Where Has the Time Gone?

Our twins are 6 months old today. Hard to believe that they've been here that long! Their birth was one of the most spectacular events of my life. One that I would relive many times over, given the chance. I know that sounds weird to some, but let me tell you why...

(This post is incredibly long, so if you don't want to read it, use the side links!)

THE C-SECTION

Trevlyn's birth wasn't horrible, but neither was it ideal. After 4 years of trying to get pregnant and finally being able to maintain a pregnancy, I knew what I wanted out of the birthing experience and a c-section wasn't it! Monday, September 11th, 2006 came and I breathed a sigh of relief as it got later into the evening with no signs of labor. I was officially 38 weeks and had been having some fabulous Braxton-Hicks off and on for a few weeks preceding that time.

At 3am I got up for one of my many nocturnal trips to the bathroom and went back to bed. Minutes later, my water broke and the contractions started with a bang. They were strong and regular and there was no doubt I was in labor. It was magical. The time had finally come that we were going to have a baby!!! I woke James up and we were off. At 5am I was admitted, 4cm dilated. What progress! By 6am, I had gained another centimeter. However, at 8am things hadn't changed much and I took the nurse up on the epidural. I felt like I had felt enough contractions that I wouldn't miss not feeling them anymore, especially if things were going to take awhile.

Following the epidural, I was also given pitocin to help encourage things to speed up. Not long after, the nurse had me attempting to flip from side to side. (It's incredibly difficult to flip yourself over when you can't feel anything from the waist down!) She told me I needed to flip as fast as I could - as if I wasn't trying to! The baby's heart rate had dropped to around 90bpm. We were successful at getting the baby's heart rate up at one point, but once it dropped to 60bpm, the path the birth took completely diverged from the one in my dreams. The room seemed to instantly fill with people and paper and all I could think was please let my baby be okay! I was given selzer water to clear my stomach - in spite of the fact that it had been 12 hours since I'd had anything to eat and more like 18 since anything substantial. I became instantly nauseated. Bless the anesthesiologist for listening! Maybe he just felt he'd rather be safe than sorry!

I was rushed to the OR in tears, fearing for my baby and sad at the same time that she wouldn't be born the way I had thought she would. The cesarean procedure itself was rather traumatic as well. Once in the OR, I could feel the incision being made, no pain, but there really is something to feeling yourself being cut into. A nurse began shoving down hard on my abdomen, I'm assuming to help push the baby into position. Each time felt like someone had just socked me a good one. All the while I was told to "breathe!" Who were they kidding? I was trying but there was someone else crushing my lungs!

At 9:27am, Tuesday, September 12th, 2006, our beautiful baby girl was removed from me. So I heard. Not her cry, someone just told me I had a little girl. My first thought was is she alive? I didn't get a chance to see her. I was told she was to my left. The perinatologists were working with her in a corner and I was able to catch a glimpse of one little arm stretching out. Finally some relief. She was okay!

James followed our little newborn while I got stitched up. I didn't meet Trevlyn until after 10. At which time she was thrust at me and I was told that her blood glucose levels were low and I needed to feed her. Okay... We tried. (For those who have never breastfed, it's a little tricky. And for a first-time mom shaking hard from anesthetic drugs, virtually impossible!) The nurse had to place the blood pressure cuff on my ankle because I was shaking so badly that my arms wouldn't allow it to register. I was scared out of my mind that the nurse would hand me a tiny little 5-pound 7-ounce infant not even an hour old and expect me not to drop her!

I'm almost positive we did nothing right in our first feeding attempts. There was a lot of passing baby back and forth to feed and get her heel pricked for glucose testing and putting her under the warmer. Needless to say, there were a lot of tears and frustration all morning.

For the rest of the day, I was only allowed liquids and felt like I was being starved to death. By 5pm I was in sheer agony from the incision and finally called the nurses' station to see if I could have anything. The response (you'll love this!) "Oh, honey, we were wondering when you were going to call." Are you kidding me?! I had major surgery!!!! Wouldn't you anticipate that I would need something?!

I didn't get to change any of Trevlyn's first diapers. Again, after 4 years of wanting a baby, I was ready for all that came with it. Bring on the poop! The one consolation was that the maternity floor had just cleared out before we came in so we had a room to ourselves and James was able to stay with me the first 2.5 nights. (He was kicked out at 2am Thursday night.)

