Hannah and Isabelle's birth story, Part II

I honestly can’t recall the first real glimpse I got of our girls. I have a faint recollection of noticing that, just as B had said, they were very, very small. The kind of small that you can’t really explain, or appreciate from pictures, but when you see it in person it takes your breath away. Fit in the palm of my hand small. I know that we didn’t stay long; I was in pain, exhausted, and out of it from pain meds.

I think it was the next day when I saw them again, this time with my dear friend Kristie, who had come to visit. I think that is when the “baby blues” hit and the shock wore off. I cried on and off most of the day. Kristie brought me up to the NICU to see the girls, and as she stood next to me and we looked down on them, I couldn’t stop crying and thinking, “I am so selfish. I forced my body to get pregnant and this is what happened.” I saw the girls with oxygen support, IVs everywhere, monitors for their hearts, O2 levels and body temperatures. I saw them greased from head to toe in Aquaphor and wrapped in cellophane so that their transparent skin would stay moist. I saw them hidden under a mask to protect their eyes from the phototherapy they were receiving for jaundice. I saw them naked, without diapers on, light fuzz covering their bodies. They looked like tiny birds that had just hatched and been unexpectedly tossed out of the nest.

In those first moments of really seeing them, I honestly wondered if they were meant to die, and we were keeping them alive selfishly and for our own good, rather than letting them pass on without suffering. They did not look like newborn babies, they looked like fetuses that should still be in the womb. What were we doing, using technology to have them in the first place and then to keep them alive. Was this truly meant to be? How premature is too premature?

And yet, with every fiber of my being, I wanted them to live. I wanted to touch them, nurse them, kiss their heads and fingers and toes. I wanted to tuck them into my hospital gown and spirit them back home. I wanted to go to sleep and have them back inside me, kicking and punching and moving around in their protective water bath with each other for company.

It wasn’t until the girls were two days old that I got to hold them, one at a time and for only a few minutes, tucked under my hospital gown and nuzzled up next to my naked skin. I was petrified to move, to disturb all of the wires and lines. They were so small that their bodies literally fit into the palm of my hand. I didn’t have much energy to sit with them for long, but the minute the nurse scooped them back up and returned them to their crib, I wanted them back again.

We spent the third day in the hospital trying to decide on a name for our second daughter, and paged through baby name books in between visits upstairs to the NICU, phone calls to family and friends, and catnaps. After some time, we decided on Isabelle Hope. Isabelle is a name we had discussed before, and Hope felt like a positive, life-affirming choice that was particularly appropriate now.

Hannah and Isabelle spent two months in the hospital and came home weighing approximately four pounds each. On many fronts, they sailed through the NICU amazingly well, escaping many of the horrors we had been told to be prepared for: life-threatening infections, heart malformations, inability to be weaned off supplemental oxygen, gastrointestinal problems. But unfortunately, we did not get off scott-free. One month after their birth, the girls had a cranial ultrasound to check for brain bleeds that are common in micropreemies (those born weighing less than 1,000 grams and earlier than 30 weeks). Hannah's ultrasound showed evidence of PVL, which put her at increased risk for being diagnosed with cerebral palsy, as well as learning disabilities.

Since their discharge, we have watched the girls grow with hope, faith, and bated breath, especially Hannah. Initially, they were on the same developmental timeline and meeting the milestones of other babies born at their "corrected" age (when they should actually have been born, which was 3 months later than their birth age. But as they grew and the fine and gross motor skill challenges increased, the gap between Hannah and Isabelle grew. First it was only a few weeks, then a month, then six months, and now it is more than a year. While Isabelle reached all of her motor milestones in an age-appopriate fashion, Hannah is developing some of those skills at a pace slower than a child at least one year younger than her.

Thankfully, on the social and verbal front, the girls are both right on target. This is a huge relief as preemies in general are more prone to learning disabilities and preemies with PVL are at an even high risk. It is hard to say if more subtle difficulties might arise when the girls are school-age, where some learning disabilities become more evident. But at this point, they are both typical two-year olds in this regard.

