Finding out we were pregnant in July was the happiest news we have had for a while. We know what a miracle getting pregnant is and were very grateful to have the opportunity. Summer got busy with moving plans and dreading saying goodbye to family and friends to move to Madison, Wisconsin for Bryce to pursue his MBA at the University of Wisconsin, but we made it through and arrived in Madison in August. Shortly after arriving we set up our prenatal care and made an appointment for our first ultrasound the same day Bryce started the big orientation for school (an almost two-week orientation of busy, busy days right before school started). By this point I was nearly 13 weeks along and a little behind in getting into an OB (we had called my OB in West Jordan after finding out we were pregnant and the office just did a confirmation pee test of pregnancy, but no ultrasound because we were going to be switching prenatal care when we moved a few weeks later). So I picked Bryce up from school (during the lunch hour of the day) and headed to the doctor's office to finally SEE the baby growing inside me that had been causing so much throwing up that not even Zofran - a drug used for treating nausea in cancer patients - would cure. The ultrasound tech took us to the ultrasound room after all the usual medical history, questions, information, etc. and got us all ready to go. We were chatting it up, asking questions, as the tech squirted the goo all over my tummy and prepared to look at the baby. She set the ultrasound scope on my stomach as she looked at Bryce to answer a question he had, all the while my eyes were glued to the monitor, anxiously awaiting the first glimpse of our baby. As I looked at the screen something looked different. She finally was done talking and started to move the scope around my stomach and I immediately saw two heads. Before the tech even said or noticed anything I said, "Is that two heads?!" She moved the scope around and examined the screen and said, "That IS two heads!" (in a very surprised voice). Bryce and I immediately looked at each other in surprise and just started giggling. I was completely at a loss for words and Bryce's uncontrollable giggles said what he couldn't say. Two little babies in one placenta - identical twins! We were quite the topic of discussion around the office that day as everyone shared our shock in finding out I was carrying two babies instead of one. (The nurse saw us again and said, "No wonder the Zofran wasn't working!") Double the hormones, double the babies, double the fun. I have to admit, the shock took a while to wear off and not all the emotions the rest of that day were of joy. I was scared to death. Feeling inadequate, feeling overwhelmed. How was I going to be a new mom to not just one baby, but TWO!
The emotional roller coaster continued for a good couple weeks as I went back and forth between excited for double the giggles, to overwhelmed at how in the world we were going to do it. We learned quickly that twins (especially identical twins) get much more attention than a singleton pregnancy (a new phrase I learned from the twin community), and that we would have twice as many appointments, including ultrasounds every other week to make sure their fluid levels are good and one isn't getting more than the other, and to make sure they are growing at a relatively equal pace. We also learned that twin pregnancies come with higher the risk for anything that can go wrong in a pregnancy and so we were assigned a giant medical team equipped with high risk OBs, a dietician, a genetic counselor, a high risk nurse, cardiologists and then the regular medical staff of a singleton pregnancy. Quite the team!
The weeks started going by and the sickness (throwing up three times a day) finally started to wear off and we were back to life as usual, mixed with the nearly once-a-week appointments for the babies. October came and things seemed to be going well, until one morning (Oct. 16) I woke up with some sharp pains and my stomach tightening. I didn't think anything of it because I have had tightening before and discomforts were not uncommon to me, so I went to work. After feeling those sharp pains all morning that seemed to be going in waves, with the sharpest pain pretty unbearable, I decided to call my doctor's office around 10:30 a.m. and just ask a nurse if there was anything to worry about. She said she would talk to the doctor about it and call me back. She called me back within a couple minutes and said that the doctor would like to see me and asked if I could come in right away. A little scared I said yes and let my work know that I needed to go into the doctor to get checked real quick and that I would hopefully be back soon. At the doctor's office they checked my vitals, asked me questions and then the OB came in. She felt my stomach and performed a pelvic exam and said she wanted me to head back to the ultrasound room and get an ultrasound to see how the babies were and get a cervical measurement. I was 19 weeks, 5 days at this point and we had our targeted ultrasound to find out the gender of the babies the following week. Seeing as the babies were being examined and gender was easily noticeable, the techs asked if I knew the gender yet and said they could clearly see they were two little girls. (Bryce was at school and I told him not to come to the appointment because I didn't want him to miss class and things unless I found out there was something to be worried about.) So while this wasn't the most ideal way of finding out what our little twins were, it was good to have some good news before the news that was to follow.
