‘all of this': taking the unexpected path

My mum said something to me yesterday that really made me think.

I was sitting with my parents and Little Man in the spectator stands at Gateshead Stadium, cheering on the drizzle-soaked runners making a torturous circuit of the athletics track before crossing the finish line of the Great North 10k, a race I had competed in myself the previous year. I had felt it necessary to sit this one out as I’ve been struggling with some minor leg niggles in training for the Great North Run and couldn’t risk doing more damage that might put me out of the half marathon.

Gateshead stadiumMy husband Andy, on the other hand, had just put in a sterling performance in the event, and stood with us soggy but happy with his new personal best and another medal around his neck. We had seen him entering the stadium to complete the final few hundred metres of the race quite easily, as the luminous orange panels on his Tiny Lives vest stood out brightly on such a dreary day. This was the first time the vest had been worn in an event, and we were proud to be flying the Tiny Lives flag, along with the logos of the brilliant businesses who had sponsored us for our fundraising printed on the back.

As we sat watching the variety of different charity vests and t-shirts being proudly paraded by other runners, Mum said, “Do you think you would have done all of this if it wasn’t for what happened with Joe?”

I realised at that point that I had never really thought about it. I considered everything that might constitute ‘all of this’.

Joe was born in September 2010 at 37 weeks, following an induced labour due to pre-eclampsia. Eight months later, when I felt physically able and mentally ready to, I signed up to Weight Watchers online. I started running, slowly at first, but seeing gradual and steady improvements as the pounds dropped off. By Christmas 2011 I had dropped 3 stones and 3 dress sizes. In May 2012 I ran my first ever 10k race, the Great Manchester Run, raising money for Tommy’s, a charity I had come across as a result of looking for information about what had happened to me. Few things have ever felt like more of an achievement than crossing the finish line on that day.

Tommy's Tent picAt the start of 2013, I threw myself into more fundraising, this time organising an online auction for Tommy’s through our newly established Facebook page Bids For Babies. I got myself onto Twitter to help publicise the auction and, it’s probably safe to say, I have never looked back. I ran the Great Manchester Run again, as did Andy, and in September we ran the Great North Run together, Andy spurring me on as I did what once I would never have considered possible. We raised over £1100 for Tommy’s. We have also been fundraising for Tiny Lives, the charity which supports our local SCBU in the hospital where Joe was born, and we’ll be doing the Great North Run again this year to raise more money.

I started writing again, something I used to love as a child and teenager with dreams of becoming a famous author or journalist, but had somehow lost along the way. I seized the opportunity to contribute guest posts when they came along and in August last year I started the Great North Mum blog, the alias I gave myself when I joined Twitter as a reference to my run training but which has now taken on a life of its own! I have my own little corner of the Internet I am very proud of, now including Blogs For Babies which is a wonderfully fulfilling side project I am really enjoying.

It was also last summer that I changed jobs and started working for the Northern England Strategic Clinical Networks, part of the NHS which focuses on regional collaboration for service improvement in various clinical areas, of which Maternity and Child Health is one. I am so grateful for the opportunities and wonderful connections my job has enabled me to make. I have realised what I am truly passionate about. Most recently, I joined MAMA Academy as a volunteer and have somehow ended up being their Media Coordinator, a role which I couldn’t be more proud to have. Having the opportunity to make a positive difference to the pregnancies of other women, which I am also extremely lucky to be able to do as part of my ‘day job’ with the NHS, is an absolute honour.

So, do I think I would have done ‘all of this’ if it wasn’t for the way my pregnancy ended?

Honestly, my gut tells me probably not.

joe hospitalI might have put some effort into losing the baby weight, but without the thought of my future health thanks to the unknown long-term effects of the pre-eclampsia, my fitness to be an active mum to the little man I was so lucky to have, and the likelihood of complications in a subsequent pregnancy, I don’t think I would have had the motivation to do as much as I did. I doubt I’d have ever pulled my finger out to do a half marathon.

I might have supported someone else’s fundraising, but without the gratitude I felt towards those who had helped me have a happy ending to my complicated pregnancy and the affiliation I then felt to the charities trying to do something about the cause, I don’t think I would have put the effort into raising money and awareness myself. I am almost certain I wouldn’t devote the time I do to volunteering and to feel so strongly about what they are hoping to achieve.

I might have come across the job opportunity I did, but without the true desire to see things improve for everyone using NHS services, for all the deserving mums and babies, for all those who are not as fortunate as we were to bring our baby home, I doubt I would have been so convincing at interview or have found my niche on the Maternity team in the way that I have. My passion drives my work everyday.

