health

The 'Life-Juggler's' Guide to a Sub 3 Marathon continued....

London Marathon Race Week

Nursery Flu.

Brilliant.

One can read as much of the scientific and lay press as one likes - and hence apply logic to circumstance - but when it actually happens to you, you never fail to get this - why me why now face!

I upped the mileage in a pre-race mild panic that i wouldn't be able to cover the distance despite having run my fastest ever half marathon in Bath — didn’t down the other stresses and immersed in the viral milieu of babyhood - i got ill, as did everyone else in the environs. 

I don’t do ill very well - as i am sure not many of you readers do either. Taking to bed - admitting that you are not bulletproof is a toughie. I threw everything at it.

 

exercise pill
  • Lemon/Ginger/Manuka honey/Apple Cider Vinegar combo on waking
  • Oregano and garlic oil capsule three times a day
  • Doubled my probiotic powder (Had just started Dr Grace Liu’s BifidoMaximus)
  • Put turmeric and black pepper on everything
  • Drank rosehip tea like it was vintage pinot
  • Vintage Pinot ;)

3 days of night sweats, drenching the bed and the Friday before the marathon - after a short 20 min ‘test’ run - I followed this by lots of food and an afternoon in bed.. bod went into conservative mode as i battled with the voice in my head saying I really was not well enough to tow the line at a marathon. 

I know the medical director of the London Marathon - Prof Sanjay Sharma and asked his advice. 

The words - viral endocarditis - were mentioned and i was told to be sensible. If you experience a heavy colds with fever in the lead in to a race - medics will advise you not to race. The risk of the virus - even if feel better for race day - there will likely still be virus in the body - travelling to the heart and causing a potentially life threatening condition is real.

Now i am not sensible - never have been - although i have become progressively more and more responsible since having Sophia.
Medical words of caution heeded - but still - these are things that happen to other people?You read about them - but its rare… right?

Not as rare as you think. My friend and prior training buddy Parys Edwards experienced this after toing the line at the Ironman 70.3 Champs in Vegas a few years ago. She was hospitalised and given high dose anti-biotics through a drip for days. She was lucky but it took a long time to recover. 

Still I managed to convince myself that Parys and me were different. I have trained with many people over the years - but aside from Jodie Swallow and Declan Doyle - I have never known anyone who can over-ride their central governor and push themselves past exhaustion - like Parys.

I have never been able to do that - always cautionary - always holding out for that sprint finish. Brett Sutton always told me that this was my downfall - my continual self-analysis - ‘just shut that brain up and race’ .. ‘suicide pace’ always alluded me. Perhaps this is a good thing. 

Saturday morning before the Sunday race.

Still not decided. Eat - go back to bed ( not so easy when you have a 1 year old toddler climbing all over you!)

running hippo

4pm - Go to London and see how you feel.

'You can always run with a hippopotamus'

A Tweet i received which cheered my dour countenance  - you have a get out plan - always have a get out plan even if it does involve a slog with a hippo.

Slept on the train and arrived at my friend Kiri’s place - where a bounty of healthy foods awaited me and my race pack. Thanks chick! A positive sign for my recovery came out of the fact i was constantly hungry in these last two days and allowed myself to eat freely and increased the amount of carbs in my diet.

Although i am well fat adapted - as in i can burn fat to a relatively high heart rate - i still do have carbohydrates to maintain some metabolic flexibility. I just need less off them to maintain steady energy levels in an event.

 I think i ate almost whole loaf of home-made Deliciously Ella Seed Bread (gluten fee) with Avocado mash, amongst other delicacies.

More of said supplements above, a himalayan salt bath and bed.

Never sleep well before a race - even if I have low expectations - and I honestly did at this point. Not particularly helped by the fact Kiri lives a stones’ throw from the famous Fabric nightclub.

6.45am Race Day

I will run. 

There is a reason London Marathon is said to be one of the best marathons in the world.

It lives up to the hype. I was in the Club Championships (CC) entry having got a qualifying 1/2 mara time so was lined up metres behind the row of Kenyan Cheetahs. 

tamsin lewis london marathon

For many a common complaint is that it is difficult to run the first few miles of the mara at all as you are barging past aforementioned hippo’s et al. Thankfully being in the CC start meant it was full pace from the start.

I found myself next to Hywel Davies - someone who I usually think of as an endurance nutter - i then reminded myself that to many I myself am an endurance nutter. 

He was aiming for sub 2.30 and blazed into the distance. Steady and Easy were my mantras. I rarely run with heart rate but the cautionary tale from Prof Sharma was ringing in my ears so i watched my heart rate like a hawk. It formed part of my decision to tow the line. Resting HR and HRV normalised in the 48hrs pre race - muscle aching persisted but its common to feel heavy pre race as extra glycogen in the muscles store water alongside. See how you feel. There is always the Hippo.

I generally felt ok during the first miles - i knew my legs were heavy - no real bounce - but i tried to stay in the moment - take in the crowds, keep my leg turnover high and not get carried away running threshold pace like many around me. Pacing is one thing I have always been good at. I prob under-pace rather than anything. It was quite cold at this point and i felt silly for ditching my gloves at the start. Body fine, peripheries not so. I noticed there were many discarded gloves at the side of the road, so i stopped and put some on. Bit cheeky but it took my mind of my cold hands - solvable discomfort - we like that.

