Jen and Evelyn.

Christa and Anna.

Evelyn in the NICU.

Anna in the NICU.

Ginger and Evelyn.

Ginger and Anna.

Okay, okay. Can we get to the delivery, finally?

Why yes, we can.

Up until now, the contractions were not so strong as to deprive Ginger of a sense of humor.  For example, the hospital provides a laminated (don't ask) scale by which they ask you to "rate your pain" on a scale of one to ten.  It's in a series of languages, which caused Ginger to joke that she wanted to have her labor in Tagolog because it didn't appear to have a word for "Excruciating," while sadly enough English apparently does.  It also has a series of round "happy" faces, descending into a very sad looking frowny face.  "Point to the frowny face that best corresponds to your pain."  I think if I were asked such a question I would be tempted to point to my own face, perhaps with a finger other than the index.  Anyway, on one occasion a nurse came in and asked her to rate her pain.  Ginger said, "Four."  And the nurse pulls out the laminated chart anyway, and asks her to point to the place on the chart that corresponds with her pain.  I'm thinking, what, are they using different numbers between one and ten?  Have six and four been transposed, making it necessary to clear up an ambiguity?  The incident caused Jen, Christa, Ginger and I to joke that we needed a new scale.  "Frolicking kitten, sad polar bear, or angry badger?"

Suffice it to say, we were now very clearly in the throes of angry badger.

Contractions are three minutes apart, and strong enough to cause Ginger to be unable to interact much while they're happening.  I'm holding Ginger's right hand; Jen is holding her left.  Christa is spelling both of us from time to time, mostly because I've been wearing the same dress shoes since 10:00 the day before and they're really killing me.  (In fact, my comment to that effect -- "My shoes are killing me"  -- was met with the very last thing Ginger said about anything other than her own pain, which I won't repeat here.)

We, being old pros at this, know that it's time to tell the nurse.  Only problem -- shift change at 6:00.  The nurse who comes in has to be brought up to speed on everything -- history, birth plan, etc.  So we try to sound as old-pro as we can, to communicate that we're not the Nervous Nellie first-timers who want to see the doctor every time there's a contraction.  I had even already put on my paper scrubs for the occasion.  Maybe I fooled her into thinking I was a new doctor on the ward.  In any event, I guess I communicated that I know transition when I see it.

The nurse, bless her heart, gets the doctor right away.  He checks Ginger and finds her at 8 cm.  And he says these words: "Given your history of quickly going from 8 to full, we'll put you in the OR now."  First we're told that Ginger can have me and one other person in the OR; Jen graciously agrees to let Christa go, as she's new to this.  Then the perinatologist asks for another set of scrubs for Jen -- all three of us are going!  Oh, right, and Ginger.  Ginger asks the perinatologist that even though we know the girls will be headed for the NICU right away, can they spend some time on her belly before they go?  He says yes, but that we'll literally only have a minute with Baby A because the cervix will start to close if you wait too long before continuing.  Uh, yeah, a minute would be fine, we say.

Yes!  Wheeling down the hall, turning the corner into the OR.  And then Christa, Jen and I are stopped at the doors.  They want us to wait while they get set up, then we can join.  Ginger is wheeled through the doors and out of sight.  We make small talk in the hallway, mostly about how ridiculous we look in paper scrubs, but also about how they really bring out my blue eyes.  At least, that's what I remember.

Finally, we go in.  Ginger's already on the table, but they're installing the stirrups.  The perinatologist is barking orders, but in a totally nice way, 'cause it's his job and all.  Ginger's had a few more contractions since we were separated, but I take my place, this time at her left hand (with Christa behind me), while Jen takes her right.  A few more contractions, some small talk in between, then PUUUUUUSH.

It took a grand total of three pushes to get Anna out.  It's 7:03.  True to his word, the perinatologist put Anna up on Ginger's belly.  We petted her and named her.  Then they took her to one of the tables, and we were back to work.  A bit of trouble -- the perinatologist seems to be handling a live squid for a bit there -- and then Evelyn is born at 7:09 and is placed on Ginger's belly.  I'm then handed Anna, all wrapped up -- exactly what we were told in advance was impossible for a NICU baby.  Ginger gets Evelyn in the same condition.

