Excitement!

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.

Met My New Specialist

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.