Okay so this isn’t usually the sort of blog post I write (and it is also the reason I haven’t written one in a long time) but when I found out I was pregnant with my “fourth” and ever-so-casually went to my first prenatal appointment–I mean, none of this is new to me by now–all I thought about was hearing an assuring heartbeat.
Well, we got two of those. I laughed my head off through the rest of the ultrasound, causing the image to shake, completely flabbergasted. Then I cried a little on the drive home, not from sadness, just from being overwhelmed.
I’ll skip the pregnancy recap for now but, suffice it to say, it was my most difficult pregnancy by far while still almost entirely free from complications. I can’t say how thankful I am, because most twin moms have it WAY harder than I did, and it was pretty darn hard to begin with.
Finding out that I was having twins instead of one baby completely changed all my normal plans. My first was born at home, and the next two were at a birth center. Uncomplicated. No issues. Baby straight to my hands, never separated from me. I was able to eat and drink and move and labor without being bothered. I have always been very glad I went that route, or rather that I was able to do so. It’s not that I’m super crunchy, I just like to know what’s going on with my body, and the pain of labor, horrible as it is, is informative and directive and I feel a little scared at the thought of having that input totally cut off. But twins almost always have to be born at a hospital, constantly monitored. Twins often need extended NICU care, twins must be delivered in the OR and epidurals are strongly recommended if not required. C-sections and inductions are routine.
Understand, I am NOT against hospital births or epidurals or formula or anything that better serves healthy outcomes for Mom and Baby. Not a bit. But you can get an idea of how the prospect of delivering twins differed in almost every particular from what I was used to.
I managed to escape the most common problems of twin pregnancies: pre-eclampsia, gestational diabetes, and pre-term labor. I was also what they call a “Di/Di” twin pregnancy, which means that each twin has their own amniotic sac and their own placenta. Most (not all) Di/Di twins are fraternal, as mine turned out to be. This is the lowest risk twin pregnancy.
But at 35 weeks I started to feel persistently itchy all over, and learned about a pregnancy ailment I’d never even heard of: “Cholestasis.” It affects the liver processes, makes mom VERY itchy–a minor matter for me–and increases the risk of stillbirth after 37 weeks, a far graver concern. I requested a lab, and, a week later, I was diagnosed with Cholestasis. I was told that I should be induced the very next day: at 36 weeks and 6 days, just one day shy of what is considered “term” for twins.
(Those queasy of stomach may opt out now, not because this is terribly frightening or gory, but just if you’re not particularly comfortable with pregnancy-related biological realities)
Desperate not to be induced, because I’ve heard that Pitocin-induced contractions are way more intense than natural contractions, I asked the doctor to sweep my membrane (A simple, short procedure, where the doctor “sweeps” their finger between the membranes of the amniotic sac). Takes about a minute, and is extremely uncomfortable, but often does the trick of kick-starting labor if your body is already headed in that direction. We also did some other activities to help labor along and that night I started having contractions. Then they slowed and we decided “oh well” and went to bed.
I did not sleep well that night. At all. And I generally slept very well this pregnancy, which is unusual for a lot of people. Then, at 3:00 a.m. the contractions started back up. I was hoping and praying that they were doing their job (dilation and effacement). We ate breakfast and headed to the hospital around 7:00 or 8:00. When they checked me an hour or so later, I was 4 cm dilated (as opposed to 1 cm the previous day…1 out of 10, for anyone unfamiliar with such matters). So they just let me alone to labor naturally. I was so relieved. No induction!
Labor progressed slow and steady, especially compared to my last labor which was 7 hours start to finish. I had three separate monitors strapped to my belly: one for each baby’s heartbeat, and one for my contractions. I also had a line in my arm for fluids and for anti-biotics since I had tested positive on the GBS swab (a minor inconvenience). I had a blood pressure cuff attached to my arm that checked me automatically every so often. I’ve never been all hooked up like that, but I could still stand, walk around a bit, sit on a birthing ball, etc. I changed position as often as I could, and we probably looked pretty absurd every time I had to go to the bathroom, because we had to unplug ALL THE THINGS, and walk with the IV and all the cords to the bathroom.
