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?
Tuesday, November 1, 2011
Thursday, October 6, 2011
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.
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.
Wednesday, October 5, 2011
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 apower 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.
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
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.
Thursday, September 29, 2011
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.
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.
Wednesday, September 21, 2011
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!
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!
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| Baby A's face front on (pretty impressive for a 2D scan) |
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| Baby B's profile |
Friday, September 2, 2011
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.
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.
Sunday, August 21, 2011
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!
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,
Friday, August 12, 2011
My sweet girl.
My sweet girl came with me to my appointment today. The boys were not very cooperative (facing away) so there were no good face shots or profiles for her to identify with while watching the monitor. I am a little bummed she wasn't able to "see" them as much as I have been the past few weeks, but she was still such an angel. Her main concern was that my hand be held and that the heartbeats not get too loud from the computer. I was proud of her while we waited for the appointment, especially since this was all during nap time. She is turning into such a big girl and is definitely anxious for the next stage to be here. She has repeatedly let me know that she wants her baby brothers to come out and asks if they are finished their naps yet.
Baby B's fluid levels are pretty low again, but since we are all monitored pretty closely this doesn't impact things and we will, once again, just wait and see how things look at next week's appointment. They are also scheduled for another growth check. I need to remember to ask what they're approximate weight is next time since I forgot at the last check. They certainly feel like they are growing! Thank you for your prayers, we definitely still need them.
Baby B's fluid levels are pretty low again, but since we are all monitored pretty closely this doesn't impact things and we will, once again, just wait and see how things look at next week's appointment. They are also scheduled for another growth check. I need to remember to ask what they're approximate weight is next time since I forgot at the last check. They certainly feel like they are growing! Thank you for your prayers, we definitely still need them.
Thursday, August 4, 2011
Quickie
Super quick, but I just wanted to let everyone know I had another appointment today and things are still looking good. AFIs were a bit lower, but still pretty equal and the boys are clearly doing alright in there. They've flipped again, now Baby A is breech, his little bottom sitting directly on top of Baby B's head. Baby B is now head down. I actually think this is helping me to be a bit more comfortable because nobody's legs are kicking me low right now. It was also decided that I need to continue going weekly pretty much until D-Day (my term for delivery day, whenever that may be). I also have started bi-weekly appointments at my regular OBs office, so I am just super happy that both places are close by to home and each other. Honestly, I like seeing the little guys every week, I count it as a very nice bonus. No pictures today to share of them, so instead you get one of my ever expanding abdominal area.
Tuesday, August 2, 2011
Delayed
So sorry for the posting delay since last week. Life has a funny way of getting in the way of things like sitting down, composing thoughts, and typing them into Blogger. My appointment actually went fantastic! The fluid levels around both babies has leveled off nicely and are more even than they have been since concerns were first discovered 5 weeks ago! Another great sign is that Baby B made some growth gains - the growth differential is now slightly under 20% which puts us just within normal range. I am hoping he continues to grow more and catch up to his "big" brother who remains right on target for growth. According to the sonographers and doctors, the boys are really, Really, REALLY active. I have no problems believing this since they have started to mandate a sleep strike for me. Every time I stop moving, they begin their own little World Cup in my uterus, keeping me from falling asleep. It is pretty funny (okay, not at 2 AM it isn't) to feel one guy move and then the other directly respond. Normally they settle down eventually and I am able to grab a few hours before they or Audra wake me up. Can I just state how thankful I am that Audra is such a superb sleeper-inner? I am SO SO SO thankful. There, I said it.
Speaking of Audra, yesterday we talked about baby brothers from breakfast to bedtime. She is really starting to latch on to the idea of new babies in the house as we are getting baby boy clothes and gear into place. Her favorite thing is to do laundry for them. This also is extremely helpful for me too. Thank goodness for our new front-loading machine which she is more than happy to load/unload for me so I don't have to bend down and reach in there.
The big event now looming in the not-distant-at-all future is my return to work. School begins for teachers in just under 3 weeks. Something that is encouraging me, should the return occur, is that my classroom has been moved from within the school building out to a trailer which is air conditioned! While I will miss being so close to everyone and everything, I know that I'd be getting a definite "no" from the doctors about returning if I didn't have AC available to me. I am very pleased that I haven't experienced swelling, my blood pressure has been fine, and my blood glucose levels are good, so these signs all point to my body handling things well. The doctors will be meeting on Friday (though I am unsure as to when they'll let me know of their decision) to discuss my case and whether or not I can go ahead, but it is all with the understanding that things could change at any moment and we all need to continue to be "prepared" for that. I use quotations around that word because, if anything has been made clear through this process, it is that no amount of preparation is really going to get us ready for what is ahead. There are a dozen probable scenarios, so we need to just be as trusting in God's plan and laid back as humanly possible about what may or may not come our way.
