I thought a long time about whether or not to publish this post. I really want this blog to be helpful to others and not be just a chronicle of my life. The birth feels more like a chronicle than anything else. I’m still publishing it because maybe it lends some credibility to my advice. It also shows the huge amount of uncertainty we faced, and hey, some people just like reading birth stories. Since this is a long story and- lets face it- you probably don’t want to read it all, I’ll give you the takeaway up front. I used to get annoyed when people would say “it’ll all work out” because it’s such a cliche. But it was true for us. We had the triplets when we were jobless, living with family, in the midst of a cross-country move, and with new doctors who had only seen me for 8 days before I gave birth via emergency C-section. We weren’t sure if anything would work out, and yet it did in a more marvelous way than we could have ever imagined or planned. I wish there was another way of saying this, but maybe there isn’t. If you are pregnant with triplets, things WILL work out for you, no matter what uncertainties you face. You can roll your eyes now (I would if I was in your shoes).
The triplets birth story starts with a neatly, carefully crafted plan for us to move from Illinois, where my husband J was finishing medical training to our hometown in Virginia. The flight tickets were purchased, the pack out date was set, a few last hurrah celebrations with friends were scheduled, and a last doctors appointment was confirmed. It was the end of June. I was 27 weeks pregnant. J’s job (and paycheck) was set to end at the end of that month. I had stopped working in early June because it was getting increasingly harder to work and I was not returning to the job after our cross-country move. J had been looking for a job for many months but despite having interviews and hope on a few possibilities, nothing had come through. As a result, our plan was for us to live with my in-laws while we continued to look for a job.
When you have a high risk pregnancy, it is a roulette game to see whether things will turn out ok. As a Type A person who accounts for every detail in our life, I wanted a checklist of items in favor of all of us surviving this pregnancy. Point one in favor of survival- our triplets were tri-amniotic, tri-chorionic. That means there were three placentas and three amniotic sacs. Medically speaking, this is the optimal triplet pregnancy because they each have their own personal systems (placental cords, amniotic fluid, sacs) for growing and developing. Point two in our favor- these were spontaneous triplets. I had no problems conceiving our first two children and we had no fertility assistance, so from all indications, I had healthy eggs and a functioning reproductive system that should allow the eggs to develop as intended. Point three in our favor- I had carried our first two children full term, so my uterus was able to hold a full term baby and my cervix had stayed shut for 40 weeks twice. Point four in our favor- I was healthy and a good weight before I got pregnant. Point five in our favor- I was gaining the appropriate amount of weight during the pregnancy and my body was responding well to the extra vitamins I was taking to increase folic acid and iron. So here we were, happy with all these tick marks in our favor and blindly believing all would continue going according to plan.
We arrived at the last doctors appointment ready to receive everything we would need for my transfer of care to doctors in Virginia. Our wonderful doctors in Illinois had prepared all my medical records for me to take and a note in case I was stopped in the airport not allowing me to get on the flight. We fully expected to get on that flight, get to my in-laws house and wait another one to two months for the arrival of the triplets. They were due in September. We knew they would be early (virtually all triplets are born premature), but we hoped they would not be born until at least the end of August. I had spent an inordinate amount of time researching and finding a doctor to take care of us in Virginia and it was all just a matter of them getting the records and continuing care. Easy peasy. The last scheduled doctors appointment was in the morning so J and I could attend a goodbye luncheon put on for him at his job a few hours later. So here we were, taking one last look at the triplets before we made their way over to our hometown.
Imagine a triangle with one tip pointing south and the other points going east and west. That triangle represents the positions of our babies in my belly. The baby at the bottom (south) was Baby A- now known as Lily. Lily was squished by her sister and her brother lying on top of her. She was also pretty close to my cervix, so Lily was always pretty closely scrutinized. At week 17, all of the triplets were growing on track and looked wonderful. But by week 24 Lily was starting to grow less quickly than the other two. We underwent a few more ultrasound assessments to measure her placental blood flow, and we learned that her blood flow was not optimal. The decreased blood flow could be accounting for her smaller weight. At 24 weeks we had a tough conversation with the doctor about Lily. If her blood flow were to worsen, we could choose to allow her to die so that the other two babies who were doing well could continue gestating as close to full term as possible (there is no way to deliver just one triplet- it is all or nothing). This conversation harkened back to our conversations about selective reduction. At 9 weeks gestation, we had adamantly chosen not to reduce any fetuses because we felt like these triplets were a miracle that were going to be born together if at all possible. So here we were later on in the game being asked whether we still wanted to save all three babies.
I remembered a conversation I had with a neonatologist a few weeks earlier. One particularly story was chilling. There was a family pregnant with triplets who had one baby in critical condition. They had decided to deliver, despite the other two doing well in utero. The baby that was in critical condition fought hard, stabilized, and survived. The two that had been doing well in utero died from complications stemming from their prematurity. These were the terrible odds we faced. Despite these odds, our gut told us there was no way we could let Baby A go.
