Here is an email I sent to my family earlier today.
Hello everyone. Thanks for all the emails and calls and sorry I haven't been able to respond to all of them. I love hearing from you though!!
I'm downstairs in the maternal fetal office where I have all of my normal appointments. I saw my own doctor today which was nice. We had an ultrasound to measure their size and their fluid levels and both are doing surprisingly well. They're both about 5 cm. The smaller baby weighs 2 lb 10 oz in the 17.6th percentile and the bigger one weighs almost 4 pounds at 3 lb 14 oz in the 61.7th percentile. They are at 29 weeks and 31 weeks 1 day respectively. Got all that? Such great progress! That's 6 lb 8 oz of baby in my belly!
Whether I'll need a c section or not is still kind of up in the air. Some doctors I talk to say yes, you will have a c section no matter what. Others say you'll have one if the smaller one is breech and another has said if we can keep them in a little longer we can still pull the smaller one out vaginally. A lot of it depends on what my doctor is comfortable with. We sure wouldn't want to try and deliver them vaginally and then have to cut my cervix because the little one's head is too big compared to his body. Eek!!
The doctor I talked to after my ultrasound said it is less likely that I'll go into spontaneous labor than another woman whose water broke this early simply because the surgery made it so much more likely that my water will break. They know my water didn't break because of some other kind of complication that will also make me go into labor. Make sense?
Ryan will be gone most of the day today. He works and then refs his last game for the season and will come back for a little while and then go to his little brother's LAST regular season game. I'm sorry I have to miss it but the state tournament has a live feed online and the later tournament games will be on TV so hopefully they make it far in the tournament!
I'm now done with my non stress test. I'll be going down there every day whenever they can fit me in. The little ones behaved really well and so the test was nice and short...only about 25 minutes which is rare with twins.
The food hasn't been too bad. They let you choose what you want each day. My nurses have all been great. I'm back in my own clothes which is much more comfortable. They have me wearing leg wraps that squeeze my calves so I don't get blood clots. It took me a little while to get used to them but then I was able to sleep just fine. Kind of like a mini massage. Speaking of massages, they have a massage therapist come in on Tuesdays and Thursdays. I need to make sure I'm on the list!!
I'm having some minor contractions but they don't hurt too much. Several times this morning my back has started hurting really bad very suddenly...to the point that I can barely breath. Thankfully it hasn't lasted! I'm also gonna take a shower in the next little while...one of the highlights of my day!! :)
Well that's a lot of info so don't get too bored when I send you emails. I might just post this as a blog so don't be disappointed when it's the same stuff :) Love you all!!
Sarah
Showing posts with label Pregnancy. Show all posts
Showing posts with label Pregnancy. Show all posts
Tuesday, February 22, 2011
Monday, February 21, 2011
Yeah, I'm in the hospital.
On Saturday night, we came home late from my in laws house and were getting ready for bed when my water broke at about 11:15. It wasn't a ton of fluid but I noticed right away. At our last appointment they told me the larger baby's amniotic fluid wasn't clear. On the ultrasound this made his intestines look shiny, basically from digesting blood. I could tell right away that must be what was coming out! We got ready right away (using the list I made weeks ago. Good thing I had so much time to prepare :) and left after talking to the doctor on call. The doctor here used three different tests and found that it had broken and said I'll be here until I deliver.
It could be up to four weeks until I have them. After your water breaks, there is a high risk that the babies will get infected because there is no protective barrier around them. They've found that up until 34 weeks it is worth the risk of infection to keep them inside but after that it's just better to deliver. They've developed enough that it's safer to avoid that risk. For me, thirty four weeks would be March 18th. I can do this, right?!
I'm on antibiotics almost constantly. I'll have two days of IV antibiotics and then five days by mouth. They gave the second round of steroids for their lung development (butt shot!) and if we can keep them in for 48 hours they will be fully effective. If I go into labor, they won't try to stop it because labor is usually one of the first signs of infection. Also, if I were to deliver now, I would have a c-section because the babies are so small. We'll have to wait until Tuesday because of the holiday to find out how big they are but I'm guessing they're about 2.5 and 3.5 pounds.
The first day I was here they had me downstairs on the labor and delivery floor. I wasn't allowed to eat or drink and the babies and my contractions were being monitored constantly which got to be a nuisance. I had to stay in the same position as much as possible and when I went to the bathroom it felt like a huge fiasco. But now I'm up on the postpartum floor. Up here I just record whenever I have contractions and the heartbeats are checked once per shift. Yay! My second nurse was a lady I had back in October when I was 13 weeks along. She even remembered I was here for Halloween!
As a side note, they switched baby A to B and B to A, so that makes it confusing for us! As of now, the bigger one is in the A position with his head down. The smaller one keeps flipping so there's no way to know where he'll be.
I've gotten about 6 hours of sleep in the last two nights so hopefully I can go back to bed soon. They came in at 2 am to give me the steroids and another round of antibiotics. The first antibiotic was making my arm hurt about 6 or 7 inches up my arm so my nurse gave me a warm blanket to help with the pain but I had to call her back in after a little while because my arm was super swollen. The IV was still in my arm but had slipped from the vein so it was filling up my arm with the medicine. My nurse said she should have listened to me when I said it hurt...well yeah! haha but things are all settled now after another vein was stubborn and they had to give me a smaller IV needle. So here's to an undetermined length of time in the hospital! Wish me luck!!
