The twins arrive!

It's funny that I published my last post when I was 27 weeks, 3 days. Turns out I would go into labor that night (though I would not know it till the next morning!).  Throughout the past MONTH of hospital stays and bedrest, I had contractions all the time. Some days were good, others were bad. Overall I was really getting used to having contractions, although I still HATED them (they didn't hurt, but they stressed me out!).

So that night, I was having more contractions than normal. I told the nurse, who told the resident. I told her that they were on the stronger side, and that they were much more frequent than normal. I eventually managed to sleep a little bit, although not very well. The resident was apparently monitoring the contractions, and apparently not concerned enough to do anything about them.

The next morning the contractions were still there. During morning rounds, I told the doctors about it (and started crying a little… clearly I knew something was wrong even before anything was confirmed). One of the residents checked me and found that I was now 5-6 cm dilated, so they said they would be sending me back to labor and delivery. That was pretty upsetting, but I was still hopeful that they could put me back on the drugs and stop the contractions, and I could buy a few more days or weeks.  Boris arrived (after being at work for about an hour), and they checked me again and I was 7cm dilated. At that point, waiting wasn't really an option -- I could either try for a vaginal delivery or go straight to a c-section.  Vaginal delivery would have been ideal because I would get to labor and buy some more time (as the doctors said, if the labor stalled, we could potentially buy another day or two), but baby B, in typical babyB fashion, was faced the wrong way. Plus, I was told that at that point, if my water broke we would have to have a c-section and it would be a true emergency, which would have sucked.

So off we went to the OR. Not a pleasant experience overall.

Some highlights from the OR:
 - The nurses attempting to give me an IV failed multiple times (I was pretty used to this… I think I got stuck around 50 times in the previous month). At one point they tried to console me by assuring me that they had gotten the IV in, but that my vein had burst. Yea, that makes it better (I still have a bruise over my entire left hand).
 - The epidural/spinal was not nearly as bad as everyone made it out to be. Overall, I think this experience has made me a lot tougher!
 - Being awake during the surgery is super gross. The best line was from the doctor saying, "Christina, you're going to feel some pressure as we put your uterus back in." Um, what? WHY IS IT OUT?! Obviously I didn't really know what the procedure would entail!

The actual best part of the surgery was when they came out (obviously). Amelia came out, and we heard lots of commotion, "baby out!" "Confirm gender!" etc.  But then we heard her cry. And it was the perfect little cry -- the cry of a baby that might be tiny, but was ready for this world. When Boris and I heard it we looked at each other and immediately started crying ourselves.  We had spent the previous month worrying about these kids without ever meeting them, and now they were here, just on the other side of the curtain.  I can't really even express how amazing that little cry sounded, although all the moms and dads out there probably do in fact understand. Then we waited for the next baby. We heard the same commotion, "baby out!" "confirm gender!" "Girl!", but then we didn't hear a cry. I kept asking, "Is she okay??" and the general consensus seemed to be yes, although I still never heard her cry (apparently she did, I just didn't hear it).

The babies were whisked away pretty quickly and I was left to be stitched up. Boris offered to stay with me but I wanted him with the babies. So they stitched me up and I went to recovery. The worst part was that because the babies were in the NICU and I was physically incapable of moving, I didn't get to see them until I had recovered enough to get into a wheelchair. I failed my first "dangle" test (i.e. dangle your feet off the side of the bed) when I got sick, and later threw up my gatorade lunch, so I didn't get to go see them until late that night.  But when I did, it was pretty amazing. They were so little, but they were doing really well. Breathing on their own (yay steroids!), on 21% oxygen (same as room air), and generally behaving.

Mere minutes old:

 

The next four days was a bit of a blur. Learning to pump, getting wheeled to the NICU as often and for as long as possible, and trying to recover. I was discharged four days later, and got to go home and sleep in my bed for the first time in a month. It was pretty glorious, although having to wake up in the middle of the night to pump is pretty shitty. I know it's hard for all new moms who have to feed their new babies at night, but pumping is really the worst. All the work, and none of the fun. I don't get to look at my baby when I pump… I play candy crush. Not really what I want to be doing in the middle of the night.

