night and day – a birth story

Truth be told, I was not unhappy about the prospect of getting induced. At a (low-key) party the Friday before SB was born, a friend who had a baby last year told me about how she and many of her fellow birthing class moms had bad experiences with it and would decline an induction next time round… and I’m sure there’s something to it, but also, my baseline for “terrible experience” is leaving the hospital without my babies. I’d take any physical discomfort over that. Plus, the total lack of control I had over C’s bag of water breaking and her birth a few days later must have left deeper scars than I’m aware of, and so I welcomed the thought of experiencing all this in a much more controlled environment.

But then the next day I woke up and had what I can best describe as cervix cramps. They weren’t really painful, so I wasn’t sure if they were productive, but once I bothered to time them I was a little surprised that they came every 5 minutes. A few weeks earlier, my doctor had told me that – once I was full term – if I had contractions every 5 minutes for at least an hour I should head to L&D. But these “contractions” (I didn’t even feel anything contracting) felt way too weak, and somehow I was paranoid of being sent home for not being sufficiently dilated – it just seemed too much hassle to head over to the hospital only to be told to go back. Despite grand plans of what I wanted to do before the planned induction I didn’t feel like doing much during the day, so we just hung out, went for a short walk, re-packed the hospital bag and timed contractions every now and then. Initially even timing them wasn’t easy, as I wasn’t necessarily sure something was a contraction until it was nearing its peak – to give you an idea of how not-strong they were. Gradually they grew more intense, but I could still comfortably talk through them even when they were 3min apart. Then, less comfortably but still talking. This was probably around 9pm and I called L&D, to get their opinion. They didn’t seem too interested in the spacing (perhaps because I was the one who was calling, and clearly still able to communicate?) and concluded I was probably in early labor. As I wasn’t planning to get an epidural, they recommended I stay home, but call again or come in once the contractions got too much to talk through.

We started to play a game, but now things were picking up and I had trouble concentrating on my moves. Around 10 we decided to go to the hospital, though until we had everything assembled and were ready to head out it was probably 10:30. Walking towards the car, I felt something moist come out of my vagina – first I thought my water may have broken, but there were no huge amounts of fluid (irrationally I was worried about making a mess in the car…) On the upside, if it was my waters that’d mean we’d get admitted regardless of how dilated I was.

By now contractions were intense enough that I closed my eyes to breathe through them. Initially I thought about counting how many contractions it took to get to the hospital, but quickly gave up. Many, despite streets being empty. Yet we got there without anything exciting happening.

The way from the hospital entrance to L&D never seemed to take longer, what with stopping every 2-3min to get through a contraction. Except for a few nurses the place was strangely deserted. I was assigned a triage room and asked for a urine sample. Once I went to the bathroom I saw that the moisture from earlier had been the mucus plug. Cleaning myself enough to give a clean-catch sample took 3 fairly painful contractions (maybe I just shouldn’t have bothered). H had been getting worried why it took me so long, while I was glad about anything I didn’t need to do or explain. Back in the room they put me on monitors – I was grateful to hear SB’s heartbeat, because with all the contractions I’d had a hard time feeling her move around that day. We’d been promised a doctor would be in, but that took a while. I started to feel lots of pressure with the contractions, which were coming every 2 minutes and quite intense. H went to find the nurses again – somehow they didn’t know where the doctors were (?!) but perhaps his insistence helped, because 5-10 minutes later a nice young doctor that I’d met at a previous testing appointment came in. She checked me and was, I think, a little surprised to find that I was 8-9cm dilated and that my amniotic sac was still intact but bulging out – this probably explained all the pressure I was feeling. Her supervisor came to also check me and reached the same conclusion. Now the plan was to get me into a labor room as soon as possible and break the bag there – once it broke, the baby might come out rather quickly, they thought. Just a quick ultrasound first to make sure baby was still head down (she was).

My right leg really hurt even with light pressure on it, so I was glad when the nurse offered to wheel me into the labor room. (So much for my plans of being active during labor.) I think it may have been the same room as where A&C were born, while H thinks it was the room next door, albeit with identical layout. (And his account on such details is probably more reliable here ;) The familiarity was strange, basically the only difference seemed to be that it was pitch black outside now, and that I was rather hazy from the contractions – although I am glad that my birthing class taught me to pay attention to the times between contractions, when there is no pain, and to rest during those.

