C section at 37 weeks with twins

Part 1 (The Surgery) — Twinside Scoop

I was finishing my strawberry smoothie as I leisurely walked into my routine ultrasound appointment, not knowing that in a little over 3 hours I would be in the O.R. holding my twins for the first time. After we got the ultrasound, the doctor came in and all I heard her say was “I’m going to deliver your twins today. I’m sending you downstairs to the O.R. for your C-section right now.” My husband (who almost didn’t come to the appointment) turned ghostly pale and my heart sank in shock.

By then, I was already full-term with my twins, 37 weeks + 4 days to be exact, but my C-section wasn’t scheduled for another 3 days (when I would be 38 weeks). When I woke up that morning, I thought I had a few more days left. I was envisioning the luxury of taking a shower, blow drying my hair, and maybe even putting on a little make-up before my scheduled C-section. Of course, on that day of my ultrasound, I regretfully decided NOT to do any of the aforementioned before going to the doctor. I was only there for what I thought was a routine ultrasound, looking oh-so-natural and “undone.” I like plans to stay on track and that was not happening. (Heck, I had already bought monogrammed gifts with their scheduled birthday on them!)

I was immediately flooded with mixed emotions: fear of being cut open for the first time, anxiousness for my impending new title of “mother” to not one but two kids, and sheer happiness to meet my children for the first time. As a medical professional myself, I’ve spent plenty of time in an O.R. with patients before. I’ve watched craniotomies, knee replacements, C-sections, bronchoscopies, etc. However, I had never been the actual patient lying on the table…until that day. Despite all of these unfamiliar emotions, I remained calm. I was ready.

Here’s the back story as to why the doctor wanted me to deliver: My boy/girl twins were growing beautifully in utero with great estimated sizes and lengths for nearly the entire pregnancy. I was told to gain between 35-45 pounds for my twin pregnancy (and I gained 42 pounds). So, I knew my nuggets were getting what they needed. However, in the last couple of weeks, while my son was still growing, he wasn’t growing at the same rate as my daughter. The OB-GYN explained in the weeks leading up to their delivery date that he was the one we needed to watch. It was thought that my daughter just snagged a more nutritious area of my uterus and was resultantly taking up his space. At each weekly ultrasound appointment towards the end, we were seeing my son’s rate of growth start to decline. That’s when my OB-GYN decided she was ready to pull the trigger. She went on to explain that even though he’s growing, and I could likely carry the twins easily past the 38-week mark, she felt my son would grow better outside of the womb.

After the doctor told me it was time, I boldly negotiated an extra 30 minutes to run home to take a very fast shower and grab my hospital bag (I live very close to the hospital, but still had no time for make-up or any of that jazz). She agreed to let me go but ONLY if I was quick. When I returned, I walked straight into the Labor and Delivery unit where they were waiting for me. Within the first 30 minutes of being there, my entire family arrived. Within 45 minutes of being there, I had my IV placed in my arm and I was back in the O.R. ready to go.

I can honestly say that my O.R. experience was overall relaxed, calm, and smooth. One of the nurses even asked me what kind of music I wanted them to play during surgery! (Coldplay was my answer, by the way). As soon as they laid me on the O.R. table, the anesthesiologist turned me onto my left side, inserted a needle into my back for the spinal block after which my lower stomach and legs became numb (by the way, that needle part wasn't nearly as scary as I thought it might be. Didn't hurt at all). They gave me medicine through my IV to keep me calm – and I tell you, it worked! I didn’t feel scared AT ALL and I stayed awake for everything. They inserted a urinary catheter (since I was numb waist down) and strapped both of my arms down for the procedure. The only discomfort I felt was dizziness associated with a drop in my blood pressure after some pain medication at the start of the surgery. It quickly resolved with an IV fluid bolus.

The entire procedure was only about 45 minutes from start to finish. Our daughter was born first at 4:57PM weighing in at 6 pounds 5 oz and then 1 minute later at 4:58PM our son was born weighing 5 pounds 15 oz! The sound of their cries was everything to me. It was the biggest relief to hear them. The staff brought my daughter to me first, but only briefly. I didn’t actually hold her until a few minutes later. Instead, they placed my son on me, chest-to-chest, to help him work out some amniotic fluid from his lungs. Both babies were beautiful and perfect. By the way, they unstrapped one of my arms (the arm that didn’t have the blood pressure cuff on it) so that I could touch each baby while still on the operating table (as they were suturing me up). Before I knew it, I had both babies on my chest doing skin-to-skin before we even rolled out to the recovery room. Before giving birth, I remember being worried that I wouldn’t have my arms free or be able to do skin-to-skin immediately in the O.R. Luckily, both babies were healthy and I was able to do it all.

