This will be the last post of the pregnancy blog. All updates about our twins can be found on the blog for Eleanor and Miranda. We have one last picture to post of the pregnancy. Here is a picture of Agnes at 38 weeks and one day, on the day that we went to the hospital for the C-section.

Back when we had pictures at 24 and 33 weeks, we posted a picture of a friend of ours who was due a couple weeks ahead of us and labeled her “Mystery Person”. That was Anne who delivered a baby boy this past Friday. Jack was 19 inches at birth and weighed 6.25 pounds. Mom seems to be doing well.

We thought we might have our C-section before Anne delivered, but Jack is going to be four days older than our twins. I got voicemail from Terry saying on Friday night: “Hey Bern. Couldn’t let you beat us. It’s a boy.” I asked if Terry minded if we wrote something here. Congratulations to Terry and Anne, and a big welcome to Jack !

We talked to Suephy this weekend. She asked if we were all ready for the babies to arrive. We thought we were doing fairly well. We have the Pack n Play set up and our Diaper Champ unpacked. We have our car seats installed. We have diapers and wipes. We have a little basket for everything we’ll need to bathe our babies. We’ve washed all of the sheets and towels and clothes. We’ve cleaned the house. We’re getting a little nervous, but we figured we had most of the things we needed. Suephy asked if we had enough food.

I guess Suephy found that it was very hard to go out to get any kind of food (even groceries) during the first couple of weeks, and that one shouldn’t expect to be able to cook. She recommended that we get a number of things that are easy to just heat and eat. Between two trips to Trader Joe’s and a trip to our local Ralph’s supermarket, we’ve stocked up the freezer. I think this is the most food we’ve ever had in our freezer. We have a number of frozen dinners (chicken and turkey pot pie, Thai green curry, and some Healthy Choice meals) as well as frozen chicken, pork, ground turkey, and fish. We have over a dozen bagels and a loaf of bread in the freezer as well. We also have a number of buns and dumplings in our freezer. Our refrigerator is filled with drinks, fruits and vegetables. Our cupboard is filled with pasta, canned foods, different kinds of noodles, and a number of snacks.

It felt like we were trying to prepare for an upcoming natural disaster. All this food shopping is a little uncharacteristic of us. We tend to shop for at most two days at a time. I think we have enough food for about two weeks, but we’ll see. At least we have our parents nearby to help out, and if we’re really in a pinch, we can always order Papa John’s.

Since July 6th, we’ve been going to the hospital twice a week for a non-stress test (NST) to verify that the babies are still doing okay. Combined with our weekly appointment with the OB, we’ve had three visits per week. The non-stress test is based on the fact that a healthy baby naturally moves around a lot and the baby’s heart rate will rise immediately after moving. If this movement and subsequent rise in heart rate happens at least twice in a twenty minute span, then the baby passes the test.

We had our last NST this morning, and it went fine. Here’s a picture of Agnes hooked up to the monitor. Two of the blue disks on her belly monitor each of the babies. The third blue disk records if Agnes’ uterus is contracting. In Agnes’ left hand is a button that she presses each time she feels one of the twins moving. You can also hear their movement on the monitor itself — it sounds like a burst of static interrupting the sound of their hearts.

Here is the machine that records the NST. You can see that twin A has a heart rate of 136 and twin B has a heart rate of 135. We normally see them in the low 140s. In addition to a paper printout which is faxed to our OB, the monitor is also connected to a computer that records the data as well.

So far the twins have been very good in each of these tests. We made sure that Agnes eats a good breakfast and the babies seem quite active during the test. A good breakfast is the right way to start the day.

Yes, today I had my third baby shower. The first one was thrown by the Department of Pediatrics; the second one was hosted by Brigitte, one of my fellow neurology residents, and today’s was done by the faculty and staff of the Department of Neurology. I am just overwhelmed by how generous everyone has been. Not too much to say about this one that can’t be done in pictures, so here they are:

My mom was invited to this baby shower. You can see the nice layout of food behind us.

This is a picture with all of the secretarial staff, nurses, and EEG technologists.

Here are most of my neurology attendings.

Neurology fellows, residents, and med students on the service.

Dr. Naylor, our newest attending, and Nima, neurophysiology fellow.

Opening presents. That huge white box on the left had four little boxes inside and ended up being a gift certificate. The gift certificate was for a huge amount of money, so I’m not complaining that I got short-of-breath opening all the boxes.

Yesterday was our last OB appointment. It was probably the least eventful of all of our appointments. I mean, the obstetrician didn’t have to check my cervix–basically, if I’m not in labor, it doesn’t really matter if I’m a few centimeters dilated. On ultrasound, there was still enough fluid in both sacs. Twin A is still breech, as she has been for over the last two months. Her butt is blocking the exit, and I think the right side of my uterus has essentially molded itself to her back and head. Everytime I contract, I feel her head in the same place–the skin overlying that spot is kind of numb as well. Twin B is still transverse, but her head is a little lower down. Basically, it’s on the left side of my uterus and her body rides over the top of Twin A. Now, I just have to keep myself from going into labor until Tuesday the 2nd. Actually it wouldn’t be terrible if I went into labor now–the babies are essentially full-term, but I would prefer that my own doctor does the C-section instead of some obstetrician that is just covering for the weekend.

Yesterday we went to our last pregnancy/baby-related class, and it was on breastfeeding. This was the make-up class for last week, where the instructor didn’t show up. As a pediatrician, I reinforce to many parents that breastfeeding is far superior to formula feeding, although, I have to admit, the prospect of breastfeeding twins, and going back to work full-time in eight weeks is quite daunting. The instructor was a registered nurse who has been a lactation consultant since lactation consultants first existed–about twenty years ago. It’s amazing to think that prior to the eighties, most doctors discouraged breastfeeding.

Breastfeeding begins ideally right after birth. With me, this might be difficult because I’m having a C-section and it will probably be difficult to get them onto the breast in the operating suite. In addition, the twins will be taken to the nursery by the neonatalogist probably in the first hour so that they can be washed and be given their vitamin K shots and erythromycin ointment, and be observed for temperature instability. Hopefully, I’ll be able to reunite with them when I’m in the recovery room, but then, I might be pretty out of it and on pain medication, and they might be in their “sleepy stage” already. (Usually newborns are the most awake in the first hour, then they fall into a very deep sleep for something like eight hours.) Oh well, I guess I’ll just have to see what happens.

I am going to bring this special twin breastfeeding pillow that I bought from a “multiples” website. It fits around the belly (protecting the C-section site), and it accomodates feeding two babies at once. One thing the instructor emphasized was that I definitely should try to feed both babies simultaneously; otherwise, I’ll be feeding constantly around the clock. Although she went over the three different positions for breastfeeding (crossover, cradle, and football), in my situation, the double football hold is really the only option. She also told me that I won’t be able to pump in the beginning because I’ll be too exhausted. This was useful information because I thought that I would have to pump just to help increase my supply of milk, but the instructor emphasized that just having two babies demanding milk would be enough to produce double the amount of breast milk.

She also went over common mistakes in breastfeeding technique, which was useful for me and Bernard to see. I’m hoping Bernard will be able to help me position the twins, keep my back straight, keep their bodies aligned, and observe for “sucking and swallowing”. She told us to get the more “difficult twin” to latch on first, and then put the “easy one” on second. Apparently, when we get good at it, I’ll be able have both babies latched on, and then, I can let go and my hands will be free! I’m not holding my breath for that. And anyway, what am I going to do with my hands? Read? Knit?

Today was our second to the last OB appointment before our scheduled C-section! Just one more visit next week. Last week, our doctor said that if I were to go into labor, she would probably give me some terbutaline to stop the contractions. This week, she said that they would just go ahead with an early C-section. I guess by 36 weeks, they’re pretty confident that the babies’ lungs are okay. From a pediatrician point-of-view, a 36 week baby usually goes home at the same time as a full-term baby would, so I feel good about that. Even though part of me wants to get this pregnancy over with, I would like to make it to my scheduled C-section date, August 2nd. Things will just be much more controlled and predictable, and the babies will be fatter and more mature, which means that they might be better at breastfeeding.

I’ve been definitely having multiple contractions a day, but nothing regular, and I’ve learned all sorts of tricks to make myself feel better. For example, emptying the bladder is key–this means I’m literally in the bathroom once an hour, even at work. Drinking lots of fluids helps as well. Warm showers are good too. Then, the best thing is to lie on my side. I can’t do the last two things at work, so I’m probably being tougher on my body than I should. On the other hand, I still feel strong enough to go to work, so I’m going to try and work until July 29th, which is the Friday before our C-section date.

Today, our doctor just did an ultrasound, which showed that Twin A is still breech, and Twin B is transverse, meaning she’s floating sideways on top. They’re still pretty equal in size, which I’m quite happy about. I’ve seen a lot of cases where one twin is almost two pounds heavier than the other one! Bernard asked our doctor about having a camera in the operating room, and she said that it was definitely allowed. She also mentioned that the anesthesiologist would probably take several pictures of the two of us with our babies, because a lot of the anesthesiologists are camera buffs. I laughed because taking pictures is probably an unofficial part of their job description. In the OR, they’re the only person besides a nurse (who is usually running around) who is not scrubbed in and sterile, so they can handle and manipulate the camera. Actually, because we’re having twins, we’ll also have a neonatologist and a few extra pediatric nurses in the room as well.

We really enjoyed the first part of the Baby Care Basics class. The nurse who taught the session was both informative and funny. We had the second part of the Baby Care Basics class this week. A pediatrician came in to answer any questions people had, but no one in the class seemed to have much to ask this time. Instead, he ended up reviewing a whole series of topics — what happens at the hospital immediately after a baby is born, a plug for breastfeeding, what we can expect in terms of a baby’s sleep schedule, immunizations, etc. All in all, I guess it was all good information, but we had also heard all of this before from the Lamaze class, the hospital tour, and the previous Baby Care Basics class. A bit of review isn’t a bad thing though. The second half of the class was a video about car seats. It was okay.