The question of pain relief came up again – the options were an IV analgesic that would have to be discontinued 30min before delivery (because it makes the baby drugged and sleepy, too) or laughing gas (N₂O), which dissipates from the body so quickly that it can be used through delivery. Worried that the last part might be the most painful, I wasn’t particularly interested in pain relief I’d have to discontinue before long, plus I was wondering how they’d figure out when “half an hour before birth” would be. So N₂O it was. They gave me a mask to push onto my face whenever I needed it, and take off once the contraction was over. It did dampen the pain somewhat, although I could definitely still feel everything. Subjectively, the main drawback was that this occupied my left hand, and they were busy poking an IV into the other, so that I had no free hand to hold my husband’s.

Still in search of ways to relax, I asked soon after this whether I could go into the tub. The nurses probably gave me a skeptical look, but I was too busy to care. I could, I was told, but the N₂O couldn’t. And I’d have to get out when it looked like I was about to deliver (they don’t do water births, sadly). So they started filling up the tub. The next contraction was so intense that I moaned. Once it was over, I announced that perhaps I wasn’t going to get into the tub after all. Everyone agreed.

Around this time the doctor came back in, with her equipment to break the amniotic sac. She was getting ready, preparing to intervene after the next contraction was over. I was feeling more and more pressure and the urge to push, but was told not do. At the peak of the next contraction, the amniotic sac broke from all the pressure. For a short moment, relief, then again lots of pressure. It must be her head, I thought. And indeed, with that same contraction, Strawberry Baby’s head emerged from my body.

H later told me that he, along with one of the nurses, was the first to see her head. The young doctor was saying “wait, not so fast” and frantically trying to put on her second glove. There was a call on the intercom and, when I “came back” into the room, suddenly there were a dozen people or more, including the midwife who was present for A’s delivery and the doctor whom I saw in my twin pregnancy. And someone else.

All the pressure was gone. After what felt like a few anxious seconds I heard SB cry, then they put her on my chest. Surreal is the closest I can come to describe it. A moment ago I had still been pregnant. It wasn’t even 1am, we had been at the hospital for at most two hours. And yet here she was, my precious little girl.

close

“Were you in Labor Room 6?” she asked suddenly.
“Er, yes… “ I said, though actually I was never quite sure if it was 5 or 6.
“I remember you! You and your husband! You went home after your water broke, and then one of your babies was born at home.”
It was stunning and touching to have an L&D nurse remember us, remember details of C’s birth that so few people in our lives even know about.

It can hardly be a coincidence that I tend to end up sufficiently worried to go to L&D in those weeks in which I have no cervix check ultrasound. I’m happy to report that both kinds of visits so far have gone well. The ultrasounds always include looking at Strawberry Baby for way longer than at the cervix – which I get, she’s much more interesting. A potential drawback is that they sometimes find minor worrisome stuff, such as a marginal cord and little things with a complicated name that are related to scar tissue. I try not to Google too much for those terms and will check with my doctor next week on what his opinion is. Chances are there’s nothing I can do about either of those things anyway.
The L&D visits mainly seem to be triggered by variations of round ligament pain, which apparently can present itself as cervical pain or cramping, particularly with movement (mine, not E’s. E’s is wonderful!). Who knew? And even knowing this I find it a little disconcerting…

This week is particularly hard. We’re reaching 20 weeks on the weekend, and while I wonder how we made it here so quickly, it also is the gestational age when things went wrong with the twins. C’s water broke at exactly 20w, they were born 3 days later. I will try to make it through these milestones without freaking out over every possible twinge.

firsts, seconds, and thirds

Between our holiday trip and my brother visiting for a few weeks (and still being exhausted, although less than in the first trimester), I haven’t had much time for blogging. I’ve tried to sort of keep up with reading, but that’s the extent of it. So, if you haven’t seen any comments from me, or are waiting for an email answer – it’s not you, it’s me. Really.

