World Prematurity Day

Every year, 15 million babies are born premature worldwide. More than one million of these babies die, and many more face serious, lifelong health challenges. Preterm birth is truly a problem that can happen to every one of us, irrespective of the country we live in, our culture or socioeconomic status.

Worldwide, one in ten babies are born too early – more than 25,000 each year in Australia alone. Giving birth to a child is one of the paramount, most positive experiences in life. Having a baby born too soon is a significant trauma for families. Preterm birth also represents a severe financial burden for many families and our often struggling healthcare systems.

November 17 is World Prematurity Day, a globally celebrated awareness day to increase awareness of preterm births as well as the deaths and disabilities due to prematurity and the simple, proven, cost-effective measures that could prevent them. 

I haven't slept properly in a week. My body is tired. It has been poked, prodded, scanned, monitored and finally sliced open. My arms and belly are covered in bruises and bandages where needles have been inserted for various reasons: steroids, amniotic fluid drains, magnesium sulphate, fluids. Both hands still have cannulas attached.

My hospital gown is crumpled. I don't see it, but it is blood stained. My hair is a mess. Giving away a night spent writhing through contractions on my hospital bed alone. Biting my lips to stop the moans escaping.

I have waited five hours to meet you after your birth via a c-section. Your father has stayed by my side so we could meet you together. Despite everything I am excited. While we waited in maternity we have rung family and friends to announce your arrival. We have quickly finalised your names. Finally the midwife announces the arrival of the orderlies who will wheel my bed down the corridor and into the Neonatal Intensive Care Unit.

I am smiling. I am about to meet our daughters. Your father holds my hand as they manoeuvre the bed over to the first humidicrib.

Later I will notice the smell of the strong disinfectant and the incessant alarms that beep at each crib. But in this moment I don't smell or hear either. I see a crib, misty with condensation. A friendly nurse smiles and opens up the two little doors, so I can see you.

You are beautiful, and yet you terrify me. You are so, so small, and very red. Your tiny body is mostly covered by your nappy. There are wires and sensors attached to your chest. Your head and face are obscured by a strange hat and tubes that go up your nose.

I don't even realise at first, but hot tears are streaming down my face. I love you already, but I am so sad at what you now have to endure. The nurse encourages me to put my hand in and gently touch you. I overcome my fear and stroke your little hand. 

We nearly get the names mixed up, but once they tell us you are the first born twin, we name you Maggie. We know it suits you already.

I wish I could stay next to you for longer, but in the next crib lies your sister. The tug of two babies in the NICU has already started. They move my bed over, and despite what I've just seen, your small, fragile body shocks me again. An ache that will follow me throughout your stay in hospital crushes my chest. 

Elisabeth we name you. Your eyes are closed tightly against the bright lights. You seem a little more relaxed than your older sister. The tears keep falling. Such a surreal moment to meet our daughters and be so conflicted by love, fear, excitement and dread.

Remembering their birth day. If you have followed my blog for awhile you will know our daughters arrived at 26 weeks due to the acute onset of Twin-to-Twin-Transfusion-Syndrome. Maggie weighed 777g and Elisabeth 889g. They spent 112 days in hospital. They are about to turn three, we are incredibly lucky to have two healthy daughters.

Text at the top is from Miracle Babies Foundation. 

Birth day

Today the girls are one! They woke me around 4am for a sneaky breast feed, and I kept both girls in the bed between us. I slept right through the time of their birth (5.54 Maggie and 5.55 Elisabeth), but I was happy as I was snuggling them close. So different to last year when we didn't get to hold our babies at all. Thank you to those of you who have been reading along and commenting, this is it, the last chapter of their birth story.

The sleeping tablets didn't work as well as previous nights. I kept waking every 15 minutes to breathe through a contraction and then I'd doze in between. I honestly thought in my befuddled state that they would calm down. Although I was alone (I didn't bother the midwives often that last night) I didn't feel lonely. The babies were wriggling around like crazy (due to the contractions), I only realised the other day that term babies would be too big to wriggle the way they did that last night. I always found their movement a comfort. Perhaps the other big hint that this was it, was that I was leaking colostrum all over the sheet. 

Around 1am I did ring the bell as the contractions felt a bit worse. The midwife gave me some panadeine and a heat pack, she stayed with me to feel how they were progressing, and said she'd see how I was at 2am. Meanwhile I had texted Rob. As we only have one phone he had borrowed my mother's old mobile. The buttons were too small for him to text very well. It made me laugh because every time he wrote xxx it came out www. I was willing the contractions to stop, but instead they were just as strong. I toughed it out, throwing aside the useless heat pack and curling up on the bed whenever one hit. 

Just after 2am I sent Rob another text to say they were not getting worse but weren't that nice either. He asked if he should come in. Why I didn't say yes then I'll never know! The midwife went to discuss my progress with another doctor to see if it was worth calling my doctor. I had not lost any fluid so I still thought they would calm down. 

