It was our 6 week viability scan; I could see two sacs on the monitor and two tiny flickering heartbeats. A big smile crept upon my face. It was twins.
I really wasn’t expecting it. Okay, we did have two embryos put back but one was a dodgy one. “Borderline quality” they said. I didn’t even have any morning sickness. We skipped out of the fertility clinic nervously laughing but filled with excitement from this huge secret we were now holding.
We went back the following week to make sure the babies were growing nicely. I knew not to get my hopes up as I’d read that “vanishing twin” sadly wasn’t uncommon in early pregnancy.
I distinctly remember lying down on the bed, the sonographer beginning the scan and the room going very quiet for a few moments. My husband and I looked at each other – we were both thinking the same thing: we’d lost one of the twins.
Nothing could have prepared me for what she was about to say:
“I’ve got some news for you. One of the embryos has split.”
My whole body began shaking and the tears flooded down my face. My husband soothed my hand and reassured me that everything was going to be okay. He had no idea what “the embryo has split” meant. He had no idea how much our lives had just changed.
“It’s triplets” I sobbed.
I don’t remember very much about that day after that, other than being told there were three heartbeats, two of the babies would be identical and one was measuring smaller than the other.
The following day I frantically googled “triplet pregnancy”. The same words kept appearing.
‘High risk, premature, selective reduction, miscarriage, NICU…’
I felt sick with fear about how the coming weeks and months were going to pan out. Parking my fears about the pregnancy to one side, if we actually managed to take 3 healthy babies home from hospital – what would life look like then? Three is a lot of babies. I guessed I would likely lose my identity and become The Triplet Mum, with a ridiculously sized pram and a creche in her living room.
The following week we went back for our 8 week scan. Whilst the thought of having triplets still terrified me, having had just 7 days to get used to the news, I began to feel attached to the fact that three miniature human beings were growing inside of me and I sincerely hoped that all three of those tiny little heartbeats would still be flickering.
The sonographer completed the scan and thankfully confirmed that the trio were growing well but suggested we speak with a specialist pregnancy clinic to discuss “viability and options”.
It was at this 10 week appointment that we received a crash course in triplet pregnancies. We found out that each of the babies had their own amniotic sac but the identical twins shared a placenta which increased the risk of the pregnancy. At this point one of the identicals was measuring 21% smaller than the other which was an early indication of a condition called SIUGR (selective intrauterine growth restriction) or an unequal sharing of the placenta. We were told it was too early to know how things would evolve but if the size difference continued to increase we would have three options to consider:
- Expectant management – the close monitoring of the babies through regular scans with early delivery if necessary.
- Laser ablation – the separation of the placenta using laser surgery.
- Selective reduction – termination of one of the babies. In our case, we were advised this would be the smaller baby.
It was this very frank and clinical conversation that shifted my mindset about the pregnancy. I went from feeling horrified at the thought of having triplets, to feeling determined that they weren’t taken away from me.
The weeks went by painfully slowly; I felt like I was living scan to scan, waiting for the next time I could see our three little jelly babies and hear the sonographer confirm everything was okay. At 15 weeks, we were ecstatic to find out we were expecting two boys and girl. Knowing the genders of the babies helped me picture these fuzzy black and white foetuses as real little people.
At 16 weeks we were told the babies would be very closely monitored from there onwards due to the risk of the identicals developing TTTS (twin to twin transfusion syndrome) being the highest between 16 and 24 weeks. It was also at this appointment that I was asked to consider having a cervical cerclage (or ‘stitch’) due to a previous cervical procedure I had several years prior due to the presence of abnormal cervical cells. Since the cervical cerclage could reduce my risk of premature labour (which I was at high risk of anyway), it seemed like an obvious decision.
The size discordance between the boys continued to fluctuate but fortunately never over the significant 25% mark at this stage. I would scrutinise every scan report, google every medical term that had been written by the consultant and read any research reports about SIUGR I could find. I obsessed over thoughts of losing “the little one”; it really consumed me. Whilst I breathed a big sigh of relief at 24 weeks (aka “viability” – the week at which a baby has a good chance of survival if born prematurely), I found myself instead worrying about the long term risks of prematurity. The fear didn’t stop.
At 25 weeks my bump was almost equal to the size of a full term singleton bump. The physical strain of the weight was exhausting. I spent each night moving from room to room trying to get comfortable before resorting to lying in the bath wishing time away. I went on maternity leave at this point and spent my days either at the hospital or on the sofa.
By 26 weeks I was being scanned weekly and it began to transpire that the smallest boy’s growth had started to slow. At 28 weeks his growth had slowed significantly and the conversation shifted to the timing of delivery. I noticed that the doctors began talking less about this baby’s size and more about his dopplers – or blood flows. I was told that as long as his dopplers remained normal and he was putting on even just an ounce each week, they would keep the triplets in situ as long as possible.
