Day 1 - January 24, 2013

**DISCLAIMER - SOME PHOTOS ARE MEDICALLY GRAPHIC AND MAY BE DISTURBING**

Alright, now for the stuff everyone is actually waiting for. In case you saw how long the last post was and skipped it, quick summary is that Andrea had a c-section at 27 weeks and 3 days into her pregnancy (which is just a little longer than 6 months).  Aubrey was born weighing 2 pounds 1.5 ounces, and Paige weighed in at 1 pound 13.5 ounces.

Aubrey:

When Aubrey was born, she let out a few cries that sounded kind of like a baby kitten. She was bruised all over her body, presumably because she was way down in the uterus and got compressed quite a bit (or maybe she and Paige got into a kicking fight and Paige won). Today is day 6 and she is still bruised up pretty badly. The picture below shows some of the bruising on her face. We have some that show the bruising pretty well, but they're a bit graphic for a blog.

From my memory, Aubrey wasn't intubated right away. They gave her a nasal cannula to help her breathe. However, after she arrived at the NICU she got tired from the effort of breathing, so her doctor intubated her.  (In the picture above you can see that tube in her mouth. It goes down her trachea and forces air in and out of her lungs to help her breathe)  I think one of her eyes was still fused closed, but one was open, so they put some antibacterial ointment in the open eye to prevent infection, shown in the picture above. Due to all her bruising, she was placed under special lights to help her body process the byproducts of the bruising (bilirubin).  She has some cool shades to protect her eyes from the lights as shown below.

  
In that picture, you get a pretty good close-up of her ventilation tubes, and you can see the IV access lines in her right arm and right leg.  Here's a picture of her mommy touching her little hand about 4 hours after she was born.

Paige:

When Paige was born, she didn't let out any noise.  She was intubated right away and given a stocking cap to keep her little head warm.

She wasn't bruised like Aubrey (like I said, I think she won the fight). One of my favorite pictures is the one below.  It shows how tiny she is.

When she was transferred to the ICU, Dr Mir was able to to insert two umbilical lines into an artery and vein of her umbilical cord (called UA and UV lines).  This is similar to a PICC line, but doesn't require any needles and is painless to the baby.  Because Dr Mir was able to establish UA and UV lines, she has not had  to have any needle sticks as of Day 6.

Apparently, establishing UA and UV lines is extremely difficult (they couldn't get Aubrey's started. A different doctor was working on hers).  A battle-hardened NICU nurse explained it as such (and I quote verbatim): "It's like sticking a fire hose up an ant's ass."

During the first night, Paige required more ventilator support than Aubrey did.  X-rays showed that Paige's lungs were less mature than Aubrey's.  Both girls' lungs are not very well developed, but that's typical for  micro preemies.

One difference between the girls is that Paige really likes to grab things.  Anything that gets placed next to her hands gets grabbed, whether it's Andrea's finger (in picture below), g-tubes, IV lines, pretty much anything within reach.  She has pulled off her heart monitoring leads a few times.  Pretty funny.

Before the girls were born, Andrea's OB doctor was suspicious that there might be something wrong with Paige's digestive tract. Paige had a lot of amniotic fluid around her, and the doctor was having a hard time seeing her stomach in her ultrasounds, so she suspected that Paige might have something called esophageal atresia.  This is a condition where the mouth and stomach are not connected due to a defect of the esophagus, and requires multiple surgeries to correct.  In the picture above, you can see that tube with the yellowish gunk in it on top of Andrea's finger.  The gunk in that tube told us Paige did not have esophageal atresia.

Well, that about sums up the girls' first birthday. All in all, they had a pretty good first day of life considering how early they were born.

How we got here

OK, this is going to be an extremely long post.  It basically explains how we got to having two baby girls in the NICU.  Feel free to skip through it.

After about 3 years of infertility struggles (still not sure why the old fashioned way didn't work), we made an appointment with the friendly people at San Diego Fertility Center.  We did IVF and found out that Andrea was pregnant with twins (If you would like to know more about IVF and fertility stuff in general, I'm sure Andrea would be happy to talk to you about that when she starts to feel better.  I suppose you could ask me too, but she talks more than I do).

