Monday, July 22, 2019

How the Twins Were Born pt 3: The recovery

Y'all, I cannot tell you how incredibly grateful Tyler and I are to our doula, Yolandi. We have both leaned on her so much from the second she and Tyler were ushered into the recovery room after the surgery, and I found out that she had helped advocate for delayed bathing of the babies after they were taken to the nursery. One teeny little victory for my discarded birth plan.

The anesthesia was making me feel freezing cold as it was wearing off, so Tyler and Yolandi found me shivering and chattering, which I know freaked Tyler out. Yolandi was a calming presence, helping to reassure him and me that this was normal, and helping Tyler ask the nurses for reassurance of her reassurances. There was a lot of reassuring going on.

From this point on, I can assure all of you that I was probably the worst patient this hospital had ever dealt with!

They didn't know what they were getting themselves into when they agreed with the midwife and forced me into surgery. I was asking to hold or at least see my babies from the second they were born, and I didn't stop asking even as I lay chattering under layers of blankets in the recovery room.

I was told no, maybe I could see them after recovery.

I asked to see my babies as they wheeled me out of recovery and into the maternity ward.

I was told no, I needed to rest.

I asked that they be brought in so that at least their father could see them.

I was told maybe after the doctor did her rounds.

At some point I was told that the babies could be brought to me at 6am. Seemed like an arbitrary time, but maybe that was when shift change happened and I could become someone else's problem.

At 6:30, I asked for my babies again. I had had an 8 pound weight put on my incision and was told that I would have to lay flat on my back like that for 8 hours. I couldn't hold the babies like that, so why bring them in?

I want to breastfeed them, I said.

Oh, no! I still had medicine in my veins, I couldn't breastfeed them.

Their father can hold them, I answered.

I could see the nurse's brain try to think of another excuse.

"You will have to take care of them," she said to Tyler.

"Yep. That's the point," he said

"Well...yes, they're the parents," Yolandi said with a gesture toward Tyler and me.

"You will have to change her pads," the nurse added, as if that was going to be a deal breaker for him.

Tyler nodded for a beat, shrugged his shoulder in defiance, and then I saw him realize he didn't actually know what that meant. My sweet husband said, "'ll have to tell me what that entails, but I can do that."

Yolandi kind of leaned in and said, "I can help with that."

With all their excuses exhausted, the nurses had no choice but to bring me my own children.

I was still so exhausted and medicated from the surgery and the painkillers they had me on, I don't actually remember which baby they gave me first. I just know I popped them on and started breastfeeding as soon as I could, which actually wasn't easy without being able to sit up at all, but I was determined to take control over some part of this experience!

It didn't take long for a nurse to come in and check on me, and she was horrified to see that I was feeding my child. "Oh! Mommy, no!" she said, searching for the words to tell me why I should stop. My doctor appeared very soon after and essentially ordered me to stop breastfeeding. I asked when I could start feeding them again, and she tried to say I wouldn't be allowed to until after the painkillers were stopped in three days.

"Can I take out the IV?" I asked

She kind of chuckled. No, I don't want to do that, she said. The IV was giving me the pain medicine.

"If the medicine is the reason why I can't breastfeed, take it out. Breastfeeding my babies is more important to me than my pain management," I said.

She gave a little nod and said she would let me breastfeed in 24 hours.

Before I get a barrage of judgement, I do realize that I likely did pass along painkillers to the babies through my breastmilk. I had already researched that possibility when I was pregnant with Sadie and again when a c-section looked likely during this pregnancy. Current research shows that the dose of fentanyl that would be passed to the babies could possibly be even smaller than what neonates receive in hospital, and the beneficial properties of breastmilk in the first hours and days of life outweigh the possible effects of the medication. Plus, these kids had already gotten a huge dose of drugs from the c-section I had just been forced into, so if anyone was to blame for the babies having drugs in their system, it was the doctors.

(And to be fair to my doctors, when I finally did come off the fentanyl, what little bit that was being automatically pumped into my body every few hours, HOLY COW WAS THERE A LOT OF PAIN! But I sure as hell wasn't going to admit that to the doctors!)

