Hospital bed rest day 49 W27D3:The doctors are getting bored!

I'm just a few days short of reaching our second milestone of 28 weeks!

Contractions

So far I have no complains - I'm still trying to figure out the difference between a Braxton Hicks contraction and a real contraction.  In triplet pregnancy, real contractions are often painless and less obvious - something that many nurses here may not agree, as they are of the opinion that only those contractions that are painful are real contractions.  It doesn't help that they do not have a contraction monitor here, so if they do want to time my contractions, they do it the archive manual way - by putting their hands over the top of my belly for 10 minutes.  They did this for a while after my 24-week pre-mature labor scare, but they have since stopped doing this.

One midwife in the labor room actually told me that it was standard international practice for contractions to be monitored for a 10-minute period only - WRONG!!!  That's the typical practice here, but base on my readings, if a contraction monitor or a Home uterine monitoring system was used, contractions are monitored for an hour. So advises Dr. Luke in her famous multiple pregnancy as well.  Also, a church member who had to go on hospital bed rest for both of her pregnancies due to pre-mature contractions shared with me that she had a contraction monitor and they did count the no. of contractions per hour.

So I guess it is really up to me to monitor my own contractions!  Right now I'm not too concern because any tightening in the abdominal I feel does not last very long.  Sometimes I do get a real contraction and I can actually see my parts of my babies sticking out in my belly - I try to guess which is the head and what part of the body I'm seeing!

The 'At Own Risk' discharge plan

I'm a bit nervous about my ultrasound appointment with my Peri this Wednesday.  First, I don't think he'll be too happy with my decision to take an AOR discharge to attend my brother-in-law's wedding this weekend.  I'm afraid he will state all the things that can go wrong and scare us all into changing our minds and then I'll be stuck in here while the rest of the family is out partying.  I'm only 50% through in my hospital bed rest stay, and for the sake of my psychological well being, I really, really need to get out of here for a bit.  It doesn't help to know, after spending the past 2 months reading every triplet mother blog and forum I can get my hands on, that I have yet to meet another triplet mother who was sentenced to hospital bed rest as early as 20 weeks for no reason other than for observation.  I even found a journal article that highlighted the psychological effect of confining triplet mothers to early bed rest where there is no medical complication.  So knowing that I was admitted in here at 20 weeks when it was not a medical necessity, but more for the convenience of the system (aka government hospital management system that does not do well for emergencies) makes it even more difficult for me.

Secondly, even if they do want me to be on hospital bed rest, for the reason that the hospital is the safest place in the world for me to be in, it is common practice (based on my readings of what other triplet mothers, yes, including Malaysian mothers who have been on bed rest) for bed rest patients to be discharged or get weekend privileges to go home.  Again, I've not been allowed to go home at all during my stay here.  Not even out for a little while.  I can't even step out of the ward on my own!  My MIL was concerned that I would be vitamin D deprived due to my non-exposure to sunlight, so she managed to get the nurses to agree for her to take me down to the garden on the wheelchair.  The garden is nothing much to shout about, but at least I do get under the sunlight!

Risk of blood clots 

Since I've been here for such a long period, i.e. long hospital bed rest, my Peri has instructed that I am injected with a Clexane, a blood thinner on a daily basis to prevent blood clots.  I have had those before when I was hospitalized with OHSS back in January this year, and they were not fun!  The Peri had initially ordered these shots at 24 weeks, then he later changed his mind and ordered them at 26 weeks.  They were going to start jabbing me from 26 weeks onwards, but I refused the jabs on the ground that I was still ambulatory and I am not on restricted bed rest.  They kept on coming in and persuading me to take the jabs to prevent blood clots, which is very serious.  Finally, the Obs said to wait till my next scan for my Peri to decide what to do.  Of course he will insist that I get the blood thinners since he was the one who prescribed it!

