By Daisy Whitney Brooks, Denver, CO USAI wrote about my pregnancy for the Denver Post. Here is my story.
PROM at 14 weeks + 3 days. Delivery at 29 weeks.
Story added: 2001-01-28
Bittersweet emotions attend birth
Grief, joy spring from in vitro twins
By Daisy Whitney
Special to The Denver Post
Jan. 28, 2001 - It either works or it doesn't.
At least that's the conventional wisdom among couples trying to conceive a child through in vitro fertilization (IVF).
That was my only thought when two eggs harvested from my ovaries and fertilized by my husband's sperm were transferred back into my uterus last May. "It worked!"
In fact, IVF worked so well that I was carrying twins. It seemed like the simple, lovely miracle my husband and I had prayed for. At the time, we did not face squarely the risks of carrying multiples. Ultimately, we faced them as we had to.
With IVF, the goal is to make possible and then maximize the odds for a live birth, and that means many couples and their doctors - including us and our infertility specialist, Dr. William Schoolcraft - choose to transfer at least two of the embryos to the uterus, to begin the journey toward birth.
In April I wrote about our quest for a "miracle."
Today I report the results. One baby died and the other was born 11 weeks premature.
My husband, Jeff Brooks, and I had tried to have a baby for more than a year when we learned that my fallopian tubes had been damaged during childhood in the aftermath of a ruptured appendix. IVF was our only hope. It was a risk and a gamble - a $12,000 gamble - and there were no guarantees we would be successful.
To boost our chances we did opt to have two embryos transferred. We were thrilled to learn that both embryos had settled in for what we hoped was a long winter's nap inside me.
After a year of trying to conceive, numerous ultrasounds, endless fertility shots and thousands of dollars, we had thought getting pregnant was the hardest part.
We were wrong.
On July 23, 2000, after 14 weeks of an idyllic twin pregnancy, my water broke, 26 weeks before my due date. The sterile, protective sac full of amniotic fluid that my lower twin had been living in had ruptured. Most women go into labor anywhere from 12 hours to 10 days after the water breaks.
If I did go into labor, my doctors said they would not stop it. When the water is broken, they explained, the body usually goes into labor for a reason, most likely to protect the mother from the risk of infection.
The prognosis wasn't good for Twin A, as we began to call the baby in that sac. It was very unlikely that I would be able to carry him 10 more weeks, the earliest point at which he could be considered viable. Even if I did made it to the magic 24week mark, the outcome for babies who have endured a prolonged time in a ruptured sac is poor. Weeks 18 to 23 are crucial for lung development, and amniotic fluid is needed for that development.
My doctor, maternal fetal specialist Dr. Greg Lindsay, told me about a rare and controversial procedure known as a delayed interval delivery. Doctors use it when one baby in a multiple pregnancy needs to be delivered early and while the other, or others, would benefit from being kept in utero as long as possible.
If the first delivery occurs before 24 weeks, the first baby will die. A delayed interval delivery is a risky procedure, with the mother and remaining babies at risk of infection, and it doesn't always work. Only a few hundred have even been done in the United States.
I was 21 weeks and three days pregnant when I went into labor on Sept. 10. The contractions came fast and furious that evening.
My husband drove as quickly as he could to Presbyterian/St. Luke's Hospital, where my doctor on call, Dr. Richard Porreco, performed an amniocentesis on twin B, the baby in the intact sac. The baby was free of infection, which meant that we could proceed with the interval delivery and, hopefully, keep him inside me.
That also meant my first twin would die.
My husband and I were alone briefly after the amnio.
"We need a name for the baby," I whispered. We tearfully picked a name for a girl and a boy. The nurses then took me to the operating room, where I was given an epidural to eliminate the pain. I didn't know labor could hurt so much when the babies are so small.
My husband held my right hand and the anesthesiologist held my left while I pushed. As soon as I heard Porreco say "nitroglycerin," a drug he gave me to calm my uterus, I knew the first baby was born. I looked over and saw him on a table.
"Is that my baby?" I asked.
"Yes," the nurse told me.
"What did I have?"
"You had a son."
I asked to hold him, so she wrapped my firstborn son in a hospital baby blanket and handed him to me. We named him Ben Russell Brooks. I held him in my arms as Porreco performed a cerclage, stitches designed to keep the cervix closed.
