I am feeling low and really don't know where to begin or how to articulate my dilemma. I'm sorry this post is so long; I started it this morning and it's been sitting on my computer. I don't have the heart to go back and try to pare it down.
I am supposed to call my doctor's office today with my answer. I was in for a non-stress test yesterday (didn't even go a full ten minutes, as both babies were reactive and fine right off the bat and my doctor got what she needed) and the OB proposed inducing, starting with Cervidil, on Wednesday of next week.
Today I completed 38 weeks with my twins. This was an internal goal of mine....making it here, being "allowed" to make it here. Now that I'm here, I am feeling distressed at the prospect of getting the "time's up" message (which I've basically gotten.)
The pressure to impose a cutoff is not exactly arbitrary, but it feels a little bit that way to me. I know that studies have shown that certain risks go up with continued gestation, and supposedly the low point for risks with my mono/di twin type is 37 weeks, but I am having a hard time seeing how these theoreticals or statistics relate to me. (When it comes down to consenting to an induction.)
The thing is, it's pretty clear that my body is not (as yet) ready to birth them. For whatever reason, I am carrying them really well (as long as I rest enough....if I overdo it, I can barely walk.) I haven't had a lot of contractions....I have had some Braxton-Hicks but that is it. Aside from my whole "stab wound" experience and the accompanying release of stress hormones (that had me contracting irregularly but frequently overnight and into the next day), my uterine activity has been pretty nonexistent.
In light of the induction talk, I consented to an internal exam yesterday, the first I've ever had this entire pregnancy, and my cervix was firm and closed. (As it was with my first pregnancy at 41 weeks.)
I am so frustrated. I avoided the risk of preterm labor, with no signs of my cervix weakening or anything, even though my twins both have tracked large (the larger of the two has been in or around the 97th percentile throughout the pregnancy.) This is supposed to be a good thing. Right?
So now I'm at 38 weeks and that same lack of uterine activity and my stoic, firm cervix seem suddenly to be liabilities.
No, I don't want to flirt with disaster where my babies are concerned. They are mono/di twins which means they share a placenta (monochorionic, in one large chorionic sac, with a thin amniotic membrane dividing them from each other inside that.) They are higher risk than other twin types, though we've avoided the known risks to this point.
Once I knew about the twins, I proceeded with a lot of intention in this pregnancy. An early, high weight gain with high protein intake is supposed to be the best insurance against complications (such as TTTS/twin-to-twin transfusion syndrome for mono/di twins, preterm labor, low birthweight.) I have spent the entire pregnancy hearing from people who say twins "come early" and "don't grow big" and "are 'term' early," and though I've sort of expected them to come on the earlier side, I never assumed they HAD to come "early" and my goal was to make it to 38 weeks with them. (And I always, always believed I would grow big babies.)
I worked hard to reach the weight gain goals on schedule or nearly on schedule (didn't quite make 25 lbs by 20 weeks, but I did make 38 lbs by 28 weeks, and I've gained about 50 lbs when a total weight gain of 40-56 lbs is recommended for optimum results.) A big part of this was so that I could better my odds at achieving the goal of babies who could stay with me after birth and go home with me. Now I suddenly feel so pressured to turn around and rush them out.
I just feel like next Wednesday is too soon for an induction. I bought some Evening Primrose Oil capsules and I've started having sex (and orgasming, myself), and I'm hoping that with the coming full moon and whatever calm messages I can send the boys that it's okay to come....something will happen spontaneously.
My OB was talking about my aging placenta. I know that can be a factor, but shouldn't the results of the biophysical profile (specific to me) weigh more heavily than general statistics/my age/expectations about single-placenta twin pregnancies? And if the NSTs and BPPs are looking good, with plenty of evidence of fetal well-being, does that not mean that my placenta is performing well? Performing adequately? (And isn't that the point of doing that extra monitoring, anyway?)
I know that complications can arise without warning, but I'm not sure that that risk justifies my consenting now to an induction next Wednesday. I guess right now, I see the risks of induction as being greater than the risks of continuing the pregnancy and giving my body a chance to become better prepared for labor.
