Doula's do more

Wonder's will never cease...my husband attended a Doula meeting on Christmas Eve.

Knocked up....now what? Vaccinations - Whooping Cough

Things are getting serious now, I'm 19 weeks pregnant and last week my Doc dropped into conversation that she should give me a vaccination next month. This would be mostly to help prevent whooping cough, and also diphtheria and something else beginning with P that I couldn't quite catch. 

Knocked up...now what? Am I Incompetent?

Or to be more precise is my cervix incompetent?

Just over a month ago, when I was 14 weeks pregnant, my doctor dropped into conversation that she wanted to test if my cervix was ok, it might be opening, and she might need to put some stitches in it.

That was pretty much what she said, no more explanation, very matter of fact, and she made it sound perfectly normal. 

Doulas - a friend in an hour of need

So I was brave and went to my very first "baby group" thing yesterday.

Doulas of Bangkok meet on the 4th Saturday every month at Kuppa,  39 Sukhumvit 16, Khlong Toei, Bangkok 10110 (see My Map page for directions)

Miscarriages - How to cope in Thailand

This post was the main reason for me starting this blog but its taken me a while to build up the courage to write this.

Fur Babies

Our original Doctor recommended that we get rid of our cats....

But how could anyone get rid of these fur babies!!!!

Where to buy fresh veg in Bangkok

This is todays haul from Sam Yan market!

Where is Sam Yan Market?

Take an MRT to Sam Yan station and its an easy walk from there - its opposite the entrance to Chulalongkorn University Stadium.

Getting the right vitamins and minerals (keeping things flowing)

Am I the only one that thinks its hard to get a balanced diet of vegetables in Thailand?

Food here is sublime but when your baby bump has decided it can't stomach anything more spicy than Margaret Thatcher's nightie what do you do in Thailand for vitamins and fibre?

Knocked up...now what? Chromosomal Testing

Having lost 3 babies, one of which we know was due to Trisomy 21 we knew we  wanted to have Non Invasive Prenatal Testing (NIPT). From the moment we found out we were expecting again we were counting down until we got these results and were treading on eggshells until we got to the 11-13 weeks window.

"Will power" my arse - How men are not superior

I'm not sure about other relationships but ours is a constant battle ground of proving who is more intelligent, who cooks the best food, who is the best at mindless trivia, who empties the dishwasher the most, who changes the cat litter and who has the most will power.

To be fair my husband probably tops me at most of this but nothing surprised me more than my husbands recent demise at completing a 3 week detox programme.

It sucks to be pregnant sometimes

OK, I've had enough now...can we fast forward 7 months where I get to hold the pink, smiley, thing that smells of "baby" and that will coo and chirp at me.

Yeah I know I'm dreaming, but for anyone else wondering what it really feels like to be 11 weeks pregnant:

1. You can't decide if the small podge on your waist is the start of a baby bump or simply chocolate biscuits. Either way your clothes are getting tight and uncomfortable
2. You can just about function in a vertical position for 2 hours, then you need to recharge. You've lost all of your Duracell abilities and are forced to re-hydrate, on not much more than water, and of course, chocolate biscuits, in an attempt to carry on with your day
3. Your mood swings are more apparent than schizophrenia
4. You work calendar is impossible to manage around your strange and unpredictable urges to either pee or stuff your face (normally with chocolate biscuits). I had to excuse myself the other day from a management meeting to inhale a chocolate brownie, it suddenly became a life and death situation, it was the brownie or my baby was going to start eating me from the inside out
5. You feel like a walking multi zone wine fridge, only you can't keep each zone at the right temperature. Your head will suddenly seem too hot, whilst your feet are freezing and then all of a sudden your feet start jumping around with irritable leg syndrome whilst your shoulders start shivering
6. Your favorite food has become the enemy, giving you at best only "wind" but at worst, nights full of heartburn and sicky burps
7. Your dreams have turned from nothing important, or memorable, into Brad Pitt orgies in birthing pools, with Brad Pitt holding the poop scoop
8. A conversation with anyone about your woe's is impossible because your friends without babies don't understand, your friends that are trying for babies are envious and your friends with babies can only remember the "baby smell" and "how it's all worth it"
9. Your husband can't associate with your problems because you don't look pregnant and he still thinks that life will be a bunch of roses and that nothing will change when the baby arrives
10. And your brain has just started the process of turning to mush, so you may have already forgotten what you read at the start of this post

Anyway, nothing I can do about it now, I got myself into this and hopefully my baby will come out of it (as it were). But I will happily admit that I don't think I'm going to be good at this pregnancy malarky...

