My New Blog

As promised, here is my new blog: Foibles of a New Parent

Drop by and have a read!

The End of an Era

After much contemplation and thought, I have decided to bring this blog to an end. Every time I see the name of this blog, I think to myself "My miracles HAVE come...I'm not waiting anymore". This blog was also something that I did to get through the years of infertility that we suffered. It's a blog about trying to get pregnant and what happens when you finally do.

While infertility has left us scarred for life, I feel that we have had the privilege of moving on with certain aspects of our lives. I still believe that I am infertile...7 years of trying with not one natural pregnancy during that time and a heck of a lot of intervention to become pregnant in the end does not a fertile woman make. I realize though that the things that concern me these days are different and I want to make a clean break from this blog, respecting what it was and is to those who find comfort in my words about the time that I walked through the valley of IF.

I have crossed over to "the other side", but I have not forgotten. Therefore, I want a different place in which to discuss matters that concern me now, respecting that this space was somewhere that I found comfort when I was in treatment and actively cycling.

As I'm sure you have noticed, it has taken me a long time to post my final post about my birth story and I think a large part of my reluctance to do so was that it represented an end to that part of my life ridiculous as it sounds. Those 7 years were among the most painful, most difficult and trying years of my life so it seems absurd that I have a hard time letting that all go. I think that part of it is that after 7 years, I know lots about being infertile and not much about being a parent. For the longest time, IF was who I was and it was such a huge part of what I did on a daily basis.

I'm not that person anymore.

I have grown. I am different. I still bear the scars that IF has etched in my life.

I have not forgotten.

So, in light of those revelations, I will be ending this blog. I am going to create another space and will post details once I have created it.

Thank you a million times over to everyone who has hung in with me and offered me such love and support through all of this. I would not have made it without you all. I hope you join me as I take my first tentative steps down another of life's pathways but I understand if you do not.

It's hard to fathom but all of you, many of whom I have never met and probably never will, are so near and dear to my heart and I am so grateful to have felt your loving cyber hugs and support.

May I be able to pay it forward a hundredfold.

Birth Story - The FINAL Installment

Hellloooooo....anyone out there?

Can't blame you all for dropping off because this has been the longest, most drawn out story ever BUT...

...I'm going to finish off my birth story.

Yes, really. Thank you for hanging in there and being patient. There is an end. It is in sight. More thoughts on that later...

Onto the birth story...

So there I am, lying on the table, children delivered and waiting for the placentas to magically slide out and for this to all be over. After all, I just pushed two human beings out of my woohoo - it couldn't get any harder than that could it? At this point, things seemed to slow down or stall a bit. The doctor was massaging my abdomen and she kept massaging.....and massaging.....and massaging. I finally asked her whether the placentas had been delivered and she told me that they had not yet detached and that it was taking a bit longer than it should. She went on massaging and then, after some more time had passed, she told me that they were going to have to manually remove them. Back up the woohoo she went and started basically tearing the placentas away from the uterine wall and let me tell you, that was when I fully realized that my epidural had worn off. I said before that could feel everything going on down there when the kids were being born but the actual birth part took place pretty quickly so I didn't have too much of a choice but to bear with it and then it was over, or so I thought. When the placentas were being removed, it *HURT* and I was in so much pain that I asked the doctor to stop and when she didn't, I finally ended up yelling at her "DOCTOR - PLEASE STOP!!" That finally got her attention and the anesthesiologist was paged to top up my epidural. My screaming also alerted my DH that someone wasn't quite right in the OR. It was pure bliss when the top up for the epidural took effect and when they handed me the button that allows me to self-administer additional doses, I hit that button five times in a row immediately. There was no chance that I was going to live through it wearing off again!

At this point, they continued to manually remove the placentas. They were using ultrasound to ensure that they got all of the pieces. Then they then moved on to stitch up the episiotomy. It was sometime around now that I began to realize that something was not right because the doctor, when asked to describe the bleeding, replied that it was "still brisk" despite there being multiple bandages being pressed to the site of the wound and applied with pressure. I remember seeing a sodden bandage soaked through with blood and thinking to myself "that must be my blood" but not really realizing how bad it was. My DH told me later that he remembers seeing a bucket with the placentas in it coming into one of the rooms where the girls were being checked out and it being filled with blood. We had agreed ahead of time that my doula would stay with me during the delivery of the placentas and he would go with the girls so this was his first clue that something wasn't right with me in the OR.

I had begin to shake uncontrollably like a leaf and nothing I could do could stop the tremors. My whole body was just shaking and shaking and I was wondering if I was beginning to go into shock. I asked the doctors if this was "normal" and was told that this was a common side effect of having an epidural. Hmmm. No one ever told me that so for those of you are pregnant and who may still be reading and considering having an epidural during your labour - beware that your epidural may give you an intense case of the shakes.

I guess at this point I had lost too much blood because the doctor started calling for blood products - 4 units to be exact. Due to the heavy bleeding, they decided to do a D&C to ensure that they removed any remaining pieces of the placenta that may have still been stuck to the uterine wall. I never knew I could have a D&C as part of giving birth but there you have it. They also cleared the OR so my DH and my doula had to wait outside.

According to the post operative report, at this point I became "hypotensive" which means that I had abnormally low blood pressure. They were unable to get a reading from using the blood pressure cuff - you know, the one where they inflate and cut off your circulation and then somehow take your blood pressure by holding a stethoscope to your arm. So, the anesthesiology team then started to try to put in an ART line. This is akin to an IV in that they are trying to slide a very thin flexible tube right into the artery that runs in your arm. They tried for a half hour to get this line in, shifting back and forth between my right arm and my left arm. I was pricked over and over again and I remember being very vocal and cranky about it, proclaiming loudly "OUCH!" every time they tried to get that thing into my artery. The next day, I had a good look at my arms and I had no less than a dozen scabs on *each* arm where they had tried to get the ART line in and my forearms were completely black and blue on the underside from my wrist right to my elbow. I appreciate how difficult it is to put one of this ART lines in because the circumstances that merit one also mean that the patient likely has collapsed arteries making it extremely difficult to slide the tube into the artery without puncturing it. However, it was intensely unpleasant from a patient's perspective.

