The Post You've All Been Waiting For - Part 3 (The fun one)

8 Weeks. Feeling Disgusting. I cannot
wait until my yard is this green again.
Winter, be gone!

It all made more sense when Tammy showed us two babies.

The extra sickness, the tons and tons and tons of movement, the movement at my ribcage at the same time as my bladder even though my baby was only supposed to be about 10 oz, the fact that I'd been measuring a month (or more) ahead, the round ligament pain so early on, the migraines, etc.

I had no idea how weird my day to day life was going to be, though.

I was eating 80-100g of protein a day and drinking a minimum of my 8 cups of water, often 12. (3 quarts)

Twins meant an instant switch to 130-150g of protein daily and a minimum of 1 gallon of water.

I had been trying to work out, even though at 20 weeks I still had morning sickness and headaches and I *really* didn't want to. But when you're pregnant, you work out.

Twins meant that workouts were suddenly very low priority, and that I wasn't to physically push myself AT. ALL.

I had been planning a home birth with my dearly-loved midwives (who were also quickly becoming my closest friends, due to getting to work with them several days a week as an admin assistant). I was going to have candlelight and a fire in my fireplace. I was going to labor in a warm birth pool. I was going to push my baby out in my own home and be tucked into my own bed just minutes after.  I wasn't going to be in a cold hospital room with nurses who switched shifts half way through my labor so that I wouldn't even have a chance to get to know the assistants who were with me. 

A snapshot by the 3 year old from 14 weeks pregnant.

Twins meant that my hopes and plans for my birth went out the window. Twins are high risk for premature delivery and transverse positioning. It's uncommon for both of them to present head down (and very hard on them during labor if they do) so there's almost always one that's breech. They're high risk for malnourishment and NICU care. My midwives don't deliver twins. That meant the cold hospital room, potential for rude or hateful nurses, probably delivery in an operating room because it's policy for a lot of hospitals, and a likely c-section.

My midwives have an OB that they have an extremely good relationship with. He studied in the Netherlands, shadowing midwives, after completing med-school and appreciates the natural process of birth. He's comfortable with delivering breech babies because he's been trained to do so, unlike the majority of American OB/GYNs who have never delivered a breech baby and who schedule a section for any mom who shows up with a baby presenting breech. He has a very high success rate for vaginal twin deliveries because he doesn't see them as an automatic c-section. Also because he is comfortable with external versions and is really good at getting baby #2 into a good position after baby #1 is born.  He's also at a small hospital, so he's on call for his patients 24/7, so there's no chance of his clients ending up with an OB who doesn't see things how he does.

20 Week 3D ultrasound of Helena and Adoniram's faces

But he's 90 miles away from us.

Our home town, as opposed to this Dr. B (different Dr. B than my fertility Dr.) has two large hospitals, one of them less than 7 minutes from our house, but a ridiculously high c-section rate.  Nobody in town will deliver a breech baby if they can help it, and twins are pretty routinely a scheduled 37 week c-section, regardless of position or health.

But it was a no-brainer to us. Of course we'd drive. I wasn't about to sign up for a voluntary abdominal surgery just because my Dr. hadn't been trained to let a baby be born in the less than most ideal position.

So we started working on insurance paper work (We've been uninsured since Q started working from home in April of 2013) so that we could set up an appointment with Dr. B.

My midwives mentioned that, since it was so far to drive, there was a possibility that the Dr. would let them do my bloodwork and more simple checkups, instead of us going out there every couple weeks.

That would be when I realized how torn I actually was. Quinn's response was "well, if we're going to all this trouble because we need different care, then why would we outsource? Don't we need as much time with this doctor as possible?" 

It had only been 3 days since we had found out, and I kind of lost it. We were in the car and I launched into a "now see here" speech. I didn't know I felt how I did, but I found myself choking through a long list of reasons I was heartbroken to be going back into the medical system for a birth that was supposed to be my dream birth. I was half way through my pregnancy and every list and hope and picture that I'd been creating was being tossed into the trash. Of course I wanted to do what was best for my babies, but it was a massive mental and emotional transition to be going through.


Quinn got it. Of course he did. He always does.

And please don't get me wrong. We couldn't stop smiling, other than that 5 minute conversation. We were/are beside ourselves with the joy of this, and every time we see pics of Gavin as a baby we go "man, how are we gonna deal with TWICE that much sweetness and cuteness?" 

