I had been having contractions/cramping every night since the
beginning of March; which had made sleep pretty impossible. The cramping got bad enough overnight on
March 10th, 2011 that around noon on Friday, March 11th
2011, I went to the birth center at Hudson Hospital, WI to get checked out. I was 3 cm dilated and having regular
contractions every 3-5 minutes. I stayed
hooked up to the monitors for 5 hours and had no change in dilation, but the
contractions didn’t stop. I asked to
just go home to rest and that we would come back if things progressed. The nurses all said that they would see me
later that night or the next day. I got
home and sat up in bed and everything stopped.
I would only get
cramping when I laid down flat to rest or sleep – exactly opposite of the norm
where activity would tend to increase contractions. So for the month of March, I tried to sleep sitting up
– although since I had to pee every 30-45 minutes, sleep was rather
elusive. Early evening of Sunday, March
20th, 2011 was similar to all previous nights except that I had an
increase in trips to the bathroom and the clear mucous discharge was still
there - although not the “bloody show or mucous plug” the books say indicates
labor is imminent. Mike and I got ready
for bed – he was heading to work in the morning and I was still working from
home full time. We lay down and watched
3 episodes of The Big Bang Theory on DVD and turned out the lights around 11
pm. I again had a restless night and restless legs (the
iPhone is great for surfing the web) – up all the time going to the bathroom
and had the usual night time cramping, but managed to sleep off and on. At 4:30 am on Monday, March 21, 2011, I woke
up and was getting up to hit the bathroom when I felt a small pop and felt
wet. I knew that my waters had broken
and ran to the bathroom to check. The
waters had broken (at least I hadn’t peed myself!) and were still leaking
slowly, but regularly. I was relieved
that waters discharge was crystal clear – there didn’t seem to be any meconium
present.
I walked out of the bathroom and said – “Mike, my water
broke.” He just got up and said
“OK.” I went to shower and he got the
few items packed that weren’t already in our bag (toothbrushes, snacks, etc.)
and to give the kitties extra food. We
headed to the hospital at about 5 am and I was having cramping the whole way
there – it seemed just like heavy period cramps, but there was pain all the
time – it didn’t come in waves. We
arrived at the ER entrance at 5:15 am and got admitted. For the first time I did not decline the
offer of a wheelchair to the birth center.
We arrived at the birth center and went to one of the labor
and delivery rooms (#137) to get hooked up to the monitors. I was checked and was 6 cm dilated with regular
contractions about 2-3 min apart. Both
babies’ heart rates were stable (in the 140-160 bpm range) and were tolerating
the contractions and labor well. At 6:00
am, the nurses notified our doctor, Dr. Dennis Hartung, that we were there and in
active labor. He was already up and getting
ready for work and said he would be there shortly.
The pain and pressure became really intense and I was
checked again around 8:00 am by Dr. Hartung who said that I was dilated to 9 cm
with just a small anterior lip of cervix – essentially complete. I began to lose control and wanted to get
some help for the pain and pressure. I
requested a combined spinal- epidural (CSE) in hopes that it would lessen the
pain (by about 70% per the anesthesiologist) but keep by legs mobile (it is a onetime
injection rather than continuous medication).
An IV for fluids was started and the anesthesiologist was there around
8:45 am and put in the CSE injection.
Unfortunately, the method did numb my legs, but had only a small effect
on my contraction/pressure pain. I
labored longer and was deemed complete at 10 cm around 9:30 am. I didn’t feel any urge to push and was having
trouble concentrating and requested a regular epidural in hopes that I would be
able to concentrate better on pushing. I
figured since I already needed assistance in changing position (since my legs were
numb) that I would rather have more complete pain relief. I had labored to complete with no medication
and was happy that I had made it so far naturally. I felt that the epidural was my best chance
at birthing two babies vaginally. Another
anesthesiologist came in around 10 am administered the regular epidural. It was so tough to stay hunched over and
completely still through the contractions, especially since it took a number of
tries to get the epidural in correctly – I think it was 4 attempts to get just
the right spot. After the epidural was
completed, I felt great. No pain, very
rested and ready to push. Since I was
completely numb, the nurses had to coach me in pushing during just the right
time. I was worried that the epidural
may stall labor (which can happen if you get it too early) or slow things down
so I would need additional labor interventions.
It was not the case at all, I got the relief at complete so labor was
well established and Dr. Hartung practices the less interventions the
better. Because of this philosophy, I
was able to try various pushing positions and push several smaller times per
contraction rather than just holding my breath and pushing the whole
contraction time. This helped conserve
energy and the babies and I still made great progress.
