24 weeks and reflections on what 10 days means

Conner and Benjamin were born at 22 weeks, 4 days.  We were 10 days away from reaching the magical 24 weeks.  At the time of their birth, their chances of survival were 1%.  Today, their baby sister is just 10 days older than they were when they were born.  And yet, her chances of survival are 50%. It's the tipping point of life and death. If Conner and Ben had been born 10 days later, the nurses and doctors would not have been asking me if I wanted them intubated, or what kind of interventions I wanted them to take.  They would have taken them as soon as they were born and tried to save their lives.  Without asking.  Because they would have been that magical age of 24 weeks.

That is not to say that survival = quality of life.  I know if we had asked for our boys to be intubated at 22 weeks and 4 days, they most likely would been tortured before they died.  Had they survived, their quality of life would have been close to zero.  They probably would not have been able to read, speak, walk, talk, feed themselves... the list goes on.  At 24 weeks, Baby C has a slim chance of coming home without long term developmental and health issues.  Like I said, we still have along way to go.

But still, what a joke.  Ten fucking days?  Ten days and my boys woud have had a chance. I think of all the days of my life that I have wasted.  Now I realize what a big difference mere days make.

I have to remind myself, though, that having Chorioamnionitis made them sick.  Making it to 24 weeks may not have meant anything.  I had to let them go. It doesn't mean that I don't wonder what could have been.  Conner and Benjamin were big enough to be intubated, and no one thought they would be.  They lived for hours without any oxygen intervention.  They were (are) strong boys.

My sister-in-law reminded me the other day that being in heaven is not a punishment.  I have to keep telling myself that.

While I'm feeling so incredibly upset about not having my sons here, I have to be grateful that we are here at 24 weeks with Baby C.  She has been tumbling around, probably taking advantage of the fact that her big brothers made so much room for her to grow in my uterus.  We've come to realize that she loves story time to her brothers at night - she's the most active when we read.

How far along?  24 weeks
What's happening with  baby? Is apparently just over a pound now (although Conner and Ben reached that milestone earlier).  She is over a foot long and her lungs are developing :)
Total weight gain: Well, my scale says I gained one pound this week.  The doctor's scale says I gained a whopping three pounds.  Yeesh.
Maternity clothes?  I'm giving in and buying something this weekend.  It's time, Krystal, it's time.
Stretch marks? No, but my belly is itchy.... uh oh?
Sleep: Not. Good.  Last night I stayed up untl 2:30 am just thinking about how the boys' first birthday was around the corner.  I also got up to pee about 27 times.
Miss Anything?  being able to wear socks without my calves swelling!
Best moment this week: Waking up today, still pregnant
Difficulties this week:  Today was Baby C's follow up growth scan.  If you remember from her 20 week A/S, her head was measuring in the 10th percentile.  Now her head width is in the 4th percentile.  It might be genetics.. it might not.  I'm not sure what to think.  We will repeat the growth scan in three weeks, and at 28 weeks we will begin monitoring her twice weekly to make sure that she is getting nutrients and oxygen from the placenta. If this is the case... we are looking at emergency delivery. I almost broke down right there in the doctor's office.
Movement: Acrobratics up in here!
Food cravings/aversions:  We had pancakes for dinner last night. PANCAKES.
Symptoms: Oh you know, just the ever expanding belly.
Looking forward to: We were going to go baby shopping Saturday.  Now I don't know if I feel up to it.. I just wish I knew her head was okay :(

She was waving at us today :)

Weekend Review and hello little froggy!

My weekend was wonderfully boring, which I love.  Tim had a bachelor party to go to on Saturday and I was feeling incredibly nauseous, so I took up residence on my couch and snuggled in with some fruit for dinner.  Later that night, I mentioned that I wanted a plain hamburger from McDonald's and low and behold, my husband came home early at 11:45 with a bag of McDonald's for me.  He snuggled in with me in bed instead of going to the next bar with the boys.  "What better way to spend a Saturday night than in bed with my wife?" he asked.  If that's not commitment, I don't know what is.

My Saturday night

As soon as I turned 8 weeks, I noticed that the pregnancy symptoms I had with Conner and Benjamin around 5 or 6 weeks were starting to manifest.  I'm not as nauseous as I was with them, but I'm definitely sticking to bland food now.  Pregnancy acne isn't awful, but I'm starting to notice it.  And the weirdest symptom I have ever had appeared over the weekend - my eyes hurt in the shower.  I can't even explain it... when I was pregnant with the boys, my eyes were sensitive when water hit my eyelids.  I was showering on Sunday and the same thing happened.  It was deja vu, but also weirdly soothing because I knew that any pregnancy symptom I had indicated that Baby C was still there.

On Sunday, Tim taught my niece how to properly kick a soccer ball and after ten minutes, she was a pro. I got to talk to my dad about my grandfather passing, which gave me a little peace. The rest of the day was spent couch surfing and contemplating what to have for dinner (salmon, rice, and veggies for me and Baby C, pasta and chicken for him).

