Postpartum

Things I did not expect about the postpartum period:

1) Temperature regulation problems: During and immediately after surgery, I shivered and shook like a leaf.  In the four days of recovery in the hospital, I roasted and could rarely stand to have more than a sheet on me.  Once settled for further recovery at my mother's, I alternated between hot flashes, suddenly ripping off whatever clothing or blankets I could, and chills, literally chattering my teeth and huddling under 3 or 4 blankets. It was BIZARRE.

2) Swelling: Everyone knows pregnant women swell during pregnancy, particularly their ankles, feet, and hands.  But I had NO IDEA that the swelling gets substantially worse AFTER you deliver, for about two weeks.  I was looking forward to wearing real shoes home from the hospital.  Instead, there were times when the back of my legs all the way up to my mid thigh was so swollen, I couldn't bend at the knee.

3. Pain: Yes, recovery from major surgery was bound to be rough, but HOLY MOLY did I have a hard time with the pain.  I have a few theories of why I had such an unexpectedly hard time coping (maybe my body had more to recover from after multiples pregnancy, maybe I was not clotting appropriately due to my low platelet count, maybe because I was not allowed anti-inflammatories for that same low platelet count, maybe I'm actually a total wimp, etc), but one things is for sure: my first shuffle to the bathroom and back was far and away the most physically difficult moment of my life.  I nearly vomited and blacked out from the blinding pain.

4. Weight loss: I was sure that I was going to be one of those women who looks about 6 weeks pregnant for the next two years.  I was fully prepared to wear the majority of my maternity wardrobe throughout the next season.  I was shocked when 50 pounds just fell off in the first two weeks.  I'm not trying to brag; I have no idea how/why other than breastfeeding twins, and I still have some baby chub around the lower half of my body.  But hot damn, it's good to see my waist again!  The female body is kind of amazing.

5. The baby blues: Everyone has heard of post-partum depression.  Brooke Shields wrote a book about her experiences with it.  It makes the news every time some poor woman without the proper treatment does something horrible to her child.  It's terrifying and extreme, but I was fully prepared to struggle with it to some degree, seeing as how I have a history of garden variety clinical depression, for which I am normally medicated.  I figured there was no way I was going to lose two placentas (and all their mood boosting hormones) at one time and be able to quickly find hormonal/emotional equilibrium.  What most people don't know or talk about enough are the "baby blues."  It's estimated that as many as 80% of mothers experience the baby blues (though my OB said it's more like every mother, and the other 20% are "full of shit"), which is a milder form of PPD that only lasts the first two weeks of postpartum.  It does not feel anything like classic depression to me.  I did not feel listless or uninterested in things or extra sensitive to hardship.  I just felt like I was made of glass and the whole world was upside down.  I felt off kilter, disoriented, and most of all, unable to stop crying.  I cried for no reason from sun up to sun down.  It was truly wild to just weep and weep and not be able to say why.  So far, I think I have avoided true PPD, for which I am deeply grateful.

6. My incision: They don't use stitches for c-section scars, they use STAPLES.  It makes your belly look like Frankenstein's monster for a few days (my husband likened it to the spine of a spiral notebook), but when they remove them (which I was nervous about but didn't hurt one tiny bit), the remaining incision line is SO subtle and thin.  I was truly impressed with the medical technology.  Now, if only they had thrown in a tummy tuck for my stretched out skin!  On the downside, I still have nerve damage in that area, so even 3 months later, it feels like I've been shot with novacaine all along the scar.

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

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.

The Second Trimester

What got better: less fatigued, fewer nosebleeds, much diminished rhinitis, tiny round ligament pains are gone

What got worse: heartburn, boob pain, sleep discomfort and disruptions, unbelievably intense round ligament pain that feels like my uterus is being torn from my body.

What's new: Symphysis Pubic Dysfunction! My extra high levels of relaxin have totally destabilized my pelvis, and this problem equals pain, pain, pain, particularly when I do things that involve my legs moving separately. For example, pulling on my jeans while standing is excruciating. I have been seeing a special pregnancy chiropractor twice a week and started wearing a special (super sexy) support belt. These steps have enabled me to function like a nearly normal person during the day (even though I'm usually walking like a geisha by the end of the night). The worst part is that I had to quit yoga and switch to water aerobics....way, way less cool.

As of yesterday, 26 weeks and 5 days, the kiddos weigh about 2.5 lb each, and my belly is measuring equal to that of a singleton pregnancy at 33 weeks. Cervix is nice and long, blood pressure is low, and I do NOT have gestational diabetes! Looks like smooth sailing (read: no bed rest) ahead!

So, are we ready? I've never seen Jake so excited and so impatient! We finally secured our awesome apartment downtown and have a move-in date scheduled, October 12th (wanna help?  Haha.). We have a lot of the big stuff already: stroller, glider, changing table, all on SUPER sales! And somehow they each already have more clothes than Jake and I combined. But ready? Hmm...ask me in a month.

For those who haven't yet heard, we're having a boy and a girl, Dexter Allen and Zoey Haven (names are mostly set in stone but who knows?). We love them so much, but if Dexter doesn't stop trying to play the vibes on my rib cage, we're going to have words upon his arrival.

