The Birth Story — or, And I Thought Getting Pregnant Was The Hard Part
October 10, 2009
Note: Here is the birth story people have been requesting. It also involves a major infertility turning point. And, it is very long — you may want to grab a snack and get comfortable.
So it looks like the magnesium did its job.
Recap: A week ago Tuesday, rehospitalized at 33w0d due to further cervical dilation (5cm). Given another course of steroid shots for the babies’ lungs, and put on mag to hold off labor until the steroids could take effect. Tuesday night, had lots of very strong contractions (up to 7/10 pain level, which is almost unheard of for me) 4 minutes apart, but cervix didn’t change further.
Wednesday, contractions slowed then stopped. No notable contractions or cervical change through Friday morning when mag was discontinued.
Friday morning, mag is stopped. Friday morning and afternoon, no contractions. Lower back, which has been hurting steadily for quite a while, starts hurting more.
Friday early evening, contractions resume. Not wanting to be deprived of food and drink for no reason, as I had been on Tuesday night for half a day, I decide to eat my dinner first then report contractions. The model patient rebels a bit. Hungry + thirsty + contractions = crankier than I intend to be.
I ate dinner, then reported the contractions. Monitor showed contractions 4 minutes apart. They weren’t as painful as those on Tuesday (more like 5/10 pain), but I definitely felt them. Cervix still at 5cm.
Throughout the past month+, DH had slept in my hospital room only the first night of each hospitalization, then visited during the day every 2 or 3 days. Most recently, he’d slept over on Tuesday night, left on Wednesday, then hadn’t returned until Friday night. He thought that the discontinuation of mag was as good a time to stay over as any, because I was at higher risk of delivering. This would be the first time he’d voluntarily slept in the hospital with me. He worked late on Friday and arrived well after dinner and the start of contractions. Because my cervix was unchanged, “contractions! come here right now” became “finish your work, see you later.”
He arrived, we hung out for a few hours, and we decided to go to bed around midnight. We wanted to watch a bit of TV before going to sleep. Halfway through the show, I had to pee.
Then something else started coming out. Something pink. Something that was not urine.
The nurse and resident quickly concluded that it was amniotic fluid. Baby A’s water had broken. Fluid continued to trickle then flow then pause then trickle then flow over several hours — such a bizarre feeling. How much fluid could there possibly be in one amniotic sac?
Previously, the perinatologist had told me that further cervical dilation would buy me a quick c-section, but that breaking my water at 5cm dilation would buy me an even quicker c-section. Once my water had broken, urgent could become emergency very quickly. (Remember this part.)
DH packed up my room and we were whisked away to Labor and Delivery.
They said that the resident and attending were occupied with another birth, but that we’d deliver soon.
My contractions got stronger and closer together.
Stronger and closer together.
We waited. What the hell?
A second vaginal birth jumped the queue. Hmm, remember how my water breaking was supposed to constitute a near-emergency?
We waited. Both very sleepy, but it was no time to sleep.
Finally, with my contractions 2 minutes apart and extremely painful (no pain meds on board, some combination of my being a trooper and it being “any minute now”), the nurse announced that both births were finished. I didn’t get to the pushing part, but no one can ever say that my c-section didn’t involve full-blown labor. When contractions are 2 minutes apart, that means that it’s 2 minutes between the peak of each contraction. The respite between the end of one contraction and the start of the next was less than a minute. The limits of my iron pain tolerance were being tested and pushed to the limit.
Finally, it was time. I headed to the OR first for anesthesia while DH was asked to wait. The anesthesiology resident attempted to place the spinal in the midst of my almost constant contractions. Just sitting up in the right position was reeeeally difficult. I got seriously pissed when I heard the anesthesiology attending tell the resident, “You blew the space.” I remembered reading that nowadays, the dreaded spinal headaches are rare and usually only happen if they keep blowing the space and have to do multiple sticks. Luckily, the second try worked. If he had blown it a second time, I was prepared to tell the resident he was incompetent and should step aside. I was also prepared to tell him that I liked the other two anesthesia residents I’d met before much better, and that he was ugly.
With the spinal in place, they started to prep me, and I lost track of the dozen people in the room. I’d never met the OB attending before, but I knew the OB/MFM resident well.
Eventually DH joined us in his gown, shower cap, and mask. He is not the type to peek behind the curtain, but he could still see plenty.
