Merriest 1st Christmas

What a wondrous week for us, all of us! First, a rush trip to Phoenix for Ben with the delivery of our four little ones that very night. Today, their first Christmas, they are 9 days old (yesterday marked week 28 gestational age). We are so grateful that for the most part each baby so far has remained stable.

Merry Christmas to our precious children:

Baby A = Thomas Clark Dawson
Baby B = Gracie Anne Dawson
Baby C = Cienna Loreal Dawson
Baby D = William Benjamin Dawson

The greatest concern with our preemies is breathing and the ability of the lungs to function properly. Aside from a few ups and downs, these little ones overall have done well. Even our top breathers, Thomas and Gracie, will sometimes just get tired and need to have assistance, then they go back to being breathing champions. We also continue to monitor their patent ductus arteriosus (PDA) . This is a normal fetal vessel that usually closes at or after birth. When babies are born prematurely it can be difficult for the vessel to close naturally. In some cases surgery is needed to stitch the vessel shut. Each one of our babies has a PDA and we are praying they will close naturally. Finally, they are checked for brain bleeds via brain scans. Their first one showed minimal issues. They will have another one in two weeks.

Two days ago we were able to start kangaroo care where they put the baby on your chest for skin to skin contact. The experience of having your itty bitty baby so close is marvelous. Today little Gracie stretched her head back, opened her eyes and looked up at me while she snuggled on my chest. We look forward to having them all come home! In the meantime I continue to recover from surgery, take in the new situation, and attempt to breast pump 10-12 times each day. Ben has learned an enormous amount about ventilators and NICU care. While I was on the phone with him today he heard an alarm go off in the background and could identify exactly what it was for.

The doctors tell us to expect the babies to be ready to come home no sooner than their full term due date, March 18. We are so grateful for your love, prayers, support, kindness, good wishes and thoughts. They have helped to carry us through. Merry Christmas 2013 to each of you!

With much love,
Ben and Celina
Thomas, Gracie, Cienna, and William

Welcome Earthside!

Surprise times 4!!!! Week 26 (Tuesday, December 10) started off uneventful and I had settled into my six-sided room in the hospital nicely. Although the medications at times seemed harsh they were doing a good job. Until Saturday. I was returning to bed from the restroom when all of the sudden I felt a gush of fluid. The nurse was with me and a quick test confirmed it was amniotic fluid and that one of the babies water had broken. The staff were quite certain it was Baby A (the boy closest to the cervix) because of the pressure resting on him from three other babies. This event graduated me to complete bed rest, use of a bedpan and all. I was encouraged because there are many people who shared how they had PPROM (premature rupture of membranes) and had lasted several more weeks. The problem I faced was that this event started to trigger contractions, despite an increase in magnesium sulfate and a dose of terbutaline. By that evening I was having regular contractions and the doctor advised Ben to try and get down here from Washington, sooner rather than later. Amazingly we were able to snag a frequent flier ticket that left Walla Walla within 12 hours and landed him Phoenix by 2 p.m. Sunday (a miracle in my opinion seeing as we get two flights out of Walla Walla a day and it tis the season to travel). By the time Ben arrived the contractions has subsided somewhat and he left with his parents to get some rest around 9 p.m.

A little after midnight I had one long, painful contraction and when the nurse checked me she discovered I had dilated to 9.5cm. In an instant the on call OR team, doctor, and Ben had been called and by the time they arrived I was all prepped and waiting in the operating room. On December 16 at 12:50 a.m, our first Miracle arrived.

 NOTE:   If you click on each line below it should connect you to a YouTube video of when that particular baby arrived.

Here are the stats:
0050: Dawson Baby Girl B, weighing 1 lb 14 oz and 13 inches long
0052: Dawson Baby Boy A, weighing 1 lb 14 oz and 14 inches long
0052: Dawson Baby Girl C, weighing 1 lb 6 oz and 11 3/4 inches long
0054: Dawson Baby Boy D, weighing 1 lb 12 1/4 oz and 13 1/4 inches long

So far everyone is doing as well as can be, especially these little ones who made it to Week 26 and 5 days. There are two major concerns they face: lung development and possible brain bleeds. To the babies advantage I had been given a steroid shot which helps with both. So far they have done very well with breathing and taking in oxygen. In two days, December 20, they will get a brain scan to see if they have been able to evade any bleeds. In the meantime, here are some pictures of our little angels.

PS: We're still working on names so for now they are still A, B, C & D.

First and second pictures: The boys and the girls are all getting getting photo-therapy for jaundice.
Third and fourth pictures: Baby A's feet compared to Ben's thumb and size comparison to my hand. He is our largest baby.
Fifth picture: AZ friends gather for a party with Ben and mamma on the day the babies were born.

