Birth story

(Coincidentally, this is also my 500th post.)

As of Wednesday the 18th, I had been moved from the hospital's labor and delivery unit to an antepartum care unit.  Because my preeclampsia had been deemed mild, based on my relative lack of symptoms and lab results, I was in "wait and see" mode.  My doctor was not prepared to allow me to go home but told me it could be days or weeks before my condition progressed to a point where delivery of the twins would become necessary.  She planned to continually reevaluate my condition and that of the babies to determine when/if I would need to be delivered.

Thursday morning I had a mild headache (relieved by Fi.ori.cet) but no other preeclampsia symptoms.  My weight and swelling stayed stable, as did my blood pressures (which were still high but not dangerously so.)  When my OB group's physician-of-the-day rounded midday, she decided to recheck my labs simply because it had then been three days since my last panel had been drawn, not with any expectation that there would be significant changes in the results.

MM and I were preparing for me to possibly spend another week or two in the hospital being monitored.  We knew both boys were doing fine in utero, and we were hopeful that I could get a little further along before having to deliver.  MM had gone so far as to talk to his supervisor about coming back to work on Monday if I hadn't delivered by then.  (He had started vacation effective immediately the day after I was admitted to the hospital when we thought I might have to deliver right away, and as time stretched on without the boys' arrival, he was starting to feel that he was wasting his time off.)

Just before 4 in the afternoon, my nurse came in to tell me that my lab results looked worse and that the doctor had instructed her to keep me without food or drink effective immediately in anticipation of a probable delivery later that night.  We knew from ultrasounds that Twin A (AJ) was breech, so a c-section was planned.

The doctor came in to see me around 6:30 p.m. and explained in more detail what the nurse had told us.  My liver function tests showed significant inflammation--a three-fold increase since Monday's lab results--and I was now considered to have severe preeclampsia, making delivery necessary for my health.

Things happened pretty fast from that point on.  MM hurried home to feed our dog and pack a few things and alerted his parents that a c-section was planned for that night.  (When he first left the hospital, the OB thought we'd have to wait until midnight, based on when I had last eaten. . . but then anesthesia agreed to proceed at 9:30 because I'd only had a light snack.  So I had to call MM and tell him to be sure and be back at the hospital by 9, further increasing his stress level.)

I was a little nervous but in some ways calmer once I knew what was happening and that it was inevitable.  I knew our boys would likely have good birth weights, based on the estimates made by ultrasound, and I was hopeful that the steroid shots I'd received would help with their breathing.  I knew we were all in good hands, and I hoped for the best.

Just as I had never spent a night in the hospital as a patient, I had also never had any type of anesthesia (apart from a local for stitches) or surgery of any kind.  So the experience of receiving spinal anesthesia and being prepped for the c-section was odd for me.  (Particularly odd in light of my first career as a registered nurse and my current career as an attorney who often handles med.ical malp.ractice cases.)

Once I was prepped, MM was allowed to come into the room with me.  (The particular shade of blue of the disposable scrubs he was given to wear really brought out the blue of his eyes, LOL.)  As I'd been told I would, I felt pressure as AJ was delivered.  I thought I heard him cry as he was taken off to be evaluated by a waiting team from the NICU, but I wasn't sure.

One minute later, MJ was delivered.  I definitely felt one of the OBs pushing him down from above as the other pulled him out.  This time I heard his cries immediately.  MM then left his post near my head to go and see how the boys were doing.

During the 5-10 minutes MM was away from me, the anesthesiologist give me a dose of Dem.erol in my IV.  I am extremely sensitive to narcotics, so I immediately felt groggy and euphoric/removed from the scene.  I vaguely remember one of the nurses bringing first MJ and then AJ up near my face so I could see them.  (And I know this happened because she was also kind enough to take photos of the moment for us.)

MJ's eyes were wide open, and he looked at me very calmly.  This was particularly noteworthy to me because my MIL had told me that MM, too, was very alert and calm at birth.

AJ was brought to me next.  His eyes were closed, and I had a hard time focusing on his face because of the Demerol.  Although there was only an ounce difference in their weights, he seemed smaller and more fragile to me than MJ.

Shortly thereafter, we were all taken to the recovery area.  Here is where I truly have reason to appreciate the quality of nursing care we all received.  AJ & MJ were in a warmer right adjacent to my bed where I could see them.  AJ's oxygen levels were being monitored because he was having a little difficulty breathing. . . . not even to the point of needing oxygen (although I later learned he had received some via positive pressure just after delivery), but he was grunting and needed to be closely monitored.  His blood sugar levels were fine.

