Childbirth, Postpartum Care, and Breastfeeding in a “Baby-Friendly” Hospital

The hospital where the twins were born is a “baby-friendly” hospital. According to Baby-Friendly USA, that means:

The Baby-Friendly Hospital Initiative (BFHI) is a global program that was launched by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) in 1991 to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding. It recognizes and awards birthing facilities who successfully implement the Ten Steps to Successful Breastfeeding and the International Code of Marketing of Breast-milk Substitutes. The BFHI assists hospitals in giving all mothers the information, confidence, and skills necessary to successfully initiate and continue breastfeeding their babies or feeding formula safely, and gives special recognition to hospitals that have done so.

Our hospital takes pride in having recently achieved “baby-friendly” status, and we heard a lot about it during our childbirth class and hospital tour. The goals of the initiative are admirable, and it leads to a lot of what I saw as benefits in terms of how the mother and baby are cared for in the hospital. Of course, no system is perfect, and the baby-friendly approach has a few problems that I found not conducive to good care, at least as I see it.

I thought I would share my thoughts, based purely on my own personal experience giving birth to twins at my local, baby-friendly hospital, in December of 2015. Of course, my experience may or may not be representative of the baby-friendly initiative over all, and mostly, I assume, reflects the care provided by the specific hospital in question and by their staff in particular.

That said, here are what I saw as the pros and cons of giving birth in a baby-friendly hospital:

PROS:
Skin-to-skin as soon as possible. This is one of the best things that happened in my delivery experience. I had an unplanned C-section, and one of my biggest concerns about having a C-section before the fact was that I might not be able to hold the babies and do skin-to-skin contact immediately after the birth. In the operating room, they did have to give L oxygen immediately after his birth and the surgical team had to sew me up, but immediately after that we were in recovery, holding the babies, doing skin-to-skin, and breastfeeding. That time was really wonderful and will probably always be one of my best memories of the experience.

Quiet time for parents and baby immediately after birth. In the hour or two immediately following the birth, the hospital does not allow anyone into the room other than the mother, baby, and partner/support person. It’s meant to be a quiet time for family bonding before any other visitors are allowed in. In our case, we didn’t have any eager family members out in the waiting room ready for their chance to get their paws on the babies — but if we had? I would have been VERY GRATEFUL for the nurses who would have kept them away during these early hours.

Daily quiet time. Every afternoon there is a two-hour stretch of designated quiet time during which no visitors are allowed in the rooms. Again, visitors weren’t an issue for us (our family lives out of state and came to visit after we were home; we didn’t invite local friends to come to the hospital). This policy was still very appreciated, though, because it turned out that this also meant hospital staff would not come in the room during this time. Sometimes, these two hours were the only respite we got from the unrelenting stream of hospital staff coming in and out of our room. More on that later.

Lactation counselors always on staff. We were really grateful for the help these women gave when it came to nursing, pumping, and eventually formula supplementation. Our current nursing-bottle feeding-pumping regimen was devised by one of these LCs and it has worked out well for us. We were also grateful for the opportunity to check in with the LCs two days after discharge to weigh the babies and revisit our feeding plan.

Babies’ care (tests, bath, shots, etc.) takes place in the room; babies “room in” with mothers/parents. It was really nice not to have to have the babies taken away to the nursery for their standard care. Hospital staff would only take the babies to the nursery if they needed special care, for example, if ours had needed feeding tubes or respiratory help. Healthy babies stay in the room with parents. In our case, E and L were healthy enough to stay in the room with us 24/7, with a couple of exceptions when the nursery staff needed to check E’s lungs for suspected fluid (she was fine).

CONS:

No pacifiers. With the focus on breastfeeding and the fears of nipple confusion, the hospital is anti-pacifier. They will not give out pacifiers, as far as I know, for any reason. During the nights when the babies were going crazy with hunger because my milk had not come in and I couldn’t cluster feed them for any longer, we needed pacifiers. Luckily, we had brought a couple with us — but we basically felt like criminals giving them to the babies! Whenever a nurse or LC would come into the room, I would whisk the pacifiers into my pajama pocket so she wouldn’t see. It doesn’t seem like a great idea to deny parents a tool that might be needed, or to make them feel guilty for employing it. See immediately below for more on this theme.

No formula. Again, due to the emphasis on exclusive breastfeeding, the hospital is anti-formula. We knew this going in, especially after the breastfeeding class we had taken, during which the LC essentially said that feeding a baby formula would turn the baby into an obese, stupid, maladjusted sociopath. (Not much of an exaggeration.) Clearly, breastfeeding is an important ideology here and formula is seen as the enemy.

In our case, we fully intended to breastfeed, exclusively if possible. But we had premature twins who didn’t weigh much to begin with and were rapidly losing weight because my milk had not come in. Three days after their birth, they’d already lost more than 10% of their birth weights. E had gone from 6lbs 12oz to 5lbs 15oz, and tiny L had gone from 5lbs 3oz to just 4lbs 11oz. We were already worried, but we thought we were going to be discharged and planned to give them formula at home until my milk came in. At least they’ll have something to eat when we get home, we said. The hospital had other ideas.