One of Agnes’ co-residents at the Neurology program threw a baby shower for Agnes Saturday afternoon. Brigitte invited us, along with all of the other Neurology residents, to her place in Manhattan Beach for an afternoon party. She cooked up a storm, serving first some cocktail shrimp and bruschetta on small slices of toast. After everyone arrived, she served a late lunch which was a salad with arugula and sliced cherries, polenta, baked potatoes with cheese, bacon, and sour cream, and two kinds of skirt steak: one marinated in maple syrup and sherry, and the other with peppercorns. Her husband Kevin was responsible for grilling the steak, which was cooked to a very nice medium to medium-rare. Everything was excellent, and they have a beautiful place with a view of the ocean.

The residents all pitched in and bought us two Graco Snugride car seats for our shower. We had been getting nervous because we saw that someone had purchased the car seats from our registry, but we weren’t sure if we would get them in time. You can’t drive home from the hospital without car seats. It’s quite a generous gift.

After the baby shower, we went home and took stock of what we had and what we still need on the first day that the babies come home. We went out shopping to make sure we at least have the bare minimum. We bought a bottle of unscented Tide to wash everything, a sheet for the Pack n Play and some burp cloths. We also bought some more newborn-sized diapers to make sure we don’t need to go out for diapers on the first day back from the hospital. I think we’re all ready. We will need some additional things during the first week, but at least we shouldn’t need to stop by Babies R Us on the way back from the hospital.

We had our breastfeeding class scheduled for Saturday morning after our biweekly (twice a week) non-stress test. Since our non-stress test ended a little early, we were the first ones at the class. We recognized some of the other people who came in for the class from our Lamaze class, which was nice. Anyway, we continued to sit around, waiting for the instructor. Around 15 minutes after the class was scheduled to start, people started asking each other if they had the time right. By 30 minutes, a couple people started pulling out cell phones to see if they could contact the instructor or the hospital administrator. By 45 minutes we all decided to leave. We still haven’t heard why the instructor wasn’t there, but we will either take a make-up class another time, or we’ll just have to learn about breastfeeding when the kids arrive. Luckily, we were going to pay for the class at the session itself, so we at least don’t have to deal with getting our money back.

Last Wednesday we had our thirty-five week appointment with the OB. In this appointment, the doctor used the ultrasound to see how the twins were doing. Twin A was still in breech position, which means we’re still aiming for our scheduled C-section on August 2nd. This means that our countdown to August 15th is a little off. It overstates the time remaining in the pregnancy by 13 days. In the ultrasound, we could see twin A’s heart beating, and we could see the chest moving. The doctor said she was practicing breathing, which is a good sign. At around 35 weeks a fetus’ lungs are pretty well developed and they can breathe on their own fairly well if they’re born at this stage.

Twin B had flipped over one more time. In our last appointment, she was in the breech position as well, but she had flipped upside down again. I suspect that it is because she sits higher up that she has more room to turn over. Twin A, who is lower down, is probably more pinned in place because of Twin B on top.

The doctor measured various pockets of amniotic fluid left, and seemed satisfied with the amount of space they have. It does look tighter in there than it has in the past.

Finally, the doctor examined Agnes’ cervix and said that there’s some indication that it’s softening, but not thinning yet. Agnes had had a series of contractions earlier in the week, so we were concerned that we wouldn’t make it all the way to August 2nd, but things seem to still be okay.

Yesterday we took part one of a two part class called “Baby Care Basics.” Agnes has a lot of experience in dealing with newborns and infants, but I have next to none. I’m the youngest in my family and most of my cousins are close to my age. I’ve never babysat in my life. The only reason I have any sense at all about what babies are like is because I spent about a year traveling to Atlanta for work, and that’s where my nephew lives (and Suephy and Ed, of course). The hospital where we’re planning on having the baby offers this class in addition to the Lamaze class we just completed and a Breast Feeding class, which we’re also signed up for.

The class itself was pretty good. It’s run by one of the nurses at the hospital. She started by discussing the “Back to Sleep” program and how it’s reduced the incidence of SIDS by 25-50%. She then gave some more practical advice about how to avoid flat spots on the backs of our babies’ heads (slightly cant them to one side using a rolled up cloth, and switch which direction you lay the baby in the crib since she will often turn to look at the center of the room). The class itself was pretty big and there were quite a lot of questions. During the class we also saw a video on different ways of holding a baby, how to wash a baby, how to change a diaper, how to swaddle a baby, how to take the baby’s temperature and how to cut the baby’s nails.

The nurse’s information was pretty up to date. She brought up the fact that many doctors now recommend cleaning the stub of the umbilical cord with water instead of alcohol now. She also stressed that glass thermometers should not be used — digital rectal thermometers should be used instead. One person in the class asked about a number of practices that he had heard of, such as putting rice cereal in the baby’s bottle to help the baby sleep through the night and to prevent reflux. The nurse said that this is no longer recommended by doctors except in very specific cases. She also mentioned that the introduction of solid foods too early (earlier than 5 months) is also associated with the development of food allergies.

She had a lot of information on bottle feeding (breast feeding is a much larger topic that has a separate class). She talked about how often to feed, the importance of making the formula according to the directions so that it produces a liquid with 20 calories per ounce, and things like how long breast milk and formula will keep in the refrigerator and freezer. She talked about warming bottles and cleaning them. She mentioned that bottled water tends to be worse than tap water when making formula, because it sits around for so long. Distilled water is always a good option though. She also had a number of suggestions on how to help out a gassy baby. She demonstrated how to burp a baby and how to give the baby a massage if the gas has already moved down too low.

The two hours went by really quickly. Next week, during the second part of the class, there will be a pediatrician there to ask additional questions. Someone in the class had asked about the water you can buy at Babies R Us to make formula. It contains fluoride, which is missing from bottled or distilled water. The nurse said that it probably wasn’t worth buying, but that the pediatrician could say more about it. When I asked Agnes about it later in the evening, she said that she would need to actually see the label to see how much fluoride was in it. During the first 6 months, babies should not receive fluoride supplements (see page 8 of the American Academy of Pediatrics recommendations). Later, the amount depends on the age of the baby.

I learned a lot. Much of it was something I had seen or read in some form or another, but the reinforcement definitely helps. We’re already expecting that I’m going to be the one bathing the kids — Agnes won’t be able to do it for a while after her C-section. I also think it’ll be fun, though messy. I’m also responsible for the nail cutting. Anyway, I’m looking forward to our next class.

Yesterday, we met the babies’ pediatrician. She’s part of a four-person practice that has been in the area for quite some time. The group was recommended by some of my colleagues at work. She was quite pleased to learn that I am a pediatric neurology fellow, since there is a shortage of pediatric neurologists, and they always have a hard time finding physicians to refer their patients to.

I think my requirements for our kids’ pediatrician are slightly different than the usual layperson’s. Of course, I want someone “able, affable, and available”, as described in Dr. Sears’ book, but I was also looking for someone with quite a bit more experience than me, e.g. someone out of training for at least ten to fifteen years, and someone I feel that I could learn from. This pediatrician did fit my requirements–she’s about twenty-five years out of training, but still gave evidence that she was up-to-date on all the latest recommendations, and struck me as someone very intelligent and clinically skillful. (For those of you who are pediatricians, she trained in the era of rampant H. flu meningitis, which means she could give intrathecal gentamicin with her eyes closed.)

At the end of the interview, I met a mom who is an infectious disease attending, who just gave birth to twins, and was bringing them in for their one week appointment. They were crying and she was looking a little frazzled, so that gave me a glimpse into my future, four weeks from now. Then our pediatrician gave me and Bernard lollipops (sugar-free Splenda pops), and mentioned that they should be the same color, to avoid fighting between the twins of course.

July 6th was our last Lamaze class. We missed last week’s class because Bernard was out of town and I didn’t want to go by myself; also, I was post-call and had a presentation to give the next day. It doesn’t seem like we missed much, except for some more graphic videos. Those might have been good for Bernard to see, but on the other hand, I’m almost certainly going to have a C-section, so he won’t have to actually deal with the goriness of a vaginal birth. (In case you didn’t read the last blog entry, we found out at our last OB appointment that now both babies are breech, and I scheduled my C-section for August 2nd!)

The instructor noted that we weren’t there last week, and she said that she thought I might have been put on bedrest. The other couple who were expecting twins as well dropped out of the class for that reason. Actually, I’m surprised that I’ve made it this far. Only about three more weeks to go! And I’m still working–although no overnight call, thank goodness.

This class dealt more with post-partum stuff and a little bit on breastfeeding. Actually it was useful for me to hear about the mother’s recovery since I haven’t had any post-partum patients since medical school. The instructor mentioned that there would be quite a bit of bleeding after the delivery, so I repacked our hospital bag with extra large “overnight”-sized maxi pads. (I only put regular-sized pads there initially.) Also, she encouraged us to ask the nurses to teach us how to massage the uterus after delivery since apparently it’s a lot less painful if you do it yourself. I’m not sure I’ll be doing this post-C-section though.

At the end of class, we practiced our breathing techniques again. Bernard and I have the techniques down pretty well. Of course, things are more relaxed now that we know that I might not actually go into labor before the scheduled C-section!

Yesterday was also when we had our thirty four week appointment with our doctor. She had the results of the non-stress test we took earlier in the day, and she said everything looked fine. She also said that the Group B Strep test from last week’s appointment came back negative. Group B Strep is a kind of bacteria that is often found in the vagina. It has the potential for causing meningitis if a baby is infected by it either during labor, or if the mother’s membranes are ruptured for a significant amount of time. Anyway, Agnes’ test came back negative.

Our doctor continued the examination in much the same way she does every other appointment. She did an ultrasound to measure the size of each baby, as well as gauge whether they still have enough space. By taking different size measurements, such as the size of the head, abdomen and femur, the ultrasound machine can estimate how big the baby is. In our case, it looks like each baby is a little over five pounds. Considering that the average birth weight for twins is 5 lbs, 5 oz, this is good.

From our Lamaze class, I realized that most people have only two or three ultrasounds done during their entire pregnancy. One nice thing about having twins is that we’ve had an ultrasound at most of our appointments. It’s nice to continue seeing them grow. Their heads barely fit on the monitor at this point.