Having the girls being in the NICU has been a real roller coaster.  At the beginning they were doing so so well. They were NICU rock stars. I had high hopes that all the advice I had heard about there being ups and downs would not apply to our little girls, they would just get bigger and better every day and never have any slips.  That lasted for a few days, then they started stressing me out constantly.  Both of them forget to breathe on a regular basis. Apparently that's normal for preemies, but oh my god, so stressful for parents. You sit next to your kid and all of a sudden alarm bells are going off and nurses are running over to startle them into breathing again.  All you have to do to bring them out of it is rub their back usually, but it's stressful to be there when it happens! Amelia also had some digestion issues where she wasn't digesting her milk (fed through a tube) and was instead giving back some gross green crap. She also couldn't poop on her own.  Eventually they decided that her high-pressure nasal cannula might be upsetting her stomach by pushing too much air into it, so they switched it out for a different one, which seemed to work. Alexis has been consistently a little healthier, and getting fatter just a little faster. Both have gained weight from when they were born though, which is great progress for only a week. They are also already up to 15ml of breast milk every 3 hours. A "full feed" for their age is 20ml. They are so close! Once they are up to full feeds, they theoretically don't need any of the nutritional supplement that they get through an IV.

Overall, they are making good progress. I've gotten to hold Alexis 3 times, and Amelia once (for an hour each). Now that Amelia isn't dropping her heart rate as often, hopefully I'll get to hold her more.  They are so so so so so cute. We love them so much. They don't even look that tiny to me anymore. They just look perfect! 

Day 2 (2/21)

Holding Alexis for the first time:

Day 3  (2/22)

Day 4 (2/23)


Mom's first diaper change:

Day 5 (2/24)

Day 7 (2/26)

(Getting a blessing from the Jewish Chaplain)

Day 8 (2/27):

26 weeks - back at the hospital

It's been over a week since this all happened so I may have forgotten some of the details, but I wanted to memorialize my experience so that I can one day tell my children how much grief they gave me before they were even born.

At home on bedrest

After my last post, I was at home on bed rest with a pretty positive attitude. We still had a great chance of making it to 36 weeks, and the outlook was as good as any of us could have hoped for. I was 25.5 weeks. On Thursday and Friday I felt awesome - barely any contractions, and I even was able to lay on my back for a few minutes without causing a contraction. That's all I really wanted in life at that point - to be able to lay flat and stretch out for a few minutes a day!

My family is amazing and someone came every day to take care of me. My brother Jason came and basically lived with us for 3 days. Boris slept on the couch (since my hospital bed was downstairs and I couldn't get upstairs) and took care of me at night, and my brother or my mom took care of me during the day. My brother was especially good at feeding me - we wanted to fatten up these babies so his goal was to get me to eat 3,000 calories a day (2600-3000 is the expected range for twins, depending on who you talk to). I ate well and my spirits were up.

On Saturday my mom came by for a little while before heading to my aunt's house to prep for my cousin's baby shower (she is due in April!). Everything was still great when she left.

Around 2pm I started noticing contractions a bit more regularly. They never really went away during the preceding days or weeks so I wasn't surprised, but I started counting them. At 2pm there were only 2-3 per hour, which was pretty normal for me at he hospital. But by 7pm, there were more than 5 in an hour and I started to get worried. Boris tried to calm me down, but even when I was in my sloth mode (which usually helped to slow contractions), they kept coming. I knew they would probably go away soon, but I also knew I would be worried all night so I called the doctor. The doctor on call was my doctor's brother. He said that because of my history (ie the recent hospital stay) I should come in to be monitored. Since I had only been home for a few days, that was pretty discouraging. Our perinatologist had given us a prescription for indomethacin (the more effective anti-contraction drug) with the instruction to only take it if we were coming back in (ie don't just self medicate and think things will be okay), so we took a dose of that and headed back to the hospital.

