(Eds note of caution: Another post so long it should have chapters, really.)
This is where I spent Friday night and Saturday morning:
It’s room 7 of the Labor and Delivery Unit at my hospital. See the cute little newborn tray across the way? I apologize for the crap photo, but it was all I could muster from my cell phone at 6 am after hardly any sleep.
No, thank God, I didn’t have the babies. Though it was pretty damned hilarious that mere hours had passed after I’d written about the milestone of potential viability for the boys when I started to notice a lot of tightening across my belly. I counted seven times in 45 minutes and thought, “huh, well I should probably call the doctor.”
I did and they said COME IN RIGHT NOW.
At this moment, the boys were at 25 weeks 1 day in development. It was about 10:30 at night. “They’ll probably just do a cervical check and send me home,” I thought. Wrong.
Walking into the Labor and Delivery unit for the first time under these circumstances felt like stepping into a starring role in a movie without ever seeing the script. It was something completely unreal for which I was utterly unprepared. Then the frightening reality hit me. At some point, I’d be delivering these two boys into the world. This was the place it would be happening. Maybe even this room.
“Not this room. We do all twin deliveries in the OR just in case we need to do a C-section.”
Okay, not in that room. But near that room, for sure.
“Wow, you really are contracting,” the nurse assured me after she hooked me up with fat hard plastic nipple-looking monitors on my belly. One each for the boys and one to monitor the contractions. And by the way, having those monitors strapped around my gut didn’t do much to ease the tightening feeling I was having. My first thought was, “SHIT” and my second was “So, this is what contractions feel like.”
Gallons upon gallons of blood collected. Peed in a cup. Then, a parade of folks came into the room. A happy trio of obstetrical staff greeted me as my “team” for the evening. It consisted of two high school aged residents (okay, they were probably late twenties) with a 12 year old boy turned medical student in tow (okay, he was probably 23). They – the team – were to going to perform the cervical exam.
“When is the last time you had sexual intercourse?” Three young pairs of expectant eyes searched mine. Alex looked up.
“Uh…” (Now, I apologize for the few of you who may read this who actually know me because a little TMI is headed your way. You can skip the next few paragraphs. In fact, I encourage you to do so.)
See, Alex and I had been so cautious since IVF (yep, that’s JUNE) we had really begged off sex in a way that was starting to make us feel inhuman. Or too sibling like. I’d never been told not to have sex once I hit that positive pregnancy test. I just had a feeling, like, maybe we shouldn’t take the chance. But last week, after such good news at the ultrasound, I figured what the hell. I wanted to celebrate. So we did it – on Wednesday night – just a couple of days before this whole thing started.
“Did you know that sex can cause contractions?”
And here I was blaming the whole thing on the #1 Value Meal from Burger King I’d had a few hours earlier. I happen to think fast food is disgusting, but I’d had the strangest craving for Burger King that night. Now they said it could have been the sex? Regardless, I vow to never eat Burger King again.
Anyway, since it had been more than 24 hours since the sex they were able to do the cervical exam. Luckily.
“Then, you just take the swab and swipe it around the outside of the vagina,” the resident said, as I watched the med student looking intently at the space between my legs. “Have you been itching? You look like maybe you have a little yeast infection here.” Lovely. Times like these make me real glad I’m not the shy type.
They performed two ultrasounds, one vaginal to check cervical length and one abdominal to check the boys. Cervix normal – between 3-4cm long. Closed, drum tight. Boys looked great. Heartbeats were just fine. All the fluid was there, where it was supposed to be.
They cultured (like a Pap Smear) for what’s called the Fetal Fibronectin (fFN) test. From the March of Dimes:
The presence of fFN during weeks 24-34 of a high-risk pregnancy, along with symptoms of labor, suggests that the “glue” may be disintegrating ahead of schedule and alerts doctors to a possibility of preterm delivery.
A negative result is highly reliable, and means that you are not generally going to go into labor within the next two weeks. That culture would have to go to the lab so we’d need to wait on that for awhile.
I was still contracting. Not hard, mind you, but it was happening. I tried to will it to stop. And I think – maybe it sounds crazy – I was able to get it to ease up a little bit. I just kept imagining my uterus as a soft pillow the babies were nestled into. I tried to think of the softest, snuggliest things I could and then imagined my uterus was made of that: clouds, Mason’s ears, jello, cool wHip, and then it finally hit me.