Anyway, those of you who know me know that I didn't wait 24 hours. I snuck the babies on to the breast as much as I could. They still received a solid amount of formula in their first three days, but I was staging my own little protest behind my hospital curtain, and I have no regrets.

The three days that I was in the hospital felt like they were filled with me challenging as many of the hospital policies as I could. I asked to get the IV and the blood transfusion line taken out every chance I got (apparently it is standard procedure in Korea for all mothers-- c-section or natural birth-- get a line put in before delivery on the off chance that a blood transfusion is needed. It was soo painful and annoying!). I refused further pain medication. I refused the oxytocin they were giving me to make my uterus contract ('cause you know what causes my uterus to contract naturally? BREASTFEEDING!). I would not let them take the babies to the nursery, so the pediatricians required that the babies go to the nursery for their check ups. I asked for the babies to be returned as soon as possible.

Through the whole thing, Yolandi was providing us invaluable support, emotionally and logistically. Unlike in America, hospitals do very little in the way of conveniences or comforts postpartum. There are no adult diapers provided, no diapers given for the babies. My meals were brought to the general area of my bed, but they weren't put within my reach and I was responsible for clearing the tray. Had Yolandi not been there when my catheter was taken out 12 hours after the surgery, I would have been responsible for cleaning up myself and the mess.

This was not because I was a difficult patient, this is just what it's like to give birth in a public hospital in a foreign country. Yolandi gave Tyler a break from the cot on the floor where he was sleeping and allowed him to go home and take care of Sadie for a few hours each day. She provided lactation teas and amazing nourishing snacks. Yolandi was a godsend and I cannot recommend enough to every pregnant woman out there to hire a doula for your birth and postpartum support. We couldn't have made it without Yolandi.

That said, most moms in Korea stay in the hospital for five days after giving birth. I'm pretty sure this hospital was very glad to discharge me after three. And the feeling was mutual.

I know I am being dramatic in all of this. Literally hundreds of thousands of women have c-sections every year, and many of them are very happy with the quick recovery. I know that in 20 years when the babies are in college or doing whatever they choose to do after high school I'm not going to be stewing in anger over their birth. I'll get there eventually, and if I'm honest, every time I look down at one of their precious faces as I'm feeding them, a little bit of the anger is chipped away and replaced by gratitude that their birth story ended with my going home with two healthy babies.

Vicariously yours,

Sunday, July 21, 2019

How the Twins Were Born pt. 2: The hospital

I called our doula as Tyler pulled out of the parking lot of the birthing center and explained what the midwife had decided. I could hear (or maybe I was convincing myself of) the disappointment in her voice as she said, "Ok. Do you want me to meet you at the hospital, or are you both ok from here?"

I knew the hospital's policies. Tyler wasn't going to be in the room, so she definitely wouldn't be allowed in either. I wasn't sure what exactly she would be doula'ing, but I was sure that I wanted at least two people in my corner as I went into this ordeal.

Living in a relatively remote part of Korea means that even when you go to one of the biggest hospitals on the island, it's still a ghost town in the middle of the night. We parked in the garage, and walked into a darkened and empty hospital. All the lights were out, there were no nurses or doctors walking around, just a faint glow coming from the door to the emergency room. We went in, and even the ER was quiet. There were a few people sitting in the waiting room, but we walked right up to reception. They didn't have to ask any questions, it was very clear why I was there. I was whisked away immediately and our doula found us easily when she arrived--just looked for the only white people in the place!

From that point on, I had no control over what happened. At least it felt that way. I met the OBGYN on duty that night--not the doctor I had broken up with. She was called and, I imagine, happily handed me off to another doctor. I'm thankful that she did, actually, because the OB on duty turned out to be the most empathetic medical professional I have met in Korea! She entertained the notion of a natural birth for about a minute while she did an ultrasound to confirm the midwife's recommendation. She asked me why I had gone to the midwife in the first place instead of scheduling a c-section weeks ago.

