Thursday, June 27, 2013

The Final Stretch (Part5)

At 27 weeks we stopped driving to Houston for ultrasounds and started staying in town. We would see one of four doctors each week for our scans. We were also seeing an OB once a week. Because of the delay in sending her the results of the ultrasounds she would often ask me how things went and I would explain it as best I could. The delay was caused because the four doctors in the group would meet each week to discuss each patients results. I liked to observe each doctors methods at the ultrasounds and ask them the same questions to see if they would give the same answer.

One thing Dr. Moise told me in Houston was that he didn't expect I would make it full term and to prepare for a cesarean.  After two vaginal births I was devastated. I researched and asked and consulted but always came up with the same issue.  There was a risk in both kinds of birth, but the risks were different. What I could not justify in pushing for a vaginal birth was the relatively low risk of acute TTTS happening while baby A was born and B was in the womb. It was a small risk percentage, but it could be fatal to baby B or cause neurological damage.  With a cesarean there was more control because baby A and B could be born and cords clamped immediately to stop the blood sharing between them. Every doctor I saw (all 7 MFMs) were unanimous that a cesarean section would be best  as well.  Try finding a doctor in town who will go against the recommendations of 7 MFMs!

I made peace with the inevitability of a surgical birth but wanted to carry them as long as I could. I was huge because of too much amniotic fluid (polyhydramnios) but at each ultrasound they measured my cervical length via ultrasound and it was great. No signs of preterm labor. The doctors said it was good that my last baby had been large and "taught" my body to handle a larger than normal uterus.
Two times after my ultrasounds and once after an OB appointment I was sent to the hospital for a nonstress test. A nonstress test measures the babies movements for one hour to ensure their heart rates go up in response to their movements and basically measures their level of health. Every time the boys did well and I was released soon after. One nurse thought I should get a vaginal exam and when I told her I didn't need one she called my doctor. My doc told her the exact same thing. I knew they tell you nothing and might send you into preterm labor and introduce infection and I would have refused all the same but it was a bit annoying to have her try to go over my head.

As the weeks went by the babies continued to grow and look fine although my fluid levels continued to creep close to the levels at which it would be enough to drain. Thankfully we never needed that.
At 30 weeks we began to notice that Jesse was slowing down in his growth while Max continued to top the charts in size for his age. The blood flow through Jesse's umbilical artery was also not looking very good. Normally you have a bit of blood flowing even between heartbeats but Jesse had no blood flow between beats and even some back flow sometimes due to force of the pull of Max's heart. 
Even this compromised blood flow situation had been working enough to allow Jesse to grow up until now but his body started showing signs of IUGR. IUGR is a big deal because if the placenta is not functioning well enough to provide adequate nutrition, the body will use up its fat stores. The first thing to be cannibalized is the fat around the organs (visceral fat) so abdominal circumference is the first indication of IUGR.  The last fat to be taken is in the brain and from there you have neurological impairment and stillbirth. I watched Jesse's abdominal size shrink dramatically from one week to the next and my heart sank. I knew we would have to have the babies early to keep poor little Jesse from starving to death. 

I had read a study that twins delivered at 37 weeks do better and actually have higher birth weights than twins who are born later and couldn't understand why that would be possible until I understood more about IUGR and how important its effects are. 

So it was decided that at 34 weeks we would have our twins via cesarean. The cesarean was to give Max the best chance (non presenting twin B) and 34 weeks was to give Jesse the best chance.  I felt like we had been walking a tightrope between the two boys needs and now I was relieved that it was almost over. 

I had done the best I could to keep them inside and eaten as much as I could to help them grow and now it was time to finally meet the little babies who showed me the scary world of high risk pregnancy.
22 weeks

24 weeks

26 weeks

28 weeks

30 weeks

33 weeks

34 weeks

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