HOW TO COPE

Nurses Sarah and Matthew Middleton had their expectations of pregnancy turned on their head when they found out that Sarah was carrying triplets. Sarah tells their story here.

Our experiences of having a baby born too soon began in July 2003 when Matthew and I attended the Rosie Maternity Hospital Cambridge for an ultrasound scan to confirm my dates. I was 11 weeks pregnant and had an intuitive sense that something was very different from my earlier births, however, we were still thrown completely off balance by the news that we were expecting triplets, an identical twin pairing and a singleton by natural conception.

We were offered an immediate appointment with the consultant Mr Lees and waited an hour to see him – easily the longest hour we have ever spent – in almost complete silence. The elation of confirming our pregnancy, the surge of adrenaline creating fear, excitement and mild hysteria on discovering triplets all came crashing to a halt when we discussed with him the journey ahead.

First we found we would be able to have any invasive diagnostic testing we had planned for genetic abnormalities as this was now considered a high-risk pregnancy. Other options were selective reduction or simply the complete termination of the pregnancy.

Mr Lees was clear that he would not expect a multiple pregnancy to reach full-term (40 weeks gestation) and that the best we could hope for was 34 to 36 weeks. Assuming that the pregnancy progressed beyond 24 weeks, the triplets would require a period of neonatal intensive care. Every week beyond 24 weeks, increased the chance of viability and reduced the risks of disability.

Matthew and I, being nurses, had some insight into the difficulties we were facing. Matthew has experience in the care of people with learning disabilities and we had strong anxieties about our abilities to care for and raise potentially three children with profound learning and/or physical disabilities. Despite this the option to terminate three lives was not acceptable, even though we appreciated the possibly greater physical, psychological and emotional challenge of a triplet pregnancy and raising five children.

Early stages

Ironically, from a physical perspective the early stages of the pregnancy turned out to be my best with minimal sickness and lethargy. We began to prepare ourselves and I gathered information about premature babies and multiple births, some of which even now remains too distressing to read. We counted every day as a blessing that the pregnancy continued and hoped and prayed that each scan would show continued healthy development. A nuchal scan [an ultrasound scan of the nuchal fold at the back of the baby's neck used to indicate chromosomal problems] was performed at 12 weeks with normal scans at 16 and 20 weeks. The planned fortnightly scans were increased to twice and sometimes three times per week after a mild twin to twin transfusion was detected [where identical twins get disproportionate amounts of blood from the shared placenta].

Between 20 and 24 weeks I felt sickened by the possibility of delivering three babies that I knew could not survive. Reaching 24 weeks was a turning point, when we dared believe that we had the chance of three viable babies. Now all we had to do was hold on to the pregnancy as every day was so important for the growth of each baby and their potential outcome. As planned, I was an inpatient on Lady Mary Ward between 24 and 28 weeks and appreciated the opportunity it provided for rest. I also met some wonderful women and I am grateful for the support we were able to provide for each other.

Emergency delivery

At nearly 28 weeks the triplets were estimated to be good weights with sufficient lung maturity to withstand delivery. There was no medical reason for me to occupy a bed any longer. With interrupted sleep, hospital food and missing my family I was delighted to go home, but I realised how close delivery could now be. Twenty eight to 30 weeks found me in the paradoxical position of wanting to remain pregnant for as long as possible, yet physically reaching zero tolerance feeling cumbersome and heavy.

The presence of twin to twin transfusion became an ever increasing concern for Mr Lees but at 30 weeks he remained hopeful that we could continue for another two to three weeks. He was due to be away and he set a scan date prior to this. I remain eternally grateful that he did, for at this scan triplet two Louie showed a decreased heart rate, reduced amniotic fluid and reverse placental blood flow. An emergency delivery was planned within the hour. I switched into automatic coping mode and adrenaline carried me through my pre-operative checks, tracing of all three babies and the gruesome shave (thankfully not filmed ). Before the delivery news arrived that there were doubts that there would be enough neonatal intensive care beds on site.

The delivery was the most surreal and beautiful experience, and I relaxed and wept. I saw them and kissed them and awaited news of where they would be sent, I had been warned it could be anywhere in the country. Fortunately, space was found for all three. The postnatal ward was adjacent to the neonatal unit, but anticipation during the walk round the corner was mixed with anxiety that crept into every pore. I dreaded walking in and finding a baby in crisis. It was my ultimate fear to face a decision on whether to continue or withdraw care.

Logistical nightmare

The medical team and nursing staff were outstanding. We were encouraged to participate in and eventually provide all care. I relinquished any nursing urges to monitor fluid charts or check pumps, monitors or alarms. I just wanted to hold, care, nurture and feed my infants. The first five days were an emotional and psychological nightmare, I was euphoric that my babies were here and yet terrified that something would go wrong. You find joy and laughter in the simplest of moments. We also knew as we held our babies that next to us babies were dying despite the absolute best efforts of all the staff. To experience such joy and sadness in one moment is almost too painful.

Louie then had to be transferred to another hospital and we were faced with the logistical problem of managing our family and travelling everyday to see Louie. Initial anger turned to a determination not to be incapacitated by an inability to cope with the problems presented to us.

The babies had an essentially uneventful journey through NICU and with Louie able to be returned to the Rosie we were all united for the first time, an amazing joyful moment and totally overwhelming. Considering the huge potential for problems we had never expected such a wonderful outcome. The babies were soon maintaining their own body temperatures, and with a combination of breastfeeding and expressed breast milk, they gained weight beautifully. I was euphoric and manic in my attempts to care for all three and we were transferred home. The babies were four weeks old, but still only 35 weeks gestation.

Home at last

To be at home was a massive relief, but the relentless physical demands were overwhelming, leaving us exhausted.

Looking back, we wouldn't change anything. We appreciate the down times, it makes the good times so much sweeter. The neonatal experience has left us with a great hunger and passion for real living.

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