Tuesday, October 7, 2014

Twin birth story **Part 2**


Making a plan

I needed to know how I was going to react to being in the hospital spaces themselves, so my OB put me in contact with the Supervisor of Labor and Delivery so we could take a private tour. To say I was tense about the whole thing would be an understatement. My dear friend, Dede, traveled 8 hours both ways to be with me during this tour. When we got to the hospital, the woman we were supposed tour with (Patty) was busy, so we were walked through by the Director of Women’s Services, Joan.
To say the tour did not go well would be an understatement. I wound up in tears in the regular L&D room, and had to take a while (and several rounds of conversation with Dede) to calm myself enough to continue. We went into the OR area, and just looking in the open door caused me have a panic attack. After a couple of minutes, I was able to actually take a few steps in and lasted about 10 seconds before I went into the hall, found the only unoccupied corner, backed myself into it, and completely broke down.

To her credit, Joan was wonderful. I sincerely doubt she had ever given a tour like that, and repeatedly asked if there was anything they could do to “make it better” for me. I was a mess, so Dede became my mouth and talked to her. We left with the understanding that I could go through the floor as many times as I needed to, and the hospital was willing to do whatever they could to help me through this. I can say with certainty they had no idea where that would eventually lead.

I understood they were trying to help, but the suggestions we got from Joan as to how they could accommodate me were not going to be good enough. I needed to stay out of an OR completely. Therefore, we started to explore our options for another hospital. There is a hospital roughly the same distance away, which is more rural, but has an OB who will catch twins out of an OR. We met with Dr. B to discuss transferring my care to him, and felt he would work if CSM refused to budge on keeping me out of an OR. We found out at the meeting, that his hospital had a Level I NICU. This meant that if I went before 36 weeks, I couldn’t birth there, and would be sent to a closer hospital to be attended by an OB I’d never met, who would likely not accommodate my needs. Even if I made it full term, if either of the babies had problems, they would likely have to be transferred to Children’s Hospital. Additionally, this OB (Dr. B) was going to be out of town my entire 37th week. While a couple of his colleagues knew how to catch breech, the other three did not, and if B didn’t flip head down, they would c-section me for that baby.

To make things even more fun, my OB, who is the only doctor I’ve trusted in 10 years, was leaving on a mission trip from when I was 32 until I was 35 weeks. Since “twins always come early” in the obstetric world, that made me nervous about him missing the birth. My midwives were confident that I would clear that timeline because I was following what I have started to call “The Midwife Twin Diet.” 

At my prenatal appointments with Dr. W, we started feeling him out on the idea of me staying out of an OR, and we were essentially given the runaround. The OB said it was the hospital’s decision, the hospital (spokesperson) said it was the OB’s. It was thrown out that anesthesiology, neonatology, and nursing would probably have opinions, and I would need to get “approval” from all of them even if Risk Management (the cover the hospital's butt department) approved. This was two weeks prior to Dr. W leaving the country, and there was no way I was going to be able to arrange conversations with all of those people before he left. We threw out the idea of a “round table” meeting with everyone, and were surprised that he agreed. We contacted Joan and she agreed to help us set it up.

We got the meeting scheduled for a few days before he left, and it turned into quite the crowd. There was myself, Joe, Dede, Deb (our midwife who was acting as our doula), our OB, the head of neonatology, the anesthesiologist on call that day, the supervisor of L&D (Patty), and Joan. It became apparent almost immediately that everyone was looking to Dr. W to make the call on if I could stay out of the OR. If he agreed, we were fairly sure everyone else would follow suit, as long as we made it clear that we understood the risks and were willing to accept them.  After some initial tension on everyone’s part, the meeting went amazingly well. Dr. W admitted that I had a 95-97% chance of everything being just fine, and I made it clear I was willing to accept those odds.
 
They agreed to keep me out of the OR for the birth if everything with the babies and I was stable. They wanted me on continuous monitoring because I am a VBAC, but would respect my right to refuse if I wanted to decline for periods of time (for example, to walk the halls or use the shower). As long as they looked good, Baby A’s cord would not be prematurely clamped and cut, and A would instead go right up to me, and they would do an ultrasound to find out where Baby B was. I agreed to a saline lock so they would have immediate IV access if they needed it, but nothing would be put in it without my explicit consent. I also agreed to a breech extraction if necessary, and Dr. W agreed to not go reaching up there unless he had to. There was no time limit on how long Baby B took to come. A key statement here was Dr. W saying, “Pending being out of the country, I plan to be there.” 

To give you an idea of the enormity of what we were trying to do, I was gearing up to be the first twin mom to have her babies outside of an OR in at least 34 years at this hospital. This was going to be a huge stretch for everyone there, but I left the meeting cautiously optimistic it could actually work.

Dr. W left for his trip, and I saw his backup Dr. L for a prenatal appointment while he was gone. I was assured he was okay with our plans, as long as the babies weren’t premature.



Waiting on babies

Everything with my pregnancy continued to be totally healthy. I stayed in communication with Patty, as we were hammering out details, and I found out they were doing trial runs in various L&D rooms to see what the best one to fit all of the equipment and people would be. Around 34 weeks, I took another tour of the floor with my therapist, and it went much better than the first time. There were a few things we added to the plan, like trying to have the copious amount of staff stay out of my line of sight to give me the illusion of privacy for the actual birth. I found out at around 36 weeks they had set the room up and had it on reserve for me.

Dr. W got back from his trip, and apparently called almost immediately after getting off the plane to see if I had the babies while he was gone. When I was 37w 5d, we had another prenatal appointment that would throw us another curveball. Dr. W told me that if I didn't have the babies by 38w 3d, he would be unavailable to attend me until 10pm of the day I hit 39w. He assumed because of the pervasive belief in obstetrics that *twins always come early* I would have had them by that point, so he had planned a vacation, because, he just didn't think I was going to go that long. There was no mention prior to then that he was going to be leaving for four days that late in my pregnancy.

I’m not sure I can adequately explain how frustrated I was with him. I had spent my entire pregnancy telling him that I was working very hard at keeping these babies in until they were full term.  He never once asked what I was doing, or the effect I expected it to have, or what basis I had for thinking that. He just assumed nothing I did would make a difference in how long I gestated. I was a little shocked at him possibly missing the birth (again), but I was not going to mess with being induced and going down the road to all the issues that could cause.
 

Click here for Part 3

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