I wish I could record a full sensory memory of having these girls asleep with me. Resting on the big nursing pillow in a double football hold, loads of legs sprawled out behind us. Fuzzy little heads inclined toward each other. Hands on me, in each other's faces, sticking out in random places. Happy sleep sighs. Fat orange cat purring on my legs, ready to run off as soon as I unbuckle the pillow. We do this when we go to bed around 10:00, and then again, these days, around 4:00AM. With a singleton, I would roll over, half asleep, and let her nurse, but I am forced, for now, to hoist my pillow from beside the bed, sit up, feed them, unbuckle the pillow, and settle back down with a daughter in each arm. It may sound inconvenient, but these are probably my last babies, and I am a little bit grateful for being mostly awake to drink it in.
Thursday, December 13, 2012
Thursday, August 30, 2012
Two Little Bees: A Birth Story
Here I am, nearly four months removed from my daughters' birth day. We're all pretty fantastic. They have lovely Welsh first names like their big sister. I think that on the internets, they shall be Little and Bit. Without much further ado, I desperately need to get their birth story recorded. Two parts, I think, perhaps a third for the hospital stay, with part one being a bit more background-y and part two being more of a procedural.
So, while I was quite happy to find an OB who said only baby A needed to be vertex for a vaginal birth to be possible, it turns out this was sort of a lie. Or at least not quite as truthful as it first appeared. As my pregnancy progressed, it became clear that not everyone at the practice would be okay with a vertex/breech vaginal delivery scenario. There was one other big piece of news that had somehow not been shared with me after my big ultrasound at the Geisinger hospital in Danville, PA: delivery at 37-38 weeks was recommended. I had read a bit about this general recommendation, but I thought my practice was being refreshingly relaxed as to putting a deadline on delivery. Wrong. They just failed to share that part of the tertiary care center's report. While I ultimately came to wholeheartedly agree with this recommendation, it was not presented in a very good way - or in a very timely fashion - and I did not react well. (Long story short: previously uncomplicated monochorionic twin pregnancies have a 1.25% chance of stillbirth after 37-38 weeks. This is unacceptably high in comparison to the risks of delivery at 38 weeks.) By "I did not react well," I mean that the huge, hormonal 36-weeks pregnant lady stormed out of the hospital crying after one of the twice-weekly non-stress tests.
What I wanted: a totally natural vaginal birth. Why I couldn't have it: baby B was just switching between being breech and being transverse. I knew perfectly well that I wasn't going to spontaneously go into labor by 38 weeks, having had my first child at 40w2d and not having shown any signs of premature labor thus far (cervix o'steel, apparently). I came to the conclusion that an induced labor with a breech twin was not safe, especially given the lack of experience with breech births most practitioners have. I can sum up weeks of research by saying that IF you are going to have a spontaneous delivery with an OB who is experienced with breech deliveries, THEN it is reasonably safe to do, but if you can't meet all of those conditions (and more, like your twins being the same size and not being your first live births) then it's time for the dreaded c-section.
I felt, and still feel, pretty comfortable knowing I had done what I could and that not all c-sections are unnecessary. I worked on controlling what I could: scheduling it for as late as possible (37w6d because my favorite OB at the practice was going on vacation the day after), contacting the hospitals IBCLCs to make sure they would be part of the birth team, insisting on having the catheter inserted after I got the spinal (it may seem inconsequential, but why have it inserted when you still have feeling?), and generally making sure everyone knew I wanted to touch and feed my babies as soon as possible. We planned to have my husband accompany the girls out of the OR so that they would be brought to me in the recovery room as quickly as possible, and not given eye ointment, a hepatitis shot, or a bath.
Going from a homebirth to a c-section was an exhausting journey. I was seriously very ready for pregnancy to be over. Finally, we gamely set out for the hospital around 9:30AM on May 3, leaving the Bee with my mom at our house... and knowing we were just hours away from meeting two new little humans.
TBC...
So, while I was quite happy to find an OB who said only baby A needed to be vertex for a vaginal birth to be possible, it turns out this was sort of a lie. Or at least not quite as truthful as it first appeared. As my pregnancy progressed, it became clear that not everyone at the practice would be okay with a vertex/breech vaginal delivery scenario. There was one other big piece of news that had somehow not been shared with me after my big ultrasound at the Geisinger hospital in Danville, PA: delivery at 37-38 weeks was recommended. I had read a bit about this general recommendation, but I thought my practice was being refreshingly relaxed as to putting a deadline on delivery. Wrong. They just failed to share that part of the tertiary care center's report. While I ultimately came to wholeheartedly agree with this recommendation, it was not presented in a very good way - or in a very timely fashion - and I did not react well. (Long story short: previously uncomplicated monochorionic twin pregnancies have a 1.25% chance of stillbirth after 37-38 weeks. This is unacceptably high in comparison to the risks of delivery at 38 weeks.) By "I did not react well," I mean that the huge, hormonal 36-weeks pregnant lady stormed out of the hospital crying after one of the twice-weekly non-stress tests.