It could be up to four weeks until I have them. After your water breaks, there is a high risk that the babies will get infected because there is no protective barrier around them. They've found that up until 34 weeks it is worth the risk of infection to keep them inside but after that it's just better to deliver. They've developed enough that it's safer to avoid that risk. For me, thirty four weeks would be March 18th. I can do this, right?!
I'm on antibiotics almost constantly. I'll have two days of IV antibiotics and then five days by mouth. They gave the second round of steroids for their lung development (butt shot!) and if we can keep them in for 48 hours they will be fully effective. If I go into labor, they won't try to stop it because labor is usually one of the first signs of infection. Also, if I were to deliver now, I would have a c-section because the babies are so small. We'll have to wait until Tuesday because of the holiday to find out how big they are but I'm guessing they're about 2.5 and 3.5 pounds.
The first day I was here they had me downstairs on the labor and delivery floor. I wasn't allowed to eat or drink and the babies and my contractions were being monitored constantly which got to be a nuisance. I had to stay in the same position as much as possible and when I went to the bathroom it felt like a huge fiasco. But now I'm up on the postpartum floor. Up here I just record whenever I have contractions and the heartbeats are checked once per shift. Yay! My second nurse was a lady I had back in October when I was 13 weeks along. She even remembered I was here for Halloween!
As a side note, they switched baby A to B and B to A, so that makes it confusing for us! As of now, the bigger one is in the A position with his head down. The smaller one keeps flipping so there's no way to know where he'll be.
I've gotten about 6 hours of sleep in the last two nights so hopefully I can go back to bed soon. They came in at 2 am to give me the steroids and another round of antibiotics. The first antibiotic was making my arm hurt about 6 or 7 inches up my arm so my nurse gave me a warm blanket to help with the pain but I had to call her back in after a little while because my arm was super swollen. The IV was still in my arm but had slipped from the vein so it was filling up my arm with the medicine. My nurse said she should have listened to me when I said it hurt...well yeah! haha but things are all settled now after another vein was stubborn and they had to give me a smaller IV needle. So here's to an undetermined length of time in the hospital! Wish me luck!!
Friday, February 11, 2011
Freedom!
I'm very happy to inform you that I am no longer on bed rest. How great is that? We had our appointment on Wednesday and I made sure to ask about the reasons I'm still on bed rest. The big concern after my surgery was that the blood clot in my uterus would become unattached and make my water break. The blood clot has been slowly absorbed back into my body. They believe they can see a remnant of the clot still, but nothing that is a concern.
I've loved being able to do more the past couple days. The day of my appointment I had so much energy because I was just so excited :) I've been doing chores around the house and went to a few stores too. It's a lot more fun than I ever remembered! It has been a great birthday present to me!!
The only lame thing about being off bed rest so far is that I don't have a car. My car sat for about a month and a half without being driven and the battery died. Died, as in dead completely. Forever. We kept meaning to drive it randomly or just start it when it was really cold out side, but we didn't, and now we're paying for it. Literally.
At our appointment we got a 3D picture of one of the babies. It's a picture of baby A who is now head up (the little stinker!) But everything else is going very well with these little ones!
I've loved being able to do more the past couple days. The day of my appointment I had so much energy because I was just so excited :) I've been doing chores around the house and went to a few stores too. It's a lot more fun than I ever remembered! It has been a great birthday present to me!!
The only lame thing about being off bed rest so far is that I don't have a car. My car sat for about a month and a half without being driven and the battery died. Died, as in dead completely. Forever. We kept meaning to drive it randomly or just start it when it was really cold out side, but we didn't, and now we're paying for it. Literally.
At our appointment we got a 3D picture of one of the babies. It's a picture of baby A who is now head up (the little stinker!) But everything else is going very well with these little ones!
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| That's his hand up by his face. Tell me who you think he looks like! |
Sunday, January 30, 2011
Update:
There has been a lot going on in my head recently because I obviously have a lot of time to think about things. I told Ryan several weeks ago that I often catch myself staring blankly at walls or floors or other inanimate objects. I'll probably be doing a lot more of that when I'm so sleep deprived I can't see straight! There's usually a lot going on in my head but Ryan just asked if I start rocking back and forth too. I've also been spending a lot of time researching different topics: breast feeding, looking up local NICU visiting hours, where to find the cheapest diapers, how to use a baby carrier, which car seats to get, how to take care of babies (which I really don't know much about and THAT scares me!)
We had an appointment last Wednesday and the babies weigh 1 pound 9 ounces at the 25th percentile and 2 pounds 6 ounces at the 61st percentile. When we had our surgery, they told us our smaller baby was in less than the 3rd percentile so don't be disheartened by the smaller baby's size. He's come a long way and we're so happy about that! The doctor told us that size becomes a concern if they are in less than the 10th percentile or so.
I've come to realize that the toughest part about being on bed rest isn't that I get bored and need to go shopping or find a movie to entertain myself. I've gotten a lot better at finding things to do! The hardest part has definitely been feeling useless. I can't do much to help people, make dinner, clean the house, or help make Ryan's day less busy. While it has become easier to let people help, it has only gotten harder not to be able to help. I know these babies of ours will be a ton of work when they come and it's hard to remember that my body is providing everything they need in an amazingly efficient way. In fact, it's providing much better for them than any care or technology could if they were born this early. I just need to remember that! I feel so blessed to be able to still provide for these little ones. They certainly are, and will continue to be, our little miracles.
