Christmas quads?

This morning, my reward for making it to 33 weeks was to finally get the babies measured again. During the ultrasound, I got some very good news: Baby A weighs 4 lb. 12 oz., Baby B weighs 4 lb. 7 oz., and Baby C weighs 4 lb. 5 oz. However, I also got some not-so-great news: Baby D hasn't grown at all in the past 3 weeks and is still weighing in at just 3 lb. 6 oz.

Yesterday Dr. S warned me that, if we learned today that any of the babies hadn't been growing properly, we might need to deliver them earlier than the original goal of 34 weeks. Since that's exactly what we found out, he did an amniocentesis on Baby A to check for lung maturity (for some reason, the largest baby usually has the least-developed lungs). We are currently awaiting the results, which should be ready later today or tomorrow. If Baby A's lungs are not sufficiently developed, we will wait a little longer to deliver. But if his lungs are mature enough, it will be go time! Stay tuned ...

Going for the A

From the beginning of this pregnancy, I've maintained that a birthdate "anytime in December" would be swell. Well, folks, we made it! Even the usually pessimistic Dr. E showed enthusiasm regarding reaching the 30-week milestone this morning—imagine what he'll be like on the off chance that I actually earn the A+ he promised me if I can last 2 more weeks!

In other exciting news, the babies were finally measured again today (after 3 long weeks of waiting). All of them were practicing their breathing during the ultrasound (yes!), and their estimated weights were exactly what we were hoping for: They are all over 3 pounds, with just a few ounces of difference between them. (According to the neonatologist, crossing the 3-pound threshold prior to premature delivery decreases the likelihood of severe problems after birth.) With more than 13 pounds of baby to support, though, it's no wonder that my back is beginning to protest; hopefully, both it and my ever-contracting uterus can hold out for another week or two.

You know, it's a good thing that Ted and I finally settled on some names last night because there's no doubt about it: Baby time is drawing nigh—it's exciting and terrifying at the same time!

Two weeks down

I'll be frank: My second week in the hospital has not been easy. Most nights, Ted has had to work later than planned (which obviously eats into our precious time together), and neither of us has yet been able to sleep well here. The stress of separation and sleep deprivation have no doubt played a part in the sore throat and general feelings of malaise that we've both come down with in the past couple of days. Add to that my ever-increasing (and grog-inducing) doses of magnesium sulfate, plus some bad news we've recently gotten regarding my mother's health, and it's no wonder that I could sometimes cry at the drop of a hat.

Thankfully, the babies seem to be doing a lot better than their mommy. Their movements are more frequent and stronger than ever, and the daily ultrasounds to check their heart tones confirm that they are not in any distress, despite the continuing contractions. They are also growing well: As of Friday, they weighed approximately 2 lb. 7 oz., 2 lb. 1 oz., 1 lb. 11 oz., and 2 lb. 1 oz. (A to D). I asked the doctor whether we should be concerned that Baby C is so much smaller than her siblings, but he said that she is doing fine and will probably just be a little more "petite" than the others. (Since her femur measures second-longest, though, I am choosing to think of her as tall and slender—you know, like a supermodel!)

Most importantly, we are now just 5 days away from the 28-week milestone. In light of this, a neonatologist recently came in to talk to us about the prognosis for babies born at this stage. Although they would have a good chance of eventually making it, the immediate and long-term risks (including all sorts of breathing problems, bleeding on the brain that could result in cerebral palsy, and a fatal inability to digest food properly) are scary to think about. Knowing a little more about what the babies would have to go through if they were born right now really reinforces our hope that they don't come for several more weeks—no matter how stressful and uncomfortable a long hospital stay proves to be. We can endure anything if it means an ounce less of pain for our babies once they're born.

Day 3 and counting

Yep, it's day 3 and I am still on the mag pump. I didn't sleep very well last night, so I napped most of the morning and plan to nap some more this afternoon (one of the perks of being on bedrest!). Dr. S came in a few hours ago (for about 2 nanosececonds—I counted), and all he said was that my uterus seems to be calmer and we'll see how I do over the weekend. The nurse came in later to expand on that, saying that I'll definitely need to be on the mag for at least 24 hours after my last steroid injection (which I had at 11am today) and then, once they decide to take me off the mag, I'll need to stay an additional couple of days for observation. So according to my calculations, the best-case scenario has me going home Monday at the earliest (although I am not holding my breath for that to happen).

