26 weeks

I swear I won't countdown every week, but I am doing mini-celebrations.  Every day, every week that passes means that twins are that much more developed and have gained that much more weight  So while I might not countdown every week, each week is significant in its on right.

As I am hoping to make it to 36 weeks, as of today, I have 10 weeks left!  Of course, this is not guarantee.  Most momos are born between 32-34 weeks, so I essentially have between 6-10 weeks.  Since by then I will be on 24/7 monitoring I am hoping to push that envelope to 36, but it all depends on how they are doing.  I want them to stay inside as long as possible while it is safe.

So...if I get to 36 weeks...the twins will be in great company with other early March birthdays.  

Home From the Hospital

I ended up only staying in for a little over 24 hours.  Both babies are doing good and have been perfect on the monitors.  YAY, for an uneventful and quick jaunt to the hospital.

Turns out while both babies had been head down for the last 3 weeks, one decided to flip and turn breach.  We'll never know if that is what caused the decel or if the decel was the reason for the flip or if it is completely unrelated, but I would like to think it was related.  

While I would have liked to not have a trial run at the hospital it was great for a lot of reasons.  I found out that all my "mental prep" has been working and I was actually more relaxed than I thought I would be.  After my tour the night before I was feeling pretty anxious about staying there, but actually being there wasn't bad.  

It was also good for my family too see what it would be like to not have me around.  My 3 year old, while he missed me, seemed to be unphased, but my husband was not prepared.  We are all feeling a bit more prepared for the eventuality than we did.

With that said, I've ordered my library books and am starting my Netflix list.  Going to have lots of time on my hands.

My Exciting Hospital Visit

Yesterday as apart of my routine home monitoring one of the babies had a decel.  A decel is when the heart rate drops below their normal range.  Decels are not abnormal, in fact they are very normal, but depending on the length, severity, and frequency, it can be serious. 

So we had 2 decels within 20 minutes.  He recovered quickly, but a I immediately contacted my perinatologist who wanted me to go into the hospital.  She notified by OB who said she wanted in the hospital for 24 hours.  SO that's where I am, as of noon yesterday.

After the decels at home we have had no other incidences, so they are doing fine.  Assuming that was the case my OB would allow me to return home, after conferring with the perinatologist.

I had a chance to talk to the neonatolgist which was nice.  We talked about "what ifs" (they came now, 2 weeks, 4 weeks, etc.) and she was very open to answering questions which was nice.

Oddly I just had the opportunity to tour the hospital and NICU the night before my admittance. Based on the specialist availability I had to transfer hospitals. 

Now I've had my trial run at the hospital.

Home Monitoring Day 1

YAY!  Today was the first day of home monitoring.  Because the equipment is older it is very sensitive and because the babies move a lot, I needed to hold both monitors to make sure we got good reads. It took me maybe 15 minutes to get a good position for both, but we got a good 20 minute reading which is what I needed to get.  I found Baby B on my right very easily.  Baby A on my left was a whole nother story.  They are both head down and low in my pelvis, but A is lower so it took a little while to in a  good position with him.

Check out my home monitoring set-up.  In my own bed!!!  Very cozy!

And here is my first monitoring strip that I sent to the doctor.

Best Laid Plans - Follow Up

After my difficult week wit the insurance company, figuring out home monitoring, and my rant things managed to work themselves out.  We decided to pay out of pocket for home monitoring and move my hospital inpatient stay from 30 weeks to 27 weeks.  

I went in for my 24 week follow up.  The twins are weighing 1lb, 9 oz an 1 lb, 13 oz and looking great.  As it it turns out my perinatologist was not pleased with the idea that my insurance would not cover home monitoring and we would have to pay for it ourselves.  He graciously offered for me to use one of their NST monitoring machines.  I was so shocked I couldn't really react.  What a gracious and generous offer.

So the plan is to go pick up the equipment and get trained on it tomorrow.  I will monitor each baby and contractions (although I am not having any) every 4 hours during the day and 6 hours in the evening.  I will fax him and my OB the results and at any sign of complications or difficulty I am to go straight to the hospital.  

