Womb to Bloom - Maternity & Beyond

When pregnant with my now three-year old twins, I- like many pregnant mothers of multiples- went into early labor. It is a scary thing, to begin having contractions at a time before the babies are viable; knowing if they are born too early they may not survive.

The viability factor works like a carrot dangling in front of you on a stick; a stick wielded by the OB-GYN who keeps on encouraging the mother, “if you can hold on just two more weeks; just three more weeks; just one more week….” It’s not that you as the mother can actually control what happens- it’s more of a mental encouragement exercise, but one that paid off in my case.

This was not my first pregnancy. My first pregnancy was a cakewalk. Textbook simple. While it consisted of the requisite fear factors of any first time mother, there were no complications, I pushed my first son for less than an hour, he was born a couple of weeks early, and still weighed over eight pounds.

Not so the second time around.  The pregnancy started out rough. I was extraordinarily ill with morning sickness.  I was exhausted. My waist began expanding the minute I peed on the stick. Because I had my first ultrasound near the Christmas holidays, it was delayed a couple of weeks later than normal. The first visit revealed a big surprise- not just one little jelly bean- but TWO!

I should note here, twins do not run in my family, and I had not taken any fertility treatments- this was a complete surprise. The second ultrasound a few weeks later revealed yet another surprise- both jelly beans had penises! (Translation-I’ll have THREE BOYS.) I informed my doctor I was not coming back because each time I did he delivered a new shock. (By the way, I now have nieces, and three boys seem fairly tame….)

The pregnancy progressed fairly normally for the first few months. I even got the OK from the doctor to go camping at the beach when I was about four or five months along. A few weeks later, however, the contractions started. Since this was not my first pregnancy, I was familiar with Braxton-Hicks contractions, and initially paid little attention. Eventually, however, the contractions not only got stronger, but closer together and more painful. A simple grocery shopping trip became an epic event; and precipitated the first trip to the hospital, where I was diagnosed with pre-term labor.

After a round of hospitalization and treatment with magnesium sulfate through an IV, the contractions were controlled enough for me to be sent home. It was not long, however, before they came back.  I lived in a fairly rural area; the nearby community hospital had a small ER, and nothing that resembled a NICU whatsoever, so my OB-GYN and hospital were approximately 80 miles away from my home.  That prompted a bit of additional concern for the doctor.

When it became clear this problem wasn’t going away, the doctor began to investigate options. He decided to check with my insurance provider on a home health care option, and dispatched an assistant to make the call. The answer was no. My insurance wouldn’t cover it. My OB-GYN is an energetic, entertaining, and feisty guy who preferred not to take no for an answer.

He got on the phone with the insurance company himself and informed them that if they didn’t make an exception and cover my home health care, he would order full hospitalization and bed rest for the next 6-8 weeks until the babies were born. Faced with the possibility of paying nearly two months’ worth of hospital bills, the insurance company relented and approved an exception.

Home Health Care for pregnancy was not something of which I had ever heard. A nurse came to my hospital room and explained how it would work; she also started my first infusion pump, and prepared us for the upcoming weeks. My health plan to prevent early delivery consisted of bedrest, contraction monitoring, and an infusion pump that fed a continual supply of terbutaline into my leg.
(Terbutaline, by the way, is FDA approved for asthma; preterm labor treatment is an off-label usage, but is fairly common.) 

The first part of the plan, the bed rest, seemed the simplest, but in reality turned out to be the most difficult. Staying in bed for weeks at a time, especially with another young child in the house can be quite taxing.

The second part of the plan was an infusion pump that fed a continual supply of the terbutaline drug into my leg, much like diabetics sometimes use. The drugs would arrive every few days via UPS, packed in cool gel packs. Once a week the line had to be removed, and a new needle inserted into my thigh.

Because I am quite the sissy, my husband got the honors of poking me with the needle each week. He was actually pretty good at it- quick and painless. The system had a digital monitor, and the amount of medication fed into my leg through the tiny line could be controlled through this. Additional doses could also be administered this way. The pump, about the size of a paperback, has to ‘go’ somewhere, and that somewhere meant it was strapped around my waist at all times. It even came with its own waterproof case so I could shower!

The last part of the plan was contraction monitoring. Because preterm labor contractions often start without much warning, or begin with small contractions the mother may not be able to feel, the doctor wanted to know how active my uterus was on a regular basis. I would strap on the contraption around the lower part of my belly, and lie still for an hour. I would do this a couple of times a day, or more if I was having a bad day. Thankfully the machine had a pause button so I could go to the bathroom!

Once I had let the belt measure the contractions for an hour, the machine was snapped into a base which was hooked up to a phone line. Much like a fax machine, it would then transmit the results to the on-call nurse, who would read them and call me within 15 minutes. If all was good, we would monitor again in a few hours. If I was having over the ‘threshold’ amount of contractions per hour, I would first self-administer an extra dose of terbutaline through the line in my leg, wait an hour, and monitor again. If that didn’t control it, we were off to the hospital again.

While this sounds perhaps complex, and maybe a bit scary or over the top, home health monitoring for early labor can be a great alternative to hospitalization, particularly for mothers who already have small children. A hospital can be a scary place for a little one, and having mom home is quite comforting. The doctors and home health care nurses were extremely caring and helpful, and helped monitor my condition until the twins were able to safely be delivered.

Through this process, I was able to incubate the babies until they were born at 36 weeks- full term for twins! There were no complications as far as the babies were concerned, except for a slight case of jaundice, and they weighed 6 lbs 10 ounces, and 6 lbs 8 ounces. We were all home within the week, and I credit the home health monitoring system with helping to stave off early labor and delivery; and the added bonus of avoiding long term hospitalization was one of the best benefits!