Our life experiences cannot fail to shape our futures, but I count myself lucky every single day for the position I find myself in. I interact with some amazing people online on an almost daily basis who are driven by their own experiences, often infinitely more tragic than mine, but all wanting to change the future for others when their own lives have already been changed forever – Jennie Henley raising the profile of SIDS after the loss of Matilda Mae; Leigh Kendall making people aware of HELLP syndrome following the passing of little Hugo; and the inspirational Heidi Eldridge, founder of MAMA Academy, working tirelessly to reduce stillbirth in memory of her son Aidan. We are all travelling down paths we wouldn’t have chosen in order to show others the right way.

That’s not to say people have to go through an adverse experience to want to make a difference but in my case, on reflection, it has definitely affected my choices. And for ‘all of this’ to come out of a situation over which I had no choice is an achievement I am really proud of.

MAMA Academy ‘Made to Measure’ campaign

new logo backgroundIn one of my ‘multitasking mummy’ roles I am Media Coordinator for the wonderful pregnancy charity MAMA Academy so I was delighted to be involved in the launch of the Made to Measure campaign which aims to reduce the UK’s shocking stillbirth rates – still among the highest in Western Europe.

pilogoMade to Measure is all about promoting uptake of the Perinatal Institute’s Growth Assessment Protocol (GAP) programme by all hospital trusts providing a maternity service. This is recommended practice, nationally endorsed by NHS England, but there are still a sizeable number of trusts that have not yet signed up for GAP training – and the implications of this are serious.

The GAP programme is designed to enable midwives to more accurately measure the growth of a baby in the womb by plotting the symphysis fundal height measurements (that your midwife takes with a tape measure) on a specially customised growth chart, unique to the mother. This takes into account the mother’s height, weight, ethnicity, and previous obstetric history to more reliably indicate if the baby is becoming growth restricted – a sign that the placenta may be failing and a key early indicator of the risk of stillbirth.

bump 3If every trust was to adopt the GAP programme in their maternity service, using the customised charts and the package of training for midwives, obstetricians and ultrasonographers that ensures all professionals involved in the care of women are properly educated in their use, it is estimated that 1000 babies could be saved each year. By detecting more growth restricted babies, we can greatly increase their chances of being born safely.

How you can help

  • Head on over to the Made to Measure campaign page on the MAMA Academy website to read all about GAP and find some related links.
  • Use the example letter on the MAMA Academy website to email your local Head of Midwifery and encourage them to sign up to GAP training.
  • Email contact@mamaacademy.org.uk to share your story of having a baby affected by growth restriction with MAMA Academy, to add to a list of case studies for media requests.
  • Email contact@mamaacademy.org.uk if you are interested in becoming a campaign ambassador in your area.
  • Write a post on your own blog to help promote the campaign or share a post with my parent blogging project Blogs For Babies and I’ll publish your story there.
  • Follow @MAMAAcademy on Twitter and like their Facebook page facebook.com/MAMAAcademy for regular updates on the campaign as more trusts are encouraged to sign up. Help promote the campaign on social media using the hashtags #1000babies and #Made2Measure.

Made to Measure flyer

listening to the new patient voice

Last week Mumsnet launched its Miscarriage Care campaign, aimed at encouraging key politicians to pledge to improve the care received by women suffering an early pregnancy loss. Mumsnet’s almost 80,000 Twitter followers were encouraged to Tweet or email MPs Jeremy Hunt, Andy Burnham and Norman Lamb to share their personal tragic experiences and ask them if they would make a promise to include better miscarriage care in their next manifesto.mumsnet 1

Twitter and Facebook were soon awash with some truly awful stories of inadequate care, including women miscarrying on maternity units alongside still-pregnant women, waiting substantially longer than 24 hours for a scan to confirm miscarriage or not, lack of empathy or basic compassion from medical staff, trivialisation of their loss and poor follow-up care. In spite of the excellent and compassionate care received by some women who responded, these stories of unacceptable practice are the ones that stand out, and cannot fail to elicit an emotional response in those reading them.

This is the power of social media.

