Labor and Delivery

To catch up with the story so far checkout the labor and delivery prologue.

On our way to the hospital Jamie debated whether she should call Deb. I told her “she gave you the number and encouraged you to call so you absolutely should.” We are both really glad she did. Jamie says for 3:00 AM Deb sounded incredibly awake and was super nice. Deb called the Presbyterian Labor and Delivery Triage nurse and let her know we were on our way. Throughout our stay at Labor and Delivery every nurse we spoke with said, “Oh, you are Deb’s friends.” While I am sure we would have received great care from the Labor and Delivery nurses having a connection made us feel like we were getting exceptional care.

We had learned during the Labor and Delivery course that when you begin labor you are supposed to go to Labor and Delivery to the triage room. Not sure where we would have gone otherwise, but it was nice to at least feel like we knew what we were doing. Triage confirmed that Jamie's water was broken and transferred us to a delivery room. We are not sure if it was because we knew Deb, but at 3:45 were given a very nice delivery room with an outstanding view.

Sunrise view from our delivery room

With us situated in a room at 3:45 AM we settled in to wait for doctors. The on call doctor visited first and since Jamie was in preterm labor decided it best for us to wait for the perinatal specialist to check on Jamie in the morning. While we had started with a very nice night shift nurse Jen, at 7:00 AM a very nice labor and deliver nurse named Marcie was assigned to Jamie and would be with her throughout the rest of her labor. Finally, at 9:00 AM Dr. Joffe from Perinatal Associates of New Mexico arrived and after running a few tests, performing an ultrasound, and making some observations decided it best to attempt to delay Jamie's labor for at least 24 hours. His immediate goal was to gain time for a steroid injection to help the twins lungs prepare for an early birth. After the 24 hour delay had Jamie's labor stopped she would have remained in the hospital until it was time to deliver the twins. Apparently, just because your water is broken does not mean you have to immediately deliver a baby. In fact, the doctors were talking about keeping Jamie pregnant for as long as a few more weeks!

Still very early in the delivery process.

There might be other mechanisms by which to delay preterm labor, but Dr. Joffe ordered the use of magnesium sulfate which has several side effects: itchiness, flushing, nausea, etc. She did not experience many of the side effects of the magnesium, but simply felt uncomfortable all over, in addition to being in labor. Interestingly, aside from helping to delay preterm labor magnesium sulfate has been shown to prevent cerebral palsy in premature infants. After the dose of magnesium sulfate Jamie started to experience what started as mild contractions, but which grew into very painful contractions. To help manage the pain she would grab the hospital bed's railing and “ride the wave.” As her contractions worsened it became evident that the gradual dose of magnesium sulfate had not slowed her labor Jamie was given a bolus (large dose) of magnesium.

Even after the bolus we now believe that Marcie saw the writing on the wall. While Jamie suffered through increasingly painful contractions and the side effects of the magnesium Marcie strongly suggested that I visit the hospital's Subway to get a sandwich and take a break. Thinking we had plenty of time I went down and ordered a foot long sub. As soon as I had finished the first six inches my phone rang calling me back to the delivery room, Jamie was 6 centimeters dilated and they were taking her into the operating room to deliver the twins via cesarean section.

The experience of being in an operating room for delivery was intense. As explained to us during our first specialist checkup there were a lot of people in the room. The anesthesiologist and I were seated at Jamie's head. Jamie who had been given a spinal block was totally awake and able to talk. I don't remember what we talked about, but oddly I remember it was not about delivery. A curtain was drawn up to keep Jamie from seeing the procedure. Each of the twins had a team from the natal intensive care unit monitoring their vitals ready to act when they were born. Lilly was delivered at 2:19 PM and Paige with a bit of forceful tugging was delivered at 2:20 PM. When she was born Jamie was briefly shown Lilly who was then whisked to the NICU. At birth Paige had some complications and was immediately taken to the NICU before Jamie could see her. The entire procedure from spinal block to finishing took a little more than an hour with more time taken to put Jamie back together than was taken to get the girls out.

Jamie and I in the recovery room after Jamie's cesarean section.

The next post will detail our NICU experience.

