Friday, October 30, 2009

Our Sweet Lion

We've finally come up with appropriate nicknames for our trio as we won't be posting names here.

Baby A is our little Seal- he smiles in his sleep all the time, makes little barking sounds when he is rooting around for food and his sister thought the seal sticker was the perfect one for his isolette.

Baby B has some seriously spiky hair, quite like a lion. So he will be The Lion, one of the twins. His nickname suits him even more with what he has gone through over the last two days.

Baby C is an amazing eater. He sucks breast milk down through his bottle and nurses like a professional. He can almost take a full feeding (36 cc's, or about an ounce) at the breast. For his isolette sign, we picked the Elephant.

Now I understand why having your babies in the NICU can be called a "Roller Coaster". I can easily say that yesterday was one of the worst and also one of the best days of my life.

But I am getting ahead of myself. Let me begin at the beginning ...

Yesterday morning, on the boys' sixth day in the world, my mom and I came in for the morning feedings. When we arrived the nurse told us that all three of the babies would have their phototherapy lights off as their billirubin levels had normalized. This means they could be held much more again and got to take off the masks they so loathed. Great news! Also, since the twins were taking their maximum feeds, their IV's could be removed. Another step closer to coming home. (Elephant is just a day behind on feeds and had his IV removed last night.) I felt like a child on Christmas morning! So many wonderful things happening.

After I nursed the Seal, we removed his IV and put him into his isolette for a nap. I was excited to nurse Lion as he'd been too sleepy at 8 pm the night before and I had not held him. T, our amazing nurse, and I went to our Lion so I could help her change him and she mentioned he'd had a hard night, fussy and seemed to be hungry, but after he was fed, he was fussier. They were watching him closely and he seemed peaceful when we arrived. As soon as we opened his diaper, we saw blood. T immediately called the neonatologist who ran into our room. I looked at her and said, "Is it NEC?" She said, "It could be. We need to run some tests, but bloody stools are never a good thing." I asked if she'd ever seen this kind of stool and it was not NEC and she said, "Maybe... once." And I burst into tears, watching the room's energy change as the doctor ordered an x-ray, blood work and a discontinuation of all oral feeds. His IV was staying in, and they were going to start antibiotics.

I have read extensively about NEC or Necrotizing Enterocolitis as it can become very serious, very quickly in premature babies and multiples are at a higher risk. It is a disease that begins after babies start feeding, and the cause is not well understood. The baby often presents with fussiness, distended abdomen, vomiting or bloody stools. An x-ray is needed to diagnose the disease. It looks for air in the liver caused by pockets or areas of necrotic (dying) tissue in the bowel. It can also cause apnea episodes, drops in the heartrate and desaturation of oxygen, all of which can call for intubation. They cannot be put on CPAP as it pushes air into the body and we do not want any air in his tummy, so it would be straight to a ventilator. The babies are started on antibiotics, their feeds are discontinued for 7-10 days and a suction tube is put into their nose to pull out any stomach contents and examine it. It some cases, it can require immediate surgery which tries to cut out the infected tissue in the bowel and sometimes bring the intestines to the surface of the abdomen. Of course, surgery on a premature infant is terrifying and must be performed by specialized nurses, surgeons and anesthesiologists. Most NICU families know what NEC is and are terrified of it.

The x-ray was performed in his isolette and we waited while the doctor obtained and read the films. It was the longest 20 minutes of my life until Dr. C walked in and said, "He has NEC." I was nursing Elephant when he came in, and could not even speak. I just looked at the baby at my breast and let my tears fall onto him while he contentedly ate. Dr. C said that he felt we'd caught it early, but we do not know how NEC will progress until we have at least a few x-ray images to compare to one another.

I kept saying, "Can he survive? Will it get worse?" and he said, "I hope this is a very mild case. Stay tuned is all I can say for now. If he is going to get sicker, we will see it quickly. He will start to look different, his vitals will become unstable, and he will change his behavior. I will let you know more when I know more. I called a surgeon from another hospital who does NEC surgeries all the time, and he's coming to read the next x-ray. We may need to transfer him to Children's or another hospital. I will come back soon. I am so sorry this happened."

My mom and I were left with our babies, sobbing, with our most caring nurse, T, who filled in the blanks on any questions we had. She reassured us that the best thing he had going for him was he looked healthy, and had stable vitals. If he had not had the bloody stool, she said, no one would know he is sick. We waited and my husband arrived, who'd been dropping A off at preschool, and I had the unbelievably hard task of telling him the news. We stared at each other and he walked to Lion, telling him how strong he is, and how much we love him. The next few hours while we waited for the next x-ray were torturous. We watched Lion like hawks, staring at his monitors, and were reassured that his vitals did not crash and he did not seem to be in pain.

The surgeon, Dr. H, arrived. He is a man of maybe 70 years, who was the chief of surgery at Children's for many years. He explained what he is looking for, and that the next x-ray would tell us a lot. He said, "We do not want to see anymore air in the liver, and certainly no air in the free space of the abdomen. That would require immediate surgery as it would indicate a bowel perforation." He assured us that if he thought it was necessary, he would have him transferred but he hoped he could stay with his brothers. He promised to visit him each day and consult with our neonatologists for updates frequently.

