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.

birth story part four: similarities

It must have been shortly after birth when our sweet nurse, M, was looking at the babies with us. H pointed out that they both had my nose and cheeks. But little A’s hands and feet were so much like her dad’s, it was amazing. Even her shoulder and arm muscles – she would have been a power girl! It was wonderful and heartbreaking at the same time.

Both of us have always said that adoption is an option for us. I don’t think either of us was very attached to physical resemblance. And still, it was so special to see what our children, these particular combinations of H and me, looked like.

I don’t think I saw it in the hospital, but later at home, maybe even days later, H pointed how beautiful little C had been. And indeed, she was, my precious tiny firstborn.

birth story part three: everything’s different

Thank you all so much for helping me through this storm. I’d love to invite you lovely people over for coffee. The kind where we can say everything, but don’t need to say anything. Because you understand.

It’s been four weeks since our girls came and went. I still cannot believe it.

When the doctor said that she hoped I’d deliver before the next morning, I had gotten a bit scared. How long could this take? The birth of C had been so easy, most of it must have happened in my sleep, and given her tiny size it hadn’t even been painful. Now, I was waiting for the drugs to work, with no idea of what would happen and when. There was no monitoring, other than nurse M coming in to check on me every now and then. They didn’t want to rush anything as long as I was stable and not bleeding. They even let me drink and eat, and I seized the chance as I was still as hungry as ever in this twin pregnancy, and I thought I’d need lots of energy to make it through the day. The doctor had said that the placenta “sticking” to the uterus was something they were concerned about, apparently this happened more frequently in (very) preterm deliveries*.

The local pain – diagonally from my sides towards my vagina – intensified rather quickly. So much that, when H texted me from home to ask if he could have lunch, I told him to rather come back as I wanted him to be there for A’s birth.

H was completely devastated. He’d written me some more texts while on the way – on the shuttle, luckily, driving might not have been safe. I was getting so busy with the physical aspects that I didn’t have the energy to be as miserable. (I’m not sure if this makes sense, but it seems the best way to describe it.)

Soon after he came back I asked the doctor to check me, as instructed, before going to the bathroom. The contractions were getting even stronger, and now they weren’t just local. She thought I was dilated enough to break A’s waters to get things moving faster. This must have been 3-4h after I got the drugs. From what I read later, it usually takes around 15h until delivery with this medication and dose, so either I respond very well to them or my body was on the way to labor already anyway.

Breaking the bag was harder than expected, especially after we had experienced the spontaneous rupture of C’s bag. It was one of those moments where we wondered if we were really doing the right thing…

Contractions picked up another notch once the fluid was out. I asked for some mild pain medication to take off the edge – it was very important to me that I stay conscious for delivery, but it just seemed pointless to endure extra physical pain. The effect was almost instantaneous and made me slightly dizzy. The doctor was sitting on one side of my bed, and a midwife came in and sat down on the other. H was standing next to the bed, holding my hand, sometimes stroking my hair. We hadn’t really talked about birth yet, and he later said that he hadn’t really known what to do, how to help me, but honestly I think he did the best thing he could – being with me, holding my hand.

They told me to “push into the pain”, but I never had the impression I made any progress with this. I was lying on my back at an angle, which gave me back pain, enough to bother me between contractions. Gravity had helped me to deliver C, so I asked to move the bed into more of a sitting position. I put one leg over the doctor’s legs and the other over the midwife’s legs – for a moment I thought this was weird, but mostly I was too busy to care much, and they were trying to do everything they could to help me through this birth and telling me I was doing great, while I still didn’t feel like I was making any progress. But after a couple more pushes, A was there. Her delivery hadn’t taken long after all – I’d say half an hour of pushing, but then, I had no grasp on time at all.

They asked H if he wanted to cut the cord, but he declined. After they’d cut it, nurse M immediately took A, wrapped her into a baby blanket and placed her in my arms. Between taking care of me she also found the time to get little C and place her next to her sister, so that I had both my daughters in my arms. Surprisingly, A was much bigger than C – we didn’t weigh them so I cannot tell you how much, but just seeing the difference was striking. The midwife said she had come out “bum first”, so those two factors might explain why it had been harder and more painful to birth her.

They set up a pitocin drip to help my uterus contract and the placentas deliver, however they came out by themselves before the drip was started, moments after doctor and midwife had left the room. Nurse M told me to not push but it was too late for that. Doctor and midwife quickly came back, examined the placentas and me for tears or other damage, but declared that everything was fine. My uterus was massaged to further contract and reduce bleeding.

For my husband, the moments directly after A’s birth must have been the strangest part of the whole experience: I was, there is no other way to say it, happy. I had just given birth to my baby, wasn’t that amazing? In part I’m sure I was glad the physical pain was over.** He sat next to me, miserable, and probably bewildered. Of course I knew, somewhere in the back of my head, that something was wrong, but the oxytocin was stronger.

Suddenly I felt a jerk. A was trying to breathe. It was heartbreaking all over again.

This happened once or twice more, with minutes in between. I have no idea how she found the energy. It was just so hard to see this, to see how strong she was, to think if only we had been able to buy her more time…

We stayed in the delivery room for a few more hours. A family of four, somehow, saying hello and saying goodbye.