To be fair, with a shared placenta there is the risk of acute TTTS, which comes up suddenly (in the 3rd trimester and even as late as during labor/birth) and can result in death of one or both babies, and if one baby dies the incidence of neurological damage in the other is very high even if he's delivered within minutes of the first twin's death. (I first read these reports soon after I learned our twins' mono/di status at 14 weeks and I felt so devastated and pessimistic about the high-risk pregnancy ahead and the intervention-laden delivery at the end.) On the other hand, some mono/di twins develop acute TTTS in labor and show the evidence of it (one baby is anemic and the other is polycythemic) but the issue resolves with no serious side effects.
There is some push for a protocol of delivering all mono/di twins via c-section at or after 37 weeks. I know ten weeks ago, I felt somewhat "lucky" that I was going to be "allowed" to go to 38 weeks, and I figured I might be able to work out some wiggle room evenso. But now it is just so hard to feel right about consenting.
And the more time I have to process the appointment, the more upset I feel. For instance, why isn't it valid to wait a little longer, give my body a chance to prepare naturally (with the prostaglandins as encouragement?) and to consult the BPPs and NSTs to continue to monitor MY placenta performance?
But the OB just mentioned my placenta wearing out, and my age (37) increasing the likelihood of my fast-aging placenta as if the evidence (Doppler imaging of the umbilical arteries showing good cord flow in the expected range, combined with behavioral evidence of fetal well-being and good growth) were not the more relevant thing. (And, no, I didn't challenge her at the time. I just was listening to her "points.")
She also said that in five years, when I have two healthy little ones running around, how they got here won't matter. What matters is that they both are here and healthy. It just seems like a horrible thing for one woman to say to another, let alone at this time.
And she played the "dead baby card," I think, saying that when one twin is in trouble so is the other, because they're linked in that way (unlike fraternal twins, or identical twins who have their own individual placentas.) She also mentioned that she'd had some experiences when things went wrong when there was no sign or indication of problems, and so (monochorionic) twins scare her.
She's been pretty supportive this whole time; her point is not that twins are so scary but that she is uncomfortable leaving them in and going longer and longer.
The proposed induction date was Wednesday the 16th. I'm not even sure what alternatives would be on the table, if I wanted a different date but felt Wed was too soon. Probably not a Friday, right? So it would be waiting through all of next week and then another weekend, so I'd be 39w3d at the earliest if it were the following Monday. I know she wouldn't be comfortable with that, given the current "standard of care" for this twin type. And of course I feel nervous, too....what if something DID go wrong? But then, that's what the BPPs and NSTs are for...right?
Her plan is to start with Cervidil (given my cervix's unripe status) and she said something about that being enough to send 1/3 of women into labor, but not for the other 2/3. If in the latter category, I'd go home and then we'd look at Pitocin (she was vague, in a day or two? It sounded very open-ended, including the option of going home if Pit didn't "work," barring complications such as fetal heart rate problems, etc.)
But my hope would be to go on my own before that (what if I can't?)
Am I irrationally afraid of induction? Of the experience, and the risks? Of what it would/could lead to?
I don't even know if it's MORE likely to stress their vascular connections and trigger acute TTTS (where they share the blood supply unequally, with one as "donor" and the other as "recipient") than natural labor would be. And I don't even think you can monitor for acute TTTS during labor, at least not effectively, because by the time the situation was reflected in "non-reassuring fetal heart tones," it already would be pretty advance (I'd think.) There's almost no information on acute TTTS out there.... But strictly speaking, if I don't go into labor on my own by X point, scheduling a c-section seems more safe (in terms of avoiding acute TTTS) than does an induction. Still, that feels TREMENDOUSLY precipitous.
Ugh. I have cried more/harder in the last day than at almost any time this pregnancy. I am at such a loss, and am dreading calling the office. Which I have to do. It is so hard for me to express myself to the doctor. I think I'm saying no, but I don't know what I'm saying yes to.
I just want a bigger window. I'm 38 weeks completed TODAY. Is that too much to ask? A chance to have this week without an induction on the books?