The x-ray began while he was here and it was a digital x-ray which allowed us to read it immediately. They had to position him on his side and hold his arms over his head, which made him scream, but we had to just stand back and soothe him with our voices as best we could. After it was over and Dr. H was able to see the images, he smiled. He looked at us and said, "These look quite normal! With NEC, we usually see a rapid progression and this is very reassuring. I think we should be cautiously optimistic." He told us to call him for anything, but he did not think our son would need surgery, just antibiotics and an empty tummy for 7 days. We thanked him over and over, crying, and sat down next to our sick baby, urging him to keep healing.

The rest of the day we clung to our babies we were allowed to hold, sat next to our little fighter and sang to him, touched his face, rubbed his soft, fuzzy head. I cursed the disease that was inside his body, wishing I could take all of his discomfort away, wishing he would keep healing. We were so encouraged by the doctors' comments and examinations, but we know how NEC can be, and kept ourselves cautious. He had an x-ray scheduled for 10 pm that would provide us with a little more info.

I went home after softly begging my son to heal, to keep his fighter spirit. I needed to spend some time with our daughter who has been missing us terribly. My amazing husband has not left the hospital in two days and sleeps with our boys each night. We do not feel that we can leave them alone right now, and so one of us is always hereI came back three hours later for the 8 pm feedings and to be with Lion. He had another x-ray that evening and we wanted to talk to the neonatologist after he read it. I tracked him after 11 pm and he came in to tell us the best news we'd heard all day: his x-ray was normal and his blood work looked great! He said if we did not know he had NEC from his previous symptoms and x-ray, he would not be able to tell. He felt hopeful he would continue to improve. Tears of relief came to us, and while we knew this disease can be so sudden, he seemed to be fighting hard to heal.

This morning I came in and his first x-ray also looked "stone cold normal" according to the surgeon, Dr. H. He decided to just check in on him this weekend but he feels great about his progress! We are overjoyed! After his last x-ray this evening and blood work, Dr. C came in and said he feels Lion is "out of the woods"! Again, things can change so quickly, but his body seems to be going in the right direction. Leaving his digestive system empty while administering strong antibiotics is working to reverse the damage. Had it not been caught so quickly by the excellent nurses here, and had the doctors not responded with knowledge and care, things could be very different right now.

Now, the plan stays the same: he will be "NPO", which means nothing by mouth, so no breast milk at all for seven days from the onset of the disease (Thursday) and strong antibiotics. All of the nurses and doctors have repeatedly told us that they were thrilled he was on breast milk only; babies on formula have a much higher risk of NEC, so when his feedings do start again, we can feel good. He will start very slowly, receiving only a few CC's (1/10 of an ounce) while we see how his bowels react to the restarting of milk feedings. In the meantime, he is on IV nutrition called TPN which delivers his calories and lipids. Unfortunately, since yesterday evening, he has started to be truly hungry, rooting for a nipple when it is time to eat, needing to suck more on his paci to feel calm, and crying very hard when we hold him and cannot feed him. It is so unbelievably difficult to want to nurse him, make him feel satiated when I know that would be the worst possible thing to do. All my maternal instincts are wrong in this case, and I've taken to singing to him through his hunger. He seems to like Coldplay.

For now, we are feeling like things might be all right, but are still watching him extra vigilantly, keeping eyes on the babies' monitors and watching for signs of NEC in his brothers. So far, they both are doing extremely well, still nursing often and taking one ounce of breast milk 8 times a day. I am so happy to say I have about 80 ounces of milk in the freezer, waiting for when Lion is ready to eat again. I cannot wait to nourish him when his body is ready.

This was one of the best moments of the day:

Seal and Elephant are dressed! They seem to have shown they maintain a normal temperature quite well and are probably moving to an open crib to co-bed tomorrow. Of course, Lion will be in his isolette while he heals and has an IV, and we know we will be aching for him to join his brothers. They haven't seen each other since birth and they were in quite tight quarters for 7 1/2 months!

Please keep our Lion in your thoughts and help us urge his body to keep fighting, keep healing and that he will feel comforted.

Wednesday, October 28, 2009

Madly in Love!

Thank you so much to my husband for being the guest blogger to let everyone know that the babies have arrived! He claims that those posts had the most comments because of his superior blogging skills, but I pointed out it could've been the news he shared: our sons are here, and they are doing marvelously!

The short version of how our boys came a few days before their "scheduled" day is that I had gone to see Dr. P for my last ultrasound and was miserable. I had woken up that day in so much pain, and had not slept in a week. The contractions were harder to control at home and I just felt off. Thank goodness my husband decided to drive me to this appointment. When Dr. P saw me she said, "Something is different!" I told her how I'd been feeling, and the boys took a while to pass their BPP's so I was worried about them. She found that I was starting to have protein in my urine and sent me over to triage for an NST.

The contractions showed up right away, and I took a hefty dose of Nifedipine after Terbutaline. They slowed for about 10 minutes and picked right back up, stronger than ever. My body was in real labor that did not want to stop, and Dr. P felt there was no need to put us all through even heavier meds, monitoring and possibly an emergency C-section, so we decided that since I hadn't eaten much, she would deliver them that night. While I was "prepped" I had regular and painful contractions and was surprised to have to recall my labor breathing from our daughter's birth. We were thrilled! And terrified!

