The Twin's Birth Story

Quite a bit of time has passed since the boy’s birth and I am so glad I’m taking the time to write it all down before it becomes a blurry memory.

If you’ve followed my health journey, you know that this pregnancy was as much of a “surprise” as an IVF pregnancy can be. Layer on the twin aspect and it’s easy to imagine that the first few weeks (months even) were spent mostly in shock. My first trimester I was incredibly miserable, with constant nausea and relentless fatigue. I felt best in my third trimester with Nell but hoped for the best that maybe I’d get the famous second trimester jolt of energy this time. No dice! Twin pregnancy is next level. I had no idea it was possible to be so miserable for an entire pregnancy (sorry just being honest). That said, I had the benefits of being high risk across the board (IVF, geriatric, AND multiples) so I was closely monitored the entire time and overall had a very normal, healthy pregnancy. Both boys were a good size and each had their own sac and placenta, the lowest-risk scenario for twins. Because of all of this, I was scheduled for a repeat c-section at 38 weeks.

I technically could have asked for a v-bac but given my emergency c-section with Nell and my history of post partum depression following a traumatic birth, it was an easy call by my doctor and I to create as ideal of a controlled birth as possible. My endometriosis is also very aggressive and I was concerned about the impact of hours of contractions considering how many of my organs are fused to my uterus. I was absolutely terrified to have a c-section as I truly hated it the first time but trusted my doctor, family and friends that it would be very different considering it would be planned and not an emergency. Of course, you know what they say about the best laid plans…

I got COVID at around 29 weeks and it really knocked me out – it felt like my energy levels were permanently depleted and I never really recovered. It wasn’t a shock, then, that the week before Mother’s Day I struggled to do much more then get out of bed to grab my laptop and work from there for the day. I’d had Braxton Hicks contractions for a few weeks so I focused on staying hydrated and just tried to rest as much as possible. The Friday before Mother’s Day I jumped out of a conference call to go to the bathroom and lost my mucus plug. I went into labor 72-hours after losing mine with Nell but I tried not to panic and did a fast google search to confirm that this could happen with multiples and technically it could grow back. I was only 32 weeks and 6 days pregnant however so I gave my doctor a call and tried to focus on work. My gut told me things were not going to go to plan again but I chalked that up to anxiety. The doctor’s office called me back and didn’t seem too worried, they said it could still be a while and to just keep them posted if I had any other signs of labor. The nurse pushed me a bit hinting that it wasn’t necessarily my mucus plug but… if you know, you know. I will spare you the details but I knew 100% what it was without a shred of doubt.

Saturday and Sunday I was really distracted and exhausted and noticed that I had quite a bit discharge (TMI), but as many second+ time moms will tell you avoided calling the doctor as I knew they’d write it in my chart and tell me to basically call them back if the baby was crowning. Saturday night I noticed that my Braxton Hicks had transitioned to full contractions spanning up and down my full belly but I could breath through them and they stopped after an hour/hour and a half. I felt funny about everything and on Sunday ended up bowing out of Mother’s Day brunch to stay home and rest. At this point I needed to wear a pad for the discharge but again, this wasn’t my first rodeo and that happened multiple times with both of my pregnancies. I had a routine appointment scheduled for Monday anyway so I figured I could talk to my doctor then and rule out any of my concerns.

Sunday night the contractions returned. I told C all I wanted for Mother’s Day was to watch a movie with Nell…what I didn’t tell him was that I had a strong feeling I didn’t have much time left to spend with her before something happened. I had quite a bit of anxiety until she got home and I felt better once we were snuggled on the couch. The contractions were pretty strong, rolling all the way up my belly and back down again, at times less than two minutes apart. I still figured they didn’t warrant a call to the doctor and then they essentially disappeared an hour or so after I went to bed.