The OB is an awesome guy... I think... we had our January prenatal with him, and he ran the ultrasound machine to check H and A's growth. He was kind and gentle and knowledgeable and was very careful to make it very clear that our transition to his care could be gradual. He was fine with me consulting with and seeing the midwives, as long as we saw him as often as he needed to check on growth and placenta health.


So my midwives are who I go to for blood work, advice, concerns, etc. I probably talk to them way more than most their full-time clients do, but I'm sooo glad that I don't have to talk to a faceless nurse everytime I have an unexpected pain or deal with ridiculous amounts of dizziness.

And my OB is who is going to be doing a dozen more ultrasounds on my darlings and who will review every bit of bloodwork and who will be there to deliver our babies.

So our new care plan:

• Continue talking to the midwives about everything under the sun that my body feels. (sorry, ladies.)
• Count down to 35 weeks - any preterm labor before April 5th means driving to one of our local Labor and Delivery units and praying that our babies don't have to go through too much misery while their lungs continue to develop.
• See Dr. B once in February for an ultrasound. (next week! I can't wait to peek at their faces again!) 
• Stop life at 32 weeks. Not entirely, but Quinn's pretty adamant that he wants me 90% off my feet at that point (which happens to fall on my birthday) so that we can be as careful about making it the last 3 needed weeks as we possibly can. 
• See Dr. B twice in March for ultrasounds.
• See Dr. B every week in April for an ultrasound, and the midwives one or two times a week for heart tone checks.
• Start natural induction methods (pretty much just herbal encouragement) at 37 weeks. 
• Use whatever (medical) induction means are needed before 39 weeks.
• Have babies the last week of April! (week 38-39)

 Induction before 40 weeks is because Dr. B feels strongly that, with a multiples pregnancy, the risk of one or both of the babies becoming malnourished (because my body can't keep up with their needs) outweighs the risk of low development around the 38 week mark.

Their growth is already delayed. That's not a bad thing with twins. At almost 20 weeks they were only a couple days behind, but at almost 24 weeks they were a little over a week behind in measurements. That's completely acceptable with twins, since growing at the rate of single babies could create way too much demand on mom's body and, honestly, there just isn't room.

I'm kind of anxious to see how far behind they will be at almost 28 weeks. I hope they're not losing too much ground, even if it is considered normal and acceptable.



So, how has it been?

It's been grueling. Honestly.

With Gavin I hit "feeling fantastic" at about 16 weeks and I felt amazing until 3 days before he was born. Sure there was round ligament pain, I had a bout with kidney stones, it was difficult to sleep, I had to pee all the time and at about 6.5 months I started getting migraines every evening that lasted for 6-8 weeks. But we camped and floated and shopped and I went to every event I could find and we traveled and I worked out several times a week...

The other day I was griping at my Mom that I kept expecting my "feeling fantastic" to hit, but it kept not hitting. She raised one eyebrow and said "honey, it hit at 16 weeks, lasted 5 days and left again."

And yeah. That was pretty much it.

I feel fine, I'm super happy and I'm enjoying all the quiet home time that I'm getting this time. Last week illustrates the difference, though, because poor Quinn was going crazy. He was lonely, tired of the house and... lonely. He kept trying to talk me into having people over, going out for double dates, crashing friends' houses to hang out, etc. Finally I was like "Look, YOU go hang out with so-and-so and I'll stay here and sleep!"

We are Di/Di wth separate placentas, which is the least
likely to have complications. So grateful!

So that's our new precedent. We go to church and I sit in a lawn chair in the basement while he and Gavin sit in service. He goes to hang with friends and I stay home. He goes out for coffee and a chat with a buddy and I make him drive through Krispy Kreme.

And up until 2 weeks ago I thought I was complication-free, but 2 weeks ago I had a scare that was either a UTI or a kidney stone. It resolved in 24 hours after 2 quarts of the pithiest, sourest cranberry juice I've ever had. (I literally just had a full body shudder just thinking about the stuff.) And then this past week has been constant glucose checks and a switch from eating every 3 hours to every 2, and adding more carbs and fats back into my diet to get higher calorie counts because I was having hypoglycemic crashes several times a day because these buggers are sapping every bit of energy and every calorie I consume.  Thankfully, I don't have to set an alarm and eat every 2 hours during the night, but I am supposed to eat a couple bites every time I get up to use the bathroom.

*sigh*

I hate food.

Is anyone still reading? This is sooo muuuuch wordage. I apologize -- I'm just hoping to get everything caught up (blog, scrap books, baby books) before they get here...