As for now, if anyone wants to come visit, I'm always game :)
We had an appointment last Wednesday and the babies weigh 1 pound 9 ounces at the 25th percentile and 2 pounds 6 ounces at the 61st percentile. When we had our surgery, they told us our smaller baby was in less than the 3rd percentile so don't be disheartened by the smaller baby's size. He's come a long way and we're so happy about that! The doctor told us that size becomes a concern if they are in less than the 10th percentile or so.
I've come to realize that the toughest part about being on bed rest isn't that I get bored and need to go shopping or find a movie to entertain myself. I've gotten a lot better at finding things to do! The hardest part has definitely been feeling useless. I can't do much to help people, make dinner, clean the house, or help make Ryan's day less busy. While it has become easier to let people help, it has only gotten harder not to be able to help. I know these babies of ours will be a ton of work when they come and it's hard to remember that my body is providing everything they need in an amazingly efficient way. In fact, it's providing much better for them than any care or technology could if they were born this early. I just need to remember that! I feel so blessed to be able to still provide for these little ones. They certainly are, and will continue to be, our little miracles.
As for now, if anyone wants to come visit, I'm always game :)
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| Here I am at 24 weeks (three weeks ago) |
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| Ryan and I at my last volleyball banquet EVER. I'm at 27 weeks. |
Friday, December 31, 2010
Peace of Mind
After we had our surgery, our doctor said it was important to have weekly checkups for four weeks. There is still some risk for a month that the babies' systems will not have stabilized. Today was our fourth checkup and the news was good! During the past few weeks, they didn't measure the growth of the babies because the appointments were so close together but today, Baby A weighed 15 ounces and Baby B weighed 1 pound 8 ounces. Though that seems like a huge difference because of how small they are, they measure only one week apart. That means A isn't catching up to B yet, but he's certainly not lagging behind! In addition, both of their fluid levels are right around 4 cms. Yay!
I felt huge relief after this appointment. It is strangely a huge comfort to know that they will soon both weigh at least a pound and that they can only get bigger! I hear and have read stories about babies that were born weighing a pound and still surviving. It's just nice to know there is now a chance, no matter what happens in the next few weeks! What a relief!
Saturday, December 18, 2010
The NEED...
I warned Ryan tonight that after I have these little guys, I will most definitely be going shopping. I don't think I've shopped for clothes since May and I am feelin the need. In addition, it doesn't help that I have seemingly endless amounts of time to shop online for cute, small clothes that I wouldn't even be able to fit into right now! And who wants to shop for maternity clothes, anyway? I'd rather spend the money on clothes to wear when I'm skinny again (but who knows when that will be! :) Keep in mind that I'm not the type of girl that wants to go shopping all the time. I like it, but mostly I find it frustrating because nothing fits. But I'll ignore that problem now and say that I'm definitely needing a SHOPPING TRIP! Ok, done with my rant :)
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Wednesday, December 15, 2010
Our Little Baby Adventure
This may take you a while to read so make sure you're comfortable!
About 8 weeks ago, when I was 13 weeks along, I started getting cramps. They were very minor but I noticed them right away. I guess when you get pregnant, you become extra sensitive with how your body is feeling because everything changes so fast. Additionally, when you start getting random pains, you worry something is wrong. Ryan and I were supposed to go out to Tooele with some of his brothers to go shooting with his brother in law that's a highway patrolman. We made it down to the Collette's house and I was in more pain so I decided not to go. I really encouraged Ryan to go even though he offered to stay. Things weren't too bad at that point and I didn't want him missing out on the fun just because I needed to.
The pain continued to get worse and worse. I called the doctor on call for my OB office and she said that I should make sure to drink a lot of water and let her know if anything changed. I've learned since that when women get dehydrated, especially in the summer, they can get contractions because the hormones that cause contractions have a higher concentration in your body without the needed hydration. Anyway, I wasn't able to keep anything down. By that time I'd thrown up 3 or 4 times. I was sick a lot anyway, and I think the pain from the contractions made the nausea worse. By this time I was really miserable. Bree, my sister in law, came over with a heat pack from my belly. I had to be careful because the heat can cause brain damage to the babies.
A little while later I started bleeding, and a little later I was bleeding a lot. I had called the doctor several times and she said if the bleeding got worse, to come into the ER. It was bad enough that there wasn't really a way to contain it with pads. By that time, Ryan had gotten home. He and his dad and Ryan, our brother in law gave me a priesthood blessing and soon after we left for the hospital.
We got into the ER very quickly. I don't think there was one person waiting in front of us. What a blessing! We were obviously very worried at this point and I was in a lot of pain. They got us into a room, I got an IV, and put me on morphine for the contractions and Zofran for the nausea. Wow, it helped considerably. Ryan likes to tell people I got hooked after one dose of morphine because I wanted it so often in the coming weeks. I say, who wouldn't?!
I got my first pelvic exam...whoopie! And then it felt like we waited forever. They finally took us down to get an ultrasound and the tech took a very long time with the examination (I have since learned that that exam was nothing compared to the ultrasounds I've had since :) and it felt like he wouldn't tell us anything! I was so nervous and desperate for information! But, he did give us some big news...they're boys!!! We knew by this time that they were identical but not their sex. He got a picture of both of them in the same shot with their "twig and berries." Yep...how funny is that?! We found out that I had a medium sized hemorrhage in my uterus and that I might be on bed rest for a while. We had instructions to go back to my OB on Monday.
