Go Babies, It’s your Birthday

Once I knew that it was the babies’ birthday, I started to get excited.  Finally, I would be able to move around again!  Finally, I’d have my babies in my arms.  Finally, I’d be able to snuggle with my son again!  The babies seemed to be moving around pretty well, and our only worry besides the possible kidney issue was whether we’d be able to tell them apart.

I texted Dr. OB to tell him that the babies were coming and ask if he could call the on-call OB and fill her in on all the craziness of my pregnancy.  He said he would and wished us luck.  We signed the paperwork for c-section and tubal ligation (no more kids for us!), met with the doctor and the neonatologist who would be taking care of the babies, and I was prepped for surgery!

Since I had a prior c-section, I knew what to expect, but it was still scary to have the spinal block and wait for my babies to be taken out of my belly.  Baby A was born at 3:02 p.m., weighing 5 pounds, 3 ounces; Baby B at 3:03 p.m., weighing 5 pounds, 2 ounces.  At first, we heard two loud cries, and we were pretty excited.  However, Baby B was having trouble breathing, and we were told that she would need to be moved to the NICU to be put on a breathing machine (CPAP) as soon as possible.  The neonatologist also mentioned that she has microcephaly.  We had no idea what that meant.  Baby A seemed to be fine.  She was taken to the baby nursery to be weighed, measured, and bathed.  I sent my husband with Baby A and listened to the doctor and her assistant (there were very few people left in the operating room once the babies left) discuss black Friday shopping and my pretty pink Kate Spade bag.

I lay there listening to their conversation and wondered if the babies were ok.  I could figure out that microcephaly meant “small head,” but I didn’t know anything else about it.  We were never told before she was born, during any of the ultrasounds (which were at least once a week, sometimes up to three times a week) that there was any concern about Baby B’s head size.

In recovery, a nurse asked if they could give Baby A some formula, because her blood sugar was low.  They wanted to ask, because I said I wanted to breastfeed.  I said, “Of course.  If she needs it, please don’t hesitate to give her formula.”  My husband rejoined me and the neonatologist came in to discuss the babies with us.  He said that Baby A seemed to be OK, but she barely squeaked by the requirements for the regular baby nursery.  Baby B was on a CPAP machine.  He said that she has microcephaly and brain damage caused by the TTTS.  Wait, what?  We were only told about a possible kidney problem!  The neonatologist said that they would do an ultrasound of her brain as well as her kidneys, and he would request an MRI of her brain as well to determine the extent of the damage.  I don’t think it really sank in at that point, because we hadn’t really seen her.  My husband said that after they pulled her out of me, she was gasping for breath and turned blue.  It was scary, but he knew that was why the doctors were there.  I didn’t even get a picture with her.  They had brought her by me and swept her away in the incubator.  In the rush of hormones and craziness, I just tried to focus on the babies being here, and I thought they would probably be OK.  I shot off a few casual text messages to some friends, coworkers, bosses, and Dr. OB, saying that the babies were born, but Baby B had some health issues and brain damage.  Dr. OB assured us that we were in good hands with the neonatologist.  Everyone said they would be praying for us.  I just posted on Facebook that Baby B had some health issues and would need to spend some time in the NICU.  I didn’t know how to explain something that I didn’t understand, and I didn’t want to answer the inevitable questions or field the barrage of condolences I was sure would come.  I just wanted to be happy and enjoy this day.

My parents came to the hospital and brought my sweet son.  He got to meet his sister, Baby A, and he stayed with Papa while my mom, husband, and I (in a wheelchair) went to the NICU to meet Baby B.

Little Baby B was hooked up to the CPAP machine, which was forcing air into her lungs.  She was only on room air, not oxygen, which was great.  It was still so scary to see her hooked up there, with her little head and tubes attached to her body.  I cried, touched her, and said, “Mommy’s here, honey.  I love you.”  I needed to get back to the room, as I had just undergone major surgery, but I still couldn’t really process what was happening.

That night, I sent my husband home to get a good night’s sleep and get all the things we needed to mail my placenta to the hospital that performed the TTTS surgery (yes, it’s weird, but it’s part of the agreement when you have the surgery).  I kept Baby A in the nursery so I could get some sleep, and I exchanged text messages with a few friends.  Again, I wasn’t able to be super-excited about the birth of my babies.  I wondered what life would be like.  What was the extent of her brain damage?  Would she be able to breathe on her own?  Would she be able to eat on her own?  Move?  Talk?  What would we do?  How would this even work?  Was I being punished for being a bitch about how much better my son was compared to other people’s kids?  Would I be able to go back to work?  Would she be functional?  Would her sister feel guilty?  Would she resent her sister, even though they clearly had no choice in the matter?  Worse, would she not have the capacity to resent her sister?  I couldn’t imagine.  I have always been proud of my intelligence, and one of the things my husband and I love so much about each other are our big brains.  Would we be able to handle this?  I had so many questions and worries, but no answers.  I did sleep that night, on and off, alone for the first and last time in a while.

