Arrival of the Manning Triplets

Shortly after the blood draw on Friday morning, an x-ray technician came in to take radiographs of my chest due to the shortness of breath that I was experiencing.  I assumed it was just the babies pushing against my lungs as I sat semi-reclined in a hospital bed.  I don't imagine that is particularly comfortable for any pregnant lady.  Unfortunately, the situation was not quite so simple.  The radiograph showed rapidly progressing pulmonary edema which is the accumulation of fluid in the air spaces of the lungs.  Pulmonary edema can lead to respiratory failure and cardiac arrest due to hypoxia; these are of particular concern during an acute episode like the one I was facing.  Basically, the constriction of the blood vessels that is characteristic of preeclampsia and was causing the headache, high blood pressure, and fluid retention that I was already experiencing had moved into my lungs at an alarmingly fast rate.  Quickly, the situation moved from urgent to emergent; within minutes, they were preparing me for surgery.

While Ryan finished putting on scrubs, they wheeled me into the operating room to administer a spinal block and finish cleaning me up for surgery.  The surgical room was a madhouse.  There were about five people attending to me and each baby had it's own team preparing to take care of them as they were born.  They put up a curtain at chest level and Ryan sat next to my head.  A lot of what happened next was a big blur and some of it I did not find out about until after the surgery was over.  Due to the placement of the babies, the doctor only had one path of entry into my uterus to retrieve them.  This path required him to cut through blood vessels that immediately led to hemorrhaging.  He was left with the task of retrieving all three babies very quickly in order to protect them as well as myself.  As soon as the hemorrhaging began, the anesthesiologist attempted to place IVs in order to administer medication to slow the bleeding.  In addition to having very fragile blood vessels, I've also had so many injured over the past year of IVF, blood draws, etc., that there was very little for him to work with.  He put in IV line after IV line with no success.  Anyone who has had an IV placed can attest that it is not the most comfortable procedure.  I can locate about 16 places up and down my arms and hands where IVs were attempted both during and shortly after the procedure.  

While the anesthesiologist was trying desperately to place an IV, the doctor was working to get the babies out and control the hemorrhaging himself.  I could feel my body rocking violently on the table as he worked.  Then I heard him say "Rupture!" and a baby cried.  This happened two more times as each child was pulled from my womb and handed to their team for analysis and life support if necessary.  I could feel myself beginning to drift at this point (presumably due to the blood loss), and looked over to see Ryan being fanned and whisked away by several nurses.  "Is he ok?" was the last thing I remember saying before things began to go dark all around me.  

Recovery from the surgery was a slow and arduous process.  I became somewhat lucid again back in the hospital room.  At first, I couldn't speak.  I didn't even have the mental capacity to ask about the babies.  After being given multiple medications and several units of blood, I could finally hold my head up long enough to talk coherently to Ryan and my family so I could find out how the babies were doing.  Due to my own recovery from surgery, it would be 27 hours between their birth and laying eyes on them for the first time.  

Our babies were born on Friday, June 21st at 10:10 am, 10:11 am, and 10:12 am at only 29 weeks and 5 days gestation.  They are all healthy for their gestational age with their only maladies being those associated with preterm birth.   We are in for a long NICU stay as they finish their growth and development outside of the womb.  

Keira Selene Manning, 3 lbs, 15.75 in

Lincoln Nolan Manning, 2 lbs 15 oz, 15.75 in

Violet Layne Manning, 2 lbs 6 oz, 14.75 in

I get discharged from the hospital today and will write soon about each of our little ones who are quickly developing personalities and preferences.  In the meantime, I've noticed people tend to worry about our tiny Violet because of her size.  Don't.  She's the healthiest and rowdiest of the bunch so far.  

False Alarm (Sort of)

It is 4:22 am in Colorado Springs and there is no sleep happening in this lonely hospital room.  I genuinely can't think of a time in my life when I've been more miserable than I am at this moment.  I definitely have preeclampsia, which means my blood pressure is elevated and there is protein in my urine.  This leads to some rather unpleasant secondary symptoms.  For instance, my feet and legs are so swollen that they are completely unrecognizable.  My knees are so fluid-filled that I am unable to bend them and as a result have to be walked to the bathroom like an elderly lady.  I have a round-the-clock headache that is being managed with medication.  Unfortunately, the medication doesn't begin working until about 30 minutes after I take it and begins to wear off approximately 2 hours later.  This would be great if I could take it like candy, but I am only able to have one every 4 hours.  For those math buffs out there, that means that I spend approximately half of my day with an excruciating headache waiting around for medication.

Currently, I am waiting for the clock to hit 6:00 am so I can have blood drawn to determine whether my blood values of various things are high enough to warrant going ahead with a c-section.  So far, they have been borderline, which makes me absolutely miserable, but does not require delivery of the babies.  

