Vaccination decisions

This is a contentious area at the moment and I, by no means, am an expert. The information in this post is a culmination of what I’ve discerned as legitimate information on the internet and therefore subject to error and misjudgement.

This week I will be offered a vaccination against Whooping cough (Pertussis) because there was a sustained outbreak of it in 2012, and whilst cases are now falling, they are still unusually high. Thousands of people a year in the UK have been taken ill, including tiny babies who are hit by it the hardest. Some have died and there are heartbreaking accounts from parents on the internet that tapped into my deepest fears as I read them over the weekend. It’s highly contagious and caught through droplets and vapour in the air from people sneezing and coughing. It doesn’t seem like there is a very effective way of treating it and the administration of antibiotics just prevents contagion from the sufferer, other than that you just have to hope their tiny lungs have what it takes it battle it.

The danger zone is the period before the baby is 8 weeks old. By 8 weeks they will be given their own primary vaccination, but before that they are vulnerable. So the NHS have decided to give pregnant mothers a whooping cough booster. This way the antibodies transfer to the foetus transplacentally, giving her the defence she needs for the first few weeks of her life. So far so good.

The vaccine the NHS are administering is called Repevax – from what I can gauge, Repevax is the copyrighted brand name for the vaccine ‘DTaP’. DTaP is a vaccine against Diptheria, Tetanus, Pertussis and Polio.

All of this sounded fine-ish to me, because growing up I had every vaccine going. Although I am still confused about why you need to sling an extra three vaccinations in there, if Pertussis is the only significant threat at the moment. Feels a bit like they had some left over in the warehouse and made do, or maybe they got a good deal on it?

Understandably I feel nervous about going from policing every chemical I put on or in my body (including using an organic deodorant made from exotic fruit and jojoba extract that cost me a very cheeky 15 quid) to blindly putting my faith in the NHS, holding out my arm and allowing it to be injected with agents and chemicals that I don’t understand. I’d never really cared much about looking into vaccines I’d been given before, but now I’m carrying a passenger without a voice I wanted to extend her the courtesy of doing some homework first.

In addition to this, Jake is cynical about the ethics of the drugs industry and his inclination is to refuse all of them unless absolutely required. I don’t necessarily disagree with him. It seems widely acknowledged that successfully peddling drugs to large medical organisations is a dirty, corporate world. There isn’t some divine board of ethics selecting our drugs with only our best interests at heart. The final selection is probably down to drug company tactics motivated by profit and slick drug reps thinking only of their commission. Less cynically, it’s down to what the NHS can afford. We don’t have a bottomless pot of money to give the whole population the best healthcare money can buy, all of the time. I’m sure the NHS have to make pragmatic decisions all time about who gets which vaccine and when and maybe sometimes, it’s not the most perfect solution.

We both also believe in being socially responsible. We’re aware there are some people who are allergic to vaccines and therefore rely on herd immunity – people like us – to have them.

All things considered, we realised we needed to know more about Repevax to feel comfortable. A quick Google search did not provide us with that comfort. The Summary of Product Characteristics says:

“The use of this combined vaccine is not recommended during pregnancy”.

This is because pregnant women are routinely left out of clinical trials, and therefore they can’t say categorically what the effects of the drug are on a foetus.

The NHS have responded and said although the drug is not ‘recommended’ it is not ‘not recommended’ or ‘cointraindicated’ as they call it in the world of drugs. Repevax is given to three years olds as a whooping cough booster, so it has been tested in that capacity, but has only been administered to pregnant women (apparently 60% have taken up the offer) since 2012, so it’s still early in the game. We can’t even learn from The States because, despite the fact they have been administering DTaP to pregnant women longer, they don’t give them Repevax – they give them some other brand.

It really weighed on me researching this, because invariably you come across stories of babies that died of whooping cough, and for every one of those there are heartbroken parents whose babies were stillborn who are utterly convinced it is down to this vaccine – as they maintain the deterioration started around 32 weeks – the time it was administered. The NHS say this would have happened anyway and that there is no link, but it still leaves an uneasy feeling.

The situation isn’t ideal. I either a) just take it and worry about consequences b) don’t take it and spend the first eight weeks of the baby’s life as a paranoid wreck worrying she will catch Pertussis or c) do a combination of what they call ‘cacooning’ and quarantine: Jake and I have the vaccine after the birth and then she and I stay inside for two months until she’s ready for her jab and receive no visitors.