There have been so many challenges to adjust to since we had our girls: their early arrival, the fact that there are TWO of them, and Hannah's developmental delays. I hope to use this blog as a place to share some of our triumphs and struggles through this process, which has changed all of us in so many ways.

Hannah and Isabelle's birth story, Part I

By way of introduction to our story and some historical background, I'm going to post Hannah and Isabelle's birth story, which I finally got around to writing after almost two years.
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On a Wednesday in my 27^th week, I noticed some very light spotting. I went to the doctor and got checked: I was not dilated or effaced, and I was not having regular contractions. Everything was fine, but the doctor told me it was time to think about quitting work and going on modified bedrest. I agreed to make Friday my last day, and started making plans for finishing up any last projects and ensuring my maternity leave replacement was ready to assume my responsibilities.

On Thursday, I woke up feeling like I was coming down with something. I had a slight temperature and my stomach was upset beyond the regular indigestion that had been plaguing me for weeks. I put in a few hours at work, went home to rest, and then met my husband(B) for dinner before we went to our birthing class. I was increasingly uncomfortable throughout the day and could barely sit through class, constantly shifting positions and trying to find ways to take the pressure off of my stomach and back.

When we finally got home, around 9pm, I noticed more, heavier spotting. We called the doctor on call and explained that I hadn’t been feeling well and was spotting again. He said that if I wasn’t cramping, I should just come in first thing in the morning to be checked, since I had been in to the office the day before and everything was fine. I went to bed and slept fitfully, slightly aware of some minor cramping but not enough to wake me fully. When I woke at 6:30am, I called the doctor again to report that I was starting to cramp, and he said I should meet him at the hospital.

B had already left for work so he planned to meet me there. As I drove the 30 minutes to the hospital, I felt waves of low-intensity cramps pass through me. I can remember thinking, “this can’t be good,” and just tried to stay focused on getting myself there as fast and as safely as I could.

I got to the hospital at around 8:30am and B met me at the entrance and helped me inside. Several people smiled at us, seeing my huge size and assuming I was a full-term mama in labor and that this was a happy occasion. The receptionist asked, “Are you in labor?” and I said, “I hope not!” They whisked us through the admitting process and directed us to the 7^th floor, where the birthing center is.

The birthing center is a new, bright, airy facility that’s just past the NICU on the 7^th floor. I paid no attention to the NICU as we walked by, not realizing that would be my second home for the next two months. A nurse met us at the door, took us to a room and had me get undressed and put on a gown. She hooked me up to a fetal heartrate monitor and spent a good bit of time trying to make sure she had both babies’ hearts being measured separately, and not just one baby being heard twice. I was also hooked up to something that kept track of my contractions.

Soon after, the OB came in and did a quick exam: I was 1-2cm dilated and 90% effaced, so he was going to have me started on magnesium to stop the contractions and prevent labor from progressing. He also ordered a steroid shot to help speed up the development of the babies’ lungs. My mind raced as I tried to remember from birthing class and my books what 90% effaced meant. I didn’t think it was good, but I felt confident that the meds he was going to give me would do the trick since I was just barely dilated. At one point, he said to me, “Well, you’re officially on bed rest now!” and I smiled weakly, assuming it would happen at some point but not quite ready to be bedridden so soon. I was also glad that I had gotten the steroids, thinking that was a good precaution so that the babies’ lungs could go on hyper-development-drive, should I deliver early.

B started making phone calls to family and we waited for the meds to kick in. The nurse told me I would start to feel very hot from the magnesium, and soon a slow, tingling heat crept across my face and chest, inching its way through my body and down to my toes. I’m not sure how much time passed, and this is where details start to get fuzzy. I think this is partly from the medication and partly from the trauma of what was happening.