In essence, my surgery couldn't have gone any better. The post-op recovery part of the C-section is a bit of a different story that I can share in more detail later. I will say this: the post-op period wasn’t easy – no sugar coating that. In all honesty, the actual surgery itself was the easiest part of everything. If you’re pregnant and think you might have a C-section (for the first time), don’t be too afraid. It’s no cakewalk, but you can do it!

Keep reading Part 2 and Part 3 for my recovery story.

My Scheduled C-Section Twin Birth Story

I’m planning on having another scheduled C-section with Baby #3, so lately I’ve been reminiscing about the twins’ C-section births. Plus, since April is Cesarean Awareness Month, I figured it was the perfect time to share My Scheduled C-Section Twin Birth Story.

I had a scheduled c-section with the twins because 1. my doctor didn’t want me to go past 38 weeks (twins’ placentas tend to stop functioning around 38 weeks and there’s a higher risk of stillbirth), and 2. Wren, my Baby B, was breech for the last several weeks of pregnancy and I did not want to have Baby A vaginally and still have to have a C-section with Baby B if she didn’t flip after her brother was born. But, honestly, I think a scheduled C-Section made me calmer. Yes, the anticipation of the surgery itself is scary, but, for me, at least I had a birth plan that had higher odds of actually being carried out than a “natural vaginal birth plan” might have.

I’m planning a C-Section with Baby #3 because I’ll be getting my tubes tied. And, for everyone who asks, yes, it is easier for my husband to get a vasectomy, but, please rest assured he will be getting snipped as well because I’m taking absolutely NO chances with a potential baby #4.

My Scheduled C-Section Twin Birth Story

The Day Before:

The day before the surgery (also known as my last day as a carefree woman who could go anywhere at any time), I made plans to go and get my hair blown out at Drybar so I wouldn’t have to deal with it while at the hospital (because I have super curly, thick hair which can easily turn into a rat’s nest if not brushed. )

I must not have have confirmed my appointment correctly because when I showed up, I didn’t have one, but they were able to squeeze me into a slot an hour later, so I went next door to the restaurant Lemonade to have lunch. I remember having a grilled cheese sandwich with a lemonade and a chocolate chip cookie for dessert. This felt symbolic because we often joked that I was going to give birth to two little grilled cheese sandwiches since I ate so many of them while pregnant. This is probably also true about the lemonade and chocolate chip cookie! After my late lunch, I then waddled over to get my hair blown out.

My husband picked me up after my appointment (I was too pregnant, too big, and in too much pain to drive by that point) and I changed into a different sweater and fancy shoes before stopping by a mural on the way home where he took some final photos of me and my huge twin baby bump. I absolutely love that we did this because it’s now become a tradition where we take photos of me and my babies in front of this mural on the evening before their birthday!

Here’s a link to the photo from just before their 1st birthday and a link to the photo just before their 2nd birthday.

The Night Before:

I remember being very nervous about the surgery the night before, but also resigning to the fact that this was it. I knew that in order to get the babies out, I had to do it, so I basically had no choice. I followed all the surgical instructions, showered (with a shower cap to protect my fresh blow out) and then had my husband help me use the sterilizing wipes they send home with you. Since, I was scheduled for the first surgery in the morning, it was an early start, and I think we set multiple alarms to make sure we got up on time.

The hospital paperwork stated to arrive at 5:30 am, but my doctor and nurse told me to get there at 6:15 am for a 7:30 am surgery or else I would be sitting around forever. I remember getting a phone call from my mom and in-laws while we were on the way and they told us that they were already there! I guess someone was a little excited to become grandparents!

Labor & Delivery:

We got into Labor & Delivery and right away I started getting fussed at for being “late” even though we were there at the time my doctor and nurse told me to get there. My anxiety started right there and then! Next time, I’ll be sure to show up when the hospital wants me there to avoid this stress.

