Twins Make Five

My Due Date

2009-04-02T20:28:00.000-07:00

Today is my official due date. Its all sort of funny now, considering the boys have been here for 6 weeks and 2 days. We knew they would be early, but we had no idea when they would come.

The official due date is cause for celebration because I now have both boys home!! It is truly a blessing. We are all adjusting to the new schedules and all three of my boys are doing really well.

It has been a long, hard, emotional journey, but we are all finally all together. I have a few more posts that I will probably make as they relate to my pregnancy, their birth, and the NICU. As for now, I'm just happy as can be.

One at home, one in the NICU

2009-03-21T21:13:00.000-07:00

It really is a blessing to have twin A home. We are all transitioning well. His older brother is thrilled to have him here. The difficulty, having twin B still in the NICU. It is no longer the emotional toll, but it is also starting to take a physical toll on me. Before when they were both together I could spend all afternoon at the NICU. Because I do have a 3 year old at home, spending all day never worked. Now I'm lucky if I get to be there for one feeding. Don't get me wrong. I am THRILLED to have A home, but maintaing the balance is not easy. Hopefully we are in for only more week. Twin B is on the finally week of medication treatment for his infection. He will have a test midweek to ensure that everything looks good. Assuming that comes back good we will be able to take him home next weekend. Keep those finger crossed for us.

Twin A is Home

2009-03-18T20:53:00.000-07:00

YAY!

We are so excited to share that Twin A came home today. I didn't know whether to cry out of joy to be taking him home or cry out of saddness to leave one in the hospital, but we are very happy to have one of them home. It is definitely bittersweet.

1 Month Old

2009-03-17T23:07:00.000-07:00

It's hard to believe the twins were born just one month ago. I honestly thought they would be home by now. The good news is that both are continuing to do well and should be home in the next 1 1/2 weeks. I'm trying hard not to get my hopes up, but I am so looking forward to having both of them home. It is looking more and more like Twin A will come home before B. While it is not ideal, because they cannot cobed in the NICU I will take one home if he is ready before the other.

It is amazing to think back to how much progress they have made over the month, while at the same time each and every day by itself is so hard to stomach being away from them.

Today however, we celebrate that we have two beautiful and healthy baby boys.

Breastfeeding in the NICU

2009-03-13T14:37:00.000-07:00

It is so amazing. One of my major concerns about having preemies was their ability to breastfeed. Amazingly, it is the one thing they had no problems with. *knock on wood*

14 hours after birth I started pumping with a hospital grade breast pump. I got very little at first, but I wanted to condition my body to be prepared to feed 2 newborns. I pumped every 2 hours consistentantly It was a pretty easy schedule to keep up in the hospital, but once I got home and was traveling back and forth it became more difficult. I occasionally pumped there, but also used the opportunity to stretch my pumping session when necessary to 3 hours.

The day I was discharge, 5 days after birth, my milk came in. I continued with the every 2 hours, with the occasional 3 hour stretch. I was startled to pump 12 oz in one sitting, so I started measuring to figure out how much I pumped in a 24 hour period. 23 days after birth I pumped around 55 -60 oz a day. That's ALOT!. I was very concerned about the amount because I read that you needed to pump 24 - 32 ounces for a singleton. I thought there is no way I can do that. I was thrilled to learn I was doing that x2!

So, since my babies have been able to feed they have received my breastmilk, whether in a bottle or by breast.

Now, for the latching onto the breast. I was actually very concerned about the boys receiving a bottle or pacifier. Everything I read said those are big no-nos if you want to have a successful breastfeeding relationship. The NICU was not willing to let them feed solely on the breast. I was initially very upset and then I realized I would do what it takes to get them out of the NICU and would work on feeding at the breast once they got home.

Little did I know how few problems we would encounter. As for the actual "latch on" I wish I had suggestions. I used what I learned as a previous breastfeeding momma and doula training to position and offer the breast properly. That was really key for the boys.