I did some research, and I can't find any triplet mother on modified home bed rest who was on blood thinners.  Those pregnant women on blood thinners are those with a history of a clotting disorder or strict bed rest.  Even those who are on hospital bed rest don't seem to talk about taking blood thinners, but then again they are discharged as soon as their condition stabilizes.  Either that or those long-term ones just do not talk about the blood thinneers.  The lady from church who visits me regularly was on modified hospital bed rest for 10 weeks, and she did not have blood thinners either.  Some of them are made to wear a compression device on their legs that massages their legs to keep the blood circulation going.  Of course, like the contraction monitors, we do not have such devices here in ulu land, sigh!  Right now, to reduce the risk of blood clots, I wear compression socks most of the time.  I exercise by walking up and down the ward several times a day.  I also do leg stretches.  And of course, I need to go to the loo every 1.5 to 2 hrs all day and night!  But the Obs is telling me that this is still not good enough because in here, my mobility is not normal.


Here's one lady's sharing:

• By norahd
• Reply 253093
• January 15, 2009 at 8:47 am
• Report post

I hear you. I was tired wearing the leg cuffs. When my MFM Dr saw me several times without the cuffs, she suggested heparin. I did not want the shots, so I told her I will wear the cuffs without taking a break, but she said she is worried about me getting blood clots. I have been too long on strict bedrest.
I did not realize you are getting up to go to the bathroom, then may be you do not need heparin. Once I was released from the hospital, with bathroom privilege, the MFM did not want me to be on heparin anymore (getting enough movement to avoid blood clot)

(https://www.inspire.com/groups/preemie/discussion/bed-rest-and-blood-clots/_

 I just have a bed feeling that I won't be able to avoid those darn injections for long now.

Steroid shots

Yup, Peri has also ordered that I get two of these really painful steroid shots, Dexa every fortnightly.  I had my first set at 24 weeks, and another set at 26 weeks, so the next one is coming up!  These are to strengthen the babies' lungs, and I know that they are commonly given to triplet mothers who are at real risk of going into premature labor.  But once every fortnight???  Again, I've not come across any triplet mother sharing that she had one every fortnight but I really do not know enough about how often they should be given.  I've mostly read about triplet mothers having a steroid shot only if they are at real risk of going into pre-term labor.  I have not refused these shots, though.

Sigh, I'm so full of complains today!  I'd better stop now.  Truth is, everything has been going rather smoothly apart from the premature contraction scare.  Till this day I do not know if I was actually having real contractions or Braxton Hicks.  When they timed my contractions using the traditional hand-on-upper-belly method, they were unable to detect more than one contraction per 10-minutes.  But that was after they gave me all that medication.  I think the doctors are getting bored of me during their morning rounds.  Nothing new for them to ask, nothing new for me to report.

As difficult a patient as I may be, boring is good, though!  Let's hope I'll remain boring for another 6 weeks :)

Hospital bed rest day 43 W26D4: There a growing baby elephant on my belly!

They don't seem to be too diligent on monitoring my weight here in this hospital. The weighing scale in my ward is not working and I have no idea how much weight I have put on since my 22nd week. I had just asked DH last night to bring our weighing scale from home so I could monitor my own weight. Anyway, today my favorite nurse in the ward decided to weigh me, so here are my stats:

   My pre-pregnancy weight was 48kg.

   My weight at the most severe part of my OHSS when I was in hospital was 57kg. There was an additional water retention of 9kg inside me!

   My weight after being discharged after 10-days of hospitalization in January was 46.6kg. Since this weight can still be considered average (on the borderline for my height, 5"2), I've used this weight as my baseline.

   Today I weigh 63.2kg.

Which means Ive put on 16.6kg (36.5 lbs) since then!

My FM specialist was back from his holiday last week, so although my next scan was scheduled for the week after, I had a surprise scan last Wednesday (W25D7).  The babies weighed:

  Baby A: 892 g (2 lbs)
  Baby B: 786 g (1.7 lbs)
  Baby C: 854 g (1.9 lbs)

So if the total weight of the babies are less than 3kg, i.e. the average birth weight of a singleton, what does the rest of my weight gain get attributed to? Well, I'm carrying three times the amount of placenta and ammonic fluid inside me :)

My cervix is 3.6 - 3.7cm!  I guess it wasn't even an issue because my FM didn't even bother to disclose the length to me until I asked him.

