The Struggles Of My Twin Pregnancy – Part 2

Twin Pregnancy

There is no plane in existence where I could ever imagine knowing what it feels like to have a miscarriage. Similarly, there is no plane in existence where I could ever imagine what it feels like to lose twins.

To have the ability to carry life is nature’s gift of love, and to be able to do so times two is a bestowment of grand proportions. It is a blessing that comes with emotions I will never be able to describe aptly. To have the opportunity to feel not one set of arms and legs but two! The joy of hearing two separate heartbeats at your ultrasounds. Feeling an equally immense responsibility to assure their survival is almost primeval – something I felt with my other two children but even more potent this time. This time because there was a nemesis working against us that was the same that brought them to life – my body.

I left off my twin pregnancy story with the beginning of my journey to getting a cerclage. (Read the first part here.) As I said then, it carried the risk of rupturing the twins amniotic sac because of my dilated cervix but also the factor that I was carrying two weighed heavily as well. When we were given the time to think about our decision we knew there wasn’t a decision to make. The odds of these boys surviving were far better with the cerclage than just lying bedridden until infection (practically guaranteed because of the bulging sac).

Both options were risky, and if anyone reading this post has dealt with the heart-wrenching decisions that come with complicated pregnancies, I send you virtual hugs. If anyone reading this post has dealt with the loss of a child (at any stage) or loss of twins, I send you virtual hugs. I have pictures to prove that I did not have to deal with one of those realities, but we were lucky. As I stated in the beginning, there is no existence where I could imagine what you feel. My heart goes out to you.

My surgery to be scheduled for the next morning.

When I was in labor with my oldest the nurses gave me the option of having an epidural. Not knowing anything about pain management and the varying types of pain medication available, I just said yes. I was 18 years old. When my daughter was finally ready to be born, I felt nothing. My abdomen, my legs, my insides were all numb, and the only way for me to know when to push was when the graph on the monitor ticked the highest. It was one of the most disappointing moments in my life. (Being pregnant at 18 was only disappointment in that I had followed all the rules for preventing pregnancy but was one of the 1% – or whatever the small margin is – that got pregnant while on birth control – yay, me.)

When the time came, and the epidural had kicked in, I started to panic. The comfort of my coping space had kept me from panicking earlier, but I would be lying if I said I hadn’t thought about waking up to bad news. In that space and time, my façade of optimism started breaking away. The creepy feeling that I could not feel my legs and I could not feel my belly began to upset me.

I thought, “I can’t feel my babies!”

The realization made me panic, and I started crying. Internally, despite my horror, I tried to rationalize and understand that everything was OK, but it wasn’t working. The nurse noticed my despair and suggested that I be knocked out. It wasn’t even a suggestion. She told one of the other nurses that I was upset therefore I needed to be knocked out. No sooner had I realized what was going on before I started to drift to sleep – probably for the best, I figured later.

I don’t know how often you have been put under for anything, but the sensation is the oddest. Every time I’ve gone under and then awakened, I feel like a chunk of my existence was just erased – in reality, I know that is not true. I have been laying on the table the entire time, the world hasn’t just stopped going or disappeared, but in my mind, I’m poof gone. If it were like a dream, it wouldn’t be so weird but even when you’re asleep and dreaming there is still a sense of being and living. Being sedated is different.

Anyway, when I wake up, I want to cry again. This time because I’m disoriented, I vaguely recall my last memory, and knew I couldn’t feel the boys but realize that now I can. I realize that THEY ARE MOVING! At this point, I’m a mess about everything and bless the nurses (men & women) for knowing that I am pregnant and susceptible because when they come to wake me up, they immediately assure me that everything went well. That there is nothing to worry about and that they are wheeling me down to see my family. I haven’t been away from the hospital room for more than a few hours, but damn I miss them.

So, there’s the happy news. The boys are now safe. The cerclage was a success, and after another day of observation, I am allowed to go home. Yay! Except, there’s some fine print written on my discharge order, it says, “Strict bed rest, no lifting, no standing more than 30 minutes, showers no longer than 30 minutes, and sitting only when tolerated and for as long as it is tolerable.”

