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:

Quick update on last ultrasound

I talked to my OB's office yesterday, and after he reviewed my ultrasound, he's decided to just repeat it in a few weeks (March 4). He's not concerned at this point with the size difference of just one week and doesn't seem to be worried about any complications that could arise with identicals sharing one amnion or one placenta. I'm looking forward to seeing the girls again and confirming they are both in fact girls!

Two more girls!!

I just got home from my ultrasound and it looks like we're getting two more girls! We are so excited!!

Emma, Charlotte, and my good friend, Julie, were with me during the ultrasound because Chris couldn't be here. He commutes to Anderson on Wednesdays. We're both very sorry he missed it because it was so amazing to see their two little bodies swimming around. I was also disappointed because the new ultrasound equipment doesn't make videotapes so all I have are a few still pictures.

The tech started out by locating both babies. Baby A was lying head down close to the middle of my belly, and Baby B was curled up transversly on my right side. I jokingly asked her, "Are you sure there are only two?" She did a quick sweep of my uterus and confirmed, "Just two." Whew!

Baby A's heart rate was 156 beats per minute and everything looks great! She was a little wiggly worm but clearly made her sex known. I was able to feel her movements and see her moving around on the screen, which was really cool. Baby B was curled up seemingly to protect herself from Baby A who was kicking her. Her heart rate was 168 beats per minute, and she measured only 16 weeks; whereas, A measured 17 weeks. She had a foot partially blocking what the tech was "pretty sure" were girl parts, so there is still a slight chance Emma is right and one baby is a boy. I'm sure we'll clear up the matter definitively in one of my later ultrasounds. Apparently I could have them as frequently as once a month from here on out.

I am 17 weeks pregnant, so A is right on target and B is a little small. This could be cause for concern, the difference in their sizes, because the tech was not able to locate a dividing membrane or more than one placenta. If the twins are identical and have only one placenta, one baby could take more nutrients from the other baby. The tech said my doctor would call me after he reviews the pictures. In my 8 week ultrasound, there was clearly a dividing membrane, so I'm confident the tech was just not able to locate it because of the equipment she was using. I suspect I will be sent to a perinatologist (prenatal specialist) to confirm whether the girls are in one sac or two and how many placentas there actually are. It's possible that there are two placentas but they're fused or very close together. We'll just have to wait and see what my doctor says.

Now the fun of picking names really begins! We'll keep you posted!

Baby Noah is home!

We got the wonderful news yesterday that Baby Noah has been released finally more than a month after his birth. Please continue to pray for his family as they make the adjustment to having their sweet son at home after such a long time in the hospital. Pray also that he will begin nursing better--he's gotten used to the bottle. Many thanks for your prayers and concern for the Picketts. God is good!

16 weeks, Ultrasound next week!!

16 weeks with twins

20 weeks with Emma

21 weeks with Charlotte

I had my 16 week prenatal appointment yesterday and everything is going well. I got to hear two strong heartbeats, each in the 140s. My uterus is measuring about 22 weeks, which means the babies are growing nicely. It also explains why I look bigger than I did when I was 21 weeks with Emma and finding out she was a girl. I haven't gained any weight but the doctor doesn't seem concerned at this point. And the best news--I'm getting an ultrasound next week!! Hopefully, by 2:30pm next Wednesday we'll know for sure if we've been blessed with two more sweet girls, boys, or one of each. You have until noon next Wednesday to submit your predictions. :)