Breastfeeding twins – getting off to a good start despite hypoplasia

I’m sat here typing one handed on my phone as I breastfeed a twin. Sometimes I feed them individually, sometimes in tandem with my trusty preloved Peanut and Piglet tandem feeding pillow – it depends who is awake when. They’re currently 3 weeks old, and compared to the first few weeks of my singleton boys’ lives, feeding is going extremely well. This is partly due to the fact that I know so much more about breastfeeding and about my condition called breast hypoplasia (underdeveloped breasts) and consequent IGT (insufficient glandular tissue), and partly because the twins have fed brilliantly right from the start, with no issues such as low blood sugar or jaundice to contend with.

I was expecting them to be lower birth weights and therefore potentially need a bit of special care where it may have been suggested to top up with formula if they struggled to maintain their body temperature and/or blood glucose levels. But I managed to produce enough colostrum during our 3-day-2-night stay in hospital to sustain them. It helped too that I had managed to express several 1ml syringes worth of colostrum antenatally, so I gave them these in hospital as well as feeding them regularly. As I wrote in the twins’ birth story, I was impressed at the huge amount of uninterrupted skin to skin time and therefore chance to freely feed that we had for about the first 10 hours of their lives outside the womb – I’m sure that this really helped us get off to a good start with breastfeeding.

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When they were first weighed on day 3 at home by the community midwives, Naomi had lost 10% of her birth weight and Samuel had lost 7%. These were both still within acceptable limits, and the midwives were happy that they looked well and that we knew what we were doing in terms of looking at nappy output etc. to see if they were getting enough and topping up with the SNS (supplemental nursing system) as necessary, after I explained our history with feeding the boys. My milk came in on day 3, which is earlier than I was thinking it might do after an elective c-section, which meant I didn’t go into spontaneous labour and therefore didn’t get to go through the hormonal process that occurs for this. My hypoplasia means I don’t really get a huge full feeling when my milk comes in after birth, but I could feel some firmness and could hand express milk that looked mature and white instead of the yellowy colostrum that it had been.

I decided that we needed to start some small top ups with the SNS on day 3, because I didn’t feel that my milk was enough to satisfy them, and nappy output started to dip a little, though soon picked up again. Even with some small top ups, their poo still looked breastfed by day 5 – yellow, loose and seedy rather than pasty like formula fed poo. In fact it still does at nearly 4 weeks old, so I’m assuming that they are getting a decent amount of milk from me – probably around half breast milk and half formula based on formula amounts taken by the average baby as well as the look of their poo! This is not bad going considering there are two of them. They were and still are soaking through a good amount of cloth nappies too.

By day 5 at their next weigh in, both had put on a good amount of weight in 2 days, so this was a great reassurance that we were going in the right direction. The next weigh in was at 13 days, and they had continued to feed well with the SNS in that time. Samuel had gone well beyond his birth weight, and Naomi was only about 80g off it, which the midwives were very happy with. They couldn’t discharge us just yet due to this 80g, but when they came back to weigh them at 21 days old, both had put on a great amount, were well over birth weight, and were starting to look like they’re following a line on the graph. I can’t quite believe how little an issue weight gain has been, after all the struggles we went through with Andrew after his dehydration in the first week and with Joel for his jaundice and related sleepiness in the first month or so. It’s such a relief to not have the battle with health professionals over the dreaded growth charts. And these are twins! And I have low milk supply!!

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The only slight issue that we have encountered is tongue tie. But again this hasn’t impacted on us nearly as much as before, because this time it has been dealt with much more quickly and less stressfully than with Andrew’s. The midwife who did the twins’ health check 24 hours after birth in the paediatric clinic at the hospital picked up on the fact that both had posterior tongue ties when she looked in their mouths. I had noticed Naomi’s myself, now I know what I’m looking for, when she was placed on my chest straight after birth, screaming her head off in my face! The midwife was very helpful and straight away told us how to get a referral to the nearest NHS tongue tie clinic at the hospital in Dudley. It was all done quickly and electronically – Tom filled in an online form, I got a quick phone interview and then an appointment through by email for when they were 24 days old.

With the help of my mum, we went to the appointment on Friday. It was such an amazing clinic, run by a midwife who clearly was an expert in tongue ties and passionate about breastfeeding. She assessed them thoroughly with a points-based system, and agreed that their posterior ties meant they weren’t maximising the amount of breast milk they could get out of me, and the fact we have to top up anyway due to the hypoplasia is masking this in terms of their weight gain being ok so far. I’ve not had any real pain whilst feeding, but I have felt that their latches were fairly shallow, and that tandem feeding them in particular was less comfortable than individual feeding. And I’d never had any real pain with Andrew before he had his snipped, but noticed the difference afterwards with a deeper latch.

So we went ahead with the snips, and both fed well from me straight afterwards. There were a few more tears from Naomi than from Samuel, who wasn’t crying at all by the time he was handed back to me. Both were mainly before they were even cut due to the fingers they had firmly holding them in their mouths, but they calmed down whilst feeding and went back to sleep after the feed. I have noticed how much wider their mouths open and therefore the deeper latches they now get, plus tandem feeding has become more comfortable.

As well as the midwife who runs the Dudley clinic, there was another one there who is currently shadowing her with the view to setting up her own NHS clinic in Bolton. It’s so good to see that this is being taken seriously by certain professionals within the NHS. I’m so glad we didn’t have to pay for a private lactation consultant to do the assessment and snip this time like we had done with the boys (Joel didn’t need his snipped).

Both of the midwives were very much in awe of me persevering with feeding like I do, despite the fact I’ll never be able to exclusively breastfeed, and thought I deserved a medal for feeding twins entirely at the breast using a supplementer. For me this was lovely to get recognition for my determination, and a reminder of why I do this despite all odds, something I don’t think of often enough myself. Most midwives I have seen at hospital and in the community haven’t had a clue what an SNS and hypoplasia even are when I’ve explained my breastfeeding story, so it was great to be able to talk about these things with professionals who are experts in lactation and know what I mean.

