Tuesday, December 29, 2009

Doctors & Nurses Part II

Doctors & Nurses Part II

We call the head of the perinatal practice “Dr. Lyle,” after my high school geometry teacher, because he looks like Mr. Lyle, although Mr. Lyle was not the sharpest tool n the shed and you get the feeling that Dr. Lyle is.  But they’re both big and lumbering and they put you at ease: Mr. Lyle because you knew he’d give you an A (unless you were a boy; boys had to show their work); Dr. Lyle because he says things like, “I think you’re gonna be fine.  In fact, you can go home today if you want.”

He also said things like “In my experience, bedrest makes people depressed,” and “I think 24/7 monitoring at this stage is overkill.”

“Dr. Whipple” was the next doctor we saw.  He’s the first doctor we met, the one who’s looking to get us to the 34 – 36 week range.  This is the guy that delivered his first pair of mono-mono twins on his birthday twenty years ago.  He also has twins of his own, four years old, who were born at 34 weeks.  Dr. Whipple recommended something in the middle: stay on this side of the Labor and Delivery ward in my comfy little private room until week 28, just to see how my insufficient cervix is holding up.  Maybe I’d go home after that; we’d see.  We’ll continue bio-physical profiles three times a week and still monitor the twins via ultrasound twice a day.  And then he revoked my walking privileges. 

So Dr. Whipple’s our man.  He’ll write up a plan and the other doctors will follow it. 

Week 28 is January 17 – so that’s the date we’re looking at for a possible return home.

This is a short post so I thought I might include some of the requests I’ve had for blog material.  They are: a haiku, FOML, and a Bryan family movie quote.  Actually, the requests were for a haiku, FOML reference and movie quote for every post, and no guarantees on that one, but here’s a start:

The fruit of Matt’s loins
Are now in week twenty-five
Yea!  My heart is glad

I’ll have to pass on the movie quote.  I can’t think of anything remotely contextual except for: “I’ll have the California health plate.  No dairy in that, eh?”

© 2010 Janine Kovac 

Sunday, December 27, 2009

Doctors & Nurses

Doctors & Nurses

She came to me on Christmas Eve, much like Jacob Marley (who I think technically called on the 23rd)—my favorite nurse, (we’ll call her “Marleyanne”).  She’s the one who gives the knitting lessons. 

She stood at the foot of my bed and her voice lowered.

“During your stay, one of the doctors will give you the option of going home.  Don’t take it.”

Huh?  What?  Really?  Why?

And then she was gone.

“You’re better off in here than you are out there,” the nurses keep telling me.  Which is exactly what Karen Hill says to Henry in the movie Goodfellas when she’s visiting him in prison.

“Karen, Karen!  They can whack me in here just as easily as they can out there!  Maybe even easier.”  Then he convinces her to keep smuggling him Quaaludes and salami and promises to never see his mistress again.

But I digress.

So who was this doctor?  Initially I thought Nurse Marleyanne was talking about the on-call doctor we saw the first night.  We’ll call him “Dr. Spaceman” ala 30 Rock (pronounced “spa-chem-en”). 

If you’ve never seen the show 30 Rock, Dr. Spaceman is the Hollywood doctor who says wacky things like, “Science is whatever we want it to be!” and “Would you like some [pills] before you go?  I’ve got reds, blues, purples.”

Our Dr. Spaceman said things like “I don’t see why you need to have a C-section just because the umbilical cords might get entangled.  You’ll want an epidural of course, because I might have to reach in and grab the second one.”  And then he made this very startling extended reaching and pulling gesture.

He said some interesting things, too (that actually made sense).  Like, “more monitoring isn’t necessarily better.  The more you look, the more you find and a lot of that stuff is meaningless.  But it usually leads to more interventions and all interventions carry risks.”

But Dr. Spaceman isn’t part of the High Risk Perinatal group that treats me.  That means Nurse Marleyanne was talking about someone else.

I knew she wasn’t talking about Dr. Q.  Dr. Q. worked Christmas Eve and Christmas.  

I like Dr. Q.  All the nurses do, too.  But Dr. Q. is recommending that I go to the Labor and Delivery ward at 26 weeks for 24/7 monitoring of the twins.  This is in the event that if an umbilical cord gets crimped, the monitors should catch it right away.  If the cord is truly crimped, then the doctors will have about 6 minutes to do an emergency C-section and pull out the babies. 

A crimped umbilical cord is the single element that makes the MonoMono twin situation a DEFCON 4 pregnancy.  It is not inevitable that a cord will get crimped, in fact, it is very likely that it will never happen.  But it is also not predictable or preventable and no one can promise that it won’t happen, just as no one can promise that you will never get in a car accident. 

Going to L&D is a big deal.  And going at 26 weeks, (especially if I am trying to hold out until 35 weeks) will be a miserable ordeal.  It means that I will be in a labor bed (terribly uncomfortable) even though I will never go into labor.  It means that every time the monitor can’t pick up one of the twins, someone will come in and adjust the ultrasound.  Keep in mind that right now I get monitored twice a day.  The twins are so small and move around so much that of every hour of monitoring, there are probably only twenty good minutes of both twins’ heartbeats. 

When I talk to the nurses, they all smile say the same thing.  “Dr. Q?  Oh, he’s great.”  When I tell them of his recommendation, they get very silent, purse their lips and drift back from me a little bit.  “It’s not respite,” they all say in a very low you-didn’t-hear-it-from-me voice.  Once, when two nurses were adjusting the ultrasound, chasing the Red Baby, one nurse said to the other (as if I weren’t there), “Dr. Q wants her to go to L&D next week.”  The other nurse looked down at me and said, “No sleep.”

So that’s the word from Dr. Q.  He has gently recommended that I talk to the neo-natalogist from the NICU (it’s a pediatrician for preemies) and each time she has come down I have sent her back up again.  One excuse was that I was tired.  Another time I said I wanted my husband to be here with me, as he would have more questions.  The third time she tried I said that I didn’t feel comfortable talking about this in front of Chiara (all true).  She tried her best to pretend not to look offended but still give the message that she had been put out.

I told Dr. Q, “I don’t want to see what a 24 week preemie looks like.  To me it’s like looking at a car wreck; it’s not going to help me be a safer driver.”

Dr. Q. nodded and half smiled and said, “Some people just want to know what they might be in for.”

“I’ll go back in a few weeks and see what a 28 week preemie looks like.  But not now.”

Of course my favorite doctor is Dr. Strawberry.  She was the first doctor I saw when I got here.  I hadn’t been admitted yet, but I had been on the monitors, so the first thing she did was take off her shoes and crawl onto the bed next to me.  After handing me a “favorite toy” and giving me a big hug, and she took the elastic belts and carefully laid them along my belly.

“Here are your ribbons, Miss Janine,” she said as she gently patted my leg.  “Everything’s going to be just fine, Miss Janine.  You’re going to be just fine.”

Unfortunately, “Dr. Strawberry,” as she calls herself, isn’t very qualified.  She’s barely in preschool and this is only her second trip into a hospital since she left one wrapped in a blanket nearly three years ago.  But she has a great bedside manner.  Unless she doesn’t get her nap.  Then she’s kinda cranky.

There are other doctors, but if I told you about them now, what would you read tomorrow?

© 2010 Janine Kovac 

I'll Be Home For President's Day . . .

I was going to include all the technical info in this post and forego the pithy stuff altogether since that was the original intent of the blog and quite frankly, for a while there, I was all out of pith. 
But things are changing SOOOO quickly, that yesterday’s news is so, well, yesterday. 

Here’s what I thought wouldn’t change when I started writing this post just yesterday: I am in the hospital to stay until the twins are born.  This has put a funny spin on it because of course, I want to be pregnant as long as possible and so I am embracing the idea of a long hospital stay.

The Peas are doing really great.  In our bio-physical ultrasound yesterday (we will be doing 3 of these thorough ultrasounds a week now), they scored 8 out of 8.  I didn’t score so well.  The ultrasound showed lots of contractions and a little more dilation than Tuesday’s measurements.  Contractions are normal (at this stage they are just your Braxton Hicks variety) and twin moms experience more contractions than singles, but that’s still too much action for comfort.  Pair an “excited” uterus (as it is called) with an incompetent cervix and suddenly it’s like they’re the Keystone Cops of the Birth Canal, bumbling and stumbling and egging each other onward: the frequent muscle contractions of the uterus encourage the cervix to open which apparently is very exciting if you are a uterus.

So they put my uterus on downers (indocin – the opposite of pitocin) which will continue for another day.  This seems to have done the trick.  Twice a day the twins’ heartbeats and my uterine contractions are measured by ultrasound (without the visuals), and according to the last two readouts, my uterus is, like, totally stoned, dude.  It has literally flatlined.  Which is good because it means they will take out the magnesium sulfate IV, which means I get to take a shower.  God Bless Us, Every One!

