Thursday, July 23, 2009

Twinathon: Twin pregnancy, delivery (c-section), recovery, and breastfeeding

For those of you who read this for running musings, this is not the entry for you. Shield your eyes, 'cause this one is going to be detailed. I've noticed (in a big brother (sister?) kind of way) an increasing amount of people finding this blog via searches about twin pregnancy. I've also received a handful of emails recently with questions and comments from readers who don't want to publicly comment - keep them coming! Pregnancy and what's happening now was a really confusing time for me and I'm happy to answer any questions.

As this is going to be a long one, here's what to expect:
  • The pregnancy - what I ate/did/didn't do
  • Gestational diabetes (GD) - what it meant
  • The delivery - abbreviated version
  • C-Section recovery
  • Breastfeeding twins
  • Getting my "grove" back - very abbreviated, this is a work in progress
But first, here's the beautiful finish/beginning:

The pregnancy:
We weren't "trying" to get pregnant and we certainly weren't expecting twins. But, come November we got a great surprise - I learned I was pregnant. About a month into the pregnancy I was spotting quite a bit and freaked. Our Dr. (side note, we changed OB's half way through - more later) said to get an early ultrasound to see if the baby (singular at the time) was OK - so off to CPMC (the hospital I wound up going to almost bi-weekly). I was running quite a bit at the time (25-30k trail races about every other week) so I was really scared that I had already messed something up. During the ultra the nurse said the one was fine ... after a short pause, she said the SECOND was fine too. I was frozen - excited, scared, and frozen.

Side-note, our twins are "natural" fraternal twins - they run in my family (both mom and dad's sides).

Side-note number 2, when you're pregnant, your girl zone is no longer "yours." It becomes property of doctor and nurse hands/eyes/xrays.

We switched OB's at 20-weeks pregnant. At first I really liked ours, he was near my office and got me in quickly the first time I called. As my appointments progressed, he was consistently late (like 45-60min late) and his admin said he just always did that - it wasn't a delivery thing. The office also seemed dirty and he was the only doctor there. I wound up getting a referral to a doctor in Laurel Heights (near CPMC) and am so glad I changed.

For the first 25-weeks of my pregnancy I continued to run. In fact, at 3-months pregnant I was asked to become an Ambassador for Lululemon and I was leading weekly running club runs for a local store. At 5-months pregnant I won my first 10k which was a huge shock (and probably not that awesome to the male and competitive female runners I beat - the bump was absolutely there). My doctor said I had to stop running at 25-weeks - now, a lot of people run through pregnancy and it's great! But with twins the pregnancy is already considered high risk and doctors are concerned about the pressure. So I switched from running to spinning and swimming and yoga at a local chichi gym (a treat to myself for having to stop running).

Working out:
I did spin 1-3 times a week throughout my pregnancy. In fact, the day before I went into labor I did spin. I also started swimming at least once a week and did yoga from 5-months pregnant to 7-months pregnant once a week. When I couldn't (or didn't want to) do a class, I did the elliptical and free weights. I also walked to work (1.2 miles) and home every day. I am pretty confident that my staying active helped maintain a healthy pregnancy - and healthy mind.

Pre-pregnancy I was pretty healthy. The occasional carrot cake slice and dried mango or snickers were my downfalls, but other than that I ate (and still eat) a lot of Greek yogurt, fruit, meats (lamb, chicken, fish, steak), and veg. I LOVE fruit and vegetables and Matt and I both like to cook so good eating came pretty easy. We also like Whole Foods (whole paycheck) and Farmer's Markets - one of my downfalls (besides shoes) is good, organic, clean food. To up my caloric intake I added cheese, extra fruit, olives, and more snacks throughout the day.

I gained 28-lbs during pregnancy. I had thought I'd gain more and had upped my consumption, but my body only felt like 28. I did look like I gained 50, though, and people loved telling me how HUGE I looked. The comments were not fun, but I have to say, in retrospect I miss my bump!

Gestational Diabetes:
Around 6.5 months pregnant I was diagnosed with Gestational Diabetes (GD). GD is more common in twins because a lot of the nutrients mom (me) eat go to the placenta and sugar doesn't get processed properly. I was so bummed because I thought pregnancy would be my chance to eat carrot cake more often. I was able to monitor my GD with diet alone but it was a bit of work.

Breakfast became a frittata, eggs, or oatmeal (no honey or sugar). I eventually brought Greek yogurt and nuts into the mix when I realized my blood sugar would hold. Lunch remained salad with protein or soup and salad, etc. Dinner remained protein and salad with a carb (corn bread, garlic bread, etc.).

