Doctors Galore and Your Questions Answered

GYN Appointment
I had an OB/GYN appointment on Wednesday back with my regular doctor (no more perinatologist for me!). It was the first time I've seen him since a few days before I delivered when he came to visit me in the hospital, so it was good to see him, though I could have done without the exam! I was surprised at how many of my old feelings were still with me sitting in the waiting room amongst all the pregnant women there. You'd think having been through a pregnancy (one that lasted, even) and having three babies to show for it, that I wouldn't still feel like a completely inadequate in a roomful of pregnant women. But I was never one of those women...I never had the luxury of taking my pregnancy for granted. I didn't get to ever assume everything was fine because I had a pregnancy that was nearly guaranteed to result in a premature delivery and one in which things seemed to be going wrong every week (and I didn't have as bad a time as I could have). Anyway, I don't mind pregnant women...some of my best friends are pregnant women..I just find it overwhelming to be around that many at once.

The doctor asked whether my husband and I were doing anything about birth control. I missed my opportunity to answer with, "Well abstinence is the preferred method of Congress..." because I burst out laughing. Instead of lecturing me about the fact that there are lots of women who end up with an "oops baby" after years of fertility treatment, he just asked whether I'd be depressed if I ended up surprised by a pregnancy. After I stopped laughing, I told him I would die of shock because it would be the immaculate conception, but that we'd be thrilled to pieces. That satisfied him, so he was okay with me not doing anything to prevent it. I was actually a little surprised not to get a lecture about not wanting to be pregnant so soon after a triplet pregnancy and c-section (I got that lecture from the perinatologist while I was pregnant), but I'm cool with that. I'm very certain I'm not going to find myself surprised with a pregnancy anytime soon, or, like, ever.

I told him I was still bitter about the c-section and he said, "what do you mean?" He was shocked that I'd ever thought I could have a vaginal triplet delivery, and was surprised to learn that two of the perinatologists in the practice I went to have done (and were willing to do) vaginal triplet deliveries. I always knew that the odds were against me avoiding the c-section, but had Abby not been so little, they would have let me try it. Anyway, I told him that I'm all ready for my VBAC because I'm definitely going for a normal singleton pregnancy some day, darnit! I told him that HE was going to deliver my next baby because it was going to be JUST ONE. I'm not sure that I really have that much confidence that I'll manage to get pregnant again, but I'm certainly going to try (while praying that the Big Guy Upstairs doesn't have a sick enough sense of humor to send me quadruplets next time).

Pediatrician
I took Ellie to the pediatrician on Friday for a weight check. Well, I mean, all three babies went, but only Ellie got weighed and seen. I've known our pediatrician for about ten years (we used to attend the same synagogue, long before I had any kids), and I adore him. There are several other doctors in the practice, but I've made nearly all of our appointments with him because of Ellie's weight issues. I prefer seeing him because he's got a better appreciation of the trends we've been seeing with Ellie's progress (or lack thereof) and because I just like him in general. One time when I saw another doctor for one of Ellie's weight checks, she sort of shrugged me off as if I was overreacting. I admit that I was beginning to wonder if perhaps I was overreacting to Ellie's lack of weight gain - she's just so little compared to Abby and Sam. But she remains an enigma. She was 7 pounds, 7 ounces this week... which was only a 7 ounce gain in 17 days. Not terrible, but not quite what we would have liked to have seen, either. Even Dr. B said it would just be nice if she would go one way or another... slightly less gain and we would have known we needed to explore options, or slightly more and we'd know there was no problem whatsoever. She consistently gains less than he'd like to see her doing, but not so much so that it points to an obvious problem. He, like me, is somewhat worried, but not inclined to intervene too much at this point. She's not showing any other signs of reflux (she rarely spits up, she's not fussy when she goes on her all-too-frequent hunger strikes, she doesn't quit in the middle of feedings, she doesn't seem uncomfortable during or after feedings...), so trying reflux medication probably wouldn't do anything other than giving us one more thing to have to keep track of on a daily basis. He doesn't want to torture her with a huge blood draw for a metabolic screen, but he did do a small blood draw to check her thyroid hormone (T4, TSH), so we'll see if that illuminates us at all.

The triplets are scheduled to return for their four month visit in two weeks, and he said we'll just keep an eye on her until then and if I feel that things are taking a turn for the worse in the interim, I'm more than welcome to bring her in for another weight check. I doubt that I'll feel the need, but you never know. It's nice to know that they don't think I'm just an overreacting new mom, but I do wish she would just gain a little more weight a little faster so we could stop worrying all together. Poor baby. The doc WAS impressed that Ellie is pretty consistently sucking her thumb. Thumb sucking is apparently a developmental milestone you expect of a full term baby at 3 or 4 months, so she's about 2 months ahead of schedule. Go Ellie! Anywho, we're back to our wait-and-see strategy with her, and that's fine. I just wish she didn't have hunger strikes!

Your Questions Answered
Allie posted this question in a comment recently:

Is it really going to be cost effective to pay for childcare for 3 kids?? I hear that childcare for 1 is bad enougth...but I can't imagine paying for childcare for 3 newborns!!!! Won't you just be working to pay for childcare costs??

I get this question (or similar questions) a lot and I don't really understand it. No one knows how much I make or how much we'll be paying a nanny, so why do people assume that it's not cost effective? And why does no one ask my husband whether it's cost effective for him to work?? We make the same amount of money! The truth is, it IS cost effective, not only in the short run, but definitely in the long run. I make more money than we'll be paying the nanny. Does that mean we can afford a nanny? No. We still have more bills than we know what to do with. But we can't pay much more than the mortgage and a few utilities with my husband's salary alone and we've eaten through what little reserves we had with me out of work for the last seven months (bed rest for three months and almost four months since... time flies when you're sleep deprived). Anyway, in the short run, yes, it is cost effective for me to work. It would not be if I made less money.

More importantly, however, it is cost effective in the long run. If I were to pull myself out of the job market until the kids went to kindergarten or 1st grade, I would no longer be marketable in my field because the standards and technology are changing too rapidly for me to keep up on my own. So even if we were losing money on a nanny at this point, it would be worth it in the long run because there is no other field that I'm qualified for in which I could maintain my current salary years down the road.

And while it's true that I have little desire to return to work, I find it odd that no one seems to consider the possibility that maybe I like what I do. (I do like what I do, though I'd gladly give it up for the opportunity to stay home with my sweet babies if we could swing it financially). Anyway, enough of that...


Tinker asked:
How do you add calories to breastmilk? Feed it from a bottle and add a supplement of sorts? What kind of supplement?

You can fortify breastmilk by adding a higher calorie supplement to expressed breastmilk in a bottle. Breastmilk and standard formulas have 20 calories per ounce. Preemie formulas have 22 or 24 calories per ounce (I think there is also 27 calorie, but I'm not certain). So Abby used to get fortified breastmilk by adding 1/2 a teaspoon of preemie formula to 3 ounces of breastmilk, which raised it to 22 calories per ounce. She's not getting extra calories anymore, though, because she's done sufficient catch up growth.

Several people have asked whether I will continue breastfeeding when I go back to work and the answer is, of course, yes. I'll be pumping during breaks and overnight (and obviously breastfeeding whenever I'm home with them). I'm very pleased that I've made it this far without needing any formula (who can afford formula for three babies??), and my hope is to make it until they are at least 6 months adjusted before adding anything else to their diets.

Any other questions?

Clean Bill of Health and Parenthood

I had my six-week post-partum appointment yesterday. I have a clean bill of health. It's kind of sad for me, really. It feels like I'm closing a chapter of my life. I'm officially not pregnant anymore. I mean, I haven't been pregnant for six weeks now, but something feels different and final now. And I miss it. And I'm sad that this may have been my last pregnancy. Even though I have four children now, I never wanted to have just one pregnancy (well, two, but the first one doesn't count in this sense).. I never thought I'd have three at once. I never thought this was how I would build my family. I don't want this to have been my last chance. And if I were a fertile myrtle, it would be easy to say, "well, okay, so if you get pregnant again, so be it, and that'll be great." But we all know it's just not that easy. So I know a lot of you are rolling your eyes that I have four kids and I'm not satisfied, and some of you probably think that this is just postpartum hormones, but I don't think it is. I'm sleep deprived, overwhelmed, can barely imagine handling another infant right now, but I long for the experience again.

Today would have been an easy day for me to say that I never want to go through this again. I was supposed to take J to school, which would have meant piling the triplets and J into the van and getting him up to school. This doesn't sound so hard, until you consider that all the babies have to be fed, changed, and put into car seats before they can be brought out to the car. Add that to the fact that J has to be changed, fed, and clothed and his lunch had to be made. Oh, and then there's the fact that Sam was up ALL NIGHT. He will NOT stop eating. He just keeps going and going. He woke up screaming with hunger at 2am (an hour before I expected him to wake up) and nursed from 2-4:45 when my husband took him away and gave him a bottle so that I could get some sleep. He wasn't just using me as a pacifier either, because he was really hungry and he would scream bloody murder if he unlatched, and he wouldn't take a regular pacifier. He was still hungry even after the bottle. He whimpered and whined for an hour and a half until he started screaming at 6:45 begging for food. So I nursed him until almost 9am when I gave up and gave him a bottle and he was STILL hungry. Meanwhile, I had three other kids to take care of, and I had decided that the four year old wasn't going to make it to preschool since none of us were dressed, fed or ready to go.

Today is the first day I have felt completely overwhelmed. But I STILL miss pregnancy. I still want to have another baby someday, even if people think I'm greedy for saying so.

