Rather than bore you with disgusting details of my hospital stay while my body tries to fight off multiple infections, I thought I'd take this opportunity in between potty breaks to write this up.
This post is made easier (and shorter) by the posts that B and my Mom wrote on the 22nd and 23rd. I think you probably got the basic picture of how the induction process went. We were frustrated that things moved so slowly and it seemed that the nurses were being overly conservative on increasing the pito.cin. Regardless, none of that seems important now other than one thought I keep having. The slower the induction, the more cervical checks they do after the water is broken, the greater the chance for uterine infection. I'm trying not to dwell on this as the infection could have been introduced during the actual delivery as well.
If I remember right (I should just have titled this post with these 4 words as it is all a bit blurry), most of my pain during labor was in my lower back. I was pretty uncomfortable once they broke my water (well, Apple's water) and they put an internal heart rate monitor on her head and an internal pressure monitor in my uterus to better track contractions.
I can't remember exactly when I requested the epidural (maybe at 4cm?), but I did so knowing it could take awhile to track down the anesthesiologist and to get it in place. The anesthesiologist showed up pretty quickly and ensured me it took longer to set up the epidural (20 minutes) than it did to actually administer it. I'm not sure if that turned out to be the case. It seemed to take forever. He had trouble getting the catheter in and kept saying that I have "small spaces." Some of that was blamed on me being short, but he seemed to think I had overly small spaces. I kept trying to lengthen my back, while rounding it at the same time. Not all that easy to do when you are contracting. I remember thinking during this process that I might have to resign myself to having no epidural and I was NOT going to be happy with that.
Regardless, he got the epidural in and everything was good for a bit. At some point I began feeling a lot of pressure. The only way I could describe it was that it felt like I really had to poop. Bad. I kept asking the nurses to do cervical checks because it felt like something was going to pop out at any moment (either a baby's head or poop!). They were hesitant to do too many once my water broke because of the risk of infection. I honestly didn't care about that at the time, I could only focus on the present. I was disappointed each time they did a check and it didn't result in confirmation of massive progress. At some point the doctor came in to check and decided I was completed dilated on one side, but still 8-9cm on the other. There was a "lip" of cervix on one side that just didn't want to go away.
Side note: we did have the Bears game on the whole time and, lucky, it ended before I was ready to push. I was even able to focus on it a bit towards the end after I had the epidural.
The doctor decided to let me start pushing even though she could still feel cervix on one side. I think she felt a little bad for me, but also maybe that pushing would get it past that last point. I think her thought was that me pushing might be more effective than relying on the contractions at that point. I pushed for about 50 minutes in the L&D room before they decided to move me to the operating room. The doctor, nurse, B and our doula all coached me through this. It was pretty tiring, but felt good to finally be "there." They were all very encouraging. They all told me I was a "really good pusher." Not really sure what that means as I didn't know what I was doing, but I guess I should give credit to the hundreds of birth shows I watched on tv on bed rest! One thing I found really difficult was pushing for a whole ten count. We usually did three pushes in a row counting to 10 and by the third push, there was no way I could make it to 10. Just never felt like I had enough air for that.
After 50 minutes, we moved to the OR. This was the plan all along. Because of the higher risk of c-sections with twin deliveries, they prefer to deliver in an operating room so that everything is ready if needed. Same theory on the epidural. If you already have an epidural in, they shouldn't need to knock you out if you do need a c-section. They put me on the operating table, added some oxygen and not sure what else they did to get ready. Felt like I was hooked up to a million tubes. The operating room table was VERY narrow and it felt like if I leaned a little too far to one side I would just topple over. I don't remember if it started in the L&D room or in the OR, but I remember my hamstrings kept cramping up and I kept having B and the doula stretch my legs out in between contractions. This was pretty annoying because it was really difficult to relax in between contractions. After about 20 minutes of exhausting pushing in the OR, Apple was born. Wow, that sentence makes it sound so easy! It wasn't. I know that she was pretty small at 4 pounds 11 ounces and I just can't imagine what this process is like with a big baby! Her tiny little head felt like a watermelon! They took her over to the side and started cleaning her off while I listened to her beautiful screaming.
