Saturday, August 29, 2009

long story, the birth (unmedicated vaginal birth of twins)

**Disclaimer-- this is long, and contains some stuff that could be considered to be gross by some. So if you get queasy when hearing about birth or internal body parts, or you could never look me in the eye again after hearing about the workings of my internal body parts, you might not want to read this.**

After we left my appointment we went straight to the hospital. It took a bazillion years to find a parking space and of course and when we finally did it was like 17 miles away from the entrance. We off loaded all of the hospital bags and made the hike in, all the while dodging the stares of strangers and trying to ignore their comments. I went to check in at the security desk and the guard kept asking me why I was there. I’m in labor, duh! Since we had left the office the adrenaline had kicked in and I wasn’t feeling any discomfort, or contractions for that matter so I guess I had lost “the look”. We waited about 20 minutes in the waiting room and then were finally sent back to the L&D rooms.

The nurse lead me to my room and I changed into that dumb hospital gown and did the requisite peeing in the cup. Now, asking a woman who is nearly 36 weeks pregnant with twins to pee in a cup is like asking her to do a gold medal worthy gymnastics routine. It is practically impossible to pee in a cup when you are that huge. Pretty much all you can do is put that cup where you think it should go and pray for the best. It is all in God’s hands at that point. The only good thing about the process is that if you do miss, you are going to have to pee again in about 8 seconds so you can try again.

Once that was done I went to the bed and got hooked up to the monitors. There was only one monitor to track a heartbeat, so I asked the nurse to get another one and she was like, Why, are you having twins??? Um, yes. Oh! Well that changes things. Um, yes. We found the babies heartbeats and they looked perfect and then the nurse asked me how far I was progressed at the doctor’s office. When I told her she said he must have been wrong because there was no way I was that far along and looking that good/ happy so she was going to double check. Knock yourself out. When she checked me her eyebrows got really high and she said I was about 6 cms and 100% effaced. Even I was surprised by that because I really wasn’t feeling any pain and my contractions were minor, at best.

It was decided that we would hold off on my IV as long as possible because, well, ew! I didn’t want it but knew it was pretty much non negotiable because I needed IV antibiotics. I knew I could refuse them, but I chose not to. I also knew I could refuse general fluids but chose not to because 1, it was 106 degrees outside and I felt a little dehydrated and 2, should something go wrong and I need an epidural, I wanted the fluids in place so I didn’t have to wait. The nurse was so awesome about everything and truthfully was one of my angels that day. Never once did she ask if I wanted pain meds, she didn’t try to push anything on me, she just trusted me to know what I needed, when I needed it and followed my lead.

The doc on call ended up being my favorite doctor, thankfully. He is the most laid back, chill guy I have ever met. Something about him is creepily calming and comforting. He finally came in about an hour after we got there and the nurse kept trying to convince him that I really was 6 cms. He didn’t believe her so he checked me and found that I was 7 cms at that point. I certainly didn’t feel like I was 7cms. The entire time I was talking and laughing and cracking jokes bad jokes... it was awesome.

The IV antibiotics were started and we all decided to sit back and let my body do what it needed to do. Typically when I’m in labor I want to be up and moving around, changing positions at least every 20 minutes to move things along. This time I didn’t feel any desire to get out of bed. I was perfectly comfortable and content lying in bed. With W’s labor I was forced to be in bed because his heart rate would decelerate so much with every contraction and it was the worst pain I have ever felt. This time I hardly felt any pain. I also had a feeling that if I was up and moving, one or both babies would start having heart decels and I didn’t want to give the doctor any reason to call for a c-section. At one point I did change positions in the bed and baby B’s heart rate dropped dramatically so I immediately moved back and she was fine again.

Close to an hour after the IV was started the doctor came in to check me again. From my looks, no one believed I was in active labor, still. But I was 8 cms so I really was in active labor, well, technically transition. In my previous labors things always got really intense starting at 7 cms. I’d get shaky and start throwing up, hot and cold, cranky and need a lot of support. At that point I would always have to do focused breathing through contractions and it would take a lot of work and concentration to stay one step ahead of the pain. I was anticipating that to happen again so I told M to get the barf bag ready and to put on the iPod so I could get into my labor space. It was almost as if I was disconnected from my labor. I didn’t feel like I was really doing anything. There were about 3 contractions I actually had to close my eyes and deep breathe through, but I honestly wasn’t feeling any pain or much discomfort and that was starting to worry me. Leave it to me to freak out about something so wonderful.