Yes, this will be difficult, but at least the twins are safe, again.

This is the part when you think everything is going to be ok. The rest of the pregnancy will be difficult, but there won’t be any more surprises – WRONG! I’m not done yet. There are still a few more hospital visits left for me. Apparently, I liked it there. The doctors and nurses were kind, I guess.

Let’s get to it then. This next stage setup is pretty mundane. When pregnant there are a few necessary tests given around approximate gestation weeks. I was due for my blood sugar test. (Yep.)

You probably guessed it already. This wasn’t even a week or two after my discharge. I suppose I didn’t have enough stuff on my plate.

The next stage of this story is gestational diabetes. Whoo hoo!

Disclaimer: I am not a medical professional. The information contained in this blog post is not meant to assist in diagnosing any medical condition. Diagnosing medical conditions is the job of a medical professional; I am not a medical professional. The sole purpose of this blog post is to inform the reader of my personal experiences.

The Struggles of My Twin Pregnancy – Part 1

Twin Pregnancy

Get ready because if you read this, you’re getting TMI. I’m covering, in detail, my struggles with my twin pregnancy.

I’m not sure where to start. I had so many things going on that at some point I said to my specialist doctor that I should be a case study. Here’s what I was dealing with: hypothyroid (I already had it pre-pregnancy, but it caused so many problems that I’m including it), incompetent cervix, gestational diabetes, gallstones, cholestasis, postpartum preeclampsia, and separated pubic symphysis. The twins themselves were perfectly healthy the duration of my pregnancy, but my body was not.

In part, I blame myself, not for my body but for inadequate baby planning. After Jacob was born, I decided I would go back to work and figure out how I felt about being away from him – as I’m sure new mothers do. I made it about two weeks before I knew I wasn’t going to continue working. I made it to about five months before deciding that I was ready to have another kid. The idea was that I was already home with one kid and I wasn’t going back to work until he was in school. If we did this right, I would have a new baby and a newly potty trained two-year-old. I would miss about four years of work before the youngest would be in preschool and Jacob nearly in kindergarten. It wasn’t going to be easy, but I would have two children close in age. I could do it. No big deal.

How does that quote go? “The best-laid plans of mice and men often go awry.” Yep. Exactly.

The most significant issue I blame myself for is not waiting longer. Jacob was less than a year old before I got pregnant again. I didn’t have any initial problems with my pregnancy with him, but I did have the usual things that happen after pregnancy: weight gain, emotional unbalance, healing. I did not give my body enough time to heal. Somewhere in some medical journal, while I was pregnant with the twins, I read that a woman should allow herself at least a year before CONTEMPLATING another pregnancy. The body goes through so much turmoil and change to make a little human it only makes sense. I cannot say that waiting would have made a difference in how things eventually turned out, but I can say that I had plenty of time to wait to make sure it turned out better.

Right now I’m sitting at my table in the kitchen, and Elliot (one of the twins) is sitting in his chair patiently waiting for me to stop typing and play with him. Every time I look at either of the twins, I’m reminded of the hard work that went into bringing them into this world, and not just work from me but my family, doctors, and nurses.

Alright, let’s get started. In the beginning, the only symptom I had to reckon with was shock. I was a smiling, giggling, panicking mess. The idea that there were going to be two little people coming soon was too grandiose a thought to accept. I don’t believe it sank in until they were born. My husband and I went through the motions of buying another crib, of buying another playpen and double our orders of subscription coffee to welcome them but it wasn’t until we both saw two tiny bodies inside the isolettes of the hospital operating room that we finally accepted being parents of twins.

Then trying to remember the first trimester of my twin pregnancy is like trying to remember what you did the night before going on that drinking binge (not that I’ve ever experienced one of those…). I recall snippets here and there but not much else. All I can say is it took a toll even from the beginning. If I think about it, it couldn’t have been that bad, because after all, I did manage to take care of Jacob all by myself during that time. I just happened to be sleeping on the floor next to a playful baby for most of it.

The real kicker came in a little later. I wrote a post a few weeks ago about dealing with cholestasis of pregnancy during my pregnancy with Jacob. It was a shitty condition on top of the cream pie that was the last few weeks of my pregnancy with Jacob. I got a face full, twice. The second time, you guessed it, during the second trimester of my twin pregnancy.

