The First Trimester

So, we are having a baby in July, if all goes to plan. And this means I am (almost) through the dreaded first trimester.
You don't hear much about how crap this particular part of pregnancy can be because a lot of women prefer not to broadcast their gravid state until having had a scan. Personally, I prefer to LOUDLY BROADCAST my gravid state to people as I see them, and everyone else can find out later. Like a celebrity.

I found out I was pregnant way back in October, at 4 weeks. I didn't feel pregnant at this point, which meant the whole thing felt unreal and odd. At 5 weeks, we told our immediate families. Then my niece came out with slapped cheek, just after she'd given me slobbery kisses. Seriously, she screamed bloody murder at me for two years, but as soon as she gets a horrible virus, she's all over me ;-) You don't want slapped cheek when you're pregnant, as it can (in a small percentage of cases) cause miscarriage or birth defects. So, to the doctors I went for an emergency blood test. I hate having blood tests, not because I dislike needles, but because I am a fainter. It's not deliberate or phobic, I just do. So, I asked to lie down and the nurse said "Oooh, how are you going to have a baby if you can't manage a blood test?"
"ERM, I HAVE HAD TWO BABIES WITHOUT ANY PAIN RELIEF, SO QUITE EASILY I IMAGINE", I huffed. I didn't have slapped cheek, for the record.
I wasn't going to tell the children about the baby for a while, but then they started elbow dropping my abdomen and suchlike, so I told them I MIGHT have a baby in my tummy, but I needed an Xray to check. This provoked the wonderful comment: "Mummy, you must be VERY CAREFUL when you do poos in case the baby falls out."

Six weeks, no change, I started to get paranoid. WHYYY don't I feel pregnant? Except for my really painful boobs, and exhaustion, and weird hormonal dreams, and repeated positive tests. Why am I even bothered by this relatively symptomless pregnancy? Mainly because I had such hideous vomiting with my other two children, and I expected the same again. I looked at getting a private scan, and promptly balked at the cost.
Seven weeks, and I went to see the midwife, to tick lots of boxes, and be frowned at for being a bit fat (NB: I've always been a bit fat). I've been booked for consultant care because I have a tendency to develop quite severe B12 deficiency anaemia in the second trimester (oh yay for that again!) and need LOTS of B12 jabs, and had a moderate postpartum haemorrhage with my last baby. BUT despite this, as long as the consultant isn't bothered, I'm allowed another homebirth, provided the baby comes out before it's 10 days late. Otherwise, I'll be lectured. If you've read this, you probably know how much attention I'm going to pay to that.

Eight weeks, and HURRAH FOR VOMIT! My sister's wedding is an alcohol-less delight, and I'm not even sick on the bus ride to and from the wedding. There is dancing. There is about 12 hours travelling all told. It ruins me for a while.
Nine weeks, and I AM OVER THE VOMIT.

Ten weeks and, no, seriously, it's nearly Christmas, I have a TMA to write, and I would like to stop vomiting all the time now. Like, in the grass on the school run, and in any vessel available, including the toddler's pot. The baby is now the size of a kumquat. I have no idea how big a kumquat is and Google to find out. Apparently, a kumquat is the same size as a 10 week foetus. Thanks, Google!
Eleven weeks, and the emotions kick in. Oh gawd, do they kick in. Christmas is TOO MUCH. The assignment will NEVER GET WRITTEN. Nobody told me you produce LESS HCG at the end of the first trimester, and that's why my mad, reflexive pregnancy tests are coming back less pregnant instead of more. Panic ensues. Reassurance is given. I go back to fretting about the five million things I haven't done, and the state of the house since bending over makes me throw up. The baby is the size of a plum, or a festive sprout. This is at least something we can relate to better than a kumquat.

Twelve weeks, and it's scan day. First impressions are "wow, scan technology has improved a LOT in four years". The sonographer shows us our baby, its brain, heart and bladder. The baby is sweet, and kicks its legs at us. We breathe a sigh of relief, hang around in the antenatal unit for hours waiting for a blood test, and show the boys their new sibling. "WHERE'S ITS VAGINA?" asks eldest, on seeing this. And then the full burden of CHRISTMAS falls upon us gracelessly. I spend much of Christmas Day vomiting, because apparently the baby objects to me ever being full up.

