The Best Days of Our Lives

Ella, Wilson, and Luke are here!!  The triplets were born on Tuesday evening at 6:12pm.  Ella was 2lbs and 13inches.  Wilson was 1lb 7oz and 12inches.  Luke was 1lb 6 oz and 11inches.  I was only 26 weeks pregnant.  We are in love with them!

The Details:
So, we last left off with us on hospital bedrest due to Ella's ruptured amniotic sac (water broke).  During the hospital stay I developed pre-eclampsia and gestational diabetes.  I read that babies with growth issues actually pass something to the mother to make her blood pressure rise so that they can get more blood from her.  Pretty cool.  I happily had pre-eclampsia for Luke.  I wasn't so happy with the diabetes but totally controlled it with diet.  We never had to treat it. 

On Monday Dr Von Donselaar, a 2nd year resident who was most hands on with me during bedrest, was having her med students practice ultrasounds on me.  As a student scanned me, Dr. V realized Luke's heart rate was down.  She jumped on the machine and though he had then gone back up, she sent us for an ultrasound on the big machines over in Dr. Sumners office.  When we arrived, Luke's umbilical cord flow had gone from being intermittment (the flow of blood to him stopped once with ever heart beat) to being reverse.  In other words, the blood was no longer flowing to him, it was just sloshing around in there.  My chief OB, Dr. Sumners, decided not to make any moves on Monday. 

On Tuesday, the exact same thing happened.  Lukes heartrate dropped while I was being scanned, and then reverse flow was detected.  Dr. Sumners came in and said, "While this is not what we had discussed, I think it's best if we deliver these babies.  We don't just have one baby with an issue; all three have their own issues."  Previously Dr. Sumners had talked to us about how if one baby got into trouble before 28 weeks, he was going to sit on our hands for the good of the other two.  He was adament about doing nothing before 28 weeks.  This was different.  Luke wasn't just struggling; he was in danger of passing away.  If he did, Wilson, his identical twin with whom he shares a placenta, would have tried to save him.  His blood would have flowed to Luke, who couldn't send it back, and then they'd both pass.  Then of course, Ella had the broken amniotic sac and was prone to infection at anytime.    So as soon as we nodded our heads in agreement with Dr. Sumners to have a c-section, he picked up the phone to call our nurse back over in the hospital.  He gave her instructions about scheduling the room, setting me up for surgery, calling anesthesia, etc.  Then suddenly he stops the conversation and exclaims, "Yes, You!"  Apparently she didn't want to do it.  Luckily, by the time we got back over to our room in the hospital, instead of our day nurse, our favorite nurse, Kim, was waiting for us!  She said she asked to stay over with us and take care of us through the whole delivery. (Kim played softball at Avon and Bellarmine, so we had bonded.  Plus she's an amazing nurse.)    So the operation prep began.

My anesthesiologist was grouchy (ready to go home), but awesomely competent- which is all I care about.  I told him in what ways my January surgery with the spinal had gone awry.  He listened and made those changes which resulted in him only taking about 3 minutes to get my spinal done.  In less than an hour we had gone from the ultrasound room in the Dr.'s office to the operating table.  During the c-section, Dr. Sumners coached Dr. Von Donselaar through the entire process, and she delivered her first triplets!  She was amazing.  I thought the teaching situation might put me on edge.  Instead, it was nice to hear both doctors fully focused on me with no side conversations, which I'd experienced before.  Dr. V didn't say oops or uh-oh once (unlike my last surgery), and she didn't really even ask questions.  She just seemed very focused.  She was always very professional and confident.  That really makes the patient feel better, even if you did already figure that it's probably her first time.   

I couldn't feel the babies coming out, not even a change in pressure.  Kristen sort of gave me a play by play, but she was pretty much in shock about the fact that we were delivering at all.  The babies were so small.  Although Ella did give a tiny little cry.  Each baby had his/her own neonatalogist and 4 nurses waiting for them.  Respiratory therapists were around too.  Each baby was whisked away, and I didn't see the babies at all.  In my last surgery with Dr. Sumners, he just sews you up half way and then walks away and lets other finish up.  He did that again, but then turned back, and said, "Oh, I've got to take a look at that placenta!  What was the problem with the twins?"   He lifted it up, and said, "Oh my god, I've never seen anything like this!  Those babies were almost conjoined.  Someone get a camera! Get their camera!"  I see him grab the camera from Kristen himself, and he starts making a nurse hold it up. "I need you to hold it against your blue gown so this picture stands out! One umbilical cord is actually coming out of the other!"  It was bizarre.  I know this is over-sharing, but here it is:

Another nurse took our camera and took the newborn pictures of the baby for us.  We were taken to recovery.  They kept us in recovery for 3 hours, so even though we didn't say it out loud, both Kristen and I knew that was bad news.  I was still recovering, but she was jittery.  The nurse's pictues: 

Luke

 Wilson

 Ella

Finally, we got to go back.  We were first met by Luke's neonatalogist at his bedside.  Dr. Hicks had worked for 13 minutes to resuscitate Luke. We haven't seen him since that night, but we are so, so thankful to him.  I'm pretty sure it was his discretion to push on with the resuscitation.  I think he could have stopped earlier.  When we saw Luke, he was on the vent and sort of stable.  We moved on to Wilson, and he too was on the vent and sort of stable.  Then we looked up and saw Ella's area.  She still had about 10 people still working on her, including 3 neonatalogists.  She was not stabilized.  She did not respond to the traditional vent, even at 100% oxygen, so they tried an oscillator vent.  So, I understand that babies lungs don't have surfactant, a substance that acts sort of like a grease.  It lubricates the lungs so that when they deflate on the exhale and the organ doesn't stick together.  An oscillator gives them quick short puffs of air so that the lungs never empty all the way and never have the opportunity to touch and get stuck together.  Ella didn't respond to that either even with the oxygen cranked up to 100%.  We were taken back to our room without knowing her status.  