More than 3 hours after my water broke, the babies emerged quite quickly. A, the boy, Burrito, came first. He had the most fabulous loud cry. They showed him to us, and he looked big and perfect. A real baby. A real baby! The neonatologists went to work on him, but not much was needed. From the first moment he was breathing room air and was just perfect.
B, the girl, Tamale, came two minutes later. Her cry was weaker. They bagged her, but she seemed to be doing okay. Also a real baby. We had two babies! All of my Dead Baby Thoughts had been unfounded, and all of the fears of severe prematurity at 26w and 28w had not come to fruition. They were alive, and apparently healthy, and so beautiful.
From my vantage point, I could see Burrito’s station very well, but couldn’t see Tamale. DH was able to see Tamale quite well, as well as some of what the doctors were doing to me. As the doctors started to work on putting me back together, I was so grateful to be distracted with views of Burrito and DH’s reports about Tamale. When I met with the neonatologist at 29w, he’d said that they might immediately whisk the babies away. The fact that the babies were still in the room seemed like a very good sign. It exquisitely seemed like forever, but was about 10 minutes, that I just watched the hustle and bustle and caught glimpses of my baby. DH, despite declaring years ahead of time that he wouldn’t feel comfortable, cut both of their cords. I was proud of him.
According to the time stamp on the photos, 13 minutes after Burrito’s birth, they brought him over to me to look at and touch for a few moments — longer than I was expecting. Was this really my baby? I knew they hadn’t smuggled any babies into the OR, and there were witnesses who saw these babies come out of me, so they must be mine. After I touched and kissed Burrito, DH held him for a minute. They said that Tamale wasn’t ready to be held, but that we could see her soon in the NICU.
Meanwhile DH could see the activity level around my abdomen growing.
Here comes the part relevant to infertility.
The babies were still in the room and I was still wonderfully distracted when the OB attending interrupted. In a very calm but clear voice (thereby telling me that the situation was serious but that he was trying not to freak me out), he said:
BabySmiling, we need to talk about what’s going on. We’re trying to finish up, but it’s not going as planned. B’s placenta was what’s called accreta. Her placenta is attached very deeply to your uterus, and it is so deep that it even goes beyond the uterus. This is very rare, but it is more common with multiples. We have been trying to remove the placenta and control the bleeding, but it’s not working. We may need to do a hysterectomy. This would mean that you couldn’t have any more children. We will try everything we can, but right now it’s looking like we will need to remove your uterus. You will still have your ovaries, so you won’t go into menopause, but you won’t be able to have more children. You have also lost a lot of blood, so we will need to transfuse you.
Here is the golden moment when 7 years of infertility came to a head.
DH and I looked at each other. In one split second it felt like three things occurred as we made eye contact: taking in what the doctor said, asking the other’s opinion, and simultaneous agreement. It felt like we both shrugged with our eyes. Here is what went through my head.
- Oh. Wow.
- Hey, it’s like Abby on ER. She lost her uterus during childbirth too.
- I guess this settles the conversation about having more babies.
- It’s fine, I can live with that. At least we don’t have to use contraception, and I never have to wonder or take a pregnancy test or cry over a BFN.
- This will make a really good blog post.
- Huh, I bet most people would be really upset right now. Abby on ER was really upset, even though she didn’t want that baby in the first place. I’m fine with it.
- DH looks fine with it.
- Those pesky placentas! First A’s was previa, and now B’s is accreta.
- Technically I could have more children via surrogacy, but I know what the doctor means.
- No surrogacy, these two are enough.
- Thank G-d the babies are okay. They both seem to be doing so well!
- Little does he know, even if I have a uterus I probably can’t have more children.
- I’m so glad the babies are still in the room for me to have something to watch while this goes on.
- The doctor probably wants an answer.
The way it looked to everyone else: Doctor finishes speaking, DH and I look at each other, and we both say something to the effect of, “Whatever you need to do.”
The doctor said, “Thank you.” In my mind, the unspoken full sentence was, “Thank you for not freaking out like most people do, thank you for not making my job harder while I’m trying to do this, and thank you for not requiring me to convince you that this is the only way to save your life.”
My little distractions weren’t in the room long, and they soon went upstairs to the NICU.
The doctors kept working, and the anesthesiologists started getting really busy.
DH made a joke/offer about the transfusion being convenient because he is a universal donor, and rolled up his sleeve.