The ultrasound also revealed that both babies are now in the breech position. Last week one was right side up, the other was upside down. Now they’re both right side up. This isn’t good. If either are in the breech position by the time Agnes goes into labor, they will have to do a C-section. Our doctor suggested that we schedule a C-section during our 38th week and if they don’t both turn before that week, then they’ll do the C-section. It’s pretty unlikely that they’ll both turn.

The 38th week is the first week of August. We scheduled the C-section for August 2nd at 12:30pm. It’s kind of weird to pick out when the babies’ birthday will be. We asked for August 1st, but the hospital was already booked for that day. It’s still possible that Agnes will go into labor before August 2nd, and in that case they’ll have less time to prepare for the C-section. For now, we know that the pregnancy won’t go past August 2nd.

Yesterday we had our first “non-stress test.” A non-stress test measures how the fetuses’ heart rates change in time to their own movement. Heart monitors are strapped to Agnes’ abdomen, and she presses a button every time she feels a movement. The heart rates are printed on a strip of paper with little arrows marking the places where Agnes pressed the button. In addition, the strip of paper also records any contractions that Agnes has. This test is different from a “stress test” where Agnes would be given Pitocin, which causes contractions and the heart rates of the fetuses are measured. We haven’t had one of these stress tests.

The heart rates generally ran between about 140 beats per minute to 160 beats per minute. The heart rates ran higher after each of the three contractions that Agnes had during the twenty minute test. It may sound like a lot of contractions to have in twenty minutes (considering the doctor told us we should be calling her if we had five or more in an hour), but these were pretty small contractions. If not for the monitor, Agnes might have dismissed them as movements from the babies. I’m not entirely sure what else they were looking for from the non-stress test, but apparently things looked okay.

We’re going to be doing these non-stress tests twice a week, in addition to our weekly OB appointment. That means we’ll be going in for an appointment of some kind three times a week from now until the end of the pregnancy. Fortunately, we’re getting close to the end.

Yesterday, I put together a duffel bag full of the things we’ll need when I go into labor. I used a recommended list of things from our Lamaze workbook:

1. robe and slippers
2. toiletries and cosmetics
3. extra pillows
4. socks
5. nursing bras
6. nursing pads
7. going home outfit and blanket for baby
8. going home outfit for mom–early pregnancy size
9. breastfeeding book

Things that were on the list, but that I opted not to include were “hand mirror to view pushing in the labor room”, “flavorings for ice chips”, “vibrating pillow”, “baby book for footprints”, “birth announcements” (we’ll email everyone), “portable CD player”, “snacks for partner” (given that this bag may sit around for a month or so, I think Bernard would prefer to bring fresh snacks).

Things that weren’t on the list, but that I thought would be useful:

1. hair dryer
2. underwear
3. feminine pads (the ones in the hospital don’t have wings etc.)
4. nipple cream
5. bathing suit for partner (in case Bernard wants to help me labor in the shower)
6. heat/ice pack
7. list of hospital policies from the hospital tour (e.g. visiting hours, phone number to your hospital room, where you can use your cell phone, cafeteria hours, reminder to call your insurance company about the hospitalization and about putting your baby on your plan, how to order social security card and birth certificate)
8. mittens for baby (they’re not allowed to cut the baby’s fingernails, so you have to bring nail cutters or mittens)

After the delivery, I’ll revisit this list to let you know if we brought the right things.

June 28th was our thirty-three week appointment. Because the appointment was on a different day than usual, I saw the other obstetrician who shares the office with my doctor. If I have a spontaneous vaginal delivery, then it’s possible that he could be doing the delivery. Scheduled or emergency Caesarean-section means that my doctor comes in no matter what. (There have to be two obstetricians for all C-sections).

I now weigh a whopping 162 pounds! I mention this partly because I’m a little tired of hearing people at work say, “You don’t look very big. You can’t possibly be carrying twins.” Everyone I run into says this. I guess I should be grateful that they’re not saying, “Wow, you’re huge! And you still have (blank) months to go?” If you’ve seen the picture of me from last week, you’ll see that I am huge, although the weight is spread out over my entire abdomen. I like to say I’m “watermelon-shaped”, as opposed to protruding like a basketball. One problem with my current shape is that I’m carrying high, and if I sit for more than fifteen minutes I get a band of numbness right under my breasts from compression. It’s quite annoying.

After this appointment, I move to weekly appointments until the delivery. I also have to get non-stress tests twice a week starting next week. This means three appointments a week! Apparently this is all routine, so there isn’t anything to be concerned about. Bernard and I are also meeting the girls’ pediatrician next week, so I’ll definitely feel like I’m constantly going to the doctor’s office. (I hope people at work are okay with me being out so much).

It’s starting to look more and more like I’m going to have a C-section because the baby on my right-side has been breech now for more than six weeks. This is despite Bernard telling her to turn over through my stomach. Although I like the idea of being able to deliver both babies naturally, I also think that the controlled, non-rushed environment of a scheduled C-section sounds good too. So we’ll see what happens!

We have earlier pictures of Agnes and each of our pregnant friends as each of them reached the twenty two week mark in their pregnancy. Susan’s picture was taken at thirty three weeks though, and so we’re putting together pictures of the same people as they each reach thirty three weeks. So far, we have three pictures: Agnes, our mystery person, and Susan. When Anna reaches 33 weeks, hopefully she’ll take a picture too and we can add it to this list.

The first picture is Agnes at 33 weeks.

The second picture is our mystery person, who remains anonymous. Unfortunately, this means that her picture is zoomed in more.

Our third picture is Anna, who was also featured in our 24 week pictures.

And our fourth picture is Susan. It’s the same picture that we posted when we showed people at 22 weeks, but it’s cropped into a square to match the other three pictures.

After skipping the Lamaze class last week, I felt a little behind. I read through the booklet they gave us while the class was starting. It looks like the parts I missed were the discussions around active labor (where the cervix dilates 4-8 cm) and transition (8-10 cm). At that point, the cervix is “fully effaced” and the baby’s head can squeeze through. The baby’s skull is a little soft, which allows it to deform a bit on the way through, and some pregnancy hormones have been softening up some tissue in the mother’s body, which allows the pelvis to pull open a bit around the cartilege. The softening of tissue in the mother’s body means that she may be more easily injured with over extending — don’t help up pregnant women by pulling on their arms or she may strain her shoulder!

During this class, we discussed stage 2 of labor. This is when the baby is actually moving through the birth canal until she’s born. This is the only time where actual pushing happens. If you start to push too early, you will be pushing against the cervix since it’s not fully open, and this will cause it to swell and close up.

We saw a video of several births, which were different from what you normally see on something like Discovery Health Channel. The births you see on Discovery Health Channel generally don’t show what is happening down between the woman’s legs as the baby is coming out, and they generally show deliveries that run into some kind of trouble. In our class we got to see the whole thing (edited for time, but not really content), and for the most part they went smoothly. It’s quite messy though. I had no idea. I mean I knew it was messy, but this was more than I expected. I’m glad I’ve had some warning.

We talked about different medications and what effects they have on deliveries. We also talked about tearing and episiotomies (cutting to prevent tearing). Agnes and I took a look at a chart that lists different possible medication preferences to see where she thinks she is. The preferences are fairly detailed but they basically range from “I don’t want to feel anything” to “I don’t want any medication under any circumstances”. Agnes gave me an idea of where she thinks she is, but obviously we need to talk about it more and give it more thought.

We ended the class with some practice of our breathing. We first did two different patterns of breathing for use during active labor and transition, and then we practiced the breathing one does while pushing. I’m supposed to count for a certain duration while Agnes is pushing and when I’m done counting, she exhales, takes in a new breath and I start counting again. I need to work on this though, because I think I was counting too slow.

Unfortunately, I’ll be missing the session next week, but I’ll be there for the final session.

Last Thursday, we got a letter from our local Honda dealership saying that they were interested in acquiring a number of 1997 Honda vehicles for their upcoming July 4th sale and that this weekend they would like such owners to come in and talk about possible trade-ins. It was kind of a strange letter — it was hard to tell if this was really any kind of special opportunity, but since we’ve been considering getting a minivan, we thought we would go in to talk to them. We had previously ruled out a wagon because we thought it would make us constantly bend over while trying to lift our kids out of the back. We ruled out an SUV because of safety reasons. We had a 1997 Civic HX Coupe and a 1997 Accord LX Sedan. Between the two, we thought we would trade in the Civic since a two-door car isn’t going to be as useful after the kids arrive.

Prior to going to the dealership, we did a bit of research first. The Honda Odyssey got good marks from Consumer Reports. The top two contenders for minivans are the Odyssey and the Toyota Sienna. As we read through the various customer reviews, we came across several points of interest. Some people found the steering wheel of the Odyssey to be a little far away and thought it a shortcoming that it did not telescope. There’s no coin holder. Some people found the arm rest so short that their elbow was barely resting on it. Some of the cup holders seem flimsy. On the whole, though, people seemed to like what they got. The other good thing about the review is that you could get a sense of what people actually paid for their Odyssey.

We also took a look at Edmunds.com and Kelly Blue Book. Edmunds gave us information about the MSRP and Invoice prices for the Odyssey as well as what they call the True Market Value (TMV). The TMV lists the national average selling price for the model we were interested in, as well as what kind of adjustment in price we should expect based on our zip code. Kelly Blue Book gave us an indication of what our Civic was worth for a trade-in.

When we got to the dealership, we were greeted immediately, and we talked about what we were interested in doing. Both Agnes and I test drove the Odyssey model we were interested in (the EX with leather — hopefully the leather will make it easier to clean up vomit and spills). I have to say that it certainly doesn’t drive like other minivans I’ve tried. Agnes’ mother has a Windstar that I’ve tried, and this has a much better feel overall. We then sat down to talk about trade-in prices and what we were willing to pay for the Odyssey.