By now it was impossible to doze between contractions, I was trying to be brave. The babies were still kicking like crazy. The contractions then went up a notch, they started getting longer and more painful without a break. I still didn't call Rob, I didn't want him to worry. Just after 4am I sent him an understated text - getting more frequent, can you come in soon. He replied ok. I didn't realise ok meant to Rob have a cup of coffee and a leisurely shower and shave. Perhaps we should have discussed my texting code. Because to me it meant come immediately! 

Lying down and breathing was doing nothing now. I could feel the contractions building up like a wave until it was intensely painful. I remember walking around the room and leaning over the bed quietly moaning. Then suddenly I felt a pressure deep in my bottom. At first I thought I had to go to the toilet and even tried. Then I suddenly remembered the day before one of the questions my Doctor asked was if I felt a pressure feeling. That's when I finally admitted this was it. I rang that bell and told the midwife, who turned and ran out the door to get help. 

Two other midwives came back with her and a wheel chair. By now the pain and pressure was constant, and when they asked me to sit in the wheel chair I initially refused. But somehow I sat down and was whisked back into a delivery room. They had already rung my Doctor. They helped me onto the bed, removed my knickers, and one of them did an internal exam as gently as she could. I remember the lamp at the end of the bed didn't work, so it was all dark. But I could see her face and heard her whispering to the others that I was fully dilated and she could feel Twin B's head. Then she told me to shut my legs and whatever I do, not to push. Stranger words I'm sure haven't been spoken in a delivery room. This I admit felt impossible, your body just takes over and does what it has to. But I gritted my teeth and tried. The midwife who had been with me all night asked where Rob was. So I rang him (I later checked my phone the call was at 4.57am), understated was thrown out the window as I gasped "get here now", followed by "where are you?" He told me he was just driving through Snug. Still a 30 minute drive from the hospital. My heart sunk. I wanted him with me, I was so scared. I didn't want to face their birth alone.

The mood of the room quickly changed and it suddenly became full of people. I was very relieved to see my Doctor. She looked very serious, even more than the other day. The lights were thrown on, and it became crazy, it felt so surreal, as if it was happening to someone else. They reattached IV lines and gave me another massive dose of magnesium sulphate. Perhaps telling about the pain I was now in, was that I didn't feel the burning this time. The other had saline reattached. They gave me an injection to slow the contractions, and those fetal heart monitors went back on. The midwife told me to breathe through a contraction rather than tense up and squirm and quickly showed me how to use gas. 

Other people were in the room, an anaesthetist was at my head asking me all sorts of questions I could barely hear or understand. On the other side my Doctor put a consent form in front of me to sign. The anaesthetist was still talking to me, but I wasn't taking anything in. I had to swallow some foul stuff to stop me choking. I could see NICU nurses checking the warming beds. I was shaved and a catheter was inserted. Then as suddenly as they appeared, everyone started leaving for the operating theatre upstairs. My bed was wheeled into the corridor, and as we went past the midwife was grabbing towels and oxygen canisters and placing them between my feet. I thought that was odd at the time, but later a NICU doctor told me when they were paged they were told I might give birth to one of the twins in the lift on the way to the theatre!

I don't actually remember any more contractions from now on. I was exhausted and kept looking for Rob. The midwives rushed me out of the lift and wanted to wheel me right into the theatre, saying to theatre nurses as they pushed there was no time for normal protocol. But in the rush it wasn't actually ready yet! As we waited briefly the anaesthetist's nurse let me know that they still weren't sure if I would be having a general or a spinal. I really wanted to be awake at least, but I knew it wouldn't be up to me. They said if it was a spinal when Rob arrived they'd bring him up. I desperately wanted him to get there, but perhaps all my silly bravery would mean he would miss it. With all the commotion I had lost track of time. 

Finally I was allowed in, I remember the huge lights above the table. I was shuffled across to the table, and noticed it was getting light outside. I saw two humidicribs, each with a NICU Doctor and nurse. The main NICU Doctor came and introduced himself. I could see my Doctor and another obstetrician in scrubs prepping. I was asked to sit up and hunch forward for the spinal tap to be placed, because my gown was open at the back it kept slipping off. One of the NICU nurses rushed forward to hold it up to preserve my dignity. I felt so defeated that I didn't even care if I was naked, and tried to tell her I didn't care. I don't remember if someone told me or I looked around and saw him, but I suddenly saw Rob standing in the corner in blue scrubs and face mask, his blue eyes fixed on me. I was so relieved. 

I had done all that I could to stop their birth. Endured more than I thought I ever could, but in the end I had to surrender (thanks Jodi for that totally appropriate word). I could do nothing more to protect my babies from their early arrival. It was now up to the NICU doctors and nurses, and the babies themselves. 

They gently laid me back down, checked I had lost sensation and hastily put up a curtain (which kept falling against my face). Rob sat next to my head and held my hand. Then the operation started. It wasn't long at all and I heard my Doctor ask Rob if he'd like to stand up and see the first baby's appearance, and I felt excited. She joyfully announced "It's a beautiful baby girl", and as Rob's tears fell on my face, I quietly wept as I heard Maggie's tiny but determined cry, and I felt it. A love stronger than anything I had ever felt, particularly for someone I hadn't even seen, as I became a Mama. One minute later the Doctor asked Rob to stand up again and Elisabeth entered the world screaming just like her sister, and another wave of love washed over me for my second daughter.