So far we have had:

  • Two steroid shots to help with lung development (betamethasone).  If I am still pregnant four weeks from now, they will give me two more.  (insert Barry Bonds placenta joke from Fat Shari post here)

  • Nearly three days of magnesium sulfate drip.  This is to stop contractions (the efficacy of which is disputed) and help reduce the incidence of cerebral palsy in preemies.  Side effects include: feeling warm (which means that my room must be an icebox), dizziness, weak legs, blurred vision, headaches, crankiness, and dangerous retention of liquids.  Luckily, all I feel is warmth (which could be my own sentiment) and crankiness (which could be attributed to not having showered in a while).

  • H1N1 vaccine, the mercury free variety

  • One pair anti-embolism stockings designed to help circulation by cutting it off.  Matt calls them “tourniquet socks.” 

  • Stool softener and lots of prune juice.  (Really, Janine, nobody wants to know about that one.  Nobody.)

Other fun stuff:

Twice a day for thirty minutes to an hour we get ultrasound readings of Peas and The Excited Uterus.  There are two ultrasound that look like “microphones,” one for each of the Peas and one “Toco” for me.  Mine is set at a frequency to pick up muscle contractions.  The Peas’ ‘phones pick up heartbeats and movements.  Because the Peas are still so tiny, this is quite tricky.  Sometimes both Pea microphones detect the same heartbeat, even though they (both sensors and peas) are on opposite sides of the belly.  The heartbeats are constantly fluctuating from 125 beats a minute to as much as 171 (although the tight range is closer to 135 – 150).  This fluctuation literally happens from beat to beat (partially a function, or dysfunction, rather, of the equipment.  It just can’t keep up.)  So while my heart beat readout reads like: 88 . . . 91 . . . 89…..The Peas are closer to: flicker, flicker, 141 . 125 . 131 . 151 . 144 . 122 flicker, flicker.

If the two ultrasound readings are consistently about two beats apart, then they are picking up the same heartbeat.  Sometimes—often times—one reading is completely blank.  Usually this means that the baby is moving, which is actually better than picking up a heartbeat, because if itsa movin’, itsa beatin’.  Doctors like it when the babies move a lot.  Nurses don’t.  It means that they still have to stick around, angling the sensor this way and that until Red Baby stops moving (it is ALWAYS the Red Baby, Baby B).  Further confirmation of babies’ movement is a fourth line on the readout and very often the blank spots on the heartbeat axis are complemented by thick black streaks representing Red Baby’s Dance Along the Uterine Wall. 

Three times a week (starting yesterday) I will go in for the ultra-deluxe bio-physical profile ultrasound.  This is the ultrasound where the twins get graded.  Umbilical cords are checked for crimping and bloodflow and that kind of thing.  On Thursdays they will also take a cervix measurement.  Shortening cervixes are signs of labor BUT sometimes the cervix can lengthen and shorten, widen and tighten.  This is called a “dynamic cervix,” and this is the outcome we are all hoping for.  (So much better than being “incompetent” or “insufficient”)  A dynamic cervix means that this week’s measurements are simply snapshots in the dance and now that the uterus is no longer excited, the cervix is just kinda dancing by herself in the corner, like me at my friend Amy’s wedding.  Or come to think of it, every wedding I ever went to before I met Matt.

Tuesday and Thursday are massage days and once a week a physical therapist is supposed to stop by to move my legs around so they don’t atrophy (tourniquet socks can only do so much for circulation).

Wednesday is support group day.  I haven’t been yet, but I think all the moms pregnant with 20-something weekers gather ‘round and either we feel sorry for ourselves or we walk away (roll away; I think we are all in wheelchairs) thinking, “Geez.  At least I don’t have it as bad as THAT poor nut.”  And I think we learn how to knit, too.  (I’m not joking about this.  One of the nurses feels very strongly about teaching American mothers the lost art of knitting and she figures that a captive audience is an easy target).

As far as stuff that won’t change, the doctor who is the head of the high risk pregnancy practice has stopped by this morning (Saturday, the day after Christmas) and doesn’t think I need three bio-physical ultrasounds a week.  He has cancelled this morning’s BPP (as we call them here on the inside) and prescribed a progesterone suppository to stop the cervix from dancing.  Oh, and he thinks that I could go home if I wanted. 

How’s that for a cliffhanger?

© 2010 Janine Kovac 

Thursday, December 24, 2009

I'll Be Home For Christmas

I’ll Be Home For Christmas . . .

Week 24 is here and with it comes the reminders as to why we started this blog in the first place.  It wasn’t to get all cutesy and share adorable news about Chiara (such as, within a week of moving to the next classroom at daycare she started singing, “Shake your boom-bas, shake your boom-bas” while dancing naked in front of the mirror).  No, it wasn’t for that; it was to let friends and family know what was going on during times when we had news to share but wouldn’t be able to call everyone and give them the update.

We kinda forgot about that this last month or so, mostly because we were in that blissful place where there wasn’t much I could do but take naps and eat triple cream goat cheese.  And so I let my inner Erma Bombeck get the best of me.

But then we had our 24 week checkup.

Here’s the skinny:

(Well, none of us is skinny.)  I have passed my max weight with Chiara by 8 pounds.  The twins are a pound and a half apiece, which puts them squarely in the 50th percentile when compared to lonely singletons.  They are moving a lot and I thought I was crazy to think that I can tell them apart when they kick but then I came away from the ultrasound convinced that it affirmed what I had already intuited: Baby A (to me, the blue baby) is head down on the lower left side and Baby B (the red baby) is transverse with a preference for having his toward the right, although he has been known to flip.  The twins are doing great.

Repeat, the twins are doing great.

Mom is feeling great.  But she’s sick of being pregnant and her body is starting to reflect that.  Had she been carrying only 1 kid, her doctor at yesterday’s ultrasound would have sent her home with orders of bedrest.

But she’s carrying two kids, so he sent her to the hospital instead.  We had been meaning to do a tour of the Labor and Delivery ward, anyway. 

“Can we go home first?”

“Do you have a bag packed?”


“Then you better just go.”

Ah.  So we did.  We checked into the hospital. Five hours later, we saw the doctor.

Which is actually a good thing.  When you are 24 weeks pregnant, and you go to a place where new little people are dropping into the world at unexpected times in unexpected ways, you want to be a low priority.  You want to be the one the doctors keep forgetting about.  You want to be just above “answer text message from wife.”  It’s their way of letting you know that they don’t expect any new little people to drop out of you any time soon.

* * * * *

We got settled right away, however.  In fact, I was in a hospital gown resting in my own private room flipping through movie channels before they had even begun the admission process.*  Bed rest was the important thing to have, so bed rest is what I got.

* BTW - admission takes FOREVER.  First there are the questions about your insurance and where they can come find you if your insurance arbitrarily decides not to cover any of your health needs.  Then there are questions about health history—surgeries, allergies, regrettable romantic relationships—for you, your parents, your spouse, your cousins’ spouses, their parents and then there are some bonus questions about some randomly picked T.V. personality, like Alex Trebec, which I assume is thrown in for extra credit.  There are questions about religious preferences, dietary preferences, and some geography questions (which are a bit tricky if you don’t know all your Russian provinces).  Then there are the legal forms, of course, which all say, “The party of the first clause hereby known as the party of the first clause and the party of the second clause hereby known as the party of the second clause” . . . which is followed by the Sanity Clause, and of course, this being Christmas, and all of you —being Marx Brothers fans or at least savvy Google searchers—know that there is no Sanity Clause. Ba-dum-pum-pum!!!  After they do the legal part (and I am not joking about this) they ask how you best understand and remember information.  Written?  Oral?  Combination?  There were two other choices, but I forgot what they were because the questions were given orally and I am “written” learner.  (Check my file)

I think I’ll put all the technical info in a separate blog post.  For this post, I’d like to just put everyone at ease.

Everything is fine, I’m just in here for a bit so they can take some further precautions to make sure that everything stays fine.  I am not experiencing any kind of early labor, but I do have what they call an insufficient cervix (it used to be called an "incompetent" cervix, but that got scrapped in favor of the less judgmental, but still accurate “insufficient” cervix.  I am totally on board with this one.  I think I would burst into tears if a doctor told me that I might deliver early because my cervix was incompetent.  It’s tantamount to having a moron for a uterus.)

How long is “a bit?”  Yeah, we’re not sure about how long that is.  It’s like the DoctorSpeak equivalent of your Mom’s “we’ll see.”  As Cathy, Matt’s sister, mentioned to me, [some] doctors like to give you time to wrap your head around these things, so, “at least until Christmas” turned into “at least until next Monday” which was followed by lots of lovely anecdotes about pregnant women like me who walked into the Black Hole of Bed Rest and emerged three months later. 

Yes, we will be here for Christmas.  Luckily, they have a open door policy for visitors.  Spouses are welcome any time.  There’s even a chair that pulls out into a bed.  Matt spent the night here last night (Tuesday) and will again tonight (Wednesday).  (Jason & Caitlin stayed with Chiara so that he could do that.  Special thanks, guys.) 

And the hospital allows kids to visit, too! 

(This is not the case at all hospitals.  In fact, I have it on good authority that it is not the case at certain hospitals in St. Paul, LA, Columbus and Tampa.  Because of the H1N1 scare, in many hospitals children under five cannot visit.  When we asked our hospital about their visitor's policy and H1N1 they looked at us kinda funny.  They thought we were asking because perhaps our daughter had H1N1.  And for the record, those children may not visit the Labor and Delivery ward.)

