Part 3

Gabby and Lilly

16 Weeks

Size: two sticks of butter!

Okay...a few things were starting to become clear.

Early positive pregnancy test...check.

Pants don't fit...check.

Exhaustion beyond 'normal'...check.

Freudian slips...check.

In hindsight I know these were 'signs' which, if I had paid any attention at all, would have made me wonder if I was having twins.

Approximately three weeks passed between finding out we were having twins and my next doctors appointment. This would make me about 16 weeks along. We had scheduled another ultrasound for this appointment as well. As I mentioned before, Shaun was still scheduled to deploy to Iraq. In September when Shaun and I had decided to try to have a baby, a January deployment seemed highly unlikely to actually come to fruition. Somehow between getting pregnant, learning of our double blessings, and the days slipping away one by one this not-so-likely deployment became really real and really scary. Our doctors agreed to an ultrasound at 16 weeks in order to determine the sex of our babies so that Shaun could help get the nursery prepared.

At this point in our journey, other than the looming deployment, our life was pure bliss. Despite others questioning our attitude, we were so carefree. From day one we accepted this blessing and never looked back. We were too young and naive to know what lay ahead. We were old and experienced enough to know that we were fortunate beyond belief. We knew that we only had one more month of being together expecting a family and we were determined to fill it with all things twins!

The ultrasound revealed we were expecting GIRLS! Even though I was just certain we were having boys, I was ecstatic. Picture bows, pink, monogramming, and tutus and you are getting close to where my mind immediately went!

Girl Parts!

(I promise to never again put pictures of girl parts on this blog...

unless we have another girl...)

I'll apologize now for the following medical jargon, but to understand the second and third trimester of our journey, this is relevant. When it was first revealed we were having twins, we were told our twins were monochorionic, diamniotic. Basically, there are three was to have twins. Dichorioic, diamniotic twins each have their own sac and placenta. This is the least complicated type of twin gestations. Monochorionic, monoamniotic twins share one sac and one placenta. This is the most complicated type of twin gestation and has only a 50% survival rate. Our twins were the third type, monochorionic, diamniotic. This means that they shared a placenta, but had separate sacs. There was a very thin membrane separating our girls, one that we anticipated being discovered during each ultrasound. Because it was so thin, it could be easily punctured and result in a mo-mo twin gestation (50% survival rate).

Yes I did receive an education during this process. No I would have rather not had to learn so much.

One interesting fact is that because technology has come so far, the type of twins listed above directly correlates to when the egg separated, in the case of identical twins. We know beyond a shadow of a doubt that our girls 'split' four to seven days after conception. Pretty amazing, right?

Okay, back to regular programming.

The 16 week appointment ultrasound and exam went well. The blood work from this appointment did not go so well.

Two days after the appoinment my sweet nurse (who also has twins) called to inform me of the results. The blood work was checking for chromosomal disorders. Our's returned with an elevated Spina Bifida marker. What does that mean? (My thoughts exactly.) In the words of my nurse, "Kristyn, it probably isn't anything. It is most likely just an inaccurate result, but you do need to know a few things. One or both of the babies could have some degree of Spina Bifida. Or...(long pause)...well, we entered data for two fetuses so that the results would be accurate, but if by chance there are more babies we haven't detected with ultrasound, this indicator would be elevated like this."

Excuse me.

I'm not sure what was more terrifying at that moment. The thought of a sick baby, or babies, or the possibility of more babies. My doctor wanted to send me to a perinatologist for a more in depth ultrasound to rule out an abnormalities or extra fetuses. We were able to get in to see him in five short days. Five short days that became the longest of my life.

I remember thinking that the portion of this pregnancy that would be like a rollercoaster had to be coming to an end soon. I mean how much more could be in store? First twins, then Spina Bifida, and, oh yeah, maybe triplets or quads. Are you kidding me? Surely things were about to level out and be smooth.

Ignorance is bliss...

We met with our perinatologist early in January. We went through genetic counseling to rule out any genetic disorders within our families. We had an ultrasound conducted by a tech and by our doctor. Upon meeting our doctor we both realized how fortunate our babies were to be in the hands of someone so intelligent. Not only was he great in terms of medicine, he was exceptional in the emotional side of high-risk pregnancy. I am just sure God hand picked my regular OB and perinatologist to help us through this journey.

The outcome of our first visit with him was mixed. Spina bifida ruled out. The sex of the babies confirmed. And the number of fetuses remained at two. Phew! on all accounts, although it should be mentioned that Shaun and I would have gladly accepted the burdened blessing of 8 children if it meant avoiding problems with our babies.

But, our doctor was a walking dictionary of twin gestation knowledge and we were about to receive our next medical lesson.

At this point during the pregnancy the placenta which nourishes the babies, was completely covering my cervix. This can lead to a lot of complications, but would just need to be monitored for now. And that wasn't it for the bad news. Because our twin gestation was monochorionic, diamniotic our girls were at a risk of developing Twin to Twin Transfusion Syndrom (TTTS) and/or Interuterine Growth Restriction (IUGR).

