Aliya & Bennett

(Originally written August 16, 2011 and moved from blog post to page on November 11, 2011)
Paul and I were introduced in April 2005 by my friend Amanda, who was engaged to Paul's younger brother (she's my sister-in-law now). Even though I was dating someone else at the time, she declared me Paul's perfect match and would not let it go! She was right, of course. Paul asked me out a couple of months after I broke up with the other guy, and we went on our first date just a week later. We got engaged Thanksgiving weekend 2005 and married in September 2006.

We started trying for our first child in October 2007, one month after our first anniversary. I saw a doctor 9 months later, even though it hadn't yet been a year and I wasn't yet 35 (I was 33.5)...I suspected something was wrong. The doctor asked me to use ovulation predictor kits (OPKs, which the woman pees on daily from days 11-18 after her period to detect the most likely time of ovulation) and wanted Paul to get a semen analysis. He procrastinated for 6 months but once we got results back, we knew we'd have a challenge: low count, low motility and poor morphology.

We tried on our own for 2.5 years. It wasn't until Paul's 20-year high school reunion in 2010, when he learned that two of his old school buddies also had issues getting pregnant, that he accepted  we should seek help. We endured ten months of lots of testing on me (most completely normal, some invasive), a diagnosis of either endometriosis or "unexplained infertility", thousands of dollars spent, four failed natural intrauterine inseminations (IUIs) and one failed injectible IUI (converted to IVF because I developed too many eggs). Finally, in May 2011, we did our second superovulation IUI using mini-Lupron and Menopur shots, plus a trigger shot of pregnancy hormone to make my body release the eggs that had developed. (The IUI procedure involves multiple vaginal ultrasounds to follow ovarian follicle growth while the woman is injected multiple times for several days with, in my case, one hormone to suppress ovulation and one to grow and mature multiple follicles, which contain egg cells. Once the eggs are likely to be mature, the last carefully timed shot causes them to be released from the ovaries, and IUIs are performed 24 and 48 hours later.)

The last weekend of my "two week wait" between the second IUI and our scheduled blood pregnancy test, or beta, I was extremely forgetful and a little testy. We had traveled several hours away on an overnight trip to Eastern Oregon to attend an event. It took me three back-to-back trips to and from the car to grab everything I needed to perform the responsibilities I had at that event. I was annoyed with myself, but it didn't occur to me that perhaps something was going on.

On Tuesday, May 24th, I felt very moody and unwell at work, so I left early. I was surprised to find I had one leftover home pregnancy test in the bathroom, so for fun, I peed on it, certain to get a negative result like I had 43 times before. I was stunned when the digital display almost instantly read "Pregnant."  I ran to Walmart to buy more tests and find a way to tell Paul the news. He beat me home and I ratted myself out - that I had left work early, peed on a stick and we're pregnant!! We were ecstatic and in total disbelief! Our scheduled beta the next day, May 25th, at 14 days post-IUI, confirmed it...we were finally, finally pregnant! Not only that, but Sierra, the medical assistant, called to say, "Girl, you are SO pregnant!" My first beta level was 227. Anything over 5 is positive.

My fertility doctor, Dr. M., only checks blood pregnancy hormone levels (human chorionic gonadotripin, or hCG) once per week, and we were holding our breath between each of the three tests. The second was 3800. I wondered if we had multiples in there. The third test was over 54,000, and Dr. M. actually wondered if there were triplets! At our 7 week ultrasound we saw two little embryos and heard their hearts beating strongly. Dr. M. confirmed we were expecting fraternal twins. We were over the moon, and scared to death. Going 43 cycles straight with no positive pregnancy tests had made us a little jaded and we waited for the other shoe to drop.

I read up on twin pregnancies and learned they're difficult, often fraught with risks, bedrest and early delivery, and learned I'd need to gain weight, as much as 50 pounds, the first 24 pounds by the 24th week of pregnancy. Given the constant nausea and frequent vomiting that started up in week 6, I was very concerned, since I'd dropped weight rather than gained it. (At time of delivery I had just finally made it back to my pre-pregnancy weight. When we got home from the hospital, I was 6 pounds below my pre-pregnancy weight...all my weight gain was due to increased blood volume, amniotic fluid and two tiny babies.)