I suspect that relatively few of these poor women made a complaint to their hospital at the time of their treatment, perhaps only reflecting on the experience later and not wishing to revisit such a traumatic time by accusing a busy doctor of not showing enough compassion after the fact. But the fact that so many of them felt the need to respond to the campaign, drawing on difficult memories with painful clarity, demonstrates how the care that is provided can have a long-standing effect on patients – and the NHS needs to listen to them.

pillsMiscarriage care is only an example. Websites such as Patient Opinion allow users of any NHS service to review the care they have received, enabling them to summarise their experience, state what could have been improved and indicate how the encounter made them feel. Organisations are then given the opportunity to respond. NHS Choices provides a similar function, enabling users to review their hospital treatment in the manner of reviewing a hotel on TripAdvisor, giving star ratings for aspects such as cleanliness, staff co-operation, dignity and respect, and involvement in decisions.

It seems that gone are days when a strongly worded letter to the Trust Chief Executive, possibly passed from pillar to post through a Complaints Department, was the only way to make your voice heard if you weren’t happy with your treatment. People are no longer content to sit and silently stew about the obnoxious consultant, the excessive waiting time, or the questionably unhygienic facilities. Before they’ve been discharged they are complaining to friends and family on Facebook or Tweeting their followers with an unfavourable review – and if the service has no online presence to respond to it, they may never even know about it until the local newspaper goes to press.

I think it is vital in this day and age that all NHS services provide a means of obtaining online feedback from their patients and users, and making the most of social media is the most immediate way to achieve this. Hospital Trusts with well-managed Twitter accounts like Northumbria Healthcare NHS FT and University College London Hospitals NHS FT provide their service users with the means to instantly tag them in feedback Tweets, enabling them to give a timely and transparent response for improved patient satisfaction – a lot less frustrating than waiting weeks for a response to an initial email from an anonymous admin department, and nipping the issue in the bud before it escalates.

It’s not all about dealing with complaints though. Social media provides an important means to convey good news stories about NHS care, in a time when the mainstream media are often more content to focus on the negative. Consistently negative reporting about the NHS can quickly break down staff morale and lead to much lower patient expectations of the treatment they are likely to receive, causing them to be more apprehensive and potentially have a worse experience than if they had total confidence in the service. Social movements like Big Up the NHS aim to spread positive stories about the NHS for the benefit of its staff and patients. Giving service users the means to publicly praise great care is brilliant for staff morale and is important to maintain high standards.

The Friends and Family Test may be the official means of collecting patient feedback for NHS services, but the real test is in every Facebook post, every Tweet and every blog where patients feel the need to comment on the care they have received. It should never reach the point where a huge online campaign is needed to improve what should be basic care and compassion. The patient voice is shouting loudly, but the people who can make a difference need to be in the right place to hear it.

 

 

mumsnet 2Support and get involved with the Mumsnet Miscarriage Care campaign

Like everyone else, we believe the NHS should provide effective, responsive care and treatment to the one in five pregnancies that ends in miscarriage, but while some trusts provide great care, unfortunately, others do not.

Please join us in asking politicians to pledge to improve miscarriage care, based on the principles in our Code, by 2020 – the end of the next parliament. The code proposes a series of simple principles, supported by best practice guidelines which, if fully implemented, would significantly lessen the trauma of early pregnancy loss.

the best medicine

Little Man wasn’t very well at the start of this week. After an afternoon haring around the soft play centre on Saturday, he complained of feeling tired the next day and insisted on being carried everywhere in town that lunchtime. Better for him as he clasped his little arms around Mummy and Daddy’s necks, less good for both of our backs as his ever increasing rate of growth, with his fourth birthday now a little over three months away, makes him a hefty weight to lug around for any length of time.

By the time we were all plonked on the settee later on, the fever started to kick in. Normally running a bit on the warm side, a rise in body temperature for Joe quickly turns him into a wriggly hot water bottle.

“I feel poorly”, was his sad little response to me asking how he felt.

Calpol and an early night it was, but he was quickly covered in sweat, wrapped in his duvet he refused to pull down past his neck to cool off, and with a temperature approaching 39 degrees, we anticipated a long night ahead. Unsurprisingly, he lay between us in our bed for most of the night, breathing laboriously and too quickly, fidgeting and rousing awake frequently.

There are few things worse for a night’s sleep than a small child with a fever. Never fully relaxing, we remained vigilant as he slumbered fitfully until morning.

Unfortunately for Daddy, this meant somewhat reluctantly stumbling off to work with heavy eyes, while I took the day off work to stay at home with our poorly boy. No nursery today, Little Man.

Strange as it may sound, we had a lovely day.