The little blankie bunneh and puppeh that Doot and Bing had gotten as a shower gift from my neice. When I lifted them to my face and felt those little baby blankies the first time I declared them the snuggliest, softest little toys I’d ever felt. So it may sound weird, but I imagined my uterus was made out of them. Every time I began to feel my belly tighten, I’d think of the puppeh/bunneh material and believe it or not, if I did it early enough, I’d feel my abdomen just relax and get soft. It didn’t work every time, but it did help. Amazing the weird little tricks you can do with your brain.
The real doctor came in and caught me up on what they knew. So far I was not showing any signs of preterm labor. Thank god. If I had been, they’d give me a steroid shot to help my babies develop their lungs to give them a better chance of survival should they – GOD FORBID – be born soon. But since, as she explained, they can really only give that shot once it was better to do it closer to when they actually suspected a delivery. That sounded fine to me.
She then told me that since everything looked good they were going to wait for the fFN test to come back and then probably transfer me to another room. All of my bloodwork was normal. No infections, no signs of pre-eclampsia. No major issues here. I was just contracting. “Some women just contract throughout their pregnancy,” she said. Great.
They gave me a 20mg dose of Procardia at around 12:30. Procardia is actually a heart drug that lowers the blood pressure, but it also helps relax the uterus. I received the most painful IV of my life – so bad that I begged the nurse to take it out. The IV was for hydration only, not meds. Luckily the doctor came in to talk to me right then and I bargained out of the IV – let me drink water. Given that everything else looked fine, they agreed and brought me a pitcher.
Eventually, my contractions did stop and my fFN test came back at 3am – negative. They took me off the monitors so I could get some proper rest. I sent Alex home to make sure Mason hadn’t destroyed the house and waited for transfer to my new room.
But then at around 4am, I felt the tightening in my uterus again. Fuck. The nurse returned with a wheelchair to take me to the new room, but instead called the doctor. They strapped the monitors back on. I’d be spending the night where I was. Stuck on my back, strapped like so much old luggage. They were going to give me another dose of Procardia, but I asked the nurse to check my blood pressure first. Sure enough, it had dropped from 137/70 (which is real high for me – this is where it was when I first arrived) to 105/58. They skipped the Procardia. Boy am I glad I asked. Another example where, no matter how much you like your medical team or how confident you are in the quality of care you are getting, you can never assume they’ve thought of everything – especially at 4am. If you’ve got a question or any reservation ask, ask, ask.
I could not sleep. I don’t know if it was my nerves, the Procardia, or the position I was lying in, but my PVCs (heart palpitations) were fucking terrible all night. I had near constant thumping in my chest. I felt like I was having an unending panic attack without the panic. Then the boys were jumping, kicking, rolling nonstop. Maybe they do that all night and I don’t notice it because I’m asleep, but hooked up to the monitor (which for some dumb reason, the volume was turned up in my room) every kick was THUD, BOOM, THRASH loud as hell. I could hear their heartbeats all night too, which at first was reassuring and then annoying, as they’d invariably wander away from where the monitor was strapped so that you then suddenly couldn’t hear their hearts. Hearing the steady heartbeats of your babies stop is not something to fall asleep by.
To bargain my way out of the IV, I drank that entire pitcher of water. So I had to pee every hour on the half hour. All in all I probably slept a total of 20-30 minutes every hour until Alex got there at 10am. Maybe it’s good practice for what’s to come.
I started contracting again at 6am. The doctor came in the morning and said, “You were so quiet all night I was going to just discharge you! But since it’s starting again I’m going to have the high risk OB/GYN come and take a look at you so we can decide what we need to do.” And I was fine with this. I did not want to go home with intermittent contractions without having every last person of expertise weigh in on the situation. Because that’s how I am.
7:30 am was change of shift. Alex was not back to the hospital yet but I was starting to really miss him. My new doctor came in and introduced herself and told me they wanted to give me the Steroid shot. “Huh what?” was my response. “But I’m not having preterm labor and I thought you could only give that shot once, and it was better to do it closer to – within a week of – delivery and my fFN test was negative so don’t I have at least two weeks minimum before that would be an issue?”
The nurse came in with the shot as the doctor was explaining her feelings. “As a mother of a pre-term child myself, let me just say this. It’s the worst thing you’ll ever go through, watching your baby in the NICU. If we give you the shot now, it will definitely help – just in case – you do go into labor within the next week. It will help lung development and help prevent brain bleeds. We can’t at this point guarantee that you won’t go into labor within a week or so. And that doesn’t mean you can’t have another shot later if it doesn’t – it just means that the second may not do as much good, but there are a lot of ways to interpret the data around this. I think this would be the safest thing to do now, but it’s up to you.”
