I Delivered Twins at 23 Weeks

Updated: Nov 8, 2018


If you're a mom, you know that even under the best of circumstances, having your first baby is a physical and emotional whirlwind. Now imagine the shock of learning you're pregnant with twins, and then going into labor months ahead of schedule. In our first installment of Special Deliveries, we talk to Alexa Zen, whose grueling initiation into motherhood is an extraordinary story of love, heartbreak, and resilience. She opens up about her dramatic labor and delivery, surviving nearly a year of parenting out of the NICU, losing her infant son, and raising two beautiful, healthy daughters (who share her last name!).


Gearing up for double the excitement!

Alexa, thank you for your willingness to share your incredible birth story. I used to think the idea of twins was so fun - built-in best friends! - until I actually became a mom and felt utterly overwhelmed by caring for just one baby. How did you react when you found out you were having twins? Did it alter your family plans and vision of the future?


I was shocked and scared when I found out I was pregnant with twins. I remember going to my OBGYN for my first appointment.The doctor was silent for a while after she began the ultrasound, and my heart dropped, because I assumed there was something wrong. No, nothing wrong, she just wanted to make sure she saw correctly that there were two in there! Mike (my husband) was sitting next to me as well, and he was in shock, too.


The idea of twins sounds fun, but really I don’t think people can truly understand and appreciate the severity of it until they’re staring down the barrel of the gun.

Since being pregnant with twins wasn’t something we planned for, it did alter our family plans a lot. Mike has always felt uncertain about his career in the Navy. Our objective has always been to stay in Hawaii, and since it’s rare for officers to re-tour over and over again in Hawaii, we knew that we were (and are always) pushing our luck for Mike to get stationed here again. So he made plans to get out of the Navy. To increase his odds of getting hired somewhere, and to earn extra income (since we were concerned about how we would start paying for double the child care costs from day one) he started working part time as an instructor at a local college. We were already in the process of renovating our home, and this is such a small detail, but we decided against putting a ceiling fan in the second bedroom because we were preparing for bunk beds down the road! But really, it changed everything. The idea of twins sounds fun, but really I don’t think people can truly understand and appreciate the severity of it until they’re staring down the barrel of the gun. And in a sense that’s what it felt like. There were increased odds of having a complicated pregnancy and/or delivery, and I certainly felt the physical changes of pregnancy much sooner than I think I would’ve had it been a singleton pregnancy.


A delivery before 37 weeks is considered pre-term, or premature. I've read that fetal viability for multiples is pretty high at 28 weeks, but there remains a substantial threat of life-endangering health complications. Can you talk about going into labor, how far along you were and what that process was like - both physically and emotionally?


Yes, if you have a preemie at 28 weeks, the chances of your baby being ok is very high. And from personal experience, I saw two 27 weekers in the NICU that were discharged prior to their due date. But the odds are still highly stacked against the micropreemies.


I’m so used to working toward a goal and getting good results, so I thought that if I treated myself right during the pregnancy I would have at least gotten to 32 weeks

I was 23 weeks exactly when I went into labor. I didn’t even realize I was in labor, but in the middle of the night I woke up to find that I was bleeding, and I knew that wasn’t good, so I went into the hospital to get checked. At that time I didn’t know how to identify contractions, so imagine my surprise when they hooked me up to a machine and told me I was having contractions every two minutes. It was a huge blow, physically and emotionally. Plus I’m so used to working toward a goal and getting good results, so I thought that if I treated myself right during the pregnancy I would have at least gotten to 32 weeks, which is when twin mothers often go into labor. But this was clearly out of my control, and I’ve since come to terms with that and have let go any guilt that I used to feel about that issue.


The first time Alexa got to hold baby Zoe - over a month after her delivery by emergency C-section

For most hospitals, 23 weeks is the earliest age that life is thought to be viable outside the womb. If I had gone into labor any earlier, the doctors might not have offered any care to the babies. But for us they gave us a choice: comfort care after the babies are born, until the likely time that they would pass away (could be minutes, maybe hours); or life support, to give them a chance at outgrowing their prematurity. Mike at first wanted the order to be "DNR" (do not resuscitate, therefore just provide comfort care), but eventually we switched the order to "resuscitate."


