THE HARD LABOR FOR THREE LOVES

Barb Elfrink and her mother-in-law, Donna Elfrink, sped to the doctor's office in Barb's red Dodge truck. Barb reclined the seat as far back it would go and propped her feet on the dash.

The image of the blood in the commode was frozen in Barb's mind, a hideous snapshot that would stain her memory forever.

She had no idea what was happening to her three babies, what might be happening to her dream of becoming a mother again. She had come so far, spent so much time, energy and hope on this pregnancy. She couldn't be losing her babies.

"Oh God. Oh God. Oh God," she prayed aloud, assuming God knew her request without getting specific.

Donna kept telling her everything would be OK, but she didn't really know that. What else could she say?

Donna parked the truck in front of 15 Doctors' Park in Cape Girardeau.

Barb walked into the doctor's office, one careful step at a time. Barb's instincts told her to lay down. She knew fluids were important, and she didn't want gravity to play any part in a miscarriage.

The doctor's office was full, and it took a few minutes to find an empty bed. Soon the nurses found her one, and Barb prayed silently while waiting for the doctor. Donna squeezed her daughter-in-law's hand.

Kenny, Barb's husband, was on his way. He showed up at the doctor's office still in his mechanic's clothes. His clothes were stained with grease, his face smeared with terror.

"What happened?" he asked.

"I'm sorry, I'm sorry," Barb said. "I don't know. I started bleeding. I'm sorry."

Dr. Scot Pringle immediately ordered a test to find out if Barb had lost any amniotic fluid.

The test was negative. Great news.

Pringle directed her to have more extensive ultrasounds at Southeast Missouri Hospital. Kenny drove her.

During the ultrasound, Barb heard all three heartbeats. She exhaled, and a sense of relief washed over her.

Although there was no damage to the sac, the pregnancy was fragile, and Pringle ordered strict bed rest for his patient. She would need to come back the next day.

It was February. Barb wasn't due until July 13. Baby A would need to hold out at least another 12 weeks for the babies to have much of a chance.

The first night home after the incident was scary and dramatic.

Family members circled in Barb's bedroom as if she were on her deathbed. Someone wheeled Barb's grandmother into the room so she could sit at her granddaughter's side. Someone brought in a statue of Mary. A candle gave the room a surreal glow.

During that long night, Barb finally came to grips with the thought of possibly losing all three of her babies. Emotionally exhausted, she fell asleep scared.

The next day Barb figured if she had to go back to the doctor, she should stop by the school as well. She needed to talk to her principal, say goodbye to the Meadow Heights friends that had cheered so loudly when Barb told them she was having triplets.

She also had to pick up some personal items from her classroom.

Facing her class was the oddest moment.

She walked into the classroom and grabbed her students' attention. They could tell Mrs. Elfrink wasn't there to teach.

"I'm not feeling real good," she told the class as she picked up her personal items. "So I'll see you later." She didn't have the heart to tell them she wasn't coming back.

Barb made the rounds of her co-workers, and several teachers told her they would pray for her.

Kenny drove the expectant mother of three to the doctor's office for more ultrasounds. The tests showed low amniotic fluid for Baby A. Baby A was also smaller than Baby B and Baby C.

But the ultrasounds showed no holes, no stretching of the placenta. Barb was not dilated. She wasn't having contractions.

"We'll just have to wait and see," Pringle said.

Kenny stayed home with Barb that day. He didn't take off work much during her pregnancy. The family just couldn't afford it.

But the latest developments angered Kenny. A man of action, he was upset at the "wait-and-see" prognosis, miffed there wasn't more the doctors could do for his wife. But Kenny, the Fat Boy League pitcher, the mechanic and the hunter, is a woman's man, too. He picked up much of the slack around the house. He kept Barb laughing. He supported her. And Trent, a miniature version of his father, did too.

The scary episode kicked off a drab several weeks during Barb's pregnancy. With few exceptions, she spent hour after hour on her back.

For the first several days after the episode, Barb didn't get up except to use the bathroom. After a few days, Pringle told her she could move from the bed to the couch and move around some -- as long as she was lying down as much as possible.

