Caroline & Emerson’s Birth

It’s 7:30am, and although I tell myself, “It’s Tuesday,” I have to do the math a few times to be certain that I’ve been here for three nights in the hospital, that it’s been (only) two days (already) since my baby girls were born. One of those nights was the labor and births and I didn’t sleep, so I don’t always know how to count it.

I have told the story of their births several times already, and I have no idea what I’ve said to whom. I will do my best to get it all down, but I sort of feel like I’m trying to tell someone else’s story, that it may not be quite accurate. It is my story, of course. Just, the parts I know are true are the parts I felt; the chronology and timing and other specifics have been told to me. I’ll let Josh or our doula correct me if I mix some things up.

First, their stats:
Caroline Quinn was born at 3:48am. She weighed 5 lbs 13 oz and measured 19.3 inches long.

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Emerson Jane was born 39 minutes later at 4:27am. She weighed 6 lbs 7 oz and measured 18.9 inches long.

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I’m going to jump back here for a bit because the context of the births is important to me. If you want to read only about the actual birth, scroll to “Go Time.”

We started this pregnancy expecting one baby and to be cared for by the same midwives as our first baby at Nativiti Birth Center. We were somewhat apprehensive about how to add a new baby to our family but felt we could manage. When we learned we were having twins just shy of 13 weeks in, not only did we (I) start to panic a bit over two babies — TWO BABIES — but we also mourned the fact that it meant leaving behind our midwives and having to find a new provider. We found an OB we liked ¬†within a few weeks. We dealt with many insurance headaches. The babies continued to grow wonderfully despite what felt to me like constant low levels of stress over finances and logistics. But around 30 weeks, I was cleared of all possible big health complications, our insurance was settled, my mother was here to help, all the major baby things were put together, the VAN was purchased and in regular use, and both babies were in an optimal position for a vaginal birth — both head down.

And then at 32 weeks, my doctor was suddenly not my doctor anymore, retired under fuzzy circumstances, and both babies had flipped breech. The only other doctor at that practice would deliver only baby B breech; the first baby had to be head down, or else laboring and birthing vaginally were out and a cesarean birth was the only course of action. Which was a long way from the birth center water birth I’d been hoping for at the start of all this.

Enter Kathleen, our incredible doula. We knew we wanted a doula for this pregnancy well before we even conceived. While I’d had an overall good birth experience the first time, I struggled with what birth meant for me and struggled with adapting to motherhood after, and I knew that, while some of that would be familiar this time, there would be other challenges, particularly managing a new baby with a toddler. I wanted to give us all the best chance at a smooth transition, and that meant hiring a doula who could support us, guide us, reassure us, provide resources, and generally have my well-being as a top priority. That was all more important when we learned we were having twins. We loved Kathleen immediately. I am spending so much time talking about this one choice because hiring Kathleen is the crux of the entire story. That decision ultimately determined the way everything played out with our births.

Not only was she a steady support and the only birth worker who saw me continuously through my pregnancy and births, but following my OB leaving me suddenly, Kathleen referred me to Dr. Gei, a maternal fetal medicine specialist, and we consulted with him about the possibility of a vaginal delivery of two breech babies. He took measurements of the girls and checked my pelvis, went over aspects of my health and previous birth, and agreed to attend my births as long as the babies didn’t grow too big before labor started. This was at 34 weeks in the pregnancy.

I had a big decision to make: transfer my care to Dr. Gei and have a shot at the vaginal birth I wanted, or stick with the other OB and have a scheduled surgical birth. I was afraid to change all our plans at what felt like the last minute. I was already registered at a hospital. I already knew where to go for appointments and when I went into labor. The drive to our original hospital and office was shorter, less stressful. Change is a tough thing for me. To change our provider, we had to change most of our other plans all at once, with time running out. I started to wonder if I really wanted to birth both girls breech. Just because I could didn’t mean I should. It looked intense in the videos Dr. Gei showed us, and I thought, Am I just bearing down on this because I’m too stubborn, or because I need to be special, or because this will be the last time I will get to experience birth? Surgery, though it never felt right, felt safer only in that it would keep all the other parts of the plan in tact and seemed more controlled.