Sequoia hospital
A few minutes later we were back at Sequoia. I had texted my mom so she was there minutes later. Luckily for us, my doctor apparently has no personal life so he was already at the hospital and was able to see us pretty quickly.

Once again, the look on my doctors face when he performed the exam was horrifying. Before he said anything, Boris grabbed my hand because we could tell it probably was not good news. My doctor said to the nurse "we need to get her tilted backwards. I see bulging membranes." Then he looked at us and said the dreaded words: "We need to transfer you to Stanford."

When he said that, it was probably the worst thing I had ever heard in my life, and was also one of the worst moments of my life. At our previous stay at sequoia, nurses and doctors would reassure us by saying that if it was serious, or if we were really going to deliver, we would not be at sequoia - they would send us to Stanford. So when we realized that's what was happening, we also realized that this meant the babies were probably coming... Soon.

My doctor told me that I was now dilated to 2 cm and that he could see membranes bulging out. Not good. Needless to say I immediately began balling hysterically.

The sequoia team started me on magnesium again. Not fun, but again I was glad to have it.  45 minutes later the transport team from Stanford arrived. They prepped me and got me in the ambulance and 30 minutes later I was at Stanford.

When I finally saw the doctor at Stanford, the resident examined me again and determined that I was already 4cm dilated, even though I was only 2cm an hour before. So that was pretty bad news. We spoke to the high-risk specialist and he said that he would finish out the course of medication that sequoia had given me, but would not give us any more than that, because "studies show that they are only effective for 24-48 hours." My doctor has quoted few same studies, but reached a different conclusion - he said hat even though studies show that on average they are not effective over the long-term, everyone is different and they may be effective for me. Since the risks and side effects were minimal, why not try? The Stanford doctor basically just said no. We were... Upset. I told him that I could accept that treatment plan, but not until he spoke to both my OB and perinatologist and they all could agree that it was the best treatment plan. He came back later and agreed to give us one more dose.

That first night, we were visited by a doctor from anesthesiology and from the nicu. Both told us what to expect. The anesthesiologist explained that since the babies were so tiny, I might have to have a "classical c-section," where they cut vertically instead of horizontally. This would mean I could never have a vaginal delivery for any subsequent children (no VBAC option at all). The nicu doctor explained the mortality rates for kids at 26 weeks, the types of health problems they typically encounter, etc. As you can imagine, none of this was easy to hear, especially at 1am. Five hours earlier I had thought we were going to get to 36 weeks, so it was a rude awakening.

We made it through the first night, which seemed huge because we hit the 26 week mark the next day. I found out the next morning that my mom and Boris's parents were still there, sleeping in the waiting room (or more likely just not sleeping at all). My mom stayed all day. I felt bad because that meant she missed my cousins baby shower - I was already bummed that I had to miss it myself! My siblings all came to visit that day too. It was a really scary time and I think none of us were in a "good place" emotionally at the time.

We made it through another day, which at this point was already longer than the doctors had predicted. They checked me again and determined that I was still 4cm dilated, so we had stopped the downward spiral at least! That was the best news of the week. I got a new room (previously I was in more of a waiting room that is right next to the nurses), which was shared but I didn't have a roommate. [A few days later I got my own private room - its small but that's okay.]

