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January 2, 2019


“A Ticking Time Bomb” – The Doctor’s Perspective

Dr. Peahen Gandhi delivers a baby.

You are giving life to someone who is helpless, and it requires ALL of your attention…you just can’t have a bad day. You just can’t. – Dr. Peahen Gandhi

Dr. Peahen Gandhi and her Medical Assistant Jourdan worked together for years at Cherokee Women’s Health Specialists. Jourdan also saw Dr. Gandhi for her annual OB/GYN care, as Jourdan and her husband planned to start a family.

When Jourdan became pregnant with twins, it was Dr. Gandhi who gave her the surprise announcement and who began Jourdan’s pregnancy care. Jourdan’s perspective as a young woman with a high risk twin pregnancy is told in her video interview here.  Yet for Dr. Gandhi, from the moment she diagnosed Jourdan’s pregnancy, her friendship and working relationship with Jourdan became something much more complex –

Jourdan was now a high risk patient under Dr. Gandhi’s direct care.

Danger at 28 Weeks: “Something Was Off”

As it turned out, Jourdan’s pregnancy would not be an easy one. Early contractions at 22 weeks sent Jourdan to Northside Hospital Cherokee, where she was treated and the contractions eventually stopped. But at 28 weeks came the most dangerous moment of the pregnancy. Jourdan came in for her check-up having contractions. Medication could not stop them. And she was already dilated.

Dr. Gandhi knew that Jourdan’s tiny twin boys were not yet ready to survive outside their mother’s body. She shares the experience from a doctor’s perspective:

“Jourdan is my medical assistant. She’s seen me practice for many years now – we’ve worked together for a really long time. She knows exactly what to say to me to not worry me.

“But that morning something was off. She didn’t feel well that day. She said she was feeling some pressure – and that’s not uncommon. For our pregnant patients, we sometimes put them on the monitor to see if they’re having contractions.

“But when patients have twins, we’re a little extra careful. Because they don’t have the typical symptoms. Sometimes they may not have contractions but they could still be dilated.

“So I asked her to get an ultrasound and examine her.”

Ultrasound Shows Contractions and Growing Dilation

Dr. Gandhi describes the next moments, when it became that things were not going well. “During the ultrasound, Brenda, our ultrasonographer who’s been with us many years – twelve-plus years – said, ‘You know Dr. Gandhi, I’d like to you to come in here and take a look at this.’”

Dr. Gandhi smiles a bit. “And that’s never a very good sign when she asks me to do that.

“Looking at the ultrasound, I could tell that there was only a very thin layer between the presenting part of the baby and the cervix. This means that the cervix has either started to dilate or shorten – there is now very little distance between the bag that holds the baby and the cervix.

“I did a speculum exam and I was able to see right away that she was dilated.”

Dr. Gandhi pauses to consider her personal relationship with Jourdan. “Of course, if this is someone you know very well, you don’t want to worry them… I took the speculum out and I told her, ‘I think we’re going to send you to the hospital for some observation.’ And she looked at me, kind of worried, and I said, ‘Oh yeah, it’s probably going to be fine.’”

Balancing Clinical Objectivity with the Personal Relationship

Dr. Gandhi confides that at this point she viewed Jourdan’s pregnancy as “a ticking time bomb.” Every decision she would make for Jourdan’s care was weighed to give her and her babies the best chance of a safe and successful delivery. At 28 weeks, the contractions and dilation were life-threatening for the babies.

“In the back of my mind, I know what all this means. She’s very early, she’s only 28 weeks, she’s already 2 centimeters dilated and she is having twins – which is all  a package – it’s kind of like a ticking time bomb.

“You have to be kind of conservative because the babies are early, but you don’t really know how much time you have in order to make sure that the babies have the best chance of surviving, to do well should they be born early. And at the same time you have to make sure you’re taking the precautions needed to get her to the right facility and be around the right pediatric care.”

Dr. Gandhi called the ambulance and had Jourdan taken directly from the office to Northside Hospital, where Dr. Gandhi met her shortly afterward.

“Her whole family was there – she has a very large, loving family – and of course she’s having twins, so they’re all very excited – but NERVOUS…”

“As her physician, I have to talk to her, be objective and explain the things that can go wrong – but at the same time make her feel comfortable. And that’s very hard to do – especially when you’re dealing with babies that are not even two pounds, advising her about the risks of them being born early – you’re trying to stop her contractions and also make her feel calm.