This was the beginning of lots and lots of doctor visits. It really hasn't been too bad going in for visits. But it is always emotional for me. Not in the sense that I cry when I go in, but that I'm nervous for whatever news they have to give me. I get scared every visit that we'll go in and one of my babies won't have a heartbeat. I guess it's just a natural instinct to be worried, but it's amazing how attached I've become to these children that I can't see or touch. Each and every one of the sacrifices I make for them help me love them and want them here with me even more.
We went back into our OB on Monday and the doctor we met with really bugged me. She wasn't our regular doctor, just another one in the office. She seriously downplayed our situation and said the hemorrhage wasn't bad at all and that I didn't need to be on bed rest. We were grateful for the news but I really felt that she was not compassionate in any way and just wanted to get rid of us quickly.
For the next week, I was still very careful. It was painful to move and so I stayed on bed rest as much as I could. My sister was in town so that was a HUGE help! She kept me company and helped clean the house and made me food. It was a crazy coincidence that she was there that week but also, such a huge blessing.
That Friday, I woke up from a nap and there was blood everywhere. Sorry for the details if this grosses you out, but it was bad. There was a huge spot on the mattress, on the floor from trying to get up and a trail all the way to the bathroom. I immediately got into the shower and texted Ryan. I was having contractions and was in some pain. At first, I didn't want Ryan to come home but after a few minutes, with the bleeding not getting any better, and the contractions continuing, I called him. He wasn't answering his phone so I kept at it, all the while, laying in the bottom of the shower. Ryan was out doing carts and a friend at work brought his phone out because she saw I kept calling. He knew it couldn't be good because I don't call him at work. He came home right away and as soon as he got home, I felt so much better emotionally. I was so scared and he has such a calming influence on me. He cleaned up the mess and helped me out of the shower and went to call the doctor. This was on a Friday and our doctor's office was still open so we went in right away.
They had to stay open a little later because of us. They did an ultrasound and the boys looked great, just as they had the week before in the ER. The doctor wanted to know how much blood I was losing currently, so they cleared out all the pooled blood and checked the flow from my cervix. It wasn't too bad at that point but they could tell from my blood pressure and heart rate when I was laying down, sitting, and standing, that I had lost a lot of blood. It was enough blood that the doctors were concerned it wouldn't be safe for me to continue the pregnancy. We were checked into the hospital to stay the night and one night turned into two. I got another blessing from Ryan and his dad after we got up to our room.
Our hospital stay consisted of monitors, an IV, a hard time getting up to go to the bathroom, keeping track of how much I was peeing, checking my blood pressure and heart rate every few hours, and checking my hematocrit every six hours. No wonder I was losing so much blood. They kept taking it from me! By the time I left the hospital, my hematocrit was stable but it had dropped to about 25 points. It needs to be 38 in order to donate blood. And by the way, that hospital food really does suck! Thankfully I had Ryan and my sister to go get food for me! My teammates, Miranda and Danielle came to visit and so did Jason and Amber. I'm so glad that they came! We left the hospital Sunday evening and were so grateful that I didn't need a blood transfusion and that my blood count was stable.
Over the next couple weeks I was very careful. I tried not to move around much. We had more doctor visits and they found that my blood count was increasing, which presumably meant I wasn't losing more blood. My doctor told me I no longer needed to be on bed rest. They also found some disturbing symptoms with the babies. Their heartbeats were looking fine, but they found that Baby B had a lot more fluid around him than Baby A. In the same visit, they found that Baby A had no visible bladder. Immediately, they were concerned about what was called twin to twin transfusion syndrome. They had warned us of the risks of this when we originally found out we were having identical twins because it can only occur in a situation where the babies share a placenta.
Twin to twin transfusion syndrome occurs randomly in about 10% of identical twins. There are about 9,000 cases in the US each year. When two (or more) babies share a placenta, the babies can actually share some of their blood. Usually this blood sharing is equal. In my case, the blood sharing was not equal. Blood vessels form that transport blood from one baby to the other and the donor baby does not get as much back as he is giving. My donor was Baby A and my recipient was Baby B. Because one baby has very little blood volume, he eventually shut down blood flow to his kidneys because his little body recognized he needed to keep all the fluid in him that he could. The kidneys stopped producing urine so there was no bladder visible on the ultrasound. The other baby, the recipient, had too much blood in his body so he started peeing excessively to get rid of that liquid. This is what creates the volume of fluid difference in the two babies. At first, my donor baby had about 2 cm of fluid with no bladder visible, and my recipient had 8 cm. Eventually, the fluid levels were about .5 cm on the donor and 13 cm on the recipient. Normal fluid levels were between 3 and 7 cm for their age. The smaller, donor twin, eventually had very little to no room for movement. He was considered a "stuck twin." I found it quite humorous that on the ultrasound, his back was to us with his little bum stuck straight up and no way to move. Don't think that I'm heartless for saying that, at this stage they were in no pain or distress.
It was much harder for me to come to the realization that something was wrong with my babies, rather than just that there was something wrong with me. I could handle the pain and the discomfort but I knew that if there was something wrong with my little boys, there was nothing I could do about it.
We worried a lot over the next few weeks. We didn't know what to expect. Twin to twin transfusion syndrome or TTTS can progress very rapidly. I'd read several cases where patients were rushed into surgery the day after they found their babies had TTTS. My doctor tried to set up an appointment with the specialist here in town that does the surgery but we were given a call later that week and the appointment was never scheduled. We found out at our next appointment, that because of the blood clot that I had in my uterus from the previous ER visit and hospital stay, he was not willing to do the surgery. This was a huge disappointment to us and our doctor even shared some of her frustration with the us that we were not going to be able to go to this doctor here in Utah.
