Chapter 41: Welcome to the World, Baby A
As Amelia drug herself out of bed on a lazy Saturday morning, she heard the kids laughing and playing with the dogs in the playroom. Bronwyn's squealing, Finley's laughing, and Oliver's animal noises joined in a melody rounded out by Nala's high-pitched bark and Simba's low-pitched woof. Rambunctious and wild play with raised volumes and increased energy was allowed in the playroom. The dogs even seemed to know that they could be louder and more playful in there.
Very soon after adopting the dogs, Owen and Amelia discovered that some clear rules about the dogs were needed. The kids, especially Oliver and Bronwyn, began throwing tennis balls from the upper hallway down to the living room, howling with laughter as the dogs raced up and down the stairs. Thus, began the rule that the dogs could play fetch in the playroom, in the garage, and outside. After playing out in the rain and stomping in puddles with their canine companions one too many times, the rule about drying off the dogs and not letting them inside if they were dripping with rainwater or mud commenced. As far as Amelia was concerned, the most important rule was that under no circumstances were the dogs allowed on any furniture or beds. This rule seemed to go by the wayside when Owen was home alone and when Lynne and Amelia were away.
As she overheard the spirited play, Amelia felt as if she was ready to burst from the weight of the girls. Her skin was stretched and her ability to see her own feet had long disappeared. Her baby bump had grown to the point that she had to hold it up to support it when she stood or walked. Even the bed exercises the PT had taught her early on were becoming impossible as she attempted to maneuver with and around her gigantic belly. A part of her couldn't wait for the babies to be born. The only concept scarier than the birth of the babies, though, was imagining bringing both the babies home and learning how to manage motherhood with two infants and a total of five children. Knowing Lynne would be around to help eased Amelia's fears, yet Amelia knew she was ultimately the mom.
While her pregnancy had provided more than its fair share of scares, Amelia was relieved that the last two weeks had proven uneventful. The pregnancy was past the most terrifying weeks when, if born, the babies would have been viable but would have likely faced many challenges. With great relief to have passed the 32-week milestone, Amelia and Owen were anticipating two healthy babies. Each day that the girls remained in utero, they grew stronger and developed further.
Christmas break had passed, and it had been a wonderful time. Carolyn's visit had been a wonderful gift and the family seemed to finally find their own routines and way of life after many months together. All three kids' birthdays were just around the corner, so Lynne had offered to head up the planning and details while Amelia grew larger and wearier.
During the week, as the kids returned to school and Bronwyn returned to daycare at the hospital, Amelia was able to steal away quiet moments for herself. She tried to relish in them, knowing they would be few and far between once the girls were born. At times, though, she was lonely and missed the social aspects of working at the hospital. Once or twice a week, Patricia would coordinate with her and help her discover a hole in Owen's schedule so they could share lunch or coffee together.
On this particular morning, even though it was Saturday, Owen had decided to go to the hospital to catch up on paperwork. Since Amelia had become so physically uncomfortable, it had become harder for her to assist him with his work like she had done earlier in her pregnancy. Sneaking in under the radar on a Saturday proved productive as long as Owen was able to remain undiscovered. The second word got out that the Chief was on site, Saturday workdays became like any frenzied weekday.
Owen's goal was to only work half a day, so the couple had arranged to share lunch in the cafeteria around 1pm in an attempt to force him to step away from his desk. In the meantime, Owen was deeply buried in staff reviews and the new proposed purchase order system. Eager to see some friends and to socialize, Amelia had planned to arrive at the hospital prior to her lunch date with her husband in hiding. After waddling around the house to get ready, Amelia heaved her bursting body into the car and drove to the hospital. Owen had encouraged her to stop driving after she began to measure over 40cm; however, Annalisa and Arizona said she could continue driving as long as she could safely reach the pedals. Besides, the drive to the hospital was a short one.
The couple looked forward to spending the afternoon together as they nested further in preparation for the girls. After lunch, Owen planned to return home and finish hanging some décor in the babies' nursery. Try as she might, Amelia simply couldn't be on her feet for very long and couldn't stretch to the height where she wanted nails. She knew Owen would have multiple litters of kittens if she dared to climb even one step on a ladder to hammer in a few nails, so she was able to easily convince him to help with her interior design details. After pounding the nails, they planned to re-check her hospital bag, install the car seats in the Buick, and pick up the Baby Bjorn they had ordered at a nearby store. Diapers and wipes were already well stocked and a dresser full of pink and purple outfits that had already been washed in baby-friendly detergent awaited the girls. After the baby shower, all the other necessities had been delivered, arranged, and put away by Kepner and Robbins.