By now we had so many ultrasounds, I was used to reading the cord blood flow results myself. Baby B (our boy) looked good- he was moving around as usual. Baby C (another girl) looked great in her little “side suite” as we called it. And then it was Baby A’s turn. The Doppler that had pulsated enthusiastically for the other two had fits of quiet in between pulsations. Things were not good. The ultrasound technician didn’t say much. I had been to enough ultrasounds to know silence from a technician was not a good thing. She called the doctor in. Lily now had what was called “absent end diastolic flow.” In other words, her placenta would sometimes not adequately return blood to her at all times like it was supposed to. The protocol at this point was to hospitalize me and monitor her blood flow regularly. Should the blood flow worsen to a point blood flow reversed (in other words, if placental cord didn’t produce enough pressure to allow nutrient poor blood out and nutrient rich blood in), we would have to deliver to save Lily.
J never once lost his cool when we learned we were having triplets. When I vacillated between hysterical laughter and crying, he smiled and excitedly told me how great this surprise was. He regularly operates on carotid arteries, has literally heard blood spewing out of this most precious artery and can approach that chaos with equanimity. It takes a lot for that man to lose his composure. So when the doctor came in and told us Lily was starting to reach a more critical point that required me to be hospitalized, I figured J would take it in stride. But it was too much. Our carefully laid plans were crumbling in front of our faces days before they came to fruition. J could barely hold it together to explain to his colleagues why he couldn’t make it to his farewell luncheon. He regrouped when he saw the panic in my face about his reaction. He helped me get admitted to the hospital, turned around and dropped one car off in time to be transported to Virginia as planned, picked up our kids from school as planned, finished packing my bags (not as planned), and then carefully thought through what we would do if the babies weren’t safe enough for me to get on the plane (not as planned). This was on Monday and our flight was scheduled to depart Wednesday. Meanwhile, I was in the hospital being hooked up to fetal monitors. The entire process of finding three separate heartbeats was comical and tedious, but after a few gallons of lube and thirteen straps per monitor, we were set up. As a side note, I should explain that there were four monitors on my belly for the non-stress tests. There was one monitor per baby for heartbeats and one monitor checking for contractions. This was my first time physically seeing the amount of equipment we would need to account for each triplet. The hospital had to find a special twin heartbeat monitor and then hook up a third monitor next to it. Sometimes the babies heartbeats were so close together, we worried we were double counting one baby and missing another, so we’d have to re-position everything and start over. There were cords everywhere. Seeing all the equipment really made an impact on me. Everything was neat on the inside, but the logistics externally was much more complicated. I had to push it all aside and just hope Lily’s blood flow would be stable.
I was monitored overnight Monday with no indication that Lily was in distress. I was given a steroid shot to help strengthen the babies lungs in case they had to be delivered. On Tuesday I was able to be taken off the monitors and only checked a few times throughout the day. That evening the doctors and I discussed the possibility of me leaving the hospital to get on the flight on Wednesday. The Maternal Fetal Medicine (MFM) specialist monitoring me thought it may be possible for me to get on the flight if Lily’s condition appeared stable. She agreed to come into the hospital early in the morning to check Lily one last time to see if we were safe enough to get on the flight. My sister had come in to town to help me get on the plane. If I wasn’t able to get on the plane, my sister would be taking our older two kids on the plane so they could be with their grandparents while J and I figured out the next steps. We had to notarize an authorization for her to fly with the kids. We had to call the flight and ensure that my sister could sit next to the kids instead of me, because the current scenario had her booked on the same plane but not next to the kids. We had to explain all this to the kids, re-pack the bags in case I couldn’t get on the flight, and pray like mad things worked out.
J stayed with me late that night. Neither one of us could sleep because we were so worried about whether I’d make it on the flight. At one point, J was looking out the window praying and he saw three birds flying high in the sky. He thought it symbolic that there were three birds flying together. He blinked and the birds had vanished from sight. He excitedly told me about his sighting. J is not a spiritual person, but he felt like this was a sign from God that everything was going to be ok. He was visibly relieved. We finally both were able to get some sleep.
At 4am, the MFM doctor came in (yes, she woke up early just for me – she was so amazing) checked Lily and happily announced that she looked the same as she had the last two days, and was therefore stable enough for us to fly. The hospital had all the discharge papers ready to go. My instructions were to get off the flight and drive directly to the hospital in Virginia. The MFM doctors in Virginia were given a heads up that I was coming, and they were to immediately do another ultrasound to see how Lily was doing.