With Josh’s support, I chose to go with Dr. Gei. For the next week, we were on the phone trying to get an Order of Transfer from my old doctor to the new one, and it was literally going nowhere. It was a catch-22. The new office needed the transfer; the old office didn’t do that. The new office couldn’t take me as an official patient without it; the old office cancelled my remaining appointments and no longer considered me their patient. I went over a week without seeing any provider at all while we tried to straighten it all out. As of the day before I went into labor, I legitimately believed there was a chance I’d just go to a random hospital in labor and meet the random on-call doctor who would rush me into surgery. By the end of that day, a Friday, the offices appeared to be moving in the right direction; I just hoped not to go into labor until I could verify on Monday.

Go Time

So, Saturday night at 11pm, just as we were falling asleep, my water broke. Contractions started up after about ten minutes, mild but less than 5 minutes apart and about 45 seconds long. We called Kathleen. I rinsed off and enjoyed the warmth of a hot shower for a bit. We packed a few last minute things and headed for the hospital, hoping Google Maps was right since we’d never been there before. We arrived around 1am and found our way easily enough.

In triage, we confirmed that the girls were still both breech. Their heart rates were hard to find separately, but when they found them, they were good. The residents kept asking if I was in any pain because they could see that I was having contractions, but they were still very manageable for me. Finally they checked me, and I was 7cm, 90% effaced, and baby A was at -1. They admitted me around 2am and started antibiotics because I’d tested GBS-positive at 30 weeks.

Kathleen met us as they brought me to a room. An anesthesiologist came in to go over consent forms and see if I wanted an epidural. For a moment I considered getting the line in but no meds, just in case, but I knew if the line was in I would want them when transition hit. I wanted to avoid anesthesia unless is was necessary, for surgery. And if I changed my mind, fine, but at least I’d have to make the choice to have it placed first.

Contractions were regular and still pretty easy for awhile. Kathleen was a steady presence, matching/modeling breathing for me, using acupressure. At one point she told me, “You’re really good at being passive,” which made me laugh because my whole life I have felt too passive, and this was the first time I think I’ve ever felt good about it. I was probably just beginning to hit transition when the contractions became pretty uncomfortable and I was starting to feel more pressure because when they checked me I was still at 7cm. That was at about 3am.

I rolled onto my side, and everything picked up quickly soon after. Suddenly, I was breathing harder, moaning, unable to relax my body into the contractions. The pain was intense without rest between contractions. I knew, then, that I was in transition and it would be over soon. I just didn’t know how long it would take, and I couldn’t shake the constant physical tension in my body. The plan was that the residents would call in Dr. Gei when I was at 9cm, and I knew I needed him to deliver my girls breech, so in the back of my mind, I was concerned that I’d progress quickly and he wouldn’t make it. I asked them to check me again because I was feeling a lot of pressure even though only 30 minutes had passed. I was 8cm dilated, which was somewhat disappointing, given the intensity of everything.

Kathleen suggested that I pee. I knew it was going to hurt to change positions again, but I also knew changing positions would speed things along for me. I agreed to go to the toilet, and right away after I peed, I felt like I was starting to push involuntarily. I either said or just just thought to myself, Someone get me off the toilet because I think it’s coming out. Kathleen and Josh grabbed me and got me back to the bed. Someone checked me and said I was complete at 3:42am. Right after that, I was pushing hard and couldn’t stop myself, and a resident announced that baby A was crowning, that she could see her butt.

And then everything was crazy. People were shouting to call Dr. Gei and the on-call doctor, Dr. Montealegre. They were yelling out phone numbers while unhooking things so we could roll to the OR. A resident asked if someone could please cover up my vagina as people were making calls, wheeling me out the door. My IV nearly got left behind. Josh grabbed a power cord hanging down so no one tripped on it, and from somewhere else Kathleen was squeezing my hand until we broke apart. My bed banged into walls. Someone kept telling me not to push. I was trying very hard not to, and it was maybe the most painful thing I’ve ever experienced. The resident turned as Josh and Kathleen entered the OR and yelled, “I need you two out of here!”