With my first baby, I was working full time. With my second baby, I was working part time and had a toddler to look after. This time, I have two children at school/preschool, and an (almost) full time uni schedule. This pregnancy, despite the far lesser sickness, has been much harder than the previous two because of the sheer amount of STUFF I have to get done every day. This is partly because the sickiest time coincided with the Christmas run-up. I am so glad the Christmas season at school has finished now. Bloody plays, and church visits, and singalongs, and parties, and Christmas bastard jumper day, and extra money demanded here there and everywhere for everything. Ugh, it's been a bit much. But technically, things should start to get easier now. Until the dreaded anaemia kicks in. Hopefully, that won't be til around April. Meanwhile, university work beckons, and the thought of doing an exam at 36 weeks pregnant is suddenly a real and alarming prospect.

May 2015 be as good as 2014 has been!

STOP PRESS: Mothers are bad

There has been a lot in the press recently about mothers. Mothers, I think we can all agree, are pretty important. They produce the next generation, and do the bulk of caring for them (hopefully as part of a loving family unit) until said generation are big enough to take care of themselves. You could argue that parenting is the most important job in the world. However, the press has been resoundingly negative about mothers. Mothers are BAD.

First, we had the woman prosecuted for drinking in pregnancy, resulting in a baby with foetal alcohol syndrome. Now, current NHS guidelines say don't drink ANYTHING alcoholic, AT ALL when you're pregnant. When I had my eldest, it was 2 units max a week, when I had my second, it was preferably none, but not more than 1 to 2 a week. So, in the last six years, this has changed. When my mum was having me thirty years ago, there was NO recommended restriction on alcohol in pregnancy, and very little advice to stop smoking aside from perhaps to cut down a bit. However, we were not plagued with children born with F.A.S in the eighties and before. Foetal alcohol syndrome only happens when the pregnant mother is an alcoholic. Most pregnant women are not alcoholic.
Now, women who plan to breed should probably be glad that the woman prosecuted was not found guilty, because if alcohol consumption was illegalised in pregnancy, they might risk being arrested for having a solitary glass of wine at a wedding, or after work. And that would have opened the doors to smoking being illegalised in pregnancy (which would actually be kind of sensible since the link between smoking and foetal damage is better understood than that of mild/moderate drinking and foetal damage), but I'm fairly sure that most smoking women consider the sheer weight of expectation to quit in pregnancy is a sufficient deterrent.

Next, we had the great breastfeeding in public debate rear its ugly head. And I say ugly head, because there is nothing uglier than people trying to claim there's something obscene about feeding a baby. There really, really isn't. Babies need feeding, doesn't matter how you do it. When they are very tiny, they need feeding all the frickin' time, literally, for eight to twelve hours a day. It's not obscene for your baby to need feeding. It's not militant for your baby to need feeding. It's not exhibitionist of your baby to need feeding. Breastfeeding mothers still need to leave the house occasionally, and sometimes they may time it wrong, or have a baby that is teething, or ill, or growth-spurting and unexpectedly demand food. And when babies are hungry, they scream. They howl. They cry like they are being murdered, getting increasingly hysterical, and making people tut. The nice thing about breastfeeding is that the milk is there, ready to go. No "shit I haven't got a bottle" panic.This whole idea that WOMEN DO NOT NEED TO BREASTFEED BECAUSE FORMULA is the most ridiculous thing I have ever heard. Even the WHO call it bollocks. Formula has become the socially acceptable way of feeding babies, primarily because society is so freaked out by breasts.
I say 'society', as Farage has pointed out, it's mostly men. Urrrghhh, that woman's using her breasts for their biological purpose! Next thing, she'll be GIVING BIRTH FROM HER VAGINA, or something EQUALLY OBSCENE.
The fact is that it is illegal to ask a woman to stop breastfeeding in public. Trust me, as someone who has fed babies all over the place, from the living room, to the pub, to the party, to the shopping centre, if you are offended by seeing a curve of nipple for literal seconds, you need to perhaps re-evaluate your priorities instead of blaming breastfeeding women for making you feel slightly uncomfortable about society's preoccupation with SEXY BOOBIES. Or, you know, join the anti-Page 3 lobby.
 **

