Yin and Yang

I’ve been writing this post in my head for nearly three weeks now. Back in September we found out Kelly was pregnant. We were trying, so that it happened wasn’t a huge surprise. Get the OB appointment, get the ball rolling with switching to Tricare Standard, BTDT.  Then, at the beginning of October, we went in for the initial ultrasound. And. This. Happened.


Yep, that’s right, twins.

[expletive deleted].

Okay. We made it through one infant, we can make it through two. It’ll be more work, but at least we aren’t going in completely blind this time.  Except that one of my previous bosses, a long-tab SF Ranger type, told me the following after his twins were born:

I thought I had been sleep deprived before. Ranger school? SF Selection? They’ve got nothing on twins.”

Great. Just breathe. Guess it’s a good thing we didn’t trade the Explorer in on a wagon after all. Gonna need an extra car seat. Gonna need an even bigger stroller. Two. Of. Everything.  Found a deal on a stroller we can carry two in and put a roller-board behind for Maddie to ride on.  Sold the old stroller.  Pulled out the old car seat.  Started kicking names around.  What genders?   Well, we did an elective gender-determination ultrasound before, let’s do that again.  One baby is a boy.  Proud of himself.  The other is shy.  Okay, we’ll take their “come back in 2 weeks” offer and maybe have genders before Christmas.  So we go back and we’ve got a boy, and a boy? Maybe? Shy?  The tech asked when our next appointment with the doc was, and insisted we make it to that appointment… which struck us as odd, but whatever.

Christmas.  Wonderful time hanging out with the family.  Mom & Dad’s house with all of their grandkids playing, and 4 more on the way (Sister and S-I-L are both pregnant as well).

7 January.  Anatomy scan time.  With twins, we knew it would take longer.  For reference, twins are labeled “A” and “B” based on who’s closer to the cervix.  The tech started with A, and went through the normal cursory checks: Head, heart, arms, legs.  She then went through a more thorough scan, taking images of A’s brain, checking for a properly formed 4-valve heart, etc, etc.  But something was ‘off’.  She got to the lower torso and moved on to the leg measurements more quickly than I remember from Maddie’s scan.  Then over to B.  Same cursory check, then into the detailed scan.  But this time there was more time spent on the abdomen.  Stomach, kidneys, spine, bladder, etc… all normal there.  Something was up, but I couldn’t put my finger on it.  Then the tech left and said the doctor would be in shortly.

“There’s a problem with Baby A.  It is a significant problem.”

[much stronger expletive deleted].

“The baby has a condition called Amniotic Band Syndrome.”

Now before you run off and check with Dr Google about this condition, let me offer an alternative: The Colorado Fetal Care Center has this article, which is a good clinical explanation of the syndrome. It lays out the pathology without too much graphic depiction, which I would advise avoiding.  You have been warned.  In layman’s terms, the amniotic sac develops lesions during fetal formation which adhere to the fetus.  So, instead of the baby being ‘tethered’ only at the umbilical cord, there are small bands which are attached to or constrict other points on the body.  In mild cases, limb extremities may be constricted or malformed.  In some cases this causes intrauterine amputation, or requires amputation post-partum.  In rarer cases, the head or in rarer still cases the torso can have these attachments, possibly resulting in what is known as Limb-Body-Wall complex.  Baby A has LBWC.

“Doc, what do you think the odds are?”

“In mild cases, prognosis is good.  The condition may require amputation of a digit or limb, but it is usually survivable.  In this case, no.”



The doc also mentioned that Baby B had an umbilical cord issue, known as Absent End Diastolic Flow, and an echogenic bowel.  AEDF can sometimes be seen at this stage of pregnancy due to the placenta not being quite developed enough to allow proper bloodflow.  It can also be an indicator of other issues if it does not resolve.  Echogenic bowel is only rarely seen, and usually means nothing, but could indicate chromosomal abnormalities. Can’t be Cystic Fibrosis, specifically because Kelly isn’t a carrier. But it could indicate Down Syndrome, even though the screening blood test and nuchal fold tests were both negative.  Or it could be nothing. Great.

We had spent a couple of weeks wrapping our heads around the idea of having 3 kids under 3, specifically a toddler and two newborns in the house.  We had come to grips with it, and were starting to get excited about the twins.  And now we’re definitely not bringing one of them home, and the other may have an issue which can cause premature delivery.  Awesome.  We talked to the doctor about a number of options, among which was ‘selective reduction’.  This is apparently more common in IVF conceptions where multiples implant, as a way of making better odds for a smaller number, rather than carrying multiples to term.  But the doc wasn’t sure it would be an option here in the state due to limited specialization in that area, meaning we’d have to travel to NYC to see a specialist.  But of course with this option there is a risk of introduced infection, or spontaneous labor.  Which at this point in pregnancy would be a miscarriage.  NOPE.  We could wait until 24 weeks (the threshold for viability), but we’d still have to go to NYC, and if something went wrong we’d be in NYC with a micro-preemie in the NICU.  Yeah, I’ll take a double-helping of NOPE for that.  But thankfully, these two are Di/Di (Dichorionic diamniotic, meaning two placentas and two amniotic sacs) and other than the risks / space limitations associated with normal twin pregnancies, A wouldn’t have any other effect on B.

We had held off on putting the announcement out on facebook because we knew there could be issues at the anatomy scan.  However, we had sent family and close friends this picture at Thanksgiving:

And now, people who knew, and who were waiting for us to have more news about the gender of our shy kiddo… needed bad news phone calls.  Explanation.  Clinical descriptions.  Kelly does a very good job explaining things from a clinical perspective, thanks to her background and education.  I do okay.  But I kept finding myself floating toward wherever she was in the house when I’d hear one of those phone calls start.  She said she was okay, but I always wanted to be there to ‘help’.  Whatever the hell that means.  I can’t make it ‘better’, and we both know it’s nothing that we did or didn’t do (ABS is anomalous, and is not caused by any known genetic issue or parental action, inaction, behavior, race, creed, eye color, political affiliation, etc.).  But I still found myself hovering.  It’s a hard thing, being told you’re going to lose a kid.

So where are we now? Well, since Kelly got moved to a weekly schedule with the perinatologist, we already know that the AEDF (cord issue) has resolved, which is a huge load off our minds.  The perinatologist also noted that the doc in Richmond who does selective reduction at this stage of pregnancy has training on twins, but that the odds of spontaneous labor for the remaining twin is 8%… so we decided on a TRIPLE helping of NOPE there.  Especially since the AEDF resolved and his odds of making it toward full term subsequently went up.  We’re waiting until later to do an amnio and get 100% confirmation or denial on other issues. We’re working with the bereavement nurse at the hospital, and have started talking about some of the other issues with close friends and family.  I’m much less angry at God, and am amazed at how little I understand about His peace. Through all of this, I am continually impressed by Kelly’s poise and strength.  And we’re both impossibly grateful to have the two-legged bundle of cuteness (as opposed to the 4-legged ones, who aren’t bad, but aren’t the same…) bouncing around the house.  Babygirl snuggles go a long way in making one feel better, I might venture to say they’re up there with puppy-breath.

As for the title of this post, when we first saw the ultrasound picture above, and we had no idea on names, its similarity to the modern taijitu (yin/yang symbol) struck Kelly, and I responded that we should call them that.  Yeah, that stuck. Little did I know what would follow would be a roller-coaster of ups and downs.  I got good news about an internship I applied for at work, then the next morning we got the bad news about Baby A.  The next week we found out Baby B’s cord issue had resolved, but then that Saturday had us at the vet for the dog’s last appointment.  I spent the first half of the next morning’s worship service angry at God, only for the message to be about His restoration in our lives, and somehow all of that hurt and hate evaporated.  The ride is not over.  But there are tracks, and we’re going somewhere.  We are in the dark a lot, but we’re going somewhere.


Edited to add: If you’re the praying type, please ask for peace for us in dealing with this.

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