My husband was awesome and had my back the whole time, encouraging me through each contraction. From 4 cm to 7 cm (about 5 or so hours) the contractions remained manageable, which is to say, requiring severe focus and breathing and even vocalization, but I was never out of control.
Now, two of the things I had been most worried about (other than the safety of the babies) were c-section, and epidural. Every doctor and midwife I talked to was very positive about my chances to have a vaginal birth, the only necessity being that Baby A (my girl) was head down, which she had been since about 32 weeks. Baby B (my boy) had been transverse the whole time, which is fine, because the second baby can literally change position during delivery, after Baby A makes some room. Some doctors are unwilling to deliver Baby B in a breech (bottom or feet down) position and would encourage a C-section, but luckily every doctor I interacted with said that my previous three uncomplicated vaginal deliveries meant that they had no problem going forward with vaginal delivery, and they weren’t worried about Baby B’s position.
The epidural, however, they all seemed keen on. No matter who I talked to throughout my pregnancy, no matter how encouraging they were about every other preference, they all said I would probably have to get an epidural, or that I really, really should. I did not want one. As labor went on and on (not long by some standards, but longer than my last two for sure) I began to think I would give in.
In all my other labors I’ve not been restricted on eating or drinking during labor, but at the hospital they only let you have “clear liquids” (pop, juice). I drank those for their sugary calories but, come early afternoon, I began to feel weak and shaky, and having nothing but bits of juice sugar seemed to make it even worse. I felt like I wasn’t going to have the strength to deliver, and maybe I should just do what the doctor (repeatedly, kindly, firmly) advised and get the epidural.
I am SO grateful that my husband insisted we talk it through, that he didn’t want me to regret making a decision in the heat of the moment, so we should make a decision while I was still coping well and stick to it no matter what. I was almost too tired to talk it through, but I am incredibly glad he did that (he had the clear head for it.)
We decided no epidural. The doctor sort of sighed in concession and warned us of the problems, that if something went really wrong I’d have to go under general anesthesia. I knew that. An unlikely outcome, but a genuine risk: if that happened I would not be awake to see them born. But I knew that if it were a severe enough emergency as that, I would probably have had to receive general anesthesia anyway.
The doctor was very gracious and accepted our decision despite his strong recommendation to the contrary, for which I’m very thankful.
The second thing we decided was that if, after Baby A was delivered, Baby B didn’t go vertex (head down) with external guidance and it became necessary for the doctor to reach up inside and manipulate his position that way, I would get a spinal block for that. A spinal block is a one-time shot (not an IV/Catheter) that numbs the area for a short period and can be administered quickly in the OR. It’s not something for a dire emergency, however, because it takes a few minutes to prep, and a minute or two to kick in. I didn’t WANT one, but I respected the doctor’s warning about how if he had to reach up and internally manipulate, I might lock up–since having someone’s hand all up inside you is NOT a normal labor pain–and put the baby in distress. I was told this is common in such circumstances, and I took that seriously.
So we had a plan.
By about hour 14 of slow, steady labor with very gradually intensifying contractions, I reached 9 cm. I was amazed, because even though I was weak, and I had to vocalize a lot (basically moan in low, low voice) through contractions, I was still coping and never felt like things got out of control, never felt like I was gonna lose it. Usually I hit a point of “Oh no, this is too intense, how will I do this?” But the intensity was so gradual in its ascent that I never felt quite that way. I was really weak from hunger though, and that did make me nervous, especially since I knew I’d have to do the delivery part twice.
We decided it was time to head over to the OR and I would have them break my water. In all my labors my babies are born within minutes of broken water: 45 for my first, 15 for my second, 2 for my third. So I had good reason to believe it would go quickly. And I was desperate for it to go quickly. I was so tired.
At about 6:00 pm or something I walked to the OR (I could still walk! I stopped midway for a contraction) then was helped onto the OR table. Much less comfortable than the hospital bed, and my back had been aching in that bed (back labor? I don’t know, it mostly felt like very tired, sore, weak muscles). It seemed to take a minute for everything to get situated, then they got the hook and broke Baby A’s water. That always intensifies things: I was pushing pretty quickly after that.
