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:
Friday, March 28, 2014
Friday, February 21, 2014
26w Update
26w6d triplet stats compared to stats 3w ago
Baby A: 2#5 oz, up from 1#8oz. She is 54% and head down
Baby B: 1#12oz, up from 1#3oz. She is 24% and head down
Baby C: 2#2oz up from 1#7oz. She is 46% and transverse
All the babies are healthy and measuring on par and above with a singleton baby at this age gestationally. Great weight gain. Doc says if Baby B continues to grow at this rate all will be well. He is not concerned that Baby B has any kind of growth restriction. Every baby and every pregnancy is different, big and small babies, so it would only make sense that in my trio there would be a variation in size.
My health is also great. I'm up 6lbs since my visit 3 weeks ago, which is about what the docs recommend. My total weight gain is about 40lbs. That is more than I've gained going full-term with my other 3 girls. But I'm carrying 3x the amount of baby and I just need to keep packing the pounds onto Abby, Bonnie, and Betsy! Blood pressure is awesome: 122/70
We also discussed vaginal birth. When I first started seeing him and there was concern for TTTS his main thought was whether the pregnancy would continue to be viable and really feeling like we needed to take baby steps. It's been about 10 weeks and everything has stayed stable. While we still have to take it week by week, but he says vaginal birth seems more plausible. But the babies must be big enough to be able to handle coming through the birth canal and possible extraction, little fragile babies would not do well with a vaginal birth.
Only Baby A needs to be head down for a vaginal birth and she is positioned properly. Doc says it's not common for a baby in a trio to flip. So I am feeling good about that. The other babies don't need to be head down and would really be silly to expect them to be. Once Baby A is born they could easily change their position.
My cervix is still doing well, measuring 4in long. He announced that this would be the last vaginal US because there is no evidence to support checking it any further. This doesn't mean I would not get vaginal exams, but they would now be with my OB and done the old fashioned way: checking for cervical softening, dilation, etc. It is not a small thing to regularly have a provider say they will or will not do a procedure due to the available evidence. Knowing that my providers won't just do something because is such a relief.
At the end of our appointment he brought up my last appointment with the other MFM doctor and asked if I had any questions or concerns. I felt that the hospital handled it well, what with an email, phone call, and a letter...I would say they covered their basis. He read my complaint and believed they were all valid complaints.
As for the personalities of the girls, there seems to be a trend. Girl A stays put, never shows her face. Baby B is little miss photogenic and moving around. Baby C seems to cooperate when she wants, Taylor thinks she will be our little stinker.
Unfortunately the US pictures were quite fuzzy, I wasn't totally impressed with the quality of the technician. She was very kind and sweet and got all the information necessary but everything, including what she got for the doc seemed a bit fuzzy. She may need to get her eyes checked, lol! I must say, every US I am intrigued by the spine. It seems so miraculous. I have become pretty good at being able to identify the kidneys, bladder, and stomach. To see the stomach empty and fill up is pretty cool. And watching the heart beat, wow. God is pretty amazing.
Baby A: 2#5 oz, up from 1#8oz. She is 54% and head down
Baby B: 1#12oz, up from 1#3oz. She is 24% and head down
Baby C: 2#2oz up from 1#7oz. She is 46% and transverse
All the babies are healthy and measuring on par and above with a singleton baby at this age gestationally. Great weight gain. Doc says if Baby B continues to grow at this rate all will be well. He is not concerned that Baby B has any kind of growth restriction. Every baby and every pregnancy is different, big and small babies, so it would only make sense that in my trio there would be a variation in size.
