Saturday, January 31, 2015

Operating Without A Net

I feel very bad for not updating in a while.  I should really work harder on the blog, but I am currently sitting in my very dirty house with no energy to clean it either and it's in my face every day.

Most days I am surviving my 8 hour work days, but by the end of the day I am exhausted.  Last Thursday I had to come home and do laundry (there was no underwear), sorting was the hardest job I'd ever done.  I literally was out of breath from bending over and tossing clothes in piles.  How am I supposed to get the house ready for triplets if this is how I feel at 15 weeks?  I'm a little concerned.  I'm hoping I get a boost of energy at some point.

Last weekend I took down the Christmas Tree and I was feeling pretty great on Sunday, so I decided to read my triplet book that everyone had recommended.  Now, almost everyone said not to take the nutrition part too seriously (with triplets I believe she says 4,000 calories which would be literally impossible for me to achieve), so I was prepared for that, but the part about contractions really freaked me out.  I ended up with only 5 hours of sleep on Sunday, but still pulled out a full workday on Monday.  Luckily Tuesday was my 16 week check up.

The babies are all growing well, still 1-3 days ahead and all about 5 ounces.  I am happy, my husband and I pushed the ultrasound tech to see if she could 'spot a penis'.  Gamely she looked close for us and found that baby A is a boy and babies B & C are identical girls!  She confirmed by the end of the appointment (she wasn't confident at first).  We did a comedy routine for her about names, essentially threatening to name them after towns and cities in Washington, she was cracking up. 

Then she went to get the doctor, who was great, I really liked her.  She did not think I needed to 'monitor' myself everyday for contractions like the book claimed, and she also confirmed that a contraction should make my belly feel as hard as my forehead... So if you see me wandering around with a finger on my forehead and another on my belly, you know why.

She also said I had a small placental tear, which is very common in multiples and should resolve without any symptoms (ie, spotting).  I tried to define what the spotting may or may not be like and she said calmly 'just call us! we're your OB and here to help you'.  It felt really great. 

My husband complained I was lethargic, she assured us it was normal (duh!) and he asked if there was lifting limits, which she said no!  My husband then said 'see I could vacuum just fine!'... ah, men...

The biggest news to come out was, unlike some ladies I've met on twitter, I am in a 'no net' zone.  My MFMs will not stop preterm labor unless I am close to the babies being viable.  They will not do progesterone or a circulage as they haven't been shown to help in multiples.  And she pointed out that most labor stopping drugs only last for an average of 48 hours and every time they give a dose of a drug it has an effect on both the babies and the mother.  They don't want to give dose after dose of drugs to stop labor (they may, at some point, but they aren't in the business of it).  I am at peace with this, technically it's still a miscarriage until 20 weeks, and I feel like it's no different from the first trimester. 

Although sometimes I wish I didn't have to know I was pregnant the WHOLE pregnancy.  My original plan for getting pregnant was to ignore not having a period for a month or more and then be surprised!  It's hard to be so aware the whole term. 

Today I am 16w3d and am feeling confident about it, but I still worry about how much I'm eating (usually hitting close to 3,000 calories a day, but not always the best calories) and (on the crazy side) worrying whether my babies will become drug addicts because I won't be able to pay enough attention to them.  Yeah, that was last night, because I'm a crazy person.  I literally have no control over that right now... also there are a lot more addicts in my family than the one mentioned in my donor's family history. 

I promise to try and update more faithfully.  Or to think about it. 

Monday, January 12, 2015

OB Check In

I'm sorry I don't update more frequently, I actually have several ideas of what to write about, but it's just been so busy.  Every night last week I was busy, and then we went to a playoff game on Saturday.  It took me all day Sunday to even slightly recover and today I still had a slight eye twitch, I assume from being exhausted and today's stress.

A few people at my OB check in could've used more gentle words with me.  I am so nervous when I go in that my blood pressure is raised, they took it twice (beginning and end).  I'm understandably nervous that it means something, I actually normally have average to low blood pressure.  I don't want the extra worries, and I know I should let it go, it's just hard since I was given a preeclampsia talk already. 

The nurse practitioner (NP) wanted me to have a quick ultrasound for a 'viability check', I'm ok with the ultrasound....I'd prefer she didn't call it that.  Then as I walked into the room I found that a doctor was going to do it.  I'm not sure why, the ultrasound tech was there 'assisting', but it was clear the doctor was not skilled or was using me as practice.  First she found baby A (I assume) and then she said the heartbeat was too fast.  I don't know what that would mean, but it doesn't sound good.  After a few minutes she confirmed that she took the heartbeat 3 times for baby A and all 3 were 'within range'.  Ok, great, really that's all I needed to know, right? 

Then she found another baby (B?) and there was shrill beeping.  She said 'that's not good' and I said 'What?!?' and then she said it was her beeper.  At this point I was just trying to breathe.  She left after measuring the heartbeat on the other two (who are also fine) and I told the ultrasound tech that I did not like having the doctor do it.  I prefer the techs, they know what they are doing and measuring and they are reassuring throughout (normally) because it's not their job to give you bad news.

Also, can I just admit now that I can't really look at the screen during my ultrasounds?  I am so terrified of the fact that I am having 3; that it's going well.  I wondered today why I'd been given this burden.  I would be scared of pregnancy regardless, but it's hard for me to focus on positivity when I'm being told so many things can go wrong.  I worry I'm too scared to pull this off, I want to do so many things better, stay calmer, eat more, feel less sick. 