We knew that we had to do everything we could to save our little babies so we planned a trip out to see a doctor in LA. Dr. Chmait has had a lot of experience with the surgery we would need to save our babies and we knew that if anyone would do the surgery, he would. He is the only doctor in the country that has shared the results of his surgeries and has much higher success rates than the average in the US. With his success rates, 90% of the time, at least one of the twins survives and 70% of the time, both twins survive. Without doing the surgery, 95% of the twins will die. It is amazing how much modern medicine has progressed. The odds are a miracle.
We were able to use all of the miles that I'd saved from traveling with my volleyball team for two and a half years plus some that Ryan had built up and were able to get our tickets for $60 each. My teammate, Stefanie Shardlow Neeley, grew up outside of LA and I asked her parents if we could stay at their house while we were out in California for the surgery. They were so gracious to let us stay in their home and let us use their car. We are so grateful to the Shardlows!!
Our appointment was Wednesday the 1st early in the morning so we woke up very early to make it into Hollywood on time with the traffic. Thankfully, we could use the carpool lane. We got there and met Terri, the nurse, and Ashley, the ultrasound tech that would be working with us for the next few days. They are awesome! Along with Dr. Chmait, we worked with some of the best people out there. We filled out some paperwork and started the ultrasound. It normally takes an hour and a half to two hours but it ended up taking us about three. My boys were right on top of each other and it made it really hard for Ashley to find the things she needed to. She has been doing ultrasounds for this type of surgery for 11 years and you could tell she was VERY focused. For the next few days, their position made it very difficult for Ashley in the two different ultrasounds and for the cardiologist. I think it's pretty cute that it was almost like they were hugging each other with their heads together for several days. They were worried too!! :)
Dr. Chmait eventually came in and introduced himself. This was probably the hardest time of our trip. He came in to present to us our options and discuss the risks. He was not aware that I was still leaking blood but thought before we came out to LA, that the bleeding had stopped. He told us there were five options. The first was to do nothing. The second option was to terminate the pregnancy. The third was to terminate the life of one baby so that the other would survive. If one baby were to pass because of the TTTS, it was very likely that the other would also die. This eliminates the possibility of the second one dying. This option was not normally offered by Dr. Chmait because of moral reasons, but because of the serious risks associated with my particular case, he would put us in contact with those who could do it. The fourth option was to do an amnioreduction to decrease pressure on the uterus. This doesn't actually solve the problem, it just is like a bandaid to the problem. You just hope that it holds until they can survive outside the womb. The fifth option was the surgery that we had come to do. We didn't realize what a great risk the surgery was in our particular case. Because of the blood clot that was in my uterus, the amniotic fluid would not be clear enough for Dr. Chmait to do the surgery. In addition, the proteins in the blood weaken the membranes around the babies. The surgery requires the membrane to be punctured and this would further weaken the membrane. The first problem could hopefully be solved. Dr. Chmait would be able to do a fluid exchange to pull out the dark fluid and put in clear fluid. This would add extra time to the surgery, increasing the risks for the baby. For the second problem, there is not much to be done. With the surgery, it would be very likely that my water would break very early, leading to premature babies and a high likelihood of severe brain damage. Ryan and I had a lot of thinking and praying to do.
We left the hospital and were able to contact one of Dr. Chmait's previous patients who was in a very similar situation to us. In over 500 surgeries that he's done, I am only the second case with a blood clot that would cause these complications. We prayed and felt strongly that we were in LA for a reason and that we should go ahead with the surgery. It was easy to eliminate the first three options and the fourth also created problems with weakening the membrane and the possibility of brain damage. We were able to talk to Melanie and hear her experience. We also found out that she was LDS and we don't believe that this was a coincidence. She had the surgery at 17 weeks and her water broke at 19 weeks. Through a miracle she was able to keep the babies until 27 weeks. Her girls were born and 10 days later one of them died. The other still has severe developmental problems related to prematurity. Her experience was very scary and was really all we could relate to, but we knew that it was the Lord's will for us to be pregnant in the first place. We knew it was His will that we have twin boys, that we would be in this situation, and that we should go forward with the surgery. We knew that if it was His will to do the surgery, we would be put in whatever situation He wanted for us. If He wants us to have two healthy boys, we know it can happen. If He wants us to have children with severe problems and handicaps, then we know that He will have entrusted them to our care and He will help us through it.
We went back to tell them what we had decided and went ahead with preparations for surgery. It was already scheduled for the next morning. We returned the next morning and made further preparations. There was another surgery scheduled for a woman at 7:30 and mine was at 9 so we had to be there by 7. I was able to watch parts of the surgery on my own monitor because they only did a local anesthetic on my stomach. The incision on my belly is tiny! They ended up taking out about a liter of fluid total after cleaning out all the fluid. The fluid was completely black from the blood. Crazy! I heard the doctor say right before the surgery that he had asked his little boys to pray for him for this surgery and later he told me if he had known it would have gone so well, he would have slept a lot better the night before. He also said he was as positive as it was possible for him to be that all of the blood vessels between the babies were lasered.
We had to stay the night in the hospital and the ultrasound was the next morning. I had contractions during and after the surgery so I was on magnesium to stop the contractions. Because of the magnesium I was on a clear liquid diet. So, I ate lots of jello! Through the night I was in some serious pain. It would happen when I would breath deeply or move my shoulders at all but I had a great amount of pain in my chest and shoulders. The doctors weren't really sure what it was but OWW! Thankfully it was gone by the next morning.