I forgot to get a good “before” photo of me and my husband. I only managed to get these silly shots of him modeling his scrubs. And then he took some unflattering photos of me lying in bed with 4 chins and looking sweaty in my hospital gown. I won’t be putting those photos on the internet, you’ll have to settle for my husband.

I felt rushed and it was ridiculous because (as my doctor later pointed out), the nursing team could have been doing things to prep the room in my absence, but they weren’t. They were just bitching about me being “late.” And then, on top of that, there was a shift change, and we had to wait for the head nurse who actually WAS late and when she walked in she said to me, “I heard you were late!” I think my husband wanted to kill her. (I also later found out at my 6-week follow-up appointment that the staff lied to my doctor. They told her that they had called me and I told them we were just getting out of bed which is a bunch of bullshit because they never called me and we didn’t oversleep.)

So, I got my IV inserted, a nurse “sheared [me] like a sheep!”, the anesthesiologist came by to discuss the administration of the drugs and any side effects, etc. My doctor stormed by and yelled at whoever was in charge. And, it was all very stress-inducing for me!

Operating Room:

Then they had me say goodbye to my husband and get up to walk into the operating room. I think there were about 18-20 people in and out of the room between my doctors/nursing team, my anesthesiologist, a NICU team for Baby A, a NICU team for Baby B, and my husband and myself. It was a small party. I can’t say it was a very fun party.

I immediately started shivering from the fear and adrenalin which the doctor and anesthesiologist had both warned me about. I got up on the operating table and sat with my legs over the side, hunched over with my back (and probably my butt) exposed. I started crying. I was squeezing the poor nurse’s hand so tight that I remember apologizing to her if it hurt. She told me that it was ok, that this was her job.

I was getting an epidural-like spinal block in which the needle goes into the space that surrounds your spinal cord, but lower than your spinal cord. It’s scary shit. You have to sit still even though your body is involuntarily shaking. Plus, I hate getting that part of my back touched. Oh! And I saw the needle beforehand! In my mind, it looked like a fucking knitting needle!

Luckily, all of that went well. I laid down, the sheet went up so I couldn’t see what was going on, and I’m sure I was then stripped naked in front of about 19 people. My arms were then strapped down because, as my OBGYN explained, people tend to jerk and then the doctor gets accidentally “gooched” with a scalpel in their hand!

My body started going numb. It felt weird. As my anesthesiologist explained, the doctor will then pinch/poke you hard with a medical instrument and ask if you can feel it. Nope! I couldn’t feel it! Then my husband was finally allowed to come in and the doctors went ahead and got started.

I remember that it took longer than I thought it would and I could feel them rummaging around in my body and obviously I could hear everything they are doing/saying. My husband was being sweet and tried to distract me by talking to me about Amy Grant (we were jamming out to Baby Baby on the radio while driving to the hospital, fitting because we were having two babies) or something and I told him I wasn’t buying his distraction conversation and to just stop.

Then, all of a sudden, the anesthesiologist asks, “Daddy, did you bring a camera? Do you get queasy? I’ll tell you when to stand up so you can take a picture.” And about 5 seconds later, my husband stands to take a photo of my baby boy being born. I mean, honestly, I could have told him when he could stand up and snap the photo because, at that exact moment, I could finally breathe again! It’s amazing how much lighter you feel after a baby is taken out of you!

My baby boy started crying and I commented that he sounds like a mewling kitten! My husband made a comment about how big his balls were! (Your doctor should warn you that your baby’s (babies’) genitals will be swollen due to all of your hormones and it’s normal. )

Everything seemed to be going well and two and a half minutes later, the anesthesiologist told my husband to stand up again and my baby girl was born! Again, I could have told my husband when to stand because shockingly, I felt even lighter after she was taken out and I could BREATHE! She started crying immediately and I think I asked if she was for sure a girl (because we never could get 100% confirmation on her unlike her brother who was showing off his penis in every ultrasound) and everyone assured me that she was, in fact, a girl!

I was told both babies were doing well. My husband then cut their umbilical cords and luckily some nurse took a video of him cutting the cords so I could see it later. And then the babies were weighed, given medications, tests, and swaddled.

And then 20 minutes after being born, I FINALLY got to meet both my babies … but only for a minute.

