My boys, Charlie, Cal and Harry are never coming back. Never. No try again. No do over. No better luck next time. I was given a one in eight thousand chance of having triplets and I lost them. I stand defeated and I hate to lose. There are no do overs this time. It's done. I have buried my flesh and blood because of no fault of their own. I have begun to travel down a road that is daunting and dark. To be quite frank, it really sucks. I could write all day about how difficult this is but I'm not sure it would be serving much good. So, if there are lessons to be learned along the way I will share those instead. I can only write of my experience and here is what I have learned about death and loss - so far (although I know my journey is just beginning):
1) The loss of an infant child is real. I'm sure it is logically impossible for some people to understand how it can be so difficult to lose someone you barely knew, had few memories of, or shared so little time with. I am an educated, stable, rational being with a healthy perspective and I can tell you without equivocation that the loss of a baby will rock you to the core. It will send you to places you do not want to go. I am not here to convince you of anything, except that you will likely never understand what a parent goes through unless you have experienced it. There is no time/grief correlation. When you bury a child you lose a piece of yourself that you will never get back. You are changed forever and you would give anything to have your old life back - but that will never happen.
2) I have learned when someone dies the worse thing you can say is nothing. I was really bad at this before. I know now that the simple cards and emails and messages after a traumatic event are like oxygen. I know going to the mailbox or looking at the comments online were the highlight of Aaron and my day for the weeks following the boy's deaths. I know how good it feels when you run into someone who knows and the first thing they say is "I'm sorry for your loss" or "I was sorry to hear about your babies." Automatic comfort. I also have learned when I buy a sympathy card - I now buy two. One for right away and one for later. It gets worse before it gets better.
3) I have learned why some people seem "so strong" or why "they're doing well" at funerals. For me, I think I was out of tears at that point. Impossible to physically cry any more. Second, although I felt as though I was in the moment, it all seemed unreal - like I would surely wake up from this horrible dream. And third, it really feels good to see everyone that cares for you. It is not a facade and it is not strength. It is humanly possible to feel gratitude and happiness along side extreme pain - all at the same time.
4) I have learned the funeral is not the end of grieving. It is just the beginning. When everyone goes home, goes back to work, resumes life as normal - that's when it really starts to hurt. And it hurts bad. The world seems to be spinning around you and you're living in a fog. In the two months following the boys death I didn't get a lot done. I guess I still don't. It was a major accomplishment to shower, write a few thank you cards and maybe scrounge up some food or pay a few bills. Don't ever ask someone in the weeks following a traumatic loss "What have you been up to?" Grieving - it's a full time job. I remember apologizing to a friend that I hadn't returned her phone call because I was having a bad week. The response was, "why, what happened?" As if I was already supposed to be over it and moving on. It takes time - eventually time makes it better but not right away. The first eights weeks were brutal.
5) Public events were hard. I didn't want to run into people who didn't know (and I ran into plenty of them anyways and had to tell the story). I remember thinking I just want to go somewhere that nobody knows me. I imagined that being lost amongst the crowds of New York City might feel pretty comforting. The first two weeks I did not go anywhere, not to John's school, not to the grocery store, not to the neighbors, nowhere without Aaron.
6) I have learned traumatic experiences do not make you stronger. The experience leaves you changed certainly, but not stronger. More empathetic, more caring, more spiritual, yes. But also more cautious, more fearful and more scared that something else will happen and it will be more than you can handle.
7) I have learned the stages of grief are real. It's not just a bunch of hooey you learn in high school psychology class.
8) I have learned watching someone die peacefully is not as bad as it sounds. I always feared being expected to be at someone's death bed waiting for them to pass, afraid I would not be able to handle it. It is okay. It is worth being there for.
9) I have learned there is nothing colder than death. I remember thinking in all the Minnesota winters I have lived - I have never felt a more numbing cold than the bodies of my dead babies. I kept trying to cover them up the night we were in the hospital, hoping more blankets would warm them up. Every time I touched someone's skin in the week after their death I would always think - they're alive - they are so alive.
10) I have learned that people who voluntarily choose professions that deal with death and pain and suffering are angels. They are angles here on earth and their comfort in a time of loss is lifeblood to those left behind.