They told us they would not discharge the babies due to their weight loss, and they wanted us to stay for at least another day until they stopped losing weight. But! My milk had not come in! There was no food for them to eat if we stayed in the hospital! How could this possibly make sense?! We knew the hospital did not feed formula and at no time was any formula offered to us.

Finally, as the super-condescending pediatrician (who was refusing to discharge us) was busy mansplaining that my milk should come in “any day now,” my husband interrupted him to ask if feeding formula was something we could do in the meantime. “Well,” said the pediatrician, gesturing at both of us with disapproval, “if that’s something you want to do, the two of you can have that conversation. You can talk about formula and decide if that’s something you want to do.” At this point I had heard enough of his condescension and (I had been crying throughout this conversation) I tearily jumped in and said “We would like to do that. DO YOU HAVE any formula HERE that we can give them NOW?”

At this point the nurse who had also been in the room left without a word and came back with formula for us a few minutes later. So, they DO have formula in the hospital. INTERESTING.

I mean, OF COURSE they have formula in the hospital. Many babies need it for a medical reason. (And in this hospital, it is apparently only given out for medical reasons.) The hospital just hadn’t considered our babies to need it, so they weren’t going to offer it or give it unless we specifically asked. But no one told us we could ask. I basically had to have an emotional breakdown because my babies were starving in order to get desperate enough to demand it.

When the nurse returned with the formula, she quietly told me, “I’m glad you said that. If you hadn’t asked about the formula, I would have told you it was time.” She had the air of sharing a confidence when she said this, as if it was something she wouldn’t have said in front of the doctor or other staff.

Needless to say, this part of the experience really colored my impression of the baby-friendly initiative. Worried parents shouldn’t have to fear that they are starving their babies and be made to feel guilty for asking for food.

Healthy twins gave the impression we needed less help. This is sort of an aspect of the above item, and isn’t specifically tied to baby-friendly policies, but I feel the need to mention it. The hospital had five sets of twins born over the weekend while we were there — a remarkable number for our small town, for sure. All the staff kept mentioning it with wonder. From what I gathered, I think our twins were maybe the only set (or one of two sets?) healthy enough to room in with their parents as opposed to being sent to the special care nursery for extra medical help. I think that because the other twins on the floor needed more help in comparison, and because ours were breastfeeding (even if only colostrum), the staff didn’t think we needed as much help as we really did.

Three patients in the same room. Because the babies room in with parents in a baby-friendly hospital (which is great!), we had three patients in the same room (me and both babies). This led to constant staff intrusions. Nurses, techs, lactation counselors, pediatricians, OBs, cleaning staff, and food delivery people were coming in and out of our room at all times for various tasks. It was insane. The morning we thought we were going to be discharged but weren’t, we had people in our room at all times from 7:00 AM to 2:00 PM, the time when quiet hours began. We never had the room to ourselves for more than 5-10 minutes at a time during those hours. I couldn’t even get dressed after a shower without having to hide from a nurse when she walked in on me while I was naked*. What I learned (too late) was that we could ask staff to coordinate better to avoid so many separate interruptions. If you find yourself in a similar situation, Reader, please ask your nurse to coordinate with the other personnel to minimize the number of separate staff visits.

In general, my impression of the baby-friendly initiative (as represented by my specific experience at my specific hospital) is that it would be better termed “breastfeeding-friendly.” It did not seem particularly friendly to babies and certainly not to parents.

*And here’s a bonus story about the worst nurse of all time:

This nurse, Jean, was the worst nurse of all time. She was on shift the afternoon/evening immediately following my C-section, and she started on the wrong foot by “not hearing” and/or “forgetting” and/or “losing the order” when I asked for my pain meds. It worked out that my first dose of pain medication didn’t come for about two hours after I initially asked for it. Because I was then “behind the pain,” they had to give me an additional med, D3m3rol, to help alleviate it. It made me so out of it that I couldn’t hold a conversation with anyone and I barely remember the first night with the babies. So Jean was on my shit list for this reason already.

That was a Friday night, and we didn’t see her again until Monday, the day we thought we would be discharged, but weren’t. Nurses over the weekend had all been WONDERFUL, so I was certainly dismayed to see Jean again. She managed to annoy me a thousand different ways during the day. She kept calling my son “Lionel,” for chrissakes. Not his name. At one point, I was in bed nursing one of the babies when she said she had to “check my bleeding” and proceeded to pull down my pants to look at my lady business. Oh…kay then? No other nurse had done that since the night of the C-section, when I was immobilized and had a catheter in.

The final straw came that afternoon, when I was sitting in the recliner where I had been trying to nurse E for about an hour. E was angry and feisty (because she was hungry and there was no milk), so latching on was really difficult. Plus, we’d had a steady stream of people interrupting us for the entire time (taking her vitals, taking my vitals, checking her lo-jack ankle tag, and all manner of other reasons). I was stressed and the baby was screaming and arching and bucking and obviously super hungry but not wanting to latch. And, as I mentioned, this had been going on for an hour.

