2014 to Mar 2016

A Labour of Love: Our GGG Triplets Birth Story

I cannot begin talking about how our triplets arrived in this world without speaking a little about their milestones during the pregnancy and all the challenges we faced to bring them to term at 36 weeks.  The C-section recovery pains I am feeling right now reminds me about the torment I was experiencing daily carrying them to term.  Looking back at my blog postings, I must have mentioned too often how much I have cried and detailing too whinily my regular suffering.  But all that suffering and worrying was not for naught:  we – I say we because Livia and my husband suffered alongside me – now have three more beautiful family members to love, enjoy and cherish.  We built a large family overnight for only 8 months rather than through several years of pregnancies.

Pre-Birth

As with all parents finding out that they have conceived triplets, it was with great shock when we heard the news from a random OBGYN who performed my first ultrasound that I was carrying three embryos .  Despite being only 7 weeks old, the OBGYN could already tell me that two of them were identical twins.  Not long after, like many regular OBGYNs who are not specialists in maternal foetal medicine, he encouraged us to consider Selective Reduction.  I remember that entire month being very gloomy.  One was not sure whether to be happy or upset about such news.  We had all along only expected an ordinary pregnancy and now told that it will be an extraordinary one, with lots of challenges and risks.

My husband decided for us on the way home from my most shocking medical check-up of the year that we will not even think of Selective Reduction.  It was abhorrent.  And while we are just a regular single-income family we will find a way, as we always have, to adapt to whatever difficult circumstances that we will face during the pregnancy.  I was on the same page as he was but I was glad to hear it out loud from him.

Our first challenge did not take too long to arrive.  My online research informed me that I should pick an experienced OBGYN in triplets from a public hospital and that appeared to be a particular OBGYN in KK’s Private Suite.  I only saw her a total of 15 mins and went to KK two times for ultrasounds before I decided that it was not going well and went to do more research again, but this time on specialists experienced in high-risk pregnancies and not just in triplet pregnancies. I was in the midst of very severe morning sickness and I felt first, KK had no consideration for its patients when scheduling appointments and second, they must have seen so many high-risk pregnancies they have forgotten how to deal with patients with sensitivity.  Our total waiting times at different departments at KK were always between 4-6 hours and they had no decency either to schedule different appointments on the same days, forcing me to visit KK more than once a week and wasting a lot time and money traveling back and fro.  Bear in mind I was not a subsidy patient, I was a Private Suite patient.

The thing that finally broke the camel’s back was the first trimester prenatal screening.  It was a terrible experience at KK from beginning to the end.  Without having to rehash the entire incident all over again, doctors who were on-call at the ultrasound department basically told us point blank that our fraternal twin, Liora, was a high risk for Down’s Syndrome. And they also said there was no point for us to seek a second opinion on this: it will still say Liora was a high-risk.  I should just take an amniocentesis, never mind it might cause a miscarriage of all three babies, to confirm their suspicion and put my mind to rest.  Oh, and its not your OBGYN whose familiar with your case doing the amniocentesis (amnio for short), its another person specialising in giving amnios.  And then at the end, shoved a booklet in our hands about life with children with Down’s Syndrome to help us decide if we wanted to go ahead with the amnio.  I cried that entire weekend, and its not because Liora was high-risk, but because I felt lost if this was the kind of care I am to be given the rest of my very difficult pregnancy.  We decided it didn’t matter if there was something wrong with the pregnancy, we were committed to bringing it to full term the moment we conceived but it mattered to us greatly how we were handled and cared for.  So back I went to Google and did research to turn around our situation.

