10/5 Worried

10/5

Today, I'm worried and maybe a bit angry too. I'm worried for the outcome of our babies. There are SO many things that can go wrong with higher order multiple births. The risks of being born prematurely are so sobering, and 41% of triplets are born very prematurely, with the average being at 33 weeks. See below for complications. If all three make it past the first trimester and the risk of "vanishing twin syndrome" drops, and they make it to 24 weeks (the youngest age of viability), they still have a high risk of prematurity and with that, lifelong complications. I feel the tremendous weight and responsibility of doing everything I can right. (Barbara Luke's books should be coming tomorrow or Wed with education and diet to help prevent prematurity). These are my first big concerns. …Not to mention all of the other things that popped into my head when we first heard the number "three," such as, where will we put them?, $$$, attention for Zach and for each to develop appropriately, how will I breastfeed?  etc., etc., etc. In the evenings Dave and I have had moments with Zach demanding our attention, or being little-boy loud, or whiny overtired—all NORMAL parts of being a little one that is growing up. But I'll look at Dave and just say, "Times 3." implying, "HOW IN THE HECK ARE WE GONNA DEAL WITH THREE AT ONE TIME???" And yet at the same time, I am filled already with such love and protectiveness for each of them, and I KNOW God is present, He is WITH us, and He NEVER gives more than we can handle. In my best times, I think, "God is giving us these three more precious children because that is what's best for us, them, and this world." In my worst of times, I wonder, "Did God just give us children because we prayed so hard for a child, and it may not have been His "best" for us? ..similar to when Israel demanded a king, and God gave them Saul, which at times was very painful to Israel."

Complications of prematurity and higher order multiples (i.e. reasons to pray for a healthy and as-long-as-possible pregnancy):

"Although only 2 percent of singletons are born very prematurely (i.e., at less than 33 weeks gestational age), 1.4 percent of twins and 41 percent of triplets have very premature births.12 Similarly, birth weight generally decreases with an increasing number of fetuses. Although only 1 percent of singletons are born weighing less than 1,500 grams, this occurs in 10 percent of twins and 32 percent of triplets." And with quadruplets and higher, the percentages of newborns that are very premature and very small are even greater.14

Compared to singletons, neonates from multiple pregnancies have an increased incidence of serious complications including hyaline membrane disease, bronchopulmonary dysplasia, intraventricular hemorrhage, and necrotizing enterocolitis.15 In addition, the perinatal mortality rate goes up significantly with multiples. Per 1,000 births, the death rate for singletons is 8.8, but for twins it is 46.8 and for triplets 82.6.16 Multiples also have a higher incidence of congenital malformations, the most common ones being intersex, anencephaly, hydrocephaly, omphalocele, anal atresia, and tracheoesophageal fistula.17 Multiples also have long-term handicaps more frequently, including cerebral palsy, mental retardation, chronic lung disease, and retinopathy of prematurity.18 The incidence of cerebral palsy increases with an increasing number of fetuses; the number of cases per 1,000 pregnancies is 1.6 for singletons, but 13.2 for twins and 75.9 for triplets.19 This represents a forty-seven-fold increase, comparing triplet and singleton pregnancies.

(Too many twins, triplets, quadruplets, and so on: a call for new priorities, by Strong, Carson Publication: The Journal of Law, Medicine & Ethics 

Date: Tuesday, July 1 2003 )