My health is also great. I'm up 6lbs since my visit 3 weeks ago, which is about what the docs recommend. My total weight gain is about 40lbs. That is more than I've gained going full-term with my other 3 girls. But I'm carrying 3x the amount of baby and I just need to keep packing the pounds onto Abby, Bonnie, and Betsy! Blood pressure is awesome: 122/70
We also discussed vaginal birth. When I first started seeing him and there was concern for TTTS his main thought was whether the pregnancy would continue to be viable and really feeling like we needed to take baby steps. It's been about 10 weeks and everything has stayed stable. While we still have to take it week by week, but he says vaginal birth seems more plausible. But the babies must be big enough to be able to handle coming through the birth canal and possible extraction, little fragile babies would not do well with a vaginal birth.
Only Baby A needs to be head down for a vaginal birth and she is positioned properly. Doc says it's not common for a baby in a trio to flip. So I am feeling good about that. The other babies don't need to be head down and would really be silly to expect them to be. Once Baby A is born they could easily change their position.
My cervix is still doing well, measuring 4in long. He announced that this would be the last vaginal US because there is no evidence to support checking it any further. This doesn't mean I would not get vaginal exams, but they would now be with my OB and done the old fashioned way: checking for cervical softening, dilation, etc. It is not a small thing to regularly have a provider say they will or will not do a procedure due to the available evidence. Knowing that my providers won't just do something because is such a relief.
At the end of our appointment he brought up my last appointment with the other MFM doctor and asked if I had any questions or concerns. I felt that the hospital handled it well, what with an email, phone call, and a letter...I would say they covered their basis. He read my complaint and believed they were all valid complaints.
As for the personalities of the girls, there seems to be a trend. Girl A stays put, never shows her face. Baby B is little miss photogenic and moving around. Baby C seems to cooperate when she wants, Taylor thinks she will be our little stinker.
Unfortunately the US pictures were quite fuzzy, I wasn't totally impressed with the quality of the technician. She was very kind and sweet and got all the information necessary but everything, including what she got for the doc seemed a bit fuzzy. She may need to get her eyes checked, lol! I must say, every US I am intrigued by the spine. It seems so miraculous. I have become pretty good at being able to identify the kidneys, bladder, and stomach. To see the stomach empty and fill up is pretty cool. And watching the heart beat, wow. God is pretty amazing.
Thursday, February 13, 2014
The Triplets Have Names!
It appears that our three little girls now have names. This is a significant accomplishment for Taylor and I. With our older girls it always came down to the final few days and with Josie we changed her name on the paperwork after she was born. Taylor wanted to wait until their birthday to make a decision, that was more than I could handle. For some reason, with the triplets I wanted them to have an identity, other than A, B, and C, as early as possible. Tuesday night I was pretty sure we would have names selected. We had them narrowed down to 4, 3 of which we had been tossing around for weeks. Honestly, I was happy with any combination of the 4, Taylor thought because I couldn't narrow them down that I was just settling for anything. I was eventually able to prove him wrong.
So last night, after we put the girls to sleep and settled in for our Alias watching, I started discussing names. We settled on three! But every so often I would ask him to pause the show and I would ask, "so our girls' names are....?" He said yes and we resumed the show. I think we did this about 5 times before we finally decided! With names for the girls I felt like I was getting to know them in a whole new way. All the names of our older girls are family names. The names of the triplets are a combination of family names and names with which we like the meaning. One thing is for sure, all 6 of our girls have old lady names =)
The names have not been assigned to the babies, nor have they been assigned colors or blankets. I was willing to compromise with Taylor on that, having names was a big enough deal!
So without further ado, the unveiling of the names of the Birchman Triplet Girls:
*Abigail (My Father Rejoices. I also really like her story in the Bible) Louise (Protectress/Watchful)
*Betsy (Oath or Promise of God) Doris (Taylor's maternal Grandmother)
*Bonnie (Taylor's mom) Victoria (my maternal grandmother)
I shared the names with Evie and Lucy this afternoon. Evie did not approve but then she recommended fridgerator and garbage can. So her judgement doesn't carry much weight in the house.
Taylor says things can still change, I beg to differ. We will know for sure on their birthday!