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So this brings us to where we are now. We’ve been handed over to the health visitor, who said they only need to be weighed once a month now unless I have concerns about their feeding. Having the ball in my court like this, being trusted on feeding and no pressure for weekly weigh ins is such a world of difference from the stress that we felt before with the boys. I’m genuinely enjoying this breastfeeding journey a lot more already, and we’re not even at a month old yet – it took a good few months to get to this before with both boys.

The twins’ birth story

As I had written about throughout pregnancy, I was hoping to give birth naturally to the twins. It turned out that this wasn’t meant to be, and I ended up with an elective Caesarean section. However, overall it was a very positive experience, and I can look back with good memories of welcoming them into the world.

I had spent the weekend trying to walk as much as possible, in the hope that it would encourage the twins to arrive on their own, but to no avail. On the Monday I had a pre-op appointment, to give some blood samples and talk to an anaesthetist about the procedure. I wasn’t feeling very positive about the prospect of a c-section, I honestly thought that labour would have started by now and I wouldn’t be in the position of having to make such a big decision about how the twins would be born. Tom was also getting fed up of being on standby whilst at work, so he decided to come with me for support and start his paternity leave half a day early. I had briefly spoken to the consultant at my last clinic appointment about what the alternative to a c-section would mean in terms of “waiting it out”, but as we didn’t know I’d get to that point, it was assumed that this conversation would come later. We weren’t sure if we’d get to have this conversation at the pre-op, but we were told then that we’d definitely get to have it before anything happened on the day of the operation (Tuesday).

So we arrived at the hospital nice and early at 7:30am on Tuesday. We were called in first (I’d been told that twin mums get priority on the elective list for the day). They did some obs on me, and of course my blood pressure was high. Not only was I in hospital, but incredibly nervous about the prospect of an operation. So this meant I had to stay in the obs room for monitoring – the midwife strapped two foetal heart rate monitors to my bump, took some blood and I did a urine sample. As I suspected, there was no sign of distress in the babies and no sign of preeclampsia in me, as usual.

Whilst I was there, an obstetric registrar came in with an ultrasound machine and asked if I wanted a scan to check the positions. Of course I said yes, and she looked closely at which twin was nearer the cervix. She said it was very close, but that the breech one was just slightly closer. Both were presenting very low in my pelvis, which doesn’t always happen with twins – often one is higher than the other. Without me asking, she then went on to have the conversation I was hoping to have about whether a c-section was necessary or whether I had the option of waiting it out. She was of the opinion that it depended how much I was keen to have a vaginal birth, to which I replied very keen! She talked about the possibility of a gentle induction – no hormone drip, just an internal examination with membrane sweep to see how far off labour I was, and possible breaking of waters if I was dilated enough. This sounded positive to me, and I was glad that she was open to the possibility of not just ploughing ahead with a c-section regardless. However, she said she needed to run this all past a consultant, before agreeing anything with me.

After a short wait, she returned. The consultant had picked up on something that she hadn’t thought of, and that was the risk of “head lock” in a vaginal birth. This is when the breech comes out first, with its bottom presenting first, but as the head comes past twin two, the chin of twin one locks onto the chin of twin two, which is near the cervix as it is presenting head down. As our twins were both so low, the risk of this head lock occurring was higher than if one twin was sitting higher up than the other in the uterus. If this head lock situation were to happen, it would mean a very fast emergency c-section, and even then the outcomes for twin one aren’t good at all. I looked this up myself from respectable sources I found on Google, as well as taking the doctor’s word for it. I decided that I didn’t want to take this risk, and that a planned c-section was the best option for us in this circumstance. I felt that it was meant to be that I hadn’t gone into spontaneous fast labour with them in this position, because if we had have found ourselves accidentally staying at home, or worse still in the car, the consequences of head lock could have been far worse than at the hospital with an operating theatre down the corridor.

Once the decision was made, it was time to get prepped for the operation. The midwife took the monitor off my bump, and I got changed into a gown and compression stockings. We then had a short wait in a delivery room until it was our turn to go into theatre. Tom also had to get changed into scrubs.

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The midwife showed us down the corridor and into theatre. Everyone in there introduced themselves. There were lots of people, mainly because with twins they need two of some types of staff! But is was a bigger room than I was imagining, so it didn’t feel overcrowded. Everyone started to get their bit ready, and soon the anaesthetist asked me to sit up on the operating table and curl forwards over a pillow so my spine was rounded. She sprayed a cold local anaesthetic on me, then apparently put the spinal block needle in, though I didn’t feel a thing. Pretty soon my feet started to feel warm and fuzzy, and she checked that this was the case. They then pulled my legs up onto the table and I lay down. The obstetricians set up the screen in front of me, whilst the anaesthetist talked through what she was doing with me – attaching a drip and BP cuff. She then got a cold water spray, and sprayed some on my arm, then down on my abdomen, and asked me if it felt cold like on my arm. It didn’t feel as cold, which showed that the spinal block was starting to work. She also checked that I couldn’t move my legs, which was really weird – like my brain was trying to do it as I thought about it, but I couldn’t actually make them move! At the same time, one of the theatre staff put a catheter in, which I couldn’t feel. After a few minutes, the anaesthetist did more of the spray tests, until I could feel no cold right up to my chest, and also some pinching tests on my abdomen – I couldn’t feel a thing. We were good to go, as she put it.

It wasn’t long before I could feel the doctors rooting around inside me. A very odd sensation, I could tell they were in there, but felt no pain at all. The next thing I knew, there was a loud cry from a baby! We had made sure they knew that we wanted to discover the sex of each baby ourselves, and the midwives were brilliant in this respect. The baby was passed to them, given a very brief check over, and within a minute was brought around naked, still attached by cord to the placenta, to our side of the screen. A boy! He was taken back over to the baby table, weighed, wrapped up in a towel, and Tom was asked if he wanted to cut the cord. He didn’t want to, so the midwives did it.