We talked to the sales person, Reza. We talked to his manager, Ed. And finally, we talked to Ed’s boss, Nasir. We started from pretty divergent points in both the trade-in value of the Civic as well as what we were wiling to pay for the minivan. When all was said and done (2 hours later and half a dozen attempts to walk out entirely), we had come to an agreement. We bought the Odyssey for almost exactly the price listed on Edmunds.com that we should have expected to pay, and we got something close to the Kelly Blue Book trade-in value for the Civic. In addition, they threw in some wheel locks (special lug nuts that must be removed with a key to prevent the wheels from being stolen), two free oil changes, and a free refill of gas. Yes, these extras don’t really amount to much, but when we got to the end of the negotiation, we were trying to close the gap on about $100.

There were a couple of things we learned from the experience.

1. Get back the keys to your trade-in as soon as possible. We gave our keys to the dealer so they could appraise the car, and it put us in a position of needing to ask for the keys back in order to walk away from the deal.
2. Start the negotiations from the right numbers. We started the trade-in negotiation from the “trade-in” value listed in Kelly Blue Book, rather than the “resale” value. The trade-in value in Kelly Blue Book is lower than the resale value because it already accounts for the dealer costs in getting the vehicle ready to sell again. Starting from the lower number just put us in a worse position.

In the end, we bought the Odyssey, paid it in full, and drove it home. I’m a little sad that we no longer have the Civic. It was the first car we ever bought, and we liked it a lot.

Once we got home, we took pictures of our new minivan.

Besides being our first minvan, it’s a first for a lot of other things. It’s the first time we have a moon roof, remote entry, a CD player in the car, leather interiors, and heated seats. When they were showing us the various features of the minivan, they kept on saying “this works just like you would expect”, and we kept on saying “but…”.

The space is great and one of the big things we’re happy about is we’re going to feel a lot more comfortable putting the infant car seats into the Odyssey than we were with the pre-LATCH 1997 Accord. That’s one more (very expensive) thing to check off of our list of things to get.

Unfortunately, Bernard was in Chicago for the third Lamaze class, so I had to go by myself. It wasn’t too bad until the instructor started going over massage techniques, and there was no one there to massage me. I just sort of sat there on my mat and did some stretching exercises, while everyone else was getting massaged by their husbands. Oh well.

During the class, we went over the “active labor” and “transition” parts of Stage One of labor. During “active labor” the cervix dilates from about 4 to 8 cm. When this part of labor starts, contractions should be about 3-4 minutes apart and this is the time to go to the hospital. During “transition”, the cervix dilates from 8 to 10 cm, and the contractions are the most intense. This is the time to use the breathing techniques that you see so often on TV shows, i.e. “hee, hee, hoo”. This type of breathing is called “modified paced breathing”, which essentially mixes rapid breaths (the “hee”) with larger exhalations (“the hoo”). You can do them in ratios of 3 to 1 then 4 to 1 etc. The instructor said it was helpful if the husband holds up fingers indicating each breath, so I’m going to have to teach Bernard how to do this.

The last half-hour of the class always involves practicing the relaxation and breathing techniques. The instructor dims the lights and we all lie down on our mats. Usually, I focus on what the instructor is saying, and also on what Bernard is doing (in case he falls asleep and starts snoring), but without him there, I completely fell asleep myself. I have no memory of what happened during the last half-hour of the class. I woke up when the lights were turned back on and people started rustling, collecting their stuff to go home.

We had our 31 week appointment this week. Before the appointment we were making guesses about the orientation of the twins. At our last appointment, the one on Agnes’ right was in breech position (butt down), and the one on Agnes’ left was head down. Agnes’ guess was that the one on the left had flipped over because she could feel a firm, orange-sized mass in the upper left-hand part of her belly, which she thought was the left one’s head.

When the doctor did the ultrasound, we found that the twin on the right was still in breech position. The one of the left had not flipped over. Instead, it had kind of migrated up and was lying across the top of Agnes’ belly. It’s such a strange position for it to be in. What we’re really hoping for now is for the one on the right to flip over. If it doesn’t by the time we reach August, we’ll be scheduling a C-section.

The two have been gaining weight nicely. Twin A (the one on the left) is about 3 lbs, 6 oz. Twin B is about 3 lbs, 12 oz. Together they make up a little over seven pounds of baby! At this point in the pregnancy, Agnes has reached about the size you would expect for a single full-term baby.

We took care of some other minor things during this appointment. We asked who else might be there for the delivery aside from our OB. It turns out that she alternates with the other doctor in their office, so it may be a good idea for us to meet him. Agnes got a renewed prescription for her pre-natal vitamins. And with a cervix examination, it looks like there were still no signs that it was “thinning”, a change the cervix goes through as the uterus is getting ready to deliver.

Since the end of April, our visits with the OB have been every two weeks. After our next appointment (the thirty-three week appointment), we’ll be moving to a schedule of every week. During that week, we’ll also start doing what is called a non-stress test to see how the babies are doing. If their vitals look decent, then we’ll just let the pregnancy continue. If there are certain warning signs, then it may be worth delivering them early.

Agnes’ co-workers threw a baby shower for her today. Actually, it was a joint baby shower with another one of her co-workers whose wife is expecting. I asked several times if she was sure I was supposed to be there (since many of these things seem to be women only), but her co-worker is a guy, and there were other guys coming, so it seemed to be okay.

This baby shower seemed to consist of eating snacks (brownies, chips, cake) and opening presents. Agnes had me write down who gave us what gift as she opened them to the “awww…..”s of everyone else. Both she and Kevin (her co-worker) were opening gifts at the same time, and a couple people were taking pictures.

We ended up with mostly clothes, which is what I expected, but there were a number of other gifts in there as well. Surprisingly, it wasn’t all pink. Some people were even daring enough to give us blue which I think is fine — our girls can’t be wearing pink all the time. I think only one gift was from our registry, but there’s no problem in that. We didn’t put any clothes on our registry, and baby clothes are a pretty common baby shower gift. Some people even thought to give clothes for kids older than 6 months. We’ve heard from several places that we shouldn’t bother buying clothes for newborns as that’s what will make up most of our gifts.

At the end, Agnes and I were able to carry all the gifts to my car in a single trip. For those of you out there attending baby showers, bring an extra bag or two to help the recipient of the gifts carry everything. It’ll really help.

I’ll take pictures of everything we got and put them up. I just haven’t had the chance to do that yet. You’ll be able to see them on the “baby stuff” page in a little bit.

[edit: 06/12/2005 — The pictures are up! Maybe if we can get pictures that other people took of the actual shower, we’ll put those up too.]

We had our second Lamaze class on Wednesday. Again we brought our pillows and a mat for the relaxation exercise at the end. We brought two mats with us this time so that I could lie down as well.

The class itself is pretty slow-paced. Last week, almost half of the class was spent on introductions and getting to know each other. This time, we started with about a half hour of the same kind of thing. We did one of those games where you need to fill out a chart with things like “Find someone who has run a 10K” and “Find someone who wears colorful earrings”. I guess we know the names of more of our classmates at least.

This class focused on early labor. This is the period of time before you reach 4cm dilation. The two big points that our instructor seemed to emphasize were that you should stay at home as long as possible and that there’s a wide range of what duration is considered “normal”. The reason that you want to stay home as long as possible is because there just isn’t a whole lot to do before you reach 4cms. We were told to come to the hospital after the contractions have been going on for 3-5 minutes for at least an hour. One student was a little worried that waiting that long may mean that they may not make it to the hospital in time, but in general, if the baby comes so quickly that it’s delivered at home, it hardly ever means that there are any problems. These tend to be the robust, healthy babies. It’s the babies that don’t come out for a long time that start to undergo stress.

We ended with Agnes’ favorite part of the class — the relaxation exercises. The point of these exercises is to eventually get a better understanding of how to force yourself to relax. I suppose this will be important for labor where you need to be relaxed for things to progress at a reasonable pace. There are other factors that can slow a delivery down, but being all tense seems to also be counterproductive. Agnes said that she thought I had fallen asleep during the relaxation exercise. I guess my breathing pattern does change, but I’m pretty sure I wasn’t asleep. It reminds me of when we were doing some relaxation exercises at the end of yoga with Shane and Anna and Agnes started kicking me because she thought I had fallen asleep. It was actually Shane (or was it Anna?) that had fallen asleep, and I just couldn’t relax because I was getting kicked.

I won’t be able to make it to class next week because I’ll be traveling again for work, but hopefully I won’t miss a whole lot.

We started our Lamaze class this past week. Our class is six two-hour sessions each Wednesday night. Before the class started, we got a call asking us to bring four pillows, a mat or towel, a watch with a second hand, and comfortable clothing. Not a lot happened in the first class. It was mostly a matter of introductions and people talking about what they wanted to get out of the class and what they were worried about with the pregnancy and delivery. Among the other people in the class, there was one other couples that go to the same OB that we do, and another couple that was also expecting twins. Here’s a picture we took with the class.

We did get a few good tips. The instructor described how to do Kegel exercises and pelvic tilts (to learn to push properly and to ease back pain). She emphasized the need to remain hydrated to prevent cramps and she talked a little bit about nutrition. This session was mostly about the pregnancy. I think it’s in subsequent sessions that we’ll talk about the labor and delivery more.

We ended the class with about 20 minutes of a relaxation exercise. I guess this is why we were asked to bring pillows and a mat. The instructor darkened the room and everyone lay down on their mats. She played a tape that talked us through relaxing, and then when the tape was done, it was time to leave. We were given a “Prepared Childbirth” booklet that we’re supposed to read from before the next session. People grumbled a bit about the homework, but really it’s not much reading at all.

June first was our twenty-nine week appointment. I’m seeing the doctor every two weeks now, and she ultrasounds the twins every time. I’m having intermittent contractions now, and random pains in my pelvis, so it’s always a relief every two weeks to see that the twins are okay, and my cervix is closed. They’re estimated at 1400 grams now, which is three pounds! They’re exactly the size they should be if I was only carrying one baby, so it appears that they’re growing well. They also keep changing their position at every appointment. Now Twin A is breech, and Twin B is still upside down.

We got these two ultrasound pictures of the twins. They’re so large now that they don’t fit completely in a picture. These pictures show their heads as well as part of their torsos.

