A Labor of Love (and post-partum complications)

At 35 weeks, I was more than ready to be done being pregnant; my stomach was measuring in at 44 weeks and I had officially surpassed K in weight (quite the feat when you think about our 11 inch height difference). When my OB removed my cerclage, we discussed the possibility of an induction should I still manage to be pregnant in the next 2-3 weeks. And while 38 weeks was always our goal to get the twins “to term,” I could not imagine being pregnant for that much longer! It was exceedingly difficult to move around -- or breathe -- and sleep was elusive as ever; our boys could not come soon enough!

The following week, I saw the maternal fetal specialist and was screened for preeclampsia due to the swelling in my feet and slightly elevated blood pressure. While I was approaching the criteria for preeclampsia, I didn’t have enough symptoms for an official diagnosis. Two days later at my weekly OB appointment, and at exactly 36 weeks, that was no longer the case; I also happened to be 3 cm dilated and 80% effaced. And so at 5PM, I left my doctor’s office and headed home to pick-up my hospital bag before heading to labor and delivery for an induction. K waited for the grandparents to pick-up C, and then headed out to meet me at the hospital. It was go time!

I was taken back to a room just past 7PM. After getting changed, reviewing my medical history, getting the IV placed, and getting both babies and myself hooked up to the monitors, my OB came in to break baby A‘s water around 9PM. I was already having contractions by the time they started my Pitocin, but it definitely got things going faster! Just 2 hours later, my contractions were intense enough to have me in tears and I was ready for an epidural. My twin labor was much worse than the back labor I experienced with C.

During the placement of my epidural, I experienced an accidental dural puncture, aka a “wet tap,” which resulted in two things of note… First, it meant that they had to perform the epidural again, and second, it meant that I would be leaking cerebral spinal fluid. The consequences of the CSF leak meant that I could only receive a low dose epidural and there was a chance for a post-dural headache. Unfortunately, after all that, the epidural never took full effect on the left side of my body; I had to rely on breathing techniques to get through the discomfort of my contractions and I wasn't abe to get any sleep.

By the early morning hours I was finally feeling some relief and ready to get some shut eye, but it turned out that wasn't going to happen – at 5AM the L&D nurse did a cervix check, only to find that baby A was officially positioned (and visible!) in the birth canal... so instead of getting some sleep, they got us ready to head into the OR where 2 anesthesiologists, 4 NICU nurses, 2 L&D nurses, and my OB were waiting for the imminent arrival of the twins (the protocol for the delivery of multiples is to deliver in the OR where they are set up for both a traditional delivery and emergency C-section should there be any complications).

The Good

The birth of our boys was incredible -- everything moved so much faster than with C. It took 1 contraction and 3 pushes to bring D into the world! He was born at 6:12AM, weighing 5 lbs 15 oz. One contraction brought R down into position for the doctor to break his water and 4 pushes later, he arrived at 6:23AM, weighing 4 lbs 13 oz -- sunny side up (and causing a first degree tear, which was NOTHING compared to the third degree episiotomy with C).

Luckily, despite being born at 36 weeks and 1 day, both boys avoided the NICU completely. To top it all off, we were a bit like celebrities during our stay. Hospital staff who came into our room and anyone who saw us in the hallway would stop us and congratulate us on the birth of our twins.

The Bad

After D & R were born, we were moved back to our room in L & D. There, while enjoying double the baby snuggles, came the dreaded postpartum uterine massage. Although a necessary evil, I had vivid memories of this surprise part of the birthing process when I had C, and it was as bad as I remembered. Unfortunately, despite this painful procedure (which, for some unknown reason, they do while you hold your brand-new and very delicate baby - or babies), my bleeding would not stop.

For more than 2 hours, the nurses applied painful pressure to my abdomen every 15 minutes. At some point during this ordeal, I received an intramuscular injection of oxytocin to help control the bleeding, and yet, I could feel large clots and waves of blood pour out of my body each time they compressed my uterus. With time, and more than 1300 cc of blood later, everything settled down -- and I narrowly avoided a blood transfusion. With that, we were transferred to recovery where we spent the next 48 hours with an amazing team of nurses. Needless to say, we were a little sad when it came time to head home -- but grateful that we all got to go home together!

Once home, we settled into a routine survival mode, and I tried to fend off my post-dural puncture headache -- a lingering side effect of the wet tap.The pain was manageable when the Tylenol/Ibuprofen and Mountain Dew cocktail was at its peak (fun fact: Mountain Dew has the highest caffeine content of all sodas and caffeine is a decent cure for all types of headaches), but it became worse when upright for too long. Since I’d declined the blood patch* while at the hospital (the thought of a fourth injection in my back and the resulting muscle pain seemed worse than my headache), I spent the first 24 hours home, mostly, reclining on the couch.

*While a possible risk of an epidural, a dural puncture occurs about 1.5% of the time. Treatment for a dural puncture is a blood patch; the anesthesiologist places another epidural, but instead of medicine, they inject your own blood into the space to close the CSF leak via blood’s natural clotting. The other option is simply time.

