Showing posts with label 28 weekers. Show all posts
Showing posts with label 28 weekers. Show all posts

Tuesday, May 15, 2012

Aeden and Noah's Story

     I found out that I was pregnant New Year's Day.  We were surprised and excited and anxious.  Of course, we had to wait several weeks before we actually got to see a doctor, so 28 days later we made our way to the doctor excited to hear our baby's heartbeat for the first time.

      At our first appointment we went in for the sonogram and it was very exciting until the technician said, ,"Oh...wait a minute..."  It got very scary for a few seconds until she identified a second heartbeat.  We were having twins.  Next the technician checked for several other things and was worried that she could not find a septum (the line between the babies indicating that they were in two separate amniotic sacs).  However, she and our doctor assured us that they would probably be able to see it at our next appointment  and scheduled a follow up for one month later.

     At our next appointment, one month later (13 weeks gestation) they were only really concerned with finding the septum.  I was amazed at how my little beans had turned into little people and looked like they were boxing each other.  When the technician excused herself to get the doctor we got worried.  It was kind of like one of those moments in movies when the doctor gets a concerned look on their face and give the parents terrible news.  The doctor came back to the room with the technician and started giving her instructions.  After a few minutes the news came..."We can not find a septum between your babies.  Let's go over to the exam room so we can talk about what this means."

      The details were scary.  Mono-amniotic/Mono-chorionic twins happen in only one in 10,000 twin pregnancies.  There was a 50-60% chance that one or both babies would be still born.  In addition, because they were split from one egg, there was a high chance that one of the babies would be born with some sort of defect ranging from heart, lung, spinal, renal, or brain defect.  It was a lot of scary stuff to hear, but there was still a chance that there was a septum and the ultrasound equipment was just not advanced enough to locate the divide.  We were referred to a perinatal specialist in Shreveport, LA (which was two hours from our home) first in hopes that their advanced equipment would find the septum, and second to give us a physician would could properly care for our very high risk pregnancy if they did not find the septum.

      The following week we made the trek to Shreveport to find out for sure what we were dealing with.  They did not find a septum.  The doctor also gave the ultrasound technician a series of directives, "check the hips, check the stomach, check the back, check the chest, etc." and then finally informed us that he was worried that they were conjoined based on the photos he had been sent.  What?!?  We had no idea that was even a concern.  Immediately following the ultrasound we met with the doctor where he gave us all the gruesome details again.  He also offered a selective termination in which they could terminate one of the babies in order to give the other a better chance of survival.  No Way!  I responded by simply saying, "no...that's actually isn't an option."  He warned us of the tough road ahead.  I would see him in Shreveport monthly, unless something more serious arose, I would see my doctor at home every two weeks.  I would go on bed rest at home at 20 weeks and begin seeing my home doctor every week.  At 24 weeks I would be admitted into the hospital for continuous monitoring and would remain there until the babies were born.

      Then the fun began.  We continued living our lives knowing that one way or the other our lives were going to change.  We both still had the stress of our jobs, preparing and taking bands to contest, in addition to the stress of the pregnancy.  Everything went along without a hitch until our appointment at 20 weeks in Shreveport when they began to check out organs.  The organs looked fine, but they did discover a single umbilical artery in twin a which could be a sign of defects that could not be detected on the ultrasound.  We would just have to wait until they were born to find out.  (This is probably the reason for Aaden's hemi-vertebrae and horseshoe kidney)

      I also began bed rest at home at 20 weeks and so instead of my days being filled with the stress of my job it was filled with the what ifs of my pregnancy.  The only thing that kept me sane was feeling them move and the security of having weekly appointments to be sure they were both okay.

      At 24 weeks I was admitted into the hospital where they monitored the boys twice a day for a few hours.  At first they were still small enough to move around quite a bit so it was very difficult to monitor them effectively so many times the monitoring sessions took quite a long time.  Things went along nicely for two weeks, then one night, right at 26 weeks, the boys began having issues.  Twin A's heart rate was dropping pretty low and staying down for too long so they began to prep me for surgery and gave me the steroid shots to speed along the boys' lung development.  For about a week I stayed hooked up to an IV while they continued to monitor the boys 24 hours a day.  I also began having contractions during this time so they gave me all sorts of drugs to try to keep them at bay.  When I was finally taken off continuous monitoring and allowed restroom privileges again (and allowed to take a real shower!) things seemed better.  I was at 27 weeks and had only 5 weeks left until they would take the boys.  Things seemed fine.  My parents came to visit and my mom was going to stay with me for a couple of weeks.  She just had to make one trip back home for a doctor's appointment and then she would be back for the long haul. Josh was busy doing drama camp in Henderson during this time so the plan was that mom would keep me entertained so that Josh wouldn't have to travel back and forth so much.  Mom left on a Sunday for her appointment (Father's day actually).  The next day I was feeling down so I called Josh to ask if he would come for the night.  He agreed without any argument and I immediately felt better.  He brought me food (it's difficult to live on hospital food) and I enjoyed that before I began an unusually late monitoring (there had been a ton of births that day so I didn't start my first monitoring until late, moving my second monitoring back later).  This turned out to be a blessing in disguise.  About 8pm Twin A went into distress and stayed that way for too long.  The next hour was one of the craziest hours of my life.  People were in and out of my room, nurses, doctors, anesthesiologists, all the while all I can think about is my baby being in distress.  I was finally wheeled (ran really) down to the operating room and within 15 minutes my babies were born and I entered the most stressful time of my life.

