October Overview

Well, clearly I never got around to writing that post about the horrors of being on a heavy magnesium sulfate treatment. Honestly, I have no excuse since I was on bedrest for most of October - but it really was pretty traumatic and I kept thinking I'd be okay to detail my experience, but I have decided not to because..well..Idonwanna. So, let's quickly look over the last 4 weeks.

I was given the go-ahead to come home from the hospital after 4 days due to our close proximity to SJMC and the assurance that I would be well looked after by family and friends. Thank you family and friends for all your help! My confinement was originally to be for about 2 weeks, but at the tail end of that the boys/my body started acting up again so it was decided to extend that bedrest until I was 35 weeks along (2 weeks ago at this point).

Also, during this time period I had another growth scan (at appx. 34 weeks) that had quite a few alarm bells ringing for the growth and health of the twins, this of course after the previous perinatal appointment during which I was essentially told we were in the clear. Basically, at some point between the growth scans at 30 and 34 weeks, Baby B (who had been making strong gains in recovering from his earlier growth deficits) completely fell off his growth curve creating a very wide growth margin between himself and Baby A and also was measuring well below the 10th percentile for his gestational age.

This information and diagnosis of Interuterine Growth Restriction (IUGR) put a great deal of stress on us all (doctors and parents) since the only course of treatment is delivery. At this point, intense monitoring every 3 days began with the knowledge that every time I go in could be delivery day if the dopplars were not favorable. Thankfully, there have only been a few questionable test results during these last 3 weeks and we remain hopeful that the boys will both be delivered healthy and that, in particular, Baby B continues to rise above the odds. This diagnosis also spurred on the strong belief that meeting the 37 week goal is the final one, and going beyond that point becomes highly risky.

Throughout the entire pregnancy I have also been hoping for a "good old fashioned' delivery, but with Baby B being breech for quite some time that was not going to be possible. Of course, once I had resigned myself to surgical delivery - he decided to flip head down a few days ago. This of course threw us back into the discussion of how best to manage my health and each of the boys. It has become pretty clear that Baby B will not tolerate labor well (based on the many monitoring sessions we've had) and so we will go ahead with a C-section. I finally have a peace about this after talking and length with my health care providers as well as the perinatologists and quite a bit of prayer. So, tomorrow is D-Day (delivery day)!

The hospital has some funky uploading things so I am not sure just how quickly the word will get out, but it is our plan to start spreading the word as soon as we can. Because their morning was full, I am not scheduled to report to L&D until the afternoon so please don't be concerned if you haven't seen an update until the evening. Thank you so much for following us during this journey and supporting us in word, deed, and prayer. We have absolutely seen God's grace through this process and are reminded of that whenever the doctors/sonographers make off-hand remarks about having made it to where we are today....these boys are truly remarkable and I can't wait to share the good news with you.

Now...off to name them?

PreTerm Labor Experience Part 2: All hooked up with no place to go

At this point I am getting wheeled over to a room in Labor and Delivery, wouldn't you know it was the same one I delivered Audra in! I am so very thankful that I had done my reading on preterm labor treatments, NICUs, etc. earlier on in pregnancy. I was able to understand why the doctor was pursuing this course of action, but none of my reading had been too recent enough that I was freaking out or anything, because if you do look up what the treatment/side effects can entail, it isn't pretty and could be very anxiety inducing. I was also take this moment to say that God clearly had a hand in my calmness, because I'm just not that calm of a person. Even though very few people knew what was going on at this point we were being covered in prayer.

I understand that there are less intense therapies to treat preterm labor, but am so happy that my Dr. simply told me what she was going to do instead of allowing me to waffle around on the idea that I could take a more cautious approach. I was very quickly hooked up to an IV for fluids, a bag of magnesium sulfate, and given the first dose of a steroid shot (at a bit before 4 PM) that is used to help mature babies' lungs in utero by triggering the production of surfactant.

