Thursday, September 26, 2013
We all stood behind the table, watching the monitor high up on the wall in back of the ultrasound technician. Well, not all of us. Josh, Jimmi and I were standing but Lyndsay was actually on the table being violated by the same type of dildo-shaped wand I'd gotten to know very intimately during my egg retrieval process. The tech turned off the lights after inserting the transducer into Lyndsay's hoo-ha and the screen above began to reveal cryptic images of the contents of her uterus. My stomach was in knots excited for what we hoped to see and nervous for what we might see...or not see.
"There are the two gestational sacs," said the tech as she moved her magic device around Lyndsay's insides. I stared at the screen and my heart sank deeply into my chest. Are they empty? They look empty! Then the dildo-cam was turned for a better view of Sac A, where I immediately noticed a small circle that put my crazy thoughts at ease for the moment, until I realized it didn't look like it had changed since the photos from the week before. And, worse yet, nothing was beating. Oh no! But then a click of the button magnified the image on the monitor above us and the small circle became a little bean, just like I remember from my first ultrasound with Dylan. "See the fluttering?" asked the tech as the beautiful sight of Baby's A's tiny, beating heart appeared for us to admire. There was no way to stop the tears, so I didn't even try, as I slid my arm through Jimmi's and rested my head on his shoulder. "Whoa," he said with the amazement of a first-time daddy, "that's crazy!" Baby A was measured and her heart rate was counted, "One-hundred and twenty beats per minute," we were told, which I knew was just perfect! A few last checks were made before the scanning phallus was twisted and turned until Sac B appeared. We all waited anxiously to see what Techie would find in there this week. Then we saw one circle. Where's the other one? Is she still there? And then another circle. "There they are," she announced before clicking the magnifying button to check for proof of life in the twins that sprouted from a single embryo. "It's hard to get them both in the picture so I'll check them one at a time," she explained. All eyes were on Baby B as different angles were tried until, finally, "There's the heart. See it?" she asked. And we did. It was every bit as beautiful as A's, and clocked very closely at 118 beats per minute. "While I'm measuring heart rates I might as well check the other one and then I'll finish marking their growth," we were told. The picture changed from Baby B to Baby C, her mirror image, and a third beating heart was detected. "Holy shit!" Jimmi released after a complete set of live triplets was revealed. "You need me to catch you, Buddy?" Josh joked as he held out his arms in case Jimmi passed out at the thought of three little girls. Baby C's heart rate came in right behind her sisters, at 116 beats per minute.
After each measurement was recorded and recorded again and recorded again, the tech turned the lights back on and handed us a sheet with four photos of our little appleseed-sized munchkins. Lyndsay got up and got dressed and the four of us headed next door for our appointment with the fetal medicine - or high-risk pregnancy - specialist, who was nice enough to fit us into his schedule immediately following the ultrasound. The waiting room wasn't too busy, but I could see that the very pregnant woman sitting next to us was clearly ready for her baby (babies?) to vacate her womb last week. Lyndsay sat there filling out a load of paperwork and Josh, Jimmi and I chatted until a tall, blonde woman named Nurse A came out to get us. I guess everyone was prepped on our unique situation because the nurse didn't bat an eye when all four of us followed her back to the exam room. She stopped quickly to have Lyndsay step on the scale and she asked each of us our names. "I'm Suzanne," I said. "I'm the mom!" She smiled and wrote down my name and I hoped she knew I was the babies' mom and not Lyndsay's mom. The men introduced themselves as well then we continued onward.
The exam room was much larger than I'd expected it to be and it had a couch long enough to seat all of us, which led me to believe we may not be the only group of four people having babies together that they've seen. Once we'd all made ourselves comfortable, Nurse A began to speak, "So," she smiled, "you're having triplets!" We all nodded and noises ranging from sighs of disbelief to laughter emerged from each of us. She continued, "Let me start by congratulating you and asking you if you have any questions for the doctor before he comes in? It's probably easiest if I write everything down for him now so you don't forget." No one spoke so I started, "I have questions," I said as I opened up the notepad on my iPhone. She got her pen ready and I rattled off everything I'd thought of in the last few days:
"Is there a chance the embryos will split again?"
