Monday, September 15, 2008

My Pregnancy and Birth with Tobias and Ari

This is incredibly long, and I'm sure there is more I could add. I may end up editing it as time goes on. There is so much I can't get across in a simple telling of the story. Mainly how emotionally difficult this all was for me.

After it took us a year to conceive Ezra, we figured it would probably take a while the second time around, as well. I thought 2 years apart was a good age difference for siblings. I'm 2 years older than my brother, so perhaps it just seems natural to me. So when Ezra was 14 months old and my cycle came back, we figured we wouldn't necessarily try to get pregnant, but we wouldn't try not to, either. Imagine our surprise when we got pregnant immediately!

I felt different about this pregnant from the very start. In fact, the other day I went back and checked, and the first time I mentioned the possibility of twins to my friends I was only 5 days post ovulation!! (At that point, the boys were either just split into two people, or hadn't even split yet.) I can't really explain it. I had taken Ezra to visit my family right after the first days of the holiday of Sukkos, so I was at my parents' house. I started to feel nauseated while nursing Ezra and randomly craved ketchup. I figured I might be pregnant, but it was a few more days before I could reasonably test. In fact, I got a negative pregnancy test at about 8 dpo, and then the next day I got a faint positive followed by an obvious positive. I was so excited!

When I was 5 weeks pregnant I called a local homebirth midwife to set up an appointment. At that time I asked her what would happen if it turned out that I was pregnant with twins. She laughed and said that it was pretty unlikely, that perhaps I was sicker this time because it was a girl or just a different pregnancy, and all second-time mothers are surprised that they get bigger earlier. So I set up an appointment for 11 weeks, and went on with life as usual. Or almost usual, as I developed pretty bad morning sickness. I was throwing up pretty much every day, and feeling sick when I wasn't throwing up. I ended up eating quite a lot because it helped keep me from being nauseated. Actually I was eating a lot of frozen Amy's burritos and things like that, because I had no energy to cook. This was also the first time that Ezra was allowed to watch TV, or specifically Signing Time DVDs that we rented from the library. He was 14/15 months old. It turned out to be a great age for him to start with Signing Time, as he was not yet verbal but quickly picked up the signs. By 17 months he had at LEAST 60 signs, and then he started talking.

I continued to feel that this pregnancy was different, but explained it away but saying it was my second pregnancy and bound to be different from the first. I had been underweight at the start (from nursing Ezra and doing a LOT of walking; I was 5'8" and about 105 lbs) but I gained weight rapidly, in spite of the morning sickness. I transitioned to maternity clothes at about 10 or 11 weeks. At 11 weeks I had my first appointment with the homebirth midwife, who found a nice heartbeat and thought that everything looked great. I asked again about twins but she still thought it was not likely.

At 14ish weeks Baruch, Ezra, and I went to visit my parents for Baruch's winter break from his last year of medical school. I went to meet a homebirth midwife in Charleston, since I wasn't sure where I'd want to give birth, as we were hoping Baruch would match for his residency in Charleston. She told me that I was measuring 19 weeks, and I asked if she could try to find two heartbeats with the doppler. She found on on the left side, and then she found another on the right side...but they were both in exactly the same range, so she said she really didn't know what to say. At that point it was too early to be able to find the same heartbeat in such distant parts of my uterus. But she still thought it might be the same baby. (I was sure my dates were right.) She also felt a spot that she was pretty sure was a fibroid (I had felt it myself). I went home and told my mother all of this; I was worried about the fibroid, but still not convinced that there was more than one baby. My mother called up her OB and had him book me for an ultrasound first thing the next morning!

When Baruch and I went for that ultrasound, I really didn't know what to expect. Part of me had thought it was twins all along, but my rational side saw no reason why that would be the case, and simply didn't believe it. The OB was fairly dismissive of this possibility, too, I think partly because he and the particular midwife I had seen do not like each other at all. Imagine our shock when we saw two babies!! First he looked and saw the fibroid (that's what it was, and it was never heard from again lol) and then he saw a baby, and then as he kept looking at the baby...there was another baby! He got all excited and called in another OB who had more experience with that ultrasound machine. They looked at both babies, and then they said something terrifying: they thought they might both be in one sac, or monoamniotic. In fact, they thought they saw them holding hands.