I am so grateful that we have this opportunity and that I can remain home with my family through the holidays.  Now since we revisited the inpatient question, we have to decide when I will be checked into the hospital.  I started to adjust to the idea that I might have to go in earlier than I thought so I'm feeling ok about it.  We just need to decide when is the right time.

24 Weeks!

Here we are, 24 weeks.  We made it!  We are officially considered viable, meaning if the twins needed to survive out of the womb it is possible.  Viability does not come without its complications.  There is no guarantee that either or both would survive or survive without serious health issues.  So we are in no hurry for the twins to make their grand entrance.  I would like another 12 weeks if possible, but we will take it day by day and week to week.  

24 weeks is just a great milestone to hit in our journey.

The Best Laid Plans

I was suppose to start home monitoring this week.  I know that occasionally insurance can be a bit of headache so I decided to start working on making sure all my ducks were in a row last week.  Since I had already verified that services I needed were covered, I thought this was more of precaution that anything else.  As it turns out, while my insurance will pay for home monitoring, the company that provides the service, Matria, does not accept my insurance (Tricare).  This is the 1st time in my life that this has ever happened to me.  I was completely stunned!!

You would because I live in large metropolitan city I could just find another provider, right???  NO.  It appears that Matria is the only company that offers the fetal monitoring I need.  

So what are my options?  Pay out of pocket and then file for reimbursement with Tricare.  I don't know what the total cost of that will be, but I can promise for what I was hoping would be 6 weeks of home monitoring will be very costly.  

Option 2, being admitted into the hospital.  This is of course a viable option and where I was going to end up eventually, but I was hoping to stay home as long as possible.  It is more comfortable, more inviting, and more relaxing, but mostly because I wanted to extend the time I have with my son and husband.

Turns out the insurance coverage is not the only issue on the table.  As it turns out, my doctor's orders, which have not deviated from our 1st conversation about home monitoring, may not be able to be met by Matria.  So it may not matter if we can work out insurance issues, they may not be able to monitor me in a way that is satisfactory to my doctor or to me.

This is a pregnancy and a high risk one at that, I know there are no guarantees, but I did not expect THIS to be an issue.  I know it is naive of me, but I never thought that I would have to make decisions on my healthcare based on cost.  I HAVE insurance!  I thought because I had insurance I could receive the best care possible.  

We are in the process of figuring out exactly what all of our options are and then will make the best decision for us.  We are now back tracking and trying to reconfigure many of the plans we had set in place.

Best laid plans.........

Tools & Processing the NICU

I'm so thrilled to be approaching the next phase in our journey, on to 24 weeks and home monitoring, but I am still struggling with a potential stay in the NICU.  I am working every day to try to mentally prepare myself.  

I having been searching for the tools to help me put things in perspective, to understand that this is just a potential step in our journey and it is what is best for the babies.  Since I wasn't able to see babies up close during our NICU tour I found this video that was very helpful.  

The NICU is just everything that is not me.  It is sterile.  It is medical.  It is impersonal.  It is invasive.  It is cold.  I know in my head that those are not the intentions.  I know the NICU is the best environment for preemies to thrive, but it seems so opposite of what comes natural to me.  Natural would be holding, nurturing, breastfeeding, cuddling, smelling, and touching.  

I can't say the NICU is everything that is not me, because I was in the NICU.  I know some of my fears come from how difficult it was for my parents, but also on a subconsious level, how difficult it was for me as a baby.  I recently had an eye opening conversation with an amazing woman who encouraged me to explore these fears and where they stem from, because it is not until I face them that I will truly be able to deal with them.  She explained and I understand that the twins chose my husband and I to be their parents and me to be the vessel in which they arrive.  That they can help guide me through facing my fears.  I believe that and I am working and processing, but it is not easy.

 

Home Monitoring Plan Set

My home monitoring plan is officially set.  NOW the fun begins!

I start next week at 24 weeks.  A nurse through the home health company Matria will come in 2 -3 a day and monitor the babies by conducting a Non-Stress Test (NST).  The test involves attaching two monitors to my abdomen to measure each baby's heart rate and another belt to measure contractions.  Their heart rates are measured for 20-30 minutes depending on how cooperative they re.

