2nd follow-up in Cincinnati

Yesterday was quite a day. We left our house around 5am to make our 8:30am ultrasound appointment, making most of the drive in the dark. I was so excited/nervous about the day, I don't think I slept a wink there. As soon as the U/S began we could see the girls both looked good, moving and causing problems for the poor sonographer. She checked their fluid levels and we were blown away! Elise actually had more fluid than Anne-Claire in the original measurement! I'd been praying for God to astonish the doctors and He did not disappoint. The final measurements for the deepest vertical pocket of fluid were 5.6cm for Anne-Claire and 5.0 for Elise. Great news! The hope with the amnioreduction was for the fluid levels to equalize and that's exactly what's happened. The dopplers all looked good except for the umbilical cord of Elise, which still shows absent flow. The maternal-fetal medicine specialist came in to talk to us and basically said if things continued in this positive direction, there was not much more they can do for us in Cincinnati--Praise God! He is still concerned with Elise's absent blood flow, which is likely more to do with the placental insufficiency than TTTS. Unfortunately, there is not a medical solution to resolve PI except for bedrest and nutrition to maximize what she does get.

We left that office with 3 hours to kill before the ECHO was scheduled. We killed some time in a park so that I could rest and then went to lunch. We laughed because lunch only took us 30 minutes. The ECHO was more difficult on me this time. I was not able to lie flat because I was having a hard time getting any air, so they let me lie on my left side. It was still pretty uncomfortable but thankfully, didn't last too long. Unfortunately, we ended up with another 3 hours before our meeting with the surgeon. The Fetal Care Center did have a nesting room available so we went there and I napped for a couple of hours.

As the hours passed I got more nervous. For some reason I thought that because last week we got the good news early that there might be a reason we were going to be late getting our news this time. An irrational mind, I know, but it's really what went through my head. I got up several times to use the restroom and had to pass the conference room where another family was having their initial conference with the team. I was overwhelmed with empathy, knowing how horrifying it is to hear news that your baby(ies) are in danger. I immediately began praying for that family and their baby(ies) and the Lord used that time to calm my own anxieties.

It was close to 6pm before the surgeon and a resident came in to talk to us. He cut to the chase right away and told us the ECHO looked good. I exclaimed, "Praise God!" and almost jumped out of my seat to hug and kiss the doctor. I restrained myself and listened as the doctor explained that Anne-Claire's right ventricle score had gone from .49 to .46 (great) and her left ventricle score went up slightly but remained within normal range. He was so encouraged that he said they'd decided if everything continued to look good during the next round of tests (Tuesday, March 31), we can begin going to the MFM in Indy for weekly ultrasounds instead of driving to Cincy. Wonderful news!

We asked him several questions about Elise's placental insufficiency and he told us that we would begin seeing some warning signs if she was deteriorating. Lack of growth and severe anemia being the most critical signs. I asked him if he could give us an estimate on how far along I might get before the placenta would stop working and we'd need to deliver and he couldn't say. Some babies are able to make it to full-term, however, which would be fabulous. He also told us that if she begins suffering from severe anemia we could do a blood transfusion in utero that would put both babies at risk of preterm delivery but might be worth the risk. For now, we're thankful that aside from the absent flow in her cord, she seems to be doing well. My prayer is that whatever rest and nutrition I'm able to get will be multiplied in value for Elise--think oil in jar and loaves and fishes. It would be a cinch for God.

Finally, I want to publicly thank all of the wonderful ladies and their families who are sacrificing to serve us during this time. I continue to be humbled by your generosity and kindness. God is using you not only to serve us physically but to put my pride to death and to lift my spirit.

Prayer requests:
1) that Anne-Claire's heart would remain stable and Elise would not show signs of anemia;

2) that my rest and nutrition would be multiplied, especially for Elise so that she can grow like she needs to;

3) that I would remain pregnant for many more weeks, getting at least to 28 weeks and hopefully to 32 or beyond (I'm 23 right now.);

4) that I would have an extra measure of understanding and patience toward my husband who is bearing more burdens than those involving the babies;

5) that our faith would continue to grow; and

6) that Emma and Charlotte woud continue to handle this all so well.

