From Zero to Quints – By Cassie Vanderwall

Note: this blog is part 2 in a series. Read the previous post: The Pregnancy.

I was settling in for a day’s work on the morning of July 31st, when I thought my bladder had finally given up on me and was done with the abuse from the 10 kicking feet. But, upon further investigation, I realized Theo [my son] had broken my water. I called my doctor’s office, but since they were closed it directed my call to the physician on-call, which just so happened to be Dr. Elliott’s “bat phone.” I felt awful for bothering him on vacation, but he didn’t mind one bit. He encouraged me to pack a bag and head to OB triage (the moms’ ER).

We arrived at the hospital and were quickly shuffled in for an assessment. They tested the fluid and confirmed that indeed it was amniotic fluid. Then, they discontinued my calcium-channel blocker (Nifedipine), gave me a steroid shot (Betamethasone) to enhance fetal lung development, and started me on 3g of Magnesium sulfate. I was then whisked away for an ultrasound to confirm the culprit. It was indeed little Theo (baby A) whose deepest vertical pocket went from around 5 cm to about 1.6 cm, which indicated that he only had about 1.6 cm of fluid surrounding his little body in his sac. His head was now so low in my pelvis, it appeared his little body stopped at his neck.

Some Reassurance

The nurses assured me that once my contractions stopped, it was entirely possible I could remain pregnant for several weeks. This amazed me, but they said it happens all of the time. Unfortunately, this scenario is only true if: 1) your contractions do stop; 2) you tolerate the medicinal anti-contraction regimen; and 3) you do not develop an infection. My contractions did stop, thanks to the magnesium. However, it was clear after 24 hours on the magnesium sulfate that I was not tolerating it, and my lungs began to fill with fluid.

Magnesium Sulfate is used for contraction management. It is thought to affect calcium channels to slow uterine contractions. Typical side-effects include water retention, muscle weakness, sweating/flushing, nausea, vomiting, constipation, and blurry vision. For most, these symptoms are tolerable and some moms of multiples can remain on magnesium sulfate for several weeks, to prolong their gestation. Unfortunately, I hit the jackpot and experienced all the symptoms above.

My body was only able to combat these side effects for about three days. I was placed on Bi-Pap to increase my oxygen saturation and Lasix to try and rid my body and lungs of the extra fluid. On the morning of August 3rd, I was moved back to labor and delivery due to my pending diagnosis of pneumonia. When I spiked a fever and my white blood cell count shot up, we knew today was the day. It was then that we got the news that we would get to meet the quints in the next few hours.

They informed us that Dr. Elliott was speeding to the hospital, on his way back from vacation, and we were going to try and wait for him to arrive around 4:00 PM. But, when he heard that I had a fever, he gave the go-ahead to deliver in his absence.

Delivery Day

On August 3, 2013 at 29 weeks and 1 day, they unraveled the most well-orchestrated delivery I have ever heard of. With over 20 people in the delivery room (6 teams: one for me and one for each baby), they delivered the quints in about three minutes. The entire operation took about 45 minutes. I vaguely remember these moments, but Frank was right by my side to catalog it all. Following delivery, Frank headed to the quints’ recovery room. I, unfortunately, could not see our little angels until my fever subsided and my breathing had stabilized.

Dr. Elliott arrived and shared with Frank that sometimes as a physician you have to make a decision with your head and not your heart. If we had waited even a moment longer, my infection may have complicated the babies’ course. We are forever grateful to Dr. Elliott and the teams at Banner Desert for their superb, patient-centered care, compassion, and wisdom. I know that if we were anywhere else, the circumstances and outcome may have been very different.

The quint’s first two weeks outside of mama were a rollercoaster. Frank and I got a crash course in NICU (neonatal intensive care unit) parenting. The highs are very high, the lows are very low, and often times they occur within minutes of each other. We spent 8-12 hours every day buzzing around the NICU watching nurses, taking part in our little ones’ care and meeting with the multidisciplinary team.

