Friday, July 27, 2012

C&G's birth story

Where did I leave off? Oh right, it was Tuesday, May 22nd and I was all kinds of miserable waiting for my scheduled c-section at 5:30am on Friday, May 25th. I had been to see my OB the day before and, in sharp contrast to my unwavering “every second inside matters” mantra up to that point, I was ready to get the boys out ASAP by whatever means necessary. My OB’s hands were tied by hospital policy so I was left counting down each second of the four days until she could put me out of my misery.

Thursday, May 24th was my mom’s birthday and my brother came into town early that morning. He’d booked his flights far in advance with the idea the boys would be a couple of weeks old when he came. It never crossed my mind they wouldn’t even be born by the time he arrived. In order for me to get as much rest as possible prior to surgery, my mom planned to take E to their condo for a sleepover on Wednesday night, and then she, my dad, and my brother would spend all day with him Thursday before bringing him back to our house in the evening for a take-out birthday dinner.

I “woke up” that morning (not that I was sleeping much at that point) and discovered that I was starting to lose my mucus plug. I didn’t think much of it since it took days from that point to delivery with E, except to feel grateful that my body was starting the ball rolling, so my planned eviction the following morning wasn’t completely out of sync with the natural course of events. I was having contractions, but they were no stronger or more regular than those I’d been having for the past couple of months. My BFF In Loco Parentis came for a visit mid-day. She brought me lunch and marveled at my amazing feat of water retention. Other than that, I pretty much just lounged around and tried to rest as much as I could.

At 5:41pm, my mom sent a text asking if I still felt up to dinner or if they should just keep E and go out without us. I texted back the following: “Have been feeling pretty good all day. Lousy last hour or so, but it may pass. I think dinner would be good. I’d like to see everyone. If still feeling bad when you get here, we can always revise plan.” It turns out that “lousy” feeling was actually early labor. (Side note: How glad am I we texted this convo instead of talking over the phone? I would never have remembered the timing and specifics of all of this, but now I have this great little time capsule to remind me.)

M got home from work at 6pm and I got up to open the door so our dog could run out and greet her. As I crossed the four feet from the couch to the door, I felt a small pop followed by a trickle of warm liquid. Denial is a funny thing. I knew immediately what it was, but almost instantly convinced myself I’d imagined it because I’d resigned myself to The Plan at that point and we were soooo close! M came in and flopped down in a chair, exhausted from a long week of tying up loose ends at work. I told her I thought my water might have broken and she gave me a look that said “you have GOT to be kidding me.” I don’t think either one of us could wrap our heads around the fact we weren’t going to get another night of sleep before we met our babies. We talked for a few minutes about how, even if my water had broken, I still might be able to make it to the c-section. It was only 12 hours away at that point. At 6:18pm I got my first contraction that was unlike any of its predecessors and I started to realize the “wait it out” plan might not work after all.

The timing of this next part is a little fuzzy for me, but at some point (6:30ish?), I called my mom who was on her way over to our house. I told her my water had broken and M and I were still coming up with our plan, but dinner was probably out. I asked her to head on to dinner without us and we’d keep her posted. A few minutes later, as it became painfully clear (literally) that we needed to head for the hospital, M and I realized we hadn’t seen E in 24 hours and weren’t going to get to for awhile longer, so we called my mom back and asked her to bring him to our house for a quick kiss before we left. It took her another 15 minutes or so to get there and we almost didn’t wait because the contractions were ramping up so quickly. According to my contraction timer (for the brief time I was collected enough to time contractions), the intervals were 11-11-9-9-6-5-5. Each contraction was lasting 1.5 to 2.5 minutes and I was already struggling to walk or talk through them. E arrived as we were making our way to the car so we got a chance to give him a squeeze and tell him we were off to get his brothers at the hospital – an event we’d been talking to him about for weeks. We got in the car a little after 7pm, I think, and it took us about 20 minutes to get to the hospital. By the time we arrived, it was taking everything I had to make it through each contraction. I wouldn’t let M drop me off so we parked in the ER lot and she gave me a white-knuckle wheelchair ride alllll the way across our large urban hospital to the pregnancy assessment unit.

