So we show up for the appointment, get paperwork, and the paperwork says "single gestation". So we proceed to correct this with the receptionist in her computer, and she's fine with it, but then when we get to the technician, he says "did you tell us it was multiple gestation before you made the appointment?" Well, no, I didn't know I was supposed to. He allows as to how they'll try to juggle the schedule. So they start me on what he says is a machine that isn't as good, because it doesn't have the measurement package. All of my previous ultrasounds had been vaginal, which is not all that fun; this one was over the belly. He adjusts the screen so I can see some, and starts hunting for parts inside of the babies which are inside of me.
But first he has to determine which baby is where and how they are related to each other, and he keeps getting confused saying "here is the face of baby A. Wait, that's baby B." After about 40 minutes, the good machine frees up, and they move me. A good idea -- I was getting tired already of lying in the same position. But a bad idea because it turns out that the good machine is situated in such a way that I cannot see the screen. How annoying! Ken can see it because he's just sitting in a random chair. So they look for parts, measure parts (the femur is about 3 cm, and the head is about 14 cm in circumference -- I think I'm remembering these right), getting confused and having to start over frequently. After another 45 minutes they let me sit up for awhile and rest, and then they go back to trying to find kidneys and brain structure and you name it they look for it.
Sometimes I was thinking that they were doing all of this just because they can, rather than for any actual medically necessary reason. One of the things they look for was an unclenched fist. Well, both of these babies were waving their hands around, clenching and unclenching their fists in real-time on the screen, and they got at least one of the fists of each of the babies, but then they had to look for the other. (Why? It turns out to be a genetic defect marker to keep your fists clenched, but you would think that one hand each would be enough to rule that one out.) It was actually pretty cool to see them waving their hands. Hi mom!
The good news: they have all the parts they look for. Of course, some parts they can't look for because they are too small to show on ultrasound. It seems like they look for all the things that they can look for. It looks like one of them is a boy! (85% certainty, he says.) The other one they couldn't tell, but girls don't have these convenient external parts, so either it was a bashful boy or it is a girl. Perhaps they will determine this at some future ultrasound -- but hopefully we won't have this grueling one again. Let's not vibrate our kids for no apparent reason.
They were complaining that these were the most active babies they had ever seen (which made it hard to get measurements) -- we asked if fetal movement was correlated with hyperactivity, and it's not -- it's correlated with general good health. So all of this enormous amount of eating I'm doing is paying off!
As usual, there were some terrific photo opportunities, and he tried to print some of the good pictures for us, but flaked out and we ended up with only some crummy pictures from the ultrasound.
Here's a photo of me as I start to show, taken about the same time
I'm in front of one of the cabins at the local youth camp -- the cabins all have names; this two-building cabin is named Twins and a three-building cabin is named Triplets. When I take walks with the babies past these cabins I explain to them that they are twins and not triplets!
We had another ultrasound. This was not as big an ordeal as the previous one, because they didn't have to measure quite as many things. They wanted to measure as much as possible, but fortunately the appointment was only for one hour, so he had to cut it short. It looks like the important things to measure are femur length, abdomen circumference, and head circumference. They are about the right size, or maybe a little bit large, for their gestational age, and the important thing, is that both of them are the same size. (Later: Whups, didn't turn out that way, did it?)
We asked him to get us another estimate on genders, and he wasn't able to figure out either of them this time. So maybe our "probably one is a boy" has been downgraded to complete cluelessness. All ultrasound photos are pretty crummy, but we're now going to only have crummy ones because of the size of the slice vs. the size of the babies -- their parts are too large to get a good view.
We have passed week 28, when the probability of survival starts going rapidly up if they are born. Obviously we still want to go to term (12 more weeks), because they are just plain healthier longer you wait.
We got an estimate on weight: 5 pounds each! This is quite large for 33 weeks. Also, they are head down, both of them, which means that if they stay that way, which the obstetrician says is likely, we can have an ordinary vaginal delivery, and no slice and dice! (There is still a small chance of a cesarean, if during the birth of the first baby, the second baby gets in some kind of emergency distress. Let's hope that doesn't happen.)
