Oscar & Bella--My Pair of Giraffes

In February 2008, after having worked with Jon to get my diabetes under control since our wedding, we were given the go-ahead by my diabetes team that we could go off birth control and try to get pregnant. I went off the pill and we spent the next month trying to conceive. When I was on day 25 of my cycle I had my annual physical with my primary doctor. I told her I was off the pill, we’d been trying, but knowing my history of irregular cycles, I asked her when I should be concerned if my cycle didn’t return and I wasn’t getting positive pregnancy tests. She told me that if I was 5 weeks late, so if my cycle lasted more than 63 days that I should contact her and she would refer me to an OB. Jon and I waited, and finally, when I couldn’t wait any longer (about CD 50) I called my doctor and got a referral to an OB.

In May 2008, we had our first appointment with the OB. He wanted Jon to have a semen analysis done and they wanted to run some labs on me to check my hormone levels. Everything came back fine. My testosterone was a little high, but still within the normal range. After reviewing the results, the doctor said that we would start me on the lowest dose of clomid (50mg per day for 5 days) and that I should use ovulation predictor strips to detect when I was ovulation. Over the course of the next 6 months we did four rounds of clomid, each month increasing the dosage to the max the OB was comfortable prescribing me (150mg). Prior to the last cycle we did with this OB, I requested we do an ultrasound (u/s) to determine whether or not I was responding to the clomid. I wasn’t. No follicles were growing. It was at that point that we received a referral to a fertility clinic.

In November 2008, we had an initial consultation with Dr. Olive. Knowing that we didn’t have male factor infertility, Dr. Olive went over the various treatment options we could follow and shared what percentage of women responded to which treatment. We left that meeting feeling hopeful and confident that we would get pregnant with their help. We began treatments the next month. Dr. Olive started me on the max dose of clomid that RE’s can prescribe (250mg/day for 5 days) and when the follow-up u/s showed I wasn’t responding, we started on the max dose of femara (12.5mg/day for 5 days) to see if I responded to that treatment. We discovered at that follow-up u/s that I didn’t respond to femara, either. We immediately moved on to injectable hormones.

After daily injections, many blood draws and u/s (as is required when using injectable hormones) we finally got to a point where we had three potential follicles ready to release. We discussed whether or not we should do intrauterine insemination (IUI) or timed intercourse (TI). Knowing that we did not want to be faced with a multiple pregnancy, we chose TI, went home with instructions on when to inject the hormone that would make me ovulate (39 hours after the shot) and when we should have intercourse. We then spent the next two weeks hoping, waiting and dealing with Ovarian Hyperstimulation Syndrome (http://www.mayoclinic.com/health/ovarian-hyperstimulation-syndrome-ohss/DS01097). I took a pregnancy test, as instructed by Dr. O and it came back negative with no sign of menstruation beginning. I was told to wait until I was three days late and then test again. Within those three days, my menses began. Both Dr. Olive and Dr. Pritts (Dr. Olive’s wife and medical partner) were SHOCKED that I wasn’t pregnant, especially with how my measurements looked during treatment, as well as my OHSS symptoms.

Due to having a cyst on my ovary, as a result of our treatments, we needed to take a break until the cyst went away. In March 2008, we got the go-ahead that we could attempt another cycle. Jon and I moved forward, afraid that with such a good cycle last time and the shock of the doctors, that we needed to be a little more aggressive this cycle. Our cycle was good, our docs said it didn’t look as good as the first cycle that we didn’t conceive in, so Jon and I decided to do a double-IUI. A double or back-to-back IUI is when an IUI is done at 12 hours post-trigger and 36 hour post-trigger, with the rationale being the first IUI provides sperm that can hang out until ovulation, as well as introducing sperm just prior to ovulation, and therefore maximizing the chances that sperm and egg will meet.