I asked him to tell me everything he remembered about the babies to keep me busy, and to show me the photos he’d taken.
DH, normally rather squeamish, was quite fascinated as the surgeons worked and told them as much. “This is so cool!” “From a medical standpoint, this is so interesting.” Usually I would be the one filled with intellectual curiosity for my own surgery. We weren’t entirely ourselves that day, in lots of ways.
DH didn’t tell me at the time because he didn’t want to alarm me, but there was a lot of blood. He later said that it seemed like an awful lot of blood, between the huge tub of suctioned blood and the giant puddle of blood on the floor that everyone kept having to step around. No one ever mentioned the word hemorrhage.
Later, DH asked how much blood I’d lost, because he thought he’d heard an amount mentioned but it couldn’t possibly be that much. They confirmed that he’d heard correctly. I had lost more than 6 units. My loss was 2/3 of the normal human blood volume, though because blood volume increases during pregnancy and even moreso during twin pregnancy my percentage was lower, closer to half of my total blood. That is still really a lot.
With a spinal, you don’t feel pain but you do feel “pressure.” The pressure got stronger. The way they were throwing my body parts around felt a lot like Thai massage.
Eventually the doctor said, “The bleeding is slowing down. We tried [a drug whose name I don't remember] and it worked. We aren’t going to transfuse you right now, and it looks like we won’t need to do a hysterectomy.”
DH asked, “Is that drug commonly used for placenta accreta, or did you just try that drug on a whim?”
As the doctors continued to work, they started talking to us more. Several times, DH or I made them laugh quite a bit. I don’t think either of us was trying to be funny.
The OB attending said that it was lucky that B had been breech and required a c-section. If I’d had a vaginal delivery, the bleeding would have been harder to control, they might not have had time to open me up, and I might have died.
After a while, they were done. With all the genuineness I could convey, as they were wheeling me to recovery, I told the doctor, “Thank you so much.” Thank you for saving an organ that I probably have no use for but would have missed, thank you for doing such an incredible job, thank you for saving my life.
As they wheeled me out of the OR, I started feeling pins and needles in my legs. This meant that the spinal was wearing off and they had finished surgery just in time. If it had taken longer or if they had needed to do the hysterectomy, they would have switched to general anesthesia.
Recovery did not go so well. It was supposed to be “an hour or two” but ended up being more than 3 hours — among other things, we had to wait for a shift change in the NICU then in the mother-baby unit. In my altered state, I had it in my mind that I shouldn’t go to sleep because I needed to be alert when they wheeled me to the NICU to glance at the babies. I really should have gone to sleep. I dozed off here and there, but mostly I lay there being agitated.
The nurse appeared periodically to tell me it wouldn’t be long (sound familiar?) then would disappear for far too long. During that time, they had a post-op conference to discuss my case. A Morbidity and Mortality meeting, without the morbidity or mortality. A “here is what went right with this crazy case” meeting.
I was also terribly thirsty even though I was hooked to an IV for hydration.
And I was itchy, so itchy, from the anesthesia.
Unprecedented sleepiness + agitation + impatience to see my babies + thirst + watching DH eat and drink + itchiness + not knowing how much longer + severe nausea + almost dying = a bad combination.
I remember so much about the birth, but the NICU trip is pretty hazy. I thought I’d just get wheeled by each isolette momentarily, the way that a tour bus pauses to look at a monument, but we stayed in each room longer than I’d expected. They told us that the babies were doing wonderfully. Tamale had disagreed with their recommendation for breathing assistance and had pulled out her tubes, so she was breathing room air like her brother by the time we saw them.
The next days were a weird combination of highs and lows. I’ve already talked about the contrast at Show and Tell earlier this week.
To preempt an inevitable question: They didn’t transfuse me because the preference in that hospital on that service is to avoid transfusion below a certain very high limit. I was actually kind of glad that they didn’t, because even screened blood carries a certain amount of risk, but dealing with that level of blood loss has made the recovery much more difficult.
My next post will have pictures of both babies, as well as some processing of the events I’ve just told you about. This post is long enough.
Birth details (in metric or disguised to reduce Google-ability):
Born one week ago exactly (on Sat.) around 3:30 a.m. at 33w4d
Burrito weighed 2.15 kg, Tamale weighed 2.25 kg
Burrito was 47 cm long, Tamale was 44 cm
APGARs 8 and 9 for both
Off the charts in terms of being loved