I have to apologize for the lack of updates, and thank my husband for at least getting a birth announcement up! It's been a very slow recovery from the c-section, and between bathroom runs, pumping and establishing an excellent supply, moving this past weekend (yes that's right...a MOVE in the middle of all this!!! We can't not laugh), NICU visits, planning some childcare for Lilah while I'm healing, not to mention the time it takes me to get up and move anywhere, I just haven't had the time or spare energy to do it! But I think we're settling into a bit of a new routine for the next little while. It was really only this past Sunday when I finally started to feel like I could get up and walk around for any length of time on my own. I suppose the month prior of bed rest hasn't helped my recovery at all. But, earlier this week I walked to the NICU from the main hospital entrance all on my own - no wheel chair! Yay!
The c-section itself went very smoothly! They'd given me magnesium sulphate just prior to surgery (as I'd mentioned in a previous post, studies have shown that it may help to prevent damage to the brain for preemies delivered this young). I'd heard awful things about the stuff, but luckily all I got was hot and flushed all over, especially inside my mouth and throat. After Noel had dropped Lilah off at his parents' place, he came back to the hospital with three of the tiniest little teddy bears, one for each of the boys, to replace the significance of the knitted blue hearts I'd ordered just a couple days before and hadn't arrived yet. I needed so badly to have something for Jude, something that touched him and laid on him for us to keep, knowing that it once was his. These little bears were so perfect. We packed them up and I was taken to the OR.
As soon as we arrived, the first thing I saw were two beds prepared for the boys we were about to meet. That's when it really hit me, even though I'd thought it already had. They were coming today, but we'd only ever take 2 of our 3 boys home. We get to meet them in less than an hour. I got really excited and really scared at the same time - 28.5 weeks. These guys are going to be so little, and being so premature I had no idea what to expect. No body did.
The OR was full of people. It was intensely crowded and noisy as everyone spoke to each other about different things - lucky for me, almost all the people in that room were the nurses and doctors I'd met and grown to adore over the last month. Some of them just came to observe, they wanted to be there when the mystery of this pregnancy was revealed. I was given spinal anesthesia, and laid down on the skinny operating table as everything below my chest turned numb.
Before I knew it, babies were popping out left, right and center with no warning (I thought I was going to be talked through it a little bit). I didn't feel a thing besides the doctors moving and shaking my body. Even though I had no sensation, I could feel immediately when they started taking babies out. I kept getting lighter and I think it was after Jude had been lifted out that I suddenly felt like I could breath again. And then after Lincoln it felt like I'd never been pregnant. I could take the deepest breaths I remember ever taking, and suddenly being on my back was the most comfortable thing in the world. To keep track of who's umbilical cord was who's after delivery, they attached one clip to the first baby's cord, two to the second, and three clips to the third. This way they could identify who belonged to which placenta if there was more than one, and which of our three love bugs we lost.
Nash came first, screaming with all his might! I couldn't believe how strong he sounded. The joke in the NICU now is that he's so loud, other nurses from across the pod think it's their baby crying. Jude came second, peacefully. Careful not to handle him too much, they gently brought him over to his special cot off to the side where one of my favourite nurses massaged oil over his resting body, and wrapped him in a white blanket. Lincoln came third, also making quite the scene! It seemed like forever before they actually got him out after Jude was delivered. We of course had been told that we'd likely not hear them make any sounds, so hearing them both scream like that was the hugest relief. I couldn't believe they were here.
Happy Birthday to all three of our darling baby boys! Such little miracles you all are!
January 22nd, 2013
Nash Manuel: 4:01PM, 2 lbs 1 oz, Apgar's 8 and 8
Jude Noel: 4:02PM, 1 lb 14 oz, our sweet resting angel born straight to heaven
Lincoln Arturo: 4:04PM, 2 lbs 3 oz, Apgar's 6 and 8
We chose names we loved, but soon realized how strong and appropriately overcoming they sounded. Names our boys have proven they'll grow into. And even more fitting - Jude. Our precious angel. His name means 'praise' or 'thanks'. And we always will, our sweet boy.