Their first few weeks were filled with medical trials and tribulations, including:

    • Spontaneous Intestinal Perforation (SIP): Two of our little ones had bowel perforations within the first three days. Both required emergent surgery, which they handled well. One of the SIP’s may have been caused by NEC (defined below), which they found in surgery. The other occurred higher in the small intestine, and they informed us that this may result in a feeding intolerance later.
    • Necrotizing Enterocolitis (NEC): NEC is one of the most common GI diseases in newborns and preemies. It is when the bowel does not get adequate blood flow and begins to die (Necrotize). Early and aggressive treatment is imperative because it can result in dire consequences – NEC is the second leading cause of death in premature infants. The good news for our quints is they did identify it early and were able to remove the affected portion completely.
    • Gastritis versus Bleeding Ulcer: Inflammation of the stomach wall and ulcers can be common as the immature digestive track is learning how to work. One of our little girls experienced this and as a result we found blood in her gastric residual. This appears to be resolving with the help of Zantac.
    • Spontaneous Lung Perforation: One of our quints got a hole in their lung, which required emergent chest tube placement. Luckily, this incident resolved quickly.
    • Complication of PICC: PICC lines, or Peripherally Inserted Central Catheters, generally have limited complications. So, yet another rare event for one of our girls where her PICC moved from her heart to near her shoulder. This resulted in infiltration into her subcutaneous tissues and ultimately her lung. She became very swollen as her upper body filled with fluid. But, this tough cookie fought it hard and it appears to have resolved rather quickly.
    • Grade 2 Intraventricular Hemorrhage (IVH): Infants born before 30 weeks are at the highest risk for brain bleeds. Grades 1 and 2 have similar outcomes and typically resolve within a month. They do cause an increased risk of developmental delay but not much more than from being a high order multiple. We continue to pray for the health of our little one diagnosed with a Grade 2 IVH.
    • Apnea and Bradycardia: Apnea is a pause in regular breathing lasting more than 20 seconds and bradycardia is a drop in the heart rate. All of our quints have experienced this at some point. “A’s and B’s” are typically caused by an immature nervous system. The good news is that all of our children are learning to pull themselves out of these events without stimulation (aka rubbing their backs).
    • Respiration machines: All of our little ones had to be intubated after day 2, which was expected. Unfortunately, one of their endotracheal (ET) tubes moved too low and collapsed their little lung. This has since resolved. All of them are continuing to advance through the variety of machines, but I thought it was noteworthy to introduce inquiring minds of the different types.

 

    • Intubation with an endotracheal tube (ET tube) with a ventilator
    • Intubation with an ET tube and continuous oscillation
    • RAM cannula with NIPPV (Nasal Intermittent Positive Pressure Ventilation)
    • Nasal Cannula on CPAP, Continuous Positive Airway Pressure
    • Nasal Cannula with higher concentration of oxygen than room air

 

Needless to say, the first two weeks were quite eventful. Although the events listed vary greatly in severity, it is difficult to watch little ones experience any hardship. At the same time, it was certainly empowering to watch our children fight hard for life. Their resiliency was and is awe-inspiring!

About the Author
Cassie is a Registered Dietitian, Certified Diabetes Educator and Certified Personal Trainer that works at the University of Wisconsin- Madison Hospital and Clinics as a Clinical Dietitian, as well as, the Program manager for the Dietetic Internship. She received her bachelor’s degree from University of IL at Urbana-Champaign and her Master’s degree from Rush University Medical Center and is pursuing her PhD at Rush University. She has also received certificates in Weight Management, Motivational Interviewing and Bio-Informatics. Cassie loves to equip and empower people to achieve their nutrition and wellness goals.

At home, she is mom to quintuplets. Her five miracles were born at 29 weeks and 1 day at Banner Desert Medical Center in 2013. Since her husband, Frank and she learned of their pregnancy, each day has been an adventure. Follow their adventures, milestones and life lessons at www.bump2babies.wordpress.com.