Welcome to the World!!!

July 5th, at 33 weeks and 1 day, our trio decided to make their debut.

Oliver James arrived at 4:06 AM. He measured 17 inches long and weighed 4 lb 1 oz. 

Nolan Michael came next at 4:07 AM. He measured 16.25 inches long and weighed 4 lb 3 oz. 

Lucas McRae made his arrival at 4:08 AM, measuring 16.5 inches long and weighing 3 lb 15 oz. 

All three babies are doing great. At this time they are all breathing and eating with assistance. Oliver was able to breathe on his own since birth. Both Nolan and Lucas (the two identical babies) spent some time on the ventilator and CPAP, but are now breathing with just a little help from a nasal cannula tube. It sounds like Nolan will soon be weaned off the nasal cannula.  Each baby is now being fed a very small amount of breast milk through a tube every few hours. They're gradually increasing the amounts as tolerated.

They'll likely be in the NICU for a few weeks, but we couldn't be happier with the progress they've made in the 11 days they've been here. These boys have been such troopers! We're so in love with them!

Cats Out of the Bag!

We finally announced to the world that we're having triplets.  It feels to have our secret out.  My Facebook pages has been going nuts!  Here are some of the pictures that we used to share our news:



Dietary Changes

I had an OB appointment yesterday.  At that appointment, my doctor told me she was glad to see that I'd finally gained some weight.  However, she quickly added that by 20 weeks, she would like for me to have gained a total of 20 lbs.  That gives me 4 weeks to gain almost 15 lbs.  I asked her how she suggested I make that happen.  Her response:  "Milkshakes....lots of milkshakes.  And eat some Cheez-its every time you have a serving of veggies."  I kind of thought she was joking, but I quickly realized she wasn't.  I'm basically under doctor's orders right now to bulk up so these babies can have a little extra fat on them when they're born (early).

I consumed just over 2500 calories today...so I'm getting there (hopefully)!

Meeting with Neonatologist/NICU Tour

My husband and I had an appointment with a neonatologist Monday afternoon. He spoke with us about what to expect during our stay at the NICU and went over what's developmental stages of various preemies. I took vigorous notes during our consult and only cried once, so I felt like it was a pretty successful visit. Afterwards we toured the facility. They have private rooms and really encourage parental involvement in the care of the babies. While no one ever wants their baby or babies to spend time in the NICU, we know that they will spend some time there (since the latest they'll let us deliver is 34 weeks). I guess it was nice to visit with one of the doctors in advance and get some answers to some of our questions.

Below are the notes I took:

Overland Park Neonatal Intensive Care Unit

Facility

• Level 3 NICU
• 40-60 babies in unit at a given time
• All babies born at 36 weeks will spend some time in the NICU
• Not a teaching hospital (not a lot of residents)
• 2 fulltime social workers

Care Team

• Neonatologists (2-3 there at a given time)
• Nurse practitioners (4-6 there at a given time)
• Nurses
• Respiratory therapists

Delivery/C-Section

• Husband is only family allowed in the delivery room
• NICU care team present:
• Neonatologists
• Nurse practitioners
• Nurses
• Respiratory therapists
• After birth will be assessed in the delivery room and we will get to see them
• Babies will then go up to NICU (hubby can stay with Mom or go with babies)
• After recovery (a couple hours after birth) Mom gets wheeled up to NICU in bed to see babies

Parents

• Have unlimited access - no visiting hours
• Encouraged to help with care:
• Holding
• Feeding
• Changing diapers
• Taking temp

Visitors

• Friends and family welcome
• Young children discouraged (not permitted during cold/flu season)
• Up to 4 people put on the list to be with babies when parents aren’t present
• 3-4 visitors at a time

Babies

• To be released from NICU, need to be able to do three things on their own:
• Breathing
• Steroid shot given towards end of pregnancy to help lungs (accelerates the production of surfactant)
• Babies will likely be on respirator (tubes) or CPAP machine (less invasive)

Eating by mouth

• Typically happens by 34 weeks
• Babies breast fed do better (breast milk is fortified)

Maintaining body temp

• Isolettes help with this
• 4.5-5 lbs is typically when babies are big enough to maintain their body temp on their own

Most babies go home around 36-38 weeks

Babies could go home at different times

ELBW (extremely low birth weight) babies

• Born between 23 and 26 weeks
• Could have long term lung problems
• Lucky to be home by due date

Stages of Preemies

• 23 weeks – age of viability (survival rate low)
• 25 weeks – over 50% survival rate
• 28 weeks – 95% survival rate (27-28 weeks considered “good outcome”)

Second Appointment with Perinatologist/MFM

Friday, my husband and I went to my second appointment with our perinatologist.  I was originally planning on going by myself, but we were going through a rather intense snow storm.  He ended up taking the day off and came with me.

At the appointment, they did an ultrasound.  I was, of course, secretly hoping they'd magically find a membrane separating our two identical babies, but no such luck.  We were very pleased, however, to hear that all three babies are measuring where they should be (even a little ahead) and they're all comparable with one another.  So despite the fact that I've only gained 3 lbs, these babies are apparently getting what they need!  The doctor did notice that we have some mild twisting of the cords already.  There's nothing we can do about that at this point and hopefully it doesn't turn into a problem.  I'm kind of just trying not to think about it too much.