I have written before about meeting the girls later that day. Despite all we had been through already, we knew it was just the beginning of a long stay in hospital for our daughters. Unlike their birth day a year ago, I only have tears of joy today. There is no sadness or fear. Just love, wonder and awe for our girls and how far they have come. We are so proud to be parents of our Maggie Simone and Elisabeth Hazel.

Another day, another needle.

Sometimes I thought maybe we could prolong the pregnancy another week, we were after all on day four in hospital. With each day I survived we slowly added the days to my gestation 25w4d, 25w5d, on a white board in my room.

Speaking of my room. Originally we had booked into a private hospital for their expected birth date in late February, but as only the public hospital in Hobart has a NICU we really didn't have a choice. So I was given a rather spartan private room (this photo was taken after their birth hence the pump). You may have noticed the lack of photos, we didn't bring a real camera into hospital. I didn't have a compilation play list of music to soothe me during labour. I hadn't even packed a suitcase for hospital, so poor Rob was sent off to shop for all sorts of things! As news spread around our family, friends and work colleagues, my room did start filling with beautiful flowers, a stark contrast with the scuffed up walls and stained ceiling. 

On Tuesday morning, however, I woke up in the delivery suite. They detached my IVs, but left the cannulas in just in case. 

Our favourite part of the day was the ultrasound to check on the babies. We headed off to radiography not long after breakfast. The babies were still doing well, the TTTS had not gotten worse (there are four stages, depending on the severity of the symptoms, the babies were still only stage one). But my Doctor was keen to perform another amnio reduction later that day. 

We headed back to the ward for a rest and some lunch. Rob even helped me have a shower. It is amazing how quickly muscles disappear with only a few days of bed rest. I laughed at my reflection in the bathroom mirror, a huge belly with little skinny arms and legs. 

I was still having the occasional contraction, but my Doctor arrived and got ready to do the fluid removal again. She decided to use a slightly bigger needle and syringe so the procedure would be faster. This time there was only my doctor, Rob and a nervous midwife in the room. Knowing what I was in for this time and not being in as much physical discomfort from the pressure of the fluid made me a little nervous. If I thought the ultrasound they used on the first day was old, the one she had to use the second time was even worse. But she carefully guided the needle in. Once the needle was through my skin I could feel it go through into my uterus. The pain was exquisite and shot through my body, also every time I had a contraction (they didn't happen the first time), it would cause the shooting pain again. 

To make matters worse baby A was awake and kicking (the needle is actually removed but a tube was in it's place), we could see it jiggle on the outside! The midwife left after a bit so the three of us chatted about life, almost as if nothing unusual was happening! We also discussed the Caesarean section she planned to do. The stress of being birthed naturally would be too much and too uncontrollable for the tiny babies. So when she decided it was best I would be prepped for surgery. 

After an hour I realised that I had been lying on a join in the delivery bed, right where my hip was. It was getting increasingly sore, but I wasn't allowed to move! I couldn't wait until it was over. She went as quickly as she could, removing another two litres over two hours. Finally the equipment was removed, a welcome but painful feeling. My Doctor happy that it had gone well, and the babies were ok, packed up and left me to rest. I was returned to my small room, and the contractions kept coming. After dinner, despite ongoing contractions I sent Rob home. He was tired and couldn't sleep in my little room anyway. But I felt the same as the day before so I didn't think the babies were arriving any time soon. I took a sleeping tablet and tried to sleep. At first it worked.

Is today the day, or not?

I woke early, the past few days caught up with me, and feeling alone I cried. I cried that at best they thought the babies would be born within a week. I cried that my pregnancy was ending before it really got going. I cried that we had no idea if the babies would survive, and if they did what their quality of life would be. After a few moments I pulled myself together, washed away my tears and got ready to face another day of trying not to give birth.

The midwives came in for a morning check of me, and the fetal heart monitors were attached. I had felt both babies kicking, so I wasn't that worried when as usual they could only find one heart beat. But the next thing I know I was being rushed down to Radiography to have an ultrasound (I was booked to have one later that day). The radiographer was pretty sweet and told me straight away they were both alive. The head radiographer came in as well as I had been rushed to the top of the list. Apparently the midwife had told them they thought one of the babies was dead! My bravery slipped and my tears returned. Rob and my Doctor (who they had obviously sent for too) appeared and I felt so relieved to see them both. She reassured us that although both babies were still doing well, the fluid imbalance was building up again, so she would try another amnio reduction the next day. She also decided to have a chat to the midwives and ask them to stop trying the heart monitoring as it was causing everyone more stress than it was worth. She was happy if I could feel the babies moving.