A second D&C was performed because of ongoing bleeding and the doctors were able to confirm that there was nothing left in the uterus. The anesthesiology team were finally successful in placing this ART line and the blasted pricking stopped. Blood work became a breeze after this because there is a valve as part of the whole ART line setup that allows you to tap into the artery and draw blood at anytime. One small positive to all the pain of having one put in! I also was thinking to myself that it was so ironic that in one arm they were giving me a blood transfusion and from the other arm, they had to repeatedly draw blood to check the levels of everything. I still wasn't stable at this point and continue to bleed and I fully realized that things were not going well because the anesthesiologists were being continually paged and they answered the pages by saying they were dealing with an emergency in the OR...to which I realized in a haze that the emergency they were referring to was ME!

To stop the bleeding, the doctors placed a balloon inside of my uterus and inflated it with saline so that the outward pressure would hopefully come into contact with the site of the hemorrhage and stop the bleeding. Thankfully, it worked because if it hadn't, the other options to stop the bleeding were to 1) place shuts in the arteries leading to the uterus and cut off the blood supply or 2) do a hysterectomy. Yes, you read right...a hysterectomy was the last option that was presented. I thankfully did not know about any of this but these options...maybe they were discussed with me but I have no recollection of that conversation...but these were discussed in detail with my DH who was anxiously waiting outside.

My condition was finally pronounced stable. Caitlyn was born at 7:04pm and by the time I was stabilized, it was 11:40pm.

The list of medications given to me is pretty impressive too:

1. Phenyleprine
2. Hemabate
3. Ergot
4. Pentaspan
5. Granisetron
6. Metoclopramide
7. Furosemide
8. Labetalol
9. Morphine
10. Metoprolol
11. Adenosine
12. Nitro

Total blood products given - 9 units of blood, 7 units of fresh frozen plasma and 5 units of platelets. They estimated that I lost over 3 litres of blood.

Yikes.

Wow.

That was close.

The key thing is that I am okay now.

As I sit here and type this, I look at the beautiful faces of my girls and feel that everything I went through was worth it to get to where we are now. It was a hard slough after their birth, but I made it and I'm fine now and I am still in possession of my uterus (!). I have an entirely new perspective on childbirth now but women go through it all the time and we get through. We make it thanks to medical technology these days and the teams of dedicated doctors & nurses who are on call for our deliveries. I am so glad we decided to choose the hospital that we did because it was their knowledge and expertise that saved me in the end. I am sure that the care that I would have received at a more local hospital would have been good as well but I am not sure I would still be in possession of my uterus and I may have ended up being transferred downtown to this hospital anyway when things took a turn for the worse. When we chose the hospital that we did, we chose it for the girls and the excellent NICU they had. Little did I know that I would also need their expertise in dealing with difficult birth situations.

So there you have it, not quite in a nutshell, but my birth story in as much detail as I can remember it.

The end.

Photos!

For those of you who are still hanging in there with me even with my excruciatingly long and drawn out birth story, here is a little peace offering...photos of my girls! These were taken a week or so ago and they have definitely put on weight and chubbed up a bit. Victoria weighed in at the doctor's office today at 7lbs 9oz and Caitlyn topped the scales at 8lbs 1oz. They're both doing well!

Victoria:

Caitlyn:

Two sisters hanging out together having some tummy time:

Victoria's closeup:

Caitlyn's closeup:

Enjoy!!

Birth Story Part III

When the anesthesiologist showed up, I asked that I only be given enough to take the discomfort away but I would still like to feel the urge to push when the time came. He only administered half the regular dose which sounded fine to me but this decision would come back to haunt me later. It was about 10am by this point of the morning and with the contractions faded into oblivion by the epidural, I decided that now would be a good time to get some sleep and some rest. I can't imagine going through hours and hours of labour only to be exhausted and then have to push a baby (or two!) out at the end so the epidural was a good decision for me.

The worst part about having the epidural put in was the local freezing that they administered to numb the area. Like all of the needles we have experienced over the years, this was no different - pinching sensation with a sharp sting and then when the actual epidural was put in, you can feel what is going on but there is no pain associated with it. The epidural itself is a flexible tube that they then proceeded to tape to my back to ensure that it didn't move. I think my entire back was covered in adhesive to ensure that it didn't move with the tube fed over my left shoulder and then attached to a self-administering button that I could press at will to "top up" if I felt the need.

The doctors came back and kept checking on me throughout the rest of the morning and at 2pm they did one final internal exam and announced that I was ready to start pushing. Now a side note about internal exams and not to scare those of you who have not yet had one or haven't gone into labour...internal exams can be very uncomfortable and can be even painful. They put a glove on their hand, some lubricant on two fingers and then those are inserted into your vagina where they feel for the cervix. When you're not in labour, the cervix should be high and closed. During an internal exam when your cervix is high, it really feels like they're trying to reach for your tonsils by way of your vagina. Truly. My first clue that internal exams were not fun was when I was in triage and the woman in the room next to me had an internal exam and yelled through the whole thing.

One of the nurses asked me if I wanted to "practice" pushing. Having never done it, I thought that this would be a good thing so she coached me through what to do. You're lying flat on your back and you need to get into a frog like position...you bend your knees and grab behind them with your hands and then lift your upper back, all the while pushing down with your abdominal muscles like you're trying to pass the biggest poo of your life. You do this for one long breath and then you exhale and inhale again quickly and then push again during the same contraction. I have never felt my face go so red and I felt like my head was going to explode at some points. Who knows if I ever got the pushing technique right because I proceeded to push for 4 hours (at my own request...I'm kind of stubborn that way) and little Victoria just wouldn't come out.

I have never pushed so hard in my life. I have never tried so hard in my life to do something and it was disheartening when the doctor would tell me that I needed to push even *harder* than I already was. I thought I was pushing pretty damn hard but the baby wasn't moving down so maybe I wasn't getting the technique or doing it properly. My doula helped me to advocate for myself at that point and we got to try different techniques...we tried squatting and we tried another technique where we wrapped my doula around the waist in a sheet and I pulled the sheet towards me while my doula braced herself and pulled against me instead of pushing. Same muscles were used in that technique, just a different way of engaging them. Still no change. At this point, it was about 5:30 and the doctor decided that it was time that the babies arrived. They were not in distress at all, it was just time.

