Chapter 18
Remember Her
"We wished upon a star, it came true… and now we're expecting baby number two and three." – Author Unknown -
ME/LE
Doctor Rawle is surprised to hear from the head of the PCT, Chris Parsons - not so much for a request to see a patient but to see Doctor Ellingham's wife. He recalled the doctors' name from a year ago, the mess with Doctor Montgomery's. "Doctor Parsons, you are speaking of the doctor that was involved with Doctor Montgomery's problem last spring."
"Yes, he married Louisa Glasson last August. She was your patient. You fitted her with an IUD at her six-week check-up but it seems the IUD fell out and she is around eleven weeks pregnant now with twins. They discovered the pregnancy when she was brought into A&E at St. Mary's with injuries."
"St. Mary's, yes I have a referral from Doctor Thyring for a patient. Where is it?" he says as he scans his emails. "Yes, here it is. Louisa Ellingham, so they are one and the same I guess?"
"That's her. Her injury is to her lower back coccyx region." Chris continues. "Doctor Ellingham is concerned about this pregnancy, her injury, and his wife's tendency to overdue with her job."
"I'll have my nurse call with the first available appointment. I will go over her record Doctor Thyring sent from London. Do you know her orthopedic specialist here at Royal Cornwall Hospital? Wait, here is the referral. I'll contact him so we can work together. Is there anything else you can pass on to me?"
ME/LE
Monday morning I start my day in Phillip's room, dressing him before taking him downstairs for breakfast, with our usual conversation but today's topic is how Phillip can help mind his mummy with Gran's help. Phillip hearing the name of one of his favorite people bellows out "Gann", as I shush him,
"Phillip, no need to shout; I am sitting right here. Yes, Gran is coming here today and with Poppy and your help to take care of Mummy." Hearing mummy Phillip says as he points upward, "Mmmm".
"Yes, Phillip your mummy is sleeping so we need to be quiet." I place his sliced banana in front of him and finish preparing his porridge.
Poppy promptly arrives at half seven and I head upstairs to serve Louisa her biscuit and tea in bed. I quickly shower and dress so I can arrive at the surgery before eight for the early patients. I kiss Louisa farewell reminding her I would be back before ten and we could go for a walk if she wished. With a contented smile and her loving words resonating in my mind, I head to the surgery.
I open the door and to my surprise, Morweena is at her desk with a patient waiting quietly. I greet Morweena and she grabs the stack of medical cards and follows me into the consulting room.
"I spoke to a couple of patients near the chemist shop and Jonah was complaining of pain in his gut," she says as she hands his card from the stack. "I thought he would be your first patient today."
I look at the medical information on my patient, "Yes, send him in." Jonah Patterson walks in holding his stomach near the umbilical "Get on the couch," I say as I wash my hands. "Pull your trousers down so I can examine your stomach." I walk over to the couch, pressing around the abdomen, stopping when I find a hard mass. "Can you feel this?" I ask and continue pressing.
"No."
"Pull up your trousers and go sit in the chair," I say as I wash my hands again. "What symptoms are you experiencing?"
"My gut hurts all the time and I feel bloated," he responds.
"I will take some blood. I need a stool sample today to examine for blood. I need you to go to the hospital for a CT scan to determine the hard masses I felt. They will send me the results and Morweena will call you to come to see me." I say as I prepare the tray to draw blood and find a container for him to collect a specimen. When I finish he asks, "Is it cancer Doc?"
"A possibility, but I won't know until the tests have been completed. There are other reasons for your symptoms." I hand him his scrip for the scan and he shuffles out carrying his little container. "Ahh… Mr. Patterson," I finally say after looking at his record, "Don't worry, I will call you as soon as possible." He turns his head back towards me and tries to smile. Feeling low with my diagnosis, I call out for the next patient.