They were then taken to recovery and I told my husband to go with them while I was put back together and sewn up. At this point, they start packaging you back up, doing tool counts, etc. I warned them that I had to throw up and the anesthesiologist moved my head to the side where I had a pan to throw up in, but I just started dry heaving and nothing actually came up. I remember that I was given a few painful shots in the arm to make me stop bleeding (I guess my uterus wouldn’t start contracting and I needed some help with that.) And, at some point, I complained of “pain” – not that it hurt, but that I was extremely uncomfortable. My doctor apologized and I think the anesthesiologist gave me more morphine. This part took WAY longer than I anticipated.

Finally, I was stitched up and wheeled to recovery to see my babies an HOUR after they had been taken away.

Recovery:

I don’t remember much about the time we spent in the post-op recovery room, but we were in there for at least 45 minutes to an hour. I just remember being wheeled in there and my husband and babies were already there. A nurse then put them both on top of me for some skin-to-skin time and I was in awe.

The anesthesiologist stopped by and asked how I was doing. He was shocked that I was awake based on the amount of medication he gave me. He oddly asked me if I drank a lot (meaning alcohol) and if I had a high tolerance which seems like a weird question to ask a women who had just given birth and obviously had not been drinking for the past 9 months. Obviously, he thought I should be knocked out.

And then my face started itching. Like crazy. This is probably what I remember most about post-op – just endlessly scratching my nose and around my eyes like crazy. They told me it was a reaction to the morphine and gave me some Benadryl which should have knocked me out EVEN MORE, but I stayed awake and we were eventually moved into the maternity ward.

Maternity Ward:

I was then wheeled to the maternity ward while holding both my babies. I remember seeing my mom and my in-laws down the hallway as we were wheeled through. We finally arrived at what had to be the smallest room in the maternity unit. I love how the hospital has you come for a tour and they show you a nice, big, sunny maternity room which has a lunch or dinner set up with flowers and there’s a gift bag, etc. … yeah, we got none of that! I was in a tiny room by the exit and it didn’t even have the little chair that converts into a bed for my husband set up in it. We had to ask for that to be brought in as well as another isolette for the twins because there was only one in the room when we got there.

My mom and my in-laws then came in to meet the babies! And we introduced them with their names for the first time: Hendrick (Hank) Clay and Wren Margaret. We visited with the parents and then …

… I got a phone call from my home security company that our fire alarm was going off. What?!? So, I made my husband drive home just a few hours after our children were born to go and check on our house (and cat) and make sure our house wasn’t on fire and that the fire department hadn’t busted down the front door. (They hadn’t. It was a faulty smoke alarm that we had to have replaced about a month later when it did it again.)

While all this is happening, my face is still itching like crazy!

I’m then offered a meeting with the lactation consultant.

Now, a little background info. I gave birth in a designated “Baby-Friendly” hospital and it was probably the factors that make it a designated “Baby-Friendly” hospital which ruined my hospital stay experience. I’ll be writing a longer post about this and will link back to it here, but basically, the birth experience went well, but I had a really hard 4-day stay at the hospital.

I was offered a meeting with the lactation consultant the same day as the babies’ births, but she never stopped by our room despite multiple requests. We eventually learned that she had left for the day. It was a Friday and the lactation consultants are not scheduled to work over the weekend. So I was left to learn how to breastfeed TWO babies, on my own, using only the support of the nursing staff, who was great, but they’re NOT lactation consultants.

I struggled with breastfeeding. My milk wasn’t coming in. I didn’t have a breast pump. I didn’t know what I was doing. And with two babies born two weeks early, they started losing their birth weight. The nurses and staff then became really alarmed with their dropping weights (probably a bit unnecessarily alarmed in front of me which was very stressful) and eventually, it was “okayed” to give them formula after my husband and I asked for it.

We also struggled with the rooming-in policy. Basically, in a designated “Baby-Friendly” hospital, the baby (or in my case babies) stay in the room with you. Which is fine. I was happy with that. But at some point, I really needed some sleep. I had just had major surgery, pumped full of morphine and Benadryl, and I’ve been stressed out, struggling, and juggling two babies. I asked a nurse if they could take the babies to the nursery for a few hours so I could take a nap and I was informed that the nursery does not exist and the babies are to stay with me the entire time.