Once there, they got me into a room quickly. They hooked up the monitors and did an internal exam – 4 cm. I’ve had my fair share of internals and this one was The Worst Ever. I’m not entirely sure what the problem was, but I was super-sensitive and they couldn’t find my cervix for anything. They did an ultrasound at one point and the babies’ heads were both so low and so close together, she couldn’t be certain it even was both babies and not just one of them. She finally gave up trying when I informed her I was a mandatory section so the babies position didn’t matter all that much. I can only imagine that having two heads jammed down there rearranged my internal organs somehow, but… yeowch. The internal was far worse than any contraction I’d had up to that point. It was clear things were progressing quickly, so it got pretty chaotic for a while as people scrambled to check off all the boxes on their respective checklists. I learned that my beloved OB - the one I made the difficult decision to keep even though it meant not delivering at the hospital I wanted - was not on call and the other OB in her practice would be doing the surgery. I was really disappointed and I thought about asking them to call my OB anyway, but that thought lasted a whole second and a half before another contraction hit and I realized that even if she would come in for me, there was a good chance I couldn’t hold on long enough for her to arrive. The nurse must have relayed the urgency of the situation to the OB because she came back with the message that the OB would be in the OR in 30 minutes and she wanted me there waiting for her. Cue more frenzy as we got ready to roll.

They peeled M off at the OR door to change into scrubs and then pushed me through the double doors. I felt like I’d rolled onto a set of a TV hospital drama. People were running everywhere, turning on machines and shouting at each other. Different people popped their faces into mine and asked me for information before darting off to finish their assigned tasks. Every few minutes, they’d stop and do a “check” where the head nurse would read off all my information and everyone in the room had to agree they were in the right place. A nurse took my nose ring and other jewelry and put it in a plastic bag (never to be seen again). The fleet of pediatric residents nominated a leader to come over and introduce himself, explain their strategy once the babies came out, and see if I had any questions. The anesthesiologist took a quick medical history. Various other people asked me to turn this way or that, describe something I was feeling, or recite my name and D.O.B. for the umpteenth time. Most of these questions were asked on top of one another (as well as my contractions) so it was quite the feat to hear and respond to each as it was asked. There must have been a dozen people in the room, maybe more? The OB was there and was trying to hurry things along, but the anesthesiologist decided it was take your intern to work day, and it took forever for her nervous trainee to get my epidural placed. They kept asking me if it felt centered and telling me it was really important that I answer accurately, and I kept thinking “How the hell am I supposed to know?! You think I can feel whether the needle in my back is off-center by a millimeter in the midst of all of this? You’re the ones looking at it!” I just remember sitting on the edge of the table, hugging a pillow, having contraction on top of contraction on top of contraction, thinking they’d never get it in. With each contraction, the OB would yell “K, whatever you do, DO NOT PUSH. Don’t push, K. Don’t push!” At one point I heard a nurse ask wasn’t I just 4cm? The OB replied “No, she went from zero to four in no time at all. She’s way past that now. Just look at her.” I actually don’t think I was fully dilated as I wasn’t feeling an urge to push just yet, but looking back on what she said and how I was feeling at that point, I’m pretty sure I was in transition.

They FINALLY got the epidural in and properly dosed, then M arrived to sit by my head and the surgery started. It can’t have been more than a minute or two before we heard the OB say “I need a catch team for Baby A,” and then we heard the high-pitched squeal we’d come to know as C’s signature cry. A team of doctors and nurses took him to the first warmer and one minute later, we heard G’s deeper, throatier cry as he was brought out into the world. I could hear them in the warmers, their two very distinct cries echoing through the OR, and it hit me: We have TWO babies. They were born at 9:01 and 9:02pm, just three hours after my first hint of labor.

M went to the babies right away and snapped a couple of pictures which she brought back to show me as the OB finished delivering the placentas and began stitching me up. They announced the babies APGARs (8 then 9 for both babies) and most of the doctors and nurses left the room. M said that once they realized how big and healthy the babies were, the mood in the peds’ corner completely shifted. They started laughing, taking bets on how much the babies would weigh, and commenting happily about the babies’ features and actions. The drugs were making me queasy and a little loopy, but I could hear the light tones in their voices and it was such a relief to know all was well. The babies weighed in at 6lbs, 10oz (C) and 6lbs, 11oz (G) – a far cry from the full pound difference they predicted on ultrasound that caused my OB to veto my plans for a VBAC.

Once in recovery, M brought each baby over to me to see and hold. We were both in total shock that they were here. They weren’t supposed to come until the next morning! The nurse came in to check on us and laughed about how crazy everything had been. She said she was working on another part of the floor when someone told her to get to the OR immediately, and she’d run there not knowing who we were or what she was walking into. It still amazes me how quickly they were able to mobilize the delivery team. We weren’t even at the hospital and hour and a half before the boys were on the outside. We called our stunned parents and texted friends. If I were to sum the whole experience up in a single word, it would be SURREAL.