She tried eating while lying down, but that didn't work out. She soon found out that three babies don't leave much room for food. She sat up to eat, and kept the Tums nearby.

Days of rest

A typical bed rest day started with Kenny fixing Barb some breakfast. He would leave for work, and she would flip on the television. She loved watching the baby stories on the cable networks.

She'd drink her water and nap until noon.

Kenny would come home from lunch and fix Barb a sandwich or something. He'd go back to work, and Barb would take another nap, watch more television, drink more water and count the minutes until Trent would come home from school at 3:35 p.m.

Sometimes she would call a friend in St. Louis who was home on maternity leave.

But there are only so many things to talk about.

She read quite a bit, especially books and articles about carrying multiples, but even that was difficult. She could only read while lying on her right side because the sun beamed right through the window in the afternoon and blinded her if she lay on her back or her left side.

Kenny would finally come home around 4:45. Sometimes after fixing cars all day, he would fix supper too. But it wasn't long before friends and family helped out with that. Kenny's boss and his boss's wife organized a system where a different person would make supper for the Elfrinks on most nights.

Barb's father, Frank Bagbey, took a serious interest in Barb's diet and nutrition, buying vitamins and minerals from health food stores.

Frank was familiar with prenatal care. He and Barb's mother, when they were married, suffered through seven miscarriages. They also lost a daughter, Elizabeth, when she was just 6 weeks old.

Trent learned how to do the laundry. Barb would direct from the couch. She'd tell him what clothes to put in the basket, how to set the washer, how much soap to put in.

It took a lot of extra hands to keep the house going.

Meanwhile Barb had to stay put, missing several special occasions, including Trent's appearance as a candidate in a school pageant.

Barb couldn't go to church either. Or anywhere except the doctor's office once a week.

Never in her life had she looked forward to doctor visits as she did in the spring of 2002.

Sometimes she would find out good news. Barb had been avoiding all salt since the early days of her pregnancy. At one of the visits, she found out she could have, even should have, salt in modest portions. Salt actually helped the amniotic fluid.

After doctor visits, Barb's cousin would take her shopping at Wal-Mart, pushing her around the store in a wheelchair. Later, they would pick up drive-through Chinese food or maybe a much-craved fruit slush from Sonic.

She felt guilty about the shopping. She knew she wasn't supposed to be doing that. But bed rest can drive a woman to the brink of insanity. There's only so much lying down a woman can take.

A couple weeks after she started bed rest, Barb developed a bad cough. She found herself in the hospital again, this time for asthma. Barb had seen plenty of asthma attacks in her early adult years as a respiratory therapist. Her first asthma episode just added to an otherwise dramatic pregnancy. She was in the hospital for three days. Nothing would come easy with this pregnancy.

Hard stomach

Two weeks later, in the second week of March, Barb felt her stomach getting hard. She looked over at the clock. It was 10 p.m.

She felt her tummy again, pushed on it a little bit.

Something's not right, she thought.

Kenny's brother came to pick up Trent, and Kenny once again took his wife to the hospital.

At the hospital, nurses determined she was having contractions. Once again, Barb's pulse rate soared at the prospect of losing her babies, but the medical staff was able to get the contractions stopped with medication.

She stayed in the hospital a couple of nights this time, but there was some great news. An ultrasound showed Baby A's amniotic fluid was at normal levels. Just like Barb knew would happen. The babies weighed about a pound apiece at Week 23.

During her stay, she began a little journal.

Dear babies,

Everyone here is so anxious to meet you. You are already loved and cherished. I'm writing this to let you know the incredible journey you have already made and to record what is yet to come.

Getting pregnant with you was not easy ...

Five days after she began the journal, she wrote:

We had another ultrasound and found out our miracle had happened. [Baby] A has normal fluid now. And you all weigh about a pound. I think we might just make it now. Your dad said the funniest thing the other day. We were lying in bed at about 7:30 on a Sunday morning. Church is at 8:00. Dad said, 'You know, we won't be able to sleep this late in a few months.' I said 'I know, the babies will get up much earlier.' I asked him how long he thought it would take to get three babies ready for 8:00 church. He said it won't take long because we will dress you the night before. He really believes that will work.