About 8 weeks ago, when I was 13 weeks along, I started getting cramps. They were very minor but I noticed them right away. I guess when you get pregnant, you become extra sensitive with how your body is feeling because everything changes so fast. Additionally, when you start getting random pains, you worry something is wrong. Ryan and I were supposed to go out to Tooele with some of his brothers to go shooting with his brother in law that's a highway patrolman. We made it down to the Collette's house and I was in more pain so I decided not to go. I really encouraged Ryan to go even though he offered to stay. Things weren't too bad at that point and I didn't want him missing out on the fun just because I needed to.
The pain continued to get worse and worse. I called the doctor on call for my OB office and she said that I should make sure to drink a lot of water and let her know if anything changed. I've learned since that when women get dehydrated, especially in the summer, they can get contractions because the hormones that cause contractions have a higher concentration in your body without the needed hydration. Anyway, I wasn't able to keep anything down. By that time I'd thrown up 3 or 4 times. I was sick a lot anyway, and I think the pain from the contractions made the nausea worse. By this time I was really miserable. Bree, my sister in law, came over with a heat pack from my belly. I had to be careful because the heat can cause brain damage to the babies.
A little while later I started bleeding, and a little later I was bleeding a lot. I had called the doctor several times and she said if the bleeding got worse, to come into the ER. It was bad enough that there wasn't really a way to contain it with pads. By that time, Ryan had gotten home. He and his dad and Ryan, our brother in law gave me a priesthood blessing and soon after we left for the hospital.
We got into the ER very quickly. I don't think there was one person waiting in front of us. What a blessing! We were obviously very worried at this point and I was in a lot of pain. They got us into a room, I got an IV, and put me on morphine for the contractions and Zofran for the nausea. Wow, it helped considerably. Ryan likes to tell people I got hooked after one dose of morphine because I wanted it so often in the coming weeks. I say, who wouldn't?!
I got my first pelvic exam...whoopie! And then it felt like we waited forever. They finally took us down to get an ultrasound and the tech took a very long time with the examination (I have since learned that that exam was nothing compared to the ultrasounds I've had since :) and it felt like he wouldn't tell us anything! I was so nervous and desperate for information! But, he did give us some big news...they're boys!!! We knew by this time that they were identical but not their sex. He got a picture of both of them in the same shot with their "twig and berries." Yep...how funny is that?! We found out that I had a medium sized hemorrhage in my uterus and that I might be on bed rest for a while. We had instructions to go back to my OB on Monday.
This was the beginning of lots and lots of doctor visits. It really hasn't been too bad going in for visits. But it is always emotional for me. Not in the sense that I cry when I go in, but that I'm nervous for whatever news they have to give me. I get scared every visit that we'll go in and one of my babies won't have a heartbeat. I guess it's just a natural instinct to be worried, but it's amazing how attached I've become to these children that I can't see or touch. Each and every one of the sacrifices I make for them help me love them and want them here with me even more.
We went back into our OB on Monday and the doctor we met with really bugged me. She wasn't our regular doctor, just another one in the office. She seriously downplayed our situation and said the hemorrhage wasn't bad at all and that I didn't need to be on bed rest. We were grateful for the news but I really felt that she was not compassionate in any way and just wanted to get rid of us quickly.
For the next week, I was still very careful. It was painful to move and so I stayed on bed rest as much as I could. My sister was in town so that was a HUGE help! She kept me company and helped clean the house and made me food. It was a crazy coincidence that she was there that week but also, such a huge blessing.
That Friday, I woke up from a nap and there was blood everywhere. Sorry for the details if this grosses you out, but it was bad. There was a huge spot on the mattress, on the floor from trying to get up and a trail all the way to the bathroom. I immediately got into the shower and texted Ryan. I was having contractions and was in some pain. At first, I didn't want Ryan to come home but after a few minutes, with the bleeding not getting any better, and the contractions continuing, I called him. He wasn't answering his phone so I kept at it, all the while, laying in the bottom of the shower. Ryan was out doing carts and a friend at work brought his phone out because she saw I kept calling. He knew it couldn't be good because I don't call him at work. He came home right away and as soon as he got home, I felt so much better emotionally. I was so scared and he has such a calming influence on me. He cleaned up the mess and helped me out of the shower and went to call the doctor. This was on a Friday and our doctor's office was still open so we went in right away.
They had to stay open a little later because of us. They did an ultrasound and the boys looked great, just as they had the week before in the ER. The doctor wanted to know how much blood I was losing currently, so they cleared out all the pooled blood and checked the flow from my cervix. It wasn't too bad at that point but they could tell from my blood pressure and heart rate when I was laying down, sitting, and standing, that I had lost a lot of blood. It was enough blood that the doctors were concerned it wouldn't be safe for me to continue the pregnancy. We were checked into the hospital to stay the night and one night turned into two. I got another blessing from Ryan and his dad after we got up to our room.
Our hospital stay consisted of monitors, an IV, a hard time getting up to go to the bathroom, keeping track of how much I was peeing, checking my blood pressure and heart rate every few hours, and checking my hematocrit every six hours. No wonder I was losing so much blood. They kept taking it from me! By the time I left the hospital, my hematocrit was stable but it had dropped to about 25 points. It needs to be 38 in order to donate blood. And by the way, that hospital food really does suck! Thankfully I had Ryan and my sister to go get food for me! My teammates, Miranda and Danielle came to visit and so did Jason and Amber. I'm so glad that they came! We left the hospital Sunday evening and were so grateful that I didn't need a blood transfusion and that my blood count was stable.