I started regularly pushing around 10:45 am and employed a
number of positions – back and both left and right side. The nurses and Mike helped to maneuver and
hold my useless, numb legs. I was able to
push slowly, but effectively. Around
noon, a number of nurses came in to turn on the baby warmers, so I knew things
were progressing. We had a total of 5
nurses (2 for me, 1 for each baby and an extra because it was twins) and 1
doctor helping to coach me through the pushing phase. I ended up pushing for a total of 3
hours.
At 1:35 pm, Alexander Squires Bulinski was born screaming
and crying. He was suctioned and
immediately placed on my belly. He was
crying, but eyes were wide open! He
stayed on me for only a couple of minutes before the nurses took him across the
room to get him in the warmer and checked out.
It was really nice that all the baby checks happened in the same room,
they never take the baby from you unless they need to. Mike was with him the whole time and taking
pictures. At 1:40 pm, Dr. Hartung used
the ultrasound to check the position of Baby B (Baby A was vertex and Baby B
was traverse since about week 32, before that Baby A was vertex and Baby B was
breech). Baby B had moved into position
head down (vertex)! All of a sudden Baby
B’s heart rate started slowly dropping from the 150s bpm. The nurses quickly moved me to my side and
put an oxygen mask on my face. It was
pretty surreal and scary. The position
change and O2 didn’t improve the heart rate and the doctor asked for the
forceps – they were all very calm. A
little before 1:50 pm, Baby B’s heart rate was at 80 bpm and Dr. Hartung used
the forceps to get her out quick.
Catherine Squires Bulinski was born at 1:51 pm, also screaming and
crying. She was suctioned and
immediately placed on my belly. I
remember rubbing her and saying I don’t think she is ok – Dr. Hartung said she
was fine and they wouldn’t have given her to me unless she was ok. He said we could have just minute because
they wanted to check her out. She was
taken to the warmer and checked out while I was being looked at and birthed the
placentas. Each baby had their own
placenta, but it had fused into one at the end of gestation (very typical for
twins). They started me on a small dose
of pitocin in order to help with any excess bleeding and cleaned me up. I don’t really remember too much about it
since I was so busy looking across the room at the babies. Although it did take a long time to push due
to being a first time mother and having an epidural, the longer, slower pushing
phase helped to open up and stretch the perineum. I ended up with a couple of small labor skid
marks (described as like skinning your knee type of injury), but no tears and
no stitches! It turns out that that Cate
had a short cord connecting her to the placenta. Since her placenta was high up in the uterus,
when she entered the birth canal, the short cord became an issue and
necessitated a quick forceps assisted delivery.
At around 2:15 pm, they decided to take Cate to the across
the hall to the nursery to have Dr. Mark Druffner (family practice doctor on call
for babies born) look at her. Mike went
with her and Alex stayed with me in the labor and delivery room. Dr. Druffner had come and looked at Cate. Mike came to let me know what had happened.
She had about a 10% pneumothorax (collapsed lung) on both sides. It was common in babies that are born at 36
weeks, 6 days gestation and she was smaller.
They had her in the nursery warmer on 1L oxygen through a small nose
cannula (essentially room air/O2 mixture).
She needed very little support, although the doctor ordered a chest
x-ray to be performed immediately then again 4 hours later and then again the
next morning to track the progress of the pheumothorax. The condition was minor and expected to
repair itself without assistance, but they kept her in the nursery overnight
for observation with a short visit allowed to our room later. The treatment was a “wait and see” approach
until the morning of March 22nd, 2011. If things did not resolve, then they may have
to remove the excess air pockets (which took the place of where the lung should
be) with a needle and surfactant.
I was in the labor and delivery room until around 5 pm until
I felt pretty good and had feeling back in my legs. I got out of bed myself and into a wheelchair
and they took me across the hall to the nursery to see Cate. We put her and Alex together in the warmer and
they both just lay there calmly. She was
doing well, but had to work harder to breathe.
You could hear it when she breathed that there was more effort behind it
than there should be. We stayed with her
and Alex until 6:30 pm when they came to take the second chest x-ray. After that, Mike, Alex and I went to our
recovery room (#134) to get settled and wait for the x-ray results. We heard around 7:30 pm that there had been
improvement on the left side, but the right side was a little worse according
to the chest x-ray and that they still felt the pneumothorax would resolve and
they would keep her overnight in the nursery for observation.