Finally, the terrible and tragic case of Charlotte Bevan. Now, until the inquest, it won't be clear whether she was suffering from puerperal psychosis or 'just' struggled to cope with new motherhood. I put just in inverted commas, because the immediate postnatal period is a time of exceptional stress and emotional upheaval in every single new mother. The leading cause of maternal death is suicide, which should be shocking, yet oddly isn't. It doesn't matter whether it's your first baby or your seventh. It doesn't matter whether you have a history of mental health problems or not. However, with your first baby it is a more pronounced shock, because you're unprepared for the bodyshock, for the odd new emotions, for the responsibility. The key to getting through it is support, and unhappily, many new mothers don't get enough, I've discussed this ad nauseum before. The provision of mental health care during pregnancy and perinatally is rubbish. I suffered very poor mental health antenatally with my second child and received essentially no help except for my understanding GP whose hands were tied. Thankfully, I got better when he was born, not worse. It is a gamble the NHS should not be willing to take.
The Daily Mail, spawn of Satan that it is, wrote an article on how she lived in A NICE EXPENSIVE HOUSE, and had been listening to R Kelly before she went missing. All the papers have suggested NHS maternity wards need better security. They already have good security to keep out baby snatchers, but women who have just had babies are not prisoners. They need help, they need support, they need a lot of love from their families. They don't need locking up like criminals, moreso if they WANT to go home. I had to self discharge to get off the ward with my eldest child, because there was not enough staff to observe me during the day and discharge me, and then when they tried to send my husband home, I freaked out. There is nothing lonelier than being left alone all night in an alien environment with a new baby, with your partner sent away. This was not a sign of incipient madness, just a sign that I badly needed to get away from a cold, unpleasant ward with no privacy (they kept opening the curtains when I was trying to sleep - how does ANYONE sleep on a shared postnatal ward?) and home with my family. Perhaps this should be a spur to improve postnatal care, rather than a reason to exercise medical authority over women who don't want to be there.

The media are increasingly happy to demonise mothers in pursuit of clickbait, with Charlotte Bevan being a particularly poignant case. Politicians are quite willing to attack public breastfeeding (the indignity!) in order to try and win votes from their conservative brethren, rather than encourage something acknowledged worldwide to be a Good Thing. People are quite happy to sit on their high horse, judging alcoholic mothers for inadvertently breaking their children, rather than wondering why there was nothing anyone could do to help. They judge women for daring to er...feed their baby in public without the protection of a niqab or something. They judge a mentally unwell woman for killing herself and her child, rather than wondering why she was allowed to get SO sleep deprived, and where her support was.

Mothers are important. Be kind.

**It makes me sad that I have to add this to every feeding-related blog I write so I don't get attacked as some sort of breastfeeding nazi, but please feed your baby however you want. This isn't an attack on formula feeding, but an attack on people who think breastfeeding is obscene.

Introductions and Conclusions

There are two common issues with TMA writing. The first, referencing, has been dealt with here before. The second is "how the hell do I write an introduction/conclusion?"

Now, the introduction and conclusion of your TMA bookend it. They demonstrate that you know what you're going to write, and that you can summarise what you've written about at the end. And they are vital, because most essay TMAs take them into account in the marking scheme.
So, how do you write them?

Well, first off, you don't have to write the introduction when you start, and the conclusion when you finish. I often write the conclusion first, before I write anything else. I may well totally rewrite it before submission, but it focuses my mind on what the final result should be. Conversely, I often write the introduction last, when I know what I've written about. You don't have to write your essay in order at all - I'll often write a few sentences that I want to get in, but I'm not sure where, and then ease them in at the end. Or not, if they turn out to be unnecessary. The important thing is to START writing.

It's times like this that an essay plan helps. I SCORNED essay plans when I started my degree. "I don't need them, they're a waste of time", I thought. But with time, I've come to value them, both as a template, and as a working frame of reference. If you have a vague idea of what you're going to write about, and in what order, before you start, half your problems of arranging the content in your head and on the page are solved. If you can work out how much of your word count you need to give to each segment, then you have an idea of how long each part needs to be.
An introduction and conclusion should not take up more than 20% total of your word count. With a thousand word essay, try and get your introduction and conclusion at around 100 words each. Any more, and you're probably waffling.

