Arrival, Part 1: Actually Arriving

In retrospect, I could probably write a long blog entry about the signs of early labor I’d been dealing with for several weeks by the time I went into the hospital on the morning of Wednesday, March 14, because as it turns out, I’d been dismissing a lot of things that I shouldn’t have been: actual contractions, loose stools, pelvic pressure, the works. For as much as I fancy myself knowledgeable on topics of pregnancy, labor, and delivery, I actually was completely clueless when it came to recognizing that I’d been in early labor for several weeks.

BUT this is already going to be long, so I’ll just fast forward to Tuesday.

Tuesday, March 13, we had a nor’easter here in the Commonwealth of Massachusetts. It was the third in less than three weeks, and everyone had a feeling of fatigue when the forecast called for a whole bunch of snow on top of the stuff we’d gotten the week before. Sam’s school was closed for the day, Kyle was working from home, and I was adamant that I absolutely would not go into labor that day.

no

Not that I had a lot of reason to believe I’d go into labor so early, of course. Despite my immense discomfort, my pregnancy had been smooth and healthy, and the twins were growing steadily enough. I itched like hell and was begging for my bile acid test to show that I had ICP so that I could start receiving treatment for it, and of course I had the aches and pains to be expected with carrying twins, but I had no reason to suspect that I’d be delivering them any earlier than overall vague guestimates of 36-38 weeks. I expected Easter babies, I expected several more weeks of misery, and I expected my body to listen when I demanded that it NOT go into labor in the middle of a snowstorm.

And, well, I didn’t, but I was uncomfortable. The discomfort was nothing new, but I just felt overall unwell, tired and full of malaise. Both were easy to chalk up to late pregnancy misery, but late pregnancy misery or no, I was relieved when it was finally time for bed.

I’ve mentioned before that falling asleep while so enormously pregnant is a difficult process, and on Tuesday night, it was no different. I rolled and I shifted, I stretched and I turned, and eventually, I fell asleep on my side, facing a gently snoring Kyle. And I’d been sleeping pretty well, too, until around 2:30 a.m. Kyle’s hand must have fallen from wherever it was resting as he slept, and it gently thwacked me in the belly, jolting me out of sleep (as even a gentle jolt against that belly is enough to shock me into consciousness). I sleepily berated him and then began the difficult task of walrusing myself out of bed to use the toilet.

Because when you’re that pregnant, you always need to use the toilet.

When I got back to bed, I settled down in my sleeping nest and was immediately greeted by hip-to-hip pelvic pain. It was pretty bad–a six or seven on a scale of 1-10.

a-better-pain-chart(per Allie Brosh’s fabulous chart, I saw Jesus coming for me)

Still, I dismissed it as round ligament pain for the most part. The entire team who’d cared for me throughout my pregnancy had warned that, especially when you’re carrying twins, round ligament pain can be excruciating. I’d just gotten up and shifted my position, which logically had shifted the twins’ position and thus the position of the pain. The fact that I managed to fall asleep within ten minutes seemed to further my conclusion that I wasn’t really in labor, that it was just regular aches and pains, that I’d be fine by morning.

Well.

Morning came as it always does. Sam woke Kyle up, and the two of them started to head downstairs in order to let me sleep a little longer (until 8:30; it was 7 at the time). The trouble was that I couldn’t fall back asleep because the pain was still there, just as bad as it had been at 2:30 in the morning. I shifted and rolled and tried to calm it down with positional changes, but it persisted. Still, I didn’t want to call it “labor” because it didn’t feel like contractions–the pain wasn’t coming in waves or intensifying and releasing. It didn’t take breaks; it just hurt. At that point, I thought I’d just really aggravated the muscles, but I still wanted to call a doctor, just to be sure.

So I called Kyle up. “Don’t start freaking out,” I told him, “but I’ve been cramping since 2:30 a.m., so I’m going to call the doctor if moving around, eating breakfast, and drinking water don’t help.”

To his credit, he kept his freak out internal as I shuffled downstairs and slowly ate breakfast. He got in touch with his boss and said that he might not be in that day. I gently urged Sam away from my lap and ate, still not noticing any ebbs and flows in pain like you’d expect from contractions, but instead noticing that the pain was lessening the longer I sat. Not lessening, however, were the number of Braxton Hicks contractions I started feeling.