"If the babies end up in the NICU (neonatal intensive care unit), would we be able to airlift them to a hospital in New Jersey?"
"Are the twins sharing a placenta and/or an amniotic sac?"
"Are triplets always delivered via C-section?"
"When would Lyndsay have to go on bed rest?"
"Do you ever stitch the cervix to prevent preterm labor?"
"Would you allow your wife to carry triplets?"
"What are the risks of carrying triplets to Lyndsay and the babies?"
She nodded as she jotted down each question. "Is that all?" she asked after I'd finally stopped speaking. I told her it was. "Anyone else?" she looked at Lyndsay then at the men who were all shaking their heads. "Ok," she said cheerily, "let me give you some phone numbers for the doctor and the nursing staff in case anything else comes up." She handed us each a few cards and I remembered another question, "If I call and ask about the pregnancy will the doctor be allowed to speak to me?" Nurse A answered, "I'll get a release form for Lyndsay to sign so that won't be a problem."
A very tall man with a friendly face entered the room a few minutes later. "Hi, I'm Dr. R," he said with a friendly tone that reminded me of American Idol's Season 2 runner-up, Clay Aiken. At that point I wondered if he'd even be able to answer the question about letting his wife carry triplets, as I was certain he wasn't interested in women in any other way than medically. "So," he continued, "It's not every day I get to tell people they're having triplets! But I guess you already knew that, which is why you came to see me today." Something about this man was so sincere and open that I instantly felt comfortable knowing he'd be caring for Lyndsay and my babies. "I see you have some questions. Let me answer those and then I'll go through our protocol for a triplet pregnancy with you." Dr. R started at the top:
"Is there a chance the embryos will split again? No. They're done splitting by now so you don't have to worry about that." A small sense of relief came over all of us as he moved on to the next question, "Can they be airlifted to a hospital in New Jersey? Good question!" he complimented. "I don't see why not. We've done it before but I think it might depend on your insurance." I nodded and he read the next question:
"Are the twins sharing a placenta and an amniotic sac? It's really too soon to tell, but it appears as though they are at least sharing a placenta. The question of one or two sacs will become clearer at about ten weeks." I'm not sure if the other three people on the couch knew the reasons for my questions, but Dr. R sure did as he explained, "There are risks associated with each of those scenarios, as you probably know since you asked the question. Monochromatic or identical twins come from a single embryo that splits. The best case is that each twin has its own placenta and its own amniotic sac. When the twins share a placenta they run the risk of developing Twin-to-Twin Transfusion Syndrome, which means one twin will get the nutrient-rich blood from the placenta, take what it needs, then, instead of it circulating back to pick up more nutrients, the same blood will go directly to the twin who won't get anything out of it. The donor twin will usually be much smaller and have deficiencies and the recipient twin will be much larger and have too much of what it needs, which is dangerous too. There will also be a large discrepancy in the amount of amniotic fluid surrounding each twin. In severe cases, Twin-to-twin leads to death of both fetuses." The room was silent until Dr. R spoke again, "The good news is that we will monitor Lyndsay very closely and if we see signs of this starting, we can perform a laser procedure to separate the connecting blood vessels to each twin. Most of the time this fixes the problem and both fetuses do very well." That lightened the air a bit until he said, "If they're sharing an amniotic sac they run the risk of getting tangled up in each other's umbilical chords which could end up strangling them both. Unfortunately, there's nothing we can do to prevent that. The larger problem is, if that happens and both twins perish, Lyndsay may go into preterm labor and be forced to deliver all the babies before they're a viable gestational age. In that case, you could lose all three." More silence. "The biggest issue with the identical twins, when they're high-risk like this, is that they can negatively impact the singleton, who is happily growing in her own little world. If anything happens to the twins, whether the singleton is healthy or not, she could be at risk as well." Yup. That's what I've read.