Labor and Delivery Prologue

In an understatement a lot has happened since we crossed the thirty-two week pregnancy mark. Over the coming days, as time and sleep allow, we will try and post summations of the past month. Our last detailed post was two days before the girls were born, so it seems appropriate to start with the story of their birth.

At Jamie's perinatal appointment on Friday, July 15th her cervix measured 2.5 centimeters, which is about the smallest size allowed before a woman is put on bed rest. A shrinking / thinning cervix (called effacement) is normal late in pregnancy and is especially normal at 32 weeks for a mother of twins. Remember at this point Jamie's uterus was measuring the size of a 43 week pregnant mother of one. Since everything appeared to be status quo we scheduled the next months worth of appointments.

Friday night we met Meghan and Justin for dinner then went back to our place so Jamie could show Meghan the newly decorated nursery. As a present Justin's mother had painted the girl's names using the nursery's color pallet. Hanging these two pictures on the wall put the finishing touches on the room. Justin then very nicely took a series of pictures of the nursery.

Justin tries out the My Brest Friend Twin Nursing pillow

The next morning Jamie and I attended a Labor and Delivery course at Presbyterian. The course was a wealth of information providing labor tips, medical facts, and a hospital tour. During the class the instructor described several indicators that labor was starting. Jamie had one of the symptoms described which led her to contact her OBGYN's office. Unfortunately, since it was Saturday we were only able to speak with the on call doctor who felt Jamie's symptoms were probably the result of the battery of tests Jamie had received the day before. He indicated she should take it easy and stay out of the sun. Confident that everything was okay Jamie and I finished the class.

Sunday morning we met Nate, Lindsey, Ryan and Deb for breakfast. This was the first time Jamie was able to meet Ryan's new girlfriend Deb who is a labor and delivery nurse at Presbyterian. Deb was kind enough to give Jamie her contact information and encouraged her to call when she went into labor. After breakfast we headed over to Duff and Libbiey's to watch the Women's World Cup Final. We left at half time because Jamie was not feeling too well. We went home and she napped the rest of the afternoon.

Jamie on Sunday morning right before we left to meet our friends

That evening we went to my parent's house for our bi-weekly family meal. Jamie still felt under the weather, but felt better than she had earlier in the day. As we visited before dinner Jamie felt Baby A (the lower baby) turn from a transverse (crosswise position) to a breached position (feet down). The baby then proceeded to kick downward repeatedly. This whole process occurred very quickly and was very painful. Once in the breached position the baby kicked off and on for the rest of the evening.

At 2:00 AM I awoke to “Andrew I think my water just broke.” It certainly had. I spent the next 10 minutes hopping around our bedroom trying to quickly get dressed and get on my walking boot. A comedy writer could pay more justice to the hilarity of this scene. Jamie and I did not have “the bag” ready. While we waited for a call back from the on call OBGYN, we grabbed the things which had been emphasized during our Labor and Delivery course the day before most specifically a tooth brush. Which I might add I am really glad the instructor emphasized bringing, if you are going to be in close proximity to your partner breathing heavily for hours on end it's nice to do it with minty fresh breath and clean teeth. While Jamie was incredibly calm I was pretty frantic. We grabbed what made the most sense and headed out the door.

Our trip to the hospital and our experiences there will be detailed in a post on labor and delivery.

One Month Old

It's been a crazy four weeks, but the girls are one month old today. We'll be posting details of labor and delivery, our NICU experience, and first weeks at home soon. Thank you to everyone for all the support!

Thirty-two weeks and counting

On Tuesday Jamie's uterus measured in size to that of a singleton pregnancy at 43 weeks. As you can imagine Jamie is very uncomfortable. Her OB/GYN has indicated that if she does not enter labor before 38 weeks she will schedule a cesarean section. Between the heat and her discomfort she is not relishing the thought of being pregnant for another six weeks.

But the good news is on Thursday, July 14, Jamie crossed the milestone of being 32 weeks pregnant. Singletons and twins are much more viable after thirty-two weeks. Meaning if the twins were born today they would probably spend a month in the intensive care unit, but statistically speaking would be okay. Reaching this point is a huge deal for a multiple pregnancy as premature labor and birth is very common for multiples.

