It has been a very exciting and eventful week and I have a lot I want to write and share about it, but as usual, life seems to happen faster than I can write about it. Our precious twin daughters were born on last Tuesday, April 7. We expected them to be born early because twins usually are, but at 31 weeks, 4 days, they came even earlier than we expected. The babies are in the NICU but doing very well, and Mommy Kate is still in the hospital recovering from her c-section but also doing well and expecting to get discharged tomorrow (Saturday). There’s much I’d like to share and make sure I get down before memory fades, but in the interest of a writing goal I hope to manage in the next hour or two, I’m not going to even try to catch up and will just tell our birth story :

Kate was on bedrest at home for about a month, ever since she was discharged from a 5-day hospital stay about a month ago for severe gall stone symptoms. Her gall bladder improved enough to delay surgery to remove it until after the babies were born (we hoped). Our OB ordered bedrest not for the gall bladder stuff, but because there were some indications that she was at elevated risk of preterm labor. We knew bedrest was probably inevitable, so it was earlier than hoped, but not really a surprise or setback. Kate came home and stayed in bed except for bathroom trips, occasional showers, and going to doctor appointments, while adhering to a low-fat diet to keep her gall bladder settled down.

Last Sunday morning (4/5), when Kate went to the bathroom after waking up, there were some signs of early labor - not enough for us to conclude for ourselves that it was definitely preterm labor, but enough to call the on-call doctor at our OB group. (It’s a group practice of four docs, so “our” doc isn’t always on call.) The on-call doc told us it might be nothing, but to keep a close eye on it and if it continued, go to the hospital. (I’m being deliberately vague about the signs only because I’ll probably share this story with a mixed audience and I don’t want to get all TMI on everyone. She wasn’t feeling contractions or water breaking, but let’s just say the color red was involved.) It didn’t stop in the next hour, so I started gathering what we needed for going to the hospital and when it still didn’t stop the next hour, we left.

We went to the nearby hospital where Kate was admitted last month. It’s the hospital we hoped to deliver at because it’s close (<10 minutes away), has nice rooms in a recently-opened wing, and we’d already bonded with several of the nurses during Kate’s last stay. However, we knew the cutoff point for delivering there was 32 weeks, because they have a NICU (neonatal intensive care unit), but they’re not equipped to handle preemies under 32 weeks. (In case you don’t know, full term for a normal singleton pregnancy is 40 weeks.) We hoped that this wasn’t full-blown preterm labor and we could still make it to at least 32 weeks to deliver at our first choice hospital, but we knew if we didn’t, we’d get sent to another hospital with a “fancier” NICU. We weren’t at all worried about the quality of care we’d get at the backup hospital, but it’s roughly 30 minutes away from home in good traffic, or more than an hour in bad. That’s still pretty close compared to some of the NICU experiences friends of ours have had, but with the prospect of extended NICU stays looming, we’d obviously prefer the 5-minute drive version.

As soon as we arrived at our first choice hospital, we were directed up to Labor & Delivery for Kate and the babies to be checked. Thanks to last month, I already knew exactly where to go so I wheeled her there myself without wasting any time. Four monitors were strapped to Kate’s belly, which would stay strapped for most of the next couple days: one heart monitor for each baby, one for Kate’s heart, and one to detect contractions. All the heartbeats were good. Kate was not aware of any contractions, but the monitor was detecting them regularly. She got put on meds (terbutaline and magnesium sulfate) to try to bring the contractions under control, but since it was hard to say whether they’d completely work or not, she was also given a steroid shot and the decision was made to transfer her to the other hospital “just in case”. The steroid shot is common when there’s a good chance of premature delivery, because it gives an extra boost to the babies’ lung development. Ideally, they get two shots, spaced 24 hrs. apart, and they’ve gotten as much benefit from it as they can about 48 hrs. from the time of the first shot.

We were both anxious and nervous, but surprisingly calm, even as we realized we might meet our babies sooner than we expected. (We were hoping for some time in May, even though the “official” due date was June 5.) I think the calmness was thanks to a few reasons: 1) We had a lot of confidence in the care we were receiving; 2) We’re pretty well educated on these contingencies, so none of this was out-of-the-blue stuff to completely freak us out; 3) We’re familiar with many other stories now of preemie deliveries and NICU’s, but even though there can be complications to be scared and worried about, there are also good outcomes and 31 weeks was farther than some of our friends made it, so we weren’t panicked; 4) We kept each other calm by being calm.

Monitoring and meds continued at Hospital #2. Like so many hospital stories, there was a lot of waiting and seeing, and not a whole lot of knowing what exactly to expect. Kate still wasn’t feeling contractions, and the meds were helping to reduce their intensity and frequency, but they didn’t go away altogether. Kate was my hero putting up with all this stuff, and I wished I could have taken over some of it so she wouldn’t have to bear all the physical discomfort alone. Even without preterm labor and a bunch of stuff strapped to you and hot flashes from the meds, being 7 months pregnant with twins is joyous, but very uncomfortable. Add various pokes, prods, and constant interruptions so you never get to sleep, and it’s just not very pleasant. Kate kept her cool (not in the literal sense thanks to hot flashes) and was just amazing.