Then I wanted to make it as easy as possible. I initially pumped through a let down and then offered the breast. After the appeared to get the hang of that I would do a little hand expression because they would initially get frustrated that they were working so hard and not getting anything so the expression allowed a little instant gratification. Now, occasionally they get frustrated when I don't but they latch on perfectly.

I did have one problem that could have been a major one. I had a clogged duct that quickly turned into mastitis. I had a fever, the chills, the whole nine yards. It came on suddenly. I took a hot shower and massaged the affected breast. I continued to pump, drink water, rest, and put warm compresses on the breast. After 10 hours my fever went down dramatically so I decided to not go to the doctor and continue to rest, by 20 hours I was back to normal. The problem was I tried to stretch my pumping out to 4 hours. Not such a good idea. I immediately returned back to the 2-3 hour routine.

There is lots of great info on the web about exclusively pumping. Here is a link to the site I found most helpful http://www.ameda.com/breastpumping/moms/. I'll also post additional links on the side of the blog that I use regularly.

Finally, I am so proud of my freezer full of milk that I had to share. Thank goodness we don't freeze a lot of food.

37 Week Update

2009-03-12T20:36:00.000-07:00

It's nice to have the internet back up and running and my computer working. I feel connected again!

The twins are both doing well in the NICU. Today they are 37 weeks in gestational age, 23 days old. One is completely off oxygen and breathing on his own and the other has limited assistance. It is a long way from 3 weeks ago. Of course it doesn't feel like that on a daily basis, but when I have a chance to step back the boys have really come along way.

Twin B developed an infection and is on day 6 of a 21 day medication regiment. SIGH! He is eating beautifully, gaining weight perfectly, but has to remain in the hospital because of the infection. He is fine, but it just sucks that this is the reason why he remains in the NICU.

Twin A is eating really well as well. He took a bit longer to get with the program, but will no be shown up by his brother. Once he is weaned off his oxygen and can breathe well on his own for 24 hours he can come home. It could be any day, but it is all up to him.

So we continue to wait...

I hate the NICU

2009-03-04T09:57:00.000-08:00

We've had Internet difficulties over the past week or so, so I haven't been able to update as much as I would like. The boys continue to do well. One of the boys developed a yeast infection in his umbilical line and has been on antibiotics and anti-fungal medication. He has been recovering fine, but this means that he will be in the hospital under treatment for at least 2.5 more weeks.

Both boys are tolerating their feedings well and we introduced the breast to one yesterday. It was an amazing experience. It took him a bit to figure out what was expected, but once he did he latched on and sucked well.

I'm just tired of the NICU. I really want my babies home with me. I know it's completely irrational. I know that they are in the best place for them right now, but nothing is harder than leaving them every day. It hurts and my heart aches every time. The staff is amazing and handles my occasional teary mutterings well. I know they are both taken care of, but it just stinks.

The Roller Coaster Ride of the NICU

2009-02-22T15:19:00.001-08:00

It has been an up and down ride the last few days in the NICU. Twin A has gone from a ventilator to an oscillator. He was not doing so well on the ventialor. It is a different breathing assistance apparatus. It is kind of scary at first because it makes the baby vibrate. It is a sight to get used to. They have to be sedated and can't be touched as often. Ok, I said it was scary at first, I still get a chill when I first walk in.

While the oscillator is a little off putting, A has responded very well to it. In the last 24 hours the doctors and nurses have been very impressed with how well he is doing and have already started adjusting the settings to wean him off.

B is also doing good. He is still on the ventilator, but is now breathing what is considered "room air." The settings on the ventialor are comparable to what we breathe normally. Today they will give him a tiny bit of breastmilk through his tubes to see how he digests. This was a very exciting development and you can imagine how happy I was to hear this. It is only a tiny bit, but it is a start.

