We usually don't talk much about our visits with Dr. Yin, but this week it plays a much larger role than normal. Lately most of my days have been generally good but, with that come some crummy days too and last Thursday was one of those days. So when it was time for our appointment I was less than enthusiastic. When the doc came into the room she asked how I was doing. I just shrugged and replied "Okay." She responded by saying, "Yeah...I saw the notes from your ultrasound with Dr. Shields." Imagine our surprise when we thought that all went well at the ultrasound with Dr. Shields and the final words that came out of his mouth were: "Everything looks good." So I asked her what she was talking about. She said that Joshua was displaying a much smaller abdomen in proportion to the rest of his body and that she expected this to happen however she thought it would have shown up earlier. She asked us to start talking about the possibility of delivering all 3 boys at 24 weeks. My eyes about popped out of my head. I knew triplets meant early delivery but this would mean babies by the end of August. Rob asked the obvious next question, as I was still trying to process this, which was what would the survival rate be for babies born that early? Her answer was shocking to us as well. In the USA she claimed that they would have about a 90% chance of survival with a 30% chance of some long term effects ranging from very minor to very severe. Rob and I have talked about this before and we came to the decision that as long as Joshua still had a heart beat we would do whatever it took to save him, even if that meant early delivery. However, we could not remember the date of viability and siting there being told that it could be in less than a month set us both on edge. Once again, Rob found his composure and explained that we would do whatever it took to give all of our babies a chance. The appointment ended on what was probably meant to be a good note but was not very reassuring. The doc told us that I was not even 22 weeks and the babies lungs had not grown together yet so the choice did not have to be made right away. All we could do for now was wait until the next ultrasound.
Now I am 22 weeks and Tuesday was our appointment with Dr. Shields. The technician started with her usual measurements and told us David was the largest weighing in at, 19oz, while Samuel was not far behind weighing in at 17oz, then came Joshua who weighed in at 14oz which set our minds at ease. Rob and I were both expecting to see him at about half of the size of the others. Then the doc came in the room and took some pictures of his own. While he was doing that we told him how the appointment went with Dr. Yin and started to ask him some of the questions that we had. The first thing that we asked was if he would agree with Dr. Yin's assessment about delivery at 24 weeks and he said no. He would only give a survival rate of 50% with a 50% chance of some critical long term effects. He then told us that at 28 weeks the survival rate would increase to 80 to 85% with a 15 to 20% chance of long term effects and that number would keep going down the longer we go. By this time he had finished looking at the babies he was very pleased that Joshua was weighing 14oz. He did say that his abdomen was only coming in at 3% of where it should be while the rest of his body was normal size. Dr. Shields is going on vacation this week so he said the when he comes back he will do another assessment of their growth and we will have more of a base to compare Joshua to. If he has not grown at all then hopefully we can try again to go see Dr. Chmait in L.A. and talk about our options but, if we do see some growth, then we just need to keep waiting and assessing the situation. We asked what he thought our options would be and he basically laid out four scenarios for us.
The first was to basically wash our hands of Joshua and use the laser to cut the cord causing his immediate demise. This is not an option as we previously stated and we really appreciated that Dr. Shields seemed to understand this. The next option would be to go down to L.A. and have the shared placenta between Samuel and Joshua spilt by laser so they would not have to share in the distribution of nutrients any more. This sounded good but he told us that we would need to keep in mind this procedure probably won't fix everything and more likely than not result in the indirect demise of Joshua. He told us that it might happen right away or it might take a week or two but we would need to talk with Dr. Chmait to get all of the information. The next option would be delivery and as stated before there would be a lot of risk for all the babies. Dr. Shields believes that the risk of delivery out weighs the risks of surgery at 24 weeks but that will switch at 28 weeks at which point it would be his preference to deliver rather than risk surgery. The last option we have is to do nothing. This is not an easy thing for a medical professional to grasp, but we don't want to put God in a box and say that he cannot perform a miracle.
Rob and I have been going back and forth with these choices but I think that the hardest thing might be continuing to wait. On the one hand I'm sitting here looking down at my ever growing belly and thinking how there are three little boys that I can't wait to meet. On the other though, I know it would be bitter sweet if I don't get to meet Joshua because that means he is at home with his Father. We are still so amazed at the things God can do but strength seems to be lacking when confronted with the length of time until our next ultrasound so, we humbly ask for your prayers as the long days go by.