In addition to the daily monitoring I will have ultrasounds every other day to monitor the babies cord flow and position.  Two of these monitors will be in the doctor's office and one will be in the hospital.

All this monitoring helps to ensure that the babies are thriving and not getting more entangled in the chords.  If everything goes as planned I hope to continue home monitoring until 28-30 weeks.  

Cord Entanglement

The biggest risk for momo twins is cord entanglement and compression.  By the end of the 1st trimester or the beginning of the second, momo twins will usually have some sort of entanglement due to the amount of space each twin has to maneuver in utero. At my 13 week appointment, cord entanglement was visible in the ultrasound.  At each one of my follow up appointments, blood flow between the cords is monitored to ensure the the tangle has not tightened or worsened cutting off vital nutrients to either baby

To give you and idea...below is a picture of the cords of another set of momo twins who were born at 32 1/2 weeks.  Many thanks to Momma Kate  and her beautiful girls for sharing your picture.

Still in Complete Awe

I cannot believe that I am having twins.  What an amazing gift our family has been given.  Two more boys to raise into respectful and responsible men.  I know there are two, but hearing two heartbeats is still amazing and seeing two little babies on the ultrasound screen is just unbelievable.  I can't wait and am so excited to meet them; although they are welcome to hang out in utero another 3 months.

The Joys of Pregnancy

I love being pregnant.  Life creating life.  It's just amazing.  Sure I'm a little more tired and hungry, but being pregnant allows me to focus on me.  Having a 3 year old doesn't always lend to complete focus, but remembering that I am not only a mother to him, but also to the twins growing inside I strive to find that balance.  I love witnessing the changes in my body.  The growth of my belly, the tenderness of my breasts, the new limits of what I am capable of doing.  Its all apart of bringing 2 health babies into the world

Yesterday I had a ultrasound checking their growth and blood flow.  They each weigh 1 lbs, 1 oz.  They are very active keeping me company all the time.  

Although this pregnancy is much more complicated than my son's, I am trying to soak up every moment of it.  Enjoying all the movements and the changes.  Enjoying being pregnant.  I always say if I would have known how much fun pregnancy and motherhood are I would have done it earlier, but I believe the reason why it is so much fun is that I waited.  

Fetal Doppler

A few weeks ago I rented one of those fetal dopplers from Stork Radio.  I started feeling movement at 13 weeks, but it wasn't consistent.  What a great thing to feel movement so early, but then when it is not consistent you can't depend on it to know the babies are ok.  Funny enough since I got the doppler I don't use it that often.  I always feel them move so I don't even really need it, but just having it in my house is reassuring.  Silly, I know.

Hospital & NICU tour

On Friday we toured the hospital where I will give birth and the NICU where the twins may stay.  It is very nice facility and the 1st thing I noticed was how incredibly friendly the staff was.  I'm not in all hospitals all that often, but I don't ever recall being greeted so warmly by the staff that weren't sitting at the information desk.  That was really nice.  

The hardest part was walking down the hall to the NICU.  There is a beautiful wall of framed photos and gifts expressing thanks to the wonderful staff at the NICU from families whose babies spent time there.  Beautiful stories and beautiful babies.  I couldn't help but cry.  I have a lot of time to get used to the idea that my babies may (and I do say may, because while the odds are in favor of the NICU it is NOT a for sure thing) spend time there.  Tubes coming out of their tiny little bodies, IVs in their arms, oxygen...I'm just not ready for that.  I do need to come to grips that it might happen.  I am trying.  I am trying to get to a point where I understand that this is apart of the process to bring home to healthy bouncing baby boys, but I am not there yet.

I was a preemie.  While I was able to come home initially, I had to go back to the hospital for several weeks.  My parents tell me this story all the time sharing how much they love me and why they are so thankful for me.  But the other side of the story is how heartbroken my mom was leaving her tiny baby at the hospital.  I've been told this story at least once a year for the past 30+ years.  It is apart of who I am.  Now to think I may have to go throw what my mom went through.......just hurts.

During my tour I did get to talk to the director of the NICU and she was amazing.  I know if they have to spend time there that they will be in good hands.  We talked about breastfeeding, visiting, and to my delight kangaroo care.  She was supportive and informative and offered to be available for any questions that may come up before and after the babies are here.

