Monday, December 16, 2013

Birth Story

On the Tuesday before Thanksgiving, I went in for my final prenatal appointment.  Dr. G and I went over the details of my scheduled c-section, set for the following Tuesday.  I was 37 weeks and 5 days, measuring 48 weeks.  We did the same old sonogram, cervix check, urine analysis, weigh-in, blood-pressure check, etc.  Everything was uneventful and as expected.  The kids looked huge; my cervix was closed tight, blood pressure nice and low.  Dr. G gave me some paperwork and a directive for blood work to take across the street to Maternal Observation at the hospital.  They basically needed my blood type and a few other tests before I went in for surgery.  The breathless waddle there and back nearly killed me, but I left excited about enjoying my last week with just me and Jake.  Should we go out for a fancy dinner?  Were there any documentaries on Netflix we'd been putting off?  What could I do or get for him to show him how much I appreciate his help and understanding these last few months of hell?

Later that night, Jake and I were curled up on the couch, eating frozen pizza and watching The Mindy Project when my phone rang.  It was Dr. G, saying that he was looking over my lab work from home and was slightly concerned with one of my numbers, namely my platelet count.  A normal count is anywhere between 150,000 and 500,000, but mine was a paltry 98,000.  What did this imply? Well, he said, it could be nothing, or it could be an early sign of a HELLP syndrome, a special variation of pre-eclampsia.  The final LP in HELLP stands for low platelets.  The first H is Hemolysis, meaning red blood cells breaking down, and the EL is elevated liver enzymes.  Hence, he wanted to check my liver and kidneys for other signs of HELLP and suggested I go down to Labor and Delivery within the hour for further testing.  I was flabbergasted, of course.  I gulped and asked him what would happen if I did have HELLP.  He replied that in that case, I would be meeting my babies tonight.  Jake and I took a deep breath and went about packing our bags for a four night hospital stay, all the while repeating to ourselves, "I bet it's nothing.  We'll be home by midnight."

Testing at the hospital went well.  We had a great nurse who kept us chatting and laughing for about two hours while they monitored my blood pressure and the babies' heart beats.  Finally, Dr. G, who had been watching my blood work and monitors from his home, called my hospital room.  It WAS looking like early onset of HELLP alright, and the recommended treatment was delivery.  Furthermore, if we decided to wait and see, we might compromise several aspects of our birth even further.  For instance, if my platelet count, which was continuing to fall, dipped below 50,000, I would not be allowed an epidural during my c-section and would instead be knocked out entirely with general anesthesia.  Additionally, Dr. G was about to leave town to visit family for Thanksgiving, so if something cropped up over the weekend, I would be delivering with someone I barely knew.  I called my mom around 10:30pm and told her the news.  "You're kidding!" she said. "I just took a Nyquil!"

The day before, I had met with my doula again, this time to discuss our plans for a Cesarean.  I wanted to take as many steps as possible to ensure a gentle, family-centered experience.  I didn't want doctors chatting over my open body about where they were going to get lunch.  I wanted to play my own music and to touch my babies as soon after their delivery as possible.  I wanted skin-to-skin contact right in the OR, and I wanted to delay the clamping of their cords until they stopped pulsing.  My doula would be there to hold my hand and keep me calm while my husband accompanied the babies to the warming table.  Most helpfully, she walked me through the sights, sounds, smells, and feelings of a c-section so I would be prepared.  Finally, we discussed the fact that complimentary drugs are customarily administered via IV after an epidural is placed, drugs intended to offset the nausea, anxiety, headaches, etc. that often accompany epidurals, often without explicit approval by the mom.  In her experience, mothers often become drowsy and detached as a result of these secondary medications (even though the anesthesiologist swore it has no such effect), and this sleepiness can make breastfeeding after the surgery especially tricky.  Research has shown that breastfeeding success rates are notably lower for c-section births than for vaginal births, so I felt that anything we could do to protect our chances was worth doing.  Therefore, I had a long talk with the anesthesiologist before the surgery about what I did and didn't want added until I specifically asked for it.

