"I was so blessed to have the twins," said Nikki Riehl.
Still, when you have a toddler and hear that you have twins on the way, it's an attention-getter.
"I'll admit there was some worry going through my head," said Riehl.
Once the impact of the news was processed, Riehl's focus shifted immediately to the health of her babies, as a twin pregnancy can mean an increased chance of health complications. Riehl's twins were fraternal.
Developing babies get oxygen and nutrition from the mother via the placenta and umbilical cord. In the case of fraternal (aka non-identical or dizygotic) twins, each has its own placenta and umbilical cord. Fraternal twins can be same or opposite sex and can look different.
Riehl knows something about fraternal twins, as she is one.
"I had my mom to lean on when it came to questions, which was really nice," she said.
A twin pregnancy with separate placentas and amniotic sacs is the optimal twin pregnancy, as each baby has its own source of nutrition (and protective membrane as well).
Mothers expecting twins can expect more ultrasounds, and one of Riehl's ultrasounds revealed that Baby B (the baby positioned lowest in the uterus is known as Baby A) had an excessive amount of amniotic fluid surrounding it. Symptoms are generally mild, but severe cases can lead to shortness of breath, swelling, discomfort and malposition of the fetus. Complications include premature birth.
Riehl was diagnosed with gestational diabetes, a known cause of an increased level of amniotic fluid (aka polyhydramnios). To combat the condition, Riehl saw a dietician, changed her diet, and was instructed to be more active.
"I went on a lot more walks," Riehl said. "And I had to poke my finger and check my blood sugar four times a day."
Her c-section was scheduled the Tuesday after Memorial Day. Riehl visited her OB/GYN, Dr. Therese Yarroch, on the previous Tuesday for her final checkup, and things seemed to check out.
"Dr. Yarroch said I'll see you next Tuesday," said Riehl, "but I got a call from her on Saturday."
Yarroch's review of the last ultrasound showed a potential anomaly: the umbilical cord could be wrapped around Baby B's neck. While the image was inconclusive, the excess amniotic fluid could have led to the baby moving around more emphatically.
"She wanted me to go to the hospital right away for an NST," Riehl said.
An NST, or Non-Stress Test, is performed in the third trimester of pregnancies to measure fetal heart rate as well as the contractions of the mother. It can indicate if the baby is not receiving adequate oxygen because of an issue with the umbilical cord.
The test showed Baby B's movements were good. If the cord had been wrapped around Baby B's neck, his heart rate would have been dropping and he wouldn't be moving as frequently as usual. The NST usually takes 20-30 minutes. Riehl's was at the two-hour mark.
"I felt Baby B moving in there and the heartbeat was fine for that entire time," said Riehl. "I wasn't sure why they were monitoring me for that long, but then Baby's B's heart rate started to drop."
Yarroch suggested the c-section be performed right away.
It turned out Baby B's cord was wrapped around his neck, three times, and he wasn't breathing when he arrived. Baby A was breathing normally but five minutes later he too began to struggle. Both were whisked to the NICU and intubated.
"They just needed a little kickstart to help their lungs," Riehl said.
She couldn't go to the NICU until she was well enough to get out of bed and into a wheelchair, which took several hours.
"I was anxious to get to the NICU because I hadn't seen my babies yet," said Riehl. "They had four nurses working on them and they were in contact with me, so I was hopeful. The nurses were so awesome."
She got to hold her twin boys, Rhett (Baby A, "the laid back, relaxed one") and River (Baby B, "who just wants to be held"), on Sunday morning. They were out of the NICU the next day.
Many thanks to mom for telling her story while deftly caring for three-month old twins and their big sister Maddie-who let us know repeatedly that she did not appreciate the lack of attention, at all.
We end with the Facebook comment from Riehl that was the catalyst for us to reach out and learn more:
"Dr. Yarroch delivered our twin boys on May 27th via c-section. Baby B was having some complications and she used her professionalism and followed her gut to get both boys out safely to avoid further problems! I am so thankful for her and now we have two beautiful and healthy boys!"