Encouraging Day

We had a great day today! We left our house early, 6am, and arrived in Cincy in plenty of time for our 9:30 U/S. The girls both looked wonderful! It was immediately apparent that they both had good fluid levels and the tech confirmed that. Normal fluid ranges from 2-8cm. Anne-Claire's was 7.7cm last Thursday, was taken down to 4.6cm on Monday with the amnioreduction, and was 5.1cm this morning. Elise's was 3.3cm last week, went down to 2.1 on Monday, but was up to 2.9cm today. Both girls also had nice big visible bladders, which is a good sign that Elise is getting nutrition and producing urine. The one negative was that Elise's cord still shows absent diastolic flow, which is a sign of placental insufficiency. The best way of dealing with this is through strict bedrest and good nutrition for me. The doctor came in after the ultrasound was over and told us he thought both girls looked very good. He said he was, "cautiously optimistic," which is a lot coming from a doctor that rarely offers positive news without good reason.

We left feeling good but cautious because we knew there was a lot riding on the ECHO. The ECHO went well but we didn't immediately get to speak to a doctor about the results. We were able to rest in one of the nesting rooms in the Fetal Care Center before Dr. Lim, one of the fetal surgeons, came to talk to us. He came early so we didn't have to wait until 5pm, which was a blessing from God. He told us that he too felt the ultrasounds looked good except for the absent flow in Elise's cord. He reiterated the importance of bedrest to improve Elise's bloodflow and nutritional intake. The big news was that the ECHOs on both girls looked very good. The only noticeable change was in Anne-Claire's right ventricle. I'm not sure what the measurement is of but normal range goes to 4.8 and hers was 4.9. He didn't feel this was a significant enough amount to consider a progression of TTTS. In other words, our girls' TTTS has not progressed and has in fact improved to some degree by the improved fluid levels.

We won't consider this a successful response to the amnioreduction until we get another positive report on Tuesday when we return to Cincinnati, but for now we're very encouraged. Dr. Lim thinks that we are safe to rely on weekly ultrsounds and ECHOs for the time being until they see some significant change that warrants further action. We'll be watching Anne-Claire's heart carefully for any signs of progression of TTTS and Elise's growth closely. Our goal is to make it to 32 weeks, when both girls have a good chance of survival without medical complications. We're going to concentrate on proper nutrition for me and good bedrest and to pray that God will continue to strengthen Anne-Claire and Elise and to keep them healthy.

We give God all of the glory for today. We've been asking Him to work in a mighty way so to astonish the doctors who were not at all encouraging last week. I do believe He has answered our petitions. I continue to pray that my hope will rest in the Father and not in the doctors or procedures. God was pleased to use the amnioreduction to help our girls, but His hand did all the work. Thank you, Father.

Please pray:1) for continued faith and His glorification;

2) for Anne-Claire's heart and Elise's growth;

3) for strength as we face weekly trips to Cincinnati;

4) that the girls stay put in my womb until it is safe for them to come out;

5) that Emma and Charlotte would continue to handle separation from us as well as they have so far.

Thank you to all who have been fasting, praying, and otherwise laying down their lives for us. We love you all very much.