Braxton Hicks contractions, for the uninitiated, are painless “practice” contractions the uterus goes through in the last several months of pregnancy. The uterus tightens and releases, but the contractions do nothing in terms of thinning or shortening the cervix, so these contractions don’t require medical attention. They’re annoying and can be pretty intense, but they’re not a sign of anything going awry.

And I was having them Wednesday morning, but they weren’t at regular intervals, and they certainly weren’t painful. Intense, yes: the way the muscles in my abdomen tightened left me entirely breathless and unable to do much until they relaxed. But painful? Not even close. It was like involuntarily trying to deconstipate or lift a heavy object; again, not painful, just a lot of effort.

I finished breakfast and excused myself from the living room, where Sam was pretty engaged with his movie (Moana, maybe? I was a little focused at that moment). I intended to sit at my computer and google my symptoms while calling the nurse line and making sure that my phone had some good labor playlists on it, which was one of my last checklist items. To my annoyance, my computer had decided to install updates overnight, so I watched it balefully while chatting with the nurse line and coming up with a plan of action.

Initially, the on-call nurse suggested that I go to an appointment at their Westborough office to get checked out. Because the pain wasn’t strong and rhythmic, she said, it didn’t sound like labor, so a quick appointment would probably help me figure out what it was and end with me going home to rest and drink water. She’d talk with the physician assistant on call to make sure, but she said it just sounded like I needed a quick once-over and that I’d be fine. My appointment would be at 9 a.m.

I got up and started pulling myself together, texting my mother to ask if she could watch Sam for a little bit, telling Kyle that he should probably hold off on going to work for at least the morning, and planning to just drive myself the half hour to Westborough and get checked out on my lonesome. Five minutes later, the nurse called back after speaking with the physician assistant. “She thinks you should go straight to labor and delivery,” the nurse explained. “It’s probably nothing, but since you’re expecting twins and since you’re 34 weeks along, she just would rather have you there, just in case.”

Alright, cool. I got off the phone and told Kyle and my mother (over the phone in a different conversation) of the change in plans. We’d drop Sam off at my mother’s house on our way to the hospital, in Framingham, and then pick him up later today or tonight, depending on how long they took to monitor Isaac and send us home. “Just in case,” I gave Kyle a list of things to pack in a labor bag, like our chargers and a bathrobe for me and so on. I went to help get Sam get dressed.

Five minutes later, the phone rang again. This time, it was the doctor at the hospital where we’d planned to deliver. “How far are you from here?” she asked. “Because the roads aren’t great, and if this is an emergency, we don’t want you to have to travel far. I see that you have two hospitals closer, Saint Vincent’s and Memorial. Saint Vincent’s is actually our affiliate, so why don’t you go there?”

COOL. I told Kyle about the new change in plans, passed the information along to my mom, and bundled everyone up in the car. I kept my phone in my hand, just in case they called again, and we sped along the highway for the ten minute drive between our house and Saint Vincent’s.

(you may wonder why we weren’t going there in the first place, and in fact, I had Sam at Saint Vincent’s, and it was a great experience. This time, I’d been more interested in following my OB-GYN, even though it meant a longer drive to an unfamiliar hospital, so heading to Saint Vincent’s again was… off-book, to say the least)

My mom met us up at registration, where the Braxton Hicks contractions hadn’t really let up and were keeping me from concentrating on the questions at hand: things like emergency contacts, insurance, and so on. We hadn’t planned to deliver at this hospital, so we weren’t preregistered or anything, and every question and signature only served to make me appreciate the preregistration process more. After what seemed like hours of paperwork, but was really only a few minutes, the registrar set me free and found me a wheelchair, which Sam desperately wanted to ride in. We denied him this and instead distracted him with the fancy glass elevator between floors.

Once off the elevator, our motley crew wheeled through the hospital’s grand atrium (complete with birds, trees, and a working waterfall) until we reached the Center for Women and Infants. Our party split there–Sam and my mom went to the waiting room while Kyle and I continued on to one of the labor and delivery suites, the one in the farthest corner of the hall.

