Friday, January 24, 2014

birth times two

When I was pregnant with Harriet, I did lots of research on unmedicated child birth. I read books and took classes. We had a doula. Our doctor was trained in water birth, and we delivered at the hospital in our area with the lowest c-section rate. I was physically, mentally, and emotionally prepared to give birth with very little intervention, and I feel really lucky to say that Harriet's birth was pretty perfect. Not only did it go off without a hitch, but it proved to be a life-changing, thoroughly healing, top-of-the-mountain experience for me.

This time around, I am becoming more and more aware that my experience will be completely different. My husband now works at a different hospital, and if we deliver there, our birth is essentially free. If we were to deliver at the hospital where Harriet was born, we would pay thousands. So the choice is obvious. This new hospital has a brand-new, beautiful mother/baby center...a far cry from the maternity ward of the hospital where Harriet was born where we had to run our tub for twenty minutes to get warm water.

This new hospital does things much differently. Most physicians are a part of a large group, so you really have no idea who is going to deliver your baby, whereas the doctor we worked with during my pregnancy with Harriet did all of my appointments and was called out of his bed at 2:00 in the morning when we needed him.

During my first appointment with my new OB group, the doctor assured me that "this isn't going to be a granola birth." She went on to explain that no hospital in our city does waterbirths for twins. She explained that I will deliver in an operating room, even if the birth is unmedicated. She also explained that there will be lots of people and lots of monitoring. If I hit 38 weeks, I will be induced. Although I really hate the idea of induction (I'd rather let the babies choose their own birthday and I know that induction makes labor much more intense), I'm actually okay with this since the stillbirth rate in twins goes up after 38 weeks. Plus, at that point, they grow better outside the womb than in it.

As far as what type of birth I'll be having, the babies and the doctors will decide. I have a little bit of power in this, but not much. If Baby A (the one who will be born first) is bigger and head down, I get to try for a vaginal birth. Otherwise, it's an automatic c-section. As of right now (26 weeks), the babies are both transverse, but Baby A is bigger.

When Baby A is born, Baby B will likely flip around due to all of the free space that suddenly opens up. Apparently, if Baby B flips breach, some doctors will literally reach their arm in while exerting pressure on the outside of my abdomen to flip the baby to a head-down position. I've heard this is the most painful part of the birth. Other doctors prefer to deliver the second baby breach and will even flip Baby B from the head-down position (using the same method I just mentioned) in order to be able to grab its ankles and deliver it feet-first. Other doctors don't flip babies at all, so if Baby B ends up breach, I get a c-section.  All of this depends on which doctor happens to be on call and what the babies do.

I do get to choose whether or not to have an epidural, and this is the part that makes me the most nervous. Assuming I'm lucky enough to have Baby A in the head down position and bigger than Baby B, I will try for a vaginal birth. I would really, REALLY prefer to do it without an epidural. Here's why:

  • I've done it without an epidural before and I know I can do it again. The fact that it's twins doesn't scare me one bit, as far as the pain goes. I trust my body 100% and I know I can handle it. I've never birthed with an epidural so there's a lot of unknown there. 
  • I hate the idea of that needle in my spine. When I was pregnant with Harriet, that fear was probably the main thing that led me to pursue unmedicated birth in the first place. 
  • I don't want somebody telling me when to push. When I was giving birth to Harriet, I had all kinds of helpers and they were all wonderful. But it was my job to bring her into the world and I liked the fact that it was me, my body and Harriet making it happen. It was such an intimate thing, and the thought of some stranger yelling "okay, now push!" already makes me irritable. I want to feel it myself. 
  • I won't go into the complications that can sometimes arise from epidurals, but from what I've researched and what I've seen friends go through, I just don't want one. I want the easiest recovery possible since I'll be caring for two newborns and a two-year-old, so I want as little intervention as possible. 
BUT if I end up having to have a c-section and I don't have an epidural in place from the beginning, they will put me completely to sleep for the remainder of the birth. This is due to the fact that they often need to get the second baby out RIGHT NOW and don't have time to put in an epidural and allow it to take full effect before making the cut.

