Preemie Twins Natural Birth: Fast Delivery After Six Weeks of Hospitalized Bed Rest by Elisa A. Schmitz 30Seconds
The birth of my twins, Cassie and Jules, could be considered one of the longest labors ever or, when it finally happened, one of the shortest. I started feeling significant contractions – ones that were more intense than Braxton-Hicks contractions – in my 28th week of pregnancy. Since my cervix was soft and already 1 cm dilated, I should have been more aware that these contractions might be something to worry about. But because my last pregnancy went so smoothly and I delivered my son, CJ, on his due date, I just didn't believe that I was at risk for preterm labor (even though I had been assigned to eight hours of bed rest per day as a preventative measure).
My regular doctor appointment was on Friday, November 6. I told my doctor about the contractions I'd been feeling and after a cervical check, he looked concerned. I was 2 cm dilated and 50 percent effaced. He decided I needed to go to to the hospital right away to be monitored. A couple of hours later, I was already 4 cm dilated and 75 percent effaced.
It seemed to me that the health care providers on duty went into panic mode at that point, and started preparing me for delivery. Because my doctor was still in his office seeing patients, the high-risk pregnancy doctors were assigned to take care of me, and they decided I was going to be giving birth to preemie twins that day. Somehow, in the midst of being prepped for labor and delivery, my doctor appeared at the hospital. When he saw that I was being prepped for delivery, he flew into action and reversed course. In his mind, there was still a chance to stop labor and keep me pregnant until 34 weeks, which is when it is considered safer to deliver premature twins.
After he took over, an IV drip of magnesium sulfate coupled with Indocin was administered. They also gave me suppositories of mag sulfate and pretty much gave me the works They called it a “bolus dose,” which is an intense amount of the medication in order for it to take effect as soon as possible. While it literally made me sick (they brought me a plastic bin so I could vomit several times), it actually worked! They were able to stop my labor.
For the next six weeks, that’s where I stayed – in the hospital on a continuous IV drip of mag sulfate. With IV changes every three days and frequent steroid shots to mature the babies’ lungs, it was a very challenging time physically. Not to mention the weight of my belly (it measured 50 cm the last I remember) and the aches and pains of being on bed rest attached to an IV with very little mobility for so long. I even had a commode next to my hospital bed because I could not get out of bed very easily and walk to the bathroom. My weekly showers were quite a treat (and an ordeal)! Mostly, I missed being with my son, CJ, who was 2 at the time. My husband would bring him a few times a week to see me, but it was tough on all of us.
But I made it to the magic date of 34 weeks pregnant! That meant the drugs could be stopped. I was elated to have made it that far since I was having contractions all along and was told that the drugs usually only forestall labor for a few days. I was told that it was truly a miracle that I had made it so far, and I was so grateful to have given my babies six extra weeks to grow and mature in the womb.
Within a few hours of the IV being removed (can I tell you how good that felt?!), my labor kicked in again – full force. On December 16, my face was very red, and I noticed that I was having some significant cramping. The monitor showed contractions every three minutes, though they still felt the same in intensity as they had for weeks. My doctor suggested I stay in the hospital another night, but I told him that we only live three blocks away and could be back in minutes if needed. We then went for our final ultrasound, where we learned that the babies were about 5 pounds each and doing great.
Lunchtime rolled around and, while I had no appetite, I forced myself to eat to keep up my strength. We decided to prepare to leave. I went to the bathroom, and that's when I felt something strange ... like something had dropped inside of me. I told my husband that I thought I should be checked before leaving the hospital, just in case something was going on. Good thing.
The resident came and checked my cervix: I was 6 cm dilated (up from 4) and 100 percent effaced (up from 50 percent) with the bag of waters bulging (the strange sensation I had felt). “I think it's time to get you downstairs to L&D and have some babies,” the resident said with a smile. After all that waiting, now that the time had come, I was petrified! How was I going to deliver two babies?