A fortnight later I could sense something wasn’t quite right during our 30 week scan. The sonographers asked a consultant to speak with me at the end of the appointment. She informed me that the small baby had begun to direct blood flow to his brain; this way the brain would be protected, but it would result in the rest of his body lacking in sufficient nourishment. I was advised we were unlikely to get to our scheduled delivery date of 34 weeks and that particularly close attention would need to be paid to the doppler scans in the coming days and weeks.
At 31 weeks, it was noted that the dopplers had continued to trend in the wrong direction and my caesarean section would need to be scheduled for the following week. At this point it was predicted the smallest baby would be 2lb 11, 33% smaller than his brother.
During the next few days I was scheduled to have steroid injections which is routine in planned preterm deliveries. The steroid injections help mature babies’ lungs which are typically one of the last organs to develop during pregnancy. The steroids had a fortunate side effect in that the agonising back pain I experienced in those final few weeks began to subside.
I was also in contact with the neonatal unit during the last few days. Being 8 weeks premature, the babies would be swiftly whisked off to NICU once they were born. If the unit didn’t have three cots available on the day, it was possible that the c-section could be delayed by a day or two – or if the dopplers were suggesting a more urgent delivery, I would need to deliver at a different hospital. The thought of the latter upset me a great deal as I’d spent so much time at Kings in the lead up to the big day.
Fortunately however I was called the night before the c-section to confirm NICU had space for the triplets. Things began to feel very real.
On the day of delivery my bump was 49 inches wide (up from 28 pre pregnancy), my fundal height was 48cm and I’d put on 45lb. I’ve never felt so physically exhausted in my life. I was however feeling relatively calm, complacent even: I’d made it to 32 weeks. Everything was going to be okay.
We were called into theatre at 11am. There was what felt like a sea of people introducing themselves to me and just behind them I could see three baby resuscitation units labelled “Triplet 1”, “Triplet 2”, “Triplet 3”. I just crumbled. The reality and enormity of what was just about to happen finally hit me. 32 weeks of constant worry, 27 scans, numerous appointments with midwifes, consultants, fertility doctors. One big chapter was over and an even bigger chapter was about to begin.
The anaesthetists administered the spinal block but it didn’t take effect as quickly as they expected. They therefore tilted me back whilst lying down (so that my head was lower than my feet) to encourage the anaesthetic to travel upwards. Eventually the anaesthetist deemed the caesarean could start but remarked to the doctor that “we didn’t have long for this one”. Within minutes of the surgery beginning I heard a cry, then another and then a third. All three babies were here! I could breathe an enormous sigh of relief.
Oscar Alexander was born at 11:59 weighing 4lb
Oliver Tobias was born at 12:00 weighing 2lb 15
Aurelia Poppy was born at 12:01 weighing 3lb 15
They were swiftly handed over to the team of NICU staff present in the room. Each baby had a doctor and two nurses to look after them. I was told they all looked great and it was just our little girl that needed a little breathing support. Once their checks had been completed and prior to them being bundled into their incubators, the boys were wrapped in towels and shown to us. They were so tiny. I couldn’t believe any of it whilst it was happening.
Whilst this was taking place, I started to feel stronger sensations in my abdomen which were becoming increasingly painful. I was given gas and air to help. What was going on? We’d been in here a while. The gas and air wasn’t cutting it. I told the anaesthetist. It turned out that my uterus, which had been overstretched during the pregnancy was refusing to contract back down naturally and the drugs they were administering to encourage the contractions weren’t helping either. I was losing a lot blood, 4 litres in total in fact. My own blood was washed and replaced before then having a number of blood transfusions. The pain was getting worse. The anaesthetist suggested giving me a general anaesthetic (which I irrationally have a fear of) before agreeing instead to give me Fentanyl. To stop the bleeding, a ‘balloon’ was eventually inserted into my uterus. Towards the end of the procedure I recall myself becoming extremely cold and violently shaking on the operating table (I understand this is a common side effect of adrenaline). My husband himself was shaking and had gone completely mute and funny shade of grey. (A very sweet midwife suggested he get a hot drink in the room next door since they were just about done!) After over 2 hours in theatre, I was wheeled to HDU where my husband and I sat in silence for a while, processing everything that had just happened.
It was later on that evening, when the spinal block had worn off, that I finally got to meet the babies. I was taken into NICU in a wheelchair. We firstly met Oliver, our tiny little miracle. Then Oscar who was peacefully sleeping. And finally Aurelia who was handed to me by a lovely nurse for a quick cuddle. It all felt unbelievably surreal.
Those tiny fragile babies are now almost 6 months old. My life since then has been a conveyor belt of nappies and bottles. But with the sleep deprivation and exhaustion has come more love and laughs than I ever could have imagined.
You can follow the rest of our journey on Instagram @dulwichtriplets