A mad dash ensued to find a way for my mom to attend the birth while our dear friend and my brother cared for our three year old daughter. My mom arrived with many bags of things I spouted off between contractions and we all prepared to meet our sons. I looked at my husband and asked if he remembered the feeling of falling completely in love when we'd met our daughter. He said, "Of course! And we get to do it again ... " I wished I had kissed our daughter before I left the house, held her tighter for a minute because I did not know it was the last time I would see her as my only child.

All the preparations were in place and I walked into the operating room, was numbed and in seconds, it seemed, Baby A was out and screaming. I heard myself say, "OH! You are here!" and cried while his brothers emerged shortly after. I watched them all be examined, and have wonderful reports shouted from the NICU nurses and Dr. C, the neonatologist. He kept saying, "They are so healthy and beautiful!" and they all hit the four pound mark. They were taken to NICU with my husband and I was wheeled to recovery with my mom, and we stopped to see our beautiful boys being checked out further. Someone told me they all got APGARs of 9/10, and needed no help breathing. I was put into my room and after a couple of hours of begging to be let up, off my IV's and meds, they let me be wheeled in to see our little men.

They were in radiant warmers, not isolettes yet, and I was able to touch each of them, smell their intoxicating baby smell and tell them how long we'd been waiting to meet them. I started getting pretty sick from the Morphine and had to go back to my room for the night. I pumped three times that night and had the nurses deliver the colostrum to the babies even though their feeds did not start until the second day. I was very proud of having something for them already. My husband stayed mainly with our sons and my mom was in and out before she went home to see our daughter, the big sister to three.

The next day they were put into their isolettes, received IV nutrition and monitored closely. No one has needed any help or interventions- no episodes of apnea or bradycardia, no need for medications or extra tests. After that they moved to feedings through their NG tubes, and the next day from the breast! They all practiced nursing while a nurse would squirt their bit of colostrum into the corner of their mouths. Now they all are able to take a bottle or nurse a bit, though we still put their feeds down their tubes to help conserve energy. Breastfeeding uses more calories and energy than bottle feeding or getting a feed through their NG tube (a tube that runs into their tummies) so we are only allowed three feeds a day at the breast right now. It is more than I had hoped for and I am thrilled to nurse them and say they are only getting breast milk. I have been pumping about every 3 hours and am producing 30+ ounces of milk a day for them. WOO HOO!

They are currently under phototherapy lights for jaundice but their levels are down already and they'll be out tomorrow. When they are under the lights, the time they spend "out" being held or nursed is strictly limited, so no extended cuddling sessions, which we hate. We cannot wait to have them be able to look around again, without their masks (protect their eyes from the lights) and able to be kangarooed for long stretches. Their IV's should come out tomorrow also since they take all their feeds orally or through their tubes. Next steps: maintain their temperatures and get into an open crib together and take all feeds orally.

We know everyone wants to hear when they'll be home. The answer: we wish we knew! They will most likely come home in about 2 weeks or so, but it could be sooner. It could be together or staggered, they might have something come up that delays them, or they could jump ahead. We just do not know, and that is the hardest part.

The recovery from the C-section is no fun at all, but I am amazed at how much better I feel each day. I was eager to get up and walking, and managed to get myself discharged early so I could be with the babies more. The nurses could never find me since I was always in the NICU anyway, so they had the doctor discharge me. The biggest hurdles are the lack of abdominal strength and just being swollen and tired. The incision does not hurt much at all.

The side effect of producing lots of breast milk for my sons is engorgement, sore nipples and general breast pain. I kind of look like Dolly Parton, with the added ability of shooting milk across a room. I am so lucky to have a good supply, but I am sort of chained to my pumps (one at home and one in the boys' room) and it is not nearly as appealing as snuggling a little baby.

My schedule is tough, but do-able and SO worth the exhaustion. I cannot wait to see them each day but miss their sister so very much when I am away. My husband and mom spend so much time with our daughter and are both very present in the boys' care. I can't stress this enough: without "Gramma", we could not do this well!

6 am: Pump and shower
7:15 am: Leave for the hospital
8 am: Nurse the boys, snuggle for a minute, help do their "cares"
9:30 am: Pump, pack up to go home
10:30 am: Hang out at home with A
12: 30 pm: Pump, eat lunch
1:15 pm: Leave for the hospital
2 pm: Nurse the boys, snuggle for a minute, help do their "cares"
3:30 pm: Pump, pack up to go home
4:30 pm: Do something with A, help at home
6:30 pm: Pump
7:15 pm: Leave for the hospital
8 pm: Nurse the boys, snuggle for a minute, help do their "cares"
9: 30 pm: Pump and go home for the night. Discuss the plan for the evening with the nurses before leaving.
11:00: Go to bed
12:30 am: Pump
3:30 am: Pump
6:00 am: Start again!

(I may need to print this so I know where I am supposed to be!)

And now ... I must go sleep a bit. I will leave you with this cutie pie picture of our little guy getting phototherapy. I cannot wait until their masks come off and we can see their gorgeous eyes again! I will try to update more frequently, and I am sure when I buy a hands-free pumping bra that I will have much more time with my lap top. I cannot wait to share about each of their personalities and the sweet things they do as well as how AMAZINGLY their big sister is doing. (She told us she'd like an isolette from Santa for her baby dolls for Christmas.) I could also write a ten page post on the range of emotions I am feeling right now, from downright euphoria to hysteria and anxiety. Ahh, the postpartum period.

