Next steps in a Nutshell:
We met with an amazing doctor from Maternal Fetal Medicine, Dr. Wilson. He seemed like the most genuine, caring, knowledgable doctor we've met so far (most of them have been pretty great though). He sat on the foot of my bed, wiggled my feet, flipped through my giant binder of charts, made me feel very at ease and not rushed in the slightest. He said that doctors aren't great at reading minds, so to please make sure that I always ask any question I have. He explained that he was going to get his team of doctors together and get everyone on the same page so that we don't have everyone coming in saying something different, because sure they each have their own opinions, but he certainly was right when he said that it has probably been confusing and stressful getting different information every time we met with someone new. He explained all of our current and potential upcoming options.
1) Progesterone Suppositories. This, I've learned, is a fairly new medication specifically used to prevent pre-term labour by helping to stop the changes in the cervix (ripening, dilating). It's a hormone that would otherwise be produced by my own body, but in vaginal 'pill' form that I'd take daily for the rest of the pregnancy. A couple of the doctors had explained that they would like to try this route, but that all evidence has shown that it has only proven effective in singleton pregnancies and actually not effective in multiple pregnancies, especially in those with higher order multiples (triplets or more). These doctors suggested that we try anyway because there are no risks, and it wouldn't hurt to give it a shot. But Dr. Wilson suggested that we not, because of that proven evidence that it absolutely does not work for triplet gestations and so why would we put something new into my body that we knew wasn't going to work. I had done my own research after talking to him, and found this to be true - but not only that, I also found that in some studies these suppositories have been shown to have a negative effect on the cervix in a small percentage of multiple pregnancies. So, these suppositories are out the window.
2) He explained to me very clearly that if the babies happened to be born within the next week or so, that a vaginal delivery would be just as 'safe' as a c-section would be for the babes. He therefor also recommended that vaginal would be best if it got to that point, but that ultimately it would be up to the delivery doctors given the situation in that moment. He even took the time to go through Lilah's labour and delivery with me, and concluded that given how quickly she was born, that it would likely be a similar situation for these little guys especially given their small size and baby A presenting head down, and thus possibly even less stressful for them than a c-section. I was also concerned that if we did have a c-section this early, that they would have to do a classical incision which could potentially threaten all future pregnancies that I have (which is what we were told by the NICU doctor we saw). But Dr. Wilson said that, while yes I would need a classical incision for a singleton pregnancy at this point, because I'm having 3 and my uterus is already so stretched out, that a modern transverse incision would be performed instead.
3) I also asked him about the possibility of, if it came down to it, having the twins born vaginally and trying everything we could to keep the fraternal brother in there. He said that it's very possible that this could happen, though it ultimately depends on what my uterus wants to do in that situation. Sometimes they are able to stop the labour and relax the uterus to keep the existing pregnancy continuing, but sometimes the uterus is strong enough to continue and try to get all of those babies out. There is also risk to the remaining baby's placenta being that it had been attached to a contracting and now potentially shrinking uterus post delivery of the twins.
4) I had been having frequent and sometimes regular contractions, uncomfortable but not painful. So he explained that we'd like to do something to get these contractions to stop as they could very well be the cause of my cervix funnelling and opening from the inside. To do this, he highly recommended using a drug known as Nifedipine, in pill form taken every 2-4 hours, which is used in the regulation of high blood pressure by relaxing smooth muscle tissue throughout the body. Because the uterus is a smooth muscle, it would also relax it meaning that it would lessen the severity of or completely stop contractions, and thus relieve some of that extra pressure on my struggling cervix. Of the available Tocolytic (anti-contraction) medications used to stop pre-term labour, this one actually seems to be the cleanest, and carries the lowest risk for adverse reactions and side effects. I haven't been put on this medication yet, and my contractions seem to have decreased greatly or completely stopped. I only notice them when I roll over too quickly, have been sitting in one position too long, or get up to pee or shower. I suspect that even these contractions aren't good to have, so I will still likely be put on Nifedipine at some point.
5) He also suggested that we consider my time spent here as working hard and smart towards very specific goals for these babies. Our first goal after getting to 24 weeks would be to get to 28. Once we're at 28 weeks, our next goal will be to get me to 32 weeks. At that point, the average 'term' for triplet pregnancies, we would decide whether it was beneficial for the babies to stay in even longer, or whether the risk for keeping them in outweighed the benefits of taking them out at that point. So around Valentine's Day, we could very well be delivering our baby boys! And if we're really lucky, we'll get another few weeks after that point before delivery.
