I’ve just extracted my 3AM feed.  I know I have to tell this story,  this story that brings to full circle a three year journey of blood, sweat and tears. I recall a poem I wrote November 2006:

11/28/2006 10:26:32 PM

Afwagting

Die holte brand waar jy moet woon
Jou tuiste wag in hoop
En jy’s reeds hier

Jou trane glinster in die oggend dou
Jou warmte tussen ons vashou
Jou asem in ons gesels oor jou

Jy’s reeds hier
In die vashou en droom van jou bestaan
Jou heenkoms word afgewag
Ons hoop is jou verwelkoming
Selfs voor jou bestaan

Jy vlinder in die onsekerheid
Van die nuutsheid
En in die wonder of die grootsheid van jou drome
In ons huis sal kan woon en leef
Ons sal vir jou moet wag
En hoop dat die liefde en die hoop
Wat jou na lewe lei jou sal omvou
En jou by ons sal hou

I remember the great hopes and expectations that were shattered month after month as we struggled to conceive. I remember fears of the possibility that we might never be able to conceive.  After 3 years of intensive fertility treatments and many hours of personal investment in my own health I tell the story that completes the circle, our birth story.

The last three weeks of my pregnancy were hell, I discovered new depths to the word discomfort.  I lived through what many consider to be equivalent to the worst torture techniques – the pregnancy rash named PUPPS.  The word still stirs terror when I read it ‘cause I know how bad it can get and it’s not a pretty picture.  PUPPS without a doubt is an initiation rite into new levels of pain and suffering, in fact some describe the cumulative pain of PUPPS to be worse than the pain of natural childbirth.  The itch still lingers a week after my C-section.

Sunday evening of the 28^th of March 2010 will remain etched in memory forever.  After a typical lazy Sunday afternoon of watching Idols, of wishing the hours away, the itch came in full force, like it did the past three weeks, every night without fail.  This time I was driven to tears, the discomfort was severe and unrelenting. This time we decided we’ll try something new (one of more than a dozen home remedies I’ve tried), I undressed, waddled into the bathtub and my husband proceeded to dress me in Bulgarian yogurt.  The cool softness brought relief, for a moment to the raw burning itch.  I rested my yogurt dressed self on a towelled recliner, in desperate exhaustion I took a few deep breaths during this brief window of relief.  As the yogurt dried, the itch returned and I decided it’s time to go shower (another method to find a few moments of relief).  Little did I know that the ultimate and only relief was on its way.

I then covered myself in Sudocrem, like every night before, a ritual that sometimes afforded me enough time to fall asleep for an hour, but this night was different.  I couldn’t fall asleep, the raw burning itch was unbearable and my tummy began aching like it was being stretched beyond capacity. I pushed the sides of my belly together to provide some relief to the bruising sensation just below my belly button.  My first thoughts were that one of the babies were probably turning and that the pain will relent once the baby has found a new comfortable position. It didn’t.  A little later I came down with an upset stomach, visited the loo, and back to bed. I had one or two sore contractions, which I believed to be too far apart to mean anything.  Not much later the vomiting started.  At this point (3AM) we started phoning our moms for advice. My mom told me to go to hospital immediately (I wasn’t quite convinced, but decided to go anyway), so we proceeded, all-a-vomitting to the ER.

Once admitted to the maternity ward I was wired to a dopler and a device measuring uterine contractions. The graph spiked off the charts, I was still in denial, believing that what I had was some kind of stomach bug. Maybe from something I ate? Clearly still completely in denial that this was actually happening.  The nurse seemed notably rattled and proceeded to call my obgyn.  All the while I was fighting for my own consciousness as I heard the nurse saying, “No! Don’t faint on me, Maritza! Don’t faint on me, wake up!” I could feel the darkness closing in on me and could see little sparks like stars in the darkness as my eyes closed involuntarily. The IV brought relief and I regained consciousness.  My obgyn arrived a few moments later, frazzled in bed-hair.  He told me: “It’s time”.  I was shocked, and in utter disbelief signed the consent papers to proceed with the C-section. I opted for general anaesthesia as I wasn’t up to coping with any more drama or being traumatised by any more pain. I was so deeply exhausted and had little to no reserve left to cope with more sensory stimulation so I asked them to turn the switch off and make me go to sleep.

