Sunday, August 24, 2014

Seeing God as Creative

Have you ever thought of or described God as being creative?  Tonight, following a leadership meeting at my church, The Baton Rouge Vineyard, a handful of people prayed over me regarding my family.  During that time of prayer the word "creative" came to mind.  Then later in the evening I resurfaced in a prayer group on facebook and posted a lengthy, stream of conscious, prayer request.  Again, the word creative came to mind.  In my daily life creative is not the word I commonly associate with God.

Recently, Taylor, the girls, and I went to the Zoo.  Whenever we go to the Zoo I think "man, God is creative."  I mean, have you seen a giraffe or a peacock lately?  Does that not scream creativity?


so then I began thinking, if God can be creative with animals then He can most definitely be creative in my family's stage of life.  So I prayed, God be creative.  

Here's the trick, I can pray and ask for God to be creative but I have to be willing to let go, stop trying to orchestrate, stop trying to figure out all the different scenarios, stop trying to please anyone who is not my family, drop any fear and anxiety.  I need to hear Him and listen.  I need to obey and follow.  I need to trust.  And I know if I were God I'd be thinking, "Hannah, are you kidding me?  You KNOW I can be trusted."  But you know what, He doesn't.  He just does what He does best: takes care of my every need and then some.

There is a sink full of dishes waiting for me.  If you haven't thought of God as creative then take a break and look out your car window, bedroom window, go to the Zoo, take a walk, visit a park.  Even a roly poly is pretty darn creative.  

Friday, August 22, 2014

Breast Feeding Triplets- My Journey So Far (4mos)

If I have learned one thing so far in my 4 month journey of breastfeeding triplets it's that flexibility is KEY!


  • Before they were born I was developing schemes for how to sneak donor milk into the NICU and I was trying to decide if I should risk pumping with three babies in utero.  I waited to pump until the night before my section and I went into labor about 30 minutes later.  Glad I waited, LOL!
  • Despite countless requests that I have a breast pump immediately following my cesarean, one was not brought to me until almost 10 hours post birth.  That's pathetic!  And that's counter productive to a mom wanting to establish her supply.  Still in and out of a sleep coma (stadol knocked my socks off) I managed to hook myself up to the pump, turned as fast and as strong as I could take it and I began to pump.  Twenty five minutes and I produced maybe 2ml TOTAL and about half of that was blood.  Yet I took it with me to the NICU.  I still thought about how I would bring milk in from home but it was stressing me out.  I decided I would pump as often and as long as I could and in the meantime the girls would get formula with a few drops of my breastmilk.  This was not a time to have any kind of dilemma or guilt trip about what I was feeding them.  My babies were feeders and growers, they just needed to learn to eat and then we could go home.  If giving them formula did that the quickest, I was on board.  





  • The girls were born on a Monday night.  By Thursday night my milk came in.  I brought in about 12oz of milk and the neonatologist made a comment that the milk truck had arrived.  By day 5 my girls were 100% on my milk, plus a little bit of fortification.  Success.
  • The coming weeks I practiced putting them to the breast.  I used the nipple shield because that's how they latched best.  And then I worried that the nipple shield would somehow sabotage things.  An informative and kind LLL told me there is no "setting myself up for failure" when nursing preemie triplets.  I just do what I need to do.  I was told it could take weeks, even months and that was ok.
  • Lactation came to my house to work on latch.  I developed a plan to try to nurse the same baby all the time until she became really good.  Then move onto the other two babies.  This lasted for about a week or two.  Betsy fought it.  Even after nursing for 30-40 minutes they were unsatisfied.  
  • Then PPD hit.  I didn't want to pump.  I didn't want to nurse.  I didn't want to do formula.  Not ideal for needing to feed three babies.  My "compromise" was that I refused to nurse.  I couldn't bring myself to do it.  It was a chore just to pump, they were "horrible" at nursing, but it's what I did.  That decision worried my OB a bit.  I got on meds, talked through some things with my husband and my OB, as well as some supportive friends, and started thinking about nursing again.
  • I started to see pumping as my refuge.  I could steal away, if I wasn't home alone, for 15-20 minutes and pump.  It was about this time that I started pumping for 25-30 minutes mainly so I could be alone that much longer.  Pumping started growing on me.  
  • Once I started to embrace pumping I realized I needed to get a better system in place in my house.  If I wanted to pump more often and help my supply I would need a second pump.  Lucky for me insurance covers the purchase of two electric pumps and the rental of a hospital grade.  Score!  So I bought the Freemie pump just for the parts that I can wear under my clothes.  
  • Just a few weeks ago someone suggested I look into whether the girls have tongue or lip tie.  They did, infact, have tie.  So two weeks ago we began Occupational Therapy for myofacial release.  It was during one of those appointments that I decided I would try nursing again. 
  • Last week I met with lactation again.  We both agreed that Abby and Betsy have a negative assocation with my breasts, not even with nursing, my breasts, ESPECIALLY Betsy. (no ""shoulda, coulda, woulda" comments allowed) She recommended I set a goal to where the girls can lay at my exposed breast, with no intent to nurse, and not cry.  It's a little sad when I sit and let myself think about it.  But I'm just trying to chalk it up to, "that's life with triplets."  Once they can do that then maybe I will play around with dripping breastmilk on my breasts so the babies realize they can get milk there and then maybe move toward nursing.  I told her that I Think I am ok with 2 out of the 3 nursing and the other getting bottles.
     