6) Twin/Triplet Childbirth Education classes. I signed us up for these last week, before all this went down. The first class starts on January 6th and I was SOOOO excited for these classes, you have no idea. There is something about getting my hands on real-life valuable information and education that I just can't replace with anything else. I just love it. So anyway, I had asked Dr. Wilson that if things remained stable and I was showing no signs of pre-term labour, if I could attend these classes. They are held at the hospital after all. He said not to refund our money yet, and that if all looks well, I could go for that 2 hour class once a week in a wheel chair. Yipee! That's something else to look forward to :) And if we make it all the way through these 6 classes, which include information on c-sections, the NICU and caring for preemie babies and multiples, we will actually be just a few days shy of our 32 week milestone. WOW. I can almost taste it...
My heart:
I had also been struggling to sleep those first few nights here because my heart was beating so fast and hard that my body and bed would literally shake. I've always had a really fast pulse this pregnancy, but never so violent that it would keep me up at night. I was also having frequent bouts of shortness of breath while lying down, and it started to scare me a little bit. So I told the doctors about it and they ordered me an EKG. My heart was beating at about 110 bpm while resting, and the results showed that I had sinus tachycardia...which is basically just a scary word for a fast heart rate. If I wasn't pregnant with three babies, they would be concerned. But they feel that given that my blood volume is exponentially increased while growing three babies and their placentas, that this is likely very normal. A cardiologist also explained that the reason I find my heart beating faster and harder when I'm lying down (which to me was the opposite of what it should be doing), and why I have trouble catching my breath, is because that while I'm sitting or standing, the blood pools in lower parts of my body. But when I lie down, that blood is then forced back up and my heart suddenly needs to deal with all that extra blood that had been pooling down below. Aha!! Now it all makes perfect sense! The things I didn't know...this stuff is all very fascinating, regardless of how simple it is ;)
New digs:
A fun tidbit: I was fitted for compression tights!! Sexy time....they are actually kind of comfortable. I like that feeling of my legs being squeezed a little. I wear them during the day to lower my risk of blood clots as I'm not moving around a whole lot. I was worried that I'd get itchy in them, but I only had to itch once...which was good because you really have a hard time scratching that itch with these tights on. The other downside is that I can't put them on or take them off by myself because they're that tight. Even Noel had a hard time taking them off of me last night without taking my skin off with them.
Ultrasounds/Cervix/TTTS:
We also had two more ultrasounds this week. One on Thursday, and another one today (our next is scheduled for Monday - Christmas Eve!). On Thursday during the transvaginal scan, they found that my cervix had shortened a tiny bit more, down to 1.6cm from the maximum measurement of 2cm that I had on Monday, but not enough to ring the alarms again. It seems that if it's continuing to shorten, it's doing it very slowly at this point - so they didn't do another cervix check today given that I haven't been having contractions, and I think they also don't want to make me paranoid with numbers and measurements every few days. I'm thankful for that. I feel good, so hopefully that means the cervix is doing good too.
Baby A had a huge change in fluid from Monday though, which was kind of worrisome, and they thought that all this excess fluid may be causing sudden extra pressure in my uterus which is why it's been contracting and why my cervix has been shortening. They were able to find a pocket of fluid bigger than any pocket they've found in our previous ultrasounds (11cmx13cm), so baby A is officially in polyhydramnios (excess amniotic fluid), though his vital signs and blood flow are still perfectly normal. His twin brother, B, is still in normal fluid and doesn't seem decreased (in fact today we were able to find a pocket of fluid bigger than we ever have for him before, too! 3.5cmx4cm I believe, which is in a perfectly normal range). Baby C has similar fluid levels to that of baby B...so really, it's just A and his polyhydramnios that are a cause for some concern, but the doctors have no idea why it is the way it is. All the babies are otherwise perfect and normal despite their fluid and size discrepancies. We are still possible candidates for the laser ablation surgery in TO, but the risks are too great unless the babies are actually presenting with TTTS for real. So until one twin is showing signs of distress, we won't be getting the procedure done. We have until 26-28 weeks for this to choose a direction to go in, and I keep being told that it's so unusual for things to be sitting on the fence like this. It's possible that the blood vessels in the placenta that the twins are sharing are unbalanced in both directions, or that at times, the flow reverses which would delay the presentation of TTTS, and then switches back again. Their umbilical cords may also not be attached to the shared placenta in ideal places, meaning that one twin has a bigger piece of the pie while the other has a little slice. They can see where the cord attaches for twin A, but can't see the cord attachment for B because he's much tighter in his sac of lower fluid. In other news, baby A has flipped!! He's been head down for a while for some reason (even though he's got tons of room to move around), and I'm hopeful that maybe this means my cervix will get a little break. I'm not sure what I like better though - a little down-there pressure, or lightning kicks directly to the cervix.
And, check this out....a picture from Thursday. Baby A is the only one with enough fluid around him to capture these amazing pictures. These 3D pictures used to freak me out more than anything, but this one turned out pretty clear and less blobby than others I've seen (thanks to that fluid!). So his identical twin looks the same...and don't they look like Noel's identical twins too?!
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