Multiple births: 46 and pregnant with triplets!
After trying for five years and having had three miscarriages, we found out we were having triplets at our 7 week scan. My husband could not wipe the grin off his face; I was a little bit more hesitant. How would my 46-year-old body cope with the pregnancy? I wanted a natural birth, is this possible with multiple births?
Having a natural birth was important to me to give my babies the best possible start and to help my body recover and prepare for the breastfeeding journey. I also wanted to breastfeed, as I loved breastfeeding my two older children. How on earth do you breastfeed three babies? I was a bit scared.
I did a lot of research online. I found several women who had vaginal births of triplets and many women who successfully breastfed their triplets. I started to feel a lot better about having triplets. I was healthy, I'd already birthed two children and I'd already breastfed two children. I thought "I can do this". I connected with support via an Australian Higher Order Multiples Facebook group and asked questions.
We made an appointment with a local obstetrician and we saw him at around 9 weeks. Armed with all the information I'd found online on multiple births, we sat down in his office and straight away I could tell he was not happy. The first thing he started talking about was selective reduction which he highly recommended due to my "advanced" age. "No", we told him, we do not want to do that. I was healthy and healthier than some women half my age! Then he told us that:
- the children would be born prematurely and we had increased risk of cerebral palsy if the child was premature;
- the children would have Down Syndrome;
- I would get Gestational Diabetes;
- there was no way any doctor in Australia would allow a vaginal delivery.
I asked him how we could prevent a premature labour; he said "well we can't turn back the clock". He told me that my local hospital also would not deliver the babies. We walked out of his office feeling very angry and even more determined to have three healthy babies. I told my husband that these babies were staying in until I reached 36 weeks at least.
I made an appointment with a maternal foetal specialist located two hours away from my home. He was wonderful. We told him that we did not want to reduce and he was OK with that, it was our decision after all. He called one of his colleagues, a very experienced obstetrician who agreed to look after us and also agreed on a vaginal birth. The only two stipulations were that the lead baby was head down and that the pregnancy had progressed over 32 weeks. He also recommended having a cervical stitch (cerclage) put in, which we agreed to and it was done at 17 weeks. The triplet pregnancies he had looked after and that had a cervical stitch had successfully reached 36 weeks gestation. This was a very simple procedure which was done under general anaesthetic, and I stayed overnight just to be sure there weren't any complications. Risks of this procedure were that the membranes could be ruptured but doctor assured me he had done thousands of cerclages and never had any problems.
We also discussed having an epidural. The obstetrician highly recommended it as he said that often in the case of multiple births, after the first baby was delivered, the other two might flip and then he would have to manually rotate them into position, and in the event of an emergency c-section it would save time if the epidural was already in place.
An uneventful pregnancy
Initially we made the two-hour drive to the obstetrician every four weeks. Then after I reached 30 weeks gestation, we went every two weeks. At every visit we had an ultrasound and report done and the usual weighing and blood pressure check. Everything was going extremely well. All the babies were head down. I had no complications, no sore back. The only affliction I had was a very sore pubic bone as the pregnancy progressed and extremely painful heartburn, for which doctor suggested Zantac as the usual Mylanta and Gaviscon were not helping.
I gave up work at 24 weeks. I had a desk job and I was finding it difficult to sit for so long and would get pains under my ribs. All I wanted to do was lie down. After I finished work, I stayed home and mostly laid down all day. My husband bought a cheap outdoor second-hand spa which I used several times a day and it was wonderful to lie there weightless. My husband began working from home at this point and he made sure I rested as much as possible. At 28 weeks I was diagnosed with gestational diabetes, which was controlled by diet from that point on. As the pregnancy progressed I felt out of breath faster and also my pubic bone felt as though a meat cleaver was wedged in it. I also had to eat a lot of small meals and I drank up to 3 litres of water a day and laid down most of the day.
The day our triplets were born
We decided to be admitted into hospital at 35 weeks so that the doctor could start me on steroids. I lived two hours away from the hospital and we were worried that we would not make it to the hospital if I went into labour and also, because the steroid shots would increase my blood sugar levels, I would have to be monitored and given insulin as needed.