I was left with changing my prenatal care to SGH or NUH because those are the only two other public hospitals left.  I was attracted to NUH because they developed and patented FISH.  FISH allows for amnio results to be told to parents on the day of the amnio itself, rather than waiting in agony for 7-10 days for the results.  I figured if I wanted an amnio done to confirm Liora’s diagnosis, I would want the result that night itself and not wait a whole week.  That led me deeper to NUH’s maternal foetal medicine specialists and then I started googling their OBGYNs.  I finally gave NUH a call and told them I was having triplets and needed to change OBGYNs as soon as possible because triplets needed regular monitoring. I asked the nurses if they could recommend me an OBGYN experienced in high-risk pregnancies and they named a few, and I picked Prof Biswas because I saw his name several times online in parenting forums.  These forums all said that Prof Biswas was a miracle worker and he was extremely caring.  It sounded too good to be true.   I added that if they could get me an appointment with him fast I would really appreciate it because there was a looming deadline for FISH to confirm Liora’s diagnosis.  While waiting for NUH’s return call I booked an appointment at SGH as a back-up and the best they could give me (despite my situation of carrying triplets) was a whole month later.  I didn’t have to hold my breathe for too long because Prof Biswas’ nurses got back to me immediately and gave me a next-day appointment to see the Prof.  If this wasn’t a sign, I don’t know what is.  Having to deal with bureaucracy at KK, it was nice to be told for once that you don’t have to wait and we’ll look at your situation immediately.

That appointment at NUH changed everything for us.  I did not have to wait 4 or 6 hours for my ultrasound.  It was a mere half-hour wait.  The Prof was also there to supervise the ultrasound scan (not just my scan, but whoever else was under his care as this is their practice in NUH). I told them about KK’s risk assessment for Liora and they re-scanned her and the sonographer said it looked within range and nothing out of the ordinary.  The Prof would later come in and look at the ultrasound and he said the same thing.  But he added that KK was right in pointing to a potential risk but he didn’t think an amnio was necessary given I am carrying triplets.  There was no point doing something so high-risk for a low-risk assessment unless I REALLY wanted to know 100%.  He said if there were problems down the road, later ultrasounds would pick it up.  And that I can be assured that he’ll be there at all my appointments.  I just felt more comfortable at NUH knowing the Prof was going to be there for us at all our appointments, even the minor ones, that I immediately signed up for NUH’s OBGYN prenatal and delivery package.  I called KK to cancel all further appointments.  But their diagnosis for Liora haunted me the rest of the pregnancy.  I never really stopped thinking about it until her birth.

Since switching to NUH, everything was more or less smooth-sailing.  Their appointments were organized:  every two weeks I would alternate between a detailed ultrasound at the Fetal Care Centre and a routine check-up at the Women’s Clinic.  The triplets grew from strength to strength in my tummy and there was no signs I was going to be in pre-term labor.  I also recovered from a very long morning sickness, around the 5th month, and was able to function a lot better. The triplets kept hitting their foetal development milestones: first they hit their 24th week milestone, then they hit their 32nd week milestone, then they went to the 34th week and finally made it to their planned C-section date at 36 weeks. Lucia measured smallest throughout the pregnancy and I began worrying more about her and less about Liora but the sonographers always assured me that she did not stop growing so it wasn’t alarming that she was the smallest.  She was always just a few couple of grams behind, and surrounded by a lot of a fluids.  I knew that uterine restricted growth could have adverse outcomes for Lucia after birth so I really tried my best to encourage her by drinking a lot of milk and eating protein to grow as far as she could.  I never worried for Lysbeth the entire pregnancy and I wonder if that was why she was the one who ended up in NICU for a day for observation despite weighing in at 2.6kg.

Sometime after the 32nd week, it got physically very challenging for me.  It always was throughout the pregnancy since the morning sickness lasted much longer than with an ordinary pregnancy and the heavy weight set in earlier.  I remember however that after the 32nd week, it was so much more pain, discomfort and I was crying a whole lot more.  My belly distended to a ridiculous size and water retention was a becoming a serious problem.  I even hoped to go into labor by the 34th week because I just couldn’t handle the pain anymore but the girls persevered.  Yet despite all these, I never really committed to bed rest.  I would have loved to have bed rest but I had an active toddler to care and a household to run because we did not have help.  I think being moderately active was crucial to my quick recovery after the surgery.