I feel like (probably because we've been told so many times by various in-the-know people around Dallas) we have the dream team for this birth.  Between our chiropractor Autumn Gore at Cafe of Life, Melissa Espey-Mueller with the North Dallas Doula Associates, and Dr. Ashwin Gaitonde, I think we have the best chance of an unmedicated, vaginal birth possible.  Yes, we are aware that with twins, we'll just have to be flexible, but if there was a way it was going to happen, I do believe it's with these people.  We've done our homework, found brilliant people, and written our birth plan.  Everything from here on out is just a matter of letting go.  To that end, I've been practicing deep relaxation and eyes-open self-hypnosis with this program on a daily basis.  Here we go!

The First Trimester

Oh, HEY THERE.  I know you guys thought I forgot about the blog and all of you who rooted and prayed and crossed fingers for us during our IVF journey.   More than a few people have suggested that it was time for an update, but I felt kind of weird.  I mean, pregnancy is pregnancy, right?  For that reason, this may be a tad dull compared to the science-fictiony world of IVF treatments previously discussed here, but a little reflection and documentation never hurt anybody.

The first trimester went smoothly.  We saw the babes 3 times on ultrasound, and each time their heartbeats looked strong and they were growing just a smidge ahead of schedule (twins tend to do that).  I didn't really have morning sickness, but I could still smell a foul odor from about a mile away and even the thought of something gross could send me hurling for what felt like hours.  Overall, pretty lucky in the stomach/nausea department.  The fatigue, though, OH THE FATIGUE.  I felt like I was trudging through wet concrete, carrying suitcases full of iron.  It was overwhelming just to walk from my car to my classroom.  I took several naps in my car in between errands and classes.  This led to a total abstention from cooking and housework, and Jake joyfully picked up the slack.  Speaking of iron, I craved beef and steak constantly as I was building my two placentas.  Carby foods held no sway over me unless they were somehow a delivery system for more meat.  Let's see, there's been half a dozen nosebleeds, pregnancy induced rhinitis (stuffy/runny/sneezy nose), cramps, mega heartburn, breathlessness, constant peeing, insatiable thirst, round ligament pain (pinch-y little pains around the groin as your uterus grows away from it), and very heavy, sore breasts.  Other than all that, pregnancy is delightful!  Hah!

My body is changing so fast.  I've been in maternity pants since week 8 and have had ligament pain (usually a blessing of the third trimester) since week 10.  Twin mamas are advised to put on more weight, obviously, but also encouraged to put in on earlier.  The recommendation often repeated is 20 pounds by 20 weeks (so long as you were a normal, healthy weight before).  That's clearly more weight than the babies alone need, so I'm storing it in all kinds of attractive places like my rear, thighs, and upper arms.  The theory is that you'll need those stores once your stomach is too compressed to keep packing in the food later, and twin babies need major nourishment toward the end since they're usually born many weeks early.  Also, breastfeeding two babies at once demands CRAZY calories, often more than an exhausted mother has time to consume.  All this makes sense logically, and I'm dutifully putting on exactly what's recommended...but deep inside I'm freaking out.  Those of you who know me well know that I've always struggled with my weight, and only about 3 years ago I was officially obese.  However, I lost 70 pounds through Weight Watchers and jogging, and though I'll never be skinny, I've eeked into a healthy weight range.  That was a hard-won victory over food addiction and genes, so packing on these "storage" pounds is emotional territory for me.  So just...you know...tell me I'm pretty.

Emotions are running high anyways with all these hormones.  Did you know each placenta makes it's own dose of estrogen, progesterone, etc?  So, I've got double everything. Sheesh.  Plus, I also stopped taking my anti-depressant shortly before beginning IVF.  I've been on and off it since high school, and at this point in my life, it's easier just to stay on them preventatively to keep me stable.  But, I'm not comfortable subjecting my babies to that drug, so for now, I'm just relying on a healthy diet, exercise, meditation, and journaling.  Most of the time, I'm fine, but there are days when I'm trapped in a funk of disinterest, malaise, and generalized pessimism.  It's as if my brain goes, "Nope, can't feel good today.  Seratonin tank on empty."  Prenatal yoga, which I couldn't start until the second trimester, is helping BIG TIME.

Man, this ended up being long.  Guess I shouldn't have waited so long to sum up three entire months!

Could it be twins?

Jake and I have been wondering lately, because we put back both our good embryos, whether both took.  According to Dr. Google, the signs could include:

1. Elevated HCG levels.  We've had this checked twice.  For day 15 past ovulation, a normal level is 150.  Mine was 480.  For day 18 past, normal is 450.  Mine was 1874.  A healthy doubling rate for hcg is every 48-60 hours.  Mine had doubled within 32 hours.

2. Excessive Morning Sickness.  Nope.  None at all.  Never mind then.

3. Early weight gain.  Hang on.  I've definitely managed to put on about 2 pounds while eating excessively healthfully.  Hmmm....

4. Extreme fatigue.  God YES.  I mean, I know all women suffer in their first trimester with fatigue, and I can't compare it to what it would be with one baby, but it certainly FEELS extreme.

5. Ultrasound confirmation.  Oh yeah, we had this yesterday.  And there's totally two little dudes in there, each with a perfect little heartbeat.  Here goes nothing!

A Whole New Kind of Wait

Due December 12, 2013