They wheeled me down to Labor and Delivery, where I put on another lovely hospital gown and got my 14th (and final!) IV inserted. My doctor showed up in jeans and a sweatshirt – he had a rare afternoon off and was going Christmas shopping. (Because my labor ended up being so quick, he was able to still go shopping that day!) We discussed pain management again, and he said that while he thought the birth would go well – vaginally and quickly – I would be more comfortable if I had an epidural when it came down to Baby B's breech birth (she was feet first!). He also said that the epidural wouldn't be strong enough if an emergency Cesarean were necessary – I would need a spinal or maybe even general anesthesia. I think that decided it for me. I wanted to have as few interventions as possible, and if the epidural wasn't good enough for the possible surgery, then it didn't seem worth it to me to have it.
I was lucky enough to be able to have my midwife at the birth as well. She was the one who delivered my first baby, and she had given me prenatal care during my second pregnancy as long as she could after we realized I was having twins. She arrived shortly thereafter and I discussed the epidural question with her. She felt confident that I could manage the pain on my own, as I had done with my son's birth. That solidified my decision to try for another natural birth. (Looking back on this, I am amazed by that decision.)
Meanwhile, the contractions were increasing in frequency and intensity. I was checked and my cervix was 7 cm. At that point, my doctor broke my bag of waters and labor got even more intense. My midwife and husband were on either side of me, encouraging me. But then things got a lot more painful. I started having flashbacks to my first birth, when I went through transition alone in my bathtub at home. “Now I remember why I didn't think I could go through this again,” I told my husband. I had remembered that it was the most incredible pain of my life, but the nature of the pain had escaped me until that moment. I concentrated on breathing through the contractions even though I couldn't remember my Lamaze techniques exactly (no time to take that refresher course).
A few minutes later, a cervical check revealed that I was at 8.5 cm dilated. They decided to wheel me into the operating room, where all multiple births are done in case an emergency Cesarean is needed. Good thing they moved me then, because within minutes I'd be giving birth. In between contractions (they seemed to be seconds apart by this time), they had me roll onto the operating table, which was so narrow and stiff that I thought I'd fall off. I had to put my feet in stirrups and lie flat on my back. I felt the most amazing pain, and then the undeniable urge to push. I never felt the urge to push with CJ, so this was new to me. I screamed something like, “I've got to get these babies out of me!”
My midwife, who had never left my side, told me to breathe and not to push. It was then that I realized the doctor was just entering the room! But I couldn't stop the push – it was a primal need that had to be fulfilled. So I pushed, one long, hard push, while my doctor put on his surgical gown. He'd gotten one glove on when Cassie's head popped right out! He quickly reached out and held her head in place so that the rest of her wouldn't come out. He got his other glove on somehow.
Cassie was suctioned and the rest of her was born at 3:13 p.m. She started crying right away and was taken to a table to be examined by the neonatologist. Meanwhile, the resident who had been checking in on me nearly every day for six weeks reached inside of me to find Jules’ feet. My husband saw her feet sticking out of me, then the resident and my doctor gently guided her through me as I pushed three times. She was born, crying, at 3:16 p.m. and was also checked out by the neonatologist. After a few photos with them, they were taken up to the NICU.
I can't tell you what a relief it was to have them out of my body. I felt so much pressure lifted from me, like a ton of bricks had been removed. I had one small tear, which required two stitches. We had the babies' cord blood collected for banking purposes, then I delivered the placenta. The massaging of the uterus to make it contract was almost as painful as transition!
Cassie, formerly known as Baby A, weighed 4 pounds, 8 ounces and Jules, Baby B, was 5 pounds even. They were both 18 inches long. Elapsed time since I left my regular hospital room for L&D to the end of the birth was two hours. After receiving some pitocin through the IV to help the uterus contract and slow the bleeding, I was wheeled to NICU to see Cassie and Jules, who looked great. They stayed in NICU for only 12 hours before being transferred to the regular nursery. They ended up staying there for 10 and 12 days, respectively. Their pediatrician was amazed by their progress and told me that they were out of the hospital much sooner than the average 34-weeker. I'm sure it's all the breast milk they got (nursing twins is also challenging but can be done – I ended up breastfeeding them for nearly two years)!
The journey was so difficult, but I feel so blessed to have given my girls every chance at a healthy and happy birth and life. The six weeks in the hospital were so worth it to have them this healthy and strong. For all of you going through this now, hang in there. It is the hardest thing you'll ever go through, but in the end the most important thing is that you and your babies are as well as can be.