I wrote this pretty much right after the delivery, but I needed to put it away for a bit. Now Mira and Ian are 5 months old...
Monday, May 18 started with a non-stress test during which I had a contraction that caused "Baby B" (Ian) to have a heart rate deceleration. This led to a trip to Labor and Delivery for extended fetal monitoring, during which all went well and I was sent home.
That Thursday started with work and another non-stress test. Both fetuses had heart rate decelerations during some long (6-7 minute) contractions. This activity caused the OB (in consultation with the perinatologist) to suggest I go back to the hospital for a trial of induction, to see if (a) the babies continued to show “decels” or other signs of stress or (b) these long contractions could be nudged into something productive (and labor-y). This marked my first laboring moment of "thank goodness Karen is with me."
I want to stress the doc said this was a trial, because this became important once we got to the hospital. Actually, before that even. After a quick chat with Ellen (her day job is midwifery and she acted as translator and reasonableness-checker throughout my labor) I called the hospital to get a little clarity on the plan. I got this clarity (and a few metaphors from the OB on call) and Chris, Karen and I headed in to L and D.
The first L and D nurse on duty made it clear that not everyone was clued to the "trial" part of the plan. She kept saying things like “you are here kind of late” or even “with inductions…” until Chris brought her up to speed on our sense of this as a trial, not an induction. From there things were smoother, as I was hooked up to fluids and fetal monitoring. Apparently the hospital’s wireless monitors won’t work with twins, or at least no one could figure out how to make them work for me.
As a side note: my first labor occurred mostly at home without much intervention and no invasive monitoring. (Chris and Ellen were there with me, but not invasive.) I went to the hospital fully dilated and resisting the urge to push while we drove. Neither Chris nor I remember any monitors during that hour between our arrival and Ada’s (though more than one nurse assured me that there must have been monitoring once we got to the hospital, because that's just what is done). All this is to say that the drip and the monitors set a very different tone for the labor, and I felt a little nervous.
After some time (hours? I can't recall) waiting and watching the monitors, we talked to the OB and anesthesiologist on service. The OB served up more metaphors, including some incomprehensible sports analogies that I don't think the OB himself understood. The anesthesiologist threw me off by talking about the pain relief benefits of epidurals. I get that many people use epidurals for pain relief, but I wanted to talk about how an epidural could be used in the event that I needed a c-section (which after a few scary contraction/decel combinations was looking like an increasingly likely outcome). The docs were trying their best to help us get the information, but it wasn't until they left the room and Chris, Ellen and I talked that I felt fully comfortable with the idea of an epidural set at a low level. The idea was to have an epi in place so that it could be ramped up later when we started moving toward a cesarean.
By this time a new anesthesiologist was on, and she hooked me up and connected me to what she referred to as "water" (a little anesthesiologist's joke about a low-dose epi). After some chatting, the new anesthesiologist (reluctantly) agreed that I could stand up in the room, but not go out into the hall. As I was wearing only a hospital gown, I was fine with this limitation. It was weird to feel like I'd "won" something by being allowed to stand up, but I appreciated the doc's willingness to work with me.
About 5 hours after we arrived at the hospital, the nurse got her orders to start the pitocin. The drip was turned on, and after 10 minutes I had a long contraction (again in the 5-7 minute range) that caused Ian's heart rate to dip noticeably. Suddenly the room was frighteningly full of people, the pitocin was shut off and everyone was in a flurry that ended once it was clear that Ian's heart recovered with the end of the contraction. So okay, no pitocin. The timing may have been coincidental, as the pitocin apparently doesn't take effect for about 15 minutes.
Even without pitocin, I then progressed fairly rapidly from 2 - 5.5 centimeters. With the epidural, I did not feel any of the contractions, though I could see them on the monitor. There were a few more decels, but nothing as scary as that first one.
After a few hours the contractions faded. We went from thinking that labor would progress quickly and maybe lead to a cesarean that night, to realizing that not much was happening. Chris, Karen, Ellen and I all tried to get some sleep, and the next morning decided to try the pitocin again. As the pitocin was gradually increased, I started contracting more, but rather than having the mega-contractions that had caused problems earlier, I was having shorter ones that weren't creating decels. I was still really amazed that I was contracting and not feeling any pain. (So ok, I get why people might want this.) I could sort of feel that a contraction was happening, but without the pain I was still kind of in the boredom phase of labor, waiting for something dramatic.
