January 9, 2015

See That? There's Two : An Identical Twin Pregnancy Story

A fellow twin mom friend of mine, Joanna over at Nesting Story wrote a wonderfully detailed post about her experience with twin pregnancy. I myself have started this post quite a few times only to be sidetracked by a baby crying or find myself delving into far too much detail about the more personal aspects of my experience.  I gave a brief retelling of our twin diagnosis here, discussed my management of gestational diabetes here and here and a few weekly updates but not much else. My last entry before they were born was a glimpse into how I really was feeling the whole time. Terrified. Truth be told a lot of the pregnancy is a blur for me. Looking back now I can recall the big things - that first ultrasound, finding out they were girls, failing the glucose test, etc. but I haven't really been able to sit down and just write about the pregnancy as a whole. I don't feel as though I'm fully through processing it yet. I just know that it was truly the scariest time of my life.

I've mentioned a few times that having identical twins changed everything about my expectation of my personal pregnancy and that really did a number on me for a while. I had always pictured myself feeling nothing but joy and nervous excitement over our first child. I'm relatively anxious by nature and tend to worry a lot but nothing prepared me for the amount of times I would feel true panic while pregnant and not just because it was twins. Starting the day I found out I was pregnant I began to worry about anything that could cause me to miscarry. I had to actively push the scary and negative thoughts away just to get through the day without panicking over losing the baby, and later, one or both of them. On top these fears was the reality that I would have to stop working, at least for a little while and we would officially be in poverty. The only reason I wasn't crying or freaking out constantly was that I knew it was probably the worst thing I could do and may even lead to the unthinkable. I did my best to put a smile on, pretending everything was sunshine and rainbows. But it was hard work and some days I barely held it together.

Then, when I was 10 weeks along my best friend in the whole world miscarried at 6 weeks. It was absolutely devastating. We were so happy to be pregnant together and here I was carrying twins and she... it was awful. It's been almost a year and she's healing and we're fine. She loves my girls so much and she is trying again but it struck a fear in me that lingered until the girls were here and made my anxiety so much worse. I tried to be strong for my best friend but every single day I thought about baby Lily Grace, who would have been their first friend and wonder why. I know it's just how life is but it really makes you wonder.

So, in short, I tuned out. I acted like I wasn't pregnant and just tried to live my life like normal. When that was no longer possible I just reminded myself every day that nothing bad had happened yet. It's not pretty and I don't like admitting it. That's probably why I am having a hard time writing this. I regret that I didn't savor every second of carrying my babies but I know myself and that is just not who I am; not in the face of fear.  At one point I remember making myself talk to them because I felt guilty I didn't do it often enough. Then I started crying because all I could think was how it would kill me if something happened. It was easier to act like they weren't there until they were physically here. I knew they were real but they weren't really real yet, not to me. It's kind of like how you don't let your kids name the stray they took in. Once you become attached it's that much harder to let go.

I often wonder if it would have been different had I been pregnant with a singleton. After the first few weeks I allowed myself to believe it was most likely going to be ok. I relaxed about every ache or pain, my fears of ectopic and chemical pregnancy were handled with the first ultrasound at 8 weeks. By then I had made educated decisions about all the big choices there were to make. The easy ones: no coffee, lunch meat, sushi or alcohol, tons of protein and vitamins, some name ideas. Then the more important things: prenatal care, our birth plans (options A, B and C), how to make it work going back to the daycare with a kid and everything else there was.  I was ready to commit to being pregnant and loving it. Even finding out it was twins (that's how she said it, "See that? There's two.") didn't really shake me until we found out they were identical and everything I thought I knew about what our bodies can do went out the window.

My plans for the care I would receive and the birth we would have were changed completely and it felt as though I had relinquish control or suffer the (potential) consequences, of which there were many. All of a sudden I was high risk for everything: late-term miscarriage, Twin-to-Twin-Transfusion Syndrome (TTTS), Intrauterine Growth Restriction (IUGR), gestational diabetes, placenta previa and premature degradation, Twin-Anemia-Polycythemia Syndrome (TAPS), pre-term labor and premature birth. I was told at 10 weeks that 24 weeks was the first "goal" we had to make it to as that's when the risk for TTTS goes down and the fetus officially becomes viable. Yeah, all my progress in chilling out went right out the window after that.

We immediately had to terminate the care of my wonderful midwife and I let the home birth midwives know that was off the table. According to Dr. Margono the risk was just far too great for monochorionic twins given the number of complications that can arise. Sure, you could say that complications can happen in any pregnancy but look at it this way: it happens often enough with identical twins that most midwives will not deliver them alone and almost no one does it at home. Mine wouldn't even entertain the idea and referred me to both Dr. Margono and my actual OB, Dr. Kittle. As for my whole idea of going as long as I could - Dr. Margono told us that if we made it through to "the end" without complications he would induce me at exactly 35 weeks. He knew it was the babies' best chance of being born as developed as possible without risking damage or demise. I looked him up, he knew what he was talking about. When he said that the risk of losing one nearly doubles during week 36 I knew I had to do it. It didn't matter how much I wanted a natural birth, I was ready to do whatever he said. I hated losing control and it made it even harder to love being pregnant. I loved my babies and was excited to have them but dear lord was it going to be a long and terrifying road.