Right now, I find myself in this really uncomfortable situation between wanting the babies out in order to regain my own comfort and leaving them in so they can develop just slightly further.  I wish I was one of those absolutely selfless mothers who could sit here and say to myself, "It's all for the babies, so it's worth it."  Really, I'm so absolutely miserable that I don't feel that way at all.  I spend so much of my time laying here with tears of pain in my eyes that it's the only thing that I can think about.  I've known a handful of women with preeclampsia, and all have arrived at the hospital in misery and were immediately delivered.  I'm the first person I know personally  that has had to sit here in this limbo.  I don't recommend it to anyone.  

At this point, the babies have had their steroids and enough time has passed that the steroids should have reached a point of efficacy (48 hours after the last dosage).  The steroids last about two weeks, so if they keep me here at the hospital for that amount of time, they will have to redo that whole process.  Otherwise, we're just waiting for something to get out of control with my own health before then.  Those things include a blood pressure of 160/110 (I'm holding strong at 158/94), an excruciating headache (apparently mine is still considered manageable with medication--not sure I feel that way), or distress for one or more of the babies (of which they are experiencing none).  If you look at the stats, I am borderline on absolutely every single one of them which means that instead of enduring one intense symptom, I have all of them pretty badly.  

I have about 45 minutes left until they come around to draw my blood again.  Until then, I continue my nightly food and water fast just in case they proceed with surgery tomorrow morning.  Usually this requires me to wait until about 10:00 am for a chat with the doctor that says, "I don't think you're at your breaking point just yet."  Then I order food and wait an hour for it to arrive.  Meanwhile, I'm going on about 14 hours without food or liquid intake.  

Maybe I'm just weak, but all I really want is for these babies to be born.  At this stage, their prognosis would be pretty darn good.  Not that it wouldn't be without it's challenges.  Right now, we have no choice but to sit and wait to see what happens.  We will do our best to keep everyone updated, but please don't be offended if we don't respond to every single email and text message. We have a lot going on right now waiting out this emotional roller coaster and we don't always have the answers nor the emotional capacity to answer even when we do.

In the Blink of an Eye

Early Monday morning, I took my specimen into the lab to check for proteinuria and also had my blood drawn.  As you know, these were precautionary measures to find out if I had signs of preeclampsia which can be a life threatening complication of pregnancy.  I called the Maternal Fetal Medicine clinic at 4:30 (just before they closed) and they told me they would call me in the morning with the test results.  All day on Monday, I had been feeling my normal pregnancy ickiness along with a light headache thrown in there to mix things up a little.  I took 650 mg of Tylenol to try to keep the headache at bay, but it did nothing for it.  One of they symptoms they told me to look out for before I left my last appointment was a terrible headache that was not effected by Tylenol.  However, I don't know if I would have defined this headache as anything other than nagging, so I decided not to go in.

That night, I was laying on the bed after eating the lovely meal Ryan had made for me (homemade pizza with pineapple and pepperoni--yum!), and noticed that my heart was racing.  I took my blood pressure and found it to be 139/79 with a pulse of 98 which are all elevated values for me.  However, they were similar to what the doctors had found on Thursday at my appointment, so I again decided I would not go in.  Lastly, I started getting ready for bed.  I put on my sexy pregnancy lingerie which consists of a pair of granny panties and an XXXL t-shirt.  I sat down to put some lotion on the parts of my legs I could reach and realized that my legs had been mysteriously replaced by reddish brown tree trunks.  I rushed over to the full length mirror to check out my legs and they looked like they had been drawn and colored by a child with no distinguishable ankles, calves, or knees and a splotchy reddish color all over.  It was time to go get this mess checked out by a professional.  

We packed up what we could quickly and left for the Labor and Delivery unit of the hospital.  The nurse checked my swelling, hooked up a blood pressure monitor and pulse oximeter on me then set up dopplers to monitor each of the babies' heartbeats. As usual, the babies were fantastic.  I, on the other hand, was a mess.  The nurse went to check on my lab results from the earlier that day and found that I did, in fact, have levels of protein in my urine that were indicative of preeclampsia.   Also, while I was waiting for the nurse to get the test results, my blood pressure soared to 161/102.  That was enough to earn me an admission into the hospital.  

They wheeled me down to the birth center where they began preparing me for my hospital stay.  They began by placing an IV to make sure that I was getting plenty of fluids.  The next step was to begin a magnesium sulfate drip.  Preeclampsia, by definition, is a precursor to eclampsia (seizures) and magnesium sulfate is designed to prevent seizures.  They began with a loading dose of the medication, which is simply a higher dosage to get it into my system more quickly.  It took over my body like a fire, beginning at the IV site and coursing it's way through my limbs and trunk.  After the magnesium had gotten it's start, they did a betamethasone shot in my right bum.  Betamethasone is a corticosteroid that is designed to mature the babies' lungs more quickly in the case of pre-term delivery.  The shot stung like crazy and took me right back to my IVF days.  I was just glad someone else was doing it for me and all I had to do was grin and bear it through the pain.  Finally, they placed a catheter to make sure that I stayed put in my bed.  I don't recommend this.  It hurts.

