Thursday, December 9, 2010

The plan...

I keep getting asked by people, including the nurses, "what is the plan?"

Frankly, I don't know. I knew what the plan was at 24 weeks when the delivery of Aurelia and most likely both of them was imminent. I don't really know the plan now that we are at 28 weeks and stable. I know it is still a balancing game of risks: balancing between the risks to Chiron in his current environment and of being delivered premature, the risk to my body of keeping them in versus the risk to Chiron of being delivered, the risk of different delivery methods and more.

My best understanding? As long as I continue to pass my workups to show that I am not developing preeclampsia or DIC and Chiron continues to show great fetal heart patterns on the daily nonstress tests, we will stay in a holding pattern as long as I avoid returning to preterm labor. Originally, the perinatologist had sounded like this would be the case until 32 weeks, but I'm hoping that we are now looking to stay in the holding pattern a few more weeks beyond that. Consider this the all is good part of the plan.

Now, if all is good workup wise but I do go into preterm labor, I believe the plan is to deliver Aurelia, the presenting Twin A, vaginally. They will then cut the cord from her body as close to her as possible, place the cord back up in the uterus leaving the placenta inside and attached and then administer magnesium sulfate and hope that it stops the labor process and that my body even closes up the cervix some. If this works, we will be in another holding pattern, but one that does not have the potential to go as long in all likelihood.

If anything is not good workup wise, I believe the answer is delivery then of both babies. The only solutions for preeclampsia and DIC are the removal of the underlying condition. While I think DIC is technically only due to the intrauterine demise of the cotwin, my understanding is it is such a serious condition that they would go ahead and deliver both twins because of the risk to maternal life is too great.

I think I've come to understand that if anything is going wrong, we are likely to go with a c-section, but there is still the possibility of delivering both vaginally, even possibly days or weeks apart.

What's funny is that even a month ago, having to have a c-section was near the top of my fears lists. Never had a problem with it and was completely on board as medically necessary, but definitely not comfortable. Now it doesn't even hit the radar. And that's with knowing some of the situations make the necessity of an emergency c-section with the older, more dramatic abdominal surgery possible.

I'm trying not to put too much faith and hope into any thought, but my actual OB is back Monday and she is much more comfortable with questions and discussing possibilities even when they don't know the answer than the covering doctor, so I'm hoping I have a better answer for the plan than these current guesses after I talked to her. I know I shouldn't set too much faith in anything changing in my understanding or anything once she's back, but I can't help but feel like it will be a relief to have the doctor that I like, that delivered my son, that communicates in a way that I understand and who puts up with my inanities without even blinking.

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