Inside the OR, someone shouted, “Who has gloves on?” and someone held her hands up to say, “I do! Put a hat on me!” Someone else asked if they were going to move me onto the operating table but we were past that point. I was completely focused on trying not to push until I couldn’t and told them, “I’m pushing now!” The on-call doctor appeared and told me it was okay to push. Calmly, he instructed the the others not to touch the baby and explained the maneuver that we’d seen Dr. Gei do in the videos he showed us. I pushed the baby about halfway out, and he tugged one of her legs out and then the other. He told a resident to gently pull the loop of umbilical cord down. When I pushed again, he turned the baby so her hips were vertical, first to release one shoulder and then the opposite way to release the other, and then he tilted her and pushed on me so that her head would go toward my back and her chin would flex correctly, and he pulled her out. She was reddish purple and didn’t cry before they cut her cord and rushed her out of the room.

I felt great physical relief then and scooted onto the OR table for the next birth. I wanted to say, “Please knock me out and take the next one.” I didn’t want to push out another breech baby. I was also pretty sure that I must have torn terribly, given how painful the first had been, and I knew baby B was the bigger of the two. They used ultrasound to determine her position, and I have never been so happy to be told a baby was head down in my life. She’d flipped after her sister was born. I wasn’t feeling any contractions and was relieved for the pace to slow down.

imageKathleen and Josh joined me with their scrubs on. Dr. Gei arrived shortly after and joked, “No video.” (He uses the videos to instruct, and of course breech delivery, especially if both babies had stayed breech, would have made a good video.) There was a long stretch of down time. I felt fine, but my body was shaking. Someone put towels over my feet to keep them warm. The team and Kathleen chatted about lotus birth and placenta encapsulation while we waited for something to happen. At some point during all this, Josh got to go see Caroline and he came back with a couple pictures for me. They also wheeled her in and let me see her before they took her to the NICU.

imageDr. Gei suggested we break Emerson’s water, and I asked if it would hurt because it had been somewhat painful/surprising with both Caroline’s and Theo’s. It was the most painless of the three, and fluid gushed out. The contractions started quickly and strongly, and I immediately understood first-hand that a bed is more comfortable than an operating table when you are flat on your back. Luckily, I’d read and believed that the second baby is easier to push out, so I was willing to do it, not that I had much choice then. It was still quite painful, though. The first push moved her down from 5 to 2, and in two more contractions/a few hard pushes she was out. They had her on the table between my legs, and Kathleen told me to reach down and touch her face. Dr. Gei let her cord pulsate a bit before clamping it and having Josh cut it. The team checked her out and swaddled her and brought her back to me so I could hold her for a couple minutes, then they took her with her sister to the NICU.

I consented to pitocin to manage the final stage. Eventually they asked me to push the placenta out, and I did not want to push anything else out of my body, but it was fine. The placentas had fused and came out together. Dr. Montealegre checked them out nearby and “prettied them up” before showing them to us. We could see the membrane that had separated the girls and their own little sacs. Finally, I got a few stitches and was surprised to find out I’d barely torn at all.

When they had me climb back into the bed from the table, I realized that my pillow I’d brought from home was under my head, and for a second I thought someone had grabbed it for me in the mad dash to the OR. Which of course was a dumb thought, but I was really touched. Then I realized it had already been under me on the bed, and they’d just moved it to the table with me.

