Thomas' and Milo's Story
After our year and a half of infertility, it felt great to be back on the path to parenthood. Follistim, Pregnyl, and an IUI was the magic combination that worked to finally get Laurie pregnant again.
Maybe it worked a bit too well.
We conceived fraternal twins.
Dan was shocked. We found out at our first (of many) ultrasounds around 6 weeks. After showing us the twins on the monitor, our RE turned to Dan and said, "if you're going to pass out, lean against the wall, I'm a little busy over here." Other than a little bit of occasional spotting, the first trimester went pretty smoothly. Laurie tried to keep her activity level low. We had weekly ultrasounds with our RE and got to watch our two little dots grow larger and larger each week. Around the end of the first trimester, we were discharged to our regular OB and our high-risk Perinatologist.
Our first of many battles was to actually see our Perinatologist/Maternal Fetal Medicine (MFM) doctors. We knew there were compelling reasons why we needed to see them in the late 1st/early 2nd trimester based on our post-loss consult with Joseph, but they couldn't get us on the schedule for weeks. Finally, after we had actually gone so far as to book an appointment with a different Peri at another hospital, they were able to get us in last minute when we were around 12 weeks. It's a good thing too, because we were given our first decision without much time to decide. The question was whether or not we wanted to do a preventative cerclage to stitch Laurie's cervix shut or not. The doctors told us if they were going to do a cerclage, they wanted us to decide quickly for it to be most effective and least risky.
Our MFM recommended against the cerclage. According to them, studies hadn't shown that cerclages were effective for twins. We got a second opinion that said the same thing. Our OB agreed as well. Everyone basically said no cerclage was our best option. They didn't think Laurie's cervix was the problem. They'd watch for cervical issues, and test for infection, but everyone expected things to go fine. We did our own research and it seemed to concur with what we were hearing. And that was the plan. No cerclage, ultrasounds every other week during the 2nd trimester, and if there was cervical change we'd cross that bridge when the time came.
Around this time, we moved into a brand new house and were getting ready to start our new lives as parents to twins. Everything seemed to be going fine. Laurie's cervix was checked every 2 weeks and it was above the 2.5 to 3 centimeter mark that doctors consider the cutoff for potential issues. It did shorten slightly from around 3.6 at 12 weeks to 3.1 at 16 weeks, but our Peri and OB never raised a concern with us. In the meantime, Dan was doing lots of research. He was a little concerned about Laurie's cervix being close to 3, but we talked about it and decided we just had to trust the doctors. Dan still learned a lot about Cervical Insufficiency and what it meant for twins. At one point he came across something called Delayed Interval Delivery and even mentioned it to his Dad (mostly just as a curiosity, not as something we expected to have to deal with) one night over dinner.
As we moved past the 17 week mark where we lost Joseph and everything seemed to be totally stable, we both finally began to relax. We planned out how we'd do the nursery with two cribs. We tried to figure out if it would be cost effective to do cloth diapers. We researched the best double strollers and monitors. I looked into when the local Multiples club was meeting. We hadn't told many people yet that we were expecting, but we even told a few close friends and family that we were expecting twins. We talked almost every night about how badly we wanted these babies. We picked out a name for a boy and a name for a girl that we loved since we didn't know what we were having yet.
And then Tuesday, February 28th happened. It started out as just another routine cervical length check ultrasound. We planned to get brunch at a local restaurant after and enjoy our morning out.
But as soon as the grainy ultrasound flickered onto the screen on that Tuesday morning, we knew that wasn't going to happen. It was very clear that Laurie's cervix had changed significantly. The ultrasound tech was instantly concerned--what closed cervix was left measured less than 1 centimeter, and there was funneling where the top of the cervix begins to open. She went to get our Peri and he immediately sent us across the street to labor and delivery for further evaluation and monitoring.
At L&D, they found that Laurie didn't have anything happening to cause the cervical change--no contractions, no placenta issues, no rupture of membranes, and no infection. She simply had an insufficient cervix. It was good to have a definitive diagnosis, and it even helped give us some closure with Joseph's loss, but it still left our twins in serious jeopardy. The bottom of the cervix was still closed, but the top simply wasn't holding the weight of the developing babies. Baby A's water could break at any moment, Laurie could go into preterm labor, or develop an infection, all of which would have potentially spelled disaster for our twins.
The usual solution to this problem is a cerclage. However, our doctors all thought that based on how little closed cervix was left and with funneling already present, any kind of cerclage was just too risky, and more likely to hurt than help. They put Laurie in the MOM unit for monitoring while they tried to come up with a plan. On top of everything else, she had slightly elevated blood pressure and her liver enzymes were high too. Nobody had an idea what was happening with that. It seemed like all of the doctors were just looking to each other to come up with a plan or make a decision, but nobody would step and put a solution on the table. The doctors didn't seem to be giving us any reason to have hope. It just seemed like once again, our hopes and dreams of parenthood were crumbling around us.
We spent the day in the hospital together, basically waiting for the other shoe to drop. For that day, at least, it didn't. We decided that Dan would head home and get some rest so at least one of us would be mentally together for the next morning, when our Peri was supposed to come by and talk with us about our options. When Dan got home, he immediately went online and began trying to find out as much as he could. There were different types of cerclage. Alternatives to cerclage. Medications. So many different things that could be tried. We weren't just going to accept doing nothing as our course of treatment.
