Delivery Day

Saturday night and early Sunday morning I had trouble sleeping thanks to my enemy, intrahepatic cholestasis.  I was up itching and couldn't sleep so I decided to go to the bedroom in the basement and read since I knew my free reading time was going to be non-existent once the twins arrived. 

I did happen to dose off and on for an hour and when I woke up at 4:00 AM, I felt weird. I noticed I was having contractions still, but they were happening more often than 4 an hour. I counted them during the next hour.  They started out being 7 minutes apart and quickly moved to 3-4 minutes apart.  YIKES!  I knew at my last appointment on Friday, I was dilated to 4 cm so I was worried I wouldn't have much time before I would be completely dilated.

I went upstairs and woke up Justin and we counted my contractions for another hour.  They remained every 3-4 minutes so we called my parents so they could come down and stay with Alena.  We showered up and waited for my parents in the driveway so we could leave as soon as they got there.  On the way, my contractions were right on top of each other so Justin picked up the speed a little bit (we both thought it was fun being able to stay at home and count contractions and then hurry to the hospital-I was induced with Alena so we missed out on all of that!). 

I got checked into the triage room and was hooked to the monitor.  Both babies looked great and I was 6cm dilated so I was moved over to labor and delivery. Today would be the day! 


In Labor and Delivery

I continued to have contractions every 3-4 minutes while my nurse put in my IV and drew labs.  I was 7cm when she checked me an hour later and feeling pretty good.  Because I was having twins, it is hospital policy to delivery in the OR in case an emergency c-section is needed.  I decided to get an epidural just in case a c-section would be needed.  Having this would prevent me from having to be put asleep for delivery if a c-section was warranted.  Unfortunately this turned out to be a big mistake.  15 minutes after getting the epidural, my blood pressure dropped and I nearly passed out.  This caused my contractions to slow down significantly.  They then had to use Pitocin to get them going again.  My epidural numbed part of my mid-section, but that was it.  Before I knew it, I needed to push.  So the nurses checked me and I was full dilated.  They threw scrubs at Justin and told him to put them on, and put two baby bracelets on my wrist before being rushed rather quickly to the OR. I had to wait another 5 minutes for my OB to get there. 

A few pushes later, out came Baby A (girl).  She looked just like Alena and cried like her too.  She was quickly evaluated by the NICU team with daddy by her side.  11 minutes, and a couple pushes later, Baby B (boy), was born.  He seemed much bigger than his sister and also cried right away.  Daddy followed him across the hall where he was assessed by the NICU team.  I was able to see both of them briefly before they went upstairs to the NICU.  They were both doing well.  As I recovered from my unmedicated delivery of twins, Justin went out to tell our families the great news and then went up to the NICU.  It was difficult not being able to hold my babies right away, but I knew that because they were younger than 35 weeks gestation (by 1 day!) they would automatically go to the NICU. 

More Complications

I ended up staying in the hospital for 3 weeks.  Originally, my OB practice wanted to keep me in the hospital until I was 32 weeks gestation, but in the end decided to keep me until 34 weeks gestation (although I did ask to be released a couple days early so I could enjoy the Iowa/Iowa State football game at home).  A baby born at 34 weeks gestation is pretty close to having a baby born at full term so this was a great goal to make.  I don't believe when I started my bed rest at 25 weeks that my physicians thought I would make it to 34 weeks.  I know we had a lot of people praying for us which made all the difference.

6 Days Before Delivery

At the end of my hospitalization, I started having intense itching, primarily of my feet and palms of my hands (odd places to itch, huh?).  It was always worse at night and would keep me up for hours.  The next morning I would have lesions on my legs where I had been itching.  I tried everything: three different lotions, benadryl, a humidifier, but nothing helped.   I discussed my itching with a few of my physicians and no one had an explanation.  One physician thought it was because of the sheets used in the hospital and the dryness of the hospital so I went ahead and accepted that explanation.  However, after I was discharged and was sleeping in my own bed with my own sheets, the itching persisted.  The evening of the football game, I had had enough. I started doing some research online and came across Intrahepatic Cholestasis of Pregnancy.  Pregnant moms who had this suffered from itching of their feet and hands and it was primarily worse at night.  Well, that described me to a T, so I called the physician on call and told her I thought I had this (thankfully she knew I was a nurse practitioner or she probably would have thought I was crazy by trying to diagnose myself).  She had me come in to the office on Monday for lab work.  The labs took 5 days to get back, but they did show I had this condition.  Just one more thing to add to the pile...At least I didn't have pre-eclampsia and gestational diabetes or I probably would have had every single pregnancy complication...

