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  • Writer's pictureMegan Sauer

Twin Miscarriage

I started December exhausted, but excited for Xavier's first Christmas. I was looking forward to having the first normal Christmas with my family in almost 3 years. I was overwhelmed and stressed while balancing work, taking care of the house, Xavier, and being pregnant with twins. For some context, we found out we were expecting identical twins when Xavier was around 7 months old. It was incredibly unexpected because it took 3 years to conceive Xavier so we never thought it would happen so soon for us, let alone be twins. We found out they were boys pretty early on through the NIPT blood test. There were some concerns about the level of risk with the type of twins I was having (mo/di - which means they share a placenta but have their own amniotic sacs), the biggest concern being twin to twin transfusion syndrome. This basically means that one twin gets too much blood flow and the other doesn't get enough which can be fatal for both babies if it's not caught in time. Once we knew this, I was going in for ultrasounds every 2 weeks and up until my anatomy scan, both babies were growing right on track and looked perfect.

December 22nd to December 24th my whole life was flipped upside down and was the most traumatic experience I have ever gone through. I don't know why, but I had a bad feeling going into my anatomy scan on the 22nd. There was no logical reason to why I felt that way...I just did. I knew it was supposed to be a long appointment, yet when I was laying on the ultrasound table, I was making a conscious effort not to look at the ultrasound tech's face because I somehow knew I would see some type of micro-expressions indicating something wasn't right. About 20 minutes into the appointment she told me I could go empty my bladder and she would be right back. When I returned and sat back down on the table, she told me she was going to move me over to an examination room and that my doctor was going to come speak with me. I knew at that moment they were gone.

I didn't bother asking the tech anything because I knew she couldn't say so I just silently followed her to the other room. As soon as the door shut I was overcome with anxiety, couldn't stop shaking and was crying by the time my OB came in. She didn't beat around the bush.

"Unfortunately it appears that both babies have died."

There were no answers as to why. She said the ultrasound indicated that one of the babies may have experienced heart failure and because of the shared blood vessels and placenta, the other likely passed soon after but there was no way to know for sure. She said it could have even been twin to twin transfusion syndrome but I had no idea it could happen that quickly when 2 weeks prior they were perfect. My doctor had called my husband to come get me because I had gone to the appointment on my own and I was told I would need to go to the hospital that day to be induced.

I was terrified for so many reasons. I'd never had to be in the hospital before, I had no idea what to expect, I was terrified of IVs, worried I wouldn't be home in time for Xavier's first Christmas, overwhelmed at the thought of having to tell everyone what was going on, but most of all worried about being away from Xavier. I'd never been away from him for more than a few hours.

I was also overwhelmed with guilt, wondering if there was anything I could have done. A week or so prior I was a bit concerned because I had never felt Baby A move, yet I did start feeling Baby B move a couple times. I was regretting not trusting my instincts, or asking more questions. I also felt guilty because I felt so disconnected with this pregnancy. I was overwhelmed with it happening way sooner than we expected, with the thought of having 3 under 2, stretching my bank account to get what we needed plus get everyone's Christmas gifts, just being so busy I was constantly forgetting that I was even pregnant. I was feeling guilty for having more babies so soon because Xavier wasn't going to get as much one on one time anymore and I would have to stop breastfeeding him way sooner than I wanted. I didn't give myself the opportunity to start getting excited about this pregnancy so when I found out they were gone it didn't feel completely real...because the pregnancy still didn't feel completely real. Yet I was still devastated, I still bawled my eyes out and almost had a panic attack, and at the same time I felt I didn't have the right to feel that way because I hadn't celebrated this pregnancy in the way that I know it deserved to be.

Peter picked me up and we went home first to grab some things because my doctor said it wasn't a rush. I got home and made Xavier some broccoli, waited for him to wake up so I could breastfeed him once more before leaving. Then we left.