• I broke my own record and went to L&D at 15w5d, and then again at 17w1d. Sigh. Fortunately both were clear cases of “better safe than sorry”, with symptoms that are probably normal, but given my history nobody wants to fully reassure me on the phone and they rather have me come in (my OB office is across the street from L&D, and basically there are no urgent office visits – if something needs checking out, you go straight to L&D). But I’ve also noticed another change – last year, I didn’t want to be the infertile who freaked out about every twinge. Now I don’t care if they think I’m hypersensitive (although everyone so far has been very understanding) – I simply want to do everything I can to make sure Strawberry Baby comes home with us.
• I bought a baby carrier. We got a good deal and have a full year to return it, in case, you know, Strawberry Baby decides she doesn’t like it, but it still seems odd. Now it’s sitting in our living room as if that was the most normal thing. And one of the most adorable sights of the last weeks was when my (skeptical) husband put it on and smiled.
• I had my second cervical length scan. It was down to 3.6cm, which I found a bit worrisome, but the doctors reassure me it is completely within the normal range and has more to do with the bladder being more or less full, etc. So I try not to worry (ha!). As this ultrasound was at 16 weeks and change, the tech asked if we wanted to know the gender. It looks like we’re having another girl! I’d be delighted about either, the only thing I want is to bring this baby home alive and healthy. I think knowing the gender makes it much easier for me to relate to the baby though. And there was something magical about being told it’s another girl, after having two for the shortest time.
• My insurance authorized the progesterone injections that should help in preventing preterm labor and pPROM. Yay! Then my nurse and I spent about 2 weeks talking to what should have been the in-network specialty pharmacy, and finding out it isn’t this one after all… but now it looks like the progesterone is about to be delivered.
• I found these haptic quilt patterns and first thought of getting one with the city we live in. While I’m too lazy to patch each block in a different color, a tie-dye fabric might have worked nicely… and it looks like a couch-suitable project (I wouldn’t be surprised if there is couch-time in my future) and Strawberry Girl could explore it with her hands and eyes. But then I saw they have a pattern with the northern star constellations… and I was sold. A and C can be in their own special colors!

the aftermath: the precious little time we had

After giving birth we stayed in the delivery room for a few more hours. Nurse M came in regularly to massage my uterus and check my bleeding. Other than that we were left alone to hold and admire and cry over our lifeless daughters.

When we went to another room where we’d stay the night, a couple with their newborn baby crossed our way. A cruel reminder of what we’d just lost, times two.

We spent almost 24h in that room, and yet I cannot say much about what we did. Cry. Hold our babies. Hold each other. Cry some more. It was the first time I saw my husband sob like this. He was completely devastated, shaking, unable to stop crying. I tried to comfort him, it hurt me to see him hurt. It took a while – days at least – for both of us to learn that we need to allow each other to cry, to grieve, to let this acute sadness out. Maybe it also just took a while to be comfortable with so much raw emotion – with my own feelings, there’s no way out, but feeling so utterly helpless in the face of his grief, shortly after feeling just as helpless because I couldn’t save my babies, was hard. We’ve both learned to be together through the sadness now, to be with the other but not try to stop the tears.

Both nurse M and the doctor who delivered our babies came to say goodbye at the end of their shift. I’m so grateful they took the time to talk to us again, to show us some extra kindness that we needed so much. The doctor also encouraged us to try again when we were ready, going over some basic options and encouraging us to talk to an MFM. Perhaps for some people this might seem inappropriate, but while we’ll always miss A & C we were still longing for a living child as much as before, if not more.

In addition to their little hats, the hospital had given us two tiny blankets. As they had always been together inside me, we kept them in the same blanket. But then we saw that the second one had stars on them, so after taking the footprints we wrapped them in this one (see picture below).

They had also given us a memory box with some material to take footprints. The nurse for the evening was supposed to help us take them. Unfortunately she was clearly uncomfortable with the fact that our babies were dead – the only negative experience we made in the hospital, everyone else was kind and supportive and going out of their way to help us. She wanted to take the babies to another room to do this. Um, no. I ended up doing the footprints myself, though she was helpful with some of the technical aspects, like how to prepare the material and how to make a flat surface. And then I think all the involved parties were glad when another (lovely) nurse was in charge of us for the night.

We had one more difficult task ahead before we could go to sleep: we needed to inform our families. Each of us wrote a few words to parents and siblings, attached some of the photos of our girls and us, and hit “send”. We’d both so have loved to send a different announcement…

The night itself was okay. I declined the repeated offer for pain medication – not that I was trying to be tough, I just didn’t feel more than mild cramps. H slept on a convertible armchair for a few hours, then crept into my bed. It was good to be close, and reaffirmed our desire to go home the next day. L&D is not an easy place to be when you’ve just lost your babies, although we were lucky and only heard a few newborns cry, and didn’t see any other than the one at the beginning of this post.

