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