Noel did the most amazing job taking pictures and showing them to me almost immediately throughout the surgery. I couldn't believe how much life they had, they were putting up the most beautiful fight. I didn't get to see our boys right away as they were immediately whisked away to the NICU, so the pictures were a blessing and really solidified everything for me - that we'd finally had our boys, that they were safe now, that there'd be no more worrying about when the next thing would go wrong inside of me and having no control whatsoever for their safety. Knowing what we know now, the NICU must have been insane waiting for our two 28-weekers. We've seen it get incredibly stressed and busy in there for just one baby that young, never mind two of them. I wish I could have been part of that scene, but at least Noel could be! I told him to please follow the boys to the NICU, that I'm fine, and that I need him to be with them. They were so far doing wonderfully - both breathing room air on their own with the assistance of the CPAP, which is used to keep positive air pressure in their lungs so that they're easier to inflate.
I'm lying on the operating table, giving smiles and reassuring thumbs-ups to my mom and one of my ultrasound techs who watched the whole thing unfold from the viewing window. They were delivering my placenta and by the time they'd taken it out, Noel was back. I could hear them fussing over it, trying to get a good look finally at the giant 6 lb mass. Noel took a video of Dr. G explaining the initial findings, and had it injected with dyes to highlight the connecting vessels and examined the placenta even further. So, here's what we've found, though I heard a couple of days ago that there may still be things they are unsure of. In any case, now that they're here and the past is behind us we're focused on the boys and trying not to think more about the what ifs and could haves:
2) The surgery performed in Toronto for TTTS was successful. They ablated all visible connections between the identical twin pair, and the dyes proved that there were no missed connections.
3) Based on the order of their birth and the umbilical cord/placenta identification system, we now know that we did in fact lose our recipient twin (not our singleton, which I was so sure of - still have a hard time believing I was wrong!). Lincoln is our fraternal boy, as he was attached to the placenta with only one umbilical connection. Nash and Jude were our identical pair. I suppose it's a little easier to have an answer, and to know that we'd done everything we possibly could have to keep all three of those little hearts beating. Unfortunately and so very sadly, it's incredibly common for the twin on the recipient end of TTTS to go through what our little Jude did and not make it out the other side. He spent at least a day, possibly two, in heart failure and a week more was all his tiny body could give to us following the surgery. I am thankful for the hope he gave to us during that week, and so thankful for his watchful eye now.
4) It was very clear that our angel, Jude (our recipient twin) had a GIANT piece of the placenta. His cord was generously inserted almost right in the middle of it. Nash (our donor twin) had a velamentous cord insertion, meaning that it was inserted at the edge of the placenta, into his membranes rather than the placenta directly and travelled through the membranes into the placenta. It's actually a dangerous condition as I know now, particularly because the cord is left so unprotected, though we didn't realize just how so until they were delivered. Nash's cord was basically hanging on by a thread. So much so that while Dr. G was examining the placenta just before Noel started filming, she gently lifted his cord and it almost tore right out. Our Nash was just a swift kick or tug away from completely disconnecting his life line inside of me. It was also clear that he had used his portion of the placenta to its fullest extent. There was nothing left for him, which explains his growth restriction, though it wasn't as bad as we'd thought. Thankfully however, his growth appeared to have slowed enough, at least through ultrasound, to require delivery to keep him alive. Had the ultrasound estimated him to weigh what he actually does, they would not have intervened, and we almost surely would have lost Nash as well, simply due to his cord insertion.
5) Sweet Nash apparently likes trouble, because we also discovered during his delivery that his left ankle had gotten tangled in the floating membranes (due to the tear in membranes during surgery) and circulation to his foot was compromised. He'd actually gotten stuck and needed to be cut loose so that they could detach him from my uterus. It hadn't gotten bad enough to cause amputation (which can actually happen! It's called amniotic band syndrome - ABS) but his left foot was swollen and purple for a day or so, and he had indentations on his leg where the amniotic bands had been tied. It's possible that it could have gotten tighter over time, or that his rapidly growing leg would have been more affected the longer he grew in my tummy. Thankfully this is now fully resolved and you would never know his little foot and leg came out looking the way it did.