“I did send her to Northside Atlanta, where they have a NICU that’s equipped to handle very early care like that. We will now have the ability here at Northside Cherokee to handle preemies – as early as 32 weeks.

“So we called the ambulance. I was in contact with her the whole time.”

Pre-Term Labor With Twins

Dr. Gandhi pauses a moment to talk about the clinical aspect of twin pregnancy and pre-term labor. “Pre-term labor happens in 11-12 per cent of pregnancies – and it’s scary because sometimes – many times – it’s a false alarm.

“But when it does happen, and it when it happens that early, it is so important to recognize it, and to intervene as quickly as possible. We want to give the baby – or potentially babies – enough time to get prepared so that the pediatric staff and the NICU staff have the best chances of providing great survival.”

In this instance of pre-term labor at 28 weeks, Jourdan’s contractions were eventually stopped and she was able to go home. Dr. Gandhi ordered Jourdan on strict bedrest. As her physician, she remained watchful and called Jourdan every day, knowing that her medical judgment could be the critical factor keeping Jourdan and her babies safe for the remainder of the pregnancy.

Finally Jourdan went into labor at 33 weeks. Dr. Gandhi relates that she safely delivered her twin boys by C-section. The babies were cared for in the NICU at Northside Hospital Cherokee for several weeks until they were breathing and eating on their own, and finally able to come home.

“The way technology is now,” Dr. Gandhi explains, “we have the capability of take care of these very, very premature babies in the NICU. But each moment the mom is away from the baby – because the baby is in the nursery – it’s heartbreaking. I sympathize with women who have to go through this. Not only because I’m an OB/GYN but because Jourdan is a very close friend –

“And I saw her through THAT side – not just the medical side.”

Obstetrics – Joy and Emergencies

As the interview concludes, Dr. Gandhi reflects on caring for patients in the specialty of Obstetrics. “As obstetricians, we have the JOY of delivering babies and everything is going fine, everything is normal and everybody is excited…

“But we get to see emergencies, too, and it’s so hard because you are giving life to someone who is helpless, and it requires ALL of your attention. And you have to  – well, you just can’t have a bad day. You just can’t.” Her voice is serious.

“The patients rely on you –  and the baby relies on you.”

Then Dr. Gandhi relaxes a bit and says with her characteristic smile, “Well, it was a little intense. But in the end it all worked out – Jourdan was completely stabilized. She ended up delivering at 33 weeks. And they did great – her boys, Briar and Wyatt.”

She fights through a hint of emotion and finishes with a smile. “It’s such a blessing to have someone in our own Cherokee Women’s family have a great outcome like that – and me being a part of it –

“It’s just a huge privilege.”

Read more on this story here: Premature Twins Part 1 – – A Young Mother Rides the Emotional Roller Coaster

Obstetrician delivers a baby in the hospital
Dr. Gandhi holds her Medical Assistant Jourdan’s twin boys.
November 28, 2018

mother and twin babies

“Nothing in the world can prepare you for going home without your children.”

Jourdan Adams is calm as she describes her high risk pregnancy, the birth of her tiny twin boys as “preemies,” and the long weeks they stayed in the Northside Hospital Cherokee NICU (Neo-Intensive Care Unit).  The emotional ups and downs will sound familiar to any mother who has given birth to a premature baby.

“The pregnancy was good – up until about 22 weeks. That was the first time I had to go to the hospital.”

Jourdan and her husband Tyler had been trying to get pregnant for a couple years, so when Jourdan’s home pregnancy test read positive, she went to the OB right away.  Jourdan’s choice of a doctor was simpler than it is for many women. As a medical assistant for an OB/GYN practice, Jourdan made an appointment with Dr. Peahen Gandhi, the physician with whom she had worked so closely over the past few years.

“We came in super early – and then again at 5 weeks, when we saw 2 sacs! And that was how we found out we had twins.”

She admits the twin pregnancy came as a shock. “I just remember looking at my husband and saying, ‘Oh my gosh – what are we going to DO?!’ And my husband was so good, he just said to me, ‘Babe, we’ve got this.’

