Oh my goodness, Twins!!! (August 2015)

     I was about 20 weeks pregnant when I went to my first pregnancy appointment with my OB.  Since this was my sixth pregnancy, I felt like I knew what to expect, so didn’t feel the need to make any appointments earlier in the pregnancy.  My doctor joked with me about my being too busy to bother with appointments, since I work full time.  I complained to her about my new health insurance, which had a high deductible, so she commented that we’ll have to make sure this is a vaginal delivery (cheaper than a c-section), and I remember thinking, “Of course it will be vaginal, all of my others were...”  Then she started doing the ultrasound scan, and she turned to me and said, “There’s two”, and I responded, “You’re joking, right?”, thinking that she was teasing me.  She turned the monitor to me so I could see the two fetuses, at which point I said “But, twins don’t run in my family”.  “They’re identical; it’s not genetic, just chance” was her reply.  I was so surprised, I think I said “But it should be genetic!”  As my doctor kept scanning, her entire demeanor changed from the light, friendly attitude, to a very serious one.  She told me that she didn’t see a dividing membrane, but at that point, I really had no idea what the implications of that were.  She hurried me out of her room and called a maternal fetal specialist for me, and got me an appointment the next day for the 20 week detailed anatomy scan.

     I went to the anatomy scan blissfully unaware of the high risks of my pregnancy.  After a long appointment, during which both fetuses were scanned very carefully and were thank God found to healthy and defect-free, the doctor came in and explained in a very matter-of-fact manner that my twins were monochorionic monoamniotic, which is high risk for cord entanglement that can lead to fetal death, and if one twin dies in utero, that frequently causes brain damage to the other twin.  He told me there is no treatment or “fix”, we just monitor weekly until ~28 weeks, at which point in-patient monitoring is recommended, and that delivery is via c-section between 32-34 weeks.  I remember my head was kind of in a whirl after the appointment.  I went out to my car, called my husband, and told him the whole thing.  Then, wanting to share with someone else, but not yet ready to freak out my mother, I called my friend, who happens to be a nurse.  We talked, and I was feeling a little better, until I checked out a link that she had emailed to me, which quoted a 40-50% fetal mortality rate.  That’s when I remember that it really hit me, “Oh my goodness, my babies can really die in utero at any second!”  I spent the rest of the day, although I was at work, googling monoamniotic twins.  I also read a lot of case studies and articles published in medical journals, since I have access to those via my workplace.

     For the next eight weeks, I went to weekly ultrasounds, praying each time that the babies would be alive.  At 28 weeks, I checked in to the hospital for in patient fetal heart rate monitoring.  It was really weird checking in to the hospital, since I felt totally healthy, and wasn’t in labor, so it felt wrong to be in a hospital.  But I kept reminding myself that this isn’t for me, it’s for the babies.  Initially, I was on intermittent monitoring for one hour, three times a day.  Every evening I would pray that my babies would survive through the night, and every morning, when the heart beats were found on the monitor, I would thank God that they were alive.  I also had weekly ultrasounds in the hospital, and got steroid shots when I first arrived.

     Although it was much more comfortable to be monitored only three times a day for one hour, I didn’t completely understand how that would help if the babies were in distress at some off-monitor time, and I had lengthy discussions with my OB and the specialists about whether cord knotting is sudden, or are there detectable signs of fetal distress prior to something catastrophic.  The difficulty is that since monoamniotic twins are so rare, there’s just not a lot of data.  Also, my specialist group had three doctors, and each had a slightly different opinion, which added to my confusion.  One felt that the way the cords were tangled in my particular case, which was a big ball, not a long twisted braid, was actually more favorable, and he felt one hour 3x a day was sufficient.  Another doctor felt, the more monitoring the better.  I actually found out that my friend’s cousin had monoamniotic twins a few years ago, and I spoke to her to hear her experience.  She was in a top hospital in NY, with a top doctor, and she was monitored basically 24/7, with only 5 minute breaks here and there for bathroom, etc.  Hearing that actually made me more nervous, since it seemed like my monitoring protocol was too lax relative to that!  In the end, my OB and I settled on as much monitoring as I could tolerate, with freedom to unplug whenever I wanted, for however long, and no monitoring at night.  I kept myself busy with lots of reading, talking on the phone, surfing the web, and praying.

It was really hard being in the hospital away from my husband and kids, and I missed them terribly, especially at nights.  They came twice a week to visit, but when they left, it exacerbated the loneliness.  They would call me every evening, and I would read them a bedtime story that I found online.  That was my virtual parenting, and I even told the nurses that I coined a new term “teleparenting”.

     After I passed the 29, then 30 week mark uneventfully, thank God, I started pressuring my OB about a decision as to whether to deliver at 32 or 34 weeks.  She wanted a wait and see approach, but I’m very goal oriented, and needed a date to look forward to.  My OB pretty much left it up to me, so I asked for a consult with the neonatologist to hear about the difference, both short and long term, between a “32 weeker” and a “34 weeker”.  In the middle of the consult, when I was 31 weeks, Baby B began to have decelerations.   There’s nothing as nerve wracking as hearing from the monitor the sound of your baby’s heart rate drop.  The nurse rushed in, put me on oxygen, rolled me on my side, and was grabbing for the phone to call the attendant OB.  I remember thinking “Oh my, it’s too early, I’m not ready!” and praying to God that my babies stay in a little longer.  After a tense minute or so, Baby B’s hear rate picked back up.  I was put on IV to increase fluid intake, and remained on the monitor the rest of the day.  Thank God, both babies heart rates looked fine for the rest of the entire day, so the decision was made not to deliver.  Based in the discussion with the neonatologist, and after reading whatever relevant journal articles I could find, my OB and I kind of settled on delivery at 33 weeks.

