Alexis and Jenna - January 2, 2011

Here we are more than a month after the birth of our twin girls, finally getting around to writing a back-dated blog post to go through the sequence of events that led to the unexpected early arrival of Alexis June and Jenna Joyner Robb. What follows is a somewhat verbose account of our time in the hospital and Katie's labor and delivery with only a single picture thrown in at the end. We're recording it here as much for our own records as to share, so if that sort of thing isn't your cup of tea we won't mind if you stop reading here and check a later post for baby pictures.

Katie began to feel contractions with back pain on Wednesday, December 29 while visiting family in Greenfield. The usual methods of stopping contractions didn't seem very effective, nor did the medication she was prescribed for that purpose. She decided to try to sleep it off, but on the morning of Thursday the 30th we decided to go ahead and call the doctors' office for a recommended course of action. We both rather hoped she'd simply go in for an office visit, get checked out and sent home, probably with instructions to rest. It didn't work out that way. We called Katie's parents over from Greenfield to watch Clark because the doctor had instructed Katie to go to the hospital's labor & delivery ward, and we knew from experience that such a visit would take at least a few hours if all went well.

Upon checking in around 11am, the triage nurse found Katie to be 1cm dilated, and because the contractions hadn't decreased in frequency or strength she was given a dose of a muscle relaxant and we were told to hang out a while. A second dose of the same drug didn't have any more effect than the first, and when they checked again at 3pm she had progressed to 2.5cm dilation, which raised the red flag.

The doctor on call made clear that she intended to be aggressive in attempting to stop Katie's labor, which unfortunately meant admitting her to the hospital and starting administration of a stronger drug in magnesium sulfate, very restricted activity, and unfortunately for her, no food. At 6pm that evening the first of two steroid shots were given, a treatment that apparently has significant impact on respiratory development of premature babies; though painful at the time, this was a sort of "insurance policy" that turned out to be a significant contributor to the girls' health later on. With some further medical assistance, Katie was able to get some sleep that night, even with all the discomfort imposed by the magnesium, fluid drips, movement restrictions and lack of food.

Friday morning, the 31st of December, brought frustration. At this point neither of us had a clear understanding of the intent of the hospitalization. Were we trying to stop labor? Was there any real hope of that at this point? Were we simply trying to hold off as long as possible (or to some arbitrary date) by any medical means possible? Why on earth were they refusing to let Katie eat anything? This day was composed mostly of sitting around waiting, broken up only by a new doctor finding Katie had progressed slightly more to 3cm, and therefore being completely forbidden from getting out of bed. Fortunately a compromise was reached later in the day and Katie was allowed to eat, so Vic brought some Subway. The second and final steroid shot went in at 6:30pm, and by that point we at least understood that another 24 hours would be required for the steroid shots to take full effect, so we figured we'd be in the hospital for at least the rest of the weekend but were still unsure as to whether labor might stop. It didn't.

After a second night of mediocre sleep in the hospital, Katie woke up to more of the same on Saturday, January 1st. A third different doctor was on call, and eventually communicated that his plan was to keep Katie on the same regimen of magnesium and bedrest until midnight to give the steroids ample time to take effect, and then stop the medication and let nature take its course. If that meant labor and delivery then so be it; there was also still a chance that labor might stop and we'd be sent home. Dr. Gomez's plan had to be adjusted that afternoon however, because Katie felt some chest pains and although an EKG and chest x-ray came up negative, he felt it best to discontinue the magnesium and remove the activity restrictions.

By 8 or 9pm Saturday night, Katie had progressed to 3-4cm dilation and began to experience some abdominal pain inconsistent with her prior labor experience with Clark. Our astute nurse moved her to a room more conducive to laboring (and closer to the operating room), and went ahead and had Katie fill out consent forms and get all her paperwork ducks in a row. This turned out to be a wise move.

The abdominal pain continued through the night and into Sunday morning, increasing in intensity. Eventually it became strong enough that Katie requested an epidural at around 7:30-8am. At this point she had progressed to 6cm dilation and it was clear that one way or another she was going to have the babies that day. We didn't realize it would be within the hour.

Part of the normal monitoring conducted by the nursing staff was to keep two fetal heart rate monitors attached to track the heart rates of each of the girls independently. Throughout our stay at the hospital the staff had had intermittent difficulty in locating the second heartbeat with the monitor, and the new nurse on duty Sunday morning wasn't having any luck either. She called in the Dr. to try to locate it by ultrasound after Katie's epidural had been put in, and we found out later that the sequence of events that followed may have made the difference between Alexis being born healthy (if early) and dying in the womb.

Dr. Gomez was able to locate the second heartbeat on the ultrasound, but rather than use the external monitor he decided to break Katie's water in order to place a scalp electrode on one baby and track the other's heart rate externally. Upon breaking her water however, Dr. Gomez was visibly taken aback and concerned by the amount of blood he found in the amniotic fluid. He immediately called for a c-section and Katie was whisked off to the operating room. I followed after putting on a set of scrubs, and no sooner had I sat down beside Katie than Alexis was being delivered at 9:07am, followed less than a minute later by Jenna. The pediatrician on call was in the operating room with us and offered to take some pictures for me, so I was able to post this photo of the girls to facebook from the operating room literally minutes after they were born. You can see more photos of the girls from that day and the rest of January by clicking on the link underneath the picture.

From January - Twins

We learned later from Dr. Gomez that the abdominal pain Katie had been feeling was Alexis's placenta detaching from the uterine wall, rupturing and bleeding. The reaction he had when breaking her water was a fear that the blood he found meant Alexis was already dead, and his assessment after successfully delivering both twins was that another 10-15 minutes of delay would have almost certainly resulted in that outcome. Fortunately that's not what happened, and Alexis and Jenna were both born without further complication and went up to the special care nursery for evaluation and monitoring.

Vic and Barb were able to come to the hospital that day as well as Tom, Sara and their kids. Clark got to come see Katie for the first time in several days on Monday, Jan 3 before Vic and Barb took him back to Ohio with them for the week. It's hard to imagine how the whole experience could have been much different from when Clark was born, but the spending the next 3 weeks visiting the twins in the hospital's special care nursery proved that it indeed could be. More on that will come later. Carving out 90 minutes to write all this up has been difficult with 3 kids needing constant attention (if the narrative was disjointed or confusing in parts, that's probably why), so further updates on life since the girls were born will come when they come.