Monday, April 25, 2011

Twin Birth Story: Cruise Control and epidurals

Having a baby without an epidural is sort of like not using cruise control in my car. I simply like to be in control. I'm not against epidurals (or cruise control for that matter). I think if you use either one you are probably very normal. I personally never use cruise control, because, well frankly, I'm afraid if I'm not "controlling" the situation, I might just fall asleep, get lazy, or forget what I'm doing. I chose with both my births to try and not use an epidural, for the same reasons I don’t use cruise control: I wanted to feel in control. I understand there are lots and lots and lots of things that can be out of a momma's control when giving birth...LOTS of things. However, if there was anything that I might be able to try to control, then I wanted to. I wasn't dead set on it. I knew I was going to try to have a natural twin birth, but I had no expectations as to what that would look like. I knew I wouldn't feel like a failure if I got an epidural or if I had a c-section. I knew as long as babies and I were happy and healthy...ok, as long as we were just healthy I'd be fine with whatever the outcome of their birth story would be.

I was 37 weeks and 4 days and Dr. C was ready to break my water and get things moving (yes, it was his weekend off and he doesn't work on Fridays) so his orders to have me come in Thursday morning may have had something to do with his personal agenda and I was ok with that! I was ready to get these babies out. My doula on the other hand was not excited about the idea and tried everything she could to talk me into waiting for the babies to come on their own terms. I listened, I heard, I understood what she was saying, but in the end, I had to make my own decision. I had made a final trip to the aacupuncturist to loosen up, I was dilated 3 cm, babies were both measuring over 6 lbs and I was beyond ready as my belly was probably close 4 feet around!

I arrived at the hospital at 7:00am per my doctor's orders the previous day. My nurse that morning started to go through some mundane questions that she asked as she stared at the computer screen and typed in the answers very routinely. "Will you be using an epidural?" As I answered her question, she stopped in her tracks and turned around and looked at me. "No?", she asked with a question mark. "No." I answered again and I went back to checking my facebook updates. “So then”, as she continued to dumbfoundly stare at me, "You are having twins, right?",  "Do you plan to use the Bradley Method?",  "Have you done all your research?"  I could hear her chuckle and saw her look at the other nurse. It was as if her eyes said to the other nurse, "yeah right, we know how this is going to end".

I didn't study the Bradley Method. I did buy the book 2 years ago since my Doula suggested it before my daughter was born. I giggled as I skimmed through it looking at 1970's sketches of a naked hippie chic with her naked hippie husband behind her birthing a naked hippie baby on their bed. Although I didn't have the right to laugh since that was the way I came into the world 32 years ago. The chapters I did read scared me. Birth is terrifying and awful enough I didn't like reading about it. I wanted to enjoy my ignorance. I believe sometimes that ignorance is bliss. When I told the nurse I didn't really "study" it, but I did skim through the book she said, "So, you're just gonna wing it"?  I couldn't find a witty way to respond, so I just answered, "yep".

I believe I gained some credibility with her later when she learned that it was not in fact my first birth, but I had given birth less than two years ago to my daughter with no epidural while being induced with pitocin. And really the only way I got through that birth naturally was because of my Doula Wendy and my fabulous male nurse Dan'L who spoke so calmly and elegantly in the most intense time I think I would've done anything he said. My husband said Dan'L missed his calling. He would've had 100% success rate had he been a negotiator who talked suicide victims off ledges.  My current nurse said in her opinion pitocin and no epidural is the hardest and most painful combinations. So it was with that information that I believe she maybe thought that I might could possibly have twins vaginally with no pain medication. And secretly I think I had as much faith in myself as she had in me that I could actually, maybe, possibly do that.

Dr. C arrived at 8:00 and sat down at the edge of the hospital bed and broke Baby A's water. The water kept coming and coming and I saw Dr C jump up so fast from the bed as the water began to get all over his nice clothes. He gave me a look as if I had just thrown a bucket of water on his head and he jokingly said he was just glad he hadn't taken a shower yet.  Baby A had a large bag of water. And what a relief it was when it all came out. It was if I had been drinking for weeks and hadn't had the chance to pee yet. Awe, that relief you feel when you finally get to a bathroom. This sensation was no different. It was a huge relief. As Dr. C left, he said he would be back in a few hours to check on me. I jokingly said not to take too long because the babies were coming fast. I was being sarcastic, of course, as I had very little hope that would actually be the case.  I may have appeared calm and been flippant about birthing twins, however, that was just my coping method. I knew I was in for it; I just didn’t want to think about it. Sarcasm usually becomes my friend in these situations.

When I asked the nurse about other scenarios when doctors break the patient’s water vs. letting it break on its own, she told me I would probably be there well into the night and she explained to me what time her shift ended and what I would expect during the shift change as she was prepared to not be my nurse when the babies were born.