The room itself embodied the unsettling sort of Lovecraftian aesthetic that’s so familiar in our part of the state, for better or for worse. The walls had a sort of mauve-and-seafoam Victorian border against beige “texture,” broken up only by a large picture of babies in hats. Jesus stared down at us from a silver crucifix–after all, it’s a Catholic hospital–and something about the decor gave the flavor of a turn-of-the-20th-century asylum more than anything else. The view of bricks and snow and the grey light from outside the frosted window only added to the eeriness, and I laughed with Kyle at the sight. Wouldn’t it be funny if I really was in labor and this was the where of it all?

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Ha.

Every trip to labor and delivery begins the same way. Once you’ve been admitted, the nurses send you into the bathroom, where you pee into a cup, take off all your clothes, and change into a gown that is in no way large enough to cover you. You’re lucky if it ties at all, enormous belly considered. You’re also lucky if they remember to give you a plastic baggie of slipper socks (I was not lucky on Wednesday, at least not to start). Once this is all done, the nurses return to you and place monitors the size of whoopie pies all over your belly to monitor your kids and your contractions. This is uncomfortable, but definitely not the most uncomfortable experience of the day.

It’s even more uncomfortable when you have one twin who is just completely disinterested in being monitored ever, ISAAC.

The nurses found him eventually, though, and I explained my situation to about 50 people coming in and out of my room to do various things–take my blood pressure, give me an IV, ask me what was going on, ask me how far along I was, introduce themselves as Nancy (I had three Nancys helping me at one point). At length, the nurse midwife on call came in, introduced herself, and performed a pelvic exam, which felt like the fist of God. I figured this would be the thing to send me home–that she’d have reached up into my tonsils and come down with the conclusion that I wasn’t dilated at all, that I just needed to poop, and that I could go home.

As I writhed on the bed and grimaced and Kyle watched me and eventually remarked, “That didn’t look like fun,” the midwife hummed and finally withdrew her hand. “You’re about 60% effaced and at a -1 station, and you’re also about 4 cm dilated.”

gastomg

And now, a lesson on dilation, effacement, and labor.

In labor, the muscles on the sides of your uterus contract to thin out, or efface, your cervix while simultaneously opening, or dilating, your cervix. The goal is to reach 100% effacement and 10 cm dilated, which can take anywhere from hours to weeks. Over the course of this process, your muscles also ease your baby, or babies, into the birth canal–their station is a determination of how close they are to birth, with -5 being “nowhere near the birth canal” and +5 being “actively being born.”

Dilation is the number most people are familiar with, and it’s also the number doctors use to determine whether or not you’re in active labor. Most won’t send you home once you’re past 4 cm dilated, and suddenly, there I was, having no idea that I’d been dilating at all and being told that this, this was it. I was 4 cm dilated, and because of the twins’ gestational age, they weren’t going to do anything to stop it. I was having two babies, and I was having two babies on that day, Wednesday, March 14.

This is, I believe, the third time during this pregnancy that a surprise revelation has caused me to say, very loudly, “Holy shit!”

Knowing that I was in active labor, everyone picked up the pace. I got a bag of fluids to start my IV adventure, and the doctor on call wheeled an ultrasound machine into the room to double check Isaac and Carrie’s positions, the latter of whom remained breech. The midwife also came back to do my test for Group B Strep, which I’d not had done yet because, again, 34 weeks pregnant. Nobody really expected me to go so soon. While I was being poked and prodded and having my dignity slowly removed (it’s kind of a burlesque routine), Kyle took charge of calling and texting everyone to let them know that hey, babies were coming TODAY, surprise!

Partway through the tests, the doctor came into the room with me and sat down next to my legs on the bed. “So we have a few options here,” she said. I liked her a lot from the get-go; she was young, with a broad smile and the most gorgeous dreds I’ve seen in my life, dyed a golden ombre. She also had the matter-of-fact attitude that I appreciate about doctors, and a sense of humor about the whole thing. “Because Baby B is breech, we normally wouldn’t be able to give you much–you’d have to delivery by Caesarian. We do have a doctor here today, though, who specializes in breech deliveries. So we could let you labor through and try to deliver Baby B breech. We could also have you labor through and then attempt an external cephalic version after Baby A is born–that would just mean me pushing on your stomach to try and get Baby B to turn head-down for delivery. There’s no guarantee either of those would work, and in both cases, that would mean a C-section. You also have the option of just going for the C-section from the get-go. It’s all in your hands; whatever you want to do, we’ll support you, because the babies are both healthy and responsive, and you’re young and healthy as well.”