Moments later I woke up in terrible, terrible pain. I huffed and puffed like I was in labour all over again.  The nurse was quietly encouraging me and kept telling me that the pain meds will start working soon.  What I didn’t know when I opted for GA is that I would wake up without any form of sedation or pain relief and would have to fight my way through the first 30 minutes of pain until the pain meds kicked in. It was sore, very, very sore. In all this mess and suffering the theatre nurse kept reassuring me that my babies were doing well and that she prayed for them as they entered the world, I cried and said thank you as I huffed and puffed my way through the pain.  I could hear my husband at the door of the theatre asking for me, but the nurse told him that they are waiting for the pain medication to take effect before I could leave for the maternity ward.  I said some things to people which to this day I still don’t remember, including a phone conversation with my brother.

Hours later I was fully conscious and wheeled into the NICU on my bed and could have a peek at my babies.   Those moments between the maternity ward and the NICU, on my way to meet my babies were the most beautiful moments in my life.  I was relieved, relieved that I brought them into this world alive, relieved that I was alive and deeply relieved that I would experience motherhood.  Those moments were flooded with joyous perfection.  My life was perfect. I was loved and had two children to consummate that love. I looked at Lize first, her body was covered in patches, all wired up with machines beeping, beeping, her face was covered with an oxygen mask, but I could see her profile and I knew. It was in that moment when I moved into myself and the world felt distant, I felt like I was in a bubble where I knew the truth which no one else seemed to see.  The story of Nella Cordelia (a story I incidentaly stumbled upon via twitter a few weeks before) flashed in front of me and I knew. The emotions that welled within me did not seem foreign, I recognised all of them as Nella’s story flashed in front of me. I knew she had Downs syndrome from the first moment I laid eyes on her, even before my paediatrician knew.  My pead only made comments about her condition days later as the swelling disappeared. All the while I kept asking “Are they both normal” and everyone kept answering “They’re both doing very well”.  It felt too silly to ask out right “Does Lize have Downs?”, what if I were wrong?  How embarrassed would I feel?  I refrained from asking and protected my heart by keeping my feelings distant as I saw the inklings of a tsunami roaring on the horizon.  The nights in hospital were long and tiring as I battled through much left over pain and itch from the rash which still didn’t relent.  My mind was busy, trying to figure out what I would do with the news I was dreading to hear.  Three days passed in a haze. I can remember distinctly, holding her, cuddling her, warming her as she laid on my bare chest with her bare body tangled in wires.  That’s when the aching started, when my heart felt like it was being electrocuted, spasms of pain shot through me as I considered the possibility, the possibility which my heart knew before my mind was sure.  Feelings flooded within me, feelings I couldn’t show because I was too afraid I was wrong.  Three days later I came home.  Babies remained in NICU.

Friday morning I woke up late morning when my husband came home from NICU walking into the bedroom, his eyes were red and before he could utter the words I knew what he was going to tell me but was too afraid to hear.  First he told me that he loved me, very much, and as he said those words he burst out in tears, and I knew, and I cried, I cried like I’ve never cried before and we held each other as we cried together and wept.  It was the single greatest moment of loss I’ve ever experienced in my life, I felt utterly helpless and sad and angry. I so desperately wanted it to be fixed, to be gone, to be untrue, but I knew.  It felt like someone I loved died.  From that moment for several weeks it felt like someone stabbed me in the heart, my heart was raw and heavy.  Inside I was a teary mess, on the outside I kept going, for their sake, they needed a mother, they needed me to be strong.  The nurses in the NICU ignored my red swolen eyes, never mentioning Down’s Syndrome, as if to afford me some dignity in a very trying situation, knowing full well that it would send me off into tears.

My birth story, I suppose, is nothing like the typical birth story, seeing that I was unconscious during the birth.  It’s also nothing like the ordinary birth story because it was fraught with difficulty, with challenge, with emotional pain, with loss.  I lost a daughter the day another was born and needed to fall in love anew. Amidst all of this lay a little boy that needed to be celebrated, fully, a normal boy which made me feel so much joy that I refrained from feeling it too much because it felt too wrong to be so sad about one child and so happy about another.  The deeper the happiness for one, the deeper the sadness for the other.  So I waddled emotionally on the tightrope of remaining in control.  The problem with “remaining in control” is that it wells up emotion until it wells up too high and somewhere something gives.

