We?ve done it!  Melanie and I have welcomed our twin baby girls into our family.  We weren?t expecting them so soon but mom and babies are all doing well!  The gestational age was estimated to be 34 weeks and 5 days when Melanie?s water broke at 7:08AM on Friday 11/21/2007.  Twins are normally born at 36 or 37 weeks so they came at least a week or so earlier than anticipated.  We?re incredibly relieved that everybody is okay and Melanie is very happy that the incredibly uncomfortable cervical pressure is finally over. 

So after the water broke, Melanie felt great physical relief since there wasn?t as much pressure after the gush of amniotic fluid.  She had some dull low back pain for a few hours and then felt her first significant contraction around 10AM after eating a bowl of oatmeal.  She felt comfortable managing her contractions alone with me at home and got relief from the heat of the fireplace on her naked back and also by semi-standing up during the contractions.  At around 11:30AM, we believe the ?mucus plug? came out a bit at a time with each contraction and additional wash out of amniotic fluid.  By Noon the contractions were getting very intense, regular and frequent (about every 4 minutes) but were short 15-30 seconds generally but sometimes a minute or longer.  We were in contact with our doctor (Andy Hannapel) and our doula (Wanda Sundermann) all day. 

Wanda arrived at 2:30PM and timed a few contractions coming every 2-3 minutes and lasting about a minute each.  She felt that since the babies were coming a bit early and could come out quickly and need assistance, we shouldn?t labor at home too long so she encouraged us to leave for the hospital after about 30 minutes of laboring at home.  We called Andy and he went to meet us at the hospital around 3:30PM, I believe.  We arrived and the ?Stork Parking? option wasn?t obvious.  There was some confusion among the staff but we were able to turn over the keys to the valet parking only to be warned that if we didn?t move the car by 7PM, it might get towed.  I told them to handle it because my wife was in labor and about to delivery my children and I certainly wouldn?t be able to move the car by 7PM. 

So when we arrived, Melanie and I walked up to the L&D (4th floor) and found that Andy and Wanda had already gotten us a room and arranged for our smooth transition into the unit.  We got into the room and Melanie took off her clothes, hoping this would discourage unnecessary staff.  Andy and Wanda were there as well as Andy?s resident who we hadn?t met and two L&D nurses.  Melanie was uncomfortable with the people she didn?t know and she hid in the bathroom.  It was extremely uncomfortable to have Andy check her dilation but she wanted it done.  I was excited to find out that she was 7cm dilated when we got into the unit and was progressing quickly through transition.  Melanie was completely in control of this most challenging part of her labor and she changed positions frequently (about every 2 minutes), including frequent trips to the bathroom.  She was very insistent that the staff leave her alone and let her do it her way, which was a struggle because the environment felt very crowded and intrusive, but we did get several of her wishes.  For example, the doctors and nurses used intermittent electronic fetal heart rate monitoring.  Melanie found even the intermittent monitoring to be extremely uncomfortable.  She mostly didn?t want anyone touching her at all.  Melanie also didn?t have any IV or medlock put in, which she was hoping to avoid.  She labored in the L&D room without any anesthesia at all.  Of course she was near or at the breaking point many times and felt like giving up and giving into the standard hospital protocol stuff (epidural, IV fluids, pitocin, lithotomy positition) because she felt a lot of pressure from the staff to get the babies out as quickly as possible, but Wanda, Andy, and I just kept assuring her that she WAS doing it and that she was going to deliver these babies the way she had planned, unmedicated.  Of course Melanie was in charge but I think our constant encouragement and reassurance helped balance out the fear and pressure that the rest of the staff wanted her to give in and let them take over.  When it was time to push, Andy gave us the choice to continue in the L&D room or to take his strong recommendation that we roll the regular L&D bed into the OR just in case an urgent intervention became necessary with the 2nd twin.  We knew that both girls were vertex (head-down) and that the risk of needing an urgent intervention was very small, but we decided that we were okay to go push in the OR just in case.  So we unplugged the bed and rolled it down the hall in to the OR.