So Jean comes in to “check my bleeding” again and at this point I was like, NOPE. “I am trying to feed my baby right now. Also, no other nurse has had to check my bleeding that way in the past two days, so I don’t think you need to do that. I’d like to decline.” She was nonplussed, to say the least, and tried to persuade me that checking my bleeding was an essential part of her job. Again, NOPE. I was not having it. I was DONE.

To make a long story short, after this horribly awkward interaction, she became convinced that I was emotionally Not Okay, so she had another nurse come in and talk to me. This gave me the opportunity to tell the other nurse that 1) I was emotionally FINE, thank you very much, and that 2) my only problem was that “I [could] not stand Jean and [did] not want to interact with her ever again.” I actually said this. So Our Nurse Jean thankfully became Not Our Nurse Anymore. Suck it, Jean.

They’re here. We did it.

Thursday, December 3rd, 2015

I have spent the day feeling stressed out and itchy. The itching I’ve had for a couple of months has gotten much worse over the last 24 hours or so, prompting me to call my doctor’s office due to worry that I might have cholestasis of pregnancy. The doctor thought I should come in for fasting bloodwork first thing in the morning, so I am preparing for that and sitting around worrying about the outcome when bedtime rolls around. Spoiler: none of this will turn out to matter.

I have made it to 36 weeks 4 days pregnant.

My husband is in bed reading and I’m on my way there when I go to use the bathroom in the front of the house. When I think I am done and go to stand up, I…seem to keep peeing. Or leaking. Or something. That’s odd. And then I just keep on leaking and leaking.

I make it back to our bedroom and then go immediately into our master bathroom and sit back down to discover I’m still leaking. Okay then. It seems like this is it: my water has broken. It’s about 8:45 PM.

I call out to my husband and alert him to what is going on and then phone Labor and Delivery to tell them — they say to find out if I could soak a maxi pad in 30-60 minutes and then call them back. I call them back in just ten minutes to report successful pad saturation and they tell me to get to the hospital.

We’re a pretty efficient machine getting out of the house — our hospital bags were already packed, so we grab a couple of last-minute items and put the dog in his travel crate so we can drop him off at the boarder on the way. We’re out the door by about 9:20.

By 9:50 we have checked in at Labor and Delivery and I’ve gotten a room. CW and I are delighted to find out that our L&D nurse just coming on shift was L, who had taught our childbirth classes back in September. So good to see a familiar and trusted face in an intense situation!

The on-call doctor is also someone we’ve met before at some random OB appointment when my regular doctor hadn’t been available — Dr. A. He hadn’t made the greatest impression on us at the time. Let’s just say if you are a medical professional in a women’s health field, maybe consider NOT using sexist idiomatic expressions in an effort to be folksy. So, anyway, I am not thrilled to see him, but I know he would be unlikely to be the doctor catching my babies because we expect to be there long past the end of his shift.

Oh yeah — I’m not having contractions. Braxton Hicks, random and painless? Story of my life. But real contractions? No. We are probably in it for the long haul.

Friday, December 4, 2015

By 12:30 AM I’m hooked up to an antibiotic IV, having tested positive for Group B Strep earlier in my pregnancy. The monitors are showing that my contractions are starting to get more regular, but there isn’t a great pattern yet. I can’t actually feel them myself.

And here, in my notes, where I wrote down the babies’ full names, I clarified to myself, “Writing these down in case I forget how to spell them later, in some kind of pain/drug/love haze.” Of course there was no way I could forget the names we had chosen for the babies, but I will say that going over the spelling on their birth certificate/SSN paperwork was a little anxiety producing! 

And I won’t be sharing their names here on the blog, which is open to the whole ding-dang internet. I don’t mind sharing their names privately or on more locked-down social media, but they’ll stay off this site. 

I get started on a pitocin drip in a very small amout at about 1:30 AM with plans to increase the dosage every thirty minutes. At this point, my cervix was still only 3cm dilated and 90% effaced — no change since my last OB appointment earlier in the week. My weak, painless contractions have done nothing so far to help dilation. Thanks for nothing, contractions.

At 2:30, after having the pitocin increased a couple of times, I can now feel contractions in my belly, but nothing lower down. They still don’t hurt.

From my notes: “3:15 doop de doooo nothing to see here.”

For the past several hours, CW and I have just been sitting up in the dark L&D room, waiting for things to happen. For the pitocin to start doing something, for the contractions to get real, for things to move along. But nothing is really changing. We’re excited and ready to go, and… we’re waiting.

At 4:00 AM, contractions start to be painful in my back and lower down. I decide I will request my epidural the next time Nurse L comes in. She told us it takes an hour from the request to actually receive the epidural, so I should plan ahead and not wait until I’m desperate. Dr. A has also told me I can call for it “any time.” I figure, why wait? But I also think that probably I am being a wimp about this — I could wait longer — but there are no medals, so let’s do it.