The nurse came in again and asked me how I was feeling, I told her a little bit too good. She told me she wished she had a video camera so she could film me because my labor should be shown to childbirth classes. She had never seen someone that far progressed, being that calm and collected. Even the doctor was a bit confused about if I was actually progressing and I kept hearing the 2 of them talking about what they should do. The doc checked me again and found I was nearly 9cms, less than 30 minutes after he had last checked. All of us were a little concerned that transition was really going to hit out of the blue and we were going to have a “running through the halls to the operating room while I’m pushing “ scenario on our hands. I really didn’t want Baby A to be born in the hallway so we decided to break Baby A’s water and head to the OR. I wanted her bag broken because I really didn’t want to be laboring in the OR for a long time and I knew that once that bag was broken she’d be coming soon.

As we headed to the OR I felt a little bit like a celebrity. All of the nurses were standing around, trying to get a good look. I had apparently been the talk of the nurses station and they wanted to see if it was really true that I was 9 cms and hadn’t made even a groan. It was kind of nice to hear all of their comments at that point because the contractions were getting a lot stronger and I was really starting to feel them. I think most of the discomfort was really from being banged into doors and walls along the way though. Those birthing beds are too darn big to be pushed through the halls. We finally got to the OR and after making sure I didn’t have whiplash I opened my eyes and realized this was actually going to happen. Everything I had stressed over was going to take place in a matter of minutes.

The OR was cold, Lord was it cold. It was scary and sterile and made me want to wear my sunglasses because it was so bright. Up until then everything had been really calm and peaceful, but something about the OR makes everyone stressed out and kind of cranky. Suddenly there were about 4 other people in the room, trying to make sure everything was set up. The nurses were arguing over if they should break down the operating table for the birth now or later, there were other people walking around trying to find things, someone was telling me to move to the operating table while another person was telling me not to. Dudes, just figure it out and let’s get on with the show.

I was finally allowed to move to the operating table (oh joy!) and the contractions immediately started to feel worse but nothing like my typical transition contractions. That table was hard and I had to lay flat on my back, besides a small hard wedge that was placed under my right side. They offered me a pillow but they might as well have put a piece of cardboard under my head because it was so thin. I started to feel pushy so I told the nurse and she told someone else to go get the doctor. The doc was nowhere to be found at that point which really made everyone in the room nervous. They finally found him and he checked me and said I needed another 15 minutes and then it would be go time.

Those next few contractions were definitely the most intense I had all day, but I was still strangely coherent and not really in pain. They were probably the worst because at that point Pitocin had been turned on to keep my uterus contracting after Baby A was born. I never thought I would have agreed to Pitocin but I knew that I would probably not get to put my babies to the breast right after they were born to help keep the uterus contracting and from hemorrhaging so the pit was the right choice. I think I said half a cuss word as I was feeling the baby move all the way down and get in position to be born but that was the most vocal I got. I don’t know if it was actually 15 minutes from when the doc had last checked me or if it was sooner but it wasn’t long before I felt that glorious urge to push, and there was no stopping it.

Baby A was born after a few pushes. No one counted, no one cheered, no one told me how to push, it was perfect. When she was born I remember thinking she was so small and had a great cry, but I didn’t get to actually see her face. She was passed to my nurse who started checking her over, who then had to pass her to the NICU nurses because the doctor needed her help, urgently.

My worst fear had come true. Baby B had flipped breech as soon as her sister was born and she did it fast too. And the kind of breech she was made it impossible for her to be born, even if the doctor was willing to do a breech extraction. He asked for an ultrasound machine, which seemed like it took FOREVER to get there, and then the fun began. Everything I had read about twin births said that the worst pain you would ever feel in your life would take place if you had to have a version to turn the second baby without an epidural. And there I was, facing a version without an epidural. When I made the decision not to have an epidural I was very much aware of the possibility of the pain but I figured I would rather endure 5-10 minutes of intense pain than deal with all of the risks and side effects associated with an epidural through an entire labor.

Somewhere between talking to Baby B and begging her to turn and the doctor beginning the version, I went into some kind of freaky trance. I didn’t feel pain, just a lot of pressure. I spent the next 15 minutes fully aware of everything that was going on, but in a weird way. It was almost like it was happening to someone else and I was just watching.