  • Yesterday I started putting Bonnie back to breast more often.  She is my "best" nursing baby, as in she only screams a little before she latches.  But she latches and she can get a full feed.  Today she was only eaten at the breast, except for the 9AM feeding because I got to sleep in.  This is HUGE!  I realized that if I want just one baby to nurse better and more often I need to see the baby as an individual and not part of triplet package deal.  If I had just one baby that was hungry and dinner needed to be made in the Ergo she would go to nurse and off to the kitchen I would go.  If I needed to go to the store and it might intersect with a feed then she would come with me.  So this afternoon I took Bonnie and the big girls to the store.  She got fussy, as I knew she would so I nursed her while we were shopping.  It's not anything new to me, so it's not that difficult.  The downside to this method is I skipped two pumping sessions because Bonnie was nursing.  On the flip side the milk I pumped earlier in the day lasted a little longer because one less mouth  was being fed.  And if I found myself in a situation where I needed milk, thank the Lord for donor milk.  


It's all about being flexible and taking care of myself.  Right now what I have the energy and peace to do is nurse my little Bonnie whenever she wants.  If it takes either of the other two girls 3 more months to be able to latch that's OK.  My goal from the beginning was breastmilk.  It didn't necessarily have to be mine and didn't have to come straight from the tap.

Wednesday, August 20, 2014

I don't know what I don't know, so next time I will be (TRY) more thoughtful

“If I can do it then you can do it” and “If that had been me I would have _____”  These are two phrases we hear pretty often.  You have probably heard me say them too.  It’s only been in the last few weeks that those phrases have not been sitting well with me.  I do believe that the many times I see friends or strangers using these phrases it is coming from a good place.  But I think it is important to think how these phrases might be received.  We don’t have to stop using them but maybe we can be more thoughtful about when we use them.  Let me give you a few examples so you can see my heart behind it all.

I hear a lot from friends and strangers “If Hannah can (breast feed three babies) then I (or you) should be able to do it with my one child.”  (And really you can substitute any example into the phrase).  When a statement like that is said we don’t consider the individual mother or the child.  Does the child have tie?  Does the mom have overactive let down?  Does the mom have IGT?  Does the baby have severe reflux?  Perhaps the mom has PPD and is so paralyzed by it that she can’t even bring herself to hold her own baby.  How does using one mom’s success (or failure for that matter) help someone else?  It can make a mom feel small.  It can make a mom feel like she is a failure.  It can even cause resentment between mom and child.  I know this because I have felt small, felt like a failure, and have had resentment show its face between myself and my babies.  I know this because this phrase in one form or another has been said to me.  I know this because friends have told me that this phrase makes them feel this way. 


Another version of this phrase that I hear often is “I don’t need help to watch my kids.  I do it all by myself.  I even cook, clean, and go to the park.”  I KNOW 95% of the time that this is said it is to help a mom who is nervous about what life with a new baby will bring. It is meant to be encouraging.  But what about the mom who can’t.  What about the mom dreading going to bed knowing she will have to do the SAME thing over again the next?  What about the mom who finds herself screaming more than she is laughing with her kids? What about the mom whose husband has worked 13 straight days with 1 day off for as long as they have had kids?  What about the mom who doesn’t have family to help?  (For the record if your mom or sister comes to help and you don’t pay that’s the same thing as someone who doesn’t have that luxuary and has to pay for help.)  To the moms who can do it, wonderful!  To the moms who need help, wonderful!  If you need help with one child, wonderful!  If you can do it alone with 8, wonderful! 




Now for the other phrase, “If that had been me then I would have.”  I call this “coulda, shoulda, woulda” or “it’s easy to know what we would do when we aren’t in the situation and we have already seen how it played out” phrase.  Recently I shared about a mom who refused a cesarean, the doctors knocked her out and cut her hip to hip and even managed to give the baby a 2 inch cut on her face in the process.   One person commented something like, “My husband would have not let that happen.  He would have been tearing the room apart.”  I cannot speak to this mom’s horrible situation. But I can speak to my own experiences to know it is NOT that simple.  The two times I have had cesareans my husband had to wait in another room while I was being prepped.  A LOT can happen in those few moments.  When I went under the knife the first time and when my healthy babies were whisked away after my recent cesarean it was not because my husband (or myself)let them , we did NOT let the doctor cut me, he did NOT let them take the babies away.  My husband felt paralyzed.  My husband believed everyone was acting in the best interest of me and my babies.  And what would my husband have accomplished by yelling, screaming, kicking over tables while his wife is cut open?  Making statements like this is insulting and hurtful to the mother but also to the father.   When I see comments like this I want to say, “the next time (or the first time) your husband is left in the hall while you are laying naked on an OR table go ahead and make blanket statements about other people’s husbands.”  Or “the next time your husband, who is only used to healthy babies that immediately go to your chest, sits watching as your baby is taken from your abdomen, while you HIS WIFE is still naked and paralyzed on a table, and the baby is whisked away into another room.”  Does he leave his naked and paralyzed wife?  Does he go to his baby who was whisked away not knowing if the baby is OK and believing the army of people caring for the baby will act in its best interest?  It is so easy to say what we would do when we aren’t the ones in a situation.  It’s easy to say what we would do until we are laying naked and paralyzed and feeling completely vulnerable, when we can’t tell if we can trust anyone.  The men and women in situations like this are not weaker than you, they don’t care less than you do for themselves, each other, or their child.