Then it's off to the NICU.  I follow and watch them unwrap and begin to prep them for their isolettes.  Jen and Christa stay with Ginger and follow her to the recovery room.

Things got better then?

Absolutely.  The contractions started to strengthen, finally.  (The nurse kept coming in and bumping up the Pitocin in the infusion line, but she did so discreetly and without asking.  By the end, we were up to 9 units -- 27 cc -- and Ginger didn't even know it.)  All I cared about was that it was working.  Contractions five to six minutes apart magically changed to five-to-four, and then four-to-three.  By 6:30 we were having contractions every three minutes, almost like clockwork.  And Ginger started to go off into that La-La land between contractions that meant that the end was near.

I should mention here who was in the room at this point.  So there's me.  And there's Jen and Christa, who have been there since 7:30 and 8:30 respectively, having returned from 10 p.m. the night before.  There's Chad, who arrived mid-afternoon with copies of a customized Thanksgiving for the Birth of a Child from the Book of Common Prayer, and who stayed almost to the end.  And there was Jan, the CPMC Chaplain, who joked that she'd never before been to a birth so well-attended by ordained clergy, and who took Ginger's mind off of the pain between contractions by talking Diocesan and Anglican politics.  (It's the closest thing Ginger wanted to an analgesic drug.)

It was finally turning into the birth we wanted.  The only catch was that it wasn't when we wanted it.  It also wasn't where we wanted it, but the people in the room and the professionals at CPMC made up for that, in spades.

You ran an epidural, then?

No.  The anesthesiologist was great.  When he came in, he saw the look in Ginger's eyes that told him that she didn't really want it.  And he ruled out installing the epidural catheter just to keep our options open.  His reasoning was impeccable:  Labor is hard enough without having an unanesthetized needle in your back.  Oh.  It never occurred to me that most people who have a needle stuck in their spine during labor DO SO FOR THE EXPRESS PURPOSE OF COMPREHENSIVE LOWER BODY PAIN RELIEF.  Having one in your back "just because" and then not using it is the height of lunacy.

The anesthesiologist said that if circumstances required an emergency C-section, he could do everything on an emergency basis.  That was enough for both of us.  Of course, we knew that one possibility was the need for a general anesthetic, which would be dangerous and bad, but it was a risk we were willing to take in order to leave open the chance for an unmedicated birth.

A major factor in the anesthesiologist's confidence, along with the perinatologist's confidence, was the fact that Ginger had had two prior term births by unmedicated vaginal delivery.  It's what they call "proven pelvis" in the baby biz.  Christa and Jen think it would make a great name for a band.  I'm unconvinced.

So you had the Pitocin. Then what?

Then we were back to waiting.  We started with one unit (3 cc).  Nothing.  Contractions were still even milder than they were on the magnesium sulfate.  So we ramped it up to two units, then three.  Each time, Ginger protested, but at that point, having lost the principle of the thing, the amount was becoming irrelevant.  We just didn't want the Pitocin to go faster than Ginger's body.  This was supposed to be a kick-start, and we didn't want to push the car to the destination.

Then there was the problem of pain relief.  We'd wanted to stick with natural childbirth, which means keeping pain relief at a minimum in order to avoid interfering with the body's natural response to labor, but the nursing staff suggested a consult with the anesthesiologist anyway.

Here's why:  Twin births are different, and not just because there are two babies to be delivered.  In a singleton birth, if the baby starts the day head-down, he or she is likely to finish the day that way.  Not so with twins.  Even though our twins were both presenting head down, the perinatologist said that it's possible that the delivery of Baby A will inadvertently create enough abdominal room to cause Baby B to flip-flop into a sideways or breach position.  This is more likely to happen when Baby B is on the smallish side.  If it happens, you might be delivering Baby A vaginally and then be forced to do a C-section to get Baby B out.  And if you need to do a C-section, you pretty much need to apply some form of pain relief, unless you're trying to reenact a torture scene from a Mel Gibson movie.  So our approach to anesthesia was now no longer just a question of Ginger's tolerance for pain; it also included a component of risk-tolerance for Baby B.  Were we willing to bet that Baby B would stay upside-down after A was delivered?  I'm not a betting man, but that was a hell of a question to ask me to decide under duress.