At Tower Bridge we approached the half marathon mark and i was still feeling good - and really did draw energy from the crowds at this juncture. I reminded myself running past my medical school Kings College - that running a marathon at that time to me (2003/4) had seemed like an impossible task. Here i was trying to do it at a pace which i could at that time not even run for 5 minutes. 

There were some dark times at medical school - a severe head injury after a skiing accident, binge eating/starving/over-boozing - a story for another time. Suffice to say i felt a mixture of sadness and pride crossing that bridge.

At 13 miles i stopped for a quick pee… then noticed less felt heavy on starting again. Hang on - they didnt feel like this at the end of the Bath Half and i still had over half way to go….hmmm … turned to the guy running next to me - ‘Do your quads hurt?’   (misery loves company)…

“No.. The real pain doesn’t start until mile 22”.. Damn that is 9miles away.. i don’t think my legs will last. 

 

I am stubborn - often very stubborn - and like the majority of you reading this i do not like to quit. 

When the pain hit - I asked myself

london marathon tamsin

Why am i in pain ? 

Too little mileage ? But i never get quad pain? You’ve only run 27k as your longest run… Shut up coach said didn’t need to run long - must be the post-viral inflammation… muscle contraction less effective. 

Will the pain improve or worsen?

At Ironman UK the last (and only) time I ran a marathon I took paracetamol at the start of the run. Studies shows it can reduced perceived effort - especially in the heat. It wasn’t hot - but at this point i was thinking perhaps i should have considered having some on board. Considered asking a random member of the crowd - maybe a boozehound had some prophylaxis in his pocket. Decided was silly thought. Note I NEVER recommend pain-killers other than paracetamol in endurance events as studies have repeatedly shown they can cause kidney and even heart damage. Chronic use even worse. One of my criticisms of former coach Brett Sutton - used to dish out Voltaren like smarties. 

 

As a side note - NSAIDS like this can quite easily burn a hole in your stomach esp. when taken whilst exercising which generally increases gut ‘leakiness’ and acidity - As Multiple Ironman Champ Lucy Gossage will tell you from her personal experience of NSAID induced gut bleeding and subsequent anaemia (before she turned pro) - it is NOT worth the risk. Some say - 'well i’ll just take an acid-blocker alongside the painkiller' - we have acid in our stomachs for a reason - it aids digestion and prevents harmful bacteria/viruses/parasites from getting in. Do not recommend. GI Upset in endurance sport is obviously a blog post in its own right. I use activated charcoal - £3 on Amazon.. superb for gas/bloating - and also for mopping up the toxins from booze on a night out :)

 

The next 13miles went from being cheery/waving and - ‘isn’t this incredible, i am finally running the London marathon’ … to ‘bugger… i may not make this.. the pain in my quads was amplifying.

Looked at my watch - i had averaged 6.30 mile pace for the first half and was capable of talking all this time - felt easy .. then the leg pain - so CV discomfort (why would there be i was well below threshold).. energy felt constant.

Mile 19 - Do you legs hurt more now than they did at mile 15?

Not really.

Great … Its therefore not pathological .. they will not give way..  

Heart rate?  Steady not going over 150bpm.

pace had dropped to 4.30 pace for a couple of miles - i couldn't seem to keep my cadence up. Coming back past Tower Bridge I had another word myself. Its now or never.. you may not be in top shape but you have come here to run a sub 3hr marathon and if you want to do that - then its time to up your game. 

You play these games with yourself which in reflection seem a bit silly.

For me i was picturing my daughter Sophia (just 14months) and the tenacity she now shows lifting and walking with things.. what would she say to Mummy? You didn’t make your goal because you couldn't stand the pain? I pictured my Mum and Sophia watching the marathon on TV willing me on - they weren’t - they were on Bournemouth beach - but it is what i chose to believe at that time and it worked. Why do you run? 

I had my second gel - Torq Rhubarb/Custard and sipped it slowly - all the time practicing the psychological tip of externalising. I thought of my summers with my beloved Grandpa - eating freshly rhubarb - topped with steaming homemade custard. 

The Tunnel - at this point you only have a few miles left - a friend had told me the BlackFriars tunnel was a lonely place - but i welcomed the sensory change and felt somewhat energised by heavy based music. 

The Embankment - I saw a man collapsed just ahead. He looked in a bad way. I had to resist urges to go over and help as medical aid had just arrived. I learnt later he died. RIP David Seath.  You just never know when you card is up. This thought pressed me for a few minutes. Prof Sharma had told me that is should not race if i was ill in race week, yet i felt confident enough in my self awareness/physiology that i could at least start.

Heart Rate 152.

Those final miles were painful. I had imagined trotting along the embankment smiling at the crowds and taking in the atmosphere but all i was looking at was the clock fast approaching 3 hours. Now or never its just a bit of pain. I had to do a bit of elbowing past folks in the final mile as from somewhere i found some leg speed and finished with a sub 6.20mile. Always like a sprint finish me. 2.58 (which in my head is infinitely better than 2.59). Semantics.

 

marathon tamsin

I did my own personal high five and then had a few tears. Boxed ticked… you can be a little bit proud of this one. 

Yes my predicted time based on half mara performance was around 5 minutes faster - but all things considered - i am happy - and i’m ok. Heart rate dropped into normal range relatively quickly - and i didn’t feel unwell. I’d like to say i put my feet up with some of my wonderful friends who came to watch me (Kiri, Arianna - thank you for the fuel and massage) - I did - but only for an hour - as back to the mommy role… race to get home to see Sophia before she went to bed. I’ll pretend she is proud of me for now.. and maybe one day we can run a marathon together.