“But I was thinking, ‘No, you DON’T!!! You have no CLUE what we’re in for!”

Pregnancy of Hospital Trips and Bedrest

Jourdan relates that early on in the pregnancy she had a small bleed, which – she quickly adds – is “not unusual. ” But at 22 weeks the real trouble started.  “I was feeling kind of weird at the office one day. Dr. Clay gave me an ultrasound and put me on the monitor – and they realized I was having contractions. She sent me to the hospital.”

At Northside Cherokee, Jourdan saw her high-risk specialist, who put her on fluids and sent her home, anticipating that the contractions would settle down once she was off her feet.

“But the next day I was still having contractions, regular – every 10 minutes. I went back to the hospital, and got three injections of terbutaline.”

Jourdan confesses, “Well, it was so early, I just wasn’t worried. I was thinking, ‘They’ll fix it… this is just normal, right?’ I never really felt super fearful they were coming.

“Then I was put on bedrest until 24 weeks – because that is viability. At that point I was allowed to work for three days.”

But at Jourdan’s next check-up, an ultrasound by Dr. Gandhi revealed a troubling development. “We realized my cervix was shrinking. After that, I was on bedrest for the rest of my pregnancy.”

 An Emergency Ambulance Ride to Atlanta

At Jourdan’s 27 week appointment, there was more trouble. “I was dilated, my cervix was shrinking further. They sent me to Northside Hospital Cherokee. The monitors showed I was having regular contractions – that I wasn’t feeling. They gave me more terbutaline – and then magnesium, which made me feel really sick. It was horrible.

“Dr. Gandhi came to check on me when got out of surgery. She took a look, and then she sent me straight to Atlanta [Northside Hospital Atlanta] – because she was afraid the boys were coming.”

Jourdan admits this time she was scared. “Dr. Gandhi said she was transferring me and I didn’t know she meant I needed to go by ambulance. It was terrifying. I was hooked up to all these machines – IV, catheter…We got there and I filled out all the paperwork. There I was, a at 27 weeks, looking at birthing my twins.

“But after a few hours at the hospital, I got settled and the contractions stopped. They let me go home again. And after that I was on bedrest until 31 weeks.

Waiting Alone, the Dog By Her Side

Jourdan describes the final weeks of bedrest as lonely.

“I was sitting by myself all day. I came down from my bed every morning. Tyler had to work of course – he was saving up his sick days for when we had the babies. He would help me downstairs, make my breakfast, and then he was gone the rest of the day. At lunch, my mom, or his mom, would come over to make me lunch and sit with me a while.

“I sat and I felt very hopeless. Dr. Gandhi called me every day to make sure I wasn’t going crazy. My husband was very supportive. But I felt so hopeless. I couldn’t do anything.”

Jourdan smiles when she mentions her dog. “We have a bulldog. And he sat with me every day. I made sure to put his bed right beside me, so I had him with me. He really did help me.

“My brother offered to get him and take care of him so I wouldn’t have anything to worry about – and I said ‘No – You can’t! He’s the only company I have all day long!’”

Jourdan made it to 33 weeks. And that’s when her boys decided to come.

 Early Labor – A Rush To C-Section

Jourdan recalls the morning of the day the twins were born. “I told my dad, ‘I feel weird, I just feel off.’

“I went to the High Risk Specialist, and I was feeling my contractions in the waiting room. That was the first time I’d ever felt them. Then Dr. Gandhi came in to evaluate me – I was already at 4 centimeters. Dr. Gandhi announced, ‘We’re going to do your C-section within the hour.’

“All of a sudden it seemed like I was surrounded with so many nurses. I looked over at my husband and he was getting fully scrubbed in.  I thought I had prepared myself, but it happened so fast. Our families got there really quick and they were able to say ‘hi and bye’ to me – and then I was taken back to the OR.”

Jourdan was admitted to the hospital at 7 pm. And by 9 pm her twins were born, at just 33 weeks. Briar John was 4 pounds, 10 ounces, Wyatt Graham, only 4 pounds, 5 ounces.

Jourdan describes the uncertain moments after the delivery, wondering, Would her babies be okay?

The Cry Of Her Babies

“Dr. Gandhi showed me the boys right away, and I heard them cry. I had been anticipating that moment for so long, and I was so scared, so to hear them cry, I was like, ‘Okay I can breathe. They are okay.’