I felt some relief on Monday morning that at least I was 33 weeks along and was able to keep myself busy with work until my appointment that afternoon. At my appointment I shared the events of the last weekend with my doctor, who checked me and confirmed that I wasn’t dilated and thankfully didn’t have any signs of pre-ecclampsia or any other major risk factors. I told her I’d been wearing a pad all weekend though and she was alarmed that I hadn’t called back especially considering I thought I’d lost my mucus plug. After the routine exam she said she felt fairly confident that I wasn’t leaking amniotic fluid but that because of everything else she’d feel better looking at it under the microscope. I was feeling kind of sorry for myself that I most likely had another month ahead of me after all haha and waited for her to come back. She’s always super fast so I got dressed and then…waited. After five minutes or so I started to get nervous and was rethinking my conclusion that all was well. A good ten, very sweaty minutes later my doctor knocked on the door and said “So….”

At that point my stomach sank and I knew things were about to veer very far off track from our pretty little plan. My doctor confirmed that I was, in fact leaking amniotic fluid and most likely had ruptured my water on Friday. Whoops. She told me I needed to head right to the hospital and that I wouldn’t be going home until the twins were delivered. I kept it together which still surprises me but I definitely felt a lump in my throat. The quick run down was that the best case scenario would be to get me to 34 weeks (that Saturday) when the baby’s lungs are more developed. There was also a chance if things really looked ok that they might try to stretch me to 35/36 weeks when the babies wouldn’t necessarily need NICU care. That said, it’s a gamble once your water has ruptured and the doctors have to balance keeping you pregnant for as long as possible vs. the risk of infection and other complications that could potentially be worse for the babies than an earlier delivery. At a minimum, I needed to get to the hospital ASAP so they could administer intravenous antibiotics, get me on a monitor, and give me the first dose of steroids to help the boy’s lungs develop more quickly. I asked about 100 times if she was sure it wasn’t a false alarm and she humored me all 100 times that it was not.

At this point she sent me off  and told me that Labor & Delivery knew I was coming and would be ready for me (pro of this scenario: I got to skip triage). I called C at work to tell him the news and he left to meet me at home while I called his mom to grab Nell from school so I could see her before left. At this point I had no idea how long (days? Weeks?) it would be before I came home again and I held back tears thinking about Nell having to react to all of this news. We’d set up her favorite babysitter, camp, and special sleepovers at Mimi & Poppy’s for my scheduled c-section date and subsequent hospital stay and I felt so guilty that instead we were all scrambling to cover her care.

I packed my hospital bag quickly and can confirm that ALL you need is a phone charger, toiletries, hospital shoes, and a going home outfit for you and baby, as that’s all I had time to pack and the only thing I ended up having C bring me was pajamas because I needed to walk down one floor to the NICU and was too exposed in just a hospital gown. I did bring a sound machine because my room was so loud when I had Nell but thankfully didn’t need it. I threw together my work bag + laptop, thinking I’d be sitting around in a hospital bed for at least a few days and could at least wrap things up considering I hadn’t planned on starting mat leave for another month (lololol denial much?!). We took one last picture as a family of three and then headed off to the hospital.

I can’t even describe the emotions I was feeling…anxious, terrified, relieved?!, confused, sad…it all happened so fast and once again it felt like a calm, “textbook” birth experience was being ripped away from me. I fought so hard for every aspect of my pregnancies, from conception via IVF, multiple surgeries to get to the point of even being able to get pregnant; through tough pregnancies, a rough delivery and brutal post partum depression… I knew what it could feel like if it was as traumatic as last time and I was simply defeated. I think I cried? But for the most part just resigned myself to the reality and got through the motions.

I like to be in control so I started to make a mental check list of things we wanted to achieve before the boys were delivered: steroid shot #1, check! First round of antibiotics, intravenous drip – check check. The doctors and nurses did a full exam of me and the babies and thankfully everything looked good. I had plenty of amniotic fluid (I had no idea you keep making it and it replenishes itself), the boys looked great, they were measuring a good size, none of us were in distress. Our goal that day became to make it to the next – even one steroid shot makes a big difference for premature babies, but two is the gold standard. They could give me the second one 24-hours later so I focused on settling in and staying calm so we could get to that point.  C got me comfortable and after the doctors confirmed that they didn’t need to deliver right away, he went home to get Nell settled and tie up loose ends at home while I got some sleep.