It is already after 3:30 and I have managed to only cry twice, which is far different from the constant sobbing I was doing before. I know part of it is just hormones, but leaving them in the NICU is still the most difficult thing I have ever done. Remind me of this when I hand them keys to go driving alone for the first time.

We are working on a good system to spend time with the boys at the hospital, our oldest son, and still make sure I am resting and eating so I can keep producing breastmilk. It so far has been a carefully crafted balance, but my husband is incredibly supportive and helpful in making sure we strike the right balance.

Cords

2009-02-21T01:02:00.000-08:00

As we know, most, if not all, momo twins have some knots and twists in their cords. It is these knots that is the cause for great concern. If the knots tighten too much or their cords get compressed it could be fatal.

Here are pictures of our little ones cords. Their was one very distinguishable knot and a twist beneath it. Later I was able to touch and examine the knot. It was very tight. I'm not sure how blood and nutrients traveled through it, but it did. It is truly a miracle that my babies not only survived, but thrived with their cords like this.

The Next Journey - NICU Stay

2009-02-20T23:33:00.001-08:00

We have turned the page and started our next journey this time into the NICU. After 47 days in the hosptial, I am being discharged tomorrow and will have to leave my tiny, sweet babies here. It is the moment I have dreaded. Is a rare occasion that I can walk into the NICU without shedding a tear. I have gotten past completely crying when I walk in the door. It is incredibly hard to see your little ones fighting to mature and grow, with lines and tubes coming out of them. You feel so helpless. I know they will be ok. I know in my head that this is the best place for them, but it doesn't make it any easier. I want to hold them. I want to hug them and I can't. Not for now at least.

The NICU is one big roller coaster ride. For every two steps forward you move, you then take two steps back. I try to keep this in mind as I gather information about how they are doing.

Both boys currently need assistance breathing. Shortly after they were born the needed only brief assistance, but after this "honeymood" period was over, the have needed additional assistance. The amount of assistance has flunctated as their lungs continue to mature and they learn to breathe a bit more on their own. As of an hour ago they were both breathing mostly on their own.

Today they had their hearts examined as a result of the work their lungs are doing. They didn't think anything was wrong, but mostly examined them as a precautionary measure. Both of their hearts look strong and healthy for their gestational age. The cardiologist didn't have any concerns.

We are not sure how long this road will be, but we will continue to keep you updated.

Birth Day

2009-02-19T06:31:00.000-08:00

The twins birthday started with contractions. I wasn't really feeling them, but I was feeling something different. This is the 2nd time I was having consistent contractions. The first time was earlier in the week and we were able to stop them. This time the contractions were spaced closer together. The doctor thought to check my cervix and see if the contractions were "productive." As it turns out, it was. I was 4cm dilated and completely effaced! Mind you these were contractions I wasn't feeling, but I was officially in labor.

Being that far along required immediate intervention to slow/stop the contractions so that I did not go into full fledged active labor. The potential for cord compression and complications increased if I went into active labor.

The nurses and doctor's began to prepare for the c-section. Remember all that anxiety I had about having a c-section? It was GONE...completely gone. Things went very smoothly. My favorite nurses were there in attendance and things weren't emergent, but were relaxed and steadily flowing.

The twins were born within the same minute (7:30pm), 20 seconds apart. They weighed the exact same grams, translating into 4 1/2 lbs and were 1 inch apart at 18 & 19 inches.

Being born at 33 weeks they are in the NICU. They are doing well, but it is definitely a roller coaster. I'm recovering, but it is hard. I've never had major surgery so this is a whole new experience for me and of course not being able to have them with me is very hard.

All and all, things could not have gone better. My body had enough and I went into labor. If I were not in the hospital I would have never known and things could have gotten much more complicated. Having had my contractions monitored we were able to do things in a controlled manor on my boy's and my body's time table, not an arbitrary date. There were no deccels, no babies in distress, but instead a very smooth process.

My nurses and the doctor's were phenomenal and I am so happy to have my babies here.

The Twins Are Here!!!!!!!

