It’s 4:31 AM, Saturday November 27, 2010 and I can’t sleep. This certainly isn’t a new occurrence, although it was one of the many things I expected to get better after the babies were born. Instead, there are just so many things going through my head that I find I cannot sleep for more than a half-hour to an hour at a time.
My labor technically started on Monday, November 22 with a visit to my midwife. It was a pretty typical visit, beginning with a trip to the ultrasound room where I discovered both babies were head down. Then I moved on to being weighed—after weeks of not be able to eat, I thought the babies must have dropped because I had gained about 5 pounds—and then to my visit, where we discussed what would happen at my induction the next day. My blood pressure had been high and, while controlled, we were all increasingly uncomfortable allowing the pregnancy to continue, especially given the fact that I was 38 weeks pregnant with twins and had a history of going overdue. The hospital in my town pretty much only does pitocin inductions as well as the occasional cytotec induction, and I absolutely did NOT want the cytotec. H. respected my choice and also agreed to check me and do a membrane strip to help stir things up. The babies were so low and applied to the cervix that she had a hard time feeling around, but finally was able to assess me. I had been a little short of breath that morning, but I have a history of exercise/cold-induced asthma and, according to that morning’s ultrasound, had approximately 14 pounds of baby sitting on my belly. Shortness of breath was to be expected! With my membranes stripped and my babies ready, we were all set for an induction bright and early.
Before I go any further, I want to make two things perfectly clear. One—every single symptom I had could be written off either due to my being pregnant with multiples or my “advanced maternal age” or because this was my eighth pregnancy. There was nothing anybody missed or messed up. This didn’t happen because I was too fat or too tired or too pregnant or because I really like steak. It just happened. Two—one of my biggest fears in sharing my story is that people will use it as ammo in the homebirth/hospital debate. I had my babies in the hospital this time and am very, very glad, as it saved my life and theirs as well. I had another baby at home with zero incident. I was extremely fortunate that the stars aligned so that I was in just the right place at just the right moment to get just what I needed this time around. That said, this all could have just have easily happened four weeks down the road postpartum, or three weeks ago when I was trying to walk around the grocery store. What happened to me has nothing to do with hospital versus home birth, so if you feel the need to have a debate about it, kindly go have your own tragedy and leave mine out of it.
I never really went to sleep on Monday night. My in-laws came up the night before and stayed at a hotel—our little three bedroom, one bath house unfortunately isn’t very conducive to houseguests—and were at our door around 6 AM. I called in, as I had been instructed, and we were still on for the induction. I was still short of breath and coughing, but I again attributed to the early hour and being pregnant with twins.
After hugs and kisses all around, we loaded up the car and stopped for a quick light breakfast. Then we pulled up to the hospital front door a few minutes later. My husband dropped me off and went to park the car, and I was absolutely disgusted to discover that all three elevators to the second floor where I had to check in were out of order. The hospital has been having elevator issues all throughout my pregnancy so I am not sure why I was so annoyed, but I was. I stood there glaring at the “out of order” sign and must have looked thoroughly disgusted, because an administrative-type dude came up and asked if I needed any help. “No,” I said, probably rather ungraciously. “I’ll just walk.” And really, it did seem quicker and easier to walk up one flight of stairs than to hike down the hall in either direction to find the other elevators. Instead, one set of steps left me panting and unable to catch my breath. It felt frightening and out of control, but I again attributed it to the twin pregnancy, eventually caught my breath, and had my husband sign me in when he met up with me.
Once on labor and delivery, things began fairly quickly. I was put in the room closest to the OR, but assured that my doctor was one of the few who didn’t make twin mamas move into the operating room to push. My wonderful midwife H. started the pitocin after checking me again and we waited. And waited. And waited. As usual, my body did not want to let go of the babies. Around noon, things started to become uncomfortable and around 2 I decided it was time for the epidural.
