Monday, May 11, 2009

Q and A #11

Anna at It's Only A Theory sent me these questions:
How did you manage to avoid a C-section with the twins?

In a nutshell, I just refused to consent to a c-section. The doctors had all kinds of reasons why a c-section was "necessary" but I knew it wasn't necessary. A c-section was one of the main things I wanted to avoid if at all possible - for many reasons, among them the fact that I knew that VBACs are becoming a thing of the past again and if I ever hoped to have another baby after the twins, I didn't want to have to succumb to a repeat c-section, and also, I just couldn't fathom trying to recover from major abdominal surgery on top of trying to care for two newborns and two other kids at home. So I did my homework and learned about what really necessitates and c-section and what doesn't. I spent almost my entire labor arguing with the doctors. I'm going to post the twins' birth story, as I wrote it shortly after they were born, below for anyone who cares to read it. I'll say, too, that out of all of my babies' births, I still look back on the twins' birth as the most traumatic, and it was a big reason I chose home birth for the next two (although, actually, we had decided on a home birth for the twins, before we knew it was twins).

Birth Story of Our Twins
Born September 22, 2004
Annabelle Jeanette, 2:21 p.m. 5 lbs. 12 oz. 18 inches
Daisy Estrella, 2:39 p.m. 6 lbs. 1 oz., 19 inches
Finding out I was expecting twins was one of the biggest shocks of my life. There was just no reason to have suspected twins - no family history, no fertility treatment. Michael and I wanted another baby and were thrilled when I got pregnant the first cycle we tried, but nothing could have prepared us for the news of twins. We had hired a midwife already with the plan of having ain home birth after having had two pretty unsatisfying hospital birth experiences. However, I did plan on seeing an OB for the first part of my pregnancy - that was just my comfort zone I guess. At my first prenatal appt. with the OB, during a routine dating ultrasound, I got the shocking news that I was carrying twins. Michael wasn't even with me, as I didn't know beforehand that I would be having a u/s that day. When we found out we were having twins, our plans for a home birth went down the toilet and I was crushed.

First picture of the twins

Although my OB continually warned me of a complicated pregnancy because I was carrying twins, I really had a pretty healthy pregnancy, with the exception of developing both PIH and PUPPS during the last few weeks. I fought hard to be treated as an individual rather than being subjected to routine protocols and procedures just because I was having twins.

I went into labor at 37 weeks + 5 days. I realized I was in labor a little after midnight. My contractions were coming about every 8 minutes and growing more and more intense. I dozed on and off through the night, and when Michael's alarm went off at 5:30 a.m. for him to get up for work, I told him I was in labor. We were both very excited.

We left the house at about 7:30 a.m., and by then my contractions were 2-3 minutes apart and really hurting. We called our doula and asked her to meet us at the hospital. Kevin, who was 7 at the time, was very excited to know that his sisters were going to be born that day. Joey, then age 2, didn't really understand any of it. We got the boys dropped off at a babysitter's and made our way to the hospital.

I knew that because I was having twins, I would have to deliver in the OR, but we were able to talk the nurses into letting me labor in one of the nice birthing suites. It seemed like we had to make a case for everything we wanted because of all the lame hospital policies. Every time I had a request or preference, I had to argue for what I wanted.

When I was admitted, I was dilated to 5 cm. I had already had to agree to an epidural because Baby B was breech, and Dr. Zepeda said he would not try to turn her unless I had an epidural. I was bugged because I know a lot of times the second baby will turn around on its own after the first baby is born, but he wasn’t going to budge on that - he said either an epidural or a c-section. It made me so angry that I was given ultimatums like that - it seemed like so many decisions had been made that way. Because I was having twins, I had to give up a lot of control over how my birth would go and it was very upsetting to me.

Anyhow, when we arrived at the hospital, Dr. Linzey was on call - my former OB/GYN whom I had left after Joey was born because he and I had butted heads on some things that were very important to me at the end of my pregnancy with Joey. Dr. Zepeda was on call the night Joey was born I liked him so much that I chose him to be my OB when I found out I was pregnant again. Dr. Z had promised me in that he would be at my birth even if he was not on call when I was ready to deliver - he left instructions in my chart that he was to be reached when I was admitted. I had left a message with his answering service earlier that morning, and when we got there I was n surprised and a little alarmed to hear that they were still trying to reach him. I did not want to deal with Dr. Linzey.

By 11:30 a.m. I was dilated to 7 cm and was given an epidural. Dr. Z still had not responded to attempts to reach him. I was really feeling disappointed about the epidural because for the first time I really think I could have made it without one. With Kevin, I was induced and begging for an epidural by the time I got to 2 cm. With Joey, I tried to go natural but after 19 hours of labor, I "hit the wall" got an epidural. This time, though, I stayed on top of the contractions and never felt like I was close to not being able to handle it. My doula took a picture of me laughing between contractions.