Surfactant is pretty much a lubricant for the lungs. It is produced naturally by babies, but not generally until a bit later in gestation. *Literally every.single.day.in utero has huge benefits for babies, so while 32 weeks and 3 days may not seem too different than 34 or 35 weeks, it has a HUGE impact on "outside baby readiness". I randomly heard that every day inside the uterus is along the lines of 4 days in the NICU.*  Triggering the natural production of surfactant earlier through use of the steroids is used to helps premature infants have less respiratory distress because the air sacs in the lungs are able to do their jobs without sticking to other lung tissue, causing or furthering respiratory distress in the wee one. Since coming home I have also found that some studies indicate that this shot may also reduce risk of brain hemorrhage, which is very commonly seen in premature babes, and of course is a major concern. In order for the steroid to work, Mom must get 2 doses of it  - best spaced at 24 hrs apart  - so this also relates to why my preterm labor was treated very aggressively even though, in the world of preterm delivery I was further along than many. A large part of the labor delay was in order to give those boys enough time to receive the benefits of the steroid shots so that whenever they do decide to arrive (a day from now or a month from now...who knows?) they will be as prepared as can be to breathe with the least amount of assistance. Medical technology is truly a miracle, but being hooked up to breathing apparatus', etc. increases risk of infection. So - we are really hoping that Baby Boys will come out with lungs slathered in surfactant, wailing, and ready to make me very tired from all of their crying.

Okay - does that cover the steroid shots? It wasn't pleasant, but it was also very much nothing compared to some of the other "lovely" experiences, and honestly - I'd take yucky shots over intense, un-medicated labor any day. Oh, and the benefits speak for themselves so it really was not an issue. We were all  just intensely relieved that we were (eventually) able to get the full treatment to the boys. At this point, if I went into labor, they wouldn't stop it because a) the boys got such an awesome benefit from this treatment and b) please, if my labor is bound and determined to start there isn't anything left that wasn't done to my body to keep it from doing so.


Quick notes:

1. I HATE IVs. I had a really good one done, since it was in for about 3 days and I didn't actually attempt to tear it out, but I still suuuuuper hate getting fluids through it and puffy and itchy and gross.
2. I totally understand why they exist, and was pretty psyched that I got a Prilosec drip to help ease the nasty heartburn that came along as a result of things like: laying down for 3 days straight, having you body pumped so full of fluids that it rapidly grows your ever-massive uterus straight into your ribcage (not that there was so much space left anyway), not being able to eat or drink for 3 days...yeah - we'll get to that., having heavy meds pumped into you over the course of 2 of those days that has a knack for making people feel like they are on fire.
3. I really don't mind blood draws. Seeing as they were happening round the clock to make sure I was in the therapeutic range for the meds, but not getting overdosed, these were the least of my concerns and I'm glad I'm not a needle-hater. This whole experience would have been much more traumatic.

Next up: The "Mag Bag" or "Dreaded Mag" aka Magnesium Sulfate...this beauty is going to get a post of it's own.

PreTerm Labor Experience Part 1: How did I get here?

Well, I know that many of you will have gathered bits and pieces of this post via facebook updates, emails, and texts, but I did want to detail the past 5 days or so anyway since that is the whole point of this blogging adventure. Also, while I do want to provide a bunch of information, I will be leaving some of the gorier details out..and off the internet. There are just some things about this experience that I do not feel need to be broadcast.

Friday Sept. 30, 4:30 AM - I wake up and am feeling yucky and crampy. I lay there for a few hours before letting Steve know that I will NOT be taking to Audra to school in the morning since I hope to catch a few more hours of sleep which thankfully does come. A few days prior, The Mr. had randomly chosen to take the day off in order to get a few things done around the house so he was able to get Audra to school after all. He spent the day running around being productive as scheduled, while I lay in the basement still feeling crampy and gross and generally sorry for myself (and him) that I was not being helpful. Around 5 that evening I finally hauled myself off the couch in order to go pick up Audra from school. During the car ride and pick-up process, I had a bunch of contractions. Mind you - I've been feeling contractions regularly for months, but these were very regular and in combination with feeling "off" I decided to keep taking it easy and go lay back down. Dehydration can be a common cause of contractions and I hadn't had nearly enough to drink during the day since I wasn't doing much, so I chalked it up to pregnancy discomforts and not being hydrated, got annoyed by timing contractions that were regular, but not intensifying, and decided to get some sleep figuring that would take care of things.