I finish the first round of consultations, just before ten I walk into my house, listening for sounds, and finally hear Phillip's giggle upstairs and Louisa talking in the lounge. I take my medical bag to my study before locating Louisa lying on her side on the sofa, talking to someone on her computer. I recall her skype meeting with that person in London and assume this is the meeting so I turn to go upstairs to find my son. Poppy and Phillip are on the floor building towers and crashing a train into them. They don't notice me and I return downstairs to prepare a healthy snack for Louisa. I fill a glass with juice and slice a few carrot and cucumber sticks along with a serving of hummus, placing it all on a plate. I take it to Louisa, place the plate next to her computer and remove her empty water glass, returning to the kitchen to refill and again return to the lounge placing the refilled glass next to the half-empty juice glass. Louisa smiles up at me and mouths out 'love you' and recast her attention to the screen. I take my leave and go to my study for the next hour, leaving the door open to hear Louisa if she needs me. A few minutes later I hear Louisa say goodbye and thank the person she was skyping. I get up and quickly walk to the lounge as my need to touch her pregnant belly has become a constant emotional need for me.
"Hello, husband, help your wife up," she says as I enter the room. "Joan came by early this morning and helped me with dressing and fixed breakfast for both of us. Martin, I see I do need help and I think I know a person that can help me. Do you remember Melanie Gibson? She recently returned to the village and is looking for summer work. Sally said she came by the school looking for an opening as a lunchtime worker till the end of term, but we don't have any vacancies. If she is still available I would like to hire her. Joan thought she was a good choice this morning when we were discussing how helpless with normal activities I am."
"Melanie Gibson, no I don't recall any patient by that name. If you feel she is capable then call her. I don't want you alone in the house."
'Martin and his lack of memory for names, I wonder if I should remind him or just wait for the two to meet,' Louisa wonders.
I help Louisa up off the sofa, hugging her briefly, and kiss her soft lips. I step back so I can look fully at her, examining her for any sign of fatigue, and place my hand over her belly. "How are you doing, any morning sickness?" I notice the plate of food is empty.
"No, the biscuit and tea helped and Joan ensured I ate a healthy breakfast, so far it is a good day. Thank you for the snack. I didn't realize I was hungry until I saw that plate," she says as she reaches up to kiss me again.
"Doctor Rawle's nurse called this morning, he would like to see you Wednesday morning," I announce.
"Good to hear he is taking me on again. You did like him, didn't you Martin?"
"Yes, he was thorough with your pregnancy with Phillip. It is getting late and I need to fix our lunch so I can return to the surgery by half twelve. Is there something special you would like to have? I cooked extra chicken last night we could have it in the salad or I could make sliced chicken sandwiches on wholemeal bread with a salad on the side," I say.
"The sandwich and salad I think. I'm famished."
ME/LE
On Tuesday mid-morning while Joan and Louisa are having a cup of tea, Louisa's mobile rings, she picks up the call and realizes Melanie is returning her call. Louisa explains why she called and asks if she is interested in the summer job. Louisa decides to invite her to the house to continue the conversation in person. What Melanie didn't realize before she redialed the missed call was the name. Wondering exactly who Mrs. Ellingham was? There never seem to be any women hanging around the Doc's bedroom before she left for University. She guessed things change when you leave, and the gossip of the village behind. Melanie talked to her dad at Leisure Center and found out that the primary school headteacher and the doc were secretly married last August. She wondered what her former teacher wanted, so she called to hear Louisa out.
Twenty minutes later there is a knock on the front door, Joan answers the door, seeing for the first time in a couple of years a mature Melanie with those big soft 'doe-like eyes' brown eyes. "Melanie, come in, Louisa is this way," she says as she guides the way to the lounge where Louisa is sitting.
"Melanie, it is good to see you again," Louisa states.
"Sit my dear, we are drinking tea, would you like a cup," Joan asks.
"Yes, that would be nice, she says as she scans the room, "Is the Doc here?" she asks.
"No, he is at the surgery until half two," Louisa responds watching the young girl's face.
"Here you go, sit," says Joan.