I've been carefully trying to eat enough and eat correctly to reach the biweekly target weight for triplet mothers in Dr. Luke's book and I've been fairly proud of myself for my weight gain at 22 weeks. The weight gain from proper nutrition for a triplet mother-to-be is essential for a healthy triplet pregnancy, because this means heavier babies at the premature birth, which can happen anytime. A heavier premature baby has a higher survival rate and less complications. Proper weight gain also helps to reduce the risk of very early premature birth.

How does it feel to be pregnant at 26 weeks with triplets? Well, it's like a baby elephant that is stuck to my belly that growing at a very fast pace! I remember complaining about the discomfort as early as 22 week, not being able to stand, sit, lie or walk for long. Funny though it seem, I've learn to adapt to the discomfort of the weight in my belly. And now that my Prenatal cradle has finally arrived from Amazon.com, I can walk comfortably enough up and down the ward without having to hold my belly!

I know it's going to get worse once I reach my third trimester, so I'm trying hard not to complain too much now. I'm just hoping the babies would be able to make it to 1kg at my next scan, where I'll be around 28 weeks!

Hospital bed rest day 34 W25D2: I'm not too sweet!

Thanks to the increased hormones produced to carry more than one baby, we mother-to-be of multiples have an increased risk of developing gestational diabetes.  Apparently, these hormones interfere with the babies' ability to process the insulin.

I had my first test for gestational diabetics at week 16 and thankfully, the results were negative.

Back in my former ward when I was still in the 4-beded room, I had a roommate who was diagnosed with gestational diabetics.  She had to test her blood sugar level several times a day and give herself daily insulin jabs, as well as count her daily calorie intake.  Not fun!

Gestational diabetes can lead to complications for both the mother and the baby. These complications may include:

• Macrosomia (oversized baby)
• Increased chance of cesarean section delivery
• High blood pressure during pregnancy
• Low blood sugar (hypoglycemia) in the baby immediately after delivery
• Stillbirth
• For the child, risk of obesity and developing type 2 diabetes later in life

Come last Thursday, the Obs decided to have me retested for gestational diabetics earlier than scheduled.  Sucks!  I had a nice marble cheese cake and three cup cakes in my mini fridge and now I felt nervous about eating them.  So after an 8-hour fast, I had my blood taken, then drank a cup of sickly sweet glucose, and waited another 2-hours for my blood to be taken again.  I've read about the sugared drink that comes in several flavors - cola, orange, and etc. but I guess they keep it pretty basic here at a Malaysian government hospital.

More than 24 hours later, I was still waiting for my results! The nurses kept on saying that they have yet to receive the results, and the medical officer said that she will go and check on the results but that was it.  No news after that!  In a private hospital you can get your results pretty soon after the test, but not so here.  Finally, when I complained to MIL who visited me with lunch, she went to check with the nurses and hey presto, the results were already in.  Just that nobody bothered enough to inform me!  Not even the medical officer who was happily sitting behind the nurse counter. I guess no one here really cares about the anxiety of a patient waiting for her blood test results :(

Anyway, the blood test revealed that I'm not too sweet!  I passed!  I passed!  I don't have gestational diabetics! Yahoo!!!  

Time to celebrate with a cupcake 

Hospital bed rest day 30 W24D5: Belly picture!

I had my scan today and all babies are active and doing well!  

Here are their weights:
Baby A: 700gms (1lb 8oz)
Baby B: 684gms (1lb 8oz))
Baby C:790gms (1lb 11oz)

I'm quite sure that Baby B was Baby C and vice versa, but the scan was done by the other FM Specialist since mine was out of the country.  I'm just glad that she made time to give me a scan today!

I was a bit worried about the differences between baby B and baby C's weight, but the FM Specialist said this was okay.