"I don't want this. I don't want to have this surgery. It's scary to have surgery in a foreign country where my husband can't be with me and I don't speak the language. I don't want this," I said. She nodded empathetically.

Nonetheless, consent forms (all in Korean) were explained and signed. I was prepped for surgery. I have never felt so helpless and scared as when they made Tyler and our doula stop at the door for the OR and wheeled me away. Watching him disappear from my sight as I was being taken into the bright sterile operating room, laying impotently on the gurney, was the stuff of my nightmares.

I tried to be brave and keep it together, but I was terrified. I wanted absolutely no part of what was happening to me, and there wasn't a friendly or familiar face anywhere near me. No one was talking to me, no explanation of what was happening. Tears streamed down as nurses and doctors started pushing and pulling me, hauling me onto the operating table, spreading my arms out and hooking me up to monitors and machines.

The anesthesiologist came in and asked me how much I weighed. I told him I wasn't sure because I don't own a scale at home and I hadn't had my weight taken for at least a month. They looked at my records to see what I weighed back in March when I last saw the doctor and said, "We'll go with that." Shouldn't it be a little more exact!? I can't be sure, but I think that anesthesia is a little more precise of a measurement than an educated guess!

I had had an epidural with Sadie, so I understood how this was going to go, but I still flinched and let out a little yelp of fear when the doctor started to put on the iodine. The OB came around and held my hand. "Are you ok?" she asked from behind her mask.

"I'm ok," I answered and continued to repeat, trying to convince myself of my own words.

I'm ok.

I'm ok.

I'll be ok.

Once the medicine was in my spine, we were off to the races. The curtain as put up and I felt like I ceased to be a person. No one spoke to me except for the doctor that had been tasked with monitoring me. He seemed confused as to why I was so scared. I started to feel some pressure and let out a gasp and simply he said, "Surgery start."

No turning back now.

I don't know how long it took. It felt like forever. The medicine, combined with the fact that it was now somewhere around 2am, was making me so tired, but the adrenaline was keeping me awake. I asked every couple of minutes what was happening, and after a while the doctor busied himself with something else to monitor and I stopped getting answers.

Until he came back into my field of vision and said, "You have a...girl?"

"Yes," I said, thinking he was talking about Sadie.

Then I heard a baby cry.

"Oh! The first baby is a girl?" I said, turning my head toward the sound and trying desperately to see something.

"Yes. You did not know the genders before now?" he asked. I couldn't answer through the tears. We had another girl! And Tyler wasn't here to see it or be with me in this huge moment. I hated the thought that I was learning this news while he was sitting somewhere in a hospital waiting room.

Suddenly a goopy, red and purple screaming little face was thrust into mine. "Hi baby," I said, as the doctors and nurses around me all snapped the very first photos of me and my daughter on their personal cell phones. And as quickly as she appeared, she was gone. I wasn't allowed to touch her and I had barely even seen her. I have never seen those photos.

A few minutes later, I felt a lot of tugging and pressure and was told that baby number two was a boy. They held his crying little face close to mine and he craned his sweet little neck as he heard my voice say, "Hi Ryman" for the first time. He wanted his mama and I so desperately wanted to hold him.

We had a boy! I celebrated the moment alone because the doctor that had broken the news to me was now having a conversation with someone else in Korean and everybody else was attending to the babies. I think I got a "congratulations" somewhere in there, but I just laid there and cried.

They tried to administer the general anesthesia, and were very confused when I still refused it. "There is still a long time to go," I could hear the doctor saying from behind the curtain, as if to suggest I would get bored or something.

I did end up sleeping fitfully as they finished things up. It was after 3 am when the whole thing was over, I think, and I was emotionally exhausted as they wheeled me into the recovery room. 

How the Twins Were Born pt. 1: The midwife

As previously mentioned, the midwife agreed to take me on as a ...patient? Client? What do midwives have? ...anyway, she agreed to deliver my babies, and I was so incredibly relieved! I wanted to have a natural medication-free birth with Sadie, but inducing labor sabotaged that idea. So this was my chance. I was going to have a badass medication free birth and it was going to be freaking TWINS!