The following morning I was instructed to get up and walk around, the theory being that that helps with circulation and, therefore, incisal healing. Oh, my land! Talk about a burning in your bosom! But the more I stayed upright, the better it felt so I walked about most of the day. Sure would have been nice if someone had mentioned that that's not a good idea either... (Found that out the next morning when my doctor came in to check on me and I was in just about as much pain as I had been the evening of the surgery!)

Prior to discharge, I had had lactation consultants working with me. I didn't find out until Trevlyn was a couple of days old that I should have had at least some milk in at that time. Let down, engorgement...what's that? More tears, more frustration. It's hard enough to figure out how the whole breastfeeding thing works, but take out the milk and you're basically working a rusted pump in the middle of the desert!

Things didn't really improve for about 4 months postpartum. The incision healed, but the milk never came in. In spite of having a fabulously caring lactation consultant calling me every few days (if I didn't call her first!) offering advice, encouragement and a shoulder to cry on, I finally threw in the towel at 6 weeks when I felt like nothing I was doing was bringing in any more milk. I was spending hours stuck in our rocking chair. We'd start each feeding with a supplemental nurser. We did get better at it, but if you think getting a baby to latch on is hard, try adding a little tube to latch on in addition! That would usually take at least 20 minutes, followed by half an hour feeding, followed by half an hour or more pumping. Feeding sessions were marathons and just when one would end, it was time to start the next one.

Bless her little heart - Trevlyn was the perfect first baby. She would nurse or take the bottle, so I was grateful that she allowed me to try. She also started sleeping 8 hours at night by 9 weeks, even though she still hadn't reached the 10-pound mark. She was the tiny little baby I had longed for. I loved every minute of her. So much so that I wouldn't nap so as not to miss a minute of her babiness. (I have learned from that mistake. I don't remember much of her first few months because I was so tired.) Napping also made me anxious, so that was a vicious cycle. Bless my husband for what he's been through! And bless the Desert Madrecitas. I feel fortunate to have avoided medication, but I do think it would have been a longer road without the support of other women who had gone through or were going through the same thing at the same time. I was able to wean myself from the meetings (I have a tendency to get very attached to people and events) in February and accept the events of the preceding months for what they were.

I have never been ungrateful for Trevlyn. I was able to bond with her early on in her infancy and I'm grateful for that. At the time, many people told me I shouldn't be so disappointed for having a c-section or not being able to nurse - look what I had! I had a beautiful baby girl, healthy and strong. I saw that, I loved that. But I wanted more. Why did I have to settle for c-sections every time and resign myself to formula? I knew there was no guarantee things would be different the next time around, but why not at least try?

QUEST TO FIND A VBAC-FRIENDLY DOCTOR

Beginning in February 2007, I started the process of locating a doctor who would allow a VBAC. I had put the question to my OB when I went in for my 6-week check following Trevlyn's birth and his answer was that he had had patients VBAC, but he wasn't entirely for the idea. Not encouraging in the slightest. But at least my doctor would let me have one, right? Well...I had another consult in February on the referral of a friend. The lady practically raked me over the coals for even entertaining the thought. She had seen a rupture. I don't recall whether or not the woman had ended up having a hysterectomy, but apparently it was a pretty bad situation. And, seeing as I was "untried", the doctor flat out told me she "wouldn't do" me.

My second consult in February was maddening. I ended up seeing the nurse practitioner. What?! So many of my questions were answered "you'd have to ask the doctor". Why the he** do you think I scheduled a consult WITH THE DOCTOR in the first place? James was able to go with me on that one and he wasn't impressed either. But the doctor did allow VBAC, so we still had 2 options open, albeit neither one someone that I felt great with.

And then our lucky star came out. In April, I met with Dr. Jennifer Reinhart. She was so sweet. She went through all my records and questions and was so on board with me. I left my consult with her on such a high. (I had left the others in tears!) I had finally found the doctor who would deliver our next baby! Or so I thought...

TWINS

On June 21st, 2007, blood work confirmed that I was indeed pregnant again. James and I were thrilled! I was also more nauseated than I remembered being with Trevlyn. I also had had some spotting, which I hadn't had with Trevlyn but had had previously when I had miscarried.