In fun news, I had an ultrasound yesterday afternoon to check the babies' heart tones (they say this will be a daily occurrence while I'm here). The resident who performed the scan was pleasantly surprised at how "big and beautiful" my 25-week quads are, and when I told her their 23-week weights, she was quite impressed (yay for my overachieving children!). She noted that the babies are very active and was glad to see that they are practicing their breathing as they should. I don't have any pictures to post, but at today's ultrasound I will try to remember to ask whether the hospital's machine has the capability to burn the images to a CD (I remembered today that I stashed one in my purse before leaving home, just in case).

The best thing that's happened so far today is that I have been granted bathroom privileges (no more bedside commode, woohoo!). And the nurse is hoping that I will be allowed to take a shower tomorrow (they let me get up to wash at the sink this morning, but it's just not the same). But now I need to lie back; the nurse just informed me that I've had six contractions in the last half-hour. RATS!!!

Shrinking spaces and two sweet faces

Our little Fab Four have increasingly been making their presence known during the past couple of weeks, making it feel like an air popper is constantly running inside my belly. In fact, about a week ago Baby C kicked hard enough for Ted to feel baby movement for the first time, which was pretty exciting for both of us. And on Monday I was actually able to feel a body part (head? heel? elbow?) when I pressed on the top of my belly!

At Tuesday's 23-week ultrasound, I found out why I've been so much more aware of the babies lately. The tech determined that they now weigh 1 lb. 7 oz., 1 lb. 5 oz., 1 lb. 2 oz., and 1 lb. 3 oz. (A to D), which is just over 5 pounds combined (up from less than 3 pounds at my 20-week ultrasound). To further confirm the babies' significant growth, the nurse said that my belly has now surpassed full-term size (37 weeks) by nearly 2 weeks. It must be getting crowded in there!

I also got to see more 4-D images of two of the babies. Here is a video of Baby B, who let us have a good, long look at his cute little face:

And here's Baby C (she had her arms in a very dramatic pose and refused to move them so that we could get a better look at her):

Babies A and D acted bashful and turned around every time we trained the camera on them. The ultrasound tech said that we'd try to get 4-D images again next week (when Ted will be with me), so hopefully I'll have more videos (or at least stills) to share at that time. I am anxious to get my first look at Baby A, and I would like to see how much Baby D has changed since the 20-week mark.

Incidentally, the round-the-clock terbutaline hasn't entirely gotten rid of the contractions, but it's definitely helping: I haven't had more than four an hour since I began the therapy. And the initial side effects have subsided except for when I get a bolus; this extra-high dose is delivered every six hours and drives my pulse up to about 120 beats per minute, often making me feel weak, shaky, and short of breath for a half-hour or more. My doctor says that this spike is normal and I shouldn't worry unless my pulse reaches 125 or higher. Otherwise, things are looking good: I have no swelling, my blood pressure is staying nice and low, and I have no protein in my urine. My body's just gotta keep this up for at least 5 more weeks!

Contractions, be gone!

At yesterday's 22-week appointment, I unexpectedly got to hear the babies' heartbeats for the first time. When I reacted to the sound, the ultrasound tech laughed and said she always forgets that moms of multiples miss out on listening to the heartbeats. I got to hear only a couple of seconds' worth for each baby, but it was long enough for me to notice that each one has a distinct rhythm. Even after all this time, I still can't believe that there are five hearts beating inside of my body!

After the ultrasound, the nurse got out the measuring tape and determined that my belly is measuring at 36 weeks—that's 4 weeks larger than I was measuring just a week ago! This could explain why I suddenly started to experience so many contractions last week; with this huge uterus, my body thinks it's time to get these babies out of here. In fact, when the doctor saw how many contractions I'd registered over the weekend, he decided to take me off the Procardia and start me on something a little more hard core: a terbutaline pump. The pump is about the size of a beeper and delivers the terbutaline (an asthma medication that has been shown to prevent preterm labor by decreasing contractions) straight into my leg muscle via a thin, flexible tube. I get a low dose around the clock, with a big dose (called a "bolus") being delivered every six hours. It makes me really weak and shaky, but the nurse said that these side effects should abate after a couple of days.