One thing I did not mention much in the post where I talked about cholestasis was that it is normally a late-term pregnancy condition. In addition, it is usually most common in women carrying multiple babies. Finally, it is highly likely to recur if it was present in a previous pregnancy. Suffice it to say I was fully expecting it to rear its ugly head, but what I was not expecting was it would be so soon. Even my maternal fetal medicine specialist didn’t believe me when I mentioned my cholestatic symptoms were back. He reiterated to me what you just read and said he would take a blood sample just to be cautious. I think were it not for my constant itching while we were talking he would have ignored me.

So, the first condition down is Cholestasis. This time around I was fully prepared, and the only recourse was to take medication and resume weekly non-stress testing (Just like with my pregnancy with Jacob. You should read that post if you want a good backstory: here). Shout out to my husband’s job for allowing him to take 2-4 hours off from work to take me to these sessions every time – at some point closer to their due date they turned into bi-weekly sessions!

Alright, who’s next? Oh! I know! So, following my appointment where I did my cholestasis blood drawing I had another check up to do: cervical. I love those! NOT! Right up there with getting a pap smear, necessary but awkward. I ended up getting pretty comfortable with those checkups though. Eventually, I had a schedule where I had the same nurse every visit so I would get undressed, (half undressed anyway) and lay down nice and pretty for her. It made things quick and easy. (LOL)

As you may have already figured out, I had a full-on incompetent cervix. It wasn’t urgent for the first checkup. My doctor made a note that it was shorter than he was comfortable with for a twin pregnancy and I was advised to start bed rest. All this occurred during the tail end of my first trimester and into the beginning of my second trimester.

You know those novellas (or even TV series) where you’re hooked, and then you get the “to be continued” bullshit? I was the living embodiment of that sentiment – within a few weeks the beginning of my second trimester brought on a slew of new tests, scary moments, anxious feelings, mental breakdowns, and unlimited loving support.

I wish I had started a twin pregnancy journal while I was pregnant. The twins are now 18 months old, and all the hubbub of dealing with them has caused me to forget the details like the timeline of diagnosis for some of my conditions. All I can say is that sometime early on in my second trimester I had a follow-up blood test (after starting the ursodiol medication for cholestasis) to review the status of my cholestasis problem. The expectation was that my bile levels would have begun decreasing because I had been on medication for a few days, but that was not the case. The following morning, after my blood draw, my results came in, and I received a call from my oby/gyn – I was to report myself to the hospital, my bile levels were too high, and I needed to be monitored.

PANIC! This didn’t happen the last time! WTF!

As it turned out, this was the shortest of my many hospital visits. I believe I was only there overnight. Magically my bile levels started decreasing, and I was feeling fine (I had been feeling fine the entire time, really). Personally, I think this was one of those situations where my doctor took the extra double precaution that wasn’t necessary. You never can tell though.

Ok, so that was just the runner-up hospital stay, guess what happened next? ANOTHER APPOINTMENT, YAY! ANOTHER HOSPITAL STAY, YAY!

Almost immediately afterward, I had another cervical check and NST (non-stress test). This one, if I recall, was to make sure the bed rest wasn’t making anything worse, but… you know already. Here comes IC making its second debut. After the cervical check, I got dressed, grabbed my bag and sat in the specialist’s office expectantly waiting to hear some good news. What I got instead rocked my world.

My doctor logged into his computer, pulled up my file and opened up the ultrasound pictures from just a few moments ago. He didn’t have to say anything. I had seen enough ultrasound images to know what was supposed to be where and there was obviously a cervix missing and a bulging sac dangerously protruding through a surface that wasn’t supposed to be made available for months, months! I heard from his mouth the words “hospital bed rest,” “possible infection,” “high probability babies won’t make it.” When I think about it now, I’m surprised I wasn’t a living waterfall. I do distinctly remember looking at my husband and looking at the saddest man I had ever seen.