So last night, after we put the girls to sleep and settled in for our Alias watching, I started discussing names. We settled on three! But every so often I would ask him to pause the show and I would ask, "so our girls' names are....?" He said yes and we resumed the show. I think we did this about 5 times before we finally decided! With names for the girls I felt like I was getting to know them in a whole new way. All the names of our older girls are family names. The names of the triplets are a combination of family names and names with which we like the meaning. One thing is for sure, all 6 of our girls have old lady names =)
The names have not been assigned to the babies, nor have they been assigned colors or blankets. I was willing to compromise with Taylor on that, having names was a big enough deal!
So without further ado, the unveiling of the names of the Birchman Triplet Girls:
*Abigail (My Father Rejoices. I also really like her story in the Bible) Louise (Protectress/Watchful)
*Betsy (Oath or Promise of God) Doris (Taylor's maternal Grandmother)
*Bonnie (Taylor's mom) Victoria (my maternal grandmother)
I shared the names with Evie and Lucy this afternoon. Evie did not approve but then she recommended fridgerator and garbage can. So her judgement doesn't carry much weight in the house.
Taylor says things can still change, I beg to differ. We will know for sure on their birthday!
Thursday, February 6, 2014
Compassion, Grace, and Perspective
This post is not intended to take a particular stance but to inform. I have been hesitant to post on this topic for a long time because it is a very hot issue. My OB encouraged me early on in the pregnancy to post about reduction just to inform people that it is a component, for many moms of higher multiples, during their pregnancy. For some it is merely a brief discussion with other moms of multiples, for others they have counseling, seek 1,2 and 3 opinions, and for some it may never come up. If you are interested, here is an article from the ACOG Ethics Committee on Multifetal Pregnancy Reduction
At two separate times in this pregnancy reduction became a part of our conversations, primarily between my husband and I. Fortunately, for us, it was just a conversation. There are so many layers to a pregnancy with multiples. Perhaps your sister, friend, or daughter is pregnant with multiples. There is so much that she and her partner must consider, experience, pray about, cry over, and hope for. And so much of it is hidden. Sometimes, from the outside, a decision seems like a no-brainer. But that's just it, you're on the outside.
Really, this post is more than just about reduction. It is about extending compassion, grace, understanding, and perspective to any mom, but given my circumstances, to moms of multiples, specifically. Having been pregnant with three children, and having 3 very different labor and birth experiences there isn't really anything that could have prepared me for triplets. Perhaps you have had 10 babies, or you are a provider and have attended hundreds of births, or maybe you breastfed your single baby til they were 4, or you swore you would never get milk from a donor, that you would or wouldn't do any myriad of things. And those experiences may make it easy for you to say what you would or wouldn't do if you were pregnant with multiples, particularly higher order ones. Carrying multiples is not easy: physically, emotionally, psychologically, and even spiritually. It is taxing. It is also a blessing. But it is still challenging. What a mom expecting and caring for multiples needs is support and compassion. Sometimes it's ok to say "that sounds really tough, you have my support." Or, "I hope you can find peace with the situation you are dealing with." And please keep in mind that all pregnancies and births are different and are even more so when multiples are in the mix. It is not so simple. I will end with my new little motto: a little compassion, grace, and perspective goes a long way.
At two separate times in this pregnancy reduction became a part of our conversations, primarily between my husband and I. Fortunately, for us, it was just a conversation. There are so many layers to a pregnancy with multiples. Perhaps your sister, friend, or daughter is pregnant with multiples. There is so much that she and her partner must consider, experience, pray about, cry over, and hope for. And so much of it is hidden. Sometimes, from the outside, a decision seems like a no-brainer. But that's just it, you're on the outside.