Paul wanted to scream our news to the world, but I wanted to wait. It's not wise or safe to spill the beans in the first trimester, and I was determined not to. However, his constant nagging at me to tell his family coupled with my extreme fatigue and horrible morning (all day) sickness wore me down, so I agreed that we could tell his family as my 40th birthday gift to him during our annual family camping trip. We told them around the campfire the first night of camping, way up in the mountains, at 7 weeks 2 days pregnant. Everyone was overjoyed and surprised.

The next day, on June 18th, in the middle of our first full day of camping, I was trying to take a nap in the tent when I felt a little gush. I had been experiencing some urine leakage thanks to my ever-expanding uterus putting pressure on the nerves, but my heart sank when I realized it was pink liquid...not blood, but definitely not urine. Thankfully, Paul rode into camp at that moment on his quad. We grabbed the dog and our clothes and raced down the mountain into cell phone range to call my doctor. He couldn't see me until the next day, and since I was certain I must be miscarrying, we opted to wait rather than waste the money on an ER visit.

We were stunned to learn I wasn't miscarrying at all. I'd had a "maternal bleed" that had already clotted, and both babies were just fine. (We didn't learn until weeks later it was actually a moderate placental abruption with Baby A, the twin closest to my cervix. Baby A also had placenta previa, meaning the placenta was attached over top of my cervix. This is something that usually corrects by week 20, but if it fails to, it can lead to catastrophic consequences. The abruption could have been a fluke, but most likely happened because I kept bending at the waist to get into and out of the tent.) I was  placed on bedrest for a week, not allowed to lift anything over 10 pounds, or bend over or exert myself in any way. Paul transformed into Superman and assumed all household and farm chores (we had a flock of chickens and 5 Scottish Highland cattle, plus a dog and two cats, plus a 2000+ square foot house...and he works full time, too).

Life became a bit challenging and even scarier, but everything seemed fine after that, even though I still spotted almost constantly. Work was becoming a challenge due to my nausea and discomfort. I was sick as a dog, often peeing my pants every time I threw up, which was no fun at all. I worried about my weight gain (or lack thereof), but was told not to worry. My doctor figured the culprit behind the continued bleeding was a cervical polyp, since none of our additional ultrasounds showed any indications of blood in the uterus. The original abruption had healed, and, little by little, Baby A's placenta was moving off of my cervix as my uterus continued to grow by leaps and bounds. My fertility doctor released me to regular obstetric care at 11 weeks 1 day, just as planned.

I had two appointments with the HMO's obstetrics department, first with a nurse to have all my bloodwork taken, then two weeks later with a midwife for an annual exam. In both cases I expressed concern about when I - a high risk twin pregnancy - would see an OB, but I was assured that "they do twins all the time", I wasn't that old, and bleeding during a twin pregnancy is perfectly normal. My first regular OB appointment was scheduled for August 23rd, at 16 weeks 6 days pregnant.

Meanwhile, Paul and I traveled 1.5 hours north up to the University of Washington for a nuchal translucency (NT) scan, which is an ultrasound technique used to detect the risks of birth defects, mainly trisomies. The car ride, what with my giant uncomfortable belly, was a bit much for me, but we made it, and were thrilled to learn that both babies were as healthy as could be! The risk for trisomies in a 37-year old woman is 1:170, but twins doubles the odds to 1:85. Amazingly, Baby A received a glowing 1:749, and Baby B stunned us with 1:1049! With odds like that, there was, thankfully, no reason to do any further testing, ruling out the need to undergo either an amniocentesis or chorionic villi sampling (CVS), both of which carry risk of miscarriage. We happily entered the second trimester - the "safe" zone - at 13 weeks on Wednesday, July 27th, and, relieved, finally felt safe enough to share our pregnancy news with friends and the outside world. We visited Babies 'R' Us that weekend to check out strollers and carseats - finally feeling confident enough to look at those big items. I'll never forget the sight of my silly husband popping wheelies and making racing noises with the double stroller in the middle of the aisle! Our car had a notoriously shallow back seat so we had more research to do, but really liked one stroller/carseat combo that had elephants on it. I know in my heart, looking back, that's the one we would have selected.