My cervix is still at 3.5cm!  Woo hoo!  They were going to give me daily progesterone pessaries if my cervix was shortening.  I had to insert one of those down there every day for several weeks during my earlier days threatened miscarriage so I'm glad I don't need them right now.

Right now they feel so heavy!  Yet, I'm hoping that they will surpass double of their current weight before they come out.
I shared my threatened pre-term labor scare to the ladies on the forum and I was really comforted when one of the triplet mothers replied (she has 3 mth old triplets delivered at 35 weeks 3 days):

I was hospitalized for 5 days for monitoring at 24 wks but went on to carry for 35 wks. I was told the goal was to make it 28 wks, then 29, 30, etc.

I took nifedipine from then until the day before the delivery. I had steroid shots then and again at 28 wks because of a positive FFN test. I thankfully avoided magnesium.

It was always hard to tell the diff between contractions and movement. I was always asked if I'd been feeling contractions and my answer was "I don't know."

Basically, what I'm trying to say is that it's certainly possible to carry to 35 wks given what you just went thru. But, make it a short-term goal to reach 28 and every wk after that is a bonus.

I still have mild contractions and I'm hoping that they don't become more regular.  Apart from that, and the increasing discomfort, I'm hanging in there :)

Hospital bedrest day 29 W24D4:Good day!

I was sleeping so much yesterday that I stayed up all night doing my favourite hospital past time - reading blogs by triplet mothers.  I thought that I'd have plenty of opportunity to sleep in today but today was a fairly "busy" day with a steady stream of visitors.  Visitors are a luxury for me since the hospital I am in is about an hour's drive away from KL, and since I'll be here for eon years I've told my friends that they have no hurry in coming to visit me.

First came dad in the morning at 8.45am.  He brought me Farmhouse Milk - my essential diary intake!  Yay!  He also brought the McDonald big breakfast that DH had bought for me this morning!  What a treat!  I was joking to DH about it just the night before but I never expected him to actually get one for me.

Dad was only in for 10 minutes when the guard came in to shoo him out of the ward, saying that he had to leave as the morning visitation hour was over.  We begged the guard for another 10 more minutes.

Then came the Obs with her team of trainee doctors.  Let me rewind a bit first.  It is all about hierarchy here among the doctors.  The houseman will first come in early in the morning to check on me and to get updates.  Then the medical officer who is probably an Obs-in-training will come in with the houseman and listen to the houseman's report about my progress.  Finally, the Obs will come in together with the medical officer and the houseman and they report to her about my progress.  So yeah, I pretty much have to repeat everything three times each morning.  The Obs will check my medical file to ensure that the treatment plan outlined by the FM Specialist is being followed.  The Obs is pretty powerful though.  She knows DH well, so I took the opportunity to request whether dad, who had come up all the way from KL, could stay with me past visitation hours.  Thankfully the Obs understood psychological well being (which many here doctors don't!) and acceded to my request, so dad got to stay with me in my room till the afternoon visitation hour! Dad took my latest belly pictures that I will post tomorrow!

My MIL and FIL arrived promptly at 11.30am when the afternoon visitation hour started.  MIL had, as usual cooked lunch for me.

Everyone left at about 1.50pm.  I was due for my fortnightly scan today but apparently the replacement FM specialist (who is scheduled to do my scan since my FM is on holiday) has her hands full today so that didn't take place.  So I took the opportunity to have an afternoon nap.

At 5pm, friends from KL arrived with homemade nachos...yahoo!  I've not had cheese for goodness how long - that's an important source of protein too, which I need.

At 5.30pm, another friend drop in with two slices of cheesecake and walnut bread.  The triplets and their mama are having a feast today!

At 7pm, DH finally arrived after another long day at work and was happy to eat up my hospital dinner.  DH was pretty tired as usual so after everyone had left, we napped together (not on the same bed, though!) till 9pm.  DH is the only who gets to stay in with me after visitation hours as the husband.  But then again, let's just skip the husband part and give him 24 hour access to my room since he is a doctor in this hospital.  Not that he would ever above this privilege anyway.