At the hospital it was one long waiting game. Checking in took forever and involved a million questions that I had to answer between tears trying to keep it together so I was coherent. We got a private room, I got an IV put in, and then eventually a doctor came to start the induction around 5:30pm. Everything from here on out is very blurry to me because it all felt like one long day. I didn't really experience contractions in the conventional sense or what I was expecting from my labour with Xavier. It was just a constant ache that felt like mild menstrual cramps. The cramps got progressively worse over the next 12 hours but were never too painful for me to breathe through. They kept offering me pain medication but I declined. I was in and out of sleep throughout the night, being woken up periodically by a stronger cramping sensation but it felt like I was in a dream. At 5:10am I had a particularly bad one that woke me up more and at the same time I felt one of the waters burst which was a flash of pain. I yelled a bit because I didn't expect my water to break like that in this situation and immediately pressed the nurse call button. Peter woke up and 30 seconds later one of the babies came out all on his own. I was frozen with shock, was scared to move, knew for sure it was one of the babies but was afraid to look. I looked anyway and knew I was right. All I remember is gripping the side rails of the bed really hard to try and control my shaking but I was shaking uncontrollably from shock so Peter came over and held my hand. The nurse came in and Peter told me later she looked visibly shocked that one of the babies was delivered already and she called for the doctor. I had warned her earlier that my pain tolerance was weird and I wasn't going to be able to tell if I was close or not based on my pain.

The doctor came and they carefully cut the cord and took the first baby away. After he had been delivered my pain immediately went away. I didn't feel anything anymore. We were waiting for the second one to come on it's own but eventually my doctor had me push and I delivered Baby B still in his amniotic sac at 5:40am. Then was the long waiting game for the placenta to be delivered, which I expected to be the easiest part because that's how it was with Xavier but that wasn't the case.

Throughout all this, and prior, I had been asked many questions about what I wanted to happen after they were delivered. Did I want to hold them? I said yes. Did I want photos? I said yes. The biggest decision was whether to let the hospital handle the burial or if we wanted to make our own arrangements. I learned that if they were 20+ weeks then we would have been responsible for the arrangements regardless but babies born before 20 weeks, the hospital offers to take care of it. Once a year they do a special burial of the cremated remains of babies born prior to 20 weeks in a mass grave which we had the option of being notified when and where that would be taking place. I was told this usually happens in October. I was grateful that we had this option because I think it would have been too much more to handle otherwise. One more week and it would have been different for us because I miscarried at 19 weeks.

While waiting for the placenta I was asked again if I wanted to hold them. I said yes, so the nurse wrapped them up in a blanket and gently placed them in my arms. I had asked Peter prior if he wanted to hold him and he said he wasn't sure. At this time he decided he wasn't comfortable so he had stepped away to the other side of the room while I had my moment with them. They were each small enough to fit in my hand. Baby A was 125 grams and Baby B was 105 grams. I could tell that Baby B was the one that had the initial issue because he looked less developed, was more red, and was visibly smaller. The nurse took a few photos for me. It felt very surreal looking at them, it still didn't feel quite real. I was surprised that I didn't cry at this moment even though I had been crying on and off the entire time prior. I was just focused on them, taking in every little detail and I didn't want tears to blur my vision. I could see their tiny fingers and the beginnings of their noses. One of the things that had upset me the most was that we hadn't even named them yet and it's what I was thinking about for most of the night while waiting for them to be delivered. When I looked at them I knew what their names were. After I gave them back to the nurse I talked to Peter about the names. They were names that I had briefly mentioned a while back when trying to think of some but we hadn't really talked about it since then. Peter agreed on the names and it immediately felt right to me. It felt better knowing they had names and identities. The first names were just ones I liked in passing and the middle names are after their daddy and uncle who are also twins. I thought it was fitting.

Their names are Hudson Peter Sauer and Greyson Paul Sauer.

While waiting for the placenta to come out I was having episodes of sweating, hot flashes, lightheadedness, nausea, dizziness, tingly limbs, and sudden drops in my blood pressure because my cervix was trying to close but couldn't because the placenta was half out. I tried pushing but it wasn't helping and I felt too weak to do so for long. My doctor ended up pulling some of it out but wasn't sure if there was any left so ordered me an abdominal ultrasound. My blood pressure kept tanking though and I was losing a lot of blood so they sent me for an emergency D&C for suspected retained placenta.

Under normal circumstances, I would have been terrified and panicked being wheeled off to some unknown location without Peter to have a procedure I'd never had before but I was too weak to even feel scared. I felt like I was dying. They had to put another IV in before the procedure so that they could give me a blood transfusion and give me the twilight medication at the same time, but my veins were collapsed from blood loss and I was freezing. They kept trying to warm me up and had to poke my other hand several times. The anesthesiologist finally said he was going to give me something to take the edge off and the burning in my other hand when he started the medication made me completely forget the IV attempts in my other hand. Next thing I know I am waking up, the procedure is done and I am being wheeled back to my room. I don't know how long I was in there but I thankfully didn't have any additional pain from the procedure.