We spent a very anxious 4th of July waiting for me to hit the 6-week mark when we could go in for an ultrasound to look at the baby and make sure there was a heartbeat. July 5th (yes, they were open the day after Independence Day, bless them!) it was confirmed that the heart was still beating, there was just some extra fluid that was most likely the cause of the bleeding. But let's just check everything, just in case. And, oh my! Another heart beat! TWINS!

I couldn't wait to get home to tell James. I told Trevy, but she didn't seem all that excited. =)

The First Trimester

I'll be honest, it was rough! I was pretty sick for the first 14 weeks. It was hard not to tell anyone that I was sick and those I had to tell it was even harder not to tell why!

We let Trevy make the announcement.

The Second Trimester

It really was the "honeymoon" trimester in almost every aspect. The nocturnal visits to the bathroom never ended so I still wasn't getting a great night's sleep ever, but the sickness went away and I still wasn't so big that I was too uncomfortable, though definitely showing by the end of the 4th month. The highlight of the trimester was by far the day we found out we were expecting one of each gender! I also began feelings movement around 15 weeks so that was a thrill as well.

We had Trevlyn's 1st birthday party the end of September and finding the energy to make her little cakes and get everything together was pretty rough, but so worth it!






The worst part of the second trimester was discovering that my OB was no longer on board for a VBAC. At my 16-week visit, she wasn't sure she wanted to be the attending for a twin VBAC. She had never had a patient want to VBAC twins before, but she was pretty certain that the extra pressure on my uterine scar would increase my chances of rupturing during labor. However, she didn't come out and say no right away, she wanted to do a little research first...

So did I. I was devastated. Relieved that she hadn't said no, but certain I didn't want to be anyone's first. One of my close friends had recently delivered so I went with her to her 6-week visit and was able to ask her doctor about her views on VBACs. She told me that she thinks all deliveries should be cesarean. At least I saved myself a consult fee!

I got online and found a local doula who was able to refer me to an OB in town who had delivered triplets vaginally. Not VBAC, but still a good sign. I also did a consult with another OB in Gilbert. Both were completely on board. I left both consults feeling the highest of highs. There are still doctors out there who care about what the mom wants and thinks and feels and take research into consideration. (The numbers show that there is minimal difference between the rupture rates during the delivery of a singleton versus twins. Granted, there are additional items to take into consideration with multiple fetuses, but rupturing is the most used excuse to get out of doing a VBAC.)

We went with the local OB so we wouldn't have to make a 2-hour drive in labor (or wear out our welcome with the Fulpses). Not to mention that I was thrilled to see him. Not once in my 2-hour consult (yes, he spent 2 HOURS talking with me and I wasn't even a patient of his at the time) did Dr. Maciulla try to even recommend a cesarean. He even apologized for the things that happened during Trevlyn's birth - like not getting to see her for over half an hour after she was born - when he was in no way involved! I just felt from the beginning that he could understand my feelings - not sure how, as he's never given birth - and he didn't think I was crazy. At the same time, he knew all the statistics and had all the experience to put me at ease that he knew exactly what he was doing.

The Third Trimester

To put things into perspective, I had someone comment to me at 6 months that I must be due soon. Well...not exactly. That was November. I was due the end of February! Yes, I was rather large.

Throughout most of the pregnancy, Baby A was vertex, but Baby B was stubbornly remaining breech. (We were still on for the VBAC. It's most important that Baby A be vertex to complete dilatation, but even that isn't completely necessary.) I saw a chiropractor as well who performed the Webster technique to help ensure proper alignment for a vaginal birth. Ironically, she was due the day before I was!

I honestly love being pregnant. Getting to carry twins was an incredible journey. However, I do remember around Christmas time literally having to roll myself out of bed. Getting up to go to the bathroom - even from a sitting position - was quite the task. Sitting on the floor was virtually out of the question and bending over was to incur such pain that I became rather skilled at picking things up with my toes. I felt very fortunate to have a lot of support from family and friends who were willing to help clean our house and even brought in meals once a week.

At 34 weeks, I had another ultrasound and got another disappointment - both twins were breech. Fortunately, my doctor happened to be passing the ultrasound room right about then and asked how things were looking. I told him. Baby A was measuring 5 lbs. 5 oz. and Baby B was measuring 6 lbs. 1 oz. He said that was perfect and we still had plenty of time and room for the babies to flip. I sure didn't feel like they had room! But what a relief that he still didn't schedule the c-section.