The twins spent 21 days in NICU. 21 Long tiring days of commuting between home and hospital, 3 hourly breast milk expressions and the emotional burden of learning about Lize’s condition all took its toll resulting in what I now believe to have been an ulcer.  Luckily my recovery was swift and the stress gradually wore off relieving my morning stomach cramps.

The hardest thing about learning about Lize’s diagnosis was the conflicting feelings, feelings I dare not admit to others, feelings I am ashamed of having felt.  My world of perfection, my world of “only the best” of “fast” and “achieve” and “intelligence” did not have room to accommodate “slow” and “challenged” and “retardation”.  This tragedy could not be happening to my daughter, to my angel daughter for whom I had the highest hopes and dreams.  I wanted to lift this veil from her face and see who she was supposed to be, who she would’ve been if she wasn’t born with one stray chromosome.  So many scenarios flashed in front of me, of experiences I probably would never be able to share with her, the pain of not being able to bear children or live completely independently.  The pain was intense and numbing and after a while I forced myself to not think about these things because it was burning a hole on both my soul and my stomach.  It was here where I truly started to live one day at a time.

I still hurt, sometimes, when I hold her close and I recognise features of my own face when I was her age, and I wonder, what if.  Swiftly however those thoughts are replaced by pure love and thankfulness, thankfulness that I get to hold her, thankfulness that I get to know her, thankfulness that I get to teach her and guide her and protect her, and thankfulness that she gets to teach me what it means to truly love, without exception, without condition, without expectation. Just to be, and to love.

The complexity of the feelings tied up with Lize and her diagnosis has made it difficult for me to truly come to grips with motherhood, to drink it in and soak it up, but I’m getting there and can’t wait for these two little angel faces to speak and interact and understand when I tell them how much I love them.  For their sake I have to calm my heart and learn to accept the way things are so that we can all grow and learn together.  I enter motherhood with a multitude of questions, of not knowing and having to learn to put my need to know on the back burner and accept that some questions will remain unanswered indefinitely.

Here begins a new journey of not knowing when or why or how, of self acceptance, of other acceptance, of being more forgiving and learning to find perfection in every imperfect moment.  Joy amongst uncertainty. Enter motherhood.

P.S. To all who held my hand to this point in time (you know who you are). Thank you muchly.

Testing, testing…testing 123.

I probably don’t deserve the title of “blogger person”, more like “lame ass non-blogger who refers to herself occasionally as a blogger”. Anyhow, let’s forgive and forget and move on to more important bits.

Did I mention I’m 21 weeks pregnant! Whoop! Whoop!

I will relieve you from your suspense and reveal to you my first open-to-the-public belly pics:

Just to put it into perspective, especially those who think I’m still small. This was April 2009, 7 measly months ago:

See what I mean? Yea? No? Oh well, whatever!

So what has happened between 12 weeks and now?

Well, our 17 Weeks fetal assessment showed no abnormalities, which came as a great relief!  After that I suffered a terrible bout of Flu, which had me staring blankly at the ceiling for about a week.  Full recovery took about two weeks (after a good dose of Augmentin).

Our 21 week assessment went fine as well.  Boy twin seems like an avid boxer and girl twin jawned twice during the scan (she clearly finds our keen interest in her wellbeing very boring and over rated). The day after our 21 week assessment the little buggers gave us a terrible fright by pushing down too hard on my bladder (which resulted in a little involuntary spill, which I thought to be amniotic fluid).  I was admitted at the Medi-clinic and they had me stay for the night to monitor for any further leakage. In a nutshell, I was admitted to hospital for peeing in my pants! Wonderful! Seems like motherhood seems to make fools of us all! An internal exam the next morning showed no evidence of amniotic leakage.  The little incident however shook us up a bit and made me realise just how important the next 7 weeks were and that I probably should be more careful and take extra precaution during the next few weeks (as opposed to waiting till I can barely stay on my two feet).

My feet and back are killing me and I’ve gained about 12kg’s!  Frik, I don’t know how they’re going to make space for another 4 months of growth, but I’m preparing myself for a LOT of discomfort and time spent on my beeeehind.

Hope to update you soon on more of Fat-Belly-Ville!  Have to go take a shower, the heat is killing me!