This was objectively refreshing. There are a lot of stories around the internet as a whole telling of forced C-sections, cascades of interventions, and painting doctors as pushing women into unnecessary C-sections for a variety of reasons, depending on how conspiracy theory you want to go with these things (liability, money, the Illuminati told them to, etc.). And I’m not saying that sort of thing never happens; I’m sure it happens plenty and in plenty of places around the country.

But. Having a C-section presented as my choice, having it be my choice, was really refreshing amidst those stories. It set the tone for the entire experience: even though a C-section is a situation in which you literally have no control over a lot of things, the medical team made sure I had control over this one thing, and that helped so much.

So I chose the C-section. I love delivering vaginally; it’s a huge rush, and I’m damn good at it. With Sam, it took me all of 45 minutes of pushing and he was out and home free. I know I could probably do a breech delivery, especially of a pre-term baby, and I know that I could cope with the discomfort of a version if I had to. But all that said, the idea of going through all of that, of laboring and laboring and trying these methods and having one fail and needing a C-section anyway? I hated it. A C-section was never my ideal, but in that moment, I knew it was the right choice for me, and I told the doctor as much.

And thus the prep began.

My C-section was tentatively scheduled for somewhere between 2 and 4 p.m., leaning closer to 4 p.m. so that (a) my breakfast would digest, and (b) the steroid shot given to help the twins’ lungs mature even a little bit more could take effect. A steady stream of people flowed in and out of my room, everyone doing something different, having me sign a different form, telling me details of a different facet of the procedure.

(Kyle sneaked out to get a slice of pizza and some coffee somewhere in there as well)

I got bags of antibiotics, both because of the surgery and because we didn’t know if I was positive for GBS or not. I got more fluids. I got another cervical check, confirming that I’d dilated to nearly 5 cm. I got a nice shave–of my bikini line. I got to meet Joe, the nurse anesthetist, who had me sign an entire book of papers. I signed that book of papers. I signed some more papers about surgical consent. I signed more papers about drug testing (standard procedure for preemies). I had a third cervical check, confirming I was at 5.5 cm.

Around 3:45, another nurse anesthetist (Nancy, not to be confused with Nancy the admitting nurse or Nancy the baby monitoring nurse) brought me a cocktail of drugs to stave off the nausea I’d normally have experienced with anesthesia. I choked down something impossibly bitter while another nurse gave Kyle his own set of scrubs, complete with hat and booties. Another nurse rolled a pair of slipper socks onto my feet, and another wrapped a sheet around my shoulders like a robe. I heard another woman give birth across the hall, and I applauded, though I don’t think she heard me.

Nancy the Nurse Anesthetist and another nurse (possibly also another Nancy, I lost track) served as my escorts as we left the labor and delivery room and made our way down the hall to the operating room. I’ve been in my fair share of operating rooms before, especially considering my history with IVF, but this one came as a pleasant surprise to me. Sure, the table and room overall were cold and sterile, but something about the two radiant warmers set up and covered with blankets settled my nerves. They seemed to say, nothing bad will happen here today. Today, this room is a room of life.

At Nancy the Nurse Anesthetist’s instructions, I heaved my walrus body up onto the operating table, my butt as far back as I could manage without actually falling off (wouldn’t that have been an adventure?). Once I’d settled, she introduced me to Sergei, another anesthesiologist, who would be monitoring me. Sergei’s job, at that point, was to keep me from moving or being too uncomfortable as Nancy gave me my spinal block, a sort of epidural on steroids that essentially turned off my entire body below my stomach. Sergei didn’t completely succeed: the spinal block still briefly felt like someone driving knuckles into my vertebrae, but at length, a warm sensation flooded down through my back and legs, and I felt insanely dizzy. Sergei and Nancy lowered me onto the table, and my legs disappeared from existence.

Well. That’s not true. I felt my legs. I felt my entire lower body. It just felt like instead of existing as things that could be moved on their own or used, they were all wrapped in a heavy blanket, warm and comfortable. The weird part was that I couldn’t move my legs or wiggle my toes, no matter how hard I tried. A lot of people would logically find this weird or frightening; I thought it was hilarious that I was putting so much brain effort into something so simple, mostly because I knew it was temporary.