Daily I had to do 4 blood tests (fasting, after breakfast, after lunch, and after dinner). Weekly I had to go in to meet with a nutritionist to review my diet and blood charts and weight. In a month I'll need to go back for a final blood test to either clear me or put me on a monitor for type 2 diabetes (if GD isn't controlled, type 2 becomes more common for moms).

While in the hospital, they continued to monitor my blood - but their needle was GIANT! If you have GD, I recommend packing your monitor kit in your hospital bag.

The delivery:
Throughout my pregnancy I had been hoping for a natural delivery. The boys were both vertex/vertex (heads down) from 7-months on, I had no preclamsia, and no complications. Leading up to the delivery I felt VERY ready to have the boys - mostly because I couldn't roll over anymore, couldn't see my feet, and was tired of all the giant comments. I also was tired period.

My water broke at 37-weeks on the day (although doctors say it was 36 weeks/5 days, but every doctor tracked the timeline differently - we had a few different due dates from different docs so I based my date on the first day of my last cycle). My water broke at work and it was less than monumental - just more oh my God than anything. After getting ahold of Matt, we went to the hospital for a quick check. After they confirmed that my water broke, I was admitted. When water breaks, it's your "ticket in" to the hospital. A lot of people stay home to go through early labor in their own realm, I wish I had done this, but didn't plan.

I was in labor for 36 hours. For the duration I was probed and prodded by countless doctors and nurses. I had been given an epidural at one point so I couldn't feel a thing down there, but it was still weird to have heads popping up noting the happs down there.

The pain started kicking in around hour 8 and I was put on meds. At one point a nurse put me on picotin (without asking) to enduce labor faster. Towards the end I remained at 5cm for 5 hours, not good. Our doctor came in and "strongly" encouraged a c-section - strongly meaning I had to do it. I cried, and couldn't talk - this was not the plan.

More pain meds and Matt calming me down later, the boys were born.

After the c-section I was monitored for 2-hours. There are complications that can happen like blood problems, clotting, etc. so docs watch c-section recipients closer.

C-Section recovery:
The days after my c-section were miserable. Aweful, actually. And totally painful. Because of laboring for so long, I had tons of chemicals in my body from the epidural to the petocin to pain killers. I was put on a saline drip and given stool softeners and pain killers - after a c-section they don't let you eat until you "pass gas." Unfortunately I got TOTALLY distended - my stomach and legs ballooned and I was as big as I had been before the labor. The doctor said that my distention only happened in 5% of c-section recipients (not encouraging) and the nurses said they had never seen anything like it. The worst part is I wasn't allowed to eat or drink any of the treats people kept bringing. Actually, the real worst part is I didn't start making milk yet and I knew I wanted to breastfeed my boys.

The hospital continued me on the saline drip and held foods for days. I was given an x-ray to see what was going on and they realized they left something in me. I was also given numerous more meds and drugs to try to get me to "pass gas." Nothing. The doctor requested I stay in the hospital an extra day (you're not allowed to leave until you have a BM after a c-section) but this was actually a blessing in disguise because Wilson (who had been in NICU) had to stay an extra day, too.

Upon returning home, here's what helped me finally start to recover:
  1. REST!
  2. Getting off the drugs (I stopped vicodin as soon as possible and switched to Motrin and a mix of camomilla, rescue remedy (for the stress))
  3. De-stressing - I talked to people in the SF Parents o fMultiples forum for reassurance and it really helped
  4. Keeping my feet up - this helped work the water out
  5. Drinking TONS of water
  6. Nutrition - good foods, and some more natural remedies (apple cider vinegar, acidophelis, and my maternity vitamins, Synergy kombucha)
  7. Walking - 15min walks daily with Matt and the boys were and are good for my brain and body
  8. Breastfeeding!
I'm now de-puffed and below my pre-pregnancy weight (which is really weird) - I'm sure this'll change.
Breastfeeding twins:
First let me jump to the why - breastfeeding twins is very very difficult. I am trying constantly to stick with it - so far, so good. I'm also open to plan B, C, D, E ... you get the picture.

Here's why I think breastfeeding is cool:
  • More nutrients for babies
  • Easier to digest for babies
  • Proven to lead to higher IQ - from an Efimil commercial, go figure
  • Bonding time with babies
  • Helps me (mom) lose weight, fast!
  • Saves money - formula is at least $1,300 / year / child
  • Less bottles to wash (not for us, yet, since we're supplementing)

Studies are proving breastfeeding (when possible) supplies the best nutrition for babies. It's the most natural and provides way more than what a formula can give. I actually wasn't so hell bent on breastfeeding until I read a formula advertisement stating that formula fed babies had an IQ of 108 on average at 4-years of age vs. breastfed babies with 112. I thought that breastfeeding would be easy, but it's proving to be VERY hard. Not only do I need to make enough milk for 2 babies, but I need to be able to hold both, cuddle, pump (which helps make milk but also gives Matt bottles to give the boys at 3 or 4am).

