Hospital bed rest day 65 W30D1: 30 weeks and still going strong!

Let's face it - No woman goes to bed wishing to wake up the next day pregnant with triplets.  Twins yes, but triplets no.  And definitely not quads!

I tried my best to be as low-key as possible when we first discovered that I was pregnant with triplets.  I do, however, have a FIL (father-in-law) who cannot contain his pride as a grandfather-to-be of triplets.  Unfortunately, FIL also happens to be friends with everyone down the street here in this town where I am currently hospitalized, so word does spread rather quickly.  It goes without saying that the entire church is aware of this fact.  Even the owner of a popular Chinese restaurant here knows.

Yet, truth to be, a triplet pregnancy is nothing like a normal, singleton pregnancy. While dad and FIL exclaimed in half-disbelief and half-delight upon receiving news of our triplet pregnancy, I remember the look of concern registered on both our mothers' face.  DH's mother was a retired midwife, so she was well aware of the risks of multiple pregnancy, so did my mother.  While I was still in my first trimester, our Peri in Kuala Lumpur told us bluntly that the body was not made to carry three babies - it may be able to tolerate two, but three...?  Then he advised us to take this as an adventure, since that was the best that we could do.

Back in January, the  other Peri who had discovered the triplets during a scan while I was still in hospital had advised us not to go and read about all the things about triplet pregnancies on the internet because she didn't want us to get too anxious.  Well of course that was just what we did.  Power is knowledge, and the more we learned about the risks involved, the survival rate of of babies, the health complications and everything there was that remains unknown to most singleton mothers, the more we prepare ourselves for this journey.  I had a mission to get my hands on every material, every resource and experience I could read on triplet pregnancies.

If you are clueless about why triplet pregnancy is considered a "high risk pregnancy" this articles spells it out it well enough: Watching risks, week by week  I remember DH reading the stats to me - triplets have a 1 in 10 risk of birth defects, including down syndrome.  I found some other stats in the Enlightenment Issue no. 10, June 2011 published by the Interwoven Soals Coalition, an organnization that supports medical research relating to complications arising from a multiple pregnancy and birth (see left).

Oh, and did I tell you that mothers of triplets are 5x more likely to develop post-partum depression? And are at a higher risk for heart complications, severe bleeding post-delivery among others.  When I think about it, I seriously feel like I have to get to the business of working on my will before I am cut open, sigh!

DH went through a period of feeling depressed after we discovered our triplet pregnancy.  When I started bleeding, having blood clots and backaches, I myself laid in bed for a week miserable waiting for my babies to go.  Our fertility doctor said it was quite common for one of them to vanish (i.e. the vanishing twin syndrome) so perhaps nature would take its course.  Yet, as I continue to bleed for another week, I didn't know how many of my babies were going to make it.  I told DH that I would grief even if I lost one of them.

Yet all three babies pulled through!  Slowly, the bleeding stopped and I heard the Lord assuring me that my babies were not going anywhere for now.  I was comforted.  DH had moved to the stage of acceptance and felt enough peace that we would just have to walk in faith, praying and hoping for the best of circumstances that was beyond our human control.

And so, even as I struggled through my all-day sickness (which the doctor said was good because it meant that my body was producing enough hormones for the babies!), we stepped into our roles as parents-to-be of triplets.  How much do we plan, and how much should we brace ourselves realistically for the worst case scenario?  How excited should we allow ourselves to get, or should we always be mindful that we could lose our babies at any time?  How do we balance between preparing to become a family of five from just the two of us, and the possibility that we could face a life of struggle and pain, should we lose our babies or have children with severe health problems.  As first time parents-to-be who had traveled down a less than smooth baby-making journey, we could not suppress the joys of pregnancy (finally!) but there was always the shadow of the unknown that remain hidden yet close by.

We started our journey of adventure in January 2012 when we first discovered the three heartbeats of our babies inside me.  Seven months later, here we are with our triplets, at 30 weeks gestation, sill going strong.  The "still going strong" part refers to our babies, their kicks are now strong compared to the flutters I felt several months ago.  I haven't always felt very strong, emotionally (and psychologically) during this journey, but DH and I continue to walk this journey in faith.  Thank you, Lord, our Jehovah Jireh, for bringing us this far.

Hospital bed rest day 63 W29D1: 29 weeks and over!