Over the next couple weeks I was very careful. I tried not to move around much. We had more doctor visits and they found that my blood count was increasing, which presumably meant I wasn't losing more blood. My doctor told me I no longer needed to be on bed rest. They also found some disturbing symptoms with the babies. Their heartbeats were looking fine, but they found that Baby B had a lot more fluid around him than Baby A. In the same visit, they found that Baby A had no visible bladder. Immediately, they were concerned about what was called twin to twin transfusion syndrome. They had warned us of the risks of this when we originally found out we were having identical twins because it can only occur in a situation where the babies share a placenta.
Twin to twin transfusion syndrome occurs randomly in about 10% of identical twins. There are about 9,000 cases in the US each year. When two (or more) babies share a placenta, the babies can actually share some of their blood. Usually this blood sharing is equal. In my case, the blood sharing was not equal. Blood vessels form that transport blood from one baby to the other and the donor baby does not get as much back as he is giving. My donor was Baby A and my recipient was Baby B. Because one baby has very little blood volume, he eventually shut down blood flow to his kidneys because his little body recognized he needed to keep all the fluid in him that he could. The kidneys stopped producing urine so there was no bladder visible on the ultrasound. The other baby, the recipient, had too much blood in his body so he started peeing excessively to get rid of that liquid. This is what creates the volume of fluid difference in the two babies. At first, my donor baby had about 2 cm of fluid with no bladder visible, and my recipient had 8 cm. Eventually, the fluid levels were about .5 cm on the donor and 13 cm on the recipient. Normal fluid levels were between 3 and 7 cm for their age. The smaller, donor twin, eventually had very little to no room for movement. He was considered a "stuck twin." I found it quite humorous that on the ultrasound, his back was to us with his little bum stuck straight up and no way to move. Don't think that I'm heartless for saying that, at this stage they were in no pain or distress.
It was much harder for me to come to the realization that something was wrong with my babies, rather than just that there was something wrong with me. I could handle the pain and the discomfort but I knew that if there was something wrong with my little boys, there was nothing I could do about it.
We worried a lot over the next few weeks. We didn't know what to expect. Twin to twin transfusion syndrome or TTTS can progress very rapidly. I'd read several cases where patients were rushed into surgery the day after they found their babies had TTTS. My doctor tried to set up an appointment with the specialist here in town that does the surgery but we were given a call later that week and the appointment was never scheduled. We found out at our next appointment, that because of the blood clot that I had in my uterus from the previous ER visit and hospital stay, he was not willing to do the surgery. This was a huge disappointment to us and our doctor even shared some of her frustration with the us that we were not going to be able to go to this doctor here in Utah.
We knew that we had to do everything we could to save our little babies so we planned a trip out to see a doctor in LA. Dr. Chmait has had a lot of experience with the surgery we would need to save our babies and we knew that if anyone would do the surgery, he would. He is the only doctor in the country that has shared the results of his surgeries and has much higher success rates than the average in the US. With his success rates, 90% of the time, at least one of the twins survives and 70% of the time, both twins survive. Without doing the surgery, 95% of the twins will die. It is amazing how much modern medicine has progressed. The odds are a miracle.
We were able to use all of the miles that I'd saved from traveling with my volleyball team for two and a half years plus some that Ryan had built up and were able to get our tickets for $60 each. My teammate, Stefanie Shardlow Neeley, grew up outside of LA and I asked her parents if we could stay at their house while we were out in California for the surgery. They were so gracious to let us stay in their home and let us use their car. We are so grateful to the Shardlows!!
Our appointment was Wednesday the 1st early in the morning so we woke up very early to make it into Hollywood on time with the traffic. Thankfully, we could use the carpool lane. We got there and met Terri, the nurse, and Ashley, the ultrasound tech that would be working with us for the next few days. They are awesome! Along with Dr. Chmait, we worked with some of the best people out there. We filled out some paperwork and started the ultrasound. It normally takes an hour and a half to two hours but it ended up taking us about three. My boys were right on top of each other and it made it really hard for Ashley to find the things she needed to. She has been doing ultrasounds for this type of surgery for 11 years and you could tell she was VERY focused. For the next few days, their position made it very difficult for Ashley in the two different ultrasounds and for the cardiologist. I think it's pretty cute that it was almost like they were hugging each other with their heads together for several days. They were worried too!! :)
Dr. Chmait eventually came in and introduced himself. This was probably the hardest time of our trip. He came in to present to us our options and discuss the risks. He was not aware that I was still leaking blood but thought before we came out to LA, that the bleeding had stopped. He told us there were five options. The first was to do nothing. The second option was to terminate the pregnancy. The third was to terminate the life of one baby so that the other would survive. If one baby were to pass because of the TTTS, it was very likely that the other would also die. This eliminates the possibility of the second one dying. This option was not normally offered by Dr. Chmait because of moral reasons, but because of the serious risks associated with my particular case, he would put us in contact with those who could do it. The fourth option was to do an amnioreduction to decrease pressure on the uterus. This doesn't actually solve the problem, it just is like a bandaid to the problem. You just hope that it holds until they can survive outside the womb. The fifth option was the surgery that we had come to do. We didn't realize what a great risk the surgery was in our particular case. Because of the blood clot that was in my uterus, the amniotic fluid would not be clear enough for Dr. Chmait to do the surgery. In addition, the proteins in the blood weaken the membranes around the babies. The surgery requires the membrane to be punctured and this would further weaken the membrane. The first problem could hopefully be solved. Dr. Chmait would be able to do a fluid exchange to pull out the dark fluid and put in clear fluid. This would add extra time to the surgery, increasing the risks for the baby. For the second problem, there is not much to be done. With the surgery, it would be very likely that my water would break very early, leading to premature babies and a high likelihood of severe brain damage. Ryan and I had a lot of thinking and praying to do.