From the time Caroline was born until we returned to the labor room, I think I said “thank you” about a hundred times. I was so incredibly grateful to have Kathleen’s support and a whole team of people who acted quickly and decisively. Even when things were intense, they were encouraging of me. In the less chaotic moments, they were warm and kind. I can’t believe my luck that Dr. Montealegre happened to be a colleague of Dr. Gei’s and had recently had Dr. Gei consult on a breech twin birth, so he was comfortable stepping in and delivering Caroline. It’s rare enough to birth twins vaginally when both are head down, rarer still when the second baby is breech, but almost unheard of when both babies are breech; many OBs simply won’t consider it, and even when the second baby is breech, the extraction is usually more aggressive than the maneuver Dr. Montealegre and Dr. Gei use. I look back at my original doctor retiring at 32 weeks and my discomfort with the backup OB there and can’t help seeing that whole situation as an absolute blessing. Neither of those doctors would have delivered my babies as they presented in labor. And here I had TWO willing to do it. Getting to do it without the just-in-case-of-emergency-epidural felt pretty special, too. For all my feelings of ambiguity about being “stuck” with a twin pregnancy and all its potential restrictions in birth, I immediately felt satisfied with how everything went. I was, and am, overwhelmed with gratitude that everyone involved believed it could be done the way we did it. I don’t really believe in birth as the empowering experience that many promise, at least not just on its face, but I absolutely believe in empowerment coming from having choices and making choices about birth, and that’s how I feel.

Recovery has been smooth so far. Pumping has been a challenge, but I’ve had good support. Even seeing our girls in the NICU and not getting to breastfeed much or hold Caroline right away has not been as scary or sad as I expected. The girls are strong and pulling through really well. It’s taken me over a day to write this, so now it is Wednesday morning and I’m back at home without them. Leaving them at the hospital was strange, particularly taking their untouched baby bag back home and loading up the van with no evidence of what I’d even been doing there at the hospital. I’m quite tired after a several days of limited sleep, lots of questions and conversations with hospital people, and pumping and visiting the girls. I’m hoping they will get to come home today. If not, it will be soon, and for that I feel extremely grateful. In the meantime, the story continues as we wait.

Some additional photos:

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I Can and I Will

I’m 35 weeks pregnant tomorrow. The last few of those weeks have been a roller coaster, and the ride is not quite over. I am not 100% certain that I have a doctor right now, which is the main thing causing anxiety. I don’t do well with limbo, and doctors’ offices are notoriously awful at doing things expediently. Meanwhile, I’m in a lot of pain, I’m crampy, I’m grumpy as hell, and I am ready for this whole pregnancy thing to be over. The pain of labor and birth and the exhaustion of two newborns now feels more manageable than continuing to be pregnant.

Except it’s still early. Ideally, I’d at least hold out til 36 weeks. Every time I suspect labor may start, I have this fantasy of them coming now. And then I remember the likelihood that they would need NICU time, that they can have both short- and long-term health issues. I remember that I don’t know if I actually have a doctor and have never even been to the hospital where he has privileges.

Why don’t I know if I have a doctor? The short version is that I transferred my care to a new doctor who is willing to deliver both babies breech vaginally, and apparently that doctor needs an official Order of Transfer from my old doctor. Old doc’s office seemed confused by this and they’re dragging their heels. I don’t blame them. I’m no longer their patient. I, too, am confused as to why they need to send an official order of transfer when I’m the one who chose to transfer my care. The new doc has my records. Why do they also need approval or permission or whatever from anyone else but me? I can’t help feeling like there is something really messed up about that. My experience with medical care this pregnancy makes me never want to see doctors for anything again. I am definitely done being a pregnant person and having my care led by them.

Today, Josh bought me a cane to help me get around. I want to articulate precisely what pain I’ve been in, but pain is relative, and it would sound like an exaggeration, I’m sure. Either way, it has been miserable. I feel trapped by my body.

Josh also found me a pool to swim at today. I thought I’d swim for about 30 minutes because breathing is harder these days and I haven’t swum since my last pregnancy, three years ago. But it was so incredible. I teared up when I got in and my belly floated up a bit to my ribs. I swam just a length at a time, but I didn’t stop for over an hour. My pain gradually waned. I felt strong and capable again. My huge belly swayed left to right to left as I swam, not really ever getting in the way, just smoothly following the rotation of my hips. I didn’t want to get out. I desperately did not want to get out.

When I climbed the ladder, my tailbone immediately bore the weight of my body again. My stomach hit the top ledge, and I had to lean back to ascend the last two steps. The group of seniors gathered for water aerobics commented on my size. A lifeguard kindly offered to return my kick board for me.