I would have been induced this week had I carried them to the end and my life would be different forever. I know I have a lot to learn as my journey through life without my sons is just beginning. It's getting better. The breakdowns are less frequent - but when they come they are so dark I wonder if I will ever pull out of it. I do. And I have to keep hoping and believe time will make these wounds scar over. I have stopped listing to Ryan Bingham's The Weary Kind (Crazy Heart) twenty times a day and feel a little more productive each week. I'm finally ready to tackle some projects around the house. After ten weeks I pray to God I have endured the worse, but I know the longer this goes on the more emotionally spent I am. I guess time will tell.
Thursday, August 26, 2010
Monday, August 9, 2010
Weighty Matters
Weight has been on my mind a lot lately. Not just my weight (more on that in a second) but the boy's weights. I finally had the nerve to look at how big the boys were measuring. On average, a single baby at 23 weeks weighs 501 grams (1.1 lb). My three boys at 23 weeks weighed 575grams, 630grams, and 610 grams putting them in the 24 to 25 week weight category. I'm pretty impressed with those numbers and I worked hard to get them there. They were right where they needed to be and doing so well. There's a reason they all weighted so much...
Starting at 12 weeks I was strongly encouraged to gain 30 pounds by 20 weeks. Translation, I gained 30 pounds in 8 weeks. The theory behind this is to get the babies as big as possible as soon as possible because 1) they are born on average at 32 weeks and 2) by the time a mother with triplets is 28 weeks there isn't a lot of room left to eat. The bible on multiple pregnancy nutrition was written by Barbara Luke and is frequently referenced by the Mayo Clinic's multiples booklet. I used that as my guide and aimed for 4,000 calories a day to make this happen. How do you eat 4,000 calories a day? Well, it's not as fun as it sounds. With that many babies inside it actually hurts. I would of course eat the fun stuff like rib eye, ice cream, biscuits and gravy, etc. but would also have to supplement with high calorie/protein drinks like Ensure and fruit/veg smoothies for extra calories and nutrients. In addition to the food I would drink a minimum of a gallon of water per day.
There was not a lot I could do in the area of physical activity. My doctor encouraged me wade in the pool to prevent fluid retention, which I did, but the rest of the time I was supposed to be taking it easy. I was also instructed, via the multiples bible, to lay down at least 4 hours during the day and also after dinner until bed (which would take weight off the cervix). I would usually make it until noon or 1:00 and then nap all afternoon, wake up, eat and lay on the couch all evening and then go to bed. I really only had about 4 hours a day when I was productive, 8am to 12pm. I remember thinking at the time, how is it physically possible to be awake all day! At 20 weeks I was no longer supposed to pick up anything heavier than a gallon of milk. All of this inactivity lead to a lot of muscle loss. I estimate a minimum of ten pounds...putting my real weight gain at closer to 40 pounds. At 23 weeks with my first pregnancy I had only gained about 7 pounds.
During birth I lost about 12 pounds (three separate placentas took up a lot of space and weight). I gained back about five pounds, likely because my metabolism is shot and I have a lot of muscle to gain back. So, here I am. Twenty three pounds over weight, out of shape and no babies to nurse. Okay, I promised no pity parties but come on girls - you've got to understand the frustration. I've been eating healthy and working out. My weight has not budged one pound. I realize it takes time, but I feel like I really don't have a lot of time.
The comfort in all of this is knowing I did everything in my control. I did what the doctors told me, gained the weight and sat around. I have no regrets and can't look back and say, "well, maybe if I had gained the weight things would be different..."
It's difficult to deal with loss emotionally, but the loss of a baby adds an additional layer - the physical evidence you cannot get a break from. The physical evidence is a constant reminder of what has happened. I am very fortunate to be healthy and realize there are bigger problems in the world than being 20 pounds overweight. But for right now, whining about my struggle is justified. This weight loss has very little to do with fitting into my favorite jeans.
Starting at 12 weeks I was strongly encouraged to gain 30 pounds by 20 weeks. Translation, I gained 30 pounds in 8 weeks. The theory behind this is to get the babies as big as possible as soon as possible because 1) they are born on average at 32 weeks and 2) by the time a mother with triplets is 28 weeks there isn't a lot of room left to eat. The bible on multiple pregnancy nutrition was written by Barbara Luke and is frequently referenced by the Mayo Clinic's multiples booklet. I used that as my guide and aimed for 4,000 calories a day to make this happen. How do you eat 4,000 calories a day? Well, it's not as fun as it sounds. With that many babies inside it actually hurts. I would of course eat the fun stuff like rib eye, ice cream, biscuits and gravy, etc. but would also have to supplement with high calorie/protein drinks like Ensure and fruit/veg smoothies for extra calories and nutrients. In addition to the food I would drink a minimum of a gallon of water per day.