“But Dr. S____ (the doctor from the night before) said she didn’t think I needed the shot or that I should have it now.”
“Look, if you get 100 different doctors in here you will get 50 doctors who say do it, and 50 who say don’t. But as someone who’s lived through it, I’m telling you it’s what I would do.”
“Um…ok…I guess…if you really think I need it.”
“Do you want to wait to talk to the high-risk doctor first?”
“Yeah, and I’d like to be able to talk to my husband about it. He’ll be here in a little bit so can we do the shot later?”
Now here’s why that little exchange is so important. See how close I came to getting that shot? I had this chat on almost no sleep. I had become more confident that I was going to be okay until this doctor – nice as she was – came in with her spiel about why this was so important and how despite absolutely no signs of preterm labor and a negative fFN screen, I might even go into labor within a week or so anyway. The nurse was standing there, shot preparation in hand. I was armed only with my groggy recollection of the rationale my other doctor had given me. My anxiety went through the roof. Of course – of course – I wanted to take every precaution I could to protect my babies.
Luckily, the doctor picked up on my hesitation and didn’t push it – actually gave me an out of talking to another doctor. Otherwise in my state of mind I might have just shown my ass and taken the shot and explained it to Alex when he got there. And that would have been bad, because of this (from Babycenter.com:
Because the benefits of the steroids are greatest during the first seven days after treatment, it used to be common practice to repeat steroid treatment weekly for women who continued to be at high risk for preterm delivery and were still pregnant after the first treatment. But experts now think the risks of repeated treatments probably outweigh the benefits. They’ve been associated in some studies with decreased fetal growth, suppressed adrenal gland function, and adverse effects on long-term lung development….
…Another thing to note is that even a single dose of steroids may have some short-term adverse effects on you. Although it doesn’t happen often, corticosteroids can raise your blood sugar to levels that require you to take insulin for a little while even if you don’t have diabetes. If you do have diabetes or gestational diabetes, corticosteroids may require you to increase your insulin dosage.
I saw the high risk doctor just after Alex got there. I really, really liked her. I actually liked all of the staff – that was one very good thing about the experience. Even the doctor who scared the shit out of me seemed very professional and on top of it. But here’s the rub with that. The high risk doctor again did a bunch of ultrasounds and saw my cervix was totally normal – 3cm long. The babies looked great. No signs of preterm labor. Other than “take it easy” and “watch for these other problems” I was given virtually no take-home instructions or restrictions. “So should I get that steroid shot now?” I asked.
Huh. I explained what the other doctor had said, yadda, yadda, yadda. The high risk doc said, “She thought you were 3-4 centimeters dialated, when the chart said your cervix was 3-4 cm long. It was just some miscommunication. I cleared it up with her.”
Fucking A, man. That was my response to that. In fact, that IS my response to that. Fucking A. A major medical decision almost made on totally wrong information. In more dire circumstances, this is how relatively healthy people die in hospitals.
Stay vigilant with your healthcare providers, no matter how much you like or trust them. It bears repeating. Even at 7:30 a.m. on no sleep, stay vigilant. More vigilant than I was.
They were going to let me go home. Oh hooray! Then came the new resident, “We’re going to send you home with a script for Procardia.”
“Are you sure? Are you going to advise me to check my blood pressure somehow then because my blood pressure dropped a lot last night after I took it and I have no way of checking it at home.”
“Huh” was her response. “Let me check with the doctor.”
No, I did NOT go home with a prescription for Procardia. Vigilance.
Here’s what I went home with: advice.
- Take it easy this weekend and don’t go back to work until you see your regular Ob/GYN on Tuesday.
- Track the contractions. If you have a bunch, drink some water and lay down for an hour. If they still get worse, call us right away.
- If you have any bleeding, spotting, discharge of any kind, call us right away.
- You’re pregnant with twins, so just get used to the idea of coming here between now and delivery as things come up. It’s not a big deal – it’s expected.
- NO SEX!
As we were driving home I asked Alex, “Do you think we caused this to happen because we had sex?”
“I say it was the Burger King.”
Whether it was or not, who’s to say. But that’s one whopper I won’t miss.