Anyway, I was pretty convinced that I wanted the baby and Gavin to bunk together, but we had to re-examine that decision when we found out there were two of them. We're still sticking with that plan, even though we could turn the office into a nursery, because we really want Gavin to start sharing his room now.

So I'm going to be picking up different furniture entirely. A more compact toddler bed instead of Gavin's convertible crib, mini cribs instead of a full size crib, a closet makeover for more storage space and a hidey-hole for Gavin. Lingerie dressers for the twins instead of standard sized dressers, a chest of drawers instead of a dresser for Gavin, etc. I'm gonna paint neutral (gray and white, still debating whether or not to use some taupe as well) and let each child's belongings be the colorful splashes that the room will need.

The really overwhelming factor in all of this isn't the extended shopping list or the to-dos of redoing a bedroom. The really overwheming factor is that my energy comes in 10 minutes spurts that end with me panting on the couch. That said, I'm soooo glad I'm not on bedrest, and can still get little things done! Even if that just means a five minute bathroom scouring, or throwing together a "homemade" meal of canned sauce and pasta.


So. To conclude. I'll keep you all updated. Part 4 will be a birth story, and may not happen until May or June, so let this little compilation of clips solace you until then:

The Post You've All Been Waiting For - Part 2

The Nitty-Gritty of The Back Story





This entry is a bit on the boring side. It's the informative piece. The piece that says exactly what we did to combat our diagnosis, once we finally got a diagnosis.
There will be more fun and storytelling in Part 3. I promise. 


The nurse injected a large needle of something into my leg. She smiled and said "most doctors make their patients do this without a painkiller. I'm always grateful for Dr. B, 'cause he won't let us do it if you haven't had something to help."


It kind of took my breath away to hear her say that. I don't know what I was expecting, but I knew I hadn't expected it to require a needle full of pain killers.  It was a "simple" procedure that was standard after the basics of progesterone blood draws and temperature charts and standard tests on Quinn. Everything so far had said we were ovulating, and with no other health complications there was no reason for us to be struggling to conceive, but here we were, 20-some cycles into our journey and they couldn't give us a reason why.

And so, we were there. I was under a massive x-ray machine thing, a radiologist, an OB, 3 nurses and my husband all in the room with me. It was cold.  My OB prepped the biggest needle I have ever seen and after a couple seconds of very sharp pain he showed me the needle on the display screen for the machine. Then he started the dye injection. He emptied that syringe of dark blue dye quickly, needing enough pressure that it wouldn't just fill my uterus, but shoot through my falopian tubes and fill my ovaries. The purpose was two-fold: To check for any blockages, collapses or cysts, as well as to potential "blast clear" any of the said blockages or collapses.

It was probably the most physically miserable 3 minutes of my life.

After 4 hours of transition and pushing out Mr. G's 14.5" head with nothing but a muscle relaxant, that's kind of a big deal for me to say.  If you're looking at a hysterosalpingogram
then make sure your doctor gives you a pain killer before he starts the procedure. You won't regret it.

But they found nothing. "Of course", he said, " If there was a collapse then we might not have seen it because the dye inflated it so quickly. Most people with unexplained infertility get pregnant within three cycles of this procedure, so if it didn't help, we'll know in three months."

20 minutes later I was sitting on the hood of our car in the hospital parking lot, my head in my hands, shaking like a leaf and trying not to throw up. The nausea and severe cramping were normal side effects. Nothing to worry about.

-----------------

6 months (and 8 cycles) later, Quinn had been re-tested but only because we didn't know what was next. If we were ovulating then the recommended fertility medication (chemical) shots wouldn't help. If Quinn was fine then there wasn't anything that would help him. Quinn had recently ordered another text book on fertility, as well as a package of LH strips so I could check LH levels.

And, frankly, the last test had jarred me enough that I wasn't sure I wanted to know what was next.

This would be the point when Quinn became the absolute hero of the story.

Why?

Because I gave up.

I was tired of crying. Tired of scheduling our marriage around graphs and charts. Tired of my piles of supplements and tired of being tired. Tired of calendars and thermometers and prayers and being told that there was nothing wrong with me, even though my body wouldn't do the one thing that a woman's body is supposed to be capable of doing, whether she's tall or short, strong or weak, and whether or not it's wanted.