I was wheeled into the OR at that point and I pushed a few more times there but still no change. Then we decided to use the vacuum and things began to happen pretty quickly then. They had to fit the vacuum in and when she was trying to work it in past my perineum, I noticed that what she was doing was pretty uncomfortable for me. Then I got an episiotomy and I definitely felt the "snip". Those should have been my first clues that my epidural was wearing off or was not strong enough for what they were about to do. I was asked to push again while they used the vacuum to help Victoria along and with the first push, I felt her head come out (finally). With the second push, I felt the rest of her body come out. I thought I heard her cry but she was whisked away almost immediately but a nurse did stop and show her to me very briefly from a few feet away.

The next thing that I remember was that my water broke - little Caitlyn was ready to make her appearance into the world and her sac ruptured after Victoria was born. There was a huge gush of liquid that went on for a few seconds and I just soaked the gown of the doctor standing at the foot of the bed. Now Caitlyn had been head down all along but with Victoria being gone from the uterus, she flipped around and became breech. All the doctor said she was that a foot was sticking out. I will be forever grateful to the doctor that was on duty that night because normally, this would have meant a c-section for Caitlyn as the breech position is not one that doctors like to deliver vaginally. However, I had told the doctor several times that I wanted to avoid a c-section if at all medically possible if there was no danger to the kids. So at first, the resident tried to reach up and grab Caitlyn but she couldn't get a good hold of her. Than, the doctor in charge reached up and grabbed her and with one or two pushes from me, out she came doing the splits! Caitlyn was taken away immediately as she did not come out crying so they wanted to examine her so I didn't even see her.

During all of this, I am realizing more and more that I can feel just about everything going on down there, not just pressure. When someone puts their entire hand, not just 2 fingers, up your uterus, it feels pretty uncomfortable. Like you're being really, really stretched in a not so nice way and that is no small feat for someone who is 8 months pregnant! I thought that the hard part was over at this point because the kids had been born and it was my misunderstanding that the placentas would just slip out and deliver themselves. Boy was I wrong.

Birth Story Part 2 of ??

I think my DH's response to my question was "Huh? What? Are you serious?". Thankfully, at 2am in the morning, there is no traffic on the highway going downtown so it was only a matter of him getting up, getting dressed and then driving to the hospital. In the meantime, the nurse got a wheelchair for me and I was transferred to the labour and delivery side of the floor.

Finally...underway. And no induction required either!

I was checked into this tiny little labour room where I was promptly strapped down with fetal heart monitors and another monitor to record and measure contractions. I wasn't in too much discomfort yet but I was beginning to appreciate why epidurals were created in the first place and why women ask for them. My contractions were not yet painful but the pressure was becoming more and more intense and I had to focus more on breathing my way through them vs. chatting with my nurse.

At 3am, my DH arrived and joined me in labour and delivery. At this point we were transferred to another much larger labour room where we called our doula and waited for her arrival. At some point, I was checked again by the resident to see how far along I had progressed. I was now 3-4 cm dialated and almost fully effaced. For my first time, labour was progressing along really nicely and I was dilating at a good rate of about 1cm per hour. I did a quick mental calculation and determined that I would be 10cm dilated by about noon - a good ways away from 5am in the morning but you know what, the time went by pretty quickly.

Since I was attached to the monitors, I couldn't get up and move around freely but I asked to be taken off the monitors for at least a few minutes at a time so I could sit on a birthing ball or at least move around and relieve the aches of lying in bed in the same position for hours. The contractions continued to intensify and started getting painful. My goal all along was to make it into active labour before getting an epidural, that being 5-6cm dilated, since the hospital's strong recommendation was to have an epidural in the case of twins given the high incidences of medical intervention. By 9am, I was finding it really hard to breathe my way through the contractions. Interestingly enough, when I froze up and held my breath as it is so instinctive to do when in pain, the contractions felt even more painful and unbearable. However, when I focussed on taking slow, deep breaths like I would in meditation and hypnosis, the contractions were definitely more bearable.

Once it was confirmed that I was in active labour, I asked for the epidural. I was incredibly nervous about having it put in as the idea of having someone poking around in my spinal column just seemed so dangerous. Words like "paralysis" kept on floating around in my mind and were exacerbated by the full disclosure discussion the anesthesiologist had with me before he proceeded (i.e. all of the risks associated with the procedure). With my DH kneeling infront of me and my hands on his shoulders, I hunched over and waited for the epidural to be put in. We got to the critical part of the procedure where the doctor says "Now don't move under any circumstances" and I looked my DH in his eyes for support. Quite funny - at that exact moment, my DH's surgical mask that was hooked on over his ears, dislodged from one side and slowly swung open across his face. I could see in his eyes that he was thinking about fixing the mask but then I said to him "Do not move. Do NOT move." So we both stayed frozen in place and the epidural was put in and everything faded into wonderful numbness.

Photos and Birth Story - Part 1 of ??

Time is not my friend these days and I have been wanting to share my birth story with all of you along with some photos of the girls and I have decided to do a few minutes here and there and get down what I can in that time as opposed to nothing at all.

First of all, here are photos of my precious miracles:

Victoria:

Caitlyn:

I blog anonymously and for those of you who wonder what we look like, we have received the comment over and over again from friends and family that Victoria is a Mini Me DH and Caitlyn is a Mini Me Kayjay. :)

Onto the birth story...

As I had blogged before, that fateful Friday morning, I woke up and felt different. I had a low back ache and I felt crampy in my lower abdomen. Before, any back pain that I had was mid to upper back and due completely to how I was carrying the twins but this time, the ache was definitely lower down. These feelings persisted throughout the day but it subsided during the afternoon and then returned with increasing persistence in the evening hours. My DH and I were talking on the phone that evening and by mutual consent, we decided not to put off running some errands until the next morning "just in case". I still didn't know if this was labour or not but we wanted to be somewhat prepared just in case.

By 10pm that evening, I was definitely feeling uncomfortable. Every time I tried to lie down, I felt like my uterus was hanging by a thread and the effort it took to lie on one side or another made me feel like my belly was going to snap free from that tenuous little thread. So, I sat upright at the side of my bed and wondered if this was labour because other than being a little uncomfortable, I wasn't in any real pain. I also found that if I got up and walked around slowly, the feelings with abate a little. However, there was still something telling me that something wasn't right and I finally called the nurse at around 11:30pm. She thought at first it was false labour because if you can alleviate the "pain" simply by shifting positions, than what I was feeling weren't true contractions.