My cervical stitch was booked in to be removed at 36 weeks. I was finding it difficult to be comfortable in any position and also had difficulty taking deep breaths. At 35+4 I had a very bad night, the babies were moving so much and I did not get any sleep.
All the babies were “chilling out” on my left side, however overnight one of the babies moved to the right hand side. At 6.30am at 35+5 my waters broke. I had 6 midwives rush into my room with all sorts of monitoring equipment, they rushed me down to delivery suite where the doctor arrived at 8am and removed the cervical stitch. My previous two deliveries were six hours and 1.5 hours respectively, so they were concerned that I would go into labour straight away. Labour had not yet started. They monitored me for a couple of hours and decided to send me back to the ward as I was not getting any contractions. They also had me take some antibiotics to prevent infection due to my waters being ruptured.
All day I paced the halls and walked around the room trying to get labour started. I was straddling the bed, rocking backward and forwards but no contractions. My ankles and feet were three times their size because of standing up all day, the fluid pooled at my feet.
I made sure I ate every meal and kept drinking so that I had energy. At 9.30pm the contractions started. They took me to the delivery suite and began monitoring me. They had external monitors on each of the babies and the baby at the bottom had an internal monitor line which clipped onto his head and monitored his heartbeat.
At around midnight I had the anaesthetist come and put in the epidural. It was a low dose so it just took the edge off the contractions so that I could still feel when they were coming and I could still move my legs and change positions in the bed. They also put in a catheter and bag as I could not get up to go to the toilet. I would change positions every 2 hours because of all the fluid retention in my body. Whenever I flipped over, the wonderful midwives would massage my body where I had been lying to stimulate circulation and move fluid. I would sleep every now and then, which I am glad I did as it gave me the energy I needed to push the babies out when the time came. They had me hooked up to an IV drip for fluids.
At 12pm the following day at 35+6 I was fully dilated. It took four pushes for my son to be born at 12.23pm, he was immediately put in my arms and it was such a fantastic feeling having this beautiful little boy in my arms, he weighed 1,835g and was wide-eyed looking around at everything. My daughter was born at 12.43pm after four pushes. She too was put immediately in my arms, she weighed 2,405g. They thought that triplet 3 had turned breech so the doctor was preparing for a breech delivery, however an ultrasound showed she was still head down. My third baby, a daughter, was born at 1pm after two pushes: her head came out, then the rest of her body slithered out. I didn't even realise she had been born and then there she was in my arms, weighing at 2,195g.
Finally after all that time wondering what they would look like and whether they would be born healthy, here they were all looking around and looking beautiful. All the babies got a 9 Apgar score and were all breathing unassisted and active. The babies were never distressed during labour.
After an hour or so we went to our room. Our biggest baby roomed in with us and our smaller two went to the special care nursery so that they could put on a bit more weight. The next day the catheter and bag were removed. After 6 days we went home with our biggest and the 2 smaller ones were transferred to our local hospital. The second biggest was home after 7 days and our little boy spent 12 days in SCN until he could regulate his body temperature.
I had severe fluid retention in my feet and ankles for about 2 weeks after the multiple births, which the doctor said was normal. The doctor was ecstatic that the delivery (and pregnancy) had gone without a hitch. He said it was the best and least complicated triplet pregnancy and birth he had looked after in his 40 years of obstetrics.
I am proud and grateful that at 46 years of age, I delivered three healthy, beautiful babies who are doing so well, and are very healthy and happy. When I look at them, I marvel at how perfect they are and how thankful I am that I did my research and made the decision to go through with my triplet pregnancy. They are 5 months now and very enthusiastically enjoying their solids and learning all about their little world. I am expressing breast milk for them all and so far have only had to rely on a handful of formula on the days where I haven't had time to express. It is hard work raising these little angels (as many random strangers will gladly tell you when you are out and about), but we would not have it any other way.