This birth experience has been tremendously healing for me. As most of you know, E’s birth was fairly traumatic and I struggled for a long time to come to terms with it. I longed for the chance to have a VBAC with my second pregnancy in hopes that it would restore some of what my first experience took from me. I didn’t get my VBAC, but in my heart of hearts, I truly believe I could have done it if my OB had let me try. I know that’s easy to say since I didn’t have to prove it, and maybe I’m wrong, but based upon what I DID get to see during my short labor, I know that my body was doing exactly what it was supposed to do. My labor was progressing. My cervix was dilating. The boys were exactly where they needed to be. And all of these things were happening quickly and efficiently. That is 180 degrees from how things went with E. And that alone has soothed my scars enormously. I feel really proud of how my body handled pregnancy, and I’m proud of how it was handling birth, until the doctors took the reins. I thought I might be angry that I wasn’t allowed to try for a VBAC, especially after the ultrasound intel turned out to be total crap, but I’m not. I feel grateful to have gone into labor on my own and had the chance to feel it take over my body in such a natural, primal way, even if only for a short time.

Other than my OB not being the one to deliver the boys, it’s hard to imagine a better scenario from a timing standpoint. I wanted them to stay in as long as possible and to come out on their own schedule. When my OB set the 38 week deadline, my hope became that the boys would come on their own before that, but as close to it as possible in order to maximize their time on the inside. Well, they did pretty darn good on that front!! Less than 12 hours pre-surgery? Well played, boys. I initially hoped they’d avoid the swarm of family birthdays in May so that they could have their own special day, seeing as they’d already have to share their birthdays with one other person. In the early evening of the 24th without a labor sign in sight, I thought we’d managed to do just that. But, they ended up zooming into the world on the tail end of my mom’s birthday, and in the weeks since then, I’ve decided that’s actually kind of special.
Before learning I was pregnant with twins, there were three hopes I had for my second pregnancy: A VBAC, a baby that could stay in our room and be discharged from the hospital with us, and a more functional breastfeeding relationship. When I learned we were expecting twins, I knew all three of those things would be more difficult if not impossible to achieve. I’m going to go ahead and say we got 2.5 of those things, and 2.5 out of 3 ain’t bad.

Sunday, July 8, 2012

Six weeks old!*

This just in: Life with a three-year-old and newborn twins is busy. Shocker, huh?

There is no way I can possibly recap all that has happened since C and G arrived. I'm going to try to hit the highlights though - please excuse the choppy post to follow!

Hospital time = Mostly good. After the shock of our crazy (but wonderful) birth experience wore off, we spent the next few days falling in love with our adorable new roommates. E was never in our room at the hospital and it is so different and so much cooler to have your baby right there with you!! (Another shocking news flash, I know.) My parents stayed with E and brought him to visit us each day. We had some really lovely nurses and the overall vibe was just really laid-back and blissful as M and I celebrated and bonded with our two healthy babes. My recovery was a little rougher in some ways because I had retained so much fluid and my body was in no hurry to release it. It took a whole day and several bags of IV fluid to jumpstart my kidneys to start producing urine again after my c-section and all that time, I just kept getting bigger and more uncomfortable. Also, the doctor who did my surgery (not my OB, thanks to the boys' early arrival - boo) botched one side of the repair job a bit. I guess it is technically closed now (it wasn't at my first postpartum visit), but it looks weird, like it isn't fully sealed. I'm not sure how else to describe it. Also, for the first two weeks, I had this unbearable nerve pain deep under the incision. Fun stuff. It's still sore, but nothing like it was, thank goodness. The pressure to supplement with formula started within hours of the boys' birth and we resisted it until the day before we left. We had a great pro-breastfeeding pediatrician while in the hospital who completely supported our refusal (truly, she cried with me when we finally had to supplement), but the day before we were scheduled to leave, the boys dropped down to 14% below birthweight and she explained she wasn't allowed to send them home until they at least started moving back in the right direction. My milk still wasn't in, so our only options were to leave the boys there (which assured they'd get formula since we couldn't be at the hospital for every feed once we were discharged) or start giving them formula ourselves. We opted for the latter and began following each breastfeeding session with 15-20mL of formula. The following morning, they'd lost even more weight despite the supplementation, but they let us stay in our room a few extra hours and by 4pm, the tide had turned and we were all able to go home together. Hallelujah!