The OB checked in on me again and said it looked like I was still having regular contractions so he was going to increase the dose of magnesium and add something else as well, something stronger. He told us that he was going to have the anesthesiologist and neonatologist come in to speak with us, so we knew what to expect if I did in fact deliver in the next 24-48 hours. At that point I felt the first flicker of fear and shock: “What do you mean? Won’t these meds stop labor and then I can just go on bedrest?” I remember asking, panicked. I think the doctor said something like, “Well, we hope so, but we like to just be prepared.”

While we waited for the docs to come by, the nurse asked if I felt contractions. I wasn’t sure: I felt cramps ripple across me periodically, but was that a contraction? I had no idea, I’d never been in labor before and was praying that this was not it. She looked at the monitor and said that it seemed I still was contracting fairly regularly.

At some point the anesthesiologist came by and explained the process for getting a spinal in case I needed to have a C-section. I don’t remember anything he said except for this: “I’m telling you this in case you do deliver in the next 24-48 hours, but hopefully that doesn’t happen and we won’t meet again until much later in your pregnancy.” Soon after, a neonatology fellow, a young guy who looked to be about our age came in. I don’t remember much at all of what he said. A few phrases floated by me: “27-weekers…vision and hearing problems…learning disabilities…breathing problems…developmental delays.”

About an hour later, the OB examined me again and said I was now 5-6cm dilated. I was amazed: “How can I be 5-6 and barely feel anything more than some cramps? Are you sure?” He said that often with twin pregnancies, the uterus is so stretched and the mother already so uncomfortable that she can go pretty far into active labor before she really starts to feel a lot of pain.

The next thing I remember is that I started to feel like I was leaking. I told the nurse and she had me roll onto my side, and just as I did, a huge gush of fluid came out of me. I started to groan, a deep, primal groan. I knew that my water just broke and I felt myself begin to fade away, deep inside myself, into my core. The OB and a resident were there, trying to find the babies on an ultrasound. They said something about one of the babies being in some distress, and that it looked like they were going to be born today.

At that point, things started to move very fast. The neonatologist fellow was back, telling us that once we got in the delivery room, we would see a lot of people in there, shouting instructions to each other, but not to freak out because that didn’t mean things were bad, it was just the way that they ensured they could hear one another through all the chaos of an emergency C-section. The anesthesiologist came back and I don’t remember what he said, I just remember his demeanor was very gentle, and calm, and kind. The nurse told B he would have to leave while I got prepped and then he would meet me in the OR. The next thing I remember is a sharp sting and then a lot of pressure as I got the spinal.

Once I was wheeled into the OR, the anesthesiologist set up camp next to me and kept up a steady stream of dialogue about a variety of topics, some related and some unrelated to what was happening to the lower half of my body. He was my link to consciousness; I listened fiercely to his voice, for fear that I would slip away otherwise into some remote place. B made his way back into the OR and stood by my side, squeezing my hand.

I felt a lot of pressure and tugging, and then someone cried out, “It’s a girl!” Hannah. Our Hannah Kate was born. 12:49pm, only 4 hours after I arrived at the hospital. I listened intently for what every mother listens for after she gives birth: the sound of her baby crying. But it was silent. And then, moments later, I heard the faintest of sounds, a soft whimper of a cry. Three minutes later, 12:52pm: “It’s another girl!” Oh my. Two girls. We don’t have another girl’s name. We hadn’t gotten that far. We had only chosen a girl and a boys’ name. And no middle names.

They wheeled the girls by us as they raced them off to the NICU and I caught a fleeting glimpse of an isolette and a tiny bundle in the center. The next thing I remember was many hours later, as I recovered in the maternity ward. B had already been up to see the babies while I slept on and off. When he came back, he reported that they were doing okay, but were very, very small. He said this several times: “They’re very, very small.” He handed me a picture of each of them, taken by one of the delivery nurses, which I studied intently. These are my children; my girls. Hannah, and “Baby B.” My two pound, two ounce little girls. How incredibly surreal.