Key Take Away Points.

 

1.” It Doesn’t Have to be fecking Hard - But it Does have to be Consistent - which in turn makes it fecking hard. “    Thanks Sutto.

2. Long Slow Steady Runs in my opinion are not the pinnacle of marathon training.

3. Functional Strength training pays dividends.

4. Mental Resilience cannot be under-estimated.

5. Knowing that your Blood biomarkers are optimised is important - esp. if you are not feeling as ship-shape as you once have done. 

 

My (Historical) Issues

 

  1. Low Iron (Ferritin <20)
  2. Inappropriate Vitamin B12/Folate metabolism (MTHFR mutation - 23andMe > Genetic Genie)
  3. Low Progesterone ( Agnus Cactus and appropriately timed natural progesterone helped with this).
  4. Low free/available Testosterone (from years of being on the contraceptive pill which increases binding protein)

5. Low Magnesium

6. Too much Omega 6 compared to Omega 3 - measured as red cell Omega 3: 6 ratio.

7. Low Thyroid

My GP gave me ferrous sulphate which upset my gut (causes inflammation which as an athlete already predisposed to leaky gut is the last thing you need)

Floradix 2 full capfuls/day is my preferred effective option - although ferrous gluconate/bisglycinate with vit C is effective & tolerated well.

The other tests are not available through the NHS so we did them through my company www.curoseven.com - alongside a host of other integrative health testing (dutchtest.com, Metabolic/Organic Acids Testing, and Gut Function Testing.

Its only in the last few weeks after a few tweaks to my supplement regime based on the results of the above and through the help of incredible and infinitely humble Dr Tommy Wood that I have started to feel like a million dollars.  

Despite juggling of all the plates commonly known to fit, full time working, mums.

My house is not tidy, however.  I’m looking to out-source this one   :)

I recently presented with pal Ben Greenfield at The Biohacker Summitt and at The Public Health Collaboration event. 

Exciting, Busy Times.

I recently heard a term coined - "productivity addict" - anyone else like to put their hand up to this one? ;) Must Forest Bathe more.

Next Up I will be part of the Expert Panel with Dr Kelly Brogan and Dr Rangan Chatterjee (BBC Doctor in The House) at

This Event  in July.

Sure will be interesting. 

Cheers!

ben greenfield tamsin lewis

 

 

 

 

 

 

 

Running a "Sub 3" - The Minimalist Route

The only sporting goal I set myself this year.

Go under 3 hours in the London Marathon.

I have only run one marathon before and that was as part of Ironman UK - a day so full of emotion and joy that the pain of those last miles has been mooted. 

For those of you who just want to skip to the ‘how i did it part’ take a peak at my Strava profile - although this allows no reading between the lines.

Just over one year since giving birth; my priorities, my perspectives and my expectations have gone through a progressive shift as described in my previous blog. 

IMG_0125.jpg

I knew when I fell pregnant that I would never return to racing as a professional athlete. I knew the toll it takes on the body and mind and increasingly i was yearning to return to medical practice and learn more about a functional medicine approach to health and healing. 

In pregnancy - not ‘training’ felt natural for me. Replete with pregnancy hormones designed to relax and nourish the body, I exercised daily but didn’t push myself and rested as much as I could. I had another soul to think about. 

Often training becomes an aim within itself - and we do not feel ‘normal’ without our daily fix. 

Some go even further and exercise/training becomes a form of self-harm - of distraction - of cross-addiction - preventing us dealing with whatever we would have to deal with if constrained in four white walls with no way out. 

Post partum - its just your head and your body again.. and hormones levels drop off precipitously and that desire to move, to run, to get a glimpse of your previous fitness, comes rushing back. Despite facing chronic sleep deprivation, warped food cravings, emotional shifts and the fact you now have a whole small human to love and care for. 

To start with i did as much as i could within the confines of the above. Think about how you feel after acing a race - matching or exceeding your expectations - you are already entering your next race the same night - and eager to get going with training again - often foregoing the fact you need to reflect and absorb the race you just aced. 

 

But then real life kicks in. I went through a round of career interviews just 2 weeks after Sophia was born whilst she was still in the ITU - as I was due to return to the NHS to finish my training to consultancy. I started working as a locum when she was 8 weeks old (2-3 days a week) and all the time working on my business baby www.curoseven.com in the background. I will forever be grateful to my mum who travelled from Devon to London most weeks and stayed overnight so i could rest. Sophia woke every few hours in the night until she was 10months old.  I feel like i aged alot in this time!

Running is simple. Put appropriate - or sometimes not so appropriate - clothing on and get out the door. One foot in front of the other. 

I entered a half marathon 5 months post partum and used it as a goal to get myself running regularly. I ignored advice to wait for the 6 week checkup from your doctor. Pelvic floor exercises and core stability were essential but I started running easy at 2 weeks post partum. My legs felt like they do in the last 10k of a marathon from the outset. But slowly it improves. And the power of running to change your mood, emotional energy and clarity of thought is immense. Studies now show that it triggers neurogenesis - the growth of new brain cells (through BDNF production)- some stick around (esp. if you nourish them with healthy fats and anti-oxidant rich foods - some don't - esp. if you don’t sleep and drink wine like its 1999)

I had no training plan.

I just ran and listened to my body - sometimes a plod. Sometimes i hit a 6 min/mile.

