September 11, 2010

Will & Jack's birth story...part 1

I want to make sure I have down the story of the twins' birth, and the weeks leading up to it.  Everything about this pregnancy was a miracle, and that definitely continued on through their birth and first few weeks of life.  I can hardly wait to see what God has in store for my precious boys!!  There are a lot of details I want to remember, so this post might have to be split into two posts! (Be warned...this is going to be long!)  I will be including details of what we understand happened to my TAC as well.


It started with the incredible miracle that happened during a routine frozen embryo transfer of the embryo implanted on March 3 split, after being frozen for almost 6 months.  My fertility doctor said that for an embryo to split after being frozen was very rare!  I call it a miracle!  My pregnancy was pretty uneventful and wonderful for the first 27 weeks...I wasn't sick, I felt great, I didn't have any stretch marks, and every appointment gave us word that they boys were developing perfectly!  At 27 weeks and 2 days, the uncomplicated pregnancy ended. I realized that something just wasn't feeling right, and I was beginning to have familiar pains in my back.  When I lost Jonathan, I never had contractions in the front, only back pain as the pressure got worse--back labor.  So by 4 am on Saturday morning, August 21, I was beginning to get worried.  Justin was my rock, and decided that we were going to the hospital to get things checked out, just to put my mind at ease.  My high risk doctor, Dr. Zaretsky, had told me a few weeks earlier, that if anything started happening before 28 weeks, to go to a different hospital than the one I was planning on delivering at so I could be near a higher level NICU.  At 5 in the morning, we arrived at Presbyterian Plano, a hospital about 25 minutes from home. The only problem was that my OB didn't have privileges at this hospital, so we knew we wouldn't be able to see her.

After getting checked in to Labor and Delivery and explaining to them why we were at this hospital where my doctor couldn't come, I was quickly hooked up to the monitors.  They found that indeed I was having some contractions, but they weren't quite regular, or developing further into stronger contractions.  I told them that I had a Transabdominal Cerclage (TAC), and that I had to have a c-section.  Many of the nurses had heard of a TAC, but most had never seen one since they are not done regularly like a vaginal cerclage is.  This hospital has a group of seven OBs that are called "Hospitalists", and they cover patients that are there when the patient's OB can't come to see them. They were a wonderful group of doctors, and it was so nice to know that there was someone on call 24 hours a day, to pop into my room if anything changed!  Dr. Zaretsky arrived a little later in the morning to do an ultrasound to see what was going on to cause these contractions.  He didn't find anything that stuck out as unusual...the TAC was holding, my cervix was 48 mm long and closed, and most importantly, the babies looked great! Everything was the same as it had been at my previous appointments, with my cervix being long and closed. But he was very concerned that I was contracting, so he ordered a 48 hour magnesium drip to try to stop the contractions, as well as 2 steroid shots to help jumpstart the babies' lungs should they come early. The reason for this major action is that my uterus had nowhere to go if I started contracting...since my cerclage was keeping my cervix closed tight, there was no pressure relief valve. This pressure from contractions could rupture my uterus and cause major problems for me and for the babies. Pretty much, from this point, I knew I was going to be on bedrest for the duration of the pregnancy.  Everyone told me how important it was to get to 28 weeks...I was determined that I was going to make it there (5 days from then) and beyond.

After completing the magnesium with hardly any side effects, the contractions had pretty much subsided, and I was released to go home on bedrest on Monday.  The instructions were that if anything changed significantly, or if there was any bleeding, to come right back to the hospital.  Pretty much the understanding was that if I came back, I was most likely going to be in the hospital for the duration.  I made it home and my parents and Justin helped me get all settled in for a few months of "rest". They were all amazing, and were prepared to take care of everything for months!!  But the next morning, I had a little bit of spotting, so back to the hospital we went.  After a few hours of monitoring and another ultrasound, they determined there weren't any contractions, only uterine irritations, and since my cervix and TAC still looked fine, I could go home to continue bedrest. I was comfortable with that, and was sure that I'd be home for awhile now.

Two days later, on Friday, August, 27th, everything changed again. My dad had come over to my house and brought me lunch.  Right after that, I went to the restroom and passed a huge (baseball or so sized) clot.  I yelled to my dad we had to go to the hospital, and we were out the door about 5 minutes later.  I knew something wasn't right, especially with that much blood.  But, at this point, I was encouraged that I was over the 28 week mark, and knew that plus the steroids were a good thing if anything were to happen.

Once I got back to the hospital and settled back in, Justin and my mom arrived.  The doctors were convinced that this bleeding was probably from my low-lying, anterior (front) placenta.  They told me that the weight of the babies, coupled with the contractions I'd had in the past week, probably had irritated the edge of my placenta and was causing the bleed.  They told me that most likely, over the weekend, the bleeding would lessen, and that I was in the hospital for the long haul.  With the bleeding, I was ready for that, and actually relieved that I would be seconds away from being checked at any time, and should anything happen, the doctors were there to get the babies out in mere minutes. Everyone was relieved to have me there, especially Justin. He knew I was in great hands, and could continue to go to work and get things done since my parents were there with me as well.