Our doctor suggested that Chiara become as comfortable as possible in my room, even going as far as making a nest for her in the corner if she wants to stay the night.  Which was my first clue that I wasn’t getting out of here any time soon.

I’m kind of OK with the whole deal for now, including the prospect of spending both Christmas and New Years in here.  It isn’t until I think of the song that I get all choked up:

I’ll be home for Christmas
You can count on me
And . . . things that blow?
And presents under the tree

I was in my 20’s going through yet another Christmas away from home before I realized John Denver doesn’t make it home; it’s only in his dreams.

It's that last line that makes me really bawl.  (Although, to be fair, I also cry uncontrollably at the bridge of “Frosty the Snowman.”  My dancer friends can back me up on this.  This was quite problematic the year I was in a show with a tap dancing Frosty.)

So tomorrow (Thursday) is Christmas Eve.  Matt and Chiara are going to get a little plastic Walgreen’s tree and put it in the corner.  We’re going to make ornaments out of Chiara’s “art” projects that I don’t really want to keep but can’t bring myself to throw out.  If I can’t be home for Christmas, home will just have to come to me.

Merry Christmas, everybody!

© 2010 Janine Kovac 

Tuesday, December 15, 2009

Survivor Mom

Survivor Mom

This post is dedicated to Amy and all my other baseball fan friends

As I was saying last time, this time is different.  This time, the thought of the unexpected is exciting.  It’ll be like the urban version of Survivor Man, the show where they drop this guy into some ferocious wilderness with nothing but a videocamera and a bottle cap and he has to survive the week. 

If you’ve ever seen the show, you know what happens. The guy takes his bottle cap and carves out a teepee from wet bark and then uses it (pick your antecedent—either the bottle cap or the wet bark—they both work) to trap quail, rabbit and small fish.  The teepee blows over on Day 2 and none of the food he catches turns out to be edible.  On Day 4, sweating and shivering and cross-eyed from delirium, he looks into the camera and admits defeat.  He’s going to call on the emergency phone.  (Wait!  He has an emergency phone?  Isn’t that cheating?)  And then he passes out from dehydration.

But on Day 5, the sun comes out.  And Survivor Man realizes that the maggots feeding on the flesh of the small and dead woodland creatures are chock full of protein.  And then he sees that he can dry out the animal carcasses in the sun and build a new teepee.  Survivor Man does it again!

This is how I picture the next five to seven months.  Like Survivor Man, who just has to last out the week, I just have to last long enough to make it to Cousin-O-Rama on Labor Day weekend.  Even if it means that Matt has lost most of his hair and mine has all turned grey.  I call it Survivor Mom. 

Except that I won’t go at it alone.  Matt will be there.  Chiara will be there (granted, she is limited in her abilities but she will be able to say things like, “Mama!  Quick!  Chester’s rolling down the stairs!”).  And we will get help.  Lots and lots of live-in help. 

Pretty soon I will start shamelessly recruiting 5 months’ worth of family and friends to come stay with us and be part of the madness.  (email me if you have some dates in mind)

Can’t you hear it?  “If you build it, they will come.”

What have we built?  We bring you twin boys.  Not just any twin boys, but the fruit of Matt’s loins.  They will be big.  They will be strong.  They will eat wallpaper.  Come witness the madness for yourself.

Will they have the same cry?  Will they have the same eating schedules?  Will they sleep most soundly sucking on each other’s toes? 

Will you be able to tell them apart?

Most importantly, will you be able to last the week?

Will you fly in on Monday, brightly armed with a videocamera and a bottle warmer prepared to make a meal and do the occasional 2 a.m. feeding only to find yourself in inhospitable territory-- there's me, walking around in a daze in a nightgown (someone else’s nightgown, you realize).  Inside the boys’ room BPA-free teethers and organic cotton burp clothes fly around like that scene from Poltergeist.  Meanwhile, Chiara is at the top of the stairs swaying back and forth: “They’re heeeeeeeeeer-eeeeer.” 

You open the fridge and realize that the Kovacs have been eating recyclable cardboard and lead-free Melissa and Doug wooden picnic food.  All the furniture is covered in spit up and baby snot.

"What’s that smell?" you ask.

Matt is nowhere to be found.  Later you discover that he’s passed out (again) in the diaper aisle of a Whole Foods somewhere in the Bay Area.  In one hand he’s clutching a carton of Luna bars.  In the other, compostable baby wipes.  They found him (again) by following the trail of leaked Pedialyte.

Will your inner Mary Poppins come out and save the day?  Or will you call home on Day 4, shivering and sweating, covered in projectile baby fluids and admitting defeat?

You don’t know.  But I know you.  You HAVE to come and see.  At least long enough to find out what happens on Day 5. 
Can’t you hear it?  It’s Darth Vader’s voice from Field of Dreams : “Ray, people will come Ray.  They'll come to Oakland for reasons they can't even fathom.  They'll turn up your driveway not knowing for sure why they're doing it.  They'll arrive at your door as innocent as children, longing for the past.  Of course, we won't mind if you look around, you'll say.  People will come, Ray. . .  The one constant through all the years, Ray, has been babies.  America has rolled by like an army of steamrollers.  It has been erased like a blackboard, rebuilt and erased again.  But babies have marked the time.  This nursery, this game: it's a part of our past, Ray.  It reminds of us of all that once was good and it could be again.  Oh... people will come Ray.  People will most definitely come.” 

© 2010 Janine Kovac 

Saturday, December 12, 2009



Nothing new to report.  Tomorrow starts Week 23.  We are two-thirds of the way there.  I was supposed to have an ultrasound this Friday, Dec 18th, but we were able to switch it to next Tuesday, Dec. 22nd.  So now our ultrasound and checkup are only a week apart, rather than 11 days apart.  (The doctors like the ultrasound and regular checkup to be as close together as possible, but because of the holidays, there are fewer scheduling options.  Our next regular appointment is December 29th).

When I was pregnant with Chiara, people would ask me if I was excited.  I hated that question.  In fact, that’s when I stopped answering the phone, which has been on vibrate ever since. 

Last time around, I just didn’t know what to expect with a baby, so it was hard to be excited.  When we got our first box of baby hand-me downs from Jeff & Liz (not their real names), I had to stop halfway through the sorting.  Somewhere in my belly was a thing that would fit into these clothes.  Were they tiny or huge?  I couldn’t tell.  So I put the box in a corner and cried instead.

Then there was the Internet search for doula information.  There was page after page after page of mother this/mother that, mother mother mother.  And I thought, “What does my mother have to do with any of this?  When does it get to be about me?”  That’s when I realized that it was all about me.  I was the mother they were talking about.  So I shut down my computer, sat in the corner on top of a box of tiny huge clothes and cried some more.

There were other things to cry about: like realizing that there is no space of time between when the kid is born and when you have to take care of her.

To be fair, there were some things to laugh about (things that wouldn’t be so funny now).  Like, during our newborn care class when we had to give mouth to mouth to a plastic doll.  We were instructed to tap the baby’s foot and say, “Baby!  Baby!  Can you hear me?”  (OK – that still makes me laugh).  And we laughed when Matt, in his performance of the Baby Heimlich Maneuver, would whack the doll on the back of the head and let its forehead smack on the table.  (Less funny now).  And then there was the time we had to dress the resuscitated doll and Matt managed to get half the shirt on right side out and the other half on inside out.  I laughed so hard (and so loud) the teacher had to stop the class. 

But this time is different.  I am SOOOO excited.  I can’t wait.  This time when I opened the box of hand-me-downs from Jeff and Liz (still not their real names), and sorted through the clothes that had gone from them to us, back to them, to Jeff’s buddy from high school and back to us, (are those just hand-me-backs?) I oohed and aaahed and found a little drawer for them. 

This time around, I don’t even think we are going to take newborn care classes.  For one thing, I plan on being too sleep deprived to be able retrieve any newly acquired information and for another, if it’s stuff I already know, why take a class on it?

This time, it’ll be different. 

And that’s where we’ll have to stop for today.  I always write these epic blog posts and I have realized that all the cool kids write short and pithy posts.  So you’ll just have to wait until tomorrow to see how I envision life with a preschooler* and newborn twins.

* I know she’s not in preschool yet but somehow I can’t call someone who reminds me to take my vitamins a toddler.

So much for short posts.

© 2010 Janine Kovac 

Tuesday, December 1, 2009

More Than Halfway There!

More Than Halfway There!!!

I had my 20-week checkup and ultrasound this week.  There was a little bit of drama, like when I called the office at 9:05 a.m. to see if they could move my appointment from 3 p.m. that day to sometime earlier. 

“Actually,” said the receptionist, “I show that your appointment was this morning at 9.”

Oh *%^$#!&*(&@!

I hung up her, changed out of my pajamas and left the house seven minutes later (but not before grabbing an apple, a banana, a tub of yogurt and a piece of homemade bread).  Good thing my mother and stepdad are visiting this week to take care of Chiara.  Otherwise I don’t know what I would have done with her.  “Stay here in the closet, I’ll be back in 90 minutes.  You’ll be fine.”