One of my coping mechanisms for anything stressful is to imagine myself past the end of that tunnel, past the point where whatever is currently happening has just passed and to the extent where whatever is happening has been surpassed by months. Most of the time it’s a picture in my mind’s eye of myself doing mundane happy things like sitting on my couch reading a book or playing with my children after they have been born. Imagining those things tells me that there will come a time where I won’t feel what I am feeling now – that there will be a time of normal feelings and normal things. I couldn’t bring myself to see “normal” at that appointment. I wasn’t a ball of tears, but I was steeling myself with stoicism. Don’t feel, just do. Go through the motions, and we’ll try to picture the normal things coming tomorrow instead – if possible.

This is the part where I am obligated to say a massive thank you to my family. My pregnancy consisted of not doing much of anything at this point. I relied on family to cook our meals, to watch my baby Jacob, and to chauffeur my oldest after school and for play dates. Literally, I could not do a thing. I was allowed 30 min showers and 30 min of light activity. I lived on my couch. MASSIVE. THANK YOU.

Luma, I thought you said you were supposed to be on hospital bed rest? Well, yes. As I’m navigating myself through my story, I am smiling, and you’ll see why in a bit.

Hospital bed rest is a bitch. No one who is genuinely fully functional can accept having someone else who wipes their ass because they’re not allowed to get up and use a bathroom like a normal person. Yes, I was truly fully functional. I could move my legs, my arms, I could lift my tush off the hospital bed but being vertical was forbidden. If I had to pee it was in one of those bed bowl thingies you have to awkwardly put your butt over and then pray you’re aiming in the correct location. (I was so embarrassed that I think my brain made my body constipated because the entire duration of my stay I did not shit.) TOO EMBARRASSED. OMG, I don’t know what I would have done if I needed to go. Side note, if you are reading this and you are in this same situation, then I am so sorry.

Also, last bit about this… if you are here and your husband is doing the ass wiping, I think it goes without saying that you will die together of old age. No man who is willing to do that for you will ever leave your side! LMAO!

OK, back on track. Here I was I believe two days into my hospital stay and a new maternal-fetal medicine specialist was on-call. She was doing her rounds and came in my room to talk. At first, she came in surprised I was on such a strict bed rest. According to her, it didn’t seem necessary. She allowed me to walk to the bathroom when I wished (YES!) and to take a shower. I was ecstatic and oh so confused. I was in the middle of discussing the change with the nurses when the specialist came back to the room; she had a look of “OMG I was so wrong!”.

By that time my husband was out of work and in the room with me. She called him over and took a seat. She explained that she had thought something was off and had reviewed my file again. As it turned out, the level of bed rest I was on before she came in was exactly as it should be (boo) – I should not be allowed to get up. Then she said she had an option for us to contemplate: a cervical cerclage. She finished explaining what it was; we were allowed a few hours to discuss it. After all, having a cerclage done with a singleton pregnancy had its risks. Imagine now trying to do a cerclage with a bulging sac on a twin pregnancy. There was a high chance of rupture during the procedure, and it was not a guarantee it would prevent any miscarriage or early labor; however, it would allow me to continue bed rest at home. This was the day that I allowed myself to go into my coping space. There would indeed come a day where I would have “normal.” Here is where I smile.

To be continued…

Disclaimer: I am not a medical professional. The information contained in this blog post is not meant to assist in diagnosing any medical condition. Diagnosing medical conditions is the job of a medical professional; I am not a medical professional. The sole purpose of this blog post is to inform the reader of my personal experiences.

Cholestasis, Incompetent Cervix – How it Changed My World

Cholestasis, Incompetent Cervix

The Beginning Was So Easy

The beginning of my pregnancy with Jacob was easy – no, it was. I loved it. There wasn’t any morning sickness (thank goodness). Most days I woke up feeling pretty darn normal. I commuted to work from the ‘burbs to the city (about a 45-minute express commute in the morning). Then I had a 10-minute walk from the train to the office. My job was stressful, but I had managed it already for five years, no big deal. The fateful diagnosis of Cholestasis and Incompetent Cervix was yet to rear its head. Yep, there was nothing out of the ordinary.