I was returned to maternity to rest and eat lunch. Rob took a few photos of me, I almost look term for a single pregnancy. They would be the last photos of my pregnancy. I could feel the pressure returning. My parents and sister came to visit. After they left I realised I had been having contractions all afternoon, not very frequently but they were noticeable. I hadn't attended any prenatal classes so it took me awhile to work out what was happening. Rob and I had been trying to watch some TV before he was going to head home, I didn't want him to go if I was about to give birth, so we called in a midwife. She sat and timed them with me for awhile, and when they didn't stop they called in my Doctor and moved me back into a delivery room.

Of course they couldn't help themselves and attached the heart rate monitor! They also inserted two new cannulas, one in my hand for saline and one in my left forearm to administer magnesium sulphate, which is thought to protect the babies underdeveloped brains during birth. They warned me that the magnesium would be very painful. I would describe it as an intense burning sensation that moved up my arm, as the drug worked its way into my bloodstream. They applied ice to my arm to help with the burning. Lastly they gave me another injection to stop the contractions. My Doctor arrived and examined me to find I was 2cm dilated. She decided to wait and see if the injection would work. So we sat and waited, the midwife counting my contractions, Rob holding my hand, and my Doctor sitting in a corner looking very serious. Given how much time I had been spending with her the last couple of days we knew she had her game face on. Naturally smiley and bubbly, she was obviously running through the next steps in her mind. I really thought that we would be rushed off for a caesarean that night. I felt unbearably hot and flushed thanks to the burning heat of the magnesium.

After half an hour, my contractions had calmed down, and I was no further dilated. My Doctor decided not to go to theatre, and went home. I was allowed to stay in the delivery room. It did feel a little strange, to be in a delivery room, and constantly be trying to stop labour progressing. We had all sat so silently we could hear other women down the corridor crying out as they birthed their babies. We even heard those first lusty cries of a newborn. I was surrounded by all that a birth was meant to be, whilst we lived in limbo wondering if today was the day we might meet our own babies, however tiny and fragile they might be.

They set up a fold up bed for Rob again, I was given another sleeping tablet, and with Rob gently stroking my forehead I fell asleep almost immediately.

A day of relative calm

This was the view from my bed as dawn lightened my room. I was so glad that warming bed remained unused.

Rob awoke. The midwives started trying to find the heart beats again. Luckily a keen registrar was happy to do an ultrasound and show me the two babies and their heart beats. After breakfast I was wheeled down to have a more extensive ultrasound. My doctor met us there and explained all the measurements of amniotic fluid, the size of the babies bladders and stomachs, the blood flow via their umbilical cords, and the state of their hearts. Considering the circumstances the news was promising, the babies were no worse than the previous day, their hearts were fine, and poor twin B whilst still stuck low in my pelvis was breathing and moving, and had visible fluid around it now. Something it wouldn't be doing if it was still stressed. 

On my return to the ward I was moved into a smaller room. I was served lunch (I figured out it was a fish burger because it was served with tartare sauce) and Rob went off in search of coffee. He returned with treats; chocolate slice, magazines and books. We were both so tired we fell asleep. 

A pair of Doctors from the NICU came to chat with us about what to expect next. So far Rob and I had been focusing on the risks and implications of the babies while they were still inside me. The Doctors discussed the possible risks once they were born. We asked questions about survival rates, and possible disabilities, and they discussed brain bleeds, respiratory support and feeding prem babies. I have to say, and this is by no means a reflection of the doctors' bedside manner, the meeting left us both in tears. Premature birth is terrifying to contemplate. We had thankfully made it 24 hours past my first steroid injection so at least the babies lungs would be given the best chance. 

Rob was extremely tired and in need of a shower and change of clothes, there wasn't room for a fold out bed anyway so although I didn't want him to leave, I let him head home. There were a few tears for both of us. My Doctor has prescribed a sleeping tablet as I had not slept properly for a week. She strongly advised I take it, so I did, and a heavy, dreamless, sleep came quickly. 

Hospital

I felt like absolute rubbish on Saturday morning. It was another really hot day. Rob headed outside to weed in the garden. I hid from the heat and tried to distract myself by writing Christmas cards. 

When at lunch after two mouthfuls of a toasted cheese sandwich I had to run to the bathroom to be sick, where I realised I was also spotting, I knew we had to go to hospital. But I still rang my sister, a mother and a nurse, and talked to her, to see if she thought I was over reacting. She told me to go to hospital even if only for my peace of mind. Sage advice that I would now give to any pregnant woman. If you are worried about something, just go. The best thing that can happen is you are sent home. 

While Rob had a quick shower I packed a bag of clothes, my contact lens solutions, glasses and my toothbrush, I had a feeling I wouldn't be coming back. We drove into the hospital where we planned to have the girls. On the way we dropped our dogs with my parents. Ever the optimist Mum just thought I was dehydrated. But the look in my Dad's eyes let me know he understood how worried I was. 

The 40 minute trip was by now excruciating, I couldn't sit up. I squirmed trying to be as horizontal as possible. Once there I waddled into the matenity ward, Rob holding my hand. The midwives showed us into a delivery suite room, after a few checks of my blood pressure and weeing into a cup, they tried to find the babies heart beats. This would be the first of many failed attempts to do this over the next five days. Try as they might, moving the round sensors around on my belly, they could only find one heart beat; mine. They reassured me that this wasn't surprising given I was only 25 weeks along, the babies were still a bit small for the monitors. But they called my obstetrician to come and do an ultrasound. 

