"I don't want to be forced into a c-section, just because I'm carrying twins."
Bianca was pretty quiet throughout her pregnancy. I scheduled more consults to get to know them a little better than I normally would, since we weren't communicating as much as I like via text, email, and phone. Every time I met them I did feel closer to them, and began to understand the working of their relationship and their feelings about this pregnancy a bit more.
At one point during one of our meetings, Bianca passionately discussed needing an end date for this pregnancy. She was wildly uncomfortable and not enjoying pregnancy, in the least bit. I identified with this want so much, being a smidge "type a" myself. It was more than a want, it was a need. She needed something to feel concrete, even if it would end up changing at some point. We discussed her requesting and induction date at her next OBGYN appointment, even though they had refused to set it the previous week. I helped by writing the language to use and which doctor to request it from in her practice.
Bianca texted me after the appointment with an induction date. She felt like she could finally take a deep breath (well as much of a deep breath as you can, when carrying twins). Of course though, that date would never come, and a surprise induction, would be what was in store for Bianca.
On Friday, July 13th, I received a text message from Bianca's wife, Emma. They had an appointment that morning, and Bianca was feeling as though something was off. Her provider eventually agreed to send her to the hospital for testing, to ease her mind. I will tell you, one thing I've learned in this profession, are that pregnant people are very rarely ever wrong about their bodies. Bianca was diagnosed with pre-eclampsia. While her blood pressures were just a smidge high, she had a ton of other tests come back positive. Some of the highest protein numbers in urine I had ever heard.
They planned to begin the
induction process that evening, with a cervical ripener. Bianca was "nothing. nada." as an OB had put it. She had no effacement and no dilation. I prepared them for a long haul, but they were both excited and ready. They started with a cervical ripener that evening, I tucked them in, and said good night.
To our surprise, we found out that the cervical ripener had actually started the dilation and effacement process all on its own, overnight.
Eventually, Bianca would need to go on pitocin, but this was a much more promising start to this induction than where we had been before. Bianca was now 2cm dilated and 80% effaced at 11:14am on July 14th. She was contracting in a regular pattern, but was uncomfortable and having pain in her sacrum. Emma stood by Bianca's side, the whole time encouraging and supporting her, in a way I had never seen a spouse offer support.
I had mentioned earlier the night before that I thought Baby A might be in OP position, or face and belly up, instead of the desired down. As the labor continued on, and Bianca's pain increased, my assumption became more and more clearly fact.
Babies are delivered in OP position all of the time. It's not a huge deal at all, but sometimes what it can do, is slow the labor, slow dilation, cause a ton of back pain, and make the pushing phase longer too.
There are lots of techiniques doulas use to help encourage babies to want to turn in the womb, but in Bianca's case, most of those things weren't something we could do.
Bianca was carrying two babies who both had anterior placentas. We wouldn't want to encourage a placenta to detach, as that would be considered a major emergency.
We did the things we could though, and occassionally got her some relief, but it was always short lived and Baby A always moved back into an uncomfortable position. It was also making him difficult to trace on the monitor, which is a requirement when being on pitocin. Eventually, Bianca agreed to have a monitor placed on his scalp, which meant she could more freely move around while they monitored him.
Around 3pm we tried to help Bianca get some rest by laying her in bed with a peanut ball in between her legs, the head of the bed was up a bit though and Bianca looked at me and said, "Can we lower the bed, I feel like a taco" and she wasn't wrong, that's exactly what she looked like!
After a few minutes Bianca said, "Nope! Get me up!". As many folks do during labor, laying in bed, isn't really option, and that stunk for her. She had been up all night and based on where she was in dilation, it was going to be another long night as well.
I suggested that she try shower to get some relief and it was helping Bianca quite a bit. This also allowed for her to get a bit of alone time. Bianca and I are very similiar, even though people wouldn't think that at first glance. I knew she needed a break from everyone to refocus herself on her end goal.
The first thing Bianca ever said to me, after polite introductions was, "I don't want to be forced into a c-section, just because I'm carrying twins." This is what landed us at Manchester Memorial Hospital and encouraged her to make a provider switch during her pregnancy. Bianca and Emma are both sociologists, who manage data for their jobs. After presenting them with statistics as well as anecdotal information, they quickly made a switch and commuted the extra bit of time, to the providers that had the best stats to accomplish the end goal, which in their case was of course beautiful, healthy babies, but with a Mommy who hadn't undergone surgery as well.
Bianca's mother, Marta, was also with us during this portion of the labor. When Bianca was in the shower, Emma and Marta both went from stoic to super excited. They were anxiously awaiting these babies and Emma taught me a new word, phonetically: "Shpeilekes". This word is yiddish and loosely means "feeling excited, while waiting for something to happen". I will now use it during every birth! It's a perfect word to describe this process.
At 5:15pm, Dr. Gildersleeve, checked Bianca's cervix again and she was now 90% effaced, 3cm dilated, and 0 station. She felt defeated, but I was excited for her. I couldn't believe how much change she had made based on where she started. So many people are often obsessed with just the dilation number, but cervical change is more effected by the other two. While I had prepped them for 3-5 days of induction, I had a feeling, we would be meeting these babies sooner than that.