Meanwhile I could still feel the doctors rooting around inside me, and pushing quite firmly on my bump. Then, two minutes after the first cry started, we heard the second cry. Again the baby was quickly brought naked to us – a girl! I couldn’t quite believe that! What was more shocking though was when we were told her weight. It was in metric – 3.3kg, and although this doesn’t mean much to me, I did remember that the boys had been roughly 3.4kg and 3.5kg, so i knew she must be about 7 and a half pounds! I was not expecting a girl twin to be almost the size of my boy singletons. But then I thought maybe in my anaesthetised state I wasn’t computing that properly. The midwives confirmed though that she was big for a twin, as they cut the cord and wrapped her up in a towel.

Whilst the doctors stitched me up, the babies were brought to us to hold. Tom held the boy whilst I had the girl across my shoulder in my arms, supported by the anaesthetist who had remained by my head throughout and was great at explaining what was going on. Once I was ready, it only took a few minutes to transfer me to a bed. Meanwhile Tom went with the babies and midwives to the recovery room first, followed shortly afterwards by me. Within 10 minutes of birth, the midwives were encouraging us to unwrap the babies and get them skin to skin with us. At first we had one each, and I fed the one on me. They both latched brilliantly straight away and had a good suck. I was really expecting this to be an issue if they’d been born smaller, so I was so happy that they were able to do this pretty much as quickly after birth as the boys had done.

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The babies had routine tests of temperature and blood sugar done, and the little boy was a bit cold and had one low sugar reading, so the midwives got me to do skin to skin with them both at the same time, and wrapped us all up together in several blankets, whilst we continued to feed. They continued to monitor them, and they warmed up as well as maintained good blood sugar levels, so they didn’t need admission to special care.

I was monitored for about an hour, and was offered some toast and lunch in that time. It felt so amazing to want to eat again! I don’t think I remember exactly when the sickness left, like when I delivered the placenta after Joel was born, probably because there was so much going on in theatre. But I knew I wanted to eat, and simple white buttered toast never tasted so good! Then I enjoyed a tasty pasta bake a little later.

I was losing quite a lot of blood, which is pretty normal for twins because the uterus has a long way to contract back down. But as a precaution the doctor who reviewed me wanted to keep me down on the delivery suite in a room so that I could have one to one midwife care for a few hours or so rather than going straight up onto the ward. I felt fine in myself, and my BP was stable in the normal range (not too high or low).

We spent the afternoon just the four of us with occasional midwife visits to check all was well and to do obs. It was a really lovely time to be able to chat about names and enjoy those first hours uninterrupted. We weren’t sure that we’d get to have this in a busy hospital. And we hadn’t had this time after the boys were born because it was the middle of the night and we were both tired so tried to rest in the birth centre. So in the end we managed to come up with our final name choices more quickly than we’d imagined. They are called Samuel John and Naomi Grace.

The boys came to visit with Granny and Grandad in the early evening. They were very impressed with their new brother and sister, and seemed to enjoy their brief trip to see us all. Not long after they’d left we were moved up onto the postnatal ward. We had our first glimpse of what it’s like to have twins in public, as the midwives wheeled me on the bed holding the twins in my arms through the reception area to the lift, and we turned lots of heads and got several “ah twins” comments.

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Tom stayed with us in the ward into the evening until around 10pm. The night shift midwives on the ward introduced themselves and told me to call if I needed any help lifting the babies to me. The cot was right next to my bed and at the right height, so actually I found it quite easy to reach across. The effect of the spinal block was wearing off and I had most movement back in my body and legs. Not that I was able to get up out of bed yet, mainly because I had the catheter attached to me and the bed still, so I tried to rest as much as possible in between feeding the twins who were quite sleepy now. It was the other noises on the ward keeping me awake, like snoring, other babies crying, monitor bleeps etc., then it got completely light by 5am.

All in all it was a very positive experience, and one that I can look back on and feel that the twins were born in the best possible way for them given the circumstances. I still would have preferred a vaginal birth like my previous experiences, and I can’t deny that the unavoidable positions of the twins means I’m a little disappointed at this, but I’m glad that modern medical techniques like the c-section exist to help in cases where natural birth may lead to seriously poor outcomes. We don’t know, we might have been alright, but I was glad that I’d been through the surgery in a calm and planned manner than having to do the same in an emergency.

I was especially pleased with the amount of uninterrupted skin to skin time we got, which is important for babies born via c-section in terms of seeding their microbiome – vaginally born babies get their seeding of “good bacteria” as they pass through the birth canal, whereas c-section babies don’t, so we should try and make up for it in other ways such as being skin to skin with mum and breastfeeding. I’m hoping that both these things will have given the twins as good a start as possible despite the c-section.

37 weeks – still pregnant, again!

Well if I wasn’t sure I’d get to write last week’s post, I definitely didn’t think I’d get to write this week’s! We appear to have somehow got to the start of 38 weeks. I feel this is quite an achievement for twins.

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I’m pretty desperate for them to arrive now though. They will be well and truly developed, and we’re only about two weeks earlier than when the boys were born at 40 weeks. I’m still holding out for a natural birth, even though we don’t have long left, because I know my body can do it and the thought of surgery I find pretty scary. But I know that there’s always the possibility that this is for the best, so of course I am willing to go down that route if needed.

I was supposed to have a c-section booked for early this week, and I was in the room when the consultant rang the booking office to request a date over two weeks ago. But when I’d heard nothing by Monday earlier this week, I rang up to see what was going on. In a moment very much like the Little Britain sketch “compu’er says no”, the receptionist I spoke to said there was no record of my name or number on the system for c-section bookings. Gotta love the NHS for admin efficiency! In this case I’m actually not bothered, because it’s given us an extra week to wait for them to arrive spontaneously. But what would have happened if I didn’t chase it? Would I just have been left to my own devices until I turned up in labour, whenever that might be? Thankfully I’m clued up on the risks of later pregnancy with twins, and what to look out for in terms of reduced movements and rising blood pressure, but would everyone be the same? She said that she’d ask one of the midwives what to do, and I made sure she knew it was twins and therefore she may need to speak to the twins specialist midwife or consultant.