Two weeks later, I took a pregnancy test at home; it was POSITIVE! Jon and I were so excited, called our fertility doctors and were told to come in on Monday to confirm the pregnancy with a quantitative blood test. We went in, took the test, got the results back and our pregnancy was confirmed. We then scheduled an u/s to take occur 3 weeks later (7w gestation) to do a head-count and make sure everything was looking good. One week later (5w gestation), I had some spotting and we called the fertility clinic. They said to come on in and they’d take a look, as I again has OHSS symptom and they wanted to verify what was going on with my body. Before Dr. Olive inserted the transducer, he told us that they usually never do u/s this early and that the number of sacs we see on the screen is not necessarily the number of babies we would end up carrying. Once the transducer was inserted we saw 4 gestational sacs on the screen—2 appeared empty and 2 appeared to have yolk sacs. Dr. Olive told us that the bleeding was nothing to be concerned about, the 2 empty sacs could begin growing or not, and the 2 sacs with yolks could stop growing or not.

Two weeks later Dr. Olive was able to count 4 little beating hearts. We briefly discussed what our path forward would be. He wanted to see us weekly until could be seen at the high-risk clinic, at which point we would need to be referred from his practice to either continue the pregnancy as is or have a selective reduction. Jon and I were thrilled and crushed at the same time. We had been so worried that we couldn’t get pregnant after the failure of cycle #1. We knew I was a high-risk pregnancy even before the head count due to my diabetes. Jon and I hoped that nature would step in so that we wouldn’t have to make a choice. One week later we went in and had an u/s with Dr. Pritts, who was only able to find 3 little beating hearts. I cried, as I think any mother would do when she finds out a life inside of her had ended, but I was also thankful that we were closer to not having to make a decision. After this appointment we were released from our fertility clinic and referred to the high-risk clinic, where we would continue to be cared for.

During our first appointment with the MFM, we told Dr. Droste of our hope that nature would still step in for us so that we wouldn’t have to choose whether or not to do a selective reduction. She was blunt, but honest, with us, “At this point nature won’t step in.” Jon and I discussed everything, looked at statistics of triplet pregnancies versus twin pregnancies and then made the hardest decision either of us had ever had to make in our lives…to perform a reduction. We scheduled the appointment for the reduction, and the follow-up appointment, and I asked for a suggestion of a counselor to help me deal with our situation. I was able to meet with a wonderful counselor, Julianne, both before and after the reduction to help me come to terms with our choice, knowing it was the best one we made with the information we had at the time.

After the reduction, we moved forward in our pregnancy, started a registry, planned a baby shower, narrowed down two boy names and two girl names and started buying things for our twins. Just a few short weeks later, on a Monday, after having popped and having to start wearing maternity clothes, I was at work and found myself going to the bathroom a lot. I thought it was the stereotypical constipation that occurs during pregnancy. Over the course of the afternoon and the night I was up frequently and in the bathroom. I felt constipated and had very low back pain. I didn’t know low back pain and rectal pressure were common signs of pre-term labor. By the next morning, I was having some spotting and could tell that there was something in the birth canal that wasn’t supposed to be there.

On Tuesday, Jon took me to the hospital, where the high-risk clinic is located, and we were hooked up to a monitor where we were able to hear our kids’ heartbeats for the very first and last time. According to the information gathered from the monitor I had some uterine irritability. Luckily, the docs wanted to physically check me. The resident that came to check me inserted the speculum, almost immediately pulled it out, told us that she thought she was seeing an amniotic sac and was going to get the MFM on call. Dr. Stewart came in, told us that they weren’t going to put the speculum back in and that they could get all the information they needed from an u/s. So, I was wheeled into an u/s room and we found out that I was dilated 2cm and one of the amniotic sacs was bulging. We were immediately admitted to labor & delivery, began the process of being monitored for infection and were told that after the labs were back on Wednesday morning they would have more information for us.

The next morning, early, some doctors came in and told us that my labs showed that I did not have any infection. If we could keep things that way, it meant we wouldn’t need to deliver our kids to save me from infection; Jon and I were hopeful that even with a long road ahead, all four of us would be okay. Later that morning, Dr. Shah (one of the MFM’s), Dr. Krupp (the MFM Fellow), a resident, a med student and nurse all came in our room during rounds. Dr. Shah told us that he looked at all of our u/s, he had an idea of what was going on, but he wanted to do another u/s that morning to confirm his theory. An u/s machine was brought into our room, he sat on the side of my bed and performed the u/s. He let me get cleaned up and then told us that his theory was confirmed: one baby’s amniotic sac was bulging and the other baby’s placenta was detaching; our hopes were crushed. When asked, Dr. Shah told us that he thought we would deliver by the weekend.

