Wednesday, 9 January 2013

"Oh my god, you're enormous!" - Polyhydramnios

Copyright T Harinaivo 2012 Creative Commons

"Oh my god, you're enormous!".  

I wasn't even 8 months pregnant when my shocked friend shouted out this choice greeting, but I was already carrying an extra 25kg (55lbs) on top of my pre-pregnancy 55kg (120Ibs).  That's a hell of a lot of extra weight to carry when you're 5'2. I was big right from the start but after a diagnosis at 29 weeks of polyhydramnios - too much amniotic fluid - I just ballooned.

It's hard not to be freaked when you're told you've got polyhydramnios (PH).  In most cases there's no known cause or treatment so lots of mums-to-be do exactly what I did which was go home after diagnosis, Google it and scare themselves silly when they find it significantly increases delivery risk and is associated with lots of fetal complications that may not be discovered until after birth.  There are times when "Dr Google" is really not a good idea, but whatever anyone tells you - you will look, it's human nature.

You have to hold onto the the good news which is that even in 50% of severe cases there are no complications.  But in my experience however hard you try this, you are still likely to be incredibly anxious and more practically, hoiking all that extra weight around is no easy matter. Although - except when associated with gestational diabetes - there is no treatment there are things you can do to handle the anxiety and the weight and to reduce some of the delivery risk.

I spent the last trimester of my pregnancy more or less stuck at home looking like a beached whale and feeling frightened, so in this post I have tried to bring together a list of all the tips that I think would really have helped me cope with PH a bit better.

If you had polyhydramnios I would love to get your thoughts and comments on your experience and what would have helped you and if you have blogged on it I would love to add  your posts to the list below:


Coping with Polyhydramnios 

What to expect ..
I think the first thing to accept is that you are probably not going to have a beautiful blooming, skipping through the meadows, picture-book pregnancy.  You will almost certainly be enormous - typical weight gain for a non-PH singleton pregnancy is 12 kg (25 Ibs) but with PH you could be double this or more. 

In addition you may:

  • Be very anxious
  • Struggle for breath because your diaphragm is being squashed by your uterus
  • Have swollen legs
  • Have swelling over the rest of the body
  • Have painful knees because of massively increased weight
  • Have limited mobility because of breathlessness and sheer weight you're carrying 
  • Receive a fair dose of unwelcome and disapproving comments about your "weight"
  • Abdominal pain from stretching of your stomach
  • Suffer from bad heartburn
  • Have frequent braxton hicks from early in pregnancy
  • Not be able to work as long as expected
  • Your bump may be very sensitive to pressure on it

In the last few months you probably won't be able to do much very physical to get ready for the baby and even if you feel you can you almost certainly shouldn't!  I went into early labour at 29 weeks - very fortunately they managed to stop it - from scrubbing the floors!  So:
  • Don't feel guilty about needing rest and help
  • Get as much rest as you can
  • Avoid going up + down stairs as much as can - get everything in one place and stay put
  • Get other people to do as much as they can for you and DO accept offers of help - the builders across the road felt so sorry for me that they would nip to the shop for me :-)
  • Do only short bursts of housework or anything else physical
  • Try some relaxation techniques - I found a hypno-birthing CD helpful - that can ease your breathing and reduce anxiety
  • Follow general advice on heartburn - eat small amounts regularly, don't lie down after eating and avoid acidic and spicey food
  • Look out for under bump jeans etc and loose dresses if your bump feels really uncomfortable with any pressure on it

What the medical team may do ...
PH is strongly associated with gestational diabetes and increases the risk of a child being born with a range of conditions.  If your medical team suspects PH you will be given an ultrasound scan and typically after a diagnosis:
  • You will be tested for diabetes with a fasting glucose test
  • The scan will be assessed for fetal abnormalities
In the majority of cases both these will be negative and - although there are some fetal abnormalities that can't be picked up by the scan - the focus for you and the medical team will be to minimise the delivery risk.  Only rarely do medical teams drain fluid as there are additional risks associated with this.

In most cases your medical team will want to monitor you but in my experience it's easy to fall between hospital consultants and outpatient midwives with neither really taking responsibility.  Unfortunately, my hospital failed to advise my midwife how she should monitor me so when she finally sent me back to the hospital at 37 weeks it was all a bit of a panic.