Been going through a terrible time of late after we got a “upper end of normal” result at our 11w2d scan.  The result for both fetuses was 2.5 mm.  After discussing the risk factors and stats we decided we didn’t want to pursue further testing as we felt that there was no need to pursue invasive testing (CVS) if we didn’t intend to terminate under any circumstance.  I then went for another scan 12w5d at another gynie, the result of which is currently unclear (more on that later), but which seemed to my untrained eye to be 4.5. It also seemed as if the nucal was visible from the top view of the baby, which caused great alarm on my part.  He only mentioned that one seems to be normal and the other not. After scanning I asked the result from the Dr. who responded that he will forward a report via fax to the sonographer that will perform further testing (fetal assessment center), at which point I realised I will not get along with the Dr. I was emotionally drained and didn’t have the energy to have the “I am entitled to my results” talk, and very politely said my goodbeys and paid my bill.  Very few things in this world infuriates me more than a medical practitioner without emotional intelligence who believes that patients are incapable of mastering medical information.  Apparently you need a medical degree to understand a bell curve *shrug*.

Anyhow, I left his consulting rooms confused, rattled and anxious and immediately followed up by arranging a fetal assessment at Kingsbury Fetal Assessment Center in Cape Town – Tel: 021 683 4653 (which was going to happen just the NEXT day).  After much discussion and tears we decided we could not buy our own peace of mind at the risk of our babies (should a CVS be performed) and I proceeded to cancel the appointment that was so kindly arranged by Elizabeth at Kingsbury at such short notice.  They were extremely kind in their response and I was choking as I said goodbey on the phone, trying to gulp down my tears.  The pressure of HAVING to do the assessment (because the expert assessor Shannon Morris was going on leave) on such short notice just broke me and I had to go with my gut feel and cancel.  The screening would have involved last minute travel arrangements to Cape Town and a lot of stress after an already long day of emotional upset and just did not feel right.

In the fuss of arrangements (trying to get my blood group from Vitalab) for the Kingsbury scan I spoke to one of the nurses at VL and she asked if I was aware of Prof. Nicolaou Tel:011 883 3070 at Morningside Medi Clinic and that they performed a bunch of non-invasive tests, I wasn’t and decided to investigate.

The nurse (Sharon) at Prof. Nicolaou’s rooms was extremely helpful and talked me through all my options and was equally infuriated at the Dr. who refused me my results. I requested that his report be sent through to Prof. Nicolaou’s rooms.  Interestingly Sharon said that most of the time amnio is better with twins as the positioning can be problematic with CVS, she also mentioned that they now have software and updated stats that improves the efficacy of blood results on twin pregnancies. I sighed a sigh of relief to finally hear a person speaking a language I could understand.

I now have a 17w appointment where they will perform all the available tests and allow us to decide based on the results of those tests if we wish to proceed with an amnio.

So, we now wait for 17 Nov when we’ll know more about the status of the twins.

I think the message that needs to be put across very clearly is that Fetal Assessment does not necessarily HAVE to involve invasive testing and that Obgyns are responsible for communicating risks in a sensitive and clear manner.  No one should be manipulated emotionally into going for further testing by ANY means.  The work of a physician is to put the facts on the table and help patients to navigate their way around the implications of those facts.

Some useful info:

What is fetal nuchal translucency?