I started having ultrasounds every two weeks always wondering about the risks of too many but never questioning Dr. Margono. The best part was getting 3-D scans every time. The worst part was how I prepared myself every single time for something to be wrong. Often it was fine but it was during these sessions that we found out about choroid plexus cysts for which we had the Harmony genetic test done (the cysts were benign and went away by week 24), Juliette's enlarged kidney and the first big weight discordance right at the end, signifying possible TAPS and placenta degradation. That reaffirmed the best reason for delivering early as the placenta was already calcifying. If I waited too long it could no longer support two babies and my body could have gone into overdrive trying to save the surviving twin and start preterm labor. We set the date for July 30th way back in March. I looked up pictures of how big I could expect to be then, as well as the survival rates and potential issues for babies born at 35 weeks. I knew NICU time would be needed. I just prayed it was short and without issue. I planned our baby "theme" and registry but didn't buy a single thing for them or set up the nursery until the first week of July. With all this fear I spent much of the time so detached from the actual babies and did all I could for my pregnant body, eating as much as I could while managing gestational diabetes and taking it easy as often as I could while trying to stay fit and active. I worked on maintaining a positive attitude although it was very difficult at times.

In the end, they grew to 4 lbs. 2 and 4 lbs. 9 oz. They were healthy and we had no complications. I had a routine scheduled c-section with a wonderful recovery. We were one of the lucky ones.

I know now that I might have been able to actually keep them in for one or two more weeks to grow but the risks were too high for me (and my doctors). The only time I regret this decision is when I think about their NICU stay and when I start to feel anxious over milestones since my girls follow their adjusted age almost entirely. I just keep reminding myself that I need to be grateful that these are the only drawbacks that we experienced. They're here, they're healthy and that's all that matters.

I was blessed to have a very physically easy pregnancy. I did not have morning sickness, just nausea if I didn't eat the instant I felt hungry. My only real symptoms were sore boobs and a missed period. Oh and getting huge
although I only gained 35 lbs., despite trying to gain more and eating pretty much constantly. I had great energy well into the third trimester, only really having to slow down towards the middle of June.  I bought a pregnancy pillow early on and slept really well right up to the end. I tried really hard to take care of my body every day. I drank gallons and gallons of water a day and had to pee every half hour. I never had any scares or complications and almost every appointment was encouraging. The one time we went to labor and delivery was at 20 weeks when I thought I
was having contractions. It turned out the girls were just big enough that I could feel their kicks really well. They were stretching me out and causing braxton hicks contractions but all was fine. My healing afterwards was easy too. I was up and moving around the next day and felt completely like myself before leaving the hospital. No big deal.

The first time I got to hold my babies at the same time.
Every woman I know can't believe how easy it was. They say they're jealous of me. I don't look at it that way at all. No, I didn't suffer very much physically but I more than made up for it with mental anguish and anxiety. And then, to top it all off, after a harrowing pregnancy with more worry than joy my babies were taken from my body (yes by choice but still...) and then rushed to the NICU. I got to smell their heads and see their faces for 2 minutes each but I didn't hold them until they were 8 hours and 2 days old.

Juliette, 4 hours old
Despite everything else those were by far the hardest parts of this whole thing: not holding them, the NICU, and leaving them behind. Even with the benefit of being prepared for it nothing made it easier.  I have a very hard time thinking about that even now and I'm not sure I will ever be able to think about it without my heart hurting. That fear from the pregnancy, that something could go wrong at any moment, only intensified with them in the NICU, despite them being in the safest place possible at the time. It was so scary with the constant monitor beeps, the tube feedings, the oxygen, the isolettes and then the extra monitoring for Jules and her kidney. I couldn't breastfeed because they weren't strong enough yet so I was pumping around the clock. I was there every day from 9-7 but I still felt like I should have been doing more. No, I felt like they should have been home with me. After 14 days they did come home and it's incredible but I will always think about those two weeks.

Vivienne, 1 day old
So, there you have it. My less than glamorous version of my twin pregnancy. I could have lied and made up memories that I don't have, pretended to have enjoyed every second and basked in the glory that was an easy pregnancy (which I AM grateful for). But that's not my reality. My reality is it was terrifying and gut-wrenching at times. The prospect of bringing not one but two unplanned babies into the world is enough to keep anyone up at night, but I had all these things on top of it too. I was so glad when it was over and I don't miss it at all. For me, this is the easy part.

People are already asking when we will have another one. The answer is, almost definitely, never. For one thing, almost everyone I know has two kids and they're fine. Just because mine came at the same time does not mean I need to have another one. But really, I do not ever want to experience that awful, sickening, wake you up in the middle of the night anxiety over something I cannot control ever again. Once in a lifetime was more than enough for me. Maybe I'm crazy and maybe I'll regret it but I don't think so. I can't imagine coping with those emotions while trying to raise my girls, either. I don't think it would be fair to do that to the babies that I already have struggled so much with. They didn't have me, not fully, for so long, and they already have to share me as it is. They deserve to have all of me for the rest of their lives. These girls are truly the best thing in my life and I am happy to have gone through the pains I did to have them but I also hope to never have to do it again.

How was your pregnancy? Can anyone out there relate to me or am I just selfish and kinda crazy?


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