I lasted until about 1:30pm at which time I called the nurse again and had her page the on call resident. Something just wasn't right and I was beginning to feel more and more uncomfortable with each passing hour. I was having very irregular contractions at that point, some lasting a few minutes to others lasting a few seconds in no set intervals. The sensation of a contraction is much like period pains except for worse...kind of like a bearing down sensation that involves your lower abdomen and culminates into intense pressure "down there".

The resident came and checked me out and did an internal exam to determine whether or not I was in labour. Remember - with my ruptured membrane, internal exams are avoided as much as possible because the risk of infection increases with each exam. I wanted to be sure that I thought in my own mind that I was in labour before I took the chance of increasing infection.

I was already 2-3 cm dilated and effacement of my cervix (thinning of the membrane) was already well underway. I was officially in labour and not a day too soon - the girls waited until they were 34 weeks exactly before deciding that it was time to make their appearance into the world.

I called my DH at 2am and asked him the question I have been waiting 7 long years to ask - "Are you ready to meet the girls honey?"

To be continued...

Our Two Miracles Have Arrived!!!!!!!!!

Saturday February 6th at 7:01pm, Victoria made her appearance into the world followed closely by her sister Caitlyn at 7:05pm. No c-section was required although a vacuum was used to help Victoria along. Caitlyn decided not to remain head down and turned breech and was born doing the splits!

Mom had complications post delivery with hemorrhaging (details to come in a subsequent post) but has recovered and is now resting at home. Babies graduated from the NICU after just 2 days and are trying to stabilize their weight and jaundice in the Level II Nursery.

Mom and babies are doing well!

Feeling Crampy...

Yes, you read the title right. I woke up this morning with a mild low back ache and a crampy feeling in my lower uterus area. I constantly feel like I have to go to the bathroom (not in a UTI kind of way) as in there is downward pressure there. I don't think I am having contractions, but I know that low back pain and crampy feelings can be the first signs of labour. My discharge this morning was pinkish so of course I was wondering what "bloody show" looked like - was that was I was seeing in the toilet?

How do I feel about it? Nervous...tinged with a little excitement. I had butterflies when I realized this morning what I was feeling. I do want to meet our girls but at the risk of repeating myself over and over again, I just want to take them as close to term as possible. I had high hopes of taking them another 2 weeks but given the way I'm feeling right now, I'm not sure.

So here's a list of silly labour related questions that I was hesitant to put out there but will now just for the fun of it. You don't have to answer as some are really personal but I'm just curious:

1. How did you groom yourself "down there"?
2. Did you bother shaving your legs?
3. Did any of you worry about having a BM while pushing or did enough time pass so you didn't have to worry about having one?
4. Can I really be in labour given the silly questions I'm asking above??

So I wait...33w6d today.

NICU, pPROM & Maternity Photos

Where to start...lots to blog about today.

Maternity Photos

We had our maternity photos taken yesterday and for a brief time, I got to really revel in the pregnancy and just enjoy being pregnant without all of the worry over the past few weeks. The photos captured the pregnancy and all of our joy and anticipation about the girls; thankfully, it did not capture any of the worry and heartache around the subchorionic hematoma, the bleeding or the pPROM (more on that later). I thought to myself that this is what it feels is like to be "normal" and to enjoy "normal" activities that most pregnant women get to enjoy.

I only got to see a few shots right at the end but she will be posting them in a gallery in the next week for me to look at. She promised to air brush away all of my keloid scars for the final prints but will only retouch one or two in the online gallery so I can see and decide how much air brushing we want. I am excited to see them and am grateful that I was able to have them taken to document this period of our lives.

pPROM & The NICU

I have discovered that there is a name for what has happened to me - pPROM stands for pre-term premature rupture of the membranes. It happens in just 1% - 2% of all pregnancies and accounts for about 35% of all pre-term deliveries. There is no known cause (although plenty of speculation regarding inflammation and infection being the culprits) and your chances of having a recurrence of pPROM in a subsequent pregnancy is about 35%.

We also had a tour of the NICU over the weekend and I have to say that I was a little shocked by what we saw. Imagining it is completely different than actually seeing the reality of a NICU. So many teeny tiny babies that look so frail and fragile, all covered in wires and hooked up to all sort of machines. We wanted to tour the NICU prior to delivery to prepare ourselves for what seems to be inevitable at this point. No matter how long my girls stay inside, it looks like there is no way around a stay in the NICU.

I had hoped that the closer to term I got, the less time and the lower the likelihood that they would need special attention in the NICU. I know they will receive excellent care and I know that they are in good hands; this is why we chose this doctor and this hospital. However, I can't escape this feeling that I've already let my girls down by not providing them with a safe place to grow for 9 months. I had my 3rd ultrasound today since being admitted and it revealed even lower levels of fluid for poor little Lefty, the lowest levels yet.

After everything that we went through with IF, I was going to do everything in my power to have the best pregnancy ever. I was going to take good care of them, provide them with all of the nutrients that they needed to grow to be healthy and strong...I was determined to give them the best start in life. Instead, I find myself struggling with the idea that little Lefty is now exposed to the risk of infection and she's squished because she doesn't have a lot of amniotic fluid surrounding her to protect her. Little Lefty is also not able to practice her breathing very well (babies practice their breathing and develop their lungs by inhaling and exhaling the amniotic fluid) and will likely need to be on a ventilator for a while. She will also be put immediately on a course of antibiotics to kill any bacteria she may have been exposed to.

It's all very scary.

I was also reading stories of parents whose kids stayed in the NICU and it was interesting to read because much like you need to mourn the things that IF will rob you of, having a preemie robs you of many of the normal things you would think you get to experience. I likely will not be able to hold my girls right after they are born; we won't be able to share that skin-to-skin contact that they say is so important in the time right after birth, I won't be able to nurse them or comfort them when they cry and I won't be able to take them home with me.

I feel helpless.

Sure, there are a lot of things that the doctors and nurses will be able to do for them, but what will *I* be able to do for them as their mother? Worry? Got that down pat...

For now, the doctors still believe that the girls will benefit from more time inside so I trust them and am trying to keep them in as long as possible. I am also upping my intake of water more than ever to try and help Lefty replenish her amniotic fluid as the doctors did tell me that the levels of fluid could fluctuate.