"The reason for my call and job offer is I was injured in London and I am required to have somebody with me at all times. Joan can't always be around and my husband suggested we hire someone. I heard you were looking for a summer job and thought you would be perfect."
"Exactly what do I need to watch out for?"
"I dislocated my tailbone. I am on rest from strenuous activities for the next ten weeks. I need help getting out of a chair, a bed to name a few. I can't have my son climb on me, but Poppy is here caring for him so that isn't a problem. I am not allowed long periods of standing, and I can only lie on my side with a pillow between my knees. I am required to sit on this whoopee cushion to help protect my tailbone from further injury. I need to move around a few minutes every hour. I can't lift anything weighing more than two kilograms. I have to exercise every day to strengthen my lower back. I find it funny and a contradiction in the word 'rest' with everything I need to do each day, but the specialist in London recommended it all," I say as I glance over to Joan with a look reminding her not to say anything about my pregnancy. "The doctors feel until I fully heal, my lower back is very weak and a fall would mean injury and a setback with possible surgery.
"Doc Martin is fine with this job offer to me?" she asks.
"Yes, I asked if he remembered your name, but Martin has a hard time remembering names, but he can always put a face to a medical condition he's diagnosed. So you weren't a patient of his?" Louisa asks trying to get some reason why Martin was so adamant against the name Melanie when they were picking out girl names last spring.
Joan watches this conversation silently, knowing all too well from the gossip that Melanie had a teenage crush on her nephew and ended up hiding in his bed one night. 'I hope she has a boyfriend at college and leaves her nephew alone.'
The conversation between the women continues for some time as Louisa hears all the happenings to her former student and Joan enjoys hearing about the shenanigans that young people like to do for fun. 'I wonder if pub crawls are anything like what the fisherman in small villages do every night, not many changes even as they age.'
Mrs. Ellingham I would like to accept the job and when do I start."
"Would now be too soon?"
"No, now would be fine. You mentioned you needed to move around every hour and I believe we have been talking for well over an hour. Are you allowed outside to move around? It is a glorious Cornish day and maybe a short walk towards the bench on the path would be good?"
I look over to Joan and she smiles; our non-verbal message in understanding that I have found someone I can tolerate for the next ten weeks. "Joan, would you like to go with us?" I ask.
"No, I'll stay here and fix your snack and check on my grandson; he was sleeping when I arrived earlier."
With Melanie's help, I remove myself from the dreaded cushioned chair and we walk along the coastal path for fifteen or so minutes till we reach the bench. I grasp the back of the bench and stretch my back while I slowly step back lowering myself over. After a few minutes of stretching, I feel ready to continue our walk back to the house.
We walk in through the back door, immediately the view of Martin standing in the kitchen talking with Joan is a welcoming vision.
I turn my head towards Louisa when I hear the back door open. Joan has just finished reminding me of exactly who Melanie Gibson is and of course, I am embarrassed as it brought back that evening I went into my bedroom to get ready for bed and she popped out from under the covers. How will I deal with her on a daily basis and Louisa has no idea what happened Joan reminded me. 'It was just a teenage crush, she more than likely has forgotten all about it. But it would be a good idea to mention the event to Louisa." Joan said. I look at the two women walking towards me, a gangly teenager no longer. I wouldn't recognize her except for her eyes. My train of thought is interrupted by Louisa,
"Husband, you're home." She points over her shoulder, "You remember Melanie, don't you?"
I again look at her and recall our first encounter in my surgery, "Yes, dislocated shoulder."
Louisa smiles and looks over to Melanie, also smiling as she says, "Yes, I was working out at the leisure center and the kungfu man punched my shoulder and it popped out. Doc Martin fixed me right up," she said as she looked me right in the face.
"Mmm… Yes." I mumble and turn back to look into Louisa's eyes, calmly gaining my composure. I glance over toward Joan and can see her smirk and now think of a good time to relay the story to Louisa.
Louisa looks into Martin's eyes and sees his embarrassment with this conversation and chooses not to discuss anything further until they are alone.