This wasn’t entirely a just-for-me decision. Epidurals can help lower the blood pressure, and mine was still a bit on the high side. I also was still having a fair bit of trouble breathing and was hoping this would help me relax. Sighing through the contractions and focusing on my body opening with the pain was no long effective. Besides, to be honest, I’m not into natural childbirth for the experience. I don’t like pain nor do I really find it particularly redeeming. I’m pretty much in it because it’s the best way for successful breastfeeding to happen. When the anesthesiologist came, he tried and failed to get the epidural in the right spot. Instead of pain relief I got what felt like an electrical current running down my back. I remember crying and saying they could just knock me out and take the babies, anything if they would just stop the pain. He pulled out the epi and tried again, and this time succeeded. My husband claims I was singing the praises of the epidural for the next hour or so. I don’t really remember.
Eventually the epidural seemed to stop working and I was having a lot of pain right around my hips, even after turning up the epidural and adding fentenol. I think this was around the time they broke the first bag of waters to help the babies make their final bit of progress. I was still having difficulty breathing and did not want to be flat on my back to be checked. I was having a complete panic attack, which unfortunately for me is a pretty good sign I am in transition. Eventually I succumbed to the check and was found to be at 10 cm—praise God! Despite my breathing issues, it was time to push.
Without much ceremony, I grabbed my legs and started pushing. I remember being surprised that they didn’t even break down the bed, they just kind of let me set my own pace. Oh my gosh, it hurt. Every bit of it hurt so much and I could feel the baby making its way down the birth canal. I had become convinced that Molly was the one who was closest to the baby door, and said her name as I pushed. I felt every tiny bit of travel though the birth canal,…through the cervix…the ring of fire… And as I yelled “Molly!” out popped Matthew. He was mottled and slimy and beautiful, all at the same time. I touched him and kissed him and told him I loved him.
At this point, everything kind of stopped, including the contractions. I asked if I could try to nurse Matthew to try to get things going again, and they gave him to me, but he pursed his lips and refused, so I gave him back. They weighed and measured him—6 pounds 7 ounces and inches long, not bad for a 38-week twin!—and after yelling out “No eye goop or circumcision or shots!” I just left them to it and concentrated on getting the second baby out.
The contractions were still pretty much not there, but the doctor noticed something in her monitoring that told him she needed to come out right away. They broke the second bag of waters and I half-heartedly tried to push the baby out. Mostly at this point I was worrying that they had screwed up and I was actually having two boys, and how on earth would I explain that to Katie Grace, who had her heart set on a baby sister? Then the doctor’s whole demeanor changed and he said “Annette, you have to get her out right now.” I pushed out a seven-and-a-half pound baby girl with a cord wrapped around her neck. She was chubby and had the angriest, most ticked off expression I have ever seen on a newborn’s face. She needed some help breathing, which is common for a second twin, and they whisked her away. That was fine, as I needed help of my own right then. Pushing her out left me feeling like I was going to die. I didn’t know at the time that I had vaginally delivered two babies– without a tear or a cut or a stitch, I might add– while going through congestive heart failure.
I don’t know what happened to the babies next. To be blunt, I didn’t particularly care. I trusted my birth team and the hospital staff to follow my orders—no eye stuff, no shots, no circ, no bottles, no formula—and left them to it. I did give permission for the Vitamin K because of my fear that they would need a little extra help, being twins and all.
After I delivered the placentas, two things happened simultaneously. I still couldn’t breath. My only comfort came when I sat up and bent forward. They called the respiratory therapist and somewhere over the next block of time I had four breathing treatments, none of which worked. I also began hemorrhaging.
