- October 8, 2015
- First Babies
- 31 Hour Labor (from water breaking to first cries)
- Vaginal Delivery
- Iowa City, IA
- University of Iowa Hospital
- Dr. Erin Eppsteiner
When I awoke Wednesday October 7, 2015 I noticed my underwear seemed wet with clear fluid. It was 5:50 am. I immediately suspected my water had broken.
The instructions I had received from the hospital told me to come in within 2 hours if that were to happen but I figured I had my already scheduled ultrasound at 8 am so I would wait until then.
The ultrasound was pretty quick. There isn’t much to see with two big babies cramped into such a small space at 36 weeks. Baby A remained head down and Baby B remained breech, slightly transverse. Per the ultrasound Baby A measured 6 lb 7 oz and Baby B measured 6 lb even. I was a little surprised our Baby Boy was measuring smaller than his sister but I was happy with their good size and curious to see if the sizes would be similar when they were born. Abe (my husband) was able to sneak down between patients in the resident of the day clinic to see them, too. At first I felt bad at how big I had become in my pregnancy, even compared to another twin pregnancy I knew, but now I was relieved they were so big when I knew they would be coming before their 38 week due date.
Overall my pregnancy went well but was quite challenging with twelve weeks of IVF injections, extreme exhaustion, typical early pregnancy morning sickness, carpal tunnel syndrome (which was difficult as I work as a surgeon, but I was able to manage it with splints and rest at home, after work, and it did improve as my pregnancy progressed), and the joys of being huge and pregnant in a hot Iowa summer including large swelling of my hands and feet. I also went in to pre-term labor at 32 weeks which I suspect was triggered by a UTI. I had two rounds of steroid injections to help with the lung development of the babies, but luckily after taking a few weeks off (to avoid delivery until 34 weeks if possible) I was back at work. I started developing increased swelling and occasional high blood pressure at about 35.5-36 weeks. I was diagnosed with gestational hypertension at 36 weeks so my induction date was moved up to 37 weeks. We were checking for protein in my urine when my water broke the next day and I was induced. So we will never know if I was developing pre-eclampsia or not! Knowing I was pregnant with my miracle babies made it all the more manageable.
I told the ultrasound tech I was concerned my water may have broke that morning and asked if I could talk to a doctor. They found a nurse to speak to me, one who had helped me multiple times the past week when I had been evaluated before. She was kind and friendly but I got the feeling she was thinking, “Oh no, you again!” when she saw my face. She did a quick hallway consult and tried to explain to me the difference between mucous (from the mucous plug) and other fluid (something I think I have a good grasp on after years of working in the mouth). Because I didn’t have the stereotypical “gush” of fluid she seemed skeptical and stated it would keep leaking if it had broken. I told her it had only been a short while so I wasn’t sure that was a good way to rule it out. She offered to have me stay to have it checked but I sensed she wasn’t convinced. I guess I was getting a little sick of being there hours and hours and this time maybe “for nothing” so I decided to go home and call if it continued.
Of course walking to the car I wondered if I was leaking and should have stayed but went home to lie down and see if more fluid would accumulate when I stood up. It was a little hard to tell but it seemed to stop (whatever little may have been there) by about 11am or noon. I knew my doctor had been on call the night before and had had a busy night so I tried to reach her but wasn’t too concerned when she didn’t answer– probably sleeping. I felt pretty certain that my water had broke that morning because I didn’t know what else the fluid could have been, but I started questioning now as it was later in the day without any additional fluid. My doctor called me back mid afternoon and I gave her the update. We decided that I would go in to be checked when I dropped off my urine sample to Labor and Delivery that evening.
I also was trying to make the decision of whether or not I should go to work the next two days. I decided I wasn’t feeling great so had them cancel my patients. I guess that ended up being a good idea!
My mother-in-law Kristin stopped by and offered to drive me in at 6 pm to be seen. Luckily, she had helped me finish packing my hospital bag shortly before (procrastination, even after my previous pre-term labor scare!). I didn’t feel like driving and parking myself so I happily accepted the ride even though it felt lazy to do so. She kindly stayed with me while we waited. I got checked in (again) at the triage and changed into a gown. They did another NST while we waited. It seemed like a long time before they finally did the cervical swab (partly because they wanted me to lie down long enough for fluid to have chance to pool). I think it was close to 9 pm when they finally did and noticed some fluid had actually accumulated. The resident wouldn’t tell me the preliminary result so we kept waiting and wondering. Finally, a nurse came in and we asked. She told me I was “ruptured.” We weren’t really sure what that meant for the plan and we asked if that meant my MIL should start texting updates that we were having the babies. The nurse said that was up to me and we were both confused what she meant until we realized she was saying, “Yes, you will be having the babies and it is between you two whether she gives you permission to tell anyone.”
Abe was on call that night and in an emergency surgery case, draining an infection with the oral surgery team. I had the nurse page him so I could tell him the news that they were going to induce me and we were about to have our babies. I didn’t want him to be the last to know so I was glad to catch him before he was scrubbed in and unavailable. We knew he would have plenty of time so I encouraged him to finish the surgery.
