Friday, November 6, 2015

A little warning, just in case

Below you will find my birth story. In keeping with my openness and also my comfort with medical terms, procedures, etc, I didn't do a lot of censoring. I didn't include any photos of the actual birth or pictures of the placentas (which look like a scene from The Walking Dead) but if you are a little squeamish about medical things or "woman" things or "personal" things you may want to steer clear or consider yourself warned. With that said, I think it is rather tame but my scale is a little skewed.

 Love Erin

Birth Story

Our first selfie!
When I awoke Wednesday October 7, 2015 I noticed my underwear seemed wet with clear fluid. It was 5:50 am. I immediately suspected my water had broken. The instructions I had received from the hospital told me to come in within 2 hours if that were to happen but I figured I had my already scheduled ultrasound at 8 am so I would wait until then.

The ultrasound was pretty quick. There isn't much to see with two big babies cramped into such a small space at 36 weeks. Baby A remained head down and Baby B remained breech, slightly transverse. Baby A measured 6 lb 7 oz and Baby B measured 6 lb even. I was a little surprised our Baby Boy was measuring smaller than his sister but I was happy with their good size and curious to see if the sizes would be similar when they were born. Abe was able to sneak down between patients in the resident of the day clinic to see them, too. At first I felt bad how big I had become in my pregnancy, even compared to another twin pregnancy I knew, but now I was relieved they were so big when I knew they would be coming before their 38 week due date.

Finally looking pregnant with twins! Induction at 36 weeks
I told the ultrasound tech I was concerned my water may have broke that morning and asked if I could talk to a doctor. They found a nurse to speak to me, one who had helped me multiple times the past week when I had been evaluated before. She was kind and friendly but I got the feeling she was thinking, "Oh no, you again!" when she saw my face. She did a quick hallway consult and tried to explain  to me the difference between mucous (from the mucous plug) and other fluid (something I think I have a good grasp on after years of working in the mouth). Because I didn't have the stereotypical "gush" of fluid she seemed skeptical and stated it would keep leaking if it had broken. I told her it had only been a short while so I wasn't sure that was a good way to rule it out. She offered to have me stay to have it checked but I sensed she wasn't convinced. I guess I was getting a little sick of being there hours and hours and this time maybe "for nothing" so I decided to go home and call if it continued.

Of course walking to the car I wondered if I was leaking and should have stayed but went home to lie down and see if more fluid would accumulate when I stood up. It was a little hard to tell but it seemed to stop (whatever little may have been there) by about 11 or noon. I knew my doctor had been on call the night before and had had a busy night so I tried to reach her but wasn't too concerned when she didn't answer-- probably sleeping. I felt pretty certain that my water had broke that morning because I didn't know what else the fluid could have been, but I started questioning now as it was later in the day without any additional fluid. My doctor called me back mid afternoon and I gave her the update. We decided that I would go in to be checked when I dropped off my urine sample to Labor and Delivery that evening.

I also was trying to make the decision of whether or not I should go to work the next two days. I decided I wasn't feeling great so had them cancel my patients. I guess that ended up being a good idea!

36 weeks
Last bump pictures

My mother-in-law Kristin stopped by and offered to drive me in at 6 pm to be seen. Luckily, she had helped me finish packing my hospital bag shortly before (procrastination, even after my previous pre-term labor scare!). I didn't feel like driving and parking myself so I happily accepted the ride even though it felt lazy to do so. She kindly stayed with me while we waited. I got checked in (again) at the triage and changed into a gown. They did another NST while we waited. It seemed like a long time before they finally did the cervical swab (partly because they wanted me to lie down long enough for fluid to have chance to pool). I think it was close to 9 pm when they finally did and noticed some fluid had actually accumulated. The resident wouldn't tell me the preliminary result so we kept waiting and wondering. Finally, a nurse came in and we asked. She told me I was "ruptured." We weren't really sure what that meant for the plan and we asked if that meant my MIL should start texting updates that we were having the babies. The nurse said that was up to me and we were both confused what she meant until we realized she was saying, "Yes, you will be having the babies and it is between you two whether she gives you permission to tell anyone."

Abe was on call that night and in an emergency surgery case, draining an infection with the oral surgery team. I had the nurse page him so I could tell him the news that they were going to induce me and we were about to have our babies. I didn't want him to be the last to know so I was glad to catch him before he was scrubbed in and unavailable. We knew he would have plenty of time so I encouraged him to finish the surgery.
Monitoring the babies while being induced

The unit was very busy but finally a real room opened up and I was transferred into it for the night. Abe's mom and sister Jessica kept me company and bought me dinner while we waited for Abe to finish his surgical case. We joked that black bean soup was probably a bad choice right before labor. We took some last pictures of my bump, got hooked up to the IV to start the pitocin, and I was strapped to the monitors and stuck in bed for the rest of the night (except for annoying and frequent trips to the bathroom). I started feeling contractions right away with the initial dosing of the pitocin but they seemed to slow or ease up after the initial feeling. They continued to ramp up the dosage and we tried to get some sleep. This was difficult and I don't think I got any sleep. By the early morning my contractions were getting worse. I was starting to feel paranoid about how dilated I was. They were trying not to check too frequently (I think since my water had broken so long before) so I had no idea how I was progressing. I felt a little torn between going as long as I could and not being caught off guard and having to rush the epidural when we needed it. About 5 am I asked for the epidural. I figured I might as well be ready and also take advantage of the relief if I was going to get it, anyway (something my doctor insisted upon for my delivery). Funny how I felt a little like I was copping out not waiting until it was unbearable.