 Noah at 28 weeks gestation


Aeden at 28 weeks gestation


      Aaden was born with an APGAR of 0 and had to be revived. His umbilical cord was completely white and the doctors had no idea how long he had not been receiving blood. His 5 minute APGAR was a 3.  Noah was born with an APGAR 3 and his 5 minute APGAR was an 8.  Noah was only on the vent for a few hours, Aaden for a few days.  It was so difficult to see my babies hooked up to so much equipment and not be able to hold or comfort them in any way.  The first week was pretty uneventful until Sunday.  We had just left the hospital for the night and decided to go to Henderson and stay with Josh's parents.  We got a phone call from the NICU before we got there telling us to come back immediately.  We got no other info except to come back.  I have never prayed or cried as hard as I did during the 45 minute drive back to the hospital.  We called once during the trip to get the same info, keep coming.  When we arrived we ran to the NICU and the doctor met us at the door.  Aaden had been in distress.  He had fluid on his lungs and he had almost died.  He was stable, but still considered critical.  I'm still unclear as to what happened, but it had to do with his pic line.  He was returned to the vent and that was how we experienced our first thrill on the roller coaster ride of the NICU.  I still get teary when I think about it.

      Noah had a similar scare later that week, but it did not escalate to the same level that Aaden did because the nurses were much more attentive because it had happened to Aaden.  The boys continued to slowly improve.  They had good days and bad days and our days directly correlated with theirs.  The were in the NICU for three months and came home one week before their due date.  They were still on heart monitors when they came home, but they were home.  Besides some developmental delays they have been great.  They are perfect.

      This is why I march for babies.  If I can help prevent even one family from experiencing the same scary things we went through then it is worth it.  Since the boys were born, just three years ago, they have upgraded the percentage from 50-60% chance of stillbirth to 70-80% chance of survival in mono mono twins with proper care and monitoring.  March of Dimes helped with that and so I will continue to march so that one day maybe mono mono twins will no longer be a high risk pregnancy.

     I never thought I would experience something like this, but it happened to me and it could happen to anyone.  I am thankful for all the people who donated and marched before me, and I will continue to pay it forward as long as I am able.

Thursday, January 19, 2012

Why YES, twins DO run in our family!!!

April 2009
My son was 15 months old and we decided to start trying for another baby....well... I had my IUD removed in March because we were talking about getting pregnant again... I didn't realize that I would get pregnant so soon.  I found out I was pregnant in the middle of April.  My first appointment with my doctor was just a sit down appointment where she asked me questions about my medical history, etc.  During the appointment she asked about history of twins and I don't know if that is what got me thinking about twins or what, because my sisters are fraternal twins.  I kept thinking "I'm probably having twins" but then thought "that's stupid, you're not having twins" right after.  Well, at my next appointment, the doctor did an ultrasound.  I was only about 9 weeks pregnant, so she did the trans vaginal ultrasound.  The first thing she said was "Guess how many are in there..."  I couldn't believe that my suspicions were correct.  I thought, "no way, I AM having twins!"  Thinking they would be fraternal, like my sisters, b/c that is what runs in families....  The next thing the doctor said was that she didn't see a membrane so she would be sending me to an ultrasound technician to have a complete ultrasound done.  She said, "this may be a type of twin pregnancy called 'monoamniotic monochorionic' which is high risk."  I asked what that meant.  She said "we will cross that bridge IF we come to it.... don't go look it up on the Internet when you get home"  WHY DO THEY ALWAYS SAY THAT?!  OF COURSE I looked it up and thought for sure my babies were going to die they minute I saw 50% chance of survival....
May 2009
At my complete ultrasound, the ultrasound technician wouldn't give me details but he did say he saw two yolk sacs... but he also said he couldn't find a dividing membrane.  When I read more stuff on the Internet, I think on the monoamniotic.org site, it said something about if there are two yolk sacs, there will also be two amniotic sacs... so I felt relieved, I thought, for sure there must be a dividing membrane, they just aren't seeing it.  Well, no, the ultrasound tech was either wrong or it just didn't work out like that for us, because there was only one amniotic sac. The doctor told us that the ultrasound did not show a membrane and that they would need to be monitored closely and that I would go inpatient at 24-26 weeks to be monitored. 
June-September 2009
In the middle of all of this, my husband decided to go back to his old job.  That meant changing insurance companies.  I got back to my insurance through my work and had to change doctors.  I knew what doctor I wanted to go to, he was a perinatologist who was highly recommended.  Of course the people at his office didn't know what momo twins were b/c they are so rare.  I called to make an appointment and explained the situation to the office workers.  They said "twins, no big deal"  basically.  When I finally had my appointment with him, the nurse practitioner came in instead of the doctor.  She did my appointment and when I brought up the plan about going inpatient and weekly ultrasounds and everything, she looked like she had no idea what I was talking about.  She said "no, we don't need to do all that... it's just twins...."  I said "No, it is monoamniotic twins, they are in the same sac and they can get asphyxiated by their cords." She then decided to go ask the doctor, probably thinking I was some over worrying pregnant mom.  But when she came back, she must have realized that she didn't know everything.  She said "Oh, yes, I spoke with the doctor and you are right."  Finally, I met the doctor.  He was great, he had just delivered another set of monoamniotic twins a few months before (apparently they were not actually his patient, but he was on call when she delivered)  He actually knew what monoamniotic twins were and that they were very rare and needed monitoring and early delivery.  I went inpatient on September 19, 2009, thinking I would be inpatient for up to 6 weeks, not knowing I would deliver my babies in just 8 days. 
September 27, 2009
My mom and my sisters were taking my nieces and nephews to Disneyland to celebrate their birthdays (my mom's bday and nephew's bday)  The night before I thought "these twins are going to want to come tomorrow..." just b/c everyone was actually doing something and I wouldn't have visitors to the hospital that day.  And, of course, during my morning NST, baby A started to have decelerations.  She would recover but then her heart rate would go back down again.  My nurse said "your doctor just called... he said don't eat breakfast, he's going to come in..." I burst into tears, I knew it was time, and I knew it was still too early.  The girls were 28 weeks and 1 day gestation.  I called my mom and my husband.  They were planning on meeting my mom and sisters at Disneyland.  My sister-in-law had already left to take my son to Disneyland, so my husband was able to come to the hospital without him.  Everyone came to meet me at the hospital and that is when my doctor showed up too.  He had been watching my NST from his computer at home.  He saw the decelerations and called the nurse, that is how cool my doctor was!  So I was prepped for C-section and my babies were born at 12:00 noon (both of them had the same time on their birth certificates, they were seconds apart).  Their cords were knotted together twice and were wrapped around Baby A's neck twice.  Both of my daughters were intubated after birth b/c they were having apnea.  
NICU experience
28 weeks is a pretty good time, the chances of survival go up to about 80%.  I felt pretty helpless though, all I could do for my babies at this point was pump my milk!  Baby A was the one having decelerations.  On the first day, I was more worried about her.  Day 1 was the honeymoon phase...  On day 2, Baby B started to have problems.  She first developed a pneumothorax.  They had to put in a chest tube.  Then a few hours later, her other lung also developed a pneumothorax and she needed another chest tube.  Her oxygen saturations continued to drop and she needed to be put on the oscillator ventilator and nitric oxide.  She developed pulmonary hypertension and pulmonary interstitial emphysema.  The doctor said her lungs looked really bad for a two day old preemie.  After the nitric oxide was started, she did start to improve.  After a few days she was switched back to the conventional ventilator and then extubated to room air!  But then she had to have a PDA ligation because her kidney function was not good enough to give her indocin for her PDA (like her sister got).  (Even since then, there have been studies that Indocin and neoprofin for PDA closures are causing Necrotizing enterocolitis so that is not always the treatment of choice today).  Both of the girls were off and on Bubble CPAP for weeks.  Then it was just working on feeds.  There were a few scares that they weren't tolerating their feeds, they got worked up for sepsis a couple times.  The NICU experience is kind of a blur now....even though I am now a NICU nurse, I forget a lot of their experience until something similar happens in my job.  
December 2009
After 11 weeks in the NICU, my daughters came home about a week before their actual due date.  We were very lucky that there were no major issues (aside from Baby B's first few days of life)  Baby B has some lung issues and paralyzed left vocal cord from the PDA ligation.  She sounds raspy and can make a good "wookie" sound when she is whining.    They are crazy, wild 2 1/4 year olds now!