My 27-Week Twin Birth Story
As I write this, I am six days postpartum. And thinking back, I wouldn’t say my birth story is necessarily traumatic, but it definitely did not go as I’d imagined and definitely not as I had ever dreamed it up in years passed.
For those who don't know my less-than-normal pregnancy story, I’ll start with a short version of that here. If you’d like to read more about it, I have series of posts about it here. If you’re just here for the birth story, keep on scrolling.
IN THE WORKS
Rather listen to us tell our birth story? My husband Matt and I talk about our story — from mom AND dad’s perspective because it takes two to tango.
A HIGH-RISK Pregnancy
My mono-di twins (each have their own sac but share a placenta) were diagnosed with Stage 1 Twin to Twin Transfusion Syndrome (TTTS) at around 16 weeks and were being monitored weekly and twice weekly. At around 18 weeks, we discovered that my cervix had shortened by half and I had been contracting for days without feeling them (yes that’s possible!). It was decided then, that I would be admitted directly after my appointment and be scheduled for a fetal laser ablation surgery to treat the TTTS and place a cervical cerclage the next morning. Talk about last minute, unexpected, and SCARY! Read more about that process in my diagnosis and surgery blogs.
Post surgery, I stayed at the hospital for two and a half days, 24 hours of which I was on a magnesium drip (not a fun drug to be on) and tocolytics to stop contractions. Upon discharge, I was put on two weeks of bed rest, followed by strict remote work and limited movement (bed rest light) orders, and began taking tocolytics every three hours around the clock to stop contractions along with progesterone for the remainder of my pregnancy.
Good News First Please
Good news - the TTTS was resolved through the laser surgery (woo!). Not so good news - the surgery often resulted in mom going into labor on average 10 weeks post surgery and could cause membrane rupture…do we see where this is going?
You didn’t know your water broke?
Around two weeks post-surgery, my water broke - but only a little bit and I didn’t know it at the time, though I knew something wasn’t right. I had called my OB that morning and told her what happened - I woke up with wet undies and sleep shorts, but not enough to get the sheets wet. They had me go into labor and delivery later that day to get tested and it came back negative for amniotic fluid.
This went on for WEEKS. I was intermittently trickling out what I now know was amniotic fluid throughout the day and at night, but only enough to warrant a liner. I told four doctors at my MFM practice throughout the 45 days after the initial gush about my concerns and they all told me that “watery discharge was normal” since I kept testing negative - I was subsequently tested two more times, both negative for fluid.
Twin A’s fluid was consistently low since my initial gush and not improving much. So we were sent back to John’s Hopkins to check of a reoccurrence of TTTS. During this visit, I told them about my leaking and FINALLY - the test came back positive because I was actively leaking fluid. And I thank the Lord it did because I was admitted to the local high risk prenatal unit at 26 weeks pregnant until I gave birth six days later at 27 weeks.
my Birth Story
The twins Couldn’t Wait to come Earthside.
I packed my bags and was prepared to be admitted to the high risk prenatal (HRP) unit for eight weeks - our goal was to get me to 34 weeks pregnant. I truly didn’t think I’d make it that long, but prayed every day to make it to at least 28-30. Though, during most of my checks my baseline was uterine irritability at best with contractions varying from every 30 minutes to sometimes every 5-8 minutes. I was often given fluids via IV despite my drinking 110+ oz of water daily.
On my sixth day in the HRP unit, my contractions began increasing and I was given my second round of beta shots to prep my babies’ brains for delivery and put on a magnesium drip to prep their brains (and slow contractions as an added side effect). After a total of 36 hours on mag over two days, the decision was made (very quickly may I add) to deliver me via c-birth. My contractions were increasing in intensity and occurring in intervals despite the mag drip - my body was ready to bring these babies earthside.
I was scared/nervous/anxious. The morning went something like this:
5:00 am
Nurse walks in “I just want you to know the docs have been chatting and it’s the expectation that you’ll likely deliver later today probably around 4 pm since that's a 24 hours post-beta shot.