I averaged around 40k a week over a 6 month period.

First 1/2 mara in Richmond I ran 1.23 which is pretty much the same time as I had ran a half marathon prior to pregnancy when I was training a huge amount more - but in three disciplines.

2 months later I ran Bournemouth 1/2 marathon in 1.22 and somehow managed to win the race. 

tamsin lewis run bournemouth

The next small challenge was the Endurance Life Coastal run - 16 miles of crazy terrain along the Dorset coast line. Anyone who has completed these races will know just how brutal they can be - not just in their geometry/elevation but how commonly one faces strong opposition from howling winds and rain. It took around 2hr 20 to cover that distance but I managed to win by a fair margin - although at the time - it felt more about survival in the face of gail force winds… which i often feel are a metaphor for life. You just keep on pushing and eventually you get there.

I finished strong on this day and it gave me hope that my years of endurance training were still buried in my physiology - despite not actually doing much in the way of long sessions at all at the current time.

After this Dorset trial race there was a bit of a hiatus until next towed the line approximately 4 months later at The Bath Half Marathon. I caught yet another nursery bug in the lead into this race and was without voice and snuffly on the start line.. but it was a chance to catch up with two of my favourite people and athletes Claire and Dunc Shea Simmonds - a good incentive. 

tamsin lewis pitchatpalace

Stunning race - wonderful support and even Chrissie Wellington showed up in her first 1/2 mara post baby (3 months?). I felt pretty blah throughout the whole thing.. it just passed in a blur and i just let my legs do the running, not actually breaking 155 heart rate. I managed a couple of near 6 min miles coming to the end, so clearly I hadn’t pushed as hard as i could, so it was reassuring to see the clock at 1.21 when i crossed the line, ahead of some super speedy girls - Vicky Gill being one. Chrissie ran a 1.25 smiling as she does most the way round. I was most impressed that she prioritised breast feeding her little one just minutes before the start. 

In the early months of 2016 I had been focusing on some career networking/business development for Curoseven and studying a mix of functional medicine, endocrinology and bio-identical hormones in my evenings when Sophia had gone to sleep

I was running 3-4 times a week with 1 or two strength sessions thrown in - of which i would count climbing stairs and superman flies with Sophia as part :)

My previous coach Tom Bennett of T2 coaching always said i could run a sub 3 so that rang in my mind when out running, as did the words of my other former, and perhaps more infamous coach Brett Sutton that women didn’t need to run long regularly in order to run long well as we were naturally better at endurance. Funny how selectively biased the brain can be - esp. as 1 i didn't have the time or 2. the inclination to run high mileage.

I periodically googled “how to run a sub 3”, I even downloaded the ASICS run sub 3 plan and would give it cursory glances now and then choosing a couple of the sessions, but ignoring the fact it told you to run every day pretty much and the 15mile plus runs every Sunday. I did 3 runs over 22km in the entire 8 month lead in.

As most of you children know - the first few years after they start nursery - they pick up every bug going and largely smear it all over you when home. I use one of those nasal suction devices to remove the snot from Sophia’s nose so she can breathe better. They work but its a messy process. She only attends nursery twice a week, my long suffering mum looking after her on the other days I work.. a choice made easier by the fact that almost every week she would bring home some foul virus of sorts (i watched a program where they looked at the bugs grow from hands of children in nursery - millions of virulent organisms) .. and almost every week my immune system was being challenged again. I do as much as I can from a nutrition/supplements stance to give my immune system a chance. I follow a high healthy fat diet, with periodic carbs (predominant pm as it helps bring down night cortisol and enhance tryptophan production and hence sleep) and lots of veggies. I largely avoid gluten, but do have a small amount of full fat dairy as tolerate it well and good source of calcium. When asked why i avoid gluten - i do not have coeliac disease, although have tested positive for blood antibodies to Gluten in 2010 - I only found out about this retrospectively when requesting my historical blood tests from my NHS GP - it was not mentioned to me. They reverted to normal when i worked on my stress and gut function/diet as my knowledge working through curoseven evolved. Who knew Sultana Bran with skimmed milk wasn't a healthy breakfast ;)

Go to supps when affected by a bug are :

but stress is a potent immune-suppressant and if you’re not sleeping well - working or multi-tasking like a mo-fo it will take its toll. HRV Monitoring through an app like HRV4TRaining can help manage this and if you heed its warnings - adapt your exercise accordingly. 

I often question now when athletes comment on their 'fitness' being lacking. Often this is based on perceived effort for a given pace/wattage. However if you are deficient in X nutrient or running too high or too low on cortisol or testosterone or other hormones are out of whack then perceived will feel infintely higher. Additional if life stress is high and then you stress yourself further by a high intensity session - reprimanding yourself when you dont hit your numbers - it becomes a recipe for poor health long term. A bit more on this here.

 

In the month leading into London did two of my biggest ever running weeks 70/80km. I know for runners out there this does not sound like much - but it was all quality and a lot of race pace and above race pace work. Race pace started to feel super comfortable. But the only long run i did of 30k 3 weeks out - reminded me of what happened at Ironman UK in 2014. Around the 15mile mark something starts to ache - whether the hip, the toe or just generally legs slow down - despite CV system feeling ok and not feeling low on fuel. This I have come to realise is just what happens when you are not used to running big miles. I have the endurance from years of triathlon, but not the mileage in the legs. I have however, remained injury free for the first time in years despite running consistently for a year. I put this down to the addition of some strength work - adding a heel wedge to my left shoe which has helped a chronic RIGHT high hamstring tendinopathy - and eating a higher fat, more nutrient dense diet.. and generally training less!

tamsin marathon training

London Marathon - The Race will be published as next blog shortly!