But that was really the only excitement we had.  I saw the doctor, the head of the prenatal practice, who was wonderfully reassuring.  My weight is up; my blood pressure is down (112 over 68.  Or is it 68 over 112?).  Two heartbeats, check.  OK – come back in four weeks.

The next day we had our ultrasound.  The Peas are too big for us to see both entire bodies in the same shot.  But we saw a bunch of parts. 

At one point we saw a perfect profile of a face.  And then over the chin, a knee.  Over the nose, a shin.  Over the forehead, an ankle and a little foot that repeatedly kicked his brother in the head.  It was magical.

The very best part is that both twins are exactly the same size, measuring at 347 grams and 349 grams respectively.  When I told my brother, the one who works for the Justice department, he said, “Oh.  So that’s about a little less than a pound each.”  (He’s right: it’s about 13 ounces.)  I was so impressed with his conversion skills he felt obligated to explain: “I know because methamphetamine is measured in grams and then we have to convert it ounces.” 

So when I see a fetal weight of 350 grams, I’m thinking like it’s enough prosciutto to feed four ballet dancers and he’s thinking it’s enough to put someone away for at least ten years.  Longer, depending on the purity of the meth, of course.

But the really important thing is not how 13 ounces compares in narcotics and deli meats; it’s how it compares to other 20-week fetuses.  And it’s 2.5 ounces MORE than the average “singleton” at the same gestation, according to this chart  I found online.  Which must be right because I found it online.  (Although, come to think if it, this also is the site where a reader commented on her “fracturnal” twins.)

In the interest of full disclosure, I should say that the error margin is +/- 50 grams.  In other words, ham for plus or minus a person at dinner or plus or minus five years jail time (depending on the purity of the meth, of course).  Or as in online fetal charts, the average weight of a singleton at 20 weeks on the minus side or a 22 weeker on the plus side.  Either way, we’re growing and looking good!  Thanks everyone for your thoughts and prayers.

And lastly, a cute thing Chiara said to me (besides running around naked with a tiara declaring that she is the Mouse King).  Chiara looked at me today—I am in my third trimester clothes already—and said, “Those are some pretty big pants for such a little lady!”

 OH - and this is what 20 weeks looks like with the fetal equivalent of $40,000 worth of meth.

© 2010 Janine Kovac 

Wednesday, November 25, 2009

The Secret to the Universe

What Have You Learned, Dorothy?

Chiara and I have been on a whirlwind tour this November.  Multiple flights, multiple visits to various family members in various time zones. My mother came along, as part of her own [lengthier] whirlwind tour.  She had just flown from El Paso to Philadelphia to visit her sisters, one of who will be a grandma in February.  (Congrats, Aunt Nancy!  I mean, congrats Cindy & Tim!)  Then, my mother flew from Philly to Oakland on Tuesday afternoon, just 13 hours before Chiara and I were scheduled to fly out on Wednesday morning.  My mother had it in her mind that I shouldn’t lift anything heavier than my laptop, so she traveled the rest of the way with Chiara and me, helping us get ourselves and our luggage through the airport. Truly heroic, and she is good company, to boot.

Our first stop was to St. Paul, Minnesota, where I nearly ate my brother and sister-in-law out of house and home (see previous post ) and looked for real estate (Hey, Matt!  In Minnesota you can buy a house AND send your kids to college!).  Then, after nearly a week at the Bryan/Kramers, I suggested that my mother stay behind to take care of all three of her grandchildren while I skipped town to visit my sister and relive my college days. 

I flew to El Paso on Monday where I actually ordered take-out FROM THE RUNWAY (Landing runway in El Paso, not departing runway in St Paul) and then made my dad and stepmom pick it up on their way to fetch me from the airport.  (Tortilla soup from Jaxon’s—YUM!)

On Tuesday I flew to San Antonio where upon landing, I made my sister take me to Mexican food.  She brought me to the place that—in her words—has the only decent Mexican food in San Antonio.  Then we went wallet shopping (my wallet, a gift from Jackie 5 years ago, was stolen just before Halloween.  I wrote a whole blog post about it but you probably didn’t read it because the words didn’t quite make it from my head to my laptop). 

At the wallet store, I bought the one wallet my sister (unbeknownst to me) had been eyeing for the last two months.  After that, I made her watch me eat a 12oz steak, (Texas red meat is so tasty it makes me tremble), some ice cream and the rest of her granola before co-opting her bed and making her sleep on the floor.

On Wednesday, I followed Jackie to her classes (We didn’t learn such cool things when I was in college).  We went back to the wallet store because it turned out that Jackie really really really wanted that wallet.  Now we have matching wallets except hers has scrunchy crinkly leather because I took the last good wallet.  That afternoon, on the way to the airport to fly back to El Paso, partly out of guilt, I switched wallets with her and now I am the proud owner of the second-best wallet in San Antonio.

Back in the west Texas town of El Paso, I met my mom and Chiara at the airport (they arrived from St Paul just as I was arrived from San Antone) and we spent Wednesday AND Thursday night at my Mom’s.  Friday through Monday we stayed at my dad’s.  Tuesday we went to my friend, Tessie’s, for green chile soup—YUM—and briefly discussed El Paso real estate (Hey, Matt!  In El Paso they have two-for-one deals: buy one house and get one free!). 

Wednesday morning I left Chiara with my stepmom, Marian, and had breakfast with one of my oldest friends, Sofia.  (I mean, our friendship is old, not that Sofia is old).  Wednesday night, our last in El Paso, Chiara and I had dinner with my mom, my stepdad and my cousin and her family, back at Jaxon’s for more tortilla soup.

Thursday we—Chiara, my mom, my stepdad and me—flew back to Oakland.  And on Friday I drove to Mt. Madonna for a weekend yoga retreat—just me and the peas.


Mt. Madonna is just ninety minutes away from Oakland if there’s no traffic, two hours away if you get lost, and three hours away if there’s rain and you have to stop twice to go to the bathroom and once for doughnuts.  It’s a national park near Watsonville.  It overlooks the ocean and is littered with campsites.

Yes, of course there’s more.  Like I would go camping!  Mt Madonna is also a yoga commune where people live and work and pee in outhouses.  They depend on their own wells for their water (hence the outhouses) and have their own schools and fire department.  They also have guest rooms (with bathrooms down the hall, thank goodness) and a m†assage center and a community building where all the meals are cooked (always vegetarian, mostly without peanuts, gluten, wheat or dairy) and some other buildings for yoga retreats and classes.  I think it’s the perfect balance between hippie and comfortable.

I had signed up for a Qi Gong and Yoga course that focused on creativity and healing.  I thought it might be a nice way to build my repertoire of active and positive practices to help me through the pregnancy.  And I thought it would be nice to get some more sleep and eat some more food that I didn’t have to plan, prepare, or clean up afterwards.  And I thought it would be even nicer if it were all me time instead of shared me time.

It was a very interesting experience.  I didn’t learn anything new and spent the whole time thinking about my family and imagining how much fun they would have had if they were with me.  All of which was very comforting.  I felt like the characters at the end of the Wizard of Oz when they all are told (or realize, rather) that they have always had that which they had been seeking.

(There was one very new thing that was offered in the weekend retreat: specific and powerful visualization techniques for positive thinking.  They were in the form of four affirmations that we repeated to ourselves while lying down.  They were so powerful that I—and everyone around me—fell asleep, which means that none of us knows just what those powerful affirmations were.)

The really really interesting part of the weekend was that I gave in to the dark side and told people the dramatic part of the pregnancy.  You know, with words like, “high risk” and “50% chance of death or complications.”  Not because I wanted their sympathy, but I guess I wanted people to know that I was there for VERY SERIOUS REASONS. 

It kind of backfired, not in a bad way, just in a non-productive way.  For example, during our round-the-room introductions, I didn’t tell people why it was high-risk which meant that I was always getting cornered by some curious and well-meaning participant and bombarded with questions.  Some thought I was concerned just because it was twins and that it wasn’t that serious. 

And for whatever silly reason, I felt compelled to assure them that, yes, it was that serious.  Which meant that, being well-meaning people, they felt obligated to say something “helpful.”  Like, “Well, are you taking vitamins?”  Or tell me the story of the sister-in-law who was six months pregnant with a baby with Trisomy 18 whose heart was on the wrong side of his body and probably wouldn’t live a week. 

“See, some people have it worse than you!” the woman said, cheerfully.

That’s when I realized how far I’d come in the thinking positively department.  I no longer focus on how bad things can get.  I focus on what I can do, which is basically just sleeping well and eating well and spending time with those in my life who can accommodate my sleep and eat lifestyle.

There is no doubt in my mind that these babies are going to make it.  Time will tell if they are born at 32 weeks or 34 weeks, but now that I know that I have the support of the doctors, I’m gunning for 34 weeks or more if I can.  In my mind, I see the Peas coming home from the hospital when I do.  Time in the NICU just isn’t part of the picture.

So I was a little bit sad to realize that on this, my meditative retreat, I’d given into the Drama That Could Be.  And after I’d talked about the Peas like we were all part of some Lifetime movie, I couldn’t very well backtrack and say, “But I’m not really worried about it.  I have a great support system through my family and friends and feel confident that everything’s going to work out just great.”  Consequently, I got sucked into a world of fear that I don’t really feel anymore.

