"Shit," Theresa hissed.
"You okay," Allison asked.
"Just really bad Braxton hicks," Theresa said, "it's never been this bad even with Aliyana I don't remember ever getting them this bad."
"Mine got worse with each baby," Allison said, "should you continue or do you want to scrub out? I've got this. It's just a tendon release now the hard part is done. I can do the tendon and close."
"I can do it," Theresa said.
"Your 34 weeks," Allison clarified.
"On Friday tomorrow is my last day," Theresa replied.
"I'll cover your post ops and you can call it," Allison suggested, " you're done. The chief is our brother-in-law. He'll okay it. Josh used to get mad about how close to her due dates Annie would work. "
"I'm fine," Theresa said, steadying herself with a deep breath.
"Page Leo Altman-Hunt," Allison commanded.
"Allison," Theresa gasped.
"You're not fine," Allison said, "scrub out and get checked. I recognize early labour. I've been there three times but actually didn't know it and confused it with Braxton hicks for about 12 hours with Ev. Ava went into labour at our house. I coached Ellie through it because I had taken my kids to Annie's to say hi and she wasn't sure what was going on. I'm not 100% sure but I've noticed you tense at regular intervals and Braxton hicks are irregular. At least scrub out and go up to OB to get checked. If it is you're here and ready to go and you phone my parents to bring your stuff."
"I'm not packed," Theresa said, "I haven't gone and gotten all the postpartum stuff."
"Can you trust me to do that and pack you," Allison asked.
"I know what I liked 17 years ago," Theresa said, "but we have time."
"No you don't," Allison replied.
"Let's just do the surgery," Theresa said, she knew Allison was right but was trying to deny it.
"When we're done you're getting checked," Allison declared, "that's my nieces or nephews."
"The suspense is just killing all of you," Theresa tried to tease.
"It's that you two know," Allison grumbelled, "you're choosing not to tell us."
"We don't want people to know," Theresa argued, "we don't want everything super gendered and we still think we might have another in a few years."
" okay," Allison agreed, "Carly has had a lot of boy stuff from Andy. We had clothes and some favorite items from Ev but it was out dated. Onesies were the only thing that still worked."
"Ev had adaptive stuff when she was younger," Theresa guessed.
"More her shoes than anything," Allison said, "we were just picky about her bottoms and having a good barrier for her legs."
"Her funky knee socks," Theresa laughed.
"That's all her," Allison smiled, "but she's finding her style with it."
"And they're in style again," Theresa said.
"I like it the knee socks and skirts or skirts for her," Allison agreed, "but she likes to hide them. When she's feeling good and uses her AFOs she's more confident but her KAFOs she hides."
"Can she do it all herself now," Theresa asked.
"Usually," Allison replied, "on a bad pain day or a day with lots of spasticity she needs help. Her spasticity cycles."
"Influenced by her cycle," Theresa questioned.
"Yeah," Allison acknowledged, "combine that with PMS and she's so much fun. I want to discuss an implant to keep hormone levels constant and help her spasticity but Ash thinks she's too young."
"15," Theresa confirmed.
"Yeah," Allison replied, "I got pregnant at 17. And I'm looking at it as symptom management."
"She's old enough to decide and ask for it without you or Asher having to give permission," Theresa reminded Allison.
"I know," Allison agreed, "she can ask if she wants it. I can let her know the information and let her decide."
"How do you manage it," Theresa asked, "with twins our risks of complications is so much higher."
"Step by step," Allison replied, "what worked six months ago doesn't work today. I've been pushing for cutting edge and new techniques with procedures and PT and OT but have always been conservative with medications. Medications need to be minimal she's still young. I want her to have options when she's older which means low doses and weaker meds now. If there is something you both have so much knowledge and experience. We started this blind, we relied on my parents and sister to help us figure out the medical side."
Allison got quiet as she moved into the final moments of the tendon release. This was the part that took total concentration. She could chat while she did other parts but this moment, releasing and reattaching the tendon had to be flawless. Theresa watched holding her breath as Allison completed the repair.