MJ's initial blood sugar level was slightly low as a result of my gestational diabetes.  Fortunately, his levels normalized right after being given some formula.  He never had any breathing problems, and both boys were able to maintain their own temperatures as well as full-term newborns from the start.

While in recovery, I had reason to be grateful for the drugs and their effect of making me feel I was outside the scene looking in.  After a short time, it became clear that my bleeding was in excess of what the nurse caring for me considered normal.  She was extremely attentive and obviously knew what she was doing.  I remember having my fundus massaged and having to have the pads under me changed numerous times. I remember receiving at least two IV bags of pit.ocin which I knew from my nursing days was being used to attempt to firm up my uterus and stop the bleeding.

Finally, a little over two hours after delivery--ironically, around the same time MM had finally gone to the waiting area to tell my mother and his parents about the boys' birth and to share photos and was experiencing some of the happiest moments of his life--the doctor was called in about my bleeding.  I didn't fully realize until later that at that time I was suffering a potentially life-threatening hemorrhage.  (I later learned that I lost over four units of blood during my c-section and in the two hours immediately following it.)  The doctor decided to use a Bakri balloon to attempt to control the bleeding; thankfully,  it worked, and I did not require further surgery.

I continued to be closely monitored throughout that night.  I was a bit out of it and not fully aware of all the details; however, having been a hospital nurse myself, I could tell by the amount of time my nurses spent in my room assessing various aspects of my condition that I was not experiencing a standard, normal post-c-section recovery.

The following morning, my lab results showed that my liver function tests had once again increased dramatically.  Not a good sign.  At this point,  my OB consulted a high risk OB whose first advice upon being told of my lab values was "deliver her immediately."  He was reassured to learn that I had been delivered the previous night, and I remember his coming to my room and talking with me at length on Friday morning.  As he explained that the "cure" for preeclampsia was delivery but that I could still experience complications including stroke and rupture of my liver for 48 hours after delivery (he knew my background as a nurse and was therefore very frank with me), I was glad that MM had gone home to catch up on some sleep and take care of our dog after being awake all night at the hospital.  (Hearing about these possibilities would have increased his anxiety exponentially, as up to this point, he had really only been worried about the babies, believing that I would be "fine" no matter what.)

I was sicker Friday than I can ever recall being in my life.  My blood pressures were sky high, and I was getting medications by mouth and through my IV to control them nearly every hour all day.  I had a Foley catheter in my bladder (as my urine output had been low during the night and needed to be monitored hourly) and was not allowed to get out of bed.  (Just as well, as I barely had the strength to turn myself in the bed.)

Because of my condition, I couldn't see my boys all day--they were in the nursery receiving care related to their difficulty feeding due to their early arrival--and when they did come to my room for a while in the late afternoon when my mother and in-laws visited, I could only hold them for a few minutes because I was so weak.  (It was also weird hearing my nurse tell the grandparents "Don't leave her alone with them," as if I was a mental incompetent or risk to their safety.)

I have to mention here that, after having said previously that she wasn't even going to be present for the boys' birth, my mother stuck around not only for the delivery but for a few days after.  She spent all day Friday with me, and I couldn't have asked for anything more from her.  (She was also a big help to me while I was on bed rest.)  She got my water and moist washcloths for my head (I was still getting IV mag and very flushed) and ran interference with the staff for me.  Totally exceeded my expectations.

Starting Saturday, I made slow but gradual improvement.  My blood pressures leveled off (although they still haven't returned completely to normal, and I will continue to be on medication for 6-12 weeks following delivery).  I was able to get out of bed and walk around (although I did faint after showering on Saturday morning, scaring the hell out of MM).

Between the mild issues the boys experienced and my hemorrhaging, the hours following their birth were far from ideal or what one might hope for.  I wasn't able to put either boy to the breast, or even start pumping, until Sunday, more than 48 hours after delivery.  (The breast feeding thing is a whole 'nother issue for a post of its own.)

However, despite the difficulties, our boys appear to be normal and healthy and avoided the NICU entirely.  MJ spent the week following his birth in the nursery to "feed and grow," and AJ was there for the same reason for ten days, requiring tube feedings for six days of that time.  (Saddest thing ever to see the tiny little tube in his nose and see how fragile he looked.)  They have now been home for a few days and continue to make progress and do well.

I was allowed to go home three days after my c-section, and though I was initially very weak and tired--and am still not entirely back to normal--I continue to improve daily.  It was hard when the boys were still in the hospital, and even harder once just MJ was home and we had to divide our time between two locations, but having them both home has been easier.  MM is a huge help with them, and my dad and stepmom have been here since last Tuesday taking care of me (preparing meals, doing laundry, etc.)

Unconventional beginning, but "all's well that ends well."  I know we will all continue to improve, and I am so grateful for my boys.