At 34 weeks 1 day, Jacob and I went to our weekly MFM appointment. Originally Jacob was to stay home and watch our youngest while I went to the appointment with my mom, but at the last minute we switched it around and my mom babysat while Jacob came with me. In hindsight, I was so glad he was with me!
We arrived at the hospital, checked in, and waited to be called back for our ultrasound. As always, I was excited to see my babies. There had been times when I was filled with anxiety before ultrasounds, but strangely, this wasn’t one of them. I was looking forward to seeing my girls, and finding out how big they’d gotten. Their growth would be measured this time, something that was done every 3 weeks.
Our ultrasound tech was one of the midwives, and she is always so wonderful to talk to. She complimented me and told me I’m the “poster child for twin pregnancy,” which made me laugh. I certainly didn’t feel like a poster child, waddling uncomfortably down the hallway to the ultrasound room!
As she started the ultrasound, we chatted about a number of things. My other kids, how summer was going, whether we were ready for the babies (how can you ever really be ready for twins?!). As we were talking, I was simultaneously keeping a close eye on the ultrasound screen. I watched as she measured the deepest vertical pocket of fluid around each baby, pleased to see that as usual, their fluids were equal and in the normal range. Everything was looking great so far.
She began to measure the size of the babies. As she measured Baby A’s head circumference, abdominal circumference, and femur length, I watched the bottom of the screen where it estimated the gestational age of the baby based on those measurements. I was 34 weeks 1 day, but the measurements were coming up as 32 weeks, in some cases 31 weeks. My heart started to pound. Something was not right.
I sensed the midwife’s apprehension. She knew. I could see her hesitate and then quickly decide to continue the charade of happy small talk with me, as if nothing was wrong. As if EVERYTHING wasn’t wrong. Knowing that ultrasound techs are not allowed to give much information, and also that my MFM would explain everything to me after the scan, I decided not to address the problem right then either. The tension in the room grew.
She took each measurement three times, as carefully as possible. I’m sure she was hoping it was simply a measuring error, rather than a growth problem. As she finished, she murmured, “the doctor will want me to check cord flow.” This was another red flag for me, since this wasn’t something they normally checked at every ultrasound. She checked the flow of blood through Baby A’s umbilical cord, and then moved onto measuring Baby B. Again, I watched the measurements pop up on the bottom of the screen, and this time, the gestational ages were coming up even earlier. This meant that Baby B was even smaller than Baby A, who was clearly smaller than she should have been. By now I was approaching panic.
After the ultrasound was over, we were lead into an exam room to wait for the MFM to meet with us. Once we were alone, I looked at Jacob and told him that something was wrong, with tears welling up in my eyes. The anxiety that had built up during the ultrasound was in danger of pouring out. I had to hold myself together! It might sound silly, but I didn’t want the MFM to see me cry. He’s always spoken to me like an equal, like he respected my intelligence. I didn’t want to appear like a weak, emotional little girl in the presence of this man whom I respected so much. I pressed a wadded up tissue firmly into the corners of my eyes, took a deep breath, and somehow managed to stop the oncoming flow of tears before the doctor entered the room.
As usual, he didn’t waste any time with pleasantries. He looked at me and said, “well, everything has changed. Your twins’ placenta has reached its limit.” Right at that moment, the doctor’s cell phone rang. He said, “I’m sorry. I have to take this,” and ducked out of the room into the hallway. Jacob and I turned and stared at each other. What awful timing to get a phone call! We needed more information about our babies!
Luckily the doctor wasn’t gone long. He came back in and explained that our twins had developed IUGR, interuterine growth restriction. They were measuring at 4 lb 7 oz and 4 lb 0 oz, which were the 11th and 2nd percentiles. Baby B had only grown 6 ounces since our last growth scan three weeks prior, and at this stage babies should grow about a half pound each week. All of this indicated that their shared placenta was failing, and they were no longer getting enough nutrients to grow. The babies needed to be born soon.
The good doctor recommended that we get steroid shots, which would be administered over the next two days, and the babies would be delivered at 34 weeks 3 days. We were to get the first round of steroids before we left that day. This would help the babies’ lungs develop quickly. I’d read all the statistics about how effective steroids can be, often reducing NICU time by 50%. My concern was whether it was safe to leave the babies in for two more days to wait for the steroids to work. The doctor felt that since the babies’ cord flow dopplers looked good, they weren’t in immediate danger, but they still needed to be born very soon. They should be ok for the next two days, and the benefit of the steroid shots outweighed the risk.
The next thing we discussed was which hospital location would be best for their birth. Our preferred hospital doesn’t have a level 3 NICU, only a level 2 NICU (aka special care nursery) which takes babies 34 weeks and beyond. Since I was right at that cutoff point, the doctor wanted to make sure the special care nursery would be equipped to handle their needs. If not, we would go to a different hospital further away. I told him that we would go wherever he recommended. We wanted our babies to be well cared for. The MFM told us that before we left that day, he would have an answer for us as to where we would deliver. He was just waiting on a call back from another doctor.
He told us that in the 5 minute span of time after our ultrasound, he had already gotten the ball rolling on everything. That ill-timed phone call he’d received was part of that process. I was pretty impressed with how quickly he had acted! He literally must have taken one look at the ultrasound report, said “yep, they have to come out,” and immediately started making arrangements. He’d scheduled us an appointment to see him again the following morning, to get the second round of steroids and another ultrasound to check on the babies and look at their cord blood flow again.
We were led to a room in the labor and delivery ward, where a very peppy young nurse administered the first steroid injection. I felt pretty awkward bending over and getting a shot in the butt, but it wasn’t too bad. It burned a little as the steroids entered my bloodstream. The whole experience felt very surreal. Was I really preparing to meet my twin babies in just two days time?!
We went back and spoke with the MFM again. He had talked with several other doctors and pediatricians, and they had determined that the special care nursery could definitely handle the needs of 34 week preemie twins. Everything was all set up for delivery at our hospital closer to home. The next thing we had to do was meet with the OB doctor who would be performing my c-section. My regular OB, Dr. Northshore, was unfortunately on vacation that week.
The OB was a young woman with a very kind demeanor. She looked about my age, and I couldn’t be sure, but she also looked to be pregnant. I didn’t want to acknowledge it and be wrong though, so I kept my mouth shut! She went over all the details about what to expect with a c-section delivery. It was scheduled for that Friday at 7:30 am, so we would need to arrive at 5:30 am. The surgery itself would not take long, and once the babies were out, there would be a separate team of doctors ready for each baby. I was scared to have a c-section, but at the same time, I knew it would be the quickest and safest way for my twins to be born.
After meeting the OB, we left the hospital. As we went through the big revolving doors, a flash of garishly bright sunlight hit me. Everything felt too real. I was dazed and in shock. My brain was having trouble processing everything. It reminded me of the day I had first found out there were two beating hearts inside of my womb. My womb that would be cut open in two days time. The two beating hearts would be taken out of me, and the two identical people I had given life to would begin to exist outside of my body.
It was time. I wasn’t sure if I was ready, but it was time.