I am supposed to call my doctor's office today with my answer. I was in for a non-stress test yesterday (didn't even go a full ten minutes, as both babies were reactive and fine right off the bat and my doctor got what she needed) and the OB proposed inducing, starting with Cervidil, on Wednesday of next week.
Today I completed 38 weeks with my twins. This was an internal goal of mine....making it here, being "allowed" to make it here. Now that I'm here, I am feeling distressed at the prospect of getting the "time's up" message (which I've basically gotten.)
The pressure to impose a cutoff is not exactly arbitrary, but it feels a little bit that way to me. I know that studies have shown that certain risks go up with continued gestation, and supposedly the low point for risks with my mono/di twin type is 37 weeks, but I am having a hard time seeing how these theoreticals or statistics relate to me. (When it comes down to consenting to an induction.)
The thing is, it's pretty clear that my body is not (as yet) ready to birth them. For whatever reason, I am carrying them really well (as long as I rest enough....if I overdo it, I can barely walk.) I haven't had a lot of contractions....I have had some Braxton-Hicks but that is it. Aside from my whole "stab wound" experience and the accompanying release of stress hormones (that had me contracting irregularly but frequently overnight and into the next day), my uterine activity has been pretty nonexistent.
In light of the induction talk, I consented to an internal exam yesterday, the first I've ever had this entire pregnancy, and my cervix was firm and closed. (As it was with my first pregnancy at 41 weeks.)
I am so frustrated. I avoided the risk of preterm labor, with no signs of my cervix weakening or anything, even though my twins both have tracked large (the larger of the two has been in or around the 97th percentile throughout the pregnancy.) This is supposed to be a good thing. Right?
So now I'm at 38 weeks and that same lack of uterine activity and my stoic, firm cervix seem suddenly to be liabilities.
No, I don't want to flirt with disaster where my babies are concerned. They are mono/di twins which means they share a placenta (monochorionic, in one large chorionic sac, with a thin amniotic membrane dividing them from each other inside that.) They are higher risk than other twin types, though we've avoided the known risks to this point.
Once I knew about the twins, I proceeded with a lot of intention in this pregnancy. An early, high weight gain with high protein intake is supposed to be the best insurance against complications (such as TTTS/twin-to-twin transfusion syndrome for mono/di twins, preterm labor, low birthweight.) I have spent the entire pregnancy hearing from people who say twins "come early" and "don't grow big" and "are 'term' early," and though I've sort of expected them to come on the earlier side, I never assumed they HAD to come "early" and my goal was to make it to 38 weeks with them. (And I always, always believed I would grow big babies.)
I worked hard to reach the weight gain goals on schedule or nearly on schedule (didn't quite make 25 lbs by 20 weeks, but I did make 38 lbs by 28 weeks, and I've gained about 50 lbs when a total weight gain of 40-56 lbs is recommended for optimum results.) A big part of this was so that I could better my odds at achieving the goal of babies who could stay with me after birth and go home with me. Now I suddenly feel so pressured to turn around and rush them out.
I just feel like next Wednesday is too soon for an induction. I bought some Evening Primrose Oil capsules and I've started having sex (and orgasming, myself), and I'm hoping that with the coming full moon and whatever calm messages I can send the boys that it's okay to come....something will happen spontaneously.
My OB was talking about my aging placenta. I know that can be a factor, but shouldn't the results of the biophysical profile (specific to me) weigh more heavily than general statistics/my age/expectations about single-placenta twin pregnancies? And if the NSTs and BPPs are looking good, with plenty of evidence of fetal well-being, does that not mean that my placenta is performing well? Performing adequately? (And isn't that the point of doing that extra monitoring, anyway?)
I know that complications can arise without warning, but I'm not sure that that risk justifies my consenting now to an induction next Wednesday. I guess right now, I see the risks of induction as being greater than the risks of continuing the pregnancy and giving my body a chance to become better prepared for labor.