Thank you for all of the congratulations and well wishes. We are so very, very blessed and we know it. Falling in love with three precious boys is just as amazing as it sounds.

Monday, October 26, 2009

Boys and Mom are doing great

This is a guest post by Carrie's husband.

Carrie asked that I give everyone a quick update until she can write a longer post about birth and the first two days. She has been amazing and spends all her time breast feeding, pumping, holding and helping care for our three beautiful sons.

The boys were born around 8:30 on Friday night. All the boys are doing great. They are all breathing room air without assistance, breast feeding and growing stronger every day. We both feel extremely blessed that are boys are healthy and doing amazingly well.

Baby A
Weight: 4 lbs 1 oz
Length: 17.3 inches
Apgar score: 9

Baby B
Weight: 4 lbs 0 oz
Length: 16.7 inches
Apgar score: 9

Baby C
Weight: 4 lbs 1 oz
Length: 17.1 inches
Apgar score: 9

Friday, October 23, 2009

Tonight is the night

This is a guest post by Carrie's husband.

I took Carrie to her final appointment this afternoon. Carrie has been having more frequent contractions for the last few days and generally not feeling well. Today, she also has a headache and the contractions continue to get more painful.

The babies looked great during the ultrasound but contractions continued. After the ultrasound, the doctor decided to send her over to Triage for NST monitoring. The contractions only got stronger throughout the day. After a few hours of monitoring and an extra dose of nifedipine, the contractions are still getting stronger. Dr P. has been checking in every few hours and decided to go ahead and schedule the delivery tonight. The babies will be born in about 2 hours. Carrie will post more tomorrow.

Thursday, October 22, 2009

Stillllllllll pregnant at 33 weeks and 4 days

87 hours and 14 minutes until my C-section. 12:15 on Monday. Are we really almost there?

A long and reflective post is working in my mind, but I have a feeling this body of mine will not allow me to post it until after the boys' birth. I could give a laundry list of the aches and pains accompanying these last few weeks, along with all the interesting things my body is doing, but mostly, I am grateful. I am so grateful to be here, and so hopeful that the boys will make it until Monday and thrive after they come into this world.

Their breathtaking movements are so encouraging, and their NST's have been wonderful. But. There is always the small chance that something could happen, and I need to hold them in my arms, hear their voices, touch their skin to know they are truly well and here to stay.

Several people have asked the excellent question of why the babies will be born at 34 weeks if I am not in labor. Why not wait until 35 or 36? GREAT QUESTION! And I have a great answer. :)

In every pregnancy, the placenta supplies oxygen and nutrients to the fetus(es) and eventually becomes less efficient at this job. Studies show that multiple babies' lungs and bodies mature faster, but their growth slows considerably after week 30-32 because the placenta(s) have done their job and cease delivering enough nutrients to the babies. In our case, we have seen the rate of growth on all of the boys slow because of both the space limitations and the placental deterioration.

Our doctor's office will NOT deliver triplets after 34-35 weeks. If the rate of growth stays good, they will go closer to 35 but not after. This book, called "Triplet Pregnancies and their Consequences" asserts that the fetal death rate for triplets is the LOWEST when they are born between weeks 35 and 35. While getting to 34 is great because of the increased lung development and eating abilities, going past 35 puts the babies at other risks, and they generally (according to my doctors, and what I've read) do better outside the womb.

In the case of our boys, their weight has gone from being in the 40th percentile to less than the 20th in two weeks. The Doppler studies which examine the quality of blood flow from the placenta into the babies' cords, bellies and hearts has become elevated- they are having to work harder to get as much nutrition. When Dr. P told me this on Tuesday, of course I asked if we should deliver NOW? Was this dangerous? She said, "No, not dangerous. It just gives us the information that they are going to be ready to come at 34, and that their placenta is aging." She said it is not a bad sign, it is just indicative of what is happening. Because their fluid, NST's and BPP's continue to be wonderful, she (and I) feel good about getting to 34 weeks, which is THREE DAYS AWAY!!

Again, this is only my understanding from our doctors and nurses, as well as the neonatologist we spoke with. I know some who have 6 pound, 36 week triplets, but it is not going to be us, and that is okay.

I seem to have "Come Monday" by Jimmy Buffet stuck in my head, once again.

"Come Monday, it'll be all right.
Come Monday, I'll be holding you tight..."

If you need to give it a listen, here you go.

Monday, October 19, 2009

33 Weeks!

Saturday night my husband and I were going to go out to dinner since the days of date nights are numbered, but around 4 pm, my uterus began to thwart our plans.

I started having contractions about every 3 minutes, and then they started to hurt. Not a lot, but enough that I didn't want to talk while I was having one. I took some Terbutaline which slowed them, but didn't stop them. Realizing this could be true labor, I called our MFM's number which automatically transfers to the answering service on the weekend. Usually. I tried it no less than 10 times and it disconnected me each time. I gave up and tried calling our hospital directly, and was also disconnected! Eventually we found a number that was not in their main network and someone transferred us to Labor and Delivery. After about 45 minutes of trying! Of course, they said to come in, but I had hoped to talk to Dr. P first.