I spent the entire rest of the day shaking. And I got very upset when I read about mo/mo (monochorionic/monoamniotic) twins and the risks associated with that. We weren't due to go back home for a few weeks, and I simply couldn't stand to wait that long to find out what was going on. So my father asked the local, well-known perinatologist, who he knew professionally, to fit me in late the next week. We spent an entire week worrying that we were carrying mo/mo twins, and it was terrifying. We were extremely relieved at the perinatologist's office to find out that in fact our twins were mono/di (monochorionic/diamniotic), and growing well with no signs whatsoever of Twin to Twin Transfusion Syndrome. We also found out that we were expecting two little boys <3

When we got back to Pennsylvania I immediately made an appointment with local perinatologists to be followed via ultrasound for our mono/di twins. Just before 20 weeks, before I was even seen by the perinatologists there, I had an episode of spotting on a Friday afternoon. They fit us in, even though they didn't want to because it was just brown spotting, one of those things that "just happens." A super quick ultrasound showed no problems, so it was dismissed. Here is where my memory gets a little murky. I think I had another episode of spotting, but a lot more (still brown), and went to the hospital. This was before our 20 week ultrasound. They told me on the phone that I didn't need to go, for brown spotting (it was more like very slight bleeding, more than "spotting"). I just don't remember the sequence of events exactly, or when I went to the hospital and when I didn't. Anyway, when they did an ultrasound, they diagnosed a complete placenta previa. At first I was put on just restricted activity, but after I kept bleeding I was put on complete bed rest. We had to get a nanny for Ezra (who I was very glad to have weaned at 17 months, just a few days before we found out we were expecting twins). In this we were incredibly blessed; we found out about the previa on a Friday morning, on Monday we interviewed a nanny, and the next day she started. Tammy was just fabulous, the best nanny we could have asked for. Here is a photo of Ezra with Tammy and the little boy who lived next door.

I kept having bleeds, and they got worse each time. It wasn't long before I was having relatively extensive, bright-red bleeds. They were self-limiting,but I had to be monitored carefully each time. Twice I went to the hospital via ambulance. I stayed in for 3-5 days each time. They kept letting me go home because we lived very very close to the hospital and could get there in time if I bled again. At 25 weeks I had quite a severe bleed. The OR and the NICU were on alert just in case. I spent a long time having a very sobering talk with a neonatologist. It was so frightening. But I stopped bleeding and the babies never showed any signs of distress at all. We had dodged a bullet. At this time I got the steroid shots to help the babies' lungs mature.

Not long after that I came down with an awful stomach virus and ended up back in the hospital for IV fluids. I still don't understand why I would randomly start to bleed just laying in bed, but violently throwing up didn't cause a bleed. After the bad 25 week one, I went a few weeks without another bleed. I started to think it might all be ok after all. The placenta was definitely moving. Soon I wouldn't have any previa at all. One of the perinatologists kept telling me that I might even make it to term and have a vaginal birth. My life-long anxiety was hitting me with a vengeance, though. Really it was the darkest, most awful experience in my life. I was constantly scared that I would start to bleed again. I was terrified that I would have micropreemies. I ended up needing to take medication for the anxiety for a few weeks. I never wanted to put that in my body. I was eating as well as I could. I stuffed myself with protein and calories, even when I didn't feel like eating. I gained quite a bit of weight. I was really just miserable during this time. Ezra was practically being raised by the nanny, and then DH when he came home in the evenings. He spent some time with me every afternoon, but I had little role in his life. He was traumatized by seeing me taken away in an ambulance, and having me stay at the hospital for days on end.

At I guess around 28 weeks Ezra got sick and passed it along to me. I got a horrible upper respiratory infection, with a cough, and an ear infection. In fact, my ear drum burst. I still couldn't hear when the babies were born a few weeks later. I was so sick. I still don't know why all the coughing didn't cause me to bleed. It did cause some contractions, but nothing that affected my cervix.

At 30 weeks and 5 days we had an appointment and our first non-stress test. We had recently found out that I no longer had placenta previa! I now only had a low-lying placenta, which was expected to correct even more to become a normal placenta. I was finally relaxing. With my last bleed (I don't even remember, was it 28 weeks? 29?) I had started to have some contractions caused by the bleeding. My cervix proved to be unchanged (in fact, it measured 4.5 cm long, which is amazing for that stage of a twin pregnancy). The non-stress test was fabulous. Since 25 weeks the nurses had been telling me that the twins had wonderful reactive heart rates, advanced for their gestational age. They had also always measured right on target. In fact at my last ultrasound the perinatologist said that my guys weren't told that twins usually slow down their growth at some point and were still growing like singletons. My first and only non-stress test was fast and easy. The nurse said she wished all her 30-week twins would behave so nicely for the tests! Actually we were lucky it was fast, because usually when being monitored in the hospital the babies would be on and off the monitors constantly. They were EXTREMELY active little guys!