So, introductions. I tend to be pretty explicit in my introductions about what I'm going to write, and allude to the TMA title. For example (and I'm making this up as I go along, so I really hope it's not actually a TMA title), if your title is "Discuss Cordelia's motivation and actions in Act One of King Lear", then you need to mention in your introduction that your essay is about Cordelia's motivation and actions in Act 1 of King Lear. This may sound REALLY OBVIOUS, but you don't need to be Shakespeare to write an introduction.
"In the play King Lear, Cordelia is a central character. She is the youngest daughter of the eponymous king, and in the first Act appears only once, and greatly displeases her father. This essay will examine her actions, and discuss the motivation behind them."
And that's it. In under 50 words, Cordelia is introduced, and the reason for writing the essay is explained.

Conclusions are equally simple. You have, hopefully, done what you said you were going to do in the introduction and written an essay discussing the motivation and actions of Cordelia in King Lear, or whatever your essay title was. Now, you need to sum up your findings and signal this is the end of the essay.
"To conclude, Cordelia's love for her father is unsullied by greed, and Lear is unable to accept the simplicity of it, as he is so used to abundant, false praise. In trying to be honest, Cordelia is disinherited by her father, but her honesty wins her the King of France as a husband." 
And again, in 50ish words, the essay is rounded off neatly. All a conclusion does is state, briefly what you've written.
(I'm not an English Lit student, can you tell?)

So, don't fret about intros and conclusions. Fret instead about your essay argument, whether you're meeting the guidance (because if the guidance says read X, you better read X, and reference it, and quote from it if necessary), and whether or not you'll ever finish the horrible thing.

Good luck!

Limbo

Foundation year was hard work for Jimmy. The Early Years Foundation Stage framework suits 90% of children down to the ground. Freeform, learning through play, no desks, no books...it's all good. But not for Jim. Jim really struggled with the lack of structure, with the lack of routine, and with needing to share his time between activities. And because Jim struggled, the staff struggled to cope with him. It took six months for them to get the staff in place for him to attend full days. It was very difficult for me, because I was constantly told what he'd done wrong, what I should be doing with him, and felt to blame. It is difficult to accept a violent, difficult five year old's behaviour isn't solely because of the parents.

Summer holidays were also difficult for us all. The first couple of weeks were OK. We did structured learning every day at "Mummy school", which sounds massively pretentious but was just me trying to teach him to read. By giving it a name, a place and a time each day, he actually accepted it. Until the wedding. Our wedding somewhat knocked Jim off balance. He went to stay with his dad for ten days; the longest he's ever stayed with him, and he didn't settle back down afterwards. He didn't sleep, he didn't want to do anything except watch videos, he was violent to his brother, and to other visiting children. We took him out to Bewilderwood for the day (amazing place, thoroughly recommended for children) and he ran away, and threatened to cut a woman who came too close to him. He went feral at my brother's wedding, biting balloons and attacking children, until he wore out and asked to be taken home. He became increasingly 'locked in', and wild. His dad has been helping to put up a united front, regardless of whose house he's at, in terms of rules and reward. This mainly made Jim not want to be with either of us.

He went back to school last Wednesday. It's already apparent that the structure of year 1 suits him a lot better, although his actual performance is pretty low. He's going to take a few weeks to settle back into going to school, and the ringing cries of "I HATE SCHOOL" are probably something we'll be dealing with for years. I'm trying to find a decent wrist restraint I can use on him during the school run, to stop him running off. If anyone has any ideas, please let me know. To some, the idea of physically restraining a child is repellent, but I have seen Jimmy stop in the middle of the road to pick up a toy, and be deaf and blind to the car blasting it's horn inches from his back.

What has got us through the last six weeks of occasional garment-rending despair is knowing that he's on the waiting list for an autism assessment, and once he has that, he can get referrals to occupational therapy etc, as well as more input with the school. The school, for what it's worth, are being far more useful this year, and have managed to get him almost full time one-on-one supervision.
Today, I rang the hospital to ask how much longer the waiting list is. And alas, the answer is that they've lost a lot of staff recently, can't get locums to cover, and simply don't know.