I really want to avoid this scenario. I'm not sure how many minutes (hours?) old the babies would be by the time I woke up and got my bearings enough to hold them and nurse them. It makes me so sad to think about missing all of that time...which makes me think I should do the epidural...but then I remember that simply having an epidural makes a c-section more likely and I change my mind right back. 

I have no idea what to do. I know that I will get plenty of comments about how the most important thing is that both of our babies are delivered safely, no matter how it happens. I am 100% with you on that. That definitely is the most important thing and the day of their birth will be fully celebrated no matter how they get here. But I do want to be my own advocate in this. I want to do my research, wisely consider my options and make the choice that's best for them and for me. I also know that there's an anxious part of me that wants as much control over this process as I can get and fears that if something goes awry, everything will fall apart. For example, I'm so scared that a c-section or even just an epidural will completely derail breastfeeding. I'm worried about having one baby vaginally and the other via c-section and how that will affect bonding. I worry about all sorts of things like that.

So if you have experience with any of this stuff, I would love to hear your thoughts. Thanks (so much) in advance.


Here's a quick update on the babies:

I'm so grateful to say that they are doing marvelously. Our growth ultrasound this week showed that they are 2 pounds (74th percentile) and 1 pound, 14 ounces (60th percentile). My cervix is right where the doctors want it to be. The fluid levels are great. We couldn't have asked for a better report.

But my OB appointment later in the week was a little sobering...and confusing. The doctor chided me for my "excessive weight gain." I have gained forty pounds thus far, and apparently I was supposed to gain 40 pounds TOTAL. No one told me this before Wednesday. In fact, I have been very purposeful about packing on the pounds. Most of the twin moms I know gained about 60-70 pounds during their pregnancies, so that's what I've been shooting for. And Dr. Barbara Luke, the author of When You're Expecting Twins, Triplets or Quads: Proven Guidelines for a Healthy Pregnancy, makes a very compelling, research-based case for gaining far more than 40 pounds during a twin pregnancy. I'm not exactly sure who to listen to or what to do about the weight issue at this point. I'm just trying to be mindful about the types of foods I'm eating and I'm watching my portions. But yeah, hearing the words "excessive weight gain" four times at your OB appointment is kind of a bummer.

Friday, January 10, 2014

how it's going

I've been asked quite a bit lately to give an update on the twins, so here it is!

Short version: Everything is going great and I am gigantic.

Longer version:

We had a growth ultrasound a few weeks ago and the babies look wonderful. No concerns whatsoever. They were both head-up, so I'm hoping that changes in the next month if it hasn't already.  They were measuring in the 55th and 52nd percentiles and had heart rates in the 150's. They're really active babies, which is so much fun. I'm slowly but surely getting an idea of their personalities. My theory is that the baby on my left side will be more of an instigator and the baby on my right will be a little more laid back. We're waiting til they're born to find out genders, just like we did with Harriet. That moment when Andrew told me she was a girl was, easily...the best moment of my life. I wouldn't trade that for anything...although it's tempting when cute crib bedding is on sale.

I'll be twenty-four weeks tomorrow and I'm really starting to feel it. I've gained just under forty pounds so far, and I'm expecting to gain another twenty or maybe even thirty. The weight gain has really slowed lately due to the fact that I can't remember the last time I was hungry. I'm learning that hunger feels like heartburn, and I'm just trying to eat every few hours whether I feel like it or not.

Probably one of my biggest challenges lately is restless leg syndrome. It has been taking me at least an hour and a half to fall asleep every night, and I'm waking up about three times per night, so I think that the days of restful sleep are over. I was pretty anti-tv for Harriet until this pregnancy. Clifford has been my saving grace on an almost daily basis as it gives me an hour to rest or some extra time to get stuff done if I happened to lie down while Harriet napped. When the twins arrive, I think we are going to give her a stuffed Clifford "from the babies" since he is her absolute favorite.

