**Long post ahead. But it's worth it, I swear!**
A little more than a week ago, I got the call from my OB. “How about having some babies today?” she asked, in her trademark chipper voice.
“Um, ok! What’s going on?”
“You’ve been officially diagnosed with HELLP syndrome. Your liver enzymes are way high and your platelet count is dropping. If we let you go any longer, you could go into liver failure or you could begin to have seizures.”
“Sounds convincing. I’ll call the dads.”
And thus commenced an 18 hour labor. I got to the hospital around 10:45 on Tuesday morning, where I stopped by the perinatology department for one last ultrasound. The perinatologist wanted to double check the relative sizes of the babies and their position to make sure that vaginal delivery was still the best option. I thought we would be meeting with the doctor to discuss all the options, but I was sent to Labor and Delivery without speaking to anyone.
What followed was an hour or so of not really knowing what was going on while they monitored the babies’ heartbeats and my contractions. Turns out I was actually in early labor anyhow. Weird. Finally, the senior resident in charge of my case (we call her Blonde Doctor, not in a pejorative way, but because she is very pretty and blonde and I love the TV show Scrubs) came in to talk to me. She told me that in my case, vaginal delivery is still the safest option, even with Baby B being breech, because my low platelet count could cause excessive bleeding during a C-section. And because I was in early labor, my body would likely react favorably to the pitocin (the synthetic hormone used to induce labor, known for producing incredibly painful, relentless contractions).
All of this sounded ok. The daddies were on their way with an ETA of about 6:00pm. I had been preparing for a pitocin-induced labor for weeks, and I had read up on what to expect during a breech extraction (do a google image search–I dare you). But then Blonde Doctor gave me some bad news–I had to be on magnesium sulfate during the entire labor and for 24 hours after the delivery. Magnesium sulfate, commonly referred to as “the devil’s drug,” is used to prevent seizures, one of the most dangerous complications of HELLP syndrome. It is a muscle relaxant, which is not what you want to be on during labor while your uterus is trying its damnedest to contract, and it causes wooziness, hot flashes, grogginess, nausea, vomiting, and all-around yuckiness–all things I would have liked to avoid during labor. But I also did not want to begin having seizures, so, at about 12:00pm, I began pitocin and magnesium.
One of the super-fun things about being on mag during labor is that you have to be on complete bedrest. And as those of you who have ever been in labor can affirm, in bed is the worst possible place to be. None of those magical yoga poses to help ease the pain and help the baby descend, no way to relieve the horrible pressure on your back and hips, and, because there is no dignity in childbirth, no trips to toilet. That’s right–for the first 7 hours of labor, before they placed my epidural, I had to use a bedpan. And let me just take this opportunity to say that nurses are the most amazing people on the planet. I cannot imagine a more selfless occupation. Thank you to each and every one of my nurses, including the one who had to help me heave my gigantic ass onto a bedpan every 90 minutes for 7 hours.
Once I began the magnesium, I entered what I began to call “mag time.” The hours were simultaneously endless and impossibly fast. The time passed in a liquid fashion, sometimes flowing so swiftly that I could not believe the clock and sometimes seeming to stop altogether. My contracts got stronger and stronger, and my labs continued to deteriorate. I worried and worried that the dads would not make it in time, and I had very conflicting feelings about wanting it to just be over and wanting to hold on until the dads got there. (If I could go back in time, I would tell myself to take a chill pill–I would have 12 more hours of labor after the dads arrived!) Finally, at 6:00pm, 6 hours after beginning the drips, Gil and Tomer arrived!
About an hour later, I decided to get my epidural. I probably could have gone longer, but Blonde Doctor was worried that if my platelet count continued to drop, they would not be able to place one at all. So my anesthesiologist, Liz, placed a very careful epidural. (Liz, by the way, has a child in Ramona’s class. It was so great to have someone I know be there for me, especially later on when things got dicey.)