My Doula Wendy  arrived soon after the Dr. left and we decided to begin walking around the birthing ward. Since she coached me through my first birth we already knew what to do. Before I even got up out of the bed contractions had already started. Not just any contractions…hard contractions.  I labored very intensely for a few hours. I walked some, squatted some, and laid in the bed some. I rarely opened my eyes and when I did, all I could see was the next contraction. There was a time where I must have looked at someone funny. It didn't phase me, but she said, "you're probably wondering who I am?" I thought to myself that no, I was not really interested, but go ahead. She said that my nurse had stepped out and asked another nurse to fill in. She laughed and said, "So, we all came in because we wanted to see what was going on." I looked around and sure enough there were about 7 or 8 nurses in my room. My doula said that they all wanted to see a "med free twin birth in action and I had been the talk around the maternity ward". My husband said it was as if I was unicorn and everyone in the hospital wanted to come and get a look for themselves.

During these hard hours of labor I remember my husband holding my hands telling me I can do this, rubbing my shoulders, and constantly asking me if I needed anything, or wanted to do anything different. When I’d start to breath out of control or start to break down, he’d simply tell me to “get it together” and I’d begin to focus again. He would hold one arm while my Doula, Wendy, held my other arm and I would squat or try to walk through a contraction. Wendy would smooth out the wrinkles on my forehead and rub her thumb between my eyes reminding me…ok, more like telling me to relax. She kept telling me not to work so hard through the contractions, to just let them do the work. It was when she told me that even lame women who cannot walk or feel have babies because the body does all the work, that I began to feel myself relax and truly let my body work.

It’s a little tricky when you are trying to walk around and labor on your own vs laying up in a hospital bed through the contractions. In a hospital bed they can keep a monitor on you and on the babies, but when you get up to walk around they have to unhook you from the monitors and this makes the nurses very nervous as they are responsible for you and the baby (ies) if something goes wrong. The nurse allowed me to be off the monitor for 15 minutes at a time and then would make me get hooked back up. After a while she had a hard time finding Baby A’s heart rate and it seemed that his heart rate would take a dip or just completely stop for a few seconds. This did not sit well with the nurse. My doula was convinced that it was because Baby A was so low pushing into my pelvic bone that the nurse could not get a good reading and assured me the baby was fine. My instincts, whatever they were worth at this time, also told me he was fine. The nurse wanted to put a monitor on the tip of the babies head. This meant she had to reach inside and stick a small needle like monitor into his head. I was told it was harmless to the baby and the doula advised me to let her do it so that it would help put her fears to rest. Sure enough, as soon as she got the monitor into the babies head his heart rate seemed fine. It never dipped, it never stopped.

I was stuck at 7 cm and knew if I didn't do something drastic I'd be there for a very long time not to mention with a large uncomfortable monitor dangling between my legs. I had flash backs of laboring with my older daughter. I was stuck at 5 cm with her for h-o-u-r-s. I decided at that point that I would give it all I had for the next 3 contractions. I would squat through them as low as I could go and wouldn’t give up. I had to think like the little engine that could and began to tell myself, “I think I can, I think I can, I think I can”. Two contractions later I was ready to give up and get back in the bed. I didn’t think I could do it. I told my doula, I need to take the next one lying down. However, the contraction beat me to the bed! As I was trying to get back into the bed the contraction was too strong so I went ahead and squatted at the edge of the bed as low as I could go. I felt something pop.

I wasn’t sure what happened, blood rushed out of me and I was pretty sure I just had a bowl movement all over the floor and the only explanation for the blood could be a ruptured hemorrhoid I never knew I had.  I flashed back to my first daughter’s birth where the nurse informed me that having a baby felt like you were pooping and she needed me to push with my bottom and not with my feet. She was right. And with that memory I looked at the nurses faces and realized that there was no poop and there was no hemorrhoid and as I reached between my legs it was confirmed that there was a babies head…right there…ready to fall out onto the floor.

They immediately made me lay down in the bed and made an emergency call to my Dr. to get over here. My doctor had called a few times throughout the last few hours to check on me and the nurses informed him of my quick progress every time. He told the nurse not to wait until I was 10 cm to call him, but to call him when I was 9 so that he wouldn't miss the delivery. Well, I was certainly passed the 10 mark when they called. Originally my doctor told me I could deliver the twins in the delivery room, however, when Baby A’s heart rate was dipping the staff felt I needed to go to the operating room as a precaution when it was time to deliver. So right away they wheeled me into the OR where the surgical team introduced themselves to me and each person looked me in the eyes and told me their name and what they did in case of an emergency Cesarean. The anesthesiologist stood behind me with a table full of needles and gas masks. I suppose ready to inject me at any time and there was a surgeon in front of me with a table on wheels full of lots of sharp objects.

It was the weirdest thing, as they wheeled me into the OR and everyone introduced themselves, (really just stalling and killing time until my doctor showed up), I didn’t have one single contraction. It was like Baby A was waiting, after being pushed back in, for the doctor to arrive.