Feeling feverish made him lethargic, and his fatigue made him want to do little more than stay curled up on the settee with Mummy, resting his hot little head on my chest as he used to do when he was our tiny baby. Episode after episode of Peppa Pig, Ben & Holly, Pocoyo; never moving from my lap, his fingers curled around my hand, poorly but content.

He wanted to draw me a picture – a pink flower and a ‘birthday balloon’ despite it being no-one’s birthday, with his name written neatly and carefully at the top – ‘Joe H’ – as he delights in writing his surname initial too just because he can.

With no energy to run around and make a mess and too much noise as he usually would when stuck in the house all day, he was filled with affection, compliments and endless cuddles. I made the most of it while I could.

By bedtime, the fever had nearly passed, and Tuesday began with the usual routine of getting up and dressed for nursery, excited to see his friends and reluctant to brush his teeth without coercion. My Little Man was back, if a bit tired still, but ready to face the day without clinging to Mummy.

As I struggled to get his shoes on while he fidgeted excitably, I had to tell him to settle down.

“I love you Mummy”, with a soft peck on the cheek to placate me, came the response.

We had another cuddle. It would be another lovely day, even if we couldn’t spend it all on the sofa.

joe garden

‘Nurturing New Families': are doulas the Prince Charming to our Cinderella service?

Last week I was fortunate enough to attend the Doula UK Conference in London, in my professional Clinical Networks guise, to learn more about what they do and how we might learn from it to inform our work with NHS maternity services. The theme of the day was ‘Life after childbirth: supporting the transition to parenthood’; a welcome addition to the national maternity events calendar, as postnatal care is so often described as a ‘Cinderella service’ that you would be forgiven for thinking nobody is bothered what happens once the umbilical cord is cut.

doula uk logoThe Doula UK website is full of information if you wish to read up on it, but a doula (a Greek word meaning ‘woman servant or caregiver’) is an experienced and trained woman who can offer both emotional and practical support to a woman (or couple) before, during and after childbirth. The doula is there to ‘mother the mother’, providing support but not in a clinical capacity, and enables the woman to have ‘the most satisfying and empowered time that she can’ during the antenatal, birth and postnatal period.

I have had plenty of engagement with midwives in my current role, but I have to confess to being largely ignorant of the role of the birth doula until relatively recently, and even more so the concept of the postnatal doula. I was perhaps still labouring under the misguided impression that doulas were a bit ‘New Age’, all sandals and hippy skirts, my thoughts tainted by that episode of Frasier where Niles and Daphne hire a doula called Harvest who provides the option of a masseuse, a shaman and a drummer to enhance the birth experience.

The modern doula is far removed from this stereotypical image, as the many wonderful ladies I met at the conference proved. Doulas are knowledgeable, compassionate and truly supportive, able to provide the kind of intuitive perinatal care that nervous fathers, interfering mothers-in-law, and well-meaning but inexperienced friends might struggle to do, despite their best intentions.

nurturing new families coverAmong the many excellent speakers on the day was Naomi Kemeny, a postnatal doula who originally trained as a midwife but now follows her passion of supporting women and their families in the postnatal period. I was lucky enough to be given a copy of her newly published book ‘Nurturing New Families’ to read and tell you about, and I found it both thought-provoking and educational in equal measure.

The book focuses on the work of a postnatal doula, in a sort of ‘how to’ guide to mother and baby centred care which will provide a new mum with the practical and emotional support she needs to recover from the birth and set off on the right foot along the road to happy parenting. There is also helpful guidance on becoming a doula and a great appendix of resources.

As a non-doula though, I found it to be full of fascinating insights which would be useful for family or friends supporting a new mother, and also for the mother herself, as a lot of the information provided aids understanding of the needs of the baby and postnatal self-care. There is a useful chapter on feeding babies including, reassuringly, some non-judgemental advice on assisting with formula feeding.

What struck me though as I read to the end of the book, was that while the work of Naomi and her fellow doulas sounded wonderful, I still had a nagging feeling that this was a luxury that few could afford, and the reality of life with a newborn for most women, especially with little family support, was very different to the glowing testimonies of clients in the book’s postscript.

Doula UK have a charitable ‘Access Fund’ which can be used to pay for doula services for mothers on low incomes, but it is by no means a guarantee that those applying for assistance can be helped, and I wonder how many potentially eligible mums are even aware of the option. Even families with modest incomes may find employing a doula a stretch whilst on maternity pay, and the ultimate option of the live-in home help I’m sure would be out the window. One estimated cost I found online for a postnatal doula is between £10-£20 an hour, plus mileage. For a doula to be most useful and be on hand a few times a week for 6-8 weeks, that could get pretty costly.