It is truly awesome that I will be 24 weeks tomorrow! 24 weeks gestation puts the boys at 50% viability should they be born now. That being said, so far things are looking very solid and my body is holding its own. Apparently, women that have carried a healthy pregnancy to full-term do a little bit better when carrying twins so that is another plus! And now, onto the pictures:
Speaking of Audra, yesterday we talked about baby brothers from breakfast to bedtime. She is really starting to latch on to the idea of new babies in the house as we are getting baby boy clothes and gear into place. Her favorite thing is to do laundry for them. This also is extremely helpful for me too. Thank goodness for our new front-loading machine which she is more than happy to load/unload for me so I don't have to bend down and reach in there.
The big event now looming in the not-distant-at-all future is my return to work. School begins for teachers in just under 3 weeks. Something that is encouraging me, should the return occur, is that my classroom has been moved from within the school building out to a trailer which is air conditioned! While I will miss being so close to everyone and everything, I know that I'd be getting a definite "no" from the doctors about returning if I didn't have AC available to me. I am very pleased that I haven't experienced swelling, my blood pressure has been fine, and my blood glucose levels are good, so these signs all point to my body handling things well. The doctors will be meeting on Friday (though I am unsure as to when they'll let me know of their decision) to discuss my case and whether or not I can go ahead, but it is all with the understanding that things could change at any moment and we all need to continue to be "prepared" for that. I use quotations around that word because, if anything has been made clear through this process, it is that no amount of preparation is really going to get us ready for what is ahead. There are a dozen probable scenarios, so we need to just be as trusting in God's plan and laid back as humanly possible about what may or may not come our way.
It is truly awesome that I will be 24 weeks tomorrow! 24 weeks gestation puts the boys at 50% viability should they be born now. That being said, so far things are looking very solid and my body is holding its own. Apparently, women that have carried a healthy pregnancy to full-term do a little bit better when carrying twins so that is another plus! And now, onto the pictures:
Tuesday, July 19, 2011
A Change
Today there was a change, not earth-shattering, but not particularly positive either. My fluid levels have continued to go up surrounding baby A, this time more rapidly. Baby A is only just within normal fluid range - by about a quarter of a centimeter. This excess of fluid, if the Maximum (also referred to as Deepest) Vertical Pocket (MVP) measurement is greater than 8, is referred to as polyhydramnios. This is a condition affecting about 1-2 percent of pregnancies and can be caused by several different issues. Of course we have been monitoring this because one cause is TTTS, though Baby B's fluid levels have also continued to increase, where as in TTTS the donor baby's fluid levels get dangerously low.
**Allow me to interject here and say that I am so thankful that Baby B continues to have adequate fluid surrounding him! I was feeling him less over the past few days and sometimes that is indicative of a problem, as it turns out, it is simply because he flipped to a breech position so I am just feeling his movements differently - no biggie!**
While there are plenty of cases of babies with polyhydramnios that are perfectly healthy, many have this condition as a result of some defect that may restrict their ability to swallow the amniotic fluid surrounding them, keeping the AFI at normal levels. Another explanation would be that I have developed gestational diabetes, that'd be a fairly simple fix so I'm almost hoping for it at this point??? As this is, and has always been, a waiting game, we will simply see how things are next Thursday at my next appointment. The next appointment will be more in depth and the boys will have full anatomy scans again to check for abnormalities and see how they are growing. I don't have any indication right now of what caused this fluid jump (it was rather rapid since it has been less than a week since my last check), but seeing as we are still flirting with the normal range we should be okay to wait.
The "good" news about finding this information today is that explains my feeling significantly worse rather suddenly. Somewhere around Saturday evening my ability to breathe became much more restricted and my heartburn came back (after a blissful 3 week lull) with a vengeance despite taking medication for it. Beyond gestating multiples, higher fluid levels cause quick compression of the lungs and stomach in the mother which can cause these issues. In addition to these symptoms, the stomach/abdominal area is, once again, stretched too quickly and becomes increasingly painful. While I was definitely larger in my pregnancy with Audra at full-term, I never experience this level of abdominal pain. In short, it sucks, and there's nothing I can do about it.
If polyhydramnios does progress, it puts me at a much higher risk for pre-term labor, placental abruption, and uterine rupture. This is without factoring in that there are two lovely young men that are growing inside me right now. Bedrest is pretty common in these cases, in order to keep pressure off the cervix and keep things still since it all gets too tight and heavy in there. Bedrest scares me to death. Audra is sooooo 3 and she is soooo not okay with Mommy's slowing down right now.
Seeing as we may all be on borrowed time, I am trying my hardest to get things a bit more organized day by day. While physically taxing, it does help me to feel more prepared in the event that we experience a drastic change. Okay, now I am laughing..of course we are going to experience a drastic change. Life with twins. Yikes. We have been rather focused on things on an appointment to appointment basis, along with some other things that have come up in our family, that time to actually think about what life will be like with the little ones is pretty much nil. Then again, perhaps it is better that way. This entire experience is one great exercise in surrendering control and trusting that God will provide, but it isn't easy, it is definitely exercise. I hate exercise. Also a bummer today, NO PICTURES! The perinatal center has been remodeled and they are moving out of their temporary location this week back into the new digs for next week so they are on a time crunch, and obviously it was more important to spend time determining how serious this new development was than to get cute pictures. *Sigh*
Alright, well I have a toddler in bed, laundry being laundered, and a kitchen to clean, so I am signing off. Thank you for your prayers - and please keep them coming!