Me, in labor at the hospital

Dr. Linzey came into our room and was very friendly at first. He talked about turning Baby B once Baby A was born, and he also talked about the possibility of a breech delivery of Baby B if she wouldn’t turn. I was completely open to that, as a c-section was my worst fear. I knew I would be going home with 2 newborns to care for in addition to my other 2 kids, and I had no family or help. I couldn’t fathom how I would manage to try and recover from a c-section on top of being on my own to take care of my kids and house (Michael would only be able to take a week or so off work). Then Dr. Linzey asked about the babies’ sizes and I told him that my last ultrasound almost 3 weeks prior had estimated Baby A (the presenting baby) to be approx. 5 lbs, and Baby B to be approx. 6 lbs. His whole tune suddenly changed then. He said Baby B could not bein delivered breech if she was a pound bigger than the first baby. I reminded him that: (a) the ultrasound had been done almost 3 weeks ago and a lot could have changed between then and now, (b) the u/s weight estimates were just that - estimates - and the report even said "+ or - 12 oz.", and (c) what happened to turning Baby B to a head down position? He got a copy of the u/s report from my file and pretty much became closed to the whole idea of even trying to turn the second baby. He had his mind made up that I should just have a c-section, period. And he was really quite a bully about it, insinuating that I was not making decisions in the best interests of my babies, and saying "We want these kids to be able to count to 10 someday." (He later used this same exact line on a friend of mine and I was appalled to realize that that’s all it was: a line, a scare tactic.) So we had gone from a very high chance of delivering both babies vaginally to pretty much no possibility of anything but a c-section. I was so upset I couldn’t even talk anymore, I was just crying and crying. Michael argued with him and Dr. L was just a total jerk. I still wanted to know where the hell MY dr. was. I felt like if I could just get Dr. Z there, we could clear the whole thing up and go back to the possibility of delivering both babies vag. Dr. Z and I had talked about it at length, even taking into consideration that Baby B might be a little bigger than Baby A, and he was definitely more open to work with me and help me achieve what I wanted, at least as far as avoiding a c-section. So I’m laying there bawling, Michael’s pissed, and finally Dr. L left the room to "give us some time."

Because of the PIH, my blood pressure was being constantly monitored, and by this time it was sky high - something like 190/110. Obviously our conversation with Dr. L didn’t help matters, but even after he left my bp wasn’t going down and they were afraid I was going to go into seizures, so they had to put me on Magnesium Sulphate then.

Finally, a little while later Dr. Z showed up. I felt such a huge relief. But suddenly he seemed to have changed from caring, supportive OB to "I'm in charge here, I know what's best," and scolded, "Lisa, we talked about this . . ." I panicked a little - what, was he suddenly on Dr. L’s side? I told him yes we had talked about it and I reminded him that he had said he was willing to work with me and help me have the birth I wanted. He finally agreed to attempt a vag birth and hope that Baby B could be turned.

Around 2:00 I suddenly felt like I needed to push even though I was completely numb. The nurse checked me and said "We’re ready to have a baby here!" So they wheeled me on the L & D bed down the hall, around a few corners, and into the operating room. What a trip that was, to be in this cold, sterile, brightly lit operating room to have my babies. At the last second, right before we were about the enter the OR, they said my doula could not go in. That came out of left field and completely caught me off guard. I was so angry - it seemed like they had intentionally waited until the last possible second to spring that one on us so we wouldn’t have time to argue about it. What the f***??? Dr. Z and everyone else knew all along that I had a doula and no one ever said anything about her not being allowed in the OR where I would give birth - and where I would especially need her!

They sent Michael to another room to put scrubs on and I was wheeled into the OR. As it turned out, an OR birth requires 2 doctors to be in attendance so guess who else was there besides Dr. Z. Yep, Dr. L, my arch enemy. They weren’t going to let me actually deliver on the regular birth bed, I had to be moved onto the operating table. It was really narrow and hard and I was flat on my back. I kept saying "I can’t push like this, I need to sit up," but the nurses were too busy hooking things up and getting things ready to pay me much attention, plus after my skirmish with the highly respected Dr. Linzey, the nurses really became pretty bitchy and cold to me. Finally they did kind of elevate my upper body with pillows to make it easier to push. For some reason that I’m still not sure of, I started crying as soon as they got me into the OR, and I think I cried the entire time we were in there. It was so overwhelming.

Michael in scrubs and gown

I asked if they could bring a mirror in so I could see my babies being born. As soon as they put the mirror at the foot of the table I could see Baby A’s head with lots of dark hair. Dr. Z told me I could start pushing. I pushed so hard I literally saw stars, but I couldn’t really feel myself pushing because I was so numb. Even so, it was only 2 contractions before Baby A was out. Annabelle Jeanette was born at 2:21 p.m., weighing 5 lbs. 12 oz. and was 18 inches long. They laid her on my chest and Michael cut her cord. I held her for a minute before a nurse took her away to clean her up and weigh and measure her, and then she was brought back to me and I got to hold her for a few more minutes before the next baby was ready to be born.