We have all seen and heard these statements and we have likely all said them ourselves.  As I said before, I’ve used them from time to time.  I’m not saying we shouldn’t use them.  I’m not saying people aren’t well intentioned.  What I am saying is perhaps next time we find ourselves about to type or say something like this is for a brief moment think about who is on the receiving end.  Will it uplift her?  Will it change the past?  Could is push a mom who is already depressed into deeper depression?  Could it make her feel less than?  Of course, we cannot possibly know how people will respond to our words and it is unrealistic to police our every word.  But we can pause before we speak.  We can look at situation and consider whether a mother is allowing herself to be vulnerable and then be a little more delicate with our words.

 Believe me, I can name countless situations after a mom has shared something hard with me and in an effort to show my support I said “I’d be so pissed.  I would have kicked him.”  It happens.  And sometimes my girlfriends appreciate it.  But sometimes they don’t.  Sometimes I have to watch my words.  And sometimes if a friend gets mad or offended by my well intentioned words I just have to take it because I don’t know.

I hope you could follow my line of thinking because as I was writing this I was tending to my children and eating lunch.  My heart is not that we police our words.  My heart is that we acknowledge that we just don’t know.


And sometimes you leave your 4 month old to cry because your 19 month old took off a poop filled diaper in her bed, smeared it all over and even managed to eat some.   Just Sayin.

Tuesday, June 24, 2014

I couldn't do it

"I couldn't do it"
"You're made for it"
"I would go crazy"

I have heard and seen these things said/written about and to me since we discovered we were expecting the triplets.  In the last week or so I sort of had an "ahha" moment.  Never in my wildest dreams did I think raising triplets was something I was made for or something I could do or even wanted to do.  I have seen friends with twins and the first thing that always ran through my mind was "I couldn't" and "I don't want to." I never in my wildest dreams wanted multiples.  And yet, here I find myself with the eldest of my trio laying next to me, another sleeping at the foot of my bed, and the third grunting in the crib.

I am no more special, equipped, or strong than any other mother out there.

After I had Josie, my 3rd baby, I thought she would break me.  I remember sending my parents off to the airport and I just cried in my mom's embrace.  She said, "You will just develop grit.  You won't have a choice, you will just do what needs to be done."  It's almost like those words were spoken to prepare me for the unthinkable, triplets.

Monday afternoon I had an appointment with my OB.  I have been struggling with PPD and we spent quite a bit of time exploring all the different things on my mind, my struggles, my resentments, my hardships, etc.  He said, "You are so strong.  I couldn't do it."  I replied, "But you would and you could.  If you found yourself in my shoes you would just do it.  If anyone has any shred of compassion for human kind you would care for all these kids and babies."

For whatever reason God chose my husband and I.  It is not because we can do it, because we are strong, because we are laid back, because we don't care if our house gets dirty, and all the other reasons people have said why we are in this position.  He did not choose us because we are equipped to handle something like this.  I don't think God ever picked anyone who was equipped.  Rather He equipped those He called.  People have also said, "God never gives you more than you can handle."  That's a total lie.  If I could handle it then I wouldn't lose my shit on a daily basis.  If I could handle it I wouldn't lay on my bed totally defeated just listening to the cries of my three babies.  If I could handle it I would brush my teeth more than 2 or 3 times in a WEEK.  Yes, I said in a week.  Honestly, I think if I could handle it we would not have been given triplets.  I think God never gives us more than He can supply us with strength, patience, love, and so on.  Does that make sense?

I'm by no means super or amazing, or no more so than any other mom out there.  Most days I am just barely making it.  I am not doing anything that any of you wouldn't do if the same situation presented itself in your life.  Before we ever got pregnant with triplets I couldn't do it.  Many days I find myself not wanting to do it.  And yet, here I am doing it, some days better than others.  Some days are full of tears.  Some days I don't want to hold another darn baby.  Some days I want to stay at a hotel and not return...for a really long time.  Some days with exhausted and sad tears in my eyes I say "shit! we have 3 babies."  Some days while laughing and in amazement I say, "holy crap, we have 3 babies."  Some days I can't stop taking pictures of them because it is all so unbelieveable.  Some days I just want to cuddle them.  Whatever kind of day it is I do it.  Right now I feel like I do it because I have to and I would feel bad leaving them with someone else to care for them, it's a lot to handle.  Whatever the day I love them immensely and thank God for them.

Don't sell yourself short.  You are amazing.  You are strong.  You may not want to do it but you could and you would.

Sunday, May 4, 2014

My Triplet Birth Story

It is hard to imagine writing the birth story of my three little girls without starting at the beginning, not the beginning of labor, but where it all began at 8w5d.  Pretty much all of my journey has been documented, so I won’t go into too much detail.  But I think I will highlight a few events and milestones, as they all played a part in my decision for their birth.