Amelia happily but slowly headed to the Main Lobby hoping to see and visit with friends and co-workers after she arrived at the hospital and parked in Owen's front row spot. Arizona and Alex had been called in to treat another mother earlier that morning and had just exited the elevators when Amelia arrived. The duo walked through the lobby and couldn't help but notice Amelia and her enormous baby bump. They approached her with wide smiles. Arizona hugged Amelia, offering, "Hey, Mama. How are you feeling today?"
"Like a bloated whale," Amelia shared as she widened her eyes, puffed out her cheeks, popped her lips together and made a silly expression.
Alex smiled, attempted to seem sympathetic, and asked, "What brings you here? Is everything ok?" As he asked, he placed his hand on her bump instinctively to assess it.
"Owen and I are having lunch in a while. I figured I'd come early and see who was around," Amelia explained as she grimaced, ignoring Alex's impromptu exam, and holding her bump from underneath.
"Are you ok?" Arizona asked curiously as she watched Amelia's face change from smiling to wincing. Alex and Arizona exchanged quick glances and Arizona dug for information, "Braxton Hicks? They're so annoying at this stage of the game, aren't they?"
With a tense smile, Amelia attempted to portray an air of confidence and comfort as she blinked multiple times and breathed deeply. She shared with a perplexed expression, "I haven't had any pain at all today until just now. It wasn't a contraction, though, just a fleeting but intense twisting sensation."
"Hey, why don't we find a place to sit down?" Alex suggested as he put his arm around Amelia's shoulders and guided her to a chair about 8 feet away. "I've been on my feet all freakin' morning and you've been rushing around getting here. We both need a break."
Arizona narrowed her eyes and observed Amelia's peculiar gait and sat down next to her. Again, Amelia placed her hand on the lower portion of her baby bump and took in a deep breath. She glanced over at Arizona, moving her eyebrows in toward each other. Her eyes expressed concern and questioning. Putting her hand on Amelia's knee, Arizona insisted, "Let's go check you out in L&D."
Amelia smiled widely but unconvincingly, "No, no. I'm just a little uncomfortable. Madeline is quite the picky eater already. She must not appreciate today's breakfast."
Alex reached over and placed his hand on Amelia's bump, noting that Madeline's side was incredibly firm. "Amelia, you don't have a choice. You're having a contraction; I can feel it." He grasped her hand and placed it where he had felt the hard tightness.
Amelia closed her eyes as she took in a large breath and slowly exhaled, softly whimpering, "It's too early. It's too early."
Alex found a wheelchair and brought it over to Amelia, who attempted to insist on walking. Both doctors fully denied her request, so Amelia reluctantly sat in the wheelchair. Between contractions when she was temporarily not in pain, Amelia pointed out, "This is the kind of action that starts rumors, you know. I'm just fine, you two. You're over-reacting." Just seconds after her snarky comment, Amelia moaned out loud, looked right at Arizona with fear in her eyes, and sputtered out the words, "Page Owen. Please. Now." Arizona ran ahead to Labor and Delivery to page Owen and arrange a room. Alex reassured Amelia that she had nothing to worry about.
Owen was wringing his hands and waiting at Labor and Delivery when Alex reached the unit and wheeled Amelia toward a room. He spotted Amelia's obvious pain as she held her baby bump, winced and closed her eyes tightly. "What's going on, Karev?" Owen inquired calmly as he knelt down both to comfort and to medically assess his wife. He ran his hand over Amelia's cheek and head, leaned into her and pulled her to his chest.
Amelia grasped his body and squeezed his back, whimpering again, "It's too early, Owen. It's too early."
"We ran into her in the lobby and she started contracting. We're going to hook her up to some monitors, get an ultrasound, and see what's up," Alex explained trying to sound more casual than he felt.
Arizona entered the hallway and called Alex over to the room she had procured for Amelia. Owen entered the room first. As Alex pushed Amelia in the wheelchair, Arizona informed Alex under her breath, "I'm grabbing some mag sulfate. Monitor her contractions first then hook everything else up. I'll send a nurse in here with terbutaline and Procardia STAT." Alex nodded, knowing Arizona's instructions meant she was concerned Amelia was in labor.