 

FURTHER RESOURCES

The Pregnancy Blog - Part 2 (Birth - 2 months)

This part of the pregnancy blog is harder to write than its predecessor. 

premature baby athlete

My pregnancy was fairly medicalised because of the early diagnosis of the heart-shaped uterus.. but generally - the nausea and vomiting for the first 16 weeks aside - i felt well during my pregnancy and even when my waters broke, once the initial fear of delivering a 1.2kg baby had subsided - i was fairly relaxed - i honestly think its a lot hard to get worked up about things when pumped full of pregnancy hormones.. emotional yes.. anxious..not so much. Maybe daily HeadSpace app sessions when in hospital post waters breaking helped too.. as my desire to move was somewhat medically restrained. 

Labour

The Vision

I had this wonderful idea of labour in my head. I knew it would be painful - but I looked forward to it - as i would a triathlon - as a challenge to get through.. with the finishing line oh so sweet with a gorgeous bubba ready to nestle to the bosom. 

Discussing pain relief during the NCT classes, my inner hard nut professed the desire to go through the experience using just paracetamol- “pfffft” to gas and air.. heard it just makes one feel sick. I wanted to feel the pain and use my extensively practiced (cough) yogic breathing to get by.

 

labour pain

The Reality

Paracetamol - like using an ice cube to put out a forest fire.

Unless this drug normally works well for you - e.g for back ache/headache - i can say with much confidence that it will do bugger all for your labour pain. 

Gas and Air.

Makes you giggle.

Also makes one dissociate somewhat from the experience as if you were watching it happen to someone else. The midwife/nurse/doctor/cleaner/ward clerk will all tell you that you’re not using it correctly… its all in the timing and depth of breathing.. allegedly. 

I was already getting sick (and having to evacuate from the other end too - bowel wants to be as empty as possible for the impending stress of delivery (kinda how you feel on the morning of an important race - magnified)  from my rapidly progressing labour - the gas and air made this worse so i stopped - although held onto the apparatus and my partner (Stuart)’s arm for dear life. 

Epidural

This is the one method of pain-relief which i had not planned into any thought process. 

I was very lucky to have the excellent Dr James Hambly look after the anaesthetic side of my labour from the start. An avid triathlete and runner - we followed each other on twitter so this was a pleasant surprise. I remember him saying that every mother he had given an epidural to, whom went through their first labour without said ‘why the hell did i not do this earlier’.

I saw having an epidural as cheating. No pain, no gain as is the oft repeated triathlete mantra. 

In my case, given that Sophia was still only 32.5 weeks (but of a good weight for her gestation) i was not allowed any opiate pain relief like fentanyl as this can depress breathing in her already undeveloped lungs. 

The midwife checked my cervix and found i had gone from 1cm dilated to almost fully dilated in less than 2 hours. No wonder it hurt so fecking much.

They call this effacing.. The nub of the cervix goes from thick to thin to non existent as the labour progresses… like rolling out a ball of dough.. kind of.. if dough could cry ;)

Just prior to her checking the status of my cervical dilation (i can imagine any male reading this has turned green by now).. the pain was so intense that I had opted - on the sound advice of Dr Hambly to have a ‘low dose’ epidural. The idea being the pain was numbed somewhat but i could still have the sensation of needing to push. 

The actual procedure was a little uncomfortable - first time he hit a blood vessel and a bit of my spine - easily and commonly done - but on second go he was successful & the tube was in to my spinal canal - one can then give anaesthetic directly into the nerves controlling the pain to the pelvis. Typically I wasn’t a standard case and one side numbed up well whilst the other side didn't ... i needed ALOT of anaesthetic to achieve pain control ... i am a fast metaboliser - its the same in the dentist's... i go through local anaesthetic like its water

Labour was progressing very quickly. All of a sudden there was a consultant in the room and (perhaps because it was the middle of the night) she shouted to the midwife “why on earth didn't you call me sooner!!).

This never bodes well for ones anxiety levels.

There were some decelerations of Sophia’s heart rate on the fetal monitoring.

“We need to get this baby out NOW”

OK.. don't panic - yoga breathing - control what you can control and let the professionals do the rest.

 Breech position (this is not Sophia )

Breech position (this is not Sophia )

I pushed AS hard as i could muster only being in pain on one side … i couldn't really tell what i was doing so followed the encouraging expressions from my partner and the medics down the bottom of the bed. It didn't work. All i could think of was that I was a failure. I had succumbed to the epidural because the pain was so excruciating (maybe my willpower pot had been drained by the experiences of the past weeks - studies show this reduces pain tolerance).
I was a fit athlete yet I couldn't push my 1.2kg baby out - this was the thought process.

Despite previous scans showing she was in a normal head down - ready to come out - position - Sophia had in fact turned herself slightly around so was in a breach position with her feet up around her ears... not so easy to push out.

I needed an epiostomy (cut through the muscle/fascia between the pee hole and the poo hole - and forceps to assist the delivery.

At that point i think i would have agreed to anything. 

And then there was a slippery mucus covered squirming baby on my chest.

She was tiny… and so skinny.

I could not hold back the tears.

