I should note several different Peri's performed the various reductions and it was interesting to see how they differed. One Peri sterilized a dinner plate size spot and was pretty casual in his technique. Another Peri painted my entire stomach and had the ultrasound tech use a glove on the ultrasound machine. She wanted the entire field sterile and used about six drapes on me. Goodness, I had as many drapes when I had my c-section.
I knew when I needed an amnio reduction too. I got very sick when Greg's fluid was really out of wack. Also, my tummy on the first reduction went from being very round to almost flat. It was really odd.
Another fact I want to note, it hurts more to have the Doctor push the baby out of the way to make a bigger pocket of fluid then to have the doctor swish the four inch tube back and forth to try to get a bigger pocket of fluid. I really could have lived life just fine not knowing this!
After the third amnio reduction the most amazing thing happened. The boys ttts went into a sort of remission. I had an amazing six weeks where my babies just grew, without any complications. That brought us well into viability. As each week ticked by, we knew we were one step closer to having babies.
TTTS is tricky though. You can stop having problems and you can start again even worse then before. I read stories online from mamas that made it to 30 and 32 weeks, thought they were in the clear and at one of their Peri appointments, a baby had died. I couldn't ever fully relax and think we'd made it. Not while the boys were still inside me with a malfunctioning placenta.
Two solid months we went to Salt Lake twice a week. We finally reached the point where the boys were big enough, far enough along that the Peri's allowed control to be switched to my local OB. It was a bit of a disaster. We knew more about how the measurements were to be taken then the local tech did. He measured the fluid like it was a singleton pregnancy, measuring and adding each quadrant. That's pretty useless for twin to twin. There was also the level of secrecy locally. They didn't want to talk or say anything.
What the local tech failed to realize was that we were experts. We had a basic knowledge at that point on how to read the flow from the umbilical cords. We knew what needed to be measured, That finding a bladder on Dave was more important then finding a bladder on Greg. Hell, in Salt Lake I personally taught a med student about ttts while she was observing our ultrasound. I might add this cracked the Salt Lake tech up.
Ah, the Salt Lake tech. We requested her again and again. She was professional, informational and dang funny. What a lovely person. I actually called her about eight months ago, she knew right who I was. She said she loves thinking about my boys because it gives her hope whenever a twin to twin case comes in.
The problems with doing the ultrasounds locally proved to be moot because we were actually within 10 days of delivering the boys. We just didn't know it yet. They were also starting to get into trouble, we didn't know that either. We saw signs, but we didn't realize how serious what we observed was.
After the reductions, Gregs fluid remained high, above six centimeters but it was well below the danger range. Dave's sac wasn't ever shrink wrapped again, he managed to remain between two and three and a half centimeters. That's still low, very low but he was obviously getting some nourishment and making amniotic fluid. At about twenty eight weeks, Greg's fluid started to drop. It fell into normal and then continued to fall until his level was similar to Dave's. That meant both boys had low amniotic fluid. Their movements the last week started to drop drastically. I had a non-stress test three days before their birth and my OB gave me the steroid shots for the boys lungs.
Kent and I had been discussing vaginal vs c-section. I desperately wanted a vaginal birth. Actually we knew we were done having children and made a deal that if I had a c-section, I'd get my tubes tied but if I had a vaginal delivery, Kent would get snipped. In trying to find the answer to this question we called the leading expert in twin to twin. He was far more concerned about the non-stress test then the method of delivery. He coached Kent on what to say after the boys delivery to make sure they received proper treatment if there was a sudden fluid transfer from one twin to the other.
I came to terms over a short period of time that my dream of delivering the boys vaginally was not meant to be. Pity. The boys were both vertex, positioned perfectly for a vaginal delivery.
We struggled with some family stuff, conflicts with inlaws, added stress I didn't need, didn't want. I cried lots right before the boys birth. Spending so much time on me was wearing on the kids, on Kent. It was a hard time.
During my pregnancy we faced a problem with where to sleep our children. Our room is to small to safely co-sleep. We didn't have egress windows and couldn't put children downstairs until we did. Kent started digging a window well in the garden during the summer but it became clear in the fall when my pregnancy went south, he was in over his head. Some wonderful friends dug the rest of the window well and a good friend put in the window. It made the downstairs bedroom a mess and we needed that room for my mom to sleep in. We were moving Jane downstairs while my mom was here so it'd be an easier transition for her.
We got a little help from Kent's dad and a few brothers to clean up the cement and drywall from the new window and cleared a spot for my mom to sleep. Mom came just in time cause the boys were done baking. We'd reach the point where it was safer for them to be out then in.
Kent said a prayer the night of the twentieth that he'd know when to take me to the hospital. A huge contraction woke me up at two am. I laid back and waited, sure enough four contractions in forty-five minutes. It was time to go to the hospital. I woke up Kent. He told me as we were driving to the hospital that he briefly thought of telling me to roll over and wait and see what happens when he thought you asked to know when to go to the hospital.
Since my mom was here it was easy to wake her up to let her know she needed to get Jane to school. It was the last day for Jane before Christmas break. The twenty-first of December.
At the hospital it started out pretty casual. We got this (as Kent put it) old battle ax for a nurse. We actually knew this woman from Ean's birth. She was there when I delivered Ean and I loved her, she was the most help in her surly ways then any other nurse I've met in labor and delivery. She hooked me up to the monitors, confirmed I was having contractions, gave me a ton of water to try to help stop the contractions. I got an oral medication, I can't even start to remember what it was. It slowed them down and briefly it looked like they had stopped but they started up again.
Some problems showed up immediately. The boys heart rates were both static except when they decelerated during a contraction. The top ultrasound tech was called in off her vacation to see me. She said not to feel to bad, she was getting triple time. The boys weren't moving. Poking, prodding, all that cold water, nothing. They were really in trouble.
I just have to interject that I honestly hate our local hospitals obsession with full bladders during an ultrasound. I never needed a full bladder in Utah, I literally had thousands of ultrasound pics done in Utah. All with an empty bladder. Yet the staff obsessed with full bladders wouldn't let me go before the ultrasound after having me sip cold water for ninety full minutes!! Oh hello, thirty-two weeks pregnant with twins here!!! The tech let me go once she confirmed that I wasn't kidding about how full my bladder was! Sheeeeeeeesh!!
ANYWAY, fetuses are rated on a scale from one to ten with ten being the best. If an infant is rated at a four then they wait an hour and test again. Both our boys were rated at a two. This meant they had to get out immediately. Ironically the two scored was for both boys having fluid. At six am the first spot that morning in the OR was now reserved for me.
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