Birth Story

Both my pregnancies had planned outcomes.  Livia was a planned induction which resulted in more than 24 hours of labor, a useless epidural that barely worked that got me screaming half the labor, and a smooth 10-min vaginal delivery. Everyone tells me the second vaginal delivery will be quicker and easier and I always had looked forward to that.  So I was pretty bummed out that with triplets, a C-section was inevitable and I had no choice.  Yet another thing to worry about: fear of surgery and fear of excruciating pain post-surgery.  I was already super exhausted from carrying the triplets 8 whole months, with worsening pain every month, and immediately jumping into C-section post-surgery pain without a break.   That last two weeks carrying the triplets I became depressed because I felt I was never going to get enough rest and energy to start the next stage of motherhood.  I was also depressed because the pains were more or less unbearable at this point.  I was nasty to my daughter and husband and was generally an ugly monster and hated myself.  All my friends were being very supportive and encouraging but it was not making me feel better than the end is nearing.  I was also afraid if all the girls would have complications and the day was finally arriving that we will find out how truly healthy they were.  There were so many emotions I had to deal with, I didn’t know how to declutter my head and separate my feelings to deal with them one by one and so they just imploded within me.  I kept asking my husband, “What if everything is not fine? How?”  And he always replied, “It will be.”  And I never believed him.  I often asked him why he does not worry and he says he’s too tired to worry.  I suppose working, being a dad, taking me to all my appointments, bringing Livia out to play and listening to my daily troubles would exhaust him.  But he was never one to worry and I suppose that’s how we balance each other out.

The C-section was suppose to take place on 09.09.14.  I thought the date was perfect.  But the Prof felt he had too many surgeries that day and the delivery ward would be overloaded and so he moved me up to 10.09.14 and I would be his first patient that Wednesday morning.  We woke up really early on 10.09.14.  I only had an hour sleep not because I was worried but because I couldn’t sleep.  I slept very little the entire pregnancy, it was just difficult to.  My husband got up and got ready and Livia woke up on her own seeing activity in the house.  We all got ready and took the usual 30-min taxi ride to NUH.  I thought Livia might continue sleeping in the Boba carrier but she was excited to be heading out.

We registered at Ward 2A where we made our deposit, registered for Medisave and waited for pre-surgery prep.  I was the first patient to be called into the pre-surgery room.  It seemed that everyone in the surgical wing knew triplets were going to be born that day because for the rest of the day, every nurse, surgeon and medical staff would ask me questions or give me opinions on triplets.  They say they rarely ever see triplets in NUH and it was an exciting day for everyone.  They took my weight and height and asked me to change into hospital clothes.  Then I laid down on a table, said goodbye to Livia and my husband.  My husband was going to meet my friend who offered to take care of Livia for the day and then join me in the operating theatre.  For some reason, I kept thinking about death and I keep thinking about how Livia was going to make life difficult for my friend.  She has never been separated from us and I was afraid she was going to throw a tantrum. I couldn’t worry too much about that now since my surgery was looming.  The nurses then pushed me to another room where you await your turn at surgery.  There were many beds with people awaiting their surgery, and I was the only one having a C-section.  Even a baby was awaiting his surgery, and I thought wow he’s so small and he’s going to be operated on.

A young female anaesthetist and her assistant then came to my bed-side and explained to me about my options and the risks associated with each option.  I started getting really, really nervous at this point because I thought, omg its happening soon.  For some reason I imagined major delays happening but no, every thing was happening on time.   I waited for about half an hour there, with nurses keeping me company and in conversation about triplets.  Even the nurses who were not in-charge of me came to my bed-side to converse.  One nurse said, everyone cannot wait to see the triplets! All I thought was how come everyone is so excited and happy and I wasn’t?  Even the anaesthetist said it was an exciting day because of my triplets.  I felt like Miranda from SATC having to perform strained smiles throughout the whole morning to excited well-wishers.