Please don’t think that I am criticising doulas in any way – I think they do amazing work and are committed to supporting women, and it is right and proper that they should be paid appropriately for their time and expertise.

That being said though, if doulas really are a luxury for the lucky few, there is a desperate need to improve the standard of postnatal care provided to the average mum. Naomi herself said in her talk at the conference that postnatal doulas have the luxury of time that community midwives and health visitors just don’t have. There is far too little postnatal support for new mums in general and too much pressure on them to get up and about and return to their ‘normal’ routine, in spite of any physical or emotional difficulties they may be experiencing. Stretched community midwives can’t spend a couple of hours cooking a meal, doing the laundry or watching older siblings as a doula could be employed to do.

I’ll let you consider part of Naomi’s book – in the chapter ‘A Career as a Postnatal Doula’, Naomi describes examples of a typical doula day, one ‘easy’ and one ‘challenging’, to help prospective doulas think about how they would cope with each situation. My thought was how a new mum with a two year old toddler and eight day old baby, without a doula, would cope with the same ‘challenging situation’ by herself.

“10am: Arrive. Mum in tears in dressing gown. Screaming toddler clinging to her leg with smelly full nappy. Baby screaming in arms, has been feeding off and on all night. Food delivery being delivered to kitchen. Cat sick on the floor. Porridge boiling over on the stove.”

It is no wonder that perinatal mental health is such an issue, not to mention the physical toll this would quickly have on an exhausted new mum.

FairyGodmotherIn Naomi’s scenario, the experienced doula sweeps into the house, takes the baby, enables mum to care for toddler then have a shower, tidies the kitchen, settles mum and baby for breastfeeding whilst distracting toddler, resettles baby and toddler after brief disruptive visit by midwife to have a cuddle and story with mum, sorts the laundry and makes lunch. This is the kind of Fairy Godmother we would all choose to have in our home – if we had the choice.

My concern is that the absolute majority of new mums receive no more postnatal assistance than a couple of short visits from a community midwife, a handover to the health visitor, and a list of local breastfeeding groups. This is not enough. Family support cannot always be relied upon when many grandparents still work or don’t live close by. Yes, most women will manage, but some will not, and not all will feel able to ask for help.

It’s time that the Cinderella service got dressed for the ball. Mums are being dealt another disservice at the hands of stretched NHS resources, and the knock-on effects of long term health problems following poor postnatal care are putting increased strain on NHS services who have to pick up the pieces when the situation could have been prevented in the first place. It’s a vicious circle that needs to be stopped.

A doula for all? That’s the fairy tale ending. (Glass slippers and pumpkin optional).

 

nurturing new families coverNaomi Kemeny’s book ‘Nurturing New Families – A guide to supporting parents and their newborn babies’ is published by Pinter and Martin, and can be ordered via their website www.pinterandmartin.com/nurturing-new-families

 

 

pre-eclampsia awareness month: know the symptoms, spread the word

I’ve written about my experience of pre-eclampsia before, and you can read all about what happened in my post ‘Under Pressure’. I’ve been moved to return to this dark cloud hanging over my otherwise straightforward pregnancy by recently being in contact with a couple of other mums who have been affected by the condition, and frankly, that’s already too many.

pre pledgeMay is Pre-eclampsia Awareness Month, promoted by the US charity Pre-eclampsia Foundation. The theme for #PreAM14 is Take the Pre-eclampsia Pledge – Know the Symptoms, Spread the Word, so that’s what I’m doing, and that’s what I’d love you all to do.

The more aware expectant mums are of the warning signs of developing pre-eclampsia, the more likely they are to report them to their midwife in a timely fashion, and the better the chance of a positive outcome for both mum and baby.

There are still gaps in our knowledge of pre-eclampsia – doctors aren’t sure what causes it or how exactly it develops. What we do know is that it only occurs in pregnancy and the postpartum period. It is a rapidly progressive condition and can deteriorate suddenly. It is characterised by high blood pressure and the presence of protein in the urine, often detected at routine midwife appointments, as was the case with me.

Severe pre-eclampsia, and the related condition HELLP syndrome, can be fatal to mother, baby or both. The consequences of ignoring this condition should not be underestimated.

The condition can only be managed with medication up to a point – the ONLY definitive cure for pre-eclampsia is delivery of the baby, and if it develops too early in pregnancy, it is clear to see how pre-eclampsia is responsible for 15% of all pre-term births in the UK.