     At 32 weeks, I got another round of steroid shots.  The next day I had an ultrasound, and though the heart rates and blood flow looked OK, both babies appeared to be sleeping, as there was no movement, and no visible chest rise indicating breathing.  We waited about 40 minutes, which is the typical in utero “nap time”, and we prodded and vibrated, but got only minimal movements.  The specialist concluded that since the main risk in my case was cord entanglement, and blood flow and heart rate look good, we don’t need to be concerned.  He mentioned something about steroid shots potentially making the fetuses sleepy, so he dismissed me back to my room.  The heart rate tracings for the rest of the day were in the right range, but had much less variability (rises and falls) than before, which isn’t a good sign.  I went to sleep praying that my babies will be OK.

The next morning, at 32 weeks and 4 days, the specialist turned up in my room with the portable ultrasound machine.  I remember thinking, “Wait, you said yesterday that you weren’t concerned, so why are you here now?”.  He scanned me, and it was much the same as the day before - good heart rates and blood flow, but minor movement and no breathing.  Again, he reached the same conclusion as before, and left.  About an hour later, Baby B had a decel, and I was rolled on my side and put on oxygen.  At this point, my OB was getting worried about the whole situation, and decided that was it, I was being delivered.  I remember thinking “wait, we wanted to get to 33 weeks, it’s still early!”, but I trusted her call.  

     I called my husband and informed him that they wanted to deliver me now.  He didn’t realize that now meant “now”, and by the time he dropped off the kids at various locations, he arrived after the delivery.  Meanwhile, I was prepped for a c-section, given some terrible tasting antacid to drink, since I had eaten lunch (a no-no for anesthesia, but we hadn’t planned on delivering today!), then rushed into the OR for delivery.  Everything was super quick, and within the same minute, doctors delivered two 3 lb. baby girls.  I didn’t hear the babies cry, and wasn’t given the babies to see or hold, so I was a little concerned.  At that point, my husband showed up, and told me that the neonatologists said the babies seemed “stunned” and not very responsive.  Both babies had very low initial APGAR scores (I think 1 and 2), and were put on CPAP right away.  Later, I was wheeled in to the NICU to see them in their isolettes- it was so hard not being able to hold them after the whole stressful pregnancy!

    The next morning, I got the report from the neonatologist, and thank God, both girls had perked up after their first few hours of life, and become more responsive.  At one point during the night, they thought they might have to intubate Baby A, but then she started breathing OK again with the CPAP.  After about 2 days on CPAP, they were switched to room air.  After a head ultrasound at two days of age, I was finally able to “kangaroo” them, though only one at a time.  They stayed in the NICU for only two and a half weeks to learn how to feed and gain weight.  They went home on the same day, weighing approximately 4 lbs.  And they’ve been doing amazing ever since!  Every day, when I look at them, I thank god for my miracle girls!

Mya and Lyla's Story

     We found out we were expecting early June. I scheduled a doctor's appointment for the next week hoping to find out how far along I was, that is not all we found out! While getting my first ultrasound the woman played the baby's heartbeat, she kept staring at the screen not saying any words so I asked if that is indeed the heartbeat. She told me yes it is...and here is the other one. I began laughing while my fiancé asked if she was joking or not, she informed us that she does not joke about twins. She kept looking at the screen after we heard each heartbeat and then told us the doctor would want to speak with us.

     The doctor came in and proceeded to tell us that they did not see a membrane dividing the twins and there is a small chance they could be monoamniotic, but majority of the time they are able to find a membrane later on.  I went home to Google "monoamniotic twins" (big mistake) and really scared myself.  All I was able to find is that this occurs in about 1 of every 60,000 twin births and that my babies only have a 50 to 60% chance of survival.  I knew the girls were monoamniotic but Chris kept trying to make me feel better by insisting that they will find a membrane. Our next appointment we were able to find out the gender of our babies but also our last chance to search for that membrane.  I was ecstatic to find out we were having girls but that was quickly trampled when we were ensured that there was no membrane making my pregnancy extremely high risk.

     Our next step was to make a plan because that doctor could not handle such a high risk pregnancy.  After seeing a few doctors, all telling me to not get too attached because there is a 50% chance I will not get to have my girls, I settled on a doctor in Pennsylvania.  We made a plan to go inpatient at 26 weeks  and to be monitored 3x daily for an hour.  Getting to 26 weeks was extremely difficult.  I was skeptical about having a baby shower because I was afraid of my girls not making it. I was afraid to sleep fearing I would wake up and not feel any movement.

     Finally 26 weeks came and I was ready to be admitted. Being inpatient was hard to say the least.  Chris was finishing school so he could not be there as much as he would have liked which was hard for me. I cried every night I was in the hospital, I felt isolated from the world and everyone was going on about their life without me. I especially hated getting my IV switched every other day. One member of my family would visit every day and that was what I would look forward to every day.

     I had one major scare during my late night monitoring where Baby B's heart dropped into the 70s for a few seconds. I was so scared and pushed my call button 100 times. The ultra sound tech came running in and could not find my baby's heartbeat, finally my doctor pushed him out of the way and found it. Words cannot describe my relief.  I was given oxygen and they kept me strapped up all night. Between the straps being so tight, my tears and my fear I did not get one minute of sleep that night. A few weeks went by with no major issues and other than being in a hospital for five weeks I was doing well.

     My doctor gave me the option of delivering at 34 weeks or 32 and I did not want to take any risks so I chose 32. Thanksgiving rolled around and Chris was finally able to stay for a while. November 26, 2013 I was on my last monitoring session of the day when Baby B's heart dropped into the 70s. I was given oxygen and my doctor told me he was just going to keep me on the monitor for a while longer and told the nurse to give me another round of steroids.  Her heart rate went back up but I would not take my eyes off of that screen. Twenty minutes later her heart rate dropped again, this time to the 50's.

     My doctor ran into my room and asked "Can I deliver your babies today?" I was so scared I could not even speak. I looked at Chris and he responded "Let's Go!" Everything after that happened so quickly. I was rushed into a bright room and Chris was told to stay behind. They put me on the operating table and everyone was scrambling around me. My doctor was yelling that the anesthesiologist was taking too long and getting his instruments ready which did not help my nerves, finally it was time to put me under.

