23 Weeks!

"Be anxious for nothing, but in everything by prayer and supplication, with Thanksgiving, let your requests be made known to God; and the peace of God, which surpasses all understanding, will guard your hearts and minds through Christ Jesus." ~Philippians 4:6, 7

Day 13 of my extended stay at on the lovely antepartum floor of my hospital is well underway. It's hard to believe it's been nearly two full weeks since that last "ER trip" that landed me here. The boys and I are doing very well, all things considered. Thank you all for your continued prayers!

I feel the need to backtrack a bit here and catch everyone up to where we are, and how we got here. My suspicion that I was carrying multiples were confirmed by ultrasound at 9 weeks. I wasn't surprised to see the two tiny little "beans" on the screen, but it did take me longer than everyone else in the room to realize they were in the same sac. Fraternal twins run in my family, and they've all been boy/girl. I had already made the assumption that I was likely carrying fraternal twins, meaning each would have his/her own placenta and sac. These are the lowest risk type of twins. But this time, I am carrying identical twins; they share a single placenta. At 9 weeks, we couldn't tell whether or not there was a membrane separating them; if not, they would be among the highest risk twins, and statistically, the odds of both surviving until birth were not promising, only about 50-60%. Thankfully, on August 6th I had an appointment with my Maternal Fetal Medicine (MFM) doctor and had an extensive sonogram confirming that there is indeed a membrane between the boys! Relief flooded my being and I began to breathe again and start daydreaming about who these little boys would be. Before we left that appointment, the doctor asked if I'd had any bleeding; I had not, and never have had bleeding in pregnancy, so even when he mentioned I had a clot visible in the sonogram, I dismissed it as something I wasn't going to worry over.

The very next day we drove to Houston so Joel could interview for a position that involved working remotely from home. It went well, then we headed off to our dear friends' home to spend the weekend with them. About an hour after our arrival, I suddenly felt a gush and made my way quickly to the bathroom where I found that I had indeed begun bleeding. And it was rather more than I expected. My first thought was that I was miscarrying; my sweet friend stayed with me, praying over me, and caring for me while I called my midwife to seek advice. As I began to calm down and started thinking rationally, it dawned on me that the doctor had seen a clot, expected bleeding, and so I had hope that the babies might be ok. I was able to see a midwife in the Houston area the very next morning and she confirmed that the boys were both fine, and I had a subchorionic hemorrhage (or hematoma). This is a pocket of blood located between the amniotic sac and the uterine wall. Most often they resolve by the second trimester, but here I was 16 weeks and mine was just starting to flare up. Still, I had hope all would be well.

Over the next month, I bled a little bit off and on, but it would seem to let up after some rest. Then on my birthday, Sept. 4th, the bleeding started back up and I just couldn't get it to stop. Any movement seemed to aggravate it, even showering, and I ended up confined to bed for about three weeks. I did find some studies that suggested one particular supplement has been helpful in resolving subchorionic hematomas, and I started that. I did feel it was making a difference, and I was so hoping I could maybe come off of bed rest within a month or so. During these three weeks of bed rest, I ended up in the Labor and Delivery triage three times. The first was due to heavier than normal bleeding; after checking me out and running blood work, they determined I was ok, babies weren't in danger, and they sent me home. Then the very next weekend I ended up rushing to the hospital after having experienced a monster contraction that seemingly came from nowhere. It held on for over five minutes, and even then, my uterus wouldn't fully relax. This reminded me of the contraction I had had with my 8th baby that pushed me well past transition. I was terrified my body was going into labor. But again, they were able to confirm that my cervix had not been affected, and the babies and I were fine. They sent me home with a muscle relaxant to help relax my uterus, and I was fine.

I had another sonogram with the MFM on Sept. 22nd that confirmed both boys were growing and doing great. But they noticed that Twin A's amniotic sac was full of blood. My doctor noted that the fluid levels in both sacs looked great, he could see no evidence of a tear in the sac, but he took the time to soberly remind me that preterm ruptured membranes (PPROM) is more commonly associated with this type of bleeding. He also said it could improve, and advised me not to get too discouraged. I spent the day reflecting on this, and the fact that the blood from the hematoma had clearly crossed over into A's sac somehow; I knew that his sac had to have been compromised somehow for this to be true. But I went about my business, remaining on bed rest and trying to help manage school lessons from bed.