At 4:20 AM I have requested the epidural. Also, my back is killing me, so I guess it’s in good time.  I’m squirming around in bed trying to find a comfortable position and I think my restlessness may have dropped one of the babies off the heart monitor. We’ll see.

I have never farted this much that I can remember.

The IV is giving me more fluids in preparation for the epidural, and it’s making a loud whirring noise and also feels cold.

CW is trying to doze on the couch.

4:29 AM OMG HORRIBLE LOUD ALARM — which turns out to be the sound the IV makes when it has eptied a bag of fluids. We finally figure out we need to use the nurse call button and get her to come shut the alarm off. So that’s pleasant.

By 4:40 AM, I’m taking my last trip to the bathroom as a free-standing, mobile person before being given the epidural. I will not walk to the bathroom on my own again for maybe two days. I take a break from the monitors and sit up for a while (a position that doesn’t work on the monitors because every time I sit up Baby A’s moves away from the belt and her heartbeat disappears). Even just a few minutes in a different position feels so good. Nurse L gives me a warm blanket for my lap and I’m feeling so much better. In this position, contractions are more like really bad period cramps than horrible side stitches.

Soon, the anesthesiologist comes in to administer the epidural. It’s really not that bad. I have to sit up, bend forward, and lean on my husband’s shoulders and chest while the doctor places the needle and catheter. It’s not terribly painful at all, and I just try not to think nervous thoughts about needles being poked into my spine. Meanwhile, CW starts to feel faint and announces he has to sit down. I’m busy laughing at him but trying not to move while Nurse L takes over as my person-to-lean-on. CW does not technically pass out, for the record. The epidural at first makes my lower body feel tingly and pain free, but not 100% numb.

Shift change. Our nurse L is sad to go before seeing the babies be born, but our new nurse M is very nice. The new OB on call is Dr. L, whom we haven’t met before but whom we immediately like. He seems smart and willing to explain everything to us. The sun is up outside our window.

By 8:40 AM my cervix is still only at 4 cm. It seems like I didn’t mark down when I went from 3 to 4, but it’s been at 4 for quite some time by now. Not much progress. At this point, the epidural has fully kicked in and my legs are like dead logs attached to my body. I do not like the feeling one bit.

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Is it wrong that this photo makes me think of Frank Booth?

An hour later, the nurse comes in to tell us that Baby B’s heart rate has dropped and he isn’t responding well to the contractions. I’ve been repositioned in bed for better circulation and been given more fluids and an oxygen mask. My BP was a bit low. The baby’s heart rate perks right back up. Whew.

It’s 12:20 PM. At this point, we’ve had a few more incidents with Baby B’s heart rate dipping too much during/after contractions and I’m starting to get nervous about it. Instead of increasing the pitocin every thirty minutes, as before, we are keeping the dose the same so as not to increase the strength of contractions and distress Baby B any further. I’m still only at 4 cm. We are “being patient” to see if I progress without increasing the dose. I have a feeling about this already. My body has shown no signs of wanting to go into real labor or to dilate further, and I certainly don’t think it’s going to start now, without increasing the meds at all. I feel like we are looking at a C-section.

From my notes: “I just farted super loud and couldn’t even feel it. Smelled horrific. Yikes. My body is not my own.”

At some point here there’s another dip in Baby B’s heart rate and after the nurse comes in to give me more oxygen, we notice she has turned the pitocin drip completely off. We know where this is headed.

It’s 1:40 PM. Dr L has come in to talk to us about how things are progressing (i.e. how things are not progressing) and the need for a C-section. Fine by me. I don’t want to worry about my Baby B’s heart rate for one more second.

Things get in motion fast. The OR had been booked for a scheduled C-section at 2:00, but Dr. L says we are bumping this woman and taking her time. “She won’t mind.” Nurses come in to get me prepped (shaved) and give CW his scrubs and hair net.

My OB, the awesome Dr. H, surprises us by popping into the room in her street clothes to say hello and tell us she’ll be scrubbing in to assist Dr. L on the surgery. I am so glad to see her! How did she get there so fast?

By 2:00, we are in the OR. There are both Drs. L and H, a handful of nurses, two pediatric teams (one for each baby), and I think two (?) anesthesiologists. One adds some additional things to my epidural catheter to numb me more for the surgery, and the other jokes around with CW and takes his phone so he can snap photos for us. I’m sure he had other stuff to do in the OR but I’m not sure what.

I’m sort of giddy and nervous and during the prep for surgery I can’t stop making chit-chat with everyone around me. I have no idea what kind of idiotic things I am saying, but I can’t shut up. At one point we are talking about the three other sets of twins born at the hospital this weekend, and I launch into how to determine the probability of same-sex vs boy-girl twins using a coin-flip problem as an example. I’m sure the surgical team was impressed and riveted by my mathematical know-how. (It’s 25% girl-girl, 25% boy-boy, and 50% boy-girl, FYI.)

The oddest things I remember from the surgery are:

1) being moved from my bed to the operating table, which, with my completely dead lower body, feels weird and scary and like I am going to fall on the floor, and

2) being able to see the entire surgery in the reflection on the surface of a light above me. YES. I can actually SEE THE WHOLE THING. And I do watch a lot of it. I’m very curious about medical stuff, and when else will I ever get a chance like this?!