6) What still boggles my mind because it seems so unbelievable is this next point. The reason I'd always thought that we lost our singleton is because our angel baby was the only baby left in his own sac. The other two babes were swimming together in one sac following the tear made in the membranes following surgery. And being that it seemed impossible for a singleton and a separate identical twin to somehow be sharing the same sac, I thought that it MUST have been the singleton that passed, and the identical twins were swimming in the same sac. Well...apparently, it's possible to puncture the membranes of a singleton baby and enter someone else's own membranes without anyones water breaking. The doctor said the membranes sort of fuse together under pressure, so they were able to do this to gain access to the proper site to perform the laser ablation. Crazy, right?? I still kind of feel like they're pulling my leg.
7) Amidst all of this, my cervix (that we hadn't checked in a week or two because we all felt it was better not to be paranoid about it - for which I'm so glad) was open!! I'm not sure how dilated I was, didn't think to ask. So their delivery was imminent anyway, it could have happened at any moment and I'm thankful that it happened this way instead. Giving me at least a few hours to prepare for what's to come without issues like trying to stop labour with numerous other drugs while waiting for the c-section and it's own cocktail of drugs, or having to go in for an emergency section which is a whole other realm of drugs. We may have even bought ourselves a few days, as I'm not sure they'd have let me stay pregnant had they known that I was so close to possibly going into labour on my own.
After the boys were delivered, the process of putting my organs back in their rightful places and stitching up layers of uterus and muscles and skin took much, much longer and was the most uncomfortable part of the process. At times it felt like they were digging up near my lungs and heart, and it was a little difficult to breath with all that pressure. Once they were finished up, they lifted my dead weight off the operating table and onto a stretcher. We weren't able to visit our boys in the NICU for the first while (I couldn't anyway on a stretcher), but it was time to meet our sweet angel baby Jude. I have to say that the way we spent our time with him was not what we thought we wanted or planned for, but the way it happened was absolutely perfect and unexpected. I will save this for his own special post, but he was gorgeous and melted our hearts and changed our world forever.
I had an awful first couple of days recovering from surgery. I was so dizzy and light headed upon sitting up, and kept getting randomly nauseous, that I couldn't even get out of bed or be wheeled to meet our boys in the NICU for the first 24ish hours. It was terrible, I lost my hearing, shook uncontrollably, and saw the world turn blue and sparkly every time I sat up. Finally, one nurse suggested that I may be having a bad reaction to the oxycodone, so she switched up my IV pain meds. I was also given a bolus of IV fluids to flush me out and increase my blood pressure. It made a WORLD of difference. By the evening of the second day, I was able to finally go and meet our teeny precious little boys. This same nurse was also extremely motivating and gentle all at once, and was a huge part of my initial postpartum recovery. She kept giving me goals to achieve throughout the day and really took my recovery into her own hands. She always came in the room with a fresh cup of water - and never once made me feel bad for being in bed. Amazing. After day 2, I had a very different nurse. I suddenly became very home sick and couldn't wait to be discharged.
After being discharged on Friday and not having a home to go to as we were moving on Saturday, my most wonderful friend offered to have me stay at her place instead, where I could be alone, with everything I needed at hand and help when I needed it too. Not to mention fed the most amazing, healthy and nutritious food and having hot tea at all hours of the day. I was SO relaxed that I swear I healed more mentally, physically and emotionally there, than I had in the previous few days in hospital. It was incredible and so needed.
I've been home for over a week, and am loving every minute of it, especially now that I can move around and play with my sweet girl. My husband has been so supportive of my recovery and rest. It's been an incredibly gentle transition. It's indescribably hard to be away from our boys, but I keep telling myself that this time will pass quickly and that they are under the best possible care, almost all of which we can't provide on our own. Every day is still a miracle, and I look forward to each and every one of them.
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