The next day, Saturday, April 19th, at about 5 am, I woke up to a gush of blood. After the first big gush, though, I thought it slowed down or stopped. I was so sad, since I didn't expect to bleed again now that I no longer had a previa. Since I didn't think it was really an emergency, we waited a bit and then called our next-door neighbor to watch Ezra as he slept. Baruch drove me to the hospital. In retrospect it is very good that this arrangement was made. When I stood up I started bleeding quite a bit more. In the car I started to have pain with the bleeding, which was totally new. At this point I was a little scared, but I still thought it was yet another bleeding episode that we'd get through. I got to L&D and they hooked me up to all the monitors. I was stable for a little while. My perinatologist got there. I started bleeding more, I started having more pain. I was having contractions and other pain as well. The perinatologist was standing there very seriously, looking at the monitors, looking at me. A nurse said something about one of the monitors, and the perinatologist looked and did a super quick pelvic and said, "We're having some babies. Start scrubbing in." Before I knew what was happening I was swallowing a nasty liquid, signing a c-section consent, and being rolled into the OR. I remember being strapped down, and having them prep my belly. I was so scared. I wanted desperately for them to get me under the anesthesia so I wouldn't be scared anymore. I told them to take good care of me. I worried about Ezra. Then I didn't know anything until the recovery room. I had an emergency c-section under general anesthesia.

Baruch says he held my hand the whole time. The babies came out crying and peeing (in his words). He had been prepared for something awful, but he was surprised that they looked as healthy as they did. Tobias Wolf was born first, weighing 3 lbs. 12 oz. Ari Jacob was born next, weighing 4 lbs. 4 oz. Ari was put on CPAP (pressure only, no oxygen) briefly because his lungs were "wet" from the c-section. Toby was breathing without any assistance from the start. They were taken straight to the NICU, of course.

One of the first things I asked for in recovery was a breast pump! I finally got one when I was moved to the post-partum room, and started pumping immediately. I think I set a record for most colostrum sent to the NICU :p My milk came in quickly and my boys were fed colostrum and milk from the start (mostly their ealry nutrition was via umbilical IV, but what they got orally was all from me). I was very anemic and unable to sit up easily, so after a few hours a very nice nurse rolled me up to the NICU in a stretcher and I saw my boys for the first time. They were beautiful and tiny. I didn't know what kind of road we had ahead of us,but I was relieved that they were healthy and in good hands. We had all made it.

Our NICU stay was remarkable for being completely uneventful. The babies progressed steadily and even more rapidly than the neonatologists predicted. The first time I tried to nurse a baby (it was Toby) for real, the nurse brought out the scale just to humor me,and was shocked to find that he had nursed his entire feeding. I told the nurses to please start giving bottles as soon as they could, because I wanted my babies home. And in the end they were only in the NICU for 3.5 weeks (25 days). And it was only a few weeks after that when they were nursing exclusively at the breast, no bottles. We gave up the nipple shield within days of that transition, too. Today, at close to 5 months chronological age (not quite 3 months corrected), they are big chubby guys. Ari especially loves to nurse and has the thighs and belly to prove it! They are actually longer than Ezra was at an equivalent age. Developmentally they are just amazing. They both have their hands in their mouths all the time, they grab things, and they can roll from tummy to back but don't often. They are honestly the happiest, most joyful babies you could ever meet. Baruch says it's like they have an inner reservoir of joy that just bubbles up into smiles and laughs. They love to smile at each other and at Ezra. They coo and make pre-babbling sounds. Ari is usually a few days ahead of Toby developmentally, so if Ari is making a certain sound, Toby will start to a few days later. We really couldn't ask for anything more. I don't even think of them as preemies, actually. There's no reason to. We know that we still have to wait until they're older to be sure, but as far as we can tell there are no lasting affects from having been born more than 9 weeks early. We are incredibly, amazingly blessed, and we adore these little boys so much.

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