‘Oh my God, Liz, there are two more heartbeats here.” The sonographer’s words cut through Liz and Seán Farrell’s happy tears and silent prayers at her seven-week scan. Liz knew she was pregnant, and that there was a chance of multiples, because it was the third round of IVF that she and her husband had undergone. But the news that she was carrying triplets overwhelmed them.
Getting to this point, after five years of trying to have a baby, had been a “hard, hard, hard journey – emotionally, spiritually and financially”, she says. “It opens up so many areas. You question everything.” Her hope, resolve and positivity were never in question. “I always said, ‘When I get pregnant’,” she says, describing her day-to-day philosophy. “You don’t have to stop hoping just because something happens.” The something she refers to is a missed miscarriage eight weeks into her first pregnancy, in 2011, and a car crash, later that year, in which she sustained multiple fractures.
Liz, who lives in Co Carlow and is an emergency nurse at St James’s Hospital in Dublin, was feeling tired but well during her pregnancy, and the babies’ growth was monitored at fortnightly scans at a Dublin maternity hospital, where the doctor described them as “chunky babies”. They were due on March 10th, this year; delivery was estimated at 34 weeks.
At 26 weeks, the world turned. Oisín and Conor, the identical triplets, were growing normally, though in breech position, but the doctor noticed that Noah, the singleton baby who was lying transverse above them, had stopped growing at 24 weeks. His heart was beating, but a Doppler scan confirmed “absent blood flow”, meaning the exchange of fluids through the placenta had reduced greatly.
Liz was admitted to hospital on the spot, without a stitch of pyjamas for herself nor even a vest for the babies. There were supportive and compassionate discussions about early delivery of the boys, and the implications of such intervention. There was a stark conversation about the risks of not delivering them early. “Our world crashed down on top of us,” says Liz. “In the course of my work I have seen everything, but I was terrified.”
The Farrells opted not to have the babies delivered then, but to take everything day by day. At this stage in pregnancy every day counts and so, they reckoned, the longer they gave Noah inside, the better the chance for all three. And so, she says, her voice faltering, “Our little boy held on, and held on, and held on.
“Every day was a bonus because it meant that all three were getting stronger. We didn’t want Noah to die. We wanted to give him every chance, and that is something we will never regret,” says Liz.
Caesarean section
At 28 weeks, a fortnight after her admission, the daily scan showed that the bloodflow to Noah had stopped. This meant the babies would all have to be delivered by Caesarean section that day. At 4.30pm on December 15th, Liz and Seán walked into a humming theatre, where a team was waiting for each baby.
“I felt like a fish in a fish bowl. I felt scared and intimidated and I knew they all felt sorry for me.
“I didn’t think they’d be able to cry at 28 weeks,” she says, still amazed by that moment. The boys were named before they were born. Oisín was first, and weighed 2lb 6oz. Next came Conor, at 2lb 9oz. Noah was 1lb 4oz and was taken immediately to be ventilated.
Liz was not able to see the boys in the neonatal intensive care unit until the next day. “Seán wheeled me to Noah in the first incubator, then to Conor, then to Oisín. We felt proud that we had made these beautiful babies. All three looked the same, but Noah was very small.”
Nothing prepares you, Liz says, not even being a nurse and knowing about drips, monitors, beeps and machines. She hated not being able to touch, kiss or cuddle them. And she was afraid. She later learned that these feelings are common among mothers who have babies in intensive care. “You forget about your surgery. You forget about yourself.”
After three days, she started to use a hospital pump to express breast milk, and all the colostrum was given to Noah, drop by droplet. Liz was discharged after five days, but every day she and Seán travelled from Carlow to see the boys.
Day 10
Christmas Day is special in hospital, says Liz. The staff in the unit were wonderfully kind, and Santa hats knitted by volunteers from
Irish Premature Babies
(IPB) were at the end of each incubator: nothing can go in that might introduce infection. “We didn’t hold our babies, but we were still with them.” They were 10 days old.
On St Stephen’s Day Noah, who was the only one still on a ventilator, was not well. “I knew at that stage what we were facing, but I didn’t want it to be true,” says Liz. “I never thought I could be going home with two babies. We spent that day and night with Noah and the next day he was baptised by my uncle, Fr Tommy Dillon.”
All day the nurses and doctors fought hard to save him. And Noah fought too. “In my job I’ve seen adults fight for their lives. Noah fought harder than anyone I’ve ever seen: his eyes open, looking at us, and his tiny fingers touching ours.”
Noah slipped away that night. “The first time I held my son was when he was handed to me after he had died. I hadn’t yet held the other two.”
When she was a student nurse on a maternity placement, Liz once carried a baby to the front door of the hospital, handing a mother her new little life as they left together. In an agonising echo of that moment, a nurse carried Noah to the door and Liz and Seán brought him home to where their family had gathered. They brought him for a walk across the fields with their dogs, as they had promised. And the next day they buried him in the small cemetery, overlooking the mountains, beside the school his brothers will attend. “I can’t express the pure happiness of having a baby, and the extreme sadness of losing a baby, all within two weeks.”
In the horrible daze that followed, once they had faced returning to the unit where Noah had died and his tiny brothers fought on, Liz and Sean lived for the day Oisín and Conor would be discharged. “The staff were so good,” says Liz. They both still draw comfort from the parents they befriended in the unit. As the boys grew, and their parents were allowed to touch them, feed them with droppers and change nappies, their day-by-day philosophy was stretched to the limit. “On a good day, they could be throwing their hands around, wriggling and looking at you; next day, they could need a blood transfusion.”
Apart from the desolation of going home to Carlow every day to “a pump and a steriliser” – not the normal picture of a house with new babies – there were days when Liz had trouble expressing milk and getting it to hospital. She saw the number for IPB on a poster in the hospital, and when she phoned, a saviour answered.
“The support Jen Crawford [the director of IPB] gave me that day got me through,” says Liz. “She offered me counselling and emotional support and, offered hospital-grade equipment to help with expressing milk. She said she would organise a courier to come to Carlow to collect milk. She told me I was doing a brilliant job. To hear that from a stranger when I was going through such a hard time: I was blown away by her kindness.”
Making progress
Conor and Oisín gained weight, were able for skin-to-skin contact, moved from incubators to cots and came off oxygen. They were discharged on February 15th after nine weeks and went home wearing their first babygros, made for babies up to 5lb. IPB organised for a lactation consultant to call to the Farrells’ home and show Liz how to breastfeed the two boys.
After three months of infection control, oxygen monitors and apnea alarms in the house, and Oisín’s hernia surgery, he and Conor are now 22 weeks (if they had been born full term they would be 10 weeks) and weigh 13lb and 12lb.
It helps Liz and Seán when people acknowledge that Noah was here. “When people say ‘You have twins,’ I always reply ‘Yes, but we had triplets’.” Their birth certificate lists Triplet 1, Triplet 2 and Triplet 3, and colleagues at St James’s had a star named after Noah; a tribute to a little boy who touched many hearts.
“The small things are the big things,” says Liz. “Just the right words and gestures at the right time. In any situation, even saying ‘I don’t know what to say’ is better than not saying anything.” See irishprematurebabies.com