Once we got into the OR, there were many more people than we had in the L&D room and it felt even more unnatural, crowded, and high-pressure.  I think I counted 15 people around the room all staring at Melanie and it became clear that most of these people either hadn?t read our birth plan or didn?t respect our wishes to have them wait out in the hall until needed.  There were a bunch of people just staring at Melanie and waiting for her to ?hurry up? or at least that?s how it felt to us.  We know that Andy and Wanda were doing their best to give us the birth experience we desired but we were both disappointed that so many of our wishes as specified in the birth plan were disregarded.  Melanie didn?t feel relaxed and able to let the babies out naturally in the OR and resisted pushing hard with each contraction because the urge to push wasn?t so strong.  She kept asking why she couldn?t just wait until she had the urge and let her body push out the babies at the pace that seemed most natural.  She didn?t want any cheerleading or directed pushing.  But even I as her birth partner and greatest advocate felt tremendous pressure from the room full of people to help Melanie to get those babies out as soon as possible under the threat of medical interventions if we didn?t prove to them that we could do it naturally and expeditiously.  Given those circumstances, I appreciated our primary nurse Shannon and everything she was telling Melanie to help encourage her to really work hard to get the girls out ASAP.  I know that Melanie was very irritated with the environment and the pressure and knew that she would be far more relaxed and able to let the babies out at home or in a birth center.  There was also the excitement that everybody knew that these babies were so close to being born and just wanted to see them and meet them.  I did everything I could to help Melanie make the most of each contraction and get those babies out.  I?m sure that most of the staff thought we were freaks for doing this without any anesthesia and I felt that we needed to show them that we were doing it and would help those babies get born in what they considered a ?normal? amount of time or otherwise the were going to start pushing interventions.  It?s bad enough that they were constantly reminding us of how dangerous this was and that they had to monitor everything and prepare to intervene if anything went wrong and that there were all sorts of sterile surgical instruments already setup on the table next to the bed.

Baby ?A? seemed to take a long time to come down the birth canal.  Melanie tried pushing her out in a several different positions but her legs were so tired that she wasn?t able to use many of the positions that have gravity as an advantage.  We could see the top of her head for a while but with each contraction and push, she would ease forward and then slide back.  Melanie was exhausted and only felt able to give one good push per contraction and had to stop when the pain became unbearable.  We discussed the option of a pudental block with Andy and he even drew one up just in case we decided to have it but he also said that it would be more uncomfortable to put it in than it would be to just push these babies out.  Shannon, Wanda, Andy and I had to try to convince Melanie that she COULD get these babies out but she had to ?push through? the pain and give us 2 or 3 good pushes per contraction, even if it felt unnatural.  Melanie didn?t want to feel the baby?s head but I think she got an extra burst of energy to push her out when we told her that her head really was coming out.  Her head emerged slowly and I was surprised to see that it was smaller than I had anticipated.  Once her head was clear, her shoulders passed with a little more push and then the rest of her body came out easier.  Baby ?A? was born at 7:25AM, weighed 2151g (4 lbs. 12 oz.), measured 18 inches long and had Apgar scores 8 and 9.  Her birth was just as we had seen on so many of those birth videos.  She cried and flailed her limbs about immediately and I just thought she was incredible!  Though we asked that the cord be given a little time to stop pulsing (even 30 seconds), Andy instead immediately clamped and cut the cord and handed the baby to the first NICU team, who rushed the baby to another room.  We asked that they not take her away from us but our request was denied.  Incredibly relieved that baby ?A? was out, we missed her terribly and felt that it was wrong that she was not with us as we waited for her sister to be born.  Shannon had to leave at this point and Domenica came in to replace her.

Andy, his resident, and the nurses used the ultrasound machine to make sure that baby ?B? was still vertex and attempted to find her heartbeat with it and the EFM.  There was a little less pressure now that we were waiting for baby ?B? to engage and start coming down and Melanie was told she could wait for her uterus to catch up and not push until she felt the urge again.  Once Melanie started pushing again, she was mostly on her back with her leg up on the squat bar because she was so exhausted.  As extremely uncomfortable as it was to do, Melanie asked Andy to check and see where baby ?B? was and he reported that she was at about -1 station, engaged but above the cervix and since her head was bigger than baby ?A?, the cervix needed to stretch a little more.  Andy noted later that we were extremely fortunate that baby ?B? was also vertex because a breech extraction of a larger second baby would have been extremely uncomfortable and most likely impossible without an epidural.  Andy used an amniohook to rupture baby ?B??s membranes as soon as baby ?A? was born but after another check, Andy found another pocket of fluid and once he ruptured it, baby ?B? came out very quickly.  In fact, she came out so quickly that Melanie tore just a little bit.   Baby ?B? was born at 8:06PM, weighed 2483g (5 lbs. 7.5oz.), measured 18 ? inches and had Apgar scores of 8 and 9.  As with baby ?A?, Andy also clamped baby ?B??s cord immediately, even though we asked to let it stop pulsing first.  I?m thinking this wasn?t an option for us because the girls were a bit early and they were concerned that they may need immediate critical care.  At least he let me cut the cord.  But then baby ?B? was also rushed over to the NICU team and whisked away to the NICU.  I saw the NICU team vigorously scrubbing off the vernix and I called over to them to please stop doing that because we specified in our birth plan that we wanted to massage in the vernix ourselves.  Ugh.

After our children were taken away from us, we waited just a bit longer for a minor contraction so that Melanie could push out the placentas.  Andy captured them in a bucket and then examined them to ensure that everything came out cleanly.  There was a lot of blood but I wasn?t alarmed because I?ve seen this so many times before on the birth videos.  Andy drew up a sample of cord blood from each baby?s placenta and then he tended to Melanie?s tear, which required a few sutures.  After we finished in the OR and Melanie had been cleaned up a bit, she was moved on the same L&D bed back to the same L&D room for some brief recovery there.  After she went to the bathroom on her own we moved up to a new room on the post-partum unit and got checked in there quickly so we could get down to the NICU to see our babies.

