Day 3: T-21

For my hospital posts, I will post the day of my stay (i.e. "day 3") and a countdown to the next goal (in this case, 21 days until 24w). As the goals change, the T- will change.

First and foremost, thank you for the prayers, comments, and emails. I havent felt much like posting or emailing since my first night here, but the overwhelming support is extremely helpful. I am also grateful for the former hospital bedrest mommies who have shared their successes, some of whom had to go into the hospital way before me and delivered near full term babies. Mentally, those stories give me strength and hope.

I will back up to Thursday to give some details. We had an 8:15 appt and it took over an hour to fully scan both babies, The report was great. Both measured between 20w5d and 22w, depending on measurements and were nearly a pound each! This was awesome news. Then we did a vag u/s. The stitch looked great and we were just about finished when the peri pushed on my belly. A slender ribbon of amniotic fluid came just below the cerclage. Most of it receded when he released, but some remained. He called Dr B, who told him to send us down. We arrived to a full waiting room but were seen immediately, and Dr B told us that he was sending us to L&D, most likely for the remainder of the pregnancy. I didnt cry until we got to the waiting room where one of the kind nurses was waiting to take us into the hospital proper. Seeing all the "normal" pregnant women who were discussing inductions and how they cant wait to deliver left me cold and heartbroken.

The kind nurse tried to reassure us as she took us to Antepartum and got us checked in. I was changed from my clothes into a gown and put in the inverted, Trendelenberg position. I was told that while I could roll to my sides and back, I was not to get up for anything, including the bathroom or to eat. They hooked me up to a contraction monitor and said they'd monitor me for any changes. After helping me use the bedpan, Peter had to leave for work.

For hours, I just laid in bed and watched the clouds move. I couldnt really do anything except worry and think, no... Peter's mom came in the afternoon and stayed with me until Peter returned around 6:30pm. While he was gone, I began having contractions regularly, about 15m apart. Dr B was called and prescribed Indocin. That settled them down and, when he came to see me before leaving for the day, he said that he expected to keep me on it for about a week before taking me off and seeing what happens. So, every 6 hours I take 25mg.

The admitting doctor was kind and told me to think positively. He also explained that, prior to 24w, there isnt a lot they can do for the babies. That the neonatologists will work to save them but that the odds are bad... less than 1% for both of them. (At 24w, the odds for both are 30%.) It was sobering to say the least. He stressed that the most important thing is to try and keep stabile.

Dr B came in the p.m. and told me that he had seen the u/s and was concerned. Typically, when he sees this, patients are 30-32w along so the risk of a micropreemie is passed and admittance usually allows them to 36-37w to get the stitch out and deliver. But the twins are putting double the stress and since 21w is about 29-30w single... You see the issue. His concern is not with the stitch itself (and even the peri commented on what a nice stitch it is), but rather with an infection due to membrane exposure. He wants me inverted until Monday for a repeat scan, with the hopes that the tiny amount of exposed bag has receded and that, due to the Indocin lessening some of the amniotic fluid (hence no long term use), there is less pressure on my cervix. I asked him if he thought we'd make it to the 24w threshhold and he said that, barring an infection leading to PROM, yes, 24w and beyond is possible. But that we are in a critical time. He was off for Fri-Sun and explained that Dr M, who covers his patients, would be around for any questions and that he would give her the number of where he'd be in case of an emergency.

Yesterday, we listened to the babies and Bobby gave the nurse a hard time first by not staying still and then by kicking the doppler whenever he had the chance. Dr M came in and I liked her. I can see why Dr B has her cover his patients when he's away. She sat on the edge of the bed and flipped through my chart. Maybe it is just me, but with our history I like an honest doc who doesnt sugar coat stuff. When she said, "Shit! You had one helluva year," I knew we'd be okay with her. After chuckling that the resident wrote poor obstetrics history on the admittance ("That's an understatement."), we discussed the plan for the weekend and how I was feeling. Like Dr B, her concern right now is PROM because at the first sign of fluid or bleeding, the stitch has to come out. Her research and lecturing is in PTL and PROM, so she was a wealth of knowledge. We discussed the positives and negatives of an FFN with twins and cerclage. While a negative would hold the diagnostic value regardless, there is a higher value of false positives due to the stitch (a foreign body offsets thbe results). So, she isnt against it, but said that with a 50% false positive rate for a patient in my condition, she's not sure the emotional impact is worth the possible negative result. So, we backburnered it for now. But she was really informative and I didnt feel rushed with asking her questions.

Late morning, a NICU nurse came and gave me some basic info. A neonate will come down once we hit viability to discuss issues. Dr M asked them to come now, but they wouldnt. The risk of loss is too high. She was ticked. Maybe because I've been here before, it didnt hit me as hard. I dont know...

Best friend S came over in the afternoon and brought a craft project to make the room more homey. I will post pics. We made little figures from pipe cleaners and she hung them from the ceiling. The kicker is a mobile with each of the kid's initials. It's over the bed and I love it. The images are very colorful and cheery, and my nurses have gotten a kick out of them.

The day was going well... until my contractions returned with a vengence. They werent painful- but they wer 4-8m apart. Bad. Dr M ordered a sugar water IV, thinking I was dehydrated- and she was right. They moved to 15 then 2o minutes before spacing way out. I didnt realize how much I hadnt been drinking until S asked me how many times I'd peed. Since 1am (and it was then 5pm), only 6 times, compared with home, where it is once and sometimes twice an hour. So... my nurse gave me a stern talking to about drinking water. I'm happy to report that today, I'm peeing a lot more. :) The IV ran all night and now I just have the hep-lock in.

My contractions have eased. I have them mostly when I am on my back. My sides are contraction free. And, they arent painful or causing bleeding, just worrisome. My weekday nurse was a sweetheart and discussed what they will and wont do for PTL this early. After Indocin, if my contractions continue and are not a result of dehydration, they normally move on to Procardia. That can be used for a longer period without the same risks to the babies. She said that the hospital does not use Magnesium Sulfate except to buy 48h for steroid injections at 24w and beyond. This early, there are birth defects associated with long term exposure and the hospital feels that the evidence against MagSulf outweighs its potential benefits. Honestly, I'm torn. I know the benefits and the risks were explained after Nicholas was born and they were trying to stabalize me with Sophia. But when you are weighing options... It is still hard. We are going to discuss this with Dr B when he returns to get his take. We trust him and know that he has our best interests at heart.

For the most part, things are going really well. Only one nurse rubbed me the wrong way (I asked her if my contractions were normal and she told me that for most women they are but for me, there was no way to know. She could have ended it there but instead added, "Not all pregnancies are meant to be." REALLY??? Take a look at that chart, sweetheart- I'm well aware.). But she was the fleeting exception. My nurses and the docs I've seen have been wonderful and supportive. They are all vocal about me being here for awhile and the babies being well taken care of in the NICU, etc. It's comforting.

Today has been a good day. Sporadic contractions on my back, none on my side. Dr M just came to check in and met Peter. It was a good consult.

I will try to keep up to date. Mentally, I'm telling myself this is no different than the last 11w; it's just a different location with more restrictions. But it's safer for Bobby and Maya. And they are what matters.