Be sure to use the bathroom and grab something to drink and eat before reading.

Milestone 1: 8w4d
I knew I was pregnant around 4w.  Taylor and I have this track record of beginning to discuss the timing of another baby only to discover we were already pregnant. 

This pregnancy was no different.  We were pretty sure that bay #4 was “IT” for us. When we first go married I wanted 4, he wanted 3.  After Josie I wanted 3 and he wanted 4.  Given the fact that we were discussing timing it was obvious that we both wanted 4.  It wasn’t long after finding out the news that I contacted my midwife and told her we would be needing her assistance for a second HBAC in late May.  I was in a group on facebook for HBAC moms and was so eager to share another homebirth story and this time have beautiful photos of another peaceful birth. 
The afternoon of 8w4d I began to bleeding out of the blue.  After changing my panty liner for the second or third time I decided I should probably call my midwife.  She spoke so calmly to me and said it probably wasn’t anything but just in case to get in bed and just rest.  She suggested trying to get in and see my OB the next day (Friday) just to have peace of mind before the weekend.  As stone faced as I could I told Taylor I needed to be in bed and would try to make an appointment in the morning.  Once in bed, by myself, the tears began to flow.  Was I losing the baby?  I prayed.  I prayed a lot.  I even prayed, “Lord, if losing this baby is your will.”  I completely lost it when I uttered those words.  I could not fathom how the loss of a baby could be God’s will.  Once I prayed it I was able to sleep.  All night, however, with every little bodily function I thought this is it, this is my body’s way of passing the baby.
8w4d was the first of many times I tearfully and fearfully prayed for God’s will. 

Milestone 2: 8w5d
With Evelyn and Lucy as my ultrasound buddies the tech announced I was having twins.  A few seconds later she corrected herself when she declared there were three babies alive and growing in me.  My reaction was a mix of awkward laughter and tears.  She asked if I was ok.  My first reaction was “I was supposed to have this baby at home.”  Immediately I became terrified that these babies would have to be born via cesarean.  Clearly, I had not yet grasped the enormity of the road ahead. 
Tearfully, with Evelyn and Lucy by my side, I waited in the US waiting room for the images to take to my OB.  I called Taylor whose first words out of his mouth were, “I’m sorry, babe.”  He thought we had lost the baby.  So you can imagine he too was shocked when I said we were expecting triplets.  He thought I was lying and was laughing, I too had an awkward laugh.  But when my laughter turned to tears he knew what I was saying was the truth. 
In my OB’s waiting room the first thing I did was post in the VBAC facts and Improving Birth group asking if it was possible to birth triplets vaginally.  I think in the time I waited to see my OB I had already read 1 or 2 articles about triplet vaginal births and had been added to a Birthing Multiples Naturally group.  I felt that not all hope was lost on a vaginal birth.
Most of my impromptu appointment with my OB and the med student was a blur.  He mentioned something about TTTS (twin to twin transfusion), that was just mumbo-jumbo to me.  The only thing on my mind was how the babies would be born.  I couldn’t imagine recovering from a cesarean with 6 children under 4.

