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.
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 intoa 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.
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.
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.
Once home, we settled into
*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.
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