To read about the rest of our TTTS journey, click here.

Smoother Sailing

So after the surgery and the growth restriction scares, we finally went to appointments with Dr. MFM where everything was looking OK.  In the meantime, I was diagnosed with Cholestasis of Pregnancy, a gallbladder disorder that can come up during pregnancy and causes major itchiness, among other potential complications.  Fortunately, the medication I took for it worked pretty well, so I wasn’t scratching my skin off day and night.

I also canceled my baby shower, because I didn’t want to have a shower at my house when I was on bed rest and when we weren’t even sure if two babies were going to survive.  It was a sad decision, and it was hard not to celebrate the pregnancy like a normal person would.  I missed seeing my friends and opening all the cute outfits, saying, “oh, they’ll be so adorable in this!”  Instead, I was laying on my side, counting kicks, drinking water, watching all the t.v. I could stand, leaving the house only for doctors’ appointments, and counting down the days until December 2, when my c-section was scheduled.

I cried a lot.  I just kept waiting for more bad news.  We thought the babies would be ok, but there was still a concern about Baby B’s kidneys.  After what we went through, I just couldn’t allow myself to feel that positive about the outcome of the pregnancy.  I tried, but it was like I had post-traumatic stress disorder from TTTS and the surgery.  I questioned every move, replaying every doctors’ appointment and visit to the hospital and wondering why no medical professional could figure out that I had the signs of TTTS before the actual diagnosis.  I did everything right.  I went to the doctor when I was concerned.  I went to Labor and Delivery when I was concerned.  I went back when I still didn’t feel right.  Why the hell did it take so long?  Why did Dr. MFM not have me in for a follow-up ultrasound earlier?  With nothing but time, I did a lot of thinking, wondering, and questioning every move.

My poor son took some time to adapt to having mommy in bed all the time.  He knew that I needed to keep the baby sisters safe, but it was still hard for him.  Up until the time I got pregnant, he was the center of my universe.  It was an adjustment for all of us when that dynamic changed.

My wonderful husband had to do everything.  He took care of our son, his sons, me, and every household chore, in addition to going to work every day.  I know it wasn’t easy for him, but he very rarely showed how worn out he was or how stressed out he was, too.

I had to watch my little man go off for trick or treating without me.  I played Farmville on my phone constantly.  I cleared out the DVR.  I just maintained and grew babies…a human incubator.  The first time I felt like a normal person again was when I tried Jamberry nail wraps.  I just felt pretty.  It had been so long since I dressed up or did anything for myself.  I kind of threw myself into it to have something to do and something else to focus on besides the ticking clock.  I know it sounds strange, but it came at a time when I needed a little lift and a way to connect with people again.

It was November, and I knew that the babies might come at any time, and yet, they stayed put.  32 weeks passed, then 33, and 34.  I was surpassing everyone’s expectations of when the babies would come, and I was so grateful.  I started to think that maybe everything WOULD actually be ok.

My last appointment with Dr. MFM was the Wednesday before Thanksgiving.  The new ultrasound technician, who I didn’t like, did the ultrasound, and Dr. MFM came in briefly to mention the kidneys and tell us to come back on Monday if I didn’t have the babies before then.  I was really upset for some reason.  I just couldn’t place it, but there seemed to be huge differences in the ventricle size in the brains of Baby A and Baby B.  He said not to worry, it was probably nothing.  I still questioned why there would be a difference like this, and he said, “why are you still crying?  If I’m not worried, you shouldn’t be worried.”  How arrogant.  I guess I couldn’t argue with that, but I still felt funny about everything.  I just wanted to meet the babies and know that they were finally OK.

My dad, the chef, agreed to cook dinner at our house for Thanksgiving, since I couldn’t go anywhere.  My uncle, aunt, cousins, grandparents, parents, and nephew came over for dinner.  It was nice to have everyone over and really get excited about the babies being born, hopefully that following week.

My friend A came over the next day with her husband and their little boy.  It was great to see them, but it was even better to know that the next time I saw them, we’d have two little girls!

I kept joking that I’d definitely have the babies that weekend after Thanksgiving, because Dr. OB was going to Ohio then.  So I wasn’t entirely surprised, though I was disappointed, when I woke up Saturday morning and thought I might be leaking amniotic fluid.  I called the on-call doctor, and she told me to go ahead and come in to Labor and Delivery at the hospital as soon as possible (I was supposed to come in around 10:30 anyway for a non-stress test) so they could test me and see if my water broke.  If so, I’d be having my c-section that day.  She hung up and called me right back to tell me not to eat or drink anything so there wouldn’t be a huge wait to perform the c-section if I needed one.  I called my parents and asked if they could come up and meet with my husband to get the kids so he could be with me, just in case the babies were ready to come.

