Warning: It's a bit of a Novel. (And I haven't bothered to go over and edit anything)
November 6th, 2010
This is the story of Micah J's EARLY arrival, and the loss of our precious Jeremiah.
To catch everyone up, I was pregnant with identical twin boys. They were considered Mo-Di twins where they shared a placenta, had seperate sacs (and therefore had their own amniotic fluid) but were incased in the same outer layer, which is called a Chorion if I remember correctly. Up to the day before I left Okinawa on 3 Sep 2010 the boys were doing fantastically as revealed in my 22wk ultrasound. There were no issues to be reported, nothing of concern. I came to the states and had to dick with my *wonderful* Tricare insurance system working to get a referral to the dang OBGYN which took FOREVER. I wasn't able to get an appt until I had been here for 6 wks, and my specialist ultrasound wasn't scheduled until November 1st! All along however, no one ever felt any major concern, no feeling of impending doom. Prepare to be blindsided.
Cameron got here from Okinawa on October 16th, and we went to my first OB appt here in the states on the 18th. All seemed well. Doc used a doppler to get the heart beats of each boy, and they were pretty much the same on each side, as they had been in earlier ultrasounds. I told him about how I was feeling, AKA miserable. I couldn't hardly breathe...my back hurt, my pelvis hurt, I couldnt stand for short periods of time. etc etc etc...I was miserable but that was to be expected being small and expecting twins. I was 29 weeks that day and my uterus was measuring 33.
Two days later I noticed I was having a lot of braxton hicks contractions. I wasn't worried but I was having way more than 4 an hour despite drinking water. We went to L&D and they hooked me up to monitors, sure enough I was contracting. Had a hard time keeping both babies on monitors, they could only get just one at a time and then it would move and pick up my pulse and it was just a lot of chasing babies. That was expected for twins and my gestation, small babies can move around a ton. They did a swab to detect some protein or something that predicts whether or not I would go into labor in the next 7 days. After 2 more hrs it came back negative. I wasn't dilated at all. They made me chug more fluids and sent me home and just told me to watch it.
Meanwhile, I have gotten more and more miserable. I was in so much ligament pain it was excrutiating at times. I couldnt lay down AT ALL. My stomach seemed to have doubled in size in under two weeks. My skin hurt, my muscles hurt. My right ribs HURT so bad. I couldnt sleep between the ribs ligament and back pain. The only relief I could find was when my mom turned down her hot tub and I could be weightless. I noticed some decrease in movement, I wasnt getting as many kicks as before but I chalked it up to have two squished babies. I still felt plenty of movement. Everything said with twins expect them to move less as time went on and so I was not concerned as it said it right there "in the books". 2-3hr night sleeps (1hr at a time if I was lucky) was taking it's toll. I was miserable and I felt DONE. I was by far larger than I was with my son at 41 weeks.
Wednesday, October 27th rolls around, exactly one week since I had gone into L&D previously. Out of desperation I went to the chiropractor. It was such a relief. I even felt little Micah drop down into my pelvis. I no longer had a waddle. 3 hrs later I noticed I had contractions that were becoming more frequent. All along I had been chuggin water to keep them away. Water was not working. Around 3pm I noticed they were pretty frequent. Between 6-8 minutes. A little later they were getting closer to 5 but still irregular. My mom and I headed over to my house and on the drive I was watching the clock and they would literally hit every 5 minutes. They were feeling crampy too, lower down in my pelvis. I knew they felt like real ones...and I wasn't going to be able to sleep at all that night. I called my doctor's office and they paged him, but I didnt hear anything back for 1.5hrs so I called again, and they tried 3 more times, where the nurse called me back often to see if my doctor had contacted me. He hadn't so she tried another way to get ahold of him. 5th time was a charm and he wanted me in L&D right away to get checked.
At this point it's almost 11pm and we get to the hospital. My doctor was on call so it was nice to have him there. He checked me pretty much as soon as I got there. And wouldn't you know it, I was dilated 1-2cm and 50% effaced. They told me then I had to stay there 24 hrs, I needed a steriod shot for their lungs, most likely would be put on magnesium...and most likely end up being on hospital bed rest until I delivered. I started to cry, as I didn't want to be trapped there. I didn't want to miss out on Isaac, and I was Oh so very uncomfortable in the hospital bed. Especially when I had to lay down. All the while my husband is at home with Isaac, both asleep, but my mom was with me and we decided not to wake him up to tell him.
