Saturday, August 29, 2009

We all came home!

Everything was cleared yesterday to allow us to discharge home (after a frustrating delay to take the 'car seat challenge test,' which they both passed). It is nice to be home and so far the babies are healthy and good, eating well while I attempt to juggle the fine line between establishing a breast milk supply and provided the needed supplements so that they grow and thrive. As my daughter followed a similar course, losing a lot of initial birth weight and from there being a slow gainer, I am very prepared as I have been down this road before. I will be very happy to see them gain, though am trying not to fall into the obsession of numbers and daily weigh-ins... Our first pediatrician visit is Monday so am hoping for a good report from our MD.

Friday, August 28, 2009

Discharge Day?

I am hoping we all go home today. Since my first episode of pre-term labor, I have been increasingly concerned about potential health issues if the boys come early. It has been my biggest hope that we could all leave the hospital together and not have to leave one or both behind. Two things right now are potential obstacals to that occuring. One is they nurses of the NICU have not yet conducted the "Car Seat Challenge" test--which sounds like some kind of baby gladiator competition, but in reality is a test to monitor their oxygen levels while they are in the carseat to ensure they can breathe adequately. If they do not pass, they have to spend 24 hours in the NICU and then get tested again. I have been asking over and over when this test will happen as I cannot be discharged until it is done and now we are going into the early hours of the morning, so it may prolong things a bit.

The other potential complication is that Walter is boarderline jaundiced right now and if he requires phototherapy, it may need to occur in the hospital.

Meanwhile I am feeling great, rested and ready to move these boys home! I know for certain that I am discharged today so I just have to sit tight a few more hours until we learn more.

Wednesday, August 26, 2009

Introducing John Daniel & Walter Joseph!

John and Walter made their appearance today, weighing in with John at 4lbs 11oz and Walter at 5lbs even at 35weeks and 6 days. In this picture, Walter is on the left, John on the right.

I started having contractions in the morning, around 11am, but chalked it up to braxton-hicks until about 5pm when they began to seem closer together and more irritating. By 8pm I realized I would have to take a visit to the hospital L&D. I was feeling them both moving a little less and was nervous. It took my husband and I a few hours to mobilize and by the time we got to the hospital it was 11pm. I had called ahead earlier in the day to find out if it was my OB on call and turns out it was one of the doctors who would not deliver breech. When we got to L&D to be checked, the nurse told us they would get me going shortly with the spinal and discussed all the basic preparations for a c-section. I mentioned that had my primary OB been available he would have gone with a vaginal breech. "Poor you!" she said and made a face as if that would be putting me through a harrowing ordeal.

When she checked me I was surprised to find I was already dilated 6cm. I thought it didn't matter anyway since I would be having a c-section and although the pain was not out of control, the contractions were annoying me and I wanted them to stop. Suddenly the RN returned to the room and said, "Your OB is coming in. He said he will deliver your babies vaginally." Part of me was so scared to hear this, but mainly I was floored that he would come in on a night he was not on-call to give me this option.

I was sent upstairs to the OR recovery room (It is standard to deliver twins in the operating room, regardless of c-section vs. vaginal birth) where I met a resident who did a scan. I recognized her from my previous hospitalization for pre-term labor and she went over some of my questions about the safety of a breech/transverse presentation with vaginal delivery. By the time my OB entered the room (had been at the hospital for an hour and 1/2), he checked me and I was 9cm! While the contractions were still painful, I still mostly found them annoying and could not believe I had progressed that far. Over continuing intense contractions I had the conversation with him that I had been agonizing over which was to take place the following morning--all my questions about the risks and pros/cons of a vaginal delivery vs. a c-section as well as questions about his skills and background delivering breech and what interventions would be employed. I had written out a page on a Word doc of questions and issues I wanted to discuss. Of course we had the abbreviated version of this.

Me: "What are the risk to breech?"
OB: "A breech vaginal delivery is slightly more risk, with head-entrapment the number one risk that occurs about 1% of the time."
Me: "Heh heh heh heh whooooo" (contractions)
OB: "I think a vaginal delivery is better for these babies."
Me: "Ok! Let's do it"

I had fortunately addressed my main concerns with the resident earlier when I was able to articulate my concerns more and one point we addressed was the back-up plan to move to Cesarean if needed. She recommended the Epidural so as to avoid general anesthesia. My OB also recommended this and requested the anesthesiologist to give me the lowest dose possible. The OB looked at me and said, "This is all you. I want you pushing."

