#WhyIWalk

Last year, we were rookies in the March for Babies.   We registered to walk only a few weeks before the big day and made very few preparations. Our skeleton team consisted only of George, Aunt CiCi, Brandi (George’s cousin), the babies, and me.  At that time, we walked in honor of our babies.  They endured seven week stint in the NICU, and at the time of the walk were making their first public appearances.   George and I felt a sense of gratitude for the March of Dimes, which funds major research to help preemies like ours grow and thrive.

This year, we started much earlier and rallied our friends and family to join us.  We even ordered royal purple team t-shirts to show group cohesiveness.  Our team doubled in size when our neighbors with quads also joined the cause.  Together our team was over thirty-eight members strong and raised $1650!  This year, the cause was bigger than just our own family.  It was in honor of our healthy, thriving babies, but also in memory of the many babies who passed away this year.  Our community of multiples is a small one, and when tragedy strikes, we all feel the sorrow.  Far too many families experienced infant loss, and the March of Dimes is helping to make sure that more families do not endure similar situations.  I can only hope that our team grows even larger and stronger next year!

The sea of royal purple warmed my heart.

The sea of royal purple warmed my heart.

This sign proudly hung in the "Garden of Hope" for other families facing premature births.

This sign proudly hung in the “Garden of Hope” for other families facing premature births.

Our sign was surrounded by signs honoring other babies.  Take a close look at each one though.  Some signs honor babies while others are memorials for babies.  We walk to help prevent future families from hanging memorial signs.  No family should have to endure the loss of an infant.

Our sign was surrounded by signs honoring other babies. Take a close look at each one though. Some signs honor babies while others are memorials for babies. We walk to help prevent future families from hanging memorial signs. No family should have to endure the loss of an infant.

 

This year, my parents and sister's boyfriend (Matt) were right at our side.

This year, my parents and sister’s boyfriend, Matt, were at our side.

Along for the walk were the Murphy Clan (top) and Bonnie Brae Crew (bottom).  Two of these walkers were expectant mothers with babies due this summer.  They know the March of Dimes is working to make sure their babies are delivered full term.

Along for the walk were the Murphy Clan (top) and Bonnie Brae Crew (bottom). Two of these walkers were expectant mothers with babies due this summer. They know the March of Dimes is working to make sure their babies are delivered full term.

Along for the walk were the Murphy Clan (top) and Bonnie Brae Crew (bottom).  Two of these walkers were expectant mothers with babies due this summer.  They know the March of Dimes is working to make sure their babies are delivered full term.

Along for the walk were the Murphy Clan (top) and Bonnie Brae Crew (bottom). Two of these walkers were expectant mothers with babies due this summer. They know the March of Dimes is working to make sure their babies are delivered full term.

Wait a minute...one of these is not like the others.  Which one doesn't belong? When Harper was unhappy in the Runabout, Spencer happily took his place.

Wait a minute…one of these is not like the others. Which one doesn’t belong?
When Mason was unhappy in the Runabout, Spencer happily took his place.

IMG_9077

Aside from group cohesiveness, a nice perk of having a large team was that we didn’t face a barrage of questions or a sea of paparazzi like we did last year.  It allowed us to just walk and enjoy the spring weather.  Also, it was far easier managing four babies with so many helping hands.  Everyone gladly took turns pushing our 120 pound stroller and entertaining fussy babies.

We crossed the finish line as a group for one cause.

We crossed the finish line as a group for one cause.  Everyone, including he babies, received a sticker that read, “I did it!”

 

Quads doubled!

Quads doubled!

After the walk, the babies enjoyed quick picnic lunch of their favorite staple: peanut butter and honey sandwiches with apple slices and goldfish.

After the walk, the babies enjoyed quick picnic lunch of their favorite staple: peanut butter and honey sandwiches with apple slices and goldfish.

Nisey and Papa beam with pride when they are with their grandbabies.

Nisey and Papa beam with pride when they are with their grand babies.  Our family team shirts didn’t come in toddler sizes so I ordered March of Dimes onsies for the babies that read, “Proof Miracles Happen.”  I thought it was quite fitting for them.