Saturday Oct. 1 AM - Steve once again was up with Audra before me and I had gotten some truly excellent sleep for the first time in a loooong time and was quite groggy. Audra hung out with me on the couch while Steve got ready for a haircut that morning. In truly Schwendy fashion, our toilet backed up into our tub and through our ceiling for the 2nd time in a week after being "fixed" on Monday AND we discovered we may have had something similar to a power surge  (just was told by the technicians it was probably a lightening strike) over night, so none of our internet/AV/TV equipment was working which I had been attempting in order to occupy the little lady so that I could help Steve gather towels/buckets/etc. All of this before 9 AM when Steve has to be downtown in 20 min. Also around this point, I realized I was still feeling crampy, although I wasn't feeling too many contractions. This was really not a good time to have concerns, but then again I am a good little student of the internet and it told me that experiencing any changes was worth at least a call to the OB answering service. I let Steve know as he ran out the door that I'd be calling, but not to think too much of it. I also took this time to call my Mom so that I had someone to remain accountable to, since I really didn't want to call on the weekend over nothing and also to share our "funny" morning tale. Mom did a very good job of making sure that I would call soon, and to let her know what they said.

I went ahead and called the help line and gave the basic overview to the woman who answered and was told a doctor would call me back in about 10 minutes or so. Sure enough, I got a call from the OB on call from my practice soon after and I went through the basics with her: crampy, some contractions, but better than the day before and nothing intensifying. At some point she realized I was a twin pregnancy (the answering service had not informed her of that fact) and she told me to get my butt to Labor and Delivery. I told her my butt had a 3 year old at home and a husband who was out, but would be in when I could be. Thankfully Steve's appointment was finished and I was able walk out of the house as he was walking in. I kissed Audra quickly and I took my phone and computer just in case I needed to wait around, but was hoping to be back by 1:15 to watch Audra so that Steve could get our cat to the vet for her yearly appointment. Also, good friends of ours were hosting a party that evening and I was very much looking forward to parking myself on their couch and having people bring me plates of food, but off I drove.

We live appx. 2-4 minutes from the ER depending on how you hit the lights and what entrance you use, so I was at the hospital in no time. Walked in, chatted with the ER receptionist about how twin pregnancies are super hard and nothing to envy and then walked up to L&D. They took me into triage and hooked me up to the contraction monitors and reviewed information and just hung out for about 45 minutes until the Dr. could come by and see what was going on. During this whole time I only had one contraction and was feeling much better so I was excited to get the show on the road and get back home. After a bit, the Dr. did come by to do a fetal fibronectin (fFn) test. I figured she might as well do something while I was there.  This is not a definitive test. Basically, it is very accurate at determining that you are NOT going to go into labor in the next week or so when negative, and then if positive, alerts you that you have a 50/50ish chance of going into labor in that same time period. All signs were showing that after an hour I'd get a negative result and could break free.

The next hour was spent occupying myself on the phone, but also noticing that I was feeling crampy,  nauseated, and that I thought I was feeling contractions again. During this hour the L&D nurse also began talking less to me and making lots of hash marks on the contraction readouts. Still, she was pleased that the boys heartrates were looking great, and of course Baby B was doing his thing rocking and rolling around so that they had to keep adjusting the straps to find his heartrate.  Imagine my surprise when the nurse let me know that they had (very quickly) gotten the results back that the fFn test was positive. The doctor told me to go use the bathroom since I had been hooked up for a while,  and that we'd talk after that. I heard,  "You are gonna hate me, but your boys are gonna looooove you". as I made my way over. At this point (around 1:30) I realized I was not going to be going home, but was more curious to know what they had in mind.

Home Stretch

I had two appointments this week and both went well. Fluid levels are still looking great,  and the boys have been having a blast turning my abdominal area into some type of contortionist attraction. Seriously - I don't know what the heck they are doing in there, but there is NO slowing these gentlemen down with the movement even though everything I read now keeps telling me I will be feeling them less since they are running out of room. This was not a measurements week for them so I don't have any additional information regarding suspected weights, etc. but I can tell you that they appear to be growing just fine since I am getting larger and more uncomfortable every day...sometimes it's evenly an hourly occurrence.

