Choosing Between Your Twins

I am interested in hearing about those who have experienced something similar prior to 32 weeks and/or with a baby under 1000 grams.

My story is that my did/di fraternal twins were doing fine. But, at 28 weeks, we discovered that Baby A had basically stopped growing. He had only put on 2 ounces, bringing him to 1 lb, 12 oz (750 grams). He is officially IUGR. His doppler cord flow has been fine. Doctors suspect placental failure. I am hospitalized for monitoring. Baby B is doing great--in the 80th percentile for her growth and about 1150 ounces--over 2 pounds.

Currently, I am 28 weeks, 4 days. Corticosteroids have kicked in. Baby A is still stable, but things could change at any time. Baby B is doing great.

So....things will start to go downhill for Baby A. At that point, we have to decide. Do we deliver--in order to give A the best chance he has--but also putting B at risk when she would do better inside. Or do we let A pass away inside in order to let B keep growing to give her the best possible chance at a good life. Of course, this means that A would pass away in the comfortable home with which he is familiar instead of in the NICU. There is some risk to B if A dies in utero.

Of course, if we make it to 32 weeks the decision is easy--but it is unlikely that we will get to that point. So we need to be prepared to make this decision at any time.

It is also important to me that my kids be able to lead good lives. I am willing to have them put up with the NICU if there is a good chance of the end result being a relatively healthy kid who doesn't suffer brain damage.

Thank you.

Again, please do not share your stories of your 34 weekers who were "only" 3 pounds as that kind of information is not only not helpful to me, but is incredibly difficult for me to hear about.

 

:hug: Momma!! I cannot even begin to imagine what you are going through. If it were me, I would not be able to choose. The survival rate for 28+ weekers is very good with the technology these days. Yes, it is an extremely long road but I can promise you it is so worth it in the end. It is truly amazing what they are able to do for these tiny babies.

I believe you said before that you are at a hospital with a level III NICU, correct?? Is there any way they can arrange to have a neonatologist from the NICU come up and talk to you and give you the exact statistics?

I am so sorry that you are having to face such tough decisions in the coming weeks/days. I am hoping for the best for both you and your babies!! :hug:

 

The neonatologist will talk with us this afternoon. Did I mention that THIS REALLY STINKS!!! :headbang: :headbang:

 

I am glad they are coming up to talk to you. Make sure you make a list of all the questions you want to ask beforehand so you don't forget them when the time comes. You are doing a great job Momma!! Keep up the good work! :hug:

 

Ooops....Baby B is 1253 grams which is 2 lounds 12 oz...a whole pound bigger than A.

 

:hug: :hug: :hug:
I am sorry you are having to go through this :hug: I don't have any experience, but wanted to send you hugs & good thoughts for you and your babies.
Sounds like you are in the right place & the babies are being monitored closely. I hope your Dr's provide you with the best of information so that you all can make the best decision that is right for you ~
I wish you all the best :grouphug:

 

:hug: I can't imagine having to make a decision like that. I'm so sorry you have to worry about that.

That is definitely a tough one to do. I agree with Kyrstyn, technology today is awesome and really does help when babies are born early. Your case is so unique that it might be that delivery early is your best choice.

I did not have to make a decision like that, but I know if I had to there is no way I could let baby A pass, no way. I would just feel way too guilty. Knowing how good technology is and the survival rates are good after 30 weeks, I (me personally) would probably choose to deliver early to help both babies. Mine were born before 27 weeks, see siggy for details. BTW, my DD was 1 lb 10 oz at birth and my DS was 2 lbs 7 oz. at birth. They both came home 5 weeks before their date! They had a pretty easy NICU stay for being so early.

The steroid shots will help. I truly believe they helped my two. They are now 3.5 years old (see avatar for picture) and they have no lingering effects of being premature and they were basically caught up by 13 months.