Of course my obstetrician was on holiday, so an on-call doctor was paged. I tried to relax and be calm as we waited for her to arrive, luckily we didn't have to wait for long. She quickly started doing an ultrasound. I couldn't see the screen, and was wriggling on my back as it was so painful now. After awhile when nothing had been said, I asked are they alive? She didn't answer straight away. But the growing frowns on her, Rob's and the midwives faces were not what I hoped to see. Eventually she told me that yes they were alive, but I had an acute case of Twin to Twin Transfusion Syndrome (TTTS). One baby was squished down in my pelvis and very hard to see, the other was floating around in a giant pool of amniotic fluid. Not what I wanted to hear at all. Despite having what I had feared all week confirmed, it was still a shock to hear it out loud. She left the room to confer with other Doctors in the practise and specialists in Melbourne who deal with TTTS more frequently. Poor Rob sat down on the chair next to my bed and shook. He was ashen and only managed to say I feel sick. I knew exactly how he was feeling, we just sat holding hands, not saying anything. 

My Doctor returned, and wondered if we were in the position to book flights to Melbourne? Depending on the results of a proper ultrasound we were about to have, it might be best for me to be sent to Melbourne for laser treatment (they close off the blood vessels that are causing the blood flow between the babies). Apparently hospital transfers would take too long to organise from Tasmania, and it would be easier if we just took a domestic flight ourselves! Our minds were in a spin as I was wheeled down in a wheelchair to the ultrasound room. I couldn't bear sitting in a car let alone in a plane.

I realised I was bleeding which didn't exactly bode well. I squirmed again as I lay on the bed as the radiographer measured and estimated. Rob sat in a corner checking flights on his iPad and then looked at the screen. He suddenly exclaimed, that's rubbish. I had no idea what he was referring to, apparently twin B, the one wedged down in my pelvis had no visible fluid around it. Eventually it was over, and our Doctor wheeled me back to the delivery room as she told us given the results of the ultrasound it was too late for laser treatment. She then went on to tell me, that my body was in labour and I needed to be transferred to the Royal Hobart Hospital for an amnio reduction. She let us know she had already booked two beds at the Neonatal Intensive Care Unit (NICU) there. Up until this point I hadn't really thought that the babies were coming any time soon, when we had discussed TTTS all those weeks ago I naively thought that if caught early it could still be treated and delay their birth by weeks. But the pressure of the extra amniotic fluid had started labour.

As we got back to the Delivery room, the midwives trying to be comforting (I suppose) said, I guess this isn't what you wanted. I broke into sobs for the first time, as I replied that all I had wanted were healthy babies, and this hope had now just about vanished. 

In that moment I realised how petty all my worries about pregnancy - the discomfort, the stretch marks, all the other various unpleasant symptoms -were. Fears about a painful birth paled into insignificance with what was now a scary prognosis for our babies.

They let me have a quick hug with Rob as we were both crying now, but then I had to lie down and keep as still as I could. I was administered steroids to protect the babies lungs (which would really only work with a second dose administered 12 hours later and then if we could delay the birth another 12 hours after that!) I was also given another drug to slow down or even stop labour.

I was transferred via ambulance to the RHH, lying precariously on my side, it was a short but bouncy trip. The ambos must have gotten a bit confused and wheeled my gurney via an internal lift into the foyer of the NICU. I came face to face with a wall of photos of tiny premature babies. I had never seen a prem baby before. The photos showed tiny red creatures, with strange looking faces, skinny limbs, covered in tubes, wires and tape. My gut reaction was one of horror. To tell you the truth they didn't look like babies, and the thought that our babies would look like that made me feel scared. I realised with a sinking heart as I read birth and death dates that some of these babies hadn't survived.

By now the receptionist had pointed the guys in the direction of the maternity ward where I was wheeled straight into a delivery suite. My Doctor was already there, once I had been shuffled onto the bed I had midwives all over me. Taking my clothes off and dressing me in a gown, helping me use a bed pan, attaching those fetal heart monitors, I was given another injection to slow the contractions that I couldn't even feel, and after three attempts a canula was inserted into my left hand for taking a blood sample and then IV fluids as I was dehydrated. Meanwhile a NICU nurse came in and checked over the warming bed on the other side of the room. Another obstetrician came to assist for the amnio reduction. I wasn't told before, or if I was I didn't remember, but apparently the procedure could cause the placenta to come away and bring on an emergency birth. Perhaps it was best I didn't know that, there really wasn't ever any choices in the treatment of TTTS, my Doctors were doing everything they could to prolong the pregnancy safely, whilst balancing effects of TTTS on the babies.

I keep saying the babies, I still didn't know I was having girls. Despite multiple scans over the next five days, at my request they still kept the sex of the babies a secret for me. 

