Friday, October 16, 2009

And so the parental decision making begins....

I can't believe that Ethelred is barely 20cm long and only halfway cooked, and already we're facing a "Big Decison" regarding his/her health.

For anyone who has been living on Mars since the early summer, I'm talking about swine flu, the H1N1 virus. And oh, what a Pandora's box has been opened this week! As of next Monday, the UK H1N1 vaccination programme begins, starting in hospitals with frontline healthcare staff and immuno-compromised patients, and then moving out into GP land and "high risk" patients on the 26th October. As a pregnant woman in the 2nd trimester, I fall firmly within the latter category - in pregnancy, the immune system is naturally suppressed, so pregnant women are more likely to catch swine flu, and if they do catch it, much more likely to develop complications such as pneumonia and breathing difficulties.

6% of the patients who have been hospitalised with swine flu have been pregnant women, and just this week two otherwise healthy pregnant young women (aged 17 and 21) have died in Britain. In fact, of the 106 confirmed deaths from swine flu in the UK, a total of six have been in pregnant women.

Nicola Sturgeon, Scotland's Health Secretary, and Sir Liam Donaldson, England's Chief Medical Officer, have both urged all pregnant women to get vaccinated - in Sir Donaldson's words, "I do not want to see pregnant women dying of a preventable disease, that's the bottom line."

And yet.....the pregnancy forums are abuzz with women vehemently proclaiming that there's no way they would risk their babies' lives with any kind of flu jab. They believe that this has been "rushed through", while an alarmingly large number of them claim to have had friends with swine flu who were absolutely fine. Non-pregnant friends, I should point out....

How could it be that the message isn't getting through?

Well....the National Health Service has opted to choose GSK's Pandemrix vaccine for their mass rollout of the H1N1 vaccination programme, rather than the less controversial Celvepan, produced by Baxter (in fact the reason Pandemrix has been chosen is because the alternative requires two doses over the space of three weeks - which leaves us unprotected for those three weeks between GP visits). And herein lies the problem.

Sky News, in their infinite wisdom, decided to start the usual vaccine scare mongering with a vengeance, confidently proclaiming that "Pandemrix, which makes up the bulk of the NHS supply, contains a chemical never tested on mums-to-be". And another killer headline: "Pregnant women in Britain are to get a form of swine flu vaccine that is not recommended by the World Health Organisation (WHO)".

This "chemical" that Sky News talks about is an adjuvant - a chemical (often aluminum or oil-based) that can be added to vaccines to reduce the amount of active ingredient (antigen) needed per dose of vaccine by “turbo-charging” the immune system response in the patient. This can maximise the supply, providing six times as many doses from the same quantity of antigen - whereas there are genuine concerns that the yield of Celvepan is not nearly high enough to meet demand, and so supplies will be unreliable and finite.

Professor David Salisbury, the Department of Health's director of vaccines, certainly doesn't have any doubts about vaccinating pregnant women with Pandemrix, and today the World Health Organisation stated that "Inactivated non-adjuvanted vaccines similar to most seasonal influenza vaccines are considered the preferred option given the extensive safety data on their use in pregnant women. However, if such a product is not available pregnant women should be vaccinated with another pandemic influenza vaccine available at that time, for example an adjuvanted inactivated influenza vaccine or a live attenuated influenza vaccine" - effectively backing the use of Pandemrix.

And yet despite all the facts surrounding the benefits of the vaccine programme, the backing of our most senior health professionals and the undisputed fact that pregnant women are at increased risk for severe disease, potentially resulting in spontaneous abortion and/or death, especially during the second or third trimesters of pregnancy, STILL most of the women on the pregnancy forums are unswayed. This morning there were well over 50 posts against the vaccine, and not a single one for.

So, I thought it might be time to inject a little reason - excuse the pun!

Here is my own response - I'm expecting the "you evil woman who doesn't care about your poor vulnerable baby" lynch mob to be banging down the front door any minute now:

"Well, I guess I'm going to put the cat among the pigeons here, but I am planning on having the vaccine!

I've grown up with medics (Dad's a Dr, Mum's a nurse & former midwife and my brother's a med student), and I work in clinical trials (including H1N1 and influenza vaccine trials), so I may be a little biased, but I'm very pro-vaccines.

(I saw someone referencing that poor girl who died after getting the cervical cancer jab, and that worries me - the worst example of media hype causing panic and misinformation....)

But I do know that pregnant women are more than 4 times more likely to develop serious (i.e. life-threatening) complications as a result of catching the swine flu. So even if you have had flu before, or your friends have had swine flu and were "fine", you have to remember that we might not be so lucky with our compromised immune systems (thanks, baby mine!).