The next few hours passed in mag time, with Mike rubbing my back and snoozing at the foot of my bed, and the dads, my mom, and my stepdad talking quietly. Sometime in the middle of the night, Blonde Doctor broke my water, and I instantly progressed to 6cm. She then upped my pitocin drip as high as it would go. No more messing around–time to get these babies out! Unfortunately, this was around the same time that my epidural began to stop working. I regained the feeling in my feet and legs, and I began to feel the pitocin-fueled contractions more and more. Mike rubbed my aching back and hips more vigorously as I moaned through the contractions.
About 4 hours later, Liz came back to urge me to let her replace the epidural. “We need a working epidural in case of an emergency C. Otherwise we’ll have to put you out completely,” she explained. I was also beginning to fear the breech extraction sans pain control. So I consented to a new epidural. It was much harder to sit still for it this time, since the contractions were now coming one on top of the other. The instant I sat up, waves of nausea hit me, and my nurse pushed some zofran into my IV.
Half an hour later, the new epidural was placed, and the pain receded a little. I began to feel a lot of pressure down below, so Blonde Doctor was called in to check my progress. 10cm! I was complete! The room was suddenly bursting with activity–the dads were suiting up, the attending physician was paged, and I was rolled from my labor room to the OR. Hospital protocol is to deliver twins in the OR since the chance of an emergency C is relatively high. This meant, however, that since both dads would be there, Mike had to stay out. I began to feel my first real pricklings of fear as I was rolled past Mike and he gave my arm a quick squeeze. “Love you,” he said. I think all I did was try to smile.
Once in the OR, I shimmied over onto the table, and placed my feet in the stirrups. I was flat on my back and the pain in my ribs was excruciating. I began to feel the overwhelming urge to push but was told to wait while everyone got into place. Finally, after an eternity, Blonde Doctor took her seat. “Woah, she’s crowning already!” she said. Umm, yeah. That’s what I was trying to tell you! When I was finally given permission to push, Baby A–soon to be known as Maya–just glided into the world with three easy pushes. The wondrous sounds of a newborn baby crying filled the air as Gil cut the cord and Maya was placed in her warmer.
Now on to Baby B and the breech extraction. I was told to not push while Blonde Doctor reached up inside me and tried to locate both of Baby B’s feet. His sac was still in tact, and the doctor seemed to be having trouble getting ahold of both feet. She kept getting a hand and a foot or a foot and an elbow. The attending physician was using an ultrasound and manipulating the baby from the outside, which was just about as comfortable for me as you might imagine. Thank goodness Liz was there, letting me squeeze her hand since the dads were understandably distracted. (Liz, if you are reading this, I would like to apologize if I broke any fingers!)
Finally, after about 5 minutes, Blonde Doctor felt confident that she had both feet, so she broke the bag of water and started to ease him out. I was told to push push push! while the attending pressed down on my belly. All of the sudden, Blonde Doctor yelled, “Stop!” I stopped pushing and watched in horror as she and attending physician began to try to get Baby B’s head unstuck from just inside my cervix. I began to cry and asked over and over “Is he ok?” No one would answer. After who knows how long (turns out is was just a couple of minutes), the attending grabbed some forceps and sat beside Blonde Doctor. He inserted the forceps to widen my cervix while Blonde Doctor reached both hands in to ease the baby’s head out. She caught him, this tiny blue creature, and the silence was deafening. Baby B–soon to be called Ben–was whisked to his warmer, where they bagged him and began administering CPR.
Time stood still as I began to doubt every decision I had made over the past few days. Why had I been so insistent on a vaginal delivery? All the doctors had told me it was the safest route for me, but what about the babies? Had I been unbelievably selfish, wanting to avoid surgery? How could I ever forgive myself if something happened to baby Ben? How could the dads every forgive me? But after the longest 30 seconds of my entire life, a shrill cry split the air. The entire room exhaled as Ben began to breathe. Tomer came over and wiped my tears, which made me feel a little better, like they wouldn’t be angry with me, but for the next few days, every time someone said the words “traumatic birth,” the guilt would come bubbling back.