 

Have you ever participated in a charity walk or fun run?  If not, I hope you’ll consider joining the March for Babies next spring.

 

Hugs!

 

Amber

 

 

We would like to extend a special thanks to those donated to our team: George Shawver, Jr., Carol Vincell, Kristi Bowman, Melissa Shaw, Megan Haley, Karen & Brad Cox,  Ashley Lopez, Patty Winkle, Leslie Murihead, Melissa Dumas, Marianne Southwick, Lindsay Howard, Treva Muirhead, Cathy Wildman and Terri McGuire.

And for those who walked with us: Jaime Balderas, LeeAnn Brager, Esmeralda Colmenero, Gracie Colmenero, Alfonso Cordova, Joey Cordova, Juana Cordova, Jen Crawford, Candelairo Hernandez, Griselda Hernandez, Kimberly Hernandez, Rojelio Hernandez, Matt Johnson, Kristen Klatt, Kelsey McGuire, Daniel Murphy, Debbie Murphy, Dennis Murpy, Sara Murphy, Ann Odom, Brenda Quintan, Alan Reid, Deven Reid, Jessica Rivera, Alondra Rodriguez, Mina Rodriguez, Viviana Rodriguez, Daria Schwalbe, Paul Schwalbe, Priscilla Serrano, Kaylie Slaughter, Tyler Slaughter, Brandi Steele, Evelyn Villanueva, Courtney Zehnder, Denise Zehnder, and Steve Zehnder.

Banding Together, Raising Awareness

Despite having a few scares, George and I were lucky during my pregnancy and subsequent NICU stay. From the moment we learned we were expecting quadruplets we were painfully aware of the inherent risks for all involved and we chose to accept them.   Even knowing these risks, it never occurred to me that we may not take one or more of them home.  The past year has been a difficult one in our community of quadruplet families.  In the past eight months we’ve wept as many families lost one or two babies.  And, three different families lost all four babies due to extremely premature deliveries.   The Peterson family was the latest to suffer this grave loss.  They bravely share their story and photographs on their Facebook page, Prayers for the Fantastic Four.

Jen and Chris shared this photograph of their angels.

Here, Jen embraces three of her angels.  Her first daughter, Serenity, is represented by the teddy bear.  Serenity was delivered  two days prior in hopes of saving her mother and siblings.  Unfortunately, the delivery of the remaining three could not be prevented.  The Peterson family has a Go Fund page established to help offset funeral and hospital expenses.  If you are able, any donation is appreciated.

What broke my heart even more was knowing that these lives may have been spared.  I believe this because of my friend, Kathryn.  Before I met her, she lost her twin boys at just 16 weeks due to incompetent cervix.  Since her losses, Kathryn has become the most articulate advocate of TACs I know.  Because she is the expert on this topic, I asked her to share her knowledge in hopes of raising awareness and helping mothers realize their options.  Here are Kathryn’s words:

Ever watch Dexter?  It’s a Showtime program chronicling the ongoings of a serial killer while following a moral code.  Dexter successfully detaches himself from his killing tendencies by referring to that part of himself as his ‘Dark Passenger.’  I have a Dark Passenger, too: an incompetent cervix.  And it killed my sons.

The cervix sits between the uterus and the vagina and acts as a safe keeper of baby.  A good cervix stays closed during pregnancy and holds baby in tightly.  A column of mucous forms in the center of the cervix to plug any possibility of good (or bad) vaginal bacteria ascending.  At the end of the gestation, contractions essentially slam baby into the cervix repeatedly to send the message, “Hey, open up, it’s time!”  After that timely prodding, the cervix will dilate and allow baby to be pushed out vaginally.  There are some other things that tell the cervix to get ready – but those also all occur at the END of gestation.

In contrast, an incompetent cervix fails.  It opens willy nilly – even at 16 weeks!  It could open ever so slightly to lose bits of the mucous plug and allow bacteria to ascend.  It could open just at the top forming a funnel that baby slips into causing all sorts of problems.  It could even open all the way causing the baby to fall out.  And just as fast as it opens, it can close back up never having its misbehavior detected.  This earns an incompetent cervix the nickname ‘Silent Killer.’