TIT - King Bhumibol the Great

My husband first taught me the meditative technique of quietly repeating the word "TIT" to yourself over and over again.

It stands for "This is Thailand" and is sometimes the only way you can explain things here when all common sense seems to have evaporated, or may not have existed in the first place.

Tonight I am sitting at home praying to the internet god for his wonderful ability to send me internet television in Thailand.

It is a sad time in Thailand as we have lost the very dear father of the nation, Bhumibol Adulyadej, known as King Bhumibol the Great. He is so revered that it has hit the nation incredibly hard and we have started 1 year of official mourning, where Thai TV has banned all "entertainment shows", and we have to wear black for the foreseeable future.

Selfishly, up there in some of my first thoughts, was how on earth will I cope with my growing baby bump with only 3 black work dresses, 2 black maxi dresses and 2 black cocktail dresses in my wardrobe, and what if I can't find black maternity clothes in Thailand???!!! 

I then panicked about what television I would be able to watch whilst I'm lying on the sofa trying not to vomit most nights.

I havent solved the clothing dilemma yet, but thankfully we do have internet television with some channels that do not seem to be affected by the entertainment blockade.

All our thoughts are with our Thai friends and colleagues, the King was a great inspiration for the Country and will be truly missed.

Knocked up...now what? Chillin

Maybe the Thai's have got something right about this pregnancy lark.

I find myself once again in the early weeks of pregnancy. This is the 4th time and of course there is a lot of trepidation. But this time I am doing things a little differently, I'm doing it Thai style.

My doctor, at the moment, is Dr Somsri (Bumrungrad). She specialises in high risk pregnancies, she is very chilled (for a doctor), she smiles and laughs and talks about her family (even when you would prefer to be talking about your expanding family) but she is lovely and her English is excellent, and she even has a dose of empathy and cultural understanding.

But Thai doctors, and therefore Thai people, can be a bit worrisome and tend to air on the side of caution, with basic advice amounting to "don't move", 'don't think' and forget about having anymore fun.

As with the previous non viable pregnancies I was planning on toughing it out as I meant to go on...this baby has to fit into my regime, not the other way around, and it might as well start now. Especially after having our first scan (6 weeks and 1 day) and finding a good heartbeat, and that for the first time I had some mild morning sickness which is the one thing that has probably made me the happiest for months and months...at last, maybe, hopefully, I am having a normal, healthy pregnancy.

But then it happened.....

That dreaded little drop of blood on the toilet paper (that toilet paper that all us TTC women are now so accustomed to studying in more detail than a mother looking for lice after an outbreak at nursery school). We were about to fly to Singapore the same day for a fun filled (now sober) weekend with friends and I didn't know what to do, less than 24 hours earlier I had seen my babies heartbeat, could it have gone so horribly wrong so quickly????

I called Dr Somsri and her advice was effectively "don't move", 'don't think' and forget about having anymore fun. She doubled my dose of Progesterone, but told me not to worry and scheduled me for a scan in 7 days, she also told me not to fly and that I should move as little as possible and have bed rest, I guess in this type of situation gravity definitely isn't your friend.

I have been finding it hard to focus on work, and to be honest my boss is a prick, plus the nausea and cramping had been genuinely getting a little worse, so for the first time ever it was easy for me to follow doctors orders, and I am currently on a full weeks sick leave doing nothing but lying down and watching TV box sets.

For the first few days I was genuinely worried. I don't know if it was mind over matter but my cramps and nausea were getting much worse, and the cramping was really worrying me. 3 days in and I tried to sit up to type some emails and 30 mins finished me off and gave me every justification I needed to lie back down and finish Season 6 of Game of Thrones. 

I'm now 6 days in to doing not much at all (with 2 days until our next scan) and I am starting to feel less worried, although even a walk to the toilet seems to set off unexpected cramps and once again provides me with all of the justification I need to sit back down on my arse and stretch out with a warm hot water bottle.

