Friday, August 22, 2008

A Taylo'2 Babies - Micro-Preemie Wonder Twins

I started surfing when I found out we were pregnant and quickly jumped into this online community family of Moms of Multiples and Parents of Preemies and Special Needs children. My online Nestie name is LSTaylor73 but I also go by Taylo2Babies on other sites and through my own personal blog.

I have to tell everyone that I find so much support and an enormous wealth of information 24 hours a day 7 days a week from this site. I get touching and valuable support from people I've never met but who know me better than my own family in many ways because of our shared bond. Because of I have learned about the different things parents deal with, generous support from other parents, how to find special discounts on things from formula and the best must have baby gear (often times 2!!) to discounts on prescription medications for my preemies. We share our experiences, our fears, we vent, we make each other laugh, we go out of our way to think about people and do things for those whom we've never met because we can either sympathize or empathize with what they are going through. Even my Dear Husband (DH) has marveled at the usefulness and support that we've received from this communication tool. I've also learned how to be a good support person to my online friends and only wish that we could all meet in person one day.

In particular the Multiples board for Mothers of Multiples (twins, triplets, and higher order multiple births) and the Preemies board and the Special Needs board are so important to me because where can you go to ask questions like, "How do you get your multiples in and out of the car safely?", or "What kind of reflux meds are your preemies on, what do you like about it and why?", or "What early signs did you notice in your Autistic child and how was it officially diagnosed?" and then get real time answers from people who have been through what you are going through. And what's also nice is that it's okay to be a lurker on the board, to just read the posts to know what's going on in the lives of others. By no means is this to say that the other boards on the site are not as important and useful, but personally these three boards are very near and dear to my heart. Blogs and message forums have become some of the biggest social information sources for the 21st century.

As for this blog "Didn't you know? Twins are IN!" I look forward to contributing info about my favorite things, useful tools and links for all things baby, multiples, and preemies. Who else knows the value of picking the right useful items because we Moms of Multiples usually have to buy more than one? I know my perspective on a $400 crib for one baby suddenly changed when I found out i needed to buy two cribs. Special thanks goes to MWilson44 from board for taking the initiative to put this blog together.

About Us: In 2007 my husband and I foolishly thought we were ready for a baby. We thought getting pregnant would take some time because I was getting closer to the magical age of 35 when all your statistics are thrown up in the air. Here are the shortened details of our babies lives.

1. Are they your first? Do twins run in your families?
Yes, our first and second. No twins on either side. But for the record, instances of multiples typically genetically follow the maternal line, though identical twins can happen spontaneously.

2. Are they identical?
We don't know yet, but our guess is they are probably fraternal though there are indications that they may be identical. They do share the same blood type. They may be dichorionic diamniotic (di/di) twins, which occurs 20–30% of the time. The only way to know for sure is to have a DNA test done on both boys which is about $175. I don't think it really matters to us either way, though it would be neat to find out.

3. How did you find out you were having twins?
At our very first prenatal OB doctor's appointment at exactly 8 weeks gestation we had no idea. All that weekend and right up to that appointment I was having some bleeding complications. My OB doctor was concerned that I would miscarry and used an in-office older model ultrasound to look for a heart beat. The heart beat was there, but because I was considered high risk due to my age (almost 35 at the time) he referred us to a peri-neonatologist maternal fetal medicine specialist (Peri-MFM) for a week later for a viability ultrasound exactly 9 weeks gestation.

We went to the Peri-MFM specialist's ultrasound and it was really neat experiencing a high quality detailed ultrasound, even though it was really just a bunch of wavy lines and blobs on the monitor. Andrew, my darling smart ass husband, was joking round with the technician and said, "Well check to see if there are nine babies in there. I want my own TLC show where they can pay for everything, like Jon & Kate Plus 8. Otherwise there should be only one in there 'cause twins don't run in the family." And the technician's response was "That's so funny you joke about that, because here's the other one!"

Dead silence. There would be no more joking that day. I asked her to double check and she showed us another amniotic sac with a fetus with a beating heart that was about half the size right above the first baby. It was the most shocking, happy, terrifying day of our lives.

And that's where the really long story begins.

4. Why is one baby so much smaller than the other?
The doctors knew Evan's (Baby B's) small size was due to Inter-Uterine Growth Restriction/Retardation (IUGR), which is where there is something limiting or preventing the flow of blood through the placenta into the umbilical cord and into the baby. Often this goes hand in hand with Twin to Twin Transfusion Syndrome, where one baby is basically stealing all the nutrients from it's sibling. This wasn't exactly the case for us. There was no stealing of food, just that there was a blood clot formed early in the development of one of the main arteries in Evan's (Baby B's) placenta where it meets the umbilical, thus preventing him from getting the same nutrient flow as his brother. Basically he was eating and breathing through a straw.

