CONCEIVING THE DREAM

Barb Elfrink ripped the pregnancy test out of her husband Kenny's hand. "Let me see that."

Sure enough, Kenny was right. There were two lines. Positive.

Suddenly, at 6 a.m. on a Monday morning, Barb had a brighter perspective on life.

Thirty minutes earlier, in the darkness before dawn, the test showed only one line. She was dreading the phone call that would come from the nurse at the fertility clinic later that day. She was sure her six-year failures would continue.

She looked at the box again, then at the results. Two lines. Definitely positive.

This can't be right, she thought, a rush of excitement pumping through her veins.

"Uh-oh," she said, skimming again. "Kenny, it says here the test is not valid after 30 minutes. Ugh!"

Barb knew over-the-counter pregnancy tests aren't 100 percent reliable. But the curiosity got the best of her. She really didn't know any more now than she did 30 minutes earlier, but sometimes there is a fine line between positive and negative, between hope and despair.

She called her sister-in-law, who scolded Barb for buying a cheap pregnancy test. Then Barb, excited but apprehensive, got ready for work with an extra bounce in her step.

Barb taught fourth grade at Meadow Heights Elementary School in Patton, Mo. The teachers at the rural school were a tight group, a sisterhood of sorts.

The Meadow Heights sorority was Barb's away-from-home cheering squad. The entire Meadow Heights staff was hoping and praying for Barb that Monday morning. They knew what was at stake.

The phone call came in around 10 a.m. The secretary transferred the call to Barb's classroom, and the wall phone near the door rang.

"Mrs. Elfrink's room," Barb answered.

"Hello, Barbara, this is Kathy Dodds with the fertility clinic. How are you this morning?"

Dodds' voice was a familiar one. The nurse and teacher had developed a friendly professional relationship over the last couple of months. Dodds was thrilled to be the one to tell Barb the good news that her body had finally reacted to the fertility drugs.

"Nervous," Barb said as she gathered the telephone cord and stepped out into the hall. Barb softly closed the door behind her. Through the vertical windows, Barb could watch her class. She could also see her teacher friend, Christy Welker, instructing her pupils in the room next door.

"I have good news for you, Barb. You're pregnant," Dodds said.

Barb did her best to contain herself.

Welker caught Barb's eye. Barb beamed and waved her fist in victory. Christy smiled back.

Barb didn't know whether to laugh or cry. She did a little of both.

"You'll have to excuse me," Barb told the nurse. "I'm a little overwhelmed right now."

"That's quite all right, Barbara," Dodd said. "The tests show that your hormones are higher than average for being only 14 days pregnant. We're probably looking at multiples here."

When Barb hung up the phone, she quickly found someone to watch over her class so she could call Kenny. She walked quickly to a work room, where two teachers overheard Barb tell her husband that he was an expectant father. The news had traveled around the school by the time Kenny hung up the telephone in the auto repair shop in Leopold.

The mechanic didn't have anything profound to say on the other end of the line, but he was thrilled. Finally, Barb spoke about pregnancy with joy instead of disappointment. He couldn't have been happier.

Staying cautious

Barb's six-year background of fertility strikeouts gave her a pessimistic view, however. She refused to get too excited. She just knew that as soon as she started celebrating, she'd have a miscarriage.

So she downplayed the news to almost everyone, but her friends and family would have none of it. They were excited for her. Barb only told close family members about the high hormone levels. She didn't want her sorority sisters to get too worked up over multiples when Barb was still not certain her babies would survive until the next ultrasound.

Two weeks later, an ultrasound confirmed that Barb was pregnant. And it confirmed what the nurse had suspected.

Four eggs had been fertilized. Three of them were vibrant and healthy. The fourth was not looking well.

Barb was told there was a good chance that one or more of the fetuses may dissolve in the early days of pregnancy.

Barb's friends at work knew that fertility drugs meant an increased chance at multiples, so they became suspicious when Barb dodged questions about twins. They asked again and again, and she sidestepped the queries like a savvy politician.

Barb, still pessimistic, wasn't giving in until she got through another ultrasound.

When that next ultrasound came, Barb faced some mixed emotions.