There was not a lot I could do in the area of physical activity. My doctor encouraged me wade in the pool to prevent fluid retention, which I did, but the rest of the time I was supposed to be taking it easy. I was also instructed, via the multiples bible, to lay down at least 4 hours during the day and also after dinner until bed (which would take weight off the cervix). I would usually make it until noon or 1:00 and then nap all afternoon, wake up, eat and lay on the couch all evening and then go to bed. I really only had about 4 hours a day when I was productive, 8am to 12pm. I remember thinking at the time, how is it physically possible to be awake all day! At 20 weeks I was no longer supposed to pick up anything heavier than a gallon of milk. All of this inactivity lead to a lot of muscle loss. I estimate a minimum of ten pounds...putting my real weight gain at closer to 40 pounds. At 23 weeks with my first pregnancy I had only gained about 7 pounds.
During birth I lost about 12 pounds (three separate placentas took up a lot of space and weight). I gained back about five pounds, likely because my metabolism is shot and I have a lot of muscle to gain back. So, here I am. Twenty three pounds over weight, out of shape and no babies to nurse. Okay, I promised no pity parties but come on girls - you've got to understand the frustration. I've been eating healthy and working out. My weight has not budged one pound. I realize it takes time, but I feel like I really don't have a lot of time.
The comfort in all of this is knowing I did everything in my control. I did what the doctors told me, gained the weight and sat around. I have no regrets and can't look back and say, "well, maybe if I had gained the weight things would be different..."
It's difficult to deal with loss emotionally, but the loss of a baby adds an additional layer - the physical evidence you cannot get a break from. The physical evidence is a constant reminder of what has happened. I am very fortunate to be healthy and realize there are bigger problems in the world than being 20 pounds overweight. But for right now, whining about my struggle is justified. This weight loss has very little to do with fitting into my favorite jeans.
Thursday, August 5, 2010
Bottom Line
I've tried writing this post a few times but for some reason don't have the belly fire right now for all the details. The bottom line is we were in an ideal situation - strong cervix, three separate sacs, three separate placentas, and healthy babies. My membranes (likely the sac around Charlie, the one closest to the cervix) had a tiny leak and that leak started the process of labor.
There is no explanation as to why my membranes started to leak. Pathology on the placenta revealed nothing. We talked to our doctor for over two hours last week on the "what if this and what about that's," and there is really nothing they can do; nothing they can do to prevent it, nothing they can do to predict it and nothing they can do to stop labor once it happens.
While the appointment was calming (no blame, nothing that could have been done differently), it was also confirmation that if we get pregnant again we could be in the same situation with no options for a better outcome. We are blessed to have a fantastic doctor (that is an understatement) and will likely continue our journey in his care.
Aside from our appointment, I'm very frustrated. I was hoping time would make this easier and instead it gets harder. I think it hit me when our doctor said, "this is one of the most difficult things you will ever face in life." He has the right to say that, he has been walking in our shoes for 25 years. I'm not sure there is anything that makes this any better. Eventually time, yes, but not now. Sometimes I go outside at the hottest times of the day to see if I can bake out the hurt, sweat it out or somehow fry it up. As the weather cooled today I realized this winter will likely be a tough one.
There is no explanation as to why my membranes started to leak. Pathology on the placenta revealed nothing. We talked to our doctor for over two hours last week on the "what if this and what about that's," and there is really nothing they can do; nothing they can do to prevent it, nothing they can do to predict it and nothing they can do to stop labor once it happens.
While the appointment was calming (no blame, nothing that could have been done differently), it was also confirmation that if we get pregnant again we could be in the same situation with no options for a better outcome. We are blessed to have a fantastic doctor (that is an understatement) and will likely continue our journey in his care.
