Our Twin Birth Story / by Martha Keyes

Like all birth stories, this one contains information and imagery that some people might not want to read about. So if you don't want to get to know me on that level, perhaps consider just looking at the pictures :)

The end of my pregnancy, unlike what I hear from most other expectant mothers, seemed to happen quickly. I was definitely uncomfortable and anxious to not be pregnant anymore, but time became short very suddenly--probably in part due to the holidays. I felt near week 34 that my belly wasn't growing as much as I had expected it to. I know that our society is concerned with being small while pregnant, but I really wanted to know my babies were growing, and my belly size didn't seem to be matching up with the growth I had expected at that stage of pregnancy. When we went in for our final growth scan at 35.5 weeks, we were told that the babies had slowed down in growth--especially our Baby B. They estimated their weights at 4lbs 15oz (Baby A) and 4lbs 10oz (Baby B). The perinatologist told us that the measurements were just estimates and often quite off, so I assumed and hoped that the babies were a bit bigger than the estimates he gave us. The doctor asked when we planned on delivering, and we told him that we had an induction set for 37 weeks--Sunday, January 1st. Babies were both head down, though Baby A was "sunny side up," as they say, or with his eyes facing my belly rather than my spine. I asked the perinatologist if he thought the baby would turn, and he said that, once labor started, Baby A would turn "like a key in a lock." That reassured me a bit, since I knew that posterior babies usually cause longer and more painful labor.

On December 27th, I spoke with my OB. She told me that she had been reading through the notes of the perinatologist and realized that he had recommended inducing no later than 37 weeks. She said she was going to call and ask him for clarification on what he would recommend. She called me back and told me that he would be very supportive of inducing a couple days before 37 weeks, given the growth slowdown we had noticed. And then suddenly we had an induction date for December 29th--a day and a half away. We spent the next day and a half preparing final things for the babies, spending some time with my family, and going out on a date together to Olive Garden. I definitely felt nervous, since being induced wasn't something I had been hoping for. But I was also anxious to do whatever would be best for the babies.

On our Olive Garden date, we waited for a call from the hospital to tell us when to come in the following morning for the induction. We were supposed to be the first induction of the day which is usually at 6 or 6:30am. The call never came, so I called the hospital, and they told us to call in at 6:30 the next morning to find out when to come since they were full. Apparently the end of the year is a very popular time to have babies. We were definitely disappointed by that information, but there was nothing to be done but wait it out. I slept fairly well, all things considered, but when I called the hospital at 6:30, they told me to call back at 10:00. Kind of a bummer, once again. But we ended up getting a call at 9:45, asking us if we could be there in half an hour. I had been hoping to have a really good meal before going in, but since we live 20 minutes from the hospital, those dreams were dashed. I settled for a breakfast platter from McDonald's (I KNOW) of which I ate approximately three bites before becoming grossed out by the food. 

We were admitted at 10:30 am on December 29th. That day marked 36 weeks 4 days for me. I knew that, because I had tested positive for Group B Strep earlier on in pregnancy, I would be on antibiotics before we could even start me on pitocin. They hung a drip of antibiotics, and then they checked me. I had been dilated to about a 2 at my doctor's appointment two weeks before, and I was really hoping that some progress had happened since. Unfortunately, none had and I was still at a 2. At 12:15 they started me on pitocin, at a level 4 dose. The dosage goes up to 20. They also hooked me up to the external heart rate and contraction monitors--3 monitors on my belly. I was a bit disappointed when I found out that I would be hooked up to the monitors the entire time, since I had been told that intermittent rather than constant monitoring would be an option. I really wanted to be able to be mobile and to change positions, but that was no longer an option. Apparently when pitocin is involved, they have to do constant monitoring of the babies to ensure that they are handling the induction well. At one point, one of our babies moved off the monitor and the nurse couldn't find his heart rate for a few minutes--she had to call in another nurse for help. I know it made the nurse and Brandon nervous, but I could still feel him moving, so I wasn't too stressed out by it. 

By 3:30 I was maxed out on pitocin. I could feel the contractions, but they weren't bad at all yet. It was actually a really interesting experience for me to feel my stomach tighten with each contraction, since I hadn't felt any Braxton Hicks during pregnancy. When they checked me at 3:30, I was only at a 2+. I've read so many birth stories, and people always describe their disappointment when they haven't progressed. I never quite understood that until my own labor experience, but that disappointment was real for me. I had mentally prepared myself for a long, slow labor, but it was still deflating to have things go so slowly. Brandon and I watched episodes of Friends as we waited for progress to happen. I started to get really hungry in the evening, and Brandon snuck me some saltines :) I know there are reasons for the rules about not eating once labor has been induced, but I also think it's insane to expect a woman to birth a baby with no food in her body. Flavored ice chips only take you so far!