Sulindac

The perinatologist would like to start me on a drug called Sulindac.  Sulindac is non stereodial anti-inflammatory drug.  While not its primary role, it has been used to help treat pre term labor and in decreasing the amniotic fluid level in mom pregnancies.  

Not being much of a "drug" user, the decision on whether to go on Sulindac is not an easy one to make.  Because there are so few momo twins we are basing our decision on the limited information we have and the experience of my health care providers.  By decreasing the fluid, the babies would have less room to maneuver in therefore limiting their ability to further tangle their cords.

Initial Stages of Planning - 15 weeks

It's very early to set anything in stone, but our initial plan is home monitoring to begin between 24 - 26 weeks.  In addition to home monitoring I will go in several times a week for ultrasounds.  My peri is agreeable for me to continue home monitoring to 30 weeks if the babies look great.  At that point I would be admitted into the hospital for 24/7 inpatient monitoring.  

During our initial planning we did not discuss delivery.  Delivery for mom twins is typically between 32-34 weeks.  I would love to aim for more towards 35 weeks, but there is not guarantee that I will make it that far.  The bigger the babies get the more danger they are face in compressing their cords so that's typically the reason for 32-234 weeks delivery. 

Here are the twins at 15 weeks facing each other.  TOO CUTE!

The Shock & Reality

Now that you know the nuts and bolts, how are I am feeling?  Initially, I was in a 100% state of shock.  Shock that I have been blessed with twins and shocked that learning the difficulties I face in this pregnancy.  The pregnancy of my 1st born was very smooth.  Minor problem here and there, but nothing that prevented me from carrying to term or enjoying my pregnancy.

I cried for several days straight.  Crying for the a loss of innocence and enjoyment of my pregnancy, crying for what might happen, crying for cryings sake.  I was pretty devastated and scared.

I spent hours online learning all I could.  Reading as many studies as I could, learning from others experiences they shared on online forums, and soaking every piece of information I could

I had a follow-up appointment with the perinatologist two weeks later and was in a much better place about the twins and my pregnancy.  I had a whole host of questions for him.  It was the first time I didn't feel fatalistic about the pregnancy and really felt like everything would be ok.  That the twins would be ok.  That I and my family would be ok.

Mourning the loss of Natural Childbirth

Maybe that's a bit dramatic way to say it, but I am really sad (really sad) about having to have a c-section. Of course this is not at all how I imagined this birth being. I was considering a home birth. My first son was born via vaginal delivery in a hospital with no complications. I got to hold him and breastfeed him immediately.

I know its what's best for my babies, but I have no idea how to start to let go of this disappointment. It's not even the actual birth itself, it's the recovery time. How can I mother two newborn twins and a 3 1/2 year old while recovering from a c-section?

I feel selfish for even feeling this way, but I do. And of course, everytime I begin to think about them in the NICU I just start crying. The loss of that bonding time, the potential difficulties of breastfeeding. I'm just scared and sad.

I have a great team of women around me. My midwife is going to see me concurrently with my peri and ob. On staff with the midwife is lactation consultant who has experience in this area. I am just scared and mourning the loss of the ideal.

Monoamniotic Monochorionic - Nuts & Bolts of MoMo Twins

At our first visit with the perinatologist we learned that as my OB suspected, our twins did not have a separating membrane. They are monoamniotic monochorionic (MoMo Twins).  MoMo Twins are pretty rare counting for 1 in 25,000 to 1 in 60,000 births.  If there was no doubt before, they are special!

What are MoMo Twins?

MoMo twins are by definition identical.  Identical twins are formed when a single fertilized egg splits in the womb.  If the egg splits prior to the placenta being formed each embryo has its own placenta, chorionic sac, and amniotic sac.  If the split occurs after the placenta has begun to form (typically 7-9 after conception) the twins begins to form in the same placenta and sacs. 

Identical Twins

 Monoamniotic Monochorionic Twins

Why are MoMos special?

Besides being a rare occurrence (less than 5% of identical twins pregnancies), momo twins are at risk for health complications due to the close proximity of their umbilical cords in the amniotic sac.  