Anyway. I couldn’t wiggle my toes, and soon, I couldn’t see anything below my chin, as the medical staff placed a huge blue sheet so close to my face that I kept inhaling it. Nancy the Nurse Anesthetist clucked her tongue at this. “I always tell them to put it a little farther down; it doesn’t need to be in your mouth,” she scolded nobody, moving the sheet away from my mouth. Meanwhile, below the sheet, someone remarked to me, “Abigail, this is going to feel like sandpaper, alright?” And then I felt no sandpaper, just someone rubbing my belly a lot. The rubbing didn’t stop and eventually turned into more of a rocking as my doctor arrived.

“Are you going to pinch me to make sure I can’t feel anything?” I asked nobody in particular, remembering what I’d seen in educational videos on C-sections. My doctor smiled at me over my sheet; or I assume she smiled, because she was wearing a mask.

“I have been,” she assured me before returning to her work. A moment later, Kyle came in, though I couldn’t really see him because of his placement and my position. Still, I gave him a cheerful smile.

“Hi honey!” I said. “I can’t feel my feet!”

“I saw your guts!” he answered in as cheerful a tone. “They’re yellow!”

Because, as it turned out, they’d already begun the surgery before he came in. I was mildly disappointed–he’d brought my phone with him so that I could play my C-section playlist, which started with Weird Al’s “Like a Surgeon”–but hey, it meant he got to see my guts. That’s a privilege not many people have experienced.

(and as he said saccharinely later that night: “Now I can say with all honesty that I love you from the inside out.”)

Someone warned me of pressure and tugging, but I didn’t feel anything different, and then before I knew what was happening, I heard a cry: angry and small and demanding to be heard. “Isaac,” Kyle confirmed, and I started to choke up.

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“He’s crying,” I said. Hearing your baby cry right when they’re born is such a relief, especially if that baby is being born early. Crying means breathing. Crying means that air is coming into and going out of their lungs. Crying means that, even if just for this moment, your baby is alright.

And Isaac was crying.

And before I could get over that emotion, I heard another cry, this one an angry kitten. “Carrie,” said Kyle, and I cried again. Carrie’s warmer was within my field of vision, and I watched a half dozen nurses surround her, rub her, and start to care for her.

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I couldn’t look away, even though my neck started protesting the position after only a few minutes. I didn’t know or care what was happening below the blue sheet. I didn’t mind at all that my upper abdomen was being used as a repository for tubs and tools and the like. I just wanted to see my babies and see that they were alright. Someone placed a mask over Carrie’s face, and I knew that she was receiving oxygen, and that was good. The doctor poked her smiling head over the sheet again. “We’re about 75% done with you, alright? You did a great job, just hang in there.”

And then came the twins, Isaac first and then Carrie, both bundled up in blankets and hats, both amazingly pink, even pinker than Sam had been when he was born. I kissed them both on the cheek, touched their soft skin, told them I was there and that it would be alright. And then they were gone, off to the nursery, and Kyle and I sat in the OR and waited for my stitches to be complete.

“You did a great job,” everyone kept saying, and I wanted to laugh. A great job at what, lying immobile on a table? If I’d known that was all I had to do to get such high praise, I’d have started inviting observers to my naps a long time ago.

They took the blue sheet down, and I could see the doctor fully now; she was spattered with blood, but she looked pleased. “Everything went really well,” she said. “Great job, mama. Those are some really healthy babies, especially for their size and age.”

A handful of nurses concurred. One said that the twins had the healthiest umbilical cords they’d ever seen: “so thick and coiled and full of nutrients. Good job mama!” I thanked them for this, though again, I had NO idea what I might have done to construct such awesome umbilical cords. I still don’t know what I did, but if I ever find out, I’m 100% going to market it and get super rich in a Gwyneth Paltrow GOOPy sort of way. Shoot, I might just pretend that I know what I did and market it anyway, like maybe I’ll say that it was because I ate so many Milano cookies and I’ll sign a deal with Pepperidge Farm and everyone will buy Milanos because (a) delicious and (b) really healthy umbilical cords!

Anyway.

The nurses rolled me out shortly thereafter, and Kyle trailed along behind on the path back to our eerie room, where I took my first steps of recovery and we started to learn how the twins were doing.

But that is another blog entry altogether.

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