2009-02-18T01:15:00.000-08:00

Born at 33.5 weeks my miracle momo twins are here. They weighed the exact same at 4 lbs, 8 ounces each and were an inch different in length at 18 & 19 weeks. The birth went wonderfully. They are needing assistance breathing so are in the NICU. I'll post their birth story later.

Has it Really Been 5 weeks?

2009-02-09T18:26:00.000-08:00

As of today I've been in the hospital for 5 weeks. Kind of amazing considering I never in a million years thought I would ever spend anytime inpatient in the hospital. I've only recently started missing "things" from home. Of course I miss being with my family, but I've started to miss my bed, my really comfy couch, and well, my home. Not to long to go now.

I had a growth scan yesterday and the babies are estimated to be 3.9 and 4.25. Awesome, just awesome.

5 weeks down, 3.5 more to go - hopefully.

A View "In the Womb"

2009-02-04T16:34:00.000-08:00

Here is a clip from National Geographic's In the Womb Series on multiples. This small clip of the 90 minute video shows interaction between multiple babies in the womb. Beginning at 3:23 they give you an idea of what momo twins are like in the womb. You can see them actually touching and grabbing each other. Our first experience with this was in our 1st ultrasound. It looked like our boys were cuddled up next to each other. If the video does not show below, please click here.

I don't have control

2009-02-04T11:21:00.000-08:00

Reality from Monday's nights close call to delivery finally set in last night. I was sad and close to tears coming to grips with the reality that I don't have control. I know that seems like a no-brainer. I haven't had any control with this pregnancy, why would I think that I did. I'm not sure. I'm doing everything I can to be healthy, to grow the babies, to ensure the safest course for their arrival, and while that matters it does not give me control. THEY will decide when to come. I want to make it to 36 weeks, but that is just a want. I realize that. I've always realized that, but the reality was something that was a little farther from my reach. I'm doing what is best for them by being in the hospital and being monitored 24/7, but they will make the decision on when to come. I'm grateful for every day that I am able to remain pregnant and they are able to continue to thrive in the womb.

Excitement!

2009-02-03T02:59:00.000-08:00

Well yesterday was my first real excitement during my 4 week hospital stay. Yes, today I am at day 29 and still counting.

The babies showed a dramatic, almost instantous shift in their heart rate baselines. While a shift is normal, shows signs of maturity, and is overall a good thing, the sudden shift was a shock and a little scarey for me. We've see the babies heart rate in the 150s as a rule and all of sudden yesterday it dropped to 110s.

This drop occured one other time before, but quickly came back up. Today it continued to dramatically flunctate for the remainder of the afternoon. My doctor was not alarmed because the rates were still in a normal range. I knew in my head everything was ok (if not the nurses would be running in), but such a dramatic shift was not what I was used to seeing.

As the evening went on, the rates continued in this new pattern and after seeing my doc I was reassured that it was definitely a switch in baseline and great varibility, showing a sign that the babies contiuned to be healthy and mature a good rate.

Several hours later, a shift in my nursing staff and a drop to the high 90s was cause for new alarm. I initally was not concerned because it was in the range that my OB had just seen. The night shift nurses however were concerned and one of the other doctors in the practice was called in (my doc had been up for 24 hours and wanted to come in only if there was going be a delivery). I asked for my nurse to be blunt about what she thought might happen and she said an impending delivery. AHHHHHH!!!! Ok, take a breath.

Needless to say, the next 45 minutes was excitement....from me putting on an oxygen mask, to the IV being prepped, to having to change from my regular clothes to a hospital gown - just in case. I was prepared for the idea that this could happen and soon, the babies shifted again and brought their heart rates up. My doc did come in because of course she couldn't sleep not knowing what was going on.

For now, the monitoring belts lay firmly affixed to my belly and the babies baseline remains lower, but the excitement has passed. My wish for a non-eventful stay has been interrupted, but events are great preparation.