I had kind of hoped that the babies would just come out in one or two pushes because, compared to my other kids, they would be so much smaller at only 37 weeks. It did only take a handful of pushes, maybe 3 contractions’ worth, to get my little girl out, but it felt like it was taking a long time. Towards the end, I could feel the doctor pulling at the perineum, like…stretching it, and I did not like it. The pain got really bad as I did the final pushes and I yelled. I found out later (my husband managed to get video, amazingly) that this was when the doctor put his finger up to pull the cord off my little girl’s neck. She cried immediately, still halfway inside! But that huuuuuurt.
Then they put her on my chest. Well, on my belly, really, because her cord was short and didn’t quite reach that far.
I’ve had all boys, and she is my first girl. I just wanted to hold on to her and take in this new reality of a daughter. She was covered in vernix, and I forgot to ask them not to rub it off. I was kinda distracted.
But the contractions started back up within just a couple of minutes, though I couldn’t do anything with them–couldn’t push–because they had pulled up the ultrasound to look at Baby B’s position and see what needed to be done. I was so nervous, and overwhelmed by knowing I had to do the whole thing again.
But he was head down! He had been transverse (crossways) the whole time, and was just waiting for his turn to dive down!
However the doctor said it looked like his hand, and perhaps his cord, were up by his head. The hand presents possibility of worse tearing, and the cord of course can cause dangerous problems. The doctor said there was a chance that, as I began pushing, he would need to reach up and move the hand and the cord.
Because we had made the decision ahead of time, I asked for them to go ahead and do the spinal block. I was afraid of the pain, yes, and so very exhausted, but the potential for baby’s distress was the reason we had made the decision beforehand, so I think (hope) I didn’t do it just from fear. Part of me was relieved that I had a good reason for this because I was so tired, and pushing my girl out had hurt worse than I expected for some reason.
I worked through a few more intense contractions without pushing, and then I had to curl sideways in the fetal position to get the shot in my back. It felt like my belly was empty by comparison, even though I had a whole other baby in there (not to mention, he was the bigger one!)
Immediately my legs went tingly, and then numb. It was the strangest sensation. My legs looked…dead. I did not like that at all. I could just still wiggle my toes, but the legs hung lifeless in the rests. I was grateful for the pain relief in the moment, but goodness I don’t think I would ever do that again. It was so weird and disconcerting. The anesthesiologist told me she had given me a half dose, presumably because it was obvious that this wasn’t going to take long.
It seemed to take a really long time for them to break my little boy’s water, but it was probably scant minutes. I had to push while they hooked until it broke, then they had to instruct me to push after that because I couldn’t feel the contraction when it came. I kept saying “Am I pushing? Am I pushing?” because it felt like I was doing nothing. Both in the moment and in retrospect, I really don’t like that. The disconnect was just…I don’t know. Not my favorite.
In the end, I pushed just a few times, and my boy just sort of worked his way out with my numb pushes.
Everybody assured me afterward that I made a good call, that babies often go into distress and have emergency c-sections whenever the doctor has to reach up. But in the end, he didn’t have to reach up, so part of me feels sad that I was numb even though I was immensely grateful for the relief in that moment.
Delivering a baby and then knowing you have to get right back and do it again? That is rough. Usually the moment of delivery brings a gush of relief. It’s over! My placenta usually comes out with almost no effort, a gentle push and no pain, so once the baby is out, everything else feels like nothing, and it’s all easy downhill from there. But knowing you have to go right back to it again is so daunting.
But my little boy came out safe and sound, which is the most important thing. They put him on my chest (his cord was longer) and rubbed him hard, because he wasn’t crying yet, but he was clearly doing just fine. I didn’t catch their APGAR numbers, but I think they were both good scores on color and breathing etc.
Soon both the babies were in their little warming/checking stations there in the OR, getting looked at, getting their oxygen checked, warming up, while I delivered my placentas and continued to wiggle my toes, boggled at the numbness in my legs. The placentas were kind of stuck together, and my husband got a video of that too, because my oldest sister LOVES that stuff. She, and my next sister, and my mom were all watching my three other kids at home.
That was another thing that made me a little sad in an otherwise positive experience: my boys couldn’t be there. My kids have no illusions about how babies come out. My eldest has been present for delivery twice, and I have explained it to them in no uncertain terms. I hate the idea of my kids thinking the babies somehow “come from the hospital” or from anywhere other than from my belly and out the proper exit.