Dr. C suited up and I watched him put his skin tight gloves on one hand at a time. He asked how I was doing and told me as soon as I felt another contraction coming on to start pushing. One push at 11:29am and baby A with no surprises was born. Dr. C handed him to me. He was blue and gray and bloody. I held him tight, kissed his lips over and over. I wiped his eyes and just stared into them as he stared back. And I was just in love. Honestly, I wasn’t sure what was going to happen from this point on. Would I go back to the delivery room and start all over laboring through more contractions for baby B to be born? Would I remain here holding sweet Baby A until I felt the urge to push again? Would they take Baby A while I pushed Baby B out?
My husband by my side got to cut Baby A’s cord while I snuggled him. My doula told me it looked like my doctor was breaking Baby B’s water. I kept taking my oxygen mask off to kiss Baby A and the anesthesiologist, who continued to stand right behind me kept putting it back on and said something like the next baby needs you to wear this so she gets some extra oxygen right now. This is when things began to get very, very intense.. My Dr. looked at me and very sternly said, "Jenny I need you to listen to me right now.” I looked at him and saw the fear in his eyes and I began to panic just a little. Remember, to me, ignorance is bliss and at this point I knew deep down in my heart something was wrong. I was not prepped for an epidural and the anesthesiologist did explain this to me when I first arrived to the OR. I didn’t really listen, but now I began to hear his words, “You are not prepped for an epidural so if anything should go wrong I will have to put you completely under”. It was then that I pictured myself closing my eyes and waking up hours later with two babies. 
My doctor continued to talk to me in the most stern voice of authority I may have ever heard, “I don't care if you don’t feel like you need to push, I need for you to push now as hard…as hard…as you possibly can. I mean hard and I mean right now! We have got to get this baby out!" I saw the surgeon lady behind the doctor getting closer and closer with her sharp tools in hand and this is when I closed my eyes as tight as I could.

People were all over me pushing my knees to my ears and my chin to my neck and I kept my eyes closed tight as I pushed and pushed as hard as I knew how. The anesthesiologist told me to push my chin to my neck and apparently I didn't do it fast enough and his large hand grabbed the back of my head and pushed it to my neck for me. The nurses were telling me to grab my legs and pull them towards my ears, but wait; did everyone forget I was still holding Baby A? I had to make a very conscious effort not to squeeze the life out of him while I pushed Baby B out with all my might. In such a state of emergency I believe everyone forgot I was STILL HOLDING Baby A!

I shut my eyes so tight and pushed with my toes, my fingers, my eyelids, everything in me was pushing. And just like that at 11:34, only 5 minutes after Baby A was born, baby B came out. The doctor cut her cord and directly handed her to a nurse. The nurse showed her to me and told me they were going to take her to the NICU. The doctor held up her unusually long umbilical cord and showed me a knot and apologized that they could not pick those types of things up on the ultrasounds. However, the knot was not the problem in and of itself. It was the fact that her placenta was being born before she was and as the placenta kept trying to come out she was losing all of her oxygen. My doctor was trying to push her placenta back in and was reaching for her to come first.

To my surprise, the nurse that showed her to me and told me she would take her to NICU turned right around and handed her to me. I had Baby A on my left arm and now Baby B on my right. The nurse said she pinked right up and didn't need to go to NICU after all.

This was the most amazing, most rewarding, most beautiful experience of my life. I was and still am overwhelmed with it all.

At 11:40 they wheeled me and my two babies back into the delivery room. My in-laws came in and saw the babies and I quickly had to ask them both to leave because the babies were puckering their lips and it was time to try to feed them. They both latched on immediately and sucked for an hour or so before they got their vitals done. I got to shower at that point which was within just a few hours after delivering. The nurse couldn’t believe I felt like getting up and taking a shower. She kept reminding me that I just gave birth an hour earlier and I needed to be careful. 

I feel so blessed.

Baby A, Lochman Thomas is 6 lbs and 17 inches
Baby B, Olivia Grace is 6 lbs 4 oz and is 19 inches

My older daughter was able to meet the babies’ just hours after they arrived. She seemed overwhelmed. However she couldn’t take her eyes off them and she took to them right away playing "this little piggy" with their toes and tickling them and kissing them. It was priceless to watch. She giggled every time they moved. She had never seen "live baby dolls" this tiny before. And from that moment on I don't think she remembers a day without them.

Later that evening my husband and I were quizzing my doctor about what happened when he came to check on me. He told us that I had about 30 more seconds to get Olivia out before they were going to put me under and cut me open. The nurse caring for me told me she had been a labor and delivery nurse for 17 years and had never seen a vaginal twin birth without and pain medication. She also told me how lucky I was that it was spring break for all the nursing students, otherwise the OR would have been full of everyone wanting to see something that happens so rarely.  

God is so good and we truly feel blessed by Him. We know so many things can happen during birth, especially births of multiples. May God have all the glory.