Praying For God's Wisdom

Hi Everyone,

We are really praying for God's wisdom, guidance and peace.

Last night was a comedy of errors but a total blessing from God. Sonia started having what turned out be contractions. Never having been pregnant, Sonia wasn't sure whether they were contractions as it just felt like consistent pressure. Our doctor arrived at around midnight and he said he could feel Rachel's entire arm and a part of her umbilical chord outside of her womb. The umbilical chord was of greatest concern and after trying to push Rachel back in failed the Doctor wanted to start delivery immediately and stopped the magnesium sulfate. One problem, knowing that there was no room at this hospital's NICU, the only started looking for NICU availability elsewhere AFTER they after deciding that they should try delivery and stop the magnesium sulfate.

Two hours later, they told us that there were no NICU beds available in a city of 23 million that is considered one of the most medically advanced countries in the world!

We think God was being merciful. They put Sonia back on the mag sulfate and while it still hurt and contractions still came up. At one point, the contractions were coming every 3 or 4 minutes.

After 8 agonizing hours on a tiny hard delivery table, Sunday morning came and they told us that there was still no luck with NICU beds and that Sonia should now be on strict bedrest, IV antibiotics, IV mag sulfate and bladder catheter until monday when they were hopeful that a couple of beds would open up.

We are thankful for the extra time to make some tough decisions. The doctors still aren't increasing the frequency of their blood and sample collections to make sure infection hasn't set in even though it is and has been the #1 cause of concern for Sonia's health as well as that of the babies.

Furthermore, they are suggesting what we move forward with a C-section to deliver Rachel and Isaac now at 22 weeks 6 days even though this NICU has NEVER had twins this young (prom or no prom) survive let alone avoid severe morbidity. After speaking with a medical group that is very experienced with situations such as Sonia's, these doctors tried to help us understand that because Rachel hasn't had water since week 18, Rachel simply won't make it and that the focus should be in trying to extend Isaacs pregnancy and protect both Isaac and Sonia from infection. They do this in the U.S. now by causing natural delivery of the PROM baby and then chemically stopping contractions again before Isaac starts to go into labor. Apparently, in situations such as this (where the prom baby is delivered before week 24 and the other baby is fine and shows no sign of infection), this procedure buys 31 days extra womb time for the other baby. They have had up to 120+ extra days. They have published 10 years worth of data with ove 50 cases (which they were amazingly kind enough to send me) that show how effective this approach is.

Unfortunately, our doctor doesn't think this is realistic even though the data is so clear.

If it is true that we are not going to be able to save Rachel no matter what if we deliver now, then I'm inclined to try this as I don't want Sonia under the knife unless necessary and NICUs here apparently have a 0% chance of survival of babies born younger than 23 weeks.

This next week plus a couple of days is particularly critical as many things happen after week 24. First, after babies reach week 24, they start to develop receptors that allow steroids to help accelerate lung development (i.e. the steroids won't work at all until week 24). Second, even Japanese NICUs have a small chance of saving babies that reach 24 weeks. Third, if the contractions can be controlled and Sonia continues to avoid infection and Rachel continues to hang in there, I don't see any reason to rush into delivery.

On top of all this, it has been impossible to find out which NICUs in Tokyo are the best. They have consistently been vague on this point. I cannot fully express how frustrating this is.

There is so much we don't know and Japan's system has been incredibly unhelpful. I am also afraid that our insurance company CIGNA / International SOS has not almost equally frustrating. I can't help but visualize every decision and response they are making being directed by cost savings and liability limitation versus what truly is in the best interests of the mother and children. I think part of the problem is that CIGNA / International SOS is relying on their Japan office to be their eyes and ears and they are cut from the same cloth as the other doctors and administrators in Japan that we are dealing with.

At this point, I can say the only One who has been consistent has been God. While I have to admit that I'm not happy right now with our current situation, I am thankful that Sonia and I hold no bitterness towards He who has been so merciful.

That being said, this has to be the fifth or sixth time that Sonia and I prepared ourselves to surrender Rachel and Isaac to the Lord until we see them again in heaven and I'm not sure how much emotional dry powder we have left.

While all of you have been so amazingly supportive and helpful, I would like to ask whether any of you could provide some suggestions or recommendations on which way to turn. A few folks have been kind enough to forward contact information for ob-gyns in the U.S. and we are trying to contact as many of them as we can. In particular, if anyone knows people at a large hospital in Tokyo with tertiary NICU (we've hear that St. Lukes is great for example), we would really appreciate a referral.

I don't want to sacrifice Sonia's health and Sonia isn't sure whether she could make it through naturally delivering Rachel and then possibly delivering Isaac by c-section if the doctors aren't able to stop Isaac's labor. We don't know what the true survival chance would be for Isaac if they delivered by c-section now versus the real and potential complications of trying to stop Isaac's labor after delivering Rachel. If the contractions can be managed and no sign of infection appears, we don't know whether it would still be the right decision to deliver both babies now.

Thanks for all of your tremendous support and prayers.

Jong