Thankful

2009-02-01T10:07:00.000-08:00

As the days and weeks have gone by I've worried about my babies surviving, delivering by c-section, having premature twins, and a NICU stay. While these are all very valid concerns, I'm realizing more and more how lucky I am. I can say this now being just over 31 weeks. I had the time to thoroughly process all of these fears, to weigh the pros and cons, and to come to grips with the possible outcomes. How lucky is that? I mean many women don't get the chance to think about these things. They are just thrown into these situations and while they have the same fears, only get to process them later under much more difficult circumstances.

My journey is by now means over and I'm still aiming for a 36 week delivery, but I feel prepared to handle what comes my way. I'm not saying it will be easy or that I won't shed tears if things don't go as I would like, but I've had the time to think about and process all of the possibilities.

I've always thought I was carrying March babies (baby, when I thought there was just one). I've long been at peace with that fact and never flinched about it changing. I will continue to hold onto this and hope for a little more than 4.5 weeks of happy babies remaining in the womb.

*knock on wood*

Met My New Specialist

2009-01-25T10:40:00.000-08:00

Yesterday I had the pleasure of meeting the head perinatologist in the practice that is now taking care of me. He has a great reputation and is very familiar with monamniotic twins. He was apart of an 8 year study advocating for intensive hospital monitoring.

I had to switch peri's because the one I was originally seeing did not have privileges at the hospital close to my home. I loved my former peri. He and I were on the same page and had a similar outlook about pregnancy. Not only was he a fabulous physician, but he was also compassionate, thoughtful and engaging.

The peri did a full ultrasound screen on me and the twins are weighing 3.3 lbs and 3.5 lbs. So excited! Grow babies! Grow! The peri was very impressed with their growth and how the monitoring as been going. He made a comment about some singletons tracings (heart rates over an extended period of time) do not even looking that good.

But it was clear it the realm of doctors that are taking care of me that his role is the "enforcer". My OB who is wonderful knows my wishes listens and as long as things continue to look good has expressed support for them. The other peri in the practice expressed a desire to proceed with caution, but was also supportive of my desires. The head peri was much more stringent. He believes there is a way things should go and that's that. He wants me to come off Sulindac, have an amnio and to deliver at 34/35 weeks. Now don't get me wrong, he listened to what I had to say and even comprised on a few things, but overall he wants things the way he wants them.

I should explain that my desire for this pregnancy is outside of the norm of how monoamniotic pregnancies typically go. Typically, patients are admitted into the hospital at 24 weeks for monitoring and deliver between 32-34 weeks. Admission into the hospital is about viability; what do you consider viability. While some doctors will require their patients to be admitted at 24 weeks, this decision is a very personal choice for the mother and the family. Survival rate, quality of life, all of these things are very difficult matters to discuss and should be by no means made by the health care provider. We haven't even gotten into the nuts and bolts of how often to monitor or how difficult it is to keep 24 week old babies on the monitor. These are all things my husband and I considered before my admission into the hospital which we decided to do at 27.5 weeks. I did begin home monitoring at 24 weeks and was comfortable with that level of "intervention."

Once admitted to the hospital families have to be prepared to deliver. So assuming everything is going great, the next question is when to deliver. As I stated, most momo twins are delivered between 32-34 weeks. The studies show this is the safest time to deliver. However, there is a gap in the studies. There is a not a study that addresses continuous monitoring and a later delivery. Since, I am on 24/7 monitoring and any signs of the babies distress can immediately be detected I see no reason to not let the babies stay inside longer. Honestly, ideally I would wait until I actually go into labor, but I also realize that babies gain a lot of weight in the last month which could very easily cause cord compression. Due to this, I am willing to deliver at 36 weeks. Again, I understand this is not the norm, but I do not feel as though I am comprising myself or the twins because I am on continuous monitoring. As I told the doctor, if they look as good as they do now, I will be hard pressed to deliver any earlier than 36 weeks.