There were about 5 hands on my belly, some holding the space where baby A had been, others moving the butt and others moving the head. The doctor was holding the ultrasound wand thingamajig with one hand and internally moving the baby while trying to keep her cord from prolapsing with the other. That was quite possibly the weirdest feeling I have ever felt. It was one of those things that made me think, “Is he really doing this? Oh, yeah, his hand really is IN my uterus right now. Ok.” And then he kept asking for longer gloves… Seriously, are you going to reach up there and pull my teeth? If I wanted my teeth pulled I would have gone to my dentist! What do you need longer gloves for?! And then all I could really think about at that point was that he was eventually going to ask for the gloves that dairy farmers use when cows are born. If you grow up where I am from, it is pretty much mandatory that you see a cow being born by the time you are in 5th grade. It's like a right of passage. The picture that always sticks in your head after you see a cow being born is of the farmer with a plastic glove all the way to his shoulder, pulling the baby cow out from inside the mama cow. And that is what I was thinking of the last 5 minutes of the version. What a lovely image to have in my head right before the birth of my daughter, no?

Thankfully, he didn’t need gloves that went up to his shoulder, although the last pair did come up to his elbow. They had moved baby B into position to be born in about 15 minutes. But then, her heart rate dropped. Well, more like plunged and wasn’t showing any signs of recovering. She needed to be born right then, but that wasn’t going to be possible. Little Miss Baby B had moved both hands above her head, and well, babies can’t really come out that way. I will never forget the look in the doctor’s eyes when he looked at me and told me he had to do a c-section. He knew how much I didn’t want one and how freaked out I was about it. I knew that he didn’t want to give me one and had tried everything possible to get Baby B to be born vaginally. There just weren’t any other options.

The anesthesiologist had been waiting outside and practically ran in the room when he heard the words “c-section”. The room erupted into chaos. Monitors were being put all over my chest, people were pulling things from cupboards and drawers and opening the surgical tools, other people were yelling instructions and then having to repeat them because no one was listening. It was nuts. And there I was, laying on that cold cold table with a billion thoughts running through my head. Everything was happening so fast and there was so much to say. I was trying to make sure that Baby A was ok, tell M that he had better not name the babies before I came out of the general anesthesia and that I loved him, tell the doctor to do a double suture when he stitched up my incision just incase we wanted to have another baby in the very distant future so I would have a better chance at having a VBAC (vaginal birth after cesarean), curse at the life insurance company for denying me coverage just 3 weeks earlier for “excessive weight gain over the past year” because I didn’t know if something was going to go wrong or how I was going to react to the anesthesia and there was no way M was going to be able to afford daycare for 4 kids if I suddenly kicked the bucket… and trying not to show that I was completely out of my mind freaked out that this was going to happen. It was a very lonely place to be.

While everyone was prepping for the c-section, the doctor had kept his hand inside my uterus to keep the cord from coming down and the ultrasound wand thing on my belly to continue to monitor the baby. I remember laughing because he thought it was so cool that he could see his fingers on the ultrasound as he was holding Baby B in place. I am so thankful he happened to mention that little discovery because it lightened the mood in the room and took some of the focus off of all of the scary stuff.

The anesthesiologist ordered that the Pitocin be turned off and started mixing his magic potions to put me under. And all of the sudden my doctor told everyone to stop and back off. He saw that Baby B had moved her hands and told me he was going to pull her down and I was going to push her out… quickly. Then chaos erupted again. The doctor ordered for the pit to be turned back on, the anesthesiologist was asking what the heck was going on, I was trying to get my mind out of the fearful state and back into the “let’s get down to business” state, and the nurses were trying to put all of the things they needed for a vaginal birth back in place. No more than 30 seconds and 2 pushes later, Baby B was born, just 17 minutes after her sister. No drugs, no c-section, no noise. It was just as perfect as when Baby A was born.

Now, I’m not one to typically be like, "The doctor saved me” when it comes to birth. I normally can’t stand it when people say that, but this time it was true. He really did save me from something that I did not want and made it so my babies were born safe and healthy and that I was safe and healthy too. I will forever be grateful to him for trying so hard to give me what I needed and respecting me and my knowledge and trusting me and my body to do what it needed to do to birth these babies. Never once did he look down on or question my choices, he never made me feel like an idiot or forced me into anything. He didn't have to do what he did. When she turned breech he could have said game over and not have even tried to flip her, but he didn't. Instead he fought for me and I think he learned a lot along the way, too. As he was leaving the Operating Room he came and shook my hand and told me he didn't think he could do what he just did. I told him I wasn't sure if I should be flattered or frightened, but I knew what he meant. The next morning when he came to check on me and we chatted about the birth. I told him that was the easiest labor I had ever had, or seen, and he said, "Really? Because that was, by far, one of the most harrowing deliveries I have ever done." Oh crap! I didn't think it was that bad. And that right there is the beauty of endorphins.