My doctor gave me the results of the blood tests I had done last time. My one hour glucose level was 103, which is normal, and my hematocrit was 37%, which means that i’m not anemic! My doctor was surprised as well. I guess the extra iron pill that I take everyday has been working.

We bought a dresser for the babies’ room and just had it delivered last weekend. When we went shopping for it, we considered a couple of possibilities. There are relatively cheap three-shelf changing tables. There are dressers with a built-in changing area on top. What we chose is a simple three drawer dresser with the idea that we could put a changing pad on top. Later, when we no longer need to change them, we can still use this dresser for their clothes. We ended up with a Pali dresser. Pali tends to be an expensive brand, but we were able to pick this up for 55% off by getting the floor model. We examined it closely in the store, and there really doesn’t seem to be anything wrong with it.

When the delivery person brought the dresser over, he asked where I wanted it. I pointed to a spot in the room and he just put his arms around the whole dresser and carried it in. I was quite impressed. Later on, when Albert and I were painting the room, we had to move the dresser back out of the room and it took both of us to move it safely.

We haven’t really been blogging much about other people’s pregnancies, but Susan has had her picture in one of our blog entries. Susan’s pregnancy had been progressing at about 12 weeks ahead of Agnes’, and last weekend on Sunday, Susan delivered about 5 days early. Anything from 38 weeks to 42 weeks is considered “full term”, so there’s no problem in delivering early.

It sounds like things went well. The new baby girl is 3.3kg (about 7.28lb), and as of last Monday when I heard from Jeremy, they hadn’t picked out a name. Susan and the new baby were already resting at home, with the new baby eating every 2 hours.

Congratulations Susan and Jeremy, and I hope you like your new sister, Sarah!

[edit] The baby’s name is Maya!

Today’s appointment started out with two blood tests, one for the glucose tolerance test and one for my hemoglobin level. One hour prior to the appointment I drank the sickeningly sweet sugar drink that you take prior to having the glucose level from your blood checked. Actually it wasn’t that bad, because it’s carbonated, and I made sure to leave it in the refrigerator at work all morning. (You’re not allowed to dilute it with ice.) The glucose tolerance test checks for gestational diabetes and is routinely done around 28 weeks. Hopefully, my glucose level won’t be too high, although I’m a little worried because I ate a huge carb load at lunch today, about two to three hours prior to the appointment. (We had catered Italian food at work.)

The hemoglobin level will reveal whether I’m severely anemic or not. I already expect to be somewhat anemic because I’m carrying twins, but I’ve been good about taking my extra iron pill, so hopefully, it won’t be too bad.

My doctor did a quick measure of my uterus and a quick ultrasound. Now, both fetuses are head down, which explains why I’ve been feeling the kicking all above my bellybutton. On the ultrasound, there’s an appropriate amount of amniotic fluid around them, and they’re quite active, so everything looks good so far. Next appointment will consist of some more measurements to make sure they’re growing well and at the same rate.

Happy Mother’s Day to all you mothers out there.

In addition to seeing the maternity ward today (some of those pregnant women were huge!), today we also reached double digits in the number of days remaining before our due date. 99 days to go!

Today we went on a tour of the maternity ward at the hospital where we will deliver the twins. It was so much fun! We got there super late, but they had just sat everyone down in a large conference room, handed out some informational flyers, and served some tea and cookies. Just before we rushed into the room, they handed us a raffle ticket for some gifts that people had donated for the expectant mothers. There were about ten pregnant women there with their significant others. One woman also brought her two other kids.

The first part of the tour was spent going over the logistics of coming to the hospital, visiting hours, who can see the baby when, etc. Security on maternity wards is especially tight because of a rash of newborn abductions that happened in California in the nineties. They drilled us about how no hospital employee can be near your baby unless they have a special pink badge. Also, the baby will have two identification bands (wrist and ankle), and the mother and the father each get an ID band as well. Only the two people with ID bands can accompany the baby back and forth from the delivery room to the nursery. (I’m going to have to reinforce this with my mom, who will feel like she’s entitled to be with the babies as well.)

There was a lot of useful information given, like how to get a social security number and birth certificate for your baby, what to bring to the hospital, what to do when you get to the hospital. Basically, all parents should pre-register so that when you show up at three a.m. saying, “I’m in labor”, you can head right up to the maternity ward because you’re already in the hospital system.

At the end of the informational session, they did the raffle ticket drawing to give away some gifts, and, somewhat embarrasingly, since we had sauntered in so late, we won the biggest gift! You can see the cute gift basket on our “Baby Stuff” page.

Then, they started the tour. They showed us the emergency entrance (to use if you go into labor in the middle of the night), and the regular entrance (if you go into labor during the day). Then, we went up to the maternity ward. I couldn’t help but compare this hospital to the hospital where I work. All I can say is, there is a huge difference between a public and a private hospital maternity ward. At the private hospital where we’ll deliver, they have to work hard to attract insured patients to deliver there, so there are some really nice amenities. At the public hospital where I work, we serve mostly uninsured and Medicaid patients, who don’t really get a choice of where to have their baby, so it’s necessities only. The Labor and Delivery rooms are large, with fancy beds that come apart and have a squatting rod too, if you want to squat during your labor. Cold reality set in when they whipped out the hidden stirrups, i.e. the room looked like a nice hotel room before they did that. They also have this awesome lighting system for the doctors where these really bright globes in the ceiling move around to wherever the nurse points a small remote control. There’s a pull-out bed for the father so that he can stay overnight as well. One thing they emphasized is that the nurses under no circumstances want to see the father in his underwear, so make sure to bring clothes for him.

We then went to see the newborn nursery, the C-section rooms, and the post-partum rooms. One really nice thing was that there’s a ninety-five percent chance you’ll be able to stay in the same room during your whole hospital stay, i.e. the same room where you delivered the baby, so you won’t have to be moved to a post-partum room. At our hospital, as soon as you recover from your delivery, you’re moved to a post-partum room that you have to share with three other patients and their families. At this hospital, in the event that you do need to be moved to a post-partum room (because they’re overloaded with a ton of women in labor), it’s still a private room that you don’t have to share with any other patients. Overall, it was a very informative and fun afternoon, so I definitely recommend the hospital tour for you pregnant couples out there.

One of the risks in twin pregnancies is that they arrive early, so starting from 22 weeks or so doctors start to monitor for signs of pre-term labor. In our last OB appointment, the doctor did a test to see if fetal fibronectin (fFN) could be detected. Fetal fibronectin is a protein that helps hold the gestational sac to the uterine wall. If the test picks up signs of this protein during the third trimester (which indicates that the sac may be coming loose) and there are other signs of labor, then we need to worry about labor starting too early. The lack of this protein in the test is a good thing.

Our doctor called us yesterday with the news from the fetal fibronectin test. It came back negative!

We’ve started to get some gifts for the kids, so we decided to show what kind of stuff we got. There’s a new link on the side of the page called “Baby Stuff” which shows pictures of everything we have so far.

No, we don’t actually have the cribs yet, but they are on order so I decided to put the picture in there anyway.

Based on a friend’s warning that it takes something like 10+ weeks for a crib to be ordered, we went shopping today for a crib. Although the twins might be able to sleep in a single crib side-by-side for the first month or two, we knew we would need two. They do make specialty twin cribs, but they don’t seem to be very common and they probably have added costs with non-standard mattresses and sheets.

We had read up on cribs in Baby Bargains, and had some idea of what we were looking for. We were looking for something pretty basic with a knee-push drop gate, hidden hardware, wheels, and multiple mattress heights. We weren’t that concerned about whether or not it had a drawer or fancy detailing.

We went to a local store called USA Baby which is situated among several other furniture store and we ended up placing an order for two cribs by Legacy. Legacy is a brand of ChildCraft, a 95 year old company based in Indiana. They have a good reputation for quality, though they suffered some financial problems in 2004 due to a flood (according to Baby Bargains). The cribs were on sale and USA Baby gave us an extra 10% off of the second crib. They give that extra discount on anything where we buy a duplicate.

Overall it was a quick purchase, but reading back on Baby Bargains, it seems like it was a reasonable buy. The order time we were quoted was 10-14 weeks. If it takes 14 weeks, Agnes will be in her 39th week of pregnancy. Given that twins tend to arrive early, that’ll be pushing it. We may need to use a Pack ‘N Play for the first few weeks, but that should be fine.

We had another OB appointment today. It’s a little before twenty five weeks, but I thought I would call it our twenty five week appointment anyway.

At our last appointment, the doctor only did a cursory ultrasound to make sure that the fetuses both had enough fluid. This time, she also checked to see that they were both growing well and at about the same pace. She made three measurements on each fetus — length of the femur, size of the abdomen and size of the cranium. The ultrasound machine then takes each measurement and comes up with an overall average guess at the age of the fetus. They both came out to be 24 weeks, 6 days, which means their growth is just about on target, and that they’re both the same size, which is great.

In addition, the doctor checked the length of Agnes’ cervix, which would appear shortened if she had signs of going into preterm labor. In this case, Agnes’ cervix looked fine. Finally, the doctor screened for fetal fibronectin, a protein that is detected when a woman enters preterm labor. We’ll find the results of that at our next appointment at twenty seven weeks.

Once again, everything looks good. We now need to start our shopping in earnest.

Two nights ago I had my hand on Agnes’ stomach as I was going to sleep. Agnes was already asleep. I felt a small thump against my hand from her left side. By now we would have expected to feel some kicking, but I wasn’t sure if this was it. I felt more carefully and definitely felt the same thing. I woke Agnes up and told her, “I think I feel them kicking.”

Agnes woke up and tried to see if she could feel the same thing, but the twins had gone quiet. She was a bit disappointed that I was the one who felt them kicking first (“Why were you feeling my stomach anyway?”), but she was also excited about it.

Anyway, tonight, two nights later, both twins have definitely been moving around. It’s quite cool.

We also took a 24 week picture of Agnes to have a better comparison with our friend who sent us a 24 week pregnancy picture two weeks ago. We’ve reposted her picture here alongside Agnes’. There is a 5 inch difference in height between Agnes and this friend.