The doctors have to prep me and everything else before CW can come in, but then they start cutting a minute or two before he gets in the room, and I’m a little worried because where is he and why did they already start? In retrospect, the way things happened so fast, I think the situation was probably a bit more emergent than I realized. The doctors and nurses all seemed so calm, but hot damn they got us into that OR fast and didn’t waste a second. At any rate, CW gets in there soon enough and sits right by my head the whole time.

At 2:37 PM, our baby girl, to be known on the blog as E, is born. I see them lifting her out of my abdominal cavity in the reflection on the light above my face. What I don’t realize is how big she is — the doctors and nurses all comment on it and when they show her to CW and me quickly over the curtain, he says something, too. They hand her off to the pediatric team and from across the room I hear her cries bleating out nice and loud. Good crying, baby girl!

We’re shocked to hear her weight: 6 lbs 12 oz. We’d just been hoping to get them both over 5 lbs.

At 2:39 PM, our baby boy, whom I’ll call L, is born. He had flipped around to breech position when he finally had the space, so he was removed by his feet and the first thing I see in the reflection above me is his little butt.

CW tells me later that he came out blue.

The pediatric team is giving him oxygen and CW is over there with them, talking back across the room to me to tell me what’s going on. I keep hearing E’s cries and hoping it’s L. When he finally cries for himself, CW tells me it’s him, our boy, crying, and that’s when I finally tear up. They’re both here. We made it.

The pediatric teams get the babies all swaddled up and give them to CW to hold right next to me while I’m crying and being stitched back together. I remember lying there looking at him holding them and the first words out of my mouth are “CW, he looks JUST LIKE YOU,” which our son absolutely does. (Doctors and nurses all vocally agreed.) The second thing: “How on earth were they both INSIDE MY BODY?!”

Another surprise: baby boy L weighs in at only 5 lbs 3 oz. Throughout the pregnancy up to our most recent ultrasound at 33 weeks, they’ve been estimated to weigh within a few ouces of each other, but now there’s a size difference of over a pound and a half! How did that happen?! Still, that’s about 12 pounds of baby all together. I reiterate: how on earth were they both inside my body?

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L in the background, E screaming in the foreground

After my incision is closed up, all four of us go to recovery together and I’m able to immediately do skin-to-skin with both babies, who decide at that point that they’re ready to breast feed. So there we are, all four of us, me tandem breastfeeding two healthy babies, just moments after the birth. I’ll never forget it. C-section or not, I’d say this went pretty damned well.

They’re here. We did it.

I have many, many other thoughts on my postpartum experience in the hospital, but I’ll save those for another time.

36 Weeks: Still Here

A few weeks ago I really did not believe if make it this far, but here we all are. 

  
That’s us. 

The Babies are the Size of: I forget what boring fruit or vegetable the comparison was this week, but the “fun and games” comparison was a Cabbage Patch Doll. Signed on the butt by Xavier Roberts, I must assume. Y’all. Do you KNOW how obsessed I was with Cabbage Patch Dolls as a child? I had SO MANY. So I am very familiar with them and they are…not small. The animal comparison was a chihuahua. I’ll let you sit there and imagine two chihuahuas wrestling it out inside your abdominal cavity. 

How I’m Doing: I’m doing well. As I was telling a friend the other night, as more time goes by,  I am necessarily moving past the fear of them being born too early and moving more into the excitement of getting to meet my son and daughter soon. 

The past week has been quite nice. Our school takes a break for the full week of Thanksgiving, which means my husband and I got to be home together all week. Who knows when the next time will be that we get to spend a stretch of days together enjoying our house and relaxing, just the two of us?

The All-Important Status of My Belly Button: As you might see in the photo, it appears my navel is moving into an outie position, but don’t believe everything you see! That’s just the upper edge of it protruding. Underneath that, the actual navel is still very much in. My skin occasionally stings with the feeling of being overstretched, but no new visible stretch marks yet. We shall see. 

Movement: normally the babies kick up a storm, stretching out my sore muscles and ligaments and rearranging my organs. The other day, though, I had a little bit of a fit because, although they were moving, their movements just felt so quiet and subtle that I worried something was off. Was I only feeling one? Were they somehow weakening? So of course I monitored and counted their kicks and called L&D (it was a weekend day) and asked about it and the lady on the phone was like, it doesn’t matter how big or small the kicks are; any movement counts. Then an hour later I ate a bowl of spicy chili for lunch and the kiddos basically started flailing around like a couple of maniacs in there. So I guess I was due for a stupid freakout that turned out to be about nothing. 

Doctor’s Appointment: My doctor came in the room today and the first thing she said was, “I can’t believe you’re still hanging on!” She said she kept calling in to L&D over the long weekend to see if I was up there. When she says stuff like this, I feel like a minor medical marvel, really. I’m maybe just a tidge more than 3cm and 90% effaced at this point, not much if any progress from last week. So, we are still just waiting for labor to start!