Week 26

One more week down and thankfully no baby debut. As great as it would be to see them, we are willing to wait! Last Wednesday I came to the hospital due to contractions and a 0.7cm cervix. The first five days were spent on magnesium sulfate. The beauty of this med is that it works. The contractions got under control and things were looking up. Doctor's report today focused on two aspects: First,a fetal fibronectin test and second, the condition of Baby C. A fetal fibronectin test is a test that helps to establish if someone is going to deliver in the next 7-10 days. If it is positive, it points to possible preterm delivery. However, a negative test says a lot more. A negative result means we can be 95% sure we won't have immediate delivery. The test was done and unfortunately came back positive. This meant a renewed effort to keep contractions at bay, so continued magnesium sulfate around the clock. I am thankful the med works, but it is a little harsh on mamma--any mamma. Before the doctor left he leaned over my bed and kindly said, "Sorry for what we put you through, but as long as you are safe, we do whatever it takes for the sake of the babies."

This week a doppler blood flow study on baby C indicated slight decreased nutrient flow to her. This has not been evident in previous check-ups. Again, there is nothing we can do to for her and again, the doctor said the best thing to do is to continue to monitor her. He is hopeful she can stay in utero a few more weeks. She will be checked weekly. On week 28 we will do a growth scan to see how everyone is doing. In the meantime I lay on either my left or right side day in and day out. There are good days and days that are more of a challenge, kinda of like regular life.

Top picture: Week 26 Belly
Second picture: Ben's parents are here to help me out for a couple weeks. His Uncle Jeff was able to stop by for a visit.
Third picture: I just met these lovely people, John and Silvia Comitz. They are from Az and Ben knows them from going on a couple of mission trips with them. They stopped by and shared pizza with me and the nurses.

In Good Hands

Reaching Week 25 was a milestone but I didn't want it to be eventful. That night I began feeling lower back pain for the first time. Initially I shrugged it off as too much bed rest. Then it hit me: contractions, the serious kind!!! By the time it was all said and done, I landed in the hospital and will no doubt be here for the rest of this pregnancy. Cervical length had dropped to 0.7cm, Baby A's head was easily palpated while it bore down, all while contractions squeezed in on the situation. The immediate action was a bolus of magnesium sulfate and shot of terbutaline to get the contractions under control. A neonatologist stopped by to explain to me and Ben what we could expect of a 25 week old baby should things progress. Since then (about three days) I have been on continuous mag sulf and uterine monitoring. The contractions are now random and things have really quieted down. We are so grateful for every single day. According to one source, a baby's chance of survival increases 2-3% each day they are able to stay in utero between week 24-26. Between the neonatologist and perinatologist here there are 60+ years experience in dealing with situations like ours and although no one can predict an outcome, they have explained how everyone with high order multiples gets to this point, it is just a matter of when. To have 25 weeks at home was great. In addition, I'm gestating a mere four babies. A couple doors down from me there is a mom with quintuplets and upstairs in the NICU is a quintuplet set. There should be a club. The next big goal is to keep contractions at bay and reach 28 weeks. A thousand thank yous to each of you who keep us in your prayers and thoughts. Ben and I feel supported and cared for in a million different ways by you.

 Other Stuff
A bed is a bed and that is where I gotta be so here are a few positives by being in the hospital: 1. Monitoring--I would be at home trying to decipher if I was feeling a real contraction or not. Here, the monitor picks it up and if there is a problem, a trained professional responds to it. A total relief to my paranoid prego brain! 2. Each morning a team that includes a neonatologist, perinatologist, nurse, social worker, case manager (and whoever else) assesses and keeps tabs on the situation. 3. If anything major happens I'm here--no frantic rush to the ER. Hallelujah!

First picture: The beautiful view from my hospital bed: Elisa and Pastor Ray, Housemate Sheryl, my mom Donna. Elisa was contacted by our friend John Mark who lives in Phoenix. She is the queen of networking! Within a short period of time she had matched us up with Sheryl and her husband Ron who graciously opened their home to us during this pregnancy.
Second picture: Baby B yesterday morning with a sibling's head

butting into her from the left.

25 Weeks: Grow, Baby, Grow!

Week 25 is finally here! My usual morning snooze was cut short due to a morning doctor's appointment--no worries as the rest of the day and night is there for the snoozing! Every few weeks they measure the babies body parts to establish their weight. It has been five weeks since we last did this and we're anxious to see how baby C is doing since she has been the littlest. Below is a fetus comparison chart from the ultrasound. From the weights, the computer generates their adjusted age (even though we know what their age is, 25 weeks) and estimated due date (even though they will all get the same delivery date). AUA = Adjusted Ultrasound Age; EDD = Estimated Delivery Date; EFW = Estimated fetal weight. EFW Ratio and Discordance are based off of Baby D since he is the closest to being 25 weeks old.

