.  Leaving my remaining leg to drag behind me, with some effort I managed to pull it across and into the footrest. The nurses wrapped the sheet around the chair. I was so happy with myself that I ignored the pain in my abdominal region. I pushed it away like a leaf down a sticky stream of mud. It was not going to stop me seeing my son.

My dad came to wheel me over to the Neo-Natal Intensive Care Unit (NICU). I gleefully joked with him about Mario Kart driving as we whizzed past the rooms and receptions of each ward. We passed the lifts that separated the mothers from their babies. A wall between us. Soon, so soon, I was outside the room where he was. Emmanuel came out to meet me and to wheel me in. My wound was throbbing now. The morphine hardly touching the edges of the pain, but it was certainly making me high. I didn’t realise at the time but the morphine and the dihydrocodeine were making me feel giddy. I was a little bit ‘away with the fairies.’

I was ready. A nurse held the door open for us and I was pushed inside a softly lit room filled with four baby beds. I was about to meet my son, properly. To hold him in my arms for the first time. To look into his face, to hold his hand and whisper his name.

Four ECV’S and a Breech Baby

The weeks progressed and the news sank in a little. Some days I would feel hopeful and happy. Others I would be full of fear for what was to come. I soon found that working nights in the private members’ club that I managed was getting too much. The loud music, the drunk people and the 4 am finishes left me exhausted. I spoke to HR and started maternity leave early. I was going to miss my job and my friends there but my body couldn’t do the late nights and my mind was elsewhere. So, in late November 2019 I finished work.

I started nesting at home and getting things ready for Zach’s arrival. I wanted to be prepared as well in case Zach was going to come early. So, by Christmas time I had our hospital suitcase packed, the nursery ready and the car seat installed. I had pretty much everything we would need all sorted. I loved standing in his nursery and looking around. I would sit in his nursing chair and imagine what it would be like to be sat there feeding him. I started to find that I needed something to do. To take my mind off things a little bit. So, I got my sewing machine out and made gift bags for my family’s Christmas presents! After Christmas I got into the routine of seeing the midwifes on a bi-weekly basis for regular measuring check-ups.

The local midwifes would measure my bump each week and check Zach’s position. He was in the ‘Breech’ position for the entire pregnancy. Which isn’t a problem, until you get towards the end. At this stage its ideal to have a baby positioned facing down, with their head in the pelvis.

Zach decided that he wanted to stay where he was, with his head sitting under my right rib-cage and his bum sat above my left hip. He was laying diagonally across in utero. This is fine for the pregnancy bit, but not so great for the birth bit. So, I was given the option to have an ECV to try and turn him around. I desperately wanted an all-natural birth. I had been practising my hypnobirthing techniques daily and wanted to use them. With Zach in breech this pushed my ideal labour and birth further away from us. 

What the heck is an ECV? Is short terms two people push your baby around to try and get the head to face down and into the pelvis. It is exactly as it sounds. Brutal. ECV stands for External Cephalic Version. External being from the outside, cephalic being the head and version being turning. So turning the head from the outside as a rough explanation. Here is why they do it and the risks involved.

As Zach is a Cardiac baby, we had to have the go-ahead from his doctors at the Evelina hospital. This also meant having the procedure done at the Evelina/St Thomas’. So, Myself and Emmanuel did the drive into central London the day of the ECV. It had to be done at the Evelina as there is a risk of inducing labour. We needed Zach to be born where his doctors and surgeons were and not need to be shipped across London in an ambulance from our local hospital.

What they actually do in an ECV

They put heart monitors on my belly to listens to Zach’s heart. They monitored Zach’s heart for 30 minutes. He always started moving around when the monitors were on me. I imagined him trying to kick them away from him. The doctor explained that they are really loud for the babies inside. It must be quite a shock, like having your house suddenly start playing loud, bass-filled music. After some time watching the heart monitors they gave me an injection of salbutamol, which works to dilate the blood vessels. This helps to reduce contractions and relax the muscles that are supporting the baby. Salbutamol makes your heart race and your hands shake. It is very unpleasant but thankfully its effects do not last for long. The midwife described it as being flustered. I would say it’s like being high (on life of course) but without the fun bit, just the shaking.

Next my blood pressure and oxygen levels were measured periodically whilst Zach’s heart rate was still being monitored. The midwife and doctor left us alone for a while to let the drugs kick in and the monitoring to continue.