Aside from our appointment, I'm very frustrated. I was hoping time would make this easier and instead it gets harder. I think it hit me when our doctor said, "this is one of the most difficult things you will ever face in life." He has the right to say that, he has been walking in our shoes for 25 years. I'm not sure there is anything that makes this any better. Eventually time, yes, but not now. Sometimes I go outside at the hottest times of the day to see if I can bake out the hurt, sweat it out or somehow fry it up. As the weather cooled today I realized this winter will likely be a tough one.
Thursday, July 29, 2010
Normal
Each day that passes is a day farther away from my pregnancy with the boys, a day farther away from their birth, a day farther away from their funeral, farther away from when "the boys room" was still "the boys room," farther away from the plans we made. Each day we move forward in a direction that puts the boys in the past. Time is making my boys a memory and I hate it.
I always had a gut feeling that I would deliver them the last week of July - 30 weeks. That is tomorrow. I should still be pregnant and I think my body knows it.
This week marks the last milestone in my pregnancy, the six week postpartum doctor's appointment. As with John, I viewed that appointment as a sign that the pregnancy and birth were complete and that our new life was about to begin - our new normal. I guess I view this appointment the same way. An end and a beginning.
Our appointment is tomorrow. I'm both looking forward to it and dreading it. To say we have a lot of questions is an understatement. While our care during the delivery was superb, the care we received the week leading up the delivery is quite a mess and that's when it mattered most. I have not talked much about it because I want to clarify with my doctor what in fact did or did not take place. Worst cast scenario is that we get no answers and I guess I'm prepared for that as well.
I always had a gut feeling that I would deliver them the last week of July - 30 weeks. That is tomorrow. I should still be pregnant and I think my body knows it.
This week marks the last milestone in my pregnancy, the six week postpartum doctor's appointment. As with John, I viewed that appointment as a sign that the pregnancy and birth were complete and that our new life was about to begin - our new normal. I guess I view this appointment the same way. An end and a beginning.
Our appointment is tomorrow. I'm both looking forward to it and dreading it. To say we have a lot of questions is an understatement. While our care during the delivery was superb, the care we received the week leading up the delivery is quite a mess and that's when it mattered most. I have not talked much about it because I want to clarify with my doctor what in fact did or did not take place. Worst cast scenario is that we get no answers and I guess I'm prepared for that as well.
Monday, July 12, 2010
Grief
In a society of instant gratification, grief is a difficult process. There is no cure. There is no quick fix. As the days go by sorrow sinks deeper into your soul. There's nothing you can buy to make it better, nothing you can sell to make it go away. No end except death itself. The permanence is frightening.
I have written a few posts in the last week that I did not publish and will not publish. They are angry and bitter and full of self pity. While those feelings may be human and real and important -they are not helpful. I refuse to send thoughts like that in a world already full of anger and pain. I will not contribute. I can tell you I've listened to the Dixie Chicks "Not Ready to Make Nice" more than a couple times. It's my anger anthem right now.
It's been four weeks today since the boys died. This Friday would have marked 28 weeks, the point at which they would have a 95% chance of living. Four weeks. A blink in time. I have had so many "four weeks" in my life that I cannot remember a single event from. The past four weeks have been special as each day that passed would have brought me closer to a different reality.
I am figuring out for myself how I will cope with my loss. The week after the funeral I spent all my daylight hours renovating an apartment only to sit down at night and be overcome with grief. I knew then I could not continue that pattern. I could not consume myself with work and staying busy, even though it would be the easiest thing to do. I decided I will face my grief and look it in the eye. I will not wake up a year, ten years or thirty years from now and be overcome with not dealing with the death of my three boys. I've seen good people lose themselves after a tragic event and I will not be one of them. I intend to emerge stronger; it's not going to be easy and it's not going to be fun. It is a conscious effort for me to embrace the waves of pain as they crash over me. When it happens I stop what I'm doing, look at the photos, read the blog, read the messages we've been sent, read the books on grief we've been given, read other mother's stories, and sometimes just kneel down and cry. When I'm done, I'm ready to continue on with whatever it is I'm doing.