Now, I totally understand the benefits and thought process behind the “rooming-in” policy, but at that point, I was so tired, I was afraid I was going to accidentally fall asleep and drop a baby off my hospital bed while doing skin-to-skin or trying to breastfeed. Finally, my nurse offered to give the babies a bath at the same time as doing their newborn tests which would give me about an hour. And then, on the last night of our stay, my nurse put a do not disturb on the door to give us a break from all the nurses and doctors checking on me and the babies and to just let us sleep unless we had to feed the babies or change diapers.

And then a social worker stopped by. She came into the room and announced she was a social worker. My husband jokingly asked if she was there to take our babies from us and she replied: “Well, maybe.” I guess she was joking, but that’s not something to really joke about. She then informed us that she was there at the request of my doctor to talk to me and wanted everyone to leave the room and well, everyone refused because at that point I was crying. I later found out from my doctor that yes, she was there at the request of my doctor, but it was a routine request due to the fact that I had twins and the social worker’s job was just to ensure that I was set up with a support system at home and ready to take on two babies. However, this social worker’s bedside manner was complete shit and she should know better than to joke about taking a new mom’s baby or babies away.

I also had to fight to stay in the hospital an extra night (I believe at that time under insurance law, we were entitled to four covered nights in the hospital following a C-Section, but be sure to look up your current state/insurance information to be sure what the current entitlements include), they wanted us to check out on Sunday, a day early, and I refused because Wren was still fairly yellow in color although they kept checking Hank’s blood for jaundice (despite his pinker appearance). Plus, I still had not seen a lactation consultant. It wasn’t until that following Monday that the lactation consultant came by and gave me additional breast shields and instructions on how to use my breast pump.

On Monday morning, we started the check-out process and it took forever. We honestly didn’t leave until about 5 pm that night. I remember crying at some point because I was just so overwhelmed and wanted to leave. And then, when we were ready to go, I was told that we couldn’t bring the car seats inside to load the kiddos into the car seats in the hospital, but that I had to be wheeled out on a wheelchair carrying both babies and we would have to load them into the car seats at the valet stop. Loading infants into their car seats for the first time. In the dark. Oh, and it was raining. Oh, and I had accidentally sent my shoes home in a bag and I only had slippers.

We managed to get the babies loaded into their car seats in the dark and in the rain thanks to the help of a kind valet driver whose wife also had just recently had a baby. Unlike moms of singletons who get to ride home in the backseat and watch their baby, I had to sit in the front seat and worry. We didn’t take the freeway home because this was also the first time we were driving our brand new SUV in the rain and it was a “first rain” in Los Angeles which meant there were a lot of oil slicks on the streets. We ended up pulling over into a CVS/Carl’s Jr. parking lot at some point because the babies were quiet and I was worried. It was at that point that I realized my feet had swelled up by at least 100%. I’m also in a parking lot, in the rain, with swollen feet, in slippers.

The babies were, of course, just fine. They were asleep. So we drove home and got them inside probably around 6-7 pm. It was an exhausting day. All I really wanted to do was sleep, but of course, we had twin babies to take care of!

All in all, I had a good birthing experience, but a mediocre postpartum stay at the hospital. I have the same OBGYN for baby #3 and we’ve spoken about some of my experiences and she did tell me that second-time moms are often better advocates for themselves in the maternity ward, so that’s what I’ll be doing, advocating better for myself and for my baby.

And I hope that by putting my birth story out there, it inspires you to advocate for yourself and your twin babies while giving birth! Let me know if you have any questions by commenting below or emailing me, I’m more than happy to answer any questions you might have.

And, if you’re reading this in preparation for your twins, be sure to check out some of my other pregnancy and twin related posts:

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Elective caesarean section for twin pregnancies

There is considerable variation in the prevalence of twins in different communities and families, and the number of older mothers has increased recently, as has the use of fertility treatments and artificial insemination. Infants with twin pregnancies are at higher risk of death during childbirth and in the immediate peripartum period than infants with single pregnancies. This occurs in some cases due to a higher risk of preterm birth. The second-born twin has an increased risk of adverse perinatal outcomes compared to the first-born twin.

