Judy's membranes ruptured about 1:00AM Friday morning. When I came downstairs at 6:30ish, planning to go horseback riding, I found a note on the refrigerator in magnetic letters "VW stay near" and a written note explaining about the membranes. When Ken came down he told me that Judy was not having regular contractions. Judy was trying to sleep, knowing that she would very likely soon need all the resources she could muster. Around nine that morning, Ken called obstetrician Beth Hardiman's office and talked to her midwife Ruth Johnson. Ruth was adamant that Ken should wake Judy and bring her to the phone, and Ken started off to do so, but stopped, saying, "I can't do it." He went back to the phone and told Ruth he would not wake Judy but would have her call as soon as she awoke. Ruth was not pleased. A little while later, Beth called, taking a much more relaxed attitude. Judy was up by then, and we all went to Mt. Auburn Hospital so Judy could have an "NST" or "non-stress test" -- a doppler stethoscope examination to check the babies' heart rates to make sure the babies were healthy. Reassured that they were, we went home.
Nothing much happened all the rest of that day and night. Judy had occasional, weak, non-progressing contractions. The next morning (Saturday) we went back to the hospital for another non-stress test that couldn't be beat and then, at the doctor's recommendation, went out for spicy Chinese food at Mary's in Central Square, walked around, bought miso and fermented black beans at a Japanese grocery, and went home. Supposedly spicy food can trigger labor. Judy speculates that it only works if you don't eat it every day. The doctor also marked pressure points on Judy's ankles that are said to start labor. We didn't try the accupressure.
At about 3:30 Sunday morning, Judy woke me to tell me she was having stronger contractions about 10 minutes apart and that she was having to use some breathing techniques to get through them. We established her in the guest room as she needed to get up on the "birth ball" to breathe through her contractions, but wanted to lie down in between. The waterbed in her bedroom was not conducive to easy getting up and down. Shortly before six, two things had happened. Judy's contractions were about 7 minutes apart, and she was starting to feel very cold. Although I was too warm, Judy was shivering in a fleece cardigan and hat. Judy was also having nearly continuous lower back pain. We didn't know it then, but an infection in the chorionic sac of Baby A (the presenting twin) had begun and Judy's temperature was starting to rise.
Ken got up and said he was sick: some kind of stomach/upper respiratory bug. Not very severe but enough to keep him from sleeping well. Very bad timing!
Around 6:10AM I called the obstetrician to report that Judy's contractions were now regular and less than ten minutes apart and that I thought she was showing signs of impending "transition" (the phase of labor where the contractions change over from thinning and pulling up and dilating the cervix to actually pushing the baby out). The sensations were getting more intense.
The doctor said we should come in. Judy vomited once from the pain. As soon as we could get organized, deflating the birth ball, putting all our pre-listed equipment and supplies into the car, we left. It turned out we could have left the birth ball at home, but we didn't know that at the time.
We got to the hospital in good time (hardly any traffic at that hour of a Sunday morning -- the only thing which had caused us to worry about our choice of hospital was that it was going to be hard to get there during rush hour). We made one pit stop on the way.
By 7:00AM we were at the hospital. Beth met us there in jeans. We were from the beginning and continue to be extremely pleased with Beth Hardiman, the obstetrician. She was a very reassuring presence and had a midwifely objection to most interventions unless they were absolutely necessary. This quality in her meant that when she said she needed to use an intervention we trusted her and knew the intervention was really necessary.
Walking down the hall to the delivery room, Judy was sick again. Her temperature was over 100. She was somewhat dehydrated. Beth wanted to start IV fluids and antibiotics, suspecting that there was an infection in the ruptured sac. Judy was 6 centimeters dilated (out of 10). Beth also wanted to put an "internal monitor", a wire connecting a tiny pin in the baby's scalp to an instrument for recording heart rate, because the baby was so far down in the pelvis that it was hard to get a reading from the doppler. Both babies and Judy had accelerated heart rates. Both an IV and an internal monitor were things we had really wanted to avoid, but it was clear that the babies were affected by Judy's fever, and we consented.
Judy continued to have contractions, closer together now, and was in considerable pain from her back. She couldn't always tell when a contraction was starting because of the ongoing back pain, but when reminded she would breathe through them. She lay on her side and really buckled down. Soon her fever reached 103, but she was breathing through her contractions.
Ken stayed by her lower back to apply counter-pressure to the back pain and I stood by her head, holding her hands and reminding her to breathe. I kept up a running babble, undoubtedly sometimes inane, saying, "Breathe! You're doing great! You're awesome! Another one gone!" When the contractions intensified and got closer together, Judy would swear and fling her head back and roll her eyes, but I would grip her hand harder and get eye contact and say "Breathe!" Judy developed her own breathing technique spontaneously, a low breathy whistle, and when that didn't work she would obediently pant when I told her to. Judy notes, "I needed to be reminded to breathe with every contraction. I couldn't have done it without the cheering section." She was working hard despite her fever.