We were shocked and stunned, especially after hearing the good news earlier that morning. We took a few minutes to collect ourselves and I found myself asking if we could have one more u/s to see I we could determine the sexes of our kids, as we didn’t know yet. In hindsight, I think my subconscious wanted the u/s to have one last chance to see my kids alive and healthy before their deaths. We also called Dr. Pritts and Dr. Olive, as we had been keeping them updated on our pregnancy, and found out that Dr. Pritts was in the hospital. When she arrived at our room, we were able to share with her what the doctors had told us and asked her if she would like to accompany us to our u/s, and she agreed. We’ve never looked at those u/s pictures, and the sonographer was not able to tell us if we were having boys, girls or one of each, but Jon and I both still remember seeing, what appeared to be, one twin kick the other twin in the head, which made us laugh and smile.

After the u/s, when we were back in our room, Jon and I began to talk things over and what our plan of action was going to be. We both felt that we had already had to make a terrible decision with the selective reduction, so our decision was to not decide when our kids would be born. Instead, we were going to wait for one of three things to happen that would force delivery: I developed an infection, I experienced more bleeding or labor progressed on its own. Jon and I were hoping for a miracle, and in a small way we received one, but not the one we wanted.

The following morning, Thursday, I woke up before 6am needing to use the restroom. A few minutes after getting back into bed, I felt the need to go again. By the time this cycle lasted about 20 minutes, I knew our decision had been made. I woke Jon and told him that I was going to call for the nurses. He nurses came in, I shared what I had been experiencing and we waited for the on-call doctor to come. When that doctor came in, it was one I had never seen before, but she had the take charge attitude that we needed, and she laid out what was going to happen to move labor along. I asked her if I could meet with my counselor before we started the meds, to which she said that was fine. Julianne was so wonderful. She came to my hospital room, we talked, she calmed me down, gave us her cell phone and we set up an appointment for the following week.

Shortly after Julianne left, we began the meds to progress labor; it was before 9am. During this time Jon began calling our friends and family to let them know that our children would be born that day. At first I didn’t want anyone to come to the hospital, but I’m so thankful that I changed my mind. Members of my family and Jon’s family were able to be with us before delivery, which greatly helped with the waiting. I remember we were in the middle of a conversation and I felt something…perhaps a gush of blood…and I knew that we would be delivering soon. I looked at my step-dad, who was sitting in a chair and the end of the bed, said, “Go” and pointed out of the room. Everyone got up, went down to the family waiting room and the doctor and nurse came in to see us.

 Quite a few of the specific details of the delivery are hazy for me, partly because of the emotional trauma, but also due to the narcotics I was on the help deal with the pain. I do remember telling the nurse that I wasn’t sure what to do. The doctor and nurse took very good care of me and Jon was by my side for the entire time, except when he walked down to update our families after our first child was born. I can’t remember how many pushes it took and I only know the length of time between their births because of their birth certificates. Trying to think back, through the fog of pain meds, it felt like there was so much time between deliveries, but in reality it was only 20 minutes.

After our first child was born, Jon asked me if it was okay to leave the room to update our families. I told him no. I was so scared that he would be gone when our second child was born. He reassured me that he would be back as fast as he could. Little did I know that he wanted to do something that any father should be able to do—walk down to the family waiting area to announce the arrival of his child. Jon returned and what seemed like such a short time later I felt the contractions increasing and our second child was born.