And now for some belly pics. Brace yourselves, people...

a few weeks ago

a few days ago
a few minutes ago
I think that one of my favorite aspects of this pregnancy is feeling continually in awe of what my body is doing - growing, stretching, adapting. Miracle is a word that is quite overused when referring to birth, babies, and all things pregnancy...but no wonder! It truly is amazing. I am just so curious and excited to see what's going to happen in the next weeks and months. What an honor it is...every part of it...even the accidental peeing when I sneeze, the difficulty standing up from the floor, the snoring, and the fact that my husband gently discouraged me from wearing a swimsuit at the pool today...



part of it.

Thursday, January 9, 2014

being that woman

I already shared the story of my ultrasound at the infertility clinic - the ultrasound I had to bring Harriet to, the  ultrasound that first introduced me to the twins. But I want to talk more about it, specifically about the internal aspects of that experience.

To refresh your memory, I had gotten a positive pregnancy test the week earlier and was having an ultrasound to confirm it. I was six weeks, five days pregnant. Andrew was camping on the north shore and both of our babysitters had sick kids, so I brought Harriet along to the ultrasound. She slept on my shoulder as I walked into the clinic and took the elevator to the fourth floor. I had called the clinic ahead of time, asking if they could scoot me right back to a room so I didn't have to make anyone's clinic visit all the more unpleasant with the presence of a longed-for child. I stood in the hallway while I waited to be called back to the ultrasound room.

I was facing the desk, and when I turned around, there she was - a woman a bit older than me in a wheelchair and hospital gown, being slowly pushed down the hallway by her husband. The tear lines on her face looked like they had become permanent ruts over time - riverbeds of sorrow. I assumed that she had recently woken up from an egg retrieval and had been given bad news. She looked up at me holding my daughter and the look on her face spoke so clearly - Really? A woman with a child in the infertility clinic right now? In my moment of pain and disappointment? I can't take any more of this.

Her husband looked at me too, but his look had a little more anger in it. I could tell he felt protective of his wife and I don't blame him. She looked so vulnerable and broken-hearted. I wanted to protect her too, but without meaning to, I was the one rubbing salt in her wounds.

Thankfully, soon after they left, I was called back for my ultrasound. I left the office with tears on my cheeks too...but they were thrilled/humbled/grateful tears, not the tears of disappointment I had seen on the face of the woman in the wheelchair.

In the elevator on the way to my car, mixed up with elation and shock were feelings of...what else? Guilt. I was her. I was that woman with the toddler on my hip, two babies in my belly and a free IVF in my back pocket. This realization stunned me. I am one of the fertile infertile. I am one of those women for whom fertility treatments actually work...more than once. The mix of emotions can be dizzying - gratitude, joy, the ever-present guilt, even embarrassment. There are worries about hurting others, offending others, selfish fears of having my infertility invalidated because I'm pregnant again.

I love being that woman and I hate being that woman.

But I've also been that other woman with two babies in heaven. I've been that woman who brings down the mood during conversations about pregnancy by adding a comment about the birth of my son after he died. I've been that woman whom no one wants to invite to their baby shower. I've been that woman whom moms can't be real with about the toughest parts of pregnancy and parenthood. I've been that woman who protects her pain ferociously and damages relationships along the way. I've been that woman who unfollows the blogs of pregnant women because I just...had to. I have been that woman, angry and disheartened by the presence of a child at the fertility clinic.

I've been that woman too. And I hated being her. It was so, so hard to be her. And it sure is easy for me to say now that I'm on the other side of it, but despite all the pain and waiting and uncertainty, I'm glad that infertility is part of my story. I will always love the babies that we lost and wouldn't trade their place in our family for a honeymoon oops baby...not in a million years.

As I click "publish" on this post, I am praying with all of my heart that the tearful woman from the clinic is now pregnant and that several years from now, she will be wrestling with these same feelings - what it's like to be infertile with a toddler on your hip and another (or two) on the way.
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