 

Mya and Lyla

     I woke up asking the nurses if my girls were ok and if they had hair, she responded yes to both questions. I was sent to recovery and was dying to meet my angels. When I saw my girls for the first time it was like a dream. My girls, my sweet babies who I had been told might not make it were finally here. Lyla weighed 2lbs 14 oz and Mya was 2lbs 15 oz. Their cords were not only tangled but Lyla's wrapped around Mya's neck. After four days we were finally able to hold Mya and the next day Lyla! I thought being inpatient was hard, but that was nothing compared to leaving without my girls every day which never got easier.

   I visited my girls every day sometimes up to 5 hours a day. The girls spent about 5 weeks in the NICU with only a few minor setbacks. Lyla came home January 11 and Mya the following day. My girls are 6 months old now and are absolutely perfect.  I love them more than I knew I could. I still stare at them in disbelief the same way I did when the night they were born.

A Dad's Perspective

The story in the link below is a dad's perspective of a monoamniotic pregnancy that was published on Esquire.com. We just had to share! It's a great read about a mo/mo pregnancy and life after babies come home.

I LIVED THROUGH THE MOST NERVE-WRACKING BIRTH STORY YOU MAY EVER READ

Triplets with a Momo Pair

In November 2012 my husband and I decided to try for our second baby. Our daughter McKenna was almost 4 and really wanted a baby brother or sister. She prayed everyday to God to put a baby in my belly. In march 2013 her prayers were answered. We received our positive pregnancy test. I was 4 weeks pregnant and immediately started my prenatal care. McKenna was overjoyed and started praying daily for twin girls. She named the babies she prayed for Mallory and Celery. I had a normal singleton pregnancy besides terrible morning sickness. It was much worse than with McKenna. Maybe we were being blessed with a boy this go around, we thought. 

At 19 weeks we went for our routine ultrasound. I asked McKenna if she wanted a brother or a sister. She replied she was going to have both. Before we began the ultrasound the tech asked if this was our first ultrasound and If we wanted to know the gender. It was our first ultrasound and we were going to have the gender put in an envelope to be revealed later. We started the U/S and the tech immediately stopped and asked again if this were my first ultrasound. I said yes. She then asked if I were taking fertility treatments. My reply "NO. WHY? IS THERE 2?" She responded, no there's 3. McKenna was right she was having a brother and Identical monoamniotic sisters. We were shocked. It's the only way to put it. 

I had no idea what having monoamniotic babies meant. I went home and googled. I was scared to death. My ob told me statistically there probably was a membrane and they would surely find it at my MFM appointment. At 23 weeks I headed to my anatomy scan. Knowing in my heart my girls were momo. It was confirmed that afternoon. That scan also put my son in a high risk category for Down's syndrome and told me one of the girls had a issue where her cerebellum was not formed correctly. I was urged then and there to terminate my girls. To sacrifice them for my son. No way, I loved them, all of them. 2 weeks later I went for another scan. No markers for Down syndrome and my daughters brain looked perfect. By this point I had disconnected from the pregnancy. I didn't believe I would bring any of my babies home. 

I went inpatient at 27 week 2 days. I would have went sooner but my baby B was suffering from IUGR (Intrauterine growth restriction) and wasn't at a viable weight. I checked in to the hospital expecting to deliver at 32 weeks. But at 29 weeks 2 days I had developed preeclampsia. We did our last ultrasound that morning to find out my sweet baby B Marissa was having reverse blood flow. We delivered that afternoon. Mallory and Marissa (no we didn't go with Celery) were born at 3:33 pm and Maddox arrived at 3:35. Sept 9, 2013. The day of their great grandpas birth and their other great grandpas death. Mallory was 2.5 lbs Maddox was 3.5lbs and my tiny Marissa was born with the smallest cord the Drs had ever seen at 1.15lbs. The doctors couldn't believe she was alive. They even cried with me.

 My triplets spent 7, 9, and 11 weeks in the hospital with little hiccups. They were for the most part healthy feeders and growers. Marissa, the last to come home came home, on her due date November 22nd. Today they are healthy, happy 6 month old's reaching all milestones for their adjusted age. They are my miracle babies.

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4tunate: Quadruplets with a Momo Pair

**The following entries are taken with permission from www.4tunate.net.  Please visit that blog for updates on the family as well as frugal living, faith journey, family-friendly foods, and finding joy in the every day!***

From http://www.4tunate.net/2007/02/about-us/

On February 2, 2007, we became parents to quadruplet boys: Henry, Brooks, Clark, and Isaac. Originally, this blog started as a way to keep family and friends on board with updates and prayer requests during our extreme high-risk pregnancy. Since then, it has “multiplied” into a collection of our family adventures, frugal living on a “quad budget”, our faith journey, family-friendly foods, and finding joy in the every day.

We thank God for His immeasurable blessings and hope that our blog can be a source of encouragement to your faith as well!

From http://www.4tunate.net/2009/03/keepin-it-real-rewinds-10/

Keepin’ It Real Rewinds 10

I don’t know if I’ll get through this post without fighting back tears, but I’ll give it my best shot…

Two weeks after the shock of our lives, (finding out we were expecting triplets), I found myself back on that same cold table, staring blankly at the black and white screen.  I immediately saw the three oval-shaped sacs, and watched breathlessly as she examined each one closely for a heartbeat.  Tiny little blips flashed on the screen proving life still existed. We knew that during the first trimester, there were certainly no guaranties. As she scanned the final sack, something caught my eye.  Before a word was spoken, I saw it.  I knew with certainty that this sac was not like the other two. Time stood still in that defining moment. There were two flashing heartbeats in one sack. 

History was written in a conversation that went down something like this:

Me: "There’s two in there, aren’t there?"  

Nurse Lisa: "What?"

Brad: "Huh? What? Are there? Are we talking four babies?"

*Blurry screen*   

Our Doctor took over the ultrasound from there…

He examined it closely in what appeared to be disbelief.  He confirmed soberly there were indeed four and waited for me to get dressed to meet with him in the conference room.  