DH left at 9pm - He looked so tired that we decided to postpone our favourite hospital couple activity for the next day - watching the latest episode of the Game of Thrones together.

10.00pm - Shower time, followed by my usual supper time.  I feel good about my protein intake today.  I had three eggs (ugh!  Had to throw some of the yolk out even though it was rich in iron, which I need!) and I even forced myself to eat the fish that MIL cooked (I've developed a distaste for fish since becoming pregnant).  Also had lot of cheese and an avocado - more power food for my babies.  And of course my nutrition shake made with my Farmhouse milk.  I think the triplets are quite happy too :)

So yeah, with a day packed with activities like that, time sure passes by a lot faster.  It is those days with not much activity that time passes by so slowly and reaching the next target duration of pregnancy feels like eternity.

28 weeks, 28 weeks....every day I wake up and chant this number.  Come quickly!

Hospital bed rest day 28 W24D3: The 24-hour ordeal

Here's my recap about what happened last Friday (Hospital bed rest day 26, W24D1):

It started out as a normal day in the hospital.  I was up early as usual (thanks to the frequent toilet trips and the nurses that loudly barge in at 5am).

8.15am - Dad came from KL for a visit.  He usually follows DH up to the hospital on Friday mornings.

8.30am - I was in the middle of showing dad my contractions when the Obstetrician taking care of me came in for her ward rounds with the medical officer who typically visits me twice a day.  The first thing the Obs asked me was whether I had any more contractions and I told her yes, I've been having them throughout the night (though not timed) and in fact, I was having one right then.  She felt my belly and confirmed that it was a contraction.  Things happened quite quickly after that.

8.45am - Obs did a vaginal probe and took a swap, which was awful!  The good news was that she confirmed that my cervix was still closed.  She decided to send me down to the labor ward for observation anyway, and to take the necessary precautions for pre-term labor.  I found out later that there was another triplet mother-to-be in hospital, also in her 24th week, who also had experienced pre-term contractions, and who was currently under observation.  So perhaps this is why she was also quick to react this time to my contractions.

9.00am - They whisked me down to the labor ward...the only thing I got to do before that was to brush my teeth.  The labor ward was a market place - it was noisy, fast-paced and brightly lit!  There was as long room that looked more like a long corridor, with beds in the middle and nurses, doctors and midwives walking up and down from both sides.  I could hear newborn babies crying in a distance and some baby's heartbeat being monitored through a fetal heart monitor.  It was not a fun place to be.

I was then put on an IV drip for magnesium sulfate to help protect the babies brain.  I hate being on drip but the worse was the catheter that they inserted into my bladder.  It hurt having the catheter go through my uretha and it felt awful having a full bladder and not being able to pee.  They wanted to monitor my urine output to ensure that the magnesium sulfate wasn't staying in my body.  Then came the painful steroid shot that is to help develop the babies' lungs.  That hurt like hell but the midwife who gave me the shot was pretty experience and it was over as fast as it could have been.  They also gave me nifedipine (thankfully these came in the form of pills) to stop my contractions.  Then I was told to rest...how the heck could I rest with all the chaos going around me?

2.00pm - Finally they took me out of the awful long corridor like room and transferred me to the small room just across the walkway.  This room had two beds and I soon discovered that the other triplet mother-to-be under observation was in the first bed.  She had already ended her 24-hr observation, was doing fine, and was waiting to be transferred back to the ward.  I felt jealous that her ordeal was over and mine had just started.  I also learned that she had conceived triplets through timed conception just like me but using clomid!  Yay to discover another non-IUI/IVF triplet mother-to-be!