My nice brother-in-law and his wife came to visit at the hospital so that Brandon could give me a blessing. Just after that blessing, my OB came to break my water. I had heard so many horror stories of the crazy combination of pitocin-induced contractions and water being broken. I wanted to experience labor more, and I really wasn't bothered by the contractions yet, but I also didn't want to be in sudden and excruciating pain only to find out the anesthesiologist was occupied. Because I was having twins, I was required to have an epidural and to deliver in the Operating Room in case of an emergency situation. Sometimes things can get a bit scary with the second baby, so hospitals like to be prepared in case of an emergency c-section. I felt really blessed that my babies were both head down (and had been for about 2 months), since that meant my chances of needing a c-section were significantly lower. However, there was still a likelihood of Baby B turning breech once Baby A was delivered, so I knew I needed to have an open mind about how birth would happen. 

The anesthesiologist came and placed the epidural. So many people seem to hate having it placed and describe it being very painful, but I felt like it was no worse than a flu shot. I started to feel my toes tingle pretty quickly. I admit, I really didn't like losing feeling. Maybe I should have chanced it and waited for more painful contractions so that I didn't dislike the numbness so much. 

When I was checked at 6:00, I was really hoping for some more progress, since I'd actually been feeling contractions up until the epidural. I was only at a 3+. Six hours and barely any progress at all. I tried not to be disappointed. At 8:30 they checked me again and I was only a 4. Pretty soon after that, I started to get really nauseated. They told me they'd give me some Zofran, and I almost refused since I had tried Zofran for morning sickness earlier on in my pregnancy and gotten migraines. The last thing I wanted during labor was a migraine. But they hooked me up to some Zofran, and it did take away the nausea without giving me any migraine troubles.

After awhile, my toes began to unnumb a bit, and I started feeling the contractions. Not just the pressure, but the pain as well. I didn't mind too much, actually, since I liked being able to experience them. I breathed through them and tried to let Brandon sleep.. At 2:30am, they checked me and I was at a 7. Finally some progress! The anesthesiologist came to check on me, and I mentioned that I was feeling the contractions. He "fixed" the epidural, and it was crazy what a quick difference it made in how much I could feel. However, my legs never went completely numb again, so I had full movement of my feet and most of my legs. 

At 3:30 when I was checked, I was at a 9. And then the shakes came on. I didn't get them as bad as some people seem to, but I was shaking nonetheless. Finally at 4:40, I was fully dilated and effaced, and baby was at a 0 station. My OB and I had discussed that after full dilation, we would do "rest and descend," where we let the baby descend further into the birth canal before beginning the pushing phase. So we waited for an hour until Baby A was at a +1 station and then finally headed to the OR just before 5:45 am. 

And then we began pushing. This was always the part of labor that scared me the most. I was afraid that, after a pregnancy full of unhealthy eating and very little physical activity, I wouldn't be able to muster the strength to push out two babies. I had recently photographed a birth story and was slightly traumatized by how exhausting pushing looked--that client pushed for about an hour and 15 minutes. As it turned out, I pushed for almost 2 and a half hours. Interestingly, time went by fairly quickly during the pushing stage--that's not to say it was easy. It was incredibly hard. The wonderful thing, though, is that my OB was there the entire time. She didn't just show up for the end, as most OBs do--she coached me through the entire thing. And I needed that. The pushing was physically tiring, but it was the other things going on that made this part of labor so hard.
I had experienced really gross reflux burps for the last half of my pregnancy--they would usually happen when I was in the middle of talking to someone...so attractive--and these showed up right in the middle of pushing, interrupting my pushes with the overpowering urge to burp or throw up. It really threw off my groove. But the worst part of it all--far and away--was the back labor I experienced. Despite the perinatologist's assurances that Baby A would "turn into position like a key in a lock," Baby A remained posterior. My OB and all the nurses didn't know it until he came out, but I knew it. Add to that the fact that my epidural completely stopped working on my back. This meant that every contraction was pretty dang excruciating. I could barely move my legs into and out of pushing position because the pain was so intense. At one point, I decided to rest for a contraction, but I discovered that this only heightened the pain. I powered through the pain for as long as I could, but we decided that the pain was affecting my pushes and that we had better call the anesthesiologist to come fix things. I was very hesitant to do that because I didn't want to lose more feeling and, consequently, have my pushes become less effective. But my pushes were already suffering from the intense pain I was in. The pain didn't stop between contractions, either, it just lessened. I was so tired, though, that I was nodding off between contractions until the pain started building so much in my back that I couldn't ignore it any longer.
The anesthesiologist was called in to see what he could do. He tried everything. He upped the dose of my epidural. Nothing. He injected a few different pain medications into the epidural space. Nothing. Nothing he did changed a thing, and at this point, my legs were completely unnumb. The only thing that stayed numb was my lady parts (which I am grateful for). Each time he injected something more or something new, he would ask me if what he had just done had helped at all. I told him no over and over again, wishing that I could tell him yes. Brandon said that the anesthesiologist was literally scratching his head because he just couldn't figure out what was wrong. At one point, he said, "Man, I suck!" I know he felt awful that he couldn't get the epidural to work for me.
Also really depressing was the fact that, even after pushing for an hour and a half, one of the nurses asked my OB how much progress we had made. As out of it as I was, focusing all my energy on trying to push correctly and managing the pain I was in, I saw Dr. Miller shake her head and try to mouth to the nurse discreetly that we hadn't made any progress. To me it felt like all the fears I had for the pushing phase of labor had been completely justified. I couldn't push out these babies. It was like I had two shoulder angels--one telling me I couldn't do it, the other one cheering me on and trying to stay positive. Many times during pushing I thought to myself, "Let's just do a C-section" or "This is gonna end in a C-section." And if the boys' heart rates hadn't been so constant and healthy, I'm absolutely sure they would've called it and put me on the operating table.
I know it was hard for Brandon to watch me in so much pain and exerting so much effort with nothing to show for it. With each contraction and push, he held his breath. He stroked my arm and encouraged me throughout it all, but I could tell he was troubled by it all.