When we arrived, they hooked me up to the monitor and only saw about 8 contractions and hour, and the babies looked wonderful! They were having good accelerations and great baseline heart rates. After the oral terb started to wear off, the contractions picked up again, this time more painful and longer. My awesome nurse checked my cervix and announced I was dilated to 2.5 cm and about 80% effaced. Not a huge deal, since I have had a child before, but we wanted to make sure it stayed that way. The nurse went off to call Dr. P and said, "Do you want to have them now? Sometimes doctors just decide your "done" and deliver." After we picked our jaws up off of the floor, we said, "We want to get to 34 weeks, and we are sure Dr. P will too."

When Dr. P came in she asked why we didn't call her and I explained the answering service didn't ANSWER! The nurse told us the entire hospital's switchboard had been down and that affected the service. Dr. P was a bit horrified and said, "Yikes! I hope it was not down too long..."

She agreed with us, of course, that she wanted to try to get to 34 weeks, and I received a shot of Terbutaline which stopped the contractions right away. They kept me overnight to make sure the contractions stayed away after the Terb wore off, which they did, and monitored the babies again in the morning. Dr. P used words I have not heard spoken by her: "gorgeous monitoring session for the babies" and "they look beautiful!" were phrases that set my mind at ease.

We left the hospital, happily, the next afternoon and I will go back tomorrow for a quickie ultrasound and NST. Then back for my LAST appointment on Friday and then three short days later, my sons will be born! There are just about seven days remaining until the big C-section. What's that? You want to know how many hours? Okay, 166 hours and two minutes. And you can figure we sleep 8 hours per day, so that is about 110 waking hours left!

So I am alternating between states of excitement, overwhelming gratitude, fear and organization. Really, you should see the closets around here. Tidy and labeled! In fact, I have been labeling everything. EVERYTHING. My daughter's toy bins, the boys' drawers, art supplies. (I am aware of the psychological implications here and that by creating order in my drawers and closets, I feel some control over the outcome of this pregnancy, but ANYWAY...)

Cases in point:

I become very annoyed when I cannot get things into a label-able category, as is often the case with my techie husband's gadgets, cords, chargers and nameless pieces of electronics. In this case I found something that fit:

Seriously, I should be a professional organizer, but I am willing to admit that I am only this good when pregnant.

Thursday, October 15, 2009

47 weeks, 12 pounds, 10 days

47 weeks is how big my fundal height measures. That is seven weeks past full-term.

12 pounds is the weight of the baby goodness in said uterus. Well, two ounces shy of it.

10 days until I get to meet my sons.

Longer post forthcoming, but I get in trouble when I do not update after visits with Dr. P.

Hoping the next ten days FLY!

Monday, October 12, 2009

32 Weeks!

Well, actually, 32 weeks and 1 day.

I am so grateful to be here and hope to make it another 13 days, 16 hours and some minutes to our scheduled C-section. 34 weeks has always been our ultimate goal and I want to get there!

Today I had a cervical measurement, and it is still around 1 centimeter, but not changing. Hard to believe a third of an inch is keeping A's head inside my body! The boys' fluid was even and plentiful and we will have our last full growth along with Dopplers on Thursday to ensure the placentas are still doing their jobs. I also had an NST which the boys aced. Baby A was asleep and we need him to be moving to show us his accelerations, so the nurse brought over something called an acoustic stimulator. It looks like a lighter or something but makes a loud buzzing sound to wake up the baby. She put it on my skin and it buzzed loudly- then I felt some swift kicks. Baby A was not happy to be awoken but we saw that his heart rate accelerated and normalized appropriately when he was moving.

Dr. P was all sunshiny again since I am past 32 weeks. We discussed how if I do go into labor, we'll still try to stop it until 34 weeks, and if my membranes rupture, I will be hospitalized but we'll still try to hold off labor. These next two weeks inside of me mean FOUR LESS WEEKS for the babies in the NICU. They are very important, so we'll keep trying to get there.

She also said I do not need to have anymore cervical measurements or fFN's, to which I replied, "No more transvaginal ultrasounds!" She laughed and said, "Not exactly. A's head is so low that a transvaginal is the only way we will be able to measure his head on Thursday for growth." So that should be interesting. I cannot wait to see how big they've grown, however we measure it! It would be a huge deal to have them around or over 4 pounds now.

Not much else to report. I still have low blood pressure and feel pretty good. I know that I will be eating my words in a week or so, but right now, although I am huge and uncomfortable, I want these boys to keep growing inside. I feel so very grateful that this pregnancy is going well for now. I know things can change so quickly, but for today, I am thrilled that we are in a safer place for our sons. I hope, hope, hope we get to bring home three healthy boys sometime soon.

I will say that the discomforts are multiplying (no pun intended). Last night, I counted six bathroom trips, almost on the hour for a while there. I cannot bend over to tie my shoes, and the days of flip flops are gone in Seattle, so I wear my cozy boots everywhere. My back really hurts, right between the shoulder blades, and my pelvis feels like someone is pushing down on it, very hard. (Oh, Wait! Three someones are!) I am sitting on the couch typing and my belly keeps getting in the way of my arms, so the laptop is elevated on pillows. The whole thing is quite a sight!

Here is the 32 week belly. I cannot believe how big it is! Can it really keep expanding? We will see...

And here is one of me and my husband whose waistline is not expanding, much to my dismay. I am happy to report I do not think I will weigh as much as him during this pregnancy.

