Well, here I am -- Mother of Dragons. The twins arrived in a dramatic fashion on January 9th after a lengthy induction process, a process that at first seemed to drag on before the proverbial shit hit the fan.
Our induction was scheduled for January 7th. Naively, we thought we would pop the babies out overnight, then head home 24 hours after that. Oh ho ho, nope.
Even though Luna's head was pretty low from the start, my cervix was only 1cm dilated so we were advised to start with a balloon placed in the uterus to stretch the cervix mechanically along with some medication to help get the body's labor process started. I've done cervical checks and placed balloons back in my days as a resident, and first and foremost, allow me to apologize to all the patients who have ever had to experience these. I would get an epidural for these alone. After the traumatic cervical check upon admit, I took their offer for a dose of fentanyl before insertion of the balloon. "It'll be like having a bit too much to drink," they said. OK, yes it was, but more like when you are clutching to your bed for dear life after a particularly ill-advised night out, praying to Jesus for the ceiling to stop spinning. Was it worth dulling the sensation of being abruptly fisted by the OB and having a balloon the size of a cutie orange inflated inside me? Maybe? Fine yes, but just barely.
Once the balloon goes in, it is checked on in 12 hours if it doesn't fall out on its own. 12 hours is a long time to be stuck in a hospital bed chained to a monitor. Uram and I watched a few episodes of Hospital Playlist to pass the time. After seeing the frankly insulting quality of the hospital food, Uram offered to go out to pick up real food. We found out that one of our favorite taco trucks that we used to frequent in our early dating days when he lived in Sunnyvale had a location across the street. We joked about how our relationship had gone full circle now while eating my "last meal" of suadero quesadillas and cabeza tacos. I am so grateful to have a such a supportive partner in Uram. I've had to pee every 10 minutes in the final stages of pregnancy and during the induction I would have to detach myself from 3 monitors, unplug my IV, and wheel everything to the bathroom quick pace to try to avoid an accident. I never had to ask Uram to help me. He took pride in "cable management" and I would watch him observing the monitors in typical Asian father fashion after each assessment. Even in the middle of the night, if I made the slightest movement, I would see his head pop up like a prairie dog from the pull out sofa to see if I needed help.
Once the balloon came out at 1am, the cervix was dilated to 3 cm. We continued pitocin overnight, but only advanced to 5cm by the morning. They offered more fentanyl for pain management and I was like "Hell no, but can I have some Tylenol to take the edge off?" The nurse asked me "For...a headache?" "And I'm like "No, for the labor and this giant orange lodged in my pelvis ." In the end, I requested the epidural less for pain management but just to get a Foley (urinary) catheter placed so I could stop getting out of bed to pee. At that point, two days into induction, it felt like we had been in that hospital room forever, but the babies' arrival was nowhere in sight.
Then that afternoon, one blood pressure reading changed everything. I'd been having mildly elevated blood pressures in an otherwise uneventful pregnancy, nothing symptomatic or that didn't improve upon repeat. My BP was now elevated to above 160. Unlike in my field of medicine, in the OB world, this blood pressure is not something that you can just "watch and wait" if there are no symptoms. When the pressure was still above this range 15 minutes later, I was diagnosed with severe preeclampsia and started on a magnesium drip. Minutes after the first bolus of this medication was started, I projectile vomited. Bring the fentanyl back, that was a happy memory compared to this. The magnesium also burned its way along my IV line and veins. The nurse was like "Yeah, that happens unfortunately... here's an ice pack." A few hours later, my epidural stopped working. I started feeling tremendous pressure and pelvic pain to the point where I requested a cervical exam. The cervix was still unmoving at 5cm, but baby's head kept descending lower and lower. I also asked the nurse to check on my Foley output to make sure it was draining -- it turns out that baby's head had dropped so low that it had compressed and obstructed my bladder catheter. After moving the catheter around, almost a liter of urine drained immediately. I don't know if it was the draining of the bladder or the redosing of my epidural that helped, but I finally got comfortable again.
At the next check, there were still no changes. I knew that something was looking gnarly down there because every provider that pulled back the sheets winced and went "oooh." I finally asked Uram to take a look and he shrugged and said "It's really swollen." "How swollen?" "It looks like testicles." THANKS URAM.
The resident brought the attending to have a discussion with us. This is when I knew that things were really not going to plan. Given that the cervix wasn't changing, my water was broken, and the risks associated with pre-eclampsia, they offered me a C-section that night. The options were to wait 4-6 hours for the next check and if there were still no changes, we could pull the trigger on the C section then or, just roll back to the OR now. While having the babies out sooner rather than later was looking more and more appealing, I also thought about the recovery process after a C-section, especially with having twins. Would I be able to lift the babies in and out of the crib? I remember the painful and slow recovery course after my fibroid removal and that was only a C-section lite. After discussing with Uram, we decided it would be reasonable to compromise and wait 2 hours and if no progress then, we would call it. We settled in to have a quick power nap.
