Pt 4 + Putting together our Care Team

July 27th rolls around and this appointment was thankfully at 7:30 in the morning. You might be thinking, who wants to have to get up and be in the doctor’s office at 7:30am?? But for an anxious mama-to-be, I was more than happy to see our babies as soon as possible, no matter the time of day! The interesting thing about this appointment is that this practice is part of the medical group where my husband sees all his doctors. He has a lot of faith in them so I think we both went in hoping and maybe even expecting to prefer this doctor over the first. But things felt very different to me from the get-go. The ultrasound tech started our exam knowing we were dealing with what was believed to be MoMo twins. She said she thought she agreed but couldn't be sure and had us move rooms mid-exam and called in another technician to get her opinion as well. And together they agreed the twins were MoMo but a doctor never came in to confirm or take a look for themselves which was a glaringly obvious difference from the previous doctor’s visit.

I’m certain the technicians are incredibly skilled and proficient at their jobs but it feels to me that the nature of an ultrasound is that without a real time look at the babies, you can’t fully understand the circumstances. Given that the twins’ status makes them high risk, I couldn’t imagine why the doctor’s wouldn’t want to take a look for themselves but this was the first indicator of major differences in the care we would receive at these two practices. In the days that followed, I came to interpret this difference to mean that at this practice we would be treated as just another case of MoMo twins. They would put us on the conveyor belt and care for us in exactly the same way they would care for all other women carrying MoMo twins. For some people, this might be satisfactory but when I was able to compare that to the other practice, where the doctor told us we were his “special patients” and he gave me his cell phone number with instructions to call at any time, I came very quickly to realize it was a no-brainer who I wanted caring for me and my twins.

And the reality is that maybe I was receiving that type of treatment at the other practice because my aunt is good friends with the doctor but either way, it was care that left me with an overwhelming sense of comfort and confidence. In the weeks that followed, that sense of comfort and confidence was only further reinforced. Dr. Loy emailed me the research that he was going to base my care off of and informed me that he had sat down with all of the doctors in his practice to discuss a care plan for me and my twins. Together he and the four other doctors in their practice had decided that they would like to see me every other week until I reached 24 weeks, at which point they would like to see me twice a week until 26 weeks when they would like to admit me to the hospital for the duration of my pregnancy.

At our next visit with Dr. Loy, we were able to ask some more follow up questions about what to expect about the duration of the pregnancy and the delivery of the twins:

Do they have to be delivered by C-section?

Will he be the one to do the delivery?

If they’re still looking good at 34 weeks, can we wait longer to deliver them?

Would I be on bed rest in the hospital?

And all of his responses left me feeling like we were active participants in the team deciding how to care for me and these babies. Our opinions were not only going to be listened to but they were going to be taken into consideration when it came to making all decisions, major and minor, about this pregnancy. And to be truly heard feels like the most valuable thing in the world. When it comes to healthcare in this country, I feel like it is too easy to feel like our healthcare is just something that happens to us. As a culture we put a lot of trust in our physicians and we should definitely trust our physicians but ultimately, and certainly with pregnancy, labor and delivery, the medical experience has effects so much greater than just health outcomes. Agency and the power to make decisions for myself and these babies as active participants in the care team is a #1 goal for me right now and I feel we are achieving that. Maintaining that however is another story…

A few days after our second consultation and then our second visit with Dr. Loy, I had my first major meltdown. A sense of panic overwhelmed me at the thought of the C-section delivery that these babies would require. Accompanied by thoughts of tiny, potentially medically fragile babies, I was spiraling into a very frantic mindset. My husband was unavailable so I called my emotional breakdown hotlines: my mom (who didn’t answer) and then my sister. I described to her through sobs the fear I experienced when visualizing their delivery: my belly wide open, my babies surrounded by doctors, my body completely numb, unable to comfort my babies. Will I even be able to see them, touch them, kiss them in the first hours of their lives? Recovery from a C-section, the pain and discomfort. The medical status of my babies. Would I even be able to hold them, much less feed them? The depth of my panic goes on and on. But my sister expressed her understanding of my fears and did her best to comfort me and then suggested that perhaps I needed a doula.

You may or may not know that I am a doula myself. I have therefore spent many, many, many hours learning about birth for my clients but ultimately for myself as well and had a good idea of a plan for the natural physiological birth that I would now no longer be having. Amidst all of the mountains of new information, I had momentarily forgotten that doulas assist with all sorts of births! Bless my dear sister for reminding me of that! A doula could help me prepare mentally for a C-section, help as a member of my care team to create a birth experience that would be empowering and beautiful, educate me about twins, and a NICU stay, etc. Her role in my birth experience would be very different than the labor support I most often provide my own clients but it would be immeasurably valuable nonetheless! And I’m still in the process of hiring a doula but I believe she is the next critical component in ensuring that I continue to feel like an active and valued part of my care team.

I’m trying to allow myself to just be the mama-to-be as much as possible during this process. Given that everything I’m going through is directly related to what I do for a living, it has been difficult at times to be present in my own experience of these events and milestones. I had a very busy season of work through the early first trimester which I was grateful for. Being busy helped keep my mind off the fears that come along with being a miscarriage survivor in the early phases of a new pregnancy. And when our challenges started arising, the discovery of the second baby, the MoMo diagnosis, I had very fortuitously planned to take a break from work to “enjoy the summer with my husband”. While it actually ended up being to visit doctors, deal with the emotional and practical challenges of having twins and a high risk pregnancy and then finally a little bit of time to enjoy the summer with my husband, it was perfectly timed and utterly necessary nonetheless.

A beautiful realization that came up last week was that all expectant parents are facing a whole new world of unknowns and we are no exception. While pregnancy and childbirth and newborns are not entirely unknown to me given that I’ve spent the last two years investing a lot of time and energy into educating myself about those topics and working hands on in those areas, we have been dealt our own unknowns and in a very cool way that puts us right back to square one. Early on in my career as a doula, a mentor taught me about the idea of the beginners mindset. If I approach each new experience with a beginners mindset, I don’t carry any baggage or expectation into that experience. I approach that experience with a fresh and open mind. I may have basic skills and knowledge to support me through the experience but I don’t ultimately know anything about this new experience I’m stepping into. And I believe that when you approach a new experience with a beginners mind, you bring the best of yourself. So these two babies and this pregnancy are forcing us back into our beginners mind. We are going to learn and grow so much through all of this and if we know that going in and we approach that with not only acceptance but excitement, eager to dive head first into the unknown, allowing our unique experience to unfold as it may and to lead us wherever it may, maybe it will be a little less scary and a lot more thrilling.