**Allow me to interject here and say that I am so thankful that Baby B continues to have adequate fluid surrounding him! I was feeling him less over the past few days and sometimes that is indicative of a problem, as it turns out, it is simply because he flipped to a breech position so I am just feeling his movements differently - no biggie!**
While there are plenty of cases of babies with polyhydramnios that are perfectly healthy, many have this condition as a result of some defect that may restrict their ability to swallow the amniotic fluid surrounding them, keeping the AFI at normal levels. Another explanation would be that I have developed gestational diabetes, that'd be a fairly simple fix so I'm almost hoping for it at this point??? As this is, and has always been, a waiting game, we will simply see how things are next Thursday at my next appointment. The next appointment will be more in depth and the boys will have full anatomy scans again to check for abnormalities and see how they are growing. I don't have any indication right now of what caused this fluid jump (it was rather rapid since it has been less than a week since my last check), but seeing as we are still flirting with the normal range we should be okay to wait.
The "good" news about finding this information today is that explains my feeling significantly worse rather suddenly. Somewhere around Saturday evening my ability to breathe became much more restricted and my heartburn came back (after a blissful 3 week lull) with a vengeance despite taking medication for it. Beyond gestating multiples, higher fluid levels cause quick compression of the lungs and stomach in the mother which can cause these issues. In addition to these symptoms, the stomach/abdominal area is, once again, stretched too quickly and becomes increasingly painful. While I was definitely larger in my pregnancy with Audra at full-term, I never experience this level of abdominal pain. In short, it sucks, and there's nothing I can do about it.
If polyhydramnios does progress, it puts me at a much higher risk for pre-term labor, placental abruption, and uterine rupture. This is without factoring in that there are two lovely young men that are growing inside me right now. Bedrest is pretty common in these cases, in order to keep pressure off the cervix and keep things still since it all gets too tight and heavy in there. Bedrest scares me to death. Audra is sooooo 3 and she is soooo not okay with Mommy's slowing down right now.
Seeing as we may all be on borrowed time, I am trying my hardest to get things a bit more organized day by day. While physically taxing, it does help me to feel more prepared in the event that we experience a drastic change. Okay, now I am laughing..of course we are going to experience a drastic change. Life with twins. Yikes. We have been rather focused on things on an appointment to appointment basis, along with some other things that have come up in our family, that time to actually think about what life will be like with the little ones is pretty much nil. Then again, perhaps it is better that way. This entire experience is one great exercise in surrendering control and trusting that God will provide, but it isn't easy, it is definitely exercise. I hate exercise. Also a bummer today, NO PICTURES! The perinatal center has been remodeled and they are moving out of their temporary location this week back into the new digs for next week so they are on a time crunch, and obviously it was more important to spend time determining how serious this new development was than to get cute pictures. *Sigh*
Alright, well I have a toddler in bed, laundry being laundered, and a kitchen to clean, so I am signing off. Thank you for your prayers - and please keep them coming!
Thursday, July 14, 2011
The power of prayer...
...is so apparent every time I go in for another appointment. The sonographer I had today was the same one that was at my initial follow-up with the perinatologist after concerns of TTTS arose. When looking over my numbers for the past two weeks, and confirming AFIs and dopplars today, she remarked how shocked they had been at that follow-up that the boys' fluid levels have remained within the normal ranges, and that the umbilical flow is remaining healthy enough and steady. We knew that the doctor was pleased at the lack of progression, but this shows that it is not medically the norm. So, I thank you for your continued thoughts and prayers, and thank God for being the penultimate Creator/Doctor/Anatomical Programmer, etc. He truly has His hand on these fine young gentlemen...Whom - YES MOM - we hope to officially name soon so as to avoid the Baby A/Baby B confusion. With Audra, we kept the name to ourselves and publicly referred to her as Bean, and in fact, we still call her Bean or subtle variants of that nickname to this day.
The boys remain head down and crammed right next to each other. This is no surprise to me as I feel them hanging out and hanging low. I think they are having a "how often can we make Mom pee" contest. Let me tell you, they are winning. Both kids have been super active this past week which has been reassuring since feeling movement is an indicator of appropriate fluid levels. Baby A is inching up with fluid levels, which while still in normal range ( <8cm), is causing me more discomfort. My body is simply stretching much more quickly than it was meant to. Another indicator of our special situation is that, while many twin moms' uterus measures 4-6 weeks ahead due to the extra baby, I am measuring a whopping 10 weeks ahead....and I definitely feel like I am rocking a baby belly that looks 31 weeks along instead of 21 weeks. Ah, which brings me to my next point - I gained 4 pounds this week! This is great news since weight gain has been a huge struggle throughout and the twins are growing rapidly at this point. Any fat on them is a huge help in their success outside of the womb, so bring it on! According to this, the boys are supposed to be about 10.5 inches long and just under 13 ounces each. I didn't get any official indication of their size today, but Baby B does still appear to be a smaller than his brother just by seeing them on the ultrasound. I will have another full anatomy scan of both boys in 2 weeks which will give us a clear idea of if Baby B is growing on track, just smaller, falling further behind, or has caught up.
And now - what you have all been waiting for...pictures!
The boys remain head down and crammed right next to each other. This is no surprise to me as I feel them hanging out and hanging low. I think they are having a "how often can we make Mom pee" contest. Let me tell you, they are winning. Both kids have been super active this past week which has been reassuring since feeling movement is an indicator of appropriate fluid levels. Baby A is inching up with fluid levels, which while still in normal range ( <8cm), is causing me more discomfort. My body is simply stretching much more quickly than it was meant to. Another indicator of our special situation is that, while many twin moms' uterus measures 4-6 weeks ahead due to the extra baby, I am measuring a whopping 10 weeks ahead....and I definitely feel like I am rocking a baby belly that looks 31 weeks along instead of 21 weeks. Ah, which brings me to my next point - I gained 4 pounds this week! This is great news since weight gain has been a huge struggle throughout and the twins are growing rapidly at this point. Any fat on them is a huge help in their success outside of the womb, so bring it on! According to this, the boys are supposed to be about 10.5 inches long and just under 13 ounces each. I didn't get any official indication of their size today, but Baby B does still appear to be a smaller than his brother just by seeing them on the ultrasound. I will have another full anatomy scan of both boys in 2 weeks which will give us a clear idea of if Baby B is growing on track, just smaller, falling further behind, or has caught up.
And now - what you have all been waiting for...pictures!
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| Here we have Baby A kissing his brother's head. Adorable much? |
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| Here is Baby B's face, lower right, with the back of Baby A's head, top left. |
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| And here is Baby A's face, lower right, with the back of Baby B's head, top left, and hand resting on top of Baby A's head. |
Thursday, July 7, 2011
A First.
We had another appointment today and for the most part, it was uneventful. This. Is. Great. While Baby B is still measuring 20% smaller, he hasn't fallen back any further. He also even had a bit more fluid around him today, although the tech did tell me not to get too caught up in that number with such a small gain, it is still a step in the right direction. Keep peeing little man! The umbilical dopplers were also stable and within adequate range, although it did take a LONG time to get a reading. The boys were very uncooperative today, but that means they are able to move around in there freely and feeling good. Something that has never happened to me before happened, I totally teared up seeing them on the screen. I've never cried at an ultrasound before. I wasn't anxious going into the appointment, so it wasn't tears of relief. I was just really, really happy to see my boys today. I also really loved today's sonographer; very peppy, explained everything she was seeing and how it related to where they were in my body. Speaking of which, they are both now head down with Baby A on my left and Baby B on my right. Their little faces are smushed right next to each other. Another first was that the machine I was on today had 3-D capabilities, either that, or the sonographer just likes to treat her patients (reeeeaaallly hope to see her again). Baby A adamantly refused to show his face, but we did catch quite a bit of Little Man B bringing his hands to his face and "smiling". Honestly, they look creepy when they are so little. They probably are rocking an average of 10 or 11 oz a piece. Still, it was great to see them . Hopefully you can figure out what you are looking at below:
Friday, July 1, 2011
Friday Follow Up
We had our follow up appointment this morning and it went really well! The twins are still doing great with good heart rates and appropriately sized bladders. The test that we will be having done regularly, and that was completed this morning, is called an Amniotic Fluid Index (AFI). It does exactly what it sounds like, measures the deepest vertical pocket of amniotic fluid. The results today were very consistent with what we saw on Tuesday. Still just within the ranges of "normal", but stable. They also performed dopplers on the umbilical cords to track the blood flow in and out of the babies. These tests are giving us a good baseline to with which to compare future tests in order to determine if intervention is necessary. Because the AFI was favorable, I will not need to continue appointments every three days, but can stick with once a week appointments at the perinatal center. Dr. R. was very pleased to see no change and mentioned that it had been a very rough week, so this bit of good news went a long way for her too. She also let us know that she spoke to the doctor down at University of Maryland Medical (UMM) about our case so they are aware of us and ready to step in should we need that extra care, but for now we can stick to being monitored at SJMC,which is great since it is so incredibly close by and I am familiar/comfortable with the campus.
We are so thankful for your thoughts and prayers. Please continue to pray that AF levels remain adequate and that Baby B is getting enough nutrients to develop properly. Survivors of TTTS do have an increased risk for neurological problems. Also pray that when they check the babies' growth in a few weeks that Baby B will have had some gains and that Baby A continues to grow on track. For now, we have so much to be thankful for - like, no bed rest yet! The thought of being on bed rest, especially for an extended period of time is extremely daunting to me as we try to prepare for these little guys. I am also trying to shower Audra with lots of physical attention when I can as it is already very difficult for me to pick her up or have her as close to me as she'd like when she requests a cuddle. She is definitely aware that this is a change and it frustrates her. I am hoping that we can continue to enjoy this summer time with friends and outdoor activities since it is inevitable that she will have quite a shock whenever the babies arrive whether it is in September (crazily a possibility at this point!) or November.
