Friday, October 30, 2009

Day 6 - Holding two of our triplets for the first time

Julia is making great progress. She moved to an isolette on Thursday morning!

The nurse unhooked several monitors and tubes and I had a chance to change her diaper, remove her eye protection, swaddle her in two blankets and hold her. She's still jaundiced, but the nurse said it was fine for her to be out of her isolette for 20-30 minutes, so we jumped at the opportunity. Both my husband and I held her. It was the first time we could see our precious daughter's features.

Her eyes were open and she was alert, studying my face as much as I was studying hers. When she heard her dad's voice, her eyes fluttered to focus and when their eyes locked, she settled in.

All three of our girls have a heart murmur. Ada and Emma's will be monitored, and the hope is that it will resolve on its own. Julia's is much more pronounced. The neonatologist wanted to rule out that nothing else was amiss, and ordered an u/s scan of her heart.

She had us very worried yesterday. The first line of defence is to treat her with medication, administered three times. If this doesn't work, she can receive two additional rounds of meds, and only if that doesn't resolve the issue, will she need to undergo surgery. Since this is a common concern in preemies, and often resolves by itself, we're hopeful that surgical intervention won't be needed.

We headed over to Ada and had a wonderful opportunity to hold her too. The nurse had already swaddled her and she looked like a little worm in her cocoon. So tiny. She tried to open her eyes, but lost the battle to sleep and was so peaceful in my arms, and the arms of my Dh. She has many of her dad's facial features and watching the two of them together made my heart melt.

Emma's nurse was away when we stopped in to check on her, and I had to head back to my hospital room and pump before being discharged. My Dh came back with the most wondrous update: Emma will be moved to an isolette this afternoon and her ventilator will be removed! She's finally catching up to her sisters and we couldn't be happier. She is breathing room air through the nasal cannula.

The milk maid

I woke up on Wednesday morning with rock hard boobs - my milk had come in overnight. Since it had been about 2 and a half days since I delivered, I had a significant amount of milk from the get go. I've never been so pleased with my body, especially after what it's gone through with carrying triplets, and recovering from HELLP Syndrome.

The nurse who helped me out of my "between a rock and a hard place" predicament, was amazed at the amount of milk I pumped the very first time. To the point where she ran out to the nurses' station and shared my good fortune. I could hear the nurses from my room, the sound of them cheering traveled all the way down the hallway! When you've gone through IVF there's precious little modesty left, so instead of feeling like my privacy had been violated, I feel proud that I could do this one thing for my babies.

After pumping every three hours and generally getting the hang of it, I met with a lactation consultant. She was very supportive and not your typical judgmental Nazi lactation consultant. Given that I'm hoping to pump and breastfeed three babies, I really appreciated her guilt-free "whatever works for you" and "take care of you first" approach. She walked me through several scenarios, including pumping exclusively, breastfeeding exclusively, breastfeeding two babies and giving the third a bottle of expressed breast milk, or breastfeeding one baby and giving the other two expressed breast milk and/or supplementing with formula.

My Dh was in the hospital room for the entire conversation and overheard all of her tips, including how to try and avoid mastitis.

Once she left, my husband said, "I didn't know women could get mastitis too."
Me, "Why? Can men get mastitis?"
My husband, "No. Cows do."

I laughed hysterically for a half-hour.

My Dh spent the night rooming in with me at the hospital. He had the presence of mind to pack a cooler so we could store the expressed breastmilk overnight and take it to the NICU in the morning. Never has he looked more masculine proudly carrying the cooler filled with breastmilk through the hospital hallways and into the NICU. It made me smile.

Today, I was wearing a shirt that said, "Meet me at the bar." The milk bar, I mean, of course. I keep referring to my little pumping operation as the "Dairy Farm" and the description was never more apt than this afternoon. One of the NICU nurses asked me to relabel all of the breast milk bottles in the NICU fridge (with labels for all three babies so the bottles can be shared among the triplets).

So, there we were, with dozens and dozens of bottles, placing them in date/time order and relabeling them. It looked like we were working in a lab. Several nurses commented on our project...