Anyway, odds are good Sam's just going through a ginormous growth spurt. Babies apparently go through growth spurts approximately every 3 weeks, and he's six weeks old exactly today, so it makes sense, right? Apparently this should "only" last 2-3 days. Which would be totally manageable if he were a singleton, but hey, did I mention that there are TWO OTHER BABIES and a four year old to take care of? But this shall pass, right? Oh, and a friend of mine came and picked up J and took him to preschool an hour and a half late, but he got there regardless. Thank heavens. So the day is looking up, and I can do this. Parenthood certainly has its challenges, but I can do this, right? RIGHT?

Lots Happening

I haven't posted in a bit and it's largely because my life consists of mooing, sleeping, mooing, taking J to school, mooing, laundry, mooing, visiting the NICU, mooing, Jewish holiday, mooing, dishes, mooing, back to NICU, more mooing, eating, mooing, thinking about a shower, mooing, sleeping, mooing, calling the NICU to check on the kiddos, mooing...

Right.

All the kiddos are still in the NICU. I'm still pumping. A lot. They are all nursing twice a day when I'm there, but that doesn't get me off the moo duty, of course. Today I pumped 46 ounces of milk, which isn't nearly enough to make any significant amount of cheese, but is enough to feed 17 day old triplets. Except Ellie keeps eating MORE! Pressure! How will I ever keep up?? They are all getting bigger, which is a relief.

Ellie and our little guy are doing well. They are both out of their isolettes and have had their feeding tubes removed. They still are having too many bradys to come home, but they are making progress. I expect them to be home probably early-to-mid-week unless something unexpected happens.

Abby is a slightly different story. On Tuesday her hematocrit dropped to 22 (it should be in the low-to-mid 30's). The doctors were alarmed, but not completely freaked out. Our bodies SHOULD theoretically make more blood when they figure out that we are low on blood and they had ruled out a brain hemorrhage already with the routine head ultrasound they had coincidentally done that morning anyway (the most obvious and also most horrifying explanation for the drop in the hematocrit). Some mention was made of the vague possibility of maybe someday considering a possible transfusion if it didn't resolve itself, but it was all very blurry and seemed unlikely. S and I and the triplets are all O-positive, but I can't be a directed donor right now because I just had a baby (three, even!). And anyway, it seemed unlikely to be necessary. After all, it could have just been a blip. Since she wasn't symptomatic, they'd treat her with vitamins and iron and hope it resolved itself.

The next day, however, the nurse practitioner told me that the doctor wanted to have S tested as a directed donor if he was willing. He needed to be tested for CMV antibodies. Most of us walk around CMV positive, which isn't a big deal, but they don't give CMV+ blood to babies. So she wrote a script for S to get tested. By the time she wrote that script, though, the lab was closed, so S came in with me to the hospital on Thursday to get the lab to draw the tests he needed. There still seemed to be no great sense of urgency on anyone's part, but everyone wanted to make sure our bases were covered should the need arise. Meanwhile, our little Abby-saurus was looking paler than ever.


Friday I went in for the babies' 11am feeding, as usual, and met with the nurse practitioner. Abby's hematocrit had dropped again, to 17. This was too low, and they didn't feel that they could wait for the results from S's CMV screening. At best, they would get the result back Saturday. Odds were not in his favor that he'd be CMV negative anyway, and even if he were, it would take 5-7 days to process his blood before it could be given to her. That was too long to wait with a level that low. The best option was to use an anonymous donor. There are risks with anonymous donors, of course. There are risks with directed donors, for sure, but you theoretically have a better handle on those odds. The NP ran through the numbers on the risks and I listened with half an ear as I usually do on such things, and she got me the consent to sign. And I went to read it.

And I stood there, pen in hand, trying to sign that piece of paper without crying.

Yesterday was Simchas Torah. It's a beautiful holiday on the Jewish calendar. A day on which I should have been in the synagogue watching my wonderful husband an beautiful son dance joyfully with the Torah. Instead, I joyfully went off to spend the morning with my three angels in the NICU, never expecting to be standing there trying to sign a consent for a blood transfusion for my tiny Abby. Worse, this was a choice I had to make on my own. I couldn't have reached Seth if I'd wanted to. He was in the synagogue. I had no way of reaching him. He had no phone, no pager, and even if he did, he wouldn't have been answering them because of the holiday. I couldn't call my rabbi, for he, too, was celebrating the day. There was no one I could reach who could get my husband quickly enough to get him to weigh in on this one. So I stood next to Abby's isolette reading this consent which said I understood that 1 in 600,000 anonymous blood donors may be HIV positive, even though the blood IS screened for it, and likewise that 1 in 66,000 may be hepatitis positive. Those are tiny, miniscule odds. Those are odds I scoff at when signing consents for myself. I wouldn't have thought twice about those numbers if it were my own blood transfusion. I didn't think twice about them as the NP was rattling them off verbally. But standing next to my tiny 3 pound baby (she's over three pounds now!) holding a pen on a day that I normally wouldn't have been signing anything... those numbers sounded huge. I was consenting to 30ml of blood... 6 teaspoons!... that could possibly be HIV or hepatitis positive to be transfused into my tiny, helpless baby's body. And it was all on me, since I couldn't get S to weigh in on that one.

Obviously I signed the consent. Because the consent also said that I understood that failure to agree to the transfusion could result in death. And well, if there's one thing we Jews understand, it's a good guilt trip. And honestly, there wasn't any way around it. Abby was tachycardic. She was having a lot of bradycardias also. Her monitors were going off left and right. She was deathly pale. My normally alert daughter was barely opening her eyes that morning. So much for not being symptomatic.

Once I signed the consent, the nurse got two IVs in. One for the blood and one for IV fluids, because they were going to hold her feedings for the transfusion. The transfusion would be done in two, two-hour sessions with a four-hour break in between. (the four-hour break turned out to be much longer, because it took the blood bank a while to get the second batch of blood up to the NICU) I couldn't stay at the hospital for the transfusion, because S didn't know what was going on and I needed to get home. Plus, being at the NICU while it was going on wasn't going to help anyone. The nurses and NP all said it would be better that she simply rest and that I go home. So that's what I did. And by Saturday morning when I saw her again, she was pinker and happier and more alert and her heartrate was down into the 150s, right where it should be. She was a much happier camper, as was I. That's my girl.

It's not lost on me that last Simchas Torah I was suffering complications from a late miscarriage, and this Simchas Torah I was making choices for the betterment of my daughter's health and well-being. More ironically... the Jewish calendar and the Gregorian calendar don't line up precisely... so Monday will be even more significant. Last Columbus Day (2006) I had a miscarriage. This Columbus Day (2007), I'll be having my first of two post-op check ups with my perinatologist following the birth of my triplets. And when that's finished, I'll walk to the other end of the hospital to nurse my babies and talk to a doctor about when they can come home.

Edited to Add: I should mention that I called the Red Cross eventually and explained that my husband had been a blood donor for a billion years and was now being asked to be a directed donor for our 2 week old infant in the NICU. Did they by any chance keep records on whether he was CMV+? Why, yes, as a matter of fact, they do. In fact, all I needed to do was provide my home telephone number and the very helpful agent gave me his full name, his blood type, and informed me that he was CMV positive. So he was ineligible as a directed donor for Abby anyway. You don't give CMV+ blood to babies, so there's a pretty small donor pool.

Someone asked why they didn't order the directed donor tests and draw on Tuesday when it first dropped... honestly, a crit of 22 is low, but since she wasn't symptomatic and her head ultrasound had JUST been done and was negative for hemorrhage, there wasn't a good reason to believe it wouldn't come back up. I spoke with a pediatrician friend of mine and she said she wouldn't have ordered the tests and draw either. Furthermore, the Red Cross wouldn't have taken the blood without the screening tests first for directed-donor for some reason. I didn't think to ask them about their record keeping until Friday when it was a moot point anyway.

It does really take 5-7 days to process blood. This is standard for the Red Cross. I'm not sure what they do to it, but it has been like this for a long time. I don't know the specifics, but I know the Red Cross tests for a wide variety of microbial and viral substances as well as drug contamination, etc. To be honest, my husband works in a hospital which is full of all sorts of germy germs, and this blood was supposed to go into my 3 pound baby... I wouldn't WANT them to rush that process.

Lastly, regarding my husband wearing a pager to shul... he did wear one to shul when I was in the hospital during Rosh Hashana before I delivered, but we hadn't really thought he would still need it, since all the babies were doing so well... we had three very healthy babies in the NICU until Friday, even accounting for Tuesday's low hematocrit. We'll see how the week goes, and ask about having him carry the pager next Shabbos just in case. It was poor planning on our parts, that's for sure.

Off To The Hospital...

Jessica Here...
First off, let me reassure everyone and let you all know that Karen sounds perfectly fine, very calm, and very "Karen-like" :) Any of us that know Karen in real life know her penchant for keeping cool in crazy situations... Hence her calm demeanor this evening!
Anyway, after talking to the Momma herself this evening, she's doing well. They've admitted her because of her possible pre-eclamptic issues. The tests that were run a few days ago, showed slightly elevated liver enzymes which along with high blood pressure, usually indicate issues with pre-eclampsia. So, for right now, she's there for observation purposes only... There are no definitive plans as to what they're going to do right now. We chatted for a bit and she laid out the three distinct possibilities:
1. The MD's come back tomorrow and decide on a delivery time. (eeek!)
2. The MD's come in and decide that the pre-eclampsia is not progressing and send her on home.
3. The MD's come in and decide to sit on her and the babes for the duration...
Tomorrow at twilight marks the start of one of the larger holidays for Karen and her Family, so of course, hanging at the hospital (while not fun) might be the most practical of the options... I'm really hoping they don't just send her home... But hey, Doctor's know best right?? :) On that thread of thought also, the Terbutaline pump that Karen has been using to keep the contractions at bay? It has been discontinued... The Doctors see a connection between pre-eclampsia and terb, so no more of that for now! I was reassured to hear that she was still taking some Procardia, but was unfortunately a little uncomfortable regardless... On the upside, they're 32 weeks tomorrow...
I'll keep you all posted with information as it becomes available! Please keep them all in your thoughts!