In the last week or so I have completely stopped working, developed pregnancy induced carpal tunnel, and the swelling and joint aching as begun in earnest. I am also measuring 42 weeks pregnant, so I am trying to give my body some grace as it begins to freak out on me since it has never been this overtaxed/pregnant before. The excellent news is that I am less than 2 weeks away from the big milestone of 34 weeks. At 34 weeks, my doctors will not attempt to stop or delay labor - they will just let the boys come! What a shock to hear this after months of concentrating on keeping everyone healthy and inside, we've pretty much done it and are in the home stretch! This does not mean that if they boys come within the next couple of weeks they won't need some extra medical assistance, but they may need some extra help adjusting to the outside world anyway, so I'm just really excited that things are looking better and better and like less intervention will be necessary. To think that I may get through this pregnancy with NO official bedrest is a miracle in itself! So, for now we are just trying to kick the preparations into high gear so that any additional time we may have in the next month or so can be spent relaxing and enjoying our less chaotic family of three.

Long time no blog...

...and that has been a very good thing. I actually now have breaks between my appointments rather than seeing the doctors once or twice a week! As of today, I am 31 weeks along. This seems so crazy to me after waiting for (what felt like forever) reaching the 24 week viability goal and now suddenly 6+ weeks have flown by. I am sure my return to work helped aid in the quick passage of the last month or so, but alas - it will not help me get through the next few weeks/months since I will be going in one last time to teach tomorrow afternoon and have been out more than in over the past two weeks.

At my appointment last week I had my paperwork with me regarding not working post delivery (and also not returning this school year at the very least), and the doctor changed it to state that I should be finished as of that very day. Did I take this advice completely? No. But I have been taking it easier while we try to find a good temporary replacement for my position and have no plans to be officially "in school" after tomorrow afternoon. At said appointment I was measuring about 39 weeks so my body is, at this point, more pregnant than it has every been before. I am pretty curious to see what happens now since the boys are only going to grow, hopefully, much more since this is the time that gestating babes pack on the poundage.

The second appointment I had was fun since Steve got to see the boys, albeit very briefly, for the first time since I was only 18 weeks along and concerns of TTTS were first brought up. Darn that long appointment wait cutting into Daddy/Son/Son bonding time. Oh well, at least there were a few good shots to be seen in those few minutes. All in all the boys haven't been cooperating when I have been going in for ultrasounds so I don't get to see too much other than their heart chambers, bladders, and kidneys. And yes - I could pretty much pick those little blobs out without any direction at this point I've seen them so much.  Baby A is appx. 3lbs 6 oz and Baby B is appx. 2 lbs 14 oz. The size difference is now less of a concern since both are gaining adequately on their own growth curve. A fantastic thing to see is that their fluid levels are looking very symmetrical and their umbilical flow is looking good as well. The doctor actually said that at this point it is very unlikely that chronic TTTS will develop so we are good to continue on with only bi-weekly appointments with the specialist! I will continue to see my regular OB as well and am glad that I have been able to see each of the doctors at least once over the course of this pregnancy since they will be the ones (barring any major snafus) delivering the boys.

There are some new concerns that arose with some of Baby A's measurements, but we are keeping an eye on it and it is very likely to be just his position which might be affecting the measurements in one way or another. Since their hearts and activity levels are looking good, the docs aren't going to pursue anything right now and I am perfectly content to just wait and see what next week brings.

After months and months of visits and concerns and prayer requests we are only now just coming to the realization that sometime in the not-to-distant-future we will have two sweet little boys coming home to be a part of the family. We are slowly but surely making progress in getting prepared and finally feel like it is appropriate to do so. Audra's baby furniture is getting switched over to the boys room, she is adjusting to her big girl bed and "princess mirror" (Pam - I speak of the dresser/vanity you had in your room with the secret drawer), I put away the clothes we have been graciously given in their drawers, and the crib bumper  is even being delivered today! I've even started freezing some meal options for the future which is something I never did when expecting Audra. Even though my due date is not for another 9 weeks, the average delivery date for twins is 35 weeks gestation which is just a month away! Please continue to pray that the boys will continue developing and gaining weight like champs and bake a bit longer. For all of my complaining and the new cruddy pregnancy symptoms that are cropping up making me miserable,  I really do know and believe that "inside babies" are preferable. However, check in 4-6 weeks from now, I may be furiously writing eviction notices to the young men.

And now - glamor shots!