The techs then started the cervical ultrasound to measure my cervix and just talked back and forth to each other while I watched and waited to get an indication of what was going on. After waiting for what seemed like forever, they told me we were done and to go back to my room and wait for the doctor with the results. The doctor came in and told me that my cervix was not where they would like it to be (measuring 2.6cm when they wanted it to be more around 3.5-4cm at this stage in pregnancy, especially since two little bodies with double the weight would be putting even more pressure on my cervix than just one baby) and that what I was feeling were indeed contractions. She then did yet another pelvic exam to make sure I wasn't dialating and said she wanted me to call my work to tell them I wouldn't be making it back to work that day because she was sending me over to the hospital triage to be monitored for contractions and watched to make sure I didn't start dialating (and she would be heading over there with me because she was on-call at the hospital for deliveries for the rest of the day). Panic set in that this was serious business, so I called Bryce and he said he would meet me at the hospital. The ride to the hospital was very painful and emotional, but I was trying to think positively and be strong. I parked in the hospital parking ramp, walked into the hospital (where I had to stop a few times when the sharpest pain of the waves would hit) and tried to keep it together to find where I needed to go. I headed for the information desk to ask where I needed to go because my brain wasn't working and I couldn't find a sign or map anywhere. As I approached the women to ask where the birthing center triage was they immediately looked at me in concern, asking if going there was for me, and I lost it. The emotions spilled over as I said yes and they began to give me directions and wanted to put me in a wheelchair to get there. Feeling embarrassed that I started to cry (I have a hard time letting people see me vulnerable) I refused the wheelchair and started walking in the direction they had given. I made it to the birthing center triage, where I was greeted by a nurse that had been called and informed I was on my way, and was taken into triage room 1 to be hooked up to the contraction machine. She got the babies heart rates as well (the babies heart rates were taken so many times that day, but I didn't mind because every time I heard them I felt a little bit of relief that they were okay.)
Bryce arrived at the hospital and we began the waiting game as the machine tracked for contractions. After a little bit the doctor who saw me over at my doctor's office came in and said contractions were picked up on the machine for the first little bit that I got there and that they seemed to be mellowing out, but that we would continue to be monitored and then she would check my cervix again. She also said that she consulted with the high risk OB and that they wanted to send me down to the perinatal ultrasound portion of the hospital to get an ultrasound of the babies and views of my cervix from where the babies are laying. During this ultrasound the tech asked if we knew the gender of the babies and I played dumb because I wanted to see and confirm again with Bryce there, so she checked again and the consensus was still girls. Then we headed back up to triage and continued contraction observation for another couple hours. After three hours of observation, the doctor came back, checked my cervix for dilation and said that it wasn't dilating. Phew. But that is looked like I was having activity-induced contractions since they went away while I was laying on the hospital bed and taking it easy. She said that the babies looked good and healthy and that she would go an speak with the high risk OB to see if I could be discharged. The high risk OB gave the okay, but with instructions. I was to be on bed rest until my next appointment (my 20-week targeted appointment we had already scheduled for the following week) where they would check my cervix again after getting all the usual 20-week measurements and gender reveal information. Scared and a little overwhelmed from the day, we were able to leave the hospital (me wheeled out in a wheelchair) and went home.