Abi Berger, Science editor

In the fetus fluid collects behind the neck, much like it does in dependent ankle oedema in later life. This occurs partly because of the fetus’s tendency to lie on its back and partly because of the laxity of the skin of the neck. As with ankle oedema this accumulation of fluid can represent the end point of several pathological processes, including heart failure. Fluid collecting behind the neck can be detected as nuchal translucency by ultrasound scanning, and it can be measured. The more fluid that has accumulated, the greater the risk of an abnormality being present.
Chromosomal abnormalities—for example, Down’s syndrome—can cause fluid accumulation. Chromosome 21 contains the gene that codes for type VI collagen. In trisomy 21 one subunit of this collagen can be overexpressed, resulting in connective tissue that has a more elastic composition.
Failure of fetal movements is also likely to cause nuchal thickening. Neuromuscular abnormalities can cause poor breathing and body movements, both of which may lead to fluid collecting as happens in peripheral oedema. One example is arthrogryposis, which causes contractures and flexion deformities and can be fatal. Other causes are intrathoracic and extrathoracic compressive syndromes. If the thoracic cage is abnormally narrow or an intrathoracic lesion is present (such as a diaphragmatic hernia) the vessels in the fetus’s head and neck become congested and oedema occurs. Likewise, if heart failure occurs (due to congenital cardiac abnormalities or cardiac dysfunction) more extravascular fluid will form.
There is a brief opportunity between 10 and 14 weeks’ gestation (when the fetal lymphatic system is developing and the peripheral resistance of the placenta is high) to detect abnormal fluid collections. After 14 weeks the lymphatic system is likely to have developed sufficiently to drain away any excess fluid, and changes to the placental circulation will result in a drop in peripheral resistance. So after this time any abnormalities causing fluid accumulation may seem to correct themselves and can thus go undetected by measuring nuchal translucency.
About 90% of fetuses with a nuchal translucency measurement of 3mm (“high”) at 12 weeks’ gestation are normal at birth, while 10% have major abnormalities. Only 10% of babies with a measurement of 6mm (“very high”) at this time will be found to be normal. In centres that perform nuchal translucency measurements, once a fetus has been identified as having a high nuchal translucency, mothers are usually offered chorionic villus sampling and a repeat scan about two weeks later to exclude chromosomal or major physical abnormalities.

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1114626/

Other Sources:
http://en.wikipedia.org/wiki/Nuchal_scan

Chorionic Villus Sampling (CVS)

Amniocentesis

Nature has taken its course and the embryo with the weaker heart has fallen away, measuring 8w6d. (If you look back to the scans you will clearly notice one weaker heartbeat)

Our embryo triplets are now twin fetusses.

Don’t want to say too much about this, ’cause I don’t want to take away any of the joy we feel for the two remaining ones.

The two remaing embryos are 100% on track, limbs are now visible and both are active and moving about.

The loss no doubt stings, but we’re so very grateful for the two remaining babies.

So very grateful for their tiny little wiggly bodies, bless them.

So I’m a little surprised that I’m not exactly the poster kid for a glowing pregnancy, or maybe the best is still to come?  Here are a few things I was rather unprepared for:

1. The paralysing nausea
2. The breathlessness
3. The exhaustion
4. The hot flushes & feeling of burning up
5. The heartburn, O dear! the heartburn
6. The inability to sneeze without feeling like I’m ripping apart
7. The chronic stuffy nose
8. The bloating

It’s not exactly a picnic in the park, in case you were wondering. A little tougher than I imagined.  Like having the flu, going on three weeks…

I have a hair dresser appointment today and dread having to sit still for that amount of time, dread the nausea, dread the need to urinate every 30 mins.  Really hope I survive!

I’m 8 Weeks today. 4 Weeks left to the all important 12 week mark, so far, so good.

Thursday I’m off to George for the weekend and hopefully will have some energy to buy some basics for our house i.e. Bed, fridge/freezer, washing machine, microwave, TV, PVR, cutlery, bedding & towels. O the pain of starting all over again!

9 week scan next Friday, hoping for good news, then 11 week appointment with a multiples specialist Obgyn and then 12 weeks appointment with Obgyn in George 19 Oct.

So far I’m not really so fond of the pregnancy experience (yes I can say that!) as much as I want these babies, I dread having to go through months and months of this feeling of sickness and increasing pain as these three litle buggers squeeze me out of space. Nevertheless, if all goes well I probably will only have to be pregnant once in my life. (Unless that one little icebaby has ideas of its own…) I’m nauseous and breathless as I’m writing this and it seldomly relents, ever present, all the time, feels like I’m breathing hot stuffy air all the time, sometimes it makes me feel a little panicky, like I’m going to suffocate, or like my heart’s going to fail. Luckilly there are moments of relief, where I catch my breath and see through the fog of illness.

Trying to keep my eyes on the prize. I might only have 6 months left to go!

Thankfully I don’t need to do much work at the moment, just some bills to sort out and the move to George. I don’t know how you working folk cope?! I really don’t know. (hats off)

My biggest challenge, to keep these babies safe and sound and growing for as long as possible. The first prize, full term triplets! (yes, it’s been done before…)

Really hoping the symptoms will ease up a little after 12 weeks, otherwise there’s a looooong 7 months ahead!