Baby A's face front on (pretty impressive for a 2D scan)

Baby B's profile

Hurricanes

The boys are hurricanes. They are unpredictable, change position, and can be quite violent. However - despite their active movements and the upheaval to our lives (mainly my sleeping life) they were not the main hurricane of the past week. Nope - my past two...well, three, weekly appointments have come and gone with nary a blog bit due to Hurricane Irene. After 6 days, our power has been restored just in time for Labor day weekend...which will likely consist of cleaning up a weeks worth of lightless living. It really was not that bad since we have very gracious friends, unseasonably pleasant August weather for Baltimore, and had water the entire time. I would much rather go multiple days without power than a single day without water.

Nothing big to report, as always that is great news! They continue to grow and their heartrates, umbilical flow, and fluid levels remain fairly stable. I entered my 28th week this past Wednesday which puts me in my 3rd trimester...Thank God...I'm not sure what I would do if there was another one to go and I am so relieved that there isn't one by His design. I am measuring 37 weeks along so over the course of the next 2 or 3 weeks my body will officially be more pregnant than it has ever been. Audra was born the day before her due date so I am very curious to see what changes will continue to come as I surpass that mark. Really - I am just waiting for the stretch marks. Glorious. A small price to pay for healthy boys.

The first week of school with students was shortened due to hurricane damage and between work and the hassle of living without power, I am quite glad that it was. Still, it was good to see the students and I am super thankful to have an air conditioned trailer outside of the school building. Can't wait to see how long I can keep this up for! My back certainly aches and I have all those other lovely pregnancy pains to go along with it, but I figure I'd have them even if I was sitting at home.

As always, thank you for your support/interest/prayers - it is all working for healthy babies and healthy Mom! And in case you're ever wondering, if there is anything to report, it will be reported here so consider yourself up to date if you are reading this!

No pictures of the boys the past few visits and I'm too lazy to stage one of myself, so instead I will offer up a shot of my lovely girl coming home from the hospital.

Growing Boys

This week's appointment was lots of fun since the boys were measured again for growth. They are really growing quite well, both of them! Baby A is around 2lbs and Baby B is catching up and looks to be around 1lb 11oz. Little man is still making those gains and closing the size gap bit by bit (only about 15% now) despite  his lower fluid levels which is a great. He also managed to flip from breech position to head down during the course of the exam much to the songorapher's surprise/confusion. This helped explain all of the kicking we saw while measuring Baby A. The flip is another great indicator that he has enough room for himself even though the AFI remains low-ish. I feel him much more than Baby A, so I'm not too concerned about him, his activity is a constant reminder that he is doing juuuuust fine. It also looks like my body is handling its job of carrying the growing boys well. I'm not showing any indications of pre-term labor or stress beyond what most late-third trimester pregnant ladies experience...then again, I'm only entering my third trimester this coming week.

In other news that you may or may not care about, I will be going back to work full time tomorrow morning and know that I will be pushing it, but I am not quite ready to give in to the aches/pains/fatigue yet and am looking forward to seeing my work family again after the summer, and of course working with my students. Please pray that this week of preparation won't do me in before the students even return, I have my work set out for me since my classroom was moved during the summer. I am super excited to have air conditioning out in the trailer, but unpacking and setting up this go around will be much more challenging. I spent a few short hours in there last week and boy did I feel it later that evening! My return to work also precipitates Audra's return to school full-time and her move to the 3's class. She has been unbelievably blessed this year with amazing teachers in her 2's class and it is bittersweet that she will be moving onward and upward. Of course, she also is showing signs of a cold just in time for this increase in activity level, so also pray that she kicks it and can remain healthy as we go into this new season.

As a student/teacher, the "new year" definitely occurs with a change in academic year versus Jan. 1st and I am getting into an autumn state of mind. This is rocking my world since I know that it is during this season that they boys will join our family "on the outside"! We are getting prepped for them bit by bit and Audra is getting significantly more excited about their arrival. This also means that we will have more information surrounding their delivery in the coming weeks. Most twins settle into position in the uterus in the next few weeks and from there we will have more of an indication of whether or not we can skirt a c-section. I know it isn't likely, but a girl can dream....

I actually have a few more profile shots of Handsome A and Handsome B this week, but they are upstairs, and I am downstairs and my desire to go get them is nil. So, I'll add them later! And they're up!