 

[Edit: 5/10/2005] I added Anna’s picture as well. Both Agnes and the mystery person were about 39 inches around. Anna is about 36 inches around. All three of these pictures were taken at 24 weeks into their respective pregnancies.

A few weeks ago on April 1, at twenty-one-and-a-half weeks, I had a fetal echocardiogram done. The fetal heart can be examined by ultrasound, similar to an adult echocardiogram, and it is done not by obstetricians, but by pediatric cardiologists. Dr. Dave Atkinson, who was my attending when I was a pediatric resident, and Ning Qi, the echocardiographer, do all the fetal echocardiograms at the hospital where I work. Fetal echos are done when the obstetrician suspects that there might be something wrong with the heart, or there is a family history of congenital heart defects. In my case, Dr. Atkinson and Ning just wanted to look at the twins’ hearts for fun. So I just showed up to the ultrasound room on a Friday afternoon to get another look at the twins on ultrasound. I also brought a videotape so that they could record the images. It’s taken us a little while to transfer the video onto the computer and edit it into four short clips. The first three clips are completely silent. Only the fourth clip has sound.

This is an ultrasound video of the aorta of “Twin A”. (By the way, twins are named by their relative position in the uterus. The twin that is lower down in the pelvis is “A”, signifying that she will be delivered first in a vaginal delivery. For me, Twin A is on the right side of my uterus.) The aorta is examined mainly for its overall size and development. There are congenital heart defects where the aorta doesn’t grow well, and either is shortened or narrowed in a specific region. The blue flashes of color represents the blood flow in the aorta, and the fact that it makes a nice candy-cane shape and that it is consistently blue throughout its length means that it is a normally developed aorta.

This is a video of the head and torso of Twin A. You can see the face on the left side of the screen and the chest in the middle. The moving dark object in the center of the chest is the heart. The heart itself is examined for abnormalities in structure. Congenital defects of the heart can include underdevelopment of any of the four chambers of the heart, or holes in the walls between chambers. It’s difficult to tell on this image unless you are an experienced reader of echocardiograms but the four chambers of the heart (two atria and two ventricles) appear normal, and there are no holes between chambers, except the one that’s supposed to be there, the foramen ovale.

This is a video of both fetuses moving. Twin A is on top Twin B is on the bottom. Twin A is lying with her head on the left side of the image facing down, and you can see her doing a lot of kicking. Twin B is lying with her head on the right side of the image and you can’t really see her legs because they’re bent off to the side and beyond the two-dimensional plane of this image. Between the twins is a thin white line which is the membrane that separates them.

This is a short Doppler ultrasound of the umbilical cord. The umbilical cord consists of two arteries and one vein, and you can aim the probe towards the cord to get an idea of the blood flow going to and from the fetus. The information obtained from one of the umbilical arteries is represented by the waves in the video. As the blood flows from the heart, it makes a pulsating sound which also corresponds to the waveforms. In this quick two second clip, you hear five “whooshes”, which, if you multiply that times thirty, you can calculate that the heart is beating 150 times a minute. As you may know, 150 is slightly fast for a fetal heartbeat, but this is due to the fact that I was about to pass out on the table. By this point in the ultrasound, I had been lying on my back for more than 30 minutes, and I wasn’t getting good blood flow to my own heart (and brain), so I started to feel faint. It’s been well documented that if the mother is uncomfortable, the fetal heart rate goes up. When I shifted to lying on my side, I felt much better, and the fetal heart rate went back to normal (around 130 beats per minute).

Last Friday we had another doctor’s appointment. The appointment started with some basics — a urine sample, a weighing and a measurement of blood pressure. With this appointment, Agnes has just about caught up to me in weight. At the start of the pregnancy, I outweighed Agnes by about twenty pounds. She says that after she puts on a little more weight, she’ll be able to squash me.

The obstetrician did a fairly informal ultrasound. She just verified that the twins had enough fluid around them still. One often find twins starting to run out of space towards the end of pregnancy. Fortunately, that’s not the case with our twins yet.

The doctor said that at our next appointment we’ll see if they’re still growing well, and if they’re close to being equal in size. In each of our appointments, one baby has always been slightly larger than the other. We want to make sure that the discrepancy in size doesn’t grow significantly. With identical twins, there is a risk of a complication known as Twin to Twin Transfusion Syndrome where, though the twins share the same placenta, one twin takes more than its share of nutrients at the expense of the other. Again, there fortunately is no sign of any such thing with our twins. The doctor moved us up to seeing her every two weeks instead of every four weeks just so things can be monitored a little more closely from here on.

Finally, we got the results of our triple screen exam. This exam tests for neural tube defects, the presence of Down Syndrome and the presence of Trisomy 18. Each of the tests establishes a probability for the likelihood of a problem, and if the probability is above a certain threshold, then further tests are recommended. We chose to do this triple screen to determine if the relatively dangerous amniocentesis was recommended. Our neural tube defect test and our Down Syndrome test came back negative. Not enough data is available on twins to tell us how to interpret the data about the Trisomy 18 test. On the other hand, Trisomy 18 is always accompanied with heart defects and two weeks ago we had a fetal echocardiogram which showed two healthy hearts. We’ll try to get some of the video from that fetal echocardiogram posted soon. Anyway, it looks like we don’t really need to be worried.

So far so good!

We recently got a picture from a friend who is 24 weeks pregnant and thought that it might be nice to show what Agnes’ pregnancy looks like these days. Until now we’ve pretty much only been posting ultrasound pictures. There was one picture of Agnes last week in the post about the body pillow, but it’s hard to get a sense of what things look like in that picture.

Here it is.

[edit: April 14] My 24-week pregnant friend said it’s fine if we also post her picture. She asked me to crop it this way. Anna, a different friend who happens to be 21 weeks pregnant gave us the picture on the right to post.

 

[edit: April 22] Susan gave us this picture of her at 33 weeks. She also sent a picture of her daughter Sarah at 26 months

 

So far this pregnancy has been relatively painless, but I am starting to feel some back soreness, especially when I wake up in the morning. One of my coworkers recommended a body pillow, which is basically a long pillow which supports your back, cushions between your knees, and supports your neck as well. Bernard insisted on taking a picture of it after we got home from the store, which you can see below.

Actually, it was pretty comfortable when I first tried it. Last night, I slept with it for the first time. I should add that pre-pregnancy, I slept mostly on my back, but since becoming heavier and heavier in my mid-section, I now do a lot of tossing and turning in my sleep. The body pillow forces you to lie on your side, which is the ideal position for sleep during pregnancy since it’s impossible to lie face down, and lying on your back is bad for the blood return to the heart and it strains the back itself. Consequently, I did find it a little annoying that I couldn’t move around very much while sleeping like I normally do, but, on the other hand, my back didn’t hurt when I woke up this morning. I guess if I can get used to sleeping on my side through the whole night, the body pillow will have been a good investment from a “back-sparing” standpoint. I’m on-call in the hospital tomorrow, and I’m considering bringing it so I can use it on the very uncomfortable on-call beds.

Today is the halfway point for a full forty-week pregnancy. Twins have a tendency to come early, but there’s no real reason this pregnancy can’t go to forty weeks. I thought I would just list a few highlights on what’s going on in the pregnancy at this point.

• Agnes hasn’t felt any kicking yet. There has been kind of a drawn-out stretching sensation, especially in the evenings. From another friend we heard that this preceded kicking by a couple of weeks.
• This morning Agnes woke me up saying that she had ironed her pants and found that they no longer fit. At first I was confused, thinking that she meant that her pants had shrunk, but it was just that these were the last pants that she had that were neither scrubs nor maternity pants that still fit.
• Today was the first time a stranger asked Agnes if she was pregnant. Now that’s a risky thing to be asking a woman, so this person must have been pretty sure.
• While Agnes hasn’t really picked up any strange food cravings, there have definitely been some changes. There have been fewer cravings for seafood, though it didn’t stop her enjoyment of some dungeness crab earlier this week. She’s been eating grape tomatoes (think cherry tomatoes, but oblong in shape and with a richer flavor) dipped in kosher salt. And she definitely doesn’t skip or delay meals very much.

We won’t have new ultrasound pictures until our next OB appointment on April 15th. Some people have asked if we will be finding out the sex of the babies. I don’t believe we’re going to get any better information than we already got from the perinatologist a few weeks ago — we’re expecting identical twin girls. We might still get a surprise at the delivery, but I doubt we’ll get any better information before then.

As for names, yes we are thinking of them, and no, we’re not naming them after any famous twins (Sheri and Teri, Patty and Selma, Mary Kate and Ashley, Tia and Tamera, Jenna and Barbara, Phoebe and Ursula, Zan and Jayna, etc).

Agnes and I were flying back from Houston today and we were sitting behind two rows of kids that were all together. There were three girls sitting together in one row and and one boy who was sitting with two women who were these kids’ mothers. The kids were all around 6 or 7 years old. We heard part of the conversation between the girls and the boy.

The girls were saying something like “We’re fat cats. We eat rats. You’re a rat,” to the boy.

The boy responded, saying, “I’m not a rat, I’m a lion! Lions eat cats.”

The girls dismissed his comment saying something about how lions are felines. The boy then came up with something different. “I’m a shark! You’re all cats. I eat cats!”

The girls conferred to see if they could come up with something bigger than a shark. They said, “We’re a giraffe! A giraffe can walk underwater. We eat sharks.”

The boy asked his mom, “Can giraffes walk underwater?” to which she replied, “If it’s shallow enough.”

The boy thought about it for just a moment and said back to the girls, “Sharks live in salt water. If you come in the water, the salt will get in your eyes.”

They were ignoring him by this point.

Oh boy. I know that if I were their parent I would need to leave their conversation alone, but it was just wrong in so many ways.

Last Friday we had our 19-week appointment with the OB. This was our first visit after telling the perinatologist that we had changed our minds about having the amniocentesis. She said that it was a very reasonable decision to change our minds. I think she’s giving us more flexibility in our decisions (and therefore less guidance) because she knows that Agnes is a doctor and probably has a good sense of how these decisions go.