Ultrasound... Attempt #1
The next day, a nurse came up and said she was taking me for an ultrasound upstairs. I didn't know why, but we went (my mom was with me). They took us upstairs to the Stanford maternal fetal medicine unit in a wheelchair and dumped me there to wait. Minutes later we still didn't even know why we were there. At this point, it was be longest I had been upright in weeks. It did not feel good. I started getting lightheaded and really a stressed out. When they finally came for me, I asked why we were there and they explained that they wanted to do the detailed anatomy scan. I already did that weeks before, so I knew it was a TWO HOUR test. I was contracting like crazy, felt like shit, and they want to probe my belly for 2 hours? No thanks. We bickered for a few minutes and I eventually just told them I wanted to go back to my room immediately. The doctor later explained that they needed their own scan, because it is their "policy" not to accept the scans from elsewhere. I was unimpressed with this rationale, since I was very confident in my perinatologist (and she trained at Stanford after all...).

Ultrasound... Attempt #2
Later, a different doctor gave me a more convincing reason for the ultrasound - that if I delivered (which they still considered to be "imminent,") it would help the nicu to know exactly how big they are, and have a recent ultrasound to know what to expect. I reluctantly agreed to the scan because that made more sense to me. When we went again, I wasn't having as many contractions so it was a much better experience overall. That's when we learned that the babies were 2 pounds each!!

Steroid shots
On Tuesday, the perinatologist and residents came by on rounds and said that they wanted to give me a second "rescue" dose of the steroid shot that helps the babies' lungs. I had my first dose at sequoia 11 days before. They only work for about 14 days though. The tricky part is that you only get two doses - so this would be my last one, and it would be out of my system if they were born more than 15 days later. I agreed to he second dose because as they explained, even though it's very good for babies to have the steroid shot, a baby born at 28.5 weeks is already much better off than a baby born at 26.5 weeks, so they don't need it as much. It was scary to get the shot again because it meant that the doctors thought delivery was likely within the next 3 days, but at least we knew there babies would have the best possible shot of survival if they were born.

Life at Stanford hospital
As I mentioned before, the folks at Stanford have very different philosophies than the docs at sequoia. I wasn't thrilled with their treatment plan at the beginning, but after making it a few days, it got better. While scary, my life at Stanford significantly improved. I'm no longer at a 6 degree backward incline, I'm allowed to walk to the bathroom, I'm not on any more medication, and the food is WAY better. So overall, my quality of life is better now.

27 weeks!
Almost exactly a week after arriving at Stanford, we made it to 27 weeks! That was so so exciting for us! The doctors even began referring to me as "stable"!! Of course they haven't performed an exam to check how dilated I am since those first few days so we don't really know how stable I am, but still, it's a much better description than the "imminent delivery" that people had been using for the previous week.

Now, my doctors say that if things start getting worse, they will even put me back on the magnesium to try to "break the cycle" of contractions if they get much worse. Who knows if that will do anything, but at least we know it's an option.

Shattered pregnancy dreams.
One of the hardest things about this process has been adjusting my expectations... Downward. When we found out we were having twins, we gave up on the idea of a 40 week pregnancy, and accepted that we would only go to 36. When I went to the hospital, I realized even 36 weeks would be tricky, but thought we could still get close, and I was hopeful that we could get to 36. After being transferred to Stanford, I had to again adjust my expectations - that now, we are aiming for survival, not perfection. That was a hard adjustment, but we came so close to delivering at 26 weeks that we adjusted quickly. There were many tears and many days where I couldn't think about anything without wanting to cry. Boris and our families were similarly stressed which made it even harder. It's hard to watch your spouse lose weight and never sleep because of anxiety.

I also feel like I kinda got ripped off. I didn't enjoy my first trimester and sure, I had my complaints during the second, but for the most part I was legitimately enjoying my pregnancy. I liked that I could finally out-eat Boris, I liked wearing cute maternity clothes, and We just had so much to look forward to. I feel like the rug was pulled out from under me. I was barely pregnant for 6 months before I had to start living in a hospital gown. I never really even got fat enough to be truly uncomfortable.

I also never got to transition my work load before I left. Instead I basically disappeared after sending a few emails via iPhone while heavily drugged. It's not how I wanted to leave things, especially on "my" case  (the one I had been managing). Luckily other folks on the team stepped up and one key coworker returned from maternity leave, but it was very frustrating to just leave in the middle of everything.