The other big news to come out of yesterday's appointment is that the doctor told me that I needed to quit working, even from home. To help keep my uterus quiet, I am to lay on my side as much as possible and avoid any unnecessary stress (these babies make sure I have enough of that as it is). So as of today, I am a woman of leisure—ordered to stay off my feet and lacking the strength or mobility to do anything else anyway! We'll see how long it takes for me to go out of my mind.

I've just seen a face (or three)

So the reason my doctor appointment was so exciting was that Ted and I unexpectedly got to see 4-D images of three of the babies! They actually looked like morphing gobs of goo most of the time (the ultrasound tech had to fiddle with a bunch of settings in order to get the right angle), but once they were brought into focus, it was so cool to see their little faces.

Without further ado, here is a screencap of Baby B (apparently we were disturbing him so much that he had to cover his ears):


And here's Baby C (the poor thing was getting kicked in the head by her sister most of the time, which is probably why she's frowning):

And finally, here's Baby D (not a great picture, but funny because she's in the process of getting kicked in the face by Baby C—that'll teach her!):

Unfortunately, Baby A was left out because he was too deep in my pelvis to see him clearly. Hopefully we'll have better luck next time.

In case you were curious, the babies weighed in at 14, 11, 11, and 12 ounces (A to D). I won't tell you what the scales read when it was my turn to get weighed, but rest assured that the doctor was very happy with the amount I've gained so far. My 20-week belly is measuring at 30 weeks, and the nurse commented that I am "stretching nicely" (whatever that means). So far I am not having any swelling and my blood pressure remains low, both of which pleased my doctor greatly.

He did warn me, however, that at this stage I will be experiencing contractions on a regular basis. Since I can't feel them yet, I have started using a home contraction monitor for an hour in the morning and an hour in the evening. (The babies go wild when I wear the monitor; I don't think they are fond of it, but I love it when they move around so much!) If I would ever have four or more contractions within the space of an hour, I would need to go to the hospital for further evaluation.

So my job for the foreseeable future is to stay hydrated and restrict my activity as much as possible in order to keep contractions to a minimum. Although I hate not being able to do anything, it's getting to the point now where it's difficult for me to move much, anyway. I predict that my new 3-month Netflix membership (thanks, Johnny and Holly!) will be getting quite the workout!

Surprise!

Yesterday morning I had some strange pains in my belly and back. A couple of hours after they started, I decided to called the doctor. They told me to come to the office in the afternoon so that they could hook me up to a contraction monitor, take a urine sample, measure my blood pressure, etc., to make sure things were all right. When I got there, however, I learned that they were also going to go ahead and do the full scans that I was scheduled to have done on Friday.

I called Ted to tell him that he was going to miss the scans (which were going to measure the babies' heads, abdomens, and femurs), but neither of us thought it was a big deal. As soon as the ultrasound tech came into the examining room, though, she asked, "So are you here to find out what you're having?" I hadn't expected to find out for a couple more weeks! I told her that I would love to know, if she could tell me, so she got to work. Within seconds, she was able to determine the sexes of all four babies!

She gave me a bunch of pictures, but it's hard to make out what exactly they're supposed to be showing, so I won't be posting them. I will, however, reveal our happy news! Without further ado (drumroll, please):

Baby A is a ... BOY!
Baby B is a ... BOY!
Baby C is a ... GIRL!
Baby D is a ... GIRL!

I asked the tech how certain she was, and she said, "I'm 98% sure. I've been in this office 20 years and have only been wrong once." So we feel pretty confident that these boys will stay boys and the girls will stay girls. The tech said that when I have my next full scan (in a month) the babies will be so much bigger that it will be much easier for the untrained eye to see who's what.