All I remember was looking over at Mike and seeing him cry the hardest tears I’ve ever seen him cry.

A flurry of chaos ensued shortly after I checked in to the hospital and they confirmed I was in preterm labor. They immediately administered lots of medication to me with the goal of stopping the labor. Pills that I took orally to “smooth out the contractions,” a steroid injection in my butt to help the babies’ lungs mature in the quickest possible time, and magnesium in an IV which has been shown to help reduce bleeding or brain injuries in the babies after they’re born. As the team was giving me this medicine, the neonatologist told me that he was going to give me a lot information about the prognosis and odds of babies born at this age, but he was going to have to talk really fast before the magnesium kicked in and started to affect me mentally. The hospital staff referred to it as being “magged out,” and that’s what happened - as soon as he said that I felt so drugged out that I couldn’t comprehend what he was telling me. Or maybe it just shows my emotional state and how shocked I was to be in labor. All I remember was looking over at Mike and seeing him cry the hardest tears I’ve ever seen him cry. And that’s why we initially put in the DNR order for the twins. He assessed the information, and I assessed his reaction to the information, which was all I needed. Later Mike told me what the neonatologist said, that both the twins were given about a 50/50 chance of surviving birth at 23 weeks. Thereafter, Zoe had (and still has) an 83% chance of developing a disability (or multiple disabilities). Oscar had a 90% chance. That disability would be unpredictable. It might be physical. It might manifest later in life as a mental or emotional disability. In all likeliness they both would be developmentally delayed (delayed milestones), but to what extent no one would know.



Twin love in the NICU

So given all that, the goal was to keep them in as long as possible. I was preparing myself for the best possible scenario, which meant living in the hospital for the next three months. At the time I was on strict bedrest, but after a day given privileges to use the bathroom (but no showers, lest I feel too relaxed and go into labor). Ultimately the labor progressed and got worse, and then I developed a fever on day 4, which meant that there was an infection, and now it was spreading to me. I was given the option of delivering them vaginally, but I elected an emergency c-section because that would provide the medical team with quick access to the babies and therefore give the twins the best chance of survival.


And the rest is history. I know you’re not asking about this, but I could write a whole book on life in the NICU. Long story short, Zoe spent five months before being discharged (only to catch a cold and be admitted again! But then thankfully returned home to us two weeks later). Oscar stayed on in the NICU for another five months. After various attempts at treatment that were unsuccessful, receiving test results back telling us he had a genetic mutation affecting his lungs, getting the call to rush to the hospital because he was dying and wouldn’t last much longer, and keeping vigil over him for 3 days while he didn’t improve or get worse, we made the decision to remove his life support.


You had to simultaneously cope with the heartbreak of losing Oscar, and on top of that maintain the energy and positivity to take care of his twin sister. How did you do it?


I don’t know. In some ways it was easier going through Oscar’s ordeal because we still had Zoe. We never asked for two babies in the first place, so I felt lucky to be walking away with one. I also felt, and still feel to this day, grateful to have had ten months with Oscar.


We never asked for two babies in the first place, so I felt lucky to be walking away with one.

But yes, it was exhausting. And I think we only were able to do it all at the expense of our marriage. Mike and I put our marriage on hold and just focused on the babies. We hardly saw each other. Keep in mind that at this point in time he had a full time job and a part-time teaching job. On top of that, one of us always had to watch Zoe, and then the other during our free time would be at the hospital with Oscar. The NICU doctors specifically told us that Zoe should only be watched by primary caregivers for a year following her discharge, because her lungs were not strong enough to be exposed to normal viruses that other babies could be exposed to, so it was truly just the two of us and a small handful of family that were watching Zoe while Mike and I shuffled between the hospital to be with Oscar.


And then after Oscar passed away, our situation with Zoe didn’t change much. At this point in time we were sending her to physical and occupational therapy, so that we could monitor her if she did show developmental delays. Plus there were a lot of sleepless nights of just missing Oscar. So back to your question . . . looking back on that point in time I think our marriage was put on hold in order to cope with everything. And that was okay with both of us. Thankfully we both made it out the other side and were still on the same team.


. . . looking back on that point in time I think our marriage was put on hold in order to cope with everything. And that was okay with both of us. Thankfully we both made it out the other side and were still on the same team.