But it was not the romanticised birth one pictures or sees on tv.. where mum and baby are united in bosom bliss. I could not hold her for more than a few seconds before my instinct spoke through tear-streaming eyes “just take her and make sure she is ok”

At this point there were about 10 people in the room. Different types of medics/students/midwifes.. and an incubator. I just wanted to know she was ok, but wasn’t given a firm answer. I heard some faint squealing which gave me a moments reassurance..but then she was gone.

I’m not sure i ever pictured what would happen next.. despite all my medical training .. 

Labour is over .. you put your feet up and have a cup of tea cuddling baby to bosom.

My placenta would not deliver. 

Thank goodness i had that epidural the doctor said as she proceeded to tug at the upper right quadrant of my uterus. The design of the placenta as such it wanted to be there for the full 40 weeks. I was loosing a lot of blood by this point.

“We are going to have to move this to the operating theatre”

All of a sudden the room was empty and Stuart was left alone sitting surrounded by pools of blood dotted with gauze.

I cannot imagine how despondent he must have felt.

The epidural was converted to a full spinal anaesthetic and the procedure to remove my placenta continued. I was given drugs to stop my uterus contracting and goodness knows what else. I remember the whole experience very vividly and talking to the medical staff to take my mind off the very uncomfortable feeling of having my insides ripped out. It wasn’t painful just a pulling…tugging and the placenta still wasn’t coming. An anxious phone call with another consultant on the phone for advice and she started to remove the placenta piece by piece. It took over 2 hours. 

The drive to hold my baby - to even hear how she was - was overwhelming. 

As I lay in the recovery ward surrounded by mothers feeding their newborns with the meshed squeals of hunger, frustration and exhaustion - I felt suddenly very scared.

Stuart had been told the operation would take 10minutes - he waited 2.5hrs with no news - until I came out then went home to get some rest. 

The drugs were wearing off and the feeling of dysphoria overwhelmed me. I was alone, I could not feel let alone move my legs and no one answered the pressed nursing bell for a good while.

When a health care assistant did come and I asked her if someone could let me know how my baby was - she was unable to let me know - she was about to finish her shift and the other nurses were in handover - her english was poor. 

I spent the next two hours in tears, summoning up every ounce of mental fortitude I could muster to move my legs - so the spinal anaesthetic would wear off and i could get up and get myself to the neonatal intensive care unit. 

8am - I had not seen or heard any news about my baby from 2.30am the night before in the operating theatre. Nursing staff said I must eat and drink something before i could get up so I swallowed some sweet tea, scooped half a weetabix into my mouth and rose to my feet like a newborn lamb wobbling on unsteady pins. 

sophia lewis day 1 premature baby

I made it to the NICU and asked for Sophia. And there she was in her incubator covered in tubes.. face puffy with the overnight positive pressure airway support. It was all i could do to hold the sides of the incubator and let the tears flow. (as they do now writing this).

 

She weighed 1.79kg at birth just around 4llbs. This is tiny. She is not meant to be here…. she needed longer… what could i have done differently… why me… all those thoughts.. followed by a relief that she had all four limbs and according to the staff was doing well. 

I was given steroids when my waters broke to help develop her lungs and they had helped. She was on ventilation support for 8 hours but then was able to breathe well alone. 

sophia week 1 premature baby

Thoughts quickly turned to how could I feed her? The nursing staff said that I could try to hand express and i was showed how to do this.

I was amazed when droplets of thick golden liquid came out and then next hour was spent with Stuart syringing whilst I squeezed. We filled 10 x 1ml syringes.. suddenly my mood lifted. I could feed Sophia.. even if it was through a tube through her nose. 

She started to open her eyes. 

 

 

I was amazed when droplets of thick golden liquid came out and then next hour was spent with Stuart syringing whilst I squeezed. We filled 10 x 1ml syringes.. suddenly my mood lifted. I could feed Sophia.. even if it was through a tube through her nose. 

She started to open her eyes. 

 

Then the first blow. 

She was unable to take on enough milk via the tube into her stomach without it coming back up - common in premature babies when the gut is under-developed. 

I had to consent to giving a central line so they could feed her nutrition directly into the blood stream. This procedure and feeding method is not without its side effects of infection and other nasties so I was reluctant - but persuaded that it was in her best interests. 

Seeing your tiny baby wailing in an incubator whilst well-intentioned doctors attempt to stick needles into their neck and minuscule hand is one of the most heart wrenching experiences i have ever known. Everything in my body wanted to run in - scoop baby up and run out of the hospital and not stop. But reason prevails - eventually - given the hormone shifts in those days post birth. There were a lot of tears.

I wanted to avoid Sophia having antibiotics given their propensity to wipe out the very fragile and developing bacterial ecosystem in the gut. Thankfully we managed this successfully.

Of interest studies show that babies born by Caesarean section have their guts populated by skin bacteria - usually from the hands of the nurses whom handle them first - these are less beneficial and contribute to reduced diversity of gut bacteria - which can give rise to a host of illness, and even an increased propensity to obesity as one ages. Being born naturally means that gut is populated by bacteria from the mothers vaginal canal (which change slightly pre labour) and also a small amount of mums poop as baby emerges. These bacteria create a healthier ecosystem in the gut. 

If you can have a natural birth - please please do. Elective C-Sections are on the rise - those which mums chose to have even those not medically necessary. This is a potentially dangerous trend.
Read more about this here

I became acquainted with a hospital grade breast pump and spent every 2 hours hooked up. There was a designated room in the NICU and mothers of tiny babies would coalesce to pump.