We had discussions with the nurses, prior to delivery, regarding what we wanted to have happen during and after delivery. We told the nurses that we wanted to know sexes, as we had two boy names and two girl names picked out. We were told that sometimes at 17w6d sex couldn’t be determined because boys and girls can still look so similar. As a result, when we chose gowns for the kids to be dressed in after they were born we said pink/blue for girls/boys, otherwise yellow and green if sexes were unclear. We asked the nurse what expectations to have for our kids after they were born. She told us that they would probably die during delivery. Expecting that they wouldn’t live through delivery, we told the nurses that we would like our kids taken out, cleaned up and then brought back it to us together, each in their own gown. While this is one of my biggest regrets, it was also a blessing that they were with the nurses immediately after delivery.

After I was taken care of post-delivery, and the kids were cleaned up, a nurse walked into our room carrying a small basket. Upon entering, she said, “You have a son and a daughter. It was very clear.” It was then that we were introduced to our first-born son, Oscar, and our second-born daughter, Bella. I don’t remember the details immediately after that, but I remember the nurse being gone, Jon holding Oscar and me holding Bella. Jon immediately opened up Oscar’s gown to check for himself that he was a boy, just like any new father would do. I just remember holding on to my beautiful little girl until Jon told me that he wanted to hold her. Then I was able to hold on to my handsome little son.

I remember finding out that after each of our kids, much to the surprise of the medical staff each lived for 10 minutes before their hearts stopped. This is my one regret. I never got to hold or see Oscar and Bella while they were alive because they weren’t expected to live through delivery. Part of me longs to have those 10 minutes with each of them. To hold them while they were naturally warm. To see their movements. To have them know what it felt like to be held by their mommy and daddy. To have them hear our voices. To tell them we loved them before they died. There is part of me, though, that is grateful the nurses were with them, listening to each and every heartbeat they had. We know for certain, that they each lived 10 minutes. As a result of this, we were able to apply for birth and death certificates. There is absolute and official proof that they existed, and for that I am grateful.

The next few hours are a blur. We had someone come in and pray with us, as a family of four. We invited our families back in to meet Oscar and Bella. Dr. Olive even held Oscar when he stopped to visit. A photographer from Now I Lay Me Down To Sleep came and took pictures that I absolutely treasure. We were given cards with Oscar’s and Bella’s footprints and birth stats. We had their footprints put into their baby book. Other than the fact that my kids were dead, it was a scene that was so typical of any birth: labor, delivery, meet kids, announce their arrival, and have everyone come in and meet them.

The next morning, Friday, we asked to have Oscar and Bella brought back in to our room so that we could say our final goodbyes. We did so, and then I insisted that we walk them to the morgue. It was something I needed to do as a mother as I could not fathom the thought that anyone other than Jon and I would walk them down there. Jon also made sure that we had the information from the funeral home that we’d be working with for Oscar’s and Bella’s cremations. We packed up and we left. We made it home and just lay on the bed and held each other. We had faced diabetes. We had faced infertility. We had faced a selective reduction. Wasn’t that enough? Hadn’t we faced enough? Now we had to face the death. And not just any death, but the deaths of our children, our hopes and dreams for them, our future together and all they would have accomplished in their lives were suddenly, in an instant, dead.

The next weeks and months were difficult. We were in a fog. We returned to work. We held a memorial service for Oscar and Bella that was originally planned for their baby shower (my sister had already mailed out the invitations, so we knew people would have already saved the date). We were hurt by those that didn’t attend and grateful for those that did. We cried. I saw Julianne regularly. We applied to attend Faith’s Lodge. We started attending our bereaved parent support group. We met others that have walked similar paths as we had just embarked on. We began to feel not so alone. We began to figure out how we were going to raise Oscar and Bella as our children even though they weren’t physically with us. We began to think of ways to incorporate and symbolize them in our lives here. And then we received a sign from them that we couldn’t ignore: my cycle came back.

I never had cycles on my own. That was the entire cause of our infertility. I thought maybe my body had reset itself, that I had received a gift from Oscar and Bella, and that we wouldn’t need fertility treatments. But it was the timing of my cycle that we don’t believe was a coincidence. If I was to have a typical 28-day cycle, I would ovulate while Jon and I were up at Faith’s Lodge. A weekend that was supposed to be devoted to spending time honoring Oscar and Bella and I was going to ovulate? How could we not think that Oscar and Bella were telling us they were okay with us trying to a little brother or sister for them?