The whole pregnancy I had been saying, "They're due May 9, but twins always come early, so they'll probably be born in late April."

Proving Mommy wrong must be a hereditary trait in my children because late April came and went and the babies were staying put. I was HUGE!

This was our family photo after church on Easter, 2.5 weeks before the babies were born. I'm not sticking my belly out for dramatic effect. It was just that big. I got even bigger than this! 

With Sadie I never got unbearably uncomfortable like I'd heard about from tons of women. I wasn't loving every minute, but I could still get up and down from bed and chairs and even the floor comfortably until the day I delivered her. That was NOT the case with the twins! I was so ready to get them out, I was desperate!

I looked into buying castor oil and shipping it in, I took essential oils, I walked miles, I ate pounds of pineapple. Finally, on May 8, I went to the acupuncturist. I was soo uncomfortable and my back was killing me, so I figured that I didn't have anything to lose.

Y'all. I went into labor that night.

Around 7pm I started getting contractions, but I figured they were Braxton-Hicks because I'd been having contractions every night for weeks. I contacted our doula, put friends on alert, and around 10 o'clock we contacted the midwife and headed to her birthing center. I fully expected her to tell me it was a false alarm and send us back home. Boy did the night not go the way I was planning.

We arrived at the midwife's around 11pm, she sat me down to do a quick sonogram, and then asked me to call a friend to translate. She said that the first baby was head down, locked and loaded and ready to go, but baby #2 was breech, and the head was 10cm.

"Ok..." I said. I mean, I wasn't excited about pushing out 10 centimeters, but Sadie's head was 9.5 when she was born, so I knew I was capable.

"So she said you need to leave to go to the hospital," I heard our friend say through the speakerphone.

"She thinks I need to go to the hospital? They are going to make me have a c-section," I said, tears welling up in my eyes. When she heard the word "c-section," the midwife nodded her head and said yes in Korean. Then she looked up and saw my chin quivering and that I was trying to choke back sobs.

"Are you sure?" I said to her, and my friend on the phone didn't even try to translate. She assured me that the hospital would be very safe and that everything would be ok. The baby was turned the wrong way and the midwife was afraid it would get stuck. I knew that the hospital would be safe, I was very aware of what the hospital was like, but I knew in my gut that I could do this! I could push this baby out!

The midwife was supposed to be my empowering feminist partner in this! We are women, hear us roar! I HAVE ENORMOUS HIPS, THIS BABY WON'T GET STUCK!

But the advice from my OB in Australia came to mind: If your practitioner isn't comfortable with the procedure, that's dangerous and could cause more injury than anything else. I thanked our friend for translating, packed away my hopes of ever having the delivery I so badly wanted, and started preparing myself mentally for whatever was about to happen. I sat in the midwife's sonogram room and just sobbed. She was a little freaked out, I think, but I didn't care at that point. She had betrayed me, she needed to see how upset she had made me.

We got back in the car and tucked tail to the very hospital that I had been going to throughout my pregnancy. The one that I was so happy to put behind me a few weeks ago. Now I had to go admit defeat and let them cut me open. I was heartbroken.

Sunday, June 23, 2019

Why is finding a doctor so hard!?

As some of you might recall, figuring out the medical system in Australia was a bit of a challenge, so I didn't expect it to be super easy here, especially considering the language barrier. I went back to the OB close to my house for the early visits, but she doesn't have a delivery room in her office, so she cut me loose around 12 weeks along. I knew there wasn't a twins specialist on the island, only 2 or 3 hospitals with English-speaking doctors or staff, and only 2 with an NICU, so my choices for places to go was limited. I also knew there was a midwife on the island (a rarity in Korea, I was told there are only 4 or 5 in the whole country), but I figured I should deliver in a hospital because I thought the chances of the twins needing medical attention right after birth would be pretty high.

