Wednesday, February 26, 2014

TwinsDay Wednesday: A Birth Story

It has taken two and a half years for me to write this story.

It's not an easy story to write, because it makes me feel fragile and a little bit powerless.

I have put off writing the story for a long time. I even spent an hour peeling broken crayons with my fingernails yesterday afternoon instead of writing it. Finally, though, it's written, because you asked to read it, and I'm sharing it with the world.

My pregnancy with my twins was my second. My first child was born after an uncomplicated pregnancy at 40 weeks and 6 days. I labored at home, arrived at the hospital in transition, and gave birth to him 3 hours later. He weighed just over 10 pounds. It was a perfect natural labor- no interventions needed. I had some nerve damage and some difficulties afterward because of his size, but his birth was just perfect. I felt like after that, I could do anything.

The first thing I learned about a twin pregnancy was that no matter how smooth and uncomplicated my prior singleton pregnancy was, twin gestations are considered "complicated." Whether or not there are actual complications, there are going to be "complications." My complications began right from the start, just before 7 weeks, when I had bleeding and went in for an ultrasound thinking I was losing my baby. Instead, I found out I was having two babies.

Everyone was excited. "What a blessing!" we heard, over and over. I knew we were blessed- instead of losing one child, we were getting two- but I mostly felt overwhelmed and anxious at the news. Now, instead of worrying about the safety of one child, I was responsible for two. As the shock began to wear off, I told the midwife that I still wanted to do everything as naturally as possible. She smiled wryly and told me that "everything is different with twins- you're going to be getting a lot more attention around here."

She was right. The bleeding continued for a couple of weeks, and I was convinced the end was around every corner. We had weekly ultrasounds for months. Once, I was sent to the hospital for monitoring to rule out preterm labor when they thought something looked off with my cervix on the ultrasound. Nothing was happening- no contractions were detected. On every ultrasound, the babies were always doing great. They were the best case scenario for twins- dizygotic, diamniotic (meaning they were fraternal twins with two separate egg sacs). They were in good shape, and so was I. I was even able to be in my sister's wedding and was feeling pretty good, although everyone commented on how big I was.

Just after the wedding, around the 23 week mark, the medical team discovered my cervix was shortening and sent me to the hospital again for monitoring. I still wasn't having any contractions, but they decided to put me on complete bedrest to keep things from progressing any more. It was the day before my 32nd birthday. I spent the next three months in bed, lying on my left side, working from home, watching borrowed movies, reading books, learning to knit and trying not to go crazy while my husband was away at work and my two year old was away at day care. Thanks to the prayers and the support of friends and family who helped clean and cook and care for us, we made it through. It was the hardest twelve weeks my marriage has ever endured.

I went in for an appointment at 36 weeks and was released from bedrest. It was finally okay for the babies to be born. I expected they'd fall out on the way home or something, but they didn't. In fact, as I was leaving the midwife's office that day, the scheduler informed me that she'd be scheduling a planned C-section for 37 weeks. "That's when twins are full term," she said, "and we don't want them to go much past that."

I was floored. After spending three months constantly worried that I was going to end up with two premature babies in a NICU somewhere, they were planning a C-section? I told the scheduler she could do whatever she wanted, but that if they scheduled a C-section for my twins (both of whom were always head down), I would not show up.

She smiled and said we could wait until the next visit to schedule it.

At 36 weeks and 4 days, I went into labor all by myself. George and I went out and walked, and things picked up nicely. After laboring at home for a while, when contractions were 5 minutes apart, we called our doula to meet us at the hospital. We had decided a doula would be helpful, considering there would be two babies and no one quite knew what would happen during labor. A friendly extra set of hands and a like-minded, calming presence seemed like a good idea. We checked in around 11 AM. Things slowed down on the way to the hospital, but I wasn't worried- I knew once I got settled and was able to start walking around again, everything would be fine.

That was my first unpleasant surprise.

"Oh, you can't walk around," the nurse said. "You'll have to stay put. They want you on constant monitoring." Even though I told her I had discussed intermittent monitoring with my midwife, she was insistent that it was against the rules for twins and that the doctor on call (who supervised the midwife) wouldn't allow it. I told her I needed to see the doctor. She went out and came back a while later, saying the doctor was busy but that they would not budge on the monitoring. Two monitors, two babies, constantly on.

