Labor Assisting Triplets.

I first met with Karen in mid-March 1995. She was expecting her fifth baby in mid-October. She had four sons whose ages ranged from 7 to 14 years of age. Her husband Mike had a vasectomy after their fourth child was born and subsequently regretted that decision. He had a reversal in December 1994, and Karen became pregnant in January 1995.

She had given birth to her sons in the hospital and wanted to have this baby at home. Karen was 39 years old, well educated regarding childbirth, and extremely responsible regarding her pregnancy.

At her first prenatal visit, she was only nine weeks and everything seemed normal. At 14 weeks things were still progressing well. Her nausea had stopped, but she still felt more tired than usual. I sent her for labwork, and we found that she was slightly anemic. She was gaining weight fairly rapidly, which she assured me she "always did." I had not received her medical records yet.

At 18 weeks Karen's fundal height was 19 cm, but she had gained about 38 pounds. She again assured me this was normal for her.

On June 6 Karen was almost 22 weeks. She had only gained four more pounds, but her fundal height was 32 cm! She again assured me that, "I always grow fast and the doctor thinks I'm having twins." I told her I would like to schedule an ultrasound to rule out multiples, especially since I thought I could hear two separate heartbeats and I was fairly certain Karen was carrying twins.

We set up an ultrasound for June 20. I was wrong: Karen was not carrying twins but triplets! I think we were all in shock. The babies looked good. They were all normal size for dates, and it appeared that they were two girls and a boy. Karen's fundal height was now 38 cm -- she had grown six cm in two weeks!

Of course, triplets meant no home birth. It also meant a high rate of intervention. After the ultrasound we met with the doctor. I think he was also in shock. We later found out that he had only dealt with two other sets of triplets and that both had bad outcomes.

The next three months were very trying for us all. Actually, the doctor remained fairly calm until early August. When the babies reached 33 weeks gestation, he became less calm.

Karen had begun weekly non-stress tests at 30 weeks, and all was well. An ultrasound at 33 weeks showed all three babies at normal size for dates, but the doctor began suggesting a planned cesarean delivery "to make sure nothing goes wrong." Karen, on the other hand, wanted to go to term and attempt a vaginal delivery if the babies were in a favorable position.

On August 28, at 33 1/2 weeks, Karen's blood pressure was up slightly. She was sent directly to the hospital to be monitored. The doctor was very concerned. He kept saying he didn't want to lose any of those babies. One of his partners suggested an immediate cesarean delivery. Karen wanted to wait, if possible, till the babies were larger, so we all started doing our research.

The next four days were some of the most stressful of my midwifery career. I worked very hard to gather info and to be an advocate for my client. We talked with several doctors in different states, including Dr. Tom Brewer.

Karen's doctor was convinced she was in danger of developing preeclampsia/eclampsia and wanted the babies delivered ASAP. This particular doctor is one I consider a friend, and things felt very strained between us.

After four days of constant stress, Karen decided to have the cesarean delivery on Friday, September 1, 1995. Her husband Mike and I were both with her. The surgery was the easiest I have ever seen. The incision was made, and the babies literally popped out one by one. First came Claire Elizabeth, at 5# 4 1/2 oz, with apgars of 9/9. One minute later Grace Ann emerged, at 4# 14 1/2 oz, with apgars of 8/8. She was followed in another minute by James Michael, at 5# 3 1/2 oz, with apgars of 8/9. The delivery was smooth, but Karen's uterus had some difficulty contracting afterwards and she lost some blood, which led to postpartum anemia.

The girls are identical twins. The boy appeared to be a week older than his sisters according to the NICU staff. They were kept in the NICU even though there was nothing wrong with them! This was very frustrating for us all; we had to continually battle the NICU staff. Karen was told she could not breastfeed, even though she had successfully nursed four children. She was finally allowed to nurse her babies a couple of days before they went home on their tenth day of life.

At this writing, the babies are five months old and still breastfeeding. Karen supplemented with formula at first, but the girls refuse to take a bottle now. Mom is incredible.

Naturally occurring triplets are about one in 10,000,000. I found there is little trust in the natural process among the medical field. I feel Karen made the decision for surgery herself, but the fears expressed by the medical community were difficult to disregard. At least all three of her babies are fine and she is happy!