I had no idea I was this big!
The resident did a great job with the placement of the epidural. I was surprised how comfortable I finally was, not realizing how much pain I was actually having. The restlessness in my legs and the discomfort of being stuck in bed for hours without being able to move much (to avoid disturbing the baby monitors) was gone (which I think almost worse than the contractions themselves). It unfortunately was replaced with itching, but I finally relaxed and got a few hours of interrupted sleep.

Getting ready to go to the OR for delivery
Later that morning the OB team finally came to check me. I was dilated to I think an 8. I was surprised and happy to know I had progressed that far. They gave me more time and by about 11 am I was at a 10. My doctor wanted to give me a little longer before taking me in to the OR for the delivery. It seemed to take a long time (and longer than they had said) to get me back in the room. The epidural was still working great as I was able to move my legs but avoid the pain.

I was happy to see a friendly face as the anesthesia staff, Matt. We had spent a lot of time together on my anesthesia rotation in residency and it was nice to have someone there I felt I could joke and speak comfortably with. Between him and my friend Erin, my OB, I felt pretty calm considering the circumstances.

It's time! 
When everything was set they informed me I should start pushing. I had a hard time understanding what they wanted me to do and an even harder time telling if I was doing it. Pushing came much harder than I had ever imagined. I felt like all of the pushing was happening in my head. I could feel the veins pulsating and I literally worried I may stroke out, detach my retinas, or maybe even just shoot my eyeballs out their sockets. I had thoughts running through my mind about how I was going to die, leaving my poor husband to take care of two babies and without ever getting to meet my children; or secretly hoping I didn't have an undiscovered aneurysm that was about to blow. I felt really frustrated, emotional, and discouraged like I was doing something wrong even though the doctors were all very encouraging and trying to tell me I was doing okay. I didn't believe them as they told me I was doing "perfect" or to keep going. It had been about an hour of pushing and I really felt like giving up as I felt a little frantic I was failing. They tried to assure me that some people have to push for 3 hours and an hour was pretty great. (Ha!) I finally felt like I started to make a little headway (oops, sorry for the pun!) and was able to direct the pressure away from my developing brain aneurysm to my pelvis.

Baby Girl
My doctor finally asked me to stop pushing and told Abe to get suited up. He gowned up, came around, and I could see him guiding our baby out, first the head and then each shoulder as he caught her. I remember noticing how cone headed she looked! They called for the pediatricians to take the baby away to be evaluated. I knew there were a bunch of people in the OR (the anesthesia team, the OB team, and two pediatric teams) but I didn't really notice. Abe came back to my side and I was very relieved that I wasn't going to have to push out Baby B.

Now on to the breech extraction. Phew!

The resident reached up inside my uterus. I was surprised and relieved (very grateful for the epidural and my doctor's sound advice to receive it) to note that this was not unpleasant or uncomfortable. I couldn't help but think of the James Harriet veterinary tales I read as a kid. She felt around trying to locate him. My doctor asked her a few times if she had him and she kept saying she had just one foot. I started to get a little nervous but shortly after she had a grip on him.

Soon I could see his little legs and body. The doctors started trying to turn him but he didn't seem to come. An older doctor at the same time was applying pressure to my abdomen. They continued to turn him as I could see his blue body flailing. I could hear them saying they were trying to turn him but his head wasn't moving with his body. My doctor asked the doctor applying pressure on my belly to come around and put on some gloves. At first she said no, "Don't you want me here? You want me here, don't you?" My doctor became more firm in her request that she move down to my pelvis. I started to sense there was a problem. Abe kept telling me calmly that everything was going to be okay. My doctor was also calmly telling me that everything was going to be okay even though I could sense an urgency in her voice and actions. But I started to worry and feel panicked. The other doctor finally came around, evidently without gloves (per Abe) and the two staff doctors started trying to turn the baby, "Come on baby, come on baby, come on baby, come on baby." He still didn't seem to want to budge one way or the other.

To her credit, my doctor has an amazing bedside manner. She ever so sweetly and calmly told me, "Ok Erin, just so you know we may have to break his arm to get him out." I started to panic and cry. I tried to tell myself that that would be okay, a broken arm would be okay, but I was actually worried he was going to die. And if he didn't, would he have long term problems from a broken arm? I was praying very hard that the angels would be there with my little baby to get him out safely. Abe told me it was going to be okay and coming from him, I believed him...mostly. I wondered if this meant I would be getting a c-section after all and if I had enough anesthesia for that to be okay or how they would even get him out the other direction when he seemed so stuck.

Baby Boy
Finally, after the longest 6 minutes of my life, our little baby boy was delivered. They whisked away his blue limp body to the pediatricians and Abe told me again he was going to be okay. We finally heard his cry and I was told he was fine.

They brought baby girl around to my head to show her to me. I got to touch her little hand before she was taken to the NICU step down unit to be evaluated. The doctors continued to work on me. I remember thinking it was disconcerting to see my suddenly deflated belly! I found myself wanting my familiar tight abdomen back instead of the soft and foreign one left behind.

I was told I was bleeding and they started applying heavy pressure and pushing on my belly. The pain was excruciating as they continued to push and knead on my abdomen around my belly button. I kept telling them that I have a sensitive belly button so that really hurt. I didn't realize at the time that what they were doing likely would have hurt anyone. The anesthesiologist finally gave me 100 mcg of fentanyl and I remember saying, "Oh, so that's what it feels like when I give it to my patient's." I felt much more relaxed but the pain was still present and severe.