The two doctors rigged up the equipment for the amnio drain. Slightly Macgyver-like, they used two pieces of cardboard in a cross to support the big needle they were about to insert. It would be connected to a syringe with a valve and then long thin tube to a bucket. Rob sat by my head holding my hand whilst everyone was in a flurry of activity around me. Once it was all ready they applied a local anaesthetic to my skin and using an extremely old ultrasound machine to guide her my Doctor inserted the needle into my tummy and right into the uterus and the amniotic sac of twin A, the recipient baby. Yes it hurt, but really everything was hurting by now. Mostly it was alright, but if someone touched the needle or my tummy, the pain would shoot through me. The process was incredibly slow, she carefully removed two litres of fluid, 10mL at a time, any faster would have triggered birth. 

The other Doctor stayed for the first hour, we all chatted about the most trivial of topics to keep my mind off the procedure. I was something of a novelty, and another Registrar Doctor requested to come and watch the procedure. Really I was beyond caring, they could have televised the event and I probably wouldn't have noticed. After a while as the amount of fluid in the bucket increased the pressure caused by my oversized uterus on my internal organs was noticeably less. She continued to drain as much fluid as possible then removed the needle, the whole procedure took three hours. She checked the babies with the ultrasound, and we watched in amazement as poor squished baby B was moving and even hiccuping. This was a huge relief, and after a quick internal exam for me, she decided we had delayed their birth for the day. 

By now it was pretty late, around midnight. They found me some sandwiches to eat and a fold up bed for Rob so he could stay the night. I dozed for the first hour, but after that I didn't really sleep. When I woke up I could hear Rob was sleeping peacefully, but I was still attached to a beeping IV drip, so needed assistance from the nurse to visit the toilet. At 4am they gave me a second steroid injection in my leg, and reattached the fetal heart monitors, and spent close to an hour trying to find their heart beats. They would pick them up and then lose them, so were never quite sure they could hear both. I could feel the babies moving, so I wasn't too alarmed. 

Last bump shot before I knew about TTTS.

I woke on Friday morning and felt so tired. I had no enthusiasm for getting up and facing what was going to be a scorching hot day, with a work presentation to organise first up.

I snapped this last bump shot at home. I look sad, and I had big black smudges around my eyes. The bump seemed to be taking over my whole body, pressing up against my ribs and down into my bladder.

At the end of the long day I headed to a dental check up, and oddly when I was tipped head down in the chair I felt some relief from the pressure and aching.

Rob and I headed home for a dinner of steak. I ate some but didn't really feel that hungry. 

After we went to bed I tossed and turned and could not get comfortable at all. I couldn't sleep, just moaned every so often as I changed position. Poor Rob. In the end I had to rush to the toilet to be sick. I hadn't been sick for months. This is going to sound a bit gross, but I realised the food was undigested, as if there wasn't even enough room inside my stomach for food. I remember crying, and asking Rob if I was okay. He rubbed my back and reassured me, cleaned me up and helped me back to bed.

My night didn't improve, I lightly dozed, but continued to toss and turn.  

A little about Twin to Twin Transfusion Syndrome

During that last week at work I was rushing to get tasks ticked off my list but I grew increasingly uncomfortable. I really hoped I was just being a first time mother hypochondriac and that it wasn't anything serious. I asked pregnant friends if they ever felt tight across their tummy. I even rang the midwives for a chat, but I guess I played it down, describing my symptoms but not mentioning just how scared I felt.

I wasn't really sleeping at night. I struggled to find a comfortable position. Sitting up in the car or at my desk was awful, it caused a continuous dull ache below my bump. One day I remember realising that the babies movement seemed to be weaker. I lay down on the (dirty) carpet under my desk and felt reassured when I felt stronger kicks against the pressure of the floor.

There was of course a scary possibility at the back of my mind. It had been there nearly the whole pregnancy. We found out very early on, at about 6 weeks, that we were expecting twins. We had sat basically speechless while my obstetrician showed us those two tiny babies and their heartbeats. I had asked him if he was joking, whilst Rob wanted reassurance there were only two! A couple of weeks later my Doctor shared another piece of news; the babies were sharing a placenta, confirming I was carrying identical twins. I asked him if this brought any added risks. He admitted that yes, one condition could develop, twin to twin transfusion syndrome (TTTS), but only about 15% of monochorionic (shared placenta) twin pregnancies developed TTTS. My Doctor reassured us that he would keep an eye on the babies frequently via ultrasound to ensure if it happened it was caught early, but not to worry too much as there were treatments.

That weekend I made the mistake of googling TTTS, and immediately wished I hadn't. I felt sick enough as it was with morning sickness, but reading about the possible outcomes of TTTS made me feel even worse. 

I quote wikipedia "As a result of sharing a single placenta, the blood supplies of monochorionic twins can become connected, so that they share blood circulation; although each foetus uses it's own portion of the placenta, the connecting blood vessels within the placenta allow blood to pass from one twin to the other. The blood can be transferred disproportionately from one twin (the donor) to the other (the recipient). The transfusion causes the donor twin to have decreased blood volume, retarding it's development and growth, and also decreased urinary output, leading to a lower than normal level of amniotic fluid. The blood volume of the recipient twin is increased which can strain the foetus' heart and eventually lead to heart failure. The recipient twin has a higher than normal urinary output, which leads to excess amniotic fluid. In early pregnancy (before 26 weeks) TTTS can cause both foetus' to die or lead to severe disabilities. The cause of TTTS is not known."

