Monday, July 16, 2007

Summer of Sextuplets

The Mache sextuplets last update was 10 days ago. At that time, the babies were 2 lbs, 7 oz to 3 lb 7 oz. Babies that size gain 10-30 grams/day (1/3-1 ounce), so it's possible that one or more is over 4 lbs by now.

The Morrison 6 are down to 2, but according to a regular poster at Quintland, those 2 are growing and tolerating their feedings. It sounds like they are probably still "critical" and there is no news yet on the Morrison6 web site.

There are 2 more sets of sextuplets whose families have chosen to publicize their pregnancies:

The Soldani's, in San Jose, CA, are a little over 21 weeks. They're hoping to make it to at least late August, when they'll be closer to 28 weeks. Single babies born at 28 weeks have about a 75% chance of surviving with no major handicaps. If they can hold out to 30 weeks, like the Mache's, that increases to about 85%. The linked article is worth a read - the Soldani's are about halfway down, but it starts with a set of quads and there is some discussion of couples who have made the choice to reduce or to limit the number of embryos implanted.

The Bylers, in Florida, are 22-23 weeks gestation. They are at the cusp of viability and hoping to hold off delivery until September.

I work in a 20+ bed level III community hospital NICU. A parent recently asked me how we'd manage sextuplets. I told him I didn't think we'd ever have to. There are several larger (40+ to 70+ bed) units within an hour of us. It would make much more sense for quintuplets or sextuplets to deliver at one of those hospitals.

There is no reason for a hospital to be surprised by sextuplets (or quints, quads, or triplets for that matter). Women who are expecting higher order multiples know about it ahead of time and most of them are admitted to the hospital days or weeks before the babies are delivered. One reason is that it's very difficult to eat enough to support that many babies and some moms are supplemented with high calorie IV feedings. The other reason is to monitor the babies and the mom. There are significant risks to both with these higher order multiples.

We've managed quads with relative ease, but the babies were 28-32 weeks and the deliveries were elective -- and in daylight. We prefer our triplet deliveries to be elective too, but we've managed them emergently several times - and anywhere from 23 weeks to 35 weeks. We don't get too stressed about triplets any more. We just put on our roller skates and kick it up a notch.

So how does a NICU prepare for higher order multiples? I can't speak for everyone, but I know how we do it. As soon as we know that triplets or quads will be delivering at our hospital, we start making contingency plans. That means casual lists of nurses who are willing to be called in on short notice for that particular delivery. They might not be willing to give up sleep or a scheduled event for just any busy night, but they're willing to make the sacrifice for what, to us, is a relatively unusual occurrence. They're hoping not to get that call. The nursing supervisors on each shift check in with us about those contingency plans and keep lists of personnel in-house they can send us if anything changes before we can get our own personnel in.

We also make sure that we have the appropriate number of baby beds available for the delivery and for the admission to the NICU. They may not actually be IN the NICU until we know that the delivery is imminent, but we'll make sure they're "dressed and ready" (stocked with the basics for an admission).

We hope that the delivery will be elective -- a scheduled C-section with all of the necessary staff pre-scheduled, the beds set up, and all the little details in place. That doesn't always happen, of course, but it's the ideal. The larger units have proportionally larger staffs with more nurses scheduled on any given shift. They'll have their own contingency plans, too. I'm sure they still prefer to have their higher order multiples delivered electively, though.

So how do you stress a NICU nurse?

"Oh. There's another one in here" The mom had no prenatal care and arrived crowning - a true OMG moment. Fortunately baby #1 was doing fine, because there was NO time to get a second team into the DR.

Updated to delete links that are no longer relevant.


Chris and Vic said...

Do you, do other NICU RNs in your unit ever talk about the ethics of high order multiples? Do you, does anyone have a problem with it?

I know we are all professionals, and give good service/care no matter the issue/circumstances . . . but we also have our feelings and beliefs.

As in, what would we do if it was us/our family? I know, I am stirring the pot . . .
Chris and Vic

Judy said...

Ethics of higher order multiples? That's a pretty broad question. But here goes.

I work in a Catholic hospital. More than a few of the triplets/quads we've seen came because they were tired of hearing about selective reduction. They tell us that. We won't see the quints or sextuplets, because they're just too high risk for mom and babies - and the larger centers will jump at the publicity every time.

I am absolutely opposed to any sort of reduction. But I also agree with my church's opposition to the high tech infertility treatments that virtually always precede the conception of higher order multiples. I understand the desperate desire to have baby (been there), but there are definitely limits.

I have co-workers who absolutely would choose reduction if they were pregnant with higher order multiples - and who have no problem with any sort of high tech infertility treatments. They pretty much know not to ask my opinion on that subject any more.

We've had twins who were reduced from quads and, at least once, a single pregnancy reduced from twins.

The only conversation a parent has ever initiated on that subject was a mom of quads who asked me if I thought she'd done the right thing by NOT reducing. It was pretty obvious that she wanted reinforcement for her choice. Fortunately, her babies did very well and didn't appear to have any long-term issues when they left us.