Intrahepatic cholestasis is usually not problematic for the mother (besides the I-would-not-wish-this-on-anybody itchiness), but it can cause still birth.  Of course I was very alarmed when I read this and until I had my official diagnosis, my OB had me come into the office twice a week to monitor the babies closely.  My OB practice sees about 1 or 2 patients a year with this diagnosis and my particular OB had never had a twin mom with this condition (I'm sure she'll never forget me now!).  I received the diagnosis on a Friday.  She spoke with a high risk OB who recommended the babies be delivered at 35 weeks, which was in 3 days, to prevent the risk of still birth.  So after trying to keep these babies inside for nearly 10 weeks, now I was being told that I would be INDUCED!  It was bittersweet hearing that because although I was pretty comfortable throughout the entire pregnancy, the last couple weeks had been horrible because of the itching and lack of sleep.  I was ready for the pregnancy to be over, but I was really hoping to make it to 36 weeks.  My bed rest restrictions were removed for the weekend, but I had to go into the hospital on Saturday and Sunday for an ultrasound and monitoring of the babies. 

That Friday night I did what I had been wanting to do for 10 weeks-I went shopping!  That night Justin, Alena, and I went to Target.  I rode in the electric cart while we shopped around (I'm sure that was a sight).  To this day whenever we go to Target, Alena asks me if I'm going to ride in the electric cart...

Since my bed rest restrictions were removed, I was also told to stop the Procardia (the medication which was helping to keep my contractions under control).  So it was no surprise when early Sunday morning, my contractions picked up.

This was our last picture as a family of 3!

And The Award Goes To...

...My husband!  Throughout all of this bed rest, he had to become Mr. Mom!  It was especially hard while I was in the hospital because I couldn't help entertain Alena at all.  He was responsible for a lot of things that I always did, which included getting her ready in the morning (he got good at picking out her clothes and combing her hair), her baths, her meals (luckily, he didn't have to do much cooking), and picking her up and dropping her off at daycare each day.  He was also in charge of the housework-thankfully he likes things as nice and tidy as I do!

One of the hardest things about being on bed rest was not being able to enjoy the summer with Alena. I wanted to do a number of special things with her because her world would turn upside down with the addition of two babies, but I couldn't.  Justin and her would visit me in the hospital about every other day after work/daycare.  They were usually short visits and there were many times I wished I hadn't seen her at all because it just made it that much more difficult.  I worried about what our relationship would be like when this was all over-would I still be her mommy? 

Alena enjoying the fair with her dad

When I was admitted to the hospital, I really didn't know how long I would be staying.  I knew there was a possibility I would stay until I delivered but I was hoping things would stabilize enough for me to go home.  After three days on the magnesium sulfate, I started having chest pain in the middle of the night.  The magnesium was decreased, but my contractions picked up. I remember asking my nurse if I should call my husband because I thought I was going to deliver that night.  The physician decided to stop the magnesium drip and start me on an oral medication called Procardia (a blood pressure medication that is also used to stop contractions).  This was my last resort so I prayed that it would work.  And it did!  A couple hours after stopping the magnesium, I felt normal again and the Procardia kept my contractions to a minimum-4 an hour, which I would continue to have until delivery. 

Room 3110

Well my 30 week appointment did not go as planned-I had been having more back pain recently and just felt "off" a couple days prior to the appointment.  My cervical length had shortened even more and I was dilated to 1 cm.  This bought me a trip to Mercy Hospital, Room 3110.

After being hooked up to the monitor for a little bit, it showed I was having contractions-about 6-7 per hour.  I was given a shot of Terbutaline to help stop the contractions.  For someone who doesn't drink any caffeine, this medication makes you feel like you've just drank a pot of coffee in 10 minutes!  My heart was racing and beating out of my chest for the next hour and a half.  The medication worked for about an hour, but then my contractions returned (although they were practically painless).  The next step was to place me on an intravenous drip of magnesium sulfate.  From all the horror stories I had read, this is not a fun medication because the side effects are horrible.  Although I wasn't thrilled with the idea of having to start this medication, I knew it was the last resort to stopping my labor.  I did not want to have my babies at 30 weeks gestation.  Although I knew their viability was over 98%, they were at risk of multiple complications due to being 10 weeks early. 

The magnesium was started and I was kept on it for three days.  It makes you feel achy/flu-like and flushed.  It caused the worst dry mouth you can imagine and I could not drink enough water or eat enough ice to quench it.  Which meant I was up going to the bathroom 1-2 times an hour (at least this decreased my risk of getting a blood clot-that was my thinking :)).  I even asked one of my night nurses if she could find me some hard candy to suck on to help-I had to force myself not to drink so much during the middle of the night so I could at least get an hour and a half of straight sleep.  By the second day of the infusion, my vision was blurry (another side effect) so it was difficult to read, surf the internet, or bascially do anything that I was doing to help pass the time.  So I pretty much laid there listening to the television.  A couple good things about hospital bed rest was getting to know my nurses and patient care technicians as they checked on me every couple of hours.  It was nice to chat with someone during the day (as opposed to bed rest at home, where I spent many hours by myself).  It was also nice having every meal delivered to me-the food was actually pretty good and there was enough variety that I didn't get sick of it. 

At this point in my pregnancy, there wasn't much room for food so I often got full after a few bites.  I most importantly tried to eat/drink as much protein as possible as this is what helps the babies grow.  This included a lot of chocolate milk, protein shakes, cottage cheese, greek yogurt, and meat.  It took a few weeks after my pregnancy for any of that to sound good again...

