32 weeks!

Our bodies and minds are resilient and incredible at adapting to any hardships or curveballs life throws at us. Just on Monday I was so broken about the growth scan, it seemed to me like I would spend the next 2 weeks in a state of teary-eyed sleepy depression, but I recovered and am back to being positive and hopeful. I continue trying to prepare for other challenges still ahead, for example getting to leave the hospital without my boys… They give me 30 min of “wheelchair privileges” a day here, so when M or my parents come by to see me, they take me outside for 30 minutes to sit by the main fountain in front of L&D drop off/pick up zone and we watch other families take their babies home. It’s tough knowing that when we go home, the two baby carseats will remain unoccupied, but as long as I set that expectation with myself now it will be easier when that time comes.

I am 32 weeks today! This was my first goal when I first checked into the hospital. I am that much closer to 34 now! Hard to believe that M and I will get to meet our precious little cargo in 14 days…

Absent End Diastolic Flow, Disappointing Growth Scan, and The Wait

When we decided to start a family, we couldn't have imagined the bumps in the road and sharp turns that this journey would take us through. As I type this, I am 31 weeks and 5 days (31+5) pregnant with twin boys (I was completely wrong in my predictions about genders!) and on strict hospital bed rest since 30+5.

30 Weeks, 5 Days

At one of what became my “routine” Doppler ultrasounds, at 30+5, the Low End Diastolic Flow turned to Absent End Diastolic Flow (AEDF). That means that when my heart was at rest in between beats, our Baby B wasn’t getting any reserve blood with oxygen and nutrients at all and that would further slow down his growth. I was devastated… The concern in the doctor’s eyes told me this wasn’t something to be taken lightly. I was handed a yellow envelope with my results and told to report to Labor and Delivery at the hospital asap. I called M in tears and asked him to drive me as it didn’t sound like my car would have a driver to return it back home from the hospital. At least not for a while. And that is how my hospital bed rest started….

Growth Scan: 31+4

Today is day 8 on strict hospital bed rest. Following the first week, just after I had adjusted to my new home and stopped working (the clock on my 12 week maternity leave at work has started to tick), things had to get more challenging.  Yesterday was probably the single most difficult day this entire pregnancy that I’ve had to endure. It’s been 3 weeks since our 28 week growth scan and it was time to see how much our little twinkies had grown. I was sooo optimistic going into it. I had been eating like a beast, drinking protein shakes any minute that I wasn’t shoving food in my mouth (I even drank a shake at night when I got up to use the restroom), and I had been on bed rest. Of course, I was wishing for our boys to be at least over 3lb each – not setting completely unreal expectations.

After the growth scan, I learned that Baby A caught up from 15% last time to 20% and weighed 3lb 4oz, but Baby B dropped further in his growth – from 15% to 10% and weighed 2lb 10oz. There was a ~18% discordance between their weights because this cord flow issue slowed down B’s growth so much. Their stomachs also continued to measure a couple weeks behind and remained on the 4% curve. I kept it together during the growth scan and kept it together as I made my calls my M, my mom, and Lee. But when I took a shower, I sobbed so hard that I saw stars all around me. The brief moment of privacy that I had in the hospital was my daily shower and I used every minute of it to let as much of my hurt out and cry it out of me. I was exhausted, scared, terrified, stressed, disappointed… I felt like I failed.

At this pace, we need to accept that Baby B will be diagnosed with IUGR (intra-uterine growth restriction) at birth and will spend the first 2 years of his life catching up. That means hitting milestones later and hopefully not having too much trouble growing and gaining weight!

As part of coping with the idea of having preemies, I started reading a lot and researching information about NICU equipment, following message boards for parents of NICU babies, and being vocal about our news with online support groups. I know that when I look back on this time after the boys arrive, it will seem like it was the easy part…  We just need to have hope and take it one day at a time.

I am being monitored very closely here. Each morning I get a Doppler ultrasound to check the AEDF and make sure it has not advanced to Reverse End Diastolic Flow (REDF), which is when the blood that is pumped to the placenta and the baby via his cord during my heartbeat is going back to the placenta without ever reaching the baby during times between beats. If unaddressed, it can lead to stillbirth. So, if they were to see REDF on my morning Doppler I would have a C-section in a matter of hours. As you can imagine, I spend my mornings laying wide awake in my hospital bed waiting and when I see the Doppler graph on the ultrasound, I say a little prayer the best way I can (M and I aren’t religious) to ask for another day… It’s the hardest, most tormenting wait of my life. And the outcome of the wait only gives peace of mind for the next 24 hours.