One book that has helped me tremendously is A Grace Disguised by Jerry Sittser, given to me from friends who lost their mother to ALS. While it hits on so many important topics regarding loss there is one line I keep coming back to. The author writes, "Sorrow enlarges the soul until the soul is capable of mourning and rejoicing simultaneously, of feeling the world's pain and hoping for the world's healing at the same time. However painful, sorrow is good for the soul." The grieving I'm going through now is enlarging my soul. It is stretching my limits. It is changing me. I vividly remember the physical pain of growing larger with the triplets (going from wearing my normal jeans and a belt to measuring 38 weeks pregnant in just 11 weeks is painful). I remember my skin feeling like it was going to crack open, my muscles ripping apart, my ligaments stretching thin. Like each day of growing triplets, expanding the soul is challenging and painful.
I take grieving very seriously not only because of the reasons I mentioned above, but also because I know I will never forget what happened. It's not likely that Aaron and I will be sitting on a porch swing in 40 years and say, "Remember that one time when we were pregnant with three boys, we delivered them alive and they all died?" "Oh geez, I totally forgot about that." Umm, yeah, not likely. I know 85 year old women who still visit the graves of their babies. While the pain may lessen and time may go on, the fact remains Aaron and I have three boys that are not with our family. They are real. They have Mayo Clinic #'s, they have a birth and death certificates, they breathed the same air as us, their hearts beat on this earth. The reality of that will not go away - ever. So - dealing with our reality is vitally important.
Despite the challenge grief has presented, it also provided a new clarity; my world right now is simple and calm and amazing. Although I'm not sure where my future is headed, my thoughts are still clear and my perspective healthy.
I have written a few posts in the last week that I did not publish and will not publish. They are angry and bitter and full of self pity. While those feelings may be human and real and important -they are not helpful. I refuse to send thoughts like that in a world already full of anger and pain. I will not contribute. I can tell you I've listened to the Dixie Chicks "Not Ready to Make Nice" more than a couple times. It's my anger anthem right now.
It's been four weeks today since the boys died. This Friday would have marked 28 weeks, the point at which they would have a 95% chance of living. Four weeks. A blink in time. I have had so many "four weeks" in my life that I cannot remember a single event from. The past four weeks have been special as each day that passed would have brought me closer to a different reality.
I am figuring out for myself how I will cope with my loss. The week after the funeral I spent all my daylight hours renovating an apartment only to sit down at night and be overcome with grief. I knew then I could not continue that pattern. I could not consume myself with work and staying busy, even though it would be the easiest thing to do. I decided I will face my grief and look it in the eye. I will not wake up a year, ten years or thirty years from now and be overcome with not dealing with the death of my three boys. I've seen good people lose themselves after a tragic event and I will not be one of them. I intend to emerge stronger; it's not going to be easy and it's not going to be fun. It is a conscious effort for me to embrace the waves of pain as they crash over me. When it happens I stop what I'm doing, look at the photos, read the blog, read the messages we've been sent, read the books on grief we've been given, read other mother's stories, and sometimes just kneel down and cry. When I'm done, I'm ready to continue on with whatever it is I'm doing.
One book that has helped me tremendously is A Grace Disguised by Jerry Sittser, given to me from friends who lost their mother to ALS. While it hits on so many important topics regarding loss there is one line I keep coming back to. The author writes, "Sorrow enlarges the soul until the soul is capable of mourning and rejoicing simultaneously, of feeling the world's pain and hoping for the world's healing at the same time. However painful, sorrow is good for the soul." The grieving I'm going through now is enlarging my soul. It is stretching my limits. It is changing me. I vividly remember the physical pain of growing larger with the triplets (going from wearing my normal jeans and a belt to measuring 38 weeks pregnant in just 11 weeks is painful). I remember my skin feeling like it was going to crack open, my muscles ripping apart, my ligaments stretching thin. Like each day of growing triplets, expanding the soul is challenging and painful.
I take grieving very seriously not only because of the reasons I mentioned above, but also because I know I will never forget what happened. It's not likely that Aaron and I will be sitting on a porch swing in 40 years and say, "Remember that one time when we were pregnant with three boys, we delivered them alive and they all died?" "Oh geez, I totally forgot about that." Umm, yeah, not likely. I know 85 year old women who still visit the graves of their babies. While the pain may lessen and time may go on, the fact remains Aaron and I have three boys that are not with our family. They are real. They have Mayo Clinic #'s, they have a birth and death certificates, they breathed the same air as us, their hearts beat on this earth. The reality of that will not go away - ever. So - dealing with our reality is vitally important.