The earlier warning helped. The smallest and weakest fetus did not survive. The life had taken its natural course, she thought. It was probably for the best.

Instead of mourning, she focused on the three healthy babies who were growing inside her.

Barb called her mother, Loretta Mohorc, who was living in a small town near Cincinnati at the time.

If anyone on the planet could understand what this news meant to Barb, it was Mom.

Mohorc had pregnancy problems of her own when she was younger. Only she had no problems getting pregnant. Her issues were with miscarriages.

Barb's mother had seven miscarriages as a younger woman. She ended up having four children, including an infant daughter who died at 6 weeks old.

Barbie, as she was called as a child, was especially loved and adored as a child. She was prissy, a girl who hated being dirty, who loved playing with dolls and getting dolled up herself.

Despite a move 10 years ago to a different state, the two women went through the ups and downs of infertility together.

When Barb finally got pregnant, Loretta was so excited that she and Barb's stepfather, Joseph, decided to move back to Southeast Missouri.

It would take awhile for Joseph and Loretta to sell the antique shop business they owned in Ohio. Joseph found a job in Charleston at the state prison.

While Loretta prepared to sell the property so she could come back home to her grandchildren, Barb's mother-in-law, Donna Elfrink, filled in as Mom on the Spot. Barb was surrounded by a close family support system.

That system also included Barb's father, Frank Bagbey, a private man who owns a camera shop in Cape Girardeau.

Bagbey didn't play a large role in the pre-pregnancy fertility struggles. For Barb, those things were best left for Mom. His support role would come after the babies were conceived.

School surprise

When it came time to tell her Meadow Heights cheering section, Barb walked into a crowded break room. Practically every teacher in the elementary school was in there, not for any announcement but for breakfast.

The buzzing stopped when Barb walked in and then began again as several teachers spoke up at once.

"Is it twins?"

"You're going to have twins?"

"What did you find out?"

"Well?"

"No, it's not twins," Barb said, grinning.

She paused for effect.

"Triplets."

The teachers shrieked. Their joyous shouts echoed in the room, and laughter spilled into the halls.

Barb asked her friends not to let the word out just yet, but that was like asking a baby not to cry. Several weeks later, when she stood in front of her class and told her pupils she had a special surprise for them, a boy blurted out, "Is it that you're going to have three babies?"

So much for the surprise.

When Barb was nine weeks pregnant, Dr. Ratts released her. She began seeing Dr. Scott Pringle again, the same doctor who had originally put Barb on fertility drugs and then referred her to a St. Louis specialist. This time, Pringle would advise her in obstetrics instead of gynecology.

One of the first things Pringle did was lay out an important choice.

It's rare that a woman in Southeast Missouri accepts the option, but Pringle gives it anyway because he wants his patients to know all the choices.

There would be no discussion. Barb wasn't going to "selectively reduce" any of her babies.

But there are reasons some women choose selective reduction when they are carrying multiples. The top reason is health. Carrying two children isn't easy, let alone three. It's even harder on the babies than it is the mothers. Triplets rarely go full term, increasing the risk that some or all of the babies may be born unhealthy, maybe even die. Protected in delicate sacs, babies need a room to grow. Three is definitely a crowd and that leads to all sorts of health risks. Triplets are usually born about eight weeks earlier than singletons.

Barb later read in a magazine that women shorter than 5 feet 4 inches tall shouldn't carry triplets. Barb is 5 feet 2 inches, but the expectant mother didn't let any of that bother her. She had heard many stories about sextuplets surviving. She'd never heard any stories of any problems with triplets. Besides, she believed her babies were a gift and she put abortion out of her mind.

Pringle moved on to other matters. The first one was preeclampsia.

Preeclampsia, Barb learned, is a condition that can prevent the placenta -- an organ that develops in the uterus and provides air and food to the baby -- from getting enough blood.

Barb showed some of the warning signs of preeclampsia, particularly high blood pressure.