Overall, the surgery went as planned.  I did experience a tiny bit of anxiety as a result of my dropping blood pressure, so I was able to ask the anesthesiologist to add just a half dose (what he called "a little margarita") so I could focus and enjoy myself.  Thankfully, I experienced no drowsiness from this.  My doula took pictures in the OR and then worked very hard to help me breastfeed in the post-surgery recovery room while they monitored my vitals.  I cannot imagine now how anyone gets through a c-section WITHOUT a doula!  I was so uncoordinated and overwhelmed after surgery, so distracted by my violent shuddering and teeth chattering, I'm sure I wouldn't have had a chance feeding my babies those first few precious hours without her there.  Jake was wonderful and sweet and supportive every step along the way, and my OB was a total rock star, as usual.  Overall, despite it being drastically different from the birth I had wanted, I was able to find peace with this experience, the moment I fell in love with my beautiful babies.

Zoey Haven Lewis, born at 12:36 am, 7 lb, 6 oz, 20 1/2 inches long

Dexter Allen Lewis, born at 12:38 am, 6 lb, 15 oz, 19 1/4 inches long

Thursday, December 5, 2013

The 3rd Trimester

There's so much to catch you up on, but I'll try to start from the beginning.  This final stretch of the race was pretty brutal for me.  I started to feel like every weird, embarrassing, uncomfortable pregnancy side effect out there, I had.  Swollen feet?  Carpal Tunnel?  Hemorrhoids?  Yeast Infections?  Heat rashes?  Acne? Sciatica?  Leaking breasts?  Braxton Hicks?  Back pain?  Check, ch-check, check, CHECK.  My issues with my pelvis (SPD) continued to severely limit my movement, and I'll be damned if I didn't get a nosebleed every single day.  And the stretch marks!  Oy vey, the stretch marks.  Some of them even bled.

Here I am at 37 weeks.

However, the babies were doing GREAT.  Both were around the 90th percentile, growth-wise, and my blood pressure, weight, urine, etc. were always right on track.   Zoey, our lower twin or Baby A, continued to hang out head down, and though Dexter (Baby B) was breech, I knew I had a doctor who would deliver the second baby that way.  I had a great meeting with my doula, going over the nitty gritty of all our birth plan questions and options, and we left saying to ourselves once again that we had found the MOST AWESOME doula; she had earned her fee with us long before the big day.  I was practicing my Hypnobabies labor preparation every night, and was feeling so confident, so happy, so eager for my natural birth.

Alas, life had other plans.  Dexter was starting to grow far bigger than Zoey, according to their sonogram estimates, and Dr. G sat me down one day and told me that I should probably start preparing for a c-section.  With his footling breech position (feet down) it was very likely that Zoey's smaller head would not adequately prepare the birth canal for his exit.  He consulted every doctor in his practice, and they all agreed: it would be incredibly risky to attempt, and if his head got stuck, those two minutes of emergency c-section (for which I would have to be knocked out by general anesthesia) might still be too long to save him from permanent brain damage.

I was devastated, both by this hypothetical scenario of horror and by the sudden change in direction.  I've been dreaming of birthing my babies naturally for about as long as I've wanted to get pregnant.  I have read every book on the subject, watched every documentary, listened with rapt attention to every birth story.  I knew it was going to be challenging, but I was so joyfully looking forward to that sacred rite of passage, that unique, enigmatic, controversial side of motherhood that leaves some women shuddering in recollection and others glowing with nostalgia and pride.  I wanted to KNOW, to experience, to be there.  I wanted to physically GIVE BIRTH to my babies, not have them cut out of me.

Now, I don't want to get mired in the politics of medicalized birth.  Some people see every new advance in obstetric care a boon to women, while others view our current model as totally crippled by interdependent interventions.  I strive to be a skeptic: I neither believe that doctors push c-sections for monetary or convenience reasons at the cost of maternal/fetal health, nor do I believe that there is something so wrong with the American female pelvis that one in three births NEED to be surgical.  All this is to say, I was deeply conflicted as to whether I should trust my doctor implicitly or dig into the research and seek another opinion.  My head was swimming with the possibilities and eventualities of every angle.  I didn't know which way was up.  And apparently, neither did my daughter, because the very next week, she turned transverse, sideways, across my cervix.  That pretty much settled that.  A c-section was scheduled for December 3rd.