Baby B, boy
They continued to work to stop the bleeding. They placed a bakri balloon (a saline filled balloon) to put pressure on my uterus to help with the bleeding and a gauze packing. I was given some medications to put in my cheek and they started stitching me up. I continued to think about how I was probably going to die without ever getting to really hold or see my babies and what a sad joke that would be (not sure why I was so fixated on my own demise). In the meantime, or maybe once I realized I might live, I joked around with the anesthesia staff until they finally finished and wheeled me back to my room.

Settled back in bed. We did it! 
I remember being so relaxed and tired from the fentanyl I was excited to get back to my room. I was sad I didn't get to hold my babies but maybe a little relieved because I felt so miserable. By the time I was settled in my room, unfortunately the euphoria of the fentanyl had worn off and I didn't think I could sleep any more. My body was shaking uncontrollably in large shivers, a side effect of the medication I was given to help stop the bleeding, so I was told. I was parched and drank about 3-4 liters of water, popsickles, and juice. I was uncomfortable in bed and really wanted to get up to walk around and use the bathroom but the nurse wouldn't let me. I was tired of being stuck in bed since about 6 pm the night before, I was bleeding, and in a lot of pain. I was told I could see my babies later when I was able to get out of bed but now my nurse was saying she didn't think it was a good idea for me to get up. I figured I may not see my babies at all that day as I would be stuck in bed the rest of the night on Labor and Delivery.

Daddy and Baby Boy

Abe went up to see the babies in the NICU. I started to feel very down and depressed. I had just gone through a horrific and scary experience on what was supposed to be one of the happiest and most exciting days of my life. After a few hours, I felt very upset. I was all alone. I was in horrible pain. I was not allowed to get out of bed. I felt like I had lost my dignity as nurses helped me with the most intimate tasks. And I felt lonely. I wondered about my babies, if I even really had babies or cared that I had babies or would even love my babies. I was glad Abe was able to be with them but I felt very alone. I couldn't even reach my call light or the remote control to turn on the TV. So I cried.

So thirsty afterward
About the time I was feeling really bad Abe came back to the room. He was excited about the babies and showed me their pictures and gave me updates. Baby girl was doing well and would probably join us that day. Baby boy was also doing well but was on a CPAP (positive pressure breathing tube) for breathing support. Luckily, despite some bruising he was doing fine and his arm was not broken (although my doctor later informed me that she had indeed tried to break it).

Feeling emotional meeting a baby for the first time

Baby Girl

About 8:00 pm they brought Baby Girl in to meet me. I didn't know what to think and worried how I would feel finally getting to see her. I almost felt mad or resentful like I wasn't sure I even wanted to see her anymore. Holding her made a big difference and my spirits improved significantly. They even told me I could get out of bed and go to the NICU if I wanted by wheelchair to see our baby boy.

Meeting Baby Boy in the NICU

Getting out of bed was horribly painful. My lower body was horribly swollen, more so than at any point in my pregnancy and I have the stretch marks on my hips and thighs to prove it (much more and much deeper than any I had at my induction the night before) and even sitting up to get out of bed was awfully painful. I wished I could jump from lying down to standing and had to have a donut to even sit. About 10 pm Abe took me to meet our little guy in the NICU. It was sad to see him all alone in that little bed with a tube in his nose but I was very happy to hold him. I felt guilty that after only a short time, maybe 10 minutes, I asked to go back to our room as I was so tired and not feeling well. Luckily when we got back to the room they had decided to transfer me to the much more comfortable Mother Baby Unit. Yay!


In the end, it was a pretty traumatic day. The nurse helping me right after my recovery told me that in her 20 years she had "never seen anything like [my delivery]." In the beginning I felt like it was going pretty well. My sister-in-law talks about how she loves labor and the magic of having that little baby. After my epidural and my initial labor I thought how things had been going so smoothly and maybe I could understand where she was coming from. Unfortunately, my experience shifted far from that and it was one of the hardest, scariest, and loneliest days of my life. I didn't experience that incredible urge to push, the magic of holding your baby in your arms right after the delivery, getting to look them over lovingly to count fingers and toes or enjoy that skin to skin contact.

But I am so glad they are here, any way it had to happen, and I have no regrets. I guess it was a fitting end to their miraculous beginning -- it was hard getting them in and it was hard getting them out!

A few days ago I cried when I coincidentally came upon this scripture:

"And God shall wipe away all tears from their eyes; and there shall be no more death, neither sorrow, nor crying, neither shall there be any more pain: for the former things are passed away."
Revelations 21:4

I thank God that all of that heartache and pain, the years of infertility, the weeks of discomfort, the hours of pain, and the minutes of fear have passed away and have been replaced with these two miraculous blessings.

* * *

By the next morning Baby Boy was off all the tubes and finally brought to our room late the next day where he met up with his sister again for the first time since birth.

Reunited for the first time out of the womb the next day
First family photo

Birth Stats:

Baby A Girl:
October 8, 2015 1:13 pm
6 lb 8 oz
19 "

Baby B Boy:
October 8, 2015 1:21 pm
6 lb

Monday, October 26, 2015

36 Week Update

36 weeks

On Friday, two days after my weekly OB appointment I went back in to the clinic after work to be evaluated. I was having symptoms of another UTI and my doctor wanted me to have a culture taken before starting a round of antibiotics. When I arrived at the clinic my systolic blood pressure was in the 140s on the first reading. I texted my doctor as this was a bit concerning to me so she arranged to have the physician in the clinic give me another NST (non-stress test -- heart rate monitoring for babies) and decided to have me do a 24 hour urine collection. (Those are pretty fun, in case you haven't experienced it for yourself, especially when you have to use the restroom about every hour while pregnant!) They also checked my blood to rule out HELLP syndrome, a form of very dangerous pre-eclampsia that my twin sister developed in her first pregnancy. Things were looking pretty normal so I got to go home and the urine test the next day came back negative for protein.