The day nurse suggested that it might be possible to "run the epidural" and just decide whether to use it later, on an "as-needed" basis only.  Okay, I can live with that.  Send in the anesthesiologist!

So why didn't you want the Pitocin?

This is a tough question to answer, because the truthful answer will sound superficially like we're super-crunchy hippies who hate modern medicine.  But the reality is that Ginger and I are both proponents of natural childbirth techniques.

We're not Luddites when it comes to other forms of medicine.  We have embraced and will continue to employ a number of medicines and procedures that were unknown to the ancients -- things like Tylenol, blood transfusions and vasectomies.  But we have become convinced that some of the things that are standard for the American Way of Birth tend to cause more complications and extend the recovery period.  For one thing, we're absolutely certain that the actual experience of pain during labor is a trigger for a number of postpartum responses, and is integral to the process of birth.  That's why we (and I use the term "we" very loosely here) used no drugs in our prior two births.

So why care about Pitocin, which is not an analgesic?  Pitocin is the trade name for a synthetic form of oxytocin, a hormone and neurotransmitter that triggers a cascade of organic changes relating to birth.  The key word here is "synthetic."  It substitutes for the oxytocin that your body produces naturally.  And it's administered in order to start a process that your body opposes.  I suppose all medicines ultimately do that at some level, but Pitocin is like a guy pushing your car to get it jump-started -- all well and good, if your body knows how to put the car into gear and let out the clutch, but useless if it doesn't, or won't.  Almost all of our stories of poor birth experiences involved Pitocin at some point in the process.

Ginger was close to devastated, but it was hard to argue -- we'd spent the last 24 hours trying to stop labor by administering medication, and now we were asking her body to do a complete 180 turn.  If any circumstances called for induced labor, it would be these, because if the perinatologist was serious about the need to deliver today, the alternative might be a C-section.

Our day shift nurse, Pat, assured us it would be okay.  And chances are, it would, but it wouldn't be the birth experience we'd had with Patrick and Charlie.  Then again, looking around, nothing about this was.  Nevertheless, Pitocin was something to grieve.  Pat left the room with a parting shot I won't soon forget:  "Pitocin gets blamed for everything, because it's always at the scene of the crime."  Yeah, but you know what else is always at the scene of the crime?  The guy who dunnit.

This is getting boring. Can I skip to the end?

You're telling me.  Imagine living it in real time.  But okay, suit yourself.  I'm going to write some present-day posts to answer to FAQs, and I'll work on filling in the rest of the narrative for you history buffs later.

So now it was just a waiting game, right?

Not quite.  After a morning of watching the contractions level off and actually subside a bit -- better than on the magnesium sulfate! -- the perinatologist returned at noon.  The blood labs had come back.  Some bad news: Ginger's kidneys and liver were sub-par and continued pregnancy was getting downright dangerous for her.  Oh, and a chest X-ray showed that she had a significant amount of fluid in her lungs.  The doctor's orders were now to deliver these babies today by hook or by crook.  He ordered the nifedipine to be stopped.  Great -- we're letting natural labor progress, right?  Wrong.  The doctor ordered Pitocin to induce labor.  Drat -- this was the development that Ginger and I dreaded most.

Did things get better in the morning?

Yes, in a way.  Our perinatologist appeared in the morning, and announced that even though it wasn't yet the magic time of 10 a.m., we were out of the woods for the effectiveness of the betamethasone, so delivery today would be far from tragic.  So we could give birth today with relative confidence, although it still meant time in the NICU.  He pulled Ginger off of the magnesium sulfate because the side effects were now worse than the outcome it was designed to forestall.

However, the cervix hadn't further dilated beyond yesterday's top measurement of 5 cm.  This gave the perinatologist hope that he could switch back to the nifedipine and still control the labor.  The babies would be allowed to "cook" a little bit more, and we could be in for a few more days of bedrest in low-grade labor.  Not fun, but at this point the perinatologist has won our complete confidence.  So we settle in for a long day of watching the monitors to see if the contractions, which were still very tolerable, would subside on the nifedipine or worsen.  Either way, we were okay with the outcome.