Meanwhile, the evening of Friday, July 29th, at 13 weeks 2 days, my "normal" vaginal discharge (which had been mostly spotting but had recently gone to clear) changed to peach-tinted mucus. I had read to expect a change in discharge in the second trimester, but I still thought it was weird, so I called our HMO's consulting nurse line. I was seen Monday, August 1st by an OB, who said it was just my cervix acting up; I was not dilating and the babies were fine. The very next day the peach color turned to red, so I called the consulting nurse line again, who immediately paged the OB on call. They arranged for me to have a very detailed ultrasound the next day at Providence St. Peter Hospital on Olympia, who has much better equipment than the HMO (necessary for checking on twins), followed by another OB visit afterward.

The ultrasound took 1.5 hours and was horribly uncomfortable, but I was able to watch on the wall-mounted flat screen and delighted in seeing my babies. Just like all our other (six) ultrasounds before, everything appeared fine. The babies were very active, causing trouble for the techs, who were trying to measure femurs and head circumferences and check for two hands and two feet for each baby.

Later that afternoon, the OB I saw said I'd had another moderate placental abruption with Baby A. Unlike the first time, this doctor did not recommend bedrest. Instead, he told me to take it easy but resume my normal activities. He did say one thing I will never forget: the presence of blood is an irritant and could cause premature rupture of the membranes...if it happened close to delivery that would be fine, but if it happened earlier it might not be fine. Given my first abruption healed itself and I had been told time and again that spotting was normal for twins, I didn't let that worry me too much. That evening I started feeling my big belly harden and soften. I even had Paul feel it. It didn't hurt and there was no regular pattern, so I thought it must be early Braxton-Hicks. Everything with multiples pregnancies happen earlier than singleton pregnancies. I wasn't worried...but in hindsight I should have been...

The next day, Thursday, August 4th, I woke up feeling like I'd been hit by a truck. My entire body hurt. I had an appointment scheduled with my osteopath that morning and almost didn't go, but decided perhaps he could help my body feel better. He did some work on my back, neck and round ligaments as they were bothering me a lot, and I left his office moving slowly but feeling a little better. I spent an hour or so at work while my manager taught me to use a VPN fob with the laptop that had been checked out to me, so that I could begin working from home full time, starting the very next day. I felt so crappy when I got home that I just lie on the couch, watching TV, the laptop and fob forgotten. Then, at 4:50 p.m., a mere 26 hours hours after hearing the OB's comment about ruptured amniotic sacs, I felt a gush. Every time I moved it gushed more. It wouldn't stop. I checked in the bathroom; this was not urine. I called the consulting nurse line, who paged the on-call OB, who told me to head to the St. Pete's ER. I called Paul, who was at his brother's house 20 minutes away, and told him to hurry home. We sped the 30 minutes to the ER as soon as he pulled in our driveway.

In the emergency room waiting area, we joked and kept it light. I guess we were both in a bit of denial, but given our early experience with "gushing" and Baby A's abruption, we thought the outcome might be the same.

Of course, time in the ER moves at a snail's pace. It took the ER doctor - who, for the record, was a total jerk, saying things like, "They told you that 25% of these things end in miscarriage, right?" - over 5 hours to get me in for an ultrasound and vaginal swab, while I lie there in a puddle of amniotic fluid.. (These were ordered by the on-call OB, Dr. A., thank God, because it seemed the ER doc was just going to send me home.) This time, the flat screen monitor - in the same ultrasound room I'm been in just two days before - was not turned on. The ultrasound tech was very serious. Paul stood by my side, watching the screen, straight-faced. (Only later did I learn that he knew what he was seeing, and that it was very, very bad. It breaks my heart that he'll carry that image in his mind forever.)