I stood by her head for four hours and never noticed that my back and feet were getting really tired. After Judy was 8 centimeters dilated, the labor nurse and the OB asked occasionally whether Judy was feeling the urge to push, but she wasn't. They told her to report if she began to feel pressure on her anus, and eventually she did. The OB was out of the room briefly and I sent the student physician's assistant Rayhme (who was GREAT, by the way) out to get her. When Beth came back in she examined Judy and said it was time to push. Judy rolled over onto her back. The doctor told her that, when a contraction came, she should pull her legs up with her arms, take a deep breath and block, put her chin to her chest and PUSH. If Beth hadn't been such a wonderful doctor she would have made a great football coach. "Push! Harder! Harder than that! Take a breath! Give me another one! And another one! I can see the baby's head!" Judy says, "I sort of understood what the contractions were going to feel like, but I was completely unprepared for pushing. It was INTENSE."
The red-and-green twisted cord of the internal monitor was a gauge of progress. When Judy pushed, it would inch out.
When the baby's head was well down, Beth decided that both babies' rapid heart rate made getting them out quickly imperative. She used a vacuum extractor, a little like a tiny plumber's helper connected to a little pump, which fastens to the baby's head and gives the doctor a handle to keep the baby down between contractions and to help pull it out. Soon, Baby A's head was all the way out. The cord was around her neck but Beth extracted it deftly. Another push or so and "It's a girl!!" Judy rested through a couple of contractions. Jocelyn weighed 5 pounds 10 ounces. We were surprised, because the ultrasound technician had calculated their weights at five pounds four weeks earlier and we had expected both babies to be closer to 7 pounds by now. He had also said Baby A was a boy, but oh, well. Jocelyn cried and pinked up very satisfyingly and received Apgar scores (a rating of how healthy a newborn is) of 9 out of 10 both at 1 minute and at 5 minutes. Seemingly she had suffered no ill effects from the infection in her little nest. Ken was the first besides medical staff to hold her.
Now it was time for Baby B to make an appearance. Judy had figured out what pushing was about by now and was really working hard. The doctor applied a vacuum extractor for this one, too. It soon became clear that Baby B had a much bigger head than Baby A, but between them Judy and Beth got him out. "It's a boy!" Perry weighed 7 pounds 14 ounces, also had Apgars of 9 and 9, and cried and pinked up.
Because Beth was in "get these babies out" mode instead of "be really gentle on mom" mode, Judy did tear a little bit with Jocelyn. Perry made things much worse, causing three big tears. Partly because of the infection, and partly due to a hemorrhage after the placentas were delivered, Judy lost a liter and a half of blood -- more than three times as much as one would give at a blood donation. She was never unconscious or incoherent, though.
Beth took a while sewing Judy back up, commenting that her husband said she was good at jigsaw puzzles. She must have done a good job because Judy has had remarkably little pain.
The twins went to the nursery for washing and examination and vitamin K shots and to have blood drawn for white blood counts and cultures (in case the infection had affected them). Ken went along and refused to be shooed away by the nursery staff. When the babies returned from the nursery, the delivery nurse helped put both babies to breast, one at a time, and both nursed well and got that vital colostrum and helped contract Judy's uterus, which was somewhat inflamed from the infection and not clamping down as well as it might have.
Later, Ken would say that the babies seem to mind having their diapers changed much more than having their vitamin K shots and blood draws. Jocelyn's white blood cell balance was shifted in a way which suggested she was fighting off an infection, so she was put on IV antibiotics for two days: ampicillin and gentamycin. Her blood culture never grew anything, though. Judy also was on antibiotics for 48 hours and her fever quickly disappeared.
Because Judy had lost so much blood and had been so sick from the infection, she was pretty wiped out for most of the time she was in the hospital. I stayed with her all night Sunday night and Monday night, helping her with the babies, sleeping on a remarkably uncomfortable sort of cot which was a chair in disguise. Ken, who was of course still sick, went to a hotel in Harvard Square Sunday night, and to a bed and breakfast near the hospital on Monday.
This might be a good place to thank Carolyn, the proprietress of the bed and breakfast, who was extremely friendly and accommodating.
The morning after the birth Beth came to see Judy in her room. Beth was carrying Judy's fleece slippers which I had left in the bathroom of the delivery room when I moved our stuff the day before. I twitted Beth, "Have you no dignity? No doctorly sense of your own importance?" Beth reckoned not, pointing out that she was in the business of delivery. I said, "And in pairs, too!"
In the middle of Sunday night Judy had a decidedly unpleasant encounter with a nurse who is in the wrong line of work. Because Judy's nipples are very large and Jocelyn is very small, it was really difficult to get her "latched on" well, and if she didn't get a good latch, she would really hurt Judy's very sensitive nipple. We asked this "nurse from hell" for help with the latch and when Jocelyn bit down and Judy yelped this woman literally threw up her hands and snapped, "People who can't take care of their own babies shouldn't have rooming in!" She was really obnoxious and is just the kind of character who would leave a less strong-willed woman than Judy in tears and ready to give up on the whole idea of breast feeding.
Ken came to the hospital in the daytime and I went to the bed and breakfast to nap in the afternoon.
On Tuesday, we got the very welcome news that Jocelyn's blood culture was negative and that, though she was a little jaundiced (neonatal jaundice is very common), her bilirubin level was low enough for her to go home.
Beth came to check Judy. She had Judy lying on her side, facing away from her, and peered at Judy's perineum. "Beautiful!" she said. I cracked up. "Obstetricians have a very weird sense of esthetics."
Of course, the hospital managed to drag out the necessary paperwork to the point that we had to drive home with the babies in rush hour in a hellacious series of thunderstorms and while corralling a huge helium balloon in the shape of a rubber duckie, which Cally had brought us.