I got ready to go, and my husband dropped me off while he went to the park to wait for my parents.  He quickly joined me at the hospital, where I was hooked up to the monitors and watching the babies move around in my belly.  The nurse did the test and confirmed that I was leaking amniotic fluid, so we’d be having the babies that day, November 29.

To read about the rest of our TTTS journey, click here.

More Bad News

The day after we came home, my mom insisted on having a birthday party for my son (a week early), because she was heading to Ohio during his actual birthday the following weekend.  I tried to rest, but I, of course, had to come out to sing happy birthday and be with him.  He was so unsure about what was going on, and it was hard for him that I couldn’t play with him or pick him up anymore.  There were nights when he would snuggle in bed with me, then start kicking or pushing on my belly.  He just wanted his mommy back.

When we went for a follow-up ultrasound the week after surgery, Baby B still did not have a visible bladder and she still had little fluid around her.  Baby A looked great!  Dr. MFM was concerned, so I was to come back in 3 more days for another ultrasound.

Three days later, Baby B finally had a visible bladder!  We were thrilled that she was making progress, however she was still much smaller than her sister.

The following weekend was our toddler’s actual third birthday.  We had a party planned for our family, and I tried to relax as much as possible as he opened monster trucks.  He had a nice birthday and really enjoyed his presents and monster truck cake, specially made by Papa.

That Monday, our toddler had an appointment for his 3-year check-up about an hour after my appointment with Dr. MFM, so my dad came up and brought me to my appointment so my husband could leave work to pick up our toddler from the sitter’s and bring him to the pediatrician.

Dr. MFM again came in during the appointment.  He was concerned about the size difference between the babies, and he initially said that he wanted to send me to the hospital for monitoring and likely delivery.  Luckily J, the ultrasound tech, mentioned that she saw signs of breathing and movement during the ultrasound, so Dr. MFM loosened his stance a bit.  He stated that he  thought that the girls would need to be delivered within the next two weeks.  Baby B’s kidneys were also enlarged.  I was so upset.  My dad held my hand as I cried and asked what we needed to do, because the babies were only 27 weeks.  I knew we had a long way to go in order to have healthy babies.  Dr. MFM provided no additional support.  He just explained “the facts” like a robot.

Dr. MFM said, “Well, if you deliver now, you’ll have two very sick babies.  However, you can choose to keep the pregnancy going and focus on getting Baby A here safely and forget about Baby B.”  I couldn’t believe what I was hearing.  I was flooded with emotion, and I couldn’t wrap my head around what he was saying.  Forget about Baby B?  Just move forward with the pregnancy, knowing that I might just have one baby at the end?  It was so hard to even imagine.

I left that appointment sad and confused, but I made it to the pediatrician’s office for my toddler’s well-visit.  I briefly told my husband what Dr. MFM said, and we just could not make sense of it.  So I called Dr. OB, who returned my call and tried to clarify that if there is a problem with Baby B becoming growth-restricted, it would be safer for her health for the babies to be delivered than for her to continue in utero.  He answered my important NICU questions.  The local hospital has a Level II NICU, but a baby must weigh at least 1000 grams in order to be able to stay in that NICU.  He spoke with the neonatologist, who said that if one of the girls is OK and able to stay in the local NICU, but one had to be transferred to APHC in Orlando, they would try to make sure that BOTH babies would be transferred (if they were stable), so that we would have both of our babies in one place.  Having a child in the NICU is difficult.  The only thing more difficult would have been having two children in two different NICU’s in hospitals an hour apart.

Dr. MFM was going out of town, so we were unable to chat with him for another two weeks.  I would still be seen in his office, but I would see doctors from one of the other office locations.  Dr. MFM also wanted me to receive a second round of steroid injections to ensure the babies’ lungs matured at birth.  I was told I had to have the injections the following week at the hospital.  However, when I came back the following week, the new doctor who we saw said that everything looked fine.  He was happy, kind, and even joked with us.  He did not want me to receive the steroid injections, because it looked like the babies were able to stay put…but I had already had the first injection the night before, so I needed to get the second one anyway.  Apparently, a pregnant woman can only receive the steroid injections twice, no more, during each pregnancy.  Plus, they were only effective for a few days, so if the babies weren’t born pretty soon, the shots would be ineffective AND I would not be able to get them again.