I ran out of the NICU pre-printed labels and went to ask for more, "Holy Cow!" the nurse behind the desk exclaimed. "Exactly," I said laughing hysterically for the second time.

Wednesday, October 28, 2009

Day 3 NICU Triplet Update

All of our girls are stable and doing as well as can be expected. Ada and Julia are receiving oxygen through nasal cannulas, but Emma is on a ventilator and struggling the most of all three. It just breaks my heart to see them all so fragile, and using their entire bodies to take a breath. It looks like breathing is the most exhausting thing in the world for them to do. Their entire torso moves with each breath.

Ada, who broke my water, is doing the best. She is already in an isolette, while Julia and Emma are in open warmers for easy access. The perinatologist who delivered them said it's typical for the baby who "wanted out" to be the strongest post-delivery, and for the one farthest from the action (Emma) to be the weakest. "Their sister might have wanted out, but Julia and Emma were still enjoying the 'air conditioning' in your uterus," the peri said. It made me laugh.

All three girls are jaundiced and receiving phototherapy. They look so cute with their eye protection on, like they're hanging out on a beach somewhere, but we wish we could see and study their tiny little faces. With all the monitors, IVs, tubes and other NICU paraphernalia, it's impossible to see their features, so we'll have to keep guessing for now whether they look alike, and which parts of mom and dad they inherited.

We are falling truly, madly, deeply in love with our babies.

- She was on 30% O2 at 5:45 this morning (21% is room air)
- She is receiving the oxygen and positive airway pressure through a nasal cannula.
- Receiving IV for nutrition (intralipids and vitamins/minerals)
- Lots of tactile motion going on, even though her eyes are covered, her tiny little fingers are exploring everything in her isolette. She was holding and sucking her binki this afternoon, and touching the vital signs monitor attached to her leg, and touching the vent going into her nose.

- She was on 35% O2 at 5:45 this morning, and they dropped it down to 30% tonight. She is receiving the oxygen and positive airway pressure through a nasal cannula.
- Receiving IV for nutrition (intralipids and vitamins/minerals)
- She pulled out her 3rd IV tonight, and the nurse said they will try to go in through her umbilical cord to re-establish the nutrition feed. Ah, mommy's little troublemaker.

- Emma is on a ventilator to help her breathe
- She started on 45-50% O2 at 5:45 this morning, they upped it to 75% this afternoon, but was able to bring it back down to 35% after she received a third round of synthetic surfactant to help lubricate her lungs. Surfactant acts like a detergent on the inner surface of the alveoli, reducing the incidence of collapse.
- Receiving IV for nutrition (intralipids and vitamins/minerals)

Mothership update
- The peri who delivered the girls told me today that I did in fact have post-partum HELLP Syndrome (hemolysis, elevated liver enzymes, and low platelets) and not "just" preeclampsia. Sunday night, Monday and Tuesday were the worst. My platelets dropped to below 75 (normal is 150). It's a good thing the doc waited to tell me how worried he was until after I started to feel better, otherwise I might have felt even more sorry for myself. LOL.

- My peri felt that preeclampsia and HELLP had been brewing for weeks as I've been showing symptoms of it, but since the bloodwork came back "normal enough" for the three weeks in a row before I delivered they weren't going to act on it.

- I'm so glad that the peri discussed the symptoms with me in detail during my office visits, because when I started to feel lung pressure and was struggling to breathe, and experiencing vision changes while in the recovery room, I knew I needed to alert the docs to it and not just power through (which would've been my normal inclination). Thank goodness I did...

- While in the high risk maternity ward, I became somewhat of a freak show. Several residents (it's a Univ. hospital) wanted to see my "party trick." I was unusually "hyperreflective," meaning that whenever they would test my reflexes in my knees, my shoulders would shake simultaneously. It was so weird!

- The peri said the best thing that could've happened, was for Ada to have broken my water when she did. If she hadn't, all four of our lives would have been in jeapordy.

Monday, October 26, 2009

32w6d - Our girls are here!