ME/LE
Wednesday morning, Louisa and I are sitting in front of Doctor Rawle. "Hello, I never thought we would be sitting here again so soon," Doctor Rawle says lightly.
"Yes, the IUD we chose failed," I say raising my eyebrow ready to enquire further but Louisa interrupts with her greeting to Doctor Rawle.
"Louisa isn't the only person with that particular IUD that has a failure. I understand NHS is working with the company on the irregularities. The batch in question had faulty material used in the production. No official recall as of today, I made my inquiry when Doctor Parsons called to pass on your request for Mrs. Ellingham," he states. "Our clinic is searching for medical information on the women inserted with the faulty batch and calling them to schedule appointments. Now let's look at what we have on Louisa."
Doctor Rawle scans over the medical record Doctor Thyring sent and asked a few questions to make certain the information is correct. "Your first day of last period," he asks.
"It was February twenty-fourth," Louisa says as she scans her pocket calendar and I nod my head in agreement. 'The doctor should ask him, he has it all on that spreadsheet. I wonder how Martin didn't notice my missed period last month, Louisa's mind questions. I'll ask him in the car on the way home.'
"Possible ovulation, March tenth gives a day one direction or the other if your menses is a twenty-eight-day cycle."
"Her cycle will run anywhere from twenty-eight to thirty-three days," I mention.
Doctor Rawle looks up from his notes, studying each of us and then peering at Martin.
"Martin has this wonderful spreadsheet of my cycle. He finds female hormones fascinating, don't you husband," she says with a wicked smile.
I glance over to her, blushing, my throat is dry and I can't form words, "Mmm… Yes."
"I calculated implantation around March twenty-second, again a day in either direction. Your examination with a scan completed by Doctor Thyring placed you at ten weeks. I would like to perform another scan today to ensure you are twelve weeks. After the scan, I would like to discuss exercise, diet, and our goals for this pregnancy. If you have no further questions let's proceed to the scanning room down the hall."
I help Louisa up, securing her hand in mine, looking deeply into her eyes ensuring she is happy before we follow the doctor out the door and down the hall, into a room fitted with an examination couch and a rolling portable ultra-sound machine. I help her onto the couch while Doctor Rawle slides onto the rolling chair and turns the machine on. Louisa rolls her jumper up and lowers her trouser top. Doctor Rawle squirts the gel on her belly near the umbilical, slowly moving the transducer through the gel, sliding it very slowly around, he stops as a grainy picture becomes evident on the screen. I view the sight first as a father before my medical mind takes over.
"There, good that is good," Doctor Rawle mumbles under his breath.
He moves the wand around more as he comments to himself what he is seeing. When he has completed his examination, he points to the screen and describes each facet of his observation.
"See here, and here there are two placentas and you can see the shadow here and here, two amniotic sacs."
I look at Louisa and smile, our babies are not monochorionic, a lower chance of TTTS*, I breathe a sigh of relief.
"What does that mean exactly, Doctor," Louisa asks.
"In your case, you are carrying fraternal twins. If you recall fraternal twins are two separate eggs fertilized by two sperm. The separate placentas and sacs also are good news. Each fetus is receiving its nutrients separately. We couldn't ask for a better outcome. My measurements are within normal range with fetus A," he points to the one on the left side of the screen "which is 5.43 centimeters and fetus B is 5.58 centimeters. Both are well within the guidelines of six point three five for twelve weeks.
Doctor Rawle continues with his measurements to include nuchal translucency at the back of the baby's neck is normal. The nasal bone is within guidelines. I don't have an issue with either measurement."
"The crown's rump length is five-point six on fetus A and five-point five on fetus B agreeing with conception at twelve weeks."
"One last measurement and I will be done. The biparietal and femur length on both fetuses are in the normal range."
As you can see the pearl necklace indicating the spinal cord and all the major organs are established and listen to this," he pushes a few buttons and we hear a strong whooshing sound.
I immediately look at my watch and count in my head - one hundred fifty.