What happened to my knees?
It looks like my calves belong to a different person than my thighs!
What a difference a few weeks can make! ~10 days post part

As the week progressed, I noticed my weight during this time had really jumped. I suddenly gained about 16 pounds in 10 or 12 days and 8 pounds in four days. This was concerning to me as I noticed I could no longer find my knees! My ankles and feet were getting much larger which has been unusual for me as long as I am wearing my compression stockings and I noticed my entire legs were looking much bigger. I went to work through Tuesday and asked them to not add on any additional patients for the day as I "was feeling it today." I felt a bit off and they were able to move most of my patients up so I could leave early. One of the nurses I work with checked my blood pressure throughout the day and it fluctuated from 120-140s. After seeing patients, I had to do a quick CPR session for some continuing education before leaving for home. I technically failed to perform adequate CPR for the last of the three cycles on the mannequin but the instructor could tell it had more to do with my large belly and lack of physical energy than any deficiencies in skill or training so she passed me. All of the people who witnessed me performing chest compressions seemed to think it was pretty funny.

After speaking to my doctor, we decided I should head in to clinic for another check so I drove straight from work. It felt like De'ja'vu being back there again just a few days later. They checked my urine again with a dip stick and found some protein and my BP was above 140 again. I was surprised how quickly things could change when I was just checked a few days prior for the same things. 

I was sent back up to Labor and Delivery for some additional monitoring. They did another longer NST and drew some more blood. My cervix was checked without significant changes from before, dilated to a 2 and effaced to 1 cm. My BP continued to fluctuate. While in clinic it was almost 150 systolic, lying in bed it was down to 102 or 104 in Labor and Delivery. I had a minor headache which wasn't fully relieved with pain medication and my swelling was pretty substantial. My doctor, who happened to be on call, diagnosed me with gestational hypertension and informed me that as such she would like to move my induction date up a week from October 21 at 38 weeks to October 14 at 37 weeks. I honestly was a little relieved to know the babies would be coming a little earlier and having a better idea when this would happen. 

I was released from Labor and Delivery that night and I was instructed to perform another 24 hour urine collection. This would help us know if I was actually having signs of pre-eclampsia which is diagnosed after signs of end organ damage (signs would be protein in the urine from kidney damage, elevated liver enzymes from liver damage, etc).

Shortly after arriving home I lost my mucous plug. I have been told this can be a sign of early labor but I also read it can sometimes happen weeks before delivery and figured it had to do with the cervical exam so I didn't think too much of it.

The next morning I had my scheduled 36 week ultrasound but the appointment with my doctor was cancelled as I had just seen her the night before. I was excited to see the babies one last time and see their weights. I figured they would be over 6 lbs this time. I was also starting to wrap my mind around seeing the babies in one more week. I was excited but suddenly realizing it would be here very quickly and wondering if I was quite ready.

I guess I was about to find out!

Week 36:
Weight: max weight on Oct 3 = 197.8 lb (our smart scale started identifying me as Abraham!). On Oct 6 weight = 191.1 lb.
Total Weight Gain: 49.1-55.8 lbs 

*Abe spoke with another twin mom about this time who told him that I would "Grow exponentially in the next few weeks." I didn't really believe that could be true but it turned out she was right. For the first time, I had a few strangers comment on my size --this still seemed to only happen at the hospital on my way in to appointments. One woman asked about my pregnancy as she slowly made her way down the hall with her walker, only to tell her friend on the phone something like,"Oh this poor little girl is hobbling in, pregnant with twins and about to pop!" Pretty bad when the sick elderly patient with the walker is taking pity on my lack of mobility! 

Less than *1 week* to go!

**New induction date at 37 weeks

Wednesday, September 30, 2015

35 Week Update

It was almost impossible to capture pictures of the Lunar Eclipse with my iphone

We really enjoyed watching the Super Moon this past Sunday. It was a perfect clear night in Iowa for sitting out to experience it. Hopefully it was a good omen for these babies! We were thinking how strange it was that the next time we will have that opportunity will be when the twins are almost ready to graduate from high school.

35 weeks!
It feels like the last week went by really quickly! Which is great as the end of the second and into the third trimester really seemed to be dragging. These babies really could come at any time and it is hard to imagine that they will be here in less than three weeks.

I made it back to work on Monday and Tuesday. The drive seemed longer than usual but we kept the days a little bit shorter and I seemed to do well. In some ways I seem to have found my second wind, feeling better than I did before going in to the hospital. I feel more mobile and less uncomfortable. I have had more energy. But I also can tell a difference after a few days of working. My swelling seems to be coming back (Hello cankles! And I gained about 8 pounds this week! -- I'm attributing it to fluid), I feel a little more stiff, and tired in the evenings.

My non-stress tests have been going well. Since they have a hard time monitoring twins with the standard doppler, they check heart rate with a non-stress test which for me is now a weekly occurrence. My babies are very cooperative! (So well behaved!) The nurses and doctors really seem to rave every time about how "good" they are. They are usually able to find the heart rates within seconds without needing to search for them again part way through. I am always happy to see them doing so well as I can't always feel my Baby B very well. It was a wonderful surprise that Abe got to pop in and say hello today while I was at the appointment.

I did have a contraction during the test today and I have noted a few at night occasionally during the week which I had attributed to Braxton Hicks. Except for that I went a week without any noticeable contractions. I guess we will see if they continue. It is difficult to really tell what is a contraction as my belly always feels tight! The nurse assured me this was normal with twins since they are taking up so much room and that I'm not clueless or dumb when I can't tell.