Normally, after you have a baby, said baby provides a distraction from what could arguably be the worst part of child birth–delivering the placenta. But with no babies on my chest, all I had to concentrate on was the nurse’s excruciating uterine massage (sounds lovely, but it’s not) as the next few contractions tried to push the the placentas out. But the placentas would not deliver, and Blonde Doctor had to sorta pull them out. After that, I got to see the babies up close and personal for the first time. They were, of course, gorgeous and cuddly, all burritoed together. I got to hold them as I was wheeled back to the labor room, back to family.
For about half an hour, everyone gushed over the babies, and I was handed them to nurse. Maya latched right on like a total champ, and a nurse was helping me to latch Ben on when I felt a gush down below. I must have said something, because my nurse came over to take a look. She pressed down gently on my belly and whoosh! All of the sudden I felt incredibly dizzy and I started shaking uncontrollably. My nurse yelled, “Get Dr. Hebl back here!” and suddenly there were hands everywhere–taking the babies from me, laying me flat, trying to place an IV, placing towels underneath me. I was whisked out of the room while I heard people call for blood and anesthesia and doctors. I heard a nurse call over her shoulder to Mike and my mom, “Someone will come back and tell you what’s happening!”
I was rolled back into the OR, and before I was even back on the table, Blonde Doctor had her hand up inside me, up to the elbow, feeling around inside my uterus. The attending physician was back, too, using the ultrasound. The two doctors began arguing about something and the nurse kept saying she couldn’t find a vein and all there was was pulling and pressure and shaking and noise and hands. Then Liz leaned down and said into my ear, “I’m going to give you some gentle sedation now.”
Next thing I know, I’m back in the labor room, pulling off my oxygen mask. I asked a nurse what had happened. She told me that I had started to hemorrhage and they were concerned that I had retained pieces of the placenta, so they had performed an emergency D&C. And in order to save my uterus and stop the bleeding, they placed a balloon inside my uterus and towels inside my vagina. This lovely “vag pack” was to remain inside me for 24 hours following the delivery. I also had to remain on the magnesium and on bedrest.
The next two and a half days in the hospital, I rested while the dads bonded with the babies and my family flowed in and out to visit. It was just as strange and emotional and wonderful as I anticipated it would be to watch the daddies with their babies. It was a little harder than I thought it would be to let go of the responsibility, to not be a part of the decision-making process about various things, but watching Gil and Tomer hold those babes felt so, so right.
We all got discharged on Friday afternoon. I was recovering well, and Maya and Ben were both looking healthy and strong. Friday evening and Saturday were spent with family. I cuddled those babies at every opportunity, knowing that we would be saying goodbye far too soon. I remember being in awe of my own kids when they were newborns, unable to believe that my body could create something so perfect. Looking at these babies, the feeling was the same–sheer and utter perfection.
We said goodbye Saturday evening. I have a hard time showing emotion publicly, so the goodbyes were swift and straightforward. It hit me sometime that night, however, that it was over, that I would not be seeing the babies or the dads every day. My life had revolved around this pregnancy for so long that it was hard for me to imagine what life would be like when things returned to normal. I felt very weepy the next few days, hormonal and sad, but it helps to know that we will see them soon. Gil and Tomer have very generously offered to have us come stay with them sometime this summer and do Disneyland! And in the meantime, there’s Skype and pictures–lots and lots, right, guys?!
I think it’s all too fresh to have some insightful wrap-up of this experience. My body needs to heal, my hormones need to settle down, and I need to rediscover my rhythm with my kids and my husband. All I know is that my life is richer for having done this and that I have gained two more children to love.
Welcome to the world, Maya and Ben. May your lives be filled with love, light, and laughter.