First week home = Heaven! We came home on Memorial Day and M took the next day off. (Yup, that's all she could take post-hospital.) E was at school and we sat around the house all day, holding sleeping babies and basking in the glow of how seamlessly the transition was going. I know, how inappropriately smug of us. Fear not, we got our comeuppance :-) On Wednesday, we took the boys to their first weight check and to our relief, they were both still gaining. C was back up to 6lbs, 3oz. and G was 6lbs, 2oz. On Thursday, we went back to the pediatrician's office for their first doctor visit. Both boys were pronounced the picture of health. Up until then, we'd continued to supplement with formula in response to the boys' hunger cues. We talked to our pediatrician about wanting to stop this and she was supportive of us cutting the formula out cold turkey. M went back to work on Wednesday, but my mom was a huge help during the hours she was gone. The next few days were idyllic (although as I look back over my notes, I can see they weren't eating nearly often enough - still sleeping when they should have been nursing) and we even managed to have a lovely breakfast out on Sunday - our first as a family of five! We wrapped up the first week home with another weight check on Monday morning, and that is when things began to crumble...

Second week home = The higher the ladder, the longer the chute. Monday morning's weight check did not bring good news - C hadn't gained any weight, and G had lost an ounce. Uh oh. This seriously rocked my confidence, as did some signs of lethargy and weakness I'd started to notice in G. The doctor came in to talk to us and said she was not concerned. The number of wet/dirty diapers we were seeing meant the boys were getting enough to eat, and she guessed they were going to move off the weight plateau any moment. She coached me to stick with EBF and to do whatever I could to r-e-l-a-x. She reassured me over and over again that everything was fine and she'd tell me if she had any concern whatsoever. We made a plan to nursenursenurse as much as possible and bring them back Thursday for another weight check. I went home resolved to take deep breaths and make it work... but the universe had other plans. A couple of hours after returning from the weight check, and just before I was about to sit down to feed the babies, I was (TMI alert) battling some constipation (thank you, Percoset), when I had what was later diagnosed as a vasovagal response, followed immediately by a hot, pulsing headache unlike anything I've ever experienced. I honestly worried something had burst in my brain. My mom called 911 and I was taken to the ER by ambulance. I spent the next 8ish hours being drugged, CT scanned and lumbar punctured, and finally sent home with the diagnosis of postpartum migraine, which is apparently A Thing. I returned home engorged but afraid to nurse because of all the meds I'd had in the ER. The nurses assured me everything I was given was compatible with breastfeeding, but come on... Morphine? M and I looked up half lives and percentages in milk for each drug and felt we should err on the side of caution. The babies had already had several formula bottles at that point, so we decided I'd pump and dump for the next 12 hours to be safe, then start fresh at noon the following day. Oh, I nearly cried watching ounce after ounce of breastmilk go down the drain in our bathroom sink. Uggggghhhhhh. So, that was day one. Nice, huh? The next morning, we had a photographer come out to take newborn pics of the boys. They came out so wonderfully and I'm SO glad we didn't cancel her after what went down the previous day. I will post a couple on the password protected blog. She'd been gone maybe an hour when E's symptoms started to show and by the afternoon, it was clear he was not well at all. His fever stayed mostly in the 102-103 range for three full days and he clearly felt awful. I was terrified he'd pass something along to the little boys so I basically sequestered the three of us in my bedroom and only checked on E intermittently, scrubbing in and out like a surgeon for each visit. M had to work all week, so most of his sick care fell to my mom, which was a heartbreaking introduction (hazing?) to what it feels like to have more children than hands. It was agonizing not to be able to care for him when he needed me, but the babies needed me more right then. (We managed to end the week without the babies getting sick, thank goodness.) On Wednesday, I tried to meet with a lactation counselor to develop a plan to safely wean our itty bitty babies off the formula. I really didn't want their weights to dip again. The LC was out, but I had the opportunity to weigh the babies pre- and post-feed, and when it appeared that they managed to LOSE weight during the feeding, I had an epic meltdown, complete with ugly public crying. This earned me another "You Must Relax" pep talk, and a recommendation to start using this supplement, which I started that afternoon. On Thursday, E went to the pediatrician to rule out strep or hand, foot, and mouth and I had my first postpartum visit - at the same time, of course. My mom took E to his appointment and my dad drove me and the babies to mine since I was still taking Percoset and couldn't drive myself. Fun times! My headaches still had not relented so I talked my OB into giving me a couple of doses of Imi.trex by promising to follow up with my primary care doctor after that. I did just that on Friday and was encouraged to try treating the headaches with caffeine which, blessedly, has been working pretty well since then. I usually don't drink any coffee, tea or soda, so even small amounts of caffeine have been making a big difference for me. Or it's a placebo effect. I couldn't care less as long as it keeps my headaches at bay, which it has thus far. Having a debilitating headache while trying to care for newborn twins and a sick three year old is torture. On Friday of that week, we went in for another weight check and they finally gained! G was only up to 6lbs, 3oz but it was something, and C was up to 6lbs., 8oz! After their 24 hours of formula early in the week, we'd continued to supplement here and there - never more than an ounce a day per baby, but enough to make me nervous to go back to EBF without one more check that they were growing on breastmilk alone. The doctor agreed we could come in for one more weight check on Tuesday, so once again, we attempted to stop supplementing, but this time we were able to follow through. Phew! Near the end of their second week home, M's mom came into town and my parents left. I was heartsick to see them go. My mom had been such an enormous help toward the end of my pregnancy and during C and G's first two weeks of life (especially that second week home, aka hell week). Having M's mom around for a few days was great, but her stay was short, and the day where I'd need to start caring for both babies all on my own was looming nearer and nearer with each passing hour and I had NO idea how I was going to manage.