When they came back they checked in with me to see if the salbutamol had taken effect yet. It most certainly had. I felt like I was running whilst laying on a bed. My breath was short and fast and my body was shaking as if I had just squatted 90kg fifty times over. I knew I needed to stay as calm as possible during the procedure so that they had the best chance at moving him. Emmanuel held my elbow (my hand was behind my head) and I started to take long deep breaths. I found a spot on the ceiling to focus on and tried not to think too hard about anything at all. Which is much easier said than done when you have salbutamol and adrenaline rushing through your body. 

The first thing they did was to disengage Zach’s buttocks from sitting in my pelvis, which means they press really hard to try and lift him upwards. They then pushed Zach’s bum up towards my ribs. They paused and the other person moved his head down towards my hips. They did this step by step movement a few times.  This was all fairly bearable. The worst was the hand that was holding Zach’s bum. It was also pressing into me so hard that I felt like my intestines were being squashed down. It was like having a hard-blunt object held in place on a bruise. This was certainly not fun.

They managed to move the Zach some of the way round. Then he must have stuck out his little hands and pushed away or something because that was as far as he would go. He refused to tuck his head in. He refused to let his bum travel any further up. I was in agony from the pressure and they had to stop. The second they moved their hands away he swivelled right back to where he started.

I imagined Zach’s little face in there scrunching up in annoyance at all the disturbance. Kicking his legs out and doing everything he could to stay put. Then when he was back to his favourite position, I imagined him snuggling his head back into where he liked it best. His peace restored. I wanted to explain to him that he needed to help out and move around. But he was comfortable where he was.

It took me a few moments to recover from the first attempt. I soon wanted to try again. It was agony, but I was determined.

ECV take two

They looked on the ultrasound to confirm Zach’s position. He was back with his head under my right rib. This time the midwife and the doctor swapped roles. The midwife took Zach’s bum and the doctor his head. This time round was just as painful but I managed to breathe through it. Again, he got half way around and wouldn’t tuck his head in. They had to move him back to the original position. They can’t leave him half way. So back he went. That was it. The second attempt failed.  

The doctor and midwife advised me that now I needed to speak to my care team and we can go from there to make a decision on what to do for the birth. I knew there and then that it was either going to be a higher risk breech vaginal birth or a C-section that I was facing. I was devastated. We had just been through all of that for what felt like nothing.

Because Zach has a heart condition a breech birth adds more risk. I knew I would be advised against it. These are the statistics. 1 in 1000 babies come into problems in a normal straight forward vaginal birth. Its 2 in 1000 for breech. So the odds just doubled right there. Then with a cardiac baby they go way higher. A caesarean section is 0.5 in 1000. Clearly the odds are in favour of the caesarean section, but I really didn’t want to have major abdominal surgery and need to recovery myself just as my baby will be having his heart surgery himself. There is of course a small chance the baby will then turn by itself. The odds are 3 in 300. I was not happy leaving that hospital. I felt like I had failed somehow. I wanted so badly to be travelling across London back home thinking about my beautiful birth. But no such luck. Not today.

Back at home, laying on my sofa the day after I felt like I had run a marathon. My stomach felt bruised all over and it was painful to move. I was so determined to get him to turn that I spent the rest of that day upside down trying to encourage him to turn. He didn’t.  All I could do was continue to hang upside down and hope. I watched a lot of movies hanging off the edge of the sofa that week.

Risk of an ECV

Just in case you are being offered one here is what they told me about the risks.

Less than 3% of women have an ECV and it causes their waters to break or for the baby to go into distress. If this happens it means you would need to have the baby pretty soon. Possibly via a C-section there and then, or at least within 24 hours.  There is a slight chance that it causes the placenta to come away and cause bleeding. Or it can cause labour to start. The midwife and the doctor where I had mine done at St Thomas hospital in London explained that for them, one woman last year and one five years before that had to have a C-section due to waters breaking at the ECV. That’s it. It is very low odds, but just in case be ready and have you hospital bag with you. That’s what we did. Take some paracetamol for the soreness afterwards and you will be ready for anything. I personally didn’t take any painkillers, preferring to just soldier it out.

It has a 50/50 success rate, some hospitals are slightly lower at a 40% success rate which is the national average. It’s worth trying it if you want to have a natural birth. It’s worth practising those deep breathing and relaxation techniques as well. Be prepared for it to hurt because it does. But so do a lot of things in life. Like labour.