I know this is such a tough decision and you have to make the best one for your family. :hug: I do want to mention that it can be frustrating talking to the neonatologist. I know when they talked to us it did not sound good. And even my Dad commented on how negative they sound, but they don't like to give false hope, just statistics. BUT there are so many of us on TS that have had babies before 30 weeks and they are perfectly healthy and are doing fantastic. Please keep that in mine, I hope some of our success stories ease your mind a bit. Feel free to PM me if you'd like any more info. Hang in there. :hug:

 

I had the same problems with my boys. Baby B for us was in the 3rd percentile for most of my pregnancy but the doppler blood flow remained good for us until 31 weeks when they decided the blood flow wasn't as good as they would have liked it to be. My little guy was 2 lbs 8oz and we spent a long time in NICU for their gestational ages. I also found that my little guy was stronger than his brother because he had to fight more in utero. The staff told me they see this a lot. My little guy had less health problems in NICU than his brother. He is a little behind right now but is making huge progress every month. It is hard but hang in there, the blood flow may remain good for a few more weeks. I can't imagine having to make your decision but choose what is best for you and your family. I new that I would deliver no matter what and once I got past 24 wks I new that anything was possible. I have worked in the NICU as a nurse and seen some very early very small babies do wonderfully. I am not aware of the risks if one baby passes away in utero. I am sorry that you are faced with this and I hope everything works out for you guys.

 

I am so sorry, I don't have any experience to share with you, but just wanted to say my thoughts are with you. Hang in there mama.

 

My best friend had 26 weekers. They were 1#13oz and 2#2oz. They spent 76 & 78 days in the NICU.
Next month they will be 2 years old. You would never know that they were preemies by looking at them. Sure they had a rough time in the NICU, they went through lots of shots & blood transfusions etc but today they are healthy and thriving.
Her son has some speech delays and is working with EI, he also has respitory issues (hes sensitive to smoke & cold weather), allergies etc.
Her little girl had to have surgery to correct a problem she had where urine kept backing up into her Uriters (not sure htats the right term)?
But thats it. They lead a very lively active life as toddlers.

Best of luck with whatever you decide. At 28 weeks the survival rate goes up to 90% and given you've had the steriod shots and it seems the doctors are taking very good care of you I think they'd BOTH have a great shot if they came anytime.

 

Big huge :hug: :hug: :hug: I am so sorry you are having to deal with this. I have no advice...but as seen as proof from some of these ladies...it is possible for babies to be born and to make it through just fine! :hug: :hug:

 

I hope the neonatologist is able to help ease some of your concerns/fears. My babies were born at 28wks and are doing fine. 28 weeks is a HUGE milestone to make. I know its very tough to think about trying to give one the best possible chance at life, ( I choose to reduce at 13 weeks from 4-2 to save at least 2) I think most drs will tell you that delivering now is a safe option. I believe the survival rate for 28 weeks is like 85% or something. Yes there can be some issues related to being a preemie. Mine are doing okay, we did a hard road in the nicu it wasn't easy at all but at 4.5 yrs old they are doing great with no delays. They are tiny but so are my other two. We have some issues related to prematurity but nothing that I would have given up one for (hope that makes sense). If this were a major concern before 24 weeks or so I would probably be feeling differently but 28 weeks is a good point.
Also if you look at how a lot of the iugr babies do, they fair pretty good. I saw many babies come in with iugr and was SOO surprised at how well they did. They are tiny but little fighters.

 

:hug: :hug: :hug:
Stinks isn't exactly the word that came to mind for me but, close enough. I am so sorry you are going through this. I can't even imagine the turmoil you must be experiencing.
This is probably not helpful but I believe that only you know what's best for your children. You and dh are their parents and will know what to do when the times comes. That said, I have learned so much from being on TS about all the amazing things doctors can do. When I first started to come here viability was about 26 weeks and now I believe it is down to 24 weeks in that short period of time. I have read so many amazing miraculous things on here. Either way, your decision will be a very difficult one. Good luck. :hug:

 

There are two women on this site that recently delivered twins at 28 and 29 weeks (if I remember correctly, though they might have both been 28 weeks). Anyway, their twins had TTTS (which has a much higher mortality rate than IUGR). They had very long NICU roads but all 4 babies are doing great! I know both women are very busy, but hopefully one (or both) of them will see your post. I wanted to tell you about them to give you hope. I hope you read the IUGR stories in the complications sticky...our story is in there. If it were me, I'd have them both. During my pregnancy I was monitored constantly for TTTS and I was happy when I went into labor early. I knew the dr's and nurses could give them better care than my body was. I wouldn't wish a NICU journey on anyone, but it saved my babies and I will be forever thankful.