Thank you!
I really have to say thank you to everyone who has been thinking of us and praying for us. I have never been religious, but I felt a lot better hearing about all the prayers out there for us. The success stories were incredibly inspirational, and got is through that first horrible week at Stanford. Every comment and "like" on Facebook is important to us. We feel so blessed to have so many pekoe out there rooting for us. I am fully convinced that this is why we have already made it this far. So thank you to everyone for your thoughts and prayers!!

Today I am 27w3d. We are counting down to 28w, and hopefully further. Now you are all caught up! 

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24 weeks - at the hospital

Last Friday I went I for my standard once-a-month visit with my OB Dr. Hoff. One of the questions I had written down was, "how will I know if I am feeling contractions?" I had read that I should call my doctor if I felt more than 4 in an hour, but I didn't really know what they felt like.  I explained one type of "expansion" of my belly that I had felt before and asked if they might be contractions. Dr. Hoff said "almost certainly" and noted that some amount of contractions are normal. Throughout the rest of the day I started noticing these funny contractions and naturally started flipping out every time I felt one. I told myself nothing had changed except that now I knew what I was feeling, but that didn't help much. That night we went to our "twin pregnancy" class and I started noticing a number of contractions towards the end. On our way out Boris asked the instructor about the contractions and she said Braxton hicks contractions are very common and that I should go home and relax with some tea. I did and felt better. That weekend I also felt surprisingly good.

On Monday I noticed a few more and downloaded a "contraction counter" app on my phone. On Tuesday I felt a little "off"  (generally sick) and counted what I thought might be 5 contractions in an hour. I figured I was overreacting but my friend (who is also pregnant) convinced me to just call the doctor so I would feel better. I called and they suggested that I come in to sequoia hospital to be monitored for a few hours. I ended up staying for 5 hours because my doctor was swamped and that's how long it took him to come see me. He did a brief exam and told me to stay home from work the next day to see how I felt - if I felt bad, I could come back to the office the next day for a sonogram.

The next day I actually felt great. I felt a contraction here and there when I moved, but generally felt pretty fabulous. I knew I probably didn't need to go back to the doctor since I felt good, but since I still felt contractions when I moved I decided to just go in. Why not? I had taken the day off so I has time.

Dr. Hoff is very chill. He is typically very unimpressed by the complexity of my pregnancy. Twins? Big deal. He delivered 4 sets last month. So when he started the sonogram and immediately said "ooooooooh that's bad. Ooh, that's really bad. You are definitely on bed rest" it pretty much scared the shit out if me. His typical smile disappeared and I struggled to fight back tears as I tried to understand what this all meant.

What I saw on the sonogram was also really scary. Nine days before, the perinatologist checked my cervix and it was a nice healthy 3.8 cm. Now it was "funneled" (ie opening) and less than 1cm at the shortest point. Dr. Hoff told me to go straight to labor and delivery at sequoia hospital next door and that he would meet me there. I left and went over, feeling contractions along the way, and texted Boris and my mom about where I was headed.

By the time I got set up on the monitors Boris was already there. They hooked me up so that you could see each contraction, which was really scary because I realized there were way more than I had been feeling.

When the doctor arrived he started me on nifedipine, an oral drug to stop the contractions. That did basically nothing so they added terbutaline, which makes you feel like you justlhad 10 cups of coffee. That stopped the contractions for a while but wasn't going to last for long and it still didn't stop them completely. I was really anxious to stop them and didn't really understand why they were taking the slow route - I was like "DRUG ME!" So they opted to out me in the infamous magnesium sulfate, affectionately known as "flu in a bag." When my sister was in pre-term labor a few years ago I witnessed what it did to her so I was pretty aware of what I was in for. The "loading" dose where they load you full of the stuff was pretty miserable. I went from feeling drunk to feeling like I was going to melt from the inside (SO hot!) to promptly throwing up all over the place (many thanks to my fabulous husband Boris for predicting this in advance and locating the barf bags before I actually needed it!)