We called our parents at 7:30 pm to let them know that the babies had
arrived and that they could come and see Alex.
My parents arrived at 8 pm and stayed for about 90 minutes and Mike’s
parents came about 9 pm and stayed for about an hour. All got to hold Alex and at about 9:30 pm,
the nursery nurse brought Cate in for a visit.
She had to stay on the heart rate and O2 level monitors throughout her
visit with us. Mike and I had yet to
hold her, so we held her until she had to go back to the nursery – grandparents
only got a peek until the next day. We
ended up sending Alex to the nursery so that they could be in the same warmer
together – it seemed to keep them both calm.
The nurse would bring in Alex every 3 hours to start nursing and for
cuddle time. Mike and I both got a
decent amount of sleep.
The next day, Tuesday, March 22nd, 2011, we woke
up early – about 6 am. The radiologist
tech was completing another x-ray on Cate.
Dr. Druffner came in about 8 am to tell us that Cate looked great and
that the chest x-ray was clear. He
looked over both babies and said they were healthy. They were going to keep her on the O2 level
monitor the rest of the day, but she could leave the nursery and stay with
us. Both she and Alex came to our room
to spend the day with us. We had a lazy
day – Rachel tried to rest and start healing up (warm baths!), we worked on
nursing and cuddled with the babies. Dr.
Druffner came by and told us that Alex had high levels of bilirubin based on
the skin reflectance test and that they were going to put him on the bili bed
overnight to help with the levels. Dr.
Hartung stopped by and to see how I was doing – which was surprisingly
good. I felt that I had had a hard
workout and my muscles were sore, but things were pretty good. Our families came again Tuesday night to visit
and got to hold Cate for the first time.
Both babies were again sent to the nursery to sleep and were brought to
our room every 3 hours to work on nursing.
Alex had a number of episodes of him choking on mucous (totally normal),
but I was worried that we wouldn’t wake up if he choked again at night since we
were so tired – so I sent him to be observed by a wide awake person. We both felt that due to the excess mucous
and bili bed, along with Cate’s initial issue, that we wanted one more night of
them being observed in the nursery.
We had planned on staying the typical 2 nights in the
hospital and heading home on Wednesday, March 23rd, 2011. Both Dr. Hartung and Dr. Druffner supported
us staying an additional night due to Cate’s slower start and the fact that I
gave birth to twins. Alex’s serum
bilirubin levels were decent – kind of borderline high, but not high enough
that he needed to stay on the lights. We
spent Wednesday just hanging out again and trying to get the babies to latch on
and nurse. We got help from the hospital
lactation consultant and started to syringe feed formula while nursing to get
the babies to be interested in nursing.
Nursing is a challenge with preemies and Alex and Cate are no
exception. They have weaker sucks and
tire more easily than full term newborns.
We plan on meeting with the lactation consultant and the county public
health nurse and possibly the midwife to get the nursing on track. The goal is healthy babies that both nurse
and bottle feed. Hopefully all breast
milk, but a breast milk/formula mixture is a possibility. We bought a breast pump at the hospital and I
started to work on building a supply.
Both Alex and Cate spent Wednesday night with us in our room. We were up every 2 hours – mostly they had broken
out of their swaddle or just needed a cuddle, but we also syringe fed them when
they needed it.
On Thursday, March 24th, 2011, we were all ready
to bust out of the hospital. Dr. Hartung
came in around 8 am to talk with Mike and I about physical and emotional
changes and things to be concerned about.
He felt I was fine to be discharged and thought we could be home by
noon. Dr. Druffner came by one last time
to check on both the babies. Alex had his blood drawn to see what his bilirubin levels. We learned late Thursday that they were still
borderline high so we needed to come to the clinic on Friday to get him tested
again, but didn’t need a bili blanket to take home. Cate was still on the smaller side, so Dr.
Druffner also wanted to see her on Friday for a weight check. Alex lost about 7% of his birth weight and
Cate lost about 8% of her birth weight – neither was considered an issue as it
was less than 10%. The babies lungs were
clear and sounded good and both had great heart rates and muscle tone. They both got the all clear to come home. The nurse arrived with the discharge
instructions for me, Alex and Cate from both doctors. We went over instructions such as the babies’
feeding, diapers, sleeping, etc. and my healing and medications. Mike and I dressed Alex and Cate in their
going home outfits with their knit hats and blankets from Nonna. The nurse did the final car seat check and we
were off home at noon. Of course that was after
Mike spent 30 minutes getting an inch of ice of the car due to a Spring ice and
snow storm.
Rachel
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