A lot of people don't know how to react or be helpful in the face of this kind of loss. What were the most (and least) helpful things that people said and did after Oscar passed?


I always appreciated, and to this day still love that people remember Oscar and talk to me about him. Even though I tear up sometimes, it’s always a welcomed emotion. It doesn’t even have to be a big deal - just saying his name is appreciated. In fact it's always best when people reference Oscar in conversation without even pausing, because it’s normal to talk about our children, present and past. I think some people also told me they made donations to March of Dimes or other nonprofits benefiting children in his name, which I welcomed too. I guess it’s always comforting knowing that other people remember him, and that it’s not just me.


In fact it's always best when people reference Oscar in conversation without even pausing, because it’s normal to talk about our children, present and past.

How do you and your family commemorate Oscar? He was such an intimate part of your lives, but for such a fleeting period of time.


A group of my friends (which also includes one of my cousins) chipped in and gave me an 'ulu (breadfruit) tree to commemorate Oscar. In Native Hawaiian culture, the 'ulu can symbolize a family member who has passed away, because back in the day you could usually count on the bountiful fruit that it gave to continue feeding the family long after the deceased member was gone. We finally planted it in the ground on our family property with some of Oscar’s ashes (I’ve been spreading his ashes here and there, never in one place because he spent his entire life in the hospital and I couldn’t bear to keep his remains in only one place).


We also talk about Oscar openly around Zoe. She sees pictures of the two of them together. It’s my hope that as she gets older she’ll understand the difficult journey she went through, as an individual as well as in conjunction with her brother’s difficult journey.


Last year you gave birth to another beautiful, healthy girl - congratulations!! How was your experience of pregnancy and childbirth different this time around (both physically and emotionally)?


For such a normal and healthy pregnancy, I was terrified the whole time! Even though I knew that the odds were I’d have a routine, healthy pregnancy and delivery, I was still very anxious around week 23. Of course that wore off by the time I reached the third trimester, and ironically Stella was born one week late. So thankfully even though I was a nervous wreck, everything went routinely. As a bonus surprise, I don’t think that Stella looks like myself or Mike, I think she looks like Oscar. It’s heartbreaking but beautiful at the same time.


Alexa today, with daughters Zoe (Oscar's twin) and Stella

Okay, this is unrelated, but I have to bring it up because I think it's so freaking cool: yours is the only family I know whose children are taking exclusively their mom's last name! How did you and your husband come to this decision, and why do you think it's still such an incredibly rare and surprising thing to do?


You might find this surprising, but it was completely Mike’s idea and at his own suggestion! Even before we got engaged, he told me that he wanted to have kids with me, and that he planned for them to take my last name. I’ve always known that I wouldn’t take my husband’s name when I got married, so he already knew of my plans for that, but the idea for the kids to take my name was truly his own. He had several reasons for doing so. First, to this day people mispronounce his name daily, which he dislikes and didn’t want for his children. Second, he read #Freakonomics, and the book talks about people who have shorter and/or names that are easier to pronounce do better in life, so that also influenced his decision. Third, he completely supports my roots in Hawaii, and thought his kids might fare better if they had a family name that was (somewhat) recognized in Hawaii. But as you can see Mike is still his own person; he didn’t take my last name for the same reason that I didn’t take his last name--which is that we are who we are, and we don’t need to share the same last name or change the identities we’ve lived with for so long in order to have a good marriage. I really lucked out with Mike. He doesn’t have the typical male ego. It doesn’t bother him that he’s not passing his name down, and why should it?!


I’ve always known that I wouldn’t take my husband’s name when I got married, so he already knew of my plans for that, but the idea for the kids to take my name was truly his own.

In the last few years we’ve come a long way with the #MeToo movement, which is supporting women’s rights and promoting strong women. I think we’re at a time when we are challenging traditional notions and not accepting the status quo. Maybe this could trickle down as we start to see the focus shift from only using a husband’s or father’s last name to using the wife’s or mother’s last name. It might take another generation of boys and girls growing up in this new age and thinking of it as normal, but perhaps by the time Zoe’s having kids of her own it will be a non-issue!


#twins #micropreemies #NICU

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