So over the weekend, the babies and I were monitored closely.  Their heartbeats were always very strong, and the nurses explained to us how their heart rates actually made them look like they were older babies that just 28 weeks.  I continued to bleed throughout the weekend had slowed some, but definitely was still coming, and much more than I wanted to be seeing at this point (or any point!) in my pregnancy.  I still had some discomfort throughout the weekend also, but not anything that developed into regular labor.

Dr. Zaretsky arrived on Monday to do another scan, hoping to see that everything was still looking the same. Once we saw the screen, we all realized that something had definitely had changed.  He took his time measuring and making sure of what he saw, but what I saw looked eerily similar to what I saw on the screen the night my water broke with Jonathan. My cervix was definitely not holding together, and Will's sac was bulging down past where it should be.  He was in the breech position (like Jonathan had been 2 years before), and he had a little foot sticking down under his rear end. We just couldn't begin to fathom what had happened to my TAC.  My cervix was measuring at 32 mm, so it had definitely shortened since he had measure it the week before.  However, the cervix had not dilated at all, even without the TAC in place, so we all thought that maybe it would stay like that and I could stay pregnant awhile longer, especially in the hospital on bedrest. Dr. Zaretsky said he would be back on Wednesday morning to measure again and see how things were going.

The TAC is made of a 5 mm band of mersilene tape that is tied around the very top of my cervix.  Mersilene tape is so strong, that they commonly use it in place of wire closures of peoples' rib cages after open heart surgery!  My doctor says it is so strong, that a man could swing from it! So we couldn't figure out how in the world it could break inside by body, especially when I hadn't had pressure that was too extremely bad. It was a mystery.  My dad sent an email to Dr. Haney, the doctor who had put in my TAC in 2009, and within an hour, he called me on the phone and we spoke for about 35 minutes about what was going on.  He then called Dr. Zaretsky, and then called me back to discuss what they had talked about.  Absolutely amazing care!  Dr. Haney wasn't completely convinced that the TAC had broken either, but had another thought about what could be happening.  I had a mild uterine septum (Click here for more info) removed 3 years ago. Dr. Haney, through his years of studying incompetent cervix and successfully placing TACs, was beginning to think that there might be a connection in women who have incompetent cervix because of weakened tissues because of this congenital defect of a uterus. Kind of confusing, but definitely something at least to think about, maybe in causing my loss with Jonathan as well.

The next two days continued in the same way...monitoring, bleeding, and resting, trying to keep my body from making any changes that would make the babies come early.  During this time, my brother decided that he needed to come out from Washington, DC.  I told him that most likely, I was going to be on bed rest for awhile longer, and that he didn't need to come just yet.  But, thank goodness, he didn't listen to me, and on Tuesday he came anyway!  Wednesday morning, September 1st brought Dr. Z back for another scan, but he was waiting for a new cord for his portable ultrasound machine.  He knew the back up battery wouldn't last long, but he wanted to at least see where I was that morning, and then would come back in the evening for a complete measurement.  What we saw during those 3 minutes showed that there was definitely a change, even from Monday.  My cervix was now down to 24mm, and we were still seeing bulging of Will's sack down into the cervix.  We all realized it was just a matter of time, and the boys most likely weren't going to make to full term, or even very much farther.

My biggest worry and HUGE concern was reliving the exact thing that happened with Jonathan...water breaking, waiting to see how long he could continue growing, and then him compressing his cord and dying.  Because of what was going on, the fact that the TAC was definitely not holding my cervix together, and seeing Will in the same breech position, I was not willing to take the chance of losing these babies also.  Even though cord compression is very rare, and even more rare (1 in 1000) this far along in pregnancy, it was enough of a risk in my mind, especially since it had happened to me before.  I told all the doctors that if my water was to break, I wanted to have them take the babies out.  I felt more confident that, even if they were born early, they would have much more of a chance in the NICU, being watched and taken care of  24 hours a day, then just hoping that they wouldn't compress their cord inside of me.  With twins, in my mind, there was even less room should their water break.  The doctors encouraged us to wait instead of rushing straight to a c-section, but were willing to respect my decision, whatever happened. I just wanted my babies to be alright, and get to take them both home alive.

So we settled in again to wait for Dr. Zaretsky, who was coming back around 7 that night, but throughout the afternoon, I started hurting again, and knew that something was definitely changing.


I will post the second part of Will and Jack's birth day very soon...


Cristina said...

The suspense is too much!!! I know what ended up happening, but it's the details in between.... I can't wait to to read the rest of the story.

Also, I love all of the pictures!!! =)

Glad you are all doing well, friend. Love you!

Amy said...

They seem to be getting bigger! In the pictures of you holding them, they look close to Lucy's size when she was born. How much do they way now? You are going to have some linebackers on your hands. Lucky you are a good cook!
Thanks for sharing your story with us. Jack and Will will appreciate having all the details recorded. Can't wait to read the rest!

Amy said...

Uhm, should have been weigh. Mommy brain. Worse than pregnancy brain

Kelly said...

Thanks so much for sharing Will & Jack's birth story Alyson! Looking forward to reading Part 2...

(Oh and I love the new blog header!)