We were just happy that Baby B finally looked good, and we hoped that this meant she would continue to grow and be healthy and stay put until the end of the pregnancy.  Her kidneys were still enlarged, and we were told again that it was just something that they would keep an eye on during the pregnancy and after she was born.  She had fluid around her, so it appeared that her kidneys were working.  We were never under the impression that it would be a big deal at all.

To read about the rest of our TTTS journey, click here.

Surgery and Back Home

At just before 7 a.m., some members of Dr. Quintero’s team came in to my room to go over paperwork, do a last-minute ultrasound to get another look at the babies and the presentation of the placenta, and prepare me mentally for surgery.  They started to move me to surgery (on another floor, in another part of the hospital) around 8 a.m., and my husband was not allowed to come with me.  We knew this ahead of time, but it was still tough to face those hallways alone.

The operating room was one of the largest I’ve ever seen.  It was at least four times the size of the operating rooms at the local hospital where I had my c-sections.  There were people coming in continuously, and I venture to guess there were at least 25 people in the room.  Only a few of these folks introduced themselves to me; it was very unnerving.  I was given a sedative to relax me, but not put me to sleep, right before I was transferred to the operating table.  The anesthesiologist also gave me some Benadryl to combat itching, which I had experienced in the past while receiving anesthesia.  There were two Labor and Delivery nurses at the end of the table and incubators at the ready in case the doctor needed to deliver the babies via c-section.  I was 26 weeks and 2 days at that point.

The nurse inserted my catheter, and the team began to prep for surgery.  Dr. Quintero came in with additional staff, and by that point, I was pretty tired and so grateful for the sedative.  I felt a bit of a sting when the local anesthetic was injected into my belly, but that was pretty much it.  I kept dozing off, but the anesthesiology assistant shook my shoulder to keep me awake, because when you sleep, you breathe deeply, which moves the placenta too much.  For such a delicate surgery, every little movement was critical.

I remember Dr. Quintero saying that he was severing the last of the vessels before he began removing fluid from Baby A.  I could breathe easier immediately when he removed the first batch of fluid.  He ended up removing FOUR (4!) liters of fluid from Baby A (imagine 2 2-liter bottles IN YOUR BELLY).  The doctor could have removed more, but he did not want to risk placental abruption by removing too much fluid.

I had the opportunity then to see my beautiful girls through the camera on the fetoscope, but I was so drowsy that I just couldn’t focus.  I vaguely recall seeing some limb-shapes projected on the screen.

Dr. Quintero said that one of the vessels the girls shared had become so huge it essentially became a fast track for the blood to flow from Baby B to Baby A.  Once the blood starts flowing in one direction, it no longer goes back and forth between the babies.  He realized before he removed the fetoscope that there was one tiny vessel that he almost missed.  He cauterized the vessel and left to speak with my husband.  I was basically passed out, but I remember being wheeled through the halls and up the elevator to the recovery room.  I had a nice, warm blanket, and I could finally breathe.  My back pain almost immediately subsided.  I took a nap and woke up to text and e-mail my friends and family to tell them that the surgery, according to Dr. Quintero, was a success!  We just needed to get through the day and have an ultrasound the following morning to see if the babies were responding to the surgery.

I spent all day in recovery, and I mean all day.  The recovery nurse kept waiting for me to be transferred, and we contacted nurse B with the FTC to see if I would be able to be moved to a nice room up there.  My husband and I were both looking forward to getting some sleep, and the suites promised a couch where he could sleep, too.

On the other side of the curtain, a woman waited.  And waited.  And waited.  She had been waiting to be brought back for her c-section since well before I got back to recovery.  This meant that she had not eaten all day.  I felt really bad for her, because she just could not get a straight answer about when she would be taken back for surgery.  The doctor on call finally came back and spoke with her, telling her that there were some emergencies that had to be fit in, but if she wanted, she could come back first thing in the morning and be put on the list then.  She waited and finally was taken back at about 8 p.m.

My catheter was finally taken out in the early evening, and still we waited to be sent to the floor.  We were basically told that they were understaffed, and we needed someone to come down to get us and bring us up to the room.

Finally, someone from the Labor and Delivery floor came to get us and bring us to one of the nice suites in the FTC section of the floor.  I was the only patient in that wing, but a nurse from Labor and Delivery was assigned to take care of me.  She was very kind and made sure I had drinks, towels, and a clean nightgown to put on.  Even though it was around 9 p.m., fairly early for two adults, we just turned on Shark Tank for a few minutes and went to sleep.  I slept well enough (as well as any pregnant woman does), and was awakened at 5 a.m. when the nurse came in to draw blood for my post-operative labs.

