Thursday, October 6, 2011

Hospital delivery of twins

Amy shares her twin sons' birth story:

Here's my story:

It actually starts out way earlier than the birth---I have PCOS and I'm infertile as a result. Ultimately, my husband and I did IVF to conceive. We didn't want multiples, so we agreed with the RE, to have only one transferred. Imagine everyone's surprise when we saw two at the 7-week ultrasound! So, we knew from then that they were identical, and immediately the fear kicked in. What if I miscarry? What if they are born too early to live? What if they are born too early to live without significant health issues? How would we afford childcare for two at once?

The pregnancy went along fine until the beginning of the 3rd trimester, when my cervix started funneling/effacing. I was pulled from work, and was home on modified bed rest. At 30 weeks, pre-term labor started for real. I was admitted to the hospital, given nifedipine and hoped for the best. Labor was stopped, but not before I was 2 centimeters dilated. I remained in the hospital and things were stable for two weeks.

At 32 weeks, another round of pre-term labor. It was stopped again, but then I was dilated to 4 centimeters. They kept me in the hospital for two more weeks, and at 34 weeks pregnant, I went home, back to bedrest for the remainder of the pregnancy. The boys held out until 36 weeks.

At exactly 36 weeks, my water (baby A's sac) broke spontaneously at 3:30 a.m., Jan. 22, 2009. So my husband and I went to the hospital. At that point, the type of delivery was based on fetal positions and of course, the babies tolerating labor. They did a quick ultrasound when I got to labor and delivery, and both boys were head down and doing fine, so my OB said it was fine to try for vaginal delivery.

The next 12 hours were pretty boring. I had constant EFM due to the high risk of delivering identical twins---one external monitor, one internal. Also, for some reason they couldn't find the results from my GBS test, so they assumed it was positive and gave me the antibiotics. I was comfortable enough in the bed, and was able to unhook myself from the monitors to go to the bathroom. Contractions weren't very strong.

After 12 hours, the OB on call suggested pitocin augmentation. The contractions were very irregular and not real strong, which was due to carrying twins and my uterus being so distended. When they gave me the pit, they also placed an epidural catheter, but did not put any drug in. I was told to just speak up if/when I wanted the epidural and they could immediately administer some. After 4 hours on the pit, things started to hurt, especially in my back, so I asked for the epidural. It worked immediately, and the contractions were no longer painful, though I could feel pressure every time one happened. I was able to nap a bit. Finally, after about 20 hours of laboring, I was ready to push.

Hospital policy was to deliver multiples in the OR, just in case the need for an emergency C-section came up. So, they wheeled me over there. Up to that point, a nurse, a resident and my husband were with me. The nurse and the resident were very nice and were coaching me during the pushing.

In the OR, the OB was also there, a team of nurses for both babies, and maybe even more people, but I'm not sure. Despite the large audience, by that time, I didn't care. Even though the epidural made it so the contractions didn't hurt, the pushing was another story. I found it quite painful, especially the "ring of fire." Not sure why I could feel the pushing but not the contractions, but there it is. Anyway, I pushed at Baby A for about two hours (I think), but he was turned a bit to one side and then he started having late decels, so they hauled him out with the vacuum. They pulled while I pushed. He came out right away then, and was fine. He was taken off to be weighed, measured, checked, etc., and I rested for a few minutes before resuming pushing.

In those few minutes, Baby B, who had been lodged in my rib cage since 20 weeks pregnant, dropped right down and it was an amazing feeling...I could breathe again! They did another quick u/s to make sure he was still head down. He was, and he was out in four pushes. Babies were born on Jan. 23, 2009, and were 12 minutes apart. Both babies could breathe fine, so neither went to the NICU, though they were observed closely in the regular nursery for an extra day to make sure they didn't lose too much weight or get too jaundiced. At birth, A was 5 pounds, 2 ounces, and B was 4 pounds, 9 ounces ... when we took them home 3 days later, A was 4 pounds, 11 ounces, and B was 4 pounds, 3 ounces. But they were stable and eating, they regained their birth weight in a normal amount of time.

About eight hours after they were born, I hemorrhaged, but there was a nurse in the room at the time, and she got a team of many people in there in seconds. It was scary, but they had me on pit and O2 and stable very quickly. I am thankful that I was still in the hospital when it happened ... the quick response prevented a transfusion (or worse).

Anyway, since I lived in that hospital for a month on bedrest, I met all the nurses on the L&D floor. They were all very nice to me, and when I came back to the hospital to have the babies, I had already met the nurses that were there during my L&D. When I had the hemorrhage, one nurse that I knew from before was holding my hand while the team did what they needed to do. She was very reassuring. The whole L&D was very calm ... there was no screaming or rushing around. The doctors and nurses were very considerate and I was asked for consent before they did anything (vaginal exam, pit, epidural, etc). The OB explained why he wanted to do what he wanted to do.

I don't plan to have any more children, but I did, I would definitely use the same OB and deliver in the same hospital. Getting the babies here safe and sound was everyone's top priority, and it was a nice bonus to have an overall pleasant experience.