Oh, and we are buying a minivan. We tried to resist, but as you know, it can be futile. We already have a ginormous SUV but the third row will not accommodate the rear-facing infant seats, and sliding door would be extremely handy with four little ones. That means we'll have to trade in my non-green SUV, which I love, and get a Soccer Mom Mobile. I always made fun of my friends who had them, and this is what I get. :)

I saw an awesome bumper sticker the other day on a van that said, "I may drive a minivan, but at least I still put out." I need one of these, until A starts reading and I have to explain it...

Sunday, October 11, 2009

Small Rant (About an NYT Article on Twins)

I read the New York Times online for my news most days. I think their Health articles are especially good and send them to friends often (a habit I am sure they do not enjoy always). Last night an article called "21st Century Babies: The Gift of Life, and its Price" by Stephanie Saul caught my eye. I called my husband over to my laptop and we read it voraciously, both of us indignant at the tone of the article and incredulous over the claims it makes.

The article focuses on twins. More specifically, how IVF can result in twins and how multiple pregnancies are infinitely more risky, and often result in preterm birth. While briefly acknowledging that most twins are completely healthy, there are still risks associated with prematurity. It begins with this:

"Scary. Like aliens. That is how Kerry Mastera remembers her twins, Max and Wes, in the traumatic days after they were born nine weeks early. Machines forced air into the infants’ lungs, pushing their tiny chests up and down in artificial heaves. Tubes delivered nourishment. They were so small her husband’s wedding band fit around an entire baby foot."

After I read that, all I could be was angry. I am quite sure that this woman who had gone through a fertility treatments and a difficult pregnancy did not just think her newborns looked like aliens. I would be she thought they were also the most perfect, desired and loved beings she'd ever seen. And I bet she was extremely grateful for fertility treatments allowing her to become pregnant.

It discusses the irresponsibility of Reproductive Endocrinology and how the "Fertility Doctors" transfer too many embryos to inflate their birth rates and "lure" more customers. It discusses the promising research on Single Embryo Transfers (SET) which are more successful as they are better able to grow embryos to blastocyst stage.

Another major focus is the cost to "society" of preterm infants and how insurers should not have to pay for babies' care conceived via fertility drugs or IVF. It alluded to a national health crisis caused by the cost of caring for babies in the NICU. The article allows for comments, and I read over 100t this morning. Most people wrote something along the lines of "Outrageous! Irresponsible and dangerous industry" or "Just adopt!" as though one could just run out and adopt a child, and not spend many years and many thousands of dollars trying to do just that. Many people wrote horror stories of higher- order multiples, selective reduction and severely disabled twins. A few were more level-headed, and acknowledged the risk of twins but also pointed out that people who underwent fertility treatments were also extremely cautious and well-cared for prenatal patients.

In response to some of these idiotic or ignorant comments, a woman wrote this, and I cheered:

" ... if you, personally, deem care of babies produced via fertility processes just too expensive to pay for, then heck, I guess I'll just deem the exceptoinal costs associated with treating cigarette addicts, overweight diabetics, and any manner of self-inflicted sicknesses out of bounds.

Really, how selfish to continue with your unhealthy and costly habits when you could just adopt an apple."

Go give this article a read, and leave the editors a comment letting them know what you think. Apparently, this article is first in a series and I really hope the Times has something better in store for the remainder.

Saturday, October 10, 2009

The Uncomfortable Place

Apologies for my brief absence. I am still pregnant with three busy boys, and have reached the Uncomfortable Place. My back, hips, legs are truly feeling the effects of the extra weight and the curvature of my spine while this body tries to support 11-ish pounds of baby. I am extremely grateful to be carrying these boys around, so I will gladly reside in the Uncomfortable Place for another 15 days. That is right, just 15 days (unless the boys conspire to exit the cozy womb earlier)!

I was fairly convinced that Dr. P would be admitting me to the hospital for the duration on Thursday, after Monday showed a shorter cervix and positive fFN. That cervix never fails to astound me. It grew again. Just a touch, but there is no further shortening or funneling. The babies did amazingly well on an NST (my first one ever) and had appropriate accelerations and no decelerations (in their heart rates) which is a good indicator of placental function and their handling of stress. They also rocked their BPP's! Baby B was sleeping and did not want to show off his breathing during the scan so I had to roll onto my right side to smoosh him to wake him up. After that he was annoyed enough to start breathing for us.

Dr. P said she thinks maybe the positive fFN was a result of my increased activity, and does not think I will go into labor until my C-section on the 26th of October! Which I would like to point out again is a mere 15 days or just less than 400 hours away. She said to stop worrying about being admitted: if I was in unstoppable labor now, she thinks our babies would still be quite healthy!

On Monday I will have another NST and a quick ultrasound, followed by a full-growth on Thursday to see how big our boys have grown. Then the following week, I have another NST on Monday and Dopplers on Friday. Then it is just the weekend, and the boys' birthday! Again, if they change their mind and want to come earlier, being past 32 weeks (which I am tomorrow) is a good place for triplets to be. I had a repeat dose of steroids for their lungs, one administered by my mom. Add another talent to Grammma's list of gifts: excellent intramuscular injection giver! I am not as worried as I once was about complications related to prematurity after seeing how well 32+ weekers usually do, so if they come sooner, it won't be as scary as it would've been a couple weeks ago.

