Molly’s Cesarean Birth of Twins (complete placenta previa!) 1


So, I was pretty much considered a “high risk pregnancy” from the start. “Advanced maternal age” at 39, conceived via IVF with ICSI (although it’s controversial as to whether this confers any/much additional risk or not), and twins. Conceiving had been so awful (three years of infertility, multiple failed attempts, arguments with my husband who didn’t want to do IVF, tens of thousands spent, finally a pregnancy with my first IVF that then miscarried before I conceived the twins on my second IVF attempt) and it had been so far from natural that I really wanted to just have a normal, natural delivery. This was my first pregnancy (not counting the miscarriage), but I’d had a huge fibroid removed a few years ago. Still, they hadn’t cut into the wall of the uterus with that, so I was assured that there was no increased risk with a vaginal delivery.

Baby A was head down from the start. And I was seeing an acupuncturist for morning sickness who assured me that she had had success in the past with using acupuncture and moxibustion to turn babies closer to term if one of them was breech. So I had high hopes for a vaginal delivery. So at my 18-week anatomy scan, I was disappointed when they said it looked like I had a complete placenta previa (PP). Still, I’m a family practice physician so I knew something about PP, and of course I read a lot more as soon as I was diagnosed. I was reassured to see that most resolve and only about 1 out of 200 pregnancies have a complete PP at term. I still felt like a vaginal delivery was possible. But I knew as a doctor (and also talking with a friend of mine who is an epidemiologist who implements plans to help with infant mortality in third world countries) that if it didn’t resolve, a complete PP truly is one of those “absolutely must have a c-section” situations (infant mortality in areas where women don’t have access to c-sections is usually well over 50%, and maternal mortality rate is high as well).

Successive scans at 22 and 26 weeks showed no resolution and the doctors started to seem less confident about it resolving. I began to feel resigned about a c-section but still felt someone “cheated” out of the vaginal birth experience. Then I bled. I was 29 weeks 2 days and woke with a slight bellyache. Drank some water, lay on my left side, felt a little better but had to go to the bathroom after all the water. Was on the toilet and just felt a (painless) “pop” and felt fluid just POURING out of me. Thought, “OMG, my water just broke and I’m only 29 weeks” then looked down and saw that it was blood pouring out of me. I was terrified. Never even thought about the possibility that I might be at risk from excessive blood loss, I just thought I was going to lose the babies.

My husband called 911 and I waited for what felt like about the longest 10 minutes of my life. The blood flow slowed but continued in a steady trickle. Finally they got there and took me to the nearest hospital. Started an IV in the ambulance, and immediately on arrival they found both heart tones (thank God!) and then ultrasounded the babies. They looked fine and the bleeding was slower but I had started contracting at that point. Long story short, the contractions weren’t stopping and I was at a small community hospital without a NICU. Snow was in the forecast so the OB felt safer transferring me into Pittsburgh to a hospital with a NICU. I was in FULL agreement!

The next few days were kind of a blur of specialists (anesthesiologists, high risk OB doctors, neonatologist) and shots to mature the babies’ lungs, magnesium sulfate to decrease the chances of cerebral palsy if I delivered that early, and meds to stop the contractions. Finally things stabilized. Speculum exam and then an U/S confirmed that my cervix was closed but I still had a complete placenta previa. As things stayed stable over the next few days, the high-risk doctors started talking about the long-term plan if I DIDN’T deliver then. They had different opinions about whether I should be on hospital bed rest until I delivered or whether I could go home on bed rest. It was kind of hard when not everyone was in agreement, but I have to say that they all gave their reasons for why they thought a certain course of action was best, and they listened to my concerns (I lived over an hour from the closest hospital with a NICU, it was winter so weather/road conditions were unpredictable, my husband travels a lot for work so I might not have someone around to take me to the hospital).

To give you an idea of my background and how that affected my thinking, I had done my residency training in a program that was very “crunchy granola.” We worked with midwives a lot, and the doctors who trained us emphasized that there was no evidence that interventions like continuous fetal monitoring improved outcomes. They encouraged women to have birth plans, and supported natural vaginal deliveries. I didn’t do obstetrics in my practice after residency, but when I talked to patients I always encouraged more “natural” things like breast feeding, vaginal deliveries if at all possible, doulas, etc. But the bleeding episode terrified me, and all of the sudden I felt like for me, I wanted a very “medical” experience. I wanted frequent non stress tests and ultrasounds. I got nervous if we went more than about 12 hours w/o listening to heart tones. And I definitely wanted to stay in the hospital until I delivered.