To be fair, with a shared placenta there is the risk of acute TTTS, which comes up suddenly (in the 3rd trimester and even as late as during labor/birth) and can result in death of one or both babies, and if one baby dies the incidence of neurological damage in the other is very high even if he's delivered within minutes of the first twin's death. (I first read these reports soon after I learned our twins' mono/di status at 14 weeks and I felt so devastated and pessimistic about the high-risk pregnancy ahead and the intervention-laden delivery at the end.) On the other hand, some mono/di twins develop acute TTTS in labor and show the evidence of it (one baby is anemic and the other is polycythemic) but the issue resolves with no serious side effects.
There is some push for a protocol of delivering all mono/di twins via c-section at or after 37 weeks. I know ten weeks ago, I felt somewhat "lucky" that I was going to be "allowed" to go to 38 weeks, and I figured I might be able to work out some wiggle room evenso. But now it is just so hard to feel right about consenting.
And the more time I have to process the appointment, the more upset I feel. For instance, why isn't it valid to wait a little longer, give my body a chance to prepare naturally (with the prostaglandins as encouragement?) and to consult the BPPs and NSTs to continue to monitor MY placenta performance?
But the OB just mentioned my placenta wearing out, and my age (37) increasing the likelihood of my fast-aging placenta as if the evidence (Doppler imaging of the umbilical arteries showing good cord flow in the expected range, combined with behavioral evidence of fetal well-being and good growth) were not the more relevant thing. (And, no, I didn't challenge her at the time. I just was listening to her "points.")
She also said that in five years, when I have two healthy little ones running around, how they got here won't matter. What matters is that they both are here and healthy. It just seems like a horrible thing for one woman to say to another, let alone at this time.
And she played the "dead baby card," I think, saying that when one twin is in trouble so is the other, because they're linked in that way (unlike fraternal twins, or identical twins who have their own individual placentas.) She also mentioned that she'd had some experiences when things went wrong when there was no sign or indication of problems, and so (monochorionic) twins scare her.
She's been pretty supportive this whole time; her point is not that twins are so scary but that she is uncomfortable leaving them in and going longer and longer.
The proposed induction date was Wednesday the 16th. I'm not even sure what alternatives would be on the table, if I wanted a different date but felt Wed was too soon. Probably not a Friday, right? So it would be waiting through all of next week and then another weekend, so I'd be 39w3d at the earliest if it were the following Monday. I know she wouldn't be comfortable with that, given the current "standard of care" for this twin type. And of course I feel nervous, too....what if something DID go wrong? But then, that's what the BPPs and NSTs are for...right?
Her plan is to start with Cervidil (given my cervix's unripe status) and she said something about that being enough to send 1/3 of women into labor, but not for the other 2/3. If in the latter category, I'd go home and then we'd look at Pitocin (she was vague, in a day or two? It sounded very open-ended, including the option of going home if Pit didn't "work," barring complications such as fetal heart rate problems, etc.)
But my hope would be to go on my own before that (what if I can't?)
Am I irrationally afraid of induction? Of the experience, and the risks? Of what it would/could lead to?
I don't even know if it's MORE likely to stress their vascular connections and trigger acute TTTS (where they share the blood supply unequally, with one as "donor" and the other as "recipient") than natural labor would be. And I don't even think you can monitor for acute TTTS during labor, at least not effectively, because by the time the situation was reflected in "non-reassuring fetal heart tones," it already would be pretty advance (I'd think.) There's almost no information on acute TTTS out there.... But strictly speaking, if I don't go into labor on my own by X point, scheduling a c-section seems more safe (in terms of avoiding acute TTTS) than does an induction. Still, that feels TREMENDOUSLY precipitous.
Ugh. I have cried more/harder in the last day than at almost any time this pregnancy. I am at such a loss, and am dreading calling the office. Which I have to do. It is so hard for me to express myself to the doctor. I think I'm saying no, but I don't know what I'm saying yes to.
I just want a bigger window. I'm 38 weeks completed TODAY. Is that too much to ask? A chance to have this week without an induction on the books?
Hey honey, we are sailing in side by side boats right now, aren't we?
: ITA. I think anyone with sense would be at least somewhat scared of induction. Considering how interventions seem to create a snowball effect. I personally am also scared of them, and pray that this babe will make her appearance before it's an issue.
(Gotta have faith....)
