Hospital

I felt like absolute rubbish on Saturday morning. It was another really hot day. Rob headed outside to weed in the garden. I hid from the heat and tried to distract myself by writing Christmas cards. 

When at lunch after two mouthfuls of a toasted cheese sandwich I had to run to the bathroom to be sick, where I realised I was also spotting, I knew we had to go to hospital. But I still rang my sister, a mother and a nurse, and talked to her, to see if she thought I was over reacting. She told me to go to hospital even if only for my peace of mind. Sage advice that I would now give to any pregnant woman. If you are worried about something, just go. The best thing that can happen is you are sent home. 

While Rob had a quick shower I packed a bag of clothes, my contact lens solutions, glasses and my toothbrush, I had a feeling I wouldn't be coming back. We drove into the hospital where we planned to have the girls. On the way we dropped our dogs with my parents. Ever the optimist Mum just thought I was dehydrated. But the look in my Dad's eyes let me know he understood how worried I was. 

The 40 minute trip was by now excruciating, I couldn't sit up. I squirmed trying to be as horizontal as possible. Once there I waddled into the matenity ward, Rob holding my hand. The midwives showed us into a delivery suite room, after a few checks of my blood pressure and weeing into a cup, they tried to find the babies heart beats. This would be the first of many failed attempts to do this over the next five days. Try as they might, moving the round sensors around on my belly, they could only find one heart beat; mine. They reassured me that this wasn't surprising given I was only 25 weeks along, the babies were still a bit small for the monitors. But they called my obstetrician to come and do an ultrasound. 

Of course my obstetrician was on holiday, so an on-call doctor was paged. I tried to relax and be calm as we waited for her to arrive, luckily we didn't have to wait for long. She quickly started doing an ultrasound. I couldn't see the screen, and was wriggling on my back as it was so painful now. After awhile when nothing had been said, I asked are they alive? She didn't answer straight away. But the growing frowns on her, Rob's and the midwives faces were not what I hoped to see. Eventually she told me that yes they were alive, but I had an acute case of Twin to Twin Transfusion Syndrome (TTTS). One baby was squished down in my pelvis and very hard to see, the other was floating around in a giant pool of amniotic fluid. Not what I wanted to hear at all. Despite having what I had feared all week confirmed, it was still a shock to hear it out loud. She left the room to confer with other Doctors in the practise and specialists in Melbourne who deal with TTTS more frequently. Poor Rob sat down on the chair next to my bed and shook. He was ashen and only managed to say I feel sick. I knew exactly how he was feeling, we just sat holding hands, not saying anything. 

My Doctor returned, and wondered if we were in the position to book flights to Melbourne? Depending on the results of a proper ultrasound we were about to have, it might be best for me to be sent to Melbourne for laser treatment (they close off the blood vessels that are causing the blood flow between the babies). Apparently hospital transfers would take too long to organise from Tasmania, and it would be easier if we just took a domestic flight ourselves! Our minds were in a spin as I was wheeled down in a wheelchair to the ultrasound room. I couldn't bear sitting in a car let alone in a plane.

I realised I was bleeding which didn't exactly bode well. I squirmed again as I lay on the bed as the radiographer measured and estimated. Rob sat in a corner checking flights on his iPad and then looked at the screen. He suddenly exclaimed, that's rubbish. I had no idea what he was referring to, apparently twin B, the one wedged down in my pelvis had no visible fluid around it. Eventually it was over, and our Doctor wheeled me back to the delivery room as she told us given the results of the ultrasound it was too late for laser treatment. She then went on to tell me, that my body was in labour and I needed to be transferred to the Royal Hobart Hospital for an amnio reduction. She let us know she had already booked two beds at the Neonatal Intensive Care Unit (NICU) there. Up until this point I hadn't really thought that the babies were coming any time soon, when we had discussed TTTS all those weeks ago I naively thought that if caught early it could still be treated and delay their birth by weeks. But the pressure of the extra amniotic fluid had started labour.

As we got back to the Delivery room, the midwives trying to be comforting (I suppose) said, I guess this isn't what you wanted. I broke into sobs for the first time, as I replied that all I had wanted were healthy babies, and this hope had now just about vanished. 