Despite the challenge grief has presented, it also provided a new clarity; my world right now is simple and calm and amazing. Although I'm not sure where my future is headed, my thoughts are still clear and my perspective healthy.
Sunday, July 4, 2010
PPROM
Emily Dickinson said it best...
Success is counted sweetest
By those who ne'er succeed.
To comprehend a nectar
Requires sorest need.
On whose forbidden ear
The distant strains of triumph
Burst agonized and clear!
Tis the season for babies. Many of my friends are pregnant or at home with newborns. I wonder if any of them truly understand how miraculous it is to carry a baby to term and to deliver a healthy child? It's easy to take for granted. I know we did with our son John.
Our son John was born prematurely. Five weeks to be exact. He spent 11 days in the level 2 nursery yet we never really questioned why he arrived early. I figured I was working too much and under too much stress and that I should probably take it easier with the next pregnancy. The doctors concluded I was probably right. We know now his premature birth was caused by the same events that happened with Charlie, Cal and Harry.
Both of my pregnancies resulted in delivering premature children due to a complication called PPROM (preterm premature rupture of membranes). Here are the basics. Normally, the cells in a woman's body trigger labor to start between 38-42 weeks. Once labor starts the sac around the baby that holds amniotic fluid will eventually rupture. We typically know of this natural process as "water breaking." When this happens as part of a normal sequence of labor it is called rupture of membranes or spontaneous rupture of membranes. When the membranes rupture prior to labor starting that is called PROM, premature rupture of membranes. When this happens prior to 37 weeks it is called PPROM (premature preterm rupture of membranes).
Many times when women experience PPROM they have a small leak in the sac. That leak can close up or it could continue to leak and not induce labor. The placenta will keep making new fluid. This can happen to some women early on in the pregnancy, say 17 week, and they can go on to carry the babies close to full term. They will likely spend their pregnancy in the hospital or on bed rest at home.
The danger when the sac actually ruptures (instead of just having a leak) is that the fluid levels are really low - that can lead to a prolapsed cord or various other complications that could be very dangerous to the baby. That did not happen with either pregnancy - all my babies had plenty of fluid around them and the sac did not actually rupture until I was delivering them. (Medically they really don't differentiate between leaking and rupturing when discussing PPROM).
The biggest danger in PROM or PPROM is the risk of infection. Once there is a leak it is feared there could be an infection already present (that caused the leak) or that an infection could now enter the amniotic sac carrying the baby. The agreed upon protocol after 34 weeks of pregnancy is to deliver the baby within 24 hours of noticing the leak because the risk of infection to the mother and babies is more dangerous than the babies being born early. The protocol is less clear prior to 34 weeks and certainly prior to 25 weeks.
In both pregnancies I was leaking a very small amount of fluid. With John I only leaked a quarter sized amount of fluid - once. In fact when I discovered it at 2am I went back to bed and only called the midwives in the morning after Aaron insisted. I walked down to the hospital not thinking for a second that I was going to be having a baby that day. With the boys I leaked a quarter sized amount three or four times in two days. It's not much at all and could easily be missed or overlooked. I did however first notice a small amount of fluid at 19 weeks; I went in to be tested and it was determined it was not amniotic fluid. I am now about 99% sure it was - I think perhaps the leak was tiny, on one of the top babies or healed up before I went in the next morning. I would not mistake it. It's clear, odorless, and watery. I never leaked again until 23 weeks.
So why does PPROM happen? Good question. Nobody really knows for sure. It occurs in less than 2% of pregnancies. There could be a genetic component (my sister delivered all three of her girls early because of the same thing - yet no studies have proven the genetic link). It could be biological - my body's cells are just messed up and trigger the wrong series of events to happen. It could be (and most studies suggest) caused by infection. Pathology on the placenta could reveal an infection, however, it's hard to determine whether the infection caused the membranes to rupture or if infection presented itself once the membranes were compromised.
If PPROM happens once it could be a fluke and not happen again in other pregnancies. Once it happens twice the odds of it happening again are higher. It's unfortunate that to discover a pattern it needs to happen more than once. Those at highest risk for PROM are smokers, drinkers, those with STD's, low BMI, drug users (all the things I am not) as well as those who have had previous PROM and pregnant with multiples (check on both of those).