We moved into the OR to get set up while my husband stayed behind in the recovery room to get his scrubs on (and looked so handsome!) At this point I was fully dilated though not quite at the pushing point. They administered the epidural--which I had to fight really hard not to get freaked out about, as I really don't like needles going into my spine--then someone brought my husband back in the OR. I laid down and the medical team--which had to have numbered about 12+ people by then--got me positioned to start pushing. Although the Epi was the lowest dose, it came on strong and numbed me so when the nurse asked, "How was that contraction?" I looked blankly and said, "What contraction?" I could still feel sensation when the OB reached inside to check the position of Twin A, and so when they told me to push I was able to with full feeling, just not much pain. I pushed for about 5 minutes--maybe 5 pushes--with Twin A, and out he came! My husband describes seeing the bag of water coming out like a balloon as big as a babies head and then it ruptured and our John entered the world, butt first, at 4lbs, 11oz and 17 inches. From my perspective, it seemed that that rupture sprayed the entire room with amniotic fluid, but that may be my exaggerated view.

He was out and cried right away. I saw him briefly and then he was brought to the pediatrician for checks, the nurses giving me regular updates. His apgars were 8/9.

Now was Twin B's turn and my OB was instructing the resident on the breech extraction. As Twin B was still in transverse, she reached up until she got a foothold and gently pulled him down. I did not quite understand all that was happening, but heard my husband explain in awe: "There are his feet!" And I was called upon again to push, and another 4 pushes brought Twin B all the way out--except his head. I looked down between my leg and saw a slimy little back and butt and body and some dark hair peeking out. His head had not fully emerged with the push and the OB pulled up forceps to nudge out the head. Now I knew from my reading that forceps can be used for breech extractions with some risk but also with success. But I have to say seeing those forceps brought up over my little babies head was the scariest moment for me, as they are quite large metal instruments that look pretty capable of being used as weapons! But it was not long before they did nudge him out and our Walter was born, weighing in at 5lbs even (yay a 5lber!) and 17 & 3/4 inches. He was more quiet which made me nervous and they brought him quickly to the pediatricians. I did not wait long before hearing his cry and hearing good reports from the doctors. His apgars were 5/9. As Walter had a bit more trouble getting out, it took him a minute to perk up.

The entire room started cheering and I looked at the clock--2 hours since we had arrived at the hospital and I had two healthy twin boys!

As I sat back happily exhausted and full of adrenaline from the birth, I heard my OB talking to a medical student. The student said something along the lines of "That was really cool to see," to which my OB replied, "And I don't know when you will see again. Birthing breeches is a dying art..." Later on my OB told me he had spoken about my birth to his associate on call who told him she would have delivered the twins by c-section, thus elevating my OB to "White Knight" status for coming in to offer this option that so few other doctors would.

With our healthy babies thriving we are really and truly blessed. And I can't help but find it interesting that my three children have all arrived 3 different ways--head, butt and feet! How will that come to define their personalities :) I am so thankful for all of the support and encouragement we have had throughout this process! I am so happy to have the babies on the outside!

Tuesday, August 25, 2009

Braxton-Hicks vs. The Real Deal

I have been having contractions since about 11am today. They are erratic, as close as 4 minutes, far apart as 11. My guess being braxton hicks. As a 2nd timer at pregnancy, I ought to *know* when it is the real deal. But I am hoping to will them as braxton hicks because I really would like to eek out a few more days...Thursday being the magical 36 week point....

Thursday, August 20, 2009

Delivering Breech

I had my ultrasound on Wednesday which confirmed TwinA is still firmly breech, TwinB is transverse. The estimated weights are 4lbs, 7oz (TwinA) and 4lbs, 12oz (TwinB). I could not even post about it yesterday because my spirits were very low as I sat with the reality of an inevitable c-section and felt concerned that the weights were not higher. I know u/s measurements can be off, but I had hoped for 5lbers at this point.