I still feel like a fraud though. I've watched most of my friends battle their way through early pregnancy as if it was nothing more than a hangover, seeing them prep themselves for the real shit that happens after 9 months, when they will have no excuses or time to think about themselves. And here I am, lying on the sofa, now working my way through every episode of The Wire (because I missed the hype the first time round).

But, this is my 4th chance, and I don't want to mess this one up. I do want to be able to look back and think that I did anything wrong, I want to start putting my baby first, to get used to the idea that life is no longer about me and instead is about protecting something innocent.

So here I am, being and thinking like a mum for the first time ever. Work is almost out of my mind, the condo is tidier, dinner is prepared on time and I've even made ice cream and baked a cake...this shit is getting real and I want it to keep getting "real".

I want as much "real" as humanly possible, so I'm gonna chill and I'm gonna chill and I'm gonna chill some more, because I'm in Thailand, because I am lucky, because I have worked hard up until now to make some of that luck, and because I can....and because it's how the Thai's do it.

Knocked up...now what? Choosing a Doctor

So you've confirmed in your own mind that you are pregnant, but how do you find a doctor that you can trust and that speaks enough English to communicate with you effectively, and with some empathy?

Knocked up...now what? Pregnancy Tests

So you've managed to get yourself pregnant, at least you think you are, but now what...

Firstly, congratulations!!! Secondly, don't panic! Thirdly, if all you can think about is having a drink to calm your nerves then go ahead (I won't tell anyone). Fourthly, are you sure you are pregnant? Have you pee'd on a stick? Have you pee'd on an English stick or a Thai stick? Have you had a blood test to confirm?

Lets start talking about the practicalities.

Pregnancy tests

Urine Tests

Average Pee Sticks are available in all Pharmacies.

My experience is that Boots tend to only stock their own brand and one called "Exact Pregnancy Test" whilst you may find a different selection in more local pharmacies.

But the problem with Thai tests are that they are not as sensitive as you can get back home. There is no such thing as "First Response" here.

Brand	Sensitivity	Cost (THB)
Exact	over 25mlU/ml	120
Boots	over 25mlU/ml	120
Check Tru (Ovulation and Pregnancy test)	over 20mlU/ml	270
First Response	over 6.3mlU/ml	Not available in Thailand

So you will have to wait a little longer to be sure, or you can easily get a blood test done at any health clinic. 

Blood Tests

It is as simple as walking in, asking for a blood test to confirm your hcg levels and within a few hours they will email you the results.

I have used:

RSU at 571, RSU Tower, Sukhumvit Soi 31.
They charge THB 900 per test (in 2015)

http://www.rsuhealth.com/en/home.php

Wellness Clinic at Interchange Building, Asoke. 
They charge THB 600 per test (in 2016)

https://www.facebook.com/pages/Wellness-Clinic-By-Dr-Nilarat/1378033225768891

You can also get an HCG test done at any of the hospitals, but they will likely charge you minimum THB1,000 plus doctors consultation time.

If you are are using an independent clinic before you choose your antenatal provider then you may also need some help and reassurance on understanding HCG tests. I used this website to help understand the basics. http://www.babymed.com/tools/hcg-calculator

Oh how I laughed

Yesterday I found myself sniggering at what would normally be quite upsetting.

Yet again, oh yes, yet again, I was asked by a Thai colleague if I had "ever thought about having children". It was phrased as if I was almost too old, too past it, too tired to have children now.

Fortunately I was facing away at the time, focussing on making the photocopier work, I say fortunate because it might've been very hard to explain, and stifle, the strange smirk that came over my face. After a moment of brief reflection the usual ache briefly came over me, with the usual tear in my eye, but instead I laughed, laughed out loud, because to be quite frank I am at the end of my tether with ill conceived and tactless dialogues about my apparent inability to bear my husband a child.

