Sunday, July 21, 2013

The Power of Three

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The Power of Three

The journey that leads to the NICU can be just as complicated, stressful and uncertain as the NICU experience itself but having top-notch medical care and staying optimistic can be crucial to a successful outcome. This was the case for Elizabeth Powell and her now 14-year old triplets.

Elizabeth’s pregnancy was full of surprises from the beginning. At age 40, after one miscarriage and a single round of self-administered fertility drugs, she became pregnant with triplets. Her obstetrician had given her less than a 5% chance of having twins, so it came as quite a surprise when an early visit revealed three heartbeats! The pregnancy was immediately elevated to high risk due to Elizabeth’s age and the fact that she was carrying multiples.

Doctors and professionals Elizabeth spoke with discussed the health benefits of reducing a triplet pregnancy to twins. A triplet pregnancy combined with advanced maternal age, complicated matters and lowered the chances of delivering three healthy babies. Another early hurdle was genetic testing.

When she was 11 weeks pregnant, Elizabeth had CVS testing with a genetic specialist whose expertise, much to Elizabeth’s surprise, turned out to be selective reduction. At 13 weeks gestation, she received good news – the CVS results showed all three babies were fine. Elizabeth and her husband made the decision to go forward with the triplet pregnancy.

The pregnancy didn’t get any easier, but Elizabeth had a few factors on her side. She was fit from being a runner and she was receiving care from an experienced maternal fetal medicine doctor at Georgetown University Medical Center which had a top notch neonatal intensive care unit (NICU.) She was able to tour the NICU and see what small babies look like and the type of care they receive. Her doctor also prepared her to be on bed rest at 20 weeks and to expect to be hospitalized by 28 weeks.

At 20 weeks, Elizabeth was measuring at full term size and the pregnancy seemed to be progressing well. The next week, however, she learned she had an incompetent cervix. She was hospitalized and had an emergency cerclage which held for only a short time. At 23 weeks, she had another emergency cerclage. The doctor had invented a special stitch that was used and, this time, the cerclage held. After receiving magnesium and being hospitalized a few weeks, Elizabeth was released and went home.

At 27 weeks, the babies were checked for distress and each appeared to be a healthy 3 ½ pounds. A month later, Elizabeth’s blood pressure soared and she began retaining water. She learned that she had preeclampsia. Her condition became so severe that she began retaining between three and four pounds of water a day. Her entire body, including her eyes, was filling with water. At 32 weeks, Elizabeth’s condition became so severe that the doctor scheduled the delivery.

On January 5, 1999, eight weeks before their March 1st due date, Victoria (2 lbs. 11 oz.), William (3 lbs. 9 oz.) and Edward (3 lbs. 11 oz.) were delivered via a planned and unremarkable Caesarian birth.
A complication of preeclampsia is that it typically worsens after giving birth. After the triplets were born, Elizabeth’s vision became blurry and impaired. She was unable to read and went color blind for a little while. Fortunately, her doctors assured her the condition would subside when the water drained from her eyes and the rest of her body.

Elizabeth’s condition prevented her from seeing the triplets for three days after they were born. The babies were small but did not have any major medical issues. There were respiratory problems to overcome and the babies came home on monitors. The boys were released from the NICU after 3 ½ weeks. Victoria was tiny, but she was a fighter. She encountered jaundice and respiratory issues, but dodged brain bleeds and heart issues. She had a hernia, which was surgically repaired before she was discharged from the NICU. At one point, she also tested positive for RSV and had to be quarantined. Thankfully, she never contracted the virus and she was released from the NICU after six weeks.

While the triplets were in the NICU, Elizabeth was able to visit every day. It was eye-opening to see other babies and their families struggling and, in some cases, dying. When her own ordeal was over, she was asked to help other parents and families with premature babies at Georgetown Medical Center by moderating group discussions. The sessions allowed her to give back to the hospital she credits with bringing her triplets into the world safely.

Thankfully, due to a combination of good fortune, good medical care and diligence, everything worked out for Elizabeth and her family as well as it possibly could have. The boys grew very quickly and, although Victoria took longer to catch up, they all eventually climbed onto the scale for normal height and weight. At 14, the triplets have talents and interests in the athletic, academic and musical realms. They are happy and full of life.

Despite the odds against it and the circumstances that developed, Elizabeth always believed she would have three healthy children and she remains convinced that her optimism was crucial to her success.

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