My husband and I both showered and got our things all ready to go while we waited for the ultrasound tech to come and get us.  We thought it would be around 8 a.m., but it was more like 10 a.m. when she got there.  Luckily, my husband was able to go and get some breakfast from Au Bon Pain, because I they forgot to bring me breakfast (since I was the only patient on that part of the floor).

We went back for the ultrasound and were pleased to see that the babies were still alive and looked pretty good, considering the circumstances.  Baby B’s bladder was still not visible, but she had a bit more fluid, so we had hopes that she would continue to improve.  Baby A was happy with the lessened fluid, and, although her bladder had thickened as a result of the fluid she was trying to process, it looked smaller and a little better already.  Dr. Quintero came in and expressed confidence that the surgery went really well.  He believed we would have two healthy babies when they were born.

We were discharged from the hospital to go home.  I was told to remain on bed rest for at least a week and see Dr. MFM for an ultrasound on Tuesday.  After that week, Dr. OB and Dr. MFM would decide whether I needed to remain on bed rest or not.

During the long drive, all my emotions and anxiety overwhelmed me, and I started to get very depressed.  I cried most of the way home, while my husband spoke to his mother and sisters to tell them about the surgery.

I was so happy to see my toddler, but I couldn’t hold him, which was very difficult for both of us.

“Where are my baby sisters?” He asked.

“They aren’t ready to be born yet.  Mommy has to lay down to try to keep them safe in her tummy as long as possible.”  He understood as much as an almost-3 year old could.

My parents had come up to clean our house before we arrived home.  It was a relief to come home and not have to worry about laundry or bathrooms.  I went to lay down in my own bed for the first time in three days, but I was having difficulty breathing.  My mom wanted me to go to the hospital, but I worried that they wouldn’t understand what I had just been through.  I called Dr. OB’s on-call number, and he called back fairly quickly.  He said that it was probably just from the shifting around during the surgery, but he wanted to see me the next day to check my lungs and make sure everything was ok.  My mom kept insisting that she should speak to him, as she always thinks I’m still 8 years old and need her to speak to medical professionals for me.

We also left a message with Dr. Quintero, and he too was not worried about my breathing problems.  I was finally able to get to sleep and begin the long process of keeping my babies safe until the latest possible date — ideally, they would be born the first week of December, and it was only September 20.  I had a long road ahead, but at least we seemed to have climbed this hurdle successfully.

To read about the rest of our TTTS journey, click here.

The Night Before Surgery

We drove through the hospital’s campus, the largest hospital I’ve ever seen, and attempted to navigate which entrance we needed to find.  My husband dropped me off so I could start to check in while he parked the car.  I found my way to Labor and Delivery through an office area and down hallways that were covered with construction materials.  Apparently the Labor and Delivery portion of the hospital was undergoing a much-needed renovation.

I went to the desk to check in and was sent to the triage area, where I filled out some forms and had my blood pressure and temperature taken before giving a urine sample.  There was a woman in there (pregnant, obviously), who had a small child with her and was coughing and hacking into a paper towel like she had tuberculosis.  My husband sent me a text message saying that the guard would not let him back to be with me, since I hadn’t been admitted yet.  I also got a call from Dr. Quintero’s nurse, B, asking where I was.  Apparently, the Labor and Delivery section is together but separate from the Fetal Therapy Center (“FTC”), although the FTC is on the same floor.  They have a separate staff for the FTC, and their suites are much nicer than the typical hospital rooms.  That made me feel better, as I was put in a triage room that was straight out of the 1970’s, and may have had original 1970’s dirt in it.  I’ve never been in a dirtier hospital room, and it (along with everything else going on) made me so uncomfortable.  However, the doctor wanted me to be hooked up to the monitors to make sure I wasn’t going into labor, so I waited on this thin stretcher while the triage nurse attempted to get both babies’ hearts on the monitor.  I hadn’t really slept at the local hospital the night before, and the exhaustion (and the pain) was really wearing on me.

Finally, I was brought back to the ultrasound room in the FTC.  It was clean, nice, and the ultrasound tech was so sweet and kind.  She warned us that this would be a 2-3 hour ultrasound, and I would likely be very uncomfortable.  Allan went to get some food for us for dinner, and we got to work with the ultrasound.  The tech needed to get accurate measurements, as well as dopplers for the babies’ hearts, umbilical cords, and brains.  If there were signs of brain damage, we would not be able to move forward with surgery.  If I went into labor, we would not be able to move forward with surgery.  We were just waiting and counting the hours until the surgery so that we could give our babies the chance to survive and hopefully thrive in the womb for at least a few more weeks.  Dr. OB called to wish us luck and remind us to get the second steroid injection (I had one the night before at the local hospital), which would help the babies’ lungs mature so they could breathe if they had to be born the next day.