After debating these three, frankly shit, options I came across some more research that has been done recently. In reaction to the concern, the manufacturers of TDaP have rallied around and collected birth registries from all the births by mothers that were vaccinated. The results showed that there was no ‘elevated frequency or unusual patterns of averse effects’ in women that received TDaP, which gives me an element of comfort.

The other important thing to acknowledge is that, at 32 weeks, the baby is completely physically developed. I think there is still some reinforcement going on the lung area, but the baby is pretty much just getting fatter until her due date from weeks 32 onwards.

It must also be mentioned that the other three components of TDaP (Tetanus, Diptheria and Polio vaccines) have been given to pregnant women for decades, it’s just the Pertussis element that is new.

The last three points cited have helped me decide to have the vaccination, but I don’t feel comfortable with the situation, or with the lack of information from a recognised and trusted authority addressing the fact there have not been clinical trials of this vaccine for use on pregnant women.

I found an article by the BBC quoting the Chief Medical Officer Prof Dame Sally Davies as saying the vaccine was a ‘no brainer’ during pregnancy. I welcome the reassurance, but with no clinical trials under our belt to show us the long term effects of giving babies a pertussis vaccination in utero, should it be?

Advertisements

Prambling on: our journey through Pramsville

This post is about prams and will be arse-achingly boring for anyone who hasn’t been, or is going through, the rigmarole of buying one. If you fall into this category, sorry, I’ve just wasted five seconds of your precious life. I won’t be offended if you stop reading this post now and go and do something more interesting. Like putting your DVDs into genre categories, boiling an egg or trimming your pubic hair.

I really haven’t been looking forward to choosing a pram. It strikes me that it is similar to choosing a mobile phone contract, in that you have to take it seriously and research because once you’ve purchased it, you’re committed to it for two years + and don’t want to be the object of other people’s pity when they realise you are stuck with it – and subject to comments after the fact such as: “ahh well, if you wanted all-you-can-eat data you should have gone for X contract, it’s way cheaper”. Yeah, thanks. Nice of you to pop up with your helpful bloody insights now I’ve signed on the dotted line.

Despite my slightly stressed tone, we have actually made major headway in our journey through Pramsville to the temple of pram ownership.

We started shakily, with me a gnat’s wing away from purchasing one yesterday based on it having pretty colours on it and being funky. To be fair to me, I also tried it out in John Lewis and it was very easy to manoeuvre and was a reasonable price (nb: ‘reasonable price’ in Pramsville means £400. The exchange rate is four pram pounds to every regular pound in Pramsville. I know, it’s not an advantageous exchange rate, but it’s a hell of a lot cheaper than going to Weddingworld where twenty of your regular pounds only counts for one). Anyway, I digress. After I got home I found it online even cheaper. My finger twitched over the ‘buy’ button, but mercifully, I decided to check the reviews just in case. I had previously been lackadaisical about this because John Lewis only sells things that are proper, right? Turns out the funky prams were on Watchdog last year because the frames kept collapsing with newborns inside them. Also turns out the matching car seat (only £100 as an add on, which is just a meagre £25 in Pramsville) handle had been breaking as mothers carried their newborns, causing one mother to throw herself down a flight of steps to break her newborn’s fall. As a result the purchase was intercepted and we resolved to roll our sleeves up and get involved in some Which? rankings and research – rather than mindlessly steaming in to Pramsville like two clueless Gringos holding a massive map and wearing socks underneath our sandals.

(I add as a side note: the funky watchdog pram brand have now apparently sorted their shit out and released a new, safe batch – but for me, just the thought that it might happen again is enough to cross them off my list).

After reconvening, we embarked on some extensive Googling, drew up the below checklist and headed into Kingston to get hands-on:

Pram / buggy criteria:

1. Is it a 3 in 1 travel system? (does it lie flat for a newborn, sit up for an older baby, and can you reverse it for parent or world facing options?)
2. Detachable carry cot? Good not to have to wake the baby when you get home.
3. Good suspension / smooth ride?
4. Adjustable handlebars so mummy and daddy can both push comfortably?
5. Maxicosi car seat compatible (we are kindly being donated one)?
6. How many years will the baby fit in it?
7. How small and easily will it fold?
8. How nippy and light is it for getting on public transport?
9. Storage space below?
10. Is it safe and trusted?

The list could easily go on, but we’ve had to draw the line.

After two hours hard graft at the showroom coal face, we retreated to Bentalls cafe for a coffee and some carrot cake. As we sat discussing the merits of on vs off road models – the universe delivered us a gift in the shape of a lovely, normal, relaxed couple with a two year old girl who had been sitting behind us. I’d noticed them before as they looked wearied but good humoured while their little girl flung herself on the floor and flapped around, convulsing and shouting: “I’m a fish! I’m a fish!”