Milestone 3: Monoamniotic/Monochorionic (MO/MO)
Several days after my initial appointment and ultrasound a fellow multiples mom messaged me on facebook.  She said it looked like two of my triplets were sharing the same sac.  She informed me that with Mo/Mo babies that even the most naturally minded doctors birthed these babies via cesarean because of extremely high risks.  Another triplet mom who had a pair of Mo/Mo twins friended me on facebook and shared a wealth of knowledge with me.  She prepared me for the reduction conversation.  She added me to two Mo/Mo support groups.  I shared what I was learning with Taylor but I am not sure much registered with him at the time.  I think he was still processing three babies.  Nothing was definitive yet.  I cried a lot in secret.  I couldn’t imagine the possibility of reducing the pregnancy.
The short journey of figuring out if babies A and B were Mo/Mo  was stressful and a roller coaster.  For a few weeks we thought for sure they were not Mo/Mo and then another US indicated that maybe they were.  I wanted the genders to be a surprise.  But at a 14w with two US techs I was OK with finding out their genders to know if we could rule out Mo/Mo.  If they were opposite genders we would know for sure they were not Mo/Mo. It was too hard to tell their gender, back to anxiously waiting.  It was not until my first appointment with MFM and a nearly 2 hour US that we ruled out Mo/Mo.
Milestone 4: TTTS
We went to my first Maternal Fetal Medicine appointment at 17w3d.  It was a long US with the tech, maybe an hour or two and then the MFM joined us and he continued the US to check things for himself.  We definitively ruled out that we had a pair of Mo/Mo twins.  We discovered that we had a set of identical triplets and not a set of twins and singletons.  We discovered also that there was already a discrepancy in fluid levels between babies A and B, a primary indicator for TTTS.  Discovering TTTS this early in the pregnancy had a worse prognosis than a discovery in the late 2nd/early 3rd trimester.  This US was the Friday before Christmas and just a day or two before my parents were flying into town.
 The doctor wanted to see us back in 10 days to check the fluid levels, at which point Taylor asked how quickly things could develop.  The doctor said things could go south in a day, in a week, or in 3 weeks.  There was no way to really know.  I am not sure if  the doctor sensed our fear, primarily Taylor’s as I was already knowledgeable about TTTS and also in denial that this could be our reality, or if the doctor was also concerned because he grabbed my notebook and wrote down his cell number.  He instructed me to call him Sunday to schedule an off-the books, after hours, Christmas Eve ultrasound.  You cannot imagine how this comforted me. 
He called his parents and sister in Houston and I called my parents and let them know that it was very likely that we would be making an emergency trip to Houston to have a procedure done to address the TTTS.  Upon posting on my triplet page that we had a possible TTTS diagnosis I was almost immediately added to a TTTS support group.  Taylor and I had arguments about providers in Texas, types of procedures, and whether or not family was too involved. 
Sunday in church, sitting with my parents, I was quite teary-eyed.  The pastor had me explain our situation to the congregation so they could pray.  If the US indicated that the fluid levels had worsened we would be heading to Houston immediately.  It was the first time I put words to my greatest fear, we could lose one or all three of the babies during the procedure.
Our Christmas Eve ultrasound indicated fluid levels had stayed the same and both of their bladders were emptying and filling up, both good signs.  We had another ultrasound 4 days later which showed the same thing as the previous ultrasounds.  We could breath again.  We continued to monitor for TTTS throughout the pregnancy, but as things remained stable from week to week we knew the girls did not have TTTS.
Milestone 5:  Viability & 28w
At 24 weeks, viability, I hit a wall.  I didn’t think I had it in me physically and especially mentally to carry all three babies to at least 32 weeks, let alone one more week.  My baby shower happened around the time I hit viability and that gave me  a surge of mental strength to make it to my next major goal of 28w. 
At a prenatal visit around 25w I told my OB that just a week prior I was ready to just have him cut me open and take the babies out.  Carrying triplets is no walk in the park. 
32 weeks is the average gestation at which triplets are born.  So when I reached 28 weeks I had this whole new view of my pregnancy and a surge of energy.  I felt like there was an end in sight and that end, if I only made it to 32w, would still result in healthy, viable, and decently sized babies.  At 28 weeks is when I allowed myself to really start thinking about vaginal birth as a viable option.  I allowed myself to read birth stories and begin drafting my birth plan.  I needed to make it to 32 weeks gestationally for each baby, for both of my providers to feel comfortable with a vaginal birth.

Milestone 6: 32 weeks
  When I checked into my 32w appointment with MFM the receptionist said to me, “Hannah, I think this is going to be your last appointment.  I think those babies are going to come any day.”

Taylor and my good friend/doula/midwife came to the appointment with me.  We had our routine ultrasound and then the MFM told us we would meet across the hall so we could  ask questions and discuss things.  I thought this was odd because all of our discussions always took place in the US room.  I figured this would be our big talk about scheduling an induction, this was the one way I could ensure both providers were at the birth and increase my chances of a vaginal birth.   I had made it to 32 weeks, I could now birth these babies vaginally.  It was at this appointment that we realized baby B’s growth was slowing down, it had dropped about 15% in the last week and she did not score in a range on the BPP that made the MFM comfortable.  It was at this appointment that he reminded us that baby B likely had a smaller portion of the placenta and that they were may be concern with restricted blood flow once A’s cord was cut.  In his opinion a vaginal birth was off the table, although he reminded me that it was still ultimately my decision.  After this appointment I went up to Labor and Delivery to receive my first round of steroid shots and one of many NSTs (non stress tests).  We were possibly looking at having these babies two days later on Sunday.

My NST came back great.  My MFM made the recommendation that I come in twice a week for NSTs.  If I made it to 34 weeks I would see him again for another BPP.  I think he was pretty sure he would not see me again.  I spent the next two weeks researching monochorionic complications, births, etc.  Friends told me to take a break from the research and just be in the moment in the last few days/weeks of my pregnancy.  I couldn’t.  I needed to know that when my babies were born, whether vaginally or cesarean, I made my decision with as much knowledge as I could so that I could look back on the experience with as few “what if’s” as possible.  A realization I had early on in my pregnancy was that I wanted my girls born in as peaceful a setting as possible, whether that was vaginal or cesarean.  I also decided around 33 weeks that I did not want my babies born out of fear.  At my 33 week appointment with my OB  apologized for the way Evelyn's birth went.  He believed I was cut unnecessarily by my previous OB and thought that experience and the doubt that it put in me really was affecting me in this pregnancy.  Until I hit 34 weeks the scenario that brought me the most peace, even though it had the most variables, was a vaginal birth. 

The plan I made with my OB at 33 weeks was that we would schedule an induction on April 21.  If I went into labor before that and baby B was not yet measuring 32w gestationally I was ok with a cesarean.   We also decided that at my 34w appointment with MFM that my OB would also attend so we could have a meeting of the minds and make informed decisions from there.