I’d still not heard back by the next day, so I tried to chase it, but couldn’t get through to the antenatal clinic where I’d spoken to the lady the day before. Eventually, later that morning, whilst I was in the swimming pool, I got a call and then voicemail from one of the twins consultant’s secretary, saying she had a date and could I ring her back to find out what it was and other details. So I did, and was pleased that it’s not until Tuesday, which is 38 weeks and 4 days, so that still gives the twins time to come on their own.

I haven’t yet had any signs of labour, but then I never do get much warning, so it’s perfectly possible that they will be born this weekend. I’m doing as much walking as I can manage, in an attempt to bring on labour. It’s fairly uncomfortable on my hips – not really pain, just pressure. I’m also eating large amounts of pineapple, which might help the cervix to soften, but I would probably have to eat even more than I am for a real effect. I love pineapple anyway though. I’m bouncing on my birth ball when sitting down, and spending as much time as possible on all fours with my arms over the birth ball for support. Both of these positions are supposed to help.

Of course I don’t actually have to have the c-section on Tuesday at all – I could “wait it out” for longer. The consultant had said that this would involve daily trips to the hospital for monitoring, though as I said, goodness knows who in admin would actually follow up on that, but for my own peace of mind I think I’d want to anyway. However, I’d also experience anxiety and high blood pressure every day at the hospital, which isn’t good for me or the babies, so I’m not sure overall that this would be a good idea. They might even insist I stay in with high BP, which I would really hate.

I feel like we’ve come so far, and the icing on the cake for waiting this long would be the natural birth that I’d really like to have, so why just cut off at 38+4? But equally I have a sense that if they haven’t come spontaneously by then, then it’s probably not meant to be, and I’d rather have a calm, planned c-section than an emergency one once I’m in labour. Maybe the breech position of twin 1 would require intervention, and the bigger they get, the more likely this is, even though I believe it is perfectly possible to birth a breech baby, particularly with the help of skilled doctors and midwives at our hospital who are used to assisting delivery of breech twin 2s.

It’s still very much not in my hands, and I trust that the right birth will happen at the right time, even if I still don’t know what that is!

36 weeks – still pregnant!

I wasn’t sure if I’d get to write a post this week. But as it’s Saturday morning and there’s no sign of the twins arriving yet, I thought I’d do a quick post!

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There’s not that much to report, other than I’m very pleased to be able to say that we got to full term! Friday was the start of 37 weeks, which is the official day that any baby is no longer classed as premature if they are born on or after it. I think this is quite an achievement for twins, who tend to come earlier on average than singletons. I do think that ironically the sickness has helped us – I’ve had to rest loads to keep it at bay, and I think rest is one factor that helps a twin pregnancy get to term. I am, however, still looking forward to delivering those placentas and being able to eat and drink normally again!

I’m very grateful this week that Tom’s parents have been here for half term. We thought they may be needed to look after the boys at any point if the twins arrived, but instead it’s been lovely for me to just take some time for me and rest some more. I have done a few things with them, like swimming and a visit to the Botanical Gardens (which are nearer to the hospital than our house!), but mainly they have taken the boys out to places of interest further away like the Think Tank and RAF Cosford whilst I stayed at home.

I was supposed to hear from the hospital this week to confirm the elective c-section date and pre-op appointment. I haven’t heard anything, so I’m guessing there’s been some kind of admin slip up. As I’m not that keen on having an elective c-section until we’ve waited a bit longer anyway, I haven’t gone out of my way to chase them. If I’ve had no signs of labour by Monday, I will chase it up and probably try to set a date for Friday (38 weeks). Maybe this is a sign that we won’t need the elective c-section anyway?!

So we’re still waiting, but we must be very near the end now! I am still fairly confident that they will come spontaneously this week if we give them chance until the end of the week. If I say it often enough, it has to be true, surely?

35 weeks – hospital trips

After an uneventful few weeks of plodding on, this week has seen quite a bit of action. No arrival of twins though!

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Over the weekend I noticed in my home monitoring of blood pressure that it was starting to rise a little. Still it was within normal range, but until that point it had been so consistently on the low to average side, so I kept an eye on it. The doctors had always said in all our chats earlier in pregnancy about blood pressure that it’s quite normal for it to rise in the third trimester, particularly with twins, and have trusted me to go in and see them if it got to the threshold of being too high. By Monday morning it had indeed just breached that threshold, so I went in to triage – thanks to my mum for keeping me company and to my dad for looking after the boys. In hindsight, I think some of the rise was down to me worrying that it had suddenly risen a little, even though I know this is normal, and the trouble with that is the worry makes my BP rise even more.

I hadn’t been sleeping so well for a few nights, partly being so warm, and partly because it’s uncomfortable lying down, even with extra pillows (which add to the warmth!) So by Monday morning I was just very fed up, tired, and worried about what might be happening. Would it be the start of preeclampsia and therefore I’d have to stay in hospital until they’re born, and would that completely scupper our chances of a spontaneous vaginal delivery? The midwife who saw me in triage was lovely, very reassuring and understanding of my white coat hypertension. She fixed me up on a foetal heart rate monitor – complete with two sensors 😉 and took some blood and urine samples. Everything was fine, with no signs of preeclampsia (no protein in the urine, liver and kidney function normal from blood tests). That in itself made me feel better. So basically it just seemed to be a bit of late pregnancy induced hypertension, not helped by my worry, which should be controllable with a drug.