At least, not in the beginning…

Incompetent Cervix

Did you ever wonder, before you got pregnant, what it was that kept the baby in place? You know, so your amniotic sac doesn’t just fall out? (LOL!) I’ll tell you. It’s your cervix – that muscle that separates the vagina from the uterus. This muscle is what keeps the amniotic sac and placenta from straight up falling out of your vagina. (Pretty graphic image there, thanks, Luma.) Clearly, it plays a HUGE role. During your pregnancy, your obstetrician will check your cervix at least twice. If this is your second pregnancy, but you didn’t have any complications during the first pregnancy, it may be fewer checks. Let me tell you something, my previous pregnancy was pretty damn near normal (except the killer morning sickness that didn’t seem normal, but I digress).

So, herein lies the problem: I have an incompetent cervix. My cervix is a bitch. I hate it. (Strong words, I know.)

First, let me explain what an incompetent cervix is. An incompetent cervix is a condition that occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy. Your cervix is supposed to be nice and tight and protective during pregnancy. It’s supposed to be like the sentinels that protect the tomb of the unknown soldier – unwavering, resilient, proud.  Mine was more like – I quit. After eight months of holding it down, it just quit. That would be like the sentinels holding their post until the last few hours before deciding they didn’t want to “walk” anymore. Um, they’re not supposed to do that, and neither is your cervix.

Cholestasis of Pregnancy

If you ever wanted to torture somebody, for whatever reason, I suggest making them somehow intensely itchy. Seriously, it will drive them INSANE! How do I know? Been there, done that (as in, I, personally, was itchy not that I tortured another person – because I didn’t).

So, WTF is “Cholestasis of Pregnancy”?  You already know one of the most critical parts – it makes you EXTREMELY itchy.

It started with itching on the bottoms of my feet. I thought at first it was an allergic reaction or that the faux fur lined snow boots I was wearing were the culprit. The problem with both those things was that the itching never stopped (this itching is evil). Imagine trying to figure out how you can walk but also scratch your feet simultaneously ALL DAY. Then imagine rubbing the palms of your hands together CONSTANTLY. So much so that you don’t get much work done because you can’t even type. You itch so much that you can’t eat properly either. Know what, you can’t think, because all you think about is how much you want the itching to stop.YOU KNOW WHAT? YOU CAN’T SLEEP EITHER! (Caps were necessary, very necessary.) So, yep, pretty bad. Also, you’re pregnant – already hard – but MOST importantly it’s bad for the baby.

The End

So at the recommendation of my husband after almost a week of itchiness, I made an appointment with my obstetrician. (I think the nurse thought I was crazy for making an appointment because my feet were itchy.) The day of the appointment, as soon as I mentioned the symptoms to my doctor, I was immediately sent to do blood work. Mind you my appointment was at 5:30 PM and the lab closed at 6 pm. Luckily, the lab was on the same floor; however, the nurse had to rush me out the door and call the receptionist at the lab so they wouldn’t lock the doors. The whole rushing scenario made me extremely nervous. The doctor wanted the results first thing in the morning, and she said she would call me immediately after she got them. I went home freaking out (internally anyway).

So, the next morning I got a phone call with the diagnosis. I had to book an appointment immediately with a maternal-fetal medicine specialist because I needed to be on special medication and I needed to start NSTs (nonstress tests) to monitor Jacob for distress (shit). This diagnosis was a big deal. My husband and I were worried. I started medication; I had to have bi-weekly NSTs (while somehow also working downtown – my doc is in the ‘burbs). Also, did I mention this was right before Christmas week? Crazy. Anyway, I went through almost three weeks of testing and regular appointments with the obstetrician and MFM. Three weeks of constant research trying to figure out what I could do to keep me, and my son, relatively healthy. So, here comes the other half of the shit show. My own body was betraying me even more!

At 4 am on January 8 at 35 weeks pregnant I was having contractions. Just boom! Out of nowhere. At first, I thought Braxton Hicks. Then they became pretty evenly timed. I emailed work that I wasn’t coming in. We called my mom immediately too she had to drive from the city to my house at 6 am, and had to hurry! Denise had to get to school, and I couldn’t leave her alone! By 7 am I was panicking, and my contractions were so intense! As soon as my mom was in the driveway we rushed out, bags packed and everything! Finally, 9:24 am January 8 Jacob was born at 5lbs 6oz, 19in long. My baby was here! Except for one giant problem: he was premature. (I’ll have a separate blog post where I talk about having preemie babies.)