Really, this post is more than just about reduction. It is about extending compassion, grace, understanding, and perspective to any mom, but given my circumstances, to moms of multiples, specifically. Having been pregnant with three children, and having 3 very different labor and birth experiences there isn't really anything that could have prepared me for triplets. Perhaps you have had 10 babies, or you are a provider and have attended hundreds of births, or maybe you breastfed your single baby til they were 4, or you swore you would never get milk from a donor, that you would or wouldn't do any myriad of things. And those experiences may make it easy for you to say what you would or wouldn't do if you were pregnant with multiples, particularly higher order ones. Carrying multiples is not easy: physically, emotionally, psychologically, and even spiritually. It is taxing. It is also a blessing. But it is still challenging. What a mom expecting and caring for multiples needs is support and compassion. Sometimes it's ok to say "that sounds really tough, you have my support." Or, "I hope you can find peace with the situation you are dealing with." And please keep in mind that all pregnancies and births are different and are even more so when multiples are in the mix. It is not so simple. I will end with my new little motto: a little compassion, grace, and perspective goes a long way.
Friday, January 31, 2014
A little respect goes a long way.
If you are wanting an uplifting or positive post don't continue reading.
Originally, I had an appointment scheduled for my regular MFM (maternal fetal medicine) doctor on Wednesday. It was cancelled due to weather and rescheduled for today. Unfortunately, he was out of the office and so I saw someone else. I had my reservations about seeing someone different. I very much like to maintain continuity of care as much as possible and I didn't want to deal with an alarmist doctor. I made several attempts to change the appointment. But between the craziness of our house and no one answering the phone, I went against my gut and had the appointment anyway.
After the regular US the doctor and resident entered the room. I have never been in a situation where I was not first informed that a resident was present and then asked if it was ok if they sat in on the appointment. This was not the case. They never told me the resident's name. Aside from the doctor introducing himself to me, he didn't say a word to me the next several minutes...he just made small talk with the US tech and the resident. The resident asked questions about the possibility of my individual membranes rupturing. Hello, I'm in the room. Please save these questions for later, especially if I never even brought up membrane rupture. The doc proceeded to put gel on my stomach, i don't even know why because he didn't really take the time to look at anything. He just moved the damn US thing around very unintentionally, or so it seemed. I wanted to say, "My babies already had a rather lengthy ultrasound, unless what you are doing is beneficial get the damn thing off me." I didn't. I really wish that I had. I lost my voice. I knew the sizes of the babies, A: 1lb8oz, B: 1lb2oz, and C: 1lb7oz. All great weights. The fluid was normal. The bladders were normal. Everything was stable. The doctor even said everything is stable. So then why did he feel the need to say "Hopefully Baby B can hang on." Are you frickin kidding me. What during that US, especially the part when you were just screwing around, indicated anything other than healthy babies? I knew going into this appointment to have very low expectations. But I didn't actually think he would make such an unnecessary and unwarranted comment. All the joy and excitement that I had from seeing my three girls, knowing they were healthy, and growing beautifully went out the window/ Now I just wanted him out of there as quickly as possible.
I scheduled my next appointment and asked for my usual MFM. He will be out of the office all that week. Two were, available, Mr Jerk-face and a different doctor. Initially, I was thinking to stay with Jerk-face to have some consistency. Now that I've had the drive home to think about it, I don't want to see him again. I will take another doctor or try to stretch my next visit a few extra days to see my normal MFM provider.
Needless to say, I'm going to complain.
Originally, I had an appointment scheduled for my regular MFM (maternal fetal medicine) doctor on Wednesday. It was cancelled due to weather and rescheduled for today. Unfortunately, he was out of the office and so I saw someone else. I had my reservations about seeing someone different. I very much like to maintain continuity of care as much as possible and I didn't want to deal with an alarmist doctor. I made several attempts to change the appointment. But between the craziness of our house and no one answering the phone, I went against my gut and had the appointment anyway.