I didn’t make an official birth plan. I knew I wanted to try for a vaginal birth but I was also open to a c-section if that would be best for me and the babies. No one in my immediate family has had a successful vaginal birth so I knew that it was asking a lot to expect be the first with a twin pregnancy! But I was glad my doctor was willing to try. We anticipated an induction and I was told I would be required to have an epidural for her to feel comfortable proceeding in case there were a need for a breech extraction or switch to a c-section. We also had the delivery in the operating room with the NICU team standing by, which is pretty standard for a twin delivery. I was disappointed I wouldn’t be allowed to labor in the tub or walk around during my labor due to the monitoring of the twins.
The unit was very busy but finally a real room opened up and I was transferred into it for the night. Abe’s mom and sister Jessica kept me company and bought me dinner while we waited for Abe to finish his surgical case. We joked that black bean soup was probably a bad choice right before labor. We took some last pictures of my bump, got hooked up to the IV to start the pitocin, and I was strapped to the monitors and stuck in bed for the rest of the night (except for annoying and frequent trips to the bathroom).
I started feeling contractions right away with the initial dosing of the pitocin but they seemed to slow or ease up after the initial feeling. They continued to ramp up the dosage and we tried to get some sleep. This was difficult and I don’t think I got any sleep. By the early morning my contractions were getting worse. I was starting to feel paranoid about how dilated I was. They were trying not to check too frequently (I think since my water had broken so long before) so I had no idea how I was progressing. I felt a little torn between going as long as I could and not being caught off guard and having to rush the epidural when we needed it. About 5 am I asked for the epidural. I figured I might as well be ready and also take advantage of the relief if I was going to get it, anyway (something my doctor insisted upon for my delivery). Funny how I felt a little like I was copping out not waiting until it was unbearable.
The resident did a great job with the placement of the epidural. I was surprised how comfortable I finally was, not realizing how much pain I was actually having. The restlessness in my legs and the discomfort of being stuck in bed for hours without being able to move much (to avoid disturbing the baby monitors) was gone (which I think almost worse than the contractions themselves). It unfortunately was replaced with itching, but I finally relaxed and got a few hours of interrupted sleep.
Later that morning the OB team finally came to check me. I was dilated to I think an 8. I was surprised and happy to know I had progressed that far. They gave me more time and by about 11 am I was at a 10. My doctor wanted to give me a little longer before taking me in to the OR for the delivery. It seemed to take a long time (and longer than they had said) to get me back in the room. The epidural was still working great as I was able to move my legs but avoid the pain.
I was happy to see a friendly face as the anesthesia staff, Matt. We had spent a lot of time together on my anesthesia rotation in residency and it was nice to have someone there I felt I could joke and speak comfortably with. Between him and my friend Erin, my OB, I felt pretty calm considering the circumstances.
When everything was set they informed me I should start pushing. I had a hard time understanding what they wanted me to do and an even harder time telling if I was doing it. Pushing came much harder than I had ever imagined. I felt like all of the pushing was happening in my head. I could feel the veins pulsating and I literally worried I may stroke out, detach my retinas, or maybe even just shoot my eyeballs out their sockets. I had thoughts running through my mind about how I was going to die, leaving my poor husband to take care of two babies and without ever getting to meet my children; or secretly hoping I didn’t have an undiscovered aneurysm that was about to blow. I felt really frustrated, emotional, and discouraged like I was doing something wrong even though the doctors were all very encouraging and trying to tell me I was doing okay. I didn’t believe them as they told me I was doing “perfect” or to keep going. It had been about an hour of pushing and I really felt like giving up as I felt a little frantic I was failing. They tried to assure me that some people have to push for 3 hours and an hour was pretty great. (Ha!) I finally felt like I started to make a little headway (oops, sorry for the pun!) and was able to direct the pressure away from my developing brain aneurysm to my pelvis.
My doctor finally asked me to stop pushing and told Abe to get suited up. He gowned up, came around, and I could see him guiding our baby out, first the head and then each shoulder as he caught her. I remember noticing how cone headed she looked! They called for the pediatricians to take the baby away to be evaluated. I knew there were a bunch of people in the OR (the anesthesia team, the OB team, and two pediatric teams) but I didn’t really notice. Abe came back to my side and I was very relieved that I wasn’t going to have to push out Baby B.
Now on to the breech extraction. Phew!
The resident reached up inside my uterus. I was surprised and relieved (very grateful for the epidural and my doctor’s sound advice to receive it) to note that this was not unpleasant or uncomfortable. I couldn’t help but think of the James Harriet veterinary tales I read as a kid. She felt around trying to locate him. My doctor asked her a few times if she had him and she kept saying she had just one foot. I started to get a little nervous but shortly after she had a grip on him.