Diagnosis of IC can be difficult.  The cervix can change so frequently, that often it’s not detected as problematic until an emergency arises.  Most often, women must lose several 2nd trimester pregnancies before most doctors will even consider IC as a diagnosis.  Doctors treat it as a diagnosis by process of elimination rather than a diagnosis based on IC symptoms.

Treatment options are severely limited by gestation and severity of the situation.   In a nutshell, current treatments include:

  1.  Wait and Watch Approach – Doctors may suspect (or even KNOW) a patient has IC and elect to simply monitor the cervix via ultrasound every two weeks from about 16 weeks to 24 weeks gestation.
  2. Preventive Transvaginal Cerclage (TVC) – entering through the vaginal canal, a cerclage is stitched in/out of the bottom of the cervix, pulled taught like a purse string, and tied off.  This placement occurs between 10 and 14 weeks gestation as an attempt to prevent any cervical changes occurring and becoming problematic.  The TVC is removed at the end of pregnancy to allow for vaginal delivery.
  3. Rescue/Emergency Transvaginal Cerclage (TVC) – This occurs during the pregnancy when doctors notice that a dangerous change has occurred in the cervical length or dilation.  There are many limits to even utilizing this option as there has to be enough length remaining to place the stitch and most doctors will not place a rescue cerclage at gestations close to or beyond viability (24 weeks).  Again, the TVC is removed at the end of pregnancy to allow for vaginal delivery.
  4. Transvaginal Cervicoisthmic Cerclage (TVCIC) – A TVCIC may be placed prior to or during pregnancy.  Though this is still a vaginal cerclage, it is placed ABOVE the cardinal ligaments.  It may be removed to allow for vaginal births or left in place for future pregnancies (and a c-section performed).  Fewer doctors currently know about and perform TVCIC than TAC.
  5. Transabdominal Cerclage (TAC) – A TAC may be placed prior to or during pregnancy at 10-14 weeks. Through an incision in the abdomen, a mersiline band is placed AROUND the very top of the cervix to disallow dilation.  Vaginal delivery is impossible with a TAC and a c-section is required.

Once a person is diagnosed with definitive IC, there should be no question that placing a preventive permanent transabdominal cerclage (TAC) is the correct path.  (side note: tvcic is a viable option, but I reserve recommending tvcic in only extreme situations such as a rescue or when multiple abdominal incisions would occur in such a tight time frame that increased risk is assigned to the patient)

While statistics depend on each doctor, here are a few rough numbers to consider:

Success rates of TVC = *80% for a live birth (about 40% of these births are preterm)

Success rates of TAC = 97%+ for a live TERM birth (certain TAC doctors have even higher success rates)

*these may be exaggerated because some women receive TVC placements who do not actually have IC and are counted towards being a TVC success even though they would’ve been successful without one.

Clearly, TAC gives the best possible outcome for baby’s life.

Another consideration ought to be the quality of pregnancy.  With IC, uncertainty rules pregnancy.  Every twinge, every pain, every flutter, every kick, every toilet visit – it’s all filled with dread and fear.  As odd as it sounds, IC support sites are filled with pics of women asking if discharge looks normal.  On top of that, TVCs often require (and I ALWAYS recommend) bed rest to keep as much pressure off the cervix as possible.  Forget baths, exercise, intimacy, lifting toddlers, etc.  Your baby’s life is relying on that thread of support at the bottom of the cervix.

With a TAC, IC considerations are gone.  The cervix will not budge.  Even if the length shortens, the cervix cannot dilate.  It cannot open and allow baby to slip out.  Baby is baking until doctor says otherwise! Unless it’s for other non-IC reasons, bed rest is not required.  I personally worked up until the day of my c-section and that is the norm for TAC sisters.  Pregnant in the summer, I spent hours each day in the pool.  In the winter, I practically lived in the bathtub.  Intimacy was allowed.  I was able to lift what I wanted, shop til I dropped, and live my normal life.  TAC allows normal pregnancy!

