Tough Choices....

Here is a true and factual statement; Babies born when Charlie, Cal and Harry were born do live. They can, with proper medical intervention early on, continue to grow in the NICU and after a few months be released to the world has happy, healthy baby boys with no lasting consequences of their premature birth. That is a totally true statement.

While that statement may be true, it is only true for very few babies. One of the best gifts we were given on Sunday night was Dr. Chris Colby, neonatologist at the Mayo Clinic (more on the rest of our A team later). Dr. Colby had met with us briefly Saturday but we didn't make any decisions with him then because it was still to early to know if I was going into labor. The OB doc on Sunday night insisted that we make a plan and she called Dr. Colby to come back in to meet with us. He didn't have to...I don't even think he was on call. He sat with us for nearly two hours giving us the information we needed to make a plan if these babies were going to be born. (Those of you who know me well know I loath plans).

Here are the stats we were given based on a triplet pregnancy at 23/3 with an estimated weight of 500 gms (they were bigger than expected). These numbers are conservative. They would have a 14% chance of living. Out of the 14% who live, half of them will live with serious complications including mental retardation, blindness, and cerebral palsy. Another week and our chances would have increased to 40%, two week gave us a 50% chance, if we could buy another 3 1/2 weeks they were 90%-95%. The numbers were also lower because they were all boys - girls have a better chance. Those numbers were for each individual baby, we had three. Based on those numbers we needed to make a choice as to whether or not we would do everything possible to save our babies, including trying to stop labor and get more time.

If we were going to intervene Dr. Colby needed to get a team in place - in the middle of the night. They have staff that can handle the babies one at a time or two at a time but three was getting tricky. If we were going to intervene they would do a c-section to get the babies out with the least trauma to their heads. The babies would then be born and immediately transferred over to St. Mary's hospital where the NICU is (we were at Methodist where are OB procedures are done. St. Mary's is a catholic hospital and will not allow some procedures that Mayo offers). Once the babies were at the NICU they would need all sorts of help to keep their little bodies growing outside of the womb. If we did this could I endure never holding my babies, could I endure not being there if they died, could I endure planning a funeral after a major surgery, could I endure a c-section possibly complicating future pregnancies?

While all the numbers and logistics were playing through our heads, what I was really thinking of were our friends who had unfortunately had make those same decisions and the outcomes of their precious children.

We needed more time...days, a couple weeks, just a little more time. We needed to stop labor. We were given the option of using magnesium for 48 hours while steroids were administered to develop the babies lungs. Magnesium was 50% effective at stopping labor at least temporarily but would only be administered once. It was our trump card. Our other option was an aggressive antibiotic therapy that would hopefully stop labor. That is what our plan was. We were going to try and stop it with the antibiotics, try and buy time and then when labor kicked up again we would use our trump card, get the babies lungs developed and then do everything possible. If we used the mag drip immediately and it only bought us 48 from where we were at, it was not likely going to buy us enough time to make a difference.

The other thing we needed to keep in mind is why this was happening in the first place. If the membranes ruptured because of infection my body was likely laboring to get the infection out to protect me. The biggest fear after PPROM (preterm premature rupture of membranes, which I now know I have an issue with since that's what happened with John at 35 weeks more on that later) is infection. Infection could have caused it or it could be caused biologically. Once the mucus plug is no longer in place both myself and the babies are open to infection. An infection in the uterus with all that blood could be life threatening. I had to trust my body knew what it was doing, even though no signs of infection had been detected by numerous tests.

We used the options we had, they were not effective in stopping labor. The babies were born peacefully - just ourselves, two quiet doctors and a nurse in a silent, cold surgical suite. As Charlie and Harry held on for two hours and Cal 45 minutes the thought crossed my mind - should we do something? Look at them, they're so healthy and perfect and look how long they've lasted with no help at all. I knew better. Those babies had a lot going on inside and they were too early.

Our biggest struggle with making this decision is our belief, like many parents believe, that our kids are the ones who will beat the odds. Our kids would have been among the 7%, we are never the other 93%, we are strong, healthy people who work hard and our kids are the same way, bad things don't happen to us, we'll look back and think this was a miracle, these are our boys-they will make it and beat the odds and life will be perfect.....We will get lucky and owe God big time for this one.

If ever the serenity prayer was helpful, it was that night when we made our choice:
God grant me the serenity to accept the things I cannot change,
The courage to change the things I can,
And the wisdom to know the difference.

We are at peace with the choices we made.