My water broke on Sunday afternoon at 1:35. We arrived at the hospital an hour later and I was 5 cm dilated. Shortly after 4 pm our babies came into the world, kicking and screaming in surround sound.

Baby A
3 lb 15 oz
4:03 pm

Baby B
3 lb 14 oz
4:04 pm

Baby C
3 lb 13 oz
4:06 pm

All 3 girls are in the NICU receiving help with breathing and hooked up to IVs for nutrition. I saw them for a few minutes on Sunday evening, but I have since developed preeclampsia and have had to rely on my Dh for photos and video clips of our babies. (They are tiny, but seem strong. And oh so adorable!)

I'm on the devil drug, magnesium sulfate, to prevent seizures and/or a stroke and have been feeling absolutely horrid. Will update more as soon as I'm able.

Friday, October 23, 2009

32w4d - No news is good news

Another week down, 24 more days to go to reach our approximate C-Section date of November 17. The peri is waiting until we get a bit closer to schedule the actual date, but if all continues to go well, it will be sometime during week 36. Of course, the girls could decide to come any day now, but it's nice to have a goal to shoot for.

During this week's appointment, the girls all scored 8/8 on their biophysical profiles. The amniotic fluid levels look great, and they completed the 30-second breathing movement, gross motor and fine motor movements.

We saw Baby B making suckling movements with her lips. It was the cutest thing! She had her little fist by her mouth and looked like she was sucking on a pacifier. It made me think of Bart Simpson's baby sister...!

My blood pressure continues to be wonderfully low, but I have other early signs and symptoms that may or may not point to preeclampsia, so the docs are keeping a close eye. This past week, I've started swelling to ridiculous proportions. Edema is no fun, but compared to all of the other discomforts, it's just par for the course. I get to do the "jug o' fun" aka the 24-hour urine collection and associated bloodwork, just to be sure I'm not spilling more than the +1 protein that has been showing up since September.

I'm also the lucky recipient of more bloodwork to recheck my liver function as the epigastric pain is unchanged and I'm still clawing at my skin from the severe itching despite taking Actigall for Cholestasis of Pregnancy.

The great news is that my cervix is still closed. I can hardly believe it with all of the contractions and pelvic pressure, but I'm really relieved about that.

The belly circumference is a whopping 48 inches now, and the fundal height is 44 centimeters (the equivalent of being a month overdue with a singleton pregnancy). There's no denying that I'm huge now.

Instead of the usual, "I can't believe you're carrying triplets! You're so small!" I'm getting more of the uninhibited stares from strangers quickly followed by, "Wow. You must be due any day now!"

One of the funnier comments was from a guy walking by me in the hospital foyer, staring at my belly and quipping, "You really should switch to light beer." It cracked me up.

At a restaurant this week, the hostess took one look at me and said, "Let me guess. You would prefer NOT to sit in a booth, right?"

Fortunately, no strangers have attempted to touch the belly, because they would surely have lost a limb in the process.

My motto for the week ahead: keep on trucking.

Friday, October 16, 2009

31w4d - Still at home

The girls are still safely in utero, and I'm still chugging away at home. This week's doctor's appointment went well - no surprises, thankfully! The girls scored 8/8 on their 4th biophysical profiles and everything looks great, so we live to fight another week.

I'm waiting for the injectable H1N1 vaccine (thimerosal free) to become available later this month and plan to get it based on the long conversation with the perinatologist about benefits/risks.

The sonographer tried again to get a 4D image of each baby's face and although the girls all had their faces turned toward the u/s wand, there were umbilical cords, arms and legs in front of all of their faces. We caught glimpses of their facial features, which was truly amazing, but unfortunately there were no clear images to print. The sonographers at the perinatal center are incredibly thoughtful. They always try and print an equal number of pictures for each baby, "Or else you'll have a hard time explaining that you love them all equally once they hit their teens and want to see these photos."