28 Weeks

The first bumps in the road shook what seemed like our perfect world at a routine 28 week growth scan. Both boys were measuring smaller on the growth curve than in prior scans – dropping off from 35% (18 weeks) to 25% (25 weeks) and at 28 weeks, down to 15%. More alarming was that their abdominal circumference, one of the three measurements used in estimating weight (head circumference and femur bone length being the other two), was only in the 4^th %. That means that only 4% of all fetuses of the same gestational age have smaller abdominal measurements than my boys!  In addition, baby B’s heart Doppler came back abnormal – this is a special type of ultrasound that shows the volume and direction of blood traveling through the umbilical cord and is an important influencing factor on how much oxygen/nutrients (carried by blood) the baby is getting. Therefore, it could partially explain why baby B was a bit smaller than A (2lb 1oz vs 2lb 4 oz). He had what’s called Low End Diastolic Flow (LEDF). A little lesson on how the placenta works in relation to the mother’s heart:  when my heart is beating, blood is pumped to the twins’ placentas (systolic flow) and when my heart is at rest in between beats, the reserve blood that was left in the vessels continues to flow to the placentas/cords just at a slower rate (diastolic flow). Picture turning the water faucet on and off real fast – even when it’s in the off position, some leftover water will still be coming out – that’s diastolic cord flow. What LEDF meant for our baby B was that he just wasn’t getting as much excess flow in between beats as he should have been. It was an early warning (yellow flag) that something was not working as it should in the placenta.  Thankfully, my boys are di/di twins meaning they are in separate sacks and have separate placentas, so each could be treated almost as a separate pregnancy.

The doctors were trying to keep us calm about the overwhelming amount of scary and new information hitting us like ricochet bullets. I was immediately strapped on to the non-stress test machine (“on the monitor”) to see if the babies were in distress and if their heartbeat patterns were indicative of any other issues. Of course, the stress and crying brought on a wave of Brackston Hicks contractions and I felt like I was barely holding on to my sanity and could lose grip at any moment. A panel of blood tests were run to rule out preeclampsia, a high blood pressure condition during pregnancy. Everything came back normal… The doctors explained that this is a relatively new issue that they were able to identify in the last 5-10 years in multiples pregnancies, which meant they didn’t know a whole lot about root causes or how to treat it. I was sent home on strict home bedrest, with orders to start counting calories to make sure I hit 2,500 kcal a day with 150 grams of protein minimum.  I was also to return to the office twice a week for ongoing Doppler studies on baby B’s cord flow.

And just like that, 2 weeks of dreaded home bed rest went by while B’s diastolic cord flow remained low. M took care of me, the pets, cooked, did laundry, etc.  I thought back then how hard it was to be confined to a bed all day for someone who used to be so active and ran a household in perfect routine order. I had to let go of my control freak antics and get over how M folded laundry and how he loaded the dishwasher. Those little things seem so trivial now, but back then they were a total thorn in my side! I was still working from home on my laptop, so it was a welcomed distraction from googling LEDF risks.

At 29 weeks, M and I had our “practice run” to the Labor & Delivery unit due to frequent contractions that just wouldn’t slow down. We had a FFN (fetal fibronectin) test done which tells the doctors if the protein that holds the sacks attached to the uterine walls is breaking down and leaking out. This test is an indicator of whether the body is preparing to go into labor in the next 2 weeks and is 99% accurate. For me, it was negative which was good. I got a shot of terbutaline, a soft tissue relaxer, to knock out contractions + 2 bags of fluids via IV and we were back home within 4 hours.  Since that trip, frequent contractions have been the norm even with home bed rest – I just knew my small torso was struggling to accommodate 2 growing boys and every little kick from one of them sometimes was enough to trigger a wave of uncomfortable uterine contractions. 

Recap of Weeks 18-28

In hindsight, I wish I hadn’t stopped blogging when I was 18 weeks along. Weeks 18-28 practically flew by uneventfully. I finally started to gain weight, we went to Destin, FL for another short vacation with family. It took us for-ever, but M and I finally agreed on 2 boy names that we could both tolerate. Neither one of us got our first pick, but now that they have been decided for a while, I just can’t think of the twins as anything other than the names we picked. They just fit!

About 3 weeks of pregnancy were spent on painting and decorating the nursery. The Winnie the Pooh design I had carefully crafted early on was scrapped and we went with an animal safari theme. I did all the painting which was painfully tedious and took what felt like years to complete, but I am so glad I did it… M installed the crown molding in the nursery and it looks beautiful – his first attempt at it too! Our mothers threw a fantastic shower and our friends have made my heart melt with thoughtful, generous, and truly touching gifts. We unveiled the nursery to everyone along with the first letter of each boy’s name (their names are painted above the cribs) – L and C.  Nobody was allowed to guess! ;-)

  

As my belly grew, I found myself on the receiving end of Jessica’s and Preeti’s maternity wardrobes – both of which fit and saved us a lot of money. My neighbor and good friend Shaney has showered me with lots of stuff her boys grew out of and again, I felt humbled taking or borrowing something from people without offering much in return. This pregnancy taught me to have a bigger heart and taught me that life changing events really do forge stronger bonds between people. When M and I got married, true friends were clear to us. Now being pregnant, it’s even more obvious that the circle of people we’re surrounded by is truly special and nothing to be taken for granted.