Amnioreduction

My anxiety level as we left our house on Monday was high. My prayer, "When my anxieties multiply within me, thy consolations delight my soul," became a mantra that got me through the incredibly stressful first half of the day. By the time we got to the clinic in Cincinnati, I thought I might pass out, but my rock and dearly beloved husband, prayed me through it and held my hand the whole time. Dr. Jaekle, too, sensed my anxiety (I was visibly shaking as I lay down on the table) and did a great job calming me down. He explained that the needle used was smaller than the one used to draw blood and that Anne-Claire was in no danger from the needle because the sharp part is actually extracted after penetration and only a narrow catheter remains in the womb. He reassured us that bumping into it would be like bumping into a straw--absolutely no danger. He also paid me what he said was a major obstetrical complement--he had to raise the table completely in order to reach me and was able to use the short needle rather than the long one to reach my womb. While gathering all his supplies, he realized he didn't have the right kind of tubing. Five or six people entered the room looking for the tubing he wanted and none of them could find it. Chris leaned in and whispered that it reminded him of a Seinfeld episode. I replied that I hoped Dr. Jaekle was a real doctor and not just pretending to be one like Kramer. I wanted to see his diploma on the wall. We giggled, which drew the attention of the doctor who wanted to know what was so funny. He'd already proven to have a sense of humor so we told him. It definitely eased some of the tension I was feeling. Finally, another doctor entered and said he should use the "kit." As Dr. Jaekle opened the packaging he revealed why he doesn't like to use the "kit," pulling a huge needle probably 15 inches long out of the box: "This tends to worry people when they see it." He also commented on the $300 the kits cost to open when all he needed was a small piece of tubing. I told him I hoped that wouldn't end up on my bill, and he knew I was relaxed enough to proceed.

Chris advised me to close my eyes and to use the breathing I'd learned in childbirth class, so the actual needle stick was not too bad. Having the catheter in me was uncomfortable and caused some cramping. Before putting in the needle, Dr. Jaekle had used ultrasound to see where Anne-Claire was and to find the deepest vertical pocket of amniotic fluid. I almost told him that he might want to check on her location again because of her high activity level but kept quiet, letting him do his job. But sure enough, as soon as the catheter was in, there was Anne-Claire investigating what this new intrusion into her space might be. She actually reached up and grabbed it and began pushing against it, which both Dr. Jaekle and I could feel. He thought he might have to restick me because she was causing the fluid to slow down its flow, but thankfully, didn't have to resort to that. He filled 2 and 1/3 jars with fluid, which was around 1 1/2 liters. I immediately felt less pressure and could see my belly had gone down in size. Dr. Jaekle mentioned it was softer to the touch as well. Anne-Claire's fluid level went from 7.7 cm to 4.6cm. He also measured Elise's fluid, which was 2.1 cm. Our hope and prayer is that Elise's levels will increase while Anne-Claire's stabilize. He said Elise's fluid could begin increasing in a day or so. He also allowed us to listen to their heartbeats, which is always a wonderful sound. As he shifted the U/S wand just slightly, I wondered aloud whether he'd actually gotten Elise's heartbeat. Yes, he assured me he had. What didn't make sense to me was that rather then being stuck way over on my right side, Elise was now in the middle of my belly. She'd already become "unstuck." It was remarkable! Even in those few moments, God was blessing us with such encouragement.

We left feeling encouraged and hopeful. God can use this procedure to heal our daughters. We pray that is what He will do. Dr. Jaekle could see that I was cramping quite a bit as we left, so he recommended I take Motrin for just a dose or two and to spend the night in Cincinnati rather than attempting the drive back to Bloomington. I am grateful for his recommendation--I was able to rest Monday night and then okay to travel on Tuesday.

I continue to feel both girls moving actively and have not started feeling full of fluid again, so I'm hoping this means the girls fluid levels are equalizing nicely. We return to Cincinnati tomorrow, Thursday, March 19, for our first follow-up ultrasound and ECHO and will meet with a fetal surgeon. It will be a long day, so please pray for strength for both Chris and I as well as positive results. We also have to go back next Tuesday, March 24, to repeat the tests for a final verdict on the success of the procedure. We're taking this one step at a time, and focusing on each day as it comes, trying not to worry about the possibility of surgery until we have to.