After Baby B was born and I was cleaned up I finally got to see my precious babies. While the nurses were examining the placentas I had asked them to order a test to see if the babies were identical. Even though they had 2 separate sacs and placentas, there was still a 25% chance they could be identical. But once I saw the babies I told the nurses to scratch that because these babies were in no way identical. I couldn’t believe how different they looked! It was sort of surreal to be holding my babies. I had stressed so much about their pregnancy and delivery and there they were. In the course of 4 hours, the focus of the past 8 months had actually taken place and it was over. When you hold one baby in your arms for the first time it’s a pretty intense feeling but to hold 2? It is indescribable. A combination of wow! and holy crap they are both mine! with a bunch of other ooey gooey mushy stuff thrown in.

During the chaos of the delivery, somehow the bed I had labored in had been lost and my labor room was given away. Apparently while I was in the later stages of labor everyone and their sister decided to go into labor too and all of the rooms filled up. So I got to go recover in the surgical recovery room, on a gurney. At that point I almost asked for an epidural because those gurneys aren’t so comfortable. Thankfully I was on a birth high so I didn't really care. We waited in the recovery room for about an hour while I scarfed down some hospital food and the nurse did her charting. She kept saying over and over that she couldn’t believe I had an unmedicated vaginal birth of twins and that I was a very rare case in that hospital.

The babies were weighed and measured and then we noticed Baby A was turning a not so nice shade of gray so both babies were sent to the nursery to be monitored. Then I was finally moved to my postpartum room. The postpartum floor was completely full so I got to spend the next 2 days on the pediatrics floor. That actually worked to our advantage because we got a private room instead of having to share. The babies were brought back to me after about 3 hours and I finally got to hold them and get a really good look at them. Then the Great Name Debate of 2009 began. It took us almost 36 hours and a few tears to name them, but we finally settled on 2 pretty much perfect names.

W and CB got to meet their sisters the morning after they were born. CB had always been my little tiny baby but when I saw her that morning I couldn’t believe how big she really was. W seemed to have turned from a little kid to a little man over night too. They were both so excited to see their new sisters it was really sweet how they wanted to look at their little toes and hold the babies. Seeing my 4 kids all together for the first time was a little overwhelming, to say the least.

We were discharged almost 48 hours after the girls were born, even though they were born a little early at 35 weeks, 6 days. **NOTE** we now know MJ was actually born late in the 34th week and A was born early in the 35th week-- 2 different conception dates and my original due date was off by over a week** They appeared to be doing fine and they seemed to be breastfeeding well so the on call pediatrician felt ok letting us go, as long as we followed up with our regular pediatrician the next day. The first day and night home were a little overwhelming but we managed, somehow. The next day I noticed MJ was having a little difficulty with some fluid in her stomach and she was spitting up more. Then the second night we were home, while I was feeding her, I heard her stomach rumble and then she had the biggest spit up I had ever seen from a baby that small. M took her to the bathroom to change her and came back out to ask me if she had ever had blood in her spit up before because there was brownish blood all over her little pajamas. And in that moment, my happy little world disappeared and I freaked. Less than an hour later, we were back at the hospital where they were born, heading into the ER.

(more to come…)


Jenn said...

Joanna, you are my hero. What an amazing birth story - I'd like to kiss your doctor. Thank you for sharing.

clanelder said...


Name Nazi said...

That's such a great story!!! I had to have c-sections with both mine, but I completely credit my doctor for doing everything he could to prevent it. He let me labor for three days after my water was broken ... and I was in the hospital with no food and water all that time ... before he let me finally decide to do the c-section. Later he told me that he would have only given me a 10% chance of being successful during a vaginal birth, but I would have totally felt cheated if he didn't let me try anything and everything I knew to do first.

Some doctors really are the best. And its a rare gem that understands that a woman NEEDS this experience to feel complete. At least, that's my belief.

Hilary said...

JoAnna, you rock. Seriously. What an amazing birth story. And the photos of you with the babies, then CB and W with the babies totally made me cry.

The Paskins said...

Hi JoAnna - I'm a childhood friend of Hilary's (we've met once or twice over the years), and I just want to say YOU ROCK!!! I had a drug-free birth, too, and your description is so spot's like you're hovering in someone else's body watching what's going on with your own body.

My daughter also had blood in her spit up and stools a few days after she was born, so I can't wait for the next part of the story to see if we really are leading parallel stories :)

God bless,

mommy-medic said...

Huge hugs, I wish I were closer and could help you out. I did have to lol at the awesome hair on CB and the not-so-much hair on W. :)

M said...

*phew*, can't finish this in one sitting. Love you, wish me luck...