Some time after nine am, I felt something dramatic. All of a sudden the contractions went from "hmm, I guess I feel something" to "wow, THAT'S a contraction." With the onset of intense contractions, the docs were back in the room to ask if I was ready to push the epidural to cesarean strength. (As it takes 15 minutes for the drugs to work, if these contractions led to fetal distress that led to needing a c-section, I would need to pump the drugs up immediately in order to use them should I need surgery at a moment's notice.) I agreed to this, and as I was 8 or 9 centimeters dilated and ready to push, after getting a kiss from my sister I was wheeled down the hall to the operating room. (for those playing along at home, twins are generally delivered in the OR, just in case a cesarean is needed quickly)
Once on the operating table, I started pushing. I have to say that while pain in general is not such a great thing, I was really glad to feel the desire to push. Following my body's natural urge really moved me along, and Mira was delivered at 10:20 am, after about 15 minutes of pushing. Pushing with Mira felt a lot easier than it had been with Ada. Maybe that was because I knew where we were going this time, or maybe it was just easier. Mostly I remember looking up at Chris standing above me as I pressed my palm into his.
I saw the doctor pull Mira into view. She cried and was taken by the nurses to the other side of the room. She was brought back to me for a moment (I am a bit fuzzy about this time - maybe this was while the doc was coaxing Ian into a head-down position, convincing him that his foot could not come out alongside his head, and insisting that his chin needed to be tucked before he came out. And again, THIS was certainly a good use of an epidural. I don't think I would have wanted to feel what the doctor was doing to make any of that Ian-wrangling happen.) Once Ian was properly aligned, it was time for me to push him out. It was at this point that the epidural was in full effect, and not only did I not feel any urge to push, I could not feel the contractions. I relied on the nurse to tell me when each contraction started, and on Chris to be with me as I tried to push with no feedback from my body.
Eventually Chris called Ellen over (she had been watching over Mira). He recognized that I needed some additional help. The emotional effort of pushing was more intense in this pain vacuum, and I had stopped looking at Chris and started staring at the overhead light. Making eye contact was too hard.
Ellen turned up the heat by telling me that I needed to push more. She told me to push, take a little breath when I needed to and then quickly get back to pushing. Her drill sergeant "no rest" message was what I needed, and I started working harder. After pushing through some number of contractions (6? 12? 30? I can not recall at all) the doctor alerted me that this was to be my last chance, saying something like: "we're going to try this one more time, then we'll try something else." It was clear what this meant, but what I did not know at the time was that while Ian's heart rate had dipped during each contraction, it had bounced back once the contraction ended. Now it was not bouncing back and I only had one more chance to make this work. I pushed and pushed, and (with some help from a vacuum extractor) out came Ian. A little blue and floppy, but he pinked up pretty quickly.
It wasn't until both babies were out that I started to cry. In a rush I felt how hard and scary it had been, and how close we'd come to something bad happening to Ian. In a few dark postpartum moments I retrospectively worried about the birth. Did I take too many risks? Should I have just gotten a cesarean earlier, and not allowed Ian to go through multiple serious heart decelerations? What if his heart had stopped? What if he'd suffered brain damage? Before going too far down this path, I worked to remember that we were surrounded by doctors and nurses. They could have advised us to act differently if they'd thought it was necessary, and I assume they would have. The doctor who caught the babies is a serious guy and I trusted his judgment. I still do. When he poked his head into the exam room at my postpartum visit, he was quick to tell my doctor that my birth had been a scary one. His response surprised me a bit, because I assumed that if we'd needed to act earlier he would have advised us to do so. When he told us I had one more chance to push before he moved to cesarean, I knew this was based on his best medical judgment. (I recognize this paragraph has gone from "what if it had gone bad" to "I trusted my providers" but this is the kind of experience that does not easily fit into an "all is well" or "wow that was terrible" mold.)
Re-reading what I have written, I recognize how inadequate (yet long-winded) this is. What I have written fails to convey how scary the process was at times, especially at the end. I also can't quite explain how the knowledge that a c-section was coming (at points it seemed an absolute certainty) affected the process. With Mira on my lap as I edit, I am amazed how vigorous, beautiful and healthy both she and Ian are. Their arrival was a bit bumpy, but once they came out, they quickly became normal healthy babies. I would like to think that even if they had come via cesarean, I would feel as happy with the birth anyway. Or at least, I would not care so much about the birth, given the outcome was so overwhelmingly good.
Re-reading this again at 5 months, I still feel happy about how things turned out. I know it is crazy, but this birth story feels like a necessary response to the recent New York Times article on how IVF is increasing the number of twins and how this leads to all kinds of crazy and expensive pregnancies, births and babies.