Now Dr. Linzey started manually trying to turn Baby B from the outside. From what I could see, it looked really painful, although I was numb, and at that point I was glad I had an epidural. How ironic it was that he was the one turning her since he was so set on doing a c-section. It only took a few minutes for him to get her head down and then Dr. Z broke her water and pretty soon I could see her head - another head with dark hair! He told me to go ahead and push, and again I pushed her out in just a few minutes. Daisy Estrella was born 18 minutes after her sister, at 2:39 p.m. She weighed 6 lbs. 1 oz. and was 19 inches long. So there was a 5 ounce difference between the two of them - not even close to a pound. No episiotomy, and no tearing. I didn’t get to see or hold Daisy right away. For some reason, they took her away right away and I didn’t get to see her until I was ready to be moved into the recovery room. After Daisy was born, they brought Annabelle back to me and I tried to nurse her for the first time. During all this, Michael was pulled in 3 different directions, between me and 2 babies. It kind of sucked. A lot of the time I was just left there on the table with no one holding my hand or paying me any attention or anything. I was (and am) still so angry that they wouldn’t let my doula be there with me.

When I was still in labor, we had been told that I would have to go to the recovery room for an hour or 2 after the birth and that the babies would have to go to the nursery for observation. I made a total stink about that until they gave in and said they could make an exception and let the babies stay with me in the recovery room. I held and nursed both babies in the recovery room. We were there for an hour or so and then I was taken to a private postpartum room. Michael stayed for a few hours and then went home to be with the boys.

My blood pressure was still pretty high so they wanted to keep me on the mag-sulph for 24 hours. During that time, someone came every hour to draw blood from me, and every hour the nurse made me get up and pee into a measuring bowl in the toilet. My blood pressure was also taken every hour, and my reflexes checked. Mag-sulph is some wicked stuff, and I spent the next 24 hours in a zombie state, just feeling incredibly weak and sick and out of it.

On that second day, Annabelle and Daisy started nursing really well, and for the rest of my stay in the hospital it seemed like if I wasn’t nursing one, I was nursing the other. On the second night I somehow managed to get them both in bed with me propped up on pillows so could nurse them at the same time. The three of us fell asleep that way and it was nice. Of course I got a talking-to from the nurse about how dangerous it is to sleep with a baby in bed with me. The nurses kept trying to convince me to let the babies go to the nursery so I could get some rest, and it just upset me. I had worked so hard to grow these 2 babies and to give birth to them - why did they think I wanted to be separated from them? I was also cautioned by more than one of the nurses that I would have to supplement with formula, that it would be too hard to breastfeed twins. Well, they didn’t know a thing about me or how determined I am. I never supplemented my first two babies, and I wasn’t about to go down that road with my twins. I ended up nursing them for 18 months - until I was about 3 months into my next pregnancy - and never did a drop of formula pass their lips.

Annabelle and Daisy

All the nurses were just amazed that I had the twins vaginally. One of them told me that there had been 5 or 6 twin deliveries that week and they had all been c-sections except me. How sad is that?

After 2 days in the hospital we were finally able to go home. What a relief that was! The whole experience made me never want to step foot in another hospital.


And how did you guys survive the first few months after they were born?

Honestly, it's all a blur now, 4 1/2 years later. The twins were born in September, so Kevin was going to school every day and I sent Joey to a babysitter a couple days a week, and that helped. I know that we were just very tired for a long time!


Megan said...

Interesting about not being able to nurse twins. @@ at them. When I was in the hospital, after Stella's birth, they told me they'd need to supplement her because of her jaundice. They said that putting her under the bili lights would dehydrate her and exacerbate her jaundice. I said, fine, I'll pump and you can give it to her via bottle. They said, "oh no, you won't have enough milk to pump and supplement" and "you don't want to trick your body into thinking you're nursing twins". @@ WTFE! I pumped, I had plently of milk and my body adjusted just fine after the 12 or so hours that I did that. Now, it was a giant pain to set my alarm to get up, hike down to the nursery and nurse her, then come back, sleep for an hour, wake up and pump. But, shit, I did it. And it was what was best for her. It makes me cringe when I think of all the things people agree to just because someone in "authority" says that's the way it is, should be, is best, will work.

Wendy P said...

You are a Fierce Warrior Mama. No doubt.

Anna Alexandrova said...

What Wendy P said. Wow, Lisa! Thanks for this amazing story.

I keep wondering about the hospital staff and their attitudes. Do you think they are actually malicious? Seems unlikely... Or just don't know any better? Or know better but want to take the path of least resistance (which often means C-section) to avoid law suits? Which is it? You must have thought about it a lot...