"I'm scrubbing out," Theresa said with a groan.
"Am I right," Allison asked.
"I don't think so but I think I need a break," Theresa said, "these braxton hicks aren't letting up. I'm going to go get some water and lay down in an on call room."
"Page Leo," Allison added.
"Fine," Theresa agreed, update me when she's in post op.
"I will," Allison agreed. She was certain her sister in law was in early labour.
When Theresa was out of ear shot Allison turned to the nurse with her phone, "text Leo Altman-Hunt for me please. Tell him to take his wife home and text Josh that they've left. Theresa needs to go home and rest."
Leo found Theresa in the attendings lounge she was bracing her self on the counter panting.
"Babe," Leo asked.
"Brutal braxton hicks," Theresa whimpered, "worse than they've ever been."
Her eyes went wide as she felt a pop and liquid trickled between her legs.
"That's not braxton hicks," Leo said seeing the liquid drip to the floor, "how long have you been in labour?"
"I've been having cramps and braxton hicks for days," Theresa said, "it just picked up this morning and won't stop."
"Lets go up to OB and call Stephanie," Leo said, taking her hand. It was too early, they were to still have four weeks until the scheduled c-section. They hadn't packed, baby clothes hadn't been washed, he hadn't put together the basinet or stroller, the car seats sat in their boxes. It was too early, the twins would be in the nicu and who knew what complications would come up.
Leo grabbed a wheel chair and pushed Theresa to the elevator.
"It'll be okay," he tried to assure her, "they'll be just fine. Micha and Chloe will be good."
"It's nicu time," Theresa said.
"It will be," Leo replied, "not for long. Just until we're sure they're breathing okay."
As much as they didn't want this they had researched and prepared for it, this was not the plan. This was not what they wanted.
Allison updated the patient's family and texted Leo, "do you want me to go get your stuff?"
Leo, "still waiting to hear but her water broke. It could be a while. Go home to your kids. Mom and dad can bring our stuff."
Stephanie Mitchell joined Leo and Theresa in the exam room, "Dr. Winquest lets do an exam and see where things are headed."
"My water broke about half an hour ago," Theresa said, "I'm only 34 weeks we wanted another month."
"I know and one of the babies was transverse a week ago," Stephanie said.
"What can we do," Leo asked.
"I want to try a vaginal delivery," Theresa said, "if it's safe."
"Looking at the monitors both babies are stable and you're not having very strong contractions yet," Stephanie replied.
"It's been like this all day," Theresa said, "I thought it was braxton hicks. Allison tried to tell me but I didn't believe it until my water broke."
"This early it can be easy to make that mistake," Stephanie assured, "I see nothing wrong with attempting a vaginal delivery with a full team as long as both babies are head down."
"If they're all stable," Leo agreed.
Stephaine grabbed the portable ultrasound and checked the positioning of both babies.
"We have to go to the OR," Stephanie said, "baby A who is closest to the cervix is transverse and blocking her descent and her brothers."
Theresa nodded.
"We knew it was the more likely option," Leo said, squeezing Theresa's hand.
Stephanie called down to the OR floor and the nurses prepped Theresa.
Leo sent a text to let the family know.
Annie joined the group of Drs outside of the OR to be ready if needed as the pediatric cardio surgeon on call.
"Steph is the best," Annie smiled squeeing Theresa's hand, "I'll be here to help if they need me. They likley won't but I'm here to help. Or I can stay with you so Leo can follow the twins to the NICU."
"If they don't need you can you sit with me in post op," Theresa asked.
"I will," Annie promised, "or I can call mama and Allison."
"You're here and Allison and I aren't close," Theresa said.
"Mom and dad are bringing us some stuff," Leo said.
They entered the OR and Annie scrubbed while Theresa was prepared for surgery and the spinal was placed in her back.
"We're ready," Stephanie said before she started the c-section.
"Can I see them before they go to the NICU," Theresa asked.
"If they're stable you can say hi," Stephanie agreed, "Dr Altman is here to assess respiratory and cardiac functions."
