Tiny Beginners

Without the miracle of modern medicine, there is a very good chance I would have started out as a triplet in my mother’s womb, been born, and grown up alone.

My mother, who had three older children from a previous marriage, and my brother with my dad, was pregnant with triplets sometime around January 1990. Triplets! Imagine already having four kids, and then you learn you’re pregnant with triplets!

Unfortunately, one of those babies would die about 12 weeks into the pregnancy. According to the Cleveland Clinic, a nonprofit academic medical center in Cleveland, Ohio, mothers are at a higher risk for complications like premature birth, preeclampsia, and fetal growth restrictions with a multiple pregnancy (twins or triplets, or obviously, more than that!).

Premature labor is defined by the Clinic as going into labor before 37 weeks. Going into labor prior to that creates the risk of the babies being born with a low birth weight.

Single fetal death, or what the medical journals call this phenomenon, “the vanishing triplet,” in triplet pregnant is apparently not a rare phenomenon, according to a 2014 article in Medicine Today, an Australian-based medical journal. And when that happens, the authors said the risk of death to the remaining fetuses is increased.

Interestingly, the authors note that there is not much reporting about “one fetal demise in triplet pregnancy.” Maybe that should be an area of study, given how more and more common multiple pregnancies are!

A 2015 article in Clinics in Mother and Child Health, they estimate that 50 percent of triplet pregnancies will experience at least “one embryo resorption,” aka the loss of the embryo around the ninth week of gestation.

The authors note why that rate is so high, “These very high resorption rates, which can be explained on the basis of the intense fetal competition for space, nutrition, or other factors during early gestation, with frequent loss of the other fetus.”

I don’t want to use bad language on the blog, so, when I think about the implication of that, it’s rather messed up, isn’t it? In other words, in order for my twin and I to live, the triplet could not. There just wasn’t enough space, or nutrition available apparently.

Even 31 years later, I still think about what it would be like to have a third one of us. If they’d be a boy or a girl. What their personality would be like, separate from the personalities of my twin and I. And if they’d be on the same proverbial twin wavelength we are on. What would they be doing today? What would be their hobbies and passions? Their occupation? What would my life, and that of my twin’s, had been like growing up with another one of us?

We will never know.

We’re cute.

But the story does not end there. As mentioned, my mother was pregnant around January 1990, and her due date was November 26. That’s yet another interesting wrinkle to all of this: We could have been Thanksgiving babies! Or at least, November babies, which is weird to think about! Instead, we came in before the recommended finish line of 37 weeks to ensure our health, by being born at 7 months, or 31 weeks. Or, 11 weeks early, or premature.

My twin and I, we are fraternal twins, meaning we are not identical, and we are different genders.

She almost didn’t make it, if not for the miracle of modern medicine, specifically, the drug surfactant, and the “slickness” of Dr. John Clements, and the genius of Dr. Mary Ellen Avery.

You see, as NPR noted, Clements was originally brought into the Army in the 1950s to study how nerve gases worked on the lungs because the United States was worried about the Soviet Union, who we were embroiled in a Cold War with (history echoes!), would use chemical weapons.

Our lungs are made up of sacs called alveoli, where oxygen enters the bloodstreams through the outer membranes of these sacs, that act like “permeable ballons,” NPR explained.

When the sacs inflate, like a balloon, there’s more surface area for oxygen to cross into the blood.

That’s when Clements found the key to the expanding lungs: A slippery substance known as surfactant, which “reduces surface tension in the alveolar membranes.”

Those with a lack of surfactant are at risk for lung disease. Or may experience trouble breathing, such as premature babies. That’s because, as Avery, who was with Harvard Medical School in 1959, discovered, premature babies can’t make that surfactant, or at least, when they are born prematurely, it is underdeveloped.

Babies born at this time before 37 weeks of gestation would die from respiratory distress syndrome. It was the leading cause of infant death.

The miracle of drugs part came in when scientists created synthetic surfactants, such as the first Food and Drug Administration-approved one, Exosurf on Aug. 2, 1990.

That’s right. Barely a month before my twin was born prematurely without a fully developed pulmonary surfactant system, a new drug came online that would save her life. What timing! If in a different timeline where we my mother was pregnant with us just one year earlier, there is a fair chance she would have died.

And I would have been alone, without my triplet, and without my twin.

She still almost did, mind you. My parents were presented with a huge booklet about Exosurf, and they had to sign on to do the treatment. As my mother tells it, there was no alternative because the alternative was her dying. But still, after two rounds of Exosurf, my twin still wasn’t breathing properly.

Think about that. The ventilator wasn’t even working. So, then, again, my parents are presented with, should we do give her Exosurf a third time? What’s the alternative? They did. She’s alive.

As for myself, apparently, I was on the ventilator for a little bit, and was able to use it, and get off of it. I don’t know why I was so fortunate.

The picture on the left is probably my favorite picture of us.

According to a Nov. 4, 1993 article in Synapse, the student newspaper at the University of California San Francisco, before this miracle drug, 5,000 babies born premature were dying every single year. In 1980, the first clinical trials were done, and by 1986, a patent was licensed.

Exosurf stopped being marketed in the United States in 2001; there have since been four FDA-approved synthetic surfactants.

Nearly 32-years-later, my twin is alive. I’m alive. We’re healthy and thriving. That’s not just a vague platitude: Premature babies, even if they survive the initial birth and year thereafter, often have long-term health problems, such as cerebral palsy, intellectual disabilities, chronic lung disease, blindness, and hearing loss.

We have none of that. We are fortunate. Privileged.

Because we are preemies, March of Dimes has always been an important organization to us. If you’re not familiar, March of Dimes is a nonprofit organization that works to improve the health of mothers and babies.

“We use research, advocacy, and education to give every baby the best possible start,” the organization said.

Its signature event each year is the March of Dimes walk to raise money and awareness for such research and advocacy.

There is real, on-the-ground impact from the organization; this is not one of those cases where it seems like all the organization does is “raise awareness.” For example, since 2001, March of Dimes has partnered with hospitals across the country to educate neonatal intensive care unit staff, and to educate and support families. Nearly 50,000 families each year are supported by this effort.

The organization also invests millions of dollars into research, including most recently, a study out of the Imperial College London to learn about Lactobacillus crispatus and its beneficial role in the maternal microbiome. In other words, if the researchers can develop a L. crispatus supplement, they can “rebalance” the microbiome to reduce inflammation and prevent preterm births. Because that would be the ultimate goal, right? It’s one thing to save the lives of premature babies once they are born, but what if we can prevent premature births completely? That is the next frontier.

And that’s not all, of course. The organization has its hands in a lot of different areas to help mothers and babies, including dealing with maternity care deserts. You can learn more about all that they do here.

The March for Babies: A Mother of a Movement walk is set for April 24. I created a page for my twin and I, appropriately named, GingerTwins90. I would be ever so grateful to anyone reading this who tosses in a few bucks to our campaign to raise money for March of Dimes.

This cause matters. This focus on preemies saved our lives, has saved the lives of millions more, and will continue to save lives.