My thoughts: Based on my increasingly painful contractions overnight, I was unsurprised that it was happening. Having decided on a c-birth weeks prior, that part didn’t bother me either. I was partially mentally prepared for the birth to occur and was happy to wait until the afternoon.
7:00 am
Anesthesiologist walks in, “Hi there, I’m here to ask you some questions for your c-birth this morning.
Me: “Uh…I was told this afternoon? Is this happening sooner than that?”
Anesthesiologist: “Oh, well the doctors will be in soon, but it’s looking like earlier than the afternoon.”
7:30 AM
Doctors arrive: “So our plan is to start prep for your c-birth at about 8:30 am.”
Me: “I mean I guess saying no right now would only delay the inevitable. Let’s do it” - *immediately starts shaking with anxiety.*
A Quick-Decision Cesarean Birth
The decision was made early in the day and my labor so the surgery didn’t have to reach an emergency-level cesarean birth. Things were calm and the NICU and surgical teams were prepped and ready. No rushing needed to occur and this gave me some peace of mind.
From here, my doctor gave me ALL the details, though I had been asking my amazing nurses what to expect with a c-birth over the last 36 hours so I felt as prepared as I could be (even without ever taking my virtual c-section e-course from the hospital). Even though I felt somewhat ready, the thought of being cut into and birthing my babies at 27 weeks scared me. I was more scared for my babies’ health than anything else. But I knew it was the best and only thing to do and we were at one of the absolute best hospitals in the nation for premature babies.
Let’s get this show on the road!
At about 8:30 AM I was wheeled down, prepped and given my spinal by 8:45. My husband was brought in once I was laying on the table and they covered my top half in warm blankets. Though, I assured them my shaking wasn’t because I was cold. Nonetheless, the blankets acted as a hug and calmed me a bit as they couldn’t give me anything for anxiety because of the babies. Each twin had their own team of about five NICU nurses and doctors ready off to our left. They were ready to get to work right away upon birth.
What is an Operating Room like?
I feel like a big part of nerves is not knowing what an OR looks like inside or what to expect. I had already had an experience in one for my laser surgery, so I was prepared for what it looked like. For those who don’t know - here’s a quick summary:
Lots of bright lights, white, and stainless steel
Monitors and machines of all types
There will be a lot of people. Without knowing proper names, and just from what I remember — there will be your direct nurse, the anesthesiologist, their nurse assistant, the doctor, possibly their resident, about 2-3 people supporting them, 3-5 people for your baby’s care team and multiply that for each child if you have multiples. It was a party to say the least.
The operating table is skinny, just a bit wider than your body. Your arms will likely be outstretched in a T-shape, each on an arm rest. I could hold onto them to feel secure on the table. Though, you will 110% not fall off the table if you don’t hold on, this was my own anxiety.
The operating table can move and tilt in any direction they need. Including legs/hips up and head down (which they did during my cerclage removal).
They may prop you at an angle with rolled blankets, and people will have to move you around once your spinal kicks in. They’ll have you get into position right away and quickly as soon as your spinal is administered.
The temperature might be cold or warm. Mine was warm to keep the babies comfortable.
The doctors and medical team might be chit chatting a bit, they will definitely be communicating to each other and with their team throughout surgery.
There might be music playing. My doctor had her preferred music going, though I barely heard it. They asked me if I wanted it changed and I could not have cared less.
My Cesarean Birth Experience
C-Birth Plan
To preface this - I had written a c-birth birth plan but opted not to share it due to the high risk nature of my delivery. If you are having a scheduled c-birth at full term, this is something you could create and share with your nurse or doctor.
However, I did ask about how they would close my incision to make sure it was what I wanted, made sure my husband would be in the room with me the whole time, and I requested for my arms to be free and not secured. Other than that, I let them do what they had to to keep me and my babies alive and well. And we were comfortable with that.