Yes, the flu doesn't harm our unborn babies, but having a dead mother absolutely does hurt our little ones!

Anyway, although this particular vaccine hasn't been around for years, and it might appear that they have been "rushed through", they will still have been through rigorous testing in the usual huge sample sizes of thousands of subjects, and animal trials before then (Animal studies do not indicate direct or indirect harmful effects with respect to fertility, pregnancy, embryonal/foetal development, parturition or post-natal development). Vaccine trials are always very fast to recruit patients, because they involve healthy volunteers - i.e. you don't need to wait for someone to be sick before you can enrol them in the trial. So all the GPs that were involved in the trials could just ask every single patient that walked through their door each day whether they were interested in receiving the investigational vaccine. It only takes a couple of weeks before you have enough patients enrolled to prove that the drug is safe and effective.

Unfortunately you are not ethically allowed to include pregnant or lactating women in clinical trials, so no new drug that is released will ever have been proven in pregnant women.

I know it's a great unknown as a result, and we don't know what the long term effects are, but I would rather take the risk with the vaccine, rather than face the known fact that several otherwise healthy pregnant women are now dead.

Sorry this has turned into a bit of an essay, but I have also been giving this a lot of thought in the last couple of days. It's unfortunate that the NHS chose Pandemrix, which makes our decision a lot harder - but the flu vaccine has been around for ages, this is just a different (albeit much more virulent) strain of flu. So we know the technology behind the vaccine is safe, and in actual fact, the WHO have now backed Pandemrix.

Anyway, I know it's a very personal decision - and I'm in no way trying to knock anyone who has decided against the vaccine, because I know it's taken me a lot of thought to get to this decision myself! - but I just thought that it might be good to see the other side of the argument....

Here's to our happy, healthy babies and mums, regardless of our choices!

The Pregnant Pepper 19+5 Smile"

Bring on the hate mail!

Monday, August 24, 2009

Tiny toes and true love!

Today marked the day of our all important 12 week scan. I'll keep this brief, but will just say that we saw that lovely fluttering little heart again, but this time was so much more exciting - we also saw some teeny tiny toes on those perfectly formed feet, crazy little arms and legs waving around, and Damyan's favourite part - two perfect brain hemispheres. Despite the fact that I had once again gone overboard in drinking 2 litres of water, a can of coke and a cup of tea beforehand so that our poor little bean was quite squished in there, Ethelred still decided to play up for the "camera" and did a little backflip for us. Which was very nice, but a bottom doesn't look nearly as exciting on the screen - I preferred the nodding dog impression he was doing at the beginning....clearly dancing to the rhythm in his head already (which is obviously Abba, and not Nine Inch Nails)!

Anyway, without further ado, I am so very happy, excited and relieved to introduce Ethelred Pepper:

By the way, for anyone who is about to put Child Protection Services on speed dial, Ethelred is baby's name only until he/she draws their first breath. Sorry Damyan.

Baby bunting is now due to enter this wicked world on March 8th 2010 - poor Milo dog, please forgive us!

Friday, August 21, 2009

Reading is bad!

That's reading, as in books and blogs, not Reading, which I'm sure is a lovely place to live.

Being the silly little first-time-mum-to-be-with-far-too-much-time-on-her-hands that I am, I hopped onto Amazon as soon as I saw that 2nd purple line and got me a "Your Pregnancy Week by Week" book to salivate over. Then, because this all has to be a great big secret until we get to the all important 12-week scan and find out that all is well, I realised that this book is just not enough - I have to be able to share this experience with someone, anyone.....well, actually several random strangers who happened to have peed on a stick around the same time as me. So, I joined a pregnancy "Due in March 2010" internet forum where I could try to forget that I should actually be busy working on clinical trial strategies, and instead spend my days sharing all the niggles and fears with a lot of other similarly petrified people.

This all seemed like a really marvelous idea until I got impatient with the "Your baby currently looks like a tadpole and measures 0.5mm" pages in my book, and decided to read on. To the Miscarriage chapter. As you do - it's like driving past a car crash after you've been queuing for 2 hours on the M25 with no idea why. You know you shouldn't look as you pass, and that if you do see anything you're going to wish that you hadn't just can't help rubbernecking all the same. So, I read on....and can I just see a show of hands for anyone who has heard of a "missed miscarriage" before?? I had no idea. I thought that if you lost your baby, you would know about it. That's what the movies told me - you wake up in the middle of the night to discover that your white bed sheets are now red, you go to the bathroom and crumple onto the cold tiles without turning the light on, cry for a month and, well, that's what a miscarriage looks like.