I laughed out loud because it was a nervous, but satisfying, reaction. It quickly blew away the tears in my eyes and enabled me to quickly turn to face my attacker. Who looked startled by my reaction. She asked why I was laughing, and I was honest. I told her I was laughing because I had been asked that by Thai people many times. She quickly seemed able to judge that my reaction was not necessarily meant to be warming, and she apologised. I laughed again and told her no need to apologise. I did her the honour of telling her that my husband and I had not had luck so far, so that she could successfully report back to her friends and colleagues with a suitable amount of gossip about the farang.

She bid me the usual Thai niceties, telling me that it will happen when the time is right, and that it has not happened because the time must have been wrong. Yeah, yeah, any woman or man that has suffered a miscarriage has heard that many times. Instead why don't Thai people try to empathise with other peoples feelings, other peoples cultures, listen and learn from other peoples experiences. They carry on blindly believing that their cultural sensitivities are the most pronounced and therefore most rewarding and deserving, and the be quite frank....its laughable.

So from now on I am going to laugh every time a Thai stranger asks why I do not have children.

Buddhism and Miscarriage...am i being judged?

I've been thinking about what my doctors and Thai friends might think about how we (expats) approach miscarriages.

Getting Prepared...POAS

At this stage I had been to the hospital for some stern words about relaxing and taking folic acid but Thailand hadn't really helped me to prepare for anything or given me any real advice of "how to" get pregnant.

So I started to download app after app, full of calendars, hints, tips, recipes, positions, recommendations and statistics and this is where I learnt about Ovulation Tests. It became apparent that one could only get pregnant on a very small handful of days each month and as I didn't have any time to waste I couldn't afford to be second guessing this. I'd spent most of my life thinking that if I missed a bus there was always another one coming along in 5 mins, but I couldn't afford to be so lackadaisical about my dwindling egg supplies...this planning shit had to get real.

If you are TTC then you may already be well ahead of me here, but I once again found myself in a quandary...where could I get Ovulation Tests in Bangkok that I could trust? Given that the pharmaceutical industry here is about as trustworthy and genuine as buying a Mulberry handbag in MBK, I once again headed back to Boots to attempt to buy a brand of Ovulation Test that may be sophisticated enough to tell this old hen when she was laying an egg.

Firstly, it doesn't seem to matter how you pronounce the word "Ovulation" you will find yourself in an awkward and rather public display of pointing, shoulder hunching, graphic gesticulation and embarrasment. 

"Ov..u..lay..tion test ka?"

"Ov..ooo..ay...tion test ka?" 

"O..woo..ay..tion test ka?" ahhhh yes ka "o..woo..ay..tion test, chai ka, have ka". 

Success, at least for a brief moment.

The box they produce from behind the counter looks about as sophisticated as a toddlers doodle pad. It was called 'Baby Sure', was made in Thailand and gave me absolutely no comfort that this would be able to tell me anything more about my eggs than if I was using a divining rod to find them. But there were some English instructions on the back the box and it was the only option they had so I decided to persevere and POATS (Pee on a 'Thai' stick) and hope for the best.

As it happened they are easier to use and understand than a Boots UK branded ovulation test, which was a huge surprise to me, and I'll be honest that I think they are actually better. They have now guided me through many months of egg production, with a few successes, and by comparison my UK sticks just cause me more confusion than certainty whenever I use them.

But are there any other options in Thailand? A friend swears by another, very cheap, Thai Brand called "Check Tru". These are strip style, also contain a pregnancy test, and are about one third of the cost. 

After another false start last month, and our third miscarriage, I have decided to try "Check Tru" for my next ovulation cycle. I plan to test it along with "Baby Sure" and I'll let you know a pee by pee comparison, but for now here is a summary of the only two tests I am aware of in Thailand.

Brand	THB	Type	Style	Ovulation Tests	Pregnancy Tests	Sensitivity of Pregnancy Test
Check Tru	฿270	Ovulation and Pregnancy	Strip	5	1	20ml/U/ml
Baby Sure	฿725	Ovulation	Stick	5	0

Both brands seem to be readily available. "Baby Sure" seems to be the mainstream (excuse the pun) test available in larger outlets like Boots and pharmacies in Central etc, whilst "Check Tru"is available in places more frequented by Thai's, smaller more local pharmacies.

You may find on occasions that pharmacies have run out of tests, but do not despair, there will always be one available in a pharmacy you can get to, just keep asking, persevering and remembering that "v's" are pronounced as "w's" and don't get too embarrassed when you realise you have started shouting the word "owoolation" to the pharmacist.

