Tuesday, June 26, 2012

The journey begins

Today was the day that the babies were coming. They had decided, and I had been in labor since the night before. Unfortunately, I was having a hard time getting the nurses and doctor to believe me. I had been at Swedish Hospital on bed rest for a week, and was exactly 27 weeks pregnant with the twins.

By the morning of the 26th, I had been in labor for 8 hours and given Tylenol for pain and Ambien to help me sleep. Neither worked. I was being constantly monitored but the machines were not picking up the severity of my contractions, most likely due to back labor. When the parade of phlebotomists, nurses, doctors, nutritionists, social workers, food services people and more started streaming into my room beginning at 6am I was already an emotional wreck. I could barely hold myself together.

Something was definitely wrong - I felt like I had little dragons breathing fire in my spine.

My doctor (who was normally pretty on-the-ball) informed me I was having twins and that my pain was due to having twins and a growing uterus. I wanted to strangle him. Nurses chalked up my cramping to the placental abruption I was still dealing with, but they were wrong. My mom arrived, started asking questions and called Jimmy to come down to the hospital urgently. She knew what was happening, but it was a bigger problem trying to convince the nurses that I was in labor.

***
On March 14th, at 12 weeks pregnant I was rear-ended in a minor motor vehicle accident. We had barely told anyone we were expecting the twins. Although I was shaken up, nothing seemed out of sorts and I made my way to work. Three hours later, my water broke.

I met Jimmy at our Perinatologist's office that afternoon. Luckily we had already been seen by Dr. H, who specialized in high-risk pregnancies, two weeks prior. We did a "peace of mind" ultrasound with our Nurse-Midwife Kris, and she was having difficulty seeing Baby B on the small monitor. They took us quickly into the large ultrasound room for a closer look. It was evident that something was wrong - Kris mentioned that there was no fluid around Baby B. I kept telling her my story about the accident and the "gush" that I had experienced earlier but it seemed like they just couldn't believe it.

Dr. H came in and did a quick look on ultrasound. He confirmed the findings, saying that it "doesn't look good for Baby B". We asked what to do, and he said that we "watch and wait." We agreed.

They sent us home with strict instructions to keep an eye out for infection, take frequent temperatures, and further measures. Otherwise, we would watch and wait. It was explained that we could have had kidney dysfunction causing the lack of water, or it could have been Premature Preterm Rupture of Membranes or pProm. We wouldn't know for sure until 16 weeks, when pProm was confirmed.


pProm (Premature Preterm Rupture of Membranes) occurs in the second trimester in less than .4% of pregnancies. There is no data for the first trimester, which is when our rupture took place. Forty percent of pProm pregnancies deliver within the first week of rupture, and 30% remain pregnant after five weeks. Survival rates diminish the earlier the rupture occur; maternal and neonatal risks are severe. If the baby does survive to delivery, the lack of amniotic fluid causes many problems, including severely impaired lung development that would prohibit survival outside the womb. There were other issues, like joint contractures, that were entirely treatable - but because of pProm the chances of your baby being born with tiny or non-existent lungs are very great.

Our doctor, who has been practicing high risk Perinatology for over 25 years, had never seen or heard of a case like ours.


***
From March 14th to June 26th, we remained pregnant for 15 weeks. We had survived 104 days from pProm and several bouts of placental abruption related to it. I was on bed rest for 10 weeks, 9 of which were spent on the couch at home watched closely by Jimmy and my Mom. We had a whole community to thank for making it this far: family and friends for food and company, flexible work environments, people all over the world sending thoughts and prayers, and more. Finally, our pregnancy was coming to an end and we were about to see just how accurate the statistics about pProm were going to be.


***
The nurses finally started to get the idea that I might be in labor and might have an infection in the afternoon. With pProm, infection is the biggest risk to Mom and babies. When some lab work came back suspect, I was whisked away for an ultrasound and an amniocentesis. We didn't have time to process what was about to happen. Once settled in the office, I signed a consent as they prepared for the amnio. Dr. H came over with a very large needle and told me to be very still. He withdrew a sample from a very small pocket of Baby B's fluid while we watched baby wriggling around. I held my breath and hoped that we both did not move. The fluid, when collected, was merlot colored and it was not known if the sample would provide the results needed to show whether an infection was present. It was obvious that the abruption was still affecting Baby B.

Following the ultrasound we went back to the room. Nurse Kris came quickly after and asked if she could do a physical check to see dilation. With pProm patients, this is always avoided due to risk of infection. I agreed, and we all took bets on the results. Kris ended up winning - I was 4-5 cm dilated and fully effaced. "You're having these babies tonight," she said.

Things moved into motion for delivery, though the method had still not been determined. The on-call doctor, Dr L, was on his way in. I was on IV antibiotics and magnesium sulfate to promote brain development for the babies. As soon as the doctor arrived, we discussed our concerns and a cesarean was decided - we planned on 8:30pm.

Jimmy and I were nervous and excited, but terrified. We were not yet certain how things would turn out. We went to the Operating Room at 8:30pm and I got the epidural. Things moved quickly forward then; the room was filled with so many nurses and staff ready to assist the babies that it was overwhelming. Within minutes, the babies were out.

***
8:54pm: Maisie Angeline (Baby A) was born, and she cried gently. Her apgars were 5 & 7.
8:55pm: James Douglas (Baby B) was born, and he came out screaming. His apgars were 7 & 8.
The neonatal teams worked fervently on them while Dr. L was finishing up. Jimmy went to see them and left with Maisie. When James was ready to leave for the NICU, he was rolled over to my side. He winked at me, and was whisked away.

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