We left the hospital and were able to contact one of Dr. Chmait's previous patients who was in a very similar situation to us. In over 500 surgeries that he's done, I am only the second case with a blood clot that would cause these complications. We prayed and felt strongly that we were in LA for a reason and that we should go ahead with the surgery. It was easy to eliminate the first three options and the fourth also created problems with weakening the membrane and the possibility of brain damage. We were able to talk to Melanie and hear her experience. We also found out that she was LDS and we don't believe that this was a coincidence. She had the surgery at 17 weeks and her water broke at 19 weeks. Through a miracle she was able to keep the babies until 27 weeks. Her girls were born and 10 days later one of them died. The other still has severe developmental problems related to prematurity. Her experience was very scary and was really all we could relate to, but we knew that it was the Lord's will for us to be pregnant in the first place. We knew it was His will that we have twin boys, that we would be in this situation, and that we should go forward with the surgery. We knew that if it was His will to do the surgery, we would be put in whatever situation He wanted for us. If He wants us to have two healthy boys, we know it can happen. If He wants us to have children with severe problems and handicaps, then we know that He will have entrusted them to our care and He will help us through it.
We went back to tell them what we had decided and went ahead with preparations for surgery. It was already scheduled for the next morning. We returned the next morning and made further preparations. There was another surgery scheduled for a woman at 7:30 and mine was at 9 so we had to be there by 7. I was able to watch parts of the surgery on my own monitor because they only did a local anesthetic on my stomach. The incision on my belly is tiny! They ended up taking out about a liter of fluid total after cleaning out all the fluid. The fluid was completely black from the blood. Crazy! I heard the doctor say right before the surgery that he had asked his little boys to pray for him for this surgery and later he told me if he had known it would have gone so well, he would have slept a lot better the night before. He also said he was as positive as it was possible for him to be that all of the blood vessels between the babies were lasered.
We had to stay the night in the hospital and the ultrasound was the next morning. I had contractions during and after the surgery so I was on magnesium to stop the contractions. Because of the magnesium I was on a clear liquid diet. So, I ate lots of jello! Through the night I was in some serious pain. It would happen when I would breath deeply or move my shoulders at all but I had a great amount of pain in my chest and shoulders. The doctors weren't really sure what it was but OWW! Thankfully it was gone by the next morning.
I was put into a wheelchair the next day and taken back over to the doctors office where we found that both of our babies had heartbeats. The greatest risk for them to pass is in those first 24 hours after surgery. Their whole world is shifted and their blood pressure changes almost instantly. That can be tough on those little guys! Our donor baby also had a visible bladder by the next morning which is rare. In addition, we found out that the lady that had surgery right before me had lost both babies by the next morning. So sad! They said they'd never seen a surgery go so well and then lose both babies. That so easily could have been us!! I pray that she will be comforted and know there is a plan for her and her little babies and that God loves her.
We returned home to Salt Lake and I started in on my bed rest. I know it won't be the easiest thing but there is no question it will be worth it. It feels good knowing I'm doing everything I can for my little ones. I started feeling them kick about a week ago. It's fun! They also situate in different places so that my belly feels hard and you can feel their body parts sometimes. We had our weekly appointment last Thursday and it went very well. The fluid levels are starting to even out and their heartbeats look great! My heartbeat on the other hand is causing some problems! My heart has started racing unexpectedly for about five or ten minutes at a time. Sometimes I'll wake up in the middle of the night from struggling to breath. One time it was as high as 170 in the middle of the night! When this happens I get dizzy, struggle to breath, and sometimes get nauseous. So before my appointment on Thursday I'm going in for a second EKG and then I'll get fitted for a halter monitor that I'll wear for a few days. Right after those appointments I have my regular OB visit. Oh hospitals...don't you love them? :)
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| Normally the doctor spends a little more time taking pictures during the surgery but with mine they didn't have time because of the fluid transfer. But here is little Baby B's toes! |
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| Here is a picture of how they're right on top of each other. A's head is on the right and B's is on the left. A is sucking his thumb. |
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| This is me ready for surgery. |
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| This is right after surgery when Ryan could finally come see me. I was on oxygen throughout the surgery and right when we got out, the medicine they put me on to stop the contractions was making my heart race like crazy so I kept it on. |
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| This was after finding out both our babies had heartbeats. Ashley, the ultrasound tech, is on the left and Terri, our nurse, is on the right. |
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| Thanks so much to the Shardlows for letting us stay at their house!!! |
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| These are just more ultrasound pictures from our many doctors appointments. Both of these are of Baby B. I think they already look like Ryan :) |
Saturday, October 9, 2010
Things That Make Me Happy
1. I'm Having Twins
Being tired and sick and grouchy is all worth it when I think I'm growing two little babies in there.
2. Fall Break
Not only is it a week long break but it's fall!
3. Mac and Cheese
Yummm
4. Knitting
It's been a long time coming but every time I break it out I'm still just as good at it! :)
The blanket I'm making is similar to this one...but mine's purple!
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