We are so thankful for your thoughts and prayers. Please continue to pray that AF levels remain adequate and that Baby B is getting enough nutrients to develop properly. Survivors of TTTS do have an increased risk for neurological problems. Also pray that when they check the babies' growth in a few weeks that Baby B will have had some gains and that Baby A continues to grow on track. For now, we have so much to be thankful for - like, no bed rest yet! The thought of being on bed rest, especially for an extended period of time is extremely daunting to me as we try to prepare for these little guys. I am also trying to shower Audra with lots of physical attention when I can as it is already very difficult for me to pick her up or have her as close to me as she'd like when she requests a cuddle. She is definitely aware that this is a change and it frustrates her. I am hoping that we can continue to enjoy this summer time with friends and outdoor activities since it is inevitable that she will have quite a shock whenever the babies arrive whether it is in September (crazily a possibility at this point!) or November.
Thursday, June 30, 2011
Back to the Future: reviewing how we got here
I found out that I was pregnant on March 19, 2011 and we gradually got used to the idea that we would be welcoming another little Schwendy into our family sometime around November 23rd. Life always seemed to be busy with a very active toddler, both parents working full time and also in graduate school, but these things have a way of working themselves out and we set out to enjoy what freedom we felt we had in the next coming months before the new addition.
My ambitions of lightly exercising to stave off the morning sickness, which I had very mildly with Audra between 7 and 11 weeks pregnant, were quickly abandoned as I began to feel sick pretty much at 5 weeks along. We told my immediate family about the pregnancy at my father's very belated and my early birthday dinner the next weekend on March 26th. The drive up to the restaurant was pretty rough and I felt VERY sick - I chalked it up to nerves or car sickness, but since the sickness never went away I now realize that the morning sickness was just kicking in.
The news was shared by giving my dad "his gift", which was a tiny, little boys madras print sun hat. Nobody knew quite what to make of it until my younger sister exclaimed, "You're not pregnant..." and I sheepishly admitted that yes, I was. It may have been the only time my mother has been speechless! At that point Steve and I already had it in our heads that we would be having a little boy, which was odd because when I was pregnant with Audra we only ever considered having a girl and the thought of a baby boy was totally foreign, hence the purchase of the little hat. During that dinner my mom and sister were also fascinated by the bump/extreme bloating and necessary maternity top that I was already sporting. That was the beginning of the twin musings. Fraternal twinning does have a hereditary link through the maternal side due to hyperovulation (releasing 2 eggs instead of one) and my maternal grandmother was a fraternal twin herself. The next few weeks were spent chalking up the heightened pregnancy symptoms to being a second pregnancy, busy at work, Steve in class two nights a week, and having a very active almost 3 year old to wrangle at home.
About a week before my first appt, I finally called my OB practice to ask if it was normal to be throwing up bits of blood (ewwww) when vomiting and they kindly said that sometimes this happens from tears in the esophagus and to try some TUMS to reduce the acid content. The Dr. also mentioned that they could pull me in for a sonogram to see if it was a multiple pregnancy, but that normally those moms are sick 8 times a day so that I shouldn't worry and they'd see me at my regularly scheduled appointment in one week's time.
April 14 finally came around. When I was pregnant with Audra, my first appointment was very early - we had our "viability" ultrasound when I was only 6 weeks 4 days along. The wait to our 8 week appointment seemed much, much longer. Steve and I were very nervous that morning as we took Audra to school and headed to our appointment. When we were called in the sonographer barely touched down on my abdomen before asking me to go to the bathroom and come back for an internal ultrasound so they could have more detail. During these few minutes I was preparing myself and Steve for them to tell me that they did not see a heartbeat since I knew they could see Audra right away even though that she was 2 weeks earlier in gestation at my first ultrasound with her. When I was settled back the sonographer very quickly said, "Well - you know how you've been so sick? That's because there's two in there!" Steve and I just laughed. When she finally turned the screen towards me so that I could see I commented on the fact that there was still only one black oval - are they identical?? She confirmed that they appeared to be. I also made sure to ask that there were only two in there, you can never be too sure!
The two weeks following that included our trip to San Francisco to visit Steve's sister and her husband and to share our news. They were also very stressful because of the fact that they had not seen a separating membrane between the twins at the initial visit, and though that condition (Monochoronic-Monoamniotic) is very rare, it was tough to wait until our next perinatal appointment to make sure that there was a membrane and the two cords becoming knotted was not likely. Thankfully, we saw the membrane on our May 2nd appointment and it was once again confirmed that the twins were identical and shared a placenta. This is called Monochorionic - Diamniotic (MoDi) twinning. This was a time for celebration and praise (or as much was possible with my moderate to severe all-day-sickness).
We continued to have positive appointments at 11w6d and 15w5d, seeing them on the ultrasound and hearing their heartbeats without any further instructions other than to eat whatever I can whenever it stays down. Through researching MoMo twins I also became aware of the other risks involved with identical twins beyond the risks of a multiple pregnancy. I tried to keep my reading to a limit since there are always horror stories on the internet and to stick with the recent research. Going into our appointment this past Tuesday I was aware of the fact that identical twins run a higher risk of some congenital defects, and of Twin to Twin Transfusion Syndrome (TTTS) which only occurs in monochorionic pregnancies.