So, why TF did, I just start having contractions out of nowhere and so strongly? It was IC – incompetent cervix. I did not have any issues with Denise, so it was never checked (other than what the routine checkups are for a healthy pregnancy). At the time it had been about eight years since I had been pregnant with her. The obstetrician never thought it was an issue, and neither did I, obviously.

To this day I constantly think this could have happened on the train to work – that I could have gotten ready and hopped on my train and been halfway there, and then BOOM contractions! Stop the train! Pregnant lady here trying to birth a child on the nasty, dirty, grimy, floor of the train. Then I would have been on the news! How embarrassing! Anyway… not important. It didn’t happen, and I am grateful.

The Beginning, Again…

So, why am I telling you this? Honestly? I want you to know I want to help. In my research, during the three weeks of constant testing, I learned a few things.

The first being that current research doesn’t understand why Cholestasis happens. The second being that the occurrence of it varies from country to country (weird). The third, and in my opinion most important, some doctors don’t even test for it when patients complain of having the same symptoms as Cholestasis.

I don’t even know how many forums, blogs, pregnancy sites, comments, and whatnot, I read through where women commented they had to switch doctors (because their current one didn’t believe there was anything wrong). Or even bring the door down on their current doctors (fucking take my blood, dammit!). Some resorted to going to the emergency room and lie to say their baby was in distress to get tested.

Why? I didn’t understand. All it took was a blood test (maybe two, I don’t remember). Especially when Cholestasis, if left untreated can be fatal to your baby. Especially, when it is treated doctors have to induce you at 37 weeks because waiting any longer can be fatal for your baby. Like, holy shit, why wouldn’t they test?

Then comes having an incompetent cervix. This one is a wholly different wormhole. I didn’t do much research into this one when I was pregnant with Jacob. I didn’t find out I had IC until I was pregnant with the twins, but once I knew, it clicked. I couldn’t understand how I could have gone through birthing Jacob so quickly (not that there aren’t women out there who are perfect birthers) when I had such a hard birth with Denise. It didn’t make sense. Regardless, this part didn’t affect me as much until I had to deal with my pregnancy with the twins. It was during that pregnancy that I started to hate my cervix so much. We’re still not on good terms, but it’s not like I can get rid of it.

Anyway…

If you are currently pregnant and feel like something isn’t right, then get checked. I don’t care if the nurses look at you funny – just do it. Also, I know a significant amount of people say “don’t google it!” or “if you google it you’ll feel worse!” But be a rebel and google away. Do your research. Be informed. BE YOUR OWN ADVOCATE. LEARN. It’s crucial for you and for your baby. HOWEVER, try your best to look at it from a third party’s perspective. Don’t go on an emotional roller coaster (even though I know it’s hard).

Lastly, find a good doctor and work with him/her. Ask lots of questions. My last MFM (Maternal Fetal Medicine) loved to send us the medical journals that he based his decisions on so we could read them. It comforted us to know that he was on top of his medical research constantly. Also, we’re weird and love to read and research things. I think we were his favorite patients.

So there it is. I’m happy I’m able to share this here. I hope someone out there finds it useful. Jacob is now a happy, healthy, almost three-year-old. Time flies.

P.S., I know there is an issue around having cervical checkups for some women due to privacy, female body empowerment, and too much medical outreach among other things. Everyone’s opinion is different; you guide your daily life based on what you think is best for YOU. I’m not trying to say here that you should have more cervical checkups but only that there is a condition that is hard to diagnose until the perfect conditions are met. So, what I am saying is you should do your research, listen to your body, and TALK to your doctor – and even if the dude (or dudette) doesn’t want to hear your side of the story then find someone else. Period.

 

Disclaimer: I am not a medical professional. The information contained in this blog post is not meant to assist in diagnosing any medical condition. Diagnosing medical conditions is the job of a medical professional; I am not a medical professional. The sole purpose of this blog post is to inform the reader of my personal experiences.