That night I got online and researched every position known to man that could possibly help the babies flip. For the next week I did pelvic tilts 2-3 times a day and laid in an inclined position every night when James could help me up and down. When I went in for my 35 week visit, both babies were vertex! A lot of people may think getting babies to flip just by body positioning is a bit superstitious, but I'm a believer! In any case, I wasn't going to risk my VBAC by not trying!


So at 35 weeks, my doctor informed me that we "had won". Babies looked great, I was far enough along that we weren't risking preterm labor. In fact, now we were hoping for it!


The VBAC

Five days later, Tuesday, January 29th, my water broke just after noon. (My water had also broken with Trevlyn so I was certain.) I was so relieved! My doctor is only at UMC on Tuesdays and Thursdays. What timing!

I decided to wait for the contractions to start. But they didn't. By 4:00 I decided it would be best to call my doula, Angela. She told me I should call my doctor. His nurse told me I should just come in.

It was a rush to get James home and all the last minute things packed for us and Trevy. (I still have no idea how Emily got here so fast to watch her for us!)

I was admitted to triage just after 5pm. (The resident doctor, Dr. Long, was FABULOUS!) I was 4cm dilated, 70% effaced with Baby A at a -2 station. Hmmm...I was also 4cm when I got to the hospital with Trevlyn. I wondered if that was a bad sign. Apparently not.

After some chastisement from my doctor about how God must hate him for making him be there for a 2am delivery, he confirmed that things looked good and we could check in and headed off to another hospital for another delivery while I labored.

Angela arrived around 8:30. The labor was going really well. I was dilating about 1 cm every 2 hours. Okay, not flying through, but definitely progressing.

Our nurse, Mayra, was wonderful as well. One thing about being in a teaching hospital is that you get a lot of attention and everyone tells you EVERYTHING they're doing! I never felt like I wasn't in control of what was going on.

Dr. Long came in about every hour to talk to me and check on everything. She was so calm and supportive. She's going to be an excellent obstetrician.

Dr. Manson, our anesthesiologist, gave me the epidural around 9:00. After much discussion, we decided to proceed with the epidural. I had previously talked to Dr. Maciulla about anesthesia and he told me I would definitely want it if Baby B flipped breech once Baby A was out. It also seemed a reasonable precaution in order that I would at least be able to be conscious, should an emergency c-section become necessary. I requested the lowest dosage possible. He did a great job on that. The pain of the contractions was definitely dulled, but I could still move quite easily. (I did end up having to have the epidural placed a second time, which ended up being the most painful part of the entire experience, but Dr. Manson was very nice about the whole thing.) Pitocin was offered - it was also declined.

I reached 8cm around 1:30am. Baby A was at a 0 station and I was 90% effaced. Time to call Dr. Maciulla. He arrived about an hour later and told me I was then at 9cm, 90% effaced and baby was at a +2 station! Unbelievable!

The OR was prepped and waiting for us. (All multiples are delivered in the OR.) Nurses were scrubbed up and they let us know they were ready for me to hit 10cm, just give the word. I was ready too. I wanted to laugh - Dr. Maciulla had called it - these babies were going to be born at 2am! Or not...

Minutes became hours. Around 4:30am, one of the nurses came in at one point to ask me if I could wait on hitting 10cm because ours were the only babies cooperating and they'd had to use both ORs on the maternity floor for c-sections. As long as I wasn't one of them...

At 5;30, Dr. Long returned as well to tell us that a number of babies were "misbehaving" but if the twins wanted to come, they'd squeeze me in.

The biggest scare came at 6:00am when Dr. Manson came in to tell me that his attending had told him to give me a medication bolus to prepare for the c-section. Almost instant panic. Fortunately, I was able to keep myself together and asked why we were having a c-section. I looked at the monitor and the babies’ heart rates were perfect, contractions were coming pretty consistently every few minutes apart and lasting for about a minute. I could feel that they were nice and strong. I was dilated past 9cm, almost completely effaced and baby A was in a +2 station. How could I possibly need a cesarean? I politely asked why we were having a c-section when everything looked good and asked if Dr. Maciulla was no longer in the hospital. Dr. Manson said that maybe he had misunderstood and maybe it was another patient so he would check.