The Ugly

On our third day home, I woke up in the early morning hours in excruciating pain. Instead of getting better, my headache had gone from bad to debilitating; the pounding in my head was like a vice grip at the base of my skull compounded with throbbing pain at the top of my head. It brought me to tears when I got up to nurse the boys. There was nothing I could do but lay as flat as possible while D & R laid on my chest, and watch the clock tick until 8AM when my OBGYN’s office opened. As soon as I could, I was on the phone to find out what needed to be done to get a blood patch and repair the post-dural puncture.

While K got the twins and C ready to head to the pediatrician for their first visit, my mom drove me to the ER, where I was told the anesthesiologist would be waiting. After being taken back to wait for the anesthesiologist, my blood pressure was dangerously high -- I was informed that they would have to admit me and officially start their “hypertensive protocol,” which included immediate placement of an IV and two rounds of emergency anti-hypertensive drugs before moving me upstairs. Official diagnosis: postpartum preeclampsia.

Once upstairs, I received the blood patch, but relief was minor -- not instantaneous like I had expected, and my blood pressure continued to be severely elevated. Speaking to the anesthesiologist and my OB about my symptoms, it seemed that my headache was likely due to both the dural puncture and preeclampsia… and possibly compounded by my pain. Due to the severity of my blood pressure, my OB informed me that the best treatment would be a 24 hour magnesium IV drip to prevent seizure and stroke.

Magnesium treatment was an experience. To give you an idea of what it is like, the side effects include the following:

• heart disturbances
• breathing difficulties
• poor reflexes
• confusion
• weakness
• feeling flush, warm, and/or tingly
• sweating
• feeling cold
• extreme drowsiness
  
  

I experienced them all; racing heart, hot flashes and sweats that turned into shivering cold, gasping for air as if my body had forgotten to breathe, imagining K and my mom being at the hospital, being too weak to push the call button... and the longer I was on the magnesium, the worse everything got. I felt like I was on a bad Alice in Wonderland drug-induced trip. Time had no real meaning, and I got little rest -- the nurses checked my vitals and reflexes every hour, and lab techs came into the room periodically for multiple blood draws to ensure that toxic levels had not been reached. Coming off the magnesium was no walk in the park either -- I received an emergency dose of calcium due to hypocalcemia (a potential risk associated with the administration of magnesium), and even after discontinuing the magnesium, it felt like I was coming off a high. After stopping treatment, and I remained at the hospital for an additional 24 hours of observation before finally being discharged when my blood pressure stabilized -- with a short term Rx for blood pressure medication.

The day I left, I was exhausted and it felt like it had been hit by a truck. But, after a scary 48 hours, I was happy to be headed home! Even though it had only been a few days, I felt like I had missed out on a lot being away from the twins, C, & K. As terrible as my experience had been, I couldn't help but worry about C being away from home and K trying to survive with two newborns without me. Needless to say, we were all beyond grateful for the support of my family and our amazing friends and neighbors who helped whenever they could!

Oh Boy, Oh Boy(s)!

Somehow (I am happy to report) this twin pregnancy has been a walk in the park – especially compared to C’s run in the womb. We are so grateful to have an uneventful go of it this time around, especially after I spent so long waiting for the proverbial shoe to drop, expecting the misery and complications to strike at any moment. It really is amazing what the body can accomplish when it has everything it needs! I can’t help but wonder just how different things would have been the first time if we had known about my NCCAH diagnosis and I had been appropriately medicated for it years ago, especially after my maternal fetal specialist has told me that I’ve been making multiples “look easy.”

The Cerclage (Round Two)

Despite things going well, it was recommended to go ahead and have a cerclage placed again; given my history and the increased risk of complications with multiples, it was mostly a preventative measure. So at 14 weeks, I found myself in the OR – this time the procedure was done with spinal anesthesia instead of IV sedation and it was a strange experience being conscious for it all, but everything went smoothly. Even the recovery was better than last time, which was good since it was done the day before Thanksgiving and I spent the Thursday cooking pies and a turkey with only minor discomfort. Honestly, the biggest inconvenience was the COVID protocol, which required that I get tested on Monday and then quarantine at home to ensure I didn’t get COVID before the procedure.

The Gender Reveal

With C, we I chose to be surprised at delivery on whether we were having a boy or girl.

I wanted that moment where the doctor places your baby on your chest and announces to the world, “It’s a …!” Honestly, I may have romanticized it a bit in my head, because when the actual moment came, the entire world fell silent around me and I didn’t even hear the doctor say “It’s a boy!”

But this time, since we were having multiples, we decided it was best to be in the know ahead of time. Our gender reveal was something we did for everyone else, and less for us. K and I knew after my 18 week ultrasound what we were having, but we thought everyone else might like to have a little fun, especially when we couldn’t have a get-together for the event.

Mathematically, the odds were in our favor to have a boy and a girl, given that our twins are fraternal, but imagine our surprise (and everyone else’s) when it turned out to be double boys! Especially when the only boy-boy guess was made because they “thought it would be funny” if I was the mother to three boys!

Twin Watch 2021

As of 2 weeks ago, I am officially at home, waiting for the twins to come. The cerclage is out and the boys were measuring 5 lbs 9 oz and 5 lbs 2 oz at the last growth scan – I am measuring 45 weeks and 100% feel that big; even the most mundane task has become a challenge. But, we are in the home stretch! That being said, at this point all we can do is anxiously await the arrival of these littles LaRosas, and then the real adventure begins!!!