I realized something else, too.  That there’s something very “busying” about wallowing in worry, almost like a comforting way to preoccupy your mind.  And in many ways, it’s much easier to wallow, to talk about how awful things could get than it is to shut up and take action to make them better, particularly when that action is just the same thing day after day. 

You can always create new and exciting things to worry about.  There isn’t a lot of thrill in the diary entry that reads: “Day 147: Same old, same old.  Ate all my vegetables and all my cheesecake.  Took two naps and all my vitamins.  Hugged my kid, laughed with my husband and rubbed my belly.”

I’m not sure what I expected from this retreat: some great secret to the universe or something.  And what I learned was that I already know these secrets.  They come in the form of friends like Ang, who is living proof that you can make it through the most difficult situations and triumph, and friends like Kara, who say things like, “Eat, get a second opinion, and don’t look back.”  It comes in the form of friends like Lara, Dr. P, Sofia, and Tessie who all said the same thing to me: “You know, I have a good feeling about this.”

It comes in the form of family who have opened their homes and their refrigerators: from moms (and stepdads) who travel halfway across the country to dads (and stepmoms) who make impromptu fast food runs to brothers who cut 12 minute slices of cheesecake, sisters who offer to sleep on the floor and daughters who bring you “a favorite toy” when you say you need to nap. 

I think it started when we were still in Lifetime movie mode, scared and worried and calling our siblings.  When we told Cathy our scary details, she just kept repeating, “I think it’s exciting!”  Our first thought was, “Did she not hear the part about death and sickness?”  Our second thought was, “Maybe that’s how you see life when you have five kids.  Maybe we should get us some of that.”

It seems like we should say, “It wasn’t always easy.”  But it kinda was easy.  Granted, we’re only halfway there, but once we reached out and got this outpouring of support, our positive outlook just kinda snowballed. 

So thanks to everyone for all the calls and emails and comments and prayers.  That’s the key to creativity and healing; that’s the secret to the universe.  Happy Thanksgiving, everyone!

Next Post: the details behind our most recent visit to the doc’s (Short version: twins are doing great!)

© 2010 Janine Kovac 

Tuesday, November 17, 2009

Eat, Like, A Pig

This post was guest-blogged by my brother and sister-in-law, whom Chiara & I went to visit last week.  They were stunned at my capacity to shovel large quantities of food at frequent intervals and quite frankly, I was a little stunned at their shock.  After all, whether I am trying to gain weight or lose weight, I only stick to two principles:
1) Only eat when you're hungry
2) Only eat until you're full

I don't know what all the fuss was about, so they spelled it out for me.

Eat, Like, A Pig

As we see it, the mantra you use to gain five pounds in approximately five days, is: eat as often as a newborn, but as much as a linebacker.

When our baby (yes, he’s still a baby even if he walks and weighs 25 pounds) woke up at midnight for a bottle, there was the Pea Momma, eating cereal in the kitchen by herself.  When he woke up again at 3 am, crying, there was the Pea Momma, drinking water and eating.  Pea Momma was eating around 6: 30 am when the baby woke up too.  Then she ate breakfast with everyone at 9 am, a snack at 10:30, lunch around noon, a post-nap snack by 2:30 or three, a little something around 4:30 to tide her over until dinner and then dinner around 6 and a pre-bedtime snack at 9 pm. 

Eating that often creates some interesting logistical problems.  Basically, if you are going to be away from the house for more than 60 minutes, you need to have at least a pound of food with you to satiate Pea Momma.  And if you are going for multiple hours, there should be an entire duffel bag devoted to food.  I am not even kidding when I tell you that upon arrival at our house, Pea Momma unloaded from her carry-on the following: a turkey/cheese wrap; a large freezer bag full of cashews, a bag of granola, a freezer bag full of cold pizza slices, two baby bottles full of whole milk, two large bottles of water, a block of graham crackers, two snack packs of cookies, at least twenty sticks of string cheese, a baggie of grapes, and a half-finished bottle of strawberry Odwalla.  AND THAT’S JUST THE FOOD THAT DIDN’T GET FINISHED ON THE PLANE!  To be fair, of course, Pea Momma also had to be ready to feed Pea Girl, who is a frequent snacker, and Pea Momma was loaded up by Pea Daddy, who is an over-packer.  But still.  It was impressive.

Here are two instances where the quantity of food cannot be blamed on toddlers or daddies.  One night, around 9 pm, we were enjoying those first magical moments of “adult time,” after the children were in bed and we could hear ourselves think.  Pea Momma’s brother stood up and announced “Can I get anyone some tea?”  In response, Pea Momma said: “I will take two slices of pizza, preferably olive or ham, and a piece of cheesecake.  Oh, and a glass of whole milk please.”  When she was served her glass of whole milk, she went back to the refrigerator, scooped the cream from the top of the jar onto the lip of her glass, and proceeded to eat her snack.  Even a salad became, um, modified.  After everyone else had finished dinner, Pea Momma went rummaging through the fridge – again.  She emerged with a bowl full of salad, already dressed with Italian vinaigrette, and added to it a bowl full of popcorn (not microwaved, but old-school air popped) and at least three large spoonfuls of peanut butter.  “No, I don’t want to try any.  Thanks.”

When you’re bedtime snack is a dollop of pure cream, plus eight ounces of whole milk, plus a seven minute slice of cheesecake (Pea Momma taught me to measure all dessert slices in minutes – not the minutes it would take to eat the slice, but the number of minutes that slice would represent if the entire cake/cheesecake/pie was an hour), plus two pieces of pizza, then you too are ready to join the marathon known as gestating twins. 

Guestblogged by MommyTude and DaddyTude (daddytude.blogspot.com)

Thursday, November 12, 2009

Right on Track at 17 Weeks

Right on Track at 17 Weeks

So here’s a picture of the Peas.  It’s from Week 13.  Just four weeks later, the twins are already too big to fit both of them in the same picture.  We showed the ultrasound photos to Chiara.  Initially we had planned to keep the pregnancy a secret until we felt we were “in the clear” (whenever that is!) but then, at about Week 14, she called me out on it.  She is belly high, so I guess she has a pretty good view of the belly changes.  We were in the bathroom and she rubbed my tummy and said, “Hey, you got a baby in there?” 

To which I replied (slyly, I thought), “Maybe.  If I do, I think it might be two babies and they would be boys.  How do you feel about that?”

“I don’t want brothers.  I want a sister.”

As my brother says, “Well, today’s the day you learn you don’t get everything you want.”

Anyway, when we showed her the ultrasound photos, she was clearly devastated.  “They don’t look like babies.  They look like animals.”  Now, I don’t know for sure, but I do have two younger brothers of my own, and I have a feeling that this might be the first time—but not the only time—she compares her siblings to animals.

But back to the Peas.

Last Monday we had two doctors' appointments.  One was a high-resolution ultrasound, the other was our regular appointment at the Whipple Clinic. 

The ultrasound took over an hour, and thank goodness it wasn’t one of those that you have to have a full bladder for.  It’s the one where they take lots of measurements: head circumference, abdomen circumference, body length and cervix length.  They counted arms and legs and kidneys and heart chambers.  They checked heartbeats and heart rates and made sure that they checked each Pea once instead of one Pea twice.

And everything looked the way it should look.  The measurements put us squarely at 17 weeks and 2 days, with the Peas “weighing in” at 7 ounces apiece.  (I have no idea how they convert centimeters into ounces, but apparently they can and do).  Each Pea has two arms and two legs and two kidneys and four heart chambers.  And each one had a heart rate within the approved range.  The cervix measurement is to have a handy baseline measurement in case it looks like I am going into early labor.  And as of Week 17, I am not.  So far, so good.

The other thing the sonographer did was check the blood flow in the umbilical cords.  Really cool to see.  Artery flow shows up as red; vein flow as blue.  This also gives an indication of where the umbilical cords attach to the placenta.  To our untrained eyes it looked like the cords were pretty far apart, but the sonographer was hesitant to say for sure. 

Later on we had our regular appointment, this time with one of Dr. Whipple’s colleagues, Dr. I-cant-remember-her-name.  She was also reassuring and happy with the preliminary ultrasound report. 

My weight is up four pounds from my last appointment at 15 weeks, which the doctor labeled as the “upper-end of acceptable” until Matt asked a follow-up question.  (Was there “unacceptable” weight gain?)  She quickly back-tracked and said that in our case, “fat preemies” are our goal so actually all weight gain is good weight gain; it just means that there’s more to lose at the end. 

For the curious, I am up another 5 pounds since that appointment 10 days ago and have already reached my goal of 20 pounds before Week 20 (we are in Week 18 now).  What can I say?  I’ve always been an over-achiever.  My belly is like a huge basketball and my belly button is shrinking and I’ve already had to take my wedding ring off.  I look and feel like I’m six months along, not four.  Good thing I don’t have to go the full 40!

Next: How I Gained Five Pound in a Week—Without Counting Calories!