Nobody warned me that you could merrily go on your way, choosing names, mentally decorating the nursery and trying not to kill your husband while your raging hormones have you leaping from ecstatic "ohmygodwe'rehavingababy" joy to "if he breathes that way one more time I swear I'm going to beat him to a bloody pulp with this wooden spoon"....only to get to the 12 week scan and be told that your little bean died 6 weeks ago. How could that be? You've been puking for England, your boobs are starting to make Pamela Anderson look positively flat-chested and Blinky has a name, godammit!

Add to this the heartwarming statistic that one in six pregnancies ends in a miscarriage, and here you have a very petrified pregnant Pepper indeed.

Then in just one day, three of the Due in March women went for an early scan to find their little ones were no more. Two days later it happened to another two. Completely ignoring that fact that the majority of women on this website had progressed from the "Miscarriage" to the "Trying to Conceive" to the "Due in March" forums...i.e. they all had previous history and underlying health issues. None of that mattered to me - my little bean was clearly in jeopardy and there was no way I could wait another month to hear what is bound to be just terrible news.

So....I threw rationality (and money) to the wind and booked us in for an 8 week reassurance scan at Clinic Nine.

They tell you to arrive with a full bladder at least 10 minutes before your appointment, which was at 7pm. So at 5.30 I made a big mug of decaff tea. Followed by a can of diet coke. Then I got in the car and went to pick up Damyan from work, taking a 1.5L bottle of water with me and slugging from it at every red traffic light. We arrived at quarter to seven, and felt like complete frauds when we saw the two very obviously pregnant girls in there for their posh 4D scans! 7pm came and went. I couldn't sit down because it put pressure on my bladder, but standing up and walking around the tiny white waiting room wasn't a huge help either. 7.10pm came and went. PEOPLE, hello!?! - pregnant lady really really really needs to pee right now!!! 7.20 I decided that maybe I could go to the loo and pee just a little bit, just enough to stop me bursting. At which point the sonographer came out and said "Kerstin??". Bugger!

The thought of someone pressing down on my stomach was a bit of a worry, but in we went nonetheless, excited but nervous. Had to confess that the reason we were there was "because, um, I read the miscarriage chapter in my baby book". Silly. Silly, silly. Oh, and at this point being told that my bladder was too full now was not helpful. Thanks.

Anyway, the long and short of it is that we saw our little bean. Which was really all it looked like - our fuzzy little bean with the most amazing, fluttering crazy train heartbeat. It even did a little flip, rolled right over on the screen. So. Very. Cool !!! Little Ethelred measured at 8 weeks and 4 days, which in case you're wondering equates to 20.8mm from crown to rump. Our teeny tiny little bean.

So I am not going to read about any more horror stories, and instead am going to gaze adoringly at our teeny one and wait impatiently for the 12-week scan on 24th August - which thanks to £95 well (and maybe a little bit frivolously) spent, we can now look forward to rather than being a little frightened of it.

Reading is bad - a little ignorance can be a very good thing!

Monday, July 20, 2009

The beginning

When I became a Pepper on May 9th this year, I thought it might be fun to start to write a little chronicle on married life, something to look back on when we're old and grey and the sofa is bearing the imprints of our rapidly expanding behinds. When I sat down to try and put the idea into actual words....I realised that being married is really no different to living together, except that occasionally I get referred to as "Wifey". I'm hoping the novelty will soon wear off. Our day to day lives have not changed, our relationship has not really changed in any discernible way and Monty the cat and Milo the dog still show us as little respect as they ever did.

And then one day, a couple of weeks ago, I saw purple.....twice!

Eeek!! And yay, obviously.... I think my exact words were "OHMYFUCKINGGODWE'REHAVINGABABYMILO!!!!!". Milo is the dog. He looked unimpressed.

Clearly though, you can't trust just one purple line. Luckily there are two in a pack.

But then I thought...hold on, these are crappy Sainsburys own pregnancy tests. I can't trust these....I must spend more money!!

I think at this point a sane and rational human being might think that these results were pretty conclusive. But in case you hadn't noticed, the words "sane and rational" have never been used to describe a pregnant woman, so after a few more days of not vomiting, not fainting and not doing any of those things that pregnant soap characters do, off I popped back up to Asda to get me another pee stick.

Holy SHIT y'all - I'm pregnant !!!!!!!

And now I have something to talk about - you lucky, lucky beans you!!