The peri is most comfortable with deliver no later than 34 weeks and may be willing to push it to 35 if everything is going great. I left the conversation there because we are still 4-6 weeks off from any of this conversation mattering and anything could happen between now and then.

I do not believe the twins need to be routinely delivered by c-section, that moms routinely need to be put on bedrest, or that they need to be routinely delivered at a certain week. I DO understand that twin pregnancies are considered high risk and therefore must closely be followed and their care adjusted to how mom and the babies are developing, but all things being equal....let nature take its course.

With all this said, I am taking each step day-by-day. My wants do not matter to the little ones growing inside of me. They have their own desires and needs and they may decide to come much sooner than I would like, but I will do what is best for them. I will also continue to listen to my perinatologist, my OB, and the neonatologist. I will not blindly follow their directions, but I will ask questions when I don't understand and encourage discussion when I disagree. This is my body and these babies are mine and my husbands. Sometimes doctors need to be reminded that you are apart of making healthcare decisions.

Officially in my 30s - I am 30 weeks!

2009-01-22T07:48:00.000-08:00

It's official, today I hit 30 weeks. 90% of babies born at this gestational age survive! This is a HUGE milestone. I am definitely doing the happy dance. Every day, every week is better, but to reach 30 is awesome!

The twins are doing great. Their heart rates have been consistent, showing no signs of distress and great variability. I've been in the hospital now 2.5 weeks and am hoping for 6 more! I've actually been throwing around delivery dates, but I'll keep those to myself for now. I'm just going to live in the moment and enjoy my 30 weeks!

Passing Time

2009-01-21T11:18:00.000-08:00

On one hand my days to have some flow and on the other hand they don't. Yesterday I woke up ridiculously early excited about the inauguration. I had a steady flow of visitors which was really nice, but by last night I was exhausted. Wouldn't you know, the one night I'm completely exhausted the babies stayed on the monitors perfectly, not a problem even when I got up to go to the bathroom. I got to sleep peacefully without interruption. My nurse actually came in this morning to say bye because she hadn't seen me all night.

My daily walk is throughout labor & delivery and the postpartum area. I try to stop in and wave to the NICU staff and occasionally I see babies in the regular nursery. That is really the highlight of trip.

Bored

2009-01-14T11:48:00.000-08:00

It's almost noon and I've already done the two things I set out to do today. Now, for the first time, I'm bored. Thank goodness its almost lunch time.

Start of a New Week

2009-01-11T16:24:00.000-08:00

I am pleased to say I am in a much better mood than I was yesterday. I got a full night's sleep and the nurse only needed to come in once to adjust the monitors. I think it is a matter of style on how each nurse handles "continuous" monitoring.

I met my new perinatalogist today and was very pleased. He did a full scan ultrasound and we talked about some of my desires including delivery at 36 weeks. He was so pleased with how great the twins are doing, how their cords looked, and how they have been behaving for the monitors that he agreed that if everything continues down this path that 36 weeks is doable. Of course things CAN change in an instant, but so far so good and we can only take it one day at a time.

I also learned that the twins weigh almost 3 lbs each!

The Last 24 Hours

2009-01-11T06:53:00.000-08:00

The last 24 hours have been a little strained. It started Friday evening when my nurse woke me almost every hour to find the babies. While this can be quite common, I had not had this experience yet. My previous nights consisted of me getting up and going to the bathroom multiple times in the evening and occasionally needing assistance getting the babies back on and staying on the monitors. The nurses came in twice maybe three times in the night.

Because the babies move often it is possible that they will come off the monitors and then come back on within a matter of seconds to a few minutes. As long as they have shown good and consistent heartbeats prior to coming off the monitor this is not a problem. Friday night it was a problem! The nurse assigned to me used every possible moment to come and adjust them. SIGH! I didn't get any sleep.