In that moment I realised how petty all my worries about pregnancy - the discomfort, the stretch marks, all the other various unpleasant symptoms -were. Fears about a painful birth paled into insignificance with what was now a scary prognosis for our babies.

They let me have a quick hug with Rob as we were both crying now, but then I had to lie down and keep as still as I could. I was administered steroids to protect the babies lungs (which would really only work with a second dose administered 12 hours later and then if we could delay the birth another 12 hours after that!) I was also given another drug to slow down or even stop labour.

I was transferred via ambulance to the RHH, lying precariously on my side, it was a short but bouncy trip. The ambos must have gotten a bit confused and wheeled my gurney via an internal lift into the foyer of the NICU. I came face to face with a wall of photos of tiny premature babies. I had never seen a prem baby before. The photos showed tiny red creatures, with strange looking faces, skinny limbs, covered in tubes, wires and tape. My gut reaction was one of horror. To tell you the truth they didn't look like babies, and the thought that our babies would look like that made me feel scared. I realised with a sinking heart as I read birth and death dates that some of these babies hadn't survived.

By now the receptionist had pointed the guys in the direction of the maternity ward where I was wheeled straight into a delivery suite. My Doctor was already there, once I had been shuffled onto the bed I had midwives all over me. Taking my clothes off and dressing me in a gown, helping me use a bed pan, attaching those fetal heart monitors, I was given another injection to slow the contractions that I couldn't even feel, and after three attempts a canula was inserted into my left hand for taking a blood sample and then IV fluids as I was dehydrated. Meanwhile a NICU nurse came in and checked over the warming bed on the other side of the room. Another obstetrician came to assist for the amnio reduction. I wasn't told before, or if I was I didn't remember, but apparently the procedure could cause the placenta to come away and bring on an emergency birth. Perhaps it was best I didn't know that, there really wasn't ever any choices in the treatment of TTTS, my Doctors were doing everything they could to prolong the pregnancy safely, whilst balancing effects of TTTS on the babies.

I keep saying the babies, I still didn't know I was having girls. Despite multiple scans over the next five days, at my request they still kept the sex of the babies a secret for me. 

The two doctors rigged up the equipment for the amnio drain. Slightly Macgyver-like, they used two pieces of cardboard in a cross to support the big needle they were about to insert. It would be connected to a syringe with a valve and then long thin tube to a bucket. Rob sat by my head holding my hand whilst everyone was in a flurry of activity around me. Once it was all ready they applied a local anaesthetic to my skin and using an extremely old ultrasound machine to guide her my Doctor inserted the needle into my tummy and right into the uterus and the amniotic sac of twin A, the recipient baby. Yes it hurt, but really everything was hurting by now. Mostly it was alright, but if someone touched the needle or my tummy, the pain would shoot through me. The process was incredibly slow, she carefully removed two litres of fluid, 10mL at a time, any faster would have triggered birth. 

The other Doctor stayed for the first hour, we all chatted about the most trivial of topics to keep my mind off the procedure. I was something of a novelty, and another Registrar Doctor requested to come and watch the procedure. Really I was beyond caring, they could have televised the event and I probably wouldn't have noticed. After a while as the amount of fluid in the bucket increased the pressure caused by my oversized uterus on my internal organs was noticeably less. She continued to drain as much fluid as possible then removed the needle, the whole procedure took three hours. She checked the babies with the ultrasound, and we watched in amazement as poor squished baby B was moving and even hiccuping. This was a huge relief, and after a quick internal exam for me, she decided we had delayed their birth for the day. 

By now it was pretty late, around midnight. They found me some sandwiches to eat and a fold up bed for Rob so he could stay the night. I dozed for the first hour, but after that I didn't really sleep. When I woke up I could hear Rob was sleeping peacefully, but I was still attached to a beeping IV drip, so needed assistance from the nurse to visit the toilet. At 4am they gave me a second steroid injection in my leg, and reattached the fetal heart monitors, and spent close to an hour trying to find their heart beats. They would pick them up and then lose them, so were never quite sure they could hear both. I could feel the babies moving, so I wasn't too alarmed.