The midwife did warn me though that the doctor would probably want to keep me in overnight just to check that the drug would indeed stabilise my BP. And that’s what he said when we saw him. I recognised him as the consultant who did my first scan at the hospital to check that I had two placentas. So I was admitted, first to the delivery suite, which was slightly unnerving, because I didn’t think there was any kind of rush to deliver that day! But it turned out that was down to staff ratios – they wanted me to have a couple of hours of one to one midwife care to check the drug was having an effect, before moving me up to the antenatal ward where they only do obs about every 4 hours. They also suggested it was a good idea for me to have a steroid injection at that point – this is to help the babies’ lungs mature a little more before birth, and is often given to mums who may end up delivering early for whatever reason, apparently it’s common for twin mums to have it, though at the end of 35 weeks, our babies should be pretty mature by now.

Thankfully I did respond well to the drug (which I knew from before), and I was moved up to the antenatal ward just before tea time. It was absolutely sweltering up there – the sun was coming directly through the window next to my bed and creating a hot greenhouse effect, with only a small openable window available. After tea it appeared to be “foetal monitoring hour”, and everyone in the room got strapped up to a machine. The sound of various heart beats going all at once, including two from us, was quite an experience!

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Two heart rate sensors strapped to my bump!

The ward seemed to be quite a mixed bag of ladies in terms of what we were in for. Two in my room were clearly there as the start of induction. As I tried to get some sleep later into the evening, it became clear to me that one of them was dilating much more quickly than the staff realised, which is what happened in my labour with Andrew, as all I could hear were her screams with each contraction. This was not exactly helping me sleep or keep my blood pressure down! I felt like shouting over to get her down to delivery! Eventually they did, with what sounded like not much time to spare. I think I got a bit of sleep once she was gone, but it really wasn’t the best environment to spend the night. The night shift midwife did, however, help direct a cool breeze from the window on to my back when I asked for a fan but there were none left for me.

In the morning I saw a doctor, who was lovely and agreed that I didn’t need to be in hospital if I was monitoring at home, and my BP had been stable overnight so was clearly responding to the drug. She wanted me to have some repeat blood tests just to check again for preeclampsia, and a few more obs in the day, but I needed to wait around until the afternoon anyway, to have the second of the two standard steroid injections 24 hours after I’d had the first. All was fine during the day, so I got home that evening after a rather chaotic discharge. I enjoyed a long sleep in my own bed that night! The next day my BP was consistently low, lower than it had been even in the second trimester, but I’m happy to take the small dose of drug and deal with low BP for the sake of only another week or two.

Then the following day I was due to have our final growth scan anyway, so I was back at the hospital for that and clinic. All was well at the scan. The twins are continuing to grow well and at a similar rate. They are still average size for gestation, and there’s about a 5% difference in size between them. Estimated weights are currently about 5 1/2 lbs each, though as I’ve said before, this has to be taken with quite a pinch of salt because scans aren’t always that accurate in this respect. It does seem plausible from my point of view, because I look/feel much bigger than I did with 7,11 lbs and 7,9 lbs worth of baby in there before! Unfortunately twin 1 is still breech, though twin 2 is head down. This may make delivery more complicated, if he/she doesn’t turn in time. And I have to say there seems so little room in there now from what I could see on the blurry scan!

In clinic I saw the same consultant as last time. We chatted a bit about BP, which was of course high in clinic, but she commented that I’ve now proven that I will go in if I’m concerned, so I’ve definitely won their trust in me on that one now! She was happy that it’s under control and I know what to do if I see changes again.

The conversation about birth options was pretty much the same as last time. If they come spontaneously in the next week or so, and if everything goes as fast and smoothly as before, then the doctors/midwives at the hospital are experienced enough to assist me with a breech vaginal delivery. I just need to go straight in at any sign of labour and we would assess from there the best course of action depending on how labour progresses. If I quickly get to full dilation then there’s no point working against nature and doing a c-section just to pull a baby back up and through my abdomen! Of course if there are concerns about it not going quickly and smoothly then they would recommend an emergency c-section.

However, if they don’t come spontaneously soon, I need to make a choice as to how to proceed. She suggested that we book in an elective c-section date now, so we know it’s there if needed, and if not then great. I’m waiting to hear exactly when this is, but it should be on Monday 5th June or soon after as that was her request, depending on availability. This is half way through week 37. She did make clear that it is entirely my choice, I don’t have to follow her advice, I could decide to delay, but the risk of stillbirth increases beyond the end of 37 weeks, so it would mean daily trips to the hospital for monitoring if I wanted to wait it out for a spontaneous labour and possible turn of twin 1. Having looked at the stats myself, the increased risk of stillbirth is there, though it’s still not very high at all, so depending on how I’m feeling by then, I may decide to wait it out, though I’m not sure what my BP would do if I spent an hour or two at the hospital every day!

If twin 1 does turn to be head down, then I would be able to opt for an induction rather than c-section, they just don’t do this for a twin 1 breech presentation, because that’s too high a risk of complications, which I can totally understand. She did say that I would be offered a presentation scan on the morning of the elective c-section, to check their final positions before going ahead, and if twin 1 had turned then I could indeed opt for induction that day instead.

Although I would rather avoid a c-section in terms of recovery, I think this seems like a reasonable and sensible plan for now. I’m still hoping and praying that it’ll all happen quickly and safely like when the boys were born and I won’t have time to think about it, I’ll just get on with it! But I think it’s a good idea to think about the alternatives in advance and be prepared for them. So it’s still a waiting game, and a rather hot one at that.

34 weeks – name decisions and rainbows

It’s been another uneventful week really. I have a little spiel prepared for when people ask me how long I’ve got to go, which happens a lot as the bump is so huge! Not that we know exactly how long there is left, and I’m very grateful to have got to the start of 35 weeks, because whenever they are born now, they should be big and strong enough to not need much (if any) special care.

34 weeks
Twin rainbows

I’ve become famous at the local swimming pool, where I’m keen to do some gentle non-weight-bearing exercise to keep me moving whilst I feel so big – the staff refer to me affectionately as the twins lady. Mums in the school playground and at toddler groups seem impressed that I’m still going, but life has to go on with older children. That’s not to say I’m not resting loads too though, it’s still a balancing act to get the rest to activity ratio right.