I was completely dilated, of course, having just delivered a baby, so it was no easy task. While the doctor worked, I held Ben. He had Jeff's nose and dark hair. He weighed 1 pound. We told him how much we loved him.
Ben was perfect in every way, except one. His heart wasn't beating.
But his brother's was. Porreco attempted to stop my labor with magnesium sulfate, indomethacin and other drugs, but it wasn't easy. I was still contracting every two to three minutes shortly after midnight as I was wheeled into my hospital room.
During the night, my contractions slowed and I began to stabilize. I figured I was home free the next morning when I was only contracting once or twice an hour. But I needed to get through that crucial first week, when the risk for infection is highest, before my doctors could breathe a small sigh of relief.
After seven days in the hospital, I was sent home on bed rest, anti-contraction drugs and antibiotics.
No one could predict how much time I would have in between Ben's birth and the birth of his twin brother. My doctors, at Obstetrix in Denver, had done 31 delayedinterval deliveries prior to mine. The average time span between babies ranged from 38 to 45 days.
We got 52 days, long enough to pass the 28-week milestone. Babies born after 28 weeks gestation have a greater than 90 percent chance of survival and less than 10 percent chance of long-term complica tions.
Walker Ben Brooks entered the world on Nov. 1, weighing 3 pounds, 1 ounce. I had been pregnant 29 weeks.
We knew we had passed the scariest time for a premature birth, but we were not out of the woods. Walker spent eight weeks in the intensive care nursery at Rose Medical Center.
Some people ask if childbirth was easy because he was small. It wasn't, physically or mentally. Preemies aren't just small. They can have a host of complications such as blindness, deafness, mental retardation and cerebral palsy.
Some people asked if I was happy to be back on my feet after 101 days in bed. I wasn't. I would gladly have endured six or seven more weeks with only bathroom privileges if it meant that Walker had more time in the womb.
But instead, I spent every day, all day, with my son in the intensive care nursery. The early days were emotionally difficult because of the extremes of opposing emotion - the devastating grief for Ben as well as the overwhelming joy for Walker.
When I watched the other mothers of twins in the nursery holding two babies, I felt a longing, an aching. One of my arms was empty. Having a survivor does not erase the pain. Ben and Walker were and are two separate beings, and I wanted them both.
Some people think that when you lose a baby, you can just have another one to make up the difference. But Ben was the one I wanted, and he is the boy who will never be. When I see the life before me in Walker, I sometimes see the shadow of his twin brother. Now there is one when there should have been two.
But what should have been is really irrelevant, I try to tell myself.
After all, we could so easily have two dead babies. We would have if it weren't for the extraordinary medical intervention and expertise of Drs. Porreco and Lindsay and their partners.
We are more than lucky to have the one baby we have.
And while we are fortunate that Walker hasn't had any complications that portend long-term health or developmental problems, his time in the intensive care nursery was often frightening. Walker needed surgery when he was 8 days old to close a blood vessel that did not close properly. He also had initial trouble gaining weight and frequently endured drops in the level of oxygen saturation in his blood.
But we knew, despite those problems, that we were the fortunate ones.
During Walker's stay at the intensive care nursery, I saw tiny babies who needed blood transfusions as well as babies with severe hydrocephalus, water on the brain that can cause brain damage.
Even worse, a baby died while Walker was there - a little boy three months premature who lived only three weeks. I have since come to know his mother and have learned that healing is possible and often comes through sharing.
I tell people embarking on the IVF journey my story - that I spent 101 out of 202 days of my pregnancy in bed, that one of my babies died and that the other was born 11 weeks premature. I try to share with them the risks of multiples, the potential for premature birth and great loss.
Then again, when I look at Walker, I don't know if I would have done anything differently.
Though the IVF experience has been bittersweet, I haven't closed the door to trying again. The bitterness of Ben's death gives us pause, but the sweetness of Walker's life gives me hope for another. Jeff, however, isn't sure he can do this twice. I do know that if we try to conceive another child, we will transfer only one embryo.
Our story isn't just about infertility anymore. Back when I was trying to conceive, all I knew was the pain of possibly never having a child. Now I know a much greater pain - that of having lost one. But I also know the greatest joy - my living son.
You can e-mail Daisy Whitney at pepr@att.net .