My belly seems to be popping out further and further. I am having a harder time finding clothes to fit. My pants don't seem to want to stay up and my shirts either wont go on or are often not quite covering the bottom of my belly. I may have to switch to some of my bigger flowy dresses if I go much further. (Ok I just noticed the picture below...Ha ha! Maybe portions like this have something to do with it!)

Jethro's BBQ in Des Moines -- enough to feed all 4 of us! (Abe, me, and babies)

Abe and I made a trip to Des Moines this weekend to buy some more items off our registry at Buy Buy Baby. Having twins is expensive! It seemed like we bought a lot of stuff and the clerks at the store seemed to agree (longest receipt ever?). I think we are mostly ready with what we need in the beginning. Now, I just need to get it put away and the house cleaned up. It's been a constant process as we keep bringing in more gear which means reorganizing and packing things away and a constant barrage of boxes and packing materials to be disposed of. I have been working to get our basement more organized as well as a place for family to stay after the babies come.

So it is pretty hard to believe we made it here, to 35 weeks. The babies will be here in no longer than three weeks, which when I really think about it, doesn't seem like very long at all (although my body argues differently). I feel grateful I am feeling less miserable and more up for the challenge. And really, whenever they decide to come now I feel confident things will be okay. Although at least another week will be better for them and hopefully give me a little more time to get things in order for their arrival. (I still need to pack my hospital bag, for one. Talk about procrastination!)

Oh, and still working on names. We are having a really hard time with Baby Girl's name.

Week 35:
Weight: 188.9 lbs (up about 8 lbs from last week!)
Total Weight Gain: 46.9 lbs 
BP: 132/84

*some really big baby movements from Baby A; Baby B is sometimes hard to find when he crowds to the right (he must like to cuddle his sister)
*arm/hand numbness mild
*hand and foot swelling increasing again, especially in ankles
*discomfort/immobility -- not bothering me as much
*poor sleep -- some nights horrible insomnia
*frequent bathroom breaks -- increasing again
*knee pain -- coming back after my first day back at work
*itchiness with foot swelling --slightly increased again
*very tired
*smaller appetite
*round ligament/pelvic discomfort
*Braxton Hicks or contractions?

Less than 3 weeks to go!

Thursday, September 24, 2015

34 Week Update

34 weeks!
Last week I set 3 progressive goals for myself: 
1. Hold off labor until I received two steroid injections
2. Hold off labor until my SIL had her baby (due this week)
3. Hold off labor until 34 weeks.

I am happy to say I have met all three goals! What a relief, as babies born after 34 weeks have a very good prognosis. Hopefully lung and feeding reflexes are getting closer and closer to normal development and we are getting farther and farther away from a NICU stay when the babies decide it is time to come.

I had my 34 week appointment yesterday and things were looking very good. We had another Non Stress Test (heart rate monitoring for babies). Every time we have done this the nurses and doctors rant and rave about how great the babies are doing. Their heart beats are pretty easy to find and they evidently have great rates. I sometimes get a little nervous that I can't feel Baby B very well so I am always glad to see him trucking along on these tests, just like his busy body sister who I feel very distinctly. And my cervix has been relatively stable since I was checked in the hospital.

I lost about 5-6 pounds this week! My doctor checked amniotic fluid levels on ultrasound yesterday just to be sure and things looked good. I think it is fluid as I perceive I am much less puffy than I was before.

My contractions have eased up and I haven't had any of that crampy back pain for a few days. I have been trying to do a little more around the house to test how I am doing and while I get very tired, I seem to be doing well! This is good because my nesting instinct is kicking in strong and I really want to have the house cleaned up and organized before the babies come. My pregnancy insomnia was really flaring up last night and I found myself doing dishes and cleaning out cupboards at 2 am. Yawn! Too bad I feel so tired this morning I haven't got anything else done today. It seems like I can't quite get caught up  as I keep getting more boxes full of baby gear arriving at my door. Who knew babies needed so much stuff!

The babies dropped on Sunday. Suddenly I noticed I had space between my chest and my belly and I can feel the babies kicking much lower in my pelvis. And suddenly I feel like I can breathe!

I plan to ease back into work next week with a shorter schedule. Honestly, I think we are all a little nervous about getting caught that far away from the hospital if I go into labor. We will give it a try and if I have a problem it is nice to know I am just a few minutes away from the Labor and Delivery Unit there. I am also hoping I will feel well and not too exhausted or sore. 

Week 34:
Weight: 181.2 lbs
Total Weight Gain: 39.2 lbs 
*I went from my highest weight gain of 45.3 lbs to 39.2 lbs this week. The last time I weighed close to this was Aug 26 when I was 180.5 lb.

*some really big baby movements from Baby A; Baby B is sometimes hard to find when he crowds to the right (he must like to cuddle his sister)
*arm/hand numbness mild
*hand and foot swelling decreased
*discomfort/immobility -- not bothering me as much
*poor sleep -- some nights horrible insomnia
*frequent bathroom breaks -- less than before
*knee pain -- haven't noticed much
*itchiness with foot swelling -- not bad this week
*very tired
*smaller appetite
*round ligament/pelvic discomfort

Less than 4 weeks to go!

Sunday, September 20, 2015

Since I've Been Home (33 week update)

33 week home from the hospital glamour shots!
I keep having that Kelly Clarkson song running through my head, except with the words "Since I've been ho-ome!"