What I wanted: a totally natural vaginal birth. Why I couldn't have it: baby B was just switching between being breech and being transverse. I knew perfectly well that I wasn't going to spontaneously go into labor by 38 weeks, having had my first child at 40w2d and not having shown any signs of premature labor thus far (cervix o'steel, apparently). I came to the conclusion that an induced labor with a breech twin was not safe, especially given the lack of experience with breech births most practitioners have. I can sum up weeks of research by saying that IF you are going to have a spontaneous delivery with an OB who is experienced with breech deliveries, THEN it is reasonably safe to do, but if you can't meet all of those conditions (and more, like your twins being the same size and not being your first live births) then it's time for the dreaded c-section.
I felt, and still feel, pretty comfortable knowing I had done what I could and that not all c-sections are unnecessary. I worked on controlling what I could: scheduling it for as late as possible (37w6d because my favorite OB at the practice was going on vacation the day after), contacting the hospitals IBCLCs to make sure they would be part of the birth team, insisting on having the catheter inserted after I got the spinal (it may seem inconsequential, but why have it inserted when you still have feeling?), and generally making sure everyone knew I wanted to touch and feed my babies as soon as possible. We planned to have my husband accompany the girls out of the OR so that they would be brought to me in the recovery room as quickly as possible, and not given eye ointment, a hepatitis shot, or a bath.
Going from a homebirth to a c-section was an exhausting journey. I was seriously very ready for pregnancy to be over. Finally, we gamely set out for the hospital around 9:30AM on May 3, leaving the Bee with my mom at our house... and knowing we were just hours away from meeting two new little humans.
TBC...
Saturday, April 7, 2012
BOGO Babies, or Getting Knocked Off My Low-Risk High Horse
Everyone loves a good pregnancy story, right? I figure I should record it for posterity before it is overwritten in my memory banks by the actual birth.
I found and had three meetings with a wonderful CPM. We decided to have just one ultrasound - my feeling being that if you are going to have a home birth, there's no harm in ruling out easily-spotted problems. I was not going to find out the sex. (I know ultrasounds aren't perfect, but I still feel that the risks of intervention are outweighed by the benefits of information in this case). So on January 4, 2012, The Husband and I happily drove half an hour to the practice of the OB the midwife works with to have an anatomy ultrasound performed.
Back to the ultrasound room we went, lighthearted enough, even though I always get a little jittery before things like this. I hopped up on the table, and the guy told me I needed to empty my bladder, and that it was the fullest one he had seen that day. So I went and did so and hopped back up (I can't believe I was that nimble just four months ago). Within about 30 seconds, he said, "How many babies were you planning on having?"
"Just the one," I said.
"Well, there are two in there."
I laughed, in a probably mildly unhinged manner, for a couple minutes, then had to be still so he could look at a few more things. He couldn't do the full anatomy scan on both twins due to scheduling, but he checked their hearts, brains, and also identified the type of twinning.
Thence began a happy, but difficult, January. I immediately, if sadly, ruled out home birth - just too risky, especially with monochorionic twins, even diamniotic ones. (No, I didn't know the terms before, but here's the important thing: they share one placenta but have their own amniotic sacs). I picked an OB/midwife practice; it was terrible, and I cried at the first appointment. I then switched practices and it has been great.
The first OB said some pretty terrible things. Like: no option of a vaginal delivery unless both twins were vertex; he would induce me when I got to 38 weeks; oh, and in the ever-so-likely even of a c-section, would I like them to tie my tubes "while they were in there?" Hence the weeping. My OB now? Vaginal delivery as long as the presenting twin is vertex (and they are about the same size, not distressed, not preterm, and other reasonable stipulations); no one will say "induction" unless I go to 41 weeks (pretty unlikely); and, in general, a c-section is not the preferred method of delivery.
I had a very hard time admitting I am a high risk pregnancy. Unfortunately, there's simply no getting around it; monochorionic twins ARE high risk. They die in utero more often than singletons, whether it's early or late in the pregnancy, even more often than dichorionic twins (twins that do not share a placenta). They can have Twin-to-Twin Transfusion Syndrome (TTTS), where their mingled circulation can cause one twin to have too much blood, urine, and amniotic fluid while the other has too little of those things. Placental abruption is more of a danger during delivery. Heart defects are more likely. Preterm delivery, and especially very preterm (before 34 weeks) is more frequent. Going past 40 weeks appears to be more risky with twins than it is with singletons as well.
Having said all that: I'm happy to say I am being treated as normally as possible, while being monitored very closely. My midwives (CNMs) have been amazing and are respectful of my general hippie-ness. I even detect a touch of excitement from them! Their plan of action has so far included: an in-depth ultrasound that checked for uneven blood flow, heart problems, and a bazillion other things (it took over an hour, and I nearly passed out from being on my back, but at least now I have an iron-clad reason not to be on my back during labor!); twice-weekly non-stress tests staring at 32 weeks; once-weekly biophysical profiles starting at 34 weeks; and growth ultrasounds at each midwife appointment going forward to verify that growth is equal and not slowing too much. (Unequal growth is a very obvious sign of the previously mentioned TTTS). Is this a lot of stuff going on from now until birth? Absolutely, but it's "stuff" that actually improves outcomes, and that's all I ask. Poke me, prod me, strap three monitors to me twice a week, but improve my chances of having healthy babies!