As women, we rely on our doctors to prescribe the best treatment.  We assume they have the same goal – and same urgency – at protecting our babies that we do.  To be clear, I do not think doctors prescribing a preventive TVC have the ill will of wanting to risk or kill our babies.  Unfortunately, every doctor placing a preventive TVC or advising a wait and watch situation when IC is known is doing just that: risking your baby.  Sometimes it’s due to a lack of education, but sometimes when you press the doctor, you’ll hear them utter, “If this doesn’t work, then next time…”

So what can a mama do?

Educate yourself on the realities of cervical insufficiency.  Understand how the cervix should work and how it fails.  Fully understand what each treatment option entails.  Find women to talk to on support boards about their experiences.  Evaluate your lifestyle and mental health and figure out what you could realistically handle during a pregnancy.  Speak to the top IC doctors in the country (Drs. Haney, Davis, and Sumners).  Talk to your OBs and MFMs.  Pointedly ask them what happens if you funnel to the stitch and shorten at 22 weeks.  Ask them what will happen if your membranes bulge or baby’s leg dangles into the vagina.  What then?  Ask them who makes the final call on treatment for baby.  Remember, this is your body, your baby, and your choice.  Nobody is going to look after preserving and protecting your baby better than you are.

As a specific point, I want to offer an asterisk to all the successful tvc stories you may hear: firstly, a woman with known IC could absolutely have a completely normal, intervention-free pregnancy.  That’s the crapshoot of IC: sometimes the cervix works and sometimes it doesn’t.  It may behave well during one pregnancy and terribly during another.

Additionally, you need to understand this equation:

TVC Success = surgical skill + cervical behavior

TAC success = surgical skill

With an IC diagnosis, you already know your cervix does not work.  Understand that choosing a TVC continues to rely, in part, on the behavior of that broken cervix.

For me, TAC was the muddy answer at the time, but oh how clear the waters have become.  I was able to slaughter that serial killing Dark Passenger who stole away my sons and conquer IC altogether.  I now have beautiful twin rainbow daughters thanks to my TAC.  And I will never regret choosing life at any cost for them.

Kathryn Nguyen is a proud mother to two sets of twins and a prayerful TAC-only advocate.  Visit her blog Beyond This Desert for more information on cervical insufficiency and TAC.  

Three other quad mom bloggers joined me in the effort to raise awareness on this sensitive topic, please visit:

Capri + 3

Chillin’ with Chad

Quads from Heaven

In honor of Pregnancy and Infant Loss Remembrance Day, I addressed my own losses, Casting a Light in the Darkness & Reflecting.

Mission: Survival

I began writing this post several months ago when the NICU director from Cook Children’s Hospital asked George and I to speak at an upcoming event about infant mortality.  I abandoned it for fear of seeming lackluster or coming off as conceited.  However, I’ve recently come into contact with several expectant mothers of multiples and think this post is worth finishing.

Apparently Dallas and Tarrant counties boast the worst infant mortality rates in Texas and some of the worst in the United States.  I stumbled across articles from The Star Telegram and Washington Post that mention some startling statistics.  According to current research, it appears that prenatal care is one of the most critical factors.  The NICU director felt that George and I made sound decisions early on to help me carry the babies as far as possible for the betterment of everyone’s health.  Reflecting back on the dog days of my pregnancy, here are some of the things I feel were beneficial.

1. Got into Shape Beforehand

When family building did not come as easily as anticipated, George and I decided to change our lifestyle to one of health and wellness.  We figured if we were dealing with infertility we knew we were in for a journey and better prepare.  I mean, you wouldn’t attempt to run a marathon without getting into shape first.  Just like a marathon, pregnancy is difficult on the body.  After scheduling routine physicals and catching up on vaccines, we developed an exercise regime. Together, we took kickboxing classes twice weekly and I practiced yoga three days a week.  Additionally, we made an effort to eat well.  We cooked fresh foods at home most of the time and rarely ate out.  I can honestly say I was in the best shape of my life just before becoming pregnant with the quads, even better than I was at 18.