33w2d and counting...

A Visit From My OB (Finally!)

I finally got to see and speak with my OB yesterday late in the day. He was all dressed up in scrubs so I take it he was between patients at the hospital and took a few minutes to come and see me. He reassured me that he had been monitoring my progress remotely and that he was very happy that we had gotten another 2 weeks gestation after the rupture.

In terms of my burning questions, the number one question was how long was he going to let me go with a ruptured membrane. If you recall, the first doctor I spoke to said a maximum of 34 weeks, the second doctor I spoke with said a minimum of 34 weeks...I just wanted to know where he fell on this 34-37 week continuum because we are talking about a 3 week difference after all. He told me that the longest he would let me go would be 35 weeks and if I didn't go into labour on my own by that point, he would induce by 36 weeks. I asked him if I was doing well and the babies were doing well if we could take it day by day after 36 weeks instead of inducing. He told me that he didn't feel that the risk of going longer would be beneficial because if I were to get an infection at that point, the risk of brain damage to the baby whose sack ruptured was greater than the benefits of remaining in utero. Okay - he had me there...as soon as he said "greater risk of brain damage" I instantly felt more comfortable about induction should it become necessary.

I guess my concerns around being induced is what if these two girls aren't ready to come out and they induce me even though they haven't dropped and my cervix is still long, tight and closed? To me, to be induced under those circumstances sounds like it may result in a long and hard labour during which the babies go into distress and then I'll end up having to have an emergency c-section, something I really want to avoid. I voiced this concern to my doctor and he stated that in his opinion, I would go into labour naturally before then. He also then went on to say that the only reason why he thinks I have been able to carry for so long is because I have ruptured and therefore released some of the pressure in my uterus!! He explained that the bigger my uterus grows, other "receptors" begin to get triggered that will prompt my body to prepare for and go into labour on its own. After all, this is my first close to term pregnancy so nothing has been stretched before and I am basically carrying the equivalent of one 7lb 9oz baby (at last check, weight estimates were 3lbs 14oz & 3lbs 11oz) which is a pretty decent size given I am normally 5' 3" and 130lbs.

At the 35 week mark, it will be Valentine's Day weekend; 36 weeks would put us around February 20th. I hope that I make it that far because I want to minimize the amount of time the girls need to spend in the NICU. During my OB's visit, the Neonatologist also popped in and advised me that no matter when my girls are born (anytime between 33 - 36 weeks), she believes that they will require time in the NICU.

I continue to wonder whether I will know that my body is preparing to go into labour. May women report that they feel that the baby has dropped and they start feeling all sorts of pelvic pressure. A lot of other women report feeling nothing. I am trying to listen to what my body is telling me but at each point when something has happened (subchorionic bleeding, bleeding in 3rd trimester and then the membrane rupture), I have felt perfectly fine and there has been no indication that something out of the ordinary was going to happen. My belly area remains pretty firm most of the time (many nurses have told me that I am "all baby") and my abdominal muscles continue to feel very stretched, almost like I can't stand up straight without pulling something.

Other than that, not much else going on here. Nice and boring, just the way I want it for now! I'm still enjoying the sunshine and the privacy of my own room. We have hired and met with our doula of choice this past week and tomorrow (Sunday), I will be having maternity photos taken at the hospital. That's all for now.

Moved to a Private Room

I'm tired of sounding like a Drama Queen or a Negative Nelly and really, at this point, I am so happy to be in a private room (I was in a semi-private room before). The situation and circumstances that got me here...well, not so great. However, silver lining and positivity first though - I'm in a private room for now!

Our health coverage is only for semi-private rooms and the cost difference between semi and private rooms is $100 per day which would be all OOP for us. I figured if I was here for 4 weeks, that would be at least $2,800, money I would much rather spend on a vacation somewhere with my DH and the kids, not on a hospital room.

Up to now, I've had a wonderful roommate until 2 nights ago when she had a c-section. I know the hospital is a 24 hour operation but she left the room at around dinnertime and the cleaning staff didn't come in until after midnight to clean her side of the room. They turned on all the lights, made lots of noise...hard to ignore that kind of commotion three feet away. Then, they actually checked someone in at 2am in the morning and that new person just had a c-section herself. Now my understanding is that, as a rule, they don't mix pregnant women with women who have had babies but they were so full that they didn't have a choice since they were out of beds. This new roommate was awful. She and her DH stayed in the room, made all sorts of noise moving in and banging into my bed among other things, conversed in normal tones and turned on the TV and left it on all night. Then, the next morning, she was making phone calls at full volume at 7:45am and even turned up the volume on the TV. By this point, having only had a few hours of sleep (and after my bleeding episode the previous night), I was completely irritated and annoyed. I barely got any sleep at all and I was tired and cranky.

I did feel sorry for her because hers was an emergency c-section and her son was just 1lb 9oz and 4 months pre-mature so he will have a long stay in the NICU (neo-natal intensive care unit). However, that doesn't give her the right to be so inconsiderate of others. We are all in the hospital for a reason. I just kept to myself for the morning, hoping and praying that someone was going to be discharged and she would be moved out of the room. By midday, I was starting to feel guilty about feeling so cranky and anti-social and I almost went over to introduce myself but I kept on hearing her DH coughing and then I heard her Mother say that she herself was not feeling well (scratchy throat - feels a cold coming on). Kept the curtains closed. After all, the doctors keep telling me that the biggest risk for the girls and I was the risk of infection and the last thing I want to pick up is a cold.

Early afternoon, a nurse came by to tell me that I was being put into isolation because my roommate was experiencing symptoms of nausea, diarrhea and vomiting (can we say Norwalk?). By being in the same room as her, she had potentially exposed me to any virus or bacteria she herself may have had. I know she did not deliberately do this and that the hospital was full but man was I steamed and my first priority was get away from her as I needed to makes sure I remained infection and virus free. Both of us were then isolated (separately) and that is how I ended up moving into a private room temporarily. Needless to say, I had the best sleep of my life last night and I feel much better this morning.