The lady leant over and asked if we were talking about prams. We said we were. She’d had four different brands already and gave us a helpful summary. She also told us she’d bought all from a second hand shop down the road for a fraction of the price, and reminded us that a pram is not something you need sitting ready before the birth. She carried her newborn in a sling for the first two months and then they took her into the store and put her into the prams to test them. After they left, we felt relaxed. We have time. Jake has even reduced his criteria to: ‘one with a beer can holder’:

20140524-160816-58096221.jpg

Growth spurt

I think the sun, swimming and all-inclusive food supply in Mallorca triggered a growth spurt. Everyone is aghast how massive I’ve suddenly become:

20140522-091751-33471881.jpg

Right now, I feel quite beautiful carrying my bump. When I catch my reflection I’m all curves and contours. I, perhaps misguidedly, feel like the belle of the ball – with people paying attention, staring and commenting. They are probably thinking: ‘crikey, poor thing’, but I’m so proud of my shape as a sign of my (hopefully) thriving little girl.

My younger sister is a midwife and has had a prod of my belly. She says the baby inside is still quite small – and it’s just my womb that’s expanded, giving her a relatively large arena to swim around in that she will grow to fill.

Currently grappling with the world of prams and buggies. Three-in-ones, foot muffs, adjustable frames. I need to immerse myself in the detail to make sure we get the right one considering how pricey they are. I promised Jake that we would get a second hand one, and that I wouldn’t get sucked into the world of fancy status prams and pointlessly expensive yummy mummy accessories, but now it’s come round to it – I don’t want a battered a second hand pram with Greggs pastry flakes in the cracks that smells faintly of another infant’s sick. I want a sparkling carriage for my princess. I may regretfully have to renege on my promise and buy her a new one, by hook or by crook.

Also downloaded a hypnobirthing hour session from iTunes, focussing specifically on pain management. The jury is out so far. I must confess I turned it off after twenty mins. I can’t really relate to it at the moment because I’m not actually giving birth. Maybe it will seem more relevant when there’s someone the size of a bowling ball barging their way through my nethers.

Feeling well and positive. My breathing has gone geriatric: short and breathless – but that’s normal as your diaphragm gets squashed. I have maddening restless leg feelings in bed at night where I just want to kick and punch my legs, which feel like they are pent up and twitching with energy.

Jake and I are having more frequent ‘is this really happening?’ moments, as we try to wrap our heads around the fact that she is going to materialise and isn’t just a fun idea and something to look forward to in the future. She will actually be here. Soon. She will fill the baby grows in the drawer, the house with noise and the bin with shitty nappies. I have never waited with such anticipation to meet another human being. Some days I feel I will combust with excitement.

Holiday!

I’m on holiday in Mallorca with Jake, my mum and dad, my two sisters, their husbands and their kids – aged three, one-and-a-half and six months. We are a tornado of brightly coloured sun hats, buckets, jelly shoes and half chewed croissants.

This will be the last holiday for a long time where I can move around freely as a single entity, choosing activities and pass times based solely on my own whim. In two months our gurgling Buddha will be here, clinging, demanding and orchestrating our movements like a chubby, midget conductor.

I’ve just left the group to steal a swim in the pool and then sit in my room on my own for a moment or two. I’m savouring the silence and stillness and I’m looking in the mirror at my unfamiliar eight month pregnant, bikini-clad body. My belly is an unapologetically huge and hard half-egg shaped protruding wok. My veins have risen to the surface of my skin like blue vines creeping across my boobs, stomach and thighs, and my knees and ankles are puffy and look like someone else’s.

As I observe my new form, I feel a punch from inside and see my stomach jolt in the mirror. Not long now, she tells me.

Happy heart

28 week check up was very straightforward. My neurosis about the appointments has ebbed away. They did the usual pee, blood and blood pressure test and listened to the baby’s heart. The midwife said her heart sounded happy, which makes me happy. She asked about patterns of movement but I haven’t really discerned a rigid pattern. It just seems like every time I stop what I’m doing to check on her, she moves eventually. And of course there’s the body popping at 4am – which I probably have my own genes to blame for. She generally moves after I drink or eat and if she doesn’t, I press my hands on each side of my belly and move them into the centre until she stirs. Probably not very polite towards her but it’s temptingly reassuring.