He continued, "Are triplets always C-section? Yes, generally they are. Usually triplets come early and it becomes a situation where it just isn't safe to let them go through the stress of labor." Ok, that's understandable. "When would Lyndsay go on bed rest? She may not have to," he said and I saw Lyndsay's face light up with relief. "If she's doing well and the babies are doing well there's no reason to put her on medical bed rest, though, she may be self-restricting activities at that point. Carrying three babies tends to make everything much harder to do." I can't even imagine. Next, "Do you stitch the cervix to prevent preterm labor? Well, we sometimes put in a stitch, or a cerclage, if there's a history of incompetent cervix. But we don't do it prophylactically. Actually, there's some evidence to suggest that a cerclage may reduce preterm labor with singletons but cause it in twins. Very interesting." And then he got to the question I was sorry I'd asked before meeting him, "Would you allow your wife to carry triplets?" He laughed and I squirmed. "I think I my wife would be the one telling me what to do!" Wait, he's not gay? I glanced at the naked ring finger on his left hand as he rattled off a story about his wife and their dogs and I realized the negative effect of a Southern accent on one's masculinity.
And, finally, "What are the risks to Lyndsay and the babies? Well, I've already discussed the major risks to the twins. As far as Lyndsay, the main concerns would be high blood pressure, pre-eclampsia and gestational diabetes. But I can control all of that. Depending on the severity, she may spend some time in the hospital to get things settled, but she'll be so closely monitored that we'd catch anything that happens very early. The absolute biggest concern with a triplet pregnancy is preterm labor. The earlier the babies come, the higher the chances they'll have longterm medical problems. If they're born before twenty-three or twenty-four weeks, they most likely won't survive. Between twenty-four and twenty-eight weeks, they can survive, but they'll probably have some type of serious medical issue. The chances of Cerebral Palsy in triplets is about ten percent. But remember, you need to dodge the bullet for each possibility three times; once for each baby." I didn't look at Jimmi's face as the doctor was speaking because I know his biggest fear is that something will be seriously wrong with the babies. The doctor continued, "With multiples, once we reach the twenty-eight week mark, we all tend to breathe a sigh of relief. At that point a lot of the risk drops significantly and most of the babies born after that will spend time in the NICU for nothing more than learning to suck and swallow and gaining weight. Realistically, most triplets are born around thirty weeks, but we like to see them go to at least thirty-two. If they get much further we'll talk about delivering between thirty-three and thirty-five weeks to avoid more complications that come with high order multiples outgrowing their quarters."
I was still digesting the answers when Dr. R asked, "Do you want me to give you information on selective reduction?" No! Don't tell me! I don't want to know! But, "Yes, I guess you should give us information on everything," came out of my mouth instead. The doctor looked at us with sympathetic eyes, "I know it's not a pleasant topic, but sometimes it becomes necessary, for various reasons, to reduce the number of fetuses to a more manageable amount. And I don't mean just for the pregnancy. Parents also need to consider the possible financial and emotional hardships of raising three children of the same age. Medically speaking, it's always safer to carry fewer babies, but that doesn't mean I haven't seen healthy triplets, or even quadruplets, leave the hospital and grow up just fine. But I've also seen it go the other way as well. You really need to weigh the risks and figure out exactly what you're prepared to handle." We all listened in silence as I felt the tide rising behind my eyes. I blinked a few times hoping to strengthen the dam and the waves subsided. "In this case, you can choose to reduce either the singleton or the twins, though keeping the single would carry fewer risks. The procedure is very quick. A long, thin needle is inserted into the chest of the chosen fetus or fetuses, then they are injected with potassium chloride which will stop the heart." The words had barely left his lips when the tightly constructed dam behind my eyes broke and the sobbing began. Jimmi's arm flew around my shoulder in an attempt to console me as Nurse A handed me a box of tissues. "I know it's not a fun thing to talk about," Dr. R said empathetically. "But sometimes it ends up becoming necessary for a variety of reasons." I sniffed back the sadness and asked, "What are the chances we'll lost the entire pregnancy if we choose to reduce?" "It's about five to eight percent," answered the doctor. "Not very high at all." I laughed at yet another slim chance being thrown my way, "I don't do well with the small percentages," I explained. "Based on statistics, I shouldn't even be alive." Dr. R's face showed confusion so I went on, "I had Small Cell Neuroendocrine Carcinoma of the Cervix." Confusion turned to shock on the doctor's face and he let out a winded, "Wow!" He shook his head and said, "I've never heard of that in the cervix before. You're very lucky to be here and I understand why you don't want to talk small chances anymore."