The doctor moves over to the other fetus and we listen again to the same intensity of one hundred fifty.
"Let me print these and we will return to my office," Doctor Rawle says as he finishes.
We find ourselves settled in Doctor Rawle's office again, as he shuffles his papers I watch Louisa as she nibbles her lower lip. I squeeze her hand, as I didn't see any problems with the scan, and was relieved about the many possibilities that were on my mind. Doctor Rawle finally has pulled all his papers from different drawers and clears his throat, ready to talk to us.
"Louisa, I am happy with your scan and your blood work. They give no indication of a chromosomal problem. Now, I want to go over what we need to do to have two healthy babies. I don't know how much you know about carrying twins and we have a higher risk due to your age. First I recommend extra folic acid and iron to go along with the prenatal vitamins. This will fight off the iron-deficiency anemia. Second, light exercise per what Doctors Thyring and Chen recommended in London. There is a yoga instructor in Wadebridge by the name of Mary Stafford, a wonderful prenatal instructor. Here is her paperwork. If you can't get to the class in Wadebridge, Mary does home instruction sometimes for special circumstances. I'm sure you can work out a schedule with her. Do yoga daily. I understand your village has a community pool. I want you to swim two days a week for twenty to thirty minutes. You have the video I recommended for floor exercises from your last pregnancy, do it on non-swim days.
"I am doing that program now," Louisa says.
"Good, now third but just as important, your diet. Your weight gain for this pregnancy is seventeen to twenty-five kilograms. It is important, no unnecessary weight gain. Lean protein, fruit, vegetables, whole grains, and healthy fats. Add three hundred calories each day. Lastly, remove as much caffeine from your diet. Caffeine is a cause for early labor and that is the last thing we want with this pregnancy.
'He sounds just like Martin, with his instructions to the patients at the surgery.' I look over to Martin and he is busy nodding his head in complete agreement. 'So much for a chocolate digestive once in a while, empty calories and the chocolate has caffeine in it'.
Your injury will require extra fiber to ward off constipation; I'll add a prescription for stool softener. It will be important to stay hydrated a minimum of one gallon of water and yes I know your bladder will start feeling smaller as each day goes by, but hydration is a very important way of waving off early labor. Now to the last item, I need to talk about - our goal - getting this pregnancy to thirty-six weeks."
"Wait thirty-six! Isn't a normal pregnancy forty weeks," Louisa states.
"Yes it is and I know your husband can explain it just as well, for women over thirty-five carrying twins can develop early labor anywhere from twenty weeks to thirty-seven weeks. Earlier labor means more issues for the babies. I included pamphlets with information for you. Our job for the next twenty-four weeks is to care for these babies. I know Martin will do everything he can and I will do my job. Rest will be important. I do not want you overdoing it. Short ten-minute walks minimum five times a day. Any questions about what I have covered?"
Louisa and I shake our heads and Doctor Rawle continues, "Good, now your job. I suggest half days for three days a week, on this Doctor Gee and I agree. Louisa, I know you like to be involved with your school, but your children and your health are all I care about. Now, are there any questions?"
I know Louisa is stunned by this information and I know I will need to explain why I agree with both doctors. Her health and the fetuses are all that matter to me. "Louisa is there anything you want to receive clarification on with the doctor," I ask.
"If I hadn't had my accident with this injury, would any of your concerns be different," she questions.
Doctor Rawle stands up and walks around his desk, sitting on the corner closest to Louisa, "No there is nothing I would change in the medical advice I gave you today. My job is to keep you healthy and deliver the healthiest babies I can. Do you understand?"
"Yes, I will follow your medical advice to the best of my ability and I know Martin will ensure I do. Just like last time Doctor Rawle, I want the best for my babies."
"Thank you, Doctor, I will help Louisa any way I can." Standing, I shake his hand, turn to help Louisa up and we leave his office. I have one thing on my mind I need to hold Louisa as I see the disappointment in her eyes. If I speak I will truly mess it up but I have learned if I hug her, I am usually correct. We make our way slowly out of the hospital, to the carpark, when we reach the car I take Louisa into my arms, telling her in my soft timber voice "I love you."