Third week home and beyond: Finding our new normal. The following Tuesday's weight check brought great news. The babies were up to 6lbs, 8oz (G) and 6lbs, 13oz (C). Both had gained 5 ounces in 4 days with no formula, so I finally had the peace of mind I needed and we've been EBFing ever since. On Wednesday morning, M's mom left at the crack of dawn and I was officially on my own. The babies were one day shy of three weeks old. *Gulp* Somehow, we all survived and since then, the pendulum seems to have come to rest on: Really freaking hard and busier than I ever could have anticipated, but manageable, and peppered with moments of such bliss and beauty that I could burst from the sheer joy that is our life. I have learned so much and I do things with the babies every day that I never would have thought possible, logistically. The learning curve is something else when you're thrown right into the deep end. We get out on our own at least once a day - sometimes for several hours of errands, sometimes just to pick E up at school - but it's something. On a couple occasions, we've stayed out through a feeding time and I've needed to nurse them, in public, on my own. At home, I tandem feed them, but when we're out, I have to do them one at a time and, somehow, keep the other baby pacified too. The first time I did it, I'll admit I felt a little like Wonder Woman. :-) We've also been doing a lot as a family on the evenings and weekends. M has been awesome about this. I'm sure she'd rather put her feet up at the end of her long workdays (HA, like we're going to be doing that anytime in the next 3-5 years!) but she knows I need to get out for my own mental health and she does what she can to make that happen. (Your efforts have not gone unnoticed, Love.) We've been having a lot of picnic dinners in parks, despite the oppressive heat, because the babies love to be outdoors and I can sit on a blanket and feed them while watching M and E play. It's been really... nice. Despite the rough start, breastfeeding is going really well. We haven't had to supplement at all in the past month and my supply seems to be keeping up with their demand. I just hope we'll have a strong enough foundation for it to stay that way once I go back to work in two short weeks. (And now, I will cease speaking of that wretched day to keep myself from vomiting.)

The babies have easy temperaments (one more so than the other, of course) and they don't have the health issues (colic, reflux) that E suffered from, so we joke that the two of them together are still easier than E was as a singleton newborn, which is NOT actually a joke because it's 100% true. They look almost nothing like each other, and yet they both look startlingly like E, which is really freaking cool for reasons long-time readers of this blog will appreciate. They were both up to 7lbs, 8oz and 21.5 inches (exactly the same size!) at their pediatrician appointment just over a week ago. They have started to outgrow preemie clothes by length and are fitting comfortably into NB and some 3mo sized clothes, as well as most of the newborn diapers in our CD stash. During the past few days, they have both become very generous with their smiles and we can consistently elicit them, which is basically the best thing to happen ever.

There are so many things I want to say; so many things I want to document here because time is racing by at breakneck speed and I know I'm going to forget so much. But, I fear I won't even get this much posted unless I pull the trigger on it now. I'd like to say I'll write more soon, but I probably won't. We're very much on our own out here. Our families live many states away and I've been a little sad to find that, with some exceptions, our local friends haven't stepped in to fill the gap the way I hoped they might. That sounds whinier than I want it to because we're really doing okay, but we're also both operating at 110% and we have zero down time in which to catch our breath. None. There are things that are far more essential to the functioning of our household than blogging that are being left to the wayside right now, so... I'll be back when I can, which will hopefully be soon enough that C and G's entire infancies don't disappear into the vortex of my feeble memory. :-)

*This post has had two previous titles, on account'a the fact that I've been writing it a couple sentences at a time for-ev-er. The first was "Three weeks old!" Then, "One month old!" Even this one is technically out of date, but it's close enough so we're rolling with it.