Its very difficult not to compare milk production with those around you.

Some mums had babies whom had been in the units for months and whose milk supply was dropping as they were unable to put their babies to the breast often… some had older babies who had medical issues - these mums seems to have better milk production. I became quite competitive.. I saw one younger woman produce 5 full bottles of milk in 20minutes - I was really envious… The ensuing weeks partially became a challenge of how i could produce more milk. I read everything I could, took on board most of the advice, but perhaps ignoring the fact that stress and anxiety would negatively effect milk quality. I was determined that Sophia would not have formula given all i had read on the effects of formula on the gut micro biome.. However - there were a few days later on in her time in the NICU that my milk supply fell short by 30-50mls and she would have to have some SMA. I felt like a failure once again.

I did not stay in hospital during Sophia’s time in the NICU as i was discharged the day after the birth - despite my traumatic surgical experience post birth. They need every bed they can in one of the busiest maternity units in the country. This meant I spent from 8am to 8pm most days in the NICU alternating breast milk pumping with hours spent with Sophia sleeping on my bare chest (to bond and encourage milk supply - she was too tiny to latch on to the nipple - but we did keep trying). I would go out at lunchtime and walk to the gym, or to Richmond Park, or when the bleeding had stopped - to the pool. This cleared my head and meant i got some fresh air.. the NICU is very dry and warm. Often during this time away from the unit I was a little emotional and the desire to be holding Sophia was great. The nursing staff made it clear, however, that she needed deep sleep (in the day as well) in order to grow - and told me she would not get this if she was sleeping on me. I think they were just fed up with me hanging around so much.

An ongoing theme, it is maternal instinct to want to care and nourish your new born. However, I had to submit to the authority of the medical staff who controlled when I could hold and feed her. As well-intentioned as this is - it is not easy or intuitive.

A few days post birth one of the Consultants asked to speak to me. This immediately sends a bolt of fear. He told me that he though Sophia may have a genetic syndrome - like Downs or Turners - based on a few physical features she appeared to have.. she did not look like me - but certainly has her dads eyes which I guess are slightly pigmy like if viewed with a biased lens. 

All my maternity genetic screening tests were normal so this was a shock.

The test results would take around 2 weeks to be returned. I was not reassured, despite some of the nursing staff telling me that they tested a lot of the babies and she did not appear to be syndromic. The next 17 days were filtered with a undertone of anxiety.

How would I cope if Sophia had Downs’ syndrome or Turners Syndrome? I tried to convince myself that she did not have any of the features really… but once that seed has been sown… 

The tests were negative. More tears. Relief.

 6 days post birth.  30mins on Wattbike (100-140W)and some light seated leg weights.&nbsp;

6 days post birth.

30mins on Wattbike (100-140W)and some light seated leg weights. 

As I am sure the reader will tell…

I felt a little wobbly these days post birth. 

My Haemoglobin had dropped from 14g/dl to 9g/dl.

This is quite a lot of blood to lose. Any benefit from that blood volume expansion and extra EPO during pregnancy had been lost.. yes this did cross my mind briefly - followed by how much iron do I now need to take to get back up. 

We walked into Kingston from the hospital - around 1 mile the day after the birth. 

 Leaving the hospital after just under 4 weeks in NICU

Leaving the hospital after just under 4 weeks in NICU

I lost control of my bladder crossing the road to Boots - i just could not feel the sensation of needing to pee and next thing i knew my trousers were soaked.. I didn't know if this was normal or not - but thinking about it - it was completely normal.. I had spent the previous night being stretched and pulled and pushed and forcepped. Bouncing back together ain’t so quick despite being fit when you’re 36 and your placenta is stuck.

Still i asked the ward doctor to have a look when I returned to the ward and she ruled out infection and reassured me that things would take time and that the nerve supply to the bladder had probably been damaged slightly during the birth and ensuing surgical procedure.

The emphasis on pelvic floor exercises was stated and as anyone who is or has been pregnant will know this becomes an oft chanted hymn. 

One can never do enough pelvic floor exercises as boring as they are.

 First Bath

First Bath

 

 

 

The next few months were to be some of the toughest i have experienced.

Below are some of thoughts

 

Newborn babies are noisy during the night… they grunt, whine and an whimper in their sleep - hence you spend whole night staring at them wondering if they are in pain or are hungry.

Don’t assume baby has colic - he/she maybe overtired.

changing nappies

Sticking a plastic tube (Windi) per rectum to relief tummy distension ?Colic was slightly disturbing - but baby didn’t mind in the slightest & it worked.

All baby clothes have hundreds of poppers - it is night on impossible to do these all at 3am with crying/squirming baby. And as for putting on a nappy the right way...

It is an overwhelming time - working out why your little one is crying - there were a few nights when i would sit in tears in the bed/bathroom - exhausted but unable to work out what she needed- and thus feeling like a failure. She slept in a SleepyHead in the bed next to me for 5 months - so i could feed, wind, pat, repeat through the night. 

 

Stuart was working 12 hour days, so he was unable to help at night but would occasionally do the 6.30am feed and go into work a little late so i could sleep. Without this and without my mum driving 4plus hours from Devon every couple of weeks - i honestly don’t know how i would have got through these months. Sleep deprivation, plus huge drops in hormone levels on a sensitive brain can wreak havoc.