I had worked with one of the high-risk doctors as a resident and I REALLY respected his opinion and he thought I should stay. And my husband was terrified to have me come home. And I just kept thinking that if I went home and something bad happened where the outcome might have been different had I stayed, I would NEVER forgive myself. So I stayed. And had nonstress tests every three days and ultrasounds every three to four weeks, for six weeks. I had many discussions during that time with the doctors about when it was best to do a c-section (risk of a bad rebleed increases closer to term, so we were trying to get the babies to grow and develop as long as possible but ideally do a section before I rebled, so it could be more planned and controlled). We decided on 36 weeks. That was their suggestion but I felt like they gave me some leeway and probably would have let me choose a week sooner or later if I felt strongly about it.

I was SO happy that I had not delivered at 29 weeks that it no longer mattered to me how I delivered. I stopped grieving the missed opportunity for a vaginal delivery because I was just so happy that we had a safe way to get the babies delivered. Then, at 35 weeks and 2 days, I bled again — suddenly and with no warning (I was sitting in bed and felt a gush). I had just finished watching the inauguration and emailed a friend about it. When I checked the time stamp later on that email, it was sent at 12:44. I was still sitting in bed when I felt a gush, scooted back, and saw blood. I hit the call button and told the nurse I was bleeding. Within less than a minute several nurses were in the room and the resident was there a minute later. I called my husband who was just leaving a meeting at work, so I was lucky to catch him. He immediately headed in but was about an hour away.

They checked the babies as they were starting a 2nd IV, and they looked fine (normal heart tones). As they ran down the hall w/me in the stretcher, I asked if I could stay awake for it (if they had time for a spinal) and they said yes as long as the bleeding didn’t get too bad. I didn’t ask them to wait for my husband. I could have asked, but traffic is unpredictable and he was AT LEAST 45 minutes away. And I’m not sure if they would have been willing to wait even if I had asked. The babies were born at 1:27 and he arrived a few minutes later (the time stamp on his first picture of them was 1:38). I was disappointed that he missed the delivery and I think he was too but he’s not one to talk about things like that. But I was so scared that something bad would happen to the babies that I think if they had asked me if I wanted to wait for him, I would have said no.

The doctor I knew from residency was on call and he held my hand and talked to me as they placed the spinal. The anesthesiologist was great and said she would be my “support person,” and she gave me a play by play of what was going on. When Baby A was born and they said it was a boy (I hadn’t found out), I was SURE I was having two boys because B had been a “troublemaker” all along (they had to chase B for heart tones, B would always kick the ultrasound tech, B was always over on A’s side crowding out A, etc., so I was sure B was a boy).

mollynikolai

 

So when they announced, “it’s a girl,” for B, I was thrilled to have one of each!

mollynatasha

 

My husband took lots of pictures and they held the babies up for me to see. And as soon as we got out of the OR, they brought them to me and my son immediately got to try to nurse (my daughter was hypoglycemic so had to get some sugar water).

Overall, it wasn’t the birth experience I would have chosen, but there really wasn’t another choice. I think I got to have autonomy and make my own decisions, and in a way it was easier than if I had to decide whether to try to deliver a breech baby vaginally or something. This was a no-brainer with the complete placenta previa. I wish my husband could have been there and been the one to announce the genders, but waiting for his arrival would have been too scary for me and probably for everyone else! Right after we delivered, another woman was wheeled into the recovery room. I never saw her but I heard them saying that her baby was 1 1/2 pounds. Hearing that, and seeing all the REALLY sick babies in the NICU (our son had a few low oxygen sats so was there for three days) definitely helped me get over any sadness I felt about having such a medicalized experience because I was just so happy that we had two fairly healthy babies.

Recovery has been tougher than I thought. Six weeks of bed rest definitely weakens the body. Add on fairly significant blood loss and then the sleep deprivation of taking care of twins (especially twins who are having trouble nursing, so I’m having to pump and feed them breast milk a lot), and I was pretty beat for the first month or so. I’m a runner and normally can run 5 miles w/o a thought. About 6-7 weeks after they were born I tried to walk/run a mile and it exhausted me! But the c-section incision has healed great. I only needed pain meds for a couple days. I’ve been taking iron and now, at 13 weeks post-partum, I feel much less exhausted.

Baby A, Nikolai, is a sweet loving little boy (always wants to cuddle and be held). Baby B (the wild feisty one I was sure was a boy) is a feisty little girl, Natasha. She barely sleeps, likes to be up and looking out at things, doesn’t want to miss anything that’s going on. Both great babies! Totally worth everything!

molly1

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One thought on “Molly’s Cesarean Birth of Twins (complete placenta previa!)

  • Laura

    Wow, Molly! What a beautiful story!! I am just all tears here and so happy that you got to make your own birth choices and felt safe. I loved how you told of your babies personalities and how you didn’t find out sexes and hot one of each!! Awesome! Thank you so much for sharing and congrats on growing two heathy babies!