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28th August 2014

You’re pregnant? Here are some of the tests and tech you might meet

London-based mother of twins Natalia Jeleva recalls the journey of her pregnancy from the first suprising ultrasound with two (!) “egg-shaped dots” to the terrifying moment when her daughter’s arm had to be broken to get her safely delivered.

As any parent will tell you, not much in life is as unpredictable as childbirth. Whether it’s the moment you see two small forms on an ultrasound screen instead of one, or you find yourself on the operating table hooked up to all sorts of drips and machines when you’d expected a serene home birthing pool experience with no medical intervention, emotions run the gamut from pure joy to sheer terror.

”The whole place felt like a laboratory with all kinds of gadgets and machines, even in the hallways.”

Nobody knows this better than London-based chiropodist Natalia Jeleva, mother of 3-month-old twins Ronit and Monika. After years of trying to give their 9-year-old son a brother or a sister, Natalia and her husband were thrilled to discover that they were expecting. But when their first ultrasound scan revealed twins, they were stunned.  “We went for a private scan at six weeks because we wanted to make sure everything was OK and the first hospital scan isn’t until about 12 weeks. When the woman asked if there were twins in the family, we were completely shocked.  For the first 24 hours, we were calling everybody and telling them the news; then I cried nonstop for the next 24 hours, wondering how I was going to manage.

The ultrasound scan, also known as a sonogram, is often the moment when the reality of pregnancy truly sinks in – though painless, the procedure can be both scary and exciting. The parents will see an image of the baby(ies) for the first time and find out the due date, but they’ll also learn about possible abnormalities like heart defects or Down’s syndrome.

Most expectant mothers will get their first ultrasound at 12 weeks (photo: Dan Meineck/Flickr)

Before the scan, the mother lies on her back and some lubricating gel is put on her abdomen. Then a small device that looks similar to a TV game controller is rubbed around the abdomen and high-frequency sound is beamed into the womb. The sound is reflected back and creates a picture, which is shown on a TV screen. Natalia was blown away by the “two dark egg-shaped dots” that she could see on the screen. She was also amazed when the sonographer said that one of those “dots” was in fact a day older than the other one.

To her relief, the babies were healthy and she didn’t need to have any additional tests like amniocentesis, where a needle is used to extract a sample of the fluid that surrounds the foetus so that it can be tested for conditions including Down’s syndrome.

A CTG strapped to Natalia’s belly monitored her contractions and the babies’ heartbeats 

After the first scan, Natalia had more scans as well as the same standard tests that are offered in all pregnancies, but she had them more often because she was carrying twins. These included regular monitoring with a hand-held ultrasound device known as a “Doppler” to listen to the babies’ heartbeats, as well as blood and urine tests to screen for infections and other potential conditions like diabetes and pre-eclampsia, which can cause complications. Because she carries the hepatitis B virus, which can be passed on to the babies during delivery, she was also monitored regularly for that.

Past due

When the babies still hadn’t arrived after more than 37 weeks of the pregnancy, Natalia was admitted to the maternity ward at University College London Hospital to have labour artificially induced. Aside from the fantastic staff, the ward itself left a lasting impression. “The whole place felt like a laboratory with all kinds of gadgets and machines, even in the hallways. Even the actual room where I was admitted was like an operating theatre because women usually give birth right in their room, unless it’s a complicated birth like twins or a Caesarean. So each room is equipped with everything you can think of. There are thousands of holes and buttons on the walls around you, and there are little mobile resuscitation units with oxygen for the babies. In my case, there were two,” she says.

“Every room has a hook on the wall and they do it right in your room. You don’t have to go anywhere. I was also amazed by the fact that you can give yourself a top-up with the touch of a button.”

After nearly two days of close monitoring and efforts to intensify the labour, the sacs surrounding the babies were still intact. The midwife had to break the sac manually for the first baby using an amnihook – a long plastic device that looks like a crochet hook – to release the surrounding fluid (commonly known as breaking the waters). Because this sped up the labour, Natalia began having strong contractions and asked for an epidural, a local anaesthetic that numbs the nerves carrying the pain impulses from the birth canal to the brain. A hollow needle is inserted into the back and a thin, plastic tube is passed through the middle of the needle. The anaesthetic is then injected through the tube.

Although the epidural is nothing out of the ordinary in childbirth, Natalia was amused by the whole procedure. “Every room has a hook on the wall and they do it right in your room. You don’t have to go anywhere. I was also amazed by the fact that you can give yourself a top-up with the touch of a button.”

The babies’ heartbeats and Natalia’s contractions were continuously monitored by a CTG, which is attached to the mother by a belt around her waist. The machine prints out a graph on paper showing real-time heartbeats as well as the mother’s contractions.

The operating theatre at University College London Hospital’s Anderson Maternity Wing (Photo via UCLH)

Not long after the epidural Natalia was moved to the operating theatre, where her first baby, Ronit, “came out on her own”, without the aid of any instruments that are commonly used, like forceps (smooth metal instruments that look like large spoons or tongs and are fitted around the baby’s head to help ease it out during delivery) or a ventouse (which is also attached to the baby’s head but uses suction as a delivery aid). Once Ronit’s umbilical cord was cut and clamped, Natalia focused on having her second baby.

This is when things got complicated

“After Ronit was born, I had about 14 people around me with all kinds of monitors. There was now so much space in my womb that the second baby had turned even though I had two women pushing down hard on each side of my belly to try and hold her in place,” Natalia recalls. The baby was now facing in a bottom down (breech) position and her arm was stuck. She was showing signs of distress and they had to deliver her quickly. “They had to cut me and go inside and get her out. They had to break her arm and then as soon as she came out they had to resuscitate her in one of those tiny mobile baby units with the oxygen.” Natalia was devastated about the broken arm but the doctor reassured her that this happened quite often in twin births and that Monika would be absolutely fine.

“The whole thing took about five hours from the time I went into labour to the birth.”

Meanwhile, while she was being stitched up from the episiotomy – the cut between the vagina and anus that was needed to take Monika out – Natalia started to go into shock. “I’d lost a lot of blood. I just felt really cold and I couldn’t stop shivering. I was aware that I had a lot of drips hooked up to me and lots of machines beeping around me. Then they brought in this disposable blanket and they inserted something that looked like a vacuum cleaner into it, but instead of sucking the air, it was blowing hot air into the blanket to warm me up. I thought that was really cool! I was still quite scared but at the same time I wasn’t panicking because I felt like I was in good hands. I knew they were probably monitoring every part of my body so I felt really secure.” The recovery went well and Natalia and her girls were home two days later.

Looking back, Natalia muses about how different this birth was compared to that of her son. “Kristian was born in Bulgaria. It was very low-tech, though I did have an epidural and they had to break my waters. I think they monitored the heartbeat once during the entire labour. There was no other machinery involved. The whole thing took about five hours from the time I went into labour to the birth.”

Header photo credit: Tom & Katrien

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