This week Tom and I had a recap on the list of names we’d come up with as possibilities a couple of months ago. During each pregnancy with the boys, we decided on a boy’s name and a girl’s name (first and middle name for each) and said that unless we really felt it wasn’t right when they were born, that’s what we’d use. And so we did. We decided not to tell anyone our girl option, in case we wanted to use it in future. This time we started trying to decide on various combinations of names, but quickly came to the conclusion that it was actually quite tricky – there are so many factors to take into account this time. For example, they’ve got to sound good as a pair, they’ve got to go with the boys’ names as a four, they’ve got to suit our surname, we both have to agree on them (and although we have similar ideas of what we like, we don’t always totally agree on individual names).

So instead we thought it best to wait until after they are born, and at least then we’ll know their sex, before making decisions. This cuts down on the possible combinations that we have to prepare in advance. It also seems much more laid back than we were previously! We do have a list of boy names and a list of girl names to work from, so it won’t all be from scratch. They are stored on Tom’s phone, so we’ll definitely have them in hospital with us. Basically, don’t expect our first announcement to contain names, these will probably follow a few days later. They will still be known as Thing 1 and Thing 2 for a while outside the womb.

To finish, I thought I’d just write a bit about rainbows. As you probably know if you follow the blog or are friends with me on Facebook, these twins will be born following the miscarriage I had in July last year. The term “rainbow baby” is now popular for a baby born after a previous loss. The idea is that the new baby is a bright and positive thing to happen after the pain and difficulty of the storm. It doesn’t mean the rain has gone completely, but it does offer a glimpse of hope for the future. As a Christian, a rainbow also symbolises to me God’s promise that he will never leave us through difficult times. In the Bible, we read how a rainbow was given in the sky to Noah and family after the great flood, as a sign of God keeping his covenant, or promise, with His people that He would never again send such devastation in response to their turning away from Him.

Twin rainbows

Last year was really hard for us, and I still get upset writing about our baby whom we never got to meet, but when I think of these two rainbow babies, I trust that God has a plan far bigger than I can ever understand, and that He is always with us, in the hard and the happy times. I don’t often see double rainbows in the sky in this country, but I did see one in the week I did a test for this pregnancy. I was sat watching Andrew’s tennis lesson, the nausea had just started a few days before and I was beginning to wonder if I was pregnant again. The kids playing tennis pointed to the sky behind where I was sat, so I looked around and saw an amazingly clear double rainbow. In hindsight this was a brilliant sign, though it was only weeks later that I saw the significance of double! I didn’t get chance to take a photo, because soon afterwards it started pouring with rain, so we all had to gather inside the club hut to keep dry. I did, however, get to take a photo of the other double rainbow that I’ve seen in this pregnancy – this one was in the second trimester when we knew about the twins. It was a lovely reminder, on a difficult day when I was lying feeling very sick and tired on the sofa, that this will all be worth it. And that’s something I have to remind myself of quite often as the weeks go on and I get more fed up of feeling sick.

33 weeks – writing a birth “plan”

There’s not been much to report this week. As I wrote at the end of last week, I’m trying to get the right balance between resting and keeping active.

33 weeks

I am getting lots of comments from people I see regularly saying how well I look and how big the bump is getting. I don’t feel particularly well but glad I come across as not looking as rough as I feel. I do feel like my body is very out of proportion with the bump being all at the front – people say I don’t look pregnant from the back. It’s hard to believe it will get any bigger, like how is that physically possible?! But I have seen photos of twin mums who got to 39/40 weeks whose bodies look like they are defying the laws of physics by not just toppling forward. It must be a huge strain on the back, though I don’t have any pain there, yet.

My hospital bag is now completely packed and ready to go whenever. I think we have everything sorted at home, and we have car seats sorted to bring them home in. We got some lovely new hand knitted cardigans this week from Tom’s aunt in very small sizes, so those have gone into the hospital bag. I’m not convinced they need to be wrapped up loads in the boiling hospital, especially in May/June, but better to have them in case any staff insist. I’d rather do skin to skin with them for temperature regulation, but I guess this may be harder with twins if they have different needs.

The one thing that I’d still like to get but haven’t actually bought yet is two sets of milestone cards. I’ve become aware of these since the boys were born, and I think they’re a great idea to easily record developmental and age milestones with a photo. So for example, at 1 month old you take a photo of the babies with a card saying “I’m one month old today”, and then I can go back later and make an album easily without having to remember how old they were on a particular date. I was going to get a twin set – they say “we are….” instead of “I am….” – but actually I’ve decided that two sets in different colours will be better, in case the twins are difficult to tell apart, particularly if they are identical or just look very similar as babies. When we look back at the photos we will definitely have a way to tell who’s who if we assign them a colour of card from the start. I’ve heard some twin mums say that they can’t always tell who’s who in early photos! There are some lovely sets of cards on Etsy, I just need to decide which ones to get.

After the chat I had with a consultant about birth options last week, I decided to write a birth “plan”. I wasn’t sure whether to do this because I’m not entirely convinced that the word “plan” can be used next to the word “birth” – there are so many permutations of what could happen that it’s pretty impossible to predict entirely how it will happen. However, having read the Positive Birth Book, Milli (the author) convinced me that it is worth doing and showing to your care providers. She actually says it’s more like “birth plans”, so A and B, and even C, D, E etc. A is how your perfect birth would go, the others are contingency plans. I see it more like a list of desirable points, which express my general wishes for how I and the babies are to be treated, as far as possible depending on the circumstances we find ourselves in. I’ve written a list of desirable points for option A – vaginal birth, and for option B – c-section. I’ve also been through it with Tom, though he knew most of it already, so he can be ready to advocate for me/us if necessary. It will be interesting to see if the babies have turned to be head down by the next scan in a couple of weeks, if they haven’t arrived by then anyway!