“I had two separate NICU teams. They were doing a full evaluation, and that was hard to wait for them to finish to hear how the boys were. My first baby, Briar, had to be put on a C-PAP [a device providing Continuous Positive Airway Pressure] – because his lungs weren’t fully developed. It was helping him breathe. So when I first saw him, he had the tubes stuck up his nose, and around his face. He just looked horrible. And I could only see him for a second, and then they had to take him upstairs.

“And then my second baby, Wyatt, he was fine. And he was the smaller one! And I got to see him for a little bit. They laid him on my chest. – and in that moment, everything just stopped for me – nothing else mattered. I didn’t hear anything, I don’t remember Dr. Gandhi sewing me back up… none of it! I just remember him being on my chest, and we were able to sit like that for just a few minutes. And then they took him to the NICU.”

Jourdan remembers being in the recovery room for a few hours, where the Neonatologist came in to talk to her about her boys, and that Briar would be on the C-Pap for 2-3 weeks.

“Dr. Gandhi sat with me the whole time, and then they took me to my room. And I remember them telling me, ‘Normally after a C-section you can’t get up for 12 hours.’

“But I had hardly seen my babies!!! And I just said, ‘THAT’S NOT going to happen. I’m going to get up, and you get whoever you need to, because I’m getting UP!!!’ So I got up about 4 hours after my surgery and I went up to the NICU and I was able to see my boys for a little bit.”

Northside NICU, Close To Home – “A Blessing”

Jourdan sits now with her twin boys beside her, each sound asleep in a car seat. She looks bright and well-rested. No one would guess that she has recently had a dangerous pregnancy, or even that she is the mother of infant twins born just 3 months ago.

We ask her, “How did you handle the waiting period before the boys could come home?”

“I didn’t anticipate, obviously, how everything went. It was hard to see them in the NICU, especially Briar, because he was doing this whimpering thing – they said he wasn’t in pain, that he was just getting adjusted to the C-PAP.

“I stayed in the hospital as long as I could – I stayed 4 or 5 days. And then they were like, ‘You need to leave. You cannot stay here any longer – you are fine, GO HOME!’

“I was anticipating that day, having to leave them – which was the hardest thing. And I had other moms tell me, you are going to be heartbroken. And I had tried to prepare myself for it, but nothing in the world can prepare you for going home without your children.

“Luckily, we only live 5 minutes from Northside Hospital, so we were there every single day, all day long. We got there every morning and only left for lunch. The boys had feeding tubes for the first week and a half, and we wanted to hold them while they were being fed so they would associate food with Mommy and Daddy. And after that we were working on bottles.

“The NICU team was so wonderful. The boys had their own room – so it was really nice.” She laughs. “We could kind of spread out.

“It was a blessing that we were in Cherokee County. I couldn’t imagine them being in Atlanta, and having to drive THAT every day. It was exhausting to be there all day long, and still recovering from surgery. It takes an emotional toil.”

Advice for Mothers of Preemies

We ask Jourdan: Do you have any advice or words of experience you would share with mothers of premature babies?

“I would get up in the middle of the night and pump in their nursery, and I had this song I would play for myself, by Darius Rucker, “It Won’t Be Like This For Long.” And I just played that over and over, and told myself, “It won’t be like this for long. The boys will be home one day.

“And I would just picture what their lives were going to be like – us on the baseball field, or whatever they will want to do – and I just dreamt about THAT. Instead of thinking about them in the NICU and everything they were going through.

“And also I put blankets under the boys in the hospital – the nurses did this for me – and they allowed me to take those home with me so I could smell them when I was at home. It kind of gave me that comfort – that they were there with me.

“In the NICU, I was trying to be very hands-on. I was always changing diapers, giving them baths, feeding them. I wanted to do those things, like I was at home. And it made me feel like I was somewhat normal. We also had a lot of people come visit them – which helped me, too. Because I kind of felt like I was able to show them off, like it was NORMAL – because usually people come to visit them when they come home. So I really liked that I could show them off, and tell people how good they were doing, and all their improvements.”

Jourdan concludes, “It is hard, so hard – but they DO come home!”

She smiles, her healthy twin boys now right beside her.

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