I had the Group B Strep screening and a syphillis test (did y’all know they do that? I didn’t) today. In suspense waiting for the results! Heh.

In addition, I had my weekly NST. For whatever reason, the hospital was packed and understaffed and it took forever to get my test started. Once I was hooked up to the monitors, I quickly became REALLY uncomfortable. I was getting back pain and cramps in my sides and tons of BH contractions and I hated to try to move because I didn’t want to lose either baby on the monitors. I eventually had to shift around a few times, though. The test wound up taking maybe two hours all in all because additionally they weren’t getting the complete data on one baby so they kept extending the time. I was so uncomfortable and hungry I wanted to cry. 

I eventually got to leave and get lunch, however, and I’m now lying in bed typing this on my phone because that stupid NST test took it out of me and I don’t want to sit up with my laptop. The struggle is real. 

Coming Up: Sunday, I will hit 37 weeks by my calendar, but my next appointment isn’t until the following Thursday. Will I make it that far? If I do, will I be begging for an induction, or will I go to 38? We’ll find out!

35 Weeks: Everything is Bigger

Another week down, you guys! Now that we are past that “hard cutoff” of 34 weeks per my medical records, I am going to stop using Wednesdays as my update days. Wednesdays are the days my weeks change over per the doctor’s office’s inexact dating method, but my more accurate one uses Sundays. SO. As far as these babies and I are concerned, we hit 35 weeks on Sunday and we are quite happy about it. 

  
Here is where I confess to you that I purposefully chose this top, my most flattering maternity top, to wear today. My OB appointment is probably the only occasion for which I will leave the house this week, so clearly I had to put on something I felt good in and snap my belly picture before making the inevitable return to pajama pants and tee shirts that are now too short to cover the bump. Most days since going on my rest protocol, I have felt like a big, useless, gross lump. All of your sweet comments about my weekly belly selfies really do bolster my mood; I cannot lie. Thanks for making an uncomfortably large pregnant lady feel good 🙂

The Babies are the Size of: Two bunches of carrots, according to my Ovia app. That sounds…pointy. 

How I’m Doing: People give me a lot of credit for being tough or, alternately seem to think I am sailing through pregnancy with no trouble. On the whole, I still think I’ve had a fairly easy pregnancy. Having to stay off my feet has been tough both in terms of work and home, but that’s my only real complaint. 

That’s not the only thing going on, though. I feel like I have truly gotten to experience many of the weird or just funny symptoms of pregnancy lately! In the spirit not of complaining, but of being real about what late pregnancy (with twins) is like, I thought it was time to list all the various uncomfortable symptoms I have accumulated at this point: 

  • My nasal passages swell up at night and I have to sleep breathing through my mouth. 
  • Lying down makes one or both of my hands/arms go numb and tingly, which wears off once I get up. 
  • I am a little short of breath at all times.
  • I have frequent heartburn at night.
  • I sleep okay with a nightly Unisom, but it is still a struggle to stay asleep all night. 
  • I wake up to take 2-4 trips to the bathroom every night. 
  • When trying to fall asleep, I get itchy all over my body with a restless-leg feeling that lasts for 20-30 minutes before I can fall asleep. 
  • I get nosebleeds and bleeding gums. 
  • My hands are too swollen to wear my wedding rings OR my backup fake wedding ring. My real wedding rings stop just below the first knuckle if I try to put them on. 
  • My feet are so swollen I can only wear Toms or riding boots on a “good” day and stick to slippers or Birkenstocks on other days. 
  • I have strong contractions every time I am on my feet and they do not let up until I sit down. 
  • I have random contractions at random times and sometimes they last up to 5 minutes. For one contraction. 
  • I am very gassy. 
  • I have jowls. 
  • I am very veiny. 
  • The sight of my own boobs is, frankly, terrifying to me for reasons I won’t describe on this blog. 
  • It’s difficult to do certain personal hygiene tasks due to limited reach and visibility, which is all I all say about that. 

Doctor’s Appointment: This week everything was looking good. My blood pressure was at 122/70, which was nice to see. I have gained and lost the same pound or two over the last few appointments, so my weight gain is hovering at just over 55lbs so far. I trust the babies are still gaining weight as they should, but I haven’t been packing in QUITE as many calories lately due to limited room for food. 

I am a bit more dilated this week than the past two– I’ve officially hit 3cm and 90% effaced. My doctor said it could be any day or it could be another week. We just don’t know! I hate not knowing! 

I would love another week so we could hit 36 (which just seems like a nice number), but I am mentally in a place where if the babies decide they want to come tonight, I trust they will be safe and I am okay with that. 

Delivery Thoughts: Oh, y’all. I don’t know what to think about the delivery. At this point it seems certain we will at least attempt a vaginal birth because both babies are head down. I feel apprehensive about this for a few reasons. I haven’t been able to work out for a few months now so I don’t have great faith in my physical strength or endurance. I worry about being able to push out Baby B after being exhausted from having pushed out Baby A. I worry about all kinds of complications  because every time a new possibility comes into my zone of awareness I fixate on it for a while. I am addicted to reading (mostly twin) birth stories online but lord help me I should really stop!  There are just so many scary things that can happen.