So, here I am, 34 weeks pregnant with monochorionic/diamniotic girls who are creeping up on 5 pounds each. Yes, I am uncomfortable, huge about the belly, tired, and I sleep alone because I get up all the time due to a full bladder, heartburn, hunger, or some combination thereof, but I'm awfully close to bringing some kick-ass healthy twins into this world, as close to "the old fashioned way" as possible. I am controlling what I can, which is mostly what I eat and how much I rest. I still think those things, especially the eating, are incredibly important.
I realize that I've left out all my feelings about the actual having of two babies thing. In short, the idea of going from one kid to three so quickly was an incredible shock, but we have mostly processed it. I don't think we will fully comprehend it until they are here. But just know... it could happen to you!
I found and had three meetings with a wonderful CPM. We decided to have just one ultrasound - my feeling being that if you are going to have a home birth, there's no harm in ruling out easily-spotted problems. I was not going to find out the sex. (I know ultrasounds aren't perfect, but I still feel that the risks of intervention are outweighed by the benefits of information in this case). So on January 4, 2012, The Husband and I happily drove half an hour to the practice of the OB the midwife works with to have an anatomy ultrasound performed.
Back to the ultrasound room we went, lighthearted enough, even though I always get a little jittery before things like this. I hopped up on the table, and the guy told me I needed to empty my bladder, and that it was the fullest one he had seen that day. So I went and did so and hopped back up (I can't believe I was that nimble just four months ago). Within about 30 seconds, he said, "How many babies were you planning on having?"
"Just the one," I said.
"Well, there are two in there."
I laughed, in a probably mildly unhinged manner, for a couple minutes, then had to be still so he could look at a few more things. He couldn't do the full anatomy scan on both twins due to scheduling, but he checked their hearts, brains, and also identified the type of twinning.
Thence began a happy, but difficult, January. I immediately, if sadly, ruled out home birth - just too risky, especially with monochorionic twins, even diamniotic ones. (No, I didn't know the terms before, but here's the important thing: they share one placenta but have their own amniotic sacs). I picked an OB/midwife practice; it was terrible, and I cried at the first appointment. I then switched practices and it has been great.
The first OB said some pretty terrible things. Like: no option of a vaginal delivery unless both twins were vertex; he would induce me when I got to 38 weeks; oh, and in the ever-so-likely even of a c-section, would I like them to tie my tubes "while they were in there?" Hence the weeping. My OB now? Vaginal delivery as long as the presenting twin is vertex (and they are about the same size, not distressed, not preterm, and other reasonable stipulations); no one will say "induction" unless I go to 41 weeks (pretty unlikely); and, in general, a c-section is not the preferred method of delivery.
I had a very hard time admitting I am a high risk pregnancy. Unfortunately, there's simply no getting around it; monochorionic twins ARE high risk. They die in utero more often than singletons, whether it's early or late in the pregnancy, even more often than dichorionic twins (twins that do not share a placenta). They can have Twin-to-Twin Transfusion Syndrome (TTTS), where their mingled circulation can cause one twin to have too much blood, urine, and amniotic fluid while the other has too little of those things. Placental abruption is more of a danger during delivery. Heart defects are more likely. Preterm delivery, and especially very preterm (before 34 weeks) is more frequent. Going past 40 weeks appears to be more risky with twins than it is with singletons as well.
Having said all that: I'm happy to say I am being treated as normally as possible, while being monitored very closely. My midwives (CNMs) have been amazing and are respectful of my general hippie-ness. I even detect a touch of excitement from them! Their plan of action has so far included: an in-depth ultrasound that checked for uneven blood flow, heart problems, and a bazillion other things (it took over an hour, and I nearly passed out from being on my back, but at least now I have an iron-clad reason not to be on my back during labor!); twice-weekly non-stress tests staring at 32 weeks; once-weekly biophysical profiles starting at 34 weeks; and growth ultrasounds at each midwife appointment going forward to verify that growth is equal and not slowing too much. (Unequal growth is a very obvious sign of the previously mentioned TTTS). Is this a lot of stuff going on from now until birth? Absolutely, but it's "stuff" that actually improves outcomes, and that's all I ask. Poke me, prod me, strap three monitors to me twice a week, but improve my chances of having healthy babies!
So, here I am, 34 weeks pregnant with monochorionic/diamniotic girls who are creeping up on 5 pounds each. Yes, I am uncomfortable, huge about the belly, tired, and I sleep alone because I get up all the time due to a full bladder, heartburn, hunger, or some combination thereof, but I'm awfully close to bringing some kick-ass healthy twins into this world, as close to "the old fashioned way" as possible. I am controlling what I can, which is mostly what I eat and how much I rest. I still think those things, especially the eating, are incredibly important.
I realize that I've left out all my feelings about the actual having of two babies thing. In short, the idea of going from one kid to three so quickly was an incredible shock, but we have mostly processed it. I don't think we will fully comprehend it until they are here. But just know... it could happen to you!
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