A NICU Story: The early arrival of triplets
I don’t think any parent ever really expects that babies are going to begin their lives in the NICU. I know I didn’t. Despite the fact that we were having triplets and I knew that at best they would only go to 36 weeks, I was still unprepared for their very premature delivery at 27 weeks. We had visited the NICU at 12 weeks and been warned that our babies would very likely spend time there, whether in passing or for a more permanent stay. Still, I thought if I did everything “right,” we could avoid that possibility. I would follow my doctor’s instructions as closely to the letter of the law as I was able, and if that were not enough there would always be drugs to stop preterm labor. The threat of magnesium sulfate loomed on the horizon for me as something that was almost a rite of passage with a multiple pregnancy – an awful medication experience that might require brief or intermittent hospitalization but would, nevertheless, keep delivery at bay. To this day, the arrogance of my beliefs and the force of my denial weigh on my soul like a rock.
I was admitted to labor and delivery at 26 weeks 3 days for preterm labor and given magnesium sulfate until my labor finally abated. I cannot remember ever feeling so sick or completely out of control as I did during those 24 hours. Two doses of beta methazone were administered to the babies, 24 hours apart, to promote their lung development. We were informed of their slim chances of survival in the event that they were delivered at such an early gestational age. My doctor had told me that she had felt feet prodding her fingers just before she admitted me. I was beginning to comprehend the gravity of the situation but still harbored the belief that as miserable as the experience was, drugs could handle most preterm labor situations. I was categorized as high risk, and was given instructions for complete bedrest.
My guilt ate away at me as I thought of my two-year-old daughter without her mother at home for perhaps the next 8-10 weeks. It was bad enough that we were about to turn her world upset down with the birth of triplets, but the additional insult of not being able to take care of her overwhelmed me. Still, I knew that this would be a small price to pay for the ultimate survival and well being of my unborn babies.
With my doctor, I set my goal for 30 weeks, and then 33 weeks, and optimally to go beyond 34 weeks. If the babies could coordinate sucking with swallowing and breathing, they might escape a lengthy stay in the NICU. However, as the days passed and my contractions began to recur just by checking the fetal heartbeats, I started to doubt whether I would even be lucky enough to make it to 30 weeks.
Ultimately, I found myself back in Labor and Delivery for the better part of the day on Sunday, April 21st, 2002. Something told me this was it, though I didn’t want to believe it. Despite the onslaught of drugs, the babies were delivered by c-section within a half hour of the obstetrician telling us that there was no more time to wait – the babies had to come now. And so Claire Grace, Emmett Marks, and Lily Francis, arrived in the world at 8:03, 8:04, and 8:05 PM, weighing 2 lbs. 2.8 oz, 2 lbs, 4 oz., and 2 lbs. 5 oz. respectively. Each of the babies was immediately intubated and moved to the NICU once stabilized.
I had been too exhausted and perhaps too scared to turn my head and see them as each baby was delivered and whisked away to the awaiting NICU teams, but I listened attentively to the commentary around me. My husband said that Lily had beautiful eyes and the obstetrician commented on how relatively big the babies looked for being 27-week triplets. The reassurance that they all looked as good as could be expected afforded me a brief reprieve from the intense worry and exhaustion from the prior 12 hours. They had each survived the delivery, and so I felt a budding sense of joy and relief as I was moved to my room and dozed on and off through the night.
Any sense of optimism was shattered, however, upon seeing each of them for the first time the next morning. Lily was the last to be transferred to an isolette and was still covered in a plastic baggie under a warming lamp, connected to every tube and machine possible. I did not see her beautiful eyes. Rather, I saw a baby who looked more alien than human, and more fragile than I ever could have imagined. Nothing could have prepared me for the shock of seeing her small body rise and fall with the labor of every breath. The babies had been so secure when they were still inside me. Now, every breath represented a fight to survive, and I felt a crushing blow of grief and guilt as I realized the fight that each would be engaged in not only to survive, but also to ultimately thrive.
The nurses and neonatologists reassured us that our babies appeared to have only the expected complications that accompany extreme prematurity, and that as long as that was the case we could expect that each of the babies would eventually go home with us. Some of the nurses tried to assuage my guilt by saying that babies come into the world in their own time and on their own terms, that some babies were just more eager to enter the world than others – but I didn’t really buy it. They echoed that sentiment by telling me that the girls appeared to be “feisty” from day one, and that it looked like they were going to be a handful. I prayed desperately that that was true.
During those first few days of sitting by their isolettes, I cried almost constantly. My pregnancy had been a physically overwhelming experience from the first. I had experienced exhaustion, nausea, congestion, and acid reflux throughout most of those 27 weeks. In addition, I had been accompanied by my constant companions: guilt and anxiety. Guilt about how this impending change would rock poor Sophia’s world, anxiety about how I would cope with the reality of triplets and four children under two years of age. I had been under a tight deadline to complete a major piece of work while caring for Sophia, using every spare minute and hour to accomplish the work before the birth of the babies. In looking at Claire, Lily, and Emmett on that first day, there was nothing I wouldn’t have given to “start over” and do the whole thing again. I felt that my deadline meant nothing if not pushing myself might have afforded a different outcome. A later birthday for my babies would have felt truly joyous; but their too-early birth seemed predominantly dreadful, even while tempered with a cautious sense of optimism.
As the days flew by, I began to feel a certain sense of safety for the babies as long as I was in close physical proximity to them. My hospital discharge without the triplets was one of the saddest days of my life. The emptiness of arriving home without a baby or babies was indescribable, and the balloons on the mailbox seemed more of a taunt than a symbol of celebration. Depression engulfed me as my initial weeks at home left me feeling helpless.