What are the concerns for the twins?

Momo twins are at risk for cord entanglement, cord compression, and twin to twin transfusion.  

Cord Entanglement - Because the twins have no membrane separating them their umbilical cords can be easily tangled.  Actually, most MoMo twins cords are tangled at some point in during the pregnancy, but severe entanglement can cause fatal complications

Cord Compression - Without a membrane separating them as the twins move around in their sacs, one can compress the other's cords cutting off nutrients and blood flow.

Twin to Twin Transfusion - This occurs when one twin receives the majority of the nourishment in the womb causing the other undernourished and sickly.  

What can be done to help ensure a healthy babies and mom?

First recognizing that carrying multiples is different from carrying a singleton.  May seem obvious, but the needs are different and not always proportional.  Secondly, very little until viability (24 - 26 weeks).  Intensive monitoring of fetal movement, blood flow between the cords and development prior to viability and then increasing post viability.

How does this affect your pregnancy?

My pregnancy is officially considered high risk.  I see my doctor's on average of every 2-3 weeks during the 1st part of pregnancy increasing to 2-3 times a week as my pregnancy progresses.  I get to see the twins often with ultrasounds at every appointment.  Once the twins reach viability I will start with home monitoring 2-3 times a day and multiple weekly ultrasounds to monitor blood flow and development.  At some point yet to be determined, I will enter the hospital for 24/7 monitoring.

What about delivery?

MoMo twins are typically born between 32-34 weeks barring any complications.  Due to cord entanglement they are born via c-section.  Due to their premature arrival, most spend  period time in the Neonatal Intensive Care Unit (NICU).

Surprise!

Although I hired midwives for my care, I had forgotten to cancel my next appointment with my OBGYN. Being to late to cancel the appointment I decided to go ahead and go. What was the harm?

Since this was just a routine appointment, I told my husband there was no need for him to come. When the doctor tried to hear the heartbeat with the doppler she got a strong heartbeat, but baby was moving to much to get a good read. She decided to do an ultrasound just to make sure everything was ok.

In the initial ultrasound she was getting a "shadow," not abnormal for an external reading at this stage of the pregnancy.  She opted for an internal ultrasound which immediately looked to me like their might be two heads. I wasn't sure, after all I am not technician trained to read these things. She moved the screen closer and out of my view (clearly, while she did not say anything, she saw what I saw). After a few seconds of her not saying anything I asked if everything was ok, she said yes, but I have news, there are two!

I was out of breath, but oddly not surprised. I kept asking if she was sure and promptly asked her to hand me my phone so I could call my husband. I took a picture of the ultrasound screen and emailed it to him. I called and had him look at the email as I gave him the news. He was pretty shocked and of course since I was not done with my appointment I had to make the phone call quick.

Staring at the ultrasound was amazing. One baby was in the fetal position that you are used to seeing in the ultrasounds, but the other looked as if it were hugging the first one with its arm wrapped around the other and its leg in a spoon like position. What an incredibly site!

My OB expressed a very small concern that there was not a membrane separating the babies. Not being an expert on assessing multiples, she referred me to a perinatologist who specializes in high risk pregnancies and has more in depth equipment to asses the babies.

1st and 2nd Ultrasounds & Healthcare Decisions

Yay, the first ultrasound at 5 weeks looks great and the follow up ultrasound at 9 weeks we can see the heartbeat. Looks like baby is growing great.

Seeing that the pregnancy was progressing well, I began exploring my birth options. My son who is now almost 3, was born via induction in a hospital. Born at 6 lbs, 13 oz there was no cause for concern. To this day he remains long and lean.

Based on my experience with my first son and other close friends birth experiences I wanted a different experience with this baby. My interest turned into a deeper passion, wanting to help educate and empower other woman on their birth options. I pursued certification as a birth doula through DONA .

Shortly after my nine week appointment I decided to hire midwives for my care and to attend my birth.

We're pregnant!

No missed period yet, but just starting "feeling" like I was pregnant. Low and behold I buy a home pregnancy test and it confirms that I am indeed pregnant. My due date is April 2, 2009.