Kenny and Barb soon tired of calling their babies by letters of the alphabet so they picked out names.

Ultrasounds were fairly clear that Baby B was a boy. He would be named Jacob Martin after Kenny's Grandpa Martin and Martin's father, Jacob. It looked like Baby C was a girl. She would be called Madeline Mary after Barb's grandmother. Her name was actually Mary Magdalene, but Barb liked the sound of Madeline Mary just a bit better.

The ultrasounds were inconclusive for Baby A. Instinctively, Barb believed Baby A was a girl. She would be called Grace because it would only be by God's grace that she would survive.

Jacob, Madeline and Grace. If everything went well, the family would double in number. Barb and Kenny picked out backup names for each baby, just in case there was a surprise at birth.

Barb had several more bleeding episodes after her first on Feb. 9.

On April 5, the family celebrated Trent's 11th birthday. The bleeding had subsided for a couple of weeks, and besides the mundane horizontal perspective from the couch, the pregnancy had fallen into a pleasant pattern.

That evening, the family came over for Trent's birthday dinner.

Barb sat at the table. She even stood up and had her photo taken with the family.

Afterward, Barb started bleeding pretty badly again. But she didn't get too alarmed.

After the last round of bleeding, Barb had gone to the emergency room. Pringle had told her there was no use in that, that there would be nothing they could do in the emergency room to help her.

Barb had an appointment with the doctor the next day anyway, a regularly scheduled checkup.

Less than a week after learning that Baby A's fluid had been replenished, the Elfrinks got some bad news at Week 24.

A test called a fetal fibronectin was new to doctors at the time. The technology allowed them to discover specific cells that are only apparent when a woman is about two weeks from delivering her babies. The test came out positive and Barb was only 24 weeks along. However, none of the sacs had ruptured.

About two weeks later, a different test and another view through the microscope revealed the presence of fluid. Baby A's sac had finally ruptured.

Dr. Pringle referred Barb to the Washington University Center for Advanced Medicine. There, Barb could see a doctor who specialized in multiple gestations and high-risk pregnancies.

She arranged a visit for April 17.

Barb's friends warned her. They told her that she ought to pack her clothes in case she didn't come back to Leopold. So Barb did just that. She also paid the bills, getting all the finances for the month in order in the event that something bad happened.

The drive took longer than expected. The couple had a hard time finding the place, which was sandwiched around several other medical buildings including Barnes-Jewish and Children's hospitals.

To a bed-ridden, pregnant school teacher and a good ol' country boy from Leopold, the trip to the huge medical complex was intimidating. The numerous buildings are all connected by a variety of tunnels and catwalks. The Barnes-Jewish campus is like a city unto itself with suburbs all its own. The facility could hold countless times the population of Leopold within just one wing.

Barb and Kenny finally found the north parking garage, one of four garages on the Barnes-Jewish Hospital campus. They paid the attendant and parked the pickup. They walked across the covered walkway over Euclid Avenue and into the lobby, located on the third floor. They stepped into elevator and went up two floors to the obstetrics and gynecology/maternal and fetal medicine offices.

Barb approached the window and signed her name.

The couple sat nervously in the unfamiliar building. Kenny, never a big fan of waiting, flipped through some magazines just to have something to do with his hands. Barb, feeling uneasy after sitting up during the entire drive and walking from the garage to the medical facility, filled out the standard patient forms. She had prepared to stay in St. Louis but expected nothing more than a patient-to-doctor chat with orders for follow-up testing. Some advice and directions on how to keep her babies alive was all she was looking for.

She got much more than that.

Barb's shared her story with Dr. Gilad Gross. The bleeding, the bed rest, the asthma, the amniotic fluid.

Gross' test reflected what Pringle's test revealed: Barb's water had broken.

When water breaks, it can happen in one of a couple ways. It can gush or it can leak slowly.