It's frustrating that the human body is so amazing (our other proof there is a God) yet sometimes works against itself. I cannot imagine the frustration of those with arthritis or cancer or other conditions in which the body is trying to fight or kill itself. My body was growing healthy babies and doing everything right and then out of nowhere something goes wrong. It's hard to fathom. It's harder when there are no answers and no clear way of knowing if and when it will happen again.
I asked my doctor if it happened so early because my uterus was measuring full term. He said no, my uterus may have been full term but the sac surrounding each baby was the same size as a singleton of the same age, 23 weeks. Not comforting. We have not talked to our doctor since the morning after delivery but will have a regular postpartum six week appointment with him.
I've read a lot of journal articles regarding PPROM and there is not a lot of data that is conclusive. They are studying a lot of possible causes and also what causes labor to start after the membranes leak/rupture. The March of Dimes has a Prematurity Research Initiative (PRI) in which they give grants for researching different areas of premature birth and premature babies. Their web site lists the topics and grantees. I will be contacting those researching PPROM to see if my experience could help them in any way. The March of Dimes has been instrumental in funding research that has lead to important discoveries regarding premature birth and also the care of premature babies. I have also used their web site frequently for dealing with the grief of losing Charlie, Cal and Harry.
It's amazing to me that although we live in such a highly technologically advanced society, the best place for babies to grow is still in the womb of their mother. No matter how many advances in medicine we have made we still do not fully understand a process that has been occurring since the beginning of time. I was listening to a program on MPR the other day in which they were talking about extending the average life span due to medical advances etc. Selfishly I wish we were less concerned about a 90 year old living until they are 100 and would instead focus on giving the littlest of our society a fighting chance to experience life. I guess they are not mutually exclusive but still you get the point.
So, there it is. PPROM. I can tell you we plan on trying to have more children but it will not be with the same excitement as our last two pregnancies. We've been burned now. Big time. If we do have a successful pregnancy it will come with 30 weeks of terror...We are optimistic and know not being pregnant with multiples will help our chances. For now, we continue to enjoy John and grieve over not having Charlie, Cal and Harry home with us.
Success is counted sweetest
By those who ne'er succeed.
To comprehend a nectar
Requires sorest need.
Not one of all the purple host
Who took the flag to-day
Can tell the definition,
So clear, of victory!
On whose forbidden ear
The distant strains of triumph
Burst agonized and clear!
Tis the season for babies. Many of my friends are pregnant or at home with newborns. I wonder if any of them truly understand how miraculous it is to carry a baby to term and to deliver a healthy child? It's easy to take for granted. I know we did with our son John.
Our son John was born prematurely. Five weeks to be exact. He spent 11 days in the level 2 nursery yet we never really questioned why he arrived early. I figured I was working too much and under too much stress and that I should probably take it easier with the next pregnancy. The doctors concluded I was probably right. We know now his premature birth was caused by the same events that happened with Charlie, Cal and Harry.
Both of my pregnancies resulted in delivering premature children due to a complication called PPROM (preterm premature rupture of membranes). Here are the basics. Normally, the cells in a woman's body trigger labor to start between 38-42 weeks. Once labor starts the sac around the baby that holds amniotic fluid will eventually rupture. We typically know of this natural process as "water breaking." When this happens as part of a normal sequence of labor it is called rupture of membranes or spontaneous rupture of membranes. When the membranes rupture prior to labor starting that is called PROM, premature rupture of membranes. When this happens prior to 37 weeks it is called PPROM (premature preterm rupture of membranes).
Many times when women experience PPROM they have a small leak in the sac. That leak can close up or it could continue to leak and not induce labor. The placenta will keep making new fluid. This can happen to some women early on in the pregnancy, say 17 week, and they can go on to carry the babies close to full term. They will likely spend their pregnancy in the hospital or on bed rest at home.
The danger when the sac actually ruptures (instead of just having a leak) is that the fluid levels are really low - that can lead to a prolapsed cord or various other complications that could be very dangerous to the baby. That did not happen with either pregnancy - all my babies had plenty of fluid around them and the sac did not actually rupture until I was delivering them. (Medically they really don't differentiate between leaking and rupturing when discussing PPROM).