Eventually I finally was taken down to get my ultrasound just to check that everything was out and I learned very quickly that I was going to experience unexpected triggers, probably for a while. Usually when I would go for ultrasounds I can't see the screen until the end when the tech turns it towards me and shows me the babies. This time I could see it the whole time and I made the mistake of looking out of habit and seeing nothing there made me really upset. That somehow made it feel more real that they were gone than when I was holding them in my arms. It was also very strange because the ultrasound tech had no context as to why I was there, so I had to explain the whole situation which I feel like wasn't my job to do. The ultrasound confirmed that everything was cleared out.

Sometime in the evening I was sitting in bed and started having uncontrollable diarrhea. I pressed the nurse call button but it was a bathroom emergency and I had been feeling relatively okay so Peter helped me to the bathroom quickly. The nurse checked on me, and we thought all was fine so she left again while I cleaned myself up. When I stood up to hold onto the metal bar, I was met with an immediate rush of lightheadedness and tingly limbs but I thought I could make it back to the bed because it was only a few steps away. I started to walk out and Peter told me after that he noticed I was wobbly so he put his arms under my armpits to steady me but then I tried to brace myself on the bed table, sent my dinner tray flying across the room and then my legs gave out and I passed out in Peter's arms. It's lucky that he was already holding me because we might have had to add a head injury to the list of things I was dealing with. I woke up on the floor so confused. It felt like I was having a dream because I thought Peter and I had been at home watching Young Sheldon. Peter managed to use his foot to bring my IV cart over and somehow reached far enough to press the nurse call button while holding me so when I woke up there were already 2 nurses there. Peter said when I passed out he leaned my head back onto his shoulder and my eyes were rolling to the back of my head.

I got back into bed and was given another blood transfusion. My OB came to see me after and explained that my blood work from earlier that day had come back with my hemoglobin at 66 which was very low. The nurses hadn't been letting on how concerning things were so we had no idea, and this was after I had already had a blood transfusion so prior to that it was dangerously low which is why I was having those episodes. I was also being given several rounds of antibiotics and after my second blood transfusion I was given an iron transfusion which I will need to go back for 3 more rounds of as outpatient over the next several weeks.

By the second night I was so emotionally, mentally, and physically exhausted. I hadn't really gotten any real sleep since being there so I was delirious from exhaustion. It's impossible to sleep when you have both hands hooked up to machines, machines beeping constantly, and having a blood pressure cuff go off every 15 minutes. I was finally given an ativan to relax and I finally got some sleep. Throughout this whole process I cycled through crying spells, feeling guilty, missing Xavier and worrying that he would think we abandoned him, forgetting why I was at the hospital entirely, and covering up my true feelings with humour because it's how I cope in public spaces.

We finally got discharged on the evening of Christmas Eve and I was home in time to snuggle and nurse Xavier before bedtime. I became really upset when we were being discharged though because like I'd mentioned, previous nurses had asked me if I wanted photos (that I was told had to be done on their camera), and a memento box. I'd said yes every time I was asked and I was told when they were happening and after they were done that I would get the photos on a CD or usb stick. My nurse came and had me write down their names so she could write little cards for their memory box. Peter heard all these things too and I confirmed with him after to make sure I wasn't crazy and misremembering. But my discharge nurse had no idea what I was talking about, she couldn't check if photos were even taken and said that there was no notes about it in my chart. She also knew nothing about a memento box. It didn't help that she kept rambling and repeating herself, and one of the things she kept repeating was "if there are no photos there's nothing we can do because they are already gone, they're already gone, they're already gone." That wasn't something I needed to be reminded of over and over. So I left the hospital crying.

Christmas plans had to be cancelled and rescheduled for the third year in a row. Some of my family asked if we wanted to cancel entirely but I didn't want Xavier's first Christmas to be ruined for him despite not knowing any different. That would have broken my heart even more. I also thought that being around normal Christmas festivities and family would be a welcome distraction. I wanted to look back on happy memories of his first Christmas and not be reminded of the days that my life was falling apart. So I laughed, I opened presents, I smiled for pictures, and I hope someday I can look back on those photos and find at least some genuine joy there amongst the sadness.

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