Happy POASing

Getting Prepared...Popping Pills

After my health check the Doc had solved one problem for me, as she'd prescribed me with Folic Acid, which I picked up as part of my overall costs that day at Bumrungrad hospital (THB1,080 for 6 months of 5mg Foliamin Tablets). So I knew I was covered for Folic Acid, but I didn't know what, or where, I could get overall pre-natal (or pregnancy) vitamins.

Looking in Boots, which was the most obvious place for me to go being a Brit, and also the easiest as the pharmacists normally speak English, I found that they simply do not have pre-natal, or pregnancy, vitamins as we do back home.

So what are the options?

• Multivitamins plus Iron
• Multivitamins Minerals plus Ginseng
• Vitamin C
• Ginkgo
• Evening Primrose Oil
• Calcium D
• Calcium D plus Collagen
• Calcium plus Vitamin D plus Minerals
• Fish Oil
• Fish Oil plus Evening Primrose Oil
• Cod Liver Oil
• Gingko plus Fish Oil
• Garlic
• Zinc

They also have Blackmore's readily available in Thailand, but they follow similar themes to above, although you can get standalone Folic Acid as well.

I didn't really want to be popping more than one vitamin tablet a day, along with the Foliamin, and I didn't want to to take too much Iron as a supplement either, so what could I do?

Assuming you live in Thailand you may have already found that it isn't always easy to get a balanced diet in the sense we are used to. Getting a variety of vegetables into your diet, for example, is difficult if you don't cook at home every day and live next to a Gourmet Supermarket. So it was all the more important at this point in my life that I really should be taking some extra vitamins, that I knew I could trust, and would provide me with the right quantities for pre-natal preparation.

But i'm afraid ladies that I simply didn't find a Thai solution for this. Even the Doctor's look blank at you when you try to ask about an alternative to Vitabiotics Pregnacare.

My solution...I did a huge Boots shop when I was back in the UK and bought 6-12 months of Pre-natal and Pregnancy Supplements. On the plus side you will earn your friend/mum a lot of Boots Advantage points (my last "TTC" Boots shopping trip in the UK earned my mother in law GBP18 of points!)

One extra thing I have recently learnt, and I will pass on to you, is that there are sometimes concerns with taking Vitamin K with anticoagulants. Following my first miscarriage I was immediately put onto "baby aspirin" for my second pregnancy. Doctor's here seem very quick to put you on medication that they think might help (and will certainly not harm). As aspirin is an anticoagulant I now pay more attention to content of the Pregnancy vitamins I choose, and for now my doctor advises to only take pure Folic Acid for the first trimester. But that is just based on my medical history and you should always listen to your healthcare provider.

Getting Prepared...am I healthy? (a costly business)

There are some things in Bangkok that you can easily throw money at, and medical tests are big business here.

I'll be honest that I've been lazy and I've had all my TTC tests done at Bumrungrad hospital. I probably should have shopped around but ease of transport, location, guaranteed spoken English, and reputation has meant that I have only ever used either Bumrungrad or Samitivej for my TTC needs (although I have used medical clinics for Visa medicals and basic pregnancy tests).

My first visit to Bumrungrad was just after we were married. As I was 36 I wanted to ensure that I had a general TTC overhaul to check there were no obvious roadblocks.

I made an appointment online with Bumrungrad. I booked a basic appointment to see a Doctor in OB/Gyn. Here's the link: https://www.bumrungrad.com/en/contact-us/request-an-appointment

Before I go on, just a word of warning for the emotional sorts (like myself). I choose to go to the hospital on my own as I figured this was a routine appointment. But as I sat in the waiting room I realised then and there that I might find out that I couldn't have children...it hit me like a wet fish and I burst into tears. I suddenly felt incredibly vulnerable and in need of a hand squeeze. As an expat, your mum or best friend cannot always be by your side, or even at end of the phone, when you need them, hubby was also unfortunately at work and I knew this was only the start of crazy arse emotions taking me hostage at inopportune moments, so I made the decision to sniff and brave it out - but you may wish to arrange to have a hand squeezer by your side.