The trouble with those monitors is that they never stay put. Every time the nurse (or two nurses, or in one case four nurses) were able to get both babies' heart rates on the screen, one baby would move. The alarm would start sounding and nurses would come running to fix the monitor. Each of these episodes took about 45 minutes to correct. Then they would leave, turn off the lights, I'd have a contraction or two, a baby would shift position, and we'd repeat the whole process.

I tried sitting in a rocking chair for a while, then on a birth ball, but any movement dislodged the monitors. They finally told me I just needed to lie on my side in the bed and avoid moving. It felt like this labor was all about the equipment.

They kept coming in. If it wasn't the monitors, it was something else- check blood pressure, check temperature, check the endless strip of paper being produced by the monitors, change the strip of paper when the paper ran out, introduce the new nurse coming on at the shift change, set up incubators and scales for the babies hours ahead of time to prepare for their arrival. I was ready to get down to the hard work of labor, but they just couldn't leave me alone. Finally, my midwife came in to check me and said I wasn't making adequate progress.

This led to the second unpleasant surprise.

"There's a first-time mom here who is also having twins," she said. "Your labor is going to go faster than hers, because you've done this before. We need you to make quicker progress- we don't have enough people on the floor to handle two sets of twins coming at once, so we need your babies to be born first. We're going to start pitocin."

I shook my head, my eyes filling with tears. I knew the risks. I knew that it was likely to make my pain unmanageable without additional medication (especially since I couldn't move from my left side for fear of disturbing the monitors), and I wasn't willing to do it. I knew I was strong and that my body could labor naturally if given the chance to do its work. I begged her to ask the doctor to let me out of bed to walk. "You and I both know it will get things going," I told her. She agreed to talk to the doctor. A few minutes later, she came back and said the doctor had agreed to let me off the monitors for ten minutes to walk.

Ten whole minutes.

I walked laps around that floor like my life depended on it. As soon as I got out and started moving, contractions picked up. They got harder and closer together. I had to stop a few times to work through them, but I walked as much as I could. As we rounded the corner, I saw the doctor standing in the doorway of my room, ready to intercept me. My ten minutes was up.

I got back into bed. The nurses descended on me to hook up the monitors. 45 minutes passed while they tried to get things set up, and the contractions faded back again.

The midwife came back after an hour, checked me again, and said I had no choice but to do the pitocin.

This was my third unpleasant surprise.

Once they started that drip, everything was different. I was no longer in control at all. I couldn't tell when a contraction would start, when it would peak, or how long it would last. Every time a nurse came in, she turned up the drip a little more. Eventually, I was suffering through incredibly long, incredibly painful contractions with no ability to shift position or do anything to lessen the pain. The hours passed slowly. George and the doula did their best to help me through contractions, but there was no discernible pattern. After several contractions that double-peaked and one really memorable one that lasted eight minutes, I told them I had to have an epidural and that I didn't want anyone to question me or make me feel bad about it. There was no end in sight, and I just couldn't take it any more.

The anesthesiologist came to administer the epidural, and my fourth unpleasant surprise happened almost right away.

My blood pressure suddenly dropped, and I passed out.

When I came to, they had given me some other drug to counteract this side effect. George's face was white as a sheet. I imagine mine must have been a similar color. He said later that while he stood and watched the numbers on the blood pressure monitor dropping lower and lower, he thought I was going to die.

Once the epidural was going and the pitocin was going and the other drug to counteract the blood pressure drop was going, things went smoothly and were easily managed by the nurses. They liked the new, less combative, placid me, who felt nothing and didn't ask to get up or move or talk to the doctor or anything. They put me on my back, informing me when it was time to push and when I was having contractions.

The other twin mom had her babies first. A nurse came in and told me.

Finally, mine were ready. We had been praying for them by name for months, willing them to stay put and grow as long as possible. Now it was time to meet them.

Baby A, Lucy Clare, was born at 5:15 AM, weighing 5 pounds, 5 ounces.
I held her for a few minutes, then reluctantly passed her to George. The hospital doesn't like there to be a break between the birth of twins. The nurses said we needed to get Baby B out as quickly as possible.