That night was awful. Like clockwork, the contractions picked back up again at exactly the same time as the two previous nights, but this time they didn’t stop after I went to bed. They started to hurt pretty good and the nurses took note that they were seeing them on the monitors. I had dilated to 1 cm (which is nothing) so we were hopeful I wouldn’t continue to advance and didn’t yet need any measures to stop labor. I didn’t sleep at all that night – I was so uncomfortable but at the same time wanted to keep it a secret, hoping if I just didn’t say anything that I’d make it to my goal, shot #2. By morning the doctor’s concerns of needing to deliver had increased and they triggered the plan to prep me for worst case scenario. At around 5 AM they sent a resident up from the NICU to brief me on what to expect if/when the boys were delivered and to sign a bunch of consent forms for a litany of things I’d never really thought about and I officially lost it. The tears just wouldn’t stop – I was so exhausted, I was in pain, I was disappointed, scared, confused – things were moving too fast for me to keep up and the number of unknowns was increasing by the hour. I hadn’t even had a chance to put my out of office up! My boss was out of pocket en route to Denmark! C hadn’t finished the school year! I needed my second shot! I forgot my toothbrush! The resident was super smart and well informed but you could tell she’d lost her sensitivity… in the grand scheme of things I was a relatively “safe” textbook twin case and she had much bigger fish to fry.

Thank god the Chief of Maternal + Fetal Medicine stopped by and finally brought me some much-needed peace of mind. You could tell he’d read my chart, he’d spoken to my doctor… he was so warm and calm and immediately put me at ease. I’d had 38 weeks in my head as the goal delivery date my entire pregnancy and his first words were “congrats!! You passed the 32-week mark! That’s always our big hurdle with twins, you’re all good!” He told me that his wife delivered their twins right at this point, they had a NICU stay to learn how to eat and grow a bit and that it was a part of their story that was quickly in the rear-view mirror. He didn’t make any promises or give me any false hope of carrying them for much longer but he met me where I was and I finally felt like I knew our plan. He confirmed that it was safer for the babies and for me to deliver at 34 weeks then to try to give their lungs more time, so at the very latest the boys would be coming on Saturday. Ideally I’d get another steroid shot in me but if not, the NICU was ready for us and the boys were looking strong. He gave me a hug and made triple sure I was feeling good and then went out to continue his rounds.

The contractions continued so C came back to the hospital and then… everything stopped. No contractions! They completely dissipated. We were cautiously optimistic and they let me have some Benadryl to try to get some sleep. By the time I woke up in the late afternoon I was only a few hours away from my second steroid shot. My doctor wasn’t working that week but she had fully briefed her colleague on call who came in to talk to me not just about what was going on but also about my past experience and all of my fears going into this birth. She shared the good news that now that I had made it 72-hours with a ruptured membrane and labor had stalled, there was a much higher likelihood that I might actually make it to the weekend! Thankfully she was on call for Saturday so she went ahead and penciled in my c-section for that morning so that I could have peace of mind that a provider that new my history would perform the delivery.

6:30 rolled around and I got my second shot! Ideally you make it another 12-hours before delivery, but I had officially hit my goal and things were looking good that I’d make it to 34-weeks. I wasn’t thrilled about sitting inside a hospital on bed rest for a week but I knew overall that was a pretty good prognosis for someone in my situation. I sent C home so Nell could sleep in her own bed, settled in and got organized so that I could wrap things up at work the next day. I felt so much better after getting some sleep and having the second steroid shot behind me. Like clockwork, my contractions picked up again around 7 PM but this time they followed their old pattern died out by nine. I was still super tired from all of the events of the last few days so I passed out. The plan was to move me out of labor and delivery the next day up to a regular floor so I tolerated the 24/7 monitors a bit better knowing it was truly temporary (if you’ve had a NST for a singleton you know how annoying they are… twins is twice the itchy Velcro and double the adjustments every time they move lol).