He also told us he was going to have us meet with a neonatologist to learn more about the developmental stages of premature babies, since we're definitely going to be having preemies.  More specifically, he wanted us to meet with one, so we could make the decision about when I will be admitted to the hospital for 24/7 monitoring.  They said they recommend between 24 and 28 weeks, but that it's really up to me.  Obviously if we go in at 24 weeks and have any complications and have to deliver right away, then the chance of survival is less than if we waited another couple weeks.  So basically, we have to decide...at what point are we willing to deliver these babies.  If we go too early, we could potentially lose all three of them and/or have to deal with some major life-long health issues.  While if we wait, the two identicals may not make it.  It's going to be a tough decision to make.  I think maybe we're leaning towards going in earlier just to be safe...maybe not right at 24 weeks, but possibly 25 or 26?  We'll have to see what the neonatologist says.  My doctor also asked us if we were interested in exploring the option of selective reduction.  It's crazy to me that this is an option past 14 weeks.  We both immediately agreed that that wasn't something we were interested in.

I guess the highlight of the appointment was during the ultrasound when the doctor looked at us and asked, "Do you guys know the sex?"  I was like, "No....do you?"  He said, "I believe so, would you like to know?"  We, of course, did.  So....

Oh boy, oh boy, oh boy!  It appears we are having 3 boys.  He found a little something in between each of their legs.  Granted, we're only 14 weeks along, and it's still very early.  We're not going to go out and buy blue everything quite yet, but we DID see something there.  So it looks like I'm going to be outnumbered in the house.  The dog and I are going to have to stick together!

MoMo Twins

Last Friday, I went to my first appointment with the perinatologist.  The main purpose of this appointment was to see if the two identicals were sharing a sac.  At our previous ultrasound with our RE, she told us she was unable to tell if they were.  We knew that if they did share a sac, that brought on a whole new mess of complications and risk factors.

So I went to that appointment the day after our scare that landed us in the ER.  The doctor was very thorough during the ultrasound.  He looked and looked...and looked and looked, trying to find a membrane separating our two identicals.  I was starting to realize there probably wasn't one, but at that time, I didn't really comprehend the severity of the situation.  The doctor had the nurse look and then called another doctor in to look as well.  None of them saw a membrane.

They concluded we had monochorionic-monoamniotic twins, meaning they are sharing both a placenta (monochorionic) and amniotic sac (monoamniotic).  This happens when the embryo splits late (between days 8 and 12).  Apparently this is very rare and only occurs in 1 out of 10,000 pregnancies and 1% of twin pregnancies.  I couldn't believe this.  We already beat so many odds by this split happening in the first place.  How could this now also happen???

The biggest concern with these types of twins is that they have skin-to-skin contact and their cords can easily get tangled or compressed.  This is often something that happens later on in the pregnancy when there isn't as much room for them to move around.  Pretty scary stuff.  When I got home from our appointment, I Googled monochorionic-monoamniotic twins and found out the following:

• These types of twins are often called "MoMo Twins"
• Complications include Twin to Twin Transfusion Syndrome, cord entanglement, and cord compression
• There's a 50-60% survival rate for MoMo twins
• MoMo twins always deliver early because it is too risky to keep them in the womb.  My doctor told me he would not let me go past 32-34 weeks.
• Many women who are pregnant with MoMo twins are admitted to the hospital between 24 and 28 weeks for 24/7 monitoring.  If any sign of cord complication is found, they will immediately deliver the babies.
• MoMo twins are always born via C-section. 
• 75% of MoMo twins are girls

Needless to say, last weekend was a very emotional one.  I pretty much just stayed on the couch with my laptop, researching this condition while crying my eyes out.  I'm in a better place about it all now.  I'm still worried at how this could all end, but I'm trying to be as optimistic as I can.  It'll all work out...

ER

We had a little too much excitement on Thursday.  I woke up at 4:00 AM to go to the bathroom and realized I was bleeding.  More than just spotting.  It was like I had just started a heavy period.  I woke the hubby up and told him. He asked what we should do.  I told him, I'd call my doctor's office as soon as they opened.  I then tried to go back to sleep, but ended up just staring at the ceiling assuming the worst.  I cried and cried, then finally around 5:30, I got up and went downstairs.  I started reading through my baby books and looking online to see what I should do.  I finally decided to call the on-call doctor.  He told me he thought it'd be best for me to go to the ER, so I got the hubby out of bed and we headed out the door.

We ended up spending 4.5 hours there.  They got me into a bed pretty quickly and took my vitals and quite a few vials of blood.  The nurse came in with a Doppler to see if she could pick up a heartbeat.  She was able to get one, which was a relief to know that I was still pregnant, but I was still nervous not knowing the status of all three.  The nurse explained that I would soon go in for an ultrasound and then they would probably do a pelvic exam and have to give me a catheter so they could get a blood-free urine sample.  No fun.

After about 2 hours, they finally got me in for an ultrasound.  Our ultrasound tech was really good about finding all three babies right away and showing me their heartbeats.  As soon as I saw that they were all three still alive and kicking in there, I felt an overwhelming sense of relief come over me.  The tech spent about 45 minutes looking at everything.  He never was able to figure out the cause for the bleeding, but was able to conclude that we had 3 strong heartbeats and 3 babies all measuring normally.

We went back to my room and waited for the doctor.  He came in and said they were still waiting on some of my labs.  They decided not to do the pelvic exam or urine sample, which was absolutely fine with me.  Finally around 11:00, they gave me a snack (I was starving and not allowed to eat or drink anything) and then let me go home.  I was given instructions to be on pelvic rest (no sex) and bed rest until Monday.  

So, everything turned out to be okay, but it was definitely a very scary ordeal.  I think it was the first time when I felt that I really needed all three to be okay.  Up until this point, the idea of triplets has scared me to death and I always wondered how I would react if something happened to one.  Now I know.  I would be devastated.  These babies....all three of them, are a part of me.  Seeing them waving their hands around and kicking their legs about was just amazing.  I was so glad to be able to go home knowing they were okay.