Now that it's hot, I'm discovering the joys of gigantic muu muus to cover my gigantic self. I have a photo taken June 20 of me in one of these.
The lake has finally warmed up, and weightlessness is very nice! Haven't yet gotten a photo of me in my ridiculous maternity swimsuit. Not sure I'm going to :-)
The biophysical profile is like any other ultrasound, but they're looking for different things. In my recent ultrasounds they have been measuring sizes of femurs and heads and verifying that the babies are firstly, the same size, and secondly, an appropriate size for their gestational age. In this one, they watch them move, and verify that they are wiggling in appropriate manners. It's kind of odd, because it's a test -- for example, they have to do "practice breathing motions" (where they move the amniotic fluid in and out of their lungs) for 30 seconds continuously -- but of course since this practice breathing is something that they do at random, and they don't know that we're measuring them, they might stop after 25 seconds. So the ultrasound technician pokes me in the belly with the ultrasound probe to stimulate them and says "come on baby keep doing it". It's kind of strange because if the doctor were doing it herself, she could evaluate qualitatively how they were doing, rather than having a specific set of eight actions that they must do in order to get a perfect score. We will probably end up having another one -- it's scheduled in ten days, and probably I won't go into labor by then. We're also having the measurements done at the next ultrasound (I'll be on the table until the end of time!), so we may have a new weight estimate then; all we can do now is extrapolate from the previous one, so we think they must be well over six pounds by now. We've given up on finding out genders; we'll find out when they arrive, the old-fashioned way!
The NST is done by hooking up the regular monitors that they use for monitoring during labor. These monitors display heart rates of the babies and any contractions had by the mother. I am having a few contractions these days, but they are on the order of one every several hours, so the likelihood of actually having one during a 20 minute test is low (and in fact I did not.) The purpose of this test is mostly to reassure the obstetrician that everything is going okay; it really doesn't seem like it's all that useful to me. Somebody with a singleton would probably never have this test (until actual labor when they were monitored), but the concern is that while I can feel babies kicking, I can't tell which is which, and so one of them could be in trouble and I would never know.
In fact, now that they are on clearly identifiable sides, I can tell at least some of the time (when they kick me in the center it could be either). They also seem to have different personalities in the way that they kick. Baby A (the one on the right, who is slightly lower and expected to come out first) kicks all at once sort of violently, while Baby B kicks in a more deliberate and slow and softer pattern -- pat, pat, pat. So maybe I don't really need to have this test anymore, but in reality, I might deliver before the next scheduled one so it's easier to just go with the flow because it makes the doctor happy. In particular, we think that by having all these tests, she will not pressure us to deliver early, because she will be pleased with their health.
Valerie told the nurse running the test that she must be an NST-siologist :-)
I found out what the "stress" version of the NST would be, and it's the same except that they give you a low dose of a contraction inducing drug to see how the babies react to contractions. However, having contractions induced is not a good idea, even with a low dose, because you might go into real labor and maybe you didn't want to yet. Hopefully they will not suggest that we have this test because we will refuse it. (I'm pretty sure that our obstetrician would not.)
After each of these tests, we then have an obstetrician appointment, but not much happens. They weigh me (233, with clothes and shoes) and measure the length of my uterus (48 cm -- full-term size for a singleton is 40 cm), and maybe extract some of my bodily fluids for testing. It does give us an opportunity to ask questions about the contractions I'm having, or what the hospital is going to do in various situations and so forth, but once a week seems awfully frequent. Fortunately it will be over soon.
Many of you know that we are planning to breast feed, but some of you may not know that Valerie is planning to help. She breast fed her two children, and so she is currently on a protocol to induce lactation. It seems actually to be working! Anyway, the first week or so they have to get milk just from me, because of the colostrum, but after that I can have help, and maybe I can get more sleep!
After the last report, there was a great hue and cry (okay, two people) for a photo of the ridiculous maternity swimsuit:
(I tried to smile in this one, but the sun was so bright it came out as squinting. Sorry! Just not photogenic I guess.)