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:

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 

Friday, October 9, 2009

One small step into the blogosphere . . .

The Pod Blog

So we decided to jump on the blogwagon.  Not just because our daughter is so adorable we wanted to have a forum to tell people about it (like, “Christmas is so far away, we’ll need a plane to get there”), but because in the foreseeable future we imagine we will have a lot of different kinds of news that we imagine a lot of people would like to know and that’s a lot of phone calls.  Nine, if you just count our immediate family.  And if we just send out of few facts, and you use the Google machine on the Interweb, you’ll find out a lot of scary sounding things indeed.  Better to get it straight from us.

Here’s the short story: we’re pregnant.  Twins.  Identical.  Boys.  Due in April, but we’ll get them in February.

We’ve told enough people and been asked enough questions that we’ve realized that we might actually need a FAQ section.  So here goes.

Do twins run in either family?
No.  But that only applies to fraternal twins, anyway.  And if you think real hard about it, can only be carried down through the mother’s side.  (Quick biology refresher: fraternal == two fertilized eggs, kids are no more similar than other siblings; identical == one fertilized egg that splits, kids have the same genetic material).

Other fraternal fun facts: there are, like, TONS more twins now in the United States than just a scant 30 years ago, by like, some really high percentage that I am too lazy to look up right now.  Some fraternal twins, of course, are due to techniques like IVF and even Clomid, but for some bizarre reason, older women who have already had a baby are more likely to have fraternal twins if they conceive again in their 40s.  (That’s a nasty little trick, isn’t it?) 

So how do you get identical twins?
Nobody knows.  Identical twins are just a fluke.  Or in fancy medical language, an anomaly.  One perinatalogist actually called it a birth defect (because “it’s not supposed to happen.”  She continued: “Let’s hope this is the only birth defect.”)  This is the same one who used the words “dead baby” during our consultation.  I don’t remember the rest of the sentence because I was so shocked.  I hadn’t heard those words spoken together since my brother went through his “dead baby” joke phase in eighth grade.  Don’t worry.  We got her back.  Stuck a “kick me” post-it on the back of her scrubs. 

So nobody knows why a fertilized egg suddenly splits, although I do recall having a serious bout of hiccups in late July.  It could also be that I’m Gary’s friend.  Gary has FIVE friends who have had twins in the last two years.  (Needless to say, Gary’s wife is a leetle worried.)  Of course he told me this AFTER we told him about the twins.  Thanks, Gary.

How do you know they’re identical?
This is a question you would only ask if you’re up on your twin reading.  It’s like this: all fraternal twins have their own little sacs to grow in.  (Placentae).  And in the identical case, if they split early, they will also get their own placenta.  And nobody will know whether or not they are identical (if they are the same sex) until after they are born.  Since fraternals can look alike, too, in some cases, there’s really no way to know without a DNA test.

On the other hand, if the egg splits late, the babies will share a placenta.  And if the egg splits really late, there’s a one in 25,000 chance that the babies will share both a placenta and an amniotic sac (or as the midwives call it, the “bag of waters.”  Awesome.  It’s like the first line of a haiku, isn’t it).  Anyway, so I burped instead of buying a lottery ticket and we blew our lottery odds on two peas in a pod.

This means that our babies will have skin to skin contact in the womb.  Which is pretty cool.  It also means that I just went from the ho-hum ordinary “40 years old and merely high risk” to, as I told Aunt Rita, “DEFCON 4 High Risk” and listening to Dr. Bedside Manner and her “Dead Baby Birth Defect” speech.

But before we delve into all the scary stuff that Dr. Bedside Manner and her staff told us, (no, I will not call her Dr. BM, that is just too infantile), let’s end our first post with a little twin haiku.  This haiku is dedicated to Greg, because I know he likes haikus although I don’t know how he feels about amniotic sacs.  It’s called, “Hiccup Hiccup Oh!”

Hiccup Hiccup Oh!

One bag of waters
Not a lot of room in here
Will you be my twin?

© 2010 Janine Kovac