In 2013, I became a patient at Akron Children’s Hospital. Saying I was a patient sounds confusing because it’s a pediatric hospital and I am an adult. I never thought I could be a patient as an adult, but as a woman with a high-risk twin pregnancy, it was the absolute best place for me to be. Here’s my patient, pregnancy and delivery experience.
The moment I entered the Maternal Fetal Medicine Center’s office, I knew I was in world-class hands, but I know I was a tough patient. I am outspoken, empowered, and stubborn. There were moments I still felt intimidated by the white coat (even though I work with some of these folks as a public health professional), but I had to stick to my mama gut and share what I felt was best for my babies. I have since heard many different stories from other moms who received their care at Akron Children’s Maternal Fetal Medicine Center. Some are less flattering than my experience, but I listen carefully and what I really hear is fear, worry about the unknown, and a just a scared mom in great need of reassurance. Every high-risk pregnant mom just wants to hear, “It’s going to be OK.” Doctors cannot promise what they don’t know and what they cannot control, so they do the best they can to explain what’s going on, make educated decisions with you based on best-practice guidelines, without adding unnecessary anxiety, but still being honest.
I had four goals for my pregnancy and delivery (without setting myself up for disappointment or absolutes):
1) Get as close to full-term as possible.
At the start of my pregnancy, no one predicted I would carry my twins past 36 weeks gestation, and twins are considered full-term at 37 weeks gestation. For all the reasons listed here and more, I wanted to be full-term or as close to full-term as possible before delivering my babies.
2) Try to deliver them vaginally by an experienced doctor (essentially avoid a c-section).
People heard I was pregnant with twins and they immediately thought I scheduled a c-section. C-sections are serious surgery which require a lot of recovery time. I did not want to set myself up for an uphill situation recovering from a c-section while trying to care for two infants and a toddler. A vaginal delivery is my preference. What I had working in my favor was a vaginal delivery with my first daughter, so she sort of “paved the way” if you will. The likelihood of a vaginal delivery was better after having one under my belt already.
3) Have 12 pounds of baby in me
I wanted 12 pounds of baby in me because, to me, this meant each baby would be about 6 lbs and this gave me a nice weight buffer to avoid the NICU. There are many paths to the NICU and one is low birth weight. If the babies weighed less than 5.5 lbs, they would not have enough fat on them to maintain their own body temperature, so they would need to be under care in the NICU for warmth and help gaining weight. Still, this is something I honestly felt like I had no control over beyond eating a healthy diet and trying to gain weight appropriately. The recommended weight gain for twins is 37–54 lb for women of normal weight. I wanted to find a balance between appropriate weight gain, and not going too far. I think, some mamas may look at pregnancy as the time to “let loose” and indulge because you’re eating for two (or more), or food is just comforting and helps with pregnancy symptoms like nausea (which I definitely experienced and ultimately turned to Zofran to help with). In truth, our bodies do not need double the calories, the recommended extra caloric intake is more like a small snack of an apple and a slice of cheese (disappointing, but true). Don’t get me wrong, I definitely increased my ooey-gooey chocolate brownie intake, but overall, my food volume and caloric intake remained roughly the same as pre-pregnancy. I gained 50 lbs with the twins, and I learned increased maternal weight gain impacts mama and baby’s overall health and delivery. A larger baby means a more arduous pregnancy and delivery for mama (and my fear, higher risk of a c-section).
4) Try to breastfeed
To set myself up for success here, I met with the IBCLC (International Board Certified Lactation Consultant) who works in the MFM office while still pregnant. At 24 weeks gestation, the babies are considered viable if they arrive early, which basically means they’ll live but with intense medical intervention and a long stay in the NICU. So, at 24 weeks, my husband and I met with the IBCLC, Liz Maseth, to talk about what to expect if the babies were born early, how I would pump around the clock to provide them with milk (which to a preemie is the best medicine). I wanted to know what our NICU stay would look like, and what the babies would look like (frail, no fat, lots of machines and tubes to survive, etc.). This is essentially a super scary image, but one I wanted to brace myself for.
Back to my pregnancy, we wanted to know what our lives would be like (what to prepare ourselves for) if the babies were born pre-term (before 37 weeks gestation for twins, which is what everyone predicted for me). Everyone I talked to about the pregnancy would look at me and make a comment akin to, “Oh honey, there is now way you’re making it past 36 weeks.” I was determined to carry these babies for as long as possible, but if an early delivery happened, my husband and I essentially decided I would live in the hospital with the twins and my husband would become a single parent for our toddler, shuttling her to and from day care, while trying to spend as much time in the hospital with me and the babies as possible (he would be split between two worlds and it would have been the hardest time in our lives for sure). We were preparing ourselves for a really tough scenario.
Even as I write this now, a lot of emotion wells up inside of me because this pregnancy was one of the scariest times in my life. People hear twins and think it’s just two adorable bundles of cuteness, but I was terrified of the unknown and I wanted to shelter myself and my babies from anything negative (including well-meaning, but incredibly unthoughtful comments about how I should delivery the babies early for one stupid reason or another… or how I was so big, I must be really looking forward to delivering the babies. Some people just are not educated – I essentially stopped talking to certain people during the pregnancy).
This is where Akron Children’s Hospital MFM staff supported us the most and provided an unending well of support. I have the deepest respect for everyone in the MFM office because they are treating at least two patients at once, the mom and baby – so in my case, 3 patients. I cannot speak for every high-risk mom, but I was very hormonal and emotionally fragile. The doctors and staff always knew how to talk to me, and they always made me feel better. I would walk in feeling nervous and walk out feeling like a million bucks. They were always available to answer questions day or night. I am a research-based person, so knowing they are on top of the latest recommendations in the field, and these doctors have even published their own cutting-edge research, means I was truly in the best care possible. They are the most knowledgeable group with the most skills, which is exactly where I wanted to be during my pregnancy.
Then I was approaching 38 weeks gestation (I made it past 36 weeks and then some!). At this point, I finally started feeling pretty good (after 34 weeks I had no more nausea, I was still mobile, and avoided bedrest altogether). My doctors changed the conversation from early delivery to induction. WHAAAAAT?! Who had ever heard of such a thing?! Don’t you want these babies to cook for as long as possible?
It’s always something right?!
SO, I had to be talked into an induction because I was not having it. No thank you. I learned, medically speaking, there is a cross-section of risks and benefits and if the twins stayed in-utero too long, new risks would arise (including stillbirth). At 38 weeks + 1 day (I hardcore negotiated for my 1 day!), I went to the MFM office to get my cervix checked and sign the paperwork for an induction before heading to the hospital. As it turns out, I was in active labor and nearly 5 cm dilated. I had cramping the night before, but compared to my first singleton pregnancy it felt like nothing. With my oldest, I walked into the hospital’s labor and delivery floor breathing through contractions and pacing like a crazy person. Everything about this pregnancy and delivery was the complete opposite.