At this point Bianca decided to try nitrous. It bought her another few hours of being epidural free, and some more cervical change.
At 8:35pm Bianca received an epidural. It had always been part of her plan, and at this point, she needed sleep. Her body was in pain and she was exhausted. Sometimes, when a laboring person can rest, their bodies dilate at a faster speed, then when they are in pain. I was hopeful this would help Bianca in this way. Bianca got some immediate relief, which was evident by her statement to the anesthesiologist, "I think you're my new favorite person."
I tucked Bianca and Emma in and went to rest for a few hours myself around 10pm. At 2am, Emma reached out to me and told me that Bianca was again really uncomfortable, but that she had slept for a bit. I returned to their room a few minutes later and reminded Bianca about her bolus button, which is an extra dose of medicine into the epidural site. It only worked for a few minutes and she was back in pain again.
Many people think that an epidural will take away pain completley, but it often does not. It still allows for women to feel pressure, which is a good thing, because they know when to push, but in cases where babies are OP, the intensity of the discomfort in the sacrum can still feel overwhelming.
At 3am we discussed calling up anesthesia for an extra dose of epidural medication to help get her a bit more rest. A cervical check at that time, would tell us that the little bit of rest she did get was helpful! Bianca was now 8cm dilated and baby was in +1 station! We still had time for the extra dose of medication and so Bianca then received in and fell in and out of sleep for a little bit.
Bianca was sitting straight up, the pain in her back was too much laying down, as many people would imagine someone with an epidural being.
This woman was impeccably strong and tolerant during all that was being thrown at her. She was on the highest dose of pitocin, pregnant with twins in OP positions, hadn't gotten a full nights rest in two nights, and was still as polite as you could imagine. She was a wonder to watch. Impressive even.
At 5:57am Bianca had a strong urge to push. A cervical check would show there was a good reason why, she was 9.5cm dilated and baby was at +3 station. Bianca was struggling to hold back the urge to push. I talked her through every contraction. Sometimes, if you aren't fully dilated and start pushing, it can swell the cervical lip that is there, and extend the dilation process. We needed to wait, and rotate her position to get her cervix as thin and gone as possible.
We would have to do this for a hour, to get her to fully dilated. Again, it was her strength and control that made all of this possible. When they told her she was 10cm dilated, Emma and I hugged each other and both welled up, while Bianca said, "Let's do this!". That's actually the perfect description of their personalities.
Emma spoke to my empath side, having me in and out of tears with her, and Bianca's strength filled the room with confidence. There wasn't one person in the space that didn't see her having these babies the exact way she wanted to.
At 7:20am Bianca would start pushing with her surges. She asked for some guidance and I gave it to her and she took off. She was moving baby within minutes and we could all see it.
After 2 hours or so, baby was in the exact same position he had been after the first few pushes. I could tell Emma and Bianca were both starting to feel anxious. Bianca was telling me how tired she was, I was having to tell her when her contractions were coming, and she kept looking at me with a look of desperation in her eyes.
Bianca's practice had another practice on-call on this day. I knew that this could be to Bianca's benefit. Mansfield Obgyn was providing her care, and while Devon their midwife had been with us for most of the time, Dr. Gildersleeve, was still on call.
While forceps have lots of negative connotations, surrounding them, they can be helpful in these situations and Dr. Gildersleeve, might just be one of the most skilled OB's I've ever seen use them. When he suggested it, Bianca, of course, questioned the statistics surrounding their use. Dr. Gildersleeve agreed with her and then discussed how he would be using them, to prevent all of the negative outcomes, to the best of his ability.
After a bit of discussion Bianca eventually agreed. Dr. Gildersleeve used forceps for less than one minute or so, just helping to guide babies face under the pubic bone and move his forward about one inch. Just as we had thought, baby was as OP as it gets and after that bit of steering from the forceps, Bianca pushed out Baby A, now named Liev, at 9:27am. Even though Bianca had been induced at 36 weeks, and was carrying twins, this baby was a fantastic size 6lbs 15oz and 19.5" long.
Emma had put on a gown, so that she could have Liev skin to skin, while Bianca worked on pushing his sister out. I could hear Emma weeping and whispering the sweetest words to this little baby about how he was going to change the world. I again welled up, but turned my focus back to supporting Bianca.
Shortly after, baby Noa, also totally OP, with no forcep assistance took her first breath earth side at 9:45am. She was more than a pound smaller than her brother, but just as fierce at 5lbs 10oz and 18" long.
Their size, and excellent response, would mean no NICU time for these babes.
I stood behind Emma and held baby Liev next to her skin, while she cut Noa's cord, in the same way she cut Liev's.
Bianca then, in just the same manner that Emma had, began to whisper to baby Noa, who was on her chest, "you are mighty and you are going to impact this world in such a big way". Goodness, what amazing words to hear as your firsts.
Bianca looked at me and mouthed, "thank you". Emma grabbed me tightly and sobbed and then they both began to cry and laugh with excitement, in a way, that I have only ever witnessed in this very moment.
I was given the honor of telling a room full of family members that the newest part of their family had come earthside. I escorted the grandmothers into the room and watched each one of them light up as they hugged their daughters, met their grandchildren, and passed the babies back and forth.