Dan also tried to find a support group for Incompetent Cervix/Cervical Insufficiency to see if other people who had been through these sort of issues had advice. Lucky for him, he happened to find an excellent Incompetent Cervix support forum (which has since gone offline). Dan threw up a quick post explaining our situation and asking for advice on cerclage, bedrest, and even Delayed Interval Delivery. Within 30 minutes, 2 wonderful ladies had already responded. Dan exchanged posts with women on the forum throughout the night. After getting a few hours of sleep, Dan left for the hospital on Wednesday morning, armed with a page full of ideas, suggestions, and questions. We were ready to fight for these babies.
Just about 5 minutes away from the hospital, Dan's phone rang. It was Laurie. Our Peri had already come to talk to her and left. He wouldn't wait for Dan to arrive, even though Laurie asked him to wait (even remarking that he wanted to get out of there before Dan showed up with all his questions). He told Laurie that they still didn't think she was a candidate for a cerclage, but they were going to have some big group meeting the next day and decide on a plan. Even with a highly emergent situation, they were putting the decision off another day. When one of our regular OB's stopped by a few hours later, she reiterated that they were still against trying a cerclage. Dan posted a quick update on the IC support forum and a woman from Hawaii suggested that there were other types of cerclage (called TAC and TVCIC) that might be possible. She mentioned 2 doctors, one in Chicago and another in New Jersey, who were at the top of the field.
Dan figured we had nothing to lose and wrote the doctors an email. Dan also put a call into the office of the doctor in New Jersey, as he was less than 2 hours drive from our hospital. By the time Dan hung up the phone, the doctor had already responded to his email, saying that he thought he might she might be a candidate for a TVCIC. Within a hour or so, we had spoken on the phone and he said if we could get to him in the next day or two he could try to help us. We agreed that it seemed to be our best chance.
Then we just had to hang in there for another night. The doctor in NJ was supposedly calling our Peri to talk about the case. Laurie was going really stir crazy in the hospital without a plan from our doctors, but did the absolute best she could staying on bedrest. And another night passed without any contractions or further complications.
The nurses came by on Thursday morning with a message for us to call the doctor in New Jersey so he could get our info and schedule Laurie for surgery. It was odd because neither our Peri or OB had come by to talk to us yet. We were a little uncomfortable leaving without even talking to them, but we decided we were going to see the NJ doctor no matter what our doctors said. He got us onto his schedule for Friday and told us to come down that night to his hospital so we'd be there for the surgery the next morning. We did get to talk to our doctors before we left. They had decided the best thing they could do would be to send us home on bedrest, but since we had found another doctor who might be able to help they'd release us to him. It really felt like they were throwing up their hands in the air and giving up, leaving it up to us to fight for our babies. We were determined to prove them all wrong. So they discharged us, and off we went for a short drive to south Jersey.
In New Jersey, the doctors basically wanted to try everything they could to keep Laurie stable until the next morning when she would get her cerclage. Ultrasounds showed that things hadn't gotten any worse yet, but she was still at high risk to go into pre-term labor at any moment. They put her into the Trendelenburg (feet elevated, head-down) position for a very tough night. Laurie's acid reflux was awful, and the head-down position just made it worse. She couldn't eat or drink either because of the surgery the next day. They had her on complete bedrest (not even allowed up for the bathroom). It was miserable.
But the sun rose on Friday and Laurie was still stable. Around 7:30 AM the next morning, the surgeon came by for our pre-op consult. He described the procedure and explained that he would not really know if it was even possible until Laurie was in the operating room, because it all depended on whether or not Baby A's sac was bulging through the cervix. We knew he would try his best, and he's one of the best and most experienced cerclage surgeons in the world. We couldn't have been in better hands. It was just 3 1/2 hours until the procedure. It seemed like we had hope again.
And then shortly after the doctor left, Laurie asked the nurse and put her back on the contraction monitor. She had gone days without a single notable contraction. It took some convincing but they agreed, and finally after moving the monitor to the spot where Laurie thought it needed to be, it became apparent that she was now having contractions. They were small, but regular, and slowly getting more intense. It didn't look good, but Laurie fought it with everything she had--she knew if her water didn't break, the babies could at least have a chance.
They took us up to pre-op a little after 10. Laurie's contractions continued to intensify while we waited. When the doctor came by, he saw how Laurie was doing and instantly knew it wasn't good. He rolled an ultrasound machine over and took a look.
What we saw was devastating. We'd seen enough ultrasounds to basically know what we were looking at--Baby A's amniotic sac had totally prolapsed. This wasn't just a bulging sac, this was a baby who was on his way out. The doctor confirmed the bad news, and offered us a D&C to terminate the pregnancy, or just let Laurie proceed naturally with delivery (almost certainly having the same result, losing both babies).
Laurie knew that we still had another option and proposed trying a Delayed Interval Delivery to save Baby B. We confirmed that they were dichorionic/diamniotic twins (fraternal, not sharing a sac or placenta). The doctor said our chances would only be maybe 20%. And frankly that 20% was way better than what any other doctor suggested was possible. We had mentioned Delayed Interval Delivery to our doctors back home and they said it almost never worked and only got you a few days when it did. As the doctor wheeled Laurie away to the OR and told her that most likely she would wake up from the general anesthesia no longer pregnant, Dan broke down behind her. We had lost another baby, and it seemed we were on our way to losing a third.
Baby A was a boy, born on March 2nd. We named him Thomas and were able to spend a few hours with him after the surgery. He was 7 ounces and perfect like his big brother Joseph, just born too soon.
Next: The conclusion to our story, and the birth of our son Milo Thomas