After the regular US the doctor and resident entered the room. I have never been in a situation where I was not first informed that a resident was present and then asked if it was ok if they sat in on the appointment. This was not the case. They never told me the resident's name. Aside from the doctor introducing himself to me, he didn't say a word to me the next several minutes...he just made small talk with the US tech and the resident. The resident asked questions about the possibility of my individual membranes rupturing. Hello, I'm in the room. Please save these questions for later, especially if I never even brought up membrane rupture. The doc proceeded to put gel on my stomach, i don't even know why because he didn't really take the time to look at anything. He just moved the damn US thing around very unintentionally, or so it seemed. I wanted to say, "My babies already had a rather lengthy ultrasound, unless what you are doing is beneficial get the damn thing off me." I didn't. I really wish that I had. I lost my voice. I knew the sizes of the babies, A: 1lb8oz, B: 1lb2oz, and C: 1lb7oz. All great weights. The fluid was normal. The bladders were normal. Everything was stable. The doctor even said everything is stable. So then why did he feel the need to say "Hopefully Baby B can hang on." Are you frickin kidding me. What during that US, especially the part when you were just screwing around, indicated anything other than healthy babies? I knew going into this appointment to have very low expectations. But I didn't actually think he would make such an unnecessary and unwarranted comment. All the joy and excitement that I had from seeing my three girls, knowing they were healthy, and growing beautifully went out the window/ Now I just wanted him out of there as quickly as possible.
I scheduled my next appointment and asked for my usual MFM. He will be out of the office all that week. Two were, available, Mr Jerk-face and a different doctor. Initially, I was thinking to stay with Jerk-face to have some consistency. Now that I've had the drive home to think about it, I don't want to see him again. I will take another doctor or try to stretch my next visit a few extra days to see my normal MFM provider.
Needless to say, I'm going to complain.
Friday, January 10, 2014
Triplet Birth Plan: Draft
Lately I have been in a "birth plan state of mind." So while my three girls were napping I decided there was no time like the present to put my thoughts on paper. I have been hesitant to write anything down for a few reasons 1) compared to my other births 20w feels so early to do a birth plan, particularly with a provider who has "proved" himself in my previous births. 2) I don't want to appear naive or even flippant to the uniqueness of my pregnancy and my birth. 3) I have only experienced "normal," low risk births and an unnecessary cesarean. So I wasn't sure I knew what was "allowed" in a triplet birth. Then I began to think about my VBACs. I did everything I could and asked all the questions I could imagine so if it came down to my birth plan taking a major detour I could feel confident that I took care of things on my end. I knew that I wouldn't have lingering feelings of doubt. So then why should this birth be any different? Why shouldn't I be able to ask for the moon and work from there?
So I drafted this birth plan in a similar way to my singleton births. Without asking for things I can't have a dialogue with my care providers. Having a dialogue with a care provider throughout the pregnancy, especially one in which things can change from visit to visit, allows the mother and provider to establish a greater degree of trust, allows the provider to better understand the desires of the mother and the mother can understand the skill set and comfort of the provider. In this type of birth, and with most other births, I believe it is important for a mother to maintain a certain degree of flexibility. But along the way it is paramount that the dialogue remain open and honest. The provider must present the facts, not over dramatizing nor down-playing them, and always discussing how they would handle situations as they arise in the birth. It is equally important for the mother to express her concerns and wishes as the pregnancy progresses as well.
So as I said, this birth plan is a draft and will likely undergo changes based on developments with the babies and conversations with the provider. I hope to be able to provide in future posts conversations that my providers and I have had about various components of the birth plan.
Birth Plan for Hannah Birchman and Triplet Birchman Girls:
So I drafted this birth plan in a similar way to my singleton births. Without asking for things I can't have a dialogue with my care providers. Having a dialogue with a care provider throughout the pregnancy, especially one in which things can change from visit to visit, allows the mother and provider to establish a greater degree of trust, allows the provider to better understand the desires of the mother and the mother can understand the skill set and comfort of the provider. In this type of birth, and with most other births, I believe it is important for a mother to maintain a certain degree of flexibility. But along the way it is paramount that the dialogue remain open and honest. The provider must present the facts, not over dramatizing nor down-playing them, and always discussing how they would handle situations as they arise in the birth. It is equally important for the mother to express her concerns and wishes as the pregnancy progresses as well.