I've asked to speak directly to the neurodevelopment team, just for some advice. I'm fairly sure Jimmy's sleeping problems are due to melatonin deficiency. He's been in the same routine for OVER A YEAR, with no improvement in time it takes to fall asleep (min 60 mins, max 3 hours) or how frequently he wakes up. I'm also sure his sensory overload is much worse when he's tired, which is almost invariably because of his sleeping problems. And he is so violent. He bashed his brother over the head with a wheelbarrow, and jumped knees first at his neck. He also scratched my godson to ribbons. Violence and coercion have become his favoured social tools.

It makes me wonder where I can find the cope to keep dealing with him, when it feels like everything I'm doing is wrong. Everyone has an opinion on what would work with Jim, and all I want is a professional opinion, which is the one I cannot seem to get.

Just Married

On 8th August, one of the wettest days of the year, me and my beloved Tom got married at Rutland Water.

It was perfect.

World War One

One hundred years ago today, World War One started. I don't know of much personal history in WW1. My dad's granddad lost his leg after a shrapnel wound, and one of my mum's granddads lost his mind. My family were not high status officers, or medal recipients, as far as I'm aware. Unlike World War Two, which is still in living memory for many, WW1 never really has been in my lifetime. It's almost a ghost of a war, as all wars end up being.

Last year, I went to France for the first time. We stayed in Verdun, which saw a year long battle in 1916 between Germany and France. When driving to Verdun along the A roads, we saw hundreds of war graves. Thousands even. Not in huge, formal cemeteries, but in small ones, just by the side of the road. And every single one is immaculate. Someone still cuts the grass. People still visit the gravestones. Bodies are still dug up every single year, and nobody knows who they are. In that area of France, WW1 is not a distant memory: it's living history.

Nothing drove into me the sheer horror of WW1 like seeing those small, unforgotten, cemeteries. Nothing drove into me the numbers of men who died like seeing the lines of white headstones. No TV footage, no worn memorial in a town centre or church, no amount of paper poppies can hammer home the scale of death like seeing the graves of the men who died. The endless sea of white on green.

Wars are happening right now. Terrible wars, wars for land, resources, religion. Wars where children are ripped to pieces alongside adults. And we shake our heads at the destruction, watch programs on the horror,  make infographics and pithy anti-war slogans, and write blogs about how awful it is. But how easily humanity forgets the slaughter, years down the line.

Some have condemned today's memorial services for celebrating the advent of World War One. But it's not a celebration. It's a commemoration of millions of lost lives, civilian as well as military. An acknowledgement of the millions more lives marred by war.

Just remember.

Understanding autism

Autism is difficult to understand. It is difficult for someone with normal brain function to fathom that someone's brain can be wired wrong, and yet still work. The brain is unfathomable to many, and the idea that neurological connections can go wrong but still create a working person is even more abstruse. Therefore, the idea that someone who looks normal, but has a messed up brain is difficult to swallow. The invisibility of autism is the root of most people's issue with it.

And HOW people take issue with it! There are plenty of folk who believe it is caused solely by bad parenting, linking it up with ADHD because it starts with the same letter and seems to affect children more than adults. There are plenty of folk who simply don't believe it exists, and that it's an excuse, a label to gain children special treatment. The idea that the only type of autism is the Rain Man stereotype is endemic.
The idea that autism occurs on a spectrum fuels the assumption that it cannot be real. The fact that most medical conditions exist on a spectrum passes most people by. Cancer manifestations can range from immediately deadly to an inconvenience. Even something as humdrum as hypertension occurs on a spectrum ranging from barely elevated to life threatening.

Then there is the debate of the causes of autism. The current best theory is that it is genetic. Some argue it is passed down the paternal line, but that may be because there is a higher percentage of male autists than female. However, other theories include the (somehow immortal, though wholly discredited) immunisation cause, and a variety of Daily Mail-esque causes related to maternal intake of Substance X in pregnancy. So, if you have a family member with autism, it can be difficult to accept there may be a genetic link. I don't know whether this guilt-denial is the same in other genetic conditions, like the breast cancer gene, or whether it's restricted to birth-onset neurological problems.