Finally, after two hours of pushing, I started to be able to feel that I was making progress with my pushes. Dr. Miller got dressed in her delivery attire, and that little gesture was so incredibly reassuring to me. I was almost there.
At 8:02 am, Baby A--our little Micah Merrill Keyes--made his entrance into the world. They put him right on my chest and rubbed and rubbed him while Brandon cut his umbilical cord. My eyes filled with tears, and I admit that those tears were every bit as much tears of relief as they were tears of love and awe for Baby Micah. Once he was out, my back felt fine. He came out weighing 5 lbs 5 oz and measuring 17.75 inches.

But that wasn't the end. One of the nurses asked Dr. Miller if she should call in the NICU team who was going to be at the ready for the birth of Baby B, since he had experienced Intrauterine Growth Restriction (IUGR) and was supposed to be quite small and potentially need more help. Dr. Miller felt where the baby was and said, "No, she's got some pushing to do." Those words. They were not welcome. I tried to mentally prepare myself for more pushing. But despite what Dr. Miller had said, Baby B had plans of his own, and he came out at 8:07 am, after just one contraction's worth of pushes--our little Jonah Maxwell Keyes. He came out with the umbilical cord wrapped around his neck 3 times. His cord was half the diameter of Micah's, he weighed only 4 lbs 7 oz, and he measured 17 inches. Such a tiny little guy! They put him on my chest, rubbed and rubbed him, and then let Brandon cut the cord. Then they took him to the warmer, and I heard the nurse talking to Jonah, telling him to cry again, since he had come out crying but then stopped. Thankfully, he started crying again, as the photos demonstrate :)

Both boys scored high on their 1 minute and 5 minute Apgars. They were champions through the whole labor, maintaining regular heartrates, despite their small sizes and the length of the process. Everyone was amazed at how well they did. 

Out of focus, but so glad we have a picture of the four of us!

Out of focus, but so glad we have a picture of the four of us!

I got to hold the two babies on my chest while Dr. Miller pushed and pushed on my stomach and tugged and tugged on both umbilical cords. Delivering the placentas took much longer than I had expected, and it was definitely uncomfortable. Brandon was pretty shocked at how big the placentas were, even though Jonah's was much smaller than Micah's. I got stitched up (the main reason I'm thankful the epidural worked in at least one part of my body), cleaned up, and then we headed back to the delivery room for a couple of hours. Everything at this point for a good few hours is a real blur to me because of how exhausted I was. I couldn't keep my eyes open.

The next couple of days were full of heel pricks and tests for our little guys whose blood sugar levels were an issue. We worked and worked to breastfeed them and supplement them with formula so they could keep their blood sugar levels up. Brandon and I both felt that things were much too task-oriented for the first day especially--a day when we were both deliriously tired. Instead of really getting to enjoy the boys, we were constantly being badgered by different nurses about when they had last been fed, scolded when their blood sugar levels were lower than we had hoped, and just generally disturbed at least once an hour. Our goal and hope was to keep the boys out of the NICU. We accomplished that goal by the skin of our teeth. They grazed by the requirements for their blood sugar levels and bilirubin levels, and they thankfully passed their 90-minute carseat tests, their hearing tests, and their other vitals tests. Brandon was amazing and absolutely integral to making that happen. Somehow we were able to be discharged after the standard 48 hours--a serious miracle. 

We were able to have Ashley Bridgewater come in and take some photos of us in the hospital together before we were discharged on January 1st (craziest start to a New Year ever!). Even though it was a bit stressful to coordinate feeding/sleeping schedules with the photo session, I'm so glad we did it! The boys have already changed so much from how they looked in the hospital in the short week and a half we've had them. 

We are so so grateful for the safe arrival of these dear little angels we've waited for for so long! They were absolutely worth the wait.