Our flight was out of a tiny airport. We had a connecting flight in Chicago that would get us to Northern Virginia. My kids (then aged 4 and 6) were elated to hear that I would be able to get on the flight with them. It had been hard for them to not be with me the last few days we were in Illinois, with so much upheaval going on in their lives. Driving to the airport in Springfield and saying goodbye to J was bittersweet. He was staying behind to tie up loose ends with finishing his job and to get the house packed up. He would then drive our second car cross-country with his dad and meet us in Virginia. We had all hoped this scenario would happen- and it appeared that it would- but now my health was more critical and he would not be able to be with me or the kids during this riskier transition.
The alternative was worse. If I hadn’t been able to get on the plane, we would have had two kids in Virginia and I would have been in the hospital indefinitely in Illinois. We were fully aware that it was unlikely I would get out of the hospital again before the triplets were born, so if I couldn’t get on the plane that day, I was looking at an extended stay in Illinois for at least a few months, either with the triplets born early or with myself in bed rest for a long time. Then at some point we would have to coordinate flying or driving with newborn triplets across country. Our 6-year-old daughter had just finished kindergarten, so we had to consider the timing of school either near her grandparents’ house or return to Illinois to be with us. You can see the types of circles we were going through thinking of these different scenarios in our mind, and how being in Virginia was ultimately a better outcome.
We got on the plane without anyone questioning how far along I was in pregnancy. I was surprised because I was measuring 40 weeks already, and most airlines won’t let you fly when you are full term. When we reached Chicago, the connecting flight was delayed. After an hour, the flight was pushed back again. I was getting increasingly worried about not getting to Virginia within the time my doctor wanted- less than 8 hours between ultrasound/heartbeat checks. I suddenly received a text. I was surprised to see it was my MFM doctor. She was following my flight and saw the delay. She asked if there were any other flights I could get on. Luckily, there was a flight going to another nearby airport in Washington D.C. We quickly got switched to that flight and told family meeting us to pick us up there instead. I was in a wheelchair and we had to arrange for wheelchair assistance when we arrived, but everything again worked out.
We arrived in Washington D.C. with no further problems. We learned the other flight finally took off about an hour later than our flight, so I was relieved with our choice. My sister-in-law and brother-in-law met us with two separate cars at the airport. My sister-in-law was in charge of getting me to the hospital and my brother-in-law would take my two kids to their grandparents. Again, it was hard to say goodbye to my kids not knowing when I would see them again, but they were excited to see their aunt and uncle and grandparents and I was happy they were distracted and around family. My sister-in-law dropped my sister and I at the hospital and I began the long process of filling out paperwork and explaining my medical history so that I could get an ultrasound. When I finally got the ultrasound, I was incredibly relieved to see that Lily was still alive. Her placental blood flow was still poor, but it had not worsened. I was admitted to the hospital. A wave of relief came over me as I finally made it to my hospital room. My kids were happy at their grandparents, J was busy packing up the house and getting ready for his trip cross country, and the babies were alive.
At the hospital in Virginia, the babies heartbeats were checked twice a day. This endeavor always took hours- first to find three heartbeats, then to keep the heartbeats steady enough to record each one a specific period of time. The doctors were looking for particular patterns with their heartbeats to ensure they were not in distress, so sometimes we would have to wait a long time before a reading was deemed acceptable to discontinue monitoring. I also began receiving daily ultrasounds to check Lily’s cord blood flow. I had to meet a new set of doctors and ultrasound technicians and explain our history and reason for coming to this hospital so late in pregnancy. I was examined by both a regular gynecologist and a Maternal Fetal Medicine team, but ultimately it was the gynecologist who was going to deliver the babies upon the advice of the MFMs. One particular MFM had a poor bedside manner. I had to explain to that gruff doctor that I understood the risks involved with saving Lily and that we still wanted to deliver everyone if she was in distress. It was painful to have this discussion again and convince another doctor that we understood the risks and had made this decision carefully.
A day after I arrived in Virginia, the readings on the triplets heartrate monitors was not optimal. The doctors decided to send me down to labor and delivery to be monitored overnight. This happened to be the night J was driving from Illinois to Virginia. I was afraid there was a possibility they would deliver the triplets without him being there. No one could say for sure what was going to happen, but being in the labor and delivery unit was not a good sign. My poor husband had to calmly continue driving carefully to Virginia as if everything would be ok and he wouldn’t miss their birth. Thankfully, the night was uneventful and I was allowed to go back to the high-risk pregnancy unit for further bedrest and less frequent monitoring. J arrived in Virginia, saw our older kids, and turned right back around to come see me at the hospital. He continued making the trip to see me every day, sometimes bringing the kids and sometimes coming on his own.
If you’ve actually made it this far in the story – wow- I’m impressed! Stay tuned for Part II. I delivered the babies exactly 8 days after making it to Virginia. I was 28 weeks pregnant.