I don’t really want to experience both a vaginal birth AND a c-section to get these babies out, which is what happens when Baby A comes out fine vaginally but for whatever reason Baby B needs to be born via emergency c-section. Recovering from two different exits sounds daunting. There’s only one sure way to avoid that, though: go directly to a c-section without attempting to do it vaginally. (Have I used the word “vaginal” enough yet? Can I work it in a few more times?) We won’t be opting for a c-section though unless there’s a medical reason to do so — for example if the babies move into a less favorable position or if there is some emergent reason they need to come out faster. So that means we will very likely be trying the vaginal route and hoping that it works for both babies. But who knows! I hate not knowing! 

So there you go. All I can do is remember my very simple, one-point birth plan: everyone comes out alive and healthy. 


34 Weeks: Phew

Thirty! Four! Weeks! We made it.

I’ve mentioned this a lot before, but this is a big milestone because our local hospital considers this the cutoff for the babies they are equipped to accommodate in their nursery (which is a Special Care nursery and not a full-fledged NICU). When talking about this with my doctor last time I saw her, she even used the phrase “hard cutoff,” which I hadn’t heard before but now it makes me even more relieved to have arrived at this marker — what if the babies had been born yesterday?

ANYWAY. They weren’t. We’re all still kicking.

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Oof. Does this shirt make me look pregnant?

The Babies are the Size of: Well, according to my Ovia app, the fruit/vegetable comparison for the week is a savoy cabbage, which, honestly, who cares? Cabbage is boring. The Parisian Bakery comparison has been good lately, though, so I looked at that and each baby is the size of a baguette bâtarde and excusez-moi, mais que dites-vous à propos de mes bébés?!

How I’m Doing: When I stand up, it feels like at least one of these two babies is halfway out. This is why pregnant women waddle, I am now discovering. Not because of our increased girth, but because of the babies that are basically hanging right out of our lady biz.  It is increasingly difficult to turn from one side to the other in bed. At the doctor’s office, I can no longer accurately get the desired sample into the tiny cup. I woke up with a Charley horse in my calf this morning and I can’t breathe through my nose at night. These are the facts.

Emotionally, I am feeling MUCH better since hitting the 34-week milestone. I don’t want the babies to come this week, but if they do, I feel more calm and prepared about it than I did last week. That helps.

I have stepped back a bit from work — I’m still working, but I’m accepting help when it comes to running the classroom sessions so I can keep everything else running from home (grading, lesson planning, student feedback, online conferences, etc.). This is psychologically…not easy. But it is the best decision I could make right now. I feel an absolutely clear difference as soon as I am sitting or lying down and the contractions slow/stop. I know I’m taking the pressure off my cervix and helping keep dilation from progressing. So that feels good.

Current Belly Button Status, Etc: Still an innie, can you believe it? The upper lip of it has started to stick out a bit, but the main belly button is still in. Still no new stretch marks that I can see, but every now and then I feel the tell-tale stinging sensation that suggests one might be forming. Maybe I just can’t see them yet? Occasionally, my abs feel really stretched out and sore, too. I assume I will wind up with some diastasis recti from this pregnancy (because, seriously, two babies are in there) but I hope it will be mild/correctable. If that were happening, would I know it already?

Movement: All the time. These little monkeys are constantly wrestling around in there. I wonder where they inherited that tendency from? Heh. They’re big enough now that sometimes their movements seem to just stretch out and re-configure my whole abdomen. I feel it all throughout my torso, deeper than I would think would be possible. Are they moving my organs around in there for fun, or what?! I never really get tired of it, though. Keep moving, babies.

Doctor’s Appointment: I went in yesterday for a regular check-up and an NST, and I was so relieved to find out that my cervix had not changed at all from last week (2cm, 90%). I think my doctor was relieved as well — she was very happy about me making the 34 week mark. She was all casual, like, “See you next week!” and “Maybe you’ll make it another three weeks for another growth ultrasound!” They only do growth ultrasounds every four weeks so that would be at the 37-week mark for me — I would be thrilled to make it there!

The NST went smoothly and both babies were looking great on the monitors. These take place at the hospital, so I wind up reviewing the results with the on-call OB there afterward (rather than my regular OB, who is at her office). This time I met a new-to-me doctor whom I really liked — especially in comparison to some of the other OBs who I absolutely have NOT clicked with. (Topic for another time, maybe.) He was talking to me about making it to 34 weeks and said “with twins, everything after 34 weeks is just gravy,” so that was nice to hear. Even better, I asked if he thought I might make it to 36 weeks and he said he thought I had a good shot. So. Let’s see if we can make that happen! But first, let’s make it to 35. One week at a time.

33 Weeks: Not Ready Yet

Thirty-three weeks down! I am so happy to have made it this far.