Three hours after the ultrasound started, around 10 p.m., Dr. Quintero came in to speak with us and take some additional ultrasound images.  He measured my uterus, and it was measuring 51.  This was just two days after it measured 43.

I wish I had taken pictures of my huge belly, but I had other things on my mind.  The difference was all attributed to the crazy increase of fluid.  Baby A, the recipient, now had a MVP of 21+, and Baby B, our donor, had no fluid.  Baby B also had no visible bladder.  Dr. Quintero said that he had never seen anyone with so much fluid.  The ultrasound tech corrected him, and he said that he had never seen anyone with so much fluid who hadn’t gone into labor and lost the babies.  A lot of the time, TTTS comes on slowly, but in my case, and in the case of many other unlucky families, it comes on very rapidly.

Dr. Quintero classified our case of TTTS as a modified Stage III due to the severity of the fluid imbalance.  Typically, a Stage III case shows signs of abnormal blood flow in the umbilical cords of the babies.  He again went over the probabilities: 80% chance that we would have one live, healthy baby, and 50% chance of both surviving.  He also explained that there are multiple complications that can arise, and multiple health issues that can arise as a result of the TTTS and the laser surgery, including, but not limited to, brain damage, kidney damage, heart problems, death of one or both babies, or death of the mother.  He went over the surgery, which was scheduled for 7:30 a.m. the following morning.  During the selective laser photocoagulation of communicating vessels for twin-twin transfusion syndrome, the mother is awake, but drowsy, during the procedure, and with a local anesthetic is provided at the site of the fetoscope (like an endoscope).  The doctor goes into the uterus with the fetoscope and severs the blood vessels that the babies share.  Fluid is also removed from the recipient’s amniotic sac.  Following the surgery, the babies will each have their own separate sources of blood flow, so each baby’s fluid should balance out, and the donor baby’s bladder should return.  For more information about TTTS and the surgery, look here: http://www.jacksonhealth.org/fetal-therapy-ttts.asp

Dr. Quintero scheduled the surgery for 7:30 a.m. the following morning.  By the time we were through with the ultrasound, it was 11:30 p.m., and I still needed an I.V. and blood drawn, the steroid injection, and I needed to be hooked up to the monitors to make sure I didn’t go into labor.  If I went into labor, he would have to deliver the babies, who, if they survived, would have the difficulties and obstacles that extremely premature babies have.  There was definitely concern that I wouldn’t make it through the night without going into labor and would not be a candidate for the TTTS surgery.

Because the doctor wanted me to be monitored for contractions, I needed to go to the Labor and Delivery floor, rather than stay in one of the FTC suites.  However, there were no rooms immediately available, so I was placed back on the stretcher in the dirty triage room.  My husband had only a hard plastic chair to try to nap on, and I was again on an uncomfortable stretcher.  The nurse came in and I asked when she thought I would have a bed, because I was so tired and was having surgery in the morning.  She was a real bitch and snapped at me that she didn’t know and they were very busy so I would just have to wait.  She expressed no sympathy or empathy at all.  Typically, at the local hospital, if you’re pregnant and in Labor and Delivery for any reason, everyone is really kind and caring.  They always ask if they can make you more comfortable.  Here I was, measuring way past full term, with babies in distress, hoping to make it through the night, and this woman was such a bitch.  I will never forget how nasty she was.  Luckily, she seemed to be the exception at this hospital, as most of the other staff members were very kind and caring.

This bitchy nurse needed to start my I.V., and she started it in my left hand.  My hand was shaking, but I had nothing to rest my arm on because I was on a stretcher.  She snapped at me to keep my hand still or she would have to start another I.V.  I was in tears.  She had to take literally 14 vials of blood, because my medical records were not sent in their entirety, so the doctor needed to do many tests that I already had done.  She gave me the second steroid injection and still had not one kind word for me.  I couldn’t believe how awful this woman was being, but I hoped they would transfer me to a bed soon.

My husband and I both nodded off periodically in our uncomfortable positions, and we finally were moved to a Labor and Delivery room just after 2 a.m.  Someone came in for the THIRD time to change my hospital bracelet and put my maiden name as my last name.  I already had them correct the bracelet after initially coming in, and for whatever reason, they thought it needed to be changed again.  The nurse in Labor and Delivery asked me the same 100 questions that the bitchy nurse and the earlier triage nurse asked.  Apparently they all just wrote the responses on paper and then promptly got rid of it.  This nurse finally put the answers in the computer — answers to questions like “what date exactly did you have a bronchoscopy when you were 14.”  It was about 3 a.m. before my husband and I could attempt to get some sleep.  It was obviously a very restless evening, but at least I had a bed to lay in while I tried to rest up and hoped and prayed that my babies would be safe.

To read about the rest of our TTTS journey, click here.