29 weeks, 2 days - Appointment

Guess who doesn't have gestational diabetes? Yep. That would be me. Apparently one of my levels was slightly high, but he said that isn't diagnostic and when he heard what my fasting levels were (this morning's was 75, yesterday's was 65... usually it's around 68-70), he said, "Yeah, you don't have it." So yay!

As for the rest of the appointment, it went well. My cervix is stable. The doctor basically said I'm just going to contract. It's what I do. He's not concerned with the quantity at this point, so much as the quality and the effect on my cervix. So we're on the same page on that one, which is good. Contractions are definitely getting stronger and more uncomfortable. He assured me that if I were in labor, I'd be in enough pain that I would know it. I'm not so convinced, since kidney stones barely make me flinch, but I do think I'd recognize it. We'll see.

He was concerned that all the monitoring was more trouble than it's worth. He wanted to make sure that with all the contractions they weren't making me re-monitor so much in the evening that it was keeping me from sleeping, and I promised him that I knew enough to tell them to just call the doctor if I wanted to sleep instead of re-monitoring and he said that was fine. The important thing is that he wants to make sure that I understand that I have to be assertive about letting Matria know if there's a significant change in quality and that I'm not concerned about quantity alone. So if they're pushing me to re-monitor, and I don't want to or feel that it's unnecessary, I shouldn't feel guilty about having them call the doctor. That's fair. And, he said, if we get a little further down the line and decide that the monitoring is just a bigger pain in the ass than it needs to be, then I won't do it anymore. Mostly, he thinks I have a good enough handle on things that he thinks that I know when to call myself, but he doesn't think the extra data point from the monitoring can hurt.

They want to keep a close eye on me, because things have been a bit dicey, but mostly, I'm doing great, all things considered. I'm astounded that I don't feel crappier than I do... I'm a whale, but not as whalish as I thought I would be... I fit into most of my pre-pregnancy clothes despite the enormous pregnancy belly (that's how much weight I've lost). I'm uncomfortable, but not NEARLY as uncomfortable as I'd imagined I would be. I have trouble walking, but the bed rest probably contributes to that, and I'm not allowed to walk much anyway (I only know how difficult -and painful- walking is because I had to walk down a long hallway to get to my doctor's office today). I have difficulty breathing, but that's not shocking. There are three babies in my very, very short torso. I'm tired all the time, but DUH! I'm still throwing up, but who cares at this point? I really expected MUCH worse. Or maybe I'm just handling it gracefully. Either way, I'm in the home stretch. I'm not there yet, but bit by bit, I'm getting there.

I go back for a growth ultrasound on Wednesday. I'll be exactly 30 weeks. If you're REALLY good, I might post another whale picture that day. We'll see.

Frustrating

First, I should note that this is my 198th post. I'm pointing this out because of the unlikelihood that I'll notice when it's my 200th post, so there you go. This is fair warning that apparently, I am verbose.

Then there's the fact that I made it to 28 weeks this week. And... I have mixed feeling about this. On the one hand, this is definitely a milestone. Babies born at 28 weeks do much better than babies born at, say, 25 weeks. But it would still be utterly devastating to me if they were born right now. Apparently I'd had my doctor worried over the weekend that he was going to be delivering me at 27+ weeks. That's not good. What is good is that he didn't make me think there was that much reason to worry until it was clear that we didn't need to worry. But anyway, in a lot of ways, I'm very sorry that I ever, ever, ever told anyone that 28 weeks was a milestone. It IS a milestone, but it is NOT the goal. The goal is 34 weeks. The first milestone along the way was 28 weeks, and here we are. But now people (not YOU people... but stupid people) keep thinking it's okay to say stupid shit like, "Well, great, you got to 28 weeks, so it's all good now, the babies can be born any time, right?!?" WRONG. And when I try to explain to these people that I appreciate their optimism and enthusiasm, but 28 weeks would still be horrifying, they tell me to stop being such a pessimist and proceed to tell me all these statistics about babies born at 28 weeks.

Yes... 90ish percent of babies born at 28 weeks survive. And most of them do not have long-term issues. But 10% don't survive. And 28 weeks, need I remind anyone, is twelve weeks early. Twelve. That's too early. If my babies were born right now, they would be about 2 pounds. That's not enough. Not when they should have the opportunity to grow to be close to 4 pounds. If my babies were born today, they would probably do just fine. But that is not what I want. And that is not what is best for them or for me. And I am so sick and tired of people accusing me of being a pessimist for not thinking it would be so great for these babies to be born this week. Case en pointe: My foster-son's grandmother called me on Wednesday (GAWD, why did I EVER acknowledge that Wednesdays are the days that I hit the new-week-milestones? WHY WHY WHY?). I was waiting for my Matria nurse to call me with my morning monitoring numbers and I'd had a terrible night the night before (10 contractions in an hour, two hours in a row), so I was a bit on edge when I picked up the phone.

"Hello?"
"28."
"28?"
"28!" (I'm still trying to figure out who the flying fig is on the other end of the phone)
"What do you mean, 28?"
"You're at 28!"
"That's not possible!" (I knew it wasn't my nurse from Matria, because she always identifies herself, but I was still in that contraction-counting-mode, and I was doing the math and there's no WAY I could have had 28 contractions in an hour)
"What do you think it is?"
"What do you mean 28?"
"28!"
"28??"
"Yes! 28!" (this went on for about two minutes)
"28 what????"
"You're at 28 weeks!!" (I finally at this point figured out who it was who was calling because this is the one person in the world who cannot seem to get the point that I need her to stop harping on the 28 week thing, plus I finally recognized her voice)

I was livid, really. I told her flat out that I don't know any other nice way of telling her that I need her to stop dwelling on this 28 week bullshit. YES, it's a milestone. NO, it's not the goal. YES, babies do very well at 28 weeks (at which point she broke in and said, "I even talked to my sister who's an OB/GYN and she said..."). But NO, it would NOT be good if these babies were born at 28 weeks. They will have so many disadvantages already. We really want to get into the thirties. Thirty-four weeks is absolutely ideal. And please, please, please, I'm begging you, stop acting like it's okay for these babies to come out right now!

I swear, it's like I almost feel like all these people who think it's "okay" now for these babies to come out are almost willing it to happen and it terrifies me. Yes, they really probably would be okay, but I don't want to find out the hard way. I just want these babies to have every chance possible. I don't want them to come out now. I'm not ready. They're not ready. They're too tiny. I'm too scared for them. Please don't come now. Please. I don't know how we'd bear it. I don't. I know we'd just do it, but I don't want to find out. I really don't. I can't.

I haven't been a seriously emotional wreck through this pregnancy. I'm not more snippy than I am when I'm not pregnant (I'm very snippy when I'm not pregnant, so who can tell the difference?). I rarely cry, though I'm crying now just thinking about these babies coming out now. I keep it together. After the first few weeks of the triplet-shock, I've been okay. I've had my moments of "oh my god how are we going to take care of triplets??" but nothing too horrifying since those early weeks. And now, with people continually acting like 28 weeks was such a huge milestone and that everything's okay now... I just feel like ... like they're saying it's okay for all my worst fears from the beginning to come true.

And it's not helping that the contractions really are out of control. I mean, the good news is they're not seriously affecting my cervix. Contracting is, apparently, just what I DO (sort of like how we discovered that bleeding in early pregnancy is just something I DO...). I'm just lucky. Somehow, that doesn't bring any peace of mind, because it makes me worry that if there really IS a problem, we'll miss it. But then again, my doctors have been careful never to assume that my contractions are just "normal for me" when they get up to a certain level. They'll bring me in any time I feel uncomfortable with the pattern or feel like I should be seen. Or if anything's different. So it's not like they're blowing it off, thankfully. And they are awesome. I love my doctors. All of them.

But I'm having so many contractions that they keep changing the terbutaline dose. And I can't keep taking the Indocin (though I suspect I'll be back on it for another 48 hours next week), even though it worked. Unfortunately, I've gotten to a point where the terbutaline side effects may be outweighing the benefits. I was having difficulty breathing, so they've lowered the dose a little, but my contractions are going up even though breathing is a little easier. I can barely keep any food down. My head hurts constantly (and these aren't "just" migraines... this is definitely terbutaline-induced). I'm afraid that we're to the point where even though I haven't topped out pharmacologically on the terbutaline, I may have topped out on how much terbutaline my body can handle.

So we'll see. I'm trying not to be frustrated. I'm trying not to be angry at people for their good intentions. I'm trying not to be too anxious about these babies. I'm trying to remember that I chose my doctors because I trust them and have nothing but faith in the care I receive from them. I'm trying to remember that there are more options after the terbutaline and even if those options require that I go into the hospital temporarily or permanently, it doesn't matter. All that matters is keeping these babies in for another 6 weeks.

Doctor's Appointment

The long and the short of it (no pun intended) is that my cervix is still short (around 2.4cm), but it's stable, which is great news. Babies all look fine, good heart rates and good amount of amniotic fluid. Dr. P. was working today, which was a relief (he was the doctor on call this past weekend, so I'd been hoping to speak with him directly today, and I got my wish).

He spent a lot of time talking to me about the changes he'd made to my protocol and why and how he hoped things would progress over the next several weeks. We're on the same page with the whole, "even though the survival rates for 28 weekers are very high, it would be very bad to deliver right now." He still wants to get me to 34 weeks before delivering, and I'm all for it.