Regardless, I spent the majority of Wednesday night researching c-sections, trying to be as prepared as possible while simultaneously reading about flipping breeches.

Today I had my OB appointment with the remaining doctor of the practice which lasted all of 3 minutes and consisted of her answering all my questions by saying, "You will want to follow up with Dr. X on that..." I went home more sick than ever of the medical establishment.

About an hour ago, my OB made up for all my angst and misgivings by calling to discuss the position of the baby. He said I am a candidate for a vaginal breech delivery! Of course the caveat is that I go into labor when he can do the actual delivering b/c the other MD's in his practice would do a c-sec, but I am SO glad to hear there is that window of possibility open! He made my day. There are more facets to consider in this turn of events, but for now I am just grateful that there is a doctor in this city that is willing to attempt to deliver a breech baby!

Monday, August 17, 2009

Belly Shot--34 weeks,3 days

I am obsessing about the stretchmarks....Never had them with my daughter! Guess there is not much that can be done though...

Sunday, August 16, 2009

Looking forward to Wednesday

Wednesday will be my next ultrasound at 34w6d. It will be a good feeling to make it so close to 35 weeks and I am really looking forward to an update on the babies estimated weights and of course positions. My OB may have given me false hope at the last appointment stating he thought during the cervical check that Twin A was head down. That would make my month. But I am skeptical. We will see!

Tuesday, August 11, 2009

Backseat Parenting

Amazing that suddenly four days have gone past and now nearly a week since I was hospitalized. I have been home on bedrest for four days, and just now up for writing. It was much harder than I imagined initally returning home. While I knew I was pampered and able to rest beyond what would be possible when at home and watching my toddler run around, I had not realized the extent of the adjustment. Having never been ill for a prolonged period, I have never had to be so dependent on others. The other part to that too is that I am not ill! I feel fine, I am just pregnant and now feeling like my body is so fragile if I stand up for too long the babies will fall out! The resident I spoke to at discharge cautioned me against feeling that way and said: "Wouldn't it be a wonder for L&D if it actually worked that way!"

I am trying to be as strict as possible--therefore as horizontal as possible--for the majority of the day, at least until I get to 35 weeks (8/20) and then I will feel I can breathe easier. Tomorrow is my 'big excursion' going to the hospital for my weekly non-stress test and a prenatal follow up with my OB, who has been on vacation missing out on all my excitement :) It will be interesting to meet with him now that I am no longer quite the "lowest risk twin pregnancy" he has seen. But I know I am in a safe(er) bracket should the boys come early, but I am still really really wanting to keep them inside me (vs. say a NICU isolate) for as long as possible. I am terrified I will have dilated further and they will just go forward with a c-section (as I am sure TwinA is remaining stubbornly breech!).

In the meantime, living as a backseat parent is the biggest adjustment. I am practicing letting go, and perhaps this is good preperation to when I will be saddled with the immobility of breastfeeding and taking care of both boys. My daughter gets to expand her social group. So while it is painful letting go that position of being her #1 caretaker, it is an adjustment that is healthy for her, as well as inevitable. I am really grateful for the help I am getting, and if these past four days has suddenly gone by, maybe before I know it I will check the calendar and it will be September, and I will still be pregnant. Here's hoping.

Thursday, August 6, 2009

Bedrest at 33 weeks

It is fair to say I am no longer in a position to be concerned about inducing labor or turning a breech. Yesterday when going to my regular prenatal appointment poised to plead to be taken out of work at 35 weeks, the OB (not my regular as I am rotating through the practice) did an internal exam to discover I was dilated to 1.5cm and 50% effaced. He said: "You are out of work starting now!" He proceeded to tell me he was sending me over to labor and delivery. It took a while to absorb this news. When pregnant with my first daughter, I walked around for two weeks 2cm dilated and 80% effaced. I was never sent to L&D until by myself when contractions started at 39w4d. But then I was between 38 weeks and 40 and at just under 33 weeks, I am still quite preterm for twins. I headed over and to my surprise discovered I was contracting (which I did not feel, except for a lower back ache) and I wound up dilating to 3cm. There was talk of a c-section and I had to meet with the neonatologist and anesthesiologist. My TwinA is still breech and so I am quite sure at this point that I will be having a c-section--which I don't care about anymore, just want the babies to be healthy. I was administered a steroid shot for the lungs (get a 2nd today) and administered Indocin to stop the contractions. This began at 10am. By around 3am, the contractions had slowed to more than 10 minutes apart, much to my great relief and I was moved from L&D to the antepartum unit to begin my hospital bedrest. From here on out I will have a lot of downtime. I can't imagine how this will go when I get home. For now I have the hospital TLC at my disposal. Can't imagine what it will be like to be around my toddler who I cannot run after and watch my husband make great efforts (perhaps) to multi-task, but knowing it just won't be done by me will be hard. At least I have more time for blogging...and no more night shifts for a while.