32 weeks – growth scan and birth options

This week we had another growth scan and clinic appointment. It was lovely to see the babies again, it’s reassuring to know they’re OK in there, even though I do feel them move lots anyway. They are getting so big that it’s really hard to make anything out on screen, unless you’re a trained sonographer and know what you’re looking for. She pointed out a few things to me and I nodded with a kind of “if you say so” smile.

32 weeks

The main thing is they are growing nicely. Both are still around average size, one slightly longer than the other, meaning their estimated weights are slightly more different from each other than last time with a 10% difference. They are estimated to be around 4-4.5 lbs each, though as I wrote before, scanning at this gestation can be quite inaccurate so these stats have to be taken with a relatively large pinch of salt. There’s a good amount of amniotic fluid around them in each sac, and the placentas look healthy and well positioned at the back of the womb. Their cord blood flow rate is healthy, and they are both very active at scans – all the sonographers that I’ve seen have remarked on this! We produce very active kids it seems. I think it’s for this reason that they have moved position between every scan, never staying in the same place.

Unfortunately their positions are slightly less favourable than at the last scan (where twin 1 was transverse with head nearer the cervix than bottom, and twin 2 was head down). This time twin 1 was properly breech (bottom sitting on the neck of the womb by the cervix!) and twin 2 was transverse, with their heads together near my ribs. Whilst it’s lovely that they have their heads together, I’d rather that their heads were near the cervix. The sonographer said there was still time to turn, and since they’ve turned lots already, I have some reassurance that this is possible. I was slightly dreading then talking to the doctor in clinic about where we would go from here in terms of birth plans. However, it turned out to be a very positive conversation.

I saw a consultant who I haven’t seen before. She seemed very laid back from the start. The usual blood pressure conversation was short, she checked that my machine read high, which it did, and joked with me about there always being one who had white coat hypertension. Then we moved on to how I’d like the babies to be born. I said that I was hoping for a vaginal birth, because I’d had very fast and easy births with my singletons, but that I understood their current positions weren’t very favourable for a vaginal birth.

To my surprise, she then said that if I go into spontaneous labour and I dilate as quickly as, or more quickly than, previous labours, they would be happy to support me in a breech vaginal birth. After I nearly fell off my chair in shock, I replied with something like “oh really! Er… um…. thank you!” When I had previously talked to a registrar about this at our first twin clinic appointment, he said that twin 1 would have to be head down if I wanted a vaginal birth. She said that if it’s fast then better to let it happen naturally than try to intervene surgically, and that they as obstetricians have the expertise to assist with a breech delivery. She then went on to say that if I was dilating more slowly than before, and there was therefore time to consider other options, that they would rather offer me a c-section at a lower dilation with sac and fluid still in tact than wait for me to go slowly to full dilation and then potentially need a c-section once my waters had broken, which was less favourable from their point of view. Although she added that I still wouldn’t need to accept the offer if I’d gone into labour spontaneously and wanted to carry on for a vaginal birth.

I think it was around this point of the discussion that she made a statement that made my ears really prick up because it was very much in line with the two central tenets of the Positive Birth Book (that I have CHOICES and RIGHTS in childbirth). She said “you do have choices in this you know, it’s not just me telling you what you can and can’t do.” Again I nearly fell off my chair in amazement!

Then she went on to talk about what would happen if I don’t go into labour spontaneously. Firstly, she said that they were happy for me to go to 38 weeks as long as all is well at my next scan. They wouldn’t offer induction at that point if twin 1 was still breech. That would mean either a planned c-section before labour starts naturally, or “wait it out” with daily monitoring to check for foetal well-being, and they would talk to me about the risks either way with both of those options if it got to that. Again I was pleased that she seemed to be quite relaxed about the prospect of waiting it out rather than just going straight for a c-section, if all is well. They would offer induction if twin 1 was head down by then, just not if he/she was breech. I’m fairly confident that my body will go into spontaneous labour by 38 weeks, because the boys were born on or just after the 40 week “due date” for singletons. Mums who go longer with twins tend to also go to 41/42 weeks with singletons – we’re all different.

And that was that! A much easier conversation than I was expecting, and a much more positive and mum-centred approach to twin birth than I was expecting from a consultant obstetrician. I feel bad for tarring them all with the same brush in my head now! She said they’d like to see me again in 3 weeks, when I’ll be nearly 36 weeks pregnant, to check the babies’ positions. Initially she said 4 weeks because all was well and the babies are growing beautifully, but then decided a week earlier would be good to give us a bit more time to discuss all options if they are still in awkward positions, which I agree with.

In the mean time, if I have any signs of labour, I have to go straight in to triage to be assessed. They would rather I came in on false alarms and they sent me home again than risk a home/car birth, which I can understand if twin 1 is breech. A twin breech home birth would be one step too far in her opinion, and I have to say that would scare me too I think! This is totally different from when I had the boys – the birth centre didn’t want us getting there too early and nearly sent us away again with Andrew, but thankfully they didn’t as he was born about an hour and a half later, and we only just made it there at all for Joel.

I came out of the appointment feeling much more positive than just after the scan which had made me fear the worst for lack of birth options. I’m praying that at least twin 1 will turn, and there is a team of friends at church who are praying the same. But if this is how it’s meant to be, I’m feeling confident in my ability to breech birth if all goes as quickly as before, and I have a sense of peace surrounding the fact that it’s not in my hands – what happens, happens. The position of twin 2 is less important at this stage because they often turn once twin 1 is out anyway.

So going into this week I’m trying to continue getting the balance right between rest and activity. I hope that swimming, yoga and spending time on all fours using my birth ball for support will give the babies as much room to turn as possible, though I know it’s getting less likely that they will. I’m still feeling nauseous and have to lie down for a rest in the afternoon and evening otherwise I think I’ll be sick. But I’m really holding onto the fact that it’s really not long to go now. If anyone used to watch the comedy quiz show Shooting Stars, I have this line from it in my head: “We don’t know how much time we’ve got, but when the time’s up you’ll hear this noise….. argh!” We’re living life on the edge right now!