I remember looking at Brad who was standing behind me, making sure he wasn’t going to pass out.  He looked so dismayed and distraught. I was instantly flooded with emotions and ten thousand questions.  I felt overcome with guilt, fear, panic, grief, pain, disappointment, and disbelief; Yet I remained emotionally unresponsive in appearance.  I couldn’t cry… I couldn’t laugh a nervous laugh… I couldn’t scream… I just wanted to pull the white sheet over my head, and disappear from this new reality. 

Instead, the nightmare worsened. We learned that not only did we have an even higher risk pregnancy by the increased number, but we were facing, (I quote), "Pretty much the worse case scenario".  Our worst case scenario involved a rare form of twinning, called mono-amniotic twins. Monoamniotic twins are rare identical twins that occur in approximately 1 in 35,000 to 1 in 60,000 pregnancies, but had not been documented to exist within a quadruplet pregnancy.  

A complicated pregnancy lends itself to a complicated explanation. (For the record the incidence of mono-mono twins or even having identical twins for that matter were unrelated to the mild fertility treatments we underwent.) Without getting too ridiculously medical, let me try my best to explain monoamniotic twins through a compiling of these resources, for those of you who may not be familiar with this terminology. (Illustrations can be found here.)

Monoamniotic twins are identical twins that develop inside the same amniotic sac. They share a placenta within their mother’s uterus, but have two separate umbilical cords for nourishment. This means that both babies share the same living space. They don’t just share their house, they share a bedroom, bathroom, and playroom! Where as other identical twins share an outer sac, but not an inner sac.  They are separated by an important membrane. Unfortunately, monoamniotic twins are at great risk for health complications due to the close proximity of the two umbilical cords in the amniotic sac. This makes it particularly easy for the twins to become entangled in each other’s cords, or to compress one another’s cords, endangering their oxygen and food supply. The survival rate for monoamniotic twins is approximately 50%, but incalculably less within a quad pregnancy scenario. 

We walked out of our 8 week appointment in anguish, after what seemed to be a death sentence for our four little heartbeats…

But God had other plans.

From http://www.4tunate.net/2007/02/page/6/

QUAD DAY – Birth Day x4

Hello everyone,
Our boys are here and doing really well. The birth went very well and Jen is recovering in our room again now. They all came out crying and breathing room air on their own.
One of the boys is now on ventilation as he was not able to continue to breath without assistance. The other three have continued to breath without a vent, but they all have a long way to go before we can breath a sigh of relief. But, God has given us five hours of life with our little boys already, and we are thankful to finally get to meet them.
Okay, here are the names and weights that you all have been waiting for in the order in which they entered the world:
Henry Samuel Murray
Born at 12:33pm
2lbs. 12oz.
Brooks Layton Murray
Born at 12:34pm
3lbs. 0oz.
Clark Thomas Murray
Born at 12:34pm
3lbs. 7oz.
Isaac Edward Murray
Born at 12:35pm
4lbs. 0oz.
Here is a picture of the boys just minutes after they were born, right before being hurried off to the NICU.
Left to right: Henry, Brooks, Clark, Isaac 
 
















(Post copied from www.triplet-update.blogspot.com)

From http://www.4tunate.net/2007/03/page/2/

Our Family of 6 is Complete!

Friends and Family,
Wednesday evening we finally went up and got Clark and brought him home! We are so excited to finally have our family at home complete. After over two months in the hospital, we finally have no reason to go to St. Vincent Women’s Hospital anymore. We want to thank everyone at the hospital for the amazing care that Jen and the boys received.
We took our first trip out with all four boys yesterday since Clark got home. The boys went to the pediatrician for a check-up and weight check. Our boys are thriving and continuing to gain weight.
Updated Weights:
Isaac: 6lbs. 13oz.
Brooks: 5lbs. 11oz.
Clark: 5lbs. 1oz.
Henry: 5lbs. 3oz.
This will be the final post for this blog. We are so thankful for everyone who has followed our progress here for the past 7 months. God is so gracious and continues to provide in amazing ways for our family. If you would like to continue to follow our family, please check out our new blogspot, I will be posting pictures there in the near future.
(Post Copied from www.triplet-update.blogspot.com)

Miracles in the UK

There I lay with a 6 month beautiful bundle of joy and my husband said "I would like another" I smile and say, "in another 5 years", he looks back "I think I will be too old in 5 years. I want to see my children grow up. Look how close Riley and Tia are." (Grandchildren of a friend that are 15 months between each other) I look at him and say "yes, that would be lovely, they would be so close they would be like twins." (Famous last words)

Only the month after I take a pregnancy test which was positive, we were excited. 6 weeks into the pregnancy I started experiencing severe cramping, the doctors sent me for scan as they thought the pregnancy may be eptopic. We went into the scan and they were looking and my husband says "I bet its twins". I hit him and say "don't be so silly", the sonographer laughed and said "do twins run in your....oh!" Both me and my hubby looked scared at her "what's wrong?" we asked. She looks up, "I need a second opinion. I think I can see two fetal poles". "TWINS?!?!" I gasped and we were sent outside for 45 minutes. I remember thinking "I'm only 20, how am I going to cope with twins and a daughter under 2?"

45 minutes later we were called in and they said after looking over the pictures determined there were two fetal poles. My husband says "so we are having twins?" The sonographer looked back and said, "yes, Mr. Reynolds you are having twins. You need to come back in two weeks to be monitored". We agreed and left. Two weeks later in the same spot feeling just as nervous as before we were called in, they looked over and stopped. They told us there was a possibility that the twins were coinjoined and that I would have to come back in 2 weeks for a definite answer.

I left feeling numb I didn't know what quite to say or think. I dodged the subject with my husband till the next scan at 10 weeks. Again same position than before watching the clock tick over more anxious than either of the times before, again we were called in and at the end of the scan she said "Good news, they are definitely not conjoined but I want you to go for a scan in two weeks with a specialist as I can't seem to find a membrane". We sighed with relief but without realising what she had just said was bad.