© 2010 Janine Kovac 

Friday, October 30, 2009

Tomorrow: Time to Deliver Near You

Tomorrow: Time to Deliver Near You

This was the subject line from an email I got from my good friend, Barack.  He emails me ALL the time and is ALWAYS in my bidnezz so I wasn’t too surprised that he knew that we were headed to the new perinatologist clinic to talk to new doctors about transferring care to a new hospital.  But it turns out he was really just talking about healthcare reform.  Not a word about where we would deliver.

But even without the President’s prodding, we had decided that it was time to deliver near us, or at least that it was time to find a hospital near us . . . and hopefully deliver much, much later. 

We had booked an appointment with a high risk pregnancy clinic in the East Bay, because if I was going to spend a month in the hospital and the peas were going to spend a month (or more?) in the NICU, we didn’t want to have to drive across a bridge to get to that hospital.  We wanted something closer to home.

It didn’t start well.  The woman behind the desk informed me that they had CANCELLED my appointment because they thought something was amiss with my insurance and they couldn’t get a hold of me to verify it . . . um. . . because I forgot to call them back.

Sometimes you hear stories about moms who suddenly have these super human powers when they feel that the safety of their children are threatened.  Well, I think that gets doubled or maybe even squared when you are carrying twins, because all of sudden I had the energy (and the urge) to leap over the counter, squeeze through that tiny window, pick up that woman by her skull and pound her body into the wall. 

But instead I burst into tears and she said, “Let me check with the doctor.  I’ll see what we can do.”  And of course they fit us in.  Me and my peas are high risk lottery tickets of nature.  We deserve VIP treatment.   (Matt is quick to point out, of course they fit us in; that’s what they do.

First the blood pressure – a little higher than normal: 122 over 69 (or is it 69 over 122?)  Weight gain, up 3 pounds from last week.  Gulp!  Then waiting to see the doctor, looking at posters of fetuses of different gestational ages and looking at the tiny 28 weekers and the huge term cartoon babies (really huge, since they weren’t actual size).  Eventually the doctor walked in.  Looks nice, affable, a lot like Mr. Whipple of the squeezed Charmin fame.

Now granted, given our experience, the bar for being a good high risk preganancy doctor is kinda low.  Just don’t say the words, “dead baby” and you’ll get a gold star.  But low expectations notwithstanding, this doctor was great.  He managed to describe all of the risks in a non-alarmist manner; he didn’t sugar-coat any of his answers, certainly, but his responses were optimistic-leaning, almost cheerful.

One thing I haven’t been able to get my head around is the mandatory 32 week due date.  I understand that if there’s a problem or if I go into early labor all bets are off, but what if everything’s going fine?  I mean, if I have to be in the hospital for 24/7 monitoring from weeks 28 – 32, what’s the difference: on week 31 day 6 they will only operate if they absolutely have to but on week 32 day 1 they open me up no matter what?  If I’m being monitored anyway, can’t we just wait a little longer?  

Yes, I know that they can do great things with babies at 32 weeks, but so can I; any way you look at it, my belly is better than their plastic box.  If everything’s going fine, can’t we just let nature do its thing?

My Internet research told me that no, 32 weeks was the norm.  Granted, web reconnaissance is just a notch above getting advice off of bathroom stalls, and only because Google makes it possible to search more bathrooms, faster.  But I also found the email address of a woman who delivered mono/mono twins last spring.  Boys.  Born at 4.5 and 4.3 pounds, in the NICU for 3 weeks.  Six months later, they are still doing great.  We emailed back and forth and having been there, she also thought that, no, our doctor probably wouldn’t allow us to go past 32 weeks.

This is what I wanted to ask Dr. Whipple.  But he beat me to the punch.  After I said that we knew we were trying to get to at least 28 weeks, he said, “Well, we hope to get you much further.  34 or 36, even.  We probably wouldn’t let you go much past 36 weeks.” 

36 weeks!  That’s practically term!  I was so excited I didn’t want to ask him to repeat it, in case he’d change his mind or something.  But Matt asked anyway.  He told the doctor of the protocol that we would have been subject to at our San Francisco hospital.

Here’s what Dr. Whipple said: “We feel that this type of pregnancy is so rare that there really aren’t the numbers available to justify a hard and fast protocol.  We’re going to base it on how you and the twins are doing.  Of course, if there’s a problem or a sign of cord crimping, we won’t hesitate to take them.  We won’t risk the babies’ health.  But we won’t operate if the babies are doing fine.”

Woo-hoo!!!!  That’s exactly the attitude we were hoping for.  He said other things we wanted to hear, too, like “Get all your traveling in now.”  (I’m planning a trip to St. Paul with Chiara and my mom in early November, along with a trip to El Paso and a side trip to visit my sister at college in San Antonio—without Chiara for the San Antone trip).  “You won’t be driving to San Antonio,” the doctor frowned.  No, flying.  “Then you should be fine.  Come in for an ultrasound before you go.”

As for mandatory hospitalization, we’ll play that one by ear, too.  Around week 25 or so, I’ll come in every week for stress tests and such and 3 times a week by 28 weeks.  And then we’ll see.

Other things that made me weep with joy:  all the doctors at this high risk clinic share the same philosophy and most of them have worked together for the better part of 20 years.  The most junior on staff has been there 8 years.  Dr. Whipple (not his real name) is one of six doctors at this clinic, so there’s a good chance we will see other doctors on the rest of our visits, which is fine with us.  It’s good to meet everybody because you never know who will be on call when the day comes.  At the hospital where we will deliver there are two obstetricians and two anesthesiologists (just for the pregnant folk) on the floor 24/7.  Plus a third OB on call.

“Of course, I can’t give you guarantees,” the doc said as he shook our hands good-bye.  “But we have lots of good outcomes.  I delivered my first mono/mono twins twenty years ago yesterday.  On my birthday.  And they’re still doing great.”  He smiled proudly.

I think this was the most reassuring prenatal appointment we’ve had in all of 2009.

And now for something cute about Chiara: I’ve read studies where they look at “gendered” toys and give the trucks to girls and the baby dolls to the boys.  The girls wind up rocking the trucks and putting them to sleep while the boys dismember the dolls and use the appendages as nunchunks.  Well, Chiara has done a similar gendered thing with her tool set.  It has become her picnic basket, or as she calls it, her “pick-a-nick” basket.  The screws are ice cream cones, the wooden wedge is a cheese knife, which she uses to spread cheese (or pea-ah-nut butter) on the little square washers, which are crackers.  If she had a little truck to play with, I’m sure he’d be invited to the pick-a-nick and offered some ice cream.

© 2010 Janine Kovac 

Monday, October 26, 2009

Fat Shari

Fat Shari

Disclaimer: this post contains some vivid depictions of childbirth.  It’s gross, but how do you think YOU got here?  So deal with it.

At the end of the last post, dear readers, your humble and waddling narrator was eating triple cream brie and dulce de leche ice cream (deluchy de leche, as Chiara calls it) and wondering,
“How does one grow fat preemies?”

You may know that babies get what they need, at the mother’s expense.  All those nutrients that keep the enamel on your teeth and your hair on you head go to the baby(ies) first and you get what’s left over.  And if there’s not enough left over, your hairbrush will let you know.  Moral: take your vitamins.

With Chiara, I took it a step further, consulting a nutritionist (who also does chiropractic and cranial-sacral work).  Actually, I was already seeing her.  I love the work she does and I wouldn’t call her a killjoy, (because she is reading this blog) but sheesh, it sure is a drag to know how bad sugar is for you.  Even if eating well makes you feel like you’ve swallowed rocket fuel, I do miss my Oreos.

This is the doctor who makes the nutritional supplement recommendations for me.  Turns out it’s not just the kind of supplements you take, it’s also how those supplements are manufactured.  Preservatives and heat pressing the supplements into little pills can actually kill the vitamins in the pills (this is especially true for the oils like Vitamin E) and the encasing of the pills can affect what your stomach absorbs.  All of my supplements are by the company Thorne Research, and I believe they are handmade by Amish children. 

So I leave it in Dr P’s capable hands to build me a big fat placenta like I had with Chiara.  This is the part where the post gets kind of gross.  That is, if you think that childbirth—the most natural thing on the planet—is gross.  Which it is.  Oh my gosh, childbirth is really gross.  (Come to think of it, so is poo—natural and gross, I mean.) 

In the birthing classes we took before Chiara was born, our teacher showed us two movies: one was from an episode of “Mad About You,” where Helen Hunt has her baby without any medical interventions.  It’s the typical sitcom birth scene: Hunt is on her back laboring in the most uncomfortable position known to pregnant women, Paul Reiser is trying to offer advice, Hunt does Linda Blair impersonation, baby is born.  In our class, about 30 couples, all in their mid-to-late 30’s, all first time parents, huddled in pairs, weeping and laughing at the miracle of staged birth.

Then we saw the movie of a real birth and all 60 of us gasped in horror.  The mother was pacing and moaning like she really was trying to exorcise a demon and when the baby was finally born, it was all wrinkled and gray and covered all kinds of slime.*  Terrifying, gross, and much worse than poo.