The other night I asked myself if I’m afraid to give birth again. I don’t think I am. All the unknown aspects have had me on edge for awhile, but I’m capable of birthing babies ¬†vaginally, as long as I’m given the chance. I found myself repeating, “I can and I will.” It’s simple, but it kind of cuts through all the noise.

I can and I will.
I can and I will.
I can and I will.

A Great Day

Last night, I cried. My son is beginning to pull away from me here and there, and it makes me feel both sad for myself and guilty that his pulling away is actually me pushing him away.

My mother has been here for over a week, helping us get the house in order, helping watch Theo, being an extra set of hands so that I can rest more in the final stretch of this pregnancy. It has been such a huge relief for me to have her here. Theo has enjoyed it, too, as he now has an enthusiastic person to get on the floor and play with him several times a day. And while I’m glad he has her — because he now gets to burn off energy and do all kinds of fun things he likes — I find him asking for her and for his dad more than he asks for me now. I am afraid I have trained him to assume I will not indulge him as I used to, so he doesn’t bother to ask.

This morning, the first thing he said to me when I woke up and greeted him was, “No! I want you to go back to sleep!” Later: “I just want you to go away!”

Sad face.

But! This is not a bummer post, I promise. Today, several really lovely things happened, and while I’m not usually one for publicly sharing my gratitude over every little thing, I am making an exception today because sometimes I am just that impressed and touched by the perfect timing of good things.

1. My mom, Theo, and I went to the mall for some items left on my list of baby-related items, and not only did he reach for my hand several times and read a book with me and generally seem pretty happy, but he also told me, “I love you, too.” (This alone made up for everything I just wrote about above.)

image2. I found this beautiful baby book for each of the twins. I anticipate that I won’t have much time or energy for filling out the extremely detailed typical books, twice over this time, so I was pleased to find a more minimal option that covers basic milestones and not much else. Plus, it is made by National Geographic and is absolutely beautiful with gorgeous photos of mostly animals (which is my jam) and poems and quotes from inspirational people. It’s not so gushy and cutesy the way many baby books are. For my tastes, it is perfect. I bought two.

3. A package arrived today with handed down baby clothes from a lovely friend. Surprise packages of goodies are always nice, but I was also touched by the note she included and the generosity of the gesture.

4. The weather was perfect today. We enjoyed it by eating lunch outside, which always feels like a special treat.

5. We went to three stores and a restaurant, and not one person commented on the fact that I’m pregnant. I cannot explain how good it feels at this stage to venture out in public and feel like a normal person.

6. My mom bought me some more maternity/nursing shirts and a great nightgown and robe for the hospital. I feel so silly buying maternity clothes at 31+ weeks pregnant, but I had only a few shirts that actually fit me, and it was becoming a real problem. Now I have enough tops to rotate throughout the week, and I will still be able to wear them after the babies are born.

7. I finally finished a handmade project I’ve been working on for the babies. I keep putting these little projects on my to-do list and then wishing I’d put one for baby A and one for baby B, because I have to do twice the work to cross one thing off. The pair of items I made turned out well, and I feel doubly accomplished, even it’s just one line to cross through.

image8. Over nine months ago, I submitted some interview answers for a motherhood and art-related website. I had no idea if the person curating the material on that site would select my answers to publish, and after a few months, I forgot about it. Today, I received an email saying my interview will be published on my birthday in about a week. It was so unexpected and a really nice surprise. It also gave me the opportunity to dig up one of my favorite pictures of Theo and me.

9. Tonight, Theo let me brush his teeth and read him a book. These are such small things, but they made me feel closer to him. I am going to try to keep doing these little things because they add up to so much more.

10. It occurred to me today, while we were out for several hours, that I am not on bedrest, which feels like a huge thing to celebrate, given how awful I felt earlier on in this pregnancy. I am still pretty active, and my pregnancy is about as medically uncomplicated as a twin pregnancy gets.

So, all in all, pretty good stuff. And it gives me the hope that I will continue to find joy with my son, even as our lives change so drastically. Thanks, dear universe, for a perfectly timed great day.