We were able to get to the NICU at around 11:45PM.  Both babies were having some difficulty breathing on their own.  They didn?t need oxygen or other assistance but they did need to be monitored because they were grunting.  Also, baby ?B? was a bit hypoglycemic.  The condition was so urgent that they couldn?t wait for Melanie to arrive to give her some colostrum.  They said that they could give her dextrose solution (sugar water) or infant formula.  We asked that only the dextrose be given and with a syringe in the mouth and if this would be enough nourishment to sustain her until she could get Melanie?s colostrum. 

So?at this point, I?m ready to share the photos!

 

Here is baby ?B? on her warmer table with all her monitors attached.  Melanie and I had a short list of baby names in mind but we wanted to see the girls and compare them side-by-side before we made our final decision.

 

We were allowed to hold the babies as long as they were still on the monitors and everything was going okay.  They let Melanie breastfeed baby ?A? because her oxygen saturation was consistently over 93% but they wouldn?t let her breastfeed baby ?B? yet because she was grunting a lot, indicating that she was still having  a hard time breathing and it might be dangerous to try to breastfeed her.  Here?s Melanie holding baby ?B? skin-to-skin.

 

Here?s baby ?B? with her eyes open.  We can tell them apart at this point because she has a lot more hair than baby ?A?.

Here?s another cute one of Melanie holding baby ?B? in the NICU.

 

And here?s one of me holding baby ?B? after Melanie got a chance to hold baby ?A?.

Here I am doing  baby ?B??s first diaper change.  It?s really pretty easy at this point!

Here?s how we first saw baby ?A? in her warmer.

After a while, we got Melanie setup with the ?EZ-2 Nurse? twin nursing pillow and she had baby ?B? nursing with her sister right behind her.  This is probably about the point where we had the two of them together and discussed their baby names.  Baby ?A? is named ?Lucy Viola Safir? and baby ?B? is named ?Bella Louise Safir?.  In this picture, Lucy is on the left and Bella is on the right.  Lucy has less hair than Bella.  You can also call Lucy ?Lucy V? or ?Lucy Vi? for short.  And you can call Bella ?Bella Lou? for short as well.

Not long after we got to the NICU and got to see our girls ourselves, Leah and Richard and Julian came to visit us at the hospital.  Leah came into the NICU with us first and got to spend lots of time holding the babies.  Here she is holding Lucy. 

Even though there were a number of items we specified in our birth plan that we didn?t want to do in the hospital, we decided to go along with ?standard practice? for a number of the items.  Here?s Bella with erythromycin in her eyes (to prevent bacterial infections).  Both babies got their ?thighs and eyes? at the same time.  The ?thighs? part relates to them getting a Vitamin K shot to help them with blood clotting in case they get a cut.

Here?s Lucy with the erythromycin goop in her eyes as well.  Both girls had plenty of time to look at us without goop in their eyes before we let the nurses (Kristin and Lessley) put it in.  We stayed in the NICU until about 3:30AM, I think and then Leah and Richard and Julian went back to our house while we went back upstairs to sleep a little before the next feeding.

Today (Saturday 11/22/2007) after the 7:30AM morning feeding, Molly and Ned stopped by on their way to the mountains in order to visit with us and the girls.  Molly wants to be called ?G? and Ned wants to be called ?Pop?.  They?re both extremely excited about these new baby girls.

 

Here?s a picture of Molly holding one of the girls.

And here?s Ned holding one of the girls.

 

Julie, the NICU nurse assigned to our babies today, needed to get the babies? footprints before letting them go up to the newborn nursery.  Here she is getting baby Bella?s footprints.

Here?s Julie holding both of our girls.  She was really great and very encouraging (Bella left, Lucy right).

Here?s a picture of Melanie and I each holding one of the girls just before they were discharged from the NICU today.  I?m holding Lucy and Melanie is holding Bella.

And here?s Melanie holding both of them.  Yes, even as small as these girls are, holding them both up like this can be pretty tiring on the back.  Lucy is on the left and Bella is on the right.

Here?s a picture of the girls.  That?s Bella on the left and Lucy on the right.

Here are the girls together.  Bella is on the left and Lucy on the right.

Here they are all swaddled up like peapods with their xmas hats on.  Lucy on the left and Bella on the right.  I know because Bella is bigger.

Here?s Lucy on the left and Bella on the right.

Lucy on the left and Bella on the right.

Here?s Richard holding Bella, I think.

And here?s Leah holding Lucy, I think.

Here?s Julian wearing the ?bunny suit? that I had to wear while in the OR.  I thought he?d think it was fun.  He looks like a ghost or something.  I also got him masks, a hair net and booties ;)

Richard and Julian in our post-partum room.

Lucy on the left and Bella on the right.

Lucy on the left and Bella on the right.