Today I had my first ultrasound with my OB.  The ultrasound tech offered her sympathies about the boys.  I told her what happened and she was in shock.  She remembered my last ultrasound, saying that my uterus was high and closed and the boys were absolutely perfect. Lady, you have no idea how perfect.  I was almost in tears, but I was so glad that she wanted to talk about them.

And then little blobby was on the screen, with a perfect heart rate of 176 bpm.  Little blobby now looks like a flattened frog, so we are now calling him/her little froggy. The relief I felt when I saw that heartbeat is indescribable.  As soon as I heard it, I knew it was faster than last time.  Little froggy is squirming away and looks perfectly happy in its little squishy world.

A nurse I have never seen before took my history before the OB came in.  She asked me if this was my first pregnancy.  No, it wasn't.  It was my second pregnancy.  Did I having children at home?  No, I do not have children at home.  Were the boys a miscarriage or an abortion?

Fuck you, lady.  Read my chart. 

I was playing with my wedding rings and my ring I got for Mother's Day.  I didn't know how to respond to her.  Were those my only options?  They died, I said.  They were premature.  Oh.  How many weeks?  22.5 weeks.  Were they twins?  What gender were they?  How much did they weigh?

Cheese and rice.  She must be illiterate. 

Walking out the door, she poked her head back in the room and asked me if this was a singleton this time.  Yes.  She winked at me and said, "good."  GET OUT. 

I've never been so happy to have a nurse leave the room before.  My OB and I discussed a possible cerclage.  Ultimately, it is my decision.  We don't know if I need one, and placing one in if I don't need one is very risky (including a higher risk of infection, which is scary after losing babies to Chorioamnionitis).  But if I do need one... well, I better get one.  The big issue is that I had no symptoms of an incompetent cervix at all, but chorio and cervical incompetence often (but not always) coexist.  My MFM is also leaving this up to me.  I would go on and on about the pros and cons of the cerclage, but truth be told I am sick of thinking about it. I've been thinking about it since January and there are still no clear answers.  The few people I mentioned it to all seem to have opinions that I am not interested in, because they are neither doctors nor have they ever been in my position.  When did people start thinking they were qualified to give medical advice on things that they have never experienced themselves? And really, who wants to give medical advice?  I sure as hell don't.  I don't want that kind of responsibility.  Yet here I am... with a huge choice to make.  I have a little time to decide what to do.  Until then, I am hoping God gives me guidance on this.  Actually, I'm hoping he sends me a signed letter on what to do with this one.  I think it's incredibly unfair that I have to be in this position in the first place. My boys should be alive. Baby C should be waiting until next spring for a transfer and a safe pregnancy. 

Tomorrow I get my culture results.  We think the infection is back.  I'm trying my hardest to protect little froggy but this is proving itself to be very difficult.  

Can it be Saturday night again?  

Update and maybe TMI

Thank you to everyone who took the time to research things for me, pray, and put up with my insanity yesterday.  Now that I've calmed down (kinda.  not really.), I think I can explain a little more what happened yesterday and why this is such a big deal for me.

My doctors can't say for sure why I lost Conner and Benjamin; it could be due to an incompetent cervix that led to an infection, or just an infection.  The popular opinion that they all feel very strongly about is that I had an infection that made it's way into my uterus and caused me to go into labor.  This could have been from normal bacteria that is just not supposed to be in the uterus.  I could have also had BV, which is normal in pregnant women because of the changes in hormones.  It could have been asymptomatic, and left untreated caused me to go into labor.

So imagine how it felt when they called me to let me know that I had BV.  Typical protocol is to let pregnant women in their first trimester ride it out, since the body usually gets rid of it on its own.  However, given my history, it had to be treated right away.  This meant the use of antibiotics that are typically not given until the second trimester, or at the very earliest, 11 weeks.

My OB explained to me that the most harmful time to take these antibiotics is between 6 and 10 weeks.  I am 6 weeks pregnant today (coincidentally, it is also Conner and Benjamin's 6 month birthday today).  He put me on the safest antibiotic he could and gave me a cream instead of oral antibiotics, which flood the bloodstream and are more toxic to the baby.  He was overly concerned that I had an infection this early in pregnancy, especially after what happened with the boys.  While he was happy to see me pregnant, I'm not sure if I have ever seen that look of worry on his face before.

I also had to talk to my RE and discuss the risks of this infection.  It is possible that I had this infection during embryo transfer and the bacteria followed the embryo into the uterus.  My RE believes that if this had happened, I wouldn't have gotten pregnant in the first place and I would be in the hospital, deathly sick.  However, my MFM believes that I could have lost Conner and Ben due to a low lying infection that followed the babies into the uterus on the day of embryo transfer.  So yes, there is a chance that I might lose this baby again in the second trimester.  We just won't know until we get there.