Thereafter, they wheeled me to the operating theatre.  My friends who did a C-section said there were a lot of people and it was a large room.  I didn’t think it was THAT many people and the room was quite small.  But it was bustling with activity all right. They then shifted me to the operating table and told me to sit up.  They gave me a pillow to hug and a nurse literally held me by the shoulders as the anaesthetist gave me the spinal epidural. It was like an ant bite, just like with the epidural I received when giving birth to Livia.  Then they laid me down and used a cold compress to test if I was losing all feeling below my chest.  I did not completely have no feeling, I could feel pressure, but certainly no pain.  I was also giddy because they took off my spectacles.  So the whole while everything was just a blur.  Prof Biswas came in and started barking about how everyone was not ready and I kept looking around for my husband.  Where was he?  He’s suppose to be here.  Just before the Prof was going to cut me open, he said bring in the husband and then this person who I couldn’t see sat beside me.  I was literally about to cry at that point because I was relieved he was there to hold my hand, I just couldn’t do it alone.  Then the surgery started and the Prof and his assistant and the nurses were all conversing in a jovial way which I wasn’t really paying attention to.  But it seemed all eyes were on when the first twin was emerging.  I asked my husband if he can see everything and he said yes and I told him what did he see and he said, oh the first one is coming out I can see her legs.  And then I heard a cry and then the anaesthetist told me its a girl, congratulations. Prof tried to show me the baby but he only ended up dripping amniotic fluid on my face and everyone laughed.  The baby was taken away to be warmed and then  a minute later, they pulled out another and I heard a cry and there was sounds of excitement to see the third one to complete the trio.  She emerged a minute later and everyone except the Prof and his assistant left my side to look at the triplets.  All I heard were the girls’ soft cries and I felt relieved the surgery was not like the nightmare I imagined.  I could hear my husband telling everyone which twin was who. And I heard a lot of phone cameras going off. My husband returned to me to show me the pictures he took and the video of the girls getting cleaned and I said, omg they look just like Livia. All three of them.   Then the nurses and the anaesthetist showed me the pictures they took.  All this while the Prof and his assistant were suturing me.  It certainly did not feel like a cold operating room.  There was a lot of happiness, joy and excitement and I finally felt it rather than the gloom and doom I felt earlier.  The nurses then brought the babies to me one by one and I even managed to give Lucia a peck.  I was really shocked how alike they all look, and how much they took after their big sister.  After suturing me the Prof said, all is done with a wide smile and wished me luck and he will check on me tomorrow.  My husband followed the babies to nursery to be weighed and checked and I was wheeled to the recovery room, where more excited nurses greeted me.  The nurses said they might wheel the babies to the recovery room if all is well and they said they will call the nursery to check.  They were all hoping to see the babies and the one nurse with photos of the triplets in her camera was showing off her pictures.

The babies did not make it to the recovery room.  They all had low blood sugar and needed monitoring but I was not too worried because my husband was with them.  I ended up staying 6 hours in the recovery room because of a bed crunch – there just wasn’t an available bed yet at a B1 Ward.  It was not boring at all.  I alternated between sleeping and talking to nurses.  I was very drugged up on morphine and painkillers.  My husband would come in from time to time to give me updates on the girls but there appeared to be nothing to worry about.  They were weighing well:  Liora and Lysbeth came in at 2.6kg (enormous for triplets) and Liora at 2.1kg (small but still quite big for a triplet).  Liora and Lucia had already moved up the Ward nursery but Lysbeth had to stay in NICU because her blood sugar remained low and she didn’t have a sucking reflex.  I moved to my ward around mid-afternoon and immediately got to see Liora and Lucia and spend a few hours with them, my husband, Livia, and two of my friends.  My friends told me Livia was totally easy to care for and didn’t show a tantrum at all the entire day.  I guess I worked hard to raise a secure girl and I shouldn’t worry anymore when we get separated for whatever reason.  For a long time I saw Livia as a baby and for some reason, now she looks like a big girl and no longer a baby.  An update also later revealed that Lysbeth should be transferred to the nursery the next day.   All for the rest of the day all I got was, how amazing you can carry the girls, they are such good weights, was it heavy for you and yada yada yada.  Besides the nurses, other families were also poking into our business.  I felt like Miranda again because I just didn’t like attention.

For the rest of the two days I was in hospital, I got sufficient rest and sleep because the nurses fed the babies formula.  I was too drugged up to think about breastfeeding yet. And I wanted to focus on walking again.  I was relieved I got the sleep and rest I needed.  And my recovery was going well that I was discharged a day earlier but the babies had to stay for jaundice monitoring so I get to go home and rest some more.  A part of me felt guilty for not returning with the babies but another part of me knows we’ll be together a lot after this.  I suppose I am a lot more relaxed the second time round.

It’s my birthday tomorrow and I hope the girls can all come home and be with me.  I miss them already.

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