I got home and curiosity got the better of me and I googled it, after reading all the horror stories. I sat there and cried. My husband sat beside me and asked what was wrong. I showed him and he said there may still be a membrane and not to worry. Having a daughter of 7 months gave me something else to concentrate on between being sick with morning sickness and feeling so tired of course. 12 weeks I sat in the same spot completely overwhelmed again she scanned them over and she looked at me again. "Urm, I'm going to clean you off and I think you should come and sit down." She cleaned my stomach, I rearranged my clothing and she looked at me and said, "I can confirm you are carrying Monochorionic Monoamniotic twins, they are extremly rare and in the UK have less than 50% survival rate. They are in the same amniotic sac and can easily tangle in each others cords which will result in fetal death, they can cut each others blood supply which will result in fetal death and also TTTS which can be handled but isn't 100% that it works. The negatives out weigh the positives and I suggest you get a termination."

On the way home we drove in silence as we parked outside our home in Broadfield, West Sussex (UK) my partner held my hand and said "I will support whatever decision you make." I sarcasticly smiled and got out the car. That night I tried to speak to a few close friends about it, neither knew what to say and told me to do what I thought was best. It was not much help at all. I then, I don't know why, searched in the tool bar MoMo twins and found the facebook group called MoMo Twins: Pregnancy, Birth and More. I spent 2 1/2 hours reading everybodies stories and it gave me a glimmer of hope. I turned to my husband and said, "Who am I to play God with two people's lives? I am not God and don't wish to be so. I am going to let nature take its course... If we come out with two, awesome, with one, so be it, and none, at least we would had tried. I can't give up on them." The next day I received my first consultants appointment at the local hospital where the consultant suggested that I go to 36 weeks and have them naturally and only have a section if there's trouble." I left feeling confused as she said the opposite of the specialist I saw, that night I lay in bed thinking about things. The next morning I decided to call East Surrey hospital (45 mins away) where I saw the specialist and asked for all my appointments there and with a more experienced specialist.

We continued our two weekly scans and all was going well until 18 weeks when I collapsed during a routine scan. I was rushed to accident and emergency and they did all sorts of tests and came back with that they thought was a blood clot on the lung. Over night they gave me blood thinning injections in hope it would flush the clot and the next day I was taken down to radiology where an Indian doctor sat me down and said, "You need to be aware that you are having radiology with gamma rays, we think your babies may have developed all its features BUT there's a chance they may have not and doing this may cause mutation." I asked, "what if I don't do this?'" He responded, "It's likely you won't be able to carry on with your pregnancy." I asked for a few minutes and thought of my options, I came to the conclusion that I would rather risk them being mutated than terminating them as I had I already felt them. I called back the Dr. and said "I will go ahead with procedure" I sat and hugged a huge machine while its took pictures of my lungs. I went back to the ward and anxiously waited the results. 5 hours later a Dr. came to me and said "they couldn't see any clot and they thought it may had flushed out."

Back home all was okay and carried on normally till 28 weeks. I was sat in my living room watching TV while my partner was in the bath  and I started to feel my stomach contracting; having a singleton before I knew what was happening. I left it a hour before I called down my hubby to take me to the hospital. We got there and they monitored me and said "if we can't stop this we need to organise an air ambulance to take you to St. Georges in London as we don't have the facilities here for two 28 week old fetuses". They gave me some medication which calmed them down and 2 hours later stopped. They told me not to go out by myself and do minimal walking and things around the house to avoid preterm labour. At the next consultants appointment she sent me for steroids straight away and said I needed a iron transfusion as my iron levels were dangerously low. The next Thursday I went in at 7am they started pumping the iron into me and at 8pm I was still there. A nurse came in and I asked "excuse me, do you know how much longer it will be as I've been 12 hours". She turned and sternly said "girls like you take up room in the delivery suite because you cannot be left in a chair. It will take as long as it takes". She walked out came back 10 minutes later, "so are you going to breast feed your twins?" I replied "I don't think its good idea to be up all night breastfeeding twins and be up early with a 14 month old."  She stared at me and said "Well, do you know you are going to kill those babies because formula will not digest in the system properly? I had a meeting with my team and we decided when and if you should have a section and we haven't agreed to it."  I looked at her and said "my consultant booked it months ago". I sat there holding back the tears and she then said "when that is finished I will take you to the NICU so you can see how they will be!".

Fifteen minutes later she left me at the door of the NICU and I went in and saw all these babies connected to machines and broke down and left the hospital and went home. The next day I called my consultant to say what had happened and she assured me the next day that the section had been confirmed and nothing to worry about. 1st of December came, delivery day, I was super excited when I looked out the window to see a blanket of snow outside.  We called a taxi who were hesitant to come and told us they would charge us double which my husband said "I don't care, we're having babies."

I got dressed in the gown, was sitting waiting patiently when I saw a smartly dressed man with a brief case who looked out of place on the ward. He was walking towards me he said "Miss Plant?" I looked at him vaguely "yes?!?". He said "I'm sorry to inform you we are unable to do your elective section today due to no space in the NICU at this current time." I got really upset I said "Do you not know how important this is? Do you not understand the consequences?" He looked down and replied, "I'm afraid I have done all I can." I asked "at least you will give me a scan right to monitor the blood flow?" He stated, "No, Miss Plant, we are unable to scan you today please make your way here tomorrow and we will try and fit you in". I went home rather angry but tried to sleep as much as I could.

The next morning I wake and look out the window and we had 2 feet of snow, we call the taxi who again is reluctant to come and said this time they would charge double and a half! Again we responded "We don't care, we are having babies." We drove to a family friend's to drop our daughter off as we went to turn around we were faced with a hill. The taxi did not want to go up but luckily there were 2 strong men trying to dig out their cars that James begged to help. We finally got up the hill with help from two local men and James when we get stuck again up a smaller hill, poor James had to push the taxi up by himself and faceplanted in the snow but like a good sport got back up without a word. It took us a hour and a half but we got to the hospital again. We got dressed for the section when I saw the smartly dressed man again. I looked at James and I said "I can't believe it, he better not be coming here." He stood at my bedside and I looked up, "Miss Plant, we are unable to do your section today due to lack of staff due to the snow. I have considered getting you to another hospital as we realise the importance but we cannot get any ambulances safely here. Please stay and we will see what we can do in the morning." James hugged me tight and said stay here and I will come back tomorrow. I was left 7 am till 7 pm with no monitoring, food or water, then the staff changed and a head midwife came and monitored me and gave me a sandwich and again before bed and showed me to a private room.

At 5am I woke to a knocking at the door and she said I've come to monitor you...I remember thinking all I want is to sleep. As she started to monitor she said "That's not good. Okay stay here I need to go get someone". 10 minutes later a group of people ran in with a scanning machine my little miracles heart rates were 200. They said "We need to get you up to delivery suite now, these babies are coming". I cried "please call my husband, I can't do this alone". They took me up to the delivery suite and the heart rates calmed down but the consultant said they need to come today. They were wheeling me out the room to theatre when James arrived as we went to exit the room I heard "there's not enough staff in the NICU". I shouted 'Noooooo!' And the anesthesiologist smiled and said don't worry "they will be here soon". After a hour I went down to theatre and Maddison Sophia was born at 10:30 on the 3rd of December, weighing 3.15lbs, and Mia Sienna 2 minutes later at 10:32 weighing exactly the same. Their cords were looped and tangled and the cord was wrapped round Mia's neck. Thankfully there was no deformities due to the gamma rays. After a 22 day stay in the NICU Maddison and Mia came home on Christmas day 2010 :)

My Momo Miracles

I had never thought I was going to be a mother.  I'd been diagnosed with polycystic kidney disease when I was twenty-one.  Due to the kidney disease I had high blood pressure, and I also have chronic migraines.  I had been told by every doctor for ten years that I should not have children.  Not that I couldn't have children but that I shouldn't have them.  I told myself that I didn't want children so as to not have to confront the idea of not being able to have them.  Then, about six months after getting married,  I found myself pregnant and everything changed.

After embracing the idea of being a mother, I was then devastated when I had a miscarriage at the beginning of my second trimester.  We tried again right away but were unsuccessful.  Due to my health issues (and the increased chance of multiples) we decided against fertility treatment and just left it up to Mother Nature.  After four years waiting, I finally found myself pregnant in September 2010.

While waiting for our first real ultrasound (around nine or ten weeks,) my husband and I were amused by the couple who come out into the waiting room very excited that they were having twins.  My husband jokingly said, "What if we are having twins?" Not amused, I said, "Don't even say that.  That is NOT going to happen."  

Ten minutes later I found myself lying on the table, stomach covered in ooze when the tech exclaimed, “Oh wow, its twins!”  Thinking (or hoping) she had made a mistake I asked if she somehow got the other lady’s ultrasound mixed up with mine!  But no, there was no mistake.  I was carrying twins.

The doctor could see right away that the separating membrane was missing and he referred us to the best--and, I think the only--perinatologist in the state.  My biggest fear was that the twins would be conjoined and I spent every minute of the next couple weeks worrying about it.

Upon meeting my perinatologist, I knew I liked him.  He had such a peaceful, quiet, reassuring way about him that I felt very comfortable.  He soon confirmed that the membrane was missing and diagnosed it as a momo pregnancy, NOT conjoined.  My relief was tempered when the doctor began explaining exactly what a momo pregnancy entailed.  Hearing that my babies only had a 50% of even being born, I had flashbacks to the pain of my miscarriage.  How could I go through that again?  The doctor explained that there were options but I had already decided that, no matter what, I wasn't giving up on the baby (now babies) that I had waited four years for.  Regardless of the odds stacked against us, I just felt that these babies were meant to be.

The first half of my pregnancy was miserable yet uneventful.  I literally spent most of my time trying to keep food down and being unsuccessful.  It was the middle of winter and my perinatologist was 100 miles away so I went into my high-risk ObGyn for check-ups, along with many long drives to see the specialist.  Each appointment, I had to hold my breath until I heard the two heart-beats and saw them on the monitor.  While I felt that the babies were doing well and would be fine if I just stayed positive, I had a difficult time bonding with the babies growing inside of me.  I needed to build a wall to protect myself in case things didn't work out.

At 22 weeks, my blood pressure spiked and I was hospitalized in an attempt to prevent pre-eclampsia.  We all knew that 22 weeks was far too early to deliver but it was a possibility.  After several days in the hospital and some serious manipulation of my blood pressure medication, we did get things under control.  I was discharged to home on modified bed rest until I was scheduled to go inpatient at twenty-eight weeks.  However, at my twenty-six week appointment with the specialist the blood flow in the cords looked dangerously constricted so I was quickly admitted and began my inpatient stay.  

The first few days in 'Mommy Jail' were stressful.  I was immediately given steroid injections to stimulate the babies' lung development.  The pressure in the cords was rather high, indicating  something (a knot) was restricting the blood flow.  At one point, Baby A dropped off the monitor and the doctor nearly delivered them at twenty-six weeks four days.  Fortunately, upon hearing that, the boys decided to settle down and from that point on, their numbers got better every day. 

 I was monitored for three one-hour blocks each day, which translated into lying flat on my back for the better part of every day and night as the nurses chased the babies around my stomach trying to get a good read.  I also had an ultra-sound every second day to monitor the blood flow in the cords.  My husband and I soon settled into a routine where he spent half the week with me in the hospital and half the week at home going to work.  Things were looking good until, around twenty-nine weeks, my blood pressure began to rise again.