While I spent the better part of each day by the babies’ bedsides I felt like a mother to no one, knowing that Sophia was home with a caregiver, and that there was very little I could do to ensure the survival of my babies. Yes, I had pumped breastmilk from the start and my husband and I eagerly participated in kangaroo care as often as the babies could tolerate it, but still I felt like a mother to all and to no one in particular.
Once I was discharged from the hospital I found it very hard to re-enter the NICU without feeling as if I was about to pass out or be sick. I tried to prepare myself each time, but in the early days I found the sight, sound, and smell of the unit to threaten my very fragile sense of stability.
It was hard to breathe. We entered the NICU dance of progress that was represented by one step forward, two steps back. There were very few clear-cut decisions in the care of our premies. Every treatment had benefits and drawbacks, and every advance our babies’ made seemed to be accompanied by some regression. We grew to expect this, but never felt less frustrated by the phenomenon. I grew to feel like a cross between a hummingbird and a whirling dervish as I moved from one isolette to another, to the pumping room and back, trying to hold, care for, and nurture each baby, as well as to document their care in each babies’ journal. It was too much to write about feelings. Keeping to the facts was safer – weight gain (or loss), feeds, support and pressure requirements, x-rays, sonograms, medications, etc.
By about week six I began to feel more like my old self. We were generally reassured that the triplets’ still had only expected complications that would be resolved in time. Now we held our breaths, hoping that our babies would be spared any complications that might arise from treatments or even from hospitalization. In having come to know some of the other parents, we shared joy in their babies’ gains and felt true sorrow and sympathy in their losses. It was hard not to compare at times, or to feel that our babies’ would never “get there;” but in the NICU it is also easy to feel instant gratitude. There is always a case that seems much better than your own, but also always one that is much worse. As a person who generally believes that God doesn’t give you more than you can handle, I often wondered how parents who lost a child could handle it.
The amazing thing about the NICU is that each of the parents involved is more or less walking through something that was once unimaginable to them. Life in the NICU cultivated a sense of strength I never knew I had, and changed both my husband and me in lasting ways. The intensity of NICU life forces you to look at the extremes of life and death, and to be truly in awe of the miracle of survival.
The excellent care our babies’ received was accompanied by a sense of compassion that made the NICU staff eventually feel like an extended family. To the extent that we desperately awaited the discharge of each baby, we felt almost the same degree of sadness on the day that our last baby, Emmett, was ready to come home. It was scary to leave behind the total support of the NICU; and it was disconcerting to think that whereas yesterday Emmett had not met the criteria for discharge, today one simple shift meant the difference between 24 hour care involving a team of specialists and a home monitor with only myself and my husband. Of course, there was always the possibility that our ambivalence in bringing Emmett home had more to do with the fact that three preemies at home would definitely push us to the brink of insanity, but I would like to think that it was really more than that!
My husband, Jeff, and I have a profound sense of gratitude to the NICU for what they were able to do for our children. With time, that gratitude has only deepened as the miracles that are Emmett, Lily, and Claire continue to unfold. As they approach their 2nd birthday they are babbling, running, and fully exploring the physical world – fully. Lily and Claire have lived up to the nurses’ expectations in their feistiness.
Never one to be contained, Claire, whose dancing feet may have helped to set things in motion at 26 weeks, is the strongest, toughest, and most agile of the group. With an ability to know just how to taunt her two sisters, she also has a smile that lights up her whole face. She is full of love, and eager to help soothe a fussing sibling by bringing his or her blanket to them.
Lily, the smallest from the start, is still petite and is often referred to as the drama queen. She seems always to be looking at us from upturned eyes and a slightly cocked head. The slightest thing may cause a tantrum, and with her elfish grin she often seems to be as much sprite as human. A pack rat like her sister Sophia, she is often found carrying 4 purses on outstretched arms as she pretends to leave for work.
Emmett, who seemed akin to the fabled tortoise while in the NICU, has maintained some of that same slow paced approach to life - but it is a slowness that seems to involve reflection and determination. Perhaps sensing that he is in a losing battle to compete with his sisters, his mantra seems to be “slow and steady wins the race.” Though we fretted over whether he would ever reach certain milestones such as sitting, standing, and walking, today he is every bit as capable as his sisters, and he is deceptively quiet. The girls’ activity is often busy and boisterous, while Emmett is content to study things without interruption, especially objects such as cords, electrical outlets, wires, hinges, and drawers! He is a moving target for injury and although he seems to be less active than the girls, he is the ultimate home wrecker! He is a scientist at heart, but his exploration opens the door to boundless mischief, which his sisters are always too eager to join into. Fortunately for him, his whole-faced grin has a way of melting your heart and reminding us of what a sweet little boy he is!
Sophia has coped well with the burden/gift of triplet siblings. She refers to them as “her babies” and has adapted well to the role of “big sister,” often trying to “help” us and to model “big girl” behavior. The payoff for her is finally coming to fruition, as “the babies” are increasingly able to play with her. She is the ringleader in a four-ring circus, and we are the proud, exhausted, insane, blessed, stressed, and delighted parents of these wonderful children.
I think I will always wonder, “what-if…” what if I had taken it easier during my pregnancy, restricted my activities sooner, listened more to the inner voice telling me something was wrong around week 26, insisted that labor was progressing when the machine wasn’t detecting it adequately at week 27, planned with more realism and less denial to be the mother of triplets, which would more likely be premature than full-term. The truth is, I could not even comprehend what life with triplets would be like, much less triplets’ “at-risk.” And the reality is that we were blessed with three healthy babies that the NICU helped to preserve so that eventually they could thrive. I guess it is the awareness on a daily basis that things could have gone very differently that sharpens my perspective and brings into relief the preciousness of life – even a life that sometimes feels like Groundhog Day.