Soon I could see his little legs and body. The doctors started trying to turn him but he didn’t seem to come. An older doctor at the same time was applying pressure to my abdomen. They continued to turn him as I could see his blue body flailing. I could hear them saying they were trying to turn him but his head wasn’t moving with his body. My doctor asked the doctor applying pressure on my belly to come around and put on some gloves. At first she said no, “Don’t you want me here? You want me here, don’t you?” My doctor became more firm in her request that she move down to my pelvis. I started to sense there was a problem. Abe kept telling me calmly that everything was going to be okay. My doctor was also calmly telling me that everything was going to be okay even though I could sense an urgency in her voice and actions. But I started to worry and feel panicked.
The other doctor finally came around, evidently without gloves (per Abe) and the two staff doctors started trying to turn the baby, “Come on baby, come on baby, come on baby, come on baby.” He still didn’t seem to want to budge one way or the other.
To her credit, my doctor has an amazing bedside manner. She ever so sweetly and calmly told me, “Ok Erin, just so you know we may have to break his arm to get him out.” I started to panic and cry. I tried to tell myself that that would be okay, a broken arm would be okay, but I was actually worried he was going to die. And if he didn’t, would he have long term problems from a broken arm? I was praying very hard that the angels would be there with my little baby to get him out safely. Abe told me it was going to be okay and coming from him, I believed him…mostly. I wondered if this meant I would be getting a c-section after all and if I had enough anesthesia for that to be okay or how they would even get him out the other direction when he seemed so stuck.
Finally, after the longest 6 minutes of my life, our little baby boy was delivered. They whisked away his blue limp body to the pediatricians and Abe told me again he was going to be okay. We finally heard his cry and I was told he was fine.
They brought baby girl around to my head to show her to me. I got to touch her little hand before she was taken to the NICU step down unit to be evaluated. The doctors continued to work on me. I remember thinking it was disconcerting to see my suddenly deflated belly! I found myself wanting my familiar tight abdomen back instead of the soft and foreign one left behind.
I was told I was bleeding and they started applying heavy pressure and pushing on my belly. The pain was excruciating as they continued to push and knead on my abdomen around my belly button. I kept telling them that I have a sensitive belly button so that really hurt. I didn’t realize at the time that what they were doing likely would have hurt anyone. The anesthesiologist finally gave me 100 mcg of fentanyl and I remember saying, “Oh, so that’s what it feels like when I give it to my patient’s.” I felt much more relaxed but the pain was still present and severe.
They continued to work to stop the bleeding. They placed a bakri balloon (a saline filled balloon) to put pressure on my uterus to help with the bleeding and a gauze packing. I was given some medications to put in my cheek and they started stitching me up. I continued to think about how I was probably going to die without ever getting to really hold or see my babies and what a sad joke that would be (not sure why I was so fixated on my own demise). In the meantime, or maybe once I realized I might live, I joked around with the anesthesia staff until they finally finished and wheeled me back to my room.
I remember being so relaxed and tired from the fentanyl I was excited to get back to my room. I was sad I didn’t get to hold my babies but maybe a little relieved because I felt so miserable. By the time I was settled in my room, unfortunately the euphoria of the fentanyl had worn off and I didn’t think I could sleep any more. My body was shaking uncontrollably in large shivers, a side effect of the medication I was given to help stop the bleeding, so I was told. I was parched and drank about 3-4 liters of water, popsicles, and juice. I was uncomfortable in bed and really wanted to get up to walk around and use the bathroom but the nurse wouldn’t let me. I was tired of being stuck in bed since about 6 pm the night before, I was bleeding, and in a lot of pain. I was told I could see my babies later when I was able to get out of bed but now my nurse was saying she didn’t think it was a good idea for me to get up. I figured I may not see my babies at all that day as I would be stuck in bed the rest of the night on Labor and Delivery.
In the end, it was a pretty traumatic day. The nurse helping me right after my recovery told me that in her 20 years she had “never seen anything like [my delivery].” In the beginning I felt like it was going pretty well. My sister-in-law talks about how she loves labor and the magic of having that little baby. After my epidural and my initial labor I thought how things had been going so smoothly and maybe I could understand where she was coming from. Unfortunately, my experience shifted far from that and it was one of the hardest, scariest, and loneliest days of my life. I didn’t experience that incredible urge to push, the magic of holding your baby in your arms right after the delivery, getting to look them over lovingly to count fingers and toes or enjoy that skin to skin contact.
But I am so glad they are here, any way it had to happen, and I have no regrets. I guess it was a fitting end to their miraculous beginning — it was hard getting them in and it was hard getting them out!
A few days ago I cried when I coincidentally came upon this scripture:
“And God shall wipe away all tears from their eyes; and there shall be no more death, neither sorrow, nor crying, neither shall there be any more pain: for the former things are passed away.”
I thank God that all of that heartache and pain, the years of infertility, the weeks of discomfort, the hours of pain, and the minutes of fear have passed away and have been replaced with these two miraculous blessings.
By the next morning Baby Boy was off all the tubes and finally brought to our room late the next day where he met up with his sister again for the first time since birth.
Baby A Girl:
October 8, 2015 1:13 pm
6 lb 8 oz
Baby B Boy:
October 8, 2015 1:21 pm