I count my weeks on Sundays, you know, because I do happen to know the exact date of my ovulation/conception and it was precisely Sunday, April 5th, also known as Easter Sunday. You don’t forget driving 2.5 hours each way for an uncomfortable catheter on Easter Sunday, you know? At any rate, I bring this up because my OB’s office insists on using the date of my last menstrual period to date the pregnancy, which is less accurate. In a normal 28-day, unmedicated cycle, sure, that would work. In the cycle when we conceived, though, fertility drugs sped up the proliferative phase enough that ovulation (& likely conception) occurred on day 11, not day 14. So while I say I hit 33 weeks this past Sunday and will hit 34 weeks this next Sunday, my OB thinks I am 33 weeks as of today, Wednesday, and will not be 34 weeks until next Wednesday. I think my way is correct. This may be important later, but I hope not.

The Babies Are the Size of: My Ovia app says two heads of cauliflower, but I feel like we’ve had cauliflower before? I looked at the Parisian Bakery theme instead and was delighted to see that EACH baby is now the size of THREE chocolate croissants. That’s a total of six chocolate croissants. I think you know where I’m going here.

How I’m Doing: Physically I feel pretty much the same as last week, though I have definitely started swelling more. Wrestling shoes or boots onto my swollen ham feet is a serious workout, and the doctor’s scale says I gained 6 pounds since last week. Surely most of that is water weight. I continue to have BH contractions often, but none are regular or painful. They’re much worse when I’m standing or walking, though, and I can really feel the weight and pressure of my uterus and the babies bearing down whenever I am vertical.

Emotionally I’ve been a mess since my doctor’s appointment on Monday (see more below) because I’m just not ready for these babies to be born yet. I need them to stay put where they are until at least 34 weeks — preferably 34 weeks by my doctor’s calendar so there will be no room for debate — that being the magic number where we believe they will be mature enough to be born and cared for at the local hospital and be unlikely to need a more intensive NICU situation.

Ultrasound: My growth ultrasound was great. Both babies are growing on track and measuring right around the 50th percentile for their estimated size and weight. Baby Girl (A) was estimated to be about 4lb 8oz and Baby Boy (B) was at around 4lb 5oz. I have nine pounds of baby in there, y’all, plus of course two placentas and two full amniotic sacs. Phew. They are both still head down, which is a hopeful sign for attempting a vaginal birth. If either were breech or transverse, a C-section would be almost sure to happen instead.

We even got to catch a glimpse of Baby Girl’s face as she was turned toward my front. (Her brother was facing my spine and ignoring the paparazzi.) The tech we had said she likes to switch on the 4D whenever she gets a good face view (our other tech never does this) and so for the first time, we were able to get an idea of what one of our babies will look like:

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Can you even handle her little mouth and chin? I can’t.

Doctor Visit & NST: After the ultrasound, we went in to see my OB, who decided it was time to do a cervical check (the first in many weeks). It turns out I am now 2cm dilated and 90% effaced. I was completely shocked to hear this — I’d sort of felt like things were sailing smoothly ahead and that we’d have no problem going at least 3 more weeks, but this really took the wind out of my sails. She told us I could be getting ready to go into labor right now, or I could go on like this for a couple more weeks, but there was just no way to predict.

My husband was with me at the doctor this week and it took him a minute to grasp all of this information (I don’t think the numbers meant anything to him at first — he was all “it doesn’t count until you’re 4cm, right?” — until I explained what 90% effaced meant, among other things), which we tensely discussed on the way from the OB to the hospital for my already-scheduled NST.

At the hospital, they put me in a regular L&D room instead of a tiny triage/evaluation room and had me get into a gown because they were going to check my cervix again after the test to see if I’d progressed. The combination of all this really set us both on edge. It felt like they were admitting me. They weren’t, but it felt like it.

Our NP was really sweet and calming, and she got the test set up and left us there to listen to the babies’ heartbeats for about half an hour. The test looked great — she said I was having small “irritability contractions” throughout but the babies’ responses were good. The on-call OB, another doctor from my practice, came in and checked me again. He said I was still no more than 2cm and, in his opinion, only 70% effaced. On the one hand, that was sort of a relief, but on the other hand, DO NUMBERS EVEN MEAN ANYTHING AT ALL? You can’t go backwards.

Anyway.

They released me with instructions to come back if I started having painful or regular contractions, bleeding, or my water broke. I also talked with the NP about my work and what my schedule and typical days were like — she said since I could sit all day, park in disabled parking, and take the elevator everywhere, there was no problem with me working at this point. I am at work today, in fact, where I am conferring with students, which means sitting at my desk in a comfortable chair with my feet up and literally nothing more. Okay. She also said at home I should basically do NO household stuff: no cooking, cleaning, laundry, etc. Fine by me.

So I suppose they can’t be too overly worried if I’m allowed to work? Right? And people go around for weeks at 2cm or more without going into labor, right? (Thank you to all the twitter ladies who shared your experiences with this; it’s very comforting.)

The bottom line, though: I do not feel that it is time for these babies to be born yet. I need seven more days, minimum. I just do. I am very firm about this. DO YOU HEAR ME YOUNG LADY AND YOUNG MAN?