Sunday, August 2, 2009

Turning a breech baby

One outcome of my recent ultrasound was learning the position of the babies. A bit of a disappointment for me was learning Twin A is now breech. I have spent a lot of time this week on the Spinning Babies website, trying inversions, cat-cow positions and am gearing up to start putting frozen peas on the top of my belly and making my husband speak through a paper-towel tube into my lower belly to coax Twin A back to vertex.

What is upsetting to me is the Spinning Babies site makes a big focus on emphasizing that if the "mother is in balance, the babies will turn," and emphasizes chiropractic adjustments, prenatal massage and deep relaxation. I have been thinking about the differences between this pregnancy and my first. I was able to swim twice a week, do yoga twice a week, and indulge in thinking deeply about my pregnancy. This time around, I just don't have that luxury. I am running after my daughter constantly and when not, I am dropping down in bed exhausted--too exhausted for yoga. A friend of mine in a similar boat just gave birth to her singleton who was a 9lb'er and vertex. I know she had no less stress throughout her pregnancy than I did.

I believe in the end the babies will do what they want to do regardless of these interventions. I can try the techniques, but really it is beyond my control. I have been reading about c-sections trying to gain some comfort if that becomes the option, but I am continuing to struggle with the various philosophies that exist for childbirth--and the limited options that exist. It was my same struggle with the possibility of induction, now focused around the breech issue. It is something that I will continue to work through in my mind.

31 Week Growth Update

This past week I also had a growth update via ultrasound. Twin A is measuring 3lbs and 9 oz; Twin B is 4lbs. I would love to believe these numbers. They are good solid numbers from the 25th percentile and above. Far greater than what I ever got with my little peanut daughter. But I know these can be so inaccurate. For now they are close enough in size there is no concerning discordance. However, as they were closer together previously, they made a big fuss about continuing to watch to be sure they do not trend further apart.

"Natural twins do really well"

On Wednesday I had my first non-stress test that I now have weekly. It is more simple than I had thought, after friends advised me that NST's involved pushing a button every time you felt a movement. I wondered how accurate I could plot both TwinA and TwinB. In the end, they just had to strap on fetal monitors and look for two heart accelerations. Both twins did fine, it was just a matter of getting them to be cooperative enough to stay put to track the hearts. Took an hour total, but I had a nice engrossing Steven King book.

At the end, the nurse who had been friendly said, "They look great. Natural twins always do really well." Knowing that in fact there is no evidience that supports such a claim, I was a bit startled by this statement and said, "Really?" She said, "Yes, there is a reason your body produced two babies."

Being on a few twin forums, I am a bit sensitized to how offensive this would be to a mother pregnant with twins or multiples due to use of fertility drugs. Even though my twins were spontaneous, I have been asked several times if drugs were used or more often the passive, "Do they run in the family?" I find these questions awkward to answer without having the personal struggle of infertility in my history. Had I been in a position that I sought the use of medical intervention to assist with having a child, I know I would be constantly floored by these questions by their intrusiveness. It is one thing when a personal friend asks--which a few have--but quite another when they are strangers or distant acquaintances. Some people will make off-hand comments to me as well, like "It seems like everyone is having twins these days..." It is true the rate of multiples has increased with medical interventions available, but it isn't like people go seeking them. Every pregnancy that results in multiples was a couple seeking a child--singular. Even if the couple or mother desired twins or more, they are simply not something that can be ordered up. Multiples are miracles, regardless of their path to development, and all children are "natural."