After several days of trying to get my blood pressure under control, everyone could see it wasn't working.  I was officially 'pre-eclamptic', I had become swollen in places I didn't know could swell and had to spend nearly all my time in bed, lying on my left side.  The day I reached the thirty week mark, the doctor came in early and--to no one's surprise--said things were just getting too dangerous and it was time to deliver.  Within the hour, after a flurry of phone calls to family back home and a quick shower, I had an IV put in and was ready to be wheeled into the operating room.

At 12:14 p.m. February 27, 2010 Casey Li came into the world, weighing 2 lbs. 4 ozs with the umbilical cord wrapped around his neck twice.  At the same time Casey was brought out, Foster John's feet came out with his brother.  Seconds later, he too was welcomed into the world weighing 2 lbs 5 ozs.  The doctor had everyone in the room come look at the umbilical knot the boys had created, not quite believing the mess they had made of it.  Each baby had a four-member NICU team who, after letting me look at each baby for a second, quickly had them intubated and whisked them away to the NICU.  

 Umbilical cord knot

It was nearly 8:00 p.m. before I was able to crawl into a wheelchair to see my babies for the first time outside the two seconds I'd seen them in the OR.  Not even the drug-induced fog I was in could contain my joy and fear upon entering the NICU and seeing them for the first.  They were impossibly tiny, yet perfect in every way.  They were even breathing on their own with just room level oxygen!  

 Casey Li  4 days old.  First ‘kangaroo care’!!

I had always felt that my children were going to be fighters, but even I was surprised by how tough they turned out to be.  My doctor attributed it to being stressed in the womb, which forced them to develop quickly and be resilient.  After dropping to 1 lb 15 ozs, the boys soon began to gain weight steadily.  The only setback they suffered was, after about a week, both boys were desatting regularly so they were put on a nasal canulla for a couple weeks.  Other than that, they made great progress every day, while I used my NICU time to learn as much as I could from the best caregivers around--the NICU nurses.

  Foster John  10 days old

We were told to expect the boys to go home around their due date, which had been May 6th.  By the beginning of April, it was clear the boys wouldn't be in the NICU that long.  The doctors said they usually never discharged a baby weighing less than five pounds, but our boys were doing so well they didn't need to stay any longer.  As one doctor put it, "They are the valedictorians of the NICU." 

 

On April 15, 2010, after an eight week stay, our boys were finally discharged.  At the time, both boys were 3 lb 13 oz and were too small to fit into a car seat so we were one of the few people ever to use the special 'car beds' the NICU had.  The boys actually had to ride in those for more than a month before finally getting large enough for a regular infant car seat!!

The first few months at home with the boys were a bit of a roller coaster.  While we were lucky and the boys were exceptionally healthy for preemies, they were still preemies and still faced preemie problems.  We were under strict orders not to take the boys anywhere or allow many people in and out of our home for at least six months so I became rather stir-crazy.  Neither boy slept well, grunting and fussing even when they did sleep, and we struggled with terrifying spit-up/choking episodes for months.  Our days were filled with visits from the county nurse, many visits to the pediatrician, trips out-of-town to see specialists, visits from our Family Outreach counselor, and even physical therapy evaluations.  Still, somehow we managed to get through every day. 

My boys are now two and doing incredibly well.  We have graduated from the Family Outreach (Early Intervention) program and the boys are developing very well.  The only stumbling block we’ve had recently is with speech.  They are a bit behind in learning to speak English but have mastered their own language “Twinglish.”  We have started therapy and have been learning sing language, which is helping them communicate without getting frustrated.  They have now started making up their own sign language, which is a fun challenge to decipher. 

 I could not be prouder of my little men.  Every step of their journey to be with us was quite a challenge and they proved to be such fighters!  Their strength amazes me.  Late at night, I sneak into their room to watch them sleep and remember them as tiny 2 lb preemies who couldn’t even keep themselves warm and often find myself crying.  I am so very, very blessed.

 Foster John (left) & Casey Li (right) 2 years old!

There's more than one!

Simon and I were very excited about our first baby scan at 11 weeks.  We couldn't wait to see our little one for the first time. Just before the scan started Simon told the OB that my sister has triplets so it would be interesting to see if we were having twins (or more!). I confidently told the OB that we were just having one baby thank you very much! As soon as the scan started Simon and I could see a baby and something else.... The OB announced "There's more than one!". There was a lot of nervous laughter and exclamations such as "no way!", "really?", "are you sure", “there’s only 2 right?”, etc. My legs started to shake as the shock set in. Almost straight away the OB told us he thought there was no dividing membrane and they looked like what are called monoamniotic twins. He then spent a while trying to work out whether they were conjoined.  I think I almost fainted.  He said he was sure that they were not conjoined but explained that this type of twinning is extremely high risk. Suddenly our low risk singleton pregnancy had turned into something very different.....

  

Treatment Plan

My OB refused to tell me the mortality rate (well, that’s telling you something!!!).  I reviewed the research myself and no one agrees on what the mortality rate is or the best way to manage this type of pregnancy because it is so rare and not much research has been done.  It is routine in the US for mothers to be admitted to hospital for inpatient monitoring from viability but that is not the case in Australia and I did not go inpatient.  I had regular high resolution scans that increased with frequency towards the end of my pregnancy.  I worked until I was 28 weeks pregnant and then I was on (self imposed) bed rest until delivery.

Coping with a High Risk Pregnancy 

I didn't know whether I was going to have 2, 1 or 0 babies in my future so it was hard to know whether to be happy, anxious, sad or....just feel nothing. I didn't know whether I should have a baby shower. Celebrating their impending birth when their chances of survival weren't great was a little odd.

I made a decision to try to be optimistic and ignore the horrible statistics. My babies were healthy according to the scans and I'm healthy so there's no use worrying! I hated people telling me to not get my hopes up and telling me not to buy baby furniture until after they were born. I wanted to pretend there were no risks - that's how I coped. My OB would tell me all the risks at every appointment leading up to viability which depressed me every time. Once I reached 26 weeks he became more optimistic and told me he was confident I would make it to the magic 32 weeks.