That week was the longest week of our lives as I sat on the couch, afraid to do anything that would cause me to go into preterm labor, and we waited to see what the next cervical measurement would tell us. That next appointment came and we had confirmed, yet again, that we are having two little girls and we got to see their tiny little tummies, heads, hearts, bums and limbs with fluid levels looking great and only a six percent difference in their size (and weighing in at 11 oz and 12 oz.) Then came the cervical measurement. After she measured she said she would be sending the perinatologist in to go over the results of the ultrasound and the results of the cervical measurement. Before she left we asked her what the measurement was and she said 1.7 cm. Not good news.) The perinatologist came in and said the babies are looking great, fluid levels and growth looked really good and said that my cervix is shorter than they want it to be, but that nothing can be done about it at this point. If it were a singleton pregnancy they could put in a cervical stitch to prevent the cervix from opening all the way, but with a twin pregnancy they said they won't do that because it could cause inflammation that could cause preterm labor. We left the hospital feeling frustrated and a little hopeless because nothing could be done. I was leaving as a ticking time bomb that if set off, they wouldn't do anything to try and stop labor and we would lose the babies. They set up a meeting with my doctor the next day to go over the plan and discuss the results more. When we went to her she said that nothing could be done to help/save the babies until we reached 24 weeks (three weeks from that day) and that my measurement was actually 2.3cm, not the 1.7cm like the ultrasound tech said. I have no idea where the 1.7cm came from, but 2.3cm sounded a lot better to me for the change in one week. She said we would just continue to watch it, but that really we can't do anything until the 24-week mark and we would just need to wait it out and hope nothing happens until then. At 24 weeks they can give steroid injections to help speed up the lung development of the babies to give them a better chance of survival if they come early, and magnesium can be given to help stop preterm labor if I were to start contracting again. So we needed to just make it three more weeks!
Needless to say there were a lot of prayers offered during those three weeks that my body would hold up and we would make it to the 24-week milestone - and we did! We had our 24-week ultrasound scheduled for Nov. 11 to see the growth of the babies and apparently my doctor had also put in orders for them to measure my cervix again, as we were now at the 24-week mark (not quite 24 weeks, but the week we would be 24 weeks). I had been feeling pretty good during those three weeks, after we made it past the raw emotions of what we were facing, and was pretty optimistic going into the appointment. The babies looked great again - healthy, active and measuring 1 lb 2 oz and 1 lb 4 oz. Then came the cervix measurement. Right away looking at my cervix Bryce and I could tell things looked different, and not in a good way. My cervix looked more open and obviously shorter than last time. The ultrasound tech finished measuring and went and got the perinatologist to discuss the results. The perinatologist came in after what seemed like forever and told us my cervix was now measuring 1.3-1.7cm and that is was funneling (dilating from the inside). He said he made a call to my OB and told her his recommendations and set up for me to see her the next morning. He also said he was going to set up weekly cervical measurements from here on out so we could watch it very close. We went to my OB the next day and she said that plan was that once my cervix reached 1 cm or below that we would start me on the steroid injections to help develop the babies' lungs and went over preterm labor signs and told me to be even more in-tune with my body and not to ignore anything uncomfortable or that feels like it has a rhythm. The good news was that we had reached the point where things could be done to help them survive if they decide to come early, the bad news was that my cervix is still a ticking time bomb that no one knows when it will go off. There is nothing more frustrating than seeing how healthy and well my babies are growing and knowing that the only thing at this point that could cause them to not have the chance to grow as big and healthy as possible is my cervix. Feeling my frustation and disappointment, my doctor told me that there was nothing wrong with my body, it is just not meant to have two babies in there and because of the extra weight from the extra baby, my uterus was measuring 33.5 weeks, 10 weeks ahead of schedule, so my body thinks I am farther along than I am and is just doing what it is supposed to be doing in the latter part of pregnancy - preparing for a baby to come.