Then came the fun stuff. They strapped me up to be monitored. They could only get the one baby's heartbeat picking up on both monitors (again). So they brought a little ultrasound and would find the heart and mark a spot on my stomach where the heart was and put the monitor over it, but still would only get the one or my heart rate/pulse. They tried for hours to get them on track, and just when they think they did one would disappear or both would our they would be the same. They just gave up and decided to keep tracking with the ultrasound for a while and try again later. Then came the steroid shot for the lungs. By far the worst poke of the 800 stickings I had the whole time. A shot right in my butt and it STUNG so bad. Then they hooked me up to an IV, which took 4 different people and 5 different tries. They put my on fluids and then magnesium to stop contractions. I had been freezing and shaking this whole time, only to have the mag make me feel like my face was melting off. My ears were burning, my face was hot, I felt like I was in an oven for waaay to long. I held ice in my hands just to make it cool. Not to mention the whole time I couldn't eat a thing. The mag gave me major dry mouth and I just wanted to drink something soooo bad. I was hungry and thirsty. No fun. The goal for me at that point was to stop contractions.
28 OCT - Morning rolled around, I think I slept one hour. Cameron got the update that I was stuck there, contracting etc. The docs wanted me to get another steroid shot at 24hrs after the first, so around 1am again later that night (thursday). Magnesium had slowed my contractions a little, but they did not go away like they should. The same swab test I had had the week before came back positive this time. The nurses were still having a rough time keeping the boys on the monitors.
Cameron arrived and my mom and him swapped Isaac and now he was with me. The perinatologist office came up to get a biophysical profile of the boys, to see how they were doing overall. It was just a tech and she had a hard time figuring out where baby b - Jeremiah - was. She went and talked to the actual doctor and he brought up his bigger machine to check it out. He started taking measurements of baby A, Micah. I saw some measurements that read around 31 weeks (I was 30 weeks 3 days). At this point everyone, my husband, the peri tech, my nurse, and the doctor were all around my bed. The tech said something about how she couldn't figure out how baby b was positioned. The doc said "because he's stuck". I didn't know what that meant but I wanted to say how could he be stuck if he's always moving from the monitors? He then had me roll to my left side so he could get more on my side. I asked Cameron how his measurements looked. He said he didn't see them. (He did, he just didn't want to tell me what they were).
So a few minutes pass and the doc turns off his machine and started with "I wish I had better news for you." My heart sank, but I didn't know what it meant. I didn't know what he was going to say. I expected bad news, obviously, but more of the, one twin isn't doing as well as the other type of news. Not what I was about to hear. He continued, "Baby A is alive and well." I held my breath. "Baby B is not, there is no heartbeat." I then argued with him a little. How could that be? How come I feel him move. We kept seeing him move on the ultrasounds just hours before. How does he not have a heart beat now? The doctor then explained to me that what actually had happened is that our precious Jeremiah had passed on WEEKS ago, 2-4 he said. Micah was then getting twice the amount of blood flow and fluids from the placenta, which had diverted from giving Jeremiah his share, called Twin to Twin transfusion. Micah therefore was swimming in a giant pool of amniotic fluid. The babies we thought they were seeing on the ultrasound was just always him. Jeremiah had been pushed up into my ribs (hence my discomfort), without hardly any fluid around him, and so all we were seeing was Micah. So all along they thought they were having a hard time keeping both on the monitors, they were only tracking one, and he could move so easy he would move away. Even the doppler at my last doctor's appointment had really just picked up Micah's heartrate.