Theresa nodded. Leo took a seat on the stool and took her hand.
Moments later Stephanie lifted one baby up, "here's baby B. He's a little boy."
The cord was cut and the nurse brought him to say hi to his parents.
"Hi Jacob," Theresa smiled, "hi little man."
"Hi buddy," Leo smiled stroking his sons cheek, "should we go give mommy a kiss then you'll have to go with auntie Annie to the nicu."
"Fast," the oncall neonatologist said, "I want him up to the nicu for assessment."
Leo held his son for a moment close to Theresa so she could kiss his little head before the team whisked him to the side to stabilise him to take up to the nicu.
Annie was at Stephanie's side and saw the look in her friends eyes.
"Come in baby girl," Annie whispered, she pulled her stethoscope out and listened to the babies chest, "there's a murmur."
"She's going straight up," the neonatologist said.
"Say hi then she can go," Annie overruled.
Annie took the baby to meet her parents, "what's her name?"
"Charlotte," Theresa said, "after my mom."
"Hi Charlie," Leo said looking in her eyes.
"Hi sweetpea," Theresa said.
Annie held her close to her parents, "Charlotte say hi then you and I are going to the NICU. Daddy will be up soon."
After letting both parents give Charlotte a kiss Annie rushed her to the incubator and worked with the respiratory therapist to hook her up to oxygen. Annie dictated orders as they ran to initiate testing on her tiny niece.
With Theresa stable Leo ripped off his mask and gown and made his way to the NICU leaving his scrub cap on. Leo saw both babies being looked after by the teams in the NICU. his heart dropped when he saw Annie bending over his daughter.
Annie, "Leo asked.
"I need an echo to confirm but I think it's a VSD," Annie replied, "she's premature. It could close on it's own. We watch it. Make sure she's gaining weight, breathing well and watch."
"How big are they," Leo asked.
"I haven't met Jacob yet," Annie replied, "McQueen has him. But Miss Charlotte here is 4 pounds 13 ounces and 16 inches long. Generally healthy other then the suspected VSD. she is on C-PAP to help her breathe and has been given surfactant and steroids to help her breathing. Leo I'm looking at a 99% chance here, it will take a few weeks but she will be home. Think close to their due date typically we can start sending home in the 37-38 week gestational age range."
"Annie," Leo said.
Annie hugged her baby brother, "they'll be okay. Leo it's okay. We have you. Our family will be here and support you."
Leo approached Dr. McQueen, Annie's right hand in peds cardio, "Dr. McQueen."
"Leo," Dr McQueen echoed Annie's demeanour, "Jacob is doing well. He won't need any cardio beyond some monitoring. His heart is sounding good. He has been given surfactant and steroids. I'm going to sign off and let the neonatologists take the lead. He's sturdy, 5 pounds 8 ounces, 18 inches."
"He's a lot bigger," Leo said.
"Gender," Annie said, "and growth is never perfect with twins if ones placenta had better blood supply it won't be equal and they're fraternal so genetically just like any other sibling set. Leo it will be okay."
"theresa ," Leo sked.
"Once she's stable you help her in a wheelchair and bring her up," Annie replied, "I'm authorising skin to skin and kangaroo care."
"I agree," the lead neonatologist said, "they both seem very healthy and I'm saying 99% chance of survival and I heard Dr. Altman expect to go home in the 37-39 week gestational age range. One may be discharged earlier than the other."
A couple hours later Leo pushed Theresa in a wheel chair upstairs.
"I want to feed them," Theresa said.
"Lets get you to pump and then try later," the nurse said, "we will get a lactation consultant up here to help you. Right now we have NG tubes placed for both we will put any colostrum you can pump into their NG tubes. Why don't we set you both up for some skin to skin time."
"How long will they be on the C-Pap machines," Theresa asked.
"Once their oxygen is stable we'll wean it down," the nurse replied, "maybe a couple days."
Little Charlotte was placed on Theresa's chest while Leo snuggled Jacob.
"They're perfect," Theresa smiled.
"They are," Leo agreed.