Pringle told Barb the condition, also called toxemia, can be managed with a proper diet. So she eliminated salt, cutting out many of the snacks she liked. Barb actually lost weight during the first several months of pregnancy, but that was a good thing. She was healthier than she'd ever been, except for the rare bouts of morning sickness. The diet wasn't as hard as she expected. She craved fruits anyway, particularly cantaloupe and watermelon. And sweets made her nauseous. The doughnut aroma that sometimes leaked from the teachers break room made her gag almost every time.

Barb's pregnancy was wonderful until the 16th week when Pringle ordered the first ultrasound in Cape Girardeau. The ultrasound technicians did all sorts of tests, took all sorts of measurements, poking and prodding for about two hours. Barb heard each baby's heartbeat but grew anxious as the ultrasound went on and on.

Pringle came back later with the pictures.

There were Baby A, Baby B and Baby C. Baby A was on the bottom.

Pringle explained to her that Baby A was low on amniotic fluid, which cushions the babies and is crucial in lung development. Judging by the ultrasound pictures, it didn't look like there was a hole in the sac, but Baby A was in trouble.

"Baby A will probably die," he said. "He has little to no fluid."

Pringle explained that it's possible for babies to get their fluid back but rare. He told her the only thing she could do was pray and wait.

Baby A's situation put the other two at risk. When fetuses die, they sometimes dissolve if they're small enough. If they're not, the mother's body goes into labor. Baby A was too far along to dissolve at that point. If one died, they'd probably all die.

Barb was no longer the pessimist she was several weeks earlier. She was sure she was meant to have the babies. Everything would be fine, she told herself. She clung to the hope that amniotic fluids could be replenished and didn't fret. She was in denial.

She read books and magazines and Internet articles about pregnancy. She found out how important it was for pregnant women, particularly those carrying multiples, to drink water. Water helps replenish the amniotic fluids.

Barb became an "aquaholic."

She downed 80 ounces of water every day. She packed four 8-ounce bottles of water in a cooler every morning. She drank all four during class before lunch, filled the four bottles again and drank them all before she left to go home. Later she chased it all down with two more bottles before bedtime.

Barb's class took five to six rest room breaks a day for the next few weeks.

Meanwhile, she lived her normal life, praying for her babies' safety. She taught. She took care of her son and husband at home. And they took care of her, too.

A week later, on Feb. 9, Barb's water intake hit her especially hard.

While her students concentrated on their work, Barb poked her head outside the door. She looked for a teacher to watch her class while she visited the ladies' room. No one.

One of the babies had to be pushing on her bladder. Barb just about couldn't stand it.

Finally, a teacher walked by, and Barb grabbed her.

Barb practically jogged to the rest room.

After she finished, something in the toilet caught her eye.

No, surely not.

She looked again.

Blood.

Fear gripped her insides. Her heart revved. Her lungs expanded then lost their elasticity. The horror took her breath away.

That didn't come from me, she thought.

Barb took a deep breath, walked to the teachers' room and asked one of the aides to watch her room.

She picked up the telephone, the same one she used to call Kenny the day she found out she was pregnant, and dialed her doctor.

The nurse told her to come in immediately.

Barb walked to the elementary office, and told the principal what was going on.

"Do you want me to drive you?" asked Donna Bristow, one of Barb's Meadow Heights sorority sisters who was in the office at the time.

"No, I'll be all right," she said.

"You really shouldn't drive. I don't mind at all."

"I know. But I'll be OK."

Barb asked one of the other teacher aides to call her mother-in-law, Donna, who worked at an electric transformer manufacturer up the road.

As Barb walked up the grass hill to her pickup truck parked not far from the building, she felt something. Like water. Like water leaking on the inside. Like her water broke.

Her heart pounded again. She climbed into the Dodge, put the key in the ignition and backed out.

She could hardly see the road through her tears.

Donna Elfrink, Barb's Mom on the Spot, got the call at work. She called Kenny and told him to meet them in Cape Girardeau. She told her supervisor she was leaving.

Barb stopped by the transformer place just as Donna Elfrink had hoped.

Barb moved over to the passenger's seat, reclined as far as she could go and put her feet up on the dash. She didn't want to lose any more fluid.

Donna took the wheel and stomped the accelerator.

Barb just closed her eyes and prayed aloud.

"Oh God, oh God, oh God."

bmiller@semissourian.com

243-6635