The Diagnosis

Dr. MFM came into the ultrasound room about ten minutes into the ultrasound, which was really rare.  Usually, he’s like the great and powerful Oz and just watches from behind his green curtain, commenting only after the test is completed.

“You have TTTS.  I’ve called my former colleague in Miami so that you can go down there to see if you can have the surgery no later than Monday morning.”

We asked questions.  I cried.  My husband looked scared.  The ultrasound continued, as they had to give accurate measurements to the hospital and surgeon in Miami.  Dr. MFM came back in and said that because of the situation and severity of the fluid discrepancy, too much for Baby A and almost none for Baby B, they wanted to get me to Miami right away to see if we could have surgery in the morning.

We were told that WITH the surgery, our chances of having one healthy, living baby was 80%.  The chance of both surviving was 50%.  Those didn’t sound like great odds to us.  However, not having the surgery would mean that I would probably have to deliver “two very sick babies” at 26 weeks’ gestation.  The chance of survival for Baby B in particular was low considering the fact that she had lost weight since the previous ultrasound two weeks before, and she now measured more like a 22 week fetus with no visible bladder.

Dr. MFM briefly told us about the procedure.  I would be brought to the operating room, where the surgeon would use an endoscope to go through my belly into my uterus and use a laser to coagulate the blood vessels that the babies shared in the placenta.  That would essentially give the babies each a separate placenta, and it should correct the fluid imbalance and other issues.  If the surgery looked like it wasn’t going to work or if I went into labor, the surgeon would deliver the babies.

We had so many questions.  I think we were just stunned, dumbfounded that we were facing this life or death situation with our two baby girls and that TTTS hadn’t really been mentioned as a possibility in the past two weeks.  Dr. MFM hurried us out of his office, saying that we needed to get in the car and drive straight to Miami.  The surgeon there would tell us more and answer any questions we had.  He told us that he would have called an ambulance, but it would be quicker if we just drove.  There was concern that I would go into labor, because I had such an abundance of fluid.  We were told that we could go home quickly to get some of our things, but we needed to get on the road.  It was almost 1 p.m., and he wanted us to be there by 4 p.m. so I could be assessed that evening by the doctor and his team.

My husband and I left the office and made some important phone calls.  I cried hysterically as I called my parents to tell them, and I asked them to pick up our toddler from the babysitter’s house and take care of him until we returned.  My dad said something in an attempt to comfort me, but I don’t remember what exactly.  I was focused on my husband’s conversation with his own mom.  I listened as his voice cracked with emotion.  I’ve never heard him sound like that before or since.  We called the babysitter and told her what was happening, and let her know to expect my parents to pick up the toddler a bit later.

When we got to our house, we both rushed through to get medications, pajamas, and everything we might need for however long we were there.   Peanut butter and jelly sandwiches were good enough for lunch in the car, accompanied by some baby carrots and water.

The drive to Miami took about three hours.  On the way, I e-mailed my bosses and coworkers and posted a quick post on Facebook that TTTS was confirmed, and we were heading to Miami for surgery.  I also Googled the surgeon who would perform the surgery and found that he was one of the pioneers of the TTTS laser ablation surgery.  The TTTS staging system is called the Quintero staging system, because Dr. Quintero devised it.  Along with apprehension, fear, and sadness, I started to feel a bit of hope that he might be able to save my babies’ lives.

B, one of Dr. Quintero’s team’s nurses, called to give me more specific directions and find out our E.T.A.  She was so helpful and friendly, and I really started to feel like at least we were going in the right direction.

However, the thoughts kept creeping in that if only I had an earlier ultrasound, we might not be in this dire situation right now.  The huge weight gain, the horrible back pain…at least now I knew why I felt so terrible.  I had been to Dr. OB two times, as well as to the hospital two times in the past two weeks.   No one recognized the signs.  Dr. MFM saw me two weeks prior and did not seem concerned about the fluid difference and possibility of TTTS, so how the hell did this happen?  I didn’t have room in my brain to dwell on it, so instead I tried to focus on getting to Miami and through the surgery with two healthy babies still in my belly.

Early September

On Wednesday, September 4, 2014, I had an appointment with Dr. MFM for an ultrasound.  Everything looked ok, except for the babies’ fluid levels.  Normally, the MVP (maximum vertical pocket) of fluid is between 2 and 8.  Baby A had 9 something, and Baby B had 4 something.  I was 24 weeks and 1 day along.  Dr. MFM came in and said that the fluid discrepancy could be the result of Twin-to-Twin Transfusion Syndrome, but he would have me back in about two weeks for a follow-up ultrasound.  I wasn’t too concerned, because he didn’t seem to be.