My midwife, doctor, and nurse all seemed mystified as to where all the blood was coming from, as my uterus seemed to be clamping down and doing all the nifty things uteruses are supposed to do after childbirth. But still, there was tons of blood. All told, I lost between 2700 and 3600 ccs of blood and had transfusions. That was still ahead of us though. At the time, I think we all thought things would come under control. I asked for hot tea, wondering if eating ice chips was exacerbating my breathing issues. I sipped my tea and they were going to heat up some lasagna for me when I felt the blood and clots slipping out of me again. I told my husband to get H.. He told a nurse, who said something like “Oh, it’s normal.” I called out that it was definitely NOT normal and she needed to get H.. H. came in, took one look, and said “Get Dr. L. right away.” The nurse asked if she should call him, and H. said no, he needed to come back to the floor immediately.
Somewhere around this time, I lost consciousness. When I woke, I had been transported off of Labor and Delivery and was in a huge freezing cold downstairs operating room. My mouth was so dry and I was begging for a drink, which they wouldn’t give me. Someone finally let me suck some water from a sponge, probably just to shut me up. I lost consciousness again.
My husband tells me two attempts were made to stop the bleeding. First, they tried to put some sort of foam-filled balloon in my uterus. When that didn’t work, they made an incision and went in and basically hot glued the arteries shut. This did work, and saved me from a hysterectomy.
This is also the point where everything went wrong in a very good way. Down in the operating room, the doctor on call was a cardiologist. He pointed out that if for breathing treatments didn’t work, we were likely dealing with something more than an asthma issue. He ordered an echocardiogram, which showed the ejection fraction of my left ventricle to be between 15 and 20%. Normal is somewhere around 65% from what I understand. He suggested the possibility of postpartum cardiac myopathy.
The Lost Day
My breathing and blood pressure still out of control, the decision was made to intubate me. Apparently I did not like this one bit, and they sedated me as well. When I next was conscious, it was Thanksgiving Day and I had lost all of Wednesday.
This is what my husband tells me:
L., a wonderful lactation consultant I have had the privilege of working with before, heard what happened and told my husband the babies needed to come down and be skin to skin with me, even if I wasn’t conscious. When he tried to argue, worried that it would just stress me out more, she insisted, saying it was as much for the babies as for me. He gave in, and my two beautiful babies were brought down and held against me.
When they took the babies away, I lost it and tried to rip out my tube. I was sedated again.
L. also brought down a hospital grade breast pump and trained my nurse and her aid to pump my breasts to stimulate my milk supply. Again, this was completely out of the norm, but the nursing staff did it graciously. By the time I was awake Thursday morning, I was getting a trickle of colostrum, which unfortunately had to be dumped out due to the medications I was on.
L. also made sure that the babies had no artificial nipples. Up until Saturday, Molly was cup fed and Matthew had been fed with a syringe. These efforts were made to hopefully help the babies transfer from formula to breast milk feeds more easily. Unfortunately, their bilirubin levels continued to rise and we had to switch to a bottle so they would get more milk. Their bilirubin levels began going down.
At some point during my intubation, my mind managed to recall every sign I had ever seen, used, or known. I began frantically fingerspelling at one point and both a family friend and a nurse who new sign recognized that I was trying to communicate “No immunizations” over and over again. I’m not sure why—while it was important to me it wasn’t my biggest issue—but I was on a lot of hard core drugs and am not expecting it to make too much sense.
My husband also tells me there was a room on the Birthplace that literally had my name on it where they allowed my children to visit with the babies. I have hoping and praying to eventually make it up there so I can stay with the babies as well. The twins were allowed to stay in the hospital through Monday and have been cared for and loved by the nursery and L&D staff. Unfortunately, on Monday my insurance company gave the order that they had to be discharged by midnight. I am so blessed that they were able to stay in the hospital as long as they did.
I don’t remember how I woke up on Thursday morning, but it must have been a fairly gentle return to consciousness because I didn’t completely panic, despite being sedated, restrained, and intubated. I played a lot of charades with the nurse before she gave me a clipboard and pen and made me promise not to rip out my vent.