It has been one week since I was admitted to the hospital. It feels like time has flown by and I am grateful the babies got a whole 7 more days (hopefully more) in before coming to meet us. I have heard people say "Every day in the womb is 3 days out of the NICU." I doubt that has any scientific basis, but it makes me feel pretty good about every day we get to share this space.

Today I am 33 weeks 4 days pregnant. The doctors all seem optimistic we could go weeks more like this and may still need to be induced on October 21 (which crazy enough is only a month away!) so I am very curious to see what happens. I find myself wishing I had a crystal ball to know when they will come, but my own twin ESP isn't kicking in, even with the amplification of three of us twins together.

Which reminds me: Abe came to the realization that he would be the only non-twin in our family. Isn't that weird and kind of funny?

Everyone seems to want to know the plan so I guess I'm not the only one. I have been off work this week and plan to be at least until my next OB appointment on Wednesday (which will be the 34 week mark!). After that I don't know if I will be back at work or not. It really depends on how I am feeling and what my doctor finds/says at my appointment. I would like to be back at work if possible if we are going to continue pregnant for weeks, but we need to do what is smart and best for me and the babies. It is hard to turn off the mentality that gets drilled into you in residency that work comes first, pushing through illness, etc, so a reasonable discussion with my doctor will really help with this decision.

Also, I am not on "bedrest." There are other problems that can come with bedrest so I've been told to "take it easy," and to be a "couch potato," instead of being on bedrest. I have only been sleeping about every other night so I have been enjoying this more than I would have thought. I have only left the house a few times since getting home: to get a much needed pedicure (Holy long toenails Batman!), to go to my baby shower yesterday, dinner at my in-laws, and an hour of church today. I have wondered as I see and hear about other pregnant women out and about if I am being dramatic by lying on the couch almost all day, but after a few of these outings I have learned that I am doing the right thing. Who knew sitting for an hour at church would be so unpleasant? Or that a few hours at my baby shower would wipe me out for the rest of the day?

Still can't wear my rings but my hands are almost back to normal! 

As for how I am feeling, I continue to get waves of discomfort in my back. This seems usually worse at bedtime and very early morning. I had one day of what seemed like more typical abdominal contractions that came every 25 minutes for about 1.5 hours and then subsided but I haven't felt that since. And when I am up and about more I tend to get more of the crampy back pain that landed me in the hospital.

I have had some really kind friends bring dinners and help clean. The missionaries from our church even helped assemble some new furniture for me! I had some lovely friends and my MIL throw me my baby shower yesterday morning which was super sweet and nice. It was great to see so many friends from different groups and times during my life in Iowa and I feel blessed by their generousity and kindness.

We finally got a couch to fit in our basement!
Strangely enough, many of my typical pregnancy symptoms haven't been bothering me as much. I figure I am focusing more on the more acute discomfort of these back/contraction pains that I am not noticing the other stuff as much. I feel strangely less hugely pregnant and more mobile (being stuck in a hospital bed on monitors for hours really makes you feel like you can't move). My hands have shrunk down quite a bit and feel better than they have in months, I'm using the bathroom less despite drinking more fluids, and my feet are less puffy and itchy.

And we finally ordered our car seats and bought a few more of the essentials to prepare for the babies to come. I will feel relieved knowing we have this done so we can bring the babies home from the hospital now when they decide to come.

Week 33:
Weight: 186.5.
Total Weight Gain: 44.5 lbs 
Week 33 day 1: 185.5
Total Weight Gain: 43.5 lbs
*My weight this month has been bouncing. I got up to 187.3 on 9/12 but have bounced back down to 185.5, which is essentially the same I weighed on 9/2 at 185.7 lbs.

*some really big baby movements from Baby A; Baby B is sometimes hard to find when he crowds to the right (he must like to cuddle his sister)
*arm/hand numbness mild
*hand and foot swelling decreased
*discomfort/immobility -- not bothering me as much
*poor sleep -- some nights horrible insomnia
*frequent bathroom breaks -- less than before
*knee pain -- haven't noticed much
*itchiness with foot swelling -- not bad this week
*very tired
*smaller appetite
*nesting--this instinct finally came back with the babies threatening to come! Too bad I can't do much of anything right now.
*left sided back cramps

Less than 4.5 weeks to go!

Saturday, September 19, 2015

False Alarm at 32 weeks 4 days

If only all hospital beds were as nice as on the Mother Baby Unit!
We had a bit of a scare this week! Saturday I was in our church temple when I noted some uncomfortable left sided crampy back pain. It was uncomfortable enough I found myself wishing the two hour session I was sitting through would be over instead of really savoring any kind of spiritual experience I was hoping to have. I felt a bit better throughout the rest of the day until the evening when the discomfort came back. We decided to ride it out and call the doctor if I wasn't feeling better by morning. I took a bath and felt quite a bit better as we watched the BYU football victory on TV.

The next morning I woke to use the bathroom. I got back in bed and noticed the pain in my back had returned. Abe was already gone for a church meeting but he encouraged me to contact my doctor. She happened to be out of town on vacation but texted me back to tell me it was probably nothing but worth checking out. I threw on some comfy clothes, texted Abe, and drove to the hospital after calling Labor and Delivery.

Walking in I realized I felt worse than I thought. It seemed like a long walk from the car. Still, I checked in to Labor and Delivery thinking it was nothing and they would send me home in time for church. I emphasized my sister's issues with HELLP syndrome and how this was caught late so requested they keep that on their radar. They did a cervical exam and noted that my cervix had thinned to about 1.5 cm (our last early on had been 4 cm) and I was dilated to 1cm. They said this wasn't normal but could have been going on for weeks so they wanted to keep me for observation to see if it was actively changing. They checked my blood to rule out HELLP (everything was great and I wasn't even anemic), a urinalysis, and a non-stress test of the babies. They had some concerns about a possible UTI, which can trigger labor. The babies looked great, baby A was still head down and baby B still breech and heart rates very good.