A community nurse came round to my flat on Tuesday to talk about breastfeeding, post-natal depression, cot death, colic, how happy my childhood was, whether the baby was planned, vaccinations, controlled crying, temperatures, baby weight loss and gain – oh, and she gave me a crap colour chart. I don’t mean a poor man’s Dulux spectrum, I mean a visual that literally depicts the different colours of baby faeces that we need to witness passing through her during her first weeks in the outside world.

I am starting to see why some mums feel upset if they can’t breastfeed, as you are lambasted with information on how ‘breast is best’ by the NHS. Of course it’s the desired way – and cheaper, but I’m not going to beat myself up if for any reason I can’t. I wasn’t breastfed and was a very healthy baby and child.

I learned that interestingly, your boobs deliver ‘starter, main and pudding’ courses throughout the feed – in the shape of different consistencies of milk with varying nutrients. And the baby has it’s own instinctive drinking settings for each course. Impressive.

The nurse asked if I had heard of ‘controlled crying’. I said I had. She said she did not recommend it, and to respond to the baby if she becomes upset. Apparently they will not understand the ‘lesson’ in being left alone when they are very young, and will become flooded with Cortisol (a distress hormone), which can be detrimental to their development.

There is a lot to take in, but we are enjoying researching everything and entering into this new, crazy territory of fluids and infant behaviours. The next big thing we need to research and come to a consensus on is vaccinations. A very controversial area at the moment. I’m more inclined to have everything going, as I always did as a child and am fearful of the repercussions if vaccinations aren’t given. Jake is more cautious about giving the baby vaccinations without researching the effects, and fears corporate, money-making motivations behind the administering of some of these drugs, so we will have to research and come to a decision together somehow.

Other than that, her little boudoir is coming together:

20140508-193245.jpg

20140508-193306.jpg

And we are gradually working through the list of things that we’re told newborns need.

I’ve decided to try and make homemade wipes in bulk before she comes, and perhaps some gentle soap for her – without chemical nasties in it. The wipes are easy – and some women just mix up an oily, lemony concoction and spray it directly onto the arse – but the soap production requires safety goggles and what looks like some Breaking Bad shit, so we’ll see if my current ‘earth mother’ inclination stretches that far, or whether I just end up squirting a load of Johnson and Johnson on her in a haze of exhaustion.

Taj Mahal tits

Bleurgh. I’ve been hit by a giant wave of pregnancy hormones since Monday evening. I’ve felt constantly on the cusp of uncontrollably sobbing or spontaneously punching a stranger in the back of the head (which you’ll be relieved to know is an urge I have not indulged). Today as I drudge to work in the rain, it feels quite similar to the aftermath of a break up when you’ve done all the crying and just feel drained and low and like nothing will ever be fun or good again. And I’m really, really physically tired to boot. I sincerely hope this phase passes soon and doesn’t signify how things will be in my third trimester – which, according to my American pregnancy app, I am now in, as of week 27 (there seems to be some disagreement over when the third trimester starts).

I have a heightened awareness of this altered emotional state, and I don’t trust any of my decisions or responses at the moment. I’m painstakingly crafting and re-reading my work emails so my irritation levels and the hatred of my fellow man can’t be detected through them.

Aside from the tidal hormone influx, everything is good. The baby is active so often, I have had to abandon the ‘activity log’ I was keeping as I’d be updating it all day. She kicked me in my rib this morning and it hurt and scared me a little. Physically, I am starting to feel cumbersome and unweildly, and I’ve developed that penguin waddle that heavily pregnant women have. In the second trimester I still felt feminine and sensual, but now I’m starting to feel like a lumbering, lethargic jacket potato with arms and legs, and have been avoiding catching sight of myself in the mirror. It’s not the bump that disturbs me, it’s the emergence of *shiver* back fat.

I went to Boots yesterday to pick up some practical things for the baby like nappies, and became overwhelmed by the sea of newborn paraphernalia. Hundreds of bottle options, sterilisers, nipple guard things. Things I didn’t know I needed or that existed. How does one choose a nipple protector? My impulse was to find a mirror and pose with them over my nipples in the store like a some kind of burlesque act sponsored by Mothercare, but I fought the urge. Some of them act as a milk catcher so you can collect errant milk and walk around with it sloshing about in your bra. Is this necessary? I remember a colleague emphatically recommending a brand of nipple guards and struggled to recall the brand name, but I’d glazed over quite early on in the conversation, so alas, the insight evaded me. After five minutes of staring at them all, wondering why some of them looked like parts for a transparent miniature replica of the Taj Mahal; and whether the shape was what was in store for my own nipples, I became upset due to delicate emotional state and fled from the shop. I will return when I am stronger, perhaps with Jake for decision-making support.

20140501-133015.jpg