31 weeks – keeping as fit as possible

This week there’s little to report in terms of pregnancy; the main event has been Andrew’s operation to remove his adenoids and insert some grommets. We spent the day in hospital, and thankfully all went well so he was discharged in the evening.

31 weeks

I wasn’t sure how I would feel spending all day in hospital, though admittedly the children’s hospital instead of the women’s hospital, so Tom took the day off work to come with us too, whilst Granny and Grandad looked after Joel and taxied for us. The day turned out to be easier than I thought it would be on pregnant me. It was quite a pleasant day-case ward, and we were able to walk around as well as sit down on hard or soft chairs. We’d taken plenty of drink and snacks to nibble on, and we managed to get some fresh air whilst Andrew was in theatre. I went to bed not long after we got in as I suddenly felt exhausted once it was all over, and the next day I was really tired, but I’m glad I was able to be there with him the whole time. Tom was the one who actually went into the anaesthetic room with him – I thought I might cry or faint or something at that, which wouldn’t have been good for Andrew, who in the end was far more unfazed by it than I was! Probably partly my hormones, as well as the fact I’m not great with hospitals, though I’m getting better with all the exposure recently.

As this week was the first week back to school and toddler groups after the holidays, I’ve had quite a few people who we haven’t seen for a few weeks ask how long I’ve got left and how things are going. I usually respond with “I’m just plodding on, literally!” It’s definitely got to a point where I feel huge, even though lots of others still think I look “neat” for twins. Sitting down is pretty uncomfortable now, because I find the bump squishes my internal bits – you know, like lungs, stomach, intestines and other organs vital to life. So I’m generally lying down on the sofa or sitting on my birth ball which gives me a good position. I’m also trying to do quite a bit of time on all fours, with support from the birth ball.

I’m still managing to walk places as much as I can, carrying on with our normal routines like the daily school runs, the daily post office run and going to a couple of toddler groups in the week. This isn’t uncomfortable yet, though I’m a bit slower. I’ve been swimming once a week for the past month or so, and I find this a lovely way to keep moving whilst feeling weightless. The only slight issue is I don’t think my maternity costume (which I used lots when pregnant with the boys) will fit me much longer! But it seems a bit expensive to buy a new one for the sake of potentially only a few weeks, so I’m hoping to eek it out longer. I’m also doing my pregnancy yoga DVD about once a week, to help with breathing techniques and good positions for my hips and back in particular. Hopefully all this will keep me as fit as possible when carrying twins late in pregnancy.

I wrote last week about starting iron tablets because my last blood tests had shown I’m anaemic, though I don’t feel particularly different from how I have throughout pregnancy. I’m pleased that the tablets don’t seem to be having any adverse side effects on me, like nausea (which is no worse than usual), so this is positive. It will be interesting to see how my haemoglobin level is next week at my 32 week scan and clinic appointment.

I’m looking forward to seeing the babies again next week at the scan, and I’m hoping they are now in a good position for a vaginal birth. I think however they are positioned the doctor I see will want to start discussing birth options, so we will see what comes of that.

 

29-30 weeks – rest and getting prepared

There wasn’t really much to write about for 29 weeks. We were away for the long Easter weekend, down with Tom’s parents in Devon. It was good to get away, and I’m glad all is going well with the pregnancy so far, which meant that we were able to go that far, even if sitting in the car wasn’t that comfortable – we had an extra stop compared to normal.

30 weeks

The last time I blogged I had just had my 28 week growth scan and blood tests, including one to check for ICP (intrahepatic cholestasis of pregnancy). I didn’t hear anything back about this, which means it must have been negative, so I’m pleased about that. The tingling/itching hasn’t got any worse, and if anything I noticed it even less when we were away.

However, when we got back home, I opened a letter from the hospital which said that my blood test for iron level showed that I am anaemic. This isn’t hugely surprising for a twin pregnancy, as lots of mums expecting multiples find their iron stores are depleted more quickly from growing two or more babies. I don’t particularly feel any different from how I have all pregnancy in terms of tiredness – one of the major symptoms. I don’t get that out of breath, though I can feel it’s starting to become harder work walking and going up stairs, for example, with the extra weight I’m carrying. When I looked up anaemia on the NHS website it did say that one of the less common symptoms is itching/tingling though, which is interesting. After a short delay in my GP receiving the letter from the hospital due to the bank holidays, I got some iron tablets and have just started taking them. I’m slightly apprehensive about the potential side effects of nausea and constipation that are common with iron tablets, but I’ll have to see how it goes.

We’ve also started to get organised this week with preparations for the twins’ arrival. I have packed my hospital bag except for a couple of additions that I need to buy (snacks and drinks). It’s been so long since I did it that I had to remind myself what we need in the bag! We were in the birth centre for less than 12 hours last time, so hardly needed anything that I’d packed. I expect we will be in for longer with twins, even if they get to term (37 weeks), because they are likely to be quite small compared to the boys, which may cause issues with starting feeding, for example. And of course this time we need double of all the baby bits. If I need a c-section, I personally will also need to be in longer than after a vaginal delivery. We don’t live very far at all from the hospital, so I’m sure we can top up with anything that we don’t have enough of pretty easily between Tom and other visitors such as our parents.

We have very kindly been given this week plenty of tiny newborn baby clothes, as we didn’t have any smaller than 0-3m ones for the boys who were born average weight for singletons. So we’ve put most of these into the drawers in the boys’ room and some have gone into the hospital bag. We’ve moved all the feeding equipment into the kitchen and found a place for it – steriliser, several SNS (supplemental nursing systems – made from bottles and thin NG tubing) and formula.

I’m sure there are a few more bits and bobs to sort out, but I feel like we are pretty prepared for them to arrive whenever (well, as much as one can ever be prepared for the arrival of twins!) Even if they were born in the next few weeks, we wouldn’t be home straight away as they’d need time in special care, so there’s still time to sort out anything here that needs doing.