I got settled into a room on the Labor and Delivery Unit. Abe made it home from his meeting not realizing at first I was actually already at the hospital and not waiting for him to take me there. Most importantly, they gave me my first dose of steroid (by an injection in the hip) to accelerate the babies' development. As an old IVF veteran this didn't bother me much. They started an IV (my hand vein has been so huge they didn't even use a tourniquet) to give me precautionary penicillin (not knowing my group B strep results) and nifedipine to help slow down/stop possible contractions. It seemed the back cramping was coming more frequently at this point. They monitored my blood pressure and pulse as they gave me a loading dose of the nifedipine every 15 minutes. I couldn't take the last dose because of nausea, dizziness, and low blood pressure. Abe went back to church for an hour while I waited things out. They resumed the nifedipine every 6 hours which seemed to slow the frequency of the pain.

In the meantime, they checked my cervix two hours after my admission, which they thought had thinned to 1 cm.  So yes, I was in labor. They also had the NICU team come and introduce themselves and answer any questions I had. That made it feel a little more real! I had been feeling pretty calm but even though intellectually I knew that what they were telling me about prognosis rates for 32 weekers was a good thing, I felt a little nervous.

Abe made it back and I continued to rest in bed with monitors on my belly for the babies and contractions. Everyone kept asking me about contractions but they were hard to identify -- again, mostly just left sided low back pain that would last for a long time (20-60 minutes? or longer?). I never felt any abdominal discomfort and it wasn't like what I had heard about timing so I felt unsure what was happening or how I was feeling. I felt hungry and a little nauseated. I hadn't eaten anything except 6 oz of applesauce on my way to the hospital, and it was hard to move with the monitors and the discomfort but the time went by amazingly fast.

Emotionally, I felt surprisingly calm. But I had a few moments of fear. I wasn't ready for the babies yet, we thought we still had weeks. I didn't even pack a hospital bag or bring anything with me, thinking I would have time to still change and make it to church after being checked that morning. I started feeling pangs of guilt and inadequacy for potentially not being able to keep the babies in longer to keep them safe and healthy, for not going in to the hospital early, and even for having a potential UTI (which I think was probably accurate as after I received antibiotics my required trips to the bathroom cut down by 1/2 or more!). I also felt torn because as time went by I was uncomfortable enough and unsure how long this would all take to play out that I was kind of wishing they would "just come" so I could be out of pain and just be excited about the babies. But then that brought more guilt because I knew keeping the babies in place was really the best thing!

By the evening, I had a number of visitors which was nice. The babies and I seemed to be stable so they let me off the monitors for the night and I took a bath in the giant whirlpool tub, I finally got some food, and then we went to bed. I didn't sleep at all until the nurse gave me an ambien at 2:30 am. I woke up at 3:30 am to a clenching pain in my back. I was wimpering in pain and really wanted to get up to use the bathroom but couldn't move. I was hoping Abe would wake up but it took a few minutes and I wasn't in the right state of mind to speak louder or wake him beyond my panting in pain. He finally heard me and he and the nurse helped me get more comfortable. The pain subsided after about 5 minutes and I tried to sleep again. This happened again 3 times about every 45 minutes.

At this point I thought the babies were coming. They increased my nifedipine dose and gave me some morphine (thank you!). I knew the team was getting nervous when they came in with my second steroid shot (this time it was quite painful) for the babies at 7:30 am instead of 11 am like we had initially planned (they like to space it out 24 hours) and we started talking about delivery plans. I thought for sure they must be on their way, but luckily the medication seemed to start working more and the severe contractions I had had calmed down. I was able to get comfortable with tylenol and a warm heating pad. I got off the monitors and took another bath and had a quiet rest of the day. By the evening, I was back off the monitors and they transferred me to the much more comfortable Mother Baby Unit. They switched my nifedipine to as needed and stopped my every four hour dose of penicillin (thank goodness because the horrible burning that caused in my IV was about as bad as the worst of the contractions I had).

I got a wonderful night of sleep and woke up Tuesday feeling pretty good. The doctors seemed happy things held off long enough for the babies to get their two doses of steroids in and that I was mostly feeling better. We did some more monitoring of the babies, I took another bath, and then we got to go home about 3 pm. I dreaded going home to my house which was in a state of disarray but my MIL wonderfully helped clean up and get things ready for us. It was wonderful that Abe was able to take me home and get me settled before heading back to work. I had been lucky that his department had been so flexible with him during my hospital stay! He was off on Sunday, they unassigned him from scheduled patient duties on Monday, and he was pretty available to pop in and out on Tuesday.
Tired after days of pain and poor sleep!

Thank you to all of the wonderful and accommodating staff at the hospital and all the friends and family saying prayers, checking in, bringing meals, and helping me around the house. We are lucky to have such a good support system and a lot of love for these babies already!

A little pampering!  
This picture cracks me up. I have a big smile on my face as I break into my food after not eating for hours!
I'm not sure if that is why I'm smiling or not but it makes me laugh looking at it!