If it's at all humanly possible and my body holds out, the peri wants me to aim for 36 weeks, which would be November 16. I'm beyond uncomfortable now, sleeping an hour or two at a time, exhausted beyond comprehension, and the cholestasis symptoms are driving me nuts. Oh, and this week, the edema went from mild to insane - think hobbit feet. It hurts to walk. The contractions start the moment I sit or stand. When I lay down in bed, it feels like I'm doing a headstand. Head rush. Almost as if there's way too much blood to keep it all inside my skull. Fortunately, no headaches, but the pressure is very unpleasant.

Some days I just want to cry and give up, but then I feel guilty and think of how much of a difference every single day makes and how much I want to give these girls the best possible start in life (but I realize that's not up to me...) And then there's the part of me that remembers what a struggle it was to get here, how many of my friends are still struggling to conceive, and how grateful I am to be experiencing a pregnancy at all. It never fails to snap me out of the pity party.

For now, I'm counting down to 32 weeks. There's just one weekend between me and that awesome 32-week milestone. And today we have exactly one month left to reach 36 weeks - it seems like an impossible goal, so I'll just focus on getting through one day at a time.

Saturday, October 10, 2009

30w4d - Another eventful dr's visit and trip to L&D

Some things - like doctor's visits - simply can't be rushed. 10 hours of waiting, scans, and testing, many of which was spent getting acquainted with the Labor & Delivery unit... More on that little excursion later.

First, we have lots of good news to celebrate. Our three baby girls are growing like weeds!
Baby A: 3 lbs 8 oz
Baby B: 3 lbs 11 oz
Baby C: 3 lbs 4 oz

That's 10 lbs 7 oz of babies. My oh my.

The biophysical profiles on the girls are looking fine, even though they each scored 6/8. The trio must have conspired beforehand, because the u/s tech couldn't catch either of the three doing a 30-second breathing movement. The girls scored 8/8 on their previous two BPPs, so nobody seemed concerned.

The perinatologist congratulated me on "growing such nice, big, healthy babies." It meant a lot to me hearing how pleased my peri is with the girls' progress.

Although our baby girls are looking terrific, the perinatologist diagnosed me with cholestasis of pregnancy. Lovely. But no real diagnosis on the constant upper right quadrant stabbing pain that I've been experiencing for the past few weeks, so off to L&D we went for further testing.

I spent about five hours in a hospital gown in the L&D triage area (can you say dress rehearsal?) The nurses hooked me up to a contraction monitor which showed I was having lots of contractions, but none that were regular enough to cause alarm. My husband found it amusing that many of the contractions were off the chart, and that he could tell when I was having a contraction.

They drew blood and wheeled me to the ultrasound suite for a closer look at my liver, gallbladder, and kidneys.

They checked the babies' heartbeats again (and with a little guidance from the mothership), were able to track them down easily. All good.

The hardest part was not being able to eat all day. I had a small breakfast around 6 a.m., we drove to the peri (about an hour away), and because of how the day unfolded, didn't have a chance to eat. Before we headed to L&D, I practically inhaled a yogurt, but then one of the L&D docs on duty said not to eat anything else in case they needed to do a C-section. Scary thought. 12 hours on a piece of toast and yogurt when you're expecting triplets... pure torture.

Fortunately, the u/s and blood work all came back normal, so I was discharged. Hooray! I've never been so happy to go home, eat, and of course, cook the babies some more.

Oh, and thank goodness for all of you who advised me to go ahead and pack that bag, because I had my laptop with me for distraction and having my stuff plus the babies' stuff there gave me fewer things to worry about when it seemed like I might need to be admitted.

Wednesday, October 07, 2009

30w2d - Another milestone conquered

Cool to have the 100th post on my blog coincide with typing the coveted "30w" in the title line. Every single day, I wake up with the thought, "I can't believe we made it this far" followed by the calculation of how far the trio and I still need to go. 12 days to 32 weeks, 33 days to 35 weeks.

For the moment, I'm still blissfully at home and go back to the peri on Friday for a growth scan of the girls. Our hope is that they're around 3 lbs each and that my blood pressure, liver enzymes, cervix and all the other indicators are still stable.

