Saturday, January 30, 2010

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 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.

Thursday, January 28, 2010

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.

Tuesday, January 26, 2010

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!

Saturday, January 23, 2010

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.

Tuesday, January 19, 2010

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 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?

Sunday, January 17, 2010

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?

Thursday, January 7, 2010

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!

Monday, January 4, 2010

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.


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.


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.