12w0d: Ultrascreen

We opted to have the first trimester screening done which consists of an ultrasound and a blood draw from me to check for possible major chromosomal abnormalities in the babies.

The ultrasound is called an NT scan and was done at the MFM's office, which is conveniently located inside the same hospital where we will deliver and where the OB is located. The ultrasound technician was really nice and there was a radiology student there who did a little more playing around at the end.

We got to spend a good 40 minutes watching our bouncing babies while the tech took all of the necessary measurements. They are looking more and more like babies. Both measured right on track at 5.0cm CRL. A's heart rate was 153bpm and B's was 149bpm.

The two key markers they are looking for the in scan is the presence of two nasal bones and a nuchal translucency measurement of under 3mm (fluid in the back of the baby's neck). Both babies had two nasal bones and the NT measurements were 1.2mm for A and 0.9mm for B. The MFM's office called with my blood test results a couple days later and gave us our odds for Trisomy 21 (Downs), 13, and 18 at <1 in 10,000. We were told these results don't get any better than this.

ETA 2/20/12: In light of some recent comments from a certain Republican candidate (Chris calls him a d-bag) whom we disagree with on many levels, I wanted to clarify that we did not elect to have this screening done so we could make a decision about keeping or aborting the pregnancy. If something was wrong, we wanted to be prepared emotionally and to line up the extra monitoring and medical care that would give our babies a happy and healthy life.

Here are a few snapshots from our scan. I could watch these babies all day.

Baby A - little foot sticking up!

Baby A - appears to be sucking a thumb

Baby B waves Hi!

Baby B lounging with a hand at the face and legs up

A little baby bump!

10w3d: Dietitian

I started doing research on multiple pregnancies when we found out there were two little ones in there and read very different things on nutrition. First, the standard singleton pregnancy guidelines don't apply so most books and websites are worthless. Second, the most extreme recommendation said to eat 3500 calories a day. Granted, it was a very balanced diet of healthy foods, but that is a lot!

When I made my first OB appointment, I immediately asked for a referral to a dietitian. Chris and I both went to the appointment and the lady we met with was super helpful. I walked through what I typically eat in a day, including all snacks. She took my height, weight, and current diet into consideration and said that I needed to add about 600 calories a day for 1900 total. Phew! That is totally manageable and way more reasonable than 3500. There is no way I could go from ~1300 calories a day to 3500 and be healthy.

The biggest component I need to add is more protein. The rest of my food groups are well represented and I'm drinking plenty of water (100-120+ oz per day). She suggested adding a scrambled egg to my breakfast, making sure I'm eating some type of protein with lunch and dinner, and including it in snacks (milk, greek yogurt, string cheese, peanut butter). I've also added a daily protein supplement drink or a smoothie with protein powder.

She said I should aim to gain between 1.5 and 2 pounds each week during the second trimester. She also cautioned that my opportunity to gain weight will end around 28 weeks. At that point, the babies will take up so much room that I won't be able to eat enough, so it is important that I build up weight now to keep the pregnancy going well for the last ~10 weeks. The weight gained after 28 weeks will be baby, fluid retention, etc.

It was a great appointment with recommendations that we can easily incorporate. Besides keeping these babies in for as long as possible, this is my best shot at healthy birth weights.

10w3d: First OB Appointment

We got a referral from Dr. NFB for an OB. I'm sure the OB/GYN I saw prior to moving to the RE would be fine for obstetrics, but we just had too bad of a taste in our mouths from everything related to how they initially handled our infertility. We needed a fresh start.

The new obstetrician, Dr. B (she doesn't have a nickname yet), is located at the hospital where we will deliver. We arrived and started the OB appointment routine: pee in a cup, get weighed, have blood pressure checked. The assistant said I will do this at every appointment. Easy enough.

We were then moved to an exam room. Dr. B came in and talked to us first. Without any prompting, she made us feel much more comfortable by saying that a twin pregnancy is not the same as a singleton pregnancy and would need to be treated differently. She said we would also be seen by a maternal-fetal medicine doctor (MFM) who is a specialist for high risk pregnancies. Dr. B answered all of our questions and we didn't feel rushed at all. We were super happy with her. 

I was due for my annual exam so she did that first and then surprised us with a quick ultrasound. She didn't take any measurements or track the heart beats, but it was clear everything looked fine. Both hearts were beating. Baby A was a little sleepy but wiggled a little. Baby B was doing jumping jacks! The little thing balled up and then pushed out its legs. It was the coolest thing we've ever seen.

Much easier to see little arms and legs now

Baby B on left, A on right. You can see Baby B's legs stretched out here.
I wish this was a video - Baby B was bouncing all around. 

9w0d: Graduation Day!

Dr. NFB took a look at our beautiful little Beans and everything was great. We even saw them wiggle just a little!

Baby A - 2.1cm, heart rate 169bpm
Baby B - 2.0cm, heart rate 171bpm

My blood draw from the prior week continued to show excellent P4 and E2 levels. After the ultrasound she told us that she was releasing us to an obstetrician for care.

We were so grateful to finally graduate from the RE, but also sad to leave the outstanding care we received from Dr. NFB and all the nurses and office staff. They were really sweet - we came out of the room and Dr. NFB and the nurses lined up for hugs. At the end, our IVF nurse coordinator handed us two silver spoons as a gift for each baby. I held myself together until we got to the car and then the tears came. I was so thankful to be pregnant and apprehensive to leave a trusted medical team. Too much for the pregnant lady to keep in. :-)

Baby A turned upside down from last week and Baby B finally peeled itself
off the upper edge of the sac

Baby A

Baby B is harder to see on the ultrasound because of the position in my uterus
Regardless, we were able to see a little heart flickering on the screen.