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Shannon's twin pregnancy journal

Week Twenty-seven
~ Balancing Act

July 19 ~ Last Sunday, I was told if I didn't deliver within the first 24-48 hours of my membranes rupturing, I "might" make it another week. Well, it's time for celebration . . . my babies have made it through one more week inside me! Every day they stay in me means at least one less day they spend in NICU. Of course, that is a very over-simplified way of looking at the whole picture. Last Monday (7/13), the neonatologist came in to talk to Peter and I. He told us the babies would have an estimated 60-70% chance of survival if they were born at 26 weeks. He explained that IF they survived, they would be on ventilators for many weeks. There would be complications such as bleeding in their brains and inability to digest as a result of their prematurity. The list of possible long-term problems, such as Cerebral Palsy, blindness, and mental retardation dashed what little hope survived the first bit of information. When the doctor first came in, Peter asked about best case/worst case scenarios. Nothing is ever that simple. Best case scenario would put me at 40 weeks, giving birth to two beautiful healthy babies. Realistically, that's not going to happen. Even without this latest complication, I probably never would have made it to 40 weeks. Okay, worst case . . . would it be worst case to immediately give birth and immediately lose both babies? I honestly think there are worse things that could happen. Losing one, or both, of my babies after giving permission for, and watching them go through months of hellish treatments, would be one of those worse things. But I'm jumping the gun here . . .

We were told if the babies stay inside me until my 28th week, their chance of survival increases to 90%. The risk of other complications drops proportionately. THERE IS HOPE,THERE IS HOPE, THERE IS HOPE! But, wait . . . the membrane has ruptured . . . there is no turning back once that's happened, is there? Okay, here's where things get really "iffy." Ultrasound scans last Sunday and Tuesday showed fluid around both babies. Baby A's fluid is somewhat reduced. Apparently, even though the membrane ruptured, there is more fluid being produced than there is leaking out. This is a great and wonderful thing . . . a miracle. As long as there is adequate fluid surrounding him, my son can continue to grow and develop. Right now, his heart is strong and steady and we have every reason to believe he is gestating along as though there has been no crisis. Staying with this delicate balance for an extended period of time would be absolutely the best case. That's what I'm shooting for as I while away my days lying on one side or the other, enjoying these lovely drugs I'm being given.

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There are many things that can upset this balance. I am being given IV penicillin to help prevent infection (I learned yesterday that I am beta strep positive). We are being carefully monitored for any signs of infection . . . rise in my temperature, abdominal tenderness, pronounced and sustained rise in the babies' heart rates . . . which would necessitate an immediate cesarean section. With the membranes being ruptured, there is no longer a sterile environment surrounding my son, and we are all at risk from stray bacteria. Another consideration is my placenta. Because my placenta is completely covering my cervix, it is helping to hold things in. My doctors believe the placental placement has helped slow the loss of amniotic fluid. Also, the babies are not going to just "pop out of me" because there's a barrier there. Maybe this previa thing is not all bad? On the other hand, the placenta presents some problems as well. In order to exit my body, released amniotic fluid has to find a way under, through, or around my placenta. This has caused me to bleed, quite heavily at times. My blood count is monitored at least once a day (I have the holes to prove it!). My red cell count is down, but I am being given extra iron and units of blood are on reserve if I should need them. I have two IVs set up, in case I begin to hemorrhage. If that were to happen, I would go for an immediate c-section.

Although infection and hemorrhage are scary things to consider, the number one concern right now (as far as keeping the babies inside) is preventing full-blown labor. Once the membranes have ruptured, labor usually begins within 24-48 hours. If the uterus can be relaxed and contractions can be stopped, delivery can be postponed. This is where these lovely meds that I keep bringing up come in. Magnesium Sulfate. All I have to do is name the drug and I see women visibly cringe. I now have the personal experience to understand why. Mag Sulfate acts as a depressant on the central nervous system. When I came in here, I began having contractions 4 minutes apart. The IV administration of Mag Sulfate pretty much stopped those contractions (I still have a mild contraction every couple of hours). This is one med where you are started off initially with a high enough dose to get an immediate reaction, then the dose is scaled back to find the lowest amount necessary to control your contractions. As if to underline it's usefulness, when my Mag dosage was first cut back, painful contractions kicked in every two minutes. I can't begin to express how grateful I am to be on this drug right now. I feel Mag Sulfate is the single most important factor right now in this balancing act that my pregnancy has become. AND, as much as I love this stuff, I LOATHE it! As a result of this medication, I fear for my sanity as I lie here. All of my senses are effected. My vision is like looking through layers of broken glass. I cannot focus both eyes at once and must keep one eye closed. I hear things (voices, music, the TV) as though underwater. I can't keep track of time. Everything seems like forever, or something that happened last week was done only minutes ago. I feel SO disconnected. I know that my feet (intestines, knees, or whatever body part) are still where they always have been . . . they just FEEL as though there is nine miles separating them from the rest of me. Something as simple as rolling from one side to the other requires intense concentration and frequent rest breaks. My only consolation is that my body has begun to adapt to this dosage. God forbid something should happen requiring that the dosage be raised back up again. I don't even want to think about it.

So this is where we all are right now: the babies remain safely inside me, I remain in my hospital bed trying to visualize myself as the world's most loving incubator, Peter is trying to be in three places at once (and doing an admirable job of it, although we both know there's a limit), and the other children are at home being looked after by my oldest son (Dave, 16), his best friend and the best friend's mom who stays at our house when she's not at work. None of this is great, but it's what we have. Considering possible alternatives, I'll take it. And celebrate this gift of a week. Give a great, rip-roaring cheer for us, and then ask "the powers that be" for another week. I'm trying to take this one day, one hour, at a time but I don't think it hurts to keep my eyes on the stars.

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