We waited through the next week until our next cervix measurement (which was Tuesday of this week) and hoped for the best going in. Right away again we saw the change in the opening (last week it looked like a 'V' from the inside and this week it looked like a 'U' - a progression to the next stage of opening) and the measurements confirmed the change - 1.0-1.3 cm. The perinatologist came in and said we are to the point where we should move things forward with the steroid injections for the babies because once my cervix gets thin enough my body will go into labor and the babies will come. He said we had the choice of starting the steroids the next day, or we could wait one more week. The only benefit of waiting one more week to start the injections is that the best window of effectiveness for the steroids on the babies' lungs in within the first seven days after the steroids are given and you want the babies to be born as close to that window as possible. The negative side of waiting one week is that if something were to happen this week and the babies came then they wouldn't have the steroids and their chance of survival would only be around 40-45 percent. We asked him his recommendation and he proceeded to tell us the benefits/risks of the two options and looked to us to decide. Bryce and I looked at each other as he waited for the decision and in our efforts to decide the perinatologist finally just said, "Get the steroids started this week." So we said okay and off he went to put in the orders to my doctor's office. These steroids cause an immature baby's lungs to produce a compound called surfactant. A full-term baby's lungs naturally produce surfactant, which lubricates the lining of the air sacs within the lungs. This allows the inner surfaces of the air sacs to slide against one another without sticking during breathing. Premature infants whose lungs have begun producing surfactant are more able to breathe on their own, or with less respiratory treatment, after birth and have a better chance of survival.
The injections are done in a round of two, one 12mg injection the first day and the second injection of 12mg 24 hours later. I had the first injection yesterday morning, and the second this morning in the other cheek. Man was it painful, but whatever we need to do to give these babies the best chance of survival. I was a wreck the night before and the whole morning getting to the first appointment because here my babies are growing so healthy, but because of something out of our control we are having to give them steroids. It wasn't until I did a bunch of reading and praying that I felt good about it and that nothing negative could come from it. Studies have been done and show that no negative side effects come from the injections and that they do nothing but good for the babies. One article said that nurses in the NICU can tell the difference between the babies who come in and have had the steroids and those who have not because of how much better they do at even the early weeks. The full effect of the steroids lasts about three weeks (the effect of opening the babies' lungs) therefore, if we last through that time it will not be as effective. However, good news is that if we end up lasting through that time and then my cervix gives out and we go into labor earlier than 36 weeks, then they can give me magnesium to hold off labor until they can get one more round of the two-injection steroid to help the babies' lung develop even more right before they come. Best case scenario is that we got the steroids as a preventative measure and my cervix holds up so the babies don't come before Christmas, but stay in until nearly Valentine's Day like they are supposed to.
Our next milestone is 28 weeks (Dec. 13), when their chances of survival increases to 90 percent and a lot more of their lung development has occurred, along with brain and intestine development. However, we are grateful for every day/week they stay in because each day and week increases the percentage of survival even just a little bit more than the day/week before. Five weeks of limited-activity bed rest down, hopefully 10-11 more to go!
Now to the real reason why I wrote this post, other than to update and get everything down on 'paper'. In the stress and emotions of all this I have not taken as much time as I should to look to the things that I am grateful for and I wanted to express that gratitude now. I am grateful for these little babies that I get to grow inside me and that keep me company throughout the day. I am grateful for the doctors who are watching after us and getting us the care we need. I am grateful for the knowledge that families can be together forever and that no matter what we are not left to go through anything alone because the Lord is there and is aware of us. After much heartache, tears, stress, frustration, disappointment and prayers, we have decided that we are doing everything we can that is in our control and we are going to leave the rest in the doctors' and the Lord's hands. We have decided that we don't want to live in fear, but that we want to still enjoy this time when we can feel the babies kick, punch, twist and turn and get ready to be parents to these two active, spunky little girls. We are so grateful for all the love, support and prayers of family and friends on our behalf and for our knowledge that Heavenly Father is aware of us and is there for us, no matter what happens.
"Choose faith over doubt, choose faith over fear, choose faith over the unknown and the unseen, and choose faith over pessimism." -Richard C. Edgley