At around 4 AM I was woken up by a really painful contraction. It took my breath away but I had been in a deep sleep so I assumed it had just caught me off guard. Then another one rolled over me and then another and another back to back. I looked at the clock and told myself I’d wait it out for twenty more minutes before calling the nurse. I’d agreed with my doctor that while things were looking good, I needed to be ok to swap courses and deliver immediately if anything changed. About ten minutes in, a huge contraction rolled up my belly and as it rolled back down, it stopped halfway. I laid there holding my breath waiting for it to keep going down and it just… didn’t. Something wasn’t right but I kept questioning myself thinking maybe it was gas (again lololol looking back). At this point I was really uncomfortable, the contraction seemed to be frozen in full swing like an equator around my abdomen.

The second the clock hit 4:23 I pressed my call button and my amazing nurse Becky stopped in. I told her what I was feeling – tears were rolling down my cheeks out of discomfort and confusion. Becky said she could see my contractions on the monitors but they were nothing major, but she didn’t like how I looked and would be back with a doctor. I pretty much knew what was coming at this point but again it escalated pretty quickly and I mostly was just worried I’d made it all up in my head. The resident came in with an ultrasound machine and after confirming the boys were good, started pushing on my belly to locate the pain. It felt fine everywhere except on the left side of the “equator” where it really hurt when they pushed even slightly. I could see the nurse and doctor looking at each other and they told me they were leaning toward delivery and were going to wake up the doctor on call. Thank GOD the physician my doctor had “briefed” was on until 8 AM so she knew my entire situation and history. She came in and did a similar exam and told me that the babies looked good but she was concerned that my old c-section scar might be coming apart and the safest solve was to deliver immediately. I knew it was coming but it hit me at that point as the room started to fill with doctors needing forms signed, etc. and I realized C wasn’t even there! Nurse Becky assured me she’d called him and he was on his way and they would do everything they could to wait for him to get there (gulp?!).

The doctor sat down next to me and held my hand and I don’t remember exactly what she said but I remember that she told me she knew I’d had a traumatic birth and she was sorry that we were in another emergency situation but that it would be different and she’d already put our “plan” in place. The anesthesiologist had drugs to help my anxiety on deck and would administer them if I needed it as soon as the babies were out. She told me she’d been texting with my doctor and between them and Nurse Becky I felt like my babies and me were in the best possible hands.

Everything happened really fast as they got me down to the ER and quickly prepped me for surgery. The doctor held me through the epidural (like what doctor does that? So above and beyond) which wasn’t too bad; it didn’t bother me with Nell either so I was pretty calm. C still wasn’t there when I started to go numb and they were laying me down and putting the drape up and then I went ice cold and had a full blown panic attack. I sat up (pretty sure that’s impossible so idk what I actually did physically but in my head I was at least trying to sit up? And run away I think haha) and just remember being in a cold sweat and saying “I can’t do it nope I can’t do it.” My doctor held my hand and my head and said “look at me. I’m going to sound like an asshole but here’s the reality: unfortunately you have to do it. Putting you out is really fucking bad for your babies and you’re going to have to do it.” I personally react well to directness in times of panic so I just laid there and tried to breath. I heard my doctor say “I need her husband in here ASAP please” and next thing I know C was smoothing my hair and I got very calm.

Next thing you know they are talking in doctor speak and I realized they’d already started the surgery! I was so relieved because I hadn’t even noticed! I felt every single tug with Nell and was already puking at this point with her, so I felt a huge weight off of my chest. I heard my doctor call for Nurse Becky to come over and look at something and Becky said, “oh my god.” The doctor said “see that. You see that? You did the right thing. You made the right call.” My curiosity was peaked but Baby A (Clark!) made his entrance and I forgot about everything but the boys. Baby B (Penn!) came just two minutes later and they both let out little squeaky cries. Funny enough the second they were out I swear I could breath for the first time in months! The NICU team said they looked great and didn’t need immediately respiratory intervention so I got to see each of them for a minute in the OR before they were sent down to the NICU. Clark clocked in at 4 lbs, 13 oz and Penn was 5 lbs, 4 oz – very good sizes for 33 weeks and 4 days!