(UPDATE: turns out the more likely passing of Jeremiah occured about 10-21 days prior, as an estimate and he may have still been alive for my doctors appointment on the 18th. However, I did notice the decrease in movement around the time Cameron came home---as this was when I started to get miserable and my ribs began to hurt like they were---so I think I would put the timing of his passing around the time i felt him in my ribs. We will never truly know)
I didn't know what to do. I was in shock. I cried...but I was in shock...my brain and heart did not believe it. Just yesterday I was expecting two bouncing baby boys. It all changed in an instant. I thought I was dreaming. I wished I was dreaming. It turns out my L&D nurse had the same experience I was having. She was pregnant with twin girls, one passed away at 26 weeks (and they knew pretty much right away because she was being monitored due to complications) and ended up giving birth at 31 weeks. Her babies were fraternal and therefore did not share a placenta so not a twin to twin transfusion, but still, she knew pretty much EXACTLY what I was going through and what I would go through. Her daughter is now 16 months old. It's a gift that God had her there for me, someone who REALLY knows what it's like to lose a twin AND have a baby so early preterm.
The past 2 weeks I had gotten HUGE (and miserable, remember?). Well this was because of the increased blood flow and resulting amniotic fluid. I had what was called polyhydramnios--too much fluid. And it happened FAST. The magnesium had failed to stop my labor. I was contracting and they had checked me sometime that morning and I was at 3-4 cm. I knew this was it. My body was going to have these babies whether the docs tried to or not. Fortunately, now that we knew what was really going on and how much stress the extra blood flow and fluid was putting on poor Micah's body having him soon was actually a GOOD thing. He was better off outside than inside, because his heart and organs were at max capacity. (Turns out now we know that this extra work caused his lower heart chambers to be thicker than normal--but still fully functioning). Now all they really wanted was to give him that second dose of steroids. I knew I wouldnt make it the full 24 hrs. My labor with Isaac was so fast (4.5hrs) and the only difference was my water hadn't yet broke. It would have gone much faster then. The gave me a catheter hoping to ease pressure off my cervix but instead it did the opposite. My contractions were getting stronger by 2pm and I said I needed my epidural. I was not in that much pain yet, but it was getting worse and I did not want to wait around. I hoped it would slow my labor. And more than anything I did not want to have to be in any physical pain during labor, facing the hugely emotional and tragic ordeal coming my way---and already there. This day was far too painful already. The anesthesiologist was in a C-Section so it took about an hr. At which point I was 6cm and I was getting very irritated hoping I wouldnt have to go through this with pain. Fortunately my labor had slowed a little, and he came on time. I got the epidural and I felt much more content. They came to give me the steroid shot and lo and behold I didn't feel a dang thing.
I had many visitors coming to offer support in this hard time. I was trying hard to not let myself "go there" knowing what I was about to face. I was about to not only deliver my babies 10 weeks early, 7 weeks pre-term, but I was having to deliver my stillborn son. Not something you want do or ever think you would have to. Birth is supposed to be amazing and exciting, full of life and joy. In my case....I was facing both. I was exciting to meet Micah but scared for his wellbeing...and devastated for how I would not get the same for my little boy Jeremiah. I had to stay strong. I needed to be strong and deal with my emotions later.
Then came a point where they thought it was just time to get him out. He started showing slight signs of distress during my contractions and they figured it need to happen soon. They considered starting me on pitocin to get things rolling. Or trying to break my water. I had the nurse check me again and it turned out was was practically fully dilated and that having a 30wk baby I didnt really need to be completely at 10cm, so they decided to tell the doctor it was ready. I had to deliver in the OR, which is normal for twins but in my case that didn't matter quite as much as the fact that the OR shared a door with the NICU so they could wisk him away as soon as he was born.
They wheeled me away, Cameron helping all dressed in his OR outfit. They brought me in and rolled me onto the other bed. Set up some stuff, put on stirrups that looked like hockey pads. I fortunately had the PERFECT epidural. I could not feel pain, but I had completely control of my legs and I could even lift myself up. Thank you Lord for that. They got all prepped...NICU people, anesthesiologist, nurses, doc, husband. I starred up at the giant light surrounded by mirrors. I cracking jokes along the way...trying to stay positive. The doc did a quicky ultrasound to make sure Micah was head down, and sure enough there was a head. So they told me to do one push. The nurse and the doctor were all impressed by how "awesome of a pusher" I was. She then said she was going to break the water, expecting it to be Micah's. Instead she said there was green in it, suggesting Meconium in the fluid which wasn't fantastic news. One more push later and it turned out that somehow Jeremiah made his way out first, despite being initially tucked up in my ribs. At 8:03 pm he came right out and they held him up to cut the cord. His umbilical cord was all swirled up tight near his belly, which could of been one reason why he had lost flow from the placenta. I was not prepared to see what I saw...and at first I just shut down, but now looking back at it, it's still precious... I'm glad I got to see him, regardless of how he looked. He's still my son and I still gave birth to him. I was still glad that I didn't know it was him who I was pushing...I think it made it less emotional for me to have ignorance in that.