Once back in the ER, Dr. A., a very compassionate, caring OB from our HMO, confirmed the bad news: Baby A had had a complete rupture of the amniotic sac and there was virtually no fluid left, plus both babies' heart rates showed signs of distress, possibly due to infection. There would be no happy ending was impossible.

She gave us three options: go to the Family Birth Center for induction of labor; go home and wait for labor to start, and then come back for delivery; or wait for the babies to pass away and do a D&C (dilation and curretege, where they would knock me out and physically remove the pregnancy from my uterus). There was no way to save the was too early and what had started could not be stopped. We chose to be admitted and have my labor induced, and we're so glad we did. We wanted to experience this most important event in our lives and see our babies.

At about 12:30 a.m., once I was comfortably in bed, they gave me Cytotec by mouth and an IV Dilaudid pump for pain. Paul, still filthy from his logging job, starving for having not eaten since 8:00 a.m. the day before and desperately tired, went home to shower, eat, grab some things from home and feed the dog. Our nurse, Stephanie, set up a bed for him next to mine when he returned and we both tried to get some sleep. (Stephanie was the same nurse who was called to the ER to swab my vagina to check for amniotic fluid. It was weird, but we were both relieved to see her sweet, familiar face, knowing she would care for us when we needed her most.)

Hours later, having dozed a little bit and realizing I was pushing the button on my Dilaudid pump quite frequently, I called Stephanie, saying I had to pee and that the Dilaudid wasn't working anymore for some reason. I had no sense of time, so didn't realize what was actually happening. Stephanie came in to help me and as I stood up, holding a giant pad thing between my legs to catch the leaks, I felt something "big" come out. When I sat on the toilet and looked into the pad, there was our daughter, all 5 1/2 inches and 1.2 oz of her, born at 6:14 a.m. I immediately started to vomit and couldn't stop. Our son was born four minutes later, in my bed, at 6:18 a.m., measuring 5 inches and weighing 1.3 oz., Paul standing next to the bed trying to get his clothes back on.

Time really stopped then; I think I was in shock. It was definitely an out of body experience. I recall looking at the clock, then at the nurses sitting between my legs, holding handfuls of giant blood clots as they dug through them, looking for the placentas, asking me to push, and massaging my uterus. In the end they rushed me in for a D&C. Paul said later he was so scared. I was oblivious to everything and remember those moments only in dim mental snapshots.

Paul called both our families as they wheeled me to surgery. Most everyone was able to come see the babies (his parents live 1.5 hours southeast of us and mine live 2 hours north, so they had a way to drive.) I think they were all stunned to find the babies in the room. I know we were surprised and overwhelmingly grateful for the opportunity to stay with our children, and to have our families meet them, even though I'm sure it was scary to see them.  Babies born earlier than 28 weeks have not yet accumulated body fat, so their skin is transparent, giving them a beet red appearance. Plus, our little 14 weekers were tiny and yet perfectly formed, with 10 wee fingers and toes each, little eyelids that were closed, round little heads. It meant the world to see both my mom and my grandma hold the babies on their laps, and I know they both said prayers over them as well.

We stayed in the hospital and let our nurses care for us for a total of 30 hours, and the babies were able to stay in the room with us the entire time. This extra time meant the world. In the hours after their births I was numb, both from the hormones and from the drugs I was given during surgery. I later heard that I seemed very pulled together, while Paul was a mess. Later, at home, as we read through the bereavement information we received from the social worker, we learned Paul had exhibited all the classic signs of shock: extreme cold, shaking, etc. I was just drugged and numb. The last family members didn't leave our room until after 7:00 p.m. I was grateful to finally have some time alone with my husband and our babies. Still, my tears didn't come until 2:30 a.m., when the Ambien they prescribed to help me sleep failed. I stood in my hospital gown and fuzzy green socks, holding my babies to my chest and sobbing, while Paul slept the sleep of the dead in his cot.