The next day, I took one of my first pregnancy pictures.  I felt like my belly finally “popped” so I didn’t just look fat, I looked pregnant.  As the days went by, I just felt huge, and I was having trouble feeling the babies move.

On Monday, September 8, 2014, I called Dr. OB because I wasn’t feeling the babies move as much as I usually did.  He sent me to Labor and Delivery at the local hospital, where they hooked me up to the monitors for a non-stress test (which measures the fetal heart rates).  The heart rates looked fine, so I was cleared to leave.  Before I left, the doctor on call came by, stood at the end of the bed, and literally spent 5 seconds asking if anything else was wrong.  He didn’t shake my hand or offer sympathy or any other words of encouragement.  I couldn’t believe how little interaction he had with me when I had concerns about my babies.  We’re still fighting the bill for that visit.

The next day, Tuesday, September 9, 2014, I went to see Dr. OB. My fundal height (uterus) measurement was 40.  Typically, that number corresponds to the number of weeks pregnant you are, although with a twin pregnancy, it’s common to measure 8 weeks ahead.  I was still not quite 25 weeks, so 33 should have been the maximum amount.  I was in pain and feeling so much pressure, and Dr. OB reasoned that it was because I was measuring full-term.  He reiterated that the babies’ heart rates looked fine at the hospital and I probably felt less movement because the babies shifted positions.  He did not want to minimize my feelings if I felt something was wrong, so he said he would order an ultrasound for me if I wanted one.  I said that I trusted his judgment and if everything else looked fine, he was probably right that they just shifted.  I would give anything to go back to that day and demand the ultrasound.

As that week went on, the pain in my tummy and back increased so that I was constantly in pain.  I had difficulty completing assignments for work.  I drank a lot of water and tried to rest as much as possible.  On the plus side, I passed my glucose test!

On Tuesday, September 16, 2014, I visited Dr. OB again.  I was measuring 43, and I had gained 5 pounds in a week (which is significant, as I had lost weight initially and was only a pound over my pre-pregnancy weight).  He prescribed a maternity belt and some muscle relaxers to help alleviate my back pain.  He also wrote another note for work so that I would only be working half-days for the remainder of the pregnancy.  I immediately went to a medical supply store and got the maternity belt.  It seemed to help for a little bit, but I was so uncomfortable and had such a hard time sitting with the computer on my lap to do work.

On Wednesday, September 17, 2014, at 26 weeks pregnant, I really had a hard time feeling my babies move.  I could only feel Baby A; Baby B was just silent.  I called Dr. OB, who sent me to Labor and Delivery again.  When I was hooked up to the monitors for the non-stress test, they discovered that I was having contractions.  I was not dilated, thankfully.  An ultrasound was ordered, and the babies did not pass the test, because Baby A had a pocket of fluid that measured 16, and Baby B had very little measurable fluid.  Baby B also was not yet showing signs of breathing, which could be normal depending on the situation, and she had no visible bladder.  I was admitted to the hospital, and one of the nurses said that I might be there until I delivered.  I was so upset, in part because I rarely spent a night away from my sweet toddler, and I couldn’t imagine spending 8-12 weeks away from him.  I also had no idea what was going on with the babies, and whether this was TTTS or not.  Dr. OB came in around 6 p.m., and the first thing he said was, “Don’t freak out.”

“Have we met?  Of course I’m freaking out!”

He explained that the hospital’s ultrasound machines weren’t that great, so it might look like there’s an issue and there isn’t.  He wanted me to stay overnight for monitoring and be discharged in the morning to see Dr. MFM for a high-level ultrasound, because Dr. MFM doesn’t come to the hospital to see patients.  Dr. OB surmised that I should be able to be on bed rest at home for the rest of the pregnancy if Dr. MFM agreed that was the right course of action.  He did mention that if this was TTTS, Dr. MFM would be able to send me to the surgeon in Miami who performs the TTTS surgery.  I would have no answers until going to Dr. MFM the following day, so I had no choice but to wait.  My parents, husband, and toddler came to visit, and I told a few friends where I was and why.  Mostly, I was so stressed out that my babies might not be ok.  Baby B was way up in my right ribs, and Baby A was free-floating around in the rest of the space.

My husband’s company was having a welcome lunch the following day where they were to meet some of the executives from the home office overseas (the company had recently been purchased by an international company).  I told him to go ahead to work, because I didn’t want him to miss too many more days and not have time available when the babies were born.  Luckily, he did not listen to me.  He came to the hospital in the morning after dropping the toddler off with the babysitter, and we waited to hear when our appointment with Dr. MFM would be.

I was discharged from the hospital to see Dr. MFM at 11:30 a.m.  We were nowhere near as nervous as we should have been going into the office.

To read about the rest of our TTTS journey, click here.