We both attended the growth appointment at the specialist on Friday. Jamie has this appointment every month and it typically lasts two to three hours. Of all the appointments Jamie attends each week this is the longest. Not only does this appointment include a multitude of tests which Jamie and the babies undergo each week it also includes measurement of both babies. To give you an idea of what this entails major parts of this appointment include

• Fetal fibronectin test - indicates if a woman is entering preterm labor by testing for fibronectin in the vagina (imagine a strep culture)
• External fetal monitoring - monitors fetal heart rate and presence and duration of uterine contractions with external sensors
• Transvaginal ultrasound - using a vaginal probe determines the length and strength of Jamie's cervix
• Obstetric ultrasound - typical external ultrasound with an emphasis on measuring particular bones to determine a baby's height and weight. In addition to growth they also test vitals measuring heart rate and rates of umbilical cord pumping

It is a lot of tests, but thus far both Jamie and the twins have been hitting all of the right numbers. Currently Baby A is 4lbs 3oz and Baby B is 3lbs 15oz. Both babies are 16.7 inches long. One of the great things about having tests so frequently is we have seen our babies almost weekly for most of the pregnancy. We have not uploaded a lot of the ultrasound photos as they have become overwhelming even for us, but wanted to upload the most recent 3D Ultrasound images of their faces.

Crazy Busy Spring & Summer

Thus far Jamie and I have had a very busy spring and summer filled with trips, celebrations, weddings, doctor appointments, and baby preparations which has left us with very little time for anything else including blogging. That isn't to say we have not wanted to do so, but hopefully by reading this post we can catch up on the status of the twins as well as with us.

May

As detailed in a previous post May began with a bang when two of Jamie’s friends threw her a baby shower. The following weekend (May 14^th) Jamie and I flew to Pittsburgh, PA to attend Carnegie Mellon’s spring commencement ceremony. While I am in the process of completing my last class, Carnegie Mellon has the Silicon Valley students participate in the large graduation ceremony prior to finishing the coursework. Pittsburgh is a great town with plenty to do. On top of seeing the sites in Pittsburgh it was nice to visit CMU and get a feel for the campus. Even though Jamie was six months pregnant Southwest Airlines was very accommodating making the flights much easier. Even with the extra leg room Jamie could not believe how swollen her ankles were after the trip. She had to lay with them up for a day to get the swelling to go down.

We spent Memorial Day weekend on another trip, this time by car to Durango, CO for the Iron Horse Bicycle Classic. Iron Horse is a bicycle race from Durango, CO to Silverton, CO spanning two mountain passes. Almost every year I ride in this event, but due to a lack of training was unable to do so this year. Jamie’s dad did participate and enjoyed some of the best weather the event has ever seen. Riding in a car was easier on Jamie than flying had been, but she was unable to ride in the front seat as it made her incredibly nauseous.

June

On June 4^th my younger brother David married his longtime girlfriend Leigh Anna. I served as David’s best man while Jamie was one of Leigh Anna’s bridesmaids. Though she will disagree Jamie looked beautiful in her maternity bridesmaid’s dress. The wedding was a wonderful time, but made me realize how infrequently we are together with all of our family.

The following week I left Albuquerque for Meghan and Justin’s destination wedding...in Scotland. Jamie was supposed to come along and even after finding out she was pregnant had toyed with the idea of accompanying me. Ultimately, we decided traveling overseas while pregnant with twins would not be the best idea. I was gone for ten days spending time in London, England and Ft. William Scotland. While in London I purchased a SIM card with unlimited data from 3 Mobile which allowed me to Skype with Jamie throughout the trip. Rather than describing everything we did you can check out my London and a Scottish Wedding photo album.

One unfortunate mishap did occur while I was in Scotland. While hiking down Ben Nevis I managed to break my ankle. Thinking that the ankle was only sprained I finished the hike, visited a whiskey distillery, attended the wedding, wedding reception, lunch and dinner before going to the hospital. Unbelievably, the United Kingdom provides social healthcare to its citizens and covers noncitizens in emergencies. The healthcare provided to me as a foreigner was on par with any paid healthcare I would have received in the United States. Traveling home with a cast ankle was difficult, but thankfully our friend Hannah was traveling with me and kindly carried my bags. United Airlines helped me pay Hannah back for her assistance by very nicely upgrading us both to business class for the return trip. If you have never flown business class I highly recommend it! Upon returning home the doctors in New Mexico put me on bed rest for four days, which is not the easiest thing to accomplish with a seven month pregnant wife. Thankfully, the ankle will not require surgery, however I will be in a walking boot until the end of July.