One question that seemed to be surprisingly difficult to answer was whether we’d get birth certificates for the girls or not. We hadn’t decided on names when they were born, and in part decided to think of some just in case we’d need them for the papers. Looking back, I think it was the right choice for us – it feels more personal to talk about A and C rather than Twin A and Twin B. But I can see that for other parents, not having names may be easier.
Our social worker eventually found out that we wouldn’t get birth certificates, though we could ask the state to send us certificates of fetal demise (and doesn’t “birth certificate” sound a million times better?). She, the social worker, had actually been meeting with us since we got to the hospital, I just haven’t written about her because we didn’t “click”; H found her downright annoying. But she did supply us with a lot of helpful material, from a leaflet with the sad title “What to do when you’re not going to breastfeed” to a list of mortuaries in the area, and advice which tend to charge less than others. We also got two little booklets, on pregnancy and infant loss and on grieving as parents, but I’m a little ashamed to admit we haven’t read them yet… we’ve just been exhausted.

The hospital also offered to send a professional photographer to take pictures of our babies, and of us as a family. I believe this photographer offers to visit all families with new babies, but while most would need to pay for the pictures, babylost parents get them as a gift. I showered and got dressed first, which made me feel a bit better, at least physically. She was kind and calm and took some pictures of A & C with far better light and quality than my phone ever could, and then some of the four of us together. They are heartbreaking and treasured.

The midwife in charge didn’t have any concerns in letting me go home, so we hugged and cradled our daughters a few more times but slowly started to pack up our belongings. It was hard to leave them, even though there was nothing we could do for them. The lovely nurse we had during the day, who had supplied me with extra maternity pads as I obviously hadn’t stocked up on them, hugged us and said “Take your time. I’ll stay with the babies.”

I’ll leave you with one of the last pictures we took of A & C, with the toys I had bought for them. They underline how tiny our daughters were – the trunk and tail are made to be grabbed by a baby’s hand. But, being so colorful, the toys also add a cheerful element to the photo. It gives me hope, somehow. This is the background picture on my phone, and most of the time I smile when I see it, see them.

Trick or treat

Short version: I went back to L&D with even more bleeding and dizziness. After many ultrasounds it still wasn’t clear whether there was leftover placenta or not. Our MFM happened to be on call and helped us make a decision – aspiration, which is less invasive than a D&C (and done without anesthesia) but might get out small amounts of tissue stuck to the uterine wall. Back home and recovering. So far there’s just minimal bleeding; you could almost call it spotting. I really hope it stays this way and tapers off eventually.

I’ll keep the long version for when I get there in the birth story. For now, I’m very glad this October is finally over. And I’ll put in a formal request for that sticker.

Insult to injury

I want a sticker. Two, actually, with sad smilies or some other symbol that makes it quite plain that my babies could not go home with me.

We went back to L&D a few nights ago. I suddenly felt a gush of blood while brushing my teeth. Trying not to panick, I finished cleaning my mouth and face – but then I noticed my pants getting wet. The (regular) pad was soaked. Not comfortable with the idea of going to bed after this experience, I called L&D, who said I should come in. My poor tired husband was first unwilling to go, and then really scared.

For reasons beyond me, it took forever for a cab to actually get here. After a looong ride, we finally arrived and were shown to a room. The nurse made some small talk while taking my vitals – and then she asked who was taking care of the twins now. Ouch. Can’t have been good for my blood pressure either. Thus the sticker.

The ultrasound showed a clot in my uterus. They don’t think it’s firmly attached, so the options were wait-and-see or drugs. I chose the latter, as I’d really like to get over with this (the physical part, anyway). But not so fast. Despite the sleepless night (because of the trip and the well-lit triage room, not the cramps) I didn’t pass any big clots. There were a few more gushes though. At the appointment with the MFM that afternoon (which is worth a post in itself, or three) he could still see debris in there, albeit smaller. He’d like to avoid a D&C if at all possible, and I agree. But those gushes keep coming – not a whole lot, maybe 2 or 3 per day, and they don’t actually soak a maternity pad, but that’s still more than I’m comfortable with. 

As an extra twist, I have a retroverted uterus. Thus perhaps the gushes have an anatomical reason – depending on my position, the blood cannot necessarily get out. Nevertheless I don’t know how much longer I want to wait this out. Experiences or suggestions, dear readers?