I did tell the NP that I was relieved that reduction was not stressed at my last appointment there.  Then she came back in the room after my ultrasound and laughingly said that one of the doctors wanted to make sure I'd been offered it.  Here's the thing: because it wasn't stressed last time I felt that I could do this, that they thought I could do this.  If they start bringing it up I'm thinking the opposite.  Ugh. 

Overall it was positive, I got a flu shot and the NP was a very nice person.  I found out that the MFMs won't necessarily deliver, they may just let an OB on staff at the hospital deliver.  Not too big a fan of that, but there's not much I can do.

When I got in my car the song playing was 'Livin on a Prayer' and it was right on these lyrics:
Whoa, we're halfway there,
Whoa, livin on a prayer,
Take my hand and we'll make it, I swear
Whoa, living on a prayer

Of course, I promptly started crying.  We aren't quite halfway to viability, but almost (14 weeks on Wednesday) and I do feel like we're living on a prayer.  I'm going to have a good cry tonight and hope that I feel much better after a long sleep.

Thursday, January 1, 2015

Updates

Of course the first post of the year should say something special or exciting or something I've learned over the past year.  So sorry if you're disappointed -  mostly this is an update after my MFM appointment on Monday.

I thought the appointment would be the OB check in, since I was referred by a fertility clinic.  It takes this office 3 days to 'properly process' a referral and I assumed incorrectly that accepting me as an OB patient was part of it.  The poor receptionist was a total moron (even though she seems like a perfectly nice person).  The office I visited (not the only office location) shares space with an OB clinic.  When she found out I didn't have an OB she thought it was a great idea to go ask the OB clinic if they'd take me as a client, surprisingly they did not want to handle a triplet case.  (I wanted to slap my forehead.)  At the end of the appointment she didn't know how to make an appointment for my official intake or my 16 week follow up, she had to call me back the next day.

After the adventure of getting checked in, we sat and waited for the ultrasound.  It was scheduled to be 90 minutes.  The ultrasound tech was amazing, she was great and chatty without being too detailed.  She confirmed the twins were MonoDi and she said that still has a risk for twin to twin transfusion, but that the doctor would talk with me more about that.  She chatted about other triplet clients that she saw and how they did (nothing scary!).  I asked her if any of the doctors in the practice delivered and she confirmed that all of them did.  She wouldn't really give us a referral, but when my husband said he wanted a straight shooter she told us what doctor he would probably like.  I convinced him I didn't want a straight shooter, I want a calm and caring doctor that will only tell me something if I need to know.  I cannot be stressed out about every little possible thing.

Speaking of stressing out, since all the babies looked amazing on the screen and all were measuring 1-3 days ahead (baby A is only measuring 1 day ahead and he has his own little placenta - get it together baby A!) you'd think I wouldn't be too nervous to speak with the doctor, but I was SO NERVOUS.  (The ultrasound was only about 20 minutes too, which was nice.)

Now, again my problem is that I wanted to see a doctor that was maybe going to deliver, but I saw a fill in doctor who is amazing and very nice and who would be wonderful to see if you were just going in for a quick opinion on your single or double babies. 

The first thing she mentioned was that I have a subchorionic hematoma, which I only know from Don't Count Your Eggs and so my immediate question was 'is it going to take a baby out?'.  She said no and looked at me like I was crazy (I'm not crazy! Though Maya had this issue 5 weeks earlier in her P).  It's apparently well on it's way to resolving and is super common in IVF patients, it also might explain my early pink spotting.

So all the news that affects what we can do:
  • Circulage and progesterone therapy to slow pre-term labor in multiples has not been shown to help, they would not recommend either of these.
  • Preeclampsia is more common in IVF patients so we need to watch it.  (I wonder if she brought this up because I was super nervous and my heart rate was 80 and my blood pressure was higher pre-discussion.)
  • Twin to twin transfusion syndrome is a possibility and we discussed treatment and options, but then I was told it only happens in 5-10% of cases.  I'm not discussing plans about that! That was about my chances (from one doctor) on my getting pregnant naturally. 
  • It's mostly impossible to do the blood tests for genetic disorders.  The defects can get diluted because you have 3 babies in there.  Basically they have to rely on ultrasounds or amniocentesis if there are symptoms.  I'm all ok with the ultrasounds, but will probably not want to do invasive tests unless there is a sign of a huge problem.
  • Growth restriction can happen, but we'd be looking for that later in the pregnancy.  I've barely popped now and my uterus is still much larger than a normal single pregnancy, so I feel like I've got lots of room for them.
  • All my placentas are on the back - which means I will be pummeled with 6 tiny fists and feet soon. Can't wait!
Mostly hilarious
  • I told her it was an egg donor, she asked how old (the donor is 21) and then she immediately asked me if there was a danger of hyperstim.........                  Uh, no, because I haven't stimmed for 6 months.  It mostly made me laugh, clearly she was stuck on the standard IVF portion of questions.
  • I do not need to actually eat 4,000 calories a day, but I should try to eat as much as possible.  This MFM said that babies grow to their genetic predisposition until 24 weeks and then food matters.  Not sure I believe her, but I'll go with it.
  • She thought, barring anything occurring, I should be able to work until 24 weeks.  At that point I may just physically be too big to drive.  When I told my coworker the next day she offered to pick me up, and then she pointed out our boss had a big truck.  I asked her if she was going to load me in the back like I'm a cow and make me moo while doing it?  She laughed (I know what she's planning!)
It was very nerve wracking, but I'm glad it's done and I'm glad they all look healthy.  It's scary to think I won't have another scan until 16 weeks.  After that I get a scan every other week and I'm not sure that's better because I'm still scared, but at least I'll be monitored.  Trying to stay positive every day and make it to at least 28 weeks.