Although our primary OB was not the on call doc the whole time, she was made aware of what was going on pretty early and was following Kate’s progress. When Tuesday morning rolled around, she came by to check on her, which included visually inspecting her cervix. (That’s Kate’s cervix - she didn’t visually inspect her own, though it would have been interesting to see her try.) Kate had finally started to feel contractions (she told me she preferred the un-felt kind) and the doc told us she was 4cm dilated. Dilation usually goes from 0 cm (all closed up) to 10 cm (ready to push), so it was looking like delivery couldn’t be delayed much longer. Initially, we were given a choice of scheduling a c-section that afternoon, or more waiting and seeing. Labor wasn’t likely to just stop at this point, so the only upside to waiting was to try to milk every last hour or minute of development in the womb, but the babies were coming up on 48 hours after that first steroid shot and a few more hours probably wouldn’t make much difference, except to have a possibly more groggy doc delivering the babies in the wee hours if that’s when it was needed. We were already leaning toward just scheduling it when the doc checked Kate’s cervix again and told us it was 6 cm dilated, so it wasn’t a choice any more. We’d be seeing our babies in 2-3 hrs.

We made some quick calls to close family to let them know what was happening, and basically looked at each other like, “I can’t believe this is happening!” We still weren’t panicking, but after all this time trying and being several weeks away form our goal of 36 weeks, and the second crib not yet assembled, and pediatrician not yet picked and…and…it was hard to believe it was really happening, and happening now.

Kate suffered through her contractions while I set up our camcorder on a tripod and read the manual on how to operate it. I then posted a play-by-play on several online forums on which I’m active because everyone wants to know what’s going on. I played a couple video games to relax me, and—

Did I get you? Of course I didn’t do that. What kind of an a-hole husband/daddy do you think I am? Kate was having contractions, but I held her hand and told her how wonderful she was and what a great job she was doing. We talked and even laughed about what we’d been through and what was ahead and how excited we were about meeting our babies. We confirmed that the names were locked in and they’d be born in alphabetical order, regardless of which baby was actually delivered first.

Around 12:30 pm, Kate got wheeled away to be prepped, and I was given my Daddy scrubs to get ready and wait in her room until someone came to take me to the operating room. I was dressed in about 90 seconds, and then stood six feet away from the door for twenty or so minutes, bouncing around and rocking side to side waiting for someone to come get me. Since I was alone in the room, I did take advantage of the waiting time to record a brief daddy’s-going-to-meet-you-soon video to show my daughters eventually. The minutes crept by during that wait, but I was eventually retrieved and taken to the OR.

Everything in the OR was very well choreographed. I couldn’t very well describe the details of who was doing what, but I was expertly directed to my place (up by Kate’s head where I could hold her hand) and gently told what I could and couldn’t touch. Even though I’m the curious type that doesn’t swoon at blood and wouldn’t mind seeing the whole procedure, there was a big drape high on Kate’s chest to block the view. (Good for Kate and most folks, no doubt.) I tried to peek around a couple times (after asking if I could), but couldn’t really see past the doctors and nurses, and my main purpose anyway was to keep talking to Kate, not to be a surgical spectator. Kate was awake, alert, and in good spirits, but not feeling any pain. We chatted a little while she got jostled around until we heard, “A is out!”, and a beautiful little cry from Brooke Marie. There were teams ready to handle each baby and deal with any immediate problems and prep them for the NICU, but in less than a minute I was invited to see our first daughter and take her first picture. While I was still working on that, we heard, “B is out!” and another beautiful cry, this one from Claire Marie. The next few minutes were a blur, which I captured for posterity by taking a few dozen blurry pictures. There was a lot of activity and the last thing I wanted to do was be in the way, but I was gently guided from spot to spot to take pictures while they were attended to, pictures when they were first weighed, pictures when they got wrapped up and laid on Mommy’s chest to meet her for the first time, and my favorite (of the OR pics), our first family portrait. I got to cut Claire’s cord and touch her tiny little hand with my finger. I so wanted to touch and hold them, but I knew I’d have to wait. I felt a little guilty that Kate was stuck while I got to see our daughters for the first time, but she did get to see them and be introduced before the NICU, and was happy to have me switch modes from husband to daddy. I followed the babies to the NICU, and on the way out of the OR, it occurred to me to count how many people were in there besides us. I’m not sure I got an accurate count, but I counted ten.