Thanks to everyone who voted in the poll; I had fun seeing what the trends were each day (people really thought I was full of boys!). Special props go to Staci, who exercised her sonography skills by examining the ultrasounds in last week's post and determining (correctly) that Baby C was a girl! And a big thank you to Becky, who brought me these pacifiers a few weeks ago in the hopes that we would have an even mix of niños and niñas. Aren't they adorable?

For those who like numbers, I am currently at 16 weeks gestation but am measuring at 27 weeks. Babies A, B, and D weigh about 6 ounces, and Baby C is a little smaller at 5 ounces (the tech says this is nothing to be concerned about). Oh, and the tests showed that I was not having any contractions, did not have a fever, and had normal blood pressure; the pains were probably due to the fact that I've been growing so fast (2 inches in the last 5 days!).

Now it's time to start thinking of some names ...

Drummer boy ... or girl?

After recovering at home for a week, I went back to work on Monday. That morning, as I was walking back to my desk from the copy room, I felt one of the babies move! The sensation was like a very light *thump* from the inside, as if someone had hit a drumskin (my uterus) with a padded drumstick (a foot?). At first I thought the kicker was George (Baby C), but based on the babies' positions on the ultrasound I had yesterday, I am now convinced it was Ringo (Baby D). Quite appropriate, no?

Despite my heightened awareness, I didn't feel any more movement until last night. This time I felt less distinct but more numerous little taps; it kind of felt like little bubbles were popping all across the top of my belly. (And no, I did not have beans for dinner!!) People keep reminding me that I'll soon grow annoyed and uncomfortable with all the gymnastics in my belly, but I am blissfully refusing to let anything lessen the thrill of feeling my babies move for the first time.

Something else I'm getting more excited about is finding out how many of my little drummers are boys and how many are girls. I am not alone in this: "Do you know yet what you're having?" is by far the number-one question I get these days. In fact, interest is so high that a colleague of mine even suggested that I start an office pool! Although I don't plan on doing that, I'd love for people to submit their guesses in the "What's in My Belly?" poll (at right). The nurse says that we should be able to find out what we're having in another 3 to 4 more weeks.

And now for yesterday's 14-week ultrasound pics. It's a good thing that we weren't trying to see the sexes this time since all but one (Baby A, aka John) kept their backs turned to the camera:

It is scheduled

I will be undergoing the aforementioned transabdominal cerclage (TAC) procedure on Friday at 1:30pm. It actually wasn't that hard of a call to make after I decided that I just cannot ignore all the good outcomes that my doctor has had with dozens of triplet/quad pregnancies. Plus, I figure that if I didn't go through with it and the babies came too early to have a chance at a normal life (or even at life, period), I would always wonder whether things would have turned out differently if I'd had the TAC.

Something else that made my decision a little easier was the opportunity I had to talk with a wonderful triplet mom named Linda (thanks for the contact, Christine!). She had the procedure done a few years ago with the same doctor and was able to answer a lot of my questions (most of which seemed too trivial to ask the doctor himself). I am all about studying up and having all the information beforehand, so my chat with Linda really set my mind at ease. And hearing about her once-tiny babies and how well they're doing three years on was really encouraging. I hope that a couple of years from now I can share my successful quad pregnancy story with a newbie!

In other news, I had my 12-week appointment with the doctor this morning. I got a full first-trimester screening, which means I got to look at my babies for a whole half-hour! For those keeping track, they now range from 5.5 to 6 centimeters in length (crown to rump). The ultrasound tech was excited when she stumbled upon the view below, which shows all four of them in one shot. She says not to expect it to ever happen again:



Part of the screening involved measuring the skin folds on the back of the babies' necks. To do this, the tech had to get a profile shot of each baby. To my delight, while she was measuring the distance between the neck muscles and skin, I got to get a good look at the faces of each of my babies. I think that Baby A looks just like Ted:


And Baby B looks like my brother did when he was little:



Babies C and D were harder to pin down, looks-wise, but it will be interesting to see if my first impressions of the other two babies turn out to be accurate. It's so exciting to see them looking more and more like little individuals!

My next ultrasound will be right before they wheel me into surgery, and then I'll have another one a few minutes after the procedure to reassure me that they all made it through okay. I will probably be too out of it to post, but Ted assures me that he will take advantage of his contributor status in order to let everyone know how things went. If all goes as planned, I'll be back in posting form by early next week!

