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.

kindness, and names

Thank you all so much for your words of sorrow and support. Each and every one of them made me cry, but not only from grief, also from gratitude for the support and love you’ve shown us, and the fact that so many people remember our tiny babies with us, and that you see how beautiful they were. I can’t even begin to explain how much this means to me.

We lit a candle for each of them yesterday, for Pregnancy and Infant Loss Remembrance day. H had brought them back from grocery shopping with a friend who kindly offered to help us out (we don’t have a car), not knowing about the remembrance day but just thinking that it’d be nice to have candles for our girls.

I want to tell you about the names we gave them, but won’t actually spell them out because of Google. Hopefully the hints will be enough. We didn’t have names for them when they were born on Friday, but it’ll be easier to tell the birth story with them, especially because Twin A will be little C and Twin B will be called A…
They are named after star constellations. One of the names was already on our (long) list of candidates, and we wanted beautiful and special names for our beautiful and special babies. I’ve always loved it, but worried that it’d be challenging for, say, a toddler learning to say her name. The stars form the shape of a W, and it’s also the name of the turtle in a children’s book I love. When I mentioned it, H immediately remembered that on Tuesday, on what I thought might be the last night we had with our babies, I wanted to go outside to show them the stars. He went looking for another star constellation that would make a good girl’s name, and found A. A is right next to C (well, it looks like that from down here anyway) and contains a galaxy with the same name that apparently is a “twin sister” of the milky way. (We didn’t know about the twin sister bit until a few days later though.)
We go out every night and look up to them. And, believe it or not, we’ve seen shooting stars a few times.

Wordless

1/2

Baby A was born this morning, at home. A precious tiny girl.
We’re in the hospital now, waiting for her sibling.
I still can’t believe this is happening.

not worse

Thanks so much for all your support!

Getting up before dawn this morning, I felt like the parents of the sick little girl in the new Star Trek movie.

There was still no fluid to be seen around baby A. We had really hoped to see at least a bit of fluid… (Does anyone know how long it takes for that to reaccumulate?) She wasn’t curled up in a ball as she’d been two days ago though, which I hope is good (because that was awful to see). The heartbeat seemed low to me – they didn’t measure it so I don’t know the numbers. Baby B still looks fine. My cervix was 2.5cm on the transabdominal US – we decided against transvaginal US because of the risk of infection. This makes it harder to get a good measurement, but as nothing will change because of that number anyway, it’s not worth taking a risk. The doctor concluded that it was “at least not worse”.
I’m still waiting to hear back on antibiotics – it appears that, before 24 weeks, this place really doesn’t do anything, although in the case of antibiotics the main reason seems to be “no data” (duh) and of course the risk of resistant pathogens. I’m thinking the benefits may still outweigh the risks in this case (but I’m not an MD). Hospital bed rest would be considered from 24 weeks on.

The prognosis they’re giving us still isn’t any better. Sigh. The doctor we saw today was also talking about all the problems preemies may have… it wasn’t exactly encouraging. From what I read online, this is typical – worst-case scenarios are mentioned, not success stories. We’ll have another scan in a week, also to assess growth. I hope we’ll make it until then (and much longer!).

To end on a more positive note – I have finally started to feel them move. Which is wonderful – it helps me cling to the hope that they can make it.

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.

can we just skip October?

And maybe November too, while we’re at it. I’d so much rather wake up just shy of 24 or 28 weeks, respectively, instead of the 19 I will be tomorrow. Not that 19 weeks per se would be a bad thing, but as my cervix measured 1.5cm today, half of what it was on Wednesday, I’m getting rather worried that we might not even make it to viability. I found the measurement particularly mean as I was feeling better – on Thursday through Saturday I took it really easy, and I think that helped. On Saturday I passed quite a bit of brown, almost solid mucus, which I found terribly scary, but my doctors thought likely came from the internal exam. On Sunday we had friends visiting, and I wanted to do some cleaning. Yeah, stupid me. I really hope the shortening was from that (or some other transient cause) and that it’s not too late to reverse it. (Otherwise, it was lovely to have them over, and really they cannot be blamed for my stupidity.)

The rest of the scan went well. It looks like we have two little girls in there! I’m kind of suspicious with one of the pictures, whether there’s really nothing between the legs… but either way, we’re so happy that they are doing well and still unaffected by the situation around them. And now so scared of losing them. It is a heartbreaking feeling that my body might fail my precious babies.

Unfortunately, according to my doctors, there’s not really much they can do at this point in a twin pregnancy. Apparently there’s no scientific evidence that a cerclage or bed rest would help, and that they may actually be harmful. I know that there’s many stories out there of women who made it, often with these – but I’m also a scientist. There is some data that progesterone may help, not enough for significance in twin pregnancies, but it seems fairly clear for singletons, so I think we’ll try that. Because it seems awful to do nothing. And then we have to try and get to 23 weeks and change, re-measure, and consider steroid shots if my cervix is still short. We have a long month ahead of us.

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”.