The policy of planned vaginal delivery in women with twin pregnancies in hospital is associated with an emergency caesarean section rate of 30% to 40%. When the first twin is born vaginally (naturally), there is still a risk of an emergency caesarean section (surgery) to deliver the second twin. It is possible that some of the adverse effects can be avoided with timely delivery by caesarean section, but the risks of caesarean section for the mother in this (current, delivery) and subsequent pregnancies must be considered.

In this review, we included two randomized trials comparing planned caesarean section and planned vaginal birth in twin pregnant women, with a total of 2864 participants. For important outcomes, the evidence was rated as moderate (moderate) quality evidence.

Maternal mortality: there were no events reported in one of the trials and there were two deaths (one in each of the compared groups) in the other trial. There was no clear evidence of a difference in death or serious illness for both mothers and infants between women randomized to elective caesarean delivery or planned vaginal delivery. None of the studies reported on childhood disability.

The number of women who had a caesarean section was reported in both trials. The majority of women in the elective caesarean section received treatment as planned (90.9%), while in the elective vaginal delivery group, 42.9% underwent caesarean section to deliver at least one of the twins. There were no significant differences between groups for inability to breastfeed or postpartum depression.

There is very little clear scientific evidence to provide guidance on the mode of delivery in twin pregnancies. Benefits and risks should be clearly explained to women, including short and long term health effects for mothers and children. Further research should be aimed at providing more clarity on this issue, as any medical intervention in the birth process should be avoided unless there is reasonable clinical certainty that it will provide long-term benefit.

Translation notes:

Translation: Tashtanbekova Cholpon Bolotbekovna. Editing: Ziganshina Lilia Evgenievna. Project coordination for translation into Russian: Cochrane Russia - Cochrane Russia (branch of the Northern Cochrane Center on the basis of Kazan Federal University). For questions related to this translation, please contact us at: [email protected]; [email protected]

Childbirth with multiple pregnancies | Mamovedia

In medicine, multiple pregnancy refers to the condition of a woman when she bears more than one baby. Multiple pregnancy has its own characteristics, since it is also a double (or triple) burden on the body of the expectant mother.

Pregnancy with twins, triplets or twins may occur in multiple pregnancies. The first ultrasound helps to determine the type of pregnancy.

Who is to be born is decided at the stage of fertilization. For example, if two (or more) eggs are fertilized at once, this means that the pregnancy is fraternal. In this case, all your future children will grow and develop each in their own placenta. Well, if the egg is divided immediately after fertilization into two or more parts, then such a pregnancy is called an identical pregnancy. If the division of the egg occurs in the first days after fertilization, then each fetus will develop in a different placenta. In the event that the separation of the egg occurred later, then the twins may have a common placenta and only a small separating septum. Very rarely, the separation of the egg occurs after 10-14 days from the moment of fertilization. If this still happened, then Siamese twins will be born.

Since multiple pregnancy has a special mechanism of occurrence and course, childbirth during multiple pregnancy differs in some features.

From the very beginning of the course, multiple pregnancy is at risk. The normal duration of pregnancy for one child is 38-40 weeks, for twins - 36-37 weeks, for triplets - 34-35 weeks. Under the influence of some factors, the lines of multiple pregnancy may decrease, for example, with a significant weight of babies, with polyhydramnios, with a threat to the health of the mother or a threat to the life of babies.

Since a woman has a double burden during multiple pregnancy, she may experience a severe course of late toxicosis, anemia, arterial hypertension. These symptoms do not have the best effect on the upcoming birth.

Babies with multiple pregnancies are almost always born earlier than the line and have a much lower weight compared to the weight of a baby who was born from a single pregnancy. Most often, the weight of twins during childbirth does not exceed two and a half kilograms.

In addition, during childbirth in multiple pregnancies, there is a high probability of complications when babies pass through the birth canal.

The choice of the type of delivery in a multiple pregnancy should be made by the doctor who manages the pregnancy, taking into account all of the above factors.

Today more and more doctors, fearing complications during childbirth, recommend a caesarean section to women. However, in fact, multiple pregnancy itself is not an indication for caesarean section.

A caesarean section is necessary when the fetus is in an abnormal position, the woman is expecting triplets or more babies, the fetus weighs more than 5-6 kilograms, the woman has a narrow pelvis or uterine hyperdistension, there is fetal hypoxia.