Milestone 7:  34 weeks
When I showed up to MFM for my 34w appointment everyone was surprised. 
My blood pressure, which had been slowly rising throughout my pregnancy but still never got higher than 130/74, was elevated.  The nurse asked if I was ok, if I had any headaches, was seeing spots, etc.  I figured it was white coat induced high blood pressure.  I was not worried.  I went on to have my US, all the babies had gained weight, including baby B.  The tech asked if I had a headache or was seeing spots.  When she finished the MFM came in shortly after and asked if I was feeling ok, checked my complexion, etc.  He didn’t say much during the appointment but told us that we would go into a consult room and chat.  My BP was high and so he ordered a HELPP panel, I went for another NST and his recommendation initially was have the babies as soon as possible via cesarean.  My OB was supposed to join us at the appointment that morning, but after 24 hours of being on-call with a lot of births he didn’t go to work that day but instead went home to rest.  He agreed to come to the hospital later in the afternoon and meet up with Taylor, myself, and MFM to discuss our next course of action.  In the meantime Taylor went home to relieve the baby sitter, I set up childcare for the next 24 hours, I called my mom, and he called his folks as they were all planning to come within the week anyway. 
We all gathered around 3:30 PM and my results from the HELLP panel had already come back.  My platelets and blood count were low, there was trace protein in my urine, and my BP was still elevated but not dangerously so.  My platelets and blood count were dangerously low but they would not rise within the next week (35w).  With having a distended uterus there was concern that it may not contract back, that there may be a lot of blood loss and trouble with my blood clotting.  They both felt that I wouldn’t necessarily gain all that much in terms of the babies health by staying pregnant one more week.  I already knew from my consult with the head of neonatology that my girls would likely just be feeders and growers at this point anyway.  So with Taylor supporting me with whatever decision, I made the choice to schedule a cesarean the next morning.  Nothing in my pregnancy yet indicated the babies had to come NOW.  And as I mentioned, I wanted my babies born as peacefully as possible.  Making the decision to have them the next day, at 34w3, would allow me to birth them in a non-emergent situation.  We asked to go home and neither of the doctors had an concern with that.  We were to report back by 4AM for my scheduled 7AM cesarean.

The Birth
I got home Monday evening around 5PM.  I wanted to spend time with the girls one last time before the triplets arrived.  I also had a laundry list of things I still wanted to get done: Abby’s afghan needed to get finished, I wanted to send off Sunday school curriculum, finish packing my bags, and start pumping milk.  I spent all pregnancy looking at my breast pump sitting in the corner of my living room.  The one night I needed it it was no where to be found.  I tried hand expressing for about 20 minutes and produced about 2ml of milk.  I decided to just let that go.  I also decided that I would just finish the afghan another time.  I sat on the floor in the girls room as Taylor made them a fort and read them a story.  (Note to self: don’t build forts at night.)  It took forever for them to fall asleep.  Around 9PM or so Taylor told me I should head to bed soon, as it would be an early morning.  I putzed around on the computer and watched TV for another hour or so.

 At 10PM I joined Taylor in bed, still with a cough I had been dealing with for over 3 or 4 weeks.  It always got worse whenever I laid my head down.  It was no different that night.  I had 3 hard coughs and then felt a gush at which point I said, “Ohhhhhh shit.”  Taylor had a feeling what that meant and I confirmed it when I told him I was pretty sure my water just broke.  We turned on the lights, saw that the fluid was clear, and began making our way to the hospital.  Immediately I got butterflies in my stomach.  I knew with such small babies and how quickly each of my previous labors shortened in length that these girls could come quickly.  I was pretty frightened that they would come before we got to the hospital and then I had an unrealistic fear that Baby A’s cord would prolapse, even though she was not in position for this to happen.  Before I even got out of bed I called my OB on his cell phone. He didn’t answer!  I left a text: “My water just broke, we are going to the hospital.”  Next I called my doula and she told me she would meet us there.  Taylor brought me a pair of depends before I got out of bed.  We both prayed the whole way to the hospital.  I called my OB again in the car and there was still no response.  A few minutes later I received a text from him, he was on his way and they were expecting me at the hospital.

Taylor dropped me off at the Assessment center.  With a trembling voice I told the security guard, “I am pregnant with triplets and my water just broke.”  To which he replied, “ok, I’m going to need you to fill out this paper.”  I could not believe it, I filled it out and then said again in a more stern voice, because maybe he didn’t understand, “I have three babies in my belly and my water broke.”  He replied, “have a seat and we will get someone with you in a minute.”  I walked over to the little waiting area outside the triage room for a nurse and saw no one.  At this point Taylor showed up and I explained what just happened, the look on his face when he realized no one had yet attended to my care was priceless.  He let himself back into assessment and hunted down a nurse.  Not long after a nurse brought me into triage and seemed a bit casual as she was taking my information.  She seemed surprised when I said I just spoke with my OB he said you guys were expecting me.  They did not act as though they were expecting me. She was getting ready to put me in an assessment room, a room that was not equipped to monitor triplets.  I thought this was bizarre.  Another nurse came in the room and said that they were expecting me upstairs in Labor and Delivery.  At this point they allowed Taylor to join me and we were wheeled upstairs.