Prayer Requests:
1) that God would be pleased to save our girls and to use this amnioreduction as a tool for His glory;

2) that our family would continue to trust Him and rely on His strength;

3) that I would get the bedrest and nutrition that I need to provide the best possible environment for the girls;

4) that Emma and Charlotte would be obedient and patient through this difficult time;

5) and for all the loving friends and family who continue to pray for us and who are laying down their lives in service to our family.

Team meeting with Fetal Care Center doctors

The second day of diagnostics at the Fetal Care Center was an emotional roller coaster, which is why I'm only now writing this post. I was just too exhausted, physically and emotionally. The verse that I meditated on yesterday was from Psalms 94: "When my anxieties multiply within me, your consolations delight my soul." Our first stop was with a nurse midwife who took my medical history and did a short exam. She told me that my uterus is abnormally large for 21 weeks because of all the amniotic fluid in Anne-Claire's sac. We mentioned to her that we'd been encouraged the day before by the ultrasound and the girls' strong heartbeats. She told us that sick babies can also have normal heartbeats, which, needless to say, was less than encouraging. She also ordered an EKG for me because I would need one before surgery. It felt like she believed surgery was a foregone conclusion for us.

We left there for cardiology completely deflated. During the ECHO, a nurse from cardiology came in to talk to us, and she told us that strong heartbeats should be an encouragement to us. That made us feel a little better. After the ECHO, the cardiologist came in to give us his initial assessment and his words gave us another glimmer of hope. He said that he couldn't believe our girls had TTTS b/c their hearts were both completely normal. In TTTS, the recipient twin (Anne-Claire) suffers from heart failure b/c of the increased volume of blood flow. He said she wasn't showing any of the telltale signs that her heart was working any harder than it ought. He also said that our girls were both so active that he had a hard time believing they had TTTS. Donor babies (Elise) that he sees usually have no fluid and can't move at all. They are literally "saran wrapped" to the side of the womb by lack of fluid. He said Elise was doing flips and moving so much she did not look like a typical "stuck twin." Even though Chris warned me against putting my hope in what the cardiologist said without all the evidence, I'm a woman and I couldn't help myself. I allowed myself to believe that maybe they didn't have TTTS at all.

Next came the big moment--the team meeting with the fetal surgeon and director of the center, Dr. Crombleholme, and the maternal fetal specialist, Dr. Van Hook. The meeting started with Dr. Van Hook telling us that in every criteria for TTTS, our girls were just on the fringe of being abnormal. Anne-Claire's fluid was just below what would be considered way too much, and Elise's was just above what would be considered way too little. Their hearts did look normal but Anne-Claire's is right on the edge and will likely soon begin showing signs of damage. The MRI looked good--neither girl displaying what they would usually see with TTTS. All these things began giving us encouragement.

Then they started giving us the more negative results. Elise's cord shows signs of resistance to normal blood flow and her head is slightly larger than it ought to be in relation to her body. This is a sign that the placenta is not working well for her. Babies with placenta insufficiency (PI) begin to compensate for the lack of nutrition by devoting more to the head and brain b/c of its imporance and give less to the rest of the body. Her cord insertion is on the edge of the placenta instead of in a nice position toward the middle of the placenta.

Their diagnosis: Our girls are stage 3A TTTS with placenta insufficiency for Elise. Basically this means they have a very early stage of TTTS but with the added complication of PI. They told us this is good b/c it gives us more options. We are not being forced into a particular treatment. Unfortunately, because of the PI, some treatments are more dangerous for Elise. The statistics for babies like ours were not encouraging. 88 babies out of 100, or 50 sets of twins, who undergo amnio reduction will survive. Translation: some moms will have both babies survive, some will have one, and some will have none. Because of Elise's PI, surgery could be quite dangerous. If she happens to have a share of the placenta that is less than 20%, she will likely die. 80 babies out of 100, or 50 sets of twins, who undergo surgery while at stage 3 and with PI will survive. There is no treatment for PI. The only recommendation is complete bed rest and concentration on nutrition.

