Lori Titus sat down in her doctor's comfy chair to hear the news.

"You know that's not good," she recalled of the meeting she had about four-and-a-half months into her pregnancy to give birth to triplets.

The doctor informed Titus, 38, that two of the identical triplet sons she was carrying had a condition known as twin-to-twin transfusion syndrome -- a rare and potentially deadly ailment.

"It's a very scary thing," she said. "In our instance, the babies most likely would have died if we would have done nothing.

"Delivery," she added, "wasn't an option."

Twin-to-twin transfusion syndrome is a condition in which blood vessels of twins are connected, according to Dr. Ahmet Baschat, a fetal medicine specialist at the University of Maryland Medical Center

"The chances are about 1 in 15,000," he said. "It's a very rare situation."

Titus, a professional beekeeper who lives near Mount Airy in the Poplar Springs community, said she and her husband, Dave, had been thrilled to learn she was going to have triplets.

The trio had been naturally-conceived and were developing in a healthy manner, but in the 18th week of her pregnancy, Titus learned that two of the three were transfused.

One of her sons was the "donor" essentially losing blood and nutrients to another of his brothers, who was receiving too much. The third child was developing normally.

Titus researched every source she could find to figure out what was going on -- and to explore her options. Those options depend on the severity of the syndrome, Baschat said. If the family decides to do nothing, there's between a 70 and 100 percent chance that the babies will die.

That didn't sit well with Titus, who read numerous stories online of women choosing that option.

Amniocentesis, another option, involves regularly draining excess fluid. But Baschat said that procedure doesn't solve the actual problem -- transfused veins.

"The impression that I was getting is that some people have the opinion that God's will, will be done," she said. "They didn't want to have any surgery, or the risks of having surgery or amniocentesis were so great (that) they'd rather risk having damage done."

Instead, Titus gravitated to another option -- laser surgery.

The procedure, called laser coagulation, involves using a laser to burn the affected blood vessels shut. Then, amniocentesis is performed to drain fluid.

"It does two things, drains the fluid, but also closes up vessels that are causing the syndrome," Baschat said.

The procedure is relatively rare, and not well known even among physicians. Only 10 to 12 centers in the United States offer the laser surgery, Baschat said.

Fortunately for Titus, the UMMC's Center for Advanced Fetal Care in Baltimore is one of them.

"A lot of physicians in the area are not aware of the availability of treatment options," Baschat said. "We've been doing it for years at Maryland. ... Whether it's the right choice or not, it's they're decision."

The chances were still only about 50/50 that the babies would survive, Baschat said.

Still, Titus decided to go for it.

First, though, she and her husband had to figure out how to pay for it. The cost of having triplets is estimated at being more than $110,000. Add to that the special care and surgery needed for the Titus trio, and the worry over money mounted quickly.

After her insurance ran out in April, Titus tried to privately insure herself, but nobody would take her on because of the pregnancy, she said. And husband Dave is on disability because of a stroke he suffered almost three years ago, about the time that their daughter, Rowan was born.

Lori sought assistance through the state, but was turned down because she was told she made too much money.

"They look at total revenue of the (beekeeping) business instead of the total profit," she said. "They were telling me I made too much money even though my bank accounts were at zero. That was very frustrating.

"I was really concerned I would miscarry because of the concern I had for the finances," she said.

Finally, Titus was approved for assistance through the Maryland Children's Health Program. The program picked up nearly all of her medical expenses and the surgery, with the exception of prescriptions.

And on Aug. 3, 2008, babies A, B and C came through the surgery and arrived -- albeit seven weeks pre-mature. Doctors labeