Time To Make The Donuts: April 2007

Given that I ended up having a planned casarean, in some ways my whole pregnancy story is a little bit more drama filled than the actual birth itself. Except, you know, for the part where the babies are actually born, which is the most dramatic part of any birth story, I guess. But if thought I'd jump right there first, well, you haven't been paying attention to the length of time it takes me to tell any story on this blog. Anyway, for awhile there in the middle of my pregnancy, I felt like I was doing a tour of emergency obstetrical services here in the ATL and in my hometown. Should you for some reason need a ranking for hospital emergency care facilities, feel free to shoot me an e-mail and I’ll give you my opinions (ie Southcrest-the ultrasound tech only gets 3 stars). It was never my intention to have a surgical birth. I’m discovering in my adulthood that I’m much more crunchy granola than I’d thought I’d be, so I had decided to have an unmedicated birth if possible, although I knew I needed to be prepared for a section with twins. So we took a 12 week childbirth class geared toward that goal. I realize you don’t get points for not having an epidural- but there are some solid studies that indicate that your best bet of not requiring a surgical birth for twins means not having an epidural, so there was no question for me which I preferred. (I ended up loving my epidural and this is in no way intended as an indictment of choosing to have one. I’ll write more about this in another post.) Anyway, I was first put on modified bed rest one day after Rob left to do his dissertation research in Egypt. I was almost 18 weeks pregnant (about 10 days after we found out E and L are girls) and noticed that I was having contractions-although it took me a couple of days to recognize that the tightening sensation followed by angry baby kicks were actually Braxton-Hicks, followed by angry baby kicks. So when I wasn’t at work, I was supposed to be lying down or sitting with my feet up. Fortunately, I could not have chosen a more sedentary line of work, unless there was one where I could actually sleep sitting up, so my active therapist-ing around wasn’t putting the babies at risk. At 28 weeks, one week before Rob returned home from Egypt, my cervix, which had been progressively shortening since 22 or so weeks had become dangerously short and my doctor instructed me to go on strict bed rest. We also learned at this visit that E, who had been hanging upside down in utero since you could first see her head at our 7 week ultrasound, had turned into a position I can only describe as "crazy breech". After 28 weeks, twins don’t have much room, so we were pretty sure then that, unless E got fed up with L kicking her in the head, they would need to be delivered surgically. From that point on, I pretty much just left the couch or bed for about 20 minutes a day, about 10 of which was me showering. Because I would have hated to be a person with unattractive hair on who never left the house. But Rob was home, so that was a lot less lonely than it would have been had he still been overseas. When he left to go up to school, he would take my work pager, because what with the bed rest and all, I certainly wasn’t using it. After a few days, we’d worked out the kinks in our system- I won’t mention names here, but apparently some members of our family do not consider a need for Pepperidge Farms Double Chocolate Chunk Cookies to be worthy of a “911” page. At 32 weeks, we had another big scare. Since I was carrying twins and obviously at risk for pre-term labor, they were seeing me every week starting at week 27. On our usual Monday visit, it appeared that I was dilating a little, so they sent me to the hospital to have the big perinatology practice there take a look with their ultrasound equipment. Unfortunately, I hadn’t eaten lunch and forgotten the giant bottle of water I was always trying to drink, so when they sent me to triage at the hospital, I was having fairly regular contractions, which happened whenever I didn’t eat or drink. That and a dilating cervix will earn you an inpatient admission and a course of injectible corticosteroids to mature your babies’ lungs. And until you're admitted, that won't let you eat or drink anything. If you learn anything from my stroy, it's that you should always eat before that trap you in triage or it will be a really long wait until dinner. So by 4 that afternoon, I was sitting up in my room on the high risk obstetrical unit, and every nurse who came in talked to me like I would be staying there for the rest of my pregnancy, which they obviously thought wasn’t going to be much longer. To say that we were a little stressed out would be the world’s biggest understatement. Let me interject here that there are far worse things than having your babies at 32 weeks-anyone carrying multiples is blessed to make it that far-it’s just that having been a regular reader of the infertility blogsphere, I knew a lot of women inside the computer who had dealt with pre-term birth, a child or children in the NICU for weeks and the emotional stress that worrying about your baby that isn’t stable enough for you to hold in your arms that they dealt with-and knew it wasn’t the best thing for E and L to come so early (plus, we only had what we called our emergency auxiliary names at that point and if they wanted good names, they were just going to have to wait). Perinatology couldn’t see me until the next day and my doctor wouldn’t release me until I’d been evaluated, so we settled in for a pleasant night of worrying and having my vitals checked every four hours. The nurses encouraged me to take an Ambie*n to sleep, which I had never done before. And I would here like to offer a formal apology to Robert, who, when dealing with some jet lag issues he was having from all the international travel, took an Ambie*n one evening. Perhaps I was a little harsh when I accused him of faking the extreme sleepiness and inability to concentrate on what I was saying when I was trying to share my feelings that night. Because if I didn’t communicate them right then, there was a very real risk I would have forgotten whatever I was obsessively worrying about and then where would I have been? Anyway, I was wrong- as advertised, Ambie*n does, in fact, make you very sleepy and people who are unable to stay awake after taking it are not necessarily being dismissive of your emotions and to accuse them of being so is unfair.
To shorten what is rapidly becoming a much longer pre-birth story than I intended, I was ultimately seen by perinatology the next day, the girls looked good, I was still contracting, but my doctor agreed to let me go on my own recognizance. But I had to stay on bed rest AND take oral Brethine every 3 to 4 hours. Which was fine, because my goal all long was to make it to 37 weeks, so I was willing to do whatever it took. As I mentioned in a previous post, Brethine made my heart palpitate and my hands twitch, so I at least felt like I was getting a little bit of a work out as I lay there, although I'm not sure I ever reached my optimal aerobic heart rate. After two weeks of this, I began to notice the uncontrollable itching I was having on the palms of my hands and the soles of my feet was getting worse. Initially, I thought this might be another side effect of the medication. When Rob wasn’t around to help me scratch, I would just lie there and think about how satisfying it would be to have a rake or a fork (or any sharply pronged instrument, for that matter); I knew that I would be perfectly happy forever if I could just scratch. When I was in for my next visit, I mentioned this to the midwife who saw me and she ordered a few tests. Naturally, it was aside effect-I had developed a new and exciting, "unusual, but not rare" complication of pregnancy- obstetric choleostasis, and that the itching was caused by bile salts building up in my skin. That sounded really gross to me, but they didn’t seem too stressed, so I went on home to add scratching to the things I was doing to keep myself entertained on bed rest. (Although I didn’t enjoy it nearly as much as I did when Christy and Rhianna would come over and eat snacks with me while we watched the Peabody’s crazy Chinese produced Alia*s DVDs.) To be honest, I did also add asking Rob reapeatedly if he minded that I had bile salts building up in my skin to the list of things I was doing. He looks back on that period of time with much fondness, I am sure. Having access to the internet, I also did a little-who am I kidding-it was all I had to do-a lot of research on the issue (choleostasis, not Rob's real opinions of people with bile salt skin)and I was feeling alarmed. The condition is essentially harmless to the mother, but for whatever reason, the instance of fetal demise and stillbirth is astronomically higher for babies who are born after the 37^th week; those who are born before then seem to be fine. So- me being alarmed. This was how things stood on April 17 of last year (Happy Birthday, Mom!), when we went in for our 36 week visit-I was anxious about the health of the girls, but pretty confident that the doctor would tell us to plan our c-section for next week. Dr. N came in and looked at my chart awhile. Then she said, "we'd have to do an awful lot of bloodwork on you this week to keep an eye on your liver enzymes"(the root issue in choleostasis).“What are you guys doing tomorrow?” Because of the bed rest, I had no previous plans-and then “Well, let’s have those babies tomorrow.” And just like that, we were on.