There is as much difference between autistic children as in any children. I personally know six autistic children other than my son Jimmy, and every single one presents differently. My son and godson are similar ages, both with ASD diagnoses and are completely different. The other autistic child in Jimmy's class is totally different again. The common threads of diagnosis are difficulty with social communication, difficulty with social interaction, and difficulty with social imagination. For Jimmy, this means that he struggles with normal conversation, turn taking, sharing, friends, playing, concentrating on things that don't directly interest him, and engages in risky behaviour because he simply cannot fathom danger. He won't look at you when you're talking to him most of the time, and very rarely makes eye contact. His emotional palette is very limited, and he doesn't recognise emotions in other people. He cannot grasp what other people think, or what behaviour is unacceptable. His lack of concentration holds him back at school, although his intelligence and ability to understand quite complicated concepts is exceptional. He has a small collection of people that he actually treats as people, and everyone else might as well be a plank of wood for all he cares. Some autistic children have a mix up in their wiring that means they process faces/people as objects, and that is very much Jimmy's thing. He also has some pronounced sensory problems, mainly with sound and proprioception (although autistic children can struggle with any combination, or all of their senses) and his main way of dealing with the resulting overload is to fight, to scream, or simply to withdraw. Jimmy falls on the aspergers end of the spectrum, which basically means his language problems are limited. Many autistic children either never speak, or take years to learn. Jimmy copies language all the time, but he is able to speak fluently and spontaneously. When he is mid-meltdown, he loses proper language, and become single-word-repetitive. Today, it was the happy word of diarrhoea, bellowed repeatedly, for some time. I'm sorry, neighbours. His social level is far lower than his brother's, and his brother is twenty five months younger.
There is a link between autism and ability to manufacture melatonin, which means many autistic children cannot fall asleep and stay asleep. Alas, this is very much Jimmy's thing as well.

This is just what he does: any other autistic child may do something completely different.

If you took each of his odd behaviours as a single entity, they could be explained away. Every child does something a bit odd that falls on the spectrum. But the collection of behaviours together is what leads you to the diagnosis of autism. It's not a diagnosis paediatricians make lightly, because in making it you are saying "this child will have social problems for the rest of their life". It is admitting the child is disabled. The idea that you can simply present your misbehaving child to a paediatrician, get an autism diagnosis and then live without guilt, or need for discipline for the rest of your child's education is a total misconception, but very popular in people who don't want to know more.

I was relieved when Jimmy was diagnosed. Not because I want him to be autistic, but because it meant there was a reason for the way he was behaving. I have felt since he was a baby that there is something wrong with him, and I finally got validation for those feelings after almost five years of being sidelined and ignored. But the reality is that he is significantly disabled by being autistic, and I have to be his advocate in everything. This is another thing that is generally overlooked by the Autism Is Not A Thing brigade - it is really hard work to be the resident parent of an autistic child.
There are lots of meetings where you're told what your child has been doing wrong, and it's your job to try and guess what insignificant thing has been the trigger, so you can avoid it again. There are meetings where you sit with clinicians and are told "this is what he's doing that isn't normal", and meetings where you sit with your child's headteacher because they want to exclude him for behaviour he can't control. There are meetings where you have to essentially put yourself in their shoes, and then walk around an area so you can spot things that might set them off, and then work out avoidance techniques, because there is no way the child has the self-awareness to do it themselves. I spent an hour and a half at Jimmy's school last week, looking at his new classroom, meeting his new teacher, meeting his new SENCo and trying to explain him, and even that wasn't time enough to give them all the information that might help. Then there's the strain on your personal life, the lack of time spent with your partner because your child needs almost constant supervision until he eventually goes to sleep around 9pm. The lack of spontaneous days out, when every potential venue has to be scouted for likely triggers. The general isolation of not being able to go out and see friends or family without weighing up the likely cost in terms of his sensory overload, because there's always a payoff in the evening, with the extended bedtime and the screaming. The worries about major events like weddings, wondering if he's going to be so uncontrollable that he'll ruin it. Trying to balance out his needs with the needs of his neurotypical brother without doing either of them a disservice. It's difficult sometimes to find the positives, especially after a bad week.

It's a constant, steep learning curve. So forgive me if I get annoyed when people tell me there's nothing wrong with my child, he just has a 'few problems' because the reality is somewhat harder, and more complex than that. It is a difficult condition to get your head round, and it is a complicated condition with many variables and an unclear aetiology, but finding out about it can only benefit you if you've got autistic people in your life.

If you'd like to know more about autism from a more objective point of view, I recommend the National Autistic Society's full and informative website.