The second room that I was in for the rest of my observation did not offer much privacy as well.  It doubled up as the doctors' workstation so there were doctors and nurses walking in and out the whole time.  The door was always left open so I could hear all the chaos that was going on.  They deliver babies non-stop here....all throughout the day and the night.  For the rest of my observation, I hears women crying in labor, newborn babies' crying as they take in their first gasp of air, and of course midwives talking loudly in the doorway.  I saw exhausted women being wheeled out of the labor warm just after delivery and midwives carrying new born babies in their arms.  I learned that in this hospital epidural was not an option for women who would go through a natural delivery because there were not enough anesthetists (and the epidural is too expensive and not considered a necessity?).  So they all had to tough it out and endure the labour pains.  I remembered my MIL telling me that it was possible to get admitted in here for delivery and be discharged the next day, and in such cases, the hospital bill only comes up to about RM10 (less than US$4)!

Back to me, with all the stuff poked inside of me, I couldn't move much or get out of bed.  So I stayed in the same position for 24 hrs.  My poor buttocks ached without relief.  I told DH that I really felt like the Princess and the Pea but DH had no idea who that was!  I couldn't drink as much as I usually did because I was afraid of having the uncomfortable feeling of having a full bladder again and I didn't feel like eating much.  My poor babies!  I said sorry to them but hoped that they would be able to toughen it up for this 24 hours.

Towards night time, the nurses who came to do 10-minute monitoring of my contractions reported that my contractions were 1 in 10 minutes or none.  My blood pressure was being monitored hourly and since it was getting low, some one gave instructions to stop the nifedipine.  Yet, I continued to feel the contractions.  I even told DH about it and he said to get the doctor to resume the nifedipine since my blood pressure was no longer low.  DH then had to leave me to travel back to KL.

I was again told to get some rest.  The doctor instructed to nurses to give me some pain relief medication that would help me relax and sleep but I refused.  I was not in pain, I told them.  I just wanted something to stop my contractions.  They told me I was just being anxious and that I didn't need the nifedipine because my contractions were irregular.  How I wished they had a contraction monitor here!

1.05am - I was wide awake.  Still feeling my contractions and timing them.  I felt 7 contractions between 1.05am - 2.25am.  When the nurse came in I told her about my contractions but she said that they only time contractions on a 10-minute basis.  I asked to speak to the doctor.    Sometime later a doctor came in...probably a houseman or a new medical officer.  I asked for the nifedipine again but she didn't dare to allow it without the green light from her superior.  At that point I decided that there was nothing else I could do so I tried to get some sleep, waking up every now and then when I felt a contraction and when the blood pressure monitor tightened around my arm.

6.30am - The nurse came in and offered to take me to the bathroom for a warm shower.  How the heck was I going to do that with the IV and the catheter?  I just didn't feel like going through all that, so they finally decided to give me a sponge bath.  The air-conditioning and warm water wasn't such a good combination for me.  I started shivering so badly that they ended the sponge bath.  They did however do a thorough cleaning down there, and that wasn't fun at all.  It was nice though to be able to brush my teeth and change into new clothes.

7.30am - I'm counting the hours to be taken off the damn catheter and the IV drip.  MIL sneaked in to give me breakfast.  She managed to meet the Obs in charge of me and told her about my contractions and wanting to be back on the nifedipine.  The Obs came in and spoke to me.  I had several contractions during our conversation and she immediately instructed the midwives, "Patient is anxious about her contractions so resume her nifedipine unless her blood pressure drops to 50."  They finally gave me the nifedipine and my contractions slowed down and subsequently stopped.

10.40am - The second steroid shot was worse than the first.  The took out the awful catheter and stopped the drip.  I waited for my bladder to fill up and requested to go to the toilet.  I was afraid of the pain that comes with peeing again after using a catheter, but thankfully there was no pain and I could pee like normal.  It's such a wonderful feeling to be able to pee again!  I'm feeling much better and am waiting to be released to the ante-natal ward (no choice, they're not sending me back to my old ward after this!)

3.30pm - I've finally got the green light to leave the labour ward.  Yipee!  Contractions have stopped.  Double yipee!

Babies, babies, during this awful ordeal, I knew you would be safe.  The Lord filled me with his peace and told me it wasn't time yet for you to come out.  I don't know how long more you'd stay inside baking, but I did know you were not coming out right now.  Mummy is not a good patient, she's not a very brave person.  But mummy will try her best to hang in there for you.