So, I had an appointment with Dr. Suleewan Ratanachai. Her English is ok and she seemed to be a very nice lady, but this was my first experience of a doctor in Thailand and I have now come to the conclusion that they can come across as disingenuous. I don't know if the problem is that they are perfectly fluent in technical english, but lacking in colloquial english or just plain culture, but they can often come across as dismissive and uncaring, which I am sure they do not mean to be.

Dr. Suleewan assured me that my age was not a worry and that many women get pregnant at my time of life. I should not assume any problems and should start TTC naturally. But you have to press Doctors here for real information and I kept pressing for information about what could, but hopefully wouldn't, be problems in the future. At this point she suggested that I could have a Pap smear and blood tests. She explained that there are various blood tests, but that detailed analysis of my hormones etc would be expensive and she recommended just a general blood overhaul.

So here is what they tested me for:

I had a Transvaginal Ultrasound to check the size, shape, endometrial echoes and appearance of my uterus, a Pap Smear and they took blood to check for:

Hemotology/Serology:

Non Panel Items:

• VDRL

Hemoglobin Typing:

• Hemoglobin Type
• Hb A
• Hb A 2
• Hb E
• Hb F
• Hemoglobin (Hb.)
• Hematocrit (Hct.)
• MCV
• Osmotic Fragility Test

CBC:

• WBC
• Neutrophil
• Lymphocyte
• Monocyte
• Eosinophil
• Basophil
• Neutrophilic Band form
• Atypical Lymphocyte
• NRBC
• RBC
• Hemoglobin (Hb.)
• Hematocrit (Hct.)
• MCV
• MCH
• MCHC
• RDW
• Anisocytosis
• Macrocyte
• Microcyte
• Poikilocytosis
• Target cells
• Fragmented cells
• Ovalocyte
• Hypochromia
• Polychromasia
• Platelet Count

Hormones/Tumor Markers:

Non Panel Items:

• Free T3
• Free T4
• TSH
• Estradiol (E2)
• FSH
• Prolactin

Blood Bank: (note that you should already know this as part of your Visa medical)

Non Panel Items:

• ABO Group
• Rh Grouping

Immunology/Infectious Diseases:

Non Panel Items:

• HIV Ag/Ab
• HBsAg
• HBsAb
• Anti HCV
• Rubella IgG

They had the test results back the very next day and Dr Suleewan gave me a priority appointment to see her quickly to explain them to me. They aren't very good in Thailand at giving you detailed explanations in words and phrases that you actually understand, they speak in clinical English and lack sensitivity and cultural awareness (cultural awareness of our needs and expectations as an English woman anyway) but she quickly told me that all of my results were fine (thankfully) and then bid me farewell, under advice to try naturally for 6 months and with a prescription for 6 months Folic Acid.

Now, the cost of peace of mind in Thailand does not come cheap. This is breakdown of costs:

THB 6,500   Health Screening Program

THB  1,000  Doctor's Fee

THB     100   Nursing Service

THB     200   Lab - pathologist's fee

THB  1,480   Lab - Pathology

THB  3,760   Laboratory - Clinical

THB  2,525   Ultrasound

THB     675   Ultrasound - Radiologist's fee

THB  1,080  Medicine

THB17,320  TOTAL

Do I think it is worth it, for peace of mind, absolutely, but I didn't really learn as much about myself as I was hoping for, as Thai Doctor's simply don't explain things to us in a way that we are used to in the UK. It was all clinical jargon to me and the only thing I could hold on to was the concluding phrase - no obvious signs of problems.

So, I have made a vow to translate as much of the above in the Glossary section of this blog to help all TTC women in Thailand for the future. You will note that some the test names are in italics, this is because I noticed that they checked for these items more than once. It can be common to be overcharged by medical establishments for non essential tests or doctor's time. I haven't questioned Bumrungrad about this yet, but as time goes on I will keep my eye on this happening again and let you know if there is anything we can do to save ourselves some unnecessary costs.

But for now, don't despair, if you are worried about your chances of getting pregnant and have the money, I would recommend getting these tests done for peace of mind. Of course they are not essential, we wouldn't get this service with the NHS back home, but why not avail yourself of modern technology and your highly prized position as an expat woman.