Even if the diabetes and scan results come back negative I would push your medical team to explain in full what they will do for the rest of the pregnancy, in particular:

  • What will they monitor? (ideally midwife should be monitoring girth and weight as this will  be easiest indicator of further rapid growth in fluid - by default UK midwives no longer measure weight so post diagnosis push yours to do it if she's not)
  • Who will be responsible for monitoring?
  • What symptoms you should look out for?
  • Whether you should continue to work?
  • Whether they will want to induce labour pre-term? (see below for why)
  • When will they make a decision on inducing labour pre-term?
  • Who will make the decision?
  • What you should do if your waters break?

Managing the delivery risk ...

Many PH pregnancies don't go to full term and a lot of medical teams want to hospitalise you pre-term and induce early so that they can manage the labour as there is an increased risk of a prolapsed cord (umbilical cord is washed out before baby), the placenta coming away, the baby not engaging and post-delivery hemorrhaging.

With this in mind it makes sense to:

  • Pack your hospital bag early
  • Get everything ready for the baby early
  • Have an emergency procedure agreed with family & friends 
  • Know what to do if your waters break
  • Know what to do if the cord prolapses
If your waters do break - and be warned it will be a great flood! - anywhere outside the hospital the first thing to do is:
  • Get on your hands and knees
  • With your bum right in the air
  • And shoulders and arms right on the ground
This is basically to try and stop the cord prolapsing.  If the cord does come out the guidelines I was given were to:
  • Call immediately for an ambulance
  • Say have woman with polyhydramnios in labour & broken waters & prolapsed cord
  • Not touch cord or push it back into vagina
  • Not to eat or drink as very likely need c-section
  • Call labour ward to tell them you're coming in in ambulance with prolapsed cord
  • Open outside door so ambulance staff can come straight in
This leaflet from the UK Royal College of Obstetricians and Gynaecologists provides a good summary of the above with a great diagram of how to get your bum in the air!

Handling labour
Unfortunately, there is a higher likelihood of the need for a c-section if you have PH so I do think it's worth working that into a birth plan.  There are plenty of women with PH who deliver "naturally" but thinking in advance about how you would like to be treated if you do need a c-section may make it a better experience.

Even if you don't need a c-section you may find labour difficult once contractions start because your abdomen is so tense and tight.  You may also find the monitoring unbearably uncomfortable for the same reason.  From my experience the things that gave at least a little relief were:

  • Hypno-birthing breathing & relaxation - really wish practiced much more than I did
  • Pethadine - which on my birth plan was the one thing I'd said I really, really didn't want but it did help me to relax sufficiently to get a little relief
Although, many mums-to-be are nervous of both induction and c-section, if you instinctively feel there is something "wrong" and you're beyond 36 weeks and your medical team aren't discussing induction, you may want to push for it.  Mocha Beanie Mummy has a heart rending post on her blog about the loss of a baby after, the mother feels, a failure to induce pre-term.

If you struggled or are struggling with Polyhydramnios do come and talk to me about it on  Facebook and Twitter and if you're looking for more pregnancy and new baby tips from other bloggers do check out this Pinterest board ...

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  1. Interesting! I've heard of this, but having no personal experience, was not intimately familiar. I'm curious why the delivery risks. Cord prolapse I understand (although if babe is already engaged, it seems that should be a non-issue), but why are other delivery risks increased? Are they *caused* by the PH? Or by the decreased health the PH is likely to cause during pregnancy (prob. harder to eat right without space in your belly, etc.)? Or is the PH likely caused by the same thing as whatever causes the increases in other complications (that is, are they all effects, rather than cause-and-effect)?

    Sorry for the million questions! Natural health and women's health are areas of interest for me, and I have to try to understand everything!

    1. Great questions Rachel - problem is that because of the fluid the baby doesn't usually engage and floats around which why cord likely to come out first. The other risks seem to be associated with the uterus being much too big and putting pressure on everything else including the placenta.

  2. I have never ever heard of polyhydramnios. But I do have experience of 'Dr' Google and how helpful he can be.

    I'm diabetic, so I also know how scary it can be to think about the risks that can come when your pregnancy doesn't go so smoothly.

    Thanks so much for sharing this, definitely something that I'll look into and try to understand better.

    1. Hi Vicki - hoping to do a post soon on diabetes in pregnancy, so would love to link up to anything you've posted on it

  3. I have been diagnosed with PH and so far has been very confusing. I thought by the way it was explained to begin with I would just have trouble breathing and wasn't that serious. Then they want to monitor me and schedule more ultrasounds, at which point I turned to Dr. Google because nothing had been explained to me and now I'm freaked out and disappointed in my healthcare. Thank you for this post. I'm going to my next appoint with a list of written questions


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