There is serious risk with IUGR conditions and they monitor closely for several things. They start getting really worried when there is about a 15 to 20% size discordance between the two babies. Also, our Peri-MFM specialist has seen other cases where very suddenly the IUGR baby will develop reverse end-diastolic blood flow. This means that the mother's heart is so strong that more blood will be pumped out of the baby's heart causing the baby to go into distress. Within a matter of hours the baby would die and sadly there is nothing that the mother would feel to know that this has happened.

It gets even scarier. All this time Cameron (Baby A) was not effected by any of his brother's complications and was happily enjoying his time baking in mommy's belly. By taking dramatic steps to save Evan's (Baby B's) life we were dooming Cameron (Baby A) to all the many terrible complications of being born prematurely.

I was living on three day increments. To check the blood flow with a doplar ultrasound. Each time they would be amazed at how well Evan (Baby B) was doing considering his limited resources. But the doctor knew there would come a time when we had to take drastic steps.

At 24 weeks a fetus is considered viable, meaning they have a 50/50 chance of surviving outside the womb. I was given my first round of Betamethesone which is a two shot steroid to help develop a baby's lungs more quickly in utero. Then I was allowed to go on moderate bed rest so that any calories I consumed would go to growing the babies faster.

At 26 weeks the doctor saw signs that Evan (Baby B) was dropping in heart rate and then coming back up. He said now was the time for 24 hour monitoring in the hospital. Because two weeks had passed and birth seemed eminent I received yet another round of the steroid shots for the babies lung development. I was there for 8 days on moderate bed rest for monitoring of Evan (Baby B). Each day we wondered would today be the day that we could save Evan? Would today be the day that Cameron would suffer great trauma from early birth?

On Sunday March 30, 2008, 12:30pm at 28 weeks and 6 days gestation the doctor finally saw Evan's (Baby B's) heart go into full reverse end-diastolic flow and distress (where the blood was flowing out of the baby back into the umbilical cord). O holy crap was I terrified!!! I was shaking so hard I couldn't stand on my own, I couldn't even hold a pen.

By 2:30pm I was in surgery with an epidural (which by the way did not hurt at all, I didn't even feel it!!) . Cameron Andrew Mettee (Baby A) was born at 2:59pm and let out a huge howl, weighing in at 2lbs 15oz. Evan Alexander Mettee (Baby B) was born at 3:04pm, weighing in at 1lb 7oz, was more difficult to reach as he was wedged under my left ribs. The doctor had to do an inverted T incision to the uterus wall in order to reach his hand and pull him out. Evan did not cry because he was not breathing at first. Both babies had to be intubated for breathing assistance. The boys are considered micro-preemies because of their very low birth weight. Cameron was 6lbs 2oz, smaller than most healthy newborns. Evan was 3lbs 8oz, the smallest preemie clothes shrunk in the dryer still don't even fit him.

5. How early were they born? Exactly how old are they?
The boys were born 11 weeks prematurely at 28 weeks 6days. Normal full term gestational growth for a single baby is 40 weeks. Cameron spent 67 days in the NICU. Evan spent 68 days in the NICU. My boys were born on March 30th, 2008 which means today 8/22/08 they are 4months 3weeks and 2days old actual age. But their estimated due date was June 16th, which means they are 2months and 6days old adjusted age.

6. Side effects to early delivery for Cameron?
Because Cameron was surprised by the necessary early eviction from my belly he was not ready for all the things he needed to do upon arrival in the outside world, primarily breathing. With preemies it is a Catch 22; you have to provide breathing assistance to keep them alive, but by doing so you are damaging the tissues in the lungs. This can, and has for Cameron, cause Respiratory Distress Syndrome and Chronic Lung Disease. Cameron also needs to be on a bradycardia (aka. bradys) and apnea monitor. Bradys are when their heart rate drops below a certain point, and apneas are when their breathing slows below a certain rate.

The boys are doing very well, and we want to thank everyone for all their love and support. We hope to introduce the boys to everyone one day soon, but for the time being it will have to be through the internet for most people.

You can follow the boys progress, weaning Cameron off of oxygen assistance, baby weight gain, and our adventures in taking tiny preemies out in the world by visiting our family blog

Hugs to all my Nestie sisters out there!

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