Baby B decided to flip over and move up under my ribs to take advantage of the wide open space that she was no longer sharing with Lucy. The doctor, now in the room, was able to wrestle her back into position from the inside. It was probably a good thing I had that epidural at this point. I watched the doctor's grimacing as she struggled with the baby, her arm invisible from the elbow down. I felt nothing. I stared over my left shoulder at Lucy, who was lying in the warmer, taken from George so they could examine her. She was staring at me with wide, calm eyes. I remember thinking I should be holding her, that when her brother was born, no one took him away. It was the first time I felt like I couldn't give her what she deserved.

Baby B, Nora Lillian, was finally born at 5:55 AM, weighing 6 pounds, 6 ounces. Her face was bruised from her struggle with the doctor. I didn't get to hold her then, because they were afraid she was blue because she needed oxygen. (She didn't.)

The girls were 36 weeks and 5 days old.

When it was time to deliver the placentas, the second one didn't detach. There was traction and pulling and a great amount of blood loss that just wouldn't stop. There were a lot of people running around and doing things. They finally stopped the bleeding with a special balloon, inflated to keep pressure evenly on the inside of my uterus. Then they said I couldn't eat or drink anything but ice chips. They wouldn't tell me why.

At this point, I hadn't eaten or had anything but ice chips in over 24 hours.

I pleaded with them, but they were resolute. No food, no drink, no explanation. After another 12 hours, when we had all been moved to a different room (though I still wasn't allowed to sit up or get out of bed), the nurse finally agreed that I could eat something. My mom and stepdad went out and got Chick-fil-A for me, and the smell of it made me cry. I was so hungry. Suddenly, our nurse burst in. "You can't eat that!" she yelled, grabbing at the box of chicken nuggets. "You can only have light food! Clear liquids! Broth!"

By then, I had been through enough. My voice shaking, I told her that I was hungry, exhausted and at the end of my rope, that I was tired of them telling me what to do without explaining the situation, that she could send my doctor in here to explain what was going on, that I wasn't taking any more information from her. The doctor (again) was too busy to come and explain, but after a long time, one of the midwives came and told me they had been worried I might bleed out and need major surgery. That's why they wouldn't let me eat.

I have never felt so controlled, so tied down, so kept in the dark about my own condition. I was angry and sad and frustrated.

The story ends sweetly because both my girls were born healthy with no complications. I didn't need a C-section. No one had to go to the NICU. I was able to keep both girls in my room with me. I was able to nurse them both easily. We had to stay one extra day because Lucy had jaundice, but it resolved on its own, and I was able to advocate to stay at the hospital with the girls instead of being discharged and leaving them behind. The extra day in the hospital gave me a chance to figure out the positioning for tandem nursing on my own, which made me feel pretty awesome.

I am so grateful that the girls were fine. We spent months praying that we could keep them inside long enough that we would be able to bring them both home when they were born, and we did. That is the most important thing.

I met with the midwife a few weeks after the girls we born. She said things hadn't gone exactly as she'd have liked them to go but that rules are rules and we had to follow them. She encouraged me to see the vaginal delivery and the well-being of the babies as a positive outcome.

I agree with her- this was, in many ways, a positive outcome.
So why was it so hard to write this story? Why do I still feel conflicted about it?

I do not think "the birth experience" is more important than the welfare of my children; however, it's not enough to say, "Well, all's well that ends well, and you should be grateful that the babies were fine."

In a situation where an invisible doctor and a group of nurses were holding all the power, I as the laboring mother felt I had no power. I felt I had no choices. I felt that I was kept out of the loop about what was happening to me and that I wasn't able to speak up for myself or my children. After my son's birth, I felt like a superhero. After the girls' birth, I felt like one who had come through the great ordeal (with the scars to show for it). For now, I have to hold the feelings of gratitude and frustration in tension. Feeling upset about how some things went doesn't negate the joy I felt in bringing my girls home with me. These things don't have to be mutually exclusive.

The truth about birth stories, even the perfect ones, is that they're just the beginning. Once the girls were born, I felt such freedom and joy at being able to hold them, to look at them, to do what I knew was best for them. I'll be forever grateful for the moment that we left the hospital, George driving with me sitting in the back squeezed between their two car seats.

My twin pregnancy and twin delivery was just the beginning, and I don't dwell on it. Some of the memories of the birth still cause me pain and regret, but I survived. They survived. The real story started once we were all together, heading out into the world to be each other's family, and we're more overwhelmed every day by the blessing of having them in our lives.

Joining in with Rosie's Twin Birth Story Linkup at A Blog for My Mom- pop over to read how some other twins decided to make their entrances.