 

I am so sorry you're going through this. :hug:

Something similar happened to me, though maybe not as severe as your case.

I'd been getting growth scans monthly. At 21 wks, both babies were above 95th percentile. At 25 wks, DS was 2nd percentile, with low fluid. They rushed me for betamethasone shots immediately.

We spent the next 9 wks living from one u/s to the next. We were getting detailed growth checks every 2 wks, doppler cord flow scans and fluid checks weekly, and 2 BPPs/NSTs per week. I was terrified the whole time, and was always afraid that between one u/s and the next DS would pass away. (With 2 babies in there, I couldn't always tell who was moving.)

Since we discovered his IUGR at 25 wks, I was faced with exactly the question you're agonizing over now: if it looks like he's not going to make it, do we attempt to save him by delivering, even though that means risking both babies? Or do we let him go so we don't jeopardize DD?

This will probably sound horrible to a lot of people, but if the question had come up early enough, we would have let him go instead of risking both babies. I'm not sure where the "early enough" line would have been. Probably after 28 weeks I would have risked delivery.

In the end, we got lucky. We scraped by until 34 wks (which we'd never have expected!!!), and delivered after a bad NST. At birth, DS was 2 lb 11 oz. (DD was 6 lb 3 oz.) (And it turned out to be a placenta problem, like what they're telling you.)

Have your doctors said anything about what they expect, your chances of making it to 32 wks, etc? One thing they told me over and over while we were going through this was that if things start to go downhill, it won't happen overnight. It was almost impossible for me to believe while in the grip of that terror, but they kept telling me that the decline would be slow enough that we'd catch it with 2x/wkly u/s. So even if things start heading south, you probably won't have to make a choice on the spot - you may even have days to think it over.

Ditto pps that TS is full of moms of 28 weekers and even earlier preemies who are healthy, thriving, and perfectly normal. I'd just add that one of our "neighbors" in the NICU was a beautiful 24 wk baby girl, Fiona. She was actually her mom's second 24 weeker - her first was a healthy, normal toddler by then. Last we knew, Fiona was doing great. And the chances after 28 wks are far, far rosier than that.

Lots of kind thoughts to you and the babies. Good luck. :hug:

 

No experience from me, just wanted to say I'm sorry you are in this position and I will be keeping you all in my thoughts. :grouphug:

 

My heart goes out to you momma during this trying time :hug: :hug:

 

Hi, I don't any helpful advice. I'm sending hugs and support your way. I'm sorry this is so incredibly difficult for you and your LO's.
Beth

 

I can't speak from my own experience, but I can tell you about a friend whose twins are a month younger than mine. She found out her son had IUGR at 26 weeks, but she made it to 32 weeks. It was definitely tough, deciding how long they could go to give her daughter the best shot without taking risking her son. They had her on bed rest in the hospital (for several reasons) and told her they wouldn't let her go past 35 weeks, but in the end, decided to do the c-section at 32 because her son's health was declining. He was only 2 lbs, but a year + later and both babies are doing great. Her son had more NICU time thah her daughter and a few complications with physical delevopment where he needed some therapy, but a few months ago he was given a basically clean bill of health. I know every situation is different, and I hope that they are able to give you a better idea of just how long you can go before it becomes a necessary decision. I agree with pps...there is so much that they can do for preterm babies that even if you have a rough start with NICU time, it is still very possible to have two healthy babies. :hug: Hang in there, mama. I can't imagine how tough this must be for you.

 

There is a member here -- Buttercup1 -- who faced something similar during her pregnancy. We were pregnant at the same time, and I vividly remember it being very touch-and-go on whether one of her babies would make it.