So as I said, this birth plan is a draft and will likely undergo changes based on developments with the babies and conversations with the provider. I hope to be able to provide in future posts conversations that my providers and I have had about various components of the birth plan.
Birth Plan for Hannah Birchman and Triplet Birchman Girls:
Due to the nature of my triplet pregnancy I am aware that
there are many variables at play. I have
informed myself of the risks and benefits of a vaginal birth, breech
extraction, and cesarean (planned and emergent). I am aware that things can change quickly. Therefore, I have prepared my birth
preferences for several different birth outcomes.
I have carefully selected my health care providers and believe they will act in the best interest of myself and my babies. However, every decision regarding my care and that of my babies should not be made without my direct consent, or that of my husband if I am physically unable to consent. It is within my rights to change my decisions at any point during the birth.
I have carefully selected my health care providers and believe they will act in the best interest of myself and my babies. However, every decision regarding my care and that of my babies should not be made without my direct consent, or that of my husband if I am physically unable to consent. It is within my rights to change my decisions at any point during the birth.
During the various stages of the birth, please limit those
attending to necessary personnel only.
Vaginal Birth:
Stage One:
*Do not ask me to asses my pain.
*Use of various comfort measures: ball, stool, toilet,
shower, and freedom to move around.
*Intermittent fetal monitoring.
*Cervical checks by the OB only or upon my request.
*No stripping of the membranes without my consent.
*No breaking my bags of water without my consent.
*Please do not offer an epidural, unless I use my code
word/phrase “Give me a c-section.”
However, due to the nature of my birth…
Please allow either my husband or doula to be present if an epidural
must be administered.
*Ability to eat and drink through the course of labor.
*No Hep-lock
*No artificial augmentation of labor.
Stage Two:
*Freedom to push in any position that will allow my pelvis
to open completely. Should an epidural
be used please help me get into the most optimal position for pushing.
*Use of an ultrasound after each baby is born to determine
their positions. Should any of the
babies present breach I am comfortable with a vaginal birth.
*If Baby B or C is presenting breach but appears to be
responding positively to contractions and is progressing please allow the baby
to be birthed with little to no interventions.
*Mother-directed pushing.
No counting.
*Use of a mirror to see the birth.
*Please allow me to grab each baby as she is birthed.
*Massage of the perenium and use of lidocaine. Please do not cut an episiotomy.
*Delayed cord clamping.
Stage Three
*Provided there are not emergent situations with the babies
I would like Immediate skin to skin until it is time to birth the next
baby. Then allow my husband to hold the
baby.
*Allow my husband the opportunity to cut the cord.
*Natural birth of the placenta. No Pitocin, unless it is apparent that it is
medically necessary.
Baby Care:
*We do not want to bathe the babies and want to keep as much
of the vernix on the babies as possible.
*We do not want the Vitamin K drops, Hep B shot, or the PKU
test.
*I plan to breastfeed and so please do not give formula or
sugar water unless direct consent has been provided.
Birth Plan for a
Cesarean:
*Please do not put any IVs in my
right (dominant arm).
*Freedom to move my arms.
*Drop the curtain and have a
mirror so I am able to view the birth.
*Please be respectful that while
this may be a routine procedure it is a major procedure for me and so please be
mindful of your conversations. I would
like to be informed of what is going on during the surgery.
*Immediate skin to skin with me or
my husband. I would like to give the
babies the opportunity to nurse as soon as possible.
*I would like either my husband or
myself to remain with the babies when at all possible.
Thursday, January 2, 2014
What does it look like to prepare for the birth of triplets?
So, what does it look like to prepare for the birth of triplets? In the mere 19w I have been pregnant I have learned that I have to be very flexible. Things change from week to week, and not just size of the baby, but potentially life threatening changes. It looks like getting in the zone for a vaginal birth one day and then having to research a pregnancy reduction the next day. It is all over the map.