So I started by going to the university hospital in the city. It was the most modern, had a translator on staff, looked a lot cleaner than the other hospital with a NICU, and I knew that one of the doctors had delivered a set of twins for an expat couple recently and they seemed to have liked her.

My first meeting with the doctor at the hospital was fine. She wasn't overly friendly, but bedside manner isn't a high priority here, it seems. She jumped immediately to a c-section as my only safe delivery option. Almost half of all births in Korea in 2017 were by cesarean, so I wasn't surprised that was her preference.

What I hadn't counted on was the non-negotiability of the c-section and the bluntness with which doctors would make the case for surgery. Simply put, I was old (the word "geriatric" was literally used to describe me), I was fat ("your size is quite large"), and I was having twins. There was no other choice but to do a c-section. I explained to the doctor (at my first appointment, at 12 weeks) that I had delivered my first baby without a c-section, so couldn't I do it again as long as there are no complications?

I was given the answer that I have come to understand is Korean for "no:" We'll see. The doctor said that if the babies were in the right position at 37 weeks, I could deliver naturally, so I focused on that as my belly grew and prepared myself for that discussion as the 37 week deadline approached.

Imagine my shock when, at 32 weeks, the doctor declared that I had no option but to do a c-section and she went ahead and put it on the calendar.

I still had five weeks before the deadline! Why put the surgery on the calendar now!? I was furious! I was disappointed! I was confused!

She said that it was because the babies weren't both head-down, and twins don't turn after 32 weeks.

Well, now I was doubting her medical knowledge, because I KNEW that wasn't correct. I asked what a c-section entailed because I knew the basic idea, but not the details. I shouldn't have asked because the details were my nightmare birth scenario.

1. Tyler couldn't be in the room, not even a little bit.
2. I couldn't do skin-to-skin.
3. In fact I wouldn't be able to touch my babies for a few hours after the birth because-- get this--they would deliver the babies, let me see them, and then PUT ME TO SLEEP UNDER GENERAL ANESTHESIA! I couldn't hide my shock when the doctor told me this, so she said, "We don't have to do that if you don't want to." Uh, yeah. Take that one off the ol' list there, Doc. Apparently that is standard operating procedure here because "many mothers are exhausted after giving birth."

Hate to break it to you, ladies, but THAT'S MOTHERHOOD!

I digress.

4. No sitting up for several hours and no standing up for at least 24 hours.
5. No breastfeeding for three days. THREE DAYS!
6. No babies rooming in during recovery.
7. The IV with pain meds stays in for at least three days.
8. No leaving the hospital for five days.
9. No going into natural labor and doing a c-section then. In fact, no carrying to full term. The babies would be taken at 37 weeks.

There wasn't a single item on that list that I was ok with. Not a single part of the hospital's policies made me comfortable with giving birth there. I was choking back tears as I thanked the doctor for her time and left the appointment.

I sat in my car and sobbed for 45 minutes. I had never been in a situation where I was so completely uncomfortable with my medical care. I had never doubted my doctor so much before. I had never felt so completely at a loss for how to advocate for myself or my babies.

After my little pity party, I left the hospital to go on the hunt for a new doctor. At the very least I wanted to find a birthing center where Tyler could be in the room with me during the surgery.

I visited or spoke to about 5 doctors at the end of it all. All of them said I would have to have a c-section. All of them said I should go back to the hospital and deliver there with my original doctor. One of them wanted to take the babies even sooner than the doctor at the hospital. One of them flat out refused to speak to me beyond the 2 minutes it took me to say, "I'm looking for a second opinion." I was feeling hopeless.

That's when we spoke with a Korean who had delivered with the midwife. I expressed my jealousy and she said I should meet with the midwife anyway. Breech birth was no problem for her, and she has delivered lots of twin before. A spark of hope returned.

I spoke to more folks that had delivered at the midwife's birthing center, including one who had to be rushed to the hospital for a complication, and all of them sang her praises. I then did a little more research and found out that only 20% of twins actually need the NICU after delivery, a number that greatly decreases the closer the babies are carried to full term. I was comfortable with those odds. 