She has two adorable 2-year-olds now. I hope she sees this post and is able to weigh in with specifics.

Sending you some positive thoughts. What a horrible position to be in!

 

We recently had to make that same decision. We found out at 26 weeks that our baby b had quite growing at that point her dopplers were still okay. Baby A was fine. We decided to continue the pregnancy until it was absolutely necessary to deliver to give B a chance. At our 29 week ultrasound her dopplers showed reversed flow in her cord. My girls were delivered on August 10 at 29 weeks. We lost Rowan (baby B) on August 12, 2009. I did the same thing you are, post asking for experiences but I never saw any stories where they lost a twin. I wanted you to know my story because there arent too many like mine out there. I am so sorry you are going through what I went through. It is absolutely heartbreaking for a mother to have to choose which of her children to save. I hope your outcome is better than mine. I pray that both your little ones are fighters and make it through this tough battle.

take care,
Jennifer

 

THANK YOU VERY MUCH.

Jennifer :hug:

 

I don't have a similar experience, but wanted to throw out there that I would definitely chose to deliver both now. I had my boys at exactly 29 weeks and they spent almost exactly 8 weeks (1 day short) in the NICU. We were told they'd be there until their due date (11 weeks) or longer. It was a long wait, but it's over with now and both are very healthy. I was more terrified of this hospital in Hawaii (bad rep) than their survival rate!

 

28 weekers have a 90% survival rate. I work on a Mom Baby Unit and we have a lot of 28 week twins and triplets deliver and do amazing.

 

I have no experience with this situation, and am so so sorry that you may potentially have to make such a choice. I know there would be a cutoff for me in which I would let one twin go in order to give the other the best chance at a great life, but I'm not sure exactly when that would be. This would be an easier decision at 26 weeks or at 32 weeks, but the time in between is a very unclear. Ultimately I hope that your doctors will be able to help you make this decision from a medical point of view rather than an emotional one. Hugs and please keep us posted. Laura

 

Hey there.

So sorry that you have had to post such a painful question. My heart goes out to you as you wrestle with this.

I do not have the same situation, but can share a little bit of empathy and some of my story. My twin pregnancy has been, pretty much, a fiasco. Not that it was unintentional, but it's just been so difficult and had so many compliations. After being hospitalized with a huge bleed and residual blood clots, I had 12 weeks of home bedrest to contemplate every possible outcome. For a long, long time, nothing happened - no change in the bleeding, babies growing, etc. Then we had an appt where a doctor other than our regular MFM specialist said that she thought baby A had a marginal cord insertion, and that it was close to the part of the placenta that had been adversely affected by the blood clot. Long story. Anyway, she basically gave us very, very little hope for that baby (A), and not much better for baby B.

So I came home, spent a few days being devastated, then started researching every potential outcome, odds, etc. What I learned, in the end, was that getting to 30 weeks made a HUGE difference in long-term outcomes for the babies. Not that they wouldn't be in the NICU, but the long-term, scary neurological issues that can really impact quality of life, etc. -- things got a lot better at 30 weeks, ESPECIALLY with the steroid shots that you've had.

So, I guess what I'd say is this: if I were you, 28 w and 5-6 days now, having had the full round of steroids, and being in a great NICU setting, I'd be thinking about delivering whenever it's the only option for your smaller twin. Hopefully, that will be 32 weeks or even more. Heck, NO ONE associated with my case thought I'd make it to 23 weeks, much less to nearly 32, so stranger things have happened ... but even if they have to be delivered NOW - e.g., today - I think the long-term prognosis is really pretty good. Long stay in the NICU, for sure, but long term, I think worth it.

I hope I don't seem anything but totally sympathetic -- that's how I feel, for sure.

Hang in there, mama. This is so hard, I'm sure...but hopefully, in a few weeks or months, you'll be holding your beautiful twins and everything will be water under the bridge.

Best of luck - Ginny

 

SO Sorry that you are having to deal with it.