Thanksgiving was a day of shock and surprises. To find out it was Thanksgiving Day and I had lost a day was a shock. Finding out what had happened to me was a bigger shock. When Chip finally came in, I reached for him and just had tears streaming down my face. I was so, so happy to see him. I asked on the clipboard what the heck happened and when he told me I wrote “Holy crap!” They talked about bringing me the babies, but I didn’t want to see them until the vent was out, which they promised would happen within the next few hours if I behaved. I was the most well-behaved patient in the universe. I didn’t want the older children to see me in the ICU at all.
I had—and still have—such a difficult time wrapping my brain around everything that happened. The day was all about getting to the next step. They removed the tube and I waited to be allowed to talk and then to drink. I drank and ate some ice chips and then waited to be allowed to eat. I hadn’t eaten since before 7 AM Tuesday morning! When a nurse gave Chip a Thanksgiving tray, I told him I wanted to bury my face in his mashed potatoes. A nurse had mercy on me and brought me a tray as well. I have never in my life tasted anything so delicious. And finally, FINALLY, they brought my babies. Holding them was like heaven.
All day long and into Friday, I pushed myself to do whatever the doctors and nurses told me. I tried to do it faster than they expected. Whenever the babies left, I wiped my tears away and dealt with it. By Thursday afternoon, I was sitting up in a chair and pumping without too much help. By early Friday morning, I was walking. And when they released me on Friday not to the Birthplace but to the cardiac floor, I tried my best to keep it together.
Skin to skin with Molly and Matthew in the ICU
I’ve been on the cardiac floor since Friday. When my babies were here in the hospital and my husband was able to stay here with me, it was tolerable. I almost hate to admit it, but especially after the babies started taking bottles and we were able to keep them in the room for 3 to 4 hour chunks at a time. In a typical attack of bullheadedness, I made sure Chip took pictures that included the babies being bottle fed. I’ll be darned if I am going to let a case of self-imposed mama guilt rewrite the babies’ history and I am working hard on not being ashamed of making hard and difficult choices.
Daily, I’ve been visited by doctors, nurses, and midwives, both those who were part of my care and those who heard the story. I had a nurse tell me she cried when she overheard L. the lactation consultant explaining how they had to pump my milk for the twins. The nurses who cared for the babies came down and sat with me on their own time just so I could have the babies with me. My midwife H. came down and we both cried. I’ve had staff throughout the hospital praying for me and my babies.
I’ve tried to be upbeat and cheerful, but I will admit that I’ve had a couple of low days. Today was one of them, when I was told I had to wait one more day to go home. I also learned that instead of being able to start trying to get the babies on the breast tomorrow, I need to wait another 10 additional days. I was on some pretty scary medications and feel really blessed that everything I need to be on will be compatible with breastfeeding. I just need to hang in there and wait for the old meds to clear my system. I have had a hospital grade pump in my room from the beginning and am getting about one or two ounces per side each time I pump. Dumping it out is killing me.
Last Saturday and Sunday I had two bad nights in a row. Technically, I suppose I had two more heart attacks. I prefer to think of them as small relapses. But they seem to have my meds under control right now and I am working on controlling my anxiety.
I’ve also been told in no uncertain terms that having more children would be extremely foolhardy. It’s not even that we were planning on having more children, but it is frustrating to essentially have the decision taken out of our hands.
The good news is that my heart function has improved already. They did some sort of enzyme test and do not believe my heart muscles are permanently damaged. They expect me to make a complete recovery within 6 months to a year, possibly sooner.
The better news is that, God willing, I get to go home in the morning. I cannot wait to get a shower and be completely unconnected from monitors and IVs.
The best news is that I get to walk out of this with my life. I have a loving husband and four beautiful children waiting at home for me with two newborn babies who are the sweetest little loves in the whole world. I’ve felt the love and prayers of friends and family across the world and have been uplifted by God’s grace and mercy throughout this ordeal. I have been well cared for and well loved, and I pray I never, ever lose this feeling of gratitude.
3:24 AM, Wednesday, December 1, 2010
All mistakes in the accounting of this are mine– I blame the drugs and lack of oxygen.