This is where it starts to get hard

I had my second visit with the maternal-fetal specialist a couple of days ago. As the first order of business, we got to see the babies again. No measurements this time; the tech was just looking for heart tones. She focused on each baby individually and showed us the flicker of the heartbeat. It was very clear that the kiddos have done some growing in the last couple of weeks; we could see them moving around and even waving at us! It's amazing to think that there's all that movement in my body, and yet I can't feel any of it. I am sure that I will long for this kind of oblivion once I have eight tiny feet (and eight tiny fists) vying for room in my torso!

Here are a couple of snapshots from the latest ultrasound (the babies are shown at 10 weeks gestation):




The second part of the visit was less fun, as it involved hearing a little more about transabdominal cerclage (TAC). The TAC is an optional procedure in which the uterus is temporarily removed (with babies in it!) via a C-section-type incision so that a band can be placed around the top of the cervix. The surgery has serious risks (including, rarely, the loss of one or more babies); however, it appears that outcomes for triplet pregnancies are encouraging (there is not much data on quad pregnancies, for obvious reasons). According to my doctor, women who have the surgery are less likely to experience the degree of preterm labor that results in a much-too-early delivery. The babies will come early regardless, of course, but this could lengthen their time in the womb (which, in turn, would mean less time in the NICU—always a good thing).

If I decide to have the procedure (and I'm pretty sure I will), my surgery will be August 1. My doctor says that I can expect to be in the hospital for two nights, and then at home for a week. Please pray for me as I face this scary prospect, that I may have peace about the decision I make. My main goal is to do whatever is best for the babies.

To end on an up note, Ted and I will celebrate our eighth anniversary on Tuesday. That's two years of marriage per baby—and you guys thought we were waiting too long to have kids!

We know the meaning of shock and awe

On June 3, 2008, Ted and I were elated to learn that I was 4 weeks pregnant. We spent the next couple of weeks making plans and smiling nonstop. When we went for my first ultrasound, at the 6-week mark, we were just praying to see a heartbeat. So imagine our utter surprise when we saw this:

Ted was speechless, and I just had to laugh. Even our doctor was stunned. Quadruplets!! Never in a million years did we imagine having more than two children total. In an instant, our entire life as we had planned it went out the window.
The doctor told us that it's not unusual for a multiple pregnancy to self-reduce this early in the game, so he warned us not to spread the news until we came back the next week for another ultrasound. When that day finally arrived, it was clear that they were all still there and growing (which is why they no longer fit into a single shot):

With this news, my doctor immediately referred me to a maternal-fetal specialist. We had our first visit with the new doctor a couple of days ago, and the ultrasound showed that the babies are all measuring approximately 1.5 to 2 centimeters. The ultrasonographer verified that none of them are identical, and she even named them for us: A, B, C, and D. Here is what they looked like at 8 weeks:

We are thrilled and feel so blessed to be having quads, but we are also terrified and very nervous! Not only do we have to worry about how we are going to afford to raise four kids, but we must also do everything in our power to keep these babies from coming too early. Quadruplet pregnancies are very risky, and preterm labor is the norm. Although my due date is February 9, the doctor says that these babies will almost certainly come before the end of the year (and spend several weeks in the NICU). He says that for them to have any real chance outside the womb, the first major milestone is 28 weeks (November 17). Ideally, however, they'll stay put until at least the 30-week mark (any time in December would be swell; the later, the better). To maximize my chances of carrying them that long, I will be going on bedrest around 20 weeks (September 22), at which time I should measure as large as a full-term singleton pregnancy!

As you can imagine, our minds are constantly racing with thoughts of everything that needs to get done before I go on bedrest, and then what needs to get done before the babies arrive, and then what needs to get done when they come home. Please pray for us as we make this big adjustment and figure out how to make it all work, pray for me as my body goes through changes that it was not really built for, and pray for our babies as they develop so that they may arrive healthy and strong. We plan to update this blog as often as possible to keep everyone posted on the status of the quads, so check back frequently for the latest news. I'm sure there won't be a dull moment!