2. We found “the quad guy”

The day of our initial sonogram with the quads, we knew we needed the best doctor for the job.  My RE referred us to a perinatologist who had experience with high order multiples, including several sets of quadruplets.  All of my prenatal visits were exclusively with my perinatologist.

This was our first ultrasound and the only time all four babies were captured in one image.

This was our first ultrasound and the only time all four babies were captured in one image.

3. Educated Ourselves and Found Support

Together, we made an effort to educate ourselves about pregnancy, especially regarding multiple gestation.  This included close communication with my perinatologist.  I read several books, including The Mayo Clinic Guide to a Healthy Pregnancy, which was my favorite one.  I read a few books about twins, but chucked them when they only mentioned terrifying things about high order multiples.  Fear was not helpful to me.  The single best advice I received from Dr. Tabor was to look up  Steece’s Pieces, a blog maintained by a former patient who also had quadruplets.  I read the archives of her blog many times over to help cope with bed rest and the future with four babies.  I kept contact with other mothers of quadruplets, both expectant and mothers of older children.  They served as a resource for “Is this normal with quads?” and served as a sounding board.  In fact, this wonderful group continues to serve as a resource for raising quadruplets.

4. Made Calories Count

During my pregnancy, my doctor advised a diet of approximately 3,000 calories.  This included the usual 1,800 calories for me and an additional 300 calories per baby.   I could have easily met the 3,000 mark with a few Whoppers and Blizzards, but I knew that what I ate was for the babies. I wanted those calories to count.  I kept a variety of healthy snacks in my office (when I was working) and at home.  I noshed on things such as Greek yogurt (high in protein and calcium), nuts, fresh fruits and veggies, popcorn (high in fiber), cheese sticks, and protein shakes.

3. Kept Hydrated

I also drank water by the gallon.  If a visitor ever asked what she could do for me, I would ask for a refill on both of my large Tervis Tumblers.  Staying hydrated was critical to keep contractions at bay and to help keep amniotic fluid levels stable (Sydney’s fluids were low at several appointments).  I veered away from most other beverages, particularly caffeinated drinks.  Popsicles, however were a fun source of fluids especially in the Texas heat.

Can you spot the two Tervis Tumblers on my nightstand?  They remained at my side the duration of my pregnancy.

Can you spot the two Tervis Tumblers on my nightstand? They remained at my side the duration of my pregnancy.

5. Popped Approved Supplements

Prior to taking any medication or supplements, I consulted with my perinatologist.  I have a blood clotting disorder called MTHFR and was prescribed a mega dose of folic acid and low dose aspirin to manage it.  In addition to those, I also took gummy prenatal vitamins (I could not keep the regular ones down so I opted for gummies) plus calcium and iron.

6. Listened to My Body

Just prior to being put on bed rest, I could feel my body become increasingly taxed.  After years of practicing yoga, I knew it was critical to listen to my body.  If I felt dizzy or fatigued, I simply rested.  It did not matter if I was at work walking to a classroom or at Walmart.  I literally found a suitable place to sit and I took deep cleansing breaths as I rested.  When I felt normal again, I took care to rise slowly and carry on.  When I felt thirsty or hungry, I took care of those needs.  I never pushed myself beyond what I felt my body could manage even though that is something I tend to do.  I knew that pregnancy was not the time to test my limits or  try a bit harder.

7. Tossed My Pride Out the Window

I am a highly independent person and I struggle to accept help.  However, with a high risk pregnancy, I knew it was necessary to swallow my pride.  When I was working full time, I was not ashamed to prop my feet on a box at my desk, to sip water during meetings, or to roll my ergonomic chair to conference tables.  The weeks just before bed rest, I wanted to do a lot of “nesting” but knew I needed to be wary of overdoing it.  When I went shopping, I did the unthinkable and used the store’s power chairs.  It was totally embarrassing zipping around in those, but it was good practice being noticed in public.  Looking back, it was probably more discreet for a pregnant girl to ride in a power chair than for me to push a stroller limo loaded with four babies now!  For the first time in my life I also let the bag boy at the grocery store load my car and I let people do things for me at home.  When I was bed ridden it pained me to sit idle while other people cooked and cleaned, but I knew that was for the best.