Our babies came out at 24 weeks and 5 days(NOT by choice)

They are perfect in every way beside the girl possibly needing a shunt due to a brain bleed earlier on.(In fact the bleed most likely happened early in her development)

Besides that, no lung, heart or ANY other issue. They are already into Day 71 of thier NICU stay.

28 weeks IS early, but in our case, I don't think if they had those extra 3 weeks that it would have done anything except shorten their NICU stay.

And our babies came out with no steroid shots...nothing.

You will be in our thoughts

 

Ah...I just saw that it was you "My Caringbridge Lurker" :acute: that started this thread.

Again...so sorry, but you know our story, and that our kids were only 1 lb 8 oz.

It's a tough decision...very tough, but just remember how well ours are at being born so early.

True we have been very blessed and lucky, but so have many other people, and you are 4 weeks further than my DW was.

Please keep us all posted...

 

First let me say big hugs to you...I remember how terrifying this is. I went in for my 27 week appt and never left the hospital. My girls had a 45% discordance and baby A was very small (I didn't know how small at that point). I overheard later that she was in the less than 1st percentile. To make a loooooong story short...I was put into the hospital that day and the neonatologist came to talk with DH and me about what they would do if they had to deliver. Basically, he told us that we would certainly lose baby A and they would do everything they could to save baby B. Well let me tell you, those little ones are fighters. My baby A made it all the way to 33w6d and was delivered at 2lb 4oz. She was still very small and her sister was 2lb bigger than her, but my little girl did much better in the NICU and never needed breathing assistance. She only needed to learn to eat and grow. And now they're 9.5 months and hitting all of their milestones ahead of time with my IUGR baby leading the way!

I know it's so difficult, but attitude is everything. We thought we wouldn't make it through that first night without delivering and then we had another scare at 30 weeks...but I knew it wasn't time. I just knew in the pit of my stomach and with all of my being that they weren't ready and neither was I.

Best wishes for you momma and know that if the time comes when you do have to make a decision, you'll have a host of mommies praying for you. :give_rose:

 

I am sorry to hear you are faced with this. Claire, my twin A, started to fall behind when I was 32wks, and had to deliver at 36wks due to poor blood flow. I know that isn't as early as you, but my sister's SIL did go through this. Her one twin had IUGR, and they were delivered at either 28 or 29 wks. I cannot remember. They did well in the NICU, though the IUGR twin was in longer. He did struggle more than the healthy twin.

They almost lost their IUGR twin due to a ER physican feeling around a hernia that went through his intestinal wall. He had sepsis. He struggled more in the PICU from this event, than when he was born at 28wks with IUGR. He went through a lot more after the sepsis, and he truely is a miracle child. Him and his twin are both thriving, and doing super great!!

 

I will pray for you! That is a hard decision. I know I would struggle with that. I would say that you should go with your gut. You know those babies better than any doctor and if you feel like A has a chance then make the best decision. Either way, I know it will be hard. My heart goes out to you!

 

**HUGS** Only you can make the decision but I just wanted to add to everyone else that the survival rate for 28 weekers is phenomenal to where it was probably just 2 years ago! We have friends that we met in the NICU during our stay that had their daughter (singleton) at 24weeks weighing 1# 13oz! She stayed in the NICU for 5 months but now is doing wonderfully!!!

Good luck with your decision!

 

I had something similar happen 7 years ago. At 22 weeks my babies were within a couple of ounces of each other, being a little over a pound apeice. At 24 weeks the gap started growing as my a grew very little in 2 weeks, and b was growing fast. At 26 weeks a had still not grown and I was told she probably would not make it. At my 28 week check they saw that the gap had widened to a whole pound difference. When the dr told me that we would have to deliver to save a, I jumped at the chance. I was given steroids and delivered at 28w3d. My baby a was 728g at birth (1lb90z), and b was 1160g (2lbs9oz). I never hesitated in my desicion to deliver early as I could not make the choice between my babies. The NICU is a hard road, but well worth the end results.

FWIW my little a is now a 68lb 7 year old who is bigger than her twin.

Good luck with your decision, and send me a message if you want to know more about what I went through.