Delivery
The surgery began at 9:00 AM. From reading many moms’ accounts of their cesareans (I’m a type A research fanatic), I knew I wouldn’t feel pain, but I would feel the pressure. Let me tell you, it’s weird. Definitely zero pain, but the feeling of having two people root around my insides isn’t something I know how to describe other than weird. My hips jostled a bit when they pulled the babies out. The twins were out in less than 10 minutes from the first incision. The doctors were keeping me informed at a high-level. So they let me know when they were about to take the babies out - which happened MUCH quicker than I expected.
Baby A came out - “It’s a boy!” they announced (even though we had already known). My husband will account for what happened after this in his story because I was so nervous that at this point things are a bit of a blur. I remember hearing Levi’s little cry and was so relieved that his lungs were working and he was alive and breathing strong. Baby B, Noah, was delivered and I heard that little teeny baby sized cry and I was again relieved. “It’s a boy!” with echoing confirmation from the NICU teams.
No Skin-to-Skin
Each baby was given straight to their designated NICU team to be put into an isolette and cared for. I was prepared that there would be no skin to skin for the twins’ safety, and I was also okay with that. Sad, but okay as it was something I expected. Our twins’ safety and health was my top priority.
Once each baby was wrapped up, with their respiratory assistance in place, they were put by my head one by one then together. The nurses helped my husband take pictures and they were so sweet and supportive through the whole surgery. Matt even got to hold baby Noah.
Dad Stayed With Babies
Once the babies were stable and ready to be transferred, they had my husband go with them to make sure all decisions could be made and the babies were with a parent. This was something Matt and I agreed to before surgery. I knew I was going to be left in the OR alone to be sewn back up (also something I was nervous about).
Post-Birth Sutures
They began working on me as soon as the babies were out. And it was definitely the longest part. I was worried that my spinal would wear off. The nurse was right by my head to hear any concerns of mine, so that gave me some peace of mind. Again, the doctors peeked over the curtain every so often to let me know their progress - “we’re on the muscle and fat layer now” was not something I’d ever expect to hear in my life but hey, at least I knew they were getting close to my skin layer? I want to say the closing back up part took about 30 minutes but it definitely felt longer. I was so relieved when they said they were on my skin layer. They took their time and my incision (at 6-days postpartum) looks literally amazing.
Cerclage Removal Experience
At my doctor’s practice, cerclages are removed in the office without anesthesia if you are not opting for a cesarean. Thank the Lord I had my spinal for my cerclages because they were IN THERE. A different doctor had placed them (I had two cerclages) and from what I gather, she had placed them quite sturdily. What I assume should’ve taken 10 minutes took at least 20.
From positioning my legs from table top, to eventually stirrups and really rooting around in there to get them out, I was starting to get worried the spinal was wearing off. I knew they usually lasted around 45 min-1 hour. I started to feel a slight stinging near my incision, which I promptly told my nurse about. So she was able to administer some pain meds into my IV to make sure I didn’t feel anything. Never be afraid to speak up if you’re worried or have a question during surgery!
Post-Surgery Recovery in the hospital
After all my procedures were complete. I was laid flat, told to hug myself so my arms were in, and the team shifted me onto a rolling hospital bed. Since my spinal had worn off the slightest bit (and I was overly anxious) I feel like I might’ve felt it in my incision a tad, but nothing too bad - call it a 2-3 out of 10 level sting. I was wheeled to the labor and delivery recovery area, where my husband was waiting, to wait for my spinal to wear off. I believe I metabolize anesthesia on the faster side and it took about 1.5 hours for me to be able to bend my knees. After my spinal wore off, we were wheeled to the postpartum recovery room, where we would be the remainder of our stay.
There you have it
Remember, every body is different and so is every pregnancy and delivery. So, this will likely not be exactly how your delivery happens. Though, I found comfort in reading real and mostly positive accounts of other moms’ cesarean deliveries. It helped me know what to realistically expect.