Oh yeah, here I am rocking the Target power chair!

Oh yeah, here I am rocking the Target power chair!

Here is an instance where I had to let George and my father in law handle something I wanted to do: organize the nursery closets.

Here is an instance where I had to let George and my father in law handle something I wanted to do: organize the nursery closets.

8. Obeyed Orders

I am a rule follower in pretty much every aspect of my life, from turning library books in on time to coming to a complete stop at stop signs.  Pregnancy was no different.  I did EXACTLY as directed.  When put on strict bed rest, I took it seriously.  I literally stayed in my bed except to go to the bathroom and shower.  After the first few weeks of strict bed rest, George impassingly mentioned to Dr. Tabor that I had not been in the kitchen.  Dr. Tabor was literally stunned that I followed his orders exactly.  I suspect this is one of the reasons I was not admitted to the hospital (rumor has it that Dr. Tabor prefers to admit mothers of high order multiples early so he can keep an eye on them).

This was my bed rest set up complete with Snoogle and laptop.  I later swapped the laptop for a secondhand ipad, which was much lighter and easier to manage.

This was my bed rest set up complete with Snoogle pillow, wedge pillow,  and laptop. I later swapped the laptop for a secondhand ipad, which was much lighter and easier to manage.

We kept the mini fridge and microwave from my office at my bed side.  George stocked it nightly so I could easily access snacks in the day.

We kept the mini fridge and microwave from my office at my bed side. George stocked it nightly so I could easily access snacks in the day.  You’ll notice a notepad, Ziploc of snacks, wallet,  and book on my nightstand as well.  I kept a running list of things I wanted to accomplish each day so that I did not feel like a sloth.   I read to keep my mind busy and nested by shopping online for the babies (hence the wallet next to the Ziploc).

9. Researched the NICU

Because quads are always delivered prematurely (34 weeks is usually the furthest they can be carried), we knew there would be a NICU stay.  Early on in the pregnancy, George and I compared the NICU facilities in our area and took tours.  We made the decision to have the babies transferred to the nearest children’s hospital (Cook Children’s).  While we knew our delivery hospital could provide outstanding medical care, we felt that the children’s hospital would better meet the needs of our family and provided a family centered approach.  I encourage all expectant parents, especially those in high risk situations, to be aware of the NICU facilities available to them.  Even parents with one baby and no known risks can have surprise NICU stay.  Being aware of options ahead of time can serve you well in the future.

10. Summoned the Power of Prayer

Pregnancy can be a stressful time, and pregnancy with high order multiples is exponentially risky and stressful.  Despite knowing all of the risks involved, George and I remained calm as possible.  He and I both knew that letting stress take over would be to the detriment of me and the babies.  To the best of our ability, we did everything we knew to maintain everyone’s health.  However, we knew it was not fully under our control.  We left the rest up to God.  People near and far prayed specifically for us and for specific situations such as when Sydney’s fluids were low.  Via this blog, I communicated very specific needs and I know that people heard them, adding them to prayer lists.  Just recently, a neighbor stopped us during an evening walk.  She exclaimed, “Oh you are the family I prayed for!  A neighbor told me someone was expecting quadruplets and needed prayer.  I prayed for these babies.”

Knowing the risks involved carrying four babies, George and I do not take our babies' health for granted.  We count our blessings every day.

Knowing the risks involved carrying four babies, George and I do not take our babies’ health for granted. We count our blessings every day.  This was a special moment when all babies were reunited for the first time since delivery.  They were four weeks old.

Ultimately I did everything in my power to sustain my pregnancy as long as possible and to give the babies the best chances I could.  I never wanted to look back and wonder “what if”. However, every mother and baby is unique.  Some mothers do everything perfectly and outcomes are not as good as ours.  Other mothers seem to make all the wrong choices and yet everything is problem free.  The best advice I can offer if you are expecting one baby or seven babies is to do your best to make sound decisions for yourself and your babies.

hugs!

Amber