I woke up early on Tuesday anxious to get Audra ready for "school" and to go find out if we were having boys or girls. Like I mentioned before, they were always boy(s) to me. We hadn't discussed any girl names, I picked out boy crib bedding, and referred to them as the crazy boys who needed to give me a break with this sickness already. I was also anxious to "see" them on the screen since it had been 6 weeks since my last ultrasound and to check on their development. To this point both babies had been measuring right on track with their gestational age, measuring only 1 day apart.
Steve and went into the exam room and the ultrasound began. It wasn't too long before we saw boy parts (phew! mother's intuition was spot on) but it was pretty anticlimactic as I was glued to the screen, trying to discover any potential issues. We were happy to have the sonographer point out a perfect 4-chamber heart on one of the babies, but I was also very aware of the fact that while Baby A was measuring spot on at 19 weeks, Baby B was measuring quite a bit smaller. While size difference isn't uncommon, a 20% difference is fairly significant and points towards possible TTTS. The initial ultrasound was scheduled for an hour and we were pretty far beyond that with, what seemed to be, a lot of checks on the umbilical blood flow, another important factor in the growth and development of any child. They also checked to make sure that my cervical length was good and that I wasn't showing signs of preterm labor, thankfully these measurements were fine.
While we waited for the doctor to come in, I mentioned to Steve that the sizes of the babies seemed off and I thought it would be mentioned once the doctor came in to review everything. When our perinatologist came in, she immediately asked if we had ever discussed the risks of identical pregnancy with my OB or was aware of the potential complications. I confirmed that I had read up on some, mainly TTTS. She then set to work reviewing the findings and occasionally asking the sonographer questions. After about 5 minutes she started us off by stating that both twins' anatomy looks great. This is something to be HUGELY thankful for! At this point Dr. R began to discuss her concerns that the twins were developing TTTS.
There are basically 4 things doctors look at when diagnosing TTTS:
**this is literally my own words and not clearly not taken from a medical text, I reserve the right to be mistaken**
1 - The deepest vertical pocket of amniotic fluid surrounding the babies. Fluid levels should not be >8cm or <2cm. Right now our little guy is right above the low mark and our bigger guy is on the higher end of normal. Though the disparity is very concerning, I am relieved to know that right now each twin has enough fluid around them for now as I wait for my next appointment. This brings us to number two...
2 - The presence/size of bladders in both twins. Often, the smaller twin, referred to as the donor, has a much smaller bladder, or one that is not visible/functional. This is because of the lack of resources he is getting, and the amount of work he is doing to pump blood for himself and the larger twin, the recipient. Basically, the donor twin dehydrates and is creating no urine, which is the reason for the lack of amniotic fluid. Yes, the baby pee = the amniotic fluid. Our wonderful news is that both bladders are looking good so far. They are both well sized and not overfilled (as in the recipient) or underfilled/empty (as in the donor).
3 - The cause of all of these imbalances is too tricky for me to paraphrase so here you go: "...there is unequal exchange of blood between twins - placental sharing of nutrients, fluid and oxygen is not balanced. For one twin, the amount of blood that leaves through the vascular anastomoses is not replaced by an equal amount coming back. For the other, the amount received in the veins coming back from the placenta is more than was sent in the arteries to the placenta. This imbalance occurs mainly because of blood vessel problems deep in the placenta. Each twin has part of the placenta where his arteries put the blood in, and his veins drain the blood out. Between the fetuses, there is an area where the blood is brought in by one fetus' artery, but drained away by the other's vein. This artery-vein mismatch produces the imbalance between circulations. This imbalance affects each fetus, but in different ways." (taken from: http://www.obgyn.umm.edu/ttts/what.html) The extra time in our exam did show that Baby B's blood flow is restricted which then causes the growth delay that we see.
4 - Size difference: The 20% size difference isn't actually diagnostically sound since it could be the result of another condition (selective interuterine growth restriction), and that acute TTTS can occur so quickly that growth is not affected before it is caught. However, this is certainly a symptom of the condition. Baby B is definitely 20% smaller at this point.
The above link is from the University of Maryland school of Medicine and does a very good job of explaining this condition, and a few others, in a succinct manner so please refer to that and not blogging if you want more information.
At our appt. Dr. R. let us know that she was very concerned, this is a very dangerous condition - seriously threatening our children's lives, but that it was in the very beginning stages of developing. On the proposed staging chart of TTTS - we don't even fit into Stage 1 because the twins are still skirting the normal levels of amniotic fluid. I certainly hope and pray that flow of blood between the twins balances out and that we can move back from even "Stage 0" as Dr. R. called it. Technically, this could happen. And with a miracle, it could definitely happen!
From this point in our appointment we learned that there is an actual procedure, selective fetoscopic laser photocoagulation (SFLP), that can be done and that one of the best specialists in TTTS treatment/surgery works out of University of Maryland Medical Center! Dr. R. said she used to send patients to Florida for this surgery, but now UMMC has gotten so good at it she can refer them there! I am really feeling the blessing of being in Baltimore at this time with such great medical care at our fingertips, or at least within 10 miles.