We left the meeting in a fog. It seemed that we were going to have to choose between our babies. Impossible. Our hearts cried out to God and I do believe He heard us. In thinking everything the doctors said over, we realized that amnio reduction did not put Elise at any greater risk of death. It is also less invasive and carries less risk of premature labor. The doctor told us they would know in about a week or so whether the amnio reduction was successful by doing another ECHO after a few days and a 2nd ECHO a few days later. If their hearts don't get worse, we can say we're in the 20% that do respond successfully to amnio reduction. If the procedure is not successful, then we'll have to move on to surgery. We're choosing to take this one step at a time and are focusing solely on the amnio reduction right now. I'm scheduled to go in for the procedure on Monday at 1pm in Cincinnati. We'll have to go back Thursday for the 1st ECHO and then back again on the following Monday.

We know that God has a plan for our girls and it is perfect. Regardless of what treatment we choose, He has them in His hands and has already determined their future. Right now our girls are doing well. They are both healthy and strong. In order to keep them that way for as long as possible I am going to go on bedrest and increasing my protein intake significantly. Our goal is to get them as far past viability (24 weeks) as possible and to deliver them before losing either one in the womb.

Please pray: 1) for strength and continued faith. It is very easy, especially for me, to slip into despair, and I don't want to do that;

2)that we will not put our hope in what the doctors say, in treatments, or in any bit of encouragment, but only in our Lord and Father;

3)that God would preserve the lives of our girls, that He would be merciful to us, and would allow us the testimony of their lives for His Glory;

4)for the details of getting to and from Cincinnati multiple times in a week and for bed rest to be possible for me;

5)for Emma and Charlotte who don't understand what's going on but each need to trust God as well.

Thank you all so much for your prayers. We wouldn't be able to stand under this burden without them. Thank you to everyone who's already been ministering to us. We love you.

Encouraging video from Twin-to-Twin Transfusion Foundation

My dear friend, Barbara, told me this morning that I needed to see this video to be encouraged by all the smiling, healthy survivors of TTTS. I wanted to share it with friends and family so you can also be encouraged. I do know that our Father loves our girls very much and has a perfect plan for them. Whether that means we get to love them for these 21 weeks they've been in my womb, for a few hours, days, months, or many, many years, He is good and loves us still.

My prayer for today is strength to get through the day, clarity and understanding as we talk to the doctors, wisdom in deciding what treatment to follow, and of course for the preservation of our beautiful and dearly loved daughters.

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Our beautiful new daughters

Anne-Claire at 21 weeks

Elise at 21 weeks

The best thing about today was getting to see our beautiful babies--Anne-Claire and Elise--and getting to share it with Chris because he's had to miss all my other ultrasounds except for the one when we discovered two baby blobs. We drove up to the Castleton area to Maternal-Fetal Medicine to get a level 2 ultrasound because my OB was concerned that Elise was measuring smaller than Anne-Claire and had less amniotic fluid. We took Emma and Charlotte with us so they could see the babies, too. Overall they were very good, especially considering neither fell asleep until right before we arrived, and Charlotte missed lunch because of her nap, albeit a short one.

During the ultrasound, Anne-Claire and Elise were both very active and fun to watch. At one point the tech was trying to get some measurements of Elise, and Anne-Claire came over and got in the shot, like she was trying to get all the attention. I can already tell what her personality is going to be like. :) Getting all the measurements and pictures on two active babies took a long time and we were all tired and hungry by the time the doctor came in to take a look for herself. She was super nice and friendly and wrapped up her part of the exam quickly. Then she told us she would join us in the conference room to discuss what she'd seen.

While we waited for the doctor I noticed Charlotte's diaper was pretty full but thought I'd just wait until after we'd spoken to the doctor to change her. I had no idea that what she had to say would take a lot longer than expected, which resulted in Charlotte's diaper leaking all over my pants and me changing her on my lap in front of a slightly shocked specialist. But I especially welcomed the opportunity to be Charlotte's mommy after hearing all the doctor had to say.