Two babies are head down and the placenta previa has finally completely resolved itself, so I told him I don't need no stinkin' c-section. He reiterated that vaginal triplet deliveries are tricky at best and not always advisable, and I said, "well, I can dream, can't I?" "Oh yes, you can can dream. And I always wanted to be 6'4"..." Anyway, he didn't say no, but did emphasize that I shouldn't get my heart set on it. He has done vaginal triplet deliveries and he's not dead set against it (for that matter, he's done a vaginal quad delivery), so it's not like he can't do it, but he wants to make sure I realize that it's a very rare occurrence that things really line up in such a way that it's remotely advisable. I understand that, but I really want to keep the door open for as long as possible, even though I know it's probably not going to happen.

He explained that I can't stay on the Indocin long term, as it tends to result in a lower amniotic fluid level, but that if we need to repeat the Indocin regimen of 48-hour treatment on a weekly basis, we can do that until about 33 weeks... after that, there are bigger problems, but then things get a little less problemmatic if I go into labor anyway. He also explained why he didn't want to do steroids yet... although steroids are good for about 4-6 weeks after they give them, they are problemmatic for a couple reasons: 1. they'll definitely raise my blood sugar (which isn't the end of the world for me, since my blood sugar is stable and normal right now, but why tempt fate if we don't have to yet?) and 2. steroids have a tendency to increase contractions both in frequency and intensity for several days to a week after administering them. I love irony. So he said steroids aren't quite as magical as everyone thinks they are. Still, he'll definitely give me steroid shots at or around 30-32 weeks to give the babies the added edge in lung development that they need, but his preference is to put it off until as late as possible.

He said one of the problems I'm facing is that my uterus is distended further than it would be if I were full-term with a singleton right now and it really does think it's done, and that's likely a huge contributing factor to the contractions. He said this is definitely aggravated by the fact that I've got a very small pelvis to rib size (read: I'm SHORT), so there isn't even much more room for things to expand, even if it wanted to. With all that pressure on my uterus and, in turn, all that pressure on my cervix, it's no surprise that sometimes my contractions get out of control, and the best they can do is try to control it with the medications they have available for the time being. Definitely, though, bed rest is doing a good job, because my cervix is hanging in there and is much improved from how short it became right before I got thrown on bed rest. So I have to keep hanging out in bed/recliner for the long haul.

Oh, he also talked about the fact that most women have more contractions at night... 4pm-4am you definitely see increased uterine activity. I definitely have noticed EXACTLY this, and thought I was losing my mind. But he said it makes sense if you want to take *any* lessons from evolution, this is one you probably could take seriously... that most mammals need to give birth under the protective cover of night. Even though this isn't so relevant to humans (at least not today), it's still a documented scientific fact that uterine activity increases between 4pm and 4am. There are also more labors that start in the middle of the night than, say, mid-morning. Interesting! This is why when all hell was breaking loose with me on Saturday night he said he wanted to raise my basal rate on the terbutaline and then let me sleep if I could and see how I was doing in the morning, because doctors are much more concerned if contractions are at a high rate during the morning hours... they tend to be much more troublesome. Since I was still over threshold in the morning, that's why he called in the Indocin.... because the morning pattern was much more indicative of a problem than the evening-into-late-night pattern had been.

The other thing he'd done Sunday morning was raise my threshold to 8 contractions per hour... and the reason he did that was because he said at this point with triplets it's a lot more realistic to expect to see 4-6 contractions per hour regularly, but 8 per hour is definitely alarming, so rather than getting up in arms about something which could be normal (and bear in mind that all weekend I was above 8 anyway, so I was still justified in being concerned), raising the threshold would allow us to focus in when there really was something that needed attention.

Anyway, that was the appointment. It was a good appointment overall. Dr. P. wasn't saying he's not concerned, because he is, but he's definitely on top of things, which gives me a lot of hope and peace of mind. Meanwhile, we'll take it one week at a time, and if necessary, one day at a time.

And now, I really, really, really must go to bed.

Almost 27 Weeks- can you believe it??

I had a ridiculously long appointment yesterday. It's really sad when the biggest excitement of my week is going to the doctor. But it's also the most exhausting part. Whew, it takes a WHOLE lot of energy for me to get up and out of my house these days! It's pathetic. Anywhozit, yesterday was a long appointment because it was more than just my normal weekly cervix check. It was:

1. 1 hour glucose screening
2. Normal prenatal BP/Urine/Weight Check
3. Fetal Fibronectin culture
4. Cervix check
5. Growth scan for the kiddos

A long appointment. Should get the glucose and fetal fibronectin results today or tomorrow. I expect that the glucose test will not be pretty and that the fetal fibronectin will be fine. Blood pressure was fine, as usual. I've lost another 2 pounds, but I didn't get yelled at this time. My doctor isn't concerned as long as the babies are growing and I'm not anemic (they drew extra blood along with the glucose screening to make sure that I'm not anemic). My cervix was slightly shorter than last week, but still relatively stable. And the kiddos are growing nicely.

Baby A is estimated at 2 pounds 2 ounces (50th percentile)
Baby B is estimated at 1 pound 14 ounces (38th percentile)
Baby C is estimated at 1 pound 13 ounces (37th percentile)

Heartbeats were all lovely in the 150s and 160s. Baby A has listened to my complaints and turned back around and is head down. Whew. Baby B also has sort of turned back around and is somewhere between head down and transverse. Baby C is mostly transverse, slightly breach. They're kind of in this weird little circle... Baby A's head down in my cervix, feet up against Baby B's head who's feet wrap around to Baby C's head and baby C's feet wrap back down and around toward Baby A. Kind of weird.

Contractions have been weird. I'm usually okay in the morning with a few or no contractions. But check out this pattern:

Friday night: 5 contractions, gave demand dose, remonitored, 3 contractions, still really crampy, slept through it.
Saturday morning: 4 contractions (threshold), gave demand dose, remonitored, no contractions, cramping, raised basal rate.
Saturday night: 7 contractions, but hadn't sent strip in until the next morning, so no remonitoring involved.
Sunday morning: 3 contractions, no big deal.
Sunday night: 5 contractions, but hadn't sent strip in until the next morning, so no remonitoring involved.
Monday morning: 2 contractions
Monday night: ELEVEN contractions, but hadn't sent strip in, so no remonitoring involved.
Tuesday morning: no contractions.

So now I get to start sending in my evening strips as well as my morning strips. Which means I have to monitor earlier in the evening (I usually monitor around 9pm or 10pm, but if I'm going to send them in, they prefer to receive them by 9pm. I don't like to monitor right at 8pm because that's when I receive an auto dose, so I don't think that gives an accurate picture, so this means I have to monitor at 7pm tonight. Yippee.

Oh, and while I was writing this entry, I got a call from my nurse... Yep, I failed my 1 hour glucose screening, apparently not by very much. But here's the kicker... normally this would mean taking the three hour glucose tolerance test, except I'm not allowed. Because that would mean sitting in the lab for four hours. And I'm not allowed to sit for that long. So instead, I get to have Matria (the company that does my contraction monitoring and terbutaline pump stuff) come out and edumacate me on gestational diabetes and using a glucometer and blah blah blah. And then I get to check my blood sugar four times a day for a couple weeks while they decide if I have gestational diabetes. And if I don't, I still get to keep checking my blood sugar just for fun, because I can! And if I do, well, the fun's just beginning!

The bitch of it is that they suspect that the terbutaline plus the whole triplet thing is what's likely caused the elevated blood sugar. I've been losing weight throughout the pregnancy, and have no family history of diabetes nor gestational diabetes. I don't eat sugary sweets or really many excess carbs in the first place. So let's say it's the terbutaline's fault. What would I rather have: high blood sugar and relatively controlled contractions, or low blood sugar and completely UNcontrollable contractions? Yeah, that's what I thought. Not a difficult choice to make. And anyway, I needed something else to do with my day, right? Wouldn't want to get bored!

I knew it was a high likelihood that I'd blow this here 1 hour test, but I was so hoping I was just being a negative nelly. Because seriously... have I mentioned that one of the problems with gestational diabetes is delayed lung development?? And have I mentioned that AT BEST these babies are going to be 6 weeks premature? Yeah. Aside from that, at this point, I have weekly cervix measurements, weekly urine protein checks, daily blood pressure monitoring, twice (sometimes more) daily contraction monitoring, and now I'll have 4x daily blood sugar monitoring. Seriously... is there ANYTHING they're NOT going to know about me by the time this pregnancy is over with?

Right. Well, you know, it's all good. It'll just give me more toys to play with. :)

Enough of the Self-Pity (Updated at Bottom)

Right. Well, that's quite enough of the self-pity. Or at least, that particular variety. I will now move on to an entirely different kind of whining. Pregnancy whining. Okay, I get it, there are lots of you out there who would give nearly anything to have the opportunity to whine about pregnancy, and I get that. So I'm sorry if it offends you that I don't find all of pregnancy all sunshine and light. Maybe I would if I had a singleton pregnancy, maybe I wouldn't. What I do know is that we infertiles HAVE to give ourselves permission to accept that there's nothing wrong with us for finding out that sometimes pregnancy isn't glamorous and sometimes parenting isn't perfect and sometimes we aren't always gracious about either one. Therefore, disclaimers aside, here are some of the good and the bad of late:

Good: I had a pretty decent week last week in terms of contractions and other such things. My appointment went well, my cervix had stablized and in fact lengthened somewhat, I even got a little cocky about it ("I don't need no stinkin' bedrest!") but not to the point that I violated doctor's orders. Contractions weren't done and over with, but I was generally having a good week, and they were definitely under better control than they had been.

The Less Good: The operative word in that last sentence, of course, is that they were under better control. Until Friday. I monitor contractions twice a day. I'm required to send them in every morning, but not in the evening unless I'm feeling symptomatic. I can also monitor any other time of day if I'm feeling off or feeling contractions or just feel like it or whatever. Friday around 5pm I felt a few contractions, but I sort of ignored them, because that's not terribly uncommon and I didn't think much of it. But then a little before 6, I had a few more and I thought, well, that's 4-6 contractions within the same hour, so I probably should call about getting a demand dose of terbutaline. After any demand dose, I have to monitor and send in the data, so that meant my evening data WOULD get sent in, which was fine.

So I called, asked if I could give myself a demand dose, was told yes, and then told to monitor from 6:30-7:30 and send it in. Fine. Except I couldn't get the pump to GIVE me a demand dose. It's a different button than the rest of the buttons and that button stopped working. So they had a work around for it, but that took some time, which put off my monitoring time until about 7ish to 8ish. Which is fine, but Shabbos (the Sabbath) was starting at 8, so the timing wasn't fabulous. I am allowed to do all the medical stuff I need to do on Shabbos, even though a lot of it isn't stuff I'd normally be allowed to do (e.g. using the phone). It's just that there are a couple things I had to do right at 8 (like light candles to bring in Shabbos), so it wasn't terribly convenient. Still, I made it work.

I expected that the monitoring session would yieled nothing interesting since I'd just given myself a demand dose and usually that takes care of the contractions immediately, but the nurse called back and said I had 5 contractions, which is above my "allowed" threshhold. Which meant I was going to have to re-monitor. Great. Except it's Friday night, late, I have a cranky 4 year old, my husband is at shul (synagogue), and I have to deal with remonitoring and once my husband gets home in theory we're supposed to eat a "festive meal" in honor of the Sabbath. (Someday maybe I'll explain the whole sabbath thing to my non-Jewish readers, but really, if you're wondering if I'm completely nutso, yes I am, but if you want more details, just email me... there's a link to my email address in my sidebar) Since 8pm is when one of my automatic doses happens anyway, the nurse wanted me to wait until about 8:30 to monitor again to give the dose some time to work its magic. And so, at 8:30, I strapped the monitor back on while attempting to appease J with some tortellini and some books and a couple cars (yes, he should have been in bed, but it's not like I can struggle with him alone these days).

And at 9:30 I sent in the data again. And while waiting for the phone call back, we started to sit down to dinner, and then, of course, the phone rang. The contractions had gotten much better..3 short contractions, which is under the "allowed" amount (thank heavens, because otherwise, doctor's orders would have mandated a phone call to the doctor on call and I REALLY didn't want to deal with that!), but the nurse didn't love that I'd been having a lot of cramping and it wasn't getting a lot better. So she waffled for a bit about calling the doctor anyway, but I talked her out of it (my doctor didn't seem OVERLY concerned when I'd mentioned it before, plus I promised to call if I couldn't sleep through it which is always my gauge of whether I should be waking up a doctor). She had me give myself another demand dose and encouraged me to call if it got any worse through the night. Fine.

And the next morning was more of the same. Too many contractions, demand dose (which they still had to use the awkward work-around to do, because the demand-button wasn't working) remonitor, better but not perfect, still a lot of cramping, so they changed my basal rate on the pump and got to work on getting a new pump programmed and couriered out to me. The increased basal rate did seem to help a bit throughout the day (it had also been increased the day before, so it had cumulatively been increased about 30% from two days prior). I didn't do an evening monitoring until quite late because I had people here visiting on and off throughout the day. I felt a little funny, but decided not to send in the data until morning since I wasn't required to and since it was so late. I figured I'd send it in the next morning. Turned out it was both a good and a bad choice not to send it in, because I'd had SEVEN contractions (nearly double my "allowed" threshhold) and a lot of irritability. So if I'd sent it in, I would have ended up having to do a demand dose and remonitor at midnight risking calling the doctor at 1 in the morning and blah blah blah. On the other hand, I'm lucky it didn't become a huge deal, since I didn't send it in... Anyway, this morning, all was clear, so life is good. I think I'll do this evening's monitoring somewhat early and go ahead and send it in just for the fun of it.

More Good: I did get the replacement pump around noon yesterday and it's working just fine. I've haven't been alarmingly uncomfortable today. I've got all the usual "hey I'm pregnant with triplets" discomforts, but nothing that's making me go "hey that's not good!" Also the babies have been kicking like mad and I'm pretty sure at least one of them has turned back around, so I'm hoping the others follow suit and SOON!

The Slightly Less Good: Baby A has discovered that JUMPING on my cervix is much more fun than punching it. I'm fairly certain that Baby A is still breech and is remaining that way simply to torture me. Youch!

Good: J is absolutely fascinated by my ever-expanding belly. "Oh Eema, your belly is getting bigger! It's a giant belly now! Why is it getting so much bigger??" Yeah, uh, now that I think about it, I'm less convinced this belongs in the "Good" category! ;) Anywhozit, I said, "Well, what's IN Eema's belly?" He giggled... "Bigger Babies!" "That's right, so Eema's belly has to get bigger so they can keep growing, right?" "Of course, Eema! You need a bigger belly so the babies can grow," he said as if it had been all his idea and he was telling me how the world works. He's really cute.

The Less Good: I absolutely cannot shake this cold. I feel disgusting, and it's making it even harder than usual to keep food down, and worse, it's making it difficult even to keep fluids down, which is bad, because the best thing I could possibly do for a cold is drink a lot of fluids. Sigh. So now in addition to waking up a lot with cramping and full bladder and general discomfort and leg cramps, I also wake up because I can't breathe, I'm parched, and my throat hurts. It's lovely. I'm not sure why I even bother trying to sleep anymore.

The Really Good: I haven't been admitted to the hospital and I'm 26 1/2 weeks. That so rocks.

More Good: I'm no longer completey nauseated every time the babies move. This is a good thing, since they do it ALL THE FREAKING TIME, especially at night. Actually, I kind of love it now, and I think I might miss it some day. I mean, I could still do without the cervix stomping, because honestly, I'm not kidding when I say that really hurts. I mean REALLY hurts. But at least I know the kiddos are still moving around, right?

The Somewhat Annoying: Heartburn really sucks. Definitely in Stretch-Mark Land. I have a weird little hematoma right above my ever-shrinking (but not yet popping-out) belly button and I have no idea why or where it came from. Pregnancy has made my belly embarrassingly furry. I wish there were something I could do about this, but I figure my doctor has probably seen scarier bellies. Right? RIGHT? I'm still getting about 3 migraines a week and tylenol with codeine isn't touching them but I don't have a lot of other pain-relief options. I'm also getting lower-grade headaches from the terbutaline, but those are easier to knock out. The terbutaline also gives me a very annoying side effect of making it uncomfortable to breathe... as if I'd been breathing heavily after running a long distance or something for a while. It's like my throat or lungs HURT when I breathe. It's not like I can't breathe, it's just an unpleasant sensation that I keep hoping will go away and it hasn't. The other terbutaline side effects have at least gotten less annoying even if they haven't subsided completely, but this one is just as annoying as ever.

The Good: My husband? Completely rocks.

On a Completely Unrelated Note:
An anonymous poster has asked me twice now why there are 4-hour auto-doses in addition to a lower basal rate on the pump, rather than having just a higher basal rate that incorporates the auto doses over a longer period of time. I'm not ignoring the question, I'm actually trying to find a real answer rather than just having my own random guesses. My husband is a pharmacist, so you'd think this would be an easy one to get an answer to, right? Not so much. Never mind that he was sitting shiva for a week, so he couldn't do any looking up for me, even now that he can he's super-busy and the bit of research he's done hasn't turned up a lot of clear-cut answers.

What he has found is that generally the auto-doses are recommended to be timed with the peak periods of uterine activity if it is possible to predict that pattern (it often IS possible to do so, apparently). This makes a bit of sense to me as one suggestion that was made by my nurse at some point was to change the interval of the auto doses for more effective treatment.

He also found that taking 5mg pills every 4 hours is effective about 30% of the time for uterine contractions. But that terbutaline pump protocols are effective closer to 90% of the time, so for whatever reason, it works.

What he hasn't found yet (and admittedly, he hasn't had time while at work to wander over to the Health Sciences Library) is a clear cut answer about why it wouldn't work to just have a high basal rate given out 24-7 with only denmand-doses as needed for breakthrough contractions. But if he DOES find an answer, I'll let you know. Also, Erin has a PhD in Pharmacology, I believe, so maybe she can shed some light on this. Or maybe not. I don't know. But if anyone else does happen to know, please let me know, because at this point, I'm intensely curious. Inquiring minds want to know.

(I also just reminded my husband, so he's going to do some more digging around now to see what he can find... I'll update this entry if he finds anything really interesting)

And that's enough for now.

Update per Anonymous' Comment:
Comment left last night: Hey, that's great that you are looking into the auto-dose/basal issue. If there are other options that could serve you better, it would be good to know! Now, are there any at-home IVs you can use for when you can't keep fluids down?

I'm looking into the basal vs. auto dose issue purely as a curiosity. I'm assuming this is a long tested issue at this point as this is very standard protocol that is used regularly for a large number of patients and has been for al ong time, so I'm not guessing that it would make more sense to raise the basal rate and eliminate auto-doses. It seems clear that the protocol of auto-doses combined with a low basal rate does work for most patients. It may be that it lowers the side effect profile to do it this way, and since the side effects aren't real pleasant, that's a good thing. At any rate, I've got my husband on it this week. He's still playing a bit of catch up at work from being out after his father died, but I'm sure he'll find some time to walk over to the library if I nudge him a little.

As for at-home IVs... the short answer is, yes, there are at-home IVs, but I don't warrant one. If my nausea were so extreme that I were never keeping fluids down and I were severely dehydrated and had an electrolyte imbalance, they could do an at-home IV-line for Zofran (which I currently take orally). If that didn't work, they'd admit me. However, my periods of not being able to keep fluids down are generally short-lived and haven't resulted in real dehydration/electrolyte imbalances, so an IV line would be a bit on the extreme side (nor do I want one! I'm already the bionic woman!!). At any rate, yes, it's an option, but not a likely one for me. Good idea though!

Followup to "Envy"

Some commenters say that my fertility envy will fade with time. Other commenters say it will never go away. Some say when I get to my ideal family size I'll feel better. Funny, I always wanted four children, which I'll have after this, but I never considered that it would be only one pregnancy. I suspect that it varies from person to person... there's no right answer here. And I definitely don't begrudge most people their pregnancies. Not even fertile myrtles. Not even, heaven help me, Michelle Duggar. But I grieve my inability to just BE pregnant. I grieve the freedom to say, as the Duggars say, that I'll have chilren until God tells me not to. I don't want 17 children per se. I want the freedom to make that choice. And I grieve the loss of that choice.

One anonymous commenter wrote:

It will fade, you will feel better over time.
For me pregnancy was almost the time to rehash and process all my infertility feelings. And of course, you're not a mother yet. Sure you wanted pregnancy, but what you REALLY wnated is the small head in the hollow of your neck, a baby nuzzling at your breast, a toddler shouting MUMMY and running over to hug you.
Those are the things that will heal you, not a terbutaline pump in the leg and bedrest.

The thing that struck me the most was : And of course, you're not a mother yet.

Oh but I am. If you're newish to my blog you may have missed it, but I have a beautiful almost-four year old foster son. He's not really a foster son, exactly, because he was a private placement, but I'm his legal guardian. I may not be his biological mother, but I've been his mother for almost 3 years. He knows no other mother. I could not love him one teeney bit more if I had given birth to him. I have no doubt that I could adopt a dozen children and love them just as much. I also know that I still would have grieved the loss of this pregnancy experience had I never gotten this far. Even though it makes no difference in how much I love my beautiful boy. J will probably be with us forever. He is my son in every sense except the legal sense. He knows no parents but us. There is no greater joy in this world than being a parent, and still, the pain of infertility is as raw as it ever was.

It's rare that it is someone else's pregnancy that brings out the pain for me. It's usually something far more personal, something intrinsic in myself. This time it happened to be someone else's pregnancy. Someone who got pregnant within six weeks of getting married. She certainly didn't do it to upset me. And it's certainly not her fault that it did. And most people in the community don't even realize that I COULD be feeling left behind in the child-bearing department. After all, we've been parents for three years. And now we're having triplets. So how could we possibly feel remotely out of place amongst those having their their third, fourth, fifth...?

It's true though... it's these babies that will ultimately heal me, not the terbutaline pump and the bed rest. The terbutaline pump and the bedrest do nothing but remind me that this is NOT a normal pregnancy and that I'm STILL set apart from most pregnant women. But I'll love these babies. Of that there is little doubt.

26 Weeks - How it's Going

Sorry for the delay in actual pregnancy updates... several of you have asked. With my husband sitting shiva, it's been hard to get real time to post anything significant. Things have mostly been okay, but have been a bit up and down. It seems like every time I want to post "Yesterday was a really good day" I end up having a really crappy day, so then I need to post "Yesterday was a really crappy day" except then things turn back around, so I just can't keep it all straight. ;) This is not an entirely bad thing.

The good news is that the up and down is largely confined to the contraction side of things. This is good news primarily because of the terbutaline pump. There's a lot of leeway in how I can deal with dosages on the pump (or rather, how the nurses at Matria, the monitoring company, can deal with dosages). They have a lot of leeway in the doctors' orders in terms of giving additional "demand doses" or changing basal rates or auto-dose rates. So we've been playing around a lot with that. We've increased my basal rate twice and yesterday increased my auto-dose rate by 10%, but there's more wiggle room still if that doesn't work.

What's been tending to happen is that I go a day or a day and a half with no, or only one, contraction during each of my two daily monitoring sessions (which doesn't mean I'm having zero throughout the day, but that's another story), which is great. But then I'll go a day or two with 5-6 during each monitoring session, which is when we start moving doses around. Most of the contractions aren't painful, but they are fairly uncomfortable. What's more painful is that I have a lot of cramping all of the time, which wakes me up a lot too, but even the increases in basal rate have helped that, so it's likely that the cramping is low-level contractions that don't really register as contractions themselves on the monitor (if they're less than 40-seconds, they don't call them contractions). See, and here I thought I got pregnant to avoid being plagued by painful menstrual-like cramps. Sigh.

The really astoundingly good news is that bed rest certainly seems to be doing its job, which is good because I really, really don't want to be admitted to the hospital just now. Each appointment that I've had since that first alarming appointment where my cervix had gone down to 1.5cm has shown definite improvement in cervical length. I didn't even know that could really happen. My last appointment, on Monday, it was, at its shortest, 2.8cm. Go me! This has also enabled me to return to weekly appointments instead of twice-weekly appointments, which is good, because with S dealing with shiva, I wouldn't have wanted to abandon him too often.

What really astounds me is that I remember my first appointment with the perinatologist was at 8 weeks, 5 days, and this week's appointment was 25 weeks, 5 days. 17 weeks have passed, but it feels like a lifetime ago. 17 weeks ago, I didn't even have a clear idea whether all three were going to make it. 17 weeks ago I didn't even know if it made more sense to consider a reduction and I was getting tremendous pressure in all directions to reduce. 17 weeks ago, I finally walked into an office that didn't say my only option was to reduce the triplets. 17 weeks ago I had no idea if I was making the right choice, but today I have no question that I made the right choice. I didn't know then if these little monsters had any chance of making it, but now, I have little doubt they will, though I have no idea what issues they'll be facing on the other side. 17 weeks ago, I was in despair... yesterday, I was conspiring with Jess to create a baby registry, something I couldn't possibly have contemplated even a month ago, let alone 17 weeks ago.

I remember clearly the day that it became obvious that I was attached to these little monsters. I blogged about it, even. April 19th. That's when I realized it was okay to be attached to these little parasites... the little parasites I was still too terrified to refer to as babies. Now I often refer to them as babies, but I can't remember when that shift took place. What I do know is that shift wasn't insignificant. I never thought I'd call a baby a baby until it was born. I never thought I could bear having that level of attachment before it was a "sure thing". But here I am, with three babies kicking me regularly, and that's what they are to me... alternately babies and monsters (in the most endearing way possible, of course).

But I digress. Back to how I'm doing.

Contractions... today not bad, tomorrow, we'll see. Check.
Cervical length... getting better, apparently bed rest works. Check.

Babies (!)... They are terrific. I haven't had a growth ultrasound since the 11th, but will have another on Monday, so I'll know more then, but they've all got perfect heartbeats, plenty of amniotic fluid, and they're all quite active, so there don't appear to be any serious concerns in that regard. Or minor concerns, for that matter. The one seriously annoying thing is that as of Monday, they had all turned breach. Even Baby A who has been head down for MONTHS! I know they all have PLENTY of time to turn right back around, but I'm bitter. Bit-ter, I tell you! They'd better move back around and fast. One good thing about it, though, is that Dr. M. thinks that it's possible that part of the reason my cervix lengthened again this week was because the pressure had been taken off of it with the baby's head not constantly pushing down on it, so I guess I can't entirely complain. At first with them all turning around I couldn't feel them moving much, but I think they must have shifted somewhat again, because now Baby A is most decidedly kicking me directly in the cervix on a regular basis, which is more painful than head-butting and honestly, more painful (and more persistent) than punching. So I'm not loving that. But the other two must also have shifted somewhat, because I can feel them fighting with each other again. I doubt that they've turned all the way around again already, but they've definitely moved somewhat since Monday.

Next Monday, they'll do another fetal fibronectin test, talk to me more about steroid shots (though they're still trying to put those off until at least 30 weeks if possible), and they'll do the 1-hour glucose tolerance test. Yum. I wish I could just skip to the 3 hour, since I'm at such a high risk for gestational diabetes in the first place (triplet pregnancy, PCOS, overweight to begin with...), but it's all good. Hopefully it won't be an issue and I'll only have to do this once. They will also, as I said, do the growth ultrasound on the babies, so it will be a long appointment, which is fine with me, because it's the one excursion out of the house that I'm allowed.

The current bane of my existence is that I have a nasty cold, which I think is just adding insult to injury, and I'm quite bitter about it, but hoping that it will be short-lived. I hate colds because they are utterly miserable, but they are "just colds" so you can't really complain about them without being a big whiner. Unless you're pregnant with triplets, in which case, I think you're perfectly justified in whining about basically anything. At least, that's MY excuse!

And that's where things are right now. I'm slowly catching up on blogs. I haven't been purposely ignoring anyone, it's just that things have been a bit crazy with everything going on between my dramarama and my husband's father's death. So hopefully things will calm down soon A girl can dream, right? Today my big plans are to be able to take a nap at some point.

Some Things of Note and Ultrasound Pictures

Lots of local people have asked me about visitors... I'm all for visitors but not until the week of August 5th since my husband will be sitting shiva here. I would prefer not to have huge crowds of people here at once, but I'm all for having company since I do so love attention! Feel free to email me if you want more details. Please note that I'm not offended if you have neither the time nor the inclination, I am merely responding to the inquiries I have received.

My husband's father's funeral is finally set for tomorrow at 2pm in New Hampshire. He's flying out tomorrow morning and coming home in the late evening. Thank you to everyone who has sent such kind words and condolences our way. Your thoughts are much appreciated. It is very difficult for me to watch Seth learning how to react to this change in his life as I struggle to consider my own parents' eventual mortality (as LJ so eloquently put it). God willing, I will not learn for many decades how I will react to this kind of a loss.

I am happy to report that this morning I had only one contraction whille monitoring. Go me! I know it sounds ridiculous, but I've been trying to use biofeedback techniques that I use for migraines when I start noticing contractions... I think it actually helps. I remain more and more convinced that if I had a normal singleton pregnancy I could totally do the drug-free birth. I haven't lost hope for a vaginal triplet delivery either... though I don't know how long I'll be able to get away without losing that hope and I know they'll at least make me have the epidural in place even if there are no drugs running through it.

And on to pictures!!

Here lies Baby A. Baby A, the little beast, is firmly lodged against my cervix and spends plenty of time reminding me of this fact, normally head-butting me, but often punching me with a fist. REPEATEDLY. I do not like it, sam I am. I do not like it at all! Yesterday, babies A and B were fighting like mad with each other. It was like watching a boxing match, only slightly less choreographed. Baby A is definitely on my list, though. I'm going to be holding a grudge for at LEAST a minute after the delivery. So there.






Here lies Baby B. Baby B is the good one. Except yesterday he (RANDOM pronoun there... We DON'T know sexes!) was punching his sibling, so now I'm not so sure. Baby B and Baby C spent a lot of time kicking me, and they love to kick things off my big belly. For example, I tend to rest my mouse on my belly while I have my laptop in my ever-shrinking lap, and they will literally kick the mouse off. Sometimes it's a team effort, but I think baby B is a little stronger than Baby C. Or maybe just better positioned with more leverage. Who knows? Anyway, for the most part, Baby B behaves. He (STILL A RANDOM PRONOUN) is always the one willing to pose for the sonographer and always lets us get a really good look at his heart. Clearly, Baby B takes after ME since he is so cooperative. Somehow, I am not certain that I have convinced my husband of this certainty... Ah well.


And here lies Baby C. I think Baby C is blowing a Spit Bubble which makes Baby C a serious trouble maker. Definitely Baby C takes after J. I HATE SPIT BUBBLES! Babies B and C are usually the ones that fight, but yesterday, Baby C was quite content all by himself (SERIOUSLY, people, it's a RANDOM PRONOUN). Anyway, Baby C had all sorts of space since Babies A and B were dueling down below. It was kind of funny, actually!










And, the picture I've been waiting 6 months for! All three heads in a row! They are all head down, which is why I'm totally NOT giving up hope for a vaginal delivery. Without drugs! It totally CAN happen! I'm telling you! Seriously! I'm seriously going for it. If, you know, I make it that far. I have to get to 34 weeks for them to agree to it. So here I lay, hating bed rest, but very grateful that it seems to be doing what it's supposed to be doing! Keeping those babies on the INSIDE.



And that's pretty much all the news for now. I hope you're all well. I'll catch up on blogs in a bit!

Don't Freak Out!

Apparently I freaked out Jess today by not being as available on IM as I usually am, or at any of the usual times. And I hadn't posted or emailed her. And you know, things haven't all been going swimmingly with me recently, so this led her to the natural conclusion that there was the vague possibility that I'd ended up back in the hospital and frankly, she'd had a shitty enough day that this was news she simply could not and would not tolerate. So there. She sent me an email around 9:30 saying "Where in All of heck are you?" among other things.

So here I am. I'm okay. I'm very slow to respond to email these days in part because emailing and lying down are sometimes mutually exclusive. I wasn't on IM most of the day because I wasn't feeling great but also because my computer was being super-finicky and ticking me off and because I had a doctor's appointment. I solemnly promise that tomorrow when things have calmed down a bit, I'll give Jess my password for my blogger account and I will call her if I have to be admitted to the hospital and can't post. She will post for me, if she's willing (and I'm assuming she will be), okay?

One bit of warning... my husband will be sitting Shiva for a week starting this Thursday. My guess is that my online presence during that week will be somewhat diminished. SO DON'T FREAK OUT. I made my doctor promise me that there would be no disasters while my husband is sitting shiva. He's a trustworthy doc, so I can't imagine he was just humoring me, right? Er...

Anywhozit, I saw the doctor today, and the good news is that my cervix is still stable, so no cerclage. The less good news is that I'm still having contractions between auto-doses of the terbutaline pump... not so many that anyone's super concerned, but enough that it seems like the baseline dose probably needs to be increased, but I'm not so much looking forward to the increased side effects. But whatever it takes to keep these babies cooking a little longer!! The not good news was that I lost 6 pounds in a week. While on bed rest for crying out loud! Now, normally a girl of my girth would be jumping for joy at a 6 pound loss. Except, well, I'm not allowed to jump. And um, while my doctor wasn't fretting about me not gaining any weight... they don't love seeing a 6 pound loss in a week either. So I have to shape up, darnit! And take an extra prenatal vitamin, apparently. And, you know, not lose another 6 pounds this week. Since I have no idea how I lost that weight, I also don't know how to avoid doing it again, so this ought to be fun.

I'm slowly catching up on blogs... but I'm not commenting nearly enough. Very sorry!!

Details and Followup

Okay, so my last entry was rather abrupt and seriously lacking in detail. It was a rather visceral reaction to a not-very-good appointment which frankly captured my mood, but not so much of the specifics. So let me esplain! No! There is too much. Lemme sum up... wait. This is my blog, I can take all the time I want. So here it all is... or at least as much of it as has remained in my brain since then:

Sunday
Sunday evening, as you'll recall, I was having about 4 contractions per hour and I paged the doctor on call. Dr. M called me back pretty quickly and she told me that if it continued, I should definitely come in to L&D to be monitored, but agreed that if I could sleep through them that coming in to my already-scheduled appointment at 10am was probably fine. She said that if I could sleep through them, the contractions were probably not so worrisome, but that if they were keeping me awake, I should definitely come in, get monitored, get IV fluids and probably terbutaline. She told me that I'd be seeing Dr. R in the office if I was able to hold off until morning. I wasn't thrilled to hear that. I'd never met Dr. R and I love the other three doctors and I just didn't want to meet another doctor. I couldn't, after all, possibly like a fourth doctor, could I? I don't deal well with change. At all. I get very set in my ways, so adding a new variable was definitely not something I was loving. Still, I definitely didn't want to spend all night in L&D and laying down for a few hours did slow my contractions back down to about 2-3 per hour, even if I didn't really sleep through them (Seriously... who was I kidding? I don't sleep through the best of nights!)

Monday
Monday morning I got up, took J to camp, hung out in my recliner for a bit and then headed over to my 10am appointment. I was of two minds about this appointment. On the one hand, I was a bit worried about the fact that my cervix had started to act a little wonky last Wednesday, but on the other hand, I really didn't expect that there would be any significant change, either. Other than taking J to school, I'd been pretty much continually sitting/laying down on my tush since Thursday afternoon. I hadn't done any moving around to speak of, everything had been going really well. I expected, really, to hear from the doctor "gosh, I don't know what Dr. G. was so worried about, everything's looking great." Or at least to hear, "Well, I see why he was concerned about the change, but there's not been any additional progress since Wednesday, so you're still doing fine."

Instead, one look at the ultrasound, before a single measurement was taken, and even I could tell that it wasn't good. Wednesday's measurement had been around 3cm. There was no way that it was still that long. Worse, as we were watching, we saw it start to funnel and shorten even more. The doctor froze the image and measured. 1.5cm. A few more measurements revealed that it shifted between 1.5 and 2.3 cm. This is called a "dynamic cervix". I never google this stuff, but if you DO happen to google the term "dynamic cervix" you'll see it referred to often as a precursor to an incompetent cervix. However, the doctor said that she sees a dynamic cerix a lot with high order multiples in general.

I told her that I'd been having 4+ contractions per hour the night before but they had slowed to 2-3 per hour through the night. I asked what my guideline ought to be...how long I should put up with them occurring 4 per hour before I call, etc. She said that if I'm getting 3-4 per hour for 2 hours or more after laying down, drinking water, etc. I should absolutely call. She said also that in light of my noticeably shortened cervix, I needed to "limit my activity" as much as possible. It wasn't until later that I realized I didn't know what the hell that meant. I did ask whether I could still drive J to and from day care and she said she would get someone else to do it.

She said that we could consider doing a Fetal Fibronectin test which might be one indicator of my risk of going into labor due to a cervical issue in the next two weeks. But, we couldn't do it then, because you can't do the test if you've had any sort of vaginal exam in the last 24 hours, including vaginal ultrasound. She also wanted to research whether the test was valid with triplets. She knew it was with twins, but wanted to check with triplets.

So we left things at: 1. Limit activity as much as possible; 2. No driving J. to and from day care; 3. Call if contractions increase to 3-4 per hour persistently; 4. Return for a re-check in a week - and we could consider doing the fetal fibronectin test then before the ultrasound. I waddled off to get my weight and blood pressure checked (down a pound, but didn't hear what my BP was). The doctor wandered back in to let me know that she found an article written by John Elliot about fetal fibronectin tests with triplets and quadruplets, which seemed to indicate that test results are valid even with HOMs, so she was comfortable recommending that we go ahead and do the test before my next ultrasound. Fair enough. She made a bit of friendly chatter and as I was leaving asked if the triplets were the result of IVF or IUI. Interesting that it didn't occur to her that they could have been spontaneous, but regardless. I told her that they were from a last-ditch IUI and that in fact, I'd been pushing for IVF for some time specifically to avoid the triplet scenario if possible, but here we are. I mean, I am now very excited about my triplets, don't get me wrong. But I'll tell you what, all the excitement this week was excitement I could have lived without. So she said, "Yeah, if I had needed fertility treatment, which I didn't, I'm quite fertile with three children and no need for more, thankfully, I would have done IVF because I wouldn't have wanted to risk it with IUI."

What. The. Heck? Did she seriously just say that? Yeah. She really did.

Basically I left the appointment in a haze. I made a couple calls to make sure I could arrange to have J picked up from camp that afternoon. I let my husband know what was going on. And I IM'd Jess and FREAKED THE HECK OUT. And she, good calm friend that she is, listened. And told me I really needed clarification on what "limit my activity" really means, which was true. I'm a girl who follows directions very well, if they're very specific. You tell me I may never get out of my chair ever again and I won't do it. You tell me to "use my judgment" and that's where we've got a problem. I'm not objective enough. I fully admit this character flaw. So I called my nurse to clarify. She gave me more specifics, which didn't sound terribly restrictive to me, considering that I'd already been pretty restricted in the first place. Outside of going to and from work, up until this point, my activity level has boiled mostly down to sitting my tush in my recliner and staying there, with only occasional trips into the kitchen and whatnot. So the only real difference seemed to be that I shouldn't take J to and from daycare/camp and that I shouldn't go to work anymore. I was told I needed to use my judgment about working from home, but I decided I didn't want to risk the stress of it. I was given permission to go into my office for an hour on Thursday because my coworkers were planning a "surprise" party for me (I've since cancelled that). But otherwise, trips out should be pretty much restricted to doctor's appointments.

"What we really need," the nurse said, "is to keep these babies in at least a few more weeks."
"I'm rather hoping for another 8 or 10 weeks!" I said.
"Well, I don't know about 10 weeks. Right now, we need to get you to at least 28 weeks, and we'll take every week after that as a bonus."

I. Freaked. Out. This was the first time I'd ever heard anyone from the practice ever say anything about 28 weeks being even remotely in the picture. They get most of their triplet patients to 34 weeks. It never occurred to me that I could or would be the exception to that rule. I didn't know whether she was speaking from her own experience with the practice. Or if she was speaking from specific knowledge of my case and details. Or if she was speaking based on her discussion with another doctor (she'd had another doctor review the notes from the visit before calling me back). I didn't know where it was coming from, all I knew was that I'd never, ever, ever wanted to hear those words. The whole reason I never wanted triplets was because I never wanted to hear the words, "We're hoping to get you to at least 28 weeks" or anything of the kind. I spent the rest of the day completely freaked out. How was I supposed to go an entire week without knowing what was going on? Why was waiting a week prudent? What was I waiting for? To lose another cm? I couldn't afford to lose another cm on my cervix! Ack, the stress!

I exchanged several emails with several triplet mamas who gave me some good advice, recommended I look for more agressive advice from the doctors in the practice that I know better (I did NOT come out of that appointment liking the new-to-me doctor one bit). I worried a lot. I spent a LOT of time thinking about that 28 week remark. I could not get that out of my head. That's only 4 weeks away. It can't be. There's no way that could be real. She couldn't have meant it. Could she? Eventually, I wrote my blog entry here, spent some time with S and J, and then went to bed. I was exhausted, anxious, and frankly, tired of thinking about this anymore. I would just see how I was feeling in the morning and take it one day at a time.

Tuesday
Things were going less well in the morning. I was in a blind panic most of the morning, not made any easier by the fact that the contractions had increased a lot, both in intensity and frequency. I kept thinking about that 28 week remark. I kept wondering what would happen if I waited a week. I continued to wonder when I should call the office about the contractions. I didn't want to be alarmist, but I didn't want to miss anything either. I have a tendency to second-guess myself when it comes to calling doctors because I spent a number of years getting called a hypochondriac as a kid (when all along, it turned out that, in fact, I really was sick all the time). The contractions did me the courtesy, though, of striking on the hour, every hour. Which made it easier to notice that they were every fifteen minutes. At first I thought that was crazy; it seemed a bit too coincidental. The next hour, I realized that they were closer together; almost exactly 10 minutes apart. And so I called and left a message for my nurse. And waited. And I emailed Jess and apparently freaked her out, because she immediately jumped on IM and told me that I shouldn't wait too long, I should just go straight to L&D if I didn't hear back soon. At 11:58, I called back, figuring I'd better try to catch them before they closed for lunch. My nurse said she'd talk to the doctor and call me back. Tick tock. Tick tock. Jess IM'd a list of items I should pack in a bag to take with me in case they sent me to L&D. She reminded me to call my husband (I had remembered to call him, but admittedly, it wasn't that long before Jess told me to call him that I'd realized that it hadn't occurred to me up until that point!).

My nurse called back and told me to go in to the office where they were waiting for me, so they could reevaluate me. This meant I had to see Dr. R. again, which wasn't really what I wanted given how uneasy I'd been with her the day before. But, in I went. I am nothing if not compliant. And I'm really glad I did, and very glad I saw Dr. R. in particular, because it gave me a chance to revise my first impression of her completely. She was thorough. She took a lot of time with me. She clarified a number of things. She talked me through what was going on, what the plan was, why they were going to do what they were going to do that, and this was all during her lunch break.

She went ahead and did the fetal fibronectin test before she did anything else, since it had been more than 24 hours since my last ultrasound. Then she did an ultrasound to check my cervix, and miraculously, it had lengthened since Monday! It was, at its shortest 1.7cm and at its longest it was 2.5, but it spent MOST of its time in the 2.x range, whereas on Monday it spent most of its time in the 1.x range, so this was quite the improvement. You could SEE the relief cross over the doctor's face immediately. This obviously still means that it's significantly shorter than it was last week, and even moreso than two weeks ago, so I'm not saying that I'm out of the woods or anything, but it is AWESOME. Unfortunately, this didn't get around the problem of the contractions which were coming one on top of another. "Contractions by themselves are not the enemy necessarily," she said. But when you put it all together you have to start thinking about the impact they have. So the first goal is to calm down the bulk of the contractions with a tocolytic. So I'm now on Procardia (Nifedipine) extended release tablets. That should calm most of the "background contractions" which will allow them to concentrate on the breakthrough contractions which are more likely the ones that they need to worry about. And for those, I've got immediate-release Procardia.

I will also be using a Home Uterine Activity Monitoring Service (HUAM). There are mixed reviews on whether HUAM does any good. The possible benefit that comes from HUAM is debated... some researchers believe the benefit actually comes from the close contact that patients have with a medical professional on a daily basis. Some researchers, in fact, believe that there may be a possible negative effect on patients because it could cause additional anxiety. Dr. R. said that this practice does frequently use HUAM, but that she came from a background of practices in which they did not frequently use HUAM. She wanted to make sure that I understood that I should not allow the monitoring to cause any additional anxiety. I told her that as far as I'm concerned it's nothing more than a datapoint to help piece the puzzle together. She agreed that this is precisely how it should be viewed.

She then took some time to really talk about what I can and cannot do. She said that whenever possible, I should do nothing, but recognized that I have a four year old in the house and sometimes that's not 100% possible. However, I should avoid anything that involves prolonged standing, excess stairs, I should do no lifting, no reaching, no cooking. I can get up to go to the bathroom, I can get up to get a sandwich. Combining trips would be good. I can stay in the recliner instead of bed if I am sufficiently reclined. Sitting upright is bad. Doing nothing is good. "You need to understand, however, that if you get up for a sandwich and your membranes rupture, you did not cause it to happen. It did not happen because you stood up, it did not happen because you wanted a sandwich. It will not be your fault." She said the truth is they don't know how much, if at all, bed rest helps, but that that it certainly seems that bed rest does a lot more to prolong pregnancy with higher order multiples than it does with singletons. (I realize as I'm writing this that I failed to ask about showers...)

She said that the next ten weeks were going to be a very long and tedious ten weeks for me and I said, "do I have another 10 weeks in me?" I told her about the 28 week remark that had so freaked me out the day before and she explained that a bit to me. First of all, on Monday they really had been worried. But more significantly, the nurse who said it comes from a NICU background and with preemies, the 28 week mark is a SIGNIFICANT milestone. The difference between a 24 weeker and a 28 weeker is astounding, she said. (A pediatrician friend of mine explained even more explicitly... she said with a 24 weeker, you spent the first week in electrolyte hell, and the next 6 months worrying about whether electrolyte hell caused brain issues, but when you get to or at least closer to 28 weeks, more of the prematurity issues you're dealing with are growth and development issues, rather than brain issues) She emphasized that it is absolutely still the goal to get me to 34 weeks, but that definitely the first milestone they want to get me to between now and then is 28 weeks. Then they'll be looking to 30 weeks, 32, and if I get to 34, she'll bring me a cupcake (which actually, she won't because she's moving back to Boston before I get to 34 weeks, but the thought is there). I felt a LOT better about the 28 week remark after that.

She also talked a little bit about the possibility of bringing me in-house for hospital bed rest. This isn't something they normally like to do for triplet patients if they can help it, but it's definitely under consideration for me. I bought myself some time, though, since my cervix lengthened a bit. They're going to keep a pretty close watch on me, but will continue to keep the idea under consideration and we'll just have to see how it goes. I continue to be astounded at just how quickly things change in this pregnancy. I am very grateful to have a team of truly excellent doctors. Yesterday it became clear that a lot had gone on behind the scenes within the practice that I didn't know about. Clearly my case had been discussed more than once among the practice members between my two visits (which were only about 26 hours apart). It's good to know I'm more than just a name and Patient ID number.

More good news... she called me at 6:30pm to let me know she'd gotten the fetal fibronectin result and it was negative, which is great. It means I've got a low likelihood of going into labor in the next two weeks due to a cervical issue. We can repeat the test in two weeks and continue to do so. They'll try to use the test as one way to help determine when to give me steroids to mature the babies' lungs. They don't want to give them too early, because they don't want to have to repeat treatments too many times before the babies are born. They'll give the steroids to me at 30 and 32 weeks regardless, but they'll give them to me sooner, if they need to.

Anyway, all in all, I feel a lot calmer. It was a much better visit. Although I don't love that I was having that many contractions, I feel like a lot of good came of having to go into the office, so I'm not sorry about the result. And in our next episode, I'll describe Wednesday's antics of getting the home monitoring set up. All I have to say is that this bed rest thing is seriously harder work and more stress than just going to the office!

Sorry for the novel, but a lot has happened in a short period!