The appointment itself was very routine. Agnes’ weight gain was on track, and the doctor did a transabdominal ultrasound to verify that both fetuses are still growing well. When we saw the perinatologist, it looked like the placentas had either fused or that both fetuses are attached to a single placenta. This was a major factor in the guess that they are identical. Anyway, having a single fused placenta means that we now need to watch to make sure that one twin doesn’t grow much faster than the other, which would indicate a dangerous condition called Twin-Twin Transfusion. At this appointment, the two fetuses were still both around the same size as each other, which is a good sign.

Below, you can see the two pictures we have from the appointment. They’re not as sharp as the pictures we got from the perinatologist because we’re back to the less sensitive ultrasound equipment that the OB has. At this point, though you can’t tell from the orientation of the pictures, both fetuses are pointing the same direction, head down. They’ll flip multiple times before the end of the pregnancy though.

Over the course of this pregnancy we’ve been given different guesses at whether our twins are going to be identical or fraternal. We thought it would be good to explain what each of these types of twins is and why it may be difficult to tell if our twins are identical or fraternal.

Identical twins start from a single egg and a single sperm and the fertilized egg splits into two early in the development process. Since they started from a single fertilized egg, they share all of the same genetic material. This means that they will be the same sex, have the same blood type, have the same hair color, etc.

Fraternal twins start from two separate eggs, which are fertilized by two separate sperm. Normally, only one egg is released during each cycle, but there are different factors that can make it more likely that two eggs will be produced. Fertility drugs, the mother’s age, or the appearance of other fraternal twins in the mother’s family are all factors which make fraternal twins more likely. Because there are two separate eggs and two separate sperm, fraternal twins are no more closely related than any other two siblings.

At this point in our pregnancy, there are no certain tests that can tell us whether our twins are identical or fraternal — there are simply signs that indicate which is more likely. The case for fraternal twins seemed to make sense at first. Agnes’ father has fraternal twin sisters, which was one of the factors that makes fraternal twins more likely. Fraternal twins are also more common, comprising about 2/3 of all twin births. Finally, we saw separate gestational sacs in the early ultrasound images. Fraternal twins always have separate gestational sacs. Identical twins only have separate sacs if they separated in the first 3-5 days after the egg was fertilized, which happens only 1/3 of the time. Overall, twins with separate gestational sacs are fraternal about 86% of the time.

On the other hand, the perinatologist did a detailed ultrasound and found other signs that the twins may be identical. The membrane separating the twins tends to be thinner with identical twins than with fraternal twins, and the junction where that membrane meets the uterine wall often has a characteristic shape when the twins are identical. Based on these reasons, he was guessing with about an 80% certainty that our twins would be identical.

We may not know for sure for years. If our twins are the same sex (and right now we believe that they are both girls), then there won’t be any clear sign at birth if they are identical or fraternal. They will both have the same blood type, O positive, because both Agnes and I have O positive blood and O is recessive. The fact that O is recessive means that neither of us carry a different gene that would cause any of our children to produce a different blood type.

We may be able to look for other characteristics that tell us if the twins are genetically different. For instance, we could check to see if they have attached or detached earlobes. Both of us have detached earlobes and detached earlobes are the dominant trait. We could both be carrying the recessive trait for attached earlobes, and if one twin had detached earlobes and the other’s were attached, then we would know that they are genetically different.

Ultimately, it probably doesn’t matter. It’s just to satisfy our own curiosity that we would want to know if they are identical or fraternal twins. Right now, if you ask us if they’re identical, we’ll have to hedge our bets and just say that we think they are.

We’ve decided it’s far enough into the pregnancy that we feel comfortable publishing our pregnancy blog. We’ve been writing for a little while, but we hadn’t made the pages publicly available until today. For those of you who haven’t been keeping up with this blog, you can start here and then navigate from one entry to the next by clicking the left and right navigation links at the top of each page.

For those of you who have young children of your own, we’d love to get your input on what things we’ll need.

Today, we went to a perinatology center to have a detailed ultrasound and amniocentesis. A perinatologist is someone who specializes in maternal-fetal health and often deals with complicated or relatively risky pregnancies. The perinatologist, however, managed to convince us not to have the amnio. It turns out that having a prior molar pregnancy doesn’t really increase the risk of having a baby with genetic abnormalities–it just increases the risk of having another molar pregnancy, which we know we don’t have. Also, it turns out that although the risk of fetal death from amniocentesis is 1 in 200 for a single fetus, the risk is actually 1 in 50 for twins, which was higher than we expected. That statistic was enough to scare us from having the amnio done.

Since we’re not having the amnio done now, we’re going to go back to the “triple screen” exam to screen for any complications. The triple screen measures the levels of certain chemicals that are produced by the fetus and end up in the mother’s blood stream. Levels that are too high or two low can both indicate that there is a problem. Because there are two fetuses, the results are less certain. There’s a higher chance for false positives (bad results when everything is actually normal) and false negatives (normal results when something is actually bad), but it still tells us enough to decide if it is worth taking the 1 in 50 risk on the twin amniocentesis.

The exciting part of the visit was the ultrasound, which was much more detailed than the cursory ultrasounds that are performed at my routine OB appointments. They measured the head, the arms, the legs, the abdomen, and the cerebellum. And this was for two fetuses, so it took a while. Then, they tried to figure out the sex of the twins. We posted pictures of the two fetuses below. The one in the first picture is completely curled up, with its feet up by its head, so they had a really hard time visualizing the groin area. The one in the second picture is lying flatter (although its legs are out of view of the picture), but they were pretty sure that one is a girl. They then tried to determine whether they are fraternal or identical twins. Apparently, there are a few membrane characteristics that point more towards identical twins, as opposed to fraternal twins. Because the membrane is relatively thin and it attaches to the wall in a “T” formation, as opposed to a “lambda” formation (the “twin peak” sign), it’s more likely that we’re having identical twins! In fact, the perinatologist said “eighty percent chance that they’re identical twin girls”.

Today is the first day of the sixteenth week of the pregnancy. We’re starting to think about what kind of things we will need once the babies arrive and we’re hoping to get some recommendations.

It would be great if people used the “comments” at the bottom of this post to give their opinions. If it looks like we’re getting some consensus, we’ll update this post with a summary of what people think we need.

Note: Unfortunately, your comment may not show up immediately. We’ve turned on the “moderation” feature to avoid getting spam comments added to our blog. There are programs out there that just crawl the web looking for places to advertise in blogs through the comments feature. Also, we don’t have the “edit” feature available in the comments — just post another comment with any additional information, and we can either keep the new comment or merge the corrections into the original one.

What do people think is indispensible? Do we need a diaper genie? We’ll probably need a stroller — any recommendations on what to look for in a stroller? What do we look for in a car seat? What brands and models do people like?

February 16th was my fourteen week visit to the obstetrician. Basically just a routine check-up. They check my weight, my urine for sugar and protein, my blood pressure, and my doctor does an ultrasound. One difference this time was that the ultrasound was transabdominal as opposed to transvaginal. As you can see, the picture is a lot less clear when the ultrasound probe has to go through my abdominal fat, instead of being right up against the uterus. The good news is the twins look great. They’re both upside down, pretty much butting heads, and their head size (biparietal diameter, or BPD) corresponds to 14 weeks. The placentas are at the top of the uterus, which is the best location. The main thing that my doctor recommended is that I continue to take twice the amount of folate and iron that is in the prenatal vitamin–this means an extra folate and an extra iron tablet. Yuck!

To help orient you, my feet are off to the left side and my head is on the right. The twins’ heads are the round bright outlines, which, since they’re on the left side, means that the twins are “upside down”. You can’t see the body of the twin on the top of the picture because he/she is behind the other one.

One of the early questions that we had about raising twins was if we should tell them (and other people) which of them is older. We’ve found that people definitely have expectations and preconceptions of how different children act when they are the oldest, the youngest, etc.. What we didn’t know is if this extends to twins.

Agnes asked one of her co-workers, Sarah (who is a twin), about her experience on this topic. Sarah said that her parents didn’t tell them who was the older one, dodging the question for years. She said that she liked the idea that they were exactly the same age, and when they finally did find out, it was very exciting. They have a picture of the two of them seeing their birth certificates for the first time.

I think we like the idea of not saying who is the older twin, and it would be nice if we could do it. From a practical standpoint, we can see all sorts of ways they might find out though. We’re going to have to give this one more thought.

Today is the last day of the first trimester of our pregnancy. I asked Agnes why a pregnancy is split into trimesters (as opposed to halves, quarters, or whatever). Agnes said that the first trimester is really about embryogenesis. Within the first trimester, we should be referring to them as embryos and all of the body parts are still being created. After this point, we can now refer to them as fetuses and the remainder of the time will be spent in further development and maturation of all of parts of the body. I guess that this means that they should have hearts, lungs, digestive systems, livers, etc., though they would all be pretty undeveloped.

The second trimester is supposed to also be marked with a big improvement in a lot of the symptoms normally associated with pregnancy. Nausea is suppose to be reduced or maybe even go away. One’s energy is supposed to come back. Of course not every pregnancy will follow the same exact pattern, but I think it’ll be nice if Agnes feels better in the coming weeks.

It’s during the second trimester that one can determine the sex of the fetus. That should happen at around the 18 week mark. We’ve decided that we do want to know the sex of the twins. Before we knew we had twins, we said it would be a nice harmless surprise to not know the sex of our child until it’s born, but with twins, we just need to be as prepared as we can.

It’s also at the 18 week mark that Agnes might start to feel movement from the twins. I’m sure that’s going to be exciting.

This past weekend we met up with some friends from high school, a couple of whom have had kids pretty recently. We made our announcement that we’re expecting twins and instantly we started getting lots of information about what we can expect once they arrive. Basically we’ve been getting two reactions when we tell people we’re expecting twins: “You’re lucky to get two out of the way at once” or “Ooooh. You guys are in trouble.” The latter response coming from, of course, those who already have kids.