We tried not to dwell on the possibility of TTTS, but we approached each ultrasound with as much dread as excitement. With each good scan Rob and I relaxed a little. So as I grew increasingly uncomfortable during that week my vain hope that the babies had just gone through a growth spurt was fading. In hindsight I wish I had gone to the Doctor earlier, but I doubt this would have changed the outcome at all. I had no idea that within a week we would be parents.

A photo from the 12 week scan, showing the two babies. The diagonal line is the membranes of their separate amniotic sacs.

This day a year ago...

I have been meaning to share a bit more of the girls' birth story. But it just seemed to be too much to write about in one post. Overwhelmed in how to write it, after writing some initial notes and feelings before I forgot, I walked away and concentrated instead on watching my two little babies grow.

As their first birthday approaches however, I have begun to think about those days before they were born, and feel if I share a little about each day that led up to their early birth, then perhaps it won't seem like such an ordeal for the writer or the reader.

Recently somebody said to me that I should start to forget their prematurity as it might hold them back if I continually have it in the back of my mind in terms of their development. Whilst I would never want to hold the girls back with my own expectations, I disagree a little. Perhaps as only someone who has watched their tiny wee babies struggle to live can understand, everything that they do, every smile, every babbled word, every step, will mean a little more to us. When I think back to that first month, nearly every time we drove into hospital or back home I wondered if that would be the last time I saw my precious babies alive. Sounds melodramatic now, but back then their tiny little hearts, lungs and digestive systems were being pushed to deal with the outside world months before they were ready to. Infections could have posed a serious threat to their immune systems. Often we watched them stop breathing or their heart rate would drop dangerously low, bringing nurses and doctors rushing to their humidicrib, as we stood and watched helplessly.

While I sincerely hope that their premature birth never holds them back, and that there will come a day when I don't think about it, the experience has changed me: my outlook, my perspective, my priorities and even some of my relationships. I will be forever grateful I can be a Mama to our daughters, Maggie and Elisabeth, because there were many times I wondered if I would ever bring them home.

A year ago today I woke up and felt incredibly tight across my bump. It was Tuesday, the previous Friday we had visited my obstetrician and a scan had showed two equally sized healthy babies. I remember discussing his upcoming holiday, and he promised he wouldn't be going anywhere in late February when we expected to be welcoming our babies (we still didn't know their sex). We even discussed the milestone of reaching 28 weeks (just after Christmas) when the risk of cerebral palsy drops significantly with premature birth. Rob and I celebrated by going out to see the new James Bond movie that night, Skyfall. Rob later joked that perhaps the excitement of seeing Daniel Craig was too much for me, and brought about their early birth.

I had been through terrible morning (all day) sickness for the first 16 weeks of my pregnancy, but my second trimester had been going along just fine. When I battled through that day at work feeling uncomfortable and achey, needing to pee every 10 minutes, I remember thinking selfishly that the next three months would be unbearable. I got home and went straight to the window seat to lie down. I even cried. Maybe deep down I knew something wasn't quite right. You can read in my post the next day that I was trying to cheer myself up.

I eventually fell asleep that night, but it was not a restful sleep.

Friday flowers

Two babies sleeping. Must be time for a quick Friday flowers.

Foxgloves

Poppy

A rootstock rose from a failed graft I think.

Chicago Peace

I am being a bit impatient for the roses to get going. Then I remembered that last year they started when I was in hospital trying not to have the babies! Dear Rob would bring in a bunch of my roses each day, to brighten up my dreary room, and our mood, as I tried to put off the inevitable. 

Our girls were 11 months old (7.5 months corrected) on Tuesday. I can not believe they'll be one next month. I have not shared much of those scary days prior to their birth or indeed the night before they were born. I was in labour, all on my own, as I had sent Rob home, and I stubbornly didn't want to believe it was happening. So I didn't trouble the midwives much until I realised that I had gotten to the pushing stage, then the midwife found out I was fully dilated, with Maggie's head ready to go. The phrase "emergency Caesarian" doesn't quite describe that last crazy rush to theatre (with Rob speeding in from home to make it just in time). 

I've been thinking about it a lot this last week. I may even write about it day by day leading up to their birthday, as I think it is too much for one post. 

Friday Flowers

I missed Monday Menu this week, do not worry we ate! I'll try and be back next week. My rose garden is still producing blooms. This week I picked Valencia roses. I love how deep the yellow is. It is also fragranced. They graced our table this week, for my tea breaks, and for a morning tea with a friend, and her 3.5 month old son. Who is the size of our two girls put together. He is already in size 0. Our girls have certainly made the most of their 0000 clothes, Elisabeth is about to move up a size. She has hit the 4000g mark, Maggie is catching her though, closing the gap, she is 3590g.