Owen and Alex assisted Amelia onto the bed and Owen covered her legs with the sheet and blanket. "Are you warm enough?" he asked lovingly.
Amelia, her eyes remaining closed as she tried to focus through the pain, uttered, "I don't know, O. I'm hurting." She was sitting up in the bed and Owen reached over and brought her into his chest. He reached out his free hand and urged, "Squeeze it if it helps." Eagerly, Amelia grabbed his hand and nearly crushed it with a contraction-level grip. Alex, who had just completed hooking up the monitors, looked up at Owen and grinned as Owen turned his head to the side and bit his bottom lip.
Walking in quickly but calmly, Arizona proceeded directly to the monitors and determined that Amelia's pain was no pulled muscle. Her contractions, while erratic and varying in intensity, were underway. Arizona grabbed Amelia's chin and instructed, "Amelia, I need you to open your eyes and look at me." Keeping her eyes tightly closed, Amelia shook her head slightly. Arizona watched the monitor detect an oncoming contraction and waited for it to pass before repeating her order, "Amelia, Look. At. Me."
Amelia looked up at Arizona with glossy eyes, "It hurts. It really hurts. I need to push. It's all pressure."
"I know," Arizona affirmed. "I'm injecting some mag sulfate right now, and Alex is going to go check on the status of the Procardia and Terbutaline pump I just requested."
Arizona turned to Alex and ordered, "Grab enough to push an initial injection of .3 mg and let it drip at a rate of 20 mcg/minute. If we don't see a result in 20 minutes, we'll push another .2 mg and increase the rate to 30 mcg/minute. Get anesthesia on standby." Alex nodded and silently noted that Arizona was wasting no time in maximizing the med doses and attempting to stop Amelia's contractions.
"I'm going to push. I have to push. She's hurting me. She feels stuck in-between my legs," Amelia groaned.
Owen softly touched one knee and coaxed Amelia to relax, "Not yet, Amelia. Deep breaths, ok? Nice, slow deep breaths." Turning to Arizona, who was examining Amelia's cervix, Owen asked, "How far?"
"4 centimeters. I can feel quite a bit of pressure on the cervix and the baby's head is right there. She's fully effaced," Arizona explained. She continued, "Amelia, I have some important decisions for you and Owen to make and we need to make them very quickly."
"Whatever," Amelia muttered as she attempted to breathe. She waved her hand in front of her as if to dismiss Arizona's words.
Owen ran a cool washcloth over Amelia's forehead and glanced at the monitor print out, "Her contractions are on top of each other, Arizona. How's the baby's heart rate?"
"The baby's perfectly fine, she's just determined to escape. Here's our challenge, Owen. We can hold off on the anti-labor meds and deliver this baby vaginally right now or we can attempt to stop labor. I'm not sure we'll be able to stop it at this point even if we try," Arizona pointed out.
Owen looked down at Amelia and stroked her hair. His assessment was that the baby was coming whether anyone tried to do otherwise or not – the magnesium sulfate was not showing any promise of slowing down the contractions. "Aims, it's looking like Madeline's on her way."
Amelia nodded with clenched teeth and groaned, "The pain isn't stopping. It's constant."
Amelia's water broke and Arizona declared, "And there's our answer. Owen – you need to gown up. Amelia, I need you to focus on your breathing," Arizona ordered as she pressed the call button. "Do you want pain meds or are you doing this drug-free, Amelia?"
Wincing, Amelia sputtered between breaths, "No narcotics, but kill this pain any other way you can. I promise to name the baby after you." Owen and Arizona exchanged quick glances and grins.
Two nurses entered the room and Arizona spouted the bullets. One nurse approached Amelia and stood across from Owen on Amelia's other side. The other prepared background items gowned up the doctors and asked about pain relief.
"Dr. Karev should have called for a possible epidural. Would you check on that? She's almost past the point," Arizona instructed the nurse who stepped out. Just as she left the room, the nurse saw the anesthesiologist walking down the hall toward her.
Looking over at the anesthesiologist as he entered the room, Arizona advised, "It's too late for an epidural now, but stand by in case we need to deliver the second twin." The anesthesiologist approached the bed, reviewed the information readily available, and insisted, "It's not too late, Robbins. I'd rather have it already in place for a possible second delivery than be scrambling if it comes to a C."