If I don't get sleep for a good reason then I am a little more tolerant, but when I look up and she is walking into the room AND the babies are already back on the monitor before she touches them I am not happy. So I woke up on Saturday very tired and frustrated.

Going into the day tired I decided to take a nap after lunch. Unfortunately, that didn't happen because physical therapy and my OB stopped by. By the time my visitors were gone I was too awake to nap.

To add to it, my son got sick the night before so I was a little worried about him. We think it was food related, but still not fun. He and my husband didn't come to see me last night because he wasn't feeling at 100% yet. I was a little sad, but knew that I needed my sleep so it was probably for the best.

Today I woke up with only 1 interruption!! I got a full night's sleep. YAY! I get to catch up on my Sunday morning politics and root for the Steelers this afternoon.

The Small Things

2009-01-07T20:44:00.001-08:00

The staff at the hospital has just been phenominial. I'm the only long term patient right now so everyone pops in to say hi figuring they will be assigned to me at some point.

I got a fridge in my room. YAY!! I can keep all sorts of goodies in there so that's very cool. Also the family came by to visit today. No nap for the preschooler 2 days in a row make it difficult for a visit, so tonight was the first night since I've been here that they've been able to come visit. I was also able to talk to the nutritionist who was able to make some arrangements for me to receive supplements to my meals. I have been very diligent about keeping up my caloric and protein intake and was not sure how much the hospital would be able to help me meet the same goals. The nutritionist added snacks and made a few other suggestions to the meal plan. Very excited.

I've said it before, but I think all the mental prep I did to prior to being admitted has been really helpful. Mind you, its only Day 2, but I'm feeling pretty good about my stay. I want the twins to stay in as long as possible and every day I am here is 1 more day.

Setting a Schedule

2009-01-06T17:08:00.000-08:00

Because I want to try to stay busy and make the best use of my time I'm pretty set on setting a schedule. I know it's silly of me, but I feel like it will bring order to the day/week.

Here's what I've got so far -

Monday, Wednesday, and Friday - ultrasounds

Shower after breakfast

Work after lunch including job hunting for friends and non-profit work

Catch up on podcasts during work time

Evening with the family

That's it for now.

Inpatient at the Hospital

2009-01-05T21:11:00.000-08:00

Today is my first official day in the hospital. It doesn't feel real yet. Kind of surreal actually. So I'm 27 1/2 weeks and am hoping to deliver at 36 weeks. That means a little over 2 months in the hospital.

The twins are doing great. While we have our moments, they are pretty much staying on the monitors great. I had a good 4 hour stretch this afternoon in which they were on the entire time.

I'm feeling ok right now. I've had time to prepare and my brief stay a few weeks ago was a bit of a reality check. Got my Netflix, got my library books, and I've got some work to do. Going to think about a routine and try to get fully settled in.

26 weeks

2008-12-25T19:41:00.000-08:00

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

2008-12-21T12:46:00.000-08:00

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

2008-12-19T11:35:00.000-08:00

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

2008-12-15T19:17:00.000-08:00

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

2008-12-14T13:27:00.000-08:00

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!

2008-12-11T19:49:00.000-08:00

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

2008-12-09T05:42:00.001-08:00

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

2008-12-08T14:34:00.000-08:00

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

2008-12-04T16:11:00.000-08:00

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

2008-12-01T19:42:00.000-08:00

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

2008-12-01T14:41:00.000-08:00

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

2008-11-25T06:54:00.000-08:00

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

2008-11-20T07:01:00.000-08:00

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

2008-11-17T09:50:00.015-08:00

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

2008-11-05T14:30:00.000-08:00

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

2008-10-20T11:21:00.000-07:00

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

2008-10-19T17:00:00.000-07:00

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

2008-10-19T14:46:00.000-07:00

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

2008-10-19T13:53:00.000-07:00

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!

2008-10-18T22:20:00.000-07:00

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

2008-10-18T21:50:00.000-07:00

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!

2008-10-18T21:46:00.000-07:00

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.