And it turns out I was REALLY comfortable with the midwife! As soon as we met her, literally within the first minute as we stood in her parking lot making introductions, I felt at peace. She put her hands on my belly and said, "Head here. Head here." She knew the positions of my babies just by looking at me. She didn't speak any English, but I didn't care. Over the course of her 37 year career as a midwife, she had delivered over SEVEN THOUSAND babies! She laughed at the idea of a c-section, was not scared of the prospect of a breech birth, and said she would be willing to deliver my babies. I was thrilled to break up with the doctor at the hospital at my next appointment.

Sadly, my dreams of having a natural birth would not come true and I would have to tuck tail back to the university hospital a few weeks later. That story will be next.

Vicariously yours,

Saturday, June 22, 2019

A couple new developments...

Once again, I've neglected this blog and a crapload of stuff has happened in our lives. At this point, if you're reading this, you probably already know that we had twins--a boy and a girl-- in May, but I feel the need to record the news for posterity. So for your reading enjoyment, here's how we found out we were pregnant.

I knew something was up when the first day of school in August began with my making a mad dash to the bathroom to throw up. I didn't have any morning sickness with Sadie, but I hadn't eaten anything exotic or undercooked recently, so I had a sneaking suspicion. And when the nausea and vomiting didn't let up for a few days, I knew. I think I picked up a pregnancy test at one point, just to confirm things, and I think I might have shown Tyler...I can't remember.

He wasn't surprised when I told him I was going to visit an OBGYN, I remember that much. I was going to the doctor, however, because I was pretty sure I was having a miscarriage. I'd been having some cramping for a couple of days, and that was the early signs of my miscarriage in Kuwait, so I figured I should go to the doctor and get the bad news over with.

Thankfully, a gynecologist just opened an office like 2 minutes from our house, so I was able to make a quick trip without having to set aside a whole day to drive into the city and back. Imagine my shock when, with the ultrasound wand charmingly shoved up my lady bits, the doctor said, "No, I think you are not having a miscarriage. You are having cramping because you have two babies."

I shot up and yelled, "WHAT?!" and almost shocked the dang wand out of her hand. I then collapsed back on the exam table and burst into tears. The doctor and her nurse were very confused by my little display of emotions. Was I happy? Surely those are tears of joy? Should you convulse quite so violently when crying from happiness? Maybe the crazy lady is just overwhelmed?

I was overwhelmed alright. I was DEVASTATED (sorry, babies)! We were just going for one! WE DIDN'T WANT TWINS! I had just started my first year at a new job! We had a one-year-old! 

I pulled it together, took my ultrasound photos, and stumbled to my car.

As is often the case here in Korea, I was blocked in by someone who had double parked, but I was also in no shape to drive, so I took advantage of the opportunity to sob in my car while I waited for the owner of the Land Rover behind me to move her car. 

Now I had to tell Tyler. He had sent me a sweet message of support before I went into the exam room, so he was expecting me to check in soon. I sent him a text asking if I could give him a call. 

The phone rang and I told him that everything was ok. I asked him if he was busy or if he had time to talk. 

"It's twins isn't it." 

There's not an easy way to recover from this kind of unexpected news. Our friends and colleagues were incredibly supportive and everyone we told was a mix of horrified and ecstatic, so we decided early to lay low with the baby talk on all forms of social media while we wrapped our heads around what we had gotten ourselves into. Telling folks you are pregnant with twins inevitably leads to someone making commentary on the father's virility or inserting their opinion on things, and I just didn't have the patience for any of that. Best to keep the news under wraps and endure the commentary from strangers who couldn't deny the ridiculously large belly protruding from my mid section.

Now that they are here, we of course love the twins, but we still have moment where we look at each other and one of us says, "Holy crap we have three kids."

As you can imagine, being pregnant in a new country, and being pregnant with twins, lent itself to a plethora of stories that need to be shared. I've made it my goal to record all these before the sleep deprivation erases them from my memory, so keep an eye out. 

Vicariously yours,