ruptured

I was getting used to my mostly-couch routine, and the babies seemed to be hanging in there. Then yesterday I suddenly felt as if something was weird, and then there was a big gush of fluid. More fluid when I got to the bathroom, and even more.
We went to L&D, who confirmed that my membranes had indeed ruptured, and saw that baby A had very little fluid. We had hoped that they’d be able to save at least one baby, but apparently that’s really difficult – the main risk now is infection, both for the babies and for me. At 20 weeks, they’re much too young to survive. The options we were presented are “expectant management”, also known as wait-and-see, and termination. Gulp. We certainly weren’t able to chose the latter, not after all these steps it took to get here.
They offered to keep me in for the night for observation, but H said he’d much rather have me home with him, unless there was a risk. Hospital germs tend to be worse than homegrown ones, so they don’t want me to stay for long anyway. My cervix was still at 1.5cm, and no contractions, so it didn’t seem as if labor was imminent. After being explained the risks three times over, we went home and cried. I have never seen my husband cry like this. That alone was heartbreaking.
The good news is that I haven’t had any more leaking or gushing of fluid since coming home. Resealing of membranes is rare, but possible. My cervix went into mucus overproduction mode, which I hope also is a good sign – maybe it is trying to regenerate the mucus plug?
Basically we now need a miracle: no infection, no contractions, resealed membranes and refilling fluid. We have an ultrasound tomorrow to see how things are going. If you have good thoughts to spare for us, or stories from other PPROM survivors, please share.

18 weeks: L&D

You didn’t think that was the appropriate way of celebrating 18 weeks? I kept thinking “but that was for 38 weeks!”, too. But I’ve felt pelvic pressure for a while now, sometimes better, sometimes worse, and yesterday it was so much that even a short walk (like, to the bathroom) wasn’t fun anymore and so I decided to call the office.
(Spoiler if this is too stressful: the babies are fine, and for the moment everything else seems to be ok, too)

Not that I’d completely ignored it before: at my last appointment I asked the doctor, but she said not to worry. It’s a bit hard to say now, but I’m fairly sure I was less uncomfortable then. Well, and then I went halfway around the world, and between jet-lag and being pregnant and getting a cold I was rather tired anyway. But back in my normal life, I thought this wasn’t developing in the normal direction at all. Dr. Google found several cases of this where it was just the pressure from the babies, which obviously gets more as they keep growing. And then there were some cases where it was actually preterm labor… I grew concerned and just plain uncomfortable. The on-call doctor said that this should be evaluated, and whether now or at my next appointment was up to me, so I decided for the better-safe-than-sorry plan and went in. After a bit of confusion because I got a “visitor” sticker initially, I was given a room and the usual parameters (urine, oxygen, temperature, blood pressure) were checked. A young doctor came in to go over my symptoms and history. Then she checked the most important part, the babies — they’re fine, as usual unperturbed by the weird stuff my body does. First breath of relief. Then she proceeded to check my cervix, and as promised that wasn’t exactly comfortable. It was also a tad dilated “but long”, which nevertheless didn’t sound too reassuring. She went off to find her more senior colleague for the cervix length measurement. Senior Doctor wanted to repeat the manual cervix check (much less uncomfortable) and declared it a tad open at the top, but then closed. The ultrasound measurement (with a wand that was supposed to remain sterile, have never seen anyone handle this thing with so much care) came to 3-3.3cm. Which they told me was ok, but the threshold for worrisome, 2.5cm, is close enough to keep me somewhat concerned. I have my anatomy scan on Monday, and they shall re-measure my cervix then, and if it shortens we’ll talk about the options. If it stays at this length we’re fine. Then they put on a contraction monitor for good measure, but it wasn’t showing anything (and I haven’t felt any either). So I was discharged and told to come back if anything got worse. At home I did far too many searches on cervical length (CL) issues and possible treatments, learning that “normal” would be 3-5cm, concern starts at 2.5cm and serious concern at 1.5cm. Eventually I decided that, while knowledge may be power, sleep was important too, and went to bed. Am feeling much less pressure today, though I have no idea what causes these changes.

A few scattered thoughts:

• In general (well, aside from having to go to L&D at 18 weeks) this was a quite positive experience. Everyone was kind and caring and tried to make me as comfortable as possible and answer all my questions. I had the feeling of being in good hands.
• 18 weeks is scarily far from viability, let along a gestational age where one can reasonably hope for the babies to be fine.
• I’ve begun to think that individual CL measures are like individual betas — they tell you something, but the development over time seems much more important. Although it can also be quite erratic, going back and forth…
• I’ve had these symptoms for almost a month now. So either my cervix started out veeery long, or this is largely discomfort and not actually doing much. I’m kind of hoping for the latter. We may know more on Monday.
• Nevertheless I decided to take it easier, in particular, less walking around (that’s when the discomfort is worst) and ideally an after-lunch break of half an hour or so where I can actually lie down.

So, here I was thinking about when and how to announce my pregnancy on facebook, and suddenly my new mantra is “long and closed”.