I think this initial post has turned into quite the monster, so I will leave you here, asking for your continued prayers for our baby boys (!!!still super excited!!!), for Audra as she adjusts to a progressively encumbered Mom who is not always able to meet her carrying/cuddling needs, and for Steve and I as we continue to seek guidance from the doctors and from God. Even if things work out perfectly and without further risk, we still have a huge change ahead of us with adjusting to 3 kids, 3 and under!
Much Love,
Bethany
My ambitions of lightly exercising to stave off the morning sickness, which I had very mildly with Audra between 7 and 11 weeks pregnant, were quickly abandoned as I began to feel sick pretty much at 5 weeks along. We told my immediate family about the pregnancy at my father's very belated and my early birthday dinner the next weekend on March 26th. The drive up to the restaurant was pretty rough and I felt VERY sick - I chalked it up to nerves or car sickness, but since the sickness never went away I now realize that the morning sickness was just kicking in.
The news was shared by giving my dad "his gift", which was a tiny, little boys madras print sun hat. Nobody knew quite what to make of it until my younger sister exclaimed, "You're not pregnant..." and I sheepishly admitted that yes, I was. It may have been the only time my mother has been speechless! At that point Steve and I already had it in our heads that we would be having a little boy, which was odd because when I was pregnant with Audra we only ever considered having a girl and the thought of a baby boy was totally foreign, hence the purchase of the little hat. During that dinner my mom and sister were also fascinated by the bump/extreme bloating and necessary maternity top that I was already sporting. That was the beginning of the twin musings. Fraternal twinning does have a hereditary link through the maternal side due to hyperovulation (releasing 2 eggs instead of one) and my maternal grandmother was a fraternal twin herself. The next few weeks were spent chalking up the heightened pregnancy symptoms to being a second pregnancy, busy at work, Steve in class two nights a week, and having a very active almost 3 year old to wrangle at home.
About a week before my first appt, I finally called my OB practice to ask if it was normal to be throwing up bits of blood (ewwww) when vomiting and they kindly said that sometimes this happens from tears in the esophagus and to try some TUMS to reduce the acid content. The Dr. also mentioned that they could pull me in for a sonogram to see if it was a multiple pregnancy, but that normally those moms are sick 8 times a day so that I shouldn't worry and they'd see me at my regularly scheduled appointment in one week's time.
April 14 finally came around. When I was pregnant with Audra, my first appointment was very early - we had our "viability" ultrasound when I was only 6 weeks 4 days along. The wait to our 8 week appointment seemed much, much longer. Steve and I were very nervous that morning as we took Audra to school and headed to our appointment. When we were called in the sonographer barely touched down on my abdomen before asking me to go to the bathroom and come back for an internal ultrasound so they could have more detail. During these few minutes I was preparing myself and Steve for them to tell me that they did not see a heartbeat since I knew they could see Audra right away even though that she was 2 weeks earlier in gestation at my first ultrasound with her. When I was settled back the sonographer very quickly said, "Well - you know how you've been so sick? That's because there's two in there!" Steve and I just laughed. When she finally turned the screen towards me so that I could see I commented on the fact that there was still only one black oval - are they identical?? She confirmed that they appeared to be. I also made sure to ask that there were only two in there, you can never be too sure!
The two weeks following that included our trip to San Francisco to visit Steve's sister and her husband and to share our news. They were also very stressful because of the fact that they had not seen a separating membrane between the twins at the initial visit, and though that condition (Monochoronic-Monoamniotic) is very rare, it was tough to wait until our next perinatal appointment to make sure that there was a membrane and the two cords becoming knotted was not likely. Thankfully, we saw the membrane on our May 2nd appointment and it was once again confirmed that the twins were identical and shared a placenta. This is called Monochorionic - Diamniotic (MoDi) twinning. This was a time for celebration and praise (or as much was possible with my moderate to severe all-day-sickness).
We continued to have positive appointments at 11w6d and 15w5d, seeing them on the ultrasound and hearing their heartbeats without any further instructions other than to eat whatever I can whenever it stays down. Through researching MoMo twins I also became aware of the other risks involved with identical twins beyond the risks of a multiple pregnancy. I tried to keep my reading to a limit since there are always horror stories on the internet and to stick with the recent research. Going into our appointment this past Tuesday I was aware of the fact that identical twins run a higher risk of some congenital defects, and of Twin to Twin Transfusion Syndrome (TTTS) which only occurs in monochorionic pregnancies.
I woke up early on Tuesday anxious to get Audra ready for "school" and to go find out if we were having boys or girls. Like I mentioned before, they were always boy(s) to me. We hadn't discussed any girl names, I picked out boy crib bedding, and referred to them as the crazy boys who needed to give me a break with this sickness already. I was also anxious to "see" them on the screen since it had been 6 weeks since my last ultrasound and to check on their development. To this point both babies had been measuring right on track with their gestational age, measuring only 1 day apart.