I'm not sure how long I'll be in a private room as a person from Infectious Disease Control just came in this morning and cleared me so I will likely be moved back into a semi-private room when one becomes available. It was good while it lasted but I could do without any more of those scares. So, grateful for the private room (and the window!) but hoping not to be exposed to any more awful roommates. My DH is also bringing me some ear plugs tonight so hopefully it won't matter how awful they are in the future.

Deja Vu - Bleeding...again

**Warning - this is one of those TMI kind of posts where a lot of bodily functions are discussed**

Last night at around 10pm, I was going about my business and getting ready to go to bed. I am still leaking amniotic fluid and I have described the sensation before as being like having a heavy period. Often, I'll feel nothing, especially if I'm sitting still or lying down; then, when I move, all of a sudden there is a huge gush of fluid. I noticed last night that the flow seemed to be a little heavier so I went to the bathroom to change my pad and I saw what I thought was a moderate amount of bright red blood. Bright red blood is never a good sign.

I immediately paged my nurse. She came down and one of the first things she told me was that bleeding, even bright red blood, was common among women who had ruptured membranes. Their treatment wouldn't vary in that they would continue to monitor the babies and ensure that they were not in distress and check with me for any other signs of pre-term labour (i.e. contractions, back aches, heavier bleeding). She put both babies on the monitor and thankfully, their heart rates were normal and they seemed to be pretty happy as I could still feel them squirming around. My nurse was great though and said that she understood that I would worry but if there was anything that she could do to alleviate some of the worry (i.e. put the babies on the monitor more frequently) she would be happy to come back sooner. I asked her to wake me up at 2am to do another check to make sure that the babies were doing okay.

Before she left, she also checked out my pad and reassured me that, although it looked like a lot of blood, it was also mixed in with amniotic fluid so it makes it look like more than it actually is. In her opinion, it wasn't a lot of blood.

At 2am, true to her word, she came back and put the babies on the monitor again and they were doing okay. She also asked to see my next pad to see how much bleeding there was and the bleeding had already started to taper off but the pad was still stained with bright red blood. Again, she reassured me that since it was mixed in with amniotic fluid, it looked worse than it actually was. She left and then I went to the bathroom only have a huge blood clot come out and fall into the toilet. Having never seen a mucous plug and the loss of one's mucous plug potentially being a sign of pre-term labour, I was immediately concerned that this was what I was looking at and I paged her to come back again. I cannot even begin to tell you how awesome this nurse was - she knew I was worried about it and so she went and got a glove and fished the clot out of the toilet to prove to me that it was just that - a blood clot and not a mucous plug.

I tried to get some sleep and she came back at 6am to do another check. By this time, the bleeding had stopped and I was leaking only amniotic fluid again. It's so strange to go from moderate bleeding with blood clots to nothing at all. The thing that confuses me the most is that I can't use how I feel as a gauge of how things are going. Usually, when something is wrong, you just know and somehow you can tell but each time something has happened (the 1st trimester subchorionic hematoma, the spotting, the rupture, bleeding), I have felt fine. I haven't felt bad at all and then something happens and I can't help but wonder if I somehow caused it. A question I will ask the doctors today during rounds.

So it seems like things have gone back to status quo for now but again, another warning that things can change on a dime. My DH told me this morning that he packed himself a bag now that he's going to leave in the car at all times so if he does need to come down, he's already ready. I'm glad that one of us is ready!

First Week Down

I'm still in the hospital and I am still pregnant.

I am officially past the 1 week mark and today post rupture and I learned some statistics that I am glad I didn't know before. My nurse was telling me that of the women who have ruptured membranes, 50% will go into labour within 24-48 hours of the rupture. Another 30% will go into labour within the first week. Only 20% make it past the 1 week mark and have a good chance of staying pregnant for a longer period. My prospects are looking good at this point and I will stay here as long as I possibly can so my girls can grow as much as possible.

I haven't seen my own OB yet but the doctors here that do daily care of the antenatal patients spoke with him about me and he very clearly conveyed that he would like me to stay pregnant for at least another 2 weeks. I am 32 weeks today and from what I was told, it sounds like 34 weeks is the minimum amount of time rather than the maximum. Of course, I need to speak with him directly, but it appears that if 34 weeks is the minimum, hopefully if everything stays status quo he will let me carry to 35 and maybe even 36 weeks. We shall see but everyone, cross your fingers for me.

Part of being in the hospital is the close monitoring they are doing. My vital signs are checked every four hours and includes a temperature check, blood pressure check and heart rate. My temperatures have always been normal but my blood pressure and heart rates are on the high side. My blood pressure was pretty high at 140/80 when I checked in but I put that down to stress. With a conscious effort to breathe deeply and do some meditation/hypnosis, I can sometimes bring my heart rate down to 120/80 if not lower. My heart rate though has remained stubbornly high at 120 bpm. Normal heart rates for women are between 60-90 bpm. Of course, I consulted with Dr. Google and there were several sites that said that for pregnant women, especially those carrying twins, 120 bpm was not uncommon so I am reassured. They ran an EKG yesterday and a CBC just to make sure there was no underlying infection and to my knowledge, everything has come back normal.

My two girls are also doing well and like to squirm around when they're trying to check their heart rates (also every 4 hours). Now that I have all sorts of time on my hands, I've noticed that little Lefty usually gets the hiccups every day but little Righty hasn't had the hiccups yet. Their movements are also changing - before, they had lots of room to move about in and I would feel a lot of quick pokes. Now, I feel movement more akin to entire limbs being dragged across my abdomen. I have yet to see the actual limb (some women say that they see hands and feet) but the movements are slower and my entire abdomen will shift so that I'm lopsided. It's kind of neat to watch!

Today a few of my friends trekked down to my house to give DH some help organizing and putting together the nursery. This was what was supposed to happen last week before the rupture and I am so grateful to have such wonderful friends who are willing to chip in and help out like this. The upstairs was in a state of disaster as 3 rooms are in a state of flux with the painting of the nursery. My DH moved a dresser into the nursery last night and was putting away the girls' laundry so the conversion from study to nursery has officially begun. I ordered some decor items from Lambs & Ivy which came in this week and I am excited to put the decals up and really make the nursery look girly girly.

We booked a doula this week and I even found someone to do maternity photos in the hospital so it has been productive - well, as much as it can be via telephone & internet. Other than that, I am trying to take advantage of this time and rest and really take it easy to give me the best shot of making it as close to term as possible. A very heartfelt thank you to everyone who has posted comments and offered support to me during this stressful time. It is truly appreciated and has kept me sane.