Wednesday's post came out of nowhere, I have been drafting a birth story, but I was only half way through. I had been describing the last 8 days of my pregnancy: the scary diagnosis of TTTS; the amniotic fluid drains; the stress of the daily ultrasounds to check on how the babies were going; trying to halt labour for 4 days; and that final night before their birth when I had sent Rob home and I laboured alone. I ended up getting to fully dilated with Maggie basically ready to go with only a heat pack and a panadeine as pain relief. I didn't bother the midwives cause I didn't quite believe it was happening. That final crazy hour when it all got scary as the babies needed to be born by c-section and the nurses and doctors later told me they thought Maggie might arrive in the lift! Rob was still at home as they prepped me for theatre and he only just made it, apparently humming the James Bond theme as he sped into the city. 

I'm not sure how or when I'll share the rest of our story. It is emotionally exhausting to write, let alone read, so I will see, and keep chapters of the story for when it feels right to share.

Happy weekend to you.

A reflection on motherhood so far.

Before I was pregnant, and even during my somewhat truncated pregnancy, I often wondered if I would be a good Mama. Not many of my friends were new Mums recently, so I hadn't spent a lot of time around babies. As the eldest of 5 children born in 6 years (ironically no twins) I have some vague memories of helping with my younger siblings, but it was all a bit foggy. As much as I love reading your many blogs and watching how you are Mama/Mum/Mom/Mother to your children, I couldn't help but compare myself to you; motherhood seemed somewhat oblique to me. I was worried about my own skills, for want of a better word.

I read your birth stories and those precious moments when you held your baby for the first time, how you fell in love, and to be honest I was worried I may not feel it.

Also with your honesty about the reality of sleep deprivation, crying babies and other keeping it real moments, I wasn't sure I would cope with one, let alone two babies.

Now I know that at 5.5 months it might be too early to call, but I can already tell my fears were unfounded. I realised it this morning as I enjoyed a shower, a precious moment of alone time that Rob ensures I enjoy every morning (well except in the rare days I decide to stay in bed all morning thereby forfeiting my shower token).

My start to motherhood has been quite different to what I expected, and certainly very different to all those stories I read. While I wouldn't wish the premmie journey on anyone, I feel it is important I recognise all the emotions I felt and celebrate how I became a Mama. Particularly as I have no photos during my labour or the emergency Caesarian to help trigger my memory. 

This is the last photo of me pregnant, in a lovely hospital gown two days before Maggie and Elisabeth's birth. 

In the last few days as my Obstetrician balanced the risks of Twin to Twin Transfusion Syndrome (TTTS) to my babies, (we still didn't know their sex), against the risks of birth at 26 weeks, I refused to think about their birth. Perhaps in a vain hope it might delay that moment until it was safer for them.

At dawn on 12.12.12, despite all our worst fears, as I lay on the operating table, with a hastily erected curtain close to my face, Rob's hand holding mine ever so tightly, I heard our Doctor ask Rob if he'd like to stand up and see the first baby's appearance, and I felt excited. She joyfully announced "It's a beautiful baby girl", and as Rob's tears fell on my face, I quietly wept as I heard Maggie's tiny but determined cry, and I felt it. A love stronger than anything I had ever felt, particularly for someone I hadn't even seen, as I became a Mama. One minute later the Doctor asked Rob to stand up again and Elisabeth entered the world screaming just like her sister, and another wave of love washed over me for my second daughter.

The girls were whisked straight away into the care of a team of Neonatalogist Doctors and NICU nurses in the corners of the room. Rob was able to take a closer look and reported back to me that they looked like skun rabbits. Once stabilised their humidicribs were wheeled past me as I lay being stitched up on the operating table.  The nurse flipped down the side so I could see Maggie (at that stage still unnamed) for the first time. But given the number of tubes and the fact she was in a plastic bag for warmth I didn't see much. 

While we were in recovery and then in my room, the adrenaline of labour kept me excited as we waited to go and meet the girls and give them their hastily finalised names.

They wheeled my whole bed into NICU and as I got close enough to see into their cribs, my emotions overflowed yet again in silent tears as I fell in love hard with our tiny, red, jelly-skinned girls. Desperately wishing they didn't have to endure such a tough start to life.

I realised then the love part of motherhood is innate. The skills side of motherhood still worried me a little as I had my first cuddles (11 and 13 days after their birth), nappy changes and baths. But I treated our 112 day stay in NICU as a motherhood apprenticeship. Surrounded by professional baby nurses and lactation consultants, many of whom were mothers or fathers themselves, I asked questions constantly. But the wisest advice given by a few nurses about how to care for babies was to do what feels right for us. 

In doing that I have surprised myself. I can be a good Mama to Maggie and Elisabeth, and I have coped so far with the intense needs of two newborns; with Rob helping me of course!

I look forward to continuing to learn and trusting my instincts as a Mama.

My first twin cuddle 38 days after their birth. Arranged as a birthday present for me by the NICU nurses. The best present I have or may ever receive.