Twin Progression Update

For the past few months we have been attended one to two doctor appointments a week. Soon these appointments will probably increase to two or three appointments a week. Three weeks ago while I was overseas, breaking my ankle, Jamie had her most recent growth checkup. At this appointment both twins weighed just under three pounds and measured 14 ½ inches. Since this appointment Jamie has had several vitality appointments and regular checkups. From those appointments we know that the twins are healthy scoring full points in all critical areas. Just as importantly we know that Jamie is also doing outstanding. Our next growth appointment is next Friday we will post current statistics after that appointment.

Baby Preparations

While the nursery is painted and the cribs assembled we are missing art work and a glider. Both items are supposed to arrive next week so we will be able to finish the nursery and post photographs. Jamie is very much in the nesting phase so it will be nice to check this important milestone off the list of baby to-dos.

Are you still with me? I know this post was incredibly long, but we wanted to bring everyone who’s been asking us why we haven’t been blogging up to speed. Hopefully, things will slow down over the next couple of weeks before the twins arrive. Speaking of arrival, the doctors are estimating the girls will be here in the early part of August. Here’s hoping they come after my walking boot is off and my department graduation on August 6^th.

Jamie 7 months 2 weeks pregnant with Andrew and his broken ankle.

Baby Shower

On May 7th two of my very best friends (Sid and Sam) threw me the most wonderful baby shower. The theme was Peacock (I have a slight obsession with Peacocks) and it could not have been more beautiful. I felt so lucky to be around so many great friends. The day was so special and made me even more excited for the girls to get here.

Baby Bump

Jamie at 20 weeks

I have had some requests from my "out of townies" to see a picture of the "bump". So here it is. It is definitely getting bigger and bigger each day. I felt the girls kick for the first time 2 weeks ago and they have been getting progressively stronger. Andrew is anxiously waiting for the day that he will be able to feel them also.

Family history of twins or fertility treatment?

As I explained in Twin Reaction Quotes people have been overwhelmingly positive when we tell them that we are having twins. Now that we know the twins are girls I get a few more "good lucks" and "serves you rights," but nothing that is insensitive. That said there is one question that What to Expect When You're Expecting indicated we would probably get a lot of:

Do twins run in your family or did you use a fertility drug?

In the beginning we were asked this question a few times, but as our happy news has spread the question has become more frequent. The question itself isn't annoying, but it is being asked too often.

To answer the question, Jamie and I did not undergo fertility treatments and twins do not run in our family. However, had we undergone fertility treatments I can see where this question could become uncomfortable to answer. The twins could be identical, which is not affected by a genetic predisposition or fraternal which typically does run in families.

To head the question off I've worked telling people that we did not use fertility treatments into my pregnancy announcement. Something to the effect of

Jamie is pregnant, with twins. Twins don't run in our family and we didn't use any fertility drugs, so it's a real surprise.

We understand all too well that people are curious about multiples. Since twins make up only 1.9% of the world's population people are bound to have questions. When someone announces to you that they are having multiples ask as many questions as you like, but I would recommend thinking twice before asking about their conception.

Baby Things for Twins

Purchasing things for twins is not as simple as it is for singletons. Everything is doubled and what might work for a singleton will not work for twins.

We read more reviews, blogs, and information about strollers than any other item. As it turns out, you just can't buy a double stroller. Many double strollers are for a baby and a toddler and do not accommodate twins. After this information narrowed our search we settled on the Chicco Cortina Together Double Stroller.

Next up was a Graco Pack 'N Play Playard for Twins. Which isn't terribly different from a regular Graco Pack 'N Play but comes with twin bassinets.

Specific items for twins do not stop with the stroller and pack 'n play. There are twin nursing pillows, twin sleep books, and a variety of overpriced if cute twin onesies.

With all of the twin baby items to choose from we are trying to make smart decisions.