Anyways, my husband followed my little girl, “E” to go get in the room and under the warmer, and my little boy, “P”, was still getting his checks while I got a little stitch or two. Surprisingly little tearing for birthing two babies!! Then they did this funny little thing where they rolled me on my side and sort of hitch/scoot/lifted me over, off the OR table and onto the hospital bed, and rolled me and my little boy into the post-delivery room.
When I got there, they were trying really hard to get E’s temperature up to the required mark. I was holding P pretty soon, and I kept asking them to give me E, because I figured skin-to-skin would do the trick for her (and when they finally gave her to me, it did.) I nursed them soon after, and my husband put in an order for the one thing so many pregnant women have longed for: sushi!!
While we waited for my sister to bring the sushi to the hospital, we marveled at how utterly, hilariously different these two are. Full head of dark hair and petite features for E (“עדין” was the word my dad used. Like, delicate, or “fine”) and P, practically bald with blonde peach fuzz, looking an awful lot like his second oldest brother. Looking at them side by side, you wouldn’t even think they were related.
E came out at 5 lb 13 oz and P came out at 6 lb 7 oz, both a bit smaller than their last growth scan estimates. So, remember, if you have to get growth scans, take those things with a grain of salt. Mine weren’t dramatically off, but I know they can be.
But those are such good weights for twins born at 37 weeks (or, technically 36 weeks and 6 days)! I was so proud of them (you know, as if they have any control over that…)
Then began the more tedious part. They had me on a Pitocin drip to prevent hemorrhage, they were checking my blood pressure all the time, and–to our shock!–they had to heel stick the babies before I fed them each time so as to test their blood sugars. They had to do this because they were preemies on a technicality (by one day!) and told us that they usually do it for 24 hours, but if they remained above a certain mark, they could stop doing it by 12 hours. Thank goodness we managed that because I was tired of them having to get heel sticks.
They also checked their temperatures frequently. Everyone was wonderful and kind, but we were just not used to these kind of constant checks, so it was a bit wearing. Anyhow, we ate the ever-loving daylights out of some sushi and sent a bunch of pictures and videos to the family chats. As soon as I proved I had the feeling back in my legs–which I got pretty quickly–and was able get up and use the bathroom, they wheeled us over the Mother-Baby side. It was still sometimes a revolving door of nurses and doctors, but the activity slowed and we were able to sleep a bit here and there. There was still paperwork to sign, a class to attend, a car-seat test.
We took a lot of pictures of them tucked side-by-side, of course, which was particularly amusing because they don’t look anything alike. (Sorry if this is disappointing but I don’t post pictures of my kids online!)
Of course, because of COVID, nobody was allowed to come see us or the babies. At this point, both sets of grandparents and both of my sisters were at our house, and my dad and my father-in-law were setting out on a drive to pick up the used passenger van we purchased since we weren’t gonna be able to be present ourselves for the transaction. Having twins caused us to very abruptly outgrow our minivan, since we have a 110 lb wolf we have to squeeze in there somewhere.
Originally we were told that we would have to stay a minimum of 48 hours after delivery, but we asked if we could go early. They were not pleased with the babies’ weight loss trajectories, and wanted to postpone the circumcision as well, but so long as we were willing to come in the next day for a follow-up weight check, they would let us go after 36 hours.
We did all the discharge requirements, of which there were several, and then they released us. My older boys were, and remain, enamored of their twin baby sister and brother, and bestowed upon them many kisses and hugs. This was the longest I’d been away from my boys, and we were so glad to be home.
The twins are two weeks as of today and we are making it so far. My mom is still here helping, and my sister lives with us right now, so I have a lot of back-up. But I’m trying to figure out methods and schedules for survival’s sake once that back-up is gone. In the mean-time, I’m so thankful for an uncomplicated delivery and healthy babies that are eating and sleeping and thriving.
So that’s my twin birth story. I wrote this because when I found out I was having twins I couldn’t get enough stories, data, information, or advice. I consumed it all to the point of obsessive absurdity. Thought I’d offer up one of the things that I so desperately wanted and sought ever since the midwife looked at the ultrasound and brightly said “Now, what do we have here?”