I woke up 2 hours later to the unpleasant sensation of my epidural no longer working on my right side. I also felt waves of pressure pain that told me that there were definitely changes. First things first, call the anesthesiologist back, because if the babies are coming out my hoo-ha, I ain't doing this with no half-ass epidural. Epidural now refreshed, the exam confirmed that the cervix was now completely dilated. We made preparations to roll back to the OR (twins are always delivered in the OR in case the second twin needs to have an emergency c-section); it is now day three of induction.
In the OR, I remember thinking, well this is anticlimactic. With the epidural now working, I felt waves of pressure but no intolerable pain. On my left, I could hear Uram (now in an adorable sterile bunny suit) encouraging me through the pushes. I preened as the OB told me how good my pushes were -- hips flexed, pelvis opened, abdominal muscles engaged -- I am textbook, I am magnificent. (To be fair, Luna did all the work because her head was already 3+ well before the cervix was open.) Just as it sounds like we are nearing the final push, I hear the haunting sound of the baby heart monitor slowing down. The atmosphere of the room changes. They quickly consent me for a vacuum assisted extraction. From my perspective lying down, Luna's arrival is announced by a spray of blood across the OB's face shield. I don't hear her cry for what felt like far too long. But my focus is split as the OB is now telling me that the second baby is not yet engaged in the pelvis and the cervix relaxed back to 6cm. We can't push again until the cervix opens up again, but she will try breaking the second bag of water to try to bring Lyra down and facilitate this. The bag of water is broken and we wait for Lyra to "labor down" but again, we hear the heart rate monitor drifting downwards. I take as many deep breaths as I can, a human oxygen conduit to my baby. I consent for an emergency C-section, but if baby's heart rate tolerates, we can try a light push to see if that will stretch the cervix again to completion so we can complete the vaginal delivery. One push gets us to 9cm, the second push allows us to push the final remnants of the cervix behind baby's head. I am now pushing for my (and Lyra's) life. The vacuum makes another appearance. Pushes are usually done in intervals of three, but when they ask me to just keep going, I know that every push matters and we are seconds from a stat section. I should have done more arms and abs in this lifetime because it was a STRUGGLE to keep my legs up through those last pushes, but praise the Lord, because Lyra was launched into this world and the beautiful sound of her shrieking immediately filled the OR. As I threw myself down back onto the table in relief, I was mesmerized by the sight of my own blood splattered on the handle of the overhead light. Someone really needs to tell the cleaning crew about that, I thought to myself, but I must have said this out loud because the nurse to my right laughed and agreed.
It turns out that our delivery was not epic enough, because now my uterus decided it was too tired to firm up and would not stop bleeding. It's one thing to learn about the treatment of uterine atony and even perform some of the maneuvers, it is entirely another thing to experience them. I could hear the names of different medications to stop bleeding being called out -- vague recollections of them telling me I would get a shot in my arm (eventually a second) and feel some pressure below (pills inserted in the rectum). Luckily, I was distracted from all this by another round of nausea and vomiting, an uncontrollable cough, and the worst dry mouth I have ever experienced in my life. I remember begging for water in my delirium and the providers telling me that they don't have any water in the OR. I would have given anything to suck on a sponge like Jesus. In the end, I lost a little more than a liter of blood. As things stabilized and the palpable relief filled the room, I couldn't help asking the most important question: "Do I still have a separate vagina and butthole?" Thank baby Jesus, only a second degree tear.
During this ordeal, I kept telling Uram to go check on and bond with the twins while they took care of me, but he kept coming back to keep me company. It turns out that he was worried that I was going to die. I was slightly disappointed that this man did not cry when his twins entered into the world and were placed into his arms. I was infinitely more satisfied when I learned this man only cried after processing the traumatic delivery at the thought of possibly losing me. What a cutie patootie. This is the man who turned on the central heating for his pregnant wife a grand total of one time during 9 months of pregnancy.
Joking aside, it is sometimes surreal to think about how this perfect stranger that waltzed into my life 6 years ago after we both swiped right over a shared love for food and cooking has come to mean so much to me. When I look at the life we have built together, now with the girls, and onward to our future together as a family, I truly feel blessed beyond measure. I see him changing every dirty diaper (He asked me if he really has to do EVERY diaper and I asked him how many of our babies he carried and expulsed from his body), letting me sleep through some nighttime feedings because I am so dead tired that I am not even roused by the sounds of our babies crying, and nagging me to take my medications and take care of my myself, and I can't imagine doing this with anyone else.
It truly takes a village. Here we are three days postpartum. My parents and sister have been bringing me a different herbal soup and other delicious foods/snacks every day during my confinement. Uram's parents check in from Korea frequently to make sure we and the babies are surviving and thriving. Friends are constantly asking how they can help. It's so comforting to know that it's never been just the two of us, even more so now that two became four.
I've never been more tired -- not in medical school, not in residency. But for the first time in my life, I have never questioned whether the struggle or adversity are worth it or whether I could have been happier doing something else. When I look into my girls' faces, my sassiness mixed with Uram's anxious eyebrows, I know I have been gifted with a new purpose.
It's a new year, new me, new bigger family.