That last morning in the hospital was very difficult. The on-call OB, Dr. C., visited and verbalized my discharge instructions. (For the record, we both hated her. She - plus the fact that I wasn't taken seriously as a high risk OB patient by the HMO - are the reason we'll be kicking our HMO to the curb come January 1.) Finally, our morning nurse came in with the written instructions, and it was time to go. She brought in our beautiful memory box, a pale teal satin-covered box, tied with a bow, containing the card with hand and footprints (the first I'd seen of them), the birth stats (the first I'd learned of their weights and measurements), two little preemie hats that could have fit their entire bodies, a card and journal, and the hospital bracelets I would have worn had they been born alive, months from then, like they should have been. When it was time, we kissed our babies one last time, and our nurse wheeled me out in a chair, holding my bag of person things and the memory box. It was surreal.

We're so grateful to the nurses who took care of us. Stephanie was so compassionate and steady in the face of our personal disaster. Vivian washed and arranged our babies so carefully, displaying them in an isolet, encouraging us to hold them and calling a photographer to take professional photos. She painstakingly recorded their hand and footprints on paper, and later transferred them to a card for our memory box. She checked on both of us (and our visiting families) frequently, making sure we were ok, and had the chaplain and social worker visit as well. Dianna helped us transition home, presenting us with our memory box, wheeling me out to the car in a wheelchair, hugging us both, hard, multiple times, and offering to personally escort our children (probably to the morgue) for cremation. We are forever grateful to these three women...and do hope to see them again in the Family Birth Center for a more joyous occasion.

The days after delivery were a very quick blur. There was a lot of crying, lots of talking and tender moments, forced meals and showers, a couple of day trips away from home. So many "what ifs" and regrets have flowed through our hearts; we know this is all part of the grief process. One thing that ate at me for days was the memory of having our children blessed the night they were born, and having no names to give them. We weren't supposed to have found out their sexes for another 6-8 weeks, and hadn't even started talking about names. Seeing "Baby Girl" and "Baby Boy" on the blessing certificate was crushing to us both. It took us four days to name our son and three more to name our daughter. I'm currently working on announcements for our families so that they get the spellings right and understand the meanings of their names, since that's why we chose them, and once our families know, I'll share their names here as well.

Today, 11 days after our loss, the waves of grief wash over us both at unexpected times. Yesterday was Paul's first day back at work; I may go back (telecommuting) next week, or may wait another week. We joined a support group one week after delivery, and look forward to the next meeting in September as it was tremendously helpful. I'm in touch with friends I've met online through a conception and pregnancy website, and that's helpful, too.

Recovery from the D&C wasn't bad. I wanted to gush blood or feel excrutiating cramps, or have my breasts become engorged and painful with milk that I couldn't use, anything to feel the physical punishment of what had happened, but it hasn't been like that at all. Recovery has been gentle, fairly easy. I regret that we didn't take photos of my belly, which was already getting really big. It amazes me how fast our bodies forget big belly is reduced to a flabby little thing that I can "suck in", whereas delivery day my belly was big and round, hard with babies, and I was waddling already.

We will start trying for Baby #3 soon, within the next couple of months, because we are fairly certain infertility treatments will be needed again and we have no time to lose. I didn't share a lot with folks what we went through up to getting pregnant, but will probably be more open this time around. I hope that as we move through our journey through pain to hope others will learn with us.

Time will heal, but will never, ever take away our memories of our first two children, nor will we want to forget. We were scared for the duration of this pregnancy, but we never imagined we'd end up in this place of loss.

(Footnote: in the weeks after this was originally written, we learned that an "infarcted endocervical polyp," or bleeding polyp inside my cervical canal, actually began the chain of events that led to our loss. The constant bleeding through the duration of my pregnancy weaked my mucus plug, letting normal vaginal bacteria get to my babies and make them sick, which started preterm labor as my body attempted to protect itself from infection. The preterm labor caused our daughter's amniotic sac to rupture. As of September 2011, all evidence of the polyp was gone. Unfortunately, I will now forever be at risk for placenta previa, placental abruption and preterm labor for future pregnancies.)
Birth stats, made for us by Nurse Vivian

Our babies' tiny foot and handprints.
Each footprint could fit inside the first joint of my little finger.