However, reality would set it, especially when we went for scans. I had 10 high resolution scans that took 1-2 hours each. I had a panic attack at every scan (a real one – I’m not exaggerating!). The first one was the worst - I had to take 6 breaks in one hour. From then on I closed my eyes for the majority of the time and I distracted myself by eating and drinking. Even after the sonographer assured me she had found 2 heartbeats I would still be very, very anxious. Seeing them was extremely emotional and overwhelming. All of the scans came back with excellent results. The flow of blood from the placenta to the babies was always good which reassured us that any knots weren't restricting the flow of nutrients.

However, good scan results didn't guarantee that we were going to take home two babies. My husband and I had a few awful but necessary conversations about what we wanted to do if one or both didn't make it. We had a plan in place and we had even picked out special names. Not that we didn't want to use "Phoebe" and "Sophia" but we wanted special names with meanings that were appropriate for the situation.

The Final Countdown

During the last 4 weeks of my pregnancy I had weekly scans and OB appointments. The last two scans showed that Sophia, the smaller girl was quite a bit smaller than Phoebe and had not grown much in the 33rd week. Week 33 I had an appointment with a different OB as mine was on holidays. This other OB told me with confidence that I would make it to 34 weeks and both babies would be fine. I asked him over and over again at the last appointment whether Sophia was going to be ok because I was so worried about her but he said she would be fine.

I tried not to obsess too much about feeling the babies move but I couldn't help making sure I felt both of them kick each day towards the end. The problem with babies in the same amniotic sac is that it is very hard to tell which baby is kicking and whether it is just one or two kicking! I would sometimes wake in the middle of the night just wishing the babies would move. So I would get up, walk around and eat something just to feel them move. Once they got going I tried to relax again and go to sleep. However, it is hard going to sleep with two babies all excited inside you!

We visited the hospital for antenatal classes and asked all sorts of questions - how often can we see our babies, who can touch the babies, how long are they are likely to be admitted for if they are healthy, should I bring clothes/blankets for them, what happens if they need to be transferred to another hospital, which type of breast pumping equipment is available?  I also got a tour of the Special Care nursery to get a feel for the place and I started to picture myself breastfeeding in the feeding areas. All this information helped us to prepare us for what was to come... 

Phoebe and Sophia's Birth Day 

The girls were born healthy via cesarean January 2010 measuring 2008 grams and 2318 grams. Immediately after they were born my OB inspected the umbilical cords and said "someone was looking after these girls". There were several knots in their cords and I believe God was definitely looking after us!

They had APGARS of 9 and were only in humidity cribs for 19 hours. They didn't need continuous O2 but they had breathing apnoea for a week. Apnoea is when they forget to breath and need to be given O2 briefly. They were fully tube fed formula (and a tiny amount of breastmilk) for 3 days and then we started to slowly introduce breastfeeding.  It’s amazing that we had all the risks but ended up with our perfectly healthy children.  We felt truly blessed.  Words cannot describe the relief we felt when they came out screaming. We couldn't stop smiling (except for when I was vomiting from the anaesthetic!).

The substitute OB that saw me the week before the birth rang my OB from Hawaii (he was on holidays!) to ask if my girls were alright. He was quite concerned about whether he had made the right decision to let me have them out at 34 weeks rather than 33 weeks. Turns out he was right but gosh - talk about "obstetrician's bluff!"

Straight after surgery I was able to hold Sophia for about 10 minutes. They would've let me hold her longer but I was feeling very dizzy and nauseous from the anaesthetic and chose to give back Sophia for fear of dropping her! About 2 hours after birth I was wheeled into the special care nursery and got to stroke Phoebe and Sophia's heads for 5 minutes each. My husband took lots of videos and photos of the girls so that I could look at them while I was recovering in my room which helped enormously. I didn't get to hold Phoebe until 29 hours after birth.  The first time I held her was so magical and it brings tears to my eyes 2 years on!  I know some mums don’t get to hold their premmie baby for weeks after birth so I was just utterly grateful it was only 1 day for me.

Our Special Care Experience

We loved special care. Probably because every time we went there we got to see our gorgeous girls! I loved the smell of the antibacterial lotion they make you wash your hands with because I associated it with seeing them. I also loved the smell of the baby shampoo in the nursery and bought a bottle at the pharmacy so I could smell that gorgeous baby scent when I wasn't with them.

Phoebe and Sophia were in special care for 3 weeks. For the first week I was also in hospital and Simon was staying in my room. Simon would visit the girls every 3 hours to feed them through the nasal gastric tube and I mean EVERY 3 hours. He was so in love :). I couldn't go every 3 hours but tried to get there 2-4 times a day. At first we were only allowed to cuddle them every 6 hours but as they gained strength we were able to cuddle them every 3 hours. It sounds strange to restrict physical contact with a baby but it really wore them out. Going home at the end of the first week was hard. We had to leave them behind :(. Every mum has that moment...commonly known as the 3^rd day blues where things get a little emotional.  Well, I had my moment the second time I had to leave the hospital and go home to two empty bassinets.  I was crying uncontrollably and asking why I had to leave them behind.  Luckily a kind nurse and the mother of the little girl next to Phoebe comforted me and assured me they would be well looked after overnight.

At first we came back to the hospital for two feeds a day, then three, then four and then I was in there all day doing 5 feeds during the day. We then stayed overnight at the hospital for 2 nights to show they were able to be fully bottle and breastfed 24/7. We took them home at 4 weeks old.  When they came home they were pretty easy to look after.  They fed, they pooped, they slept.  Yes, there wasn’t much sleep for mum or dad but they were content most of the time.  Little did I realise that this was the “easy” stage!!!  I will leave the reflux, colic, RSV, gastro, bottle and breast refusal, overtiredness, overstimulation, etc. for my personal blog :).  I really wish someone had told me about silent reflux - it's so common in preemies! 

Two Years On

My girls are now loud, vivacious 2 year olds that are just like every other two year old...except there’s two of them of course!  You would never know they were a high risk pregnancy or premature.  They are healthy and happy - we are so incredibly blessed.