Once they took him away the doc again did another ultrasound to check where Micah's head was. It was a concern that since he was A) in so much fluid he could do summersaults easy and be breech in seconds and B) Jeremiah coming first may have pushed Micah to turn breech. But thankfully he was also head down. The doctor then got buckets to prep to break my water. [There is a thing they call AFI, Amniotic Fluid Index, where they measure 4 pockets of amniotic fluid on ultrasound and add them up to see what your AFI is. Normal is usually 10-20, 8 being pretty low for normal, 22 being about as high as they really want to see. When I had them done with Isaac his AFI was normally about 14 or so. The doctor however estimated that Micah's AFI, fluid for just him alone, was a 50! yeah.] So she got the hook and said here we go, and out game a river of fluid. It sounded like someone pouring a 5 gallon bucket of water. It seriously was like a waterfall. The doctor jumped back at first and my water kept coming at force for over a minute. Just when you thought it was done it would keep on coming. The doctor and nurses and my husband were all in awe. I said "Thank God, I had to pee so bad!" Seriously, I felt the pressure release and it felt amazing to have my lungs back again. The whole time the doc was also trying to keep Micah's cord from coming out first and had the nurse push behind him to keep him from turning.
Once the water stopped gushing she asked if I was ready to push.I pushed once and he went into the birth canal. I felt pressure and had to push again, so she let me do my own pushes (no one counting I just did what I needed to). I pushed one more time and at that point I was crowning, my body was pushing him down on its own (contractions were one on top of the other). She had me wait so the NICU people could get ready, so breathed hard trying so hard not to push, be he still kept coming. She said "ready or not he's coming!" So they said they were ready and she told me to push once more and out he came. At 8:09 pm She held him up to cut his cord. He looked so long, longer than I expected. His eyes were closed and mouth wide open but no crying or attempts to. I expected that. He was dark but not blue. They took him away right to the NICU where they got him breathing and put on a ventillator. They also go him all hooked up and gave him suffactant, which is produced naturally later in term, to prepare his longs and soften them so he could use them to breathe.
I then delivered the placenta and she showed me how the vessels look and where the umbilical cords were attached. I did well for my delivery, no complications, no tears, no nothing. They got me back on my other bed to take me back to my room after cleaning me up. Cameron stayed with the nurse who had Jeremiah. I came back and then felt more emotional. So much had just transpired. I was not pregnant...but empty handed. I finally let myself feel some emotions.
Shortly after I got to my room and all situated Cameron came back and they brought Jeremiah in all wrapped up in blankets. But I will share that story some other time...this one is long enough as it is. But just know that I did get to hold my precious boy. I got to feel the weight of his body in my arms. And I got to cry.
Once my epidural wore off enough and I went to the bathroom like they wanted I was able to be wheeled in a chair to see Micah. That was the moment where my devastation turned to joy. Two completely polar opposite emotions that I have to deal with hand in hand, every hour of every day.
Jeremiah Colton Settle, born sleeping (but alive with the Lord) at 8:03 pm on October 28th weighing 2lbs .7oz and 15in long
Micah J Carson Settle, born at 8:09pm on October 28th weighing 3lbs 6oz and 15.4 in long
They were born at 30 weeks and 3 days gestation.
One of my last pictures of me pregnant - October 17th, 2010
About to Roll into the OR for Delivery - Putting on my Game Face
Holding My Sweet "Sleeping" Jeremiah
Micah J - October 28, 2010
(Holding Daddy's Finger)
The Boys Together - Eternity Cannot Come Soon Enough