Too much information

(A birth story. Don’t read if you don’t want gory, nitty-gritty details.)

It was the last Thursday in August when I noticed the tiniest amount of spotting in my underwear in the morning. There was also a lot of, um, moisture, which I blamed on me being negligent in the kegels department. I was tired that morning, but also on the downslope of my last full week at work, with exciting plans and a long weekend coming up. I could make it.

The spotting was still there when I went to the washroom at work; a faint pink tinge on wiping, a few tiny flecks of bright blood in the toilet. I was really too tired to be much use at work; my brain was all over the place and I could hardly focus to look through my microscope. But there was a meeting that morning, and pizza lunch. The spotting concerned me just a little, though, so I called my OB’s office to see if they thought I should get it checked out. I hadn’t had the least hint of spotting since early in the first trimester. By 9:30, they got back to me to tell me to go in to the hospital to the antepartum assessment unit to get checked out, just in case.

I asked my co-worker to drive me the short jaunt over to the hospital. It was 9:45 and I was worried she wouldn’t make it back in time for the 10:00 meeting, though I knew she wouldn’t care too much about that.

At Antepartum, they hooked me up to a bunch of fœtal monitors, and we settled in to wait. Heartbeats were good. I answered a lot of questions, but nothing seemed really alarming. I called Robin and he flew in on the dirtbike. Eventually the non-stress test was done. A resident came and checked my cervix (closed) and took a few samples for other tests, including strep and, just in case, a test for amniotic fluid leak.

She was back a few minutes later, and everything changed. I had tested positive for leaked amniotic fluid, so they were going to admit me.

The rest of Thursday and Friday were both busy and quiet. Since I wasn’t in labour yet, the goal was to keep me pregnant as long as possible. As long as the amniotic fluid recharged sufficiently, labour didn’t start, and they could mitigate the risk of infection, we could hold this off. I saw my OB—i would not be going back to work, she said quite definitively, but there was a chance if everything settled down I could go home. I settled into my room, planning to stay for a week or more, hoping that nothing would change and they’d eventually send me home.

I was placed on something called the Mercer Protocol, a course of IV antibiotics to be followed up by oral antibiotics, plus steroid shots to help mature the babies’ lungs. There was an ultrasound on Friday to assess the babies’ conditions, which were fine, and measure the degree of loss of amniotic fluid. They confirmed that it was Twin A (Tris) who had ruptured. But there was still fluid in there, and she didn’t seem distressed, and everything else looked normal. I went back to my IV antibiotics and waiting around. I had plenty of visitors, and thought hard about the best case scenario. I was having a lot of little tiny contractions, but I’d been having those for ages, not really paying much attention.

About 4 am on Saturday morning, I was trying to get back to sleep after the latest change of my meds when I had a contraction just a hair sharper than most of the others, accompanied by a faint “pop” and a small gush or fluid. Fairly paranoid at this point, I alerted my nurse. Neither of us were sure if it was significant, but she checked with the doctor on call and they decided to put me on the fœtal monitors again. This took awhile as the babies weren’t being amenable to being monitored, and I also had several more contractions, about three every ten minutes, although they varied wildly in strength. Eventually, though, after about forty minutes, they had a decent read, and the doctor came to check my cervix again. The heartbeats had all been good. But my cervix was 3-4 cm dilated.

I called my husband at 5:11 am to tell him they were moving me over to labour and delivery.

He and Tyo must’ve moved VERY quickly. They arrived not long after I reached the L&D room and was getting settled in. (Syo was at the lake with her grandmother.) An anesthetist resident inquired about the recommended epidural, but we weren’t quite ready for it (the doctor on call agreed). They hooked my IV up to the final medication to help protect the babies’ brains against potential cerebral palsy.

My contractions were showing up clearly on the baby monitors at L&D, and some of them were starting to feel quite intense. Shortly after I was settled in, maybe around 5:45, the resident checked my cervix again. 6 cm dilated. We discussed that only Robin could come in the OR for the delivery. They gave Robin scrubs to change into. I was squirming on the bed with some of the contractions, wishing I could be up and moving around. They were hurting. The anesthetist sucks started running around, prepping.

And then the next contraction came. “I think I need to push,” I said.

The attending resident checked my cervix as the contraction ebbed. “Move her over to the OR,” she said. “She’s 10 cm dilated and fully effaced.” I don’t know the exact time. Maybe around 6:15?

I found myself panting frantically as they wheeled the bed to the OR next door, trying not to push. Not something I’ve ever been good at. People were milling around the OR, around the two NICU bassinets at the other end and around my bed. The resident was trying to get gloved and suited up; people were trying to page the attending physician, but he wasn’t responding.

“I have to push!” I said

“Don’t push! There’s no one to catch her!” My husband grabbed my hand.

The resident got her last glove on as I pushed, and Tris’s head and shoulders slid out of me. A moment later the rest followed, with a tiny gush of the remaining amniotic fluid. Robin and I stared, amazed, at the tiny thing that had come out of me. It (she) stared back and then opened its mouth to cry. She was crying. That meant she was breathing. That meant she was ALIVE. And then they took her away.

Tris, later that day

The resident and the attending were discussing what to do next. With the one twin born, I had a brief break from the contractions. The resident had felt a foot attempting to descend; she was worried the second amniotic sac would rupture unduly—“the membranes are very tight” and she would be stuck with the baby in a poor position. The attending didn’t seem phased—he was confident she could grab both feet and pull the baby out breech. After about ten minutes of consultation, this is exactly what they did, and my uterus was happy to contract just enough to flush poor River out in another two contractions. Feet first breech isn’t an ideal birthing position, but it works just fine for a not-quite-three-pound baby. Again I got to see her for a few fleeting instants before they whisked her away.

River, later that day

I actually remember the delivery of the placenta this time. The anesthesiologists, having been unable to do anything for the birth, gave me a mask for nitrous to get through the placental delivery. The fused placentas were almost bigger than each of the babies, though squishier coming out. With the two umbilical cords coming out, it looked very alien. I got to hold Tris briefly, wrapped in a pod of blankets and the world’s teeniest toque, before they took her away, and the same thing a moment later with River.

And then they wheeled me back into the L&D room for recovery. They checked for tears (none), and pressed clots of blood out of me (not fun) and hooked me up to an IV of oxytocin to encourage my uterus to contract swiftly. And then we sat and stared at each other. Because what do you do, when you’re in recovery after labour, but the babies are gone? I was wide awake, full of adrenaline, ready to run a race that was already behind me, while the prize at the end was just… missing.

Tris was born at 6:27 in the morning, and River at 6:41. And by 7 am, as we stared stunned around that recovery room, they were gone. We didn’t even have photos yet.

First time holding Tris

Later that day, after I was moved to the post parfum ward, after all the family gathered, after lunch, we finally got to go down and get our first introduction to the strange and overwhelming world of the NICU. But that’s a whole different post.