Update From the Hospital and Thoughts On Becoming A Parent

The high risk obstetrical team makes rounds every day and checks in on all of the patients here. Today, I asked the question regarding how likely it would be that I would be able to carry the girls to term (i.e. 37 weeks for twins). Right now I am 31w2d. The doctor making rounds that day advised me that in cases such as mine with a ruptured membrane, they usually don't like to go beyond 34 weeks as their belief is that the risk of infection at that point outweighs the benefits of carrying longer. So if I'm lucky, I will carry for another 3 weeks at most. My regular OB (who also runs a high risk practice) will come in to discuss with me what we are going to do but I have yet to see him on rounds. I was also told that it is not just the first 48 hours that matter after a rupture - it is the first week after a rupture when most women will go into labour. If I make it past this Friday, than I have a good shot of carrying for a little longer.

The thought of delivering a 34 weeks frightens me. I'm not sure why and I've been trying to figure out what it is that I find so scary. Random thoughts are:

• I'm afraid that the health of my little girls will be compromised at such early gestation and they may have to spend an extended amount of time in the NICU
• there may be long-term effects on the health of my girls being born so early
  
• I'm scared about actually becoming a parent & I feel some days very woefully inadequate and unprepared
  
• I'm scared about the pain of labour and what may happen (i.e. epidural, emergency c-section) and my ability to make good choices under stressful circumstances
  
• this is likely the only time in my life that I will be pregnant and I feel that if I don't carry to term, that means that I didn't do a good job of having a healthy pregnancy
  

When I look back on Friday, the one thing that struck me is the unshakable feeling that the girls were not supposed to arrive that day - it was just too early. I was envisioning the worst where we would lose one or both of them and that it was all spiraling out of our control. I have since been reassured many times that their prognosis even at 31 weeks is excellent and survival rates are in the range of 90% and above but you never know what could happen and I was just so afraid. To short change them 6 weeks in utero seemed like such a long time during which they would have learned valuable lessons such as breathing and sucking (two of the last skills they learn in utero before being born). In addition, with our roots in IF, you know all too well the feeling of not falling into the majority and I can't help but to look at the "what if" of falling in the 10% as opposed to the 90%.

I wasn't clear as well if there would be long-term implications of being born so early. They were going to be so teeny tiny and at last check, they were hovering around 3.5lbs each which seemed so big at the time but so small if they were born right then and there. I was thinking that 3.5lbs was a great start if they were going to double their weight by 37 weeks but as an actual birth weight, I would like to see them in the 5lb range at least. However, that being said, I have since heard stories and have been greatly encouraged by all of you sharing your stories about your preemies (thanks Andrea!) that have more than made it and have done really well. I just want to make sure they get the best possible start in this world.

After everything that IF put us through, I thought that I was more than ready to become a parent but the closer that day comes, the more I realize that it's something that stresses me out. You see, I think of our little girls as these beautiful blank slates and it is up to my DH and I to teach them what they need to know. They're so innocent. We all start out with the best intentions but there are so many dysfunctional families out there...how do we know we're not going to turn into one of those? At what point are good intentions not enough? I have had several nightmares here and there throughout my pregnancy from which I have woken up in tears that tell me that this is something that is weighing on my subconscious. What kind of family will we be able to create for these two precious girls? Don't get me wrong - I think my DH is going to make a wonderful father and I hope that we will be able to raise our girls so that they are happy and secure in the knowledge that they are wanted and loved. I just worry that something may be lost in the execution of our good intentions, that's all.

Labour and delivery is also a big unknown for me. We're trying to hire a doula (labour coach) since both girls are still presenting head down and I am very hopeful that we will be able to delivery vaginally rather than through c-section (and avoid all of the issues with keloid scarring). I'm hoping that a doula will allay my fears and be able to provide us with information as we need it through the birthing process. For some reason, I am also not comfortable with having an epidural - just the thought of having someone poking around in my spine gives me the shivers. However, at my hospital, it is standard protocol for someone having multiples to have an epidural in the event that medical intervention may become necessary. I will also be giving birth in the OR rather than a birthing room for the same reason - just in case medical intervention becomes necessary. I know that this is a natural process and that it happens all the time but it has never happened to me so I wonder what it is going to be like when it eventually does happen.

Anyway, that's what has been rattling around in my brain today. See what happens when I have too much time on my hands?

Admitted to the Hospital

Before I get into the gory details, I have been admitted to the hospital and I am still pregnant...for now. This is not related to the spotting that I had last week but something new. Read on...

Friday night at 6:30pm, I felt a little gush of what I thought was a little heavier than usual discharge. Well, I soaked through the pantyliner and then rushed upstairs to consult the pregnancy "bible" and to put on another pantyliner. Was I leaking amniotic fluid? How does one tell? I had just started eating dinner as I waited for my DH to return from work so I sat back down and started eating again...only to feel a few stronger gushes of fluid. I went and sat on the toilet at which point a few big gushes came out. Then it hit me...this was just way too much fluid to be a leak. Did my water just break???

I was freaking out. We were nowhere near being ready for the babies to come. They were just 1 day shy of 31 weeks and while the prognosis is excellent at this point, it would still be best for them to stay inside for a few more weeks. I have always kept my eye on the end goal of 37 weeks if not 38 weeks and I couldn't fathom having them so early. I was crying uncontrollably at this point, panicking that we would lose one or both of them and really feeling that this was not the right time for them to arrive.

My DH walked in the door and I immediately told him that we needed to go to the hospital as my water had broken. Not the first thing he expected to hear arriving home from work. I was terrified that this meant that we would be delivering that night - once your water breaks, I thought you immediately went into hard labour and that there was no turning back. Thankfully, I would learn that this assumption was wrong.

We arrived at triage where the nurses and doctors calmly checked me out. I was still gushing fluid at this point, the same sort of thing like when you have a period. Nothing comes out until you move and then whoosh - out it all comes. The good thing was that the fluid was always clear because if one of the babies was in distress, it may have passed its stool into the amniotic fluid and then it would no longer be clear and I would probably have been rushed into an emergency c-section at that point. Clear fluid was a good sign.