Grace's amniotic fluid leaked slowly. On the day she started bleeding at school, she felt a small gush, but tests revealed there was no fluid leakage. She was now having doubts about that first test.

She didn't feel a gush this time, but the microscope doesn't lie.

There was a reason Grace's fluids were low sometimes and not others. Whether or not the ultrasounds could detect it, there had to be a hole or a tear in the sac.

Grace wouldn't have had a chance to last this long if not for Barb's strict adherence to her 80-ounces-of-water-per-day policy.

The bed rest kept the pressure off of Grace's sac as much as possible. And Barb's water regimen kept replenishing the fluid that would keep Grace, Jacob and Madeline alive.

Gross, a physician who specializes in high-risk pregnancies, a doctor who has won several awards for his teaching and research, told Barb that she'd have to be admitted to the hospital. She'd have to stay at Barnes-Jewish for the rest of her pregnancy.

Barb, still weary from the trip and the walking and waiting, thought about how brilliant her friends were to warn her of this exact scenario. She was glad she didn't have to send Kenny home after her clothes..

More than that, she worried about Jacob, Madeline and Grace. The worrying never stopped, but the optimism never ceased. There was a constant struggle in that regard. It was the similar internal wrestling match she had when she was trying to get pregnant. The silent monologue a few months ago went from I'm never going to get pregnant to I will get pregnant to I'm pregnant! to I'm not going to get my hopes up yet.

By the time she found herself in the waiting room at Barnes-Jewish Hospital, the stakes had been raised.

Part of her believed, another part doubted. Fear and faith whispered in Barb's ears much like the parody of an angel and a devil perched on each shoulder of a cartoon character.

They might die.

No. They will be just fine. God hasn't brought them this far to die.

The conflicting mental shades of angst and sanguinity occasionally transformed into visions at night.

Barb once dreamed that the nursery in her Leopold home was dark, cold and dreary. Eerie, life-sustaining equipment crowded the room like some dark experimental laboratory. But as frightening as the images were, there were also three sets of wires, three sets of machines and three beds. All three babies were at least alive, yet something of doom lurked in the darkness. She didn't know if the dream meant anything, but the images scared her more than they gave her hope. She prayed not only for her babies' lives but that they would not have long-term illnesses.

Gross's insistence that Barb stay in the hospital for the rest of her term wasn't a huge surprise. But it would be a huge inconvenience. Barb had so much to think about. She would miss Kenny and Trent, her mother and stepfather, her father, Kenny's parents and the entire family support system. She would be in St. Louis alone for days at a time.

But, she figured, it just made sense. It all started with polycystic ovary syndrome. Then the six years of fertility drug failure. Then the scary incident at the school followed by bed rest, asthma and intermittent rounds of bleeding. This news simply fit the pattern. Another test. Another hurdle.

Barb and Kenny strolled back to the parking garage to get their red Dodge pickup and drive to another parking garage closer to the hospital. Barb and Kenny walked over a carpeted catwalk across Euclid Avenue and into a high-ceiling foyer adorned with a large fountain. They saw a sign for "outpatient admissions" and walked there.

They were then sent to the fifth floor to the waiting room between the antepartum and delivery sections of the hospital.

As she waited, Barb suddenly realized she wasn't just tired. She was feeling ill. She looked at the huge aquarium in the waiting room and remembered that she hadn't had her water for the day.

She asked Kenny to go get her a bottle.

The nurses found her a room and a bed. They wrapped belt-like monitors around Barb's belly. On each belt was a coaster-sized disc which would monitor the babies' heartbeats and Barb's contractions.

When you're pregnant with triplets, your belly is always tight. Barb hadn't noticed that for quite some time, perhaps hours, her belly was tightening and relaxing at steady intervals.

Once the nurses hooked up the monitors, they quickly discovered Barb was having contractions.

In just a few minutes, they learned Barb wasn't just having contractions. Barb was having contractions two minutes apart.

Barb was in full-blown labor.

The Elfrinks' story continues on Friday.

bmiller@semissourian.com

243-6635