This morning I had my usual appointment with MFM. I am currently 31w6d. The babies all did well gaining weight:
Baby A: 4#2 oz and measuring in the 49% for growth
Baby B: 3# and measuring 18%, a decline from 29%
Baby C: 4#2 oz and measuring 49%
With the size of the babies and with what little room that they have there isn't tons to see, not a lot of pictures to take, and so on. But Baby B surely put a show on for us just sucking away on her thumb and then covering her face with her hand.
At this appointment we did a BPP or biophysical profile. A and C both scored well, B we were unable to see her breath at all. But the fact that she was sucking her thumb meant there was something going on and we saw her heart beating away.
Following the US my MFM joined us in the room and checked for breathing as well. He did not see any with Baby B. None of this really phased me because I saw the heart beating, her fluids were good which indicate that their is oxygen going to her kidneys, and she was moving. We then went into a consult room so he could answer any of our questions. At this point, I just had one question to ask and it was about inducing at 35w.
My husband, doula, and I waited in the consult room and after a few minutes my MFM joined us with a large framed photograph of his mentor, Dr Crenshaw. He proceeded to tell us that when he (his mentor) attended births his cesarean rate was under 10%. Every baby: breech, multiple, etc, was born vaginally. He used to be able to tell when his nurses were pregnant before they even did because he practiced medicine in such a way that you observed and diagnosed. So he noticed little things like flushed cheeks that come with a rise in hormones. This Dr Crenshaw sounds to me like a phenomenal OB! All of this was said as a seg-way to discuss the recent developments with the pregnancies and birth, but I can't for the life of me remember what it was, lol!
Since week 17 of this pregnancy when we thought there was a risk of TTTS we have known that Baby B was our runt and that she would likely dictate how the pregnancy and birth played out. Ruling out TTTS was huge. But Baby B was still measuring smaller than her sisters after every US. Two things factor into this: although they share a placenta it doesn't mean it is shared equally, B likely has a much smaller portion of the pie, if you will. Also B has a two vessel cord
If you remember, all three babies share 1 placenta, this is known as monochorionic. this is more common among spontaneously conceived triplets. It is also not uncommon for mothers to be advised to reduce a baby because the risks and complications associated from one shared placenta is among the highest for triplets.
So we have the issue with Baby B not showing any breathing, two vessel cord, smaller portion of the placenta, and a decline in growth and we discussed how these things all factor into a vaginal birth. I am still trying to understand it all and hopefully I can have a better understanding after I see my OB Monday, but here I go anyway trying to explain it as best as I can. With the shared placenta and having a smaller piece, for that matter, Baby B runs the risk of not getting enough blood flow, nutrients, etc from the placenta once Baby A is born. This is because once A is born the placenta begins to relax, if you will. And so if Baby B is already getting a limited flow and even more decreased flow isn't any good. So there is concern if we can get Baby B out fast enough to not risk complications. He even said with a cesarean some of this same risk is there, with the placenta "taking a break" but B can be birthed quicker. If B were A, aka closer to my cervix and the first to be born, then it may not pose as great a risk.
So first blow: vaginal birth may not be a safe option given all the variables,
Second blow: Baby B didn't do well on the breathing component of the BPP
Third blow: Baby B is beginning to have a decline in her growth and is quite smaller than her sisters
So what does all this mean? I would be sent to labor and delivery to monitor the heart tones of all three babies, especially baby B. If the strips didn't come back with 8/10 then we were possibly looking at a birth on Sunday. Given that they are still under 34w it is recommended that babies get steroid shots to help with lung maturity. So while in L&D I got my first round of steroid shots. I am returning tomorrow for my second round. Thankfully the test strips came back well, they showed good heart tones and that the babies could tolerate the contractions I was having.
All of this is so hard. It is hard to know what to accept and what to push back against. There isn't a storehouse of research and evidence for monochorionic triplets. There is even less so with all the "issues" Baby B has. And even FAR less for what to do with a monochorionic triplet vaginal birth and all these variables. Are the risks astronomically high or are they less than 1% like a uterine rupture? No decision that we will make from here on out will be easy or made without lots of tears and prayer.
So now what? I am to resume life as normal. Unless I go into labor these babies won't come Sunday. I am monitoring Baby B's movements as that can be an indication of her health. Monday I have my regularly scheduled appointment with my OB. I will no doubt have him explain a lot of this to me again. There is so much to understand. The girls will also be monitored again. I would not be surprised if the NST becomes something we do several times a week until the babies are born.
Needless to say I cried a lot. I cried in the consult room. I cried walking over to L&D. I cried as I shared the news with my family, a few close friends, and my triplet group. I cried as people sent me encouraging words. I cried on my way home when I knew, for now, everything was OK (but isn't that soooo relative). I cried when I was finally able to lay down and rest. I'm crying right now, lol.
I'm nearly 32w. That is a major milestone for a triplet pregnancy. I am home and not on bedrest. That is huge. But there is still a long and challenging journey ahead. Still a lot of unknowns. Now I am living this pregnancy day by day.
I need to revisit Psalm 139 as well as this song as it has been my rock during this pregnancy. And this song:
