Another month went by and all was fine. We had another ultrasound, both kids were doing fine, I had done my blood tests and they were all favourable. The kids development was fine, weight, organs, everything. By the 18th week, I realised the slight twinges in my abdomen were not gas but actually my babies moving! It took me a while to figure it out, but it was definitely them! And they seemed specially active at night when I was trying to sleep. :) By now, sleeping was a bit uncomfortable, so I was enclosed by side pillows most of the time. But we were thrilled! They were moving, developing fine, everything was going ok. We started cautiously telling people about our good news. The dusty book of baby names came off the shelf....nothing final we told ourselves, but always nice to look at options. :)
We were feeling a bit more secure. We scheduled a Level II scan on my 20th week.
20th week, where it all started going to hell.
We went for the level II ultrasound. This was a far more detailed one that any before. It was astonishing to see how developed our babies were. One was actually facing us. The doc was great. He showed us so many things - spine, head, nose, eyes, lips, arms, fingers, heart, stomach, kidneys, bladder, legs, little toes. One of them even made clapping hand movements!! One had a perfectly circular head while the other was a little more oval. Both heartbeats were normal, weight and size all normal. They were both perfect...and perfectly adorable.
At this time, I mentioned to him the slight pain I was having in my lower abdomen and he decided to do an internal scan. In this scan, it suddenly turned out that my cervix was opening!! Way way too soon. I had an incompetent cervix! Luckily we had detected it and it hadn't opened much yet. Still I would need to immediately get admitted for a surgical procedure, called cervical cerclage, which would put a stitch in my cervix and stop it from opening further. We were a little scared but the remedy was there and we felt it had been caught in time, plus the kids were fine. I got admitted the same evening and into surgery the next day. Out the day after with strict instructions to be on total bed rest in the Tredelenburg position and allowed only bathroom breaks.
I tried to follow it religiously, though the position was terrible. I was having constant digestive issues of gas and reflux now and my shoulders hurt like the devil, taking most of my weight. I had at least 17 weeks to go through, but on the happy side, I was more than half way through and my kids were doing great!!
One night, in my 22nd week, I woke up with back and abdominal pain. (Why do bad things always happen in the middle of the night???) I stayed with it for a while, tossing about the find a position were the pain would be lesser. Much much later, I would realise that what I went through was premature labor pain and it was an alarm call. I SMSed my doc in the morning and she told me to go in for a urine test. I called the Pathology guy for home collection and when he came, went to the bathroom for giving the sample. That's when I felt a smooth something trying pass out as well. I was terrified. I stopped everything, ran to my bed and lay down with the legs raised right up. Sent off the path guy without the sample, called my hubby and asked him to call for an ambulance. I also called both my gynae and my fertility doc. The latter was now also consulting at the hospital nearest to my home and she told me to go straight there and she would get someone to check me. My husband arrived, packed a few essentials. The ambulance arrived and got me stretchered from bed to hospital. My vital signs were good. I was trying very hard not to think about anything else.
At the hospital, I was transferred to a labor/private room for observation, where it came out that I was definitely getting labor pains, the earlier stitch had not held and there was some sac membrane already down all the way into my cervix. They put me on IV to stop the labor pains so that they could plan for an emergency second cerclage if possible. I was now on total bed rest (no bathroom) in my upside down Tredelenburg position. Some were gas pains, some were Braxton-Hicks, some was real labor contractins....it was all a series of pain, panic and prayer.
The next day, it seemed there was some settling down in my state, the kids seemed to be doing fine and we figured we could go for another emergency cerclage. My infertility doc was there and she did the surgery. Everything seemed to be going fine. I would have to be on total bed rest in the hospital till the end of the pregnancy, but we were ok with that. We crossed our fingers and hoped for the best.
Then came 2 weeks of chaos. Off and on contractions, I was running a low grade fever, my wbc counts were too high, digestive problems was a constant companion. Along with this, the indignity of being on total bed rest, middle of the night bathroom needs, eating while lying upside down, overall discomfort of lying upside down and IV problems. I have very thin veins that are difficult to find. The hospital had a policy of changing IV site every 3-4 days. Some of my IVs didn't last even a day. All were painful, while putting in, while they were in and after they were out. Most drips needed pre IV flushing as my veins kept clotting.
