When I found out I was having twins, one of the first things I thought about is how that would influence delivery. My first delivery was vaginal and overall a good experience, minus some unexpected bleeding issues.
Twins aren’t an automatic c section but obviously it’s more likely to happen. I really hoped to avoid one (my birth plan for my first delivery boiled down to avoid a c section) but knew I would have to keep an open mind and see how things went. My goal was 37-38 weeks; towards the end I could only see 37 weeks- and current research actually supports that as the best time for twins to be born.
Throughout most of the pregnancy, the babies were transverse (side to side across my stomach). Baby A was “on the bottom bunk” and baby B was “on the top bunk”. Transverse requires a c section. There are also concerns of cord prolapse if your water breaks, so it can become an emergent type situation.
I did a lot of reading. If baby A turns head down, a vaginal delivery can be attempted. Baby b can be flipped once baby A comes out, if it’s not head down. However, even if baby B is head down, they can turn around during the delivery. This can cause either a combined vaginal/c section delivery or possible delays in the delivery of baby B.
My history of hemorrhage with my first delivery (placenta didn’t detach) combined with having twins, being anemic, and one of the medications I am on (Zoloft)- I had quite a few risk factors for repeat hemorrhage.
Adding up bleeding risks along with wanting to make sure both babies were delivered quickly with no reduction in their oxygen during delivery meant one thing- I wanted to opt for the most controlled scenario: a scheduled c section.
It felt comforting to make a decision so I could wrap my mind around it ahead of time. My OB and I agreed on a scheduled c section at 37 weeks- keeping in mind I would have up to twice weekly monitoring to make sure the babies were growing well, not under stress, and I showed no signs of preeclampsia (more common in both donor conceived pregnancies as well as twin pregnancies).
Baby A turned from transverse to breech (c section still indicated) and baby B alternated between transverse and breech (sometimes both within the same ultrasound). The babies kept reconfirming my decision for a scheduled c section.
I had three trips to L&D during the pregnancy. One for contractions (dehydration despite drinking inhuman amounts of fluids plus UTI), one for low cramping (normal misery of everything stretching with twins), and one for sudden swelling (normal misery of the uterine weight of twins pushing all fluids down combined with using compression socks- the fluid was pushed in both directions to my knees). I got steroid shots for the babies’ lungs at one of the trips, just as a precaution.
Around 35 weeks, my OB did routine bloodwork to check on my anemia. Luckily it responded well to the extra iron (with a high dose vitamin C to help with absorption). Unfortunately, it also showed my platelets had dropped very low. Platelets can drop low during pregnancy due to the increase in blood volume, but mine dropped into the 80,000s which is much less common and can be a cause for concern at delivery. What it boils down to is it can be dangerous to do a spinal at that low value, which means the delivery would need to be under general anethesia (I would be completely asleep for the delivery).
This had me spinning. I had come up with a “gentle c section” in my mind that would allow skin to skin/bonding right away. This erased that vision. My OB had concerns with blood loss increasing under general anethesia and wanted to avoid that if possible. She consulted my MFM and they came up with a plan for me to take several days of a high dose of steroids. Although my drop was unknown origin- sometimes the steroids help with an immunity component- so we hoped this would help.
After a week, repeat bloodwork showed a modest rise in my platelets. If they could stay stable or even rise, I could have the spinal after all. The difficult part was I would not know that until right before delivery (bloodwork would be repeated when I came back to the hospital). Type A control freak anxiety ridden me wouldn’t know until I got there if I would be asleep for my babies being born. And there was the bleeding issue. I kept thinking I didn’t want to die.
My c section was set for Friday morning. I had my to do list and I slowly tried to make sure everything was in order. I had little energy and such bad hip and sciatic pain that I could barely get myself from sitting to standing. Luckily I had minimal leg and ankle swelling. Most of my swelling was right below my bump/stomach which turned out to be miserable (I couldn’t wear waistbands at all towards the end).
Tuesday night, I went to bed as normal. Around 1:45 am (early Wednesday morning) I got up for my hourly bathroom trip. I laid back down and went into a light sleep. All of a sudden my mind alarmed awake and I felt a pop in my stomach. Out gushed large amounts of warm fluid. I knew it wasn’t pee- since I had just gone (and it was way too much!). D was laying in baby boy’s room trying to get some sound sleep (baby boy was with me in our bed). I yelled for D but he didn’t respond. Eventually he heard me and got up. This was around 2:05am.
My bag wasn’t packed. I threw some things into a bag. D called his mom to come over to watch baby boy (who slept through all of this). And to the hospital we went, with me wrapped in a bathrobe that barely covered my massive bump along with several towels still catching fluid. I was beyond the point of caring about anything. I was worried about cord prolapse since I didn’t know the babies’ exact current positioning and didn’t know if I was dilated or not.
When we got to the hospital, we had to go through the ER since it was the middle of the night. They weren’t busy- but right after I came in, someone else came in in very active labor- so we were wheeled up to L&D together (she apparently had her baby within the hour!).