Andrea's official due date was April 22, 2013.  Those 6 months of pregnancy were the most enjoyable, rewarding, and peaceful times of her life.  It was absolute bliss, and everything she had ever hoped pregnancy would be (sarcasm).  She had a kidney stone (thought she was miscarrying), puked up blood, puked up Olive Garden, puked up cereal, puked up waffles, puked up pulled pork, puked up....you get the picture.

She started having some weird tightness in her abdomen in early December.  If I remember correctly (probably don't), she was told by her doctor's office to go into Labor and Delivery to be monitored.  They saw that she was having some contractions, so she was put on bed rest.  While on bed rest, the tightness/contractions continued, and she was on an oral medication called nifedipine, which helps to reduce contractions.  That medication seemed to work for the first few weeks, but it made her pretty nauseous.  She  started having more contractions at some point in December, and was again directed to go in to Labor and Delivery to be monitored.  She was kept overnight, and her doctor decided to send her home with an increase in her nifedipine. On December 27, she had a routine prenatal checkup with her doctor, and we found out that her cervix had shortened from approximately 3 cm (little over an inch) to about 1.9 cm (about 3/4 of an inch) over a time period of about 1 week.  Her doctor didn't like that, so Andrea was admitted to the hospital, diagnosed with preterm labor.

At that point, she was 23 weeks and 3 days along in her pregnancy (we knew this because we had done IVF and knew the exact day, hour, and minute of conception).  Read here for more information about survival and outcomes of preterm babies.  OK, if you glanced through that website I linked to in the last sentence, you'll see that survival rates for babies born then is somewhere in the 15 - 40% range (In other words, 60-85% of them die). About 10% of them come out of it without any type of moderate to severe life-long disability or health condition.  The one's that do make it go through A LOT of suffering.  Andrea was at the point where she could have gone into labor at any time, and the medical team needed to know if they were expected to try to do everything possible to resuscitate the babies, or to provide comfort care as we held them during their short few moments of life.  Hard decisions to make.....

Andrea was started on an IV medication called magnesium (nifedipine obviously wasn't working).  I think magnesium is latin for "drug that makes you feel absolutely terrible emotionally, physically, mentally; and it blurs your vision so you can't see."  She was on magnesium for 28 days (right up until c-section).  It did its job and kept the babies in her for 4 extra weeks.  Statistically, 4 weeks means our girls' chances for survival have increased from the 15-40% range to the 75-85% range.  4 weeks means our girls' chances of not having a lifelong disability or chronic health problem have increased from 10% to about 50%.  That was a long 4 weeks for us.

On January 24, 2013, the last morning Andrea was pregnant, her doctor noticed that Baby B (Paige) had a little too much amniotic fluid around her.  She decided to come back while I was with Andrea and have a second look with the ultrasound.  After examining Paige, she looked at Baby A (Aubrey), but couldn't see her head because Aubrey had gotten so low.  The doctor felt around and determined that Andrea was dilated to about 8 or 9 cm, which is way past the point of no return.  Less than an hour later, Andrea and I were the proud but scared parents of two baby girls.  Aubrey, our heavyweight, was born at 5:46 PM, weighing in at 2 pounts 1.5 ounces.  Paige, our petite girl, was born at 5:48 PM, weighing in at 1 pound 13.5 ounces.

Introduction

Andrea and I have really appreciated all the love and support we have received from family and friends the past week since the birth of our twin girls.  As one would expect after a c-section and having two babies in the NICU, Andrea doesn't have enough time or energy to reply to all the encouraging texts, emails, and facebook comments she has been receiving from everyone, so I figured I could help her out by making this blog describing what is going on in our lives.  Andrea and I truly do appreciate all of your love and concern.  Knowing that friends and family are thinking of us, praying for us, and doing other acts of service is an inspiration to us both.