Thank you all for your encouraging words, the reality checks, and being so supportive throughout this journey. I have started packing my hospital bag, just in case.

The belly circumference is an astounding 47 inches now, and I've gained 35 lbs overall. My frame is really feeling the extra weight, and I can hardly imagine how uncomfortable and painful it must be to gain 70+ lbs during a triplet pregnancy. My hat is off to the women who are able to do so.

The girls must be going through a growth spurt right now, because I'm constantly hungry again, like I was in the first trimester. I've been drinking more milk and trying to eat smaller meals more frequently, but the heartburn makes it rather difficult.

I'm starting to go numb around my belly button and I'm wondering what that's about. Anyone care to enlighten me? It's the weirdest feeling to itch there, but to not feel the scratch. Truly bizarre, but I guess nothing surprises me anymore. This pregnancy has been one strange trip!

Baby C is hiccuping quite often; I love feeling it. So cute, and it makes me happy to know she is practicing her lungs. I haven't felt hiccups from Baby A & B yet, but they are very active. Baby A jerks and jumps with both feet and hands. It's startling when she does that, but never fails to make me smile. Baby B pushes out and makes these crazy bulges on the right side of my tummy. It feels like she's stretching constantly, and wants more room to do so. Baby C makes squirming snake-lake movements under my ribcage where her body is, and kicks strongly on my left side. It's amazing to know who's who in the zoo, and completely reassuring to know they're moving.

As tough as this pregnancy has now become, I know I will miss feeling their movements inside me after they're born.

Saturday, October 03, 2009

29w5d - Increasing discomforts - to the 3rd degree

I knew this would get harder as the weeks progressed, but I guess you can't be truly prepared for it until it starts to happen. Compared to a single pregnancy, I'm overdue now. Two doctors' appointments ago, the fundal height was at 40 cm. My uterus is already stretched to the limit, but we have several more weeks to go. To 36 weeks, if I can make it.

The past few days even the usual discomforts have been amplified. Not being able to sleep, constant heartburn, increased swelling of my hands and feet, carpal tunnel syndrome in my wrists, itching all over, headaches, not being able to breathe or eat properly, hip pain, pelvic pressure, have all intensified.

I haven't yet hit "the wall" that triplet moms refer to, but I can see that it's not far off. Still, I consider myself fortunate. I worked full-time until yesterday, and will work a few more hours from home next week before I'm completely done. It has been great to wrap things up at work and keep my mind occupied, but I'm at the point now where I really need to have time to take a nap during the day since I'm not sleeping much at night.

Last Sunday, I had painful contractions about 10-15 minutes apart, but fortunately they subsided within two hours without any middle-of-the-night escapades to L&D. The perinatologist is concerned about the upper quadrant pain I've been experiencing because it may be an early sign of a liver problem. I also see specs of light, and have other symptoms that could be something or nothing.

The labs (liver enzymes and bile salts) came back within normal ranges, and my blood pressure is thankfully still nice and low: 106/60. It is rare, but she said preeclampsia sometimes presents without high blood pressure (but that it could change fast). She's also monitoring me for cholestasis and HELLP syndrome, because something is up, but it's too early to know what. Hospitalization and even closer monitoring were mentioned, but thankfully, since the labs came back okay, they're still allowing me to stay home.

The perinatologist discussed HELLP Syndrome in particular, as they would need to admit me immediately, give steroid shots to help the babies' lungs, wait 48 hours, and then deliver the babies as the condition is life threatening to mom and babies.

I passed the gestational diabetes test just a few days prior, but the most recent bloodwork showed a dangerously low blood glucose level. I had a call from the hospital Wednesday evening telling me that I'm hypoglycemic and instructing me to eat and drink fruit juice immediately, and to head to the ER if I feel faint or jittery. (They scared the cr*p out of me, but I'm fine.)

Despite all the threats of impending problems and hospitalization, I haven't packed a bag. Maybe I'm in denial. Or maybe it's mind over matter.

My belly circumference is 46 inches and I've gained 33 lbs overall! Wow, it's getting up there! I can't wait to type "30w" in the Title line of next week's post.