Arizona nodded and the doctor began to set up the epidural, "Amelia, I need to roll you onto your side. You know the drill – stay as perfectly still as you can." With great speed, the doctor washed her back and anesthetized the injection site. Then he instructed Amelia to sit up and bend over as best as she could while he encouraged the nurse to support Amelia's weight and help her balance. As he inserted the needle in the space between her vertebrae, he placed the needle and catheter near the spinal cord with great finesse. The epidural was underway, and he'd made it look easy.
While the anesthesiologist worked, Owen pulled Arizona aside and mumbled, "Can she have the baby vaginally after the surgery on Asha? I thought cesarean was our only option."
Arizona whispered, "Usually that is the case and would be my preference, but Amelia's now at 5 cm and her labor is moving very fast – we'll just have to keep a close eye on the surgical site using ultrasound. If it appears to be tearing or stretching too much, she may be having one baby each way today. One step at a time." She walked back over to Amelia and explained that she needed to check her cervix.
After Arizona had explained the conundrum to Owen and returned to her patient, Karev entered the room and rolled in a radiant warmer for the baby. On it was a bag with all the supplies he might need. The nurse met him at the door and gowned him up as Alex inquired, "Are we that close already?"
Arizona looked up from examining Amelia and nodded, sharing, "In the last 5 minutes, she's gone from 5 to 7." Owen, watching and listing carefully, held Amelia's hand and stroked her arm as she twisted and moaned in pain.
Within 10 minutes, the epidural was working its magic and relieving Amelia's pain. Arizona turned to her patient and advised, "Amelia, your little girl is in a big hurry to be born. I need you to lie back and rest until we're ready to deliver." Owen climbed onto the bed and sat behind her, rubbing her shoulders and back. She leaned all of her weight on him as he placed his legs tightly around her sides so he could wrap her in support. He kissed her neck and whispered encouraging and loving words in her ear. With the pain gone, Amelia welcomed the physical attention. Had Owen even begun to attempt it 15 minutes ago, she would have raged. Now, as she fell into his chest, Amelia actually dozed off with a sense of peace. Owen's embrace and touch held her as safely and securely as her dad's arms had held her when she was a little girl.
Checking Amelia's dilation again, Arizona looked up to Alex and then to Owen and said quietly, "She's at 8 ½ cm. We are really close." As everyone in the room took a moment to breathe before the delivery, Arizona softly asked Owen for confirmation on the delivery plan. There was no better time to review their options.
She, Annalisa, and Alex had reviewed the plan multiple times and had discussed it with Amelia and Owen. In the moment, however, everyone involved knew that all plans could end up set aside. Arizona summarized, "Owen, with your permission, we will attempt a delayed interval delivery which means we will attempt to stop labor after Madeline is delivered. If we are able to do so, we'll provide antibiotics to Amelia to prevent infection and we'll watch carefully for possible hemorrhage or placental abruption. We'll stand ready to deliver Asha by Caesarean if she shows any signs of distress or if Amelia is in danger; otherwise, I will perform a cervical cerclage to close the cervix."
"Right," Owen answered with confidence. "Exactly."
Arizona nodded and placed her hand on Amelia's baby bump as she reviewed the contraction print out. "Her labor has slowed but it is still progressing. Both babies appear steady. Alex, are you almost ready?"
"Ready and waiting," Alex confirmed. "Church hill's on back up for the 2nd twin. NICU standing by."
"Owen, it is likely that you and Amelia will only see the baby briefly before Alex assesses her and heads to the NICU. You know that, right?" Arizona confirmed.
"Yeah," Owen agreed with a little trepidation as the reality of what was about to happen hit him.
After resting for 20 minutes, an intense pressure woke Amelia up. She stirred and offered a groan, "Oh my. When you warned me, I'd feel pressure, you weren't joking."
Checking one last time, Arizona confirmed that Amelia was fully dilated and declared, "Here we go people. Let's have a baby. She's already crowning."
As a contraction came on, Arizona coached Amelia to push as the nurse and Owen supported her back and urged her on. She rested briefly, then pushed again, repeating the pattern multiple times. On the tenth attempt, Arizona informed Amelia, "This time, you are going to keep pushing, Amelia. This is it. Just keep pushing…there you go…good…breathe and keep pushing…that's it…you can do it. I know it's tough, I know you're tired. Keep at it. Almost done." Arizona looked at Owen and ordered, "Don't let her stop. We're there, Owen. Keep her going."