Steve and went into the exam room and the ultrasound began. It wasn't too long before we saw boy parts (phew! mother's intuition was spot on) but it was pretty anticlimactic as I was glued to the screen, trying to discover any potential issues. We were happy to have the sonographer point out a perfect 4-chamber heart on one of the babies, but I was also very aware of the fact that while Baby A was measuring spot on at 19 weeks, Baby B was measuring quite a bit smaller. While size difference isn't uncommon, a 20% difference is fairly significant and points towards possible TTTS. The initial ultrasound was scheduled for an hour and we were pretty far beyond that with, what seemed to be, a lot of checks on the umbilical blood flow, another important factor in the growth and development of any child. They also checked to make sure that my cervical length was good and that I wasn't showing signs of preterm labor, thankfully these measurements were fine.
While we waited for the doctor to come in, I mentioned to Steve that the sizes of the babies seemed off and I thought it would be mentioned once the doctor came in to review everything. When our perinatologist came in, she immediately asked if we had ever discussed the risks of identical pregnancy with my OB or was aware of the potential complications. I confirmed that I had read up on some, mainly TTTS. She then set to work reviewing the findings and occasionally asking the sonographer questions. After about 5 minutes she started us off by stating that both twins' anatomy looks great. This is something to be HUGELY thankful for! At this point Dr. R began to discuss her concerns that the twins were developing TTTS.
There are basically 4 things doctors look at when diagnosing TTTS:
**this is literally my own words and not clearly not taken from a medical text, I reserve the right to be mistaken**
1 - The deepest vertical pocket of amniotic fluid surrounding the babies. Fluid levels should not be >8cm or <2cm. Right now our little guy is right above the low mark and our bigger guy is on the higher end of normal. Though the disparity is very concerning, I am relieved to know that right now each twin has enough fluid around them for now as I wait for my next appointment. This brings us to number two...
2 - The presence/size of bladders in both twins. Often, the smaller twin, referred to as the donor, has a much smaller bladder, or one that is not visible/functional. This is because of the lack of resources he is getting, and the amount of work he is doing to pump blood for himself and the larger twin, the recipient. Basically, the donor twin dehydrates and is creating no urine, which is the reason for the lack of amniotic fluid. Yes, the baby pee = the amniotic fluid. Our wonderful news is that both bladders are looking good so far. They are both well sized and not overfilled (as in the recipient) or underfilled/empty (as in the donor).
3 - The cause of all of these imbalances is too tricky for me to paraphrase so here you go: "...there is unequal exchange of blood between twins - placental sharing of nutrients, fluid and oxygen is not balanced. For one twin, the amount of blood that leaves through the vascular anastomoses is not replaced by an equal amount coming back. For the other, the amount received in the veins coming back from the placenta is more than was sent in the arteries to the placenta. This imbalance occurs mainly because of blood vessel problems deep in the placenta. Each twin has part of the placenta where his arteries put the blood in, and his veins drain the blood out. Between the fetuses, there is an area where the blood is brought in by one fetus' artery, but drained away by the other's vein. This artery-vein mismatch produces the imbalance between circulations. This imbalance affects each fetus, but in different ways." (taken from: http://www.obgyn.umm.edu/ttts/what.html) The extra time in our exam did show that Baby B's blood flow is restricted which then causes the growth delay that we see.
4 - Size difference: The 20% size difference isn't actually diagnostically sound since it could be the result of another condition (selective interuterine growth restriction), and that acute TTTS can occur so quickly that growth is not affected before it is caught. However, this is certainly a symptom of the condition. Baby B is definitely 20% smaller at this point.
The above link is from the University of Maryland school of Medicine and does a very good job of explaining this condition, and a few others, in a succinct manner so please refer to that and not blogging if you want more information.
At our appt. Dr. R. let us know that she was very concerned, this is a very dangerous condition - seriously threatening our children's lives, but that it was in the very beginning stages of developing. On the proposed staging chart of TTTS - we don't even fit into Stage 1 because the twins are still skirting the normal levels of amniotic fluid. I certainly hope and pray that flow of blood between the twins balances out and that we can move back from even "Stage 0" as Dr. R. called it. Technically, this could happen. And with a miracle, it could definitely happen!
From this point in our appointment we learned that there is an actual procedure, selective fetoscopic laser photocoagulation (SFLP), that can be done and that one of the best specialists in TTTS treatment/surgery works out of University of Maryland Medical Center! Dr. R. said she used to send patients to Florida for this surgery, but now UMMC has gotten so good at it she can refer them there! I am really feeling the blessing of being in Baltimore at this time with such great medical care at our fingertips, or at least within 10 miles.
I think this initial post has turned into quite the monster, so I will leave you here, asking for your continued prayers for our baby boys (!!!still super excited!!!), for Audra as she adjusts to a progressively encumbered Mom who is not always able to meet her carrying/cuddling needs, and for Steve and I as we continue to seek guidance from the doctors and from God. Even if things work out perfectly and without further risk, we still have a huge change ahead of us with adjusting to 3 kids, 3 and under!
Much Love,
Bethany
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