After a quick ultrasound, it was determined that the membrane hadn't fully ruptured but there was a tear somewhere and that was where the leak was coming from. The sack that tore was little Righty's sack - she's the one that likes to wedge herself right on top of my ribs and her sack was always a little bigger than Lefty's. Lefty's sack was still intact and there was still a good amount of fluid around both. I received the steroid injections to help mature their lungs just in case they did decide to make an early appearance into this world and then I was admitted.

I'll be in the hospital for the duration of my pregnancy. I was told that if I were to go into pre-term labour, it would likely be within the first 24-48 hours after the rupture and after that time, the risk drops off. We're 2 1/2 hours away from he 48 hour mark after which I will breathe much easier. I have not be confined to strict bed rest so I can get up and walk around the floor, which I do at a very slow pace. Every little twinge, every little twang, every little muscle ache or soreness I examine in minute detail to try and figure out whether or not it was a contraction or just a Braxton Hicks or round ligament pains.

I just want my babies to be okay and although they have an excellent prognosis being born at 31 weeks, it didn't feel like the right time for them to arrive. Somehow it feels too early. I am still hoping to carry them for another 6 weeks but every additional day we are grateful for. Please girls, stay inside for a little while longer okay?

Back to the Hospital

It's Thursday and 4 days after I first started spotting.

It hasn't stopped.

After a quick consult with the nurse at my doctor's office on the phone, we decided to trek back downtown and have it looked at again. I've been resting and trying my best to do "modified rest" but the spotting has continued. Granted, it is still dark brown in colour so it isn't bright red, profuse or anything like that. I still don't have any other symptoms of pre-term labour (thank goodness) but I honestly thought it would have stopped by now.

Once I got to the hospital, they strapped on the fetal heart monitors and little Lefty and Righty were moving around like crazy, trying to reassure Mom and Dad that things were okay. They did another internal exam and concluded that the bleeding was still coming from inside the uterus rather than the cervix itself but they weren't concerned because of the colour and the lack of other pre-term labour symptoms.

We were sent home.

I still worry about making mountains out of molehills but after everything we've been through, I want to make sure that my babies stay inside for as long as possible to give them the best possible chance when they finally do arrive in this world. It did strike both my DH and I that the kids could arrive at any moment. That realization was a real eye opener. Time is getting short!

So I'm back at home on modified rest. I hope this spotting stops soon!

Scary Day But Things are OK Now

So I woke up this morning, fully intent on getting up and going to work for my last four days. It is year-end for the company I contract for and we mutually agreed to extend my contract until the end of this week. They have been very good to me and the extension in my contract is the only reason why I now qualify for Employment Insurance benefits.

I have to admit that I still check the TP every time I go to the bathroom, especially after I had all of the bleeding early on from the subchorionic hematoma. Things have been all clear for the past 4 months. Well, this morning at 6:30am, I wiped and found some blood.

OMG.

I wiped again, just to make sure I wasn't seeing things but yep, there was some blood on the TP.

Inhale. Exhale.

I called my DH up from the downstairs and showed him (honestly, we share everything) - what to do? I called triage at our hospital and the nurse asked me a few questions to try to figure out what was going on.

Nurse: "What colour is the blood?"
Me: "Dark brown"

Nurse: "Have you bled through a pad?"
Me: "No - there is nothing on the pantyliner but when I wipe, there is blood"

We go through a few more questions regarding symptoms of pre-term labour like whether I am experiencing any back pain (no), any contractions (no), leaking fluids (no), any cramping (no).

Nurse: "Wait until your doctor's office opens up and see what they say. They'll likely tell you to come in and have it checked out as any bleeding should be followed up with and then come into triage."

My DH and I live in a suburb of Toronto and we decided to go down right away rather than waiting for the doctor's office to open up. It's a traffic thing - if you don't get moving ahead of the rush, you get stuck for a long time and we decided that since it was a high probability that we would be told to go into the hospital, we should get moving ASAP.

Once we got there, we checked in with our doctor's office and was told to go to the hospital so it was a good thing we got a jump on the traffic and left when we did. We checked in through admissions and then went upstairs to triage. By then, I went to the bathroom to discover that there was not a trace of any of the bleeding. Good that the bleeding stopped but bad because I always wonder if I'm making a mountain out of a mole hill and it doesn't help that you can't show the doctor what is going on. I was strapped to two fetal heart monitors and something else to monitor uterine activity and then we waited. The one comfort was that the two babies were moving around like crazy, so much so that my belly was rippling away, and their HBs were right where they should have been, around 150 bpm.

11:30am came and I was up to go to the bathroom and discovered that the bleeding had resumed. Again, nothing on the pantyliner but something on the tissue when I wiped. The resident came in and did an internal exam and saw what I saw so it was good in that we could actually talk about what brought us into the hospital that day. She confirmed that the bleeding was coming from inside the uterus and not from the cervix itself. The doctor came in afterwards and did an ultrasound and both babies were doing fine and showing no signs of stress. His theory is that the bleeding is old blood due to the colour and that there is a tiny placental abruption. In layman's terms, this means that he thinks that the placenta has torn away from the wall of the uterus a little bit. If it was something that was severe and required immediate attention, I would be bleeding profusely and the colour would be bright red. He reviewed with me the signs of pre-term labour and reminded me that this was the number one concern for people carrying multiples. He also told me that I have been having some contractions and I didn't even know it!

He asked me if I was still working and I said that I was and that this was my last week and he said to me "Well, you're done now!" I was pretty surprised but he really wants me to rest more and not work at all. I haven't been confined to bed rest but I was told to rest more and take it easy from here on out.

Wow.

I was reminded again today as to how things can turn on a dime and one second you're fine and going about your business and the next thing you're in triage, having an internal and discussing bleeding. Life can change in a second and I am reminded about how fragile things are. I didn't have a fall, bump into anything, slip and land funny...I don't even think I've done anything strenuous over the last few weeks. However, I guess I need to redefine my definition of "strenuous" because I have been tired lately with all of the Christmas activities. They're fun but they're also tiring.

I'm okay. Lefty and Righty are okay. I'm resting at home. I let my boss know that I wouldn't be able to help them this week after all and that I would be returning my laptop to them. When I was in triage waiting to be seen, 37 weeks seemed to be a LONG way away from my 29w2d. Hopefully, with these changes, we'll have a shot at making it that far.