I kept getting contractions from time to time, even though I was on medication to prevent it. My low grade fever and wbc count wouldn't let up. It was around 15th November. It had been 2 weeks since my second cerclage. The medications couldn't control my contractions. I had been constantly leaking some fluid, possibly amniotic. One sac did look to carry lesser fluid on the ultrasound, but not so less to reach concern levels. On 17th November, I would complete 24 weeks (from June 02 LMP) and 22 weeks 5 days gestation (from implantation). At this point we knew I wouldn't last the normal minimum 37 weeks. We were now looking for minimum alternatives for fetus viability. My dad is a paediatrician. I hounded him to tell me everything, got both my parents (both docs) to call up everyone they knew. But all information pointed at the same thing, 32 weeks was safest, 30 weeks doable, 28 weeks minimum but not preferable. Nothing below that. I had at least a month to go and I was having painful contractions every 3-5 minutes that couldn't be controlled by medication, a low grade fever and a high wbc count despite weeks of antibiotics. I was desperately trying to hold on to anything....anything that would give my babies a chance. Their heartbeats were still regular, but that was all. Another 2-3 weeks, and my babies would have a chance. But my contractions wouldn't stop. And since the stitches were holding them in, I was in constant severe lower abdomen pain. No position helped, no medication helped. I'd been in varying degrees of pain for 2 weeks now, and now, the contractions were getting uncontrollable. The only thing holding my babies in was the stitches, and they couldn't hold in the leaking fluid from one of the sacs.
It was the most difficult decision of my life. Though I still felt huge self recrimination that I couldn't hold on for 3 more weeks, the decision in many ways was inevitable. The contractions were constant and couldn't be controlled, the leakage couldn't be stopped, the fever and wbc count wouldn't normalise (indicating some lasting infection), nothing was working. There was a chance of chorioamnionitis, and reducing fluid in one of the sacs. Even if it was only one baby who was affected, it was only a matter of time before the other did too. None of them would survive for long on delivery at this stage. Their neural, brain and blood systems were yet to develop. Holding on was postponing the inevitable.
On 18th November, we decided to let them go. That evening, my stitches were removed. The doc said she could see a foot already in the cervix post removal. No sign of a sac. It seemed one sac had already ruptured. She said it wouldn't be long. I was already upset at losing them, now I realised that I would actually have to deliver them...no caesarean, no numbing anaesthetic....the real real pain of delivering my precious babies, conceived after years of trying, nurtured through months of hope and discomfort, condemned to death on birth.
I had been in labor for days now. It was just a matter of pushing. The first baby come out in minutes. It was a girl. No sac. I couldn't even see if she was born alive. I had to work on her twin. They said it was higher up and would take some time. At this point, I just wanted it all over with. Within the next couple of hours, I delivered my baby boy. He was in his sac which I had to burst for delivery. The placenta ejection came next. And then it was all over. My two perfect babies, the prayed for completion to our family, lying in two small trays, looking perfect. The girl was already cold, but the boy was still warm. I was up immediately on delivery and walking around. I touched them, held them....bid them goodbye. No more little nudges in my abdomen, no more planning nurseries, no more hope.
I couldn't go to bury them, my husband and mother did. I couldn't believe it was over. After 6 months of anticipation, hope, anxiety, pain, discomfort, surgeries, planning...it all came down to nothing. Our little family of daddy, mommy, daughter, son and dog.....was again just daddy, mommy and dog. They were gone. I'd failed them, I'd failed my patient rock of a husband yet again, I had failed myself.
In the delivery process, I gave myself a cervical tear. The next day, I went for an ultrasound to get it checked and in the process discovered that I had gallstones!! What?? Hadn't I been through enough already!!! I went back into surgery for a D&C and repair of my cervical tear. I was still reeling from the delivery and twin loss, now I had gallstones. Perfect.
From the histopath report from the delivery (and visually from the babies themselves), it was clear that my baby girl had been infected, though my baby boy had been fine at birth. There was however, very little chance I would have carried to term, or even much longer. By the time I would have hit fetal viability, both would have been infected, and I would probably also have been in trouble. Once infected, survival of the twins was unlikely. So in retrospect, it was the correct decision for the babies and for us. I have the solace that I spared my babies a lot of pain before I would anyway have lost them. Loss sadly, is still loss.
Post surgery, I developed a dry cough that I sometimes do from the anaesthesia process. Plus, I had edema in my legs. Turned out my protein (albumen) levels and haemoglobin levels were very low. So I was given a list of medications, a high protein diet and finally sent home. I couldn't wait to get out of hospital and come back to terms with my life.
Yes, I cried while writing this post.
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