The latest update on my triplet pregnancy is that each baby is in its own sac, so no Mo/Mo, and we are still within the range of normal with regard to fluids to TTTS has not been diagnosed. So, I'm just a regular high risk triplet pregnancy without added risk. What a relief. But now that I am not trying to educate myself regarding Mo/Mo or TTTS I feel like I have to do something. For whatever reason I can't just BE pregnant. The fewer the complications the greater the likelihood for a vaginal birth. And so in the past few days I have allowed myself to finally read the few triplet vaginal birth stories that are out there. They are all amazing, but I am most amazed by the VBAC moms who have had a successful triplet birth, and not just VBAC, but VBA2C.
I remind myself constantly, as does my OB and my MFM, that there are so many variables in a triplet pregnancy. It would be foolish to sign-off on a vaginal birth now at 19w because things can literally change from week to week. This does not mean my care providers are not supportive of a vaginal birth, should that be the best option and my decision. In all honesty, in this pregnancy I am setting very small goals. Goals that really I have very little control over attaining, but I set them none-the-less. Every Sunday when I make it 1 more week that is cause for celebration and thankfulness. Every ultra sound, which is now happening weekly, that indicates babies are growing, bladders are functioning, amniotic fluid is within the range of normal, my cervix is still holding up(and apparently it's beautiful and boxy and indicating no cause for concern), and my 1 placenta for all 3 hasn't crapped out that is cause for celebration and thankfulness. Beyond weekly goals, my next major milestone is 24w, viability week. Ok, so those are my goals about them living one week longer.
Then other factors that I'm at increased risk for due to the multiple gestation is pre-eclampsia and gestational diabetes. At my 24w visit we will test for GD. This is earlier than if I were your average woman pregnant with a singleton. And in the past, I have declined the test and I have that choice again and the "ok" from my OB should that be the route I choose. But I don't need to have additional stress on my placenta and if there are things I can do dietary wise that I'm not already doing, sign me up.
So I suppose there are other things occupying my mind even after TTTS and Mo/Mo were not associated with this pregnancy. But thinking about all those things I listed above aren't much fun. Reading stories of vaginal triplet births and connecting with moms who have accomplished this feat or who are hoping for one is fun, encouraging, and gives me hope. But I am not naive. This pregnancy and birth is not just about thinking positive thoughts, saying affirmations, picturing my cervix opening, and hiring just the right people to attend my birth. And quite frankly that view extremely minimizes every other issue, hardship, and concern. It is about making it one more week. It's about reducing the number of days each baby will be in the NICU. It's also about figuring out how to care for my 3 children I already have at home and caring for the new little babies joining our family. It is not about how strong or determine I am. Thankfully, I have already had 2 successful VBACs so I don't doubt my body. I know that it will do what it needs to if and when it needs to. I also believe the outcome has been determined by God, I just need the wisdom and discernment to follow the plan He has set and be at peace with it.
I can't just show up and expect to have a vaginal birth with triplets. So I need to put some time and effort into finding what little data and information there is. Uterine rupture, even with two successful VBACs, is still a possibility simply because of the extra babies. But there isn't a lot of statistical data on rupture, vbac, and triplets...go figure. Each triplet pregnancy is so different, it's hard to find consistent protocols among OBs because of the great variability, so you can imagine there isn't a lot of information on the hows/whys/etc for a vaginal triplet birth. So I am doing my homework and making friends with like-minded moms who have as much similarity to my pregnancy as is possible given my birth history and current pregnancy "profile." As much as I am doing my homework on vaginal, I am also watching videos and reading about cesareans, specifically family centered ones. Like I already said, I am not naive. I know things can change on a dime. I've said it before, I am so thankful that I am under the care of two health care providers who respect and practice evidence based birth, respect the almost delicate nature of the pregnancy, want what is best for me even if it may not be what they would choose, and ultimately leave the decisions up to me. God has blessed me in so many ways in this pregnancy.