* Parenthood is one of my all time favorite movies, but it was only after Chiara was born did Matt and I realize how silly the ending is.  Dianne Wiest has her baby in a hospital, on her back, all the doctors are wearing surgical masks as if noxious gases are being emitted from the mother (insert pregnant lady/noxious gas emission joke here), and the baby that is “born” is at least five months old, covered in some kind of pink goo.  The baby is even aware enough to actually look around with a little frown on his face, like, “What the . . . “

We also saw a movie of a Cesarean birth, and you’d think live surgery would be grosser to watch, but it wasn’t. 

The teacher went on to let us know some of the other gross things about birthing babies that nobody ever tells you about. 

“After the baby is born, the mother must deliver the afterbirth, or placenta.  Sometimes your doctor or midwife will give you a tour of your placenta.  It’s quite interesting.”

Stop right there, Birthy Lady.  A tour of the placenta?  “And on your left we have . . .”

But she didn’t stop.  “If you want to bring your placenta home with you, make sure you bring a Tupperware container with you to the hospital.  Some couples choose to plant the placenta under a tree.  Others choose to cook it.  Your placenta is loaded with lots of nutrients that are very healthy for the mother to ingest to aid in her recovery.  You can find lots of recipes online to bake your placenta into lasagna, or dry it into a tea . . .” 

Nyah nyah nyah . . . I am not listening . . . I am not listening

So as soon as we got home, Matt and I added to our birth plan, right after, “NO dangerous life-threatening drugs, NO PLACENTA TOUR.”

Dr. P was on board with the placenta meal plan, too.  “It’s just an organ meat.”  Yeah, I don’t eat those, either.  “If you ever need some recipes.”  Nyah nyah nyah.

During Chiara’s birth, the NO PLACENTA TOUR line item was the only request the midwives ignored.  They were SO excited by the sheer size of it.  Apparently, all those Amish vitamins helped grow some kind of huge, record-breaking afterbirth.  Somebody even had to go find another container for the placenta because it was too big for the bedpan that was provided, and of course, we had NOT brought any Tupperware from home.

“Are you SURE you don’t want a tour of your placenta?  It’s amazing!”

Oh please leave me alone with my screaming baby and take my afterbirth with you.

Matt used to say, “We had the Barry Bonds of placentas.”  To which people would respond, “Huh?   Your placenta was on steroids?”  But what he meant was that Chiara’s placenta was so huge and intimidating that it had its own barcalounger and none of the other placentae complained because they knew that the big guy would always come through in the clutch.

Even now, Chiara’s placenta is a thing of mystical lore at St. Luke’s hospital.  If we go for a routine check-up at the pediatrician’s and are recognized, a blanket of hushed silence falls over the nurses as they whisper to each other, “That’s the little girl with the enormous placenta.”  Occasionally, a flash bulb erupts as our picture is taken.

“What’s a placenta, Mama?”

“It’s a kind of lasagna.  Hurry up, let’s go.”

So that’s what I’m aiming for with the twins.  A placenta so huge it grows two 5 pound preemies and is worthy of its own paragon example. 

(But what?  The A-Rod of Placentas?  “What?  Your placenta dated Madonna?”  The Serena Williams of Placentas?  The Tiger Woods of Placentas?)

This morning it came to me: I shall call my placenta Fat Shari, after the sting operation my brother the assistant US Attorney was involved in (on the stinger side, not the stung side).  After all, what’s more intimidating than a successful DEA sting operation on the Mexican drug cartels?

Here’s to you, Fat Shari, I say, raising my glass of strawberry tofu protein shake.

© 2010 Janine Kovac 

Friday, October 23, 2009

The Quest for Five-Pound Preemies

The Quest for Five-Pound Preemies

But first, something cute that Chiara said: Sometimes she pretends to be a baby (most of the time she’s a mama or a grandma).  The other day she told me, “Hold me, I’m a baby.  But be careful [sic] my umbilicord.”

Back to the Peas: there’s a lot of shocking things we’ve heard so far, but I won’t do the recap.  At our third prenatal appointment, our first with the high risk perinatologist, we heard another doozy:

 “You know, there’s a lot we can do with 3 pound babies.”

A lot we can do with 3 pound babies????  He made it sound like that was our goal weight.  Are you serious?  Can’t we aim a little bit higher?  I have textbooks that weigh more than three pounds.  In fact, I think my first cell phone weighed more than three pounds.  I don’t care what you can do with three pound babies.  I don’t want no three pound babies!  I want babies that weigh at least as much as my laptop.  So how do I grow huge, healthy preemies?

The thing is, if all goes well, these babies will only be preemies because the risk of cord entanglement is so great, and the doctors think it’ll be safer to take them early than to let them cook a little longer.  So in theory, these should be the healthiest preemies ever because they weren’t delivered early as a reaction to an early labor, as the case in most situations.

Back to the FAQS:

There are several different ranks of preemies, based on gestational age.  Obviously, the earlier the gestational age, the higher the risks for complications, both acute and chronic and the longer the babies will have to stay in the neonatal intensive care unit (the “NICU”).

23 – 24 weeks is considered to be the edge of viability.

23 – 28 are the “micro preemies.”  These are the twins that Ang had.  (See first post).  Her twins are healthy now, but a lot of that’s because Ang and her husband work hard to keep them that way.  (Mr. Ang has a special relationship with his Purell bottle and in fact, wears one on his belt like a modern day germ-killing gunslinger). Because of their delicate immune systems, micro preemies can’t travel on planes or be in daycare for two flu seasons.  I have told the Peas that this is not an option for us.  We have a very important family reunion Labor Day weekend and the Peas MUST be there to meet the other three new cousins that are coming into this world between February and April, 2010.

28 – 32 weeks is considered early preterm.  If we had stayed at our hospital in the city (instead of transferring care to an Oakland hospital), 28 weeks is when I’d check in and 32 weeks (best case scenario) is when the twins would come out.  If the delivery isn’t an emergency (and hopefully ours won’t be), the mother is given steroid shots a few days before her C-section.  This helps the babies’ lungs develop more quickly.  Babies born at 32 weeks can still have complications, but they can be out and home in as early as 3 weeks. These are the 3 pounders that the doctor was talking about.  They can’t breastfeed right away because they haven’t developed their sucking reflex yet, but many moms of early preterms are able to pump so their milk still gets fed to the babes. 

32 – 34 weeks is considered late preterm for twins (for “singletons”—a term Matt thinks sounds a little condescending—late term is 34 – 36 weeks).  At 34 weeks, if the babies weigh enough, there’s a good chance that they can come home either with the mother or just a few days later.

37 weeks is considered term for any baby, but for twins, 37 weeks is pretty much as cooked as they need to be.  Twins often come early, and for some bizarre reason that baffles scientists, twins progress faster neurologically in weeks 33 – 35 than do the lonely singletons, and therefore are ready to be born earlier, too. 

Preterms are also determined by weight but the charts make my eyes cross because everything’s measured in grams.  1000 is the cut-off between micro preemies and early preemies in this currency.  2500 is the goal weight to go home.

Now, my only experience with the metric system was the time I spent in Italy and my only experience with grams was the time I spent at the shop of the macellaio.  That’s my only point of reference.  So for me, 1000 grams is about five days’ worth of prosciutto for four people, even if everybody has seconds.  And 2500 is enough for a party, but only if it’s right after payday.  Otherwise, it’s mortadella for the group.

Start the Party!

So how do we get this party started?  How do we get the fattest preemies possible?

Kara’s suggestion (you remember Kara from Post #1, right?) was to see if I could eat 4000 calories a day.  Four THOUSAND calories a day.  The only time I ever counted calories was early in my ballet career and if memory serves, 4000 calories is like, a week’s worth of food.  So I’m going to have to eat a week’s worth of food everyday in hopes that I can get two babies that are the prosciutto equivalent of two Opening Night receptions.  Apparently my goal is 20 pounds by 20 weeks and 40 – 56 pounds before it’s all said and done.  Gaining weight early on is important for twin mommies in order to have enough fat stores & nutrients “thereby providing a nutritional reserve for the second half of pregnancy, when diet alone can’t keep pace with the nutritional demands of the fetuses.” (from the book Kara recommended: When You’re Expecting Twins, Triplets or Quads)

If my progress with Chiara is any indication, I will pass the 20/20 mark no problem.  But it’s not just what I get to eat that matters, it’s what the Peas get to eat.  So I gotta beef up that placenta, since there’s only one for two of them.  And how do I do that?

Stay tuned!
© 2010 Janine Kovac 

Friday, October 16, 2009

Pregnant at DEFCON 4

Pregnant at DEFCON 4

Part 1

But first, something cute that Chiara said:  This morning we were talking about her transition to the next classroom, "the Busy Bees."  (Right now she's in the "Wobblies").  She asked, "How come I'm big enough instead of I'm small enough?"  Good question.  I'll have to get back to you on that one.