Wednesday, September 9, 2015

Week 31/32 Update

31 weeks
The big question I keep getting lately is, are you still working? Somehow the answer continues to be yes! The past few weeks I am feeling much more uncomfortable and very tired. But, I tend to feel probably my best at work. This probably has to do with me staying more mobile and distracted from my many aches/pains/discomforts. My patients are starting to get a little belly button to the face or shoulder and maybe even a few baby love taps, and I find myself positioning myself closer and closer to the patient chair to improve my reach. My belly button area is a little sensitive so I do mostly fine unless it starts getting too close to the patient or chair. By the afternoon I am pretty wiped out! I plan to continue working as long as possible and am crossing my fingers I continue on, although it may mean shorter hours with how exhausted I feel.

The three of us (babies and I) attended a breastfeeding class (which I thought was great and alleviated a lot of my anxiety about feeding twins) and daddy joined us for a birthing class. I dreaded the breathing exercises and getting hammered about natural birth (my OB has taken this off the table for me) but I thought it was very helpful and didn't focus too much on either of those topics. In all of my healthcare and physiological training over the years, I have never learned about the birthing process so it was really educational to learn what will happen to me and the babies. We did SOME breathing exercises but didn't dwell on that too much and I even got a nap in while doing some relaxation techniques (if only I could fall asleep like that at night or when I try to nap at home). Abe got to wear the "empathy belly" and complained about shortness of breath when tying his shoe and having pressure on his bladder so it must have worked at least a little! Despite how good the class was, it was difficult and exhausting to sit through about 8 hours of class in my third trimester, harder than a full day at work.

32 weeks. Tired!
I feel like you can see how my stomach is a little lopsided to the right where both babies like to hang out!
Best of all, Abe moved home! After 9 weeks in Des Moines on a rotation for work, he finally got to move back in. It has been so nice to have him home. He has been a wonderful support -- helping with dishes and laundry (as usual), feeding me, helping me get up from the couch or bed, and making sure I am doing and feeling okay as much as possible. In the end, despite my serious misgivings about having to share a bed with someone else again (and not just my pillows), it has been a worthy trade-off, and just in the nick of time as I feel even minor chores like heating up food (not even cooking it!) are becoming daunting feats!

I have been talking about getting pictures taken of us for years. We haven't had "family pictures" since our wedding. So it good timing to get this done. I found myself wishing we had taken care of it about 28 weeks instead of 30 as I was feeling puffy and large that day, but I'm expecting good things of our photographer, Sarah Siler. I'm excited to see how they turned out. (I think I did get some chigger bites while rolling around in the grass which made my already itchy legs that much itchier, so I really hope they turned out!)

Our teaser image from our shoot
I recently bought some more maternity clothes because I had to upgrade a size or two as I entered my third trimester. I bought this denim dress and found it again in a bigger size on sale for only a few bucks. I decided to send the smaller one to my twin sister Amber who is also pregnant and thought it would make for a good chance to get a twin picture. She is about 10 weeks behind me in her pregnancy with a little boy. She always tells me she thinks she is bigger than me, but we can clearly see that even in a baggier version of the dress, I look much more pregnant! I don't think we look super identical in these pictures but it is still fun to compare.

Twins! I think I am about 30.5 weeks here and she is about 22 or 23.
As we get closer to my due date I find myself feeling a little more nervous. My belly has episodes of feeling very tight and uncomfortable. I question whether this sensation is labor or Braxton Hicks (so far I think it is just babies hanging out under my ribs). I have been paranoid about swelling and blood pressure and wondering if my face and nose are looking swollen, knowing my twin sister had complications with HELLP syndrome which can be a deadly form of pre-eclampsia. So far things are checking out and my blood pressure has been better than it was before. I will start weekly checks from now on with the doctor which makes me feel more confident hopefully we will find any symptoms early on.

So, just hanging in there! In a lot of ways I feel optimistic and happy how things are going. I am still working, avoiding complications, and the babies are becoming bigger and healthier each day. But I also feel immobile and sore, tired, itchy, and more and more ready to deliver these babies...oh, and then enjoy them! I think God was wise in making pregnancy, especially the end, pretty uncomfortable so women will be ready to have the baby any way necessary ("I don't care, just get it out!"). Unfortunately for me, I feel like I have been "full term" for about a month now, with over a month still to go.

Week 31:
Weight: 185.7 lbs (Whoah, I gained over 5 lbs in what seemed overnight!)
Total Weight Gain: 43.7 lbs
Week 32:
Weight: 184.1 (down 1.6 lbs from last week)
Total Weight Gain: 42.2 lbs
BP: 120/78 Pulse: 83
Baby A profile (with Baby B booty in her face!)
Baby A: 
Weight: 4 lbs 7 oz (70 percentile)
FHR: 132 bpm
Position: head down
Another uncooperative spine pic of Baby B
Baby B:
Weight: 4 lbs 9 oz (75%)
FHR: 155 bpm
Position: breech (he flipped!)
*I feel like those are some big babies! We may be on track for 7-8 pounders!
*baby kicks -- big movements from Baby A, Baby B is harder to feel. They both tend to move to the right side (Baby B under my belly button). I guess they like to cuddle? I kind of wish they would stay on their own side though!
*arm/hand numbness
*joint popping
*hand and foot swelling 
*discomfort/immobility -- YUP! 
*poor sleep
*frequent bathroom breaks, especially at night (hourly)
*nee pain -- ouch!
*itchiness with foot swelling -- so uncomfortable! And more white splotches on my lower legs (they are starting to look like constellations of the sky) and extending up my legs
*reflux (more controlled)
*very tired
*occasional dizziness and mild headaches
*smaller appetite
*I've implemented my own form of "modified bed rest" -- doing nothing when I am home! I'm doing pretty well staving off guilt for lazy days and evenings when I am not working because I really just don't have it in me
*getting more excited for babies!

6 weeks to go!