The longest week of my life (and the longest blog entry).

It’s been a while since my last blog entry, a lot has happened. I’ll start back to the week before all the chaos, when everything was still stable. April 22^nd and 26^th I had my appointments for U/S’s. Tuesday’s check was very quick to check the status on the babies and measure fluid levels, both ok. Friday’s checkup on the 26^th was more detailed, with measurements of the babies weights. Phoebe weighed in at 1lb 4oz, and Ursula 1lb 8oz, which was a huge jump from two weeks prior to this appointment. The deepest pocket in Ursula’s sac was around 8 cm, getting past the normal range but not ready for another amnioreduction.

That Friday I was noticing a lot of thick mucous. I never noticed a “mucous plug” with Emily so I didn’t really know a lot about it, but it was something new, and it worried me. I called early labour assessment unit in the morning to find out if it was something to be concerned about. They told me it was normal and not to be concerned unless it was bright red and I was having contractions. So that was that…as the day went on, it still worried me because I read “mucous plug’s” are often an indicator or preterm labour, so I called back at shift change and gave them more information about having twins and TTTS, etc….but still they said not to worry….

Saturday…same guck, still worried, called early labour assessment again, asked to speak with a doctor, which I never was able to, gave them more information about my cerclage and amnioreduction, and then I was told to come in right away. After a very long wait, and a quick assessment, the Dr working said she was also a little concerned about the mucous so she admitted me to the 7^th floor. All weekend I was having menstrual like cramps and rectal pressure, which is what I had before delivering Emily. The cramps weren’t getting any worse so I didn’t think they were contractions at the time. The weekends and nights in here are very long, because my doctor isn’t here, and it is usually residents who you deal with. I know residents are qualified to do their work, but I am so used to Dr. M, or even Dr. V, so when someone else steps in and makes big decisions, it is pretty scary when we know Lynne may have done things differently.

Monday couldn’t come soon enough, still having lots of cramping and pressure. I was wheeled down to the fetal assessment and treatment unit around lunch time to assess the situation. Babies still looking good, although there was some thickening around Ursula’s heart, but no other signs of congestive heart failure. The fluid remained relatively stable around 8-8.6 cm. Then Dr. M did a vaginal ultrasound to check the status of my cervix…and this was the beginning of the longest week of my life.

I am no U/S pro, but I can tell when there is something significantly wrong. There was a huge opening that I’d never seen before, I couldn’t see the last stitch, and I could have sworn I saw membranes pushing out. Apparently I am an U/S pro. The look across Lynne’s face would have terrified the calmest person. She explained to us that the cervix was opening up, and that the membranes were starting to push out and we had some major decisions to make. I didn’t know at the time how far dilated I was, I’ve heard a couple things. I think I was 5 cm dilated at the time of the U/S and close to full later that day.

Our first three tough decisions.

a) Allow Lynne and Dr. V to attempt “heroic” measures and do a “rescue” cerclage. This procedure at this time is called rescue for a reason. It is a very risky procedure, with only a 50% chance that it will work, and a large chance that my membranes would rupture. Meaning delivering twins at 23.4 weeks without having the chance for the steroid to be absorbed…which was another major decision that I’ll talk about later.

b) Our second option was to do the “wait and see method”. Basically tilt the bed into a Trendelenberg position where my head is lower then my feet, hoping to buy us more time without further dilating….and therefore would not be inducing labour futher by poking around, hopefully giving us enough time for the steroid to be absorbed.

c) Our final choice was not an option to us. Lynne told us that it was perfectly acceptable at this point to go through with the delivery, as there is not much more that can be done, and just accepting that basically it was over.

None of these decisions sounded very hopeful to me at first.

Our second set of decisions that needed to be made were based on if we were going to be delivering. The neonatalogist came in to talk with Keith and I about survival rates and handicaps for premature babies at 23 weeks. She told us that if we were 17-21 weeks or so, we wouldn’t really need to make this decision because the babies would be too small to survive. When you get to 23 weeks, the decision is ultimately up to the parents on how aggressive you want them to work on the babies. Survival rates for a singleton baby is 30% and also a good chance for handicaps, and therefore even smaller survival rates for a twin pregnancy. Also because the steroid injection did not have time to absord, the lungs would be very premature.

So again very hard decisions: Do we get the entire team of specialists in, knowing the low survival rates and high handicap rates, and have them rescusitate over and over again, until the babies can take no more, or HOPE that they make it through…even though we may be putting these poor children in a life that they could never be happy wit??. OR, do we have a specialist come in during delivery to assess the babies and determine if he/she thinks they are a “miracle baby” and have a good survival chance, and make our final decision then?? OR do we have the doctors wrap the babies up in blankets and let us hold them for a while, and let the doctors provide them with comfort care?? Not decisions that ANY parent wants to make…No body wants to give up on their baby, because nobody really knows what can happen….but on the other hand, no body wants their children to go through a tough life, full of surgeries, handicaps, pain and poor prognosis.

After a lot of discussion, Keith and I felt the best decision was to go along with the surgery and hope and pray that it went well. I felt that at least we were doing something, and Dr. M and Dr. V are excellent doctors, so we had a lot of faith in them. The surgery took about an hour. I was on the operating table with my head down very low and my feet up high. They filled up my bladder in hopes that the pressure in my bladder would push the membranes back in. Dr. M said you could see one of the babies feet trying to kick out. Once the membranes were back in, they had to find as much cervix as possible to stitch below. And all of this happened without rupturing my membranes….we were SO happy and relieved, during surgery we finally picked the girls names. After recovery I was transferred back into my room, and very shortly after that, the cramping started AND contractions began. We were very scared because I was already on Indocid, a medication to help prevent contractures. I was transferred down to birth and labour again, and was given Atalat (I don’t know the spelling of all these drugs), a blood pressure medication but also used to help relax the smooth muscles of the uterus….and after a very long night, contractions finally stopped and I got my first hour of sleep from 6-7am.

The next couple days I remained relatively stable and was moved back up to the 7^th floor. I got another steroid injection that Tuesday, antibiotics daily to prevent infection, both Indocid and Atalat to prevent contractures, continued on Heparin for blood clots since I’m on bedrest, and still in the Trendelenberg position (hard to type and eat like this), other stool medications that I’m sure you don’t need to know about it, and the occasional Tylenol 3.

Thursday evening…the cramping and contractures started again, and they became more painful then Monday towards the end. I was transferred downstairs again back to the birthing unit, given more medications (by this time I was finished my dose of Atalat and Indocid), and then given some Morphine for the pain. I love Morphine, the pain was so much better, and I could barely keep my eyes open….finally some sleep. Once the morphine wore off, I was still feeling some contractions, but less, so I got more medication for contractions, more Morphine, and settled back to sleep. They discharged the heparin one of the times I went downstairs, in fear that I would go into labour and bleed to much, but they have recently restarted it again.

So here I am, still pregnant and still stable and still planning to deliver two healthy little girls, who knows when that may be. We have not come this far for nothing. Our next major challenge next week, may be another amnioreduction. I know Dr. M is a little apprehensive about it, because she doesn’t want to stir things up if possible, but my fluid levels continue to creep up.

I don’t have access to the internet, but have been receiving my messages from email and facebook from Keith…who will also copy and paste this blog sometime tonight.

Thanks to all of you for your nice messages, cards, thoughts, visits, flowers, treats and prayers. It continues to mean a lot.