28 weeks (2 weeks before hospital admission)-ignore Alena's mismatched jammies :)

Laying Low

At my first appointment, my OB mentioned that approxiately 50% of moms carrying twins will end up on bed rest.  I had no idea that my bed rest would start as early as it did.

My pregnancy had been going pretty smoothly and I was feeling great.  During a twin pregnancy, the cervical length is measured frequently.  Due to extra pressure from the second baby, this length can shorten, which is often an indicator of being at an increased risk of pre-term labor.  At 24 weeks gestation my cervical length had begun to shorten.  I was told to lay low over the next week and had a repeat ultrasound completed at 25 weeks gestation.  I immediately saw the length on the ultrasound and knew I would be placed on bed rest. I did not know, however, that I would be hospitalized overnight for observation.  During this hospitalization, I received two steroid shots, which would help mature the babies's lungs if I should deliver early.  I was discharged the next day to strict bed rest at home. 

25 Weeks

Strict bed rest meant one quick shower a day, eating most of my meals on the couch, and staying as supine as possible, lying on my left side primarily.  I quickly made myself get into a routine to prevent going crazy.  I also found a list of bed rest exercises to do to help maintain as much of my muscle tone as possible.  It was hard to believe that 9 months ago I was running a marathon and now here I was laid up on the couch! 

I spent the next five weeks on bed rest at home.  I think these twins will be athletes because what better timing to go on bed rest than during the Olympics!  Those two weeks of Olympic coverage made the time go quickly and I got to enjoy some sports I've never seen!  In my opnion this was the MOST ideal time to be on bed rest and I think my babies knew I would enjoy it. 

I also spent my time reading, doing crosswords, Words With Friends, online shopping :), napping, and a lot of time on the internet.  My dad came down a few days a week to keep me company and I had friends and other family members who would drop in.  Our neighborhood was wonderful when I was on bedrest.  Twice a week neighbors would bring meals over to our house (we always had enough for leftovers), and they also paid to have a cleaning lady come to our house.  Besides that, one neighbor placed a storage box on our porch which allowed people to drop off magazines, books and other things to help occupy my time.  My parents also helped with laundry and cleaning and watched Alena when Justin needed a break.  We are forever grateful for the help we received during this time...

Pink, Blue, or Both?

The first trimester was much different than my first pregnancy, thanks to double the hormones.  I can remember one or two days of nausea when I was pregnant with Alena, but during this pregnancy, I can remember one or two days when I DIDN'T have nausea during the first 14 weeks.  The only thing that helped was to eat frequently so that is what I did.  My OB wanted me to gain 40-60 pounds so I figured I better start packing it on :). 

As much as we wanted to keep the genders a secret the entire pregnancy (which we did with Alena), we knew it would be easier to plan if we knew the genders.  At my 16 week ultrasound the technician was able to identify the gender of each baby.  We asked her to put a picture of each baby in an envelope so we could open the envelope in private later that day (who wants to share the gender reveal with a complete stranger?). 

We were too excited to wait until we got home for the reveal, so we opened the envelope in the car right outside of the office.  I took one picture and Justin took the other.  Then we exchanged pictures.  We were absolutely thrilled when we found out we were having a boy and a girl-the best of both worlds!  I was so excited to tell Alena because she kept saying she really wanted a brother AND a sister.  I hope some day she will realize how special it is to have a brother and a sister the same age to play with. 

Baby A

Baby B

Sharing the News

A few days after our 8 week ultrasound, we flew to Colorado to help celebrate our niece, Kelsey's, first birthday.  We had also planned to tell my family about our exciting news because everyone would be together.  The day we flew in, also happened to be my mom's birthday so I'm sure it was a birthday she will never forget. 

I was very nervous about sharing the news because it would be the first time we would see how other people would react to hearing we were going to have twins. I already knew how shocking it was for us, so I could only imagine how others would react.  We decided to share the news that first evening in Colorado. 

After the girls (Alena, Addison, and Kelsey) took their bath, I put Alena in her "Big Sister" shirt and sent her downstairs where my parents and brother were chatting.  My mom was busy opening her gifts, which included a decorated bra from her sisters (apparently it is tradition to send the bra to the next sister or sister-in-law who is celebrating that "special birthday," adorned with something new added to it).  I'm hoping this tradition ends before I turn that "special age." 

Anyway, it took a while for anyone to notice Alena's shirt (even though it OBVIOUSLY did not match her pajama bottoms :)).  Finally my brother read her shirt and figured it out.  They all congratulated us and then I showed my brother the most recent ultrasound to see if he would notice Baby A and Baby B.  He didn't pick up on it until I told him to take a closer look. 

"Twins?"  Everyone was excited but shocked.  My mom's exact words were, "I need another glass of wine."  It was nice to get the news out and the following week we told Justin's family.  We waited until we were in the clear at 12 weeks to share the news with our extended families and friends.  By this point I was obviously pregnant and couldn't hide the news any longer.