I would, however, love to be sedated or heavily drugged until their arrival date. The worry I feel is also part of the Uncomfortable Place. Wemberly has been working overtime about all the "what if's" that could happen in the next 15 days. What if I make it this far with healthy boys and still, I do not get to keep them? What if I have to go through fertility treatments and a scary pregnancy again? I know this seems irrational to most of you, but after wanting something SO much for SO long, the end is quite terrifying.

I am already a parent and know I will continue to worry once they are born, but this is a different feeling entirely. I need to know they are here, they are alive and healthy before I can truly relax. I love to feel their movements and kicks and hiccups for now, but holding them, studying their noses and staring into their eyes is what we've been waiting for. To this Infertile, seeing is truly believing.

Monday, October 5, 2009

It was nice while it lasted...

Back to the couch with me. Do not pass the nursery, do not fold clothes. Bed rest is in effect again.

The boys looked fantastic today! They were all swimming in lots of fluid, wiggling around with strong heart beats and showing us their breathing. Go boys! I asked what the results of my fFN from last week were and they realized that instead of running the culture, they discarded it. Some doctors only run it if the cervical measurement is alarming, but my Dr. P always runs one per week. They repeated it today - more people seeing me without pants.

Then, the cervical ultrasound. Not. So. Good. It is measuring just about 1 cm. Still stable under pressure, though, so Dr. P was not too concerned. She told me to take it "easier" and stay off of my feet more, but that she wouldn't admit me until it was less than one centimeter this week. After 32 weeks, she would not. We made appointments for me to get steroid injections next week for the babies' lungs and scheduled my last (!) growth scan for next week.

I came home and waited for the "Your fFN was negative!" call that I usually get about 3 hours after arriving home. After not hearing from the nurses, I left them a message and had a feeling that they were not calling me back this time because it was positive and they had to Dr. P before calling me.

I hate being right all the time. Positive fFN.

You may recall that a negative fFN indicates a less than five percent chance of delivering in the next two weeks. A positive fFN is less clear. It means one is at an increased risk of delivering in the next two weeks due to cervical changes, but only 20-30% of women actually deliver in that window. I have heard doctors say they hate positive fFN's because they are compelled to be more aggressive with tocolytics like Terbutaline but the majority of women do not deliver within two weeks.

It does cause alarm when it is coupled with a shortened cervix (like mine) after several negative fFN's. Dr. P wants me to come in tomorrow to treat me with Betamethasone, a steroid which speeds fetal lung maturity. I was treated with this at 24 weeks, but it is not uncommon for docs to do it again around this time. Then I will inject myself again on Wednesday, and go back to their office on Thursday to have my cervix measured and Dopplers on the babies.

When I was talking to the nurse, she reminded me to go to L & D if my contractions are more than six per hour or are not controlled by Terbutaline and to report any leaking or change in discharge immediately. Because I am about 30 minutes from the hospital, she said just to leave for L & D and call on the way and they would page my MFM for me. Then she said, "But your cervix is okay right?" I said, "It was around 1 cm. To which she said, "Oooooooooh" in a not thrilled way.

If I had a shortening cervix, but negative a fFN, I am certain Dr. P would not admit me. That was always my argument if she threatened to admit me: "Shortening cervices are to be expected at this stage with triplets and I have a negative fFN!" - not anymore. Hopefully Thursday will show it has not changed, but if it is losing any length, into the hospital I will go and I have a feeling there will not be parole this time.

I am a little scared. I don't want to go back to the hospital, but even more than that, I don't want the babies to come too early. Hang in there boys! Mommy promises to put her feet up.

Sunday, October 4, 2009

Another great reason to be born in October

Today's Multiples and More Question of the Week about our favorite cookie recipes. Why, you ask?

It is National Cookie Month! In my previous life, before I was a bed-resting, triplet-gestating lady, I baked! My daughter and I baked something nearly every day, especially in the fall and winter. Since the fabulous Dr. P has given me a bit more freedom, I am going to try to bake some cookies with my three-year old today.

Our favorite fall cookies are Auntie H's Pumpkin Cookies. Unfortunately, the national pumpkin shortage means there is NO canned pumpkin in Seattle. Seriously. Go read this if you don't believe me. We have combed the shelves of our local stores, but it seems to be a national problem. Libby's, the supplier of 90% of our national canned pumpkin supply apparently had a bad harvest last year, but thankfully, more is on the way. When you can find yourself a can or if you feel like roasting a sugar pumpkin, make these. They are AMAZING.

Auntie H's Pumpkin Cookies

1 C sugar
1/2 C butter
1 C canned or roasted, pureed pumpkin
1 egg
1 tsp baking soda
1 tsp baking powder
1 tsp vanilla
1 tsp cinnamon
1/2 tsp salt
2 C flour

Preheat oven to 350.

1. Cream butter and sugar until light and fluffy. Add egg, vanilla and pumpkin. Mix well.

2. Meanwhile, whisk together flour, soda, powder, cinnamon and salt in a medium bowl.

3. Add in batches the dry ingredients to the wet and mix until incorporated.

4. Drop desired size amounts of dough (I use a 1/2" ice cream scoop) on Silpat-lined cookie sheets (or use parchment paper) 2 - 3 inches apart.