The NICU was fully prepared to offer whatever care was needed, like ventilators, or whatever, but Brooke and Claire came out crying and have continued to breathe without assistance. Thank you, steroids. Brooke weighed 3 lbs., 12 oz., and 16.5” long. Claire was a little smaller at 3 lbs., 1 oz., and 15.75” long. They both got great APGAR scores, which are little observational tests all newborns get to evaluate things like their color, their breathing, and so on. They were cleaned up a little and had monitors attached to track their vitals, regulate their body temps in the isolettes, and so on, but for a couple of preemies that came at 31 weeks and 4 days, they were in great shape. About a half hour later, Kate was wheeled in for a brief visit before being taken to recovery and got to have her first post-delivery direct contact with them (reaching in the portholes of the isolettes.). I got to hold Claire for the first time, lifting her up while they adjusted a cloth or something under her.

The NICU can be a very stressful, scary, sad place, but I didn’t feel any of those things as I met my daughters for the first time. I wished I could touch and hold them, but I knew (from other people’s stories and being told) that preemies get very easily over-stimulated and don’t know how to soothe themselves, so I only touched when and how I was told was okay, like cupping a head in the palm of my hand, but no stroking or patting or moving around. (Basically, we have to suppress most of our baby-touching instincts and do what they need instead of what we want.) Both girls were by all reports doing great, so I didn’t have the stress of immediate or obvious problems, and was too busy being happy, proud, and relieved to feel scared or weirded out by all the NICU equipment.

Brooke and Claire will probably have at least 5-6 weeks in the NICU before they can come home. They’ll have to make the bounce from losing birthweight (which is normal) to gaining weight again. They’ll be closely monitored for apnea (forgetting to breathe), especially in the first 5 days, and will have to be reliable breathers before they can go home. They’ll also have to learn how to eat. They’re so young gestationally that they don’t have the suck and swallow reflex yet, so they’re each being fed through a tube that goes through one nostril and down into their stomach. They’ve spent some time under lights for jaundice, but that’s also normal and not something to worry about.

Except during shift changes and doctors’ rounds, which covers bout 3.5 hrs./day, we can go into the NICU whenever we want to see Brooke and Claire. Each time we go in, we have to “scrub in” for three minutes, washing our arms and hands like you see surgeons do on tv. (They do it in real life, too, but I doubt you see that.) We don’t have to wear scrubs, but they’re very careful about germs in there because preemies don’t have much immunity going for them yet. We’re happy to comply, of course, not only for our own daughters’ sakes, but for the sake of the ten other babies that are also in the NICU.

Brooke and Claire mostly sleep, which is exactly what we want them to do. We’re allowed to reach into the isolettes to touch them, but with the caution against overstimulation, we don’t do it as much as we want to. We get to hold them twice a day before feedings, once on dayshift and once on nightshift. Even a little stimulation during or immediately after feeding can provoke reflux (spit up), so of course we want them keeping their food down. Kate was already doing a well enough the day after delivery to start visiting in the NICU. We’ve both gotten to hold both girls now, including some skin-to-skin time with Claire, and we alternate who holds who since we have two. I’ve been working out a couple of quiet singy songs for holding time with Daddy. I have neither singing nor songwriting talent, but Claire’s starts with, “I declare Claire, I do love Claire, you’re my baby daughter girl. With your blonde hair swirling everywhere, you’re my favorite Claire in the world.” Brooke’s goes, “Me and my Brookie Brooke, we like to looky look, in each others’ eyes…” Then I’m more stuck, because the line about Chewbacca being a Wookie Wook just doesn’t seem to work even though it rhymes.

I’ve seen both girls’s eyes, and it’s not easy to tell for sure with them squinting and dark lighting, but I think both have slate blue eyes for now. They both still have that birth fuzz all over their bodies that’s common to newborns, especially preemies. Both have full heads of hair, but Brooke’s has a little more. The hair looked dark brown at first for both girls, but under the jaundice lights, I’m not so sure. Brooke’s is still brown, but maybe a little lighter than we first thought. Claire looks like she might be a blonde. I’ve never really been one to see family resemblances in newborns, but Brooke’s face does remind me a little bit of my mom. One of the nurses said she could see a resemblance to me in both babies, but also a resemblance to Kate in Brooke.

Now it’s time to wrap it up so I can go see my girls again and hopefully get there in time to hold before the next feeding. We’re not taking anything for granted, but so far things have gone like we hoped, instead of like we expected for delivering this early. Our beautiful daughters are impressing everyone - including doctors and nurses - with how well they’re doing. Their biggest issue for now seems to be spitting up and digestional issues, but they’re getting meds to help with that and no one has told us it’s unusual or cause for alarm. Kate has post-surgical discomfort, but is doing well and will get discharged tomorrow (Saturday). She can’t breastfeed directly yet, but she is pumping and already started producing some milk (colustrum) yesterday, which is fantastic. And in a very happy development that we didn’t expect, we’re going to be able to transfer Brooke and Claire to the hospital closer to home, probably on Monday. They’ll still be in NICU, but they’re stable enough not to need the special capabilities of the higher level facility where they are now. Everyone has been fantastic to us where the babies were born, and we’ll miss our nurses, but we do look forward to being closer to home, and seeing those other nurses we got to know last time.

Please pardon any glaring typos or grammatical errors. I’m going to let this one go with less proofreading than usual so I can go see my girls.