Owen held Amelia's back and applied counter-pressure to help her push. He whispered encouragement and leaned against her back. After begging her, "Keep going, Aims…you've got this," Amelia let out a moan and the room was filled with the sounds of a crying infant.
Arizona called out quickly as the nurse handed Owen the scissors, "Cord, Owen. Quickly. It's all yours." Owen cut the cord, Arizona lifted the baby onto Amelia's chest and said, "Here's your little girl!" A nurse set a few blankets on top of the baby. Amelia held the baby for less than 30 seconds before Alex apologetically swooped her away.
Alex set the baby under the warming light and wrapped her up. He made a quick assessment and immediately set up a CPAP to help her breathe. Various leads and needles were inserted then and there to monitor her. Then he inserted an umbilical catheter and declared, "First APGAR is a 6. Heartrate 98, active motion, and mostly pink. Breathing irregular and reflexes a 1. Weighs 4 pounds 1 ounce, 16 ½". Nice size for her age."
Owen had mixed feelings in the emotional moment. Tears of joy fell down his cheeks as he kissed and hugged his wife and praised her, but his head told him that a 6 was a concern. Arizona called out orders to the nurse and urged her to readjust the bed and so Amelia could lay flat. Arizona needed to move very quickly to attempt the delayed interval delivery.
As Amelia and Owen fixed their gazes on the baby and on Alex a few feet away, Arizona explained, "We're going to deliver the placenta, then give you Procardia and get the terbutaline pump moving, Amelia." Arizona turned to the nurse and ordered, "Push an initial injection of .3 mg and let it drip at a rate of 30 mcg/minute. Give me an update on contractions in 3, 5 and 8 minutes."
"Can I hold her?" Amelia begged. Alex glanced quickly and shook his head subtly at Arizona who responded by raising one eyebrow and shaking her head slowly in agreement.
Alex responded, "I'm afraid not, but I can wheel her over briefly." Alex rolled the baby, her bed and monitors over to the couple. She was swaddled tightly, already had a cannula with oxygen in place and had a head full of red hair. Alex softly asked, "Gotta camera?" He took a few pictures for them as Amelia, blown away by the wonder of motherhood, placed her hand carefully on the baby. Alex handed Owen a stethoscope. After warming it up in his hand, Owen placed it on his daughter and whispered, "Your heart sounds pretty solid there, little one." The baby gazed toward the sound of Owen's voice and caused her daddy to tear up all over again. "What was her heartrate?" Owen sought to confirm.
"Right at the border. It was at 98," Alex shared. Alex apologized as he began pushing the baby out the door, "I need to get her hooked up. I'll be with her in the NICU."
"Go with her, Owen," Amelia requested.
Owen caressed Amelia's hair and whispered, "I will. Later. I'll stay here with you until we know if your labor stops."
Amelia shook her head, "We can page you. Stay with her."
"Okay," Owen quietly agreed as he stood up, kissed Amelia and walked toward Alex and the baby. Looking at her once again, Owen shared with a grimace, "She just doesn't look like a Madeline."
Amelia smiled and inquired, "Who does she look like then?"
"I'm not sure yet, but not Madeline," Owen mused as Amelia smiled in return and shrugged.
Owen, Alex, and the baby headed toward the NICU slowly. Alex was relieved that the baby did not seem to be experiencing serious distress or issues. Once he had the baby in the NICU, he'd be able to examine her more fully. At this point, though, she seemed pretty solid for a 32 weeker.
Back in the delivery room, Arizona touched Amelia's knee softly and conveyed with a smile, "No contractions. Cervix is sealed. Amelia, everything appears to be great. I couldn't ask for a better outcome." Placing a transducer on Amelia's now smaller baby bump, Arizona observed that the surgical site was intact. "It looks like Asha is pretty thrilled to have some space to stretch. Can you feel her readjusting?" Arizona asked as she giggled at the baby's efforts to expand her tiny home.
"Not especially. That is one hell of an epidural. Can I just keep it in until Asha's born?" Amelia smirked playfully.
Grinning back, Arizona suggested, "How about you get some rest? Do you want me to send Owen back in?"
"I want him to stay with whatever-her-name's-gonna-be," Amelia winked and then closed her eyes in exhaustion.
So, Twin One has entered the word...What do you think?