"I love you too, husband."
As I pull out onto the road heading home I push in the CD with compilationin piano** of Mendelssohn, Chopin, Debussy, Liszt, and Chaminade to listen as I drive to Portwenn.
Sometime down the road Louisa finally looks over to me with a questioning look.
"Martin, are you sure everything is fine with my pregnancy?"
I glance over and Louisa has pulled her lower lip between her teeth, "Yes, I am very satisfied with Doctor Rawle's observations," I say. "He didn't explain exactly why he was happy with the two amniotic sacs."
Louisa shakes her head, "Is that important?"
"Yes, it is. Two amniotic sacs mean each fetus… Humm… child has its own placenta. Separate so one is not taking more than the other in nutrients or blood. They can each develop without the hindrance of TTTS, better known as twin-to-twin transfusion syndrome. But that does not mean each fetus will not have difficulties."
"Martin, are you stating the worst-case scenario?" she asks with frightened eyes.
I don't know what I said to frighten her, "No, I am explaining what I saw and trying to explain that I believe your pregnancy is developing well considering all the possible problems that can develop early. Each time you pass medical markers in this pregnancy the chances of abnormalities and premature delivery are lower."
A glint in her green eyes, is it tears I see, could they be tears of happiness? Yes, happiness as I see her lower lip released and a smile come upon her face. I have relieved her anxiety.
"Martin, is that Debussy's 'Clair de Lune'?
"Mmm… yes. Beautiful isn't it? Just as beautiful as you," I answer as I look over to her once again.
We settle into a quiet happy silence for the rest of the trip as the music changes to each composer. I notice Louisa has fallen asleep with her hand resting on my upper thigh and I am content with the touch from my lovely wife. Reaching down I take hold of her hand and bring it to my lips to kiss before returning it to my leg.
ME/LE
By the end of the week, Louisa is making remarkable improvement - traversing the stairs without pain. The strengthening exercises and stretching she has done are relieving her pain. The scan showed the procedure Doctor Chen performed to normalize the coccyx is stable, and most of the swelling is gone. Louisa is not relying on pain meds, now only using ice after exercises and I give her massages each night before bed.
I like Doctor Gee, Louisa saw him on Friday morning. He is knowledgeable and agreed Louisa should not be left alone. He explained to Louisa, the injured coccyx could move with one of the possible problems to the coccyx would press against the nerves, causing pain in the sciatic nerve, the largest nerve in the sacral plexus. Compression of the sciatica nerves causes a group of symptoms called sciatica that is known for lower back and leg pain. The coccygeal nerve is the one serving the tailbone, compression can also cause numbness which could cause loss of feeling in your legs, causing you to collapse, injuring you and/or the fetuses.
Doctor Gee expressed, "Doctor Chen's recommendation of twelve weeks is correct in my opinion. The strengthening of the muscles around the coccyx is very important during this time. Doing the abdominal, pelvic muscle excises, including Kegel exercise will ensure an easier pregnancy and delivery. Here is a handout, many I believe you know from your previous pregnancy. Proper posture while sitting is very important, sit with your 'whoopee cushion' and your back flat against the chair along with feet flat on the floor. Your pain comes from sitting for long periods. But can also occur when standing and walking for long periods. It's a catch twenty-two for you and the addition of your pregnancy, and this will be a long twelve weeks. The growing fetuses are putting pressure on the coccyx. We want to do everything possible to strengthen and stretch the muscles and ligaments in the pelvic region to support your coccyx and uterus before your third trimester starts. Did your OB explain the body secretes hormones that soften the area between the sacrum and the coccyx? This enables the coccyx to move as necessary during childbirth, unfortunately, such movement may stretch the muscles and ligaments around the coccyx too far, causing additional pain. I have a referral for a Physical Therapist and Mary Stafford, a yoga instructor.