The Health Visitor suggested i see my GP as she raised the question of post natal depression - but my very frank and wonderful GP said `to invest in a night nanny for a few nights and that sleep would solve all. We couldn't quite stretch to £250 a night for the night nanny but did have a local nanny help out once a week and she would come at 5.30am so i would sleep from 5.30am to 10.30am. Some people manage to sleep well between feeds at night - but often i’d be mostly awake the whole night listening for sounds and worrying about the next time she would wake - my cortisol levels were sky high - so even when i could sleep 3-5am for example - i would be awake worrying about the fact i couldn't sleep - or had i fed Sophia enough, did she have tummy ache etc etc. Sophia still wakes every 3-4hours even now at 7.5 months. I have given up being envious of my NCT mums who’s babies slept through the night from 6 weeks.

BreastFeeding: There is nothing more wonderful than being able to feed and nourish your baby and i loved this.. it was very time consuming as Sophia so small. The health visitor told me to establish my milk supply i should stay in bed for a week with baby. However, this was now a month post delivery so not straight forward. Plus as you can imagine, i find it difficult to stay in bed. 

A good breast pump is essentialI rented a hospital grade one from AnaWiz— esp. if like me baby was pre - latching onto the breast is often difficult & often she would just nibble away for an hour and fall asleep - not conducive to gaining weight. My obsession with producing enough milk continued. I would pump 4-5 times in the day with some additional breast feeds and 1-3 times at night. Many a night was spent with one boob in a pump with baby on other then after 30mins i would pour pumped milk into a bottle and feed. I tried all the techniques advised for increasing milk production - possible with the exception of ‘eating for milk’ - i.e eating cake/carbs..but as my sleepless nights continued and i forced myself out on short runs/swims most days to clear the brain fog from no sleep - my milk production did wane. I tried the herb fenugreek and it did increase milk - but at the expense of creating a lot of wind in both of us.

Many people give up breast feeding early because they have problems with supply, latch or any number of problems. My advise would be to try everything possible and get specialist help - it really is the best start you can give your baby - esp. if premature or born via C-Section for reasons discussed above. Yes the formulas claim to be advanced and contain all the nutrients, but they don't contain antibodies and only a few address the good bacteria balance - Aptamil has prebiotics (which feed good bacteria).. a couple of French brands and US Brand Eptamil offer some probiotic support. This made Sophia even more windy - so we went back to SMA - which is what she was first offered on the NICU on the days i couldn't quite produce enough milk. I was offered Aptamil and SMA on the NICU but because SMA was packaged on in glass bottles as opposed to plastic i chose SMA.

I lasted 4 months breast feeding/pumping before I - with a heavy heart - decided to give it up.

Although would then get emotional and try feeding/pumping again… feeling like a failure.

Sophia had ongoing problems with reflux and colic and I wanted to make sure nothing I was doing was contributing. I craved a lot of dairy products whilst breast feeding. Goodness knows how much full fat greek yoghurt and decaff lattes i drank.. i tried a week dairy free to observe for effect ( i tolerate dairy very well) but Sophia still suffered with the same symptoms. 

 We tried about 6 different types of formula -including lactose free/easy digest/anti-reflux/extensively hydrolysed - never soy (most soy beans are genetically modified). 

Nothing helped. I gave in to the paediatricians ant-acid medication reluctantly (Zantac - Ranitidine) as I couldn't bear to see Sophia in pain and bringing so much milk up - if you've ever had heartburn - imagine how this feels to a baby - they start to associate feeding with pain - not good.

So for one month the anti-acids did their thing but then constipation set in and boy did her poo start to become icky/dark green/horrid smelling. Formula milk generally isn’t great for their developing micro biome and neither are ant-acids - allowing nasty bacteria to grow - i could see this in the change in her poo. Upsetting, but i kept thinking - just short term. 

 

Finally we settled on NannyCare - formula made from New Zealand Goats. 

They now have all the necessary additional vitamins required by law to market as formula.

And no added whey protein which all cow’s milk derived formulas have.. making it easier on the tummy. I also am rather fond of goats - as anyone who has ever climbed mountains in Morzine will know - goat village is a joy- goats are happy, playful animals - perhaps some of this is down to their early diet ;)

I also began to give a powdered probiotic in her milk from 3 months - Bifidobacteria is one of the friendliest bacteria and is found in breast milk but not in formula. I use Biocare (not cheap - and needs to be in the fridge - i like to think it helps. 

 

Exercise wise in these first few months - I tried to do one thing every day - be this a 20-60min run. An hour or two's bike ride or a 30min swim/sauna/stretch. Some days when I had been up all night - it was all i could do to get out of the door - but never did exercise make me feel worse - if it does at this stage..  back off or seek advice.

The 6 week check - the standard advice being don't do anything until you have been through this. For most fit types who have had uncomplicated deliveries this is probably 3 weeks later than needed. I had been running/jogging.. from 2 weeks and at the 6 week check i was asked about bleeding (this stopped within a week).... pain (nope)... my episotomy stitches and that was it. My consultant knew i would have been exercising for some time already - it didn't seem to phase her. 

In Part 3 of this blog i will go through exercise post pregnancy/getting back into shape. in more detail.

 

Coming Soon!

nannycare happy goats babies


I also began to give a powdered probiotic in her milk from 3 months - Bifidobacteria is one of the friendliest bacteria and is found in breast milk but not in formula. I use Biocare (not cheap - and needs to be in the fridge - i like to think it helps.