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.