At 2am, one of the neonatalogists came to give us an update saying that her lungs were fine, so perhaps she had a heart problem.  She said they were really out of options for Ella.    I immediately called my nurse to bring me a wheelchair.  Crying, Kristen and I headed back to the NICU to be with her.  I'm foggy on the timeline, and I'm sure Kristen will edit this soon to correct my erroneous details.  At some point, the neonatalogist told us that she tried an experimental procedure for preemies, and it worked perfectly!  She gave Ella nitric oxide, and it somehow relaxed her brittle (I think) veins allowing her blood to be oxygenated.  So, they concluded that her lungs and heart were fine.  She then quickly stabilized and was breathing 21% oxygen (same as our air)  from the oscillating vent.  However, she was on 100% for over 6 hours, and that has potentially horrible effects- from damage to the eyes to brain damage.  At 7-10 days, they'll do brain scans on all of them to see if any of the three have brain bleeds.  Brain bleeds can develop anytime during the first week.  Now we wait.

Since then, Ella has been our rock star!  She's now off the vent, and on the CPAP.  Yesterday I did kangaroo care with her for an hour.  Kristen gave her her first kiss, right on the knee.  Also, Ella's nurse, Brooke, had Kristen in her isolette changing her diaper.  Hopefully this weekend, she'll get to have real milk and more kangaroo time.  Now that she's on the CPAP, we can hear her cry.  It's the best sound I've ever heard.  She's really good about letting you know if she doesn't like the position the nurse has placed in, and she settles right in if she does like it.  I'm thankful to not have to wonder if she is comfortable or not.  Now her cries let us know.  Ella has the LONGEST fingers! They are so disproportionate to the rest of her.  She's adorable.  Those fingers say "full ride" to me- a pitcher? basketball? volleyball? piano?  Whatever she wants.

The diaper change and crying:

Kangaroo Care:

Now on to Wilson and Luke:
We were all expecting Wilson to come out about at a decent size, but not as big as Ella.  In the most recent ultrasound, he had scored in the 29th percentile for growth.  We expected Luke to be dangerously small, as he had just measured in the 3rd percentile for growth.  However, they were within an ounce of each other!!! So when Dr. V pulled them out, Dr. Sumners said she pulled out Wilson first.  The twins were all tangled in each other, and I think he called that baby Wilson based on size.  Then when the second boy came out, I think he was confused, but obviously by default, that was Luke.  While Luke was the one that needed to be resuscitated, Luke also had higher red blood cells than Wilson, and has improved faster.  With this conflicting info, I asked Dr. Sumners about it, and he was just totally honest, "I don't know."  Who cares anyway; that was and is the least of our worries.  I do think it's kind of funny though.  We alreadly have no idea which is which.  How did they get to be the same size?  Maybe Wilson had already started feeding Luke.  (Wilson is no where near 29th percentile as he last measured. I think he's in the 11th.)  Maybe the ultrasound measurements were off.  They don't know.

So far Wilson hasn't given us any big scares, but he's been through a lot.  He has had 3 blood transfusions, which he doesn't give him the big boost that it should.  They did a brain scan today to see if he had a brain bleed that might be using up the transfusion and not letting it work.  They had two different docs read it, and they can't agree.  One says he has no brain bleeding; the other thinks he has a Level II brain bleed.  So we wait until the usual 7-10 days for another scan.  He also had a picc line put in.  Thank God for that neonatal NP.  She put that thing is perfectly.  She had warned me not to watch and that it could take up to an hour.  It took her about 3 minutes.  She did the xray to check her work, gave it a little tweak, and was done.  He was, of course, sedated, but I hope it wasn't too painful for him.  Wilson is quiet and sleeps a lot. 

Wilson

After being resuscitated Luke actually had the best start.  He took well to the vent and weened down.  He was very active during the first day- kicking, waving his arms, squeezing your finger, trying to take off his wires and vent, etc.  He did eventually need the oscillating vent, so that makes them less active.  He still breaks out of his swaddle quite often.  Yesterday, we returned to the NICU to get a last summary from the day shift before they went home, and we arrived to 3 neonatalogists, 2 respiratory therapists, and 5 nurses in Luke's space.  Apparently he lost oxygenation in his blood had to be cranked up to 100% oxygen.  His nurse Ashley was tipped off that it was about to happen because she noticed his toes turning gray.  She already had a doc at his side when it happened.  Thank you Ashley.  By the time we arrived, his vitals were on their way back up, and they were turning the oxygen back down, but it's super scary to see that kind of gathering at his bed.  We were freaked.  Luke is back to being a pretty good boy.  Right now his oxygen level is at 50%, he's been as low as 21% (room oxygen level).  We're watching both boys closely. 

Luke

We are so, so thankful for all of the prayers, love and support the triplets are getting.  We are still in need of many prayers so please keep them coming!