* I don’t know if this had anything to do with me later having to go back twice for a tiny bit of what seemed to be leftover placenta or membranes.
** I’m sure a full-term vaginal birth is much more painful, but this was painful enough.

birth story part two: in between

Thank you so much for staying with me as I try to process our daughters’ birth story. While the last part was perhaps the most traumatic, I feel that this here is the hardest to write about in all honesty, as it involves some choices we had to make. But that is what I need to do – it won’t help if I process a censored version of what happened. Also, if anyone ever finds themselves in a similar situation, I’d want them to know that they are not alone.

We were directly taken to a delivery room. They took my vitals, tried to put in another IV, decided I was stable, eventually succeeded with the 2nd attempt of the hand IV. My memory isn’t very clear on all the details, and in particular the order of events here. But even then I was aware of the strange limbo I was in: just having given birth to my firstborn, and yet still pregnant with her sister.

H was talking to the doctor about saving little A. He’d been talking about this with the firefighters, the doctor in the ER, anyone. I think it was what kept him going. Unfortunately the doctor – who was very kind and down-to-earth, and very understanding of the fact that this was an awful situation with no good options – didn’t give us much hope. Buying one or two weeks might be possible, she said, but we’d need at least four. She recommended inducing because of the high risk of infection that could endanger A, my uterus (in case they had to do a hysterectomy to save me) or my life. They left to give us time to think.

When my waters broke we were hoping for a miracle, a way to save both our babies. Now, one of them had been stillborn. There had been nothing we could do for her. I think seeing her perfect but tiny body also changed something for me. I understood how hard it would be for doctors to help her. And now there was a cord hanging out of my uterus, a well-lit 6-lane highway for bacteria. Plus, there was a problem of timescales – bacteria grow from a single bug to a full-sized colony overnight, while my tiny baby would need weeks and weeks.

At some point the nurse – a kind and positive woman, and I mean positive in a very supportive and not obnoxious way – came in to check on me, and also asked if we knew their gender. We said the ultrasound tech thought they were both girls. She asked if we had checked. Um, no. She asked if we wanted to see and hold our baby, if we were ready. She did this in an almost excited way – I’d like to think she does it in the same way with a live baby. I said I was as ready as I’d ever be. So she brought over little C, who had been in our room all the time, cleaned her up very gently, checked – obviously a girl – and gave her to me. With the legs stretched out she was longer than my hand, and surprisingly heavy. I held her close to my heart. We were both so incredibly sad.

At one of the check-ups, my temperature had gone up to 99.7F. The pains in my belly were getting stronger – back then I thought they might be indications of infection, but they could also have been early contractions. That same kind of pain intensified later, before “full” labor started. H was getting seriously worried about losing me. With very, very heavy hearts we decided to induce. And I’m not sure we’ll ever fully come to peace with this decision.

I was given a drug to promote dilation and contractions. The doctor said they were hoping I’d deliver “sometime before tomorrow morning” (I was 2cm dilated at that point). They’d increase the dose if things didn’t move far enough. H wanted to go home and pick up some stuff for himself for the night, as well as for me for the way home, as I had arrived wearing only the t-shirt I slept in. They suggested him to go now, nobody knew how fast things would progress (or not). They also suggested me to take a nap, which I thought was highly unlikely. But my wonderful husband had grabbed the stuffed animals I had bought for our babies, so I curled up in bed with C and the toys and held my baby and cried.

birth story part one: an unexpected home delivery

We were actually kind of hopeful on Thursday when we went to bed. We had made it more than 48 hours out of the preterm rupture (apparently most moms go into labor within 24h after rupture, then lots more within 48h), my temperature was still fine, and I didn’t notice any contractions. I had had an episode of uncontrollable shivering in the morning, and I had some weird localized pain in my belly every now and then, so clearly it wasn’t all sunshine and roses, but we had hope. I had read a number of PPROM success stories online, but also scientific papers with statistics on larger numbers of cases, which were much less encouraging*.

On Friday I woke up around 6am, feeling lots of pressure, which wasn’t uncommon at this point. I went to the bathroom, but found that peeing didn’t relieve much of the pressure – this was a bit odd, but I was too tired to think much of it. H woke up, thinking he’d heard me scream. I told him everything was ok, and we went back to bed.
I woke up again after 7, still feeling lots of pressure, and decided to try the bathroom again. But as I sat down I realized, no, this pressure was coming from somewhere else… I got up, grabbed a few sheets of paper as I had no idea what was coming, and called for H. Moments later, I held my precious little C in my hand. I don’t know if I pushed at all, if so, very little. It wasn’t painful, physically.
I sat down on the floor, largely in shock. The I-don’t-feel kind of shock. I talked H through finding a piece of yarn to tie off the cord (for some reason I thought that was important), calling 911, packing the last items for my mostly pre-packed bag.

Looking back, I regret not immediately hugging my baby. In part of course this wasn’t possible, with the cord. In part I was just in too much shock. But she was (is) my firstborn, and I feel bad about not giving her the love she deserved in that moment.

The firefighters arrived very quickly and were very kind and professional. They clamped and cut the cord, gave me extra oxygen but decided I was stable, put me onto a chair-stretcher-thing and took us to our hospital. We spent just enough time in the ER for me to be hoisted from their stretcher onto the ER bed, then L&D communicated that they wanted me up on their floor.

* That’s the drawback of actually looking up the statistics, they aren’t always comforting. We had a friend come over (with a 3-course dinner!) a couple of days ago, and he could commiserate – his father died from cancer earlier this year, and there had been many appointments when the doctors painted a rosier picture than what our friend, having read a number of papers, knew to be more likely.