The latest update on my triplet pregnancy is that each baby is in its own sac, so no Mo/Mo, and we are still within the range of normal with regard to fluids to TTTS has not been diagnosed. So, I'm just a regular high risk triplet pregnancy without added risk. What a relief. But now that I am not trying to educate myself regarding Mo/Mo or TTTS I feel like I have to do something. For whatever reason I can't just BE pregnant. The fewer the complications the greater the likelihood for a vaginal birth. And so in the past few days I have allowed myself to finally read the few triplet vaginal birth stories that are out there. They are all amazing, but I am most amazed by the VBAC moms who have had a successful triplet birth, and not just VBAC, but VBA2C.
I remind myself constantly, as does my OB and my MFM, that there are so many variables in a triplet pregnancy. It would be foolish to sign-off on a vaginal birth now at 19w because things can literally change from week to week. This does not mean my care providers are not supportive of a vaginal birth, should that be the best option and my decision. In all honesty, in this pregnancy I am setting very small goals. Goals that really I have very little control over attaining, but I set them none-the-less. Every Sunday when I make it 1 more week that is cause for celebration and thankfulness. Every ultra sound, which is now happening weekly, that indicates babies are growing, bladders are functioning, amniotic fluid is within the range of normal, my cervix is still holding up(and apparently it's beautiful and boxy and indicating no cause for concern), and my 1 placenta for all 3 hasn't crapped out that is cause for celebration and thankfulness. Beyond weekly goals, my next major milestone is 24w, viability week. Ok, so those are my goals about them living one week longer.
Then other factors that I'm at increased risk for due to the multiple gestation is pre-eclampsia and gestational diabetes. At my 24w visit we will test for GD. This is earlier than if I were your average woman pregnant with a singleton. And in the past, I have declined the test and I have that choice again and the "ok" from my OB should that be the route I choose. But I don't need to have additional stress on my placenta and if there are things I can do dietary wise that I'm not already doing, sign me up.
So I suppose there are other things occupying my mind even after TTTS and Mo/Mo were not associated with this pregnancy. But thinking about all those things I listed above aren't much fun. Reading stories of vaginal triplet births and connecting with moms who have accomplished this feat or who are hoping for one is fun, encouraging, and gives me hope. But I am not naive. This pregnancy and birth is not just about thinking positive thoughts, saying affirmations, picturing my cervix opening, and hiring just the right people to attend my birth. And quite frankly that view extremely minimizes every other issue, hardship, and concern. It is about making it one more week. It's about reducing the number of days each baby will be in the NICU. It's also about figuring out how to care for my 3 children I already have at home and caring for the new little babies joining our family. It is not about how strong or determine I am. Thankfully, I have already had 2 successful VBACs so I don't doubt my body. I know that it will do what it needs to if and when it needs to. I also believe the outcome has been determined by God, I just need the wisdom and discernment to follow the plan He has set and be at peace with it.
I can't just show up and expect to have a vaginal birth with triplets. So I need to put some time and effort into finding what little data and information there is. Uterine rupture, even with two successful VBACs, is still a possibility simply because of the extra babies. But there isn't a lot of statistical data on rupture, vbac, and triplets...go figure. Each triplet pregnancy is so different, it's hard to find consistent protocols among OBs because of the great variability, so you can imagine there isn't a lot of information on the hows/whys/etc for a vaginal triplet birth. So I am doing my homework and making friends with like-minded moms who have as much similarity to my pregnancy as is possible given my birth history and current pregnancy "profile." As much as I am doing my homework on vaginal, I am also watching videos and reading about cesareans, specifically family centered ones. Like I already said, I am not naive. I know things can change on a dime. I've said it before, I am so thankful that I am under the care of two health care providers who respect and practice evidence based birth, respect the almost delicate nature of the pregnancy, want what is best for me even if it may not be what they would choose, and ultimately leave the decisions up to me. God has blessed me in so many ways in this pregnancy.
Subscribe to:
Posts (Atom)