This is really hard, but here goes. The doctor began by explaining to us that Anne-Claire and Elise share one placenta. They also have discordant sizes: Anne-Claire weighs 15 ounces and is in the 70th percentile for weight. Elise's weight puts her in the less than 3% category. The discordancy for the girls is 32%, which is apparently pretty high. Anne-Claire has a lot more amniotic fluid than Elise, and Elise has problems with blood flow through her cord--the doctor called it "absent blood flow." Several things could be causing all of this: intrauterine growth restriction, maternal infection early in gestation, chromosomal abnormalities, or twin-to-twin transfusion syndrome (TTTS).

Based on what she saw today, the doctor believes our girls have TTTS, which occurs at a rate of .1 to .9 per 1000 births. In TTTS, babies have one or more blood vessels in their shared placenta that connect their blood flow. One baby donates blood to the other, which causes her to receive less nutrition. In our case Elise is donating blood to Anne-Claire. Because she is the donor, Elise is smaller. Because she's receiving less nutrition, Elise is also producing less urine, which is why her amniotic fluid is so much less than Anne-Claire's. The obvious danger for Elise is death due to lack of adequate blood flow, nutrition, and fluid. The danger for Anne-Claire is death due to heart failure. Because of the higher than normal amount of amniotic fluid, her heart has to work harder to pump. TTTS if left untreated is very dangerous and almost always fatal. The positive things we were left with were that both girls are very active and have good, strong heartbeats. The doctor also said that there are some babies that come in with no amniotic fluid at all, so Elise is doing well having the fluid she's got.

Not exactly what we were expecting to hear when we drove up to Indy this afternoon. Before hearing this news, my worst-case scenario was mandatory bed rest. I would gladly welcome hospitalized bed rest at this point.

So, our obvious first question was what do we do now? The options were: do nothing (really, they actually give that as an option), serial amniotic fluid reduction, or laser fetal surgery. In serial anminotic fluid reduction, a needle would be inserted into my uterus to draw out fluid from Anne-Claire's sac in order to equalize the amount of fluid for both girls and to take pressure off of the restricted blood vessels in Elise's cord. The doctor couldn't say how often this procedure would be required but could be weekly. Laser fetal surgery actually closes off the vessels that are shared to stop Elise from transfusing her blood to Anne-Claire. The closest center that does this surgery is in Cincinnati at the Fetal Care Center. At this center, there is a 91.7% survival rate of one or both twins and 64% of both twins treated with fetoscopic laser surgery.

We decided to go to Cincinnati to see if they can help us there. The doctor today stressed that there is still a chance that our girls don't have TTTS, so the Fetal Care Center will conduct their own diagnostic tests: ultrasound, MRI, echocardiograms, and amniocentisis to confirm TTTS. Then if Anne-Claire and Elise have TTTS, we'll find out if we're even candidates for the surgery. If we're not, we'll come back to Indy for the amnioreduction therapy. The doctor we saw today is going to call Cincinnati first thing in the morning to get us an appointment. They will get us in as soon as possible, hopefully this week. They do all the diagnostics in one day so that if we're candidates for the surgery we can do it right away as well.

Needless to say, we're terrified. I don't even know how to put into words what I'm feeling right now but fear of losing one or both of our babies is literally weighing me down so heavily that I have no idea how I'm actually typing all this right now and not in a heap on the floor. We obviously covet your prayers not only for Anne-Claire and Elise but for our faith. It seems like all I do these days is say, "We're trusting God. He's in control. He's good. He only does what is best for us." But it is getting harder and harder every moment I turn around. Last night I lay in bed trying to figure out how I was going to get my cleaning and housework done and this morning a dear friend offered to come by in the morning to clean my house. I know that God hears my heart crying out so often and answers me over and over with love and gentleness. Even though He hears me and loves me, I'm so afraid He might take what is most precious and still expect love and obedience from me. Behold the handmaiden of the Lord.