20 minutes had passed since my water broke and contractions had started and were strong.  I took my very last belly picture.  A few minutes later my doula showed up.  It didn’t take long for her to realize I was in active labor.  The nurses were running around rather frantically.  Apparently there were three other babies in addition to mine that would be admitted to the NICU that night and so the births needed to be spaced out so make sure there was enough NICU staff.  And my understanding was I was not first in line for an OR.  About 25 minutes after my water broke my contractions were 90 seconds long and 2 minutes apart.  I was laboring on the side of the bed and wanted both Taylor and my doula present, but I didn’t want to be touched.  I heard the nurse say they would give my doctor a 30 minute heads up before he needed to leave his house for the hospital.  30 minute heads up!?  All I could think was, “oh my God there is not going to be a doctor present when I push this first baby out.  I had already made up my mind that I would get an epidural and have a cesarean.  I was mentally prepared for that type of birth.  I was most definitely not prepared any longer for a vaginal birth of triplets, especially without my OB.  I told my doula I was so scared.  She reassured me that everything was ok and there was no need to birth these babies in fear.  About 28 minutes after ROM I agreed to get into bed to monitor the babies and my contractions.  Surprisingly the contractions were not as bad as I thought sitting reclined in the bed.  Once I got into bed I started feeling pressure.  The nurses asked me if I wanted to be checked, they knew my birth plan said no cervical checks.  I told them I wanted it.  I was 6cm.  I was feeling pressure.  With every contraction I clenched my cervix, the opposite of what you should do when birthing a baby.  It was at this point that my doula called my OB and said I was about to have the first baby, he was already on his way, speeding in the rain.  All the while the nurses were watching the machines, running in and out of the room, but not watching me and my pattern of labor.  The nurse, realizing my doula was on the phone with my OB, asked to speak with him and let him know everything was ready on their end.  A few minutes later I was wheeled into the OR and my OB was anxiously awaiting my arrival.  In the end, both he and I were waiting for the nurses to take me back to the OR.

 All the while I was still terrified of giving birth and then I had an epiphany sitting on the OR table that I had given birth to two babies vaginally and we all survived and it was then that I realized if Baby A decided to born right then she and I would live and I all of a sudden felt a wave of peace come over me and I finally let my cervix relax.   My fear was gone but I was still not in a place mentally where I could birth all three babies vaginally.  A minute or two later I got my epidural.  That shit hurt and it was the one time during the labor that I cried. 

My doctor knew Baby A could come at anytime and the epidural was taking a while to set in so they tilted the table back and my feet were in the air.  My OB said, “Hannah, I’m not sure you ever imagined you would be in this position pregnant with triplets.”  We both laughed.  A few seconds like that and we were all prepped for surgery and I was so relieved.

It took him the longest to get Baby A out and I remember him saying “she is really down there.”  And then a few seconds later I heard her crying (11:53PM).  The room erupted in cheers, the nurse showed her to me for a split second and whisked her away. 
Next came Baby B (11:55PM), crying her little lungs out and again everyone cheered.  They showed her to me and I got close enough to give her a kiss but in an instant she too was whisked away.  Next came Baby C (11:56PM), she was silent and I knew that to mean she was having trouble breathing and so I was not surprised when she was not shown to me.  Taylor immediately went to the adjoining room to be with the babies and my doula stayed by my side.  My OB was thrilled to tell me that my placenta looked fabulous, my uterus was in great shape, and the bleeding was fortunately not an issue.  He said once he removed Baby A both the other girls shot head first for my cervix.  It was in this moment that I internally questioned my decision for the cesarean.  He stitched me up with a double layer suture.  Throughout the procedure the nurses, the other attending OB and my OB commented on how amazing it was that I carried the babies to 34w, how healthy my insides were and how healthy the babies were. 

Once I was all stitched up they took out my epidural, that was terrifying because I was completely numb and they rolled me off the table nearly perpendicular to the floor to remove it, all the while being held up by two nurses.  I was so relieved to be back on the table.  Once the epidural was out I was transferred to a different bed that allowed me to sit upright, at which point I was wheeled into the adjoining room to see the babies.  The room was filled with people.  Each baby had one or two nurses, there was a respitory specialist and a neonatologist. Each baby was in their own warmer and were being fed formula.  It all was a surprise to me, I half expected it with Betsy because I knew her glucose levels might warrant it.   Bonnie was brought to me first, this was the first time I ever cried following a birth.  Next they brought me Abby, I think.  And I was able to hold both of them at the same time.  Next I got to hold Betsy.  Bonnie and Betsy were both on room air and Abby needed a tube.  I wasn’t able to hold them long as they were concerned with their body temperature.  I also noticed that all the vernix had essentially been cleaned off of all of them, even though as I was being cut open I told one of the nurses I did not want the babies washed.  She assured me that would not happen.  In those few minutes I was with all three girls I was not in the state of mind to second guess, question, or advocate for my girls.

In hindsight now I know that for temperature control the best thing to do for a baby, even a 34w baby, born via cesarean,  is to put them skin to skin with mom or dad.  I know that glucose can be checked within the first 2 hours and that if there is indication of glucose issues that one of the best things to do is put baby to breast.  I also learned that Bonnie and Betsy had 1 and 5 minute APGAR scores of 8/9.  These two girls were healthy and stable.  They were not in the room long enough with me for the APGAR to even be administered and to allow me the chance to have them on my chest, even just for a brief moment. 

Next I was taken back to my labor and delivery room to recover for an hour or two.  I had the chills and was exhausted but managed to ask the nurse for a pump.  I was told there would be one waiting for me in Mother/Baby.  Two hours passed and I was taken up to Mother/Baby.  There was not a pump and so I asked for one.  The Mother/Baby nurse told me one would be coming.  Nearly 10 hours passed from the time the babies were born that I was given a pump.  I reacted to either one of the meds or the epidural and I was itching constantly.  It made it close to impossible to get any kind of rest.  I was given Benadryl to relieve the itching, the itching didn’t subside and come to find out Benadryl is not one of those safe to give meds if you plan to breastfeed.  I requested food and was brought a liquid diet as is standard following a section.  Everything, except for the broth, had sugar and my blood sugar dropped making me nauseous.  I was a hot mess.  All the while my nurse never acknowledged that I had babies or that they were in the NICU.  At shift change I asked for something different to help with the itching.  She gave me stadol.  She told me it might make me drowsy.  Whoa, that was strong.  Within minutes of swallowing it I was passing in and out of sleep.  I would be talking to Taylor one minute and out cold the next.  I remember falling asleep with a boiled egg in my hand on my way to my mouth.  By this time, I think it was 10 or 11 AM, Taylor had already gone to see  the babies, my epidural had been worn off for several hours and I was ready to see them.  The stadol and not yet warn off and so as he wheeled me to the NICU I was still drifting in and out of sleep.  I am pretty sure my speech was slurred as I spoke with the NICU nurses.  I had never been separated from any of my girls for longer than a minute or two.  The 10 plus hours that passed until I saw them made it extremely difficult to bond with the babies for the first 24-48 hours.  I even remember telling the NICU nurses, in my slurred speech, that the babies did not feel like they were mine yet I was feeling simultaneously guilty for taking so long to see them.  It took me even longer to feel like I had the right to hold them and even touch them.  Taylor, on the other hand, bonded with them almost immediately.  He napped for a few hours after the birth but then went to the NICU early in the morning and spent an hour or two there.  Having three babies and babies that were bottle fed really allowed him to establish a great bond with them.  Almost immediately I felt like the three of them replaced me, he was in love and wanted to spend every waking moment with them.  This warmed my heart.
Tuesday afternoon my MFM stopped in to see me.  Hhe affirmed that my decision to have the cesarean was the right one as my BP was still elevated.  Later that night the pain became unbearable and started to cry a lot.  Taylor asked what was wrong and I began weeping, “Why the hell would I decide to be cut open.  Who the hell chooses to be cut open.”  Immediately he shut down my train of thought and declared “No!  You sacrificed your body for these girls.  You gave them life for 34 weeks and carried them this long.  They are healthy.  You sacrificed yourself for our family.  I am so thankful for what you did.”  In this moment I realized that what I accomplished was nothing short of miraculous.  I felt like a warrior.  (I still cry every time I relive this moment). Wednesday during the day I was at peace with my decision and again Wednesday night doubt set it again.  Thursday, my legs were more swollen then they had ever been and my BP spiked to 189/100.  It was at this moment that my doubt began to subside.  About a week after the birth the doula who was encapsulating my placenta posted information about the placenta and their cords.  In her examination she discovered that Betsy’s cord had a velamentous insertion.  With this type of cord the chances of IUGR and growth discordance is great.  It is considered risky in just a singleton birth.  If the cord was close to the cervix there was also an increased chance of abruption and still birth.  Her cord was barely hanging on by a few blood vessels.  She believed Betsy to truly be a miracle baby.  When I read this I knew my intuition to have these babies via cesarean was right. All doubt had been removed.  And again it was hard not to marvel at my pregnancy and their birth. 


Ultimately, I wanted to be the one who made the decision for my birth and how my girls entered this world.  I was.  I am at peace with my cesarean.  I would still choose a cesarean if the same situation presented itself.  There are still aspects of the birth and especially postpartum care of the babies that bother me.  I am allowing myself to feel what I want to feel when I want, completely free of any guilt.  I gave them life and I love them fiercely.



At 8w4d I thought I was losing our baby.  The next day I discovered that God blessed and entrusted us with 3 babies.   We had moments along that way that were frightening and prayed for God’s will, even if it meant losing one or all of our babies.  We all expected I would go on bed rest, I did not.  I was at increased risk of developing gestational diabetes and pre-eclampsia given that I was carrying multiples.  I had two weeks where my sugars tested moderately high and then they remained in the range of normal for the duration of the pregnancy.  Every time I showed up for a prenatal appointment both with my OB and MFM and babies and I were healthy they were amazed.  My MFM was really surprised when I showed up for an appointment still pregnant at 34w.  As we all discussed my birth plan at 34w2d they both said I was their most successful triplet pregnancy and congratulated me on such a healthy pregnancy.  My triplet pregnancy was essentially complication free.  In the end I birthed 3 healthy girls, two of which were on room air immediately, the other followed 24 hours later.  The NICU nurses and doctors were amazed as well.  God knew all along what lay before me and He was faithful to the very last detail.  My faith and walk with God deepened in a way I cannot put to words.  Every time I doubted He proved Himself over and over and in an ever so gently way.

Friday, March 28, 2014

Living Day by Day

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, 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.