Baby C is determined to poke along at her own pace. Because she is one of the monochorionic twins and at risk for TTTS, this could have greater implications. She is 21% smaller than twin B (a sign of TTTS) however, her fluid levels are similar to baby B and well within normal range. At this point it does not look like her slow growth is due to TTTS. She is in the 3rd percentile and this is a worry. After examining her measurements and blood flow, the doctor is 98% sure that she is genetically programmed to be smaller (verses a chromosomal abnormality or TTTS). Over the next three weeks we will monitor her. If she does not grow at all we may face the possibility of delivering all of the babies at 28 weeks for her sake. This of course puts everyone at risk for health and survival issues, so keep the prayers going on her behalf! Grow baby Grow!!!

The cervix continues to shrink and is now just 1.1cm, down from 1.5cm the week before and still below the 2cm minimum. It is scary to see baby A's head so close to the outside world! Each week I am monitored for uterine contractions which are influential in shortening the cervix and promoting preterm labor. This week they found the uterus to be "cranky" and "irritated" so I am now taking Nifedipine in addition to Motrin in an effort to quiet it down. All four babies are still under 2 lbs and we're praying for more time to grow them in an effort to increase their chance of survival and lower the risk of life long disabilities. In the meantime, the sweet little babies are looking like cavemen in the 3D imaging. Good luck finding their faces. Check out how baby D continues to have his knee in his face, a position we've seen him in several times now!

Baby A trying to find some room

Baby B  Pressed in on every side

Baby C with her hand on her nose and eye 

Baby D taking a nap

My mom took this of me getting monitored.  It has been great having her here!
PS Thanks for the shirt Silvia!

24 Weeks! Viability

Yesterday marked 24 weeks for us! It also means I've been holding a bed down for one full month, with hopefully two and a half more months to go (not for my sake or sanity!!! We're just hoping for at least a 34 week gestation). A week ago a shortened cervix (under 2 cm) and contractions landed me in the ER. I truly believe a miracle happened that night. After a shot of terbutaline, monitoring and prayers, all cervical measurements came back above 2 cm and I was able to leave the hospital that night, sans cerclage or hospital stay. The rest of the week was uneventful and we made it to "viability," or the point at which if the babies come a hospital will implement live-saving measures for them. We also got to feel them kick for the first time and by the end of the week Baby A was kicking nonstop. He currently sits on my bladder while kicking...Thanks, kiddo! At yesterday's appointment we found that everyone has the important stuff: normal amniotic fluid levels and a working bladder, stomach, and heart. It was so great to see them! Below are a few pictures. I think it truly does take a degree and lots of imagination to actually see a baby's face and body parts from an ultrasound, but these guys are getting old enough that even I can see it. PS If you click on the pictures they should enlarge.

He may look like he's sleeping but don't be fooled

Taking it easy somewhere under my belly button

Good luck finding her sweet face

He's all boy!

To the doctor's office,  my one trip out each week.

Here she is!

A Kick?

Twenty-three and a half weeks and we finally got a kick-a-roo (I think?!). All day I'd felt little patterings through my abdomen area. It didn't feel like anything anyone had described to me before so I didn't know if I should call it kicking. But about 10 p.m. last night I felt a definite umph umph that just had to be baby D (or B, or A?) giving a swift two kick punch to the right.

Prego Story: Weeks 4-22

Wk 4:  We get a positive HCG test. We're cautiously hopeful, this has happened before. The next HCG test shows rising numbers. When the doctor's office calls to tell us the results she says, "By the way, the HCG results are a little higher than average so there may be more than one."

 Wk 5-7:   I feel pregnant. Then I don't. Then I do. I start trying to get hubby to engage in irrational discussions. He quietly decides I must be prego.

 Wk 7:  The big ultrasound to see if the pregnancy is still on and if cardiac activity as been established. "Are you ready for this?" my OB asks. He's been there for all the miscarriages. I'm certain it hasn't stuck and say I'm ready to find out the dismal truth. Within seconds he and the nurse excitedly show me a heartbeat. I can't believe it! Then silence. The OB is trying to figure something out. He's studying the ultrasound and saying, "Huh....Huh........Huh.....Huh" Huh what??? "Well," he says, "Here you have a sack and there's a heartbeat inside. And here you have a sack and there's a heartbeat inside. And here, well, you have a sack and, um, there's two heartbeats. Looks like an embryo split, there are four in there!" Ben and I are elated. I meet my sister-in-law Sunday for lunch after the ultrasound and glow through the whole meal. We just can't believe it!

 Wk 8-9:  The excitement is short-lived as the gravity of having four babies at once sets in. In addition, the two heartbeats are monochorionic, meaning they share one placenta. This puts them at risk for twin to twin transfusion syndrome(TTTS), a condition where the majority of nutrients and fluid go to one twin while the other has too little. I start reading everything I can get my hands on. I get on forums, talk with people from groups such as MOST (Mothers of Super Twins) and the Twin to Twin Transfusion Syndrome Foundation. I read blogs about other families who have had quadruplets. I read the good and the bad. I call a major NICU in Washington. They overwhelmingly tell me to reduce the pregnancy. I cry, feel overwhelmed, and don't know how we can get four babies safely into the world.

 Wk 10:  Ultrasound confirms all four are still going! In the meantime I order When You're Expecting Twins, Triplets or Quads, an excellent source of guidance! In addition, I connect with Dr. John Elliott of Phoenix, AZ who has by now delivered 101 quadruplets. He spends an hour on the phone explaining quadruplet pregnancies. I begin to hope.

 Wk 12:  This whole time I'm not really sick, but don't like the idea of food and I sleep any chance I can. Dr. Elliott and my newly arrived Quad book tell me I need to gain at least 75 lbs, the sooner the better. I love to eat, why is this so hard???!!! Sister-in-law Beth begins to outline just how to eat the daily recommended 4500 calories. I also have a 3 hr ultrasound. All four are still going, and they're too big to fit in one picture. It starts to sink in that this is really happening.

 Wk 17:   My first visit with a perinatologist. The ultrasound takes almost four hours while my mom, Beth and I watch the little ones kick, wave, turn, tumble, and blow amniotic fluid through their lips. They take about 400 pictures and we leave with an album's worth of babies A, B, C, and D. I realize I've been so worried about losing the pregnancy that I've forgotten to worry about what we'll do if they all make it and we have four babies all at once. I start to get tired of always being worried!

 Wk 19:  Ultrasound check up and all is well. We have made plans to become Dr. Elliott's patient starting at week 20. Friends in Phoenix set us up with other friends and before we know it, the Cherington family opens their home to us for the remainder of the pregnancy. So many details have worked out and we are overwhelmed with God's providence and the kindness and support from friends, family and strangers. The 18 hr trip from Eastern WA to Phoenix takes us three days, the slowest road trip we've ever taken.

Wk 20:   There is a runt in every litter. Baby C takes the prize at the ultrasound today, coming in at 252 grams. The boys, A and D, are 359g and 351g respectively, and Baby B is 332g. At this point there is nothing to do but monitor C. Babies B and C are the monochorionic twins and are being closely monitored for signs of TTTS. Today they have fluid levels in the normal range (2-8 cm) and relatively equal (B, 4.7cm and C, 4.6cm)! It is a good day!  

Wk: 21:   I'm all tucked in my new home, my dad arrives to care for me and everything is great until I begin having a series of contractions. Of course it happens on a Sunday. For one hour they came approx 6 mins apart. I used The Bump's contraction monitor to keep tract of them. I was advised to take 600 mg Motrin and although they slowed down, they didn't stop. By now people were praying and at the start of the 3rd hour they finally subsided. At the doctor's appointment we found that although my cervix is firm and holding, it has shortened from 3.3 cm to 2.8 cm. The goal is to prevent contractions and maintain a cervical length of more than 2 cm.

Wk 22:  Wonderfully uneventful! My belly just gets bigger, I lay around all the more, and my dad gets better at cooking. I am on prescribed Motrin q 6hrs and have had very few contractions. Although the water in the pool outside is about 65 degrees, I find great relief getting into it a couple times a day. My doctor said there is no concern for the cold water and I monitor for contractions after each dip and have had no indication of trouble. There's nothing like being able to lay in the bright, warm sun in the middle of November!

Belly Progression Wk 12-21

Week 21

A, B, C, and D have been claiming real estate this week. The girls (B and C)have branched out from their posterior cubby and are rising to the anterior while stretching their feet up into my top right rib. Problem is, this is where D has been putting his feet. Lets just say ouch I'm feeling it. Meanwhile baby A continues to rumble and roll down near the cervix,staying clear of the foray above. This is how we found them at the doctor's appointment today. All had great heartbeats and fluid levels. The girls who share a placenta and are at risk for Twin to Twin Transfusion Syndrome (TTTS) are sharing equally, we are grateful! Two days ago on Sunday I had several contractions that eased off after meds and prayers. Although the cervix is firm and holding, it did shorten from 3.3 cm to 2.8 cm. so bed rest is in earnest. Today starts week 22!

It's a boy! It's a girl! It's another boy! It's another girl!

Needless to say, when Ben and I realized the doctor found not one, two, or three heartbeats but four, we were shocked. It was the most terribly wonderful news of our marriage. We had been trying for as many years as we had heartbeats but had miscarried right about the time cardiac activity should have been developing. But there they were, four little blinkers flashing on the ultrasound screen. We got four when one of the implanted embryos decided to split, making identical twin girls. The other two heartbeats became our two boys.