I remember thinking to myself “I feel happiness! I will remember it this time!” and cautiously let myself relax. Once the babies were whisked off to the NICU and C followed them down, I felt the dreaded anxiety rushing back as I waited for them to finish putting me back together. I don’t think I will ever be okay being awake with my insides being operated on and I am thrilled that there are no more c-sections in my future! I said something to somebody that I was feeling anxious and the anesthesiologist jumped right in with a small dose of something (no idea honestly) and it completely took the edge off.

My doctor finished sewing me up and gave me a hug and told me to take it one step at a time, call them immediately if I felt anything like last time, and to give myself grace with things like breastfeeding especially since it was twins. I rested in recovery feeling an overall sense of relief that everyone was here safe, the boys seemed to be doing well, and I didn’t feel anything like I did last time. I am positive that this was a different experience in a large part to my doctors and my nurses. I felt like they were all working together and what could have been another traumatic experience was mitigated by genuine care and compassion. I think it was about 30 minutes from when they made the call to deliver to the time the boys were both out – I still can’t believe my in-laws made it to our house for Nell and C made it to the hospital in time!

I couldn’t go see the babies until the anesthesia wore off which felt like forever, but it was hardly 6 am at this point so I let myself doze off and was ok’d to take a wheelchair ride to see them as soon as I woke up.

My doctor stopped down to see me and shared that I delivered just in time for two reasons: they were right that my old c-section scar had started to unravel, and I had also developed what they call “a window.” My uterus had stretched so thin in one place (the exact location that hurt when they pushed on it!) that they could see Clark’s hair waving in the amniotic fluid. She said my uterus was held together by literally cells and if they’d pushed any harder when they were examining me my uterus probably would have ruptured. I think my body has officially waved it’s white flag that it physically cannot safely bear any more children. Scary for sure but I’m so grateful we averted a crisis. My doctor was able to make a new incision between the old one and the window that allowed the window to close and prevented my old scar from rupturing, which salvaged my uterus. She did say that she couldn’t believe how much of my bowel was fused to the back of my uterus but thankfully that was a problem for another day 😊

I will share more about our NICU journey later as this post is long enough, but thankfully the boys did very well on room air and spent their time simply learning how to eat and growing strong enough to come home. I hadn’t planned on pumping or breast feeding but ended up pumping to support them as best as I could while they were in the NICU. They were also born at the height of the formula shortage so I needed the peace of mind that I could contribute to their food supply. Similar to last time I think the pumping helped my uterus contract well. Overall my recovery was significantly easier. I didn’t have any of the burning nerve pain by my incision, I was able to walk and sit up within a day and overall felt really good both physically and mentally. I know the PPD hit a few weeks post partum but I can say with certainty that is started with my birth experience and I am so grateful to share that I didn’t have any of those feelings this time regardless of it being another emergency.

I think a part of me will always mourn the “textbook” birth I’ll never have but I have such peace and closure that my births brought me three beautiful children and helped me grow so much as a mother and a person. I hope if nothing else my experiences give another mama confidence that an emergency birth with every possible intervention CAN be peaceful and won’t necessarily lead to PTSD or PPD. Again this is a long one so I will save my postpartum experience for another time.

Thank you to so many of you that supported me in infinite ways from the second we shared we were expecting again through their dramatic entrance, even as we disappeared for a while to focus on our family. I’m a hard person to be friends with during this season – it takes me ages to return texts, I always need help, and I’m usually a mess, yet so many of you have stuck around. I’ve learned a lot about how to support other families and friends through all of this and cannot express my gratitude to all of you.

Please don’t hesitate to shoot me an email or leave a comment if I can help in any way with additional details from my birth experience.