The magnesium sulfate is meant to keep anything from happening to me while we wait for the babies to get the necessary dosages of steroids so that they have a fighting chance if they debut early.  Things that could happen to me at this stage include seizures, ischemia, and resulting brain damage.  Turns out the headache I'm feeling is a sign that the swelling that I am visualizing on my feet and legs is beginning in my brain.  As far as the babies go, they need two steroid shots 24 hours apart prior to delivery.  At this point, they've had both.  They had one on Monday night at midnight and one last night at midnight.  As for me, I'm on the magnesium sulfate until midnight tonight, then we'll see what happens.  They can't leave me on it because long term usage can lead to failure of multiple organ symptoms.  Tonight, we'll see if my symptoms stabilize or if they go crazy.  If my blood pressure sky rockets or my headache intensifies and is not manageable with relatively mild medications, they will check my protein levels in the the morning and make the call about whether or not to deliver the babies via c-section mid-morning tomorrow.  If things stabilize tonight, then I will be in for a stay at the hospital until things do change for the worse.  Unfortunately, the only known "cure" for preeclampsia is delivery of the babies.

Over the past day and a half, I've had multiple blood draws to check for protein and other various things.  I wear a blood pressure cuff constantly and it monitors my BP every 15 minutes. They come around with headache medication every 4 hours.  I have had multiple checks of my lady parts.  I've chatted with the doctor on several occasions.  I suppose the silver lining in this whole event is that we have had multiple ultrasounds and dopplers on the babies and they are all fantastic.  Better than that, really.  They are ahead in development.  They are practicing their breathing.  They are big.  Their hearts are strong.  In fact, in the last ultrasound that we had they were all head up and it looked like they were putting their heads together and facing each other.  I think they're plotting against me to get out.  Either way, it looks like the Manning triplets will be here sooner rather than later.  We'll keep you updated on the event.  

29 Weeks (Fat Feet and Sausage Fingers)

Over the last week or so my symptoms have increased dramatically.  If I stand for more than 10 minutes, my fingers and hands swell and turn bright red.  Moving too much brings on contractions.  I've had to give up piano because my fingers are so sore and swollen that it's more frustrating than soothing.  Breathing feels like a workout.  Every joint in my body is aches.  Getting up from a sitting position or readjusting in the bed causes me to groan and lose my breath, which stinks because I have to get up every 20 minutes or so to go to the bathroom.  I can't eat more than a couple of handfuls of food in a sitting.  I'm exhausted, but I can't sleep because I can't breathe and I'm sore.  So I guess what I'm saying is that I'm starting to feel like I'm pregnant with triplets.

This past Thursday I had a doctor's appointment that left me feeling completely deflated.  It's not that things are going horribly with the pregnancy right now; I'm just not the triplet mom rock star they told me I was for the longest time.  It's like being an A student and all of a sudden getting back a big paper with a B- on it.  It's not like I failed, but I'm still not particularly happy. Let me preface this by saying that according to the ultrasound the babies are fantastic.  They are perfectly happy in there leaching all of mommy's resources and leaving me a hot mess.

Of course, the doctors and nurses noticed the swelling at the appointment.  It's pretty amazing.  Also, they took my blood pressure and it was significantly elevated.  It went from 96/68 at my first appointment to 140/80 on Thursday.  This caused them to worry about preeclampsia (more commonly known as hypertension of pregnancy).  Oh...skip to the next paragraph now if you don't like medical stuff or details about lady parts and pregnancy.   Preeclampsia is usually diagnosed using three factors:  fluid retention, elevated blood pressure and protein in the urine.  Since I definitely have the first two symptoms, they checked my urine for protein.  Unfortunately,  I was too well-hydrated and, therefore, it was too dilute for them to detect any protein.  Don't worry, the protein check is not over yet.  I get the joy of doing a 24-hour collection beginning Sunday morning.  I have to collect every drop of urine I produce for a 24-hour period and submit it for testing.  Fun.  They will also do a blood test on Monday morning to check for additional protein.  Finally, just to be on the extra safe side they did a Fetal Fibronectin Test and checked my cervix.  Fetal Fibronectin is a protein that is released when the amniotic sac begins to detach from the wall of the uterus.  If it is detected, there is a 40% chance you will go into labor in the next two weeks.  If not, there is a less than 2% chance of labor beginning.  Fortunately, that test came back negative.  I probably won't be going into labor in the very near future, but that does not eliminate the risk of preeclampsia which can lead to emergency delivery of the babies if it progresses to a certain point.  Finally, the cervix check revealed that my cervix was not dilated, but it had softened and shortened.  This earned more strict bed rest than I had previously.  I'm not particularly excited about that one.

I should have more information about my risk for preeclampsia on Monday afternoon or Tuesday morning.  In the mean time, I will be "enjoying" more strict bed rest.  Next week we will have a growth scan to make sure the babies are growing at an appropriate rate and they will give us the estimated weights.  Last check, each weighed over 2 lbs with our boy being the biggest.  We've also just about finished the nursery, so that will be coming soon.  Until then, here is a long awaited picture of the bump.  I'm currently measuring almost 42 weeks and carrying an extra 47 lbs.  I am currently larger than the average full term mother and I still have 7 weeks to go (if we're very lucky).

29 Weeks with the Manning Trio