TTTS is what occurs when the babies share blood vessels in the umbilical cord (where they attach to the placenta) and the babies begin to share fluid, nutriets, etc unequally. Picture a house with two rooms and one refrigerator. Now picture the baby in Room B 'throwing' food at the baby in Room A and forcing her to eat it, at the detriment to both babies. The recipient baby gains so much fluid and blood that its heartrate becomes extremely elevated and eventually gives out. The donor baby does not have enough fluid or blood to continue to develop and therefore its heart and brain stop functioning. When untreated, TTTS almost always results in death to one or both babies or extreme mental and physical disabilities, at best.

IUGR is similar to TTTS but instead of a donor/recipient baby situation, one baby simply doesn't receive the same amount and quality of nutrients that the other does. In extreme cases it is fatal, but was presented to us as a slightly better situation to be in, if we had to chose.

At the 18 week appointment, the first time we met our perinatologist, he explained that we would need to have ultrasounds every 10 days so tht we could monitor the babies and make sure they weren't developing these conditions.

We left feeling optimistic. I guess we both felt like we dodged a bullet in the sense of Spina Bifida. We knew this pregnancy was high-risk in every sense of the word, but, being the glass half full people we are, we just knew nothing would happen to our girls. It was thirty days until Shaun's deployment.

Ten days came and went. The ultrasound was conducted. The fluid levels had started shifting, but only minutely. We were scheduled an ultrasound for 8 days out. It was twenty days until Shaun's deployment.

Eight days came and went. The ultrasound was conducted. More shift in fluid levels. Some separation in estimated weight. We were still clear to go home, but our doctor began talking to us about treatment options. Suddenly things became real and scary. It was twelve days until Shaun's deployment.

Twenty One Weeks

Measuring 34 weeks!

Ten days came and went. The ultrasound was conducted. More shift in fluid levels and bigger discrepancy in weight. Our doctor explained that if things continued in this fashion we would need to treat the babies in some way. The plan was that the day TTTS was diagnosed, our doctor would remove fluid from the amniotic sac of the recipient baby. This procedure is similar to amniocenticis, but required removing much more fluid. The next step would be to fly to Seattle where I would undergo surgery on the babies, in utero. Basically, once inside, a laser would be used to separate the blood vessels in the umbilical cord that the babies shared. It was high risk to both mother and babies. It was experimental. And it wasn't covered by health insurance. There wasn't any way of knowing if I would return from Seattle for the remainder of my pregnancy, whether or not the procedure would be successful, or if the girls would make it through the procedure. The doctor needed to see us back in seven days. Shaun was scheduled to deploy in 48 hours.

There aren't any words to describe my fear, my anxiety, or the feelings of loneliness that were starting to creep in.

I mentioned before how wonderful our doctor was and I feel compelled to tell you this short story about the day he gave us this news. He was about to leave the examination room. As he opened the door he said, "I know you are worried, but I've had many patients who I was next to positive I would be diagnosing with twin to twin during their next visit, who never had to be diagnosed. Don't lose hope. And about the expenses, you don't worry about that. I don't care if I never receive a cent from treating you, our main priority is to get these babies here, healthy. You understand?"

I told you he was both gifted and a gift.

So there I was, right in on the verge of my first emotional breakdown, with my husband, mother-in-law, and rest of my family encouraging me that everything would be fine. Because I could barely speak, much less rant, I kept my thoughts to myself. But, if I could have been able to actually form sentences that made sense, I would have asked them how they could tell me things would be okay?!? I mean, was I the only one living in the real world, who knew that I was carrying twins, who were becoming sicker and sicker by the hour, who might have to undergo surgery in utero which might or might not help then and might or might not kill them? Oh, and my husband was going to the worst place on the face of the planet in 48 hours??

Everything was going to be okay?

I think not.

So, what do you do when you realize that absolutely nothing about your current situation is under your control? How do you handle it when your doctor tells you that no hospital will attempt to save your babies until you are 24 weeks along, and that is 3 weeks away? How do you face the world, a world that somehow is going on as if everything is normal, when you know in 48 hours your soul mate, bestfriend, and father of your sick children will have to leave a battle at home to go fight a war?

At the time, I so wished there was someone who could have answered those questions. All I knew to do was push through. I cried until my eyes were dry, all the time hearing my mother's voice in my head telling me I needed to get control of myself for my babies. I stopped praying and starting trying to bargon with God. I held my belly and talked to my unborn girls as if it might be the last conversation I had with them. I understood what was important in life with a clarity never before seen. And asked God to give this human, who admittedly doubted the existence of miracles, a miracle of her own.

How could such perfect looking babies be sick?
Gabby and Lilly
February 6, 2008
21 Weeks

Click here for part four. (coming soon)

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