This is where things get a bit blurry for me. The had an extra doctor in the room to help if things got dicey and for us that meant trying to get Banana to turn head down. They had an ultrasound machine out and were trying to guide his head down. From what I understand, he was actually piked so that at one point both his head and feet were down, with his butt up in my belly. I just remember excruciating pain and wishing he would come out and that they could work faster (the extra doses of epidural at this point were doing nothing) and I think I was being pretty vocal about it. My main doc had most of her arm up trying to grab him while the other doc was manipulating from the outside. I remember wondering if I was supposed to be pushing at that point and I'm not sure why I didn't ask. I think I finally just decided to (or did someone tell me to?), and with that push, Banana's feet popped out. That is what decided the breech factor once and for all. So the doc grabbed his feet and started pulling him out.
The details of the rest of the delivery are a little unclear as we heard more details from the nurses in postpardum than we heard from the doctor at the time. All we were told when Banana came out was that he might have a broken arm or separated shoulder as they had heard a pop pulling him out. All of this happened in only 8 minutes time so he was born 8 minutes after his big sister. Each shift of nurses we had in postpardum commented on the difficult delivery and a somewhat benign "broken arm" turned into the fact that the doctor had broken his arm to save his life. I can't remember now who told us this (doctor, nurse?), but it seems my cervix started to clamp down once they got his feet out and they had to act quickly so that it didn't clamp down on his neck or head. I do remember hearing that his arms were above his head when they pulled his body out and they had to reach in and pull his arms down before they could get his head out. This is when his right upper arm bone popped.
At the time, I didn't think twice of any of it. I was just happy to hear him cry once they got him out and of course I was crying the whole time they were cleaning him off. They brought each baby to me one by one and put them on my chest. I told B he had to hold them on me because I was shaking so bad I was afraid I would drop one of them. B got to cut both cords and went with the babies when they took them to the nursery to weigh and measure them and check them out. They did tell me that both babies got 9's with both APGAR's, but we found out later that this was only true for Apple, Banana got a 7 and an 8, so still pretty good. While B was in the nursery with the babies, he went back and forth from one warmer to the other like a ping pong ball. Then they sent Banana up to get x-rays of his arm. It seemed to take forever and we were told one of the elevator banks was down.
They got me cleaned and stitched up. I did have a small episiotomy once the doctor thought I was starting to tear internally and B thought they did it when they were having trouble getting Banana out. From his perspective, he thought he heard them talking quietly about doing a c-section for Banana and that it did sound like there were some tense moments and were extremely close to doing the c-section. He also watched them do the episiotomy and thought it was cool (ewww). From what the doctors have told me, breech extractions are not very common these days and when the baby has its arms above its head and kind of wrapped behind (nuchal arms or something like that), it is quite common to have a broken clavicle and not quite as common for a broken humerus, but it does happen. The OB that I saw this morning (who is my regular OB) said that there was some drama in the OR and that the OB who delivered was not likely to forget the delivery. And she is the one with the most experience in the practice. We were lucky that they got Banana out without more damage, but it is scary to think of what could have happened.
I'm finally at the point where I can think about it and write about it without sobbing and hopefully soon I'll be able to talk about it without crying at all. I just can't believe how close we came to disaster after everything we've been through. But both babies are healthy and managed to escape without any NICU time whatsoever.
Aside from my little side trip back to the hospital, Banana's arm and Apple's jaundice, things are pretty damn good and we are counting our blessings. Thank you so much for everyone's support this week. It has been such a help to us. From simple good wishes to making meals for us, every little gesture has helped. (and thanks to our neighbors for feeding B while I'm in the hospital!)