"I know of Mary, she instructs the prenatal yoga in Wadebridge and is starting a class at our Leisure Center. I have signed up for her class."
"Good, I don't have any more information to provide, except this," Doctor Gee explains. "Let your body do the talking, don't overdo and rest whenever possible."
These last words put a smile on my face. I am not the ogre that told Louisa what to do so maybe she will listen to them and do what they have asked.
End of Chapter
The compilation in piano CD **has some of the following pieces that I listened to writing this chapter: Mendelssohn – Opus 19b; Frederic Chopin – Nocturne in B flat – minor, Op 9, #1; Claude Debussy – Clair de Lune, L-32; Franz Liszt – Consolation in E flat Major, S. 172; Cecile Chaminade – The Seasons, Op 37a, #10, October Autumn Song.
Risks for the Babies *
Twin pregnancies have a higher rate of miscarriage. In some cases, one twin may miscarry or simply "vanish," leaving a surviving twin. This is also known as vanishing twin syndrome.
Twins * are at risk for intrauterine growth discordance, which is when one twin grows significantly slower than another. In identical twin pregnancies or pregnancies where twins share one placenta, this can be a sign of twin-to-twin transfusion syndrome (TTTS), where one twin takes more than its share of blood flow from the placenta. SGA that Edith talks about in the series is an example of intrauterine growth discordance in a singular pregnancy.
TTTS occurs in 10% of monochorionic pregnancies. If left untreated, severe TTTS can lead to infant heart failure or the death of one or both twins.
Biparietal diameter (BPD) is one of many measurements that are taken during ultrasound procedures in pregnancy. It is a measurement of the diameter of a developing baby's skull, from one parietal bone to the other. Biparietal diameter is used to estimate fetal weight and gestational age.
Crown-rump length (CRL) is an ultrasound measurement that is used during pregnancy. The baby is measured, in centimeters, from the top of their head (crown) to the bottom of their buttocks (rump). The limbs and yolk sac are not included in the measurement. The CRL can be measured starting around six or seven weeks of pregnancy up until 14 weeks.
I included plenty of medical information in this chapter but chose to not explain further at the end of the chapter. Most of it was found on WebMD and different Women Health sites dealing with pregnancy in women over 35. But I leave you with these bits of information:
Risks for the Mother
Twin pregnancy is not just risky for the babies, but also for the mother. However, many of the risks to the mother are also risks to the unborn babies, since they can lead to premature labor, complications, or in the worst cases, fetal death. Some of these risks are more of a nuisance than a real danger, while others can be life-threatening if left untreated.
Hypertension
Gestational hypertension is high blood pressure during pregnancy. In multifetal pregnancies (twins, triplets, or more), there is an increased incidence of hypertension. In a singleton pregnancy, the rate of hypertension is 6.5%; in twin pregnancies, it is almost double that at 12.7%. Left untreated, gestational hypertension can lead to premature labor, babies who don't grow well, or stillbirth. It can also be a serious threat to the mother's health, especially if it develops into preeclampsia.
Preeclampsia
Preeclampsia is a condition that includes both high blood pressure and protein in the urine. Symptoms may include swelling, severe headache, and rapid weight gain. It is twice as likely to occur in mothers of multiples. If left untreated, preeclampsia can lead to eclampsia, also known as toxemia. Eclampsia causes seizures and can be life-threatening to the mother and unborn babies. While blood pressure medications and anticonvulsant medications may stabilize the mother in severe cases, so the baby can spend a little more time in the womb, the only cure for preeclampsia is delivery of the baby.
Gestational Diabetes
Gestational diabetes is a condition where a person who was not diabetic prior to pregnancy has difficulty maintaining normal blood sugar levels. Gestational diabetes occurs in about 5% of singleton pregnancies, but women pregnant with twins are twice as likely to experience it. Gestational diabetes can usually be treated with diet and lifestyle changes. However, some people do require medication to adequately control their glucose levels.
As Louisa's pregnancy continues more medical information will be revealed.