After a while on the magnesium I started feeling better but the contractions hadn't stopped so I was surprisingly anxious for more drugs. My doctor had been consulting with my perinatologist, and they decided to add indomethacin to the mix.

Fast forward 12 hours and the contractions have slowed down, I'm on an IV, I've had blood drawn multiple times, I am now on about 10 different drugs, and my magnesium level is approaching the highest level that my nurse has ever seen. Needless to say we did not sleep much that first night. I think breakfast arrived right around the time things were slowing down.

Somewhere in the middle of this I realize how amazing my mom and Boris have been, and that this is probably pretty unpleasant for them as well. At one point Boris broke my heart when he said "I just keep thinking this is all just a bad dream and we are going to wake up and be in bed." I had been so focused on my own stress that I hadn't really thought about how hard this must be for him. He had to worry not only about out little ones, but also about his wife being harassed and poked and made to be so sick.

At some point in the middle of the night the results come back from our fetal fibrobectin (ffn) test, which theoretically indicates whether I'm likely to go into labor in the next week. The result was negative (yay!). The doctors and nurses spoiled my fun by reminding me that there is a 10% false negative risk, but it was still good news (although I would argue that labor in a week, at 25 weeks, is still pretty flipping terrible. Admittedly better than 24 weeks though).

By the weekend (4 full days in the hospital) things were starting to normalize. My doctor had seen me every day and things at least were not getting worse. My mom gave me a "Pinecrest shower" (or washed my hair in a bucket on the bed) so I even almost felt human again.

At this point though, the discomfort of being in bed was almost unbearable. It's one thing to be stuck in bed - that I could handle. It's quite another thing to be stuck in a bed with a decline (ie my head is much lower than my feet) and stuck laying on one side or the other. Every time I lay on my back I get a contraction, so that seems to not be a real option. By Monday (nearly a week) I felt like I was laying on two broken hips, but every time I tried to adjust I was punished with a contraction. I figured it was better to be miserable and pregnant than miserable with micro-preemies, so I mostly just toughed it out (although not silently - I bitched a lot!)

On Tuesday we were discharged to my perinatologist so I got to go OUTSIDE! It was awesome (although surprisingly, I was more excited to just see the hallway if the hospital because I had been trying to remember what was out there for the past week). At the perinatologist I got the standard ultrasound to check the fluid of the babies, etc. my doctor and perinatologist were there with the technician to look. Fluid levels looked good, and there was no evidence of twin-to-twin transfusion syndrome (remember when THAT was my concern?!??). Then the moment of truth, they looked at my pitiful cervix via ultrasound. What we saw was as good as we could have hoped for - while it is still small and I still need to be on bed rest, much of the funneling had disappeared and it looked like it was closing up a bit. The doctors were cautiously thrilled, and while they noted that it could change again tomorrow, this was a great result. The perinatologist is convinced that two of my medications - progesterone and the indomethacin, had decreased the fluid build up and taken pressure off the cervix, allowing it to close back up a bit. It didn't "re-grow" (unclear whether or not that is possible), but the smallest point is now much longer because the funnel isn't there. So we will take it!

I got home later that afternoon. My family had come and set up my new rented hospital bed with much more comfortable mattress pads, so I am much more comfortable now. My brother Jason also stepped up to the plate and agreed to be my caretaker during the week while Boris is at work. He's been great - keeping track of my calories and always asking if I need more food :) we are going to fatten these kiddos up as much as possible in case they arrive early!

So that's my explanation of where I have been all week. Thank you to everyone who has been praying and sending good thoughts. They seem to be working! No doubt I will have more posts about my bed rest hell - hopefully for 12 more weeks!!

Ps sorry for any typos... Had to write all this with one hand on my iPhone!


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