OK - so the quick recap is we’re going to have twin boys.  Maybe one day I’ll tell the boys that when the midwife said, “Oh, wait.  There are two,” I had tears of joy, but let’s face it, at the time they were tears of grief.  Grief for the life I was about to lose: mine.  GREs – don’t need to study for that anymore.  Grad school is out for 2010.  And 2011.  And 2012.  Maybe even 2018.  My cute little black Jetta?  That’s got to go.  Now we’ll need some kind of behemoth vehicle that gets 8 miles to the gallon. I will never take another yoga class or go on another retreat.  I will have to stop volunteering for the Greater Good Center.  And of course, I will never sleep for five consecutive hours ever again.  Ever. 

It felt like a prison sentence.  But all that was about to change over the next week.

No pretty segue here, but what we went through in the first half of 2009 was really a drag, and I have to say, I was a little bit angry at the doctors we saw during that time.  When I was pregnant with Chiara (2006), I felt like I really had to seek out positive information about healthy pregnancy.  The midwives were great to that end, but I felt like the doctors treated pregnancy (literally) like a medical condition rather than a natural occurrence.  We were constantly being given the worst case scenario rather than positive preventive health information, as if they were secretly hoping for dramatic and dangerous flare-ups so they would have a more exciting and more involved role in the birth of my daughter.  I know I’m being slightly unfair.  But only slightly.  It’s like that terrible book: What to Expect When You’re Expecting.  Have you ever flipped through that?  It’s like, 800 pages of stuff I most definitely don’t want to “expect,” like gestational diabetes and preeclampsia and my favorite, cramps in my feet from “pointing my toes.”  Oh yes, pregnant women should never point their toes. 

(There are a lot of really cool cognitive science discussions we could have about this, because after all, these books and the doctors’ consensus is really just a manifestation of our cultural concept of health and the role of medicine.  It’s not based on any “truths” that are handed down from the heavens.  It’s all brains, baby.  But I’ll have to address all that in the book.)

Flash forward to spring 2009: because my pregnancy with Chiara had been so picture perfect, it was really hard for me to take the doctors at their word when they started with their gloom and doom observations: this ambiguous measurement could mean a neural tube problem.  That fuzzy gray picture could mean a heart defect.  This blood test, compared to all the other blood tests from 39 year old Mexican-American moms-to-be was probably indicative of some genetic problem. 

Then, just a few days after graduation, and almost halfway through the pregnancy, we lost the baby.  The whole time a part of me had felt that something was wrong with my baby.  At the same time, I was angry and defensive that the doctors also thought that something was wrong with my baby.  Of course, in the final analysis, the doctors were right; something was wrong with my baby.  But the whole time they hedged their bets: maybe it was indicative of a heart defect.  Probably the neural tube would close.  For us it was like this awful waiting game, always hoping for the best case and then ending up with the worst.

So this time, with the experience of the spring behind us, we said, no screenings, no hedges.  This time we want the diagnostic tests.  And we want them now.

That’s what led us to opt for CVS (a genetic diagnostic test) at the earliest opportunity—11 weeks—and that’s how we found out 5-8 weeks sooner than we would have otherwise, that our twins are monoamniotic and monochronionic, i.e., sharing a placenta and sharing an amniotic sac.

At first we thought it was the coolest thing ever.  (Because identicals are way more in demand for twin studies experiments than fraternals.  Duh).  We saw the twins on the high resolution ultrasound, facing each other, mirroring each other, either playing patty-cake or already beating the crap out of each other.  It was awesome.  Not awesome like surfer-awesome, awesome like feeling-full-of-awe-awesome.

But clearly the doctor thought it was neither cool nor awesome.  And clearly he was not prepared to tell us what he had to tell us.  He stumbled and stuttered and frowned and instead of doing the CVS procedure, booked us an appointment for the next day with the head of the Maternal & Fetal Medicine clinic.  We went home dazed and confused with his words: “Some couples in your situation choose to terminate” hanging in our heads.

Suddenly I couldn’t care less about my Jetta, or my yoga or my sleep.  I just wanted my babies to live.

The first thing I did when we got home was call my friend Ang, whom I know through my friend, Gary, and of course being Gary’s friend is how Ang got twins.  I knew her twins were born prematurely, but I didn’t know the half of it.  Her babies were born at 25 weeks, and what she, her husband and the babies went through was nothing short of heroic.  And here she was, a year later, laughing and talking on the phone to me, feeding one twin and holding the other and reassuring me that miracles do happen daily in the NICU (neonatal intensive care unit).

Then I emailed my friend, Kara.  Kara, in spite of not knowing who Gary is, had her twins six years ago.  Her quest for substantial literature on twin pregnancies led her to edit a book on the subject.  (She is also a journalist, so check it out: http://karathom.com)

Then we did something we knew shouldn’t do: we Googled “monoamniotic/monochronionic.”  And we read a lot of things we wished we hadn’t read about.  So much so that I won’t even give examples.  But when we went to the doctor’s office the next day, we were prepared for what he might tell us.

He confirmed that:
This is not going to be the birth that I had with Chiara: with midwives and birthing tubs.  This is going to be a high-tech birth.

By far the highest risk to monoamniotic/monochronionic twins (or “MoMos”) is cord entanglement.  Meaning that, as the babies get bigger, the umbilical cords can get crimped or twisted and there isn’t enough room for the babies to unwind themselves.  For this reason, MoMo twins are always “taken” early by C-section, usually at 32 weeks.

Because cord entanglement issues can happen earlier, the protocol at many hospitals is to admit MoMo moms at 28 weeks for 24/7 monitoring.

The other big problem that can happen with MoMos is uneven nourishment.  They share a placenta, and it can happen that one twin (for various reasons) doesn’t get enough sustenance.  This is visible in the ultrasound; one twin gets bigger, the other one doesn’t.  As long as the twins are “viable” (25 weeks or older), the doctors can take them via C-section, and save both babies.

Twin-to-twin Transfusion Syndrome (TTTS) is another problem that can happen with twins that share a placenta (is less common when they share an amniotic sac).  It has to do with how the blood vessels grow and attach, but it amounts to the same end as uneven placenta sharing (see above).

There’s nothing the doctors can help us with if something happens before 25 weeks.  And if one twin is sick or undernourished, there’s no way to save just the healthy twin.  If something happens before 25 weeks, we’ll lose them both.

Between 25 and 28 weeks, the twins will be “viable” but then they’re considered micro-preemies.  There are added risks to the respiratory, neurological, and digestive systems and it’s the outcome that some doctors are least comfortable with, because some of these early problems can turn into life-long disabilities.

Part 2

The specialist we saw on this day was really nice.  He let us know that our situation was serious, but he also let us know that we were in good hands.  He didn’t mention anything about what “some couples in our situation choose to do,” didn’t give any numbers or statistics regarding our chances for healthy babies (we already knew that they are slightly better than chance), and didn’t say the words “dead baby” once.  Not once. 

(There was one odd moment before we were called in to see him.  The nurse informed us that he had just been called to a birth.  Could we wait?  Oh, then it might be while, Matt commented.  It might, responded the nurse, but not longer than 25 – 30 minutes.  Matt and I looked at each other.  Welcome to the Land of High Tech Birth.  Sure enough, we were called into his office 27 minutes later.  We would have never known that he had just come from a birth.  He was in his shirt and tie and didn’t even look out of breath.  That was weird.  I mean, just the round trip elevator ride must have taken 6 minutes.  I couldn’t help but picture the scene from Monty Python’s Meaning of Life in which John Cleese is a doctor in the hospital looking for the machine that goes “ping!”  A woman is on her back about to give birth.  The babe is born and then it and all the machines are whisked away and mom is left in the dark on a gurney in a completely empty room.  That’s my picture of High Tech Birth). 

Anyway . . .
The doctor also outlined some thing we’ve got going for us:
1.     I’ve already carried a baby to term and had a healthy birth under ideal conditions, without complications.
2.     I have a very low-stress job.  Basically, it consists of making sure that Chiara gets to daycare some time before 11 am and that any clothes in the washer get moved to the dryer within 48 hours.  Oh – and I have to make sure that the mail gets from the bottom of the stairs to the top of the stairs.
3.     I have a great support system (Matt & our families).

It took awhile for this information to sink in.  It was like the end of the movie A Christmas Story where the narrator outlines all the leftovers they won’t have now that the Bumpus’ dogs got to the turkey first.  No turkey sandwiches!  No turkey stew!  No letting nature take its course!  No staying home with my daughter in the weeks before the twins come!  No coming home with the babies!  No colostrum as their first meal!  (In fact, one month in the NICU for the peas could mean no breastfeeding, period.)

Then: rolling up our sleeves.  One month in the hospital?  Then we’d better transfer to a facility with a Level 3 NICU that’s closer to home.  Better ask some grandmas to come early to help out.  Better check out the fine print on the health insurance plan.  Better find out the hospital’s visiting hours’ policy.  Better find out if they have a hospital grade breast pump for the preemie moms.  Better find out if they have WiFi.

We left the doctor’s office thinking, “OK – bring it on!  Let’s grow these babies!”  A week later we came back for our CVS procedure.  A week after that we got our results (everything is AOK fine) and that, dear readers, is how we know they’re boys.  (Did I mention that 75% of all MoMo twins are girls?  Where’s our lottery ticket?  We’re playing with 1 in 100,000 odds here.)

Coming up next: the quest for 5 pound preemies.
© 2010 Janine Kovac