While he was gone, my heart rate just sped up and I noticed the contractions subside significantly. I tried to breathe as evenly as I could to get things going again. I was hoping that I would suddenly reach 10cm while Dr. Manson was gone. He did return shortly thereafter and confirmed that he had the wrong patient.

Dr. Maciulla came back in around 6:15. I think he must have just slept at the hospital. Somehow, he didn’t look very tired, which was a relief, but I know he was up a good part of the night and can’t imagine how he can put together too many nights like that. He checked me again and I had made more progress, albeit not to a 10. I was 9.5cm dilated and 95% effaced. He said that we could try the pitocin and get the labor over with. I told him I was fine with the progress and would really rather give it more time. I was still 6 hours away from the 24-hour deadline they give you for delivery once your water breaks. Dr. Maciulla never brought it up again. I know he understood as much as a man can how badly I wanted my VBAC and how hard I’d worked to know just the way I wanted things to go. Since I was still making progress, there wasn’t any reason to rush into the pitocin.

By 6:30, my contractions were coming every 3 minutes and lasting at least a minute. The peaks on the monitor were hitting around the top line so I knew they were pretty consistently strong and I was still making progress. However, try as I might, I still could not feel the urge to push.

las, 7:00 came and brought a shift change. Dr. Long and Mayra both said goodbye. I was sad that Dr. Long wouldn't be there when the babies finally decided to make their appearance. At the same time, it hit me that I was going to have my VBAC. I truly felt that I was well past the point of a rupture.

Dr. Maciulla came in at 8. Turns out I had a bit of an anterior lip remaining and that was the only thing holding delivery back. Then he said the sweetest words - I could push! I'd never even gotten close with Trevlyn. He left me to work with Donna, my new nurse. She was wonderful, too. It took about an hour to get Baby A to crown and then we were off to the OR. Everything seemed very surreal. I could see the finish line!

The operating room was all set up for me. The only thing that I didn’t like seeing was the arm pieces attached to the table for the cesarean. I was pushed past that section of the table and transferred from the labor bed. I really could have walked myself over. I could still feel my legs and it was great to be in control. Even the few nurses and doctors who were in there at that point commented that I had a lot of feeling still, apparently, by what I was able to do.

Once I was on the table, the room seemed to fill with people. The resident doctor told me that I was just a couple of pushes away from baby A. I couldn’t believe it! Finally things were ready and I was allowed to push with the contractions. He was right. It was only one contraction and a few good pushes before Landon Joseph, all 5 pounds, 7 ounces of him, arrived at 9:19am. There was just a brief relief of the pressure and then there was more in my pelvis. The doctor had reached inside to grab whatever he could of baby B. I wasn’t allowed to push right away. Doctor Maciulla got baby B on the ultrasound so he could tell what part the resident had hold of. He was holding one of her feet, but baby was in no mood for cooperation. She was basking in the new-found room in my uterus and was happily swimming around.

Then came another of the peak moments – if not the ultimate – of the delivery – I was told to push when I felt the next contraction. It was all me! I got to say, “Here it comes” when I felt the contraction coming on. No one had to tell me from a monitor and they just all bore down with me. I grabbed my legs and pushed. I could hear Dr. Maciulla telling the resident how to turn the baby, where to hold on to the baby. She was indeed going to be born breech, feet first. I had to keep my eyes closed while pushing so I couldn’t see everything. Definitely a lot more pressure than baby A. I could hear Donna helping me count while I was pushing. James was there on my left telling me I was doing a great job. I gave a few really strong pushes before I had to relax my head back and take a deep breath. There was no waiting for another contraction, it was just push, push, push and one gigantic tidal wave as baby B’s sac ruptured. Another push or two and Callie Dyann emerged into the world, weighing 6 pounds, 3 ounces at 9:24am. I opened my eyes and saw her flailing little body. The tears came. We did it! I had my VBAC!!!

I got to see both of my infants the second they came out of me. I saw their cords and how thick and strong they were. I heard their little cries. It was truly a miracle birth and worth the months of consults, the hours online finding support groups, the tears of being told I shouldn’t even attempt a VBAC because I’d never had a vaginal birth and definitely not now that I was having twins! All the reading, the visits to the chiropractor, hiring a doula…I would do it all again in a heartbeat.