The Steele Babies are Ladies

Yesterday Jamie and I had our second specialist appointment at Perinatal Associates of New Mexico. During this visit our ultrasound was again one and a half hours, but we learned some very exciting news: our twins are girls!

Funny enough Jamie was more disappointed by this news than I was. She was convinced that she was having one of each. Going so far as to say that Baby A was a girl and that Baby B was a boy. I on the other hand was convinced the twins were going to be of the same sex. I was not sure if they were boys or girls, but I knew they'd be the same.

After informing us that the twins were girls the doctor proceeded to tell us that the twins might be identical. As I explained in Types of Twins, identical Dichorionic-Diamniotic (DiDi) twins can occur if the zygote splits within four days after fertilization. This came as a surprise to Jamie and I as we had been told in January that it was likely our twins were fraternal. Even though we understood the facts about DiDi twins we had put the thought of identical twins out of our mind. We will not know if the girls are identical until after birth and even then only if we perform a DNA test.

In any case, we could not be happier with the news. Both the twins and mom are extremely healthy. Everything is progressing normally and our next specialist checkup is in a month.

Types of Twins

Like most people, Jamie and I thought twinning was as simple as identical or fraternal. As you may have already guessed it is not that simple. I have summarizied most of what you see below from the Wikipedia Twin article.
The first twin distinction is their zygosity: the degree of identity in the genome. There are five common variations

• Fraternal (dizygotic) twins occur when two separate eggs are fertilized at around the same time:
  
  • male-female (most common)
  • female-female
  • male-male
• Identical (monozygotic) twins occur when a single egg is fertilized forming a single zygote which splits:
  
• female-female
• male-male (least common)

The second twin distinction is the degree of separation of the twins in utero. Twins can share more than just their mother's womb. Fraternal twins are always Dichorionic-Diamniotic (DiDi), but when identical twins separate affects their type of separation.

Type	Description	Day
Dichorionic-Diamniotic	Twins share only the womb	Days 1-4
Monochorionic-Diamniotic	Twins share the same placenta	Days 4-8
Monochorionic-Monoamniotic	Twins share the same amnion	Days 9-12
Conjoined twins	Twins are physically connected	Days 12 or >

Jamie is having DiDi twins. They share the same womb, but nothing else. The ultrasound picture below shows the separation between the twins.

Regardless of the type, twins are rare, estimated to be approximately 1.9% of the world's population, with identical twins making up only 0.2% of the total population-and 8% of all twins.

First Specialist Checkup

Last Friday we had our first appointment at Perinatal Associates of New Mexico which is a group of physicians specializing in high risk pregnancies. No matter the type of twin pregnancy, all twin pregnancies are classified high risk. As such, we will continue to see the specialists throughout the pregnancy. The attention to detail during this doctor visit was impressive. The appointment took a little over three hours with one and half hours of that time spent with an ultrasound technician.

The technician was very kind in providing us with a ton of photographs. Even cooler than the photographs was watching live video of the twins moving around. Both twins appeared to be doing back flips and full body twists. Of course all of this activity made it difficult for the technician to get the measurements she was after.

The technician eventually persevered getting all necessary measurements and capturing photographs at the needed angles. Throughout the appointment the technician provided us with insight into what she was looking for. Frankly, it is amazing what trained professionals can determine from an ultrasound. Thankfully, all measurements and vitals point to a healthy pregnancy.

Presently the twins are on-top of one another. To us in this ultrasound photograph it looks like they are sleeping on a bunk bed.

After meeting with the technician we had an appointment with the doctor. Our general OB/GYN had advised us that the specialist Obstetrician would provide a flood of statistics. This advice could not have been more correct. The statistics provided were a bit overwhelming, but boiled down to everything appears normal.

The fact that stood out during the information deluge was there will be around 13 people in the room when Jamie delivers. Two obstetricians, a anesthesiologist, a nurse trained in anesthesiology, a pediatrician, and six nurses (three for each baby). The remaining two people will be Jamie and I.

At this point Jamie is through her first trimester. She’s still battling morning (more like all day) sickness, but is looking forward to getting over it soon. We continue to be overjoyed at the prospect of having twins.