Blood PressureUnfortunately, there is very little you can do to avoid developing pre-eclampsia in the first place. There are risk factors that for some reason make some women more susceptible than others, but if it’s going to strike you down, it will, regardless. The best thing you can do is look after yourself in pregnancy – follow a healthy diet, light exercise and ensure you are obtaining the correct vitamins and minerals.

In addition, you must attend all of your routine antenatal appointments with your midwife, and ensure that your blood pressure and urine are tested at each visit. Don’t be afraid to question the midwife if either of these tests is omitted. If the signs are there, they should be detected and your midwife will act on it.

Pre-eclampsia is sometimes referred to, rather melodramatically yet somewhat accurately, as the ‘silent killer’ – not all women with measurably high BP and proteinuria will exhibit or be aware of any physical symptoms. I certainly wasn’t, which is why the sudden diagnosis of a serious condition I couldn’t feel came as such a shock. However, the majority of women developing pre-eclampsia will experience one or more of the following symptoms:

  • Swelling of the hands and face, especially around the eyes (swollen feet or ankles are very common in later pregnancy and aren’t necessarily a sign of pre-eclampsia)
  • Weight gain of more than 5lbs in a week
  • A severe headache that won’t go away with painkillers
  • Changes in vision such as seeing spots or flashing lights, or any loss of vision (if you have ever been unfortunate enough to have a migraine with aura, it is similar to this)
  • Nausea or throwing up, often suddenly, in mid to late pregnancy (this is different to the ‘morning sickness’ common in early pregnancy)
  • Upper abdominal pain, sometimes mistaken for indigestion
  • Difficulty breathing, gasping or panting

I want you to remember these. I would have them on little laminated cards for every pregnant woman at their first antenatal appointment. Recognising these symptoms could literally mean the difference between life and death.

Another one to add to the list would be ‘mother’s instinct’ or feeling that something just isn’t ‘right’. If at any time, day or night, you don’t feel 100% happy with something, even if you can’t put your finger on it, call your midwife or maternity unit for advice. It is absolutely better to be safe rather than sorry. You know your baby. You know when they are normally active and when they like to have a rest. You can tell if they aren’t moving as they usually do. Trust yourself and call your midwife.

joe hospitalI was lucky. My pre-eclampsia developed at 36 weeks and I was able to be induced at term. Joseph was small for his gestation, as pre-eclampsia can cause growth restriction, but he was otherwise healthy, and so was I. I had an attentive community midwife who picked up on my raised BP and was sufficiently concerned to order further tests which confirmed my diagnosis although I had no symptoms. Other women will, which is why you all need to be aware of what to look out for.

Don’t fall victim to the silent killer. The sooner pre-eclampsia is detected, the better chance you and your baby have. Trust your instincts, know the symptoms, spread the word.

 

awareness survey

For more information on pre-eclampsia and HELLP syndrome, visit:

MAMA Academy

logo1SquareWhite

Pre-eclampsia Foundation

pre eclampsia foundation

Tommy’s

tommys

Action on Pre-eclampsia

APEC

 

the wisdom of children 5

It was my mum’s 60th birthday over the Easter weekend, and we had a wonderful time with the glorious weather, lots of food, and a surprise visit from my brother and his girlfriend who made a last minute decision to come up from Manchester and attempt to give Mum a heart attack by leaping out unexpectedly as she arrived at our house on Easter Sunday.

Joe was thrilled and full of beans to have so many people around to keep him entertained, and he was endlessly endearing and affectionate for the couple of days of excitement (aside from a disagreement with Aunty Emma about whose go it was with the football). With an Easter Egg Hunt on Sunday, followed by a day out involving a ride on a steam train on Monday, he was a very happy bunny.

And he was, as always, consistently hilarious.

“Whose birthday is it on Monday, Little Man?”

“Grandma!”Joe egg hunt

“And do you know how old Grandma will be?”

“Erm….”

“Well, how old are you?”

“Three!!!”

“And how old is Mummy?”

After a little prompting… “32!”

“Well, Grandma is going to be 60.”

Then, incredulous as only a three year old could be… “60?!”

“Yes, 60.”

Surely no-one could be so old.

“That’s a very long way away number, Mummy.”

“Yes, Little Man, I suppose it is. Grandma will be thrilled to hear how comparatively ancient she is.”

“I’ll give her lots of cuddles and treats.”

Happy long way away birthday Grandma.