One of the things that our friend Jennifer recommended was getting a co-sleeper. A co-sleeper is a small crib that attaches to the side of your bed. In the middle of the night, if the baby (babies in our case) wakes up, you can just roll over and pick them up without getting out of bed. It seems like a great idea for at least the first months while we’re considering breast feeding. It even looks like it would be okay for twins, assuming that their combined weight remains less than the 30 lbs that this sleeper is rated for. That may last us 6 months depending on how quickly they grow. After that, they’re moving out to their own room.

The thing I can’t figure out is if it’ll be a pain to get in and out of the bed with the co-sleeper attached. Also, we have to figure out if we’re going to need the leg extensions to raise this to the height of our bed, which is relatively tall.

The other advice that our friends had for us is to get a breast pump, even if we’re planning on breast feeding. We were told that we need one. Kim said that they didn’t get one at first because they figured they would breast feed the whole time, but apparently one is still useful. She said to get a heavy-duty, hospital grade breast pump and not to skimp by getting something manual (Kim recommended something from Medela). The manual pumps that she saw were a lot of effort to use. I suppose an additional benefit to pumping is that I’ll be able to help out with the feeding. Agnes just can’t be expected to feed both of them throughout the night, every night.

Personally, I think the gear that we need to shop for will be the least of our difficulties in taking care of the babies, but we do need to start looking for what we’ll need. We welcome any recommendations on strollers (for two), car seats, and anything else you can think of.

When Agnes called me after the 8-week appointment, I couldn’t tell what she was thinking. At that appointment we were just making sure that we didn’t have another molar pregnancy on our hands. I could tell that Agnes wasn’t upset, but there was something more she wasn’t saying. I couldn’t figure out what was going on. Then she said that it’s twins and I was dumbfounded. It suddenly made sense that Agnes couldn’t quite figure out what to say. Wow.

Our doctor had asked Agnes to come back two weeks later for our ten-week appointment to make sure that things were still progressing okay and luckily this coincided with a week that I was going to be in LA. I had met our doctor the previous year when we had our molar pregnancy so this wasn’t my first time meeting her. I like her. She has a direct and confident approach and I feel that we were in good hands with her.

We went to her office on January 19th for our appointment and Agnes got ready in the examination room while I sat on the one seat near the foot of the examination table. When the doctor showed up, she pulled up a stool to start the exam, and I knew that I should immediately move over to stand near Agnes’ head. Our doctor had firmly instructed me to stand over there the last time we saw her — I think she thinks it’s inappropriate for me to stand down near where she’s examining Agnes.

Both fetuses looked like they were growing well. An ultrasound is kind of strange to watch. The doctor is manipulating the probe and things kind of suddenly loom into view. In the previous appointment, she couldn’t get both fetuses into view at the same time, but this time she was able to.

In this picture, the fetus on the left has its head towards the bottom of the picture. The fetus on the right is right-side up in the picture. The brighter X shaped mark near the head of the fetus on the right is where the heart is.

The doctor took several pictures and said that she couldn’t get either fetus into view from the side. Both of them were always head-on. She was trying to see the fetuses from the side to see if the necks have extra folds, which can be an early indication of the possibility of a neural tube defect or of Down Syndrome. We couldn’t tell with this examination. Because of our previous molar pregnancy, this pregnancy is considered at risk for genetic disorders, so it’s good if we can find out about any warning signs as early as we can.

The check-up was over relatively quickly. Agnes asked “If it weren’t for our molar pregnancy, would you consider this a normal twin pregnancy?” and our doctor said “Definitely.” I think this means that everything looks like it’s going well so far. Our doctor recommended that Agnes start taking some additional folic acid and iron supplements (beyond what she gets in the prenatal vitamins) and we went to the drug store later that day to pick some up.

Our next appointment is at week 14. I think it’s a good sign that she didn’t ask for another follow-up for four weeks this time.

Our first obstetrics appointment was in early January 2005. My gestational age was 8 weeks and 2 days. Bernard was in Chicago so I left work early and went by myself. We were especially nervous about this appointment because in October 2003, we found out that I was carrying a molar pregnancy. I won’t go into too many details about that experience, but essentially a molar pregnancy is a placental tumor with no viable fetus. It can metastasize and become malignant so it has to be removed right away. I had a D and C (dilation and curretage) in October and had to have my blood levels of beta-HCG (which is super-high in molar pregnancies) monitored for one year. In addition, you can’t try to get pregnant again for one year after a molar pregnancy because of the risk of the tumor coming back.

I told my doctor while getting ready for the ultrasound, “I’m hoping for the best, but I’ve prepared myself for the worst.”

She nodded and said, “Well statistically, we can definitely be optimistic.” (My risk of another molar pregnancy was 2 to 3 percent.)

I stared at the ultrasound screen while my obstetrician was looking around. Even though I have some experience with vascular ultrasound, prenatal ultrasound is very different so I wasn’t quite sure what I was looking at. Suddenly, my doctor made a funny sound — a snort? A laugh? I suddenly panicked and thought, “What’s going on?”

My obstetrician said, “Boy, you are full of surprises.” She pointed to the screen. “Here’s one gestational sac.” She then pointed to another clearly defined dark space to the right of the first one, “And here’s another one.” She brought the ultrasound probe back over to the sac on the left. “Here’s one fetus and its heartbeat and — here’s the other fetus and the heartbeat.” (You can see the pictures from this appointment in our first blog entry)

“Twins?” I gasped.

“Twins.” She said. “And they both look healthy, but I want you to come back in two weeks for another ultrasound.”

I was still in a daze as I was walking to my car after the appointment. I called Chicago from my cell phone. The last time I called Bernard after an OB appointment was in October 2003 and at that time, I was hyperventilating and crying, because I was literally walking from my obstetrician’s office to the main hospital to schedule my surgery for the next day. This time, I was in shock, but grinning.

“How did it go?” Bernard said.

“It went okay,” I said. I was temporarily tongue-tied so there was an awkward pause, where I’m sure Bernard was getting confused. Finally, I blurted it out, “We’re having twins.”

There was silence on the phone again. “Really?” He finally said. Actually, we didn’t even know what to say to each other after that. Just a lot of “wows” and “what are we going to do?”

(I asked Agnes to write about the night she found out she was pregnant. This happened back in December. — Bernard)

I was on-call the night I found out I was pregnant. Taking advantage of a brief lull between patients, Bernard and I were chatting on the phone, talking about how I was feeling. I mentioned that I was tired and felt a little bloated and nauseous, but that I thought it was because I should be getting my period “any day now”. The truth was, I was two days late, and Bernard realized that I was probably pregnant. He didn’t say anything though, since he assumes that I know all the “medical stuff”, and if I didn’t think I was pregnant, then that’s that.

It took about half-an-hour after getting off the phone with Bernard for me to realize that I should be taking a pregnancy test. I ran down to the Emergency Department and stole a urine pregnancy test, fondly known in medical circles as the “ICON”. (I believe ICON is the name of the company that makes the enzyme assay for beta-HCG that is bought in bulk in a lot of hospitals. For example, when we’re talking about a patient, we say, “She’s ICON positive”, for “She’s pregnant”.) For those of you used to the fancy, expensive urine tests that they sell in the drug store, the ICON is very no-frills. There’s no urine cup or syringe, just a plastic nondescript plate with a well for urine, a well for the control line, and a well that shows two lines if it’s positive. I had to use a styrofoam cup for the urine and a needle syringe to get the drops into the well.

Needless to say, I was pretty surprised and excited when two lines appeared. When I called Bernard though, his reaction was muted. Later, I found out that he was struggling to keep from saying, “Duh.” I spent the rest of that night in the Emergency Department seeing stroke patients. Everytime the portable x-ray machine came by, I smiled at my patient and said, “I’ll be right back”. Then, I ran away thinking, “I don’t want to irradiate my baby”.

Last night Agnes and I once again got up in the middle of the night for a snack. This one was at 3:00 am. I was awake because I had fallen asleep before getting ready for bed, and I had gotten up to shower, floss and brush my teeth. Agnes was awake because she needed to go to the bathroom. I also might have woken her when I came back to bed.

By the way, I say “Another Late Night Snack” because this certainly hasn’t been the first. Earlier this week, we got up and ate most of a bag of tortilla chips with a jar of salsa. In general, Agnes has been eating a lot better than this, but I think I’m a bad influence when it comes to late night snacks.

Anyway, Agnes said she was hungry and so I asked if she wanted to split an orange. We ended up splitting the orange. Agnes and I also had some Terra Kettles Sea Salt White, Russet & Blue Potato Chips. In addition, Agnes also had a piece of toast from our loaf of St. Honore bread that I bought at Mitsuwa (a thick, rich, flavorful white bread) and a Del Monte Fruit Naturals® Red Grapefruit cup. She was eyeing the Men’s Chocolate Pocky Sticks, but I don’t think she had any. This morning, I found that the outer box had been opened, but the inner foil packs were still sealed. I wouldn’t have minded, but I guess Agnes reconsidered.

Okay, we really don’t have a good excuse for how long it’s taken us to start this blog about our pregnancy. We don’t really intend on linking this page into the rest of our site until around week 17 or 18 or so, but the point is that I should have been writing all this time. Today is week 12, day 4, and we’ve known that Agnes is pregnant since she took a home pregnancy test around week 4.

The big news of course is that Agnes is pregnant! And it’s twins!

There is a lot to catch up on, and I won’t try doing it all at once. We will catch up with what happened in the past over the remainder of the pregnancy. For now, it’s probably worth mentioning that the babies are due in mid-August. We don’t know the sex of either of them yet, but we’ll probably find out. And yes, the twins were a major shock to us, but Agnes’ Dad does have twin sisters.

Here are two pictures from the ultrasound we had at the 8 week mark.

You can see that each fetus is in its own gestational sac which shows up as the dark area around the fetus. That means that they are most likely fraternal twins (not identical). There is still a 25% chance that they are identical and that the fertilized egg split early enough for them to develop in separate gestational sacs. In these pictures (which you can click to view a slightly larger version), the larger + sign is on the “crown” of the fetus, and the smaller + sign is on the “rump”. By marking the crown and rump of the fetus, the ultrasound machine can estimate how long it’s been developing. Both of them are upside down.