But Quinn, being the research-aholic that he is, blasted through his text book and took over. He started sticking the thermometer in my mouth every morning when he got up (he's always been the early bird in the family) and keeping track of the charts. He started handing me my vitamins every day and he pushed me into talking to my midwife friend about where we were and what my symptoms were.

My sister in law had recommended several months before that I go gluten-free, since there were lots of links between gluten-sensitivity and unexplained infertility, and since Quinn was handling the emotional burden of the pills and charts, I decided I may as well cut wheat out of my diet. (My first cycle after going off gluten was 4 days longer than my cycles had been for the past 2 years, which was the first notable difference that ANY supplement or treatment we had tried had affected)  About that time my midwife recommended a saliva test to check essential hormones ( < link is an affiliate link)  that she could look at, and that we could use to start consultations with a hormone specialist if it showed up any abnormalities. We were in a somewhat tight spot, financially, but God put it on a friend's heart to offer to pay for half of the test for us, so we went for it.

And so in April of 2013, we got the test results back and they showed that all of my hormones were either truly elevated or borderline elevated. My midwife told me something I absolutely did not expect. Those results indicated PCOS. Especially the fact that both my testosterone AND estrogen were significantly elevated. And then there was the fact that my LH strips were almost useless because I could use them for 10 days straight and get a positive result every day. So I had elevated LH as well.

Now, PCOS isn't for early-20's girls who are well inside their healthy weight spectrum and who have super short cycles.

No, PCOS is typically symptomized first and foremost by cycles that go 2-3 months instead of 28-32 days. Doctors won't even test for PCOS of you don't fit a fairly standard set of symptoms:

Excess Weight
Excessively Long Cycles
Extra Body Hair
High Blood Pressure

PCOS wasn't me.

It couldn't be me.

And the dye test had shown that I didn't have any cysts. How could I be PCOS without any cysts?

Turns out that the PCOS disorder eventually causes cysts, but the actual disorder is a specific hormone imbalance, not a list of symptoms.

AND, since that's what my body was saying, that's what we were going to treat. Being gluten free already was the perfect start, since “…85% of her PCOS clients test positive for a sensitivity to gluten. When these women remove gluten from their diets they often see a marked improvement in their PCOS symptoms". As far as diet recommendations go, that was just the beginning. Gluten free was good, but it was essential to maintain as steady of a blood sugar balance as possible, so I was told to eat every 3 hours, avoid any large doses of sugar, and to supplement with chromium and cinnamon. The main goal of the PCOS diet was to eat only foods with a low glycemic index and to keep my sugars balanced. But of course, Quinn wasn't gonna stop there. He took it a step further and researched D-chiro inositol and Myo-inositol and ordered both for me.

Inositol regulates the reception insulin. One of the main reasons for PCOS (as I understand it) is insulin resistance causing overproduction of hormones.  That's why EVERYTHING gets elevated with PCOS. (Note, with a gluten sensitivity the body reads gluten as sugar, thereby creating even larger sugar spikes and causing the well-known gluten headaches. Not sure whether a breakdown in our insulin receptors causes the gluten sensitivity, or if the gluten sensitivity causes an overload on the receptors, but either way they are very closely tied together)  Inositol is being studied in relation to PCOS all the time, and every study seems to be more promising than the last.

He was still regimenting my pills and temperatures, and I was using LH strips. Now he was making sure I had food every 3 hours as well, and dosing me with DCI (D-chiro inositol). 

The DCI was brutal stuff. I thought I had the flu for the first 3 days I was on it before we realized that it was actually the DCI, so we switched to the Myo-inositol, which is a lot gentler. It also comes in a powder, so we were able to start with smaller doses and work our way up. We used it through June and July, accompanied by the diet changes, and had possible miscarriages both months. (one month was a faint positive at 24 days, but then a negative at 25 and obviously didn't maintain).

August is when we conceived, just 4.5 months after going off gluten and 3.5 months after fighting my invisible foe. It was 4.5 months of Quinn bringing me pills, sticking a thermometer in my mouth, charting the calendar, bringing me gluten-free take out at work, buying me gluten free snacks, and holding me night after night, telling me that we were so close. It seems like it was a daily ritual for him to point out all the specifics of how God had led those few months, and to recite the symptoms of progress that we were making.

He wouldn't let it rest.

And I'm so glad he didn't.


Part 3 will be some of the differences between a twins pregnancy and a singleton pregnancy, why we switched care providers, and more of the story of how the last 2 months of gone. For now, I'm healthy and happy and 26 weeks along.