I was relieved when the subject changed to the general care of a triplet pregnancy, including how often Lyndsay would be seen and monitored and given ultrasounds. At the beginning it shouldn't be much different than a normal, run-of-the mill pregnancy. But if the twins are sharing a placenta or an amniotic sac, the visits and ultrasounds will probably become weekly occurrences. "The goal here is to keep those babies in as long as possible. The earlier they're born the more likely it is that they'll have some sort of longterm health issue." And that's the biggest problem. As confident as Lyndsay is that she's gonna, "Hold 'em in until thirty-three weeks," there's no guarantee. She can be as careful and positive and heathy as can be, but if the babies decide they want out at 25 weeks, there's very little we can do to stop them.
We finished up with the doctor and Nurse A took us out to set up Lyndsay's next ultrasound and follow-up appointment, which will be on October 11th. Since she works at the hospital, Lyndsay then took us to meet her coworkers down the hall. I must say, if we have to have a high-risk pregnancy, it's really nice to know that, three to four days a week, she'll be in the complex where she'll give birth, just a few steps away from the team of specialists who will care for her over the next six, seven or eight months. We were immediately greeted with huge smiles and shouts of, "congratulations!" as soon as we entered the blood donor suite where Lyndsay works. Everyone knew who we were and I kind of felt like a rock star. While we spoke to Lyndsay's friends, she headed to the computer to check the results of her blood test from the morning. We were all anxious to see what the number would be this week since 14,747 blew us away seven days earlier. "Look at the number," I heard her giggling voice call to me from a few steps away. I looked past Lyndsay to the monitor behind her, where the huge numbers were taking up almost the entire screen. 71,272. "Whoa," was all I could get out as Lyndsay laughed and exclaimed, "I guess I'm very pregnant!"
After showing off our first baby pictures to anyone who would look and accepting the generous well-wishes from everyone who knew our story, we headed off for a quick lunch and then back to Lyndsay and Josh's house where I met their beautiful and incredibly well-mannered children. Hunter, their 5 year-old son, wanted me to watch an episode of The Incredible Hulk with him so badly and, as I did, he snuggled up next to me so he could make sure I was paying attention. Hallie, who is 3, has the biggest blue eyes and such gorgeous blonde hair I think Disney might end up modeling a new princess after her. While Hallie is still too young to really understand what her mommy is doing for us, Hunter gets in on an age-appropriate level. "You're having THREE babies!" he told me with a giant smile. I nodded. "What are their names?" he asked and I told him our current choices. "Thank you for letting me borrow your mom's tummy," I said to him. "Why can't you put the babies in your tummy?" he questioned. I thought quickly, "My tummy is broken so babies can't grow in there." He wasn't satisfied with that, "Why is it broken?" he asked. "Well, the doctor had to take out the parts that grow babies because they didn't work anymore." That seemed acceptable but he needed more information, "The doctor took all the food out of your tummy?" Ok, I'm out. I looked over at Josh for help and he rescued me with a quick, "Yes!" But Hunter had to know more, "How did they get everything out of there?" I explained, "They gave me an operation. They cut me open with a knife..." The poor kid's eyes almost flew out of his head so I quickly added, "I was asleep and didn't feel a thing. Do you want to see my scars?" He nodded so I lifted my shirt enough to show him the battle wounds from my hysterectomy. After a quick glance his mind shifted, "Do you want to see my room?" And that was the end of that!
We spent about an hour at the house before we needed to get on our way to the airport. Just before we left, Hallie ran to the refrigerator where she'd hung up an art project she'd made at preschool. She lifted the magnet and removed the rectangular paper from it's spot and I asked, "Can I see?" It was her name in black marker, covered with glitter. "Did you pour the glitter on the glue all by yourself?" I asked. She nodded as she scratched at something else stuck onto the glittery letters. As she picked at it the small, red piece fell to the floor. I stuck the pad of my pointer finger on top of the fallen piece and lifted it to my face to look at it. A heart. It was a tiny, red glitter heart. Interesting. I put it on the counter as she continued to scratch off the only other glitter hearts on her project. They, too, fell to the floor. Two more. I picked them up and put them on the counter next to the first one, where I instantly had one of those, "Holy crap!" moments.
There were three hearts.