I was put in my room (209) and hooked up to monitors both myself and both babies. The babies showed no signs of distress. The hospitalist OB came in to check on me. He didn’t do the fluid swab since it was apparent that my water did break. My contractions increased but were tolerable (I had been having contractions close together on and off for the past SEVERAL weeks). They told me I could get an epidural if it got to be too much. My OB was called and it was decided she would do the c section when she got there at 7am.
I tried to rest. I tried to be patient while I waited to hear back on my platelet counts. Anethesia came in and talked to me. I heard back that my platelets were high enough for a spinal- huge breath of relief!
Once they came to get me for the surgery, everything became a whirlwind. I was wheeled back to the operating room. They slid me onto the table which was very skinny and had arm boards out (like a T shape). The room was stark white with so many lights. It took my breath away. I had a flashback to when I woke up in the operating room after my d&c and I saw the container of blood and my baby. I tried to numb my mind to that.
They had me sit up for my spinal. My OB had me lean into her. The CRNA gave me the numbing shot (just a pinch). I leaned as far forward as my bump would allow, trying to relax and open my spine. Then she put in the spinal injection. In no time my legs started feeling warm and heavy. They poked up and down my body asking if I felt anything (I didn’t) and they put some oxygen on me. D was able to come back and he sat down next to my head. The big blue drape was in front of me. The room was full of staff along with several nursing students. My OB said a very comforting prayer over me and the babies.
And it began.
I felt down tugging pressure. It made me feel sick. They put warm blankets around my neck and shoulders because I was violently shivering. The curtain felt so close to my face and I stared at it. I tried to remove my consciousness from the room and go to a blank place in my mind.
25 minutes after going into the surgery room, baby A was born. They held her up but I don’t remember much. I didn’t want to hold her. I couldn’t stop shaking. I didn’t hear her cry, but I heard my mom and the nurses talking to her in a cheerful voice so I figured she must be ok. 1 minute later baby B was born. She cried and went over to the nurses as well- I didn’t feel safe holding them and I wasn’t mentally present anyway.
I tried to focus on the blue drape. I let it come close to my face to blanket my perception. I just didn’t want to bleed to death. I didn’t want to die. I kept asking D if my placenta(s) was(were) out yet.
I could tell from the conversation things must be going ok. Nothing seemed heated or pressured. I didn’t realize all the layers of stitching they had to do. Finally it was over. They moved me back onto my bed (which was surprisingly scary- I felt like I was falling yet I was completely numb and at their mercy).
At that point I still hadn’t really seen the babies. They may have already gone to the nursery. I was brought back to my room. I remember feeling how flat my stomach was- it seemed the flattest it had been in my entire life.
At some point they said I lost less blood than the average c section. My doctor had used a preventative hemorrhaging medication (TXA) and given me an iron infusion- just out of precaution.
I remember seeing the babies when my mom and the lactation nurse brought them to the room to try to nurse. Neither latched well (to be expected in the 36th week).
I don’t really remember holding them but I’m sure I did. It is all a fog. Family came to visit. Throughout the day the babies had a lot of excited guests. They were snuggled and awed over. Eventually my legs regained sensation. I was able to eat and drink.
The next several days were pretty intense and miserable. My stomach hurt badly- to get my legs on and off the bed especially. I also had a cough but it hurt like a knife to cough. I tried to avoid narcotics. I didn’t want to be drowsy or feel sick. My OB told me pain wouldn’t help bonding (so take it and sleep if need be vs suffering to stay awake). Eventually I had to give in- and surprisingly the pain was so bad that the heavy duty instant release narcotic made me neither tired nor sick. I alternated that with ibuprofen.
The second day my stomach went from flat to bloated and extremely lumpy. No one told me to avoid carbonation so I had several sprites after I had the babies. Combine that with constipation (and probably the iron infusion), and I was completely miserable. You could see and touch massive air bubbles throughout my stomach.
So the pain was gas, constipation, sore muscles, and stabbing incision pain: not a fun combo! I forced myself to get up and walk the halls. I forced myself to take a shower. I relied on others to do all diapers and bottles for both babies. This type of delivery was a lot more focused on me than my connection with my babies. BUT- we were all safe and healthy and that’s ultimately all that matters!
It turns out, baby A had low sugar at birth. She was three points away from a NICU admission but responded well to some drinks of formula right after birth and her sugars went up. Baby B was smaller and hadn’t had her water break, so she had a little trouble the first day clearing her lungs and staying warm enough. She got some chest percussions and extra clothing layers- which helped a lot. It feels like such a blessing to leave with healthy twins who had no NICU time.
In the end, this entire process has been a leap of faith- from transfer to delivery. It’s not at all how I envisioned myself and my family. But as my OB said, sometimes God gives us what we need, not what we (think we) want.
My mantra through my anxiety has been one I learned from my therapist: “There is a Savior and I am not Him”. This constant surrender is yet another refining process in my life.
When it feels too scary or too hard or too expensive- I am not the one ultimately holding it all together.