I had my transvaginal scan last Wednesday, and my Peri took two measurements of my cervix - 3.7 and 3.2cm!  And the sludge was gone too!  I was so relieved that my cervix was not shortening but there was no one with me to share my good news, so I had to be content with a silent prayer of thanks and inner feelings of happiness.

I am currently 64.1kg, so I've put on almost 18kgs since I got pregnant!  It has started becoming difficult to walk as my belly feels heavier.  I'm really waddling now.  I know that I look really funny, but I still try to waddle up and down the ward several times a day just to keep active.  The joints of my legs are hurting even more and the pelvic pressure is a pain every time I go to the loo, which is about once every one and a half hours. The most comfortable position is still for me to be lying on my bed which is propped up and lined with pillows, from hard to soft.   

My contractions are increasing so I'm getting worried again.  The nurses come once in a while to time my contractions (using the hand-on-belly method), but they only time for 10 minutes.  I started timing this evening and I have about 3 to 4 contractions per hour.  I just hope that they are Braxton Hicks and not the real thing.  We still have 5 more weeks to go!

Hospital bed rest day 59 W28D5: Woo hoo, we are passed 28 weeks and belly pictures!

Finally, we have passed the second goal of 28 weeks!  This means that if the triplets are to come any time now, they are most likely than not to survive, although they will probably be very ill babies, with possible long-term medical and health problems.

At the scan with the Peri last Wednesday (W27D7), the babies weight were:

Baby A: 1047g

Baby B: 1054g

Baby C;1001g

Oh, by the way, did I mention that we are having BBB triplets?  We found this out quite early at week 16. DH was hoping for a girl, but I reckon that if we were to have a set of single gender triplets three boys is still more manageable than three girls, ha ha.

According to Dr. Luke’s statistics for fraternal triplet boys, our boys are slightly below the 50^th percentile of birth rate.  I guess this is where our babies' growth will unfortunately start to slow down in comparison to a singleton baby.  Still, DH and I are quite satisfied with the weight of our boys given my 5’2 height and small frame.  Also, we are conscious that the stats were taken from a sample of Western triplets and we wonder if perhaps Asian babies are smaller than Western babies?   I was a bit worried because I felt that I had not put on enough weight over the past 2 weeks, so we’re just happy that they’re all above 1kg now.

Now for the cervix.  The Peri said this was going to be our last cevix scan since anything beyond 28 weeks would be redundant as the cervix starts to shorten in preparation for labor thereafter.  He took the first measurement and it was 2.1cm – bad news.  Prior to this, my cervix had been pretty consistent, at abou t 3.5cm so this was pretty drastic shortening.  Anything below 3.0cm is not good.  The Peri took another measurement and this time the cervix was 3.2cm.  So is it 2.1 or 3,2?  Also, he was concerned about some sludge that he sported in my cervix.  He gave me some progesterone pessaries  for daily use, and I go back this Wednesday, i.e. tomorrow for another cervix scan. 

I’m trying not to get too worked up about my cervix, since the only thing I can do is to pray and wait.  Everything has been going on fairly smoothly so far, and I do hope that it will continue this way.

The Peri did mention in passing about my refusal to get the daily blood thinner jab.  He didn’t insist on it, though.  I’m trying to be as ambulatory as possible but although I feel the increase in my pelvic pressure whenever I walk, and it making walking uncomfortable.  Actually, I am truly waddling (not walking) at this stage.  Even the prenatal cradle does not help much with the increasing pelvic pressure.

I’m also worried that the increase in pelvic pressure means that my baby has dropped and that this is another indication of pre-term labor.  The Obs assures me though that this pressure is normal because I’m carrying three babies.   So I guess right now I just have to bite the bullet and tolerate it in addition to the pain in my leg joints, sleep of not more than two hours in a stretch, and pain in my fingers every time I wake up.  I know these are still considered minimal complains.  I have no backache, heartburn, acid reflux, nausea or serious carpel tunnel syndrome, so I have a lot to be thankful for.

Our boy would have to almost double their weight in order to reach the ideal minimum weight of triplets at birth, 1.8kg.  I already feel so heavy so I have no idea how it would be like to be carrying double of my babies weight! That would be equivalent to about twice the weight of an average birth weight of a singleton baby (i.e. 3kg) in additional to three times the amount of placenta and amonic asid inside my poor uterus.

From now onwards, every additional two weeks is a milestone for us.  Our next goal is reaching the big 3 – 30 weeks.  It doesn’t seem too far away.

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 :)