5. Bake at 350 for 10 - 12 minutes until cookies are firm. Cool on racks before frosting.


3 Tbsp butter
1/2 C brown sugar
1/4 C milk

Boil these ingredients for three minutes. Then whisk in powdered sugar to "icing" consistency, about 2 cups. If it gets too thick, you can add back more milk and whisk it until smooth. Frost cookies with a bit, or drizzle over in a waffle pattern when cookies are completely cool.

These are a huge favorite around here. I cannot wait until we can get a can of pumpkin, but we might just have to make our own pumpkin puree.

Happy 31 weeks to the boys! Quick ultrasound tomorrow morning. Can't wait to "see" where they are- I feel like Baby C has flipped over again since there seems to be a head in my ribs. :)

Friday, October 2, 2009

Show and Tell: She's Baaaaack.

You know who she is. Wemberly is back.

For those of you unfamiliar, Wemberly is a little white mouse in an awesome children's book written by Kevin Henkes called "Wemberly Worried." I knew the book when I was in education but was reintroduced to it by my friend at Just Another Infertile. We are both Wemberlies. What do Wemberlies do? We worry. All the time. About all sorts of things, but in this case, pregnancy. Pregnancy, miscarriages, still birth, TTTS. You name it. If it can go wrong in a pregnancy, Wemberly reminds me of it.

Today I am 30 weeks and 5 days pregnant with our three boys. 23 days away from my scheduled C-section. We are in the home stretch, on the last leg, the finish line is in sight. (Choose your sports metaphor.) And although the likelihood of TTTS is teeny tiny now, and if the babies were born today, they would most likely be just fine, I am worried. What could I possibly be worried about? I am glad you asked! Today, I am worried about sudden and unforeseeable fetal death and Tetanus (I dropped a kitchen knife on my foot yesterday). Let me explain.

After crossing the threshold of Week 30, I began to relax. I pulled tags from clothes previously untouched and unwashed. I put art up in the nursery. I let myself get excited. Then suddenly, She was back. Wemberly is back, and has taken up residence in my subconscious. She keeps reminding me that anything can happen. People lose babies at the end of pregnancy. Abruptions are more common with multiples. She seems to implore me: "YOU CANNOT STOP WORRYING YET!" And while I admit to always having been a worrier in the extreme, even as a child, it has become worse. And I have a theory about that. Infertility conjured Wemberly.

My pregnancy with my daughter was a breeze: easily conceived, carried and born. Easy as pie! Pregnancy is so EASY! What I was meant to do! Then we started trying for number two. After a few months of wacky cycles, we managed to get pregnant again. At our ten week ultrasound, we found there was no heartbeat- and no baby at all- it had been a blighted ovum. Deeply painful, but we felt many couples had one miscarriage and it was not indicative of a bigger problem. Then we got pregnant again! The next month! Meant to be. We saw our daughter's heartbeat three times before the day when I laid on the table and was told the baby was "quiet." She had Trisomy 18, we later discovered. Then on to Clomid. No luck. Then IUI's with Clomid. On IUI #2, a BFP! Beta came back at 5, however. A chemical pregnancy. Then fallopian tubes removed. IVF is our only option.

It was during this time that the cute white mouse Wemberly began to chatter in my ear. The worries began to overtake the hope. Moving through IVF was a true test in my ability to work through each worry, one at a time. Then the discovery of triplets brought many new worries to life, each with their own statistics, likelihood and outcomes stamped on my brain. For me, knowing more is better, and I have become a master of navigating clinical studies and Perinatology journals. I know the survival rates for triplets born at each week of gestation.

Since the milestone of 30 weeks passed, and the survival rates went up, I am not so worried about them being born too early. Now I am worried that something will happen before they are born. When I don't feel each baby moving, I become nervous. I can tell who is moving accurately most of the time, so I will occasionally have to wake a baby up, just to calm myself down. As soon as an ultrasound begins, I hold my breath while the sonographer searches for heart tones on everyone. I am terrified to ever hear the words, "the baby is quiet" again. I have wanted to be pregnant for so very long, and love looking at my belly, full of babies. Although I know this will be my last pregnancy unless the unthinkable happens, I want it to speed up. I want to hold my sons, and watch them breathe, and know they are HERE. They are alive and ours.

Unfortunately, the statistics on "unforeseeable and sudden fetal death" are sparse. I am aware of how extremely rare it is, but know too well, in life and in the ALI community, that it does happen. I discussed this concern yesterday with Dr. P who said, "While it does happen, the risk is low for you. We see the babies twice a week and monitor them closely." I know this should be comforting. I should be comfortable with this answer. Babies are not always born to be brought home, though. I desperately want ours to come home with us, breathing in and out, crying and giggling and making our family complete.

I cannot wait to meet this little boy and his perfect brothers. (Nose, lips and eyes, with his arm over his face.)

Yesterday, all of the boys looked wonderful. Their little hearts were a-beating and they showed us they were breathing. Babies A and B (the twins) were both 3 pounds, 6 ounces, and Baby C was 3 pounds, 8 ounces! Big for triplets and growing at a wonderful rate. All passed their BPP's with flying colors! I know I "should" stop worrying, but until these boys are nestled in our arms, I will continue to be a Wemberly.

Go see what the rest of the class is showing today at Mel's Show and Tell!