A few facts for Week 11

I have been really enjoying reading about pregnancy and what to expect with multiples...I came across some advise for what kind of maternity clothes to wear in the book, When You're Expecting Twins, Triplets, or Quads.

Here are the words of wisdom: For clothes with extra roominess in the belly choose: a denim jumper, a cotton tent dress or a jersey cat suit...so which one will it be...only time will tell, but I think I am leaning towards the cat suit:)

I discovered my "baby bump" this week. It is not visible in clothing yet, but it is there!

My 11 week doctors appointment was on Wednesday and I was able to hear both of the babies heartbeats via Doppler. They were both 160bpm....very strong.

One more week of my first trimester and into the second:)

10 Weeks and Counting...

Today I am 10 weeks along and I am feeling much better! The past 5 weeks have been filled with a lot of sleeping and not eating (morning sickness that lasts all day...no fun). I am really looking forward to the 2nd trimester and feeling a lot better, having more energy, and putting on the lbs. We found out that because we are having twins we are automatically classified as a high risk pregnancy. I have my first appointment with the specialist on February 25th. The specialist will take full measurements of the babies and go over all the risks/complications. The good thing about seeing a specialist is that we will get an ultrasound each month. I am excited that we are going to see the little munchkins that often!

Here is to a healthy final 2 weeks of my first trimester:)

Twin Reaction Quotes

In What to Expect When You're Expecting there is a section about handling insensitive reactions to the news of your twin pregnancy. Thankfully, we have not had any insensitive comments, but have had a few comments which are worth sharing.

Religious sentiment

God doesn't give us anything which we can't handle.

A commentary on Jamie and I

You guys don't do anything half way do you?

A commentary on twins

Dude, having one kid is hard enough, having two.... there's a support group for that.

It's not Steele Baby but Babies

We are having TWINS!

After 3 weeks of tests and ultrasounds, we are happy to announce that on Wednesday, January 19th we were able to hear both of the babies heartbeats. Both heartbeats are healthy and strong. Talk about an out of body experience. Andrew and I were in a moment of complete JOY.

The due date is somewhere between August 11th - September 8th. Twins usually deliver around the 36th or 37th week, but full term would be September 8th.

This is truly one of the greatest blessing and miracles that we have ever received and we are excited for the coming months and being able to share it with all of you!

Steele Baby might be Babies

The Steele Baby might be babies. Put another way, Jamie and I might be having twins.

Due to a previous ectopic pregnancy, Jamie is in the high risk pregnancy category. Her status means that she will have more and more frequent tests than most women have during a low risk pregnancy. The first round of tests began with blood work which confirmed her pregnancy via a test of her human chorionic gonadotropin (hGC) levels. Two days later a test showing a doubling of her hGC confirmed a healthy pregnancy.

The second test showed Jamie’s hGC levels did not just double, they nearly tripled. To our relief our doctor’s nurse assured us this was not a problem. However, Jamie’s high hGC levels indicated the pregnancy was far enough along to perform an ultrasound. The ultrasound would be the final early confirmation that the pregnancy was healthy.

During our appointment the ultrasound technician immediately confirmed that the pregnancy was in Jamie’s uterus. Upon zooming in she said “we have two dots.” Jamie and I happy to hear the pregnancy was in the right place paused for a moment, before I said “wait, what does two dots mean?” The ultrasound technician quickly replied “well, twins do happen.” Jamie swears that upon hearing this news I went white as a sheet. I am sure I did, as the first thought that raced through my mind was “how am I going to pay for college?”

The technician took a number of pictures, documenting the size and position of each embryo. Our doctor then came in confirming that yes they were twins and that both embryos looked healthy. The doctor then explained that from indicators on both of Jamie’s ovaries it appears that the twins are fraternal.

Everything documented here took place from December 29th – January 5th. The Twelfth Day of Christmas (January 5th) will now always hold a special place in our hearts.

This early ultrasound does not guarantee that we are having twins. There is a 21-30% chance that this will result in a vanishing twin. To confirm the twin pregnancy Jamie has another ultrasound scheduled for January 19th, after which we will have our first prenatal appointment.

We had never considered the possibility of twins, but as the shock subsides, elation over the possibility ramps up. Waiting for the second ultrasound is proving to be very difficult.