Breatfeeding is absolutely still NOT easy. But it's getting easier (knock on wood fast!). Matt and I tried to figure it out on our own with the help of forums and websites but different sites and forums say different things. The important note here is everyone has a different story - so mine is different than most.

Making milk:
After a c-section it takes longer for the milk to come in. This is partly due to the meds but also because the body has literally been cut up and it needs to heal. I did not make any milk at first which was SO frustrating. I felt like a failure as a woman and a mom. But it is starting to come in more and more. Based on a doctors rec, I started taking fenugreek to help with production.

After countless sleepless nights and lots of crying babies, we called a lactation consultant and it's the best thing we've done since being home. The consultant came to our house and helped teach us how to latch, learn about nutrition, and offered more tips on ways to make more milk.

Here's what we're doing now...
Latching: this is a tough one, especially with tiny babies. We are using nipple shields for both boys to help them latch and suck. It turns out Cole is tongue tied (I am too) which makes it harder for him to latch and swaller - we're going to get this fixed as soon as possible (it just means snipping the bit under the tongue).

Tandem: I am trying to do tandem - otherwise all we'd be doing is feeding/changing/feeding - right now we have time to go to the bathroom and eat occasionally, but that's about it. I'm a fan of the football hold and when I feed do skin/skin with the boys. Then we change them, swaddle them, and give them more.

Amount: with formula it's easy to monitor how much the boys are eating - you see it right on the bottle. With the breast it's not so easy. We bought a scale because 1oz of breastmilk equates to 1oz gained in the baby. What we discovered is they're not getting that much (maybe half an oz per feed because they just can't suck that hard). I now feed for 20-30 minutes, then we change, swaddle, and give 30-35ml of bottled breastmilk (when there's enough - otherwise we do formula).

Nutrition: as with pregnancy, during breastfeeding good nutrition is imperative - I'll list some foods below.

For the boys, we're putting 1/16 tsp babydophelus in their bottle once a day. Because they were born via c-section, they didn't get the good flora coming out - the lactation consultant recommended this.

Making more milk: last week I was at a loss as to feeding my boys. I didn't think I could/would make enough milk. Here's what I'm taking that I think is helping:
  • Fenugreek
  • Mother's Milk - More Milk Plus liquid formula
  • Mother's Milk Plus tea
  • Camomilla and Rescue Remedie (you can't make milk if you're stressed)
  • LOTS of water
  • Sticking to 1 coffee/day (although I want 10)
What I'm avoiding:
  • Rosemary
  • Thyme
  • Peppermint
  • Massive amounts of chocolate
  • Juice (citric)
  • Aspertame
What I'm eating more of:
  • Grains
  • Beans
  • Nuts
  • Fresh fruit (yay!) but I'm monitoring my sugars
  • Vegetables - especially dark leafy greens
Anyhow, there's my novel / my story. Everyone's story is different and mine will surely evolve (and I can't wait to experience more!) If you are reading this because you found it based on questions around twin pregnancy, birth, etc. you are more than welcome to email with questions. There's a lot of info out there - the key is to find what works for you.


Valerie said...

Hi Amber, I love your post and I'm so glad it's full of information. I'm a first time expecting mom and it's Twins. They don't run in the family so it's a big surprise. I'm only 14 weeks but really worried about how to gain more weight. I still feel so small!! What's the best for me to eat to gain the weight I need? ... Please help... My email is

Rachael said...

Really appreciate your post. My husband and I just found out we're expecting our third and fourth (and last) children. It is definitely overwhelming to think about! It was so nice reading from someone else who survived it, and especially someone else who worked so hard to keep themselves healthy through their pregnancy!

Kelly said...

Hi, Amber--
I am so glad to read your post. I'm a competitive long distance runner, mom of a 2 year old, and now expecting twins from IVF. Although I was too sick to do anything more than elliptical for the first two months, I'm finally back to running with the help of some awesome anti-nausea prescriptions. It's so nice to read the post of someone who had a good experience and gives such practical advice. Although I don't think I'll be running all the way through my pregnancy like I did with my first, it's encouraging to hear you made it as long as you did. Thanks for posting!!!

Kelly said...

Hi, Amber--
I am so glad I found your blog! I have been a competitive long distance runner, even through my first pregnancy, and now I am pregnant with twins through IVF. I was pretty sick for the first two months, but with the help of two anti-nausea prescriptions, I finally have the energy to do a little running again. It was so nice to be back on the trails with the jog stroller! I am so encouraged reading your blog; what practical advice! You definitely made me feel less overwhelmed going into this. Thank you for sharing!