First things first...baby names and then U/S news

I waited to post details about my latest ultrasound until today when I got to see my doctor. The U/S was yesterday. I've also become very tired of having to refer to our girls as Baby A and Baby B, so I wanted to wait until we finalized their names before posting so that I can reveal their names and begin calling each by her appropriate moniker. So, here goes...

Our newest daughters are Anne-Claire and Elise. As you all know Emma and Charlotte both have three Christian names and all the middle names come from family sources. To refresh your memory, Emma Maria Isabel gets her name from Chris's great-grandmother, Emi, my mom, grandma and great-grandmother are/were all Maria's, and Chris's Memaw's middle name was Isabel. Charlotte Mary Caron is named for Chris's mom, Mary, and his Granny whose middle name is Caron. We will reveal Anne-Claire and Elise's middle names when they are born.

It has also become something of a tradition to look to literary sources for our girls' names--Jane Austen and Emily, Charlotte, and Anne Bronte have all influenced our taste. After Charlotte was born we jokingly said our third daughter had to be named Anne, but it just seemed to fit when we were faced with an actual child needing a name. Claire was a name that Chris and I both liked and seemed to fit perfectly with Anne. In case you're wondering she will be called Anne-Claire, but we're counting Claire as the second name of her three. We came up with Elise as an alternative to Elizabeth, which we both liked but thought came with too many common nicknames we weren't real interested in attaching to our daughter.

So there you have them. The four Holmes girls are Emma, Charlotte, Anne-Claire, and Elise. We hope everyone will love their names as much as we do, but if you don't, please keep it to yourselves. :)

Now, about my ultrasound...while it was wonderful to get to see beautiful Anne-Claire and Elise again, it wasn't all positive yesterday. As you've probably figured out, I did get confirmation that they are in fact both girls. We still don't know whether they are identical or fraternal and might not know that until after they're born. Identical twins can have two different placentas (dichorionic) and two different amniotic sacs (diamniotic), so if we discover in another ultrasound that they are dichorionic/diamniotic that doesn't necessarily rule out their being identical. With that said, yesterday the tech thought she detected a thin dividing membrane, which indicates they are diamniotic, but still only saw one placenta (monochorionic). It is still possible they are dichorionic but the placentas have fused or it could be one big placenta.

The things that concerned the tech yesterday and my OB today, were that it appears as though the thin membrane is located in such a place as to give Elise a lot less room in my uterus than Anne-Claire has. In other words, Anne-Claire has an olympic-size pool to enjoy, and Elise is in a small wading pool. This could be contributing to Elise's smaller size and lower fluid level both of which could be problematic. Both girls had strong heartbeats and are moving and kicking appropriately. However, despite the large area Anne-Claire appears to have at her disposal she seems to be staying right by Elise, which puts both girls primarily on my right side. The tech said that the location of the membrane and the placement of her cord could be keeping Anne-Claire so close to Elise.

The tech recommended that I see a maternal-fetal specialist, or a doctor that specializes in higher risk pregnancies, and my OB concurred, so we can see if there is real cause for concern or not. I hope to get in to see the specialist in Indianapolis early next week for a level 2 ultrasound. In the meantime, my OB wants me to limit my activity, get more rest, and drink more water. He asked me if I worked and was pleased when I said, "No." However, I'm not sure that being at home with a 3 1/2 year- and 17 month-old is that much better in terms of getting more rest, but we'll see. I'm going to do my best to take it easy and praying that this doesn't turn into official bed rest.

Now for pictures...I have to say I don't love the picture we got of Anne-Claire because it is a full-face shot instead of a profile but it's what the tech gave me. She gave me 2 profile shots of Elise, so I considered using them both and saying that one of them was Anne-Claire but couldn't do that to her. She also gave me a shot with both little round heads. Here they are: