Hey, thanks for coming back!
So, Bottles, Boobs, and Feeding Tubes huh?
When I tell you I debated on this name for several months. I had so many thoughts and doubts. Will someone take offense to the boobs? Will someone think the boobs meant something sexual? Well, I decided it’s “Because Boobs.”
Where did this idea come from?
My head of course. Haha! No seriously, it actually came from a conversation I had with a fellow mom friend of mine. She has child with special needs. I don’t even know if she knows that our conversations led to the birth of “Bottles, Boobs, and Feeding Tubes.” After having my twins, she was pretty much the only mom I felt understood what I was going through. She was always so positive when I discussed the need for a feeding tube for Kali. She kept saying that it would be good for her. That she will thrive, and she was right. Now, I am kind of jumping ahead. I guess I’ll back it up a little. I’ll discuss how we got to this point and beyond in later post.
I.U.G.R.
Now about this thing called I.U.G.R? It means Inside Undeniable Greatness Resides or Intrauterine Growth Restrictions, I prefer the later. So, this Intrauterine Grumble Rumble is what exactly? Intrauterine Growth Restriction means a baby or multiple babies are not growing well on the inside. This can occur at any point in the pregnancy and for many different reasons. The baby can have no complications as a result or serious complications to include death.
How is size determined and when is it considered restricted?
A quick and relatively accurate way to estimate size in a singleton pregnancy is by measuring the fundal height. The second way to measure the baby’s size is by doing an ultrasound. During a twin or multiple pregnancy, the babies’ sizes are checked frequently by using ultrasound. The ultrasound technician measures the baby's head, abdomen and femur bone. I.U.G.R. is diagnosed when the estimated weight for gestational age is less than the 10th percentile.
What happens if my baby is diagnosed with I.U.G.R.?
If you care currently pregnant and diagnosed with I.U.G.R. this information is not meant to scare you. Unfortunately, there is no treatment, i.e. cure for I.U.G.R. however it can be monitored closely. Once diagnosed with I.U.G.R. you will undergo frequent monitoring with Ultrasounds and NST, nonstress tests. These tests can help the doctor identifying if there's a need for an early delivery. I was having fetal growth ultrasounds every 2 weeks starting around 20 weeks. Then weekly growth scans and NST testing around 30 weeks until about 34 weeks. Then twice weekly testing on separate days. A growth scan and BPP (biophysical profile) until 37 weeks.
What about delivery?
When being monitored regularly and showing no fetal complications, 34 weeks gestation appears to be the gold standard for delivery. Sometimes babies can be delivered as early as 27 weeks but usually no later than 37 weeks. Babies as early as 24 weeks of gestation has been noted to survive. The age of viability is 27 weeks in which it is believed most babies born around this age should be able to survive with proper medical attention and intervention.
How I found out about I.U.G.R.?
Ummm, I definitely do not remember learning about I.U.G.R. in nursing school. I cannot say it wasn’t taught, but I can say I remembered other complications of pregnancy and childbirth. I was around 24 weeks pregnant with the twins having our follow up anatomy scan. During the 20 weeks scan they could not get full view of Twin A, Kali’s, heart. This is when I realized Kali was my “Stubborn Independent Leader.” They were unable to see the full heart AGAIN. I needed to schedule an echocardiogram with the neonatal cardiologist. During that 24 week scan the doctor mentioned Kali was measuring smaller than her sister, Kori. I do not remember the exact numbers but they said it was less than 20% discordance. Discordances is a fancy way of saying they are measuring different in size. The risk for fetal demise or other complications increases when the size difference is greater than 20%.
Oh, but here is a list of reasons why not to worry!
The perinatologist said it could be that they are fraternal due to my husband and I having short and tall people in the family. She also said it's not that concerning as they are dichorionic diamniotic twins, own placenta and amniotic sac. The risk for TTTS, twin to twin transfusion syndrome, was 0%. I was given a lot of reassurance so I wasn’t too concerned about this. Oh, but wait! The ultrasounds can be off by at least a pound. No one took this into consideration not even me. We later found out during delivery that this can be true.
Oh YEAH, you made it to the end…now stay tuned for more on I.U.G.R., our delivery story, feeding difficulties and all-around parenting information.
CITE THAT
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