After speaking to my nurse at the clinic and to my OB, we have decided to transfer my care to my OB early after we have established fetal heartbeat, which should be on Monday.  Typically, the release does not happen until 10 or 12 weeks but I am free to go whenever I feel comfortable.  I would like to get the fuck out of my clinic, especially after they kept telling me my symptoms were "normal" and that I could wait a couple weeks to get all this checked out.

This is why we all need to be advocates for our babies and for our own health.  I went over their heads and saw my OB, even though I had not been released to his care yet.

My OB will be repeating cultures frequently even when I am asymptomatic (as I was asymptomatic with the infection that took Conner and Benjamin).  Thankfully, I have an OB that has stated that they are going to be as aggressive as possible so that I do not lose another baby.

So, in a nutshell, these are the concerns:

1. That I had an infection for weeks but did not know it; bacteria then traveled with the embryo on transfer day and will lead me to lose a baby later in the second trimester once the bacteria has grown out of control. We can test this with amniocentesis, but it might not show up in the test. 
2. That I will have recurring BV, which is a cause of premature labor.  I seem to be susceptible to varying levels of PH which means that I may be more susceptible for infections recurring. 
3. That the antibiotics I am using this early will cause developmental damage to Baby C. 
4. That the antibiotics I am using will actually cause a miscarriage. 

I trust my doctor and I know that it is in the baby's best interest to treat aggressively. While I know women treat infections during pregnancy all the time without issues, my case is a little fragile.  Well, very fragile.  My body hates me, and right now, I'm not too happy with it either. 

I can't stop rubbing my belly and telling Baby C that s/he needs to keep growing and needs to come home with us.  But that is an awful lot of pressure to put on a little baby. 

Bad news

I have a bacterial infection.

It could be the same infection that caused me to lose Conner and Benjamin.

They have to put me on antibiotics, which are routinely not given to pregnant mothers until after the first trimester.

But I need to take them now, given my history.

So I could lose this baby due to infection, or something can be horribly wrong with the baby because of the medication that they are putting me on.

I probably won't be posting for awhile.  I think I've just about given up on trying to have a healthy baby.

No chance

"They had no chance."  She is stern but I can see that this is even hard for her to say.

"That  makes me feel better about the choice we made."  It doesn't.

"Even if you had made it to 24 weeks, with that infection, they would not have survived."

A pause.

"Thank you for helping us make the right decision for them."

She has tears in her eyes now.

At least I let my boys die with dignity.

So what happened?

via Etsy

I guess at this point, I should mention what brought us to the hospital on that deplorable January night.  We just recently (read: last week through my ob and yesterday through the mfm) found out that it was from chorioamnionitis.  Yeah.  Try saying that five times fast, or better yet, spelling it. I literally googled it five seconds ago just to make sure it was spelled correctly, since I always says its chorioamniocentisis (which doesn't even exist).

Chorio is estimated to affect 1 in 100 pregnancies.  It is caused by normal bacteria that resides in the vagina, and every pregnant woman is at risk for it.  There is no way to prevent this motherf'er.  Every once in awhile, this bastard makes its way up to the uterus and infects the placenta(s), making its way to the baby(ies).  Most of the time, this happens late in pregnancy.  And, most of the time, it is the result of a prolonged labor and the cervix being open for so long.  The mother gives birth, say around 37 or 38 weeks, the mother and baby are treated with antibiotics, and they are wheeled out a few days later, mother holding baby and balloons while daddy helps them into the car.

I delivered Conner and Benjamin at 22.5 weeks.  Because I was already dilated when I came in, and because I went from 2 centimeters to 10 centimeters so quickly, both my OB and my MFM believe that chorio caused me to go into labor, rather than just being a result of the labor.  Because it happened so early in my pregnancy (and would be the indirect reason why my babies died), my OB said this was a 1 in 10,000 chance this would happen.  He has only seen it happen like this a few times in his 20 years of practice.

The placenta autopsy showed that one of the babies, probably baby "B", had a moderately severe case of chorio that had even reached his umbilical cord.  The other baby, probably baby "A", had a mild case.  I say probably about the babies, because when I delivered the placentas they both came out at once and it was most likely difficult to tell whose placenta was whose.  My babies were sick.  The MFM and OB later explained to me that even if I had made it to 24 weeks (viability), they had 0% chance to survive with this infection paired with the complications of premature delivery.  Hearing this made me feel better that we made the right decision for them, but also awful - they were (are) such beautiful babies, and they fought for so long. It was incredibly painful to hear that they had no chance, regardless of how brave they were.

Everyone says that I shouldn't blame myself, and now there is pathological proof that I could not have prevented this.  Even if I came in a day earlier to the hospital, the damage was already done.  But I am their mommy.  I was supposed to carry them, help them, save them.  I would have laid down my life for them.  I didn't get that chance.  I will always feel guilt.  My body turned on them.  My body didn't carry them to term, or even to viability.  This infection didn't happen to me, it happened to them.  I will live the rest of my life owing those boys the world.