The next day I began to feel like I was leaking; it didn't seem to be from the SCH. I had a feeling I would need to head back to the hospital if this feeling continued, but I didn't want to rush right in. First, I had Joel reach out to our local Greek priest and he came by in the afternoon to anoint me and pray over me, and to offer me the Eucharist. That was a wonderful blessing, and I felt so much peace afterward. I was praying that God would simply heal me completely and allow me back up on my feet to take care of my family again. But that was not to be the case. About an hour after he left, I got up from the bed and my water broke with a gush. I think I was still slightly in denial; I had almost convinced myself it was perhaps just more bleeding from the hematoma (the waters were red, due to the presence of blood in his sac). But after being checked at the hospital that night, it became clear A's fluid levels were drastically reduced, and I was leaking so much fluid; it wasn't just blood. We were 21 weeks and 5 days along, and considered to be in the pre-viable stage. I knew that if I was to go into full blown labor, our boys would not survive.

I spent the first night in a labor and delivery room, Joel on the couch beside me. I was a wreck. My heart was racing, I kept breaking out in sweats, and I was over-analyzing every little sensation inside my body. Medications didn't help. I kept begging God for mercy, but felt certain that the outcome was not going to be as I hoped. They started me on IV antibiotics to prevent infection, one of the biggest risk factors for PPROM, and I was monitored very closely. The next morning, the MFM sonographer came in to do a more detailed sonogram and we heard the first bit of encouraging news since the night before: A's fluid level was back up to normal! The doctor seemed impressed by this. After 48 hours with me showing no signs of imminent labor, they moved me from Labor and Delivery to the Antepartum floor, where women like me hope to be able to settle in for a longer stay and give our babies more time to develop before they are born. The nurses here have all reassured me there is every reason to hope for a long stay, as they have seen this happen many times.

The first week here was hard; I was able to speak with a NICU doctor and we came up with a plan in case I were to give birth that week. It wasn't optimistic; based on what he shared, and how small our boys were, Joel and I decided that we would likely just pursue comfort care only if they were to come before 23 weeks. This would mean I could birth them vaginally, then Joel and I would hopefully have time to hold them and allow them to pass peacefully in our arms. The sad reality is that most babies this gestational age are just not big enough for the life-saving equipment to offer them real help. I spent much of this week wrestling through the feelings of anxiety and grief, struck by the reality that only six months after my dad's passing, here I am considering what it would look like to say goodbye to my own two precious babies. As heartbreaking as it seemed, I just kept thinking of the Paschal troparion, and I had peace: "Christ is risen from the dead, trampling down death by death. And upon those in the tombs, bestowing life!"

In His mercy, God has granted us that full week and we are now 23 weeks and 4 days. When the doctors all came to see me on Friday, the day we hit the 23 week mark, their attitudes had palpably shifted. Suddenly, there was hope. We have life-saving measures we can choose that will be much more promising this week than last. The latest sonograms showed both boys' weights to be over the 500 gram mark the NICU team looks for, and ironically, they were measuring almost exactly the same. This in itself is a bit of a miracle; in monochorionic/diamniotic twins (one placenta, two sacs), one of the most common issues is a discrepancy in the twins' growth. It is better that they both be small than for one baby to be significantly bigger than the other; this can be a marker for Twin to Twin Transfusion Syndrome, one of the most common complications of these types of twins. But as of our last growth scan, they both looked almost identical and were of a good size. A's fluid level continues to be within "normal" limits, as well. They are looking so well, in fact, that initially, both of my doctors questioned how certain it was that my water had broken. Unfortunately, I am certain. But I am confident that my body and these baby boys are being held together by the prayers of so many wonderful, faithful believers. For now, Christ has not seen fit to simply heal me. Instead, I think He is using this situation and the time here to make a bigger statement about the importance of trusting in Him and His goodness, and letting go of any silly notion we might have that we can somehow control the outcome. Or that we would even want our desired outcome over His. He is the lover of mankind; how could anything He orchestrates for our lives be any less than the absolute best possible scenario?

We are still very much in dangerous waters for these two little boys, and yet, I am starting to really feel that "peace that passes all understanding." I have enjoyed having the time to dedicate to prayer when I feel unsettled and afraid. Father Peter was able to come to me last night and anoint me again, and also offer me the Eucharist. I had spent much of yesterday taking it very easy due to more bleeding, cramping, and passing blood clots; not every day is like this, but it is anxiety-inducing when I do have such days. It was such a blessing to be able to partake of the Body and Blood of Christ before I laid myself down for sleep. I truly slept like a baby, and all my pain and anxiety was gone.

I will continue to provide updates on the boys and myself as the situation evolves. For now, my family and I so appreciate your prayers and encouragement. Sending love to you all!