The biggest danger in PROM or PPROM is the risk of infection. Once there is a leak it is feared there could be an infection already present (that caused the leak) or that an infection could now enter the amniotic sac carrying the baby. The agreed upon protocol after 34 weeks of pregnancy is to deliver the baby within 24 hours of noticing the leak because the risk of infection to the mother and babies is more dangerous than the babies being born early. The protocol is less clear prior to 34 weeks and certainly prior to 25 weeks.
In both pregnancies I was leaking a very small amount of fluid. With John I only leaked a quarter sized amount of fluid - once. In fact when I discovered it at 2am I went back to bed and only called the midwives in the morning after Aaron insisted. I walked down to the hospital not thinking for a second that I was going to be having a baby that day. With the boys I leaked a quarter sized amount three or four times in two days. It's not much at all and could easily be missed or overlooked. I did however first notice a small amount of fluid at 19 weeks; I went in to be tested and it was determined it was not amniotic fluid. I am now about 99% sure it was - I think perhaps the leak was tiny, on one of the top babies or healed up before I went in the next morning. I would not mistake it. It's clear, odorless, and watery. I never leaked again until 23 weeks.
So why does PPROM happen? Good question. Nobody really knows for sure. It occurs in less than 2% of pregnancies. There could be a genetic component (my sister delivered all three of her girls early because of the same thing - yet no studies have proven the genetic link). It could be biological - my body's cells are just messed up and trigger the wrong series of events to happen. It could be (and most studies suggest) caused by infection. Pathology on the placenta could reveal an infection, however, it's hard to determine whether the infection caused the membranes to rupture or if infection presented itself once the membranes were compromised.
If PPROM happens once it could be a fluke and not happen again in other pregnancies. Once it happens twice the odds of it happening again are higher. It's unfortunate that to discover a pattern it needs to happen more than once. Those at highest risk for PROM are smokers, drinkers, those with STD's, low BMI, drug users (all the things I am not) as well as those who have had previous PROM and pregnant with multiples (check on both of those).
It's frustrating that the human body is so amazing (our other proof there is a God) yet sometimes works against itself. I cannot imagine the frustration of those with arthritis or cancer or other conditions in which the body is trying to fight or kill itself. My body was growing healthy babies and doing everything right and then out of nowhere something goes wrong. It's hard to fathom. It's harder when there are no answers and no clear way of knowing if and when it will happen again.
I asked my doctor if it happened so early because my uterus was measuring full term. He said no, my uterus may have been full term but the sac surrounding each baby was the same size as a singleton of the same age, 23 weeks. Not comforting. We have not talked to our doctor since the morning after delivery but will have a regular postpartum six week appointment with him.
I've read a lot of journal articles regarding PPROM and there is not a lot of data that is conclusive. They are studying a lot of possible causes and also what causes labor to start after the membranes leak/rupture. The March of Dimes has a Prematurity Research Initiative (PRI) in which they give grants for researching different areas of premature birth and premature babies. Their web site lists the topics and grantees. I will be contacting those researching PPROM to see if my experience could help them in any way. The March of Dimes has been instrumental in funding research that has lead to important discoveries regarding premature birth and also the care of premature babies. I have also used their web site frequently for dealing with the grief of losing Charlie, Cal and Harry.
It's amazing to me that although we live in such a highly technologically advanced society, the best place for babies to grow is still in the womb of their mother. No matter how many advances in medicine we have made we still do not fully understand a process that has been occurring since the beginning of time. I was listening to a program on MPR the other day in which they were talking about extending the average life span due to medical advances etc. Selfishly I wish we were less concerned about a 90 year old living until they are 100 and would instead focus on giving the littlest of our society a fighting chance to experience life. I guess they are not mutually exclusive but still you get the point.
So, there it is. PPROM. I can tell you we plan on trying to have more children but it will not be with the same excitement as our last two pregnancies. We've been burned now. Big time. If we do have a successful pregnancy it will come with 30 weeks of terror...We are optimistic and know not being pregnant with multiples will help our chances. For now, we continue to enjoy John and grieve over not having Charlie, Cal and Harry home with us.
Thursday, July 1, 2010
It's Good to Feel Loved
I wish I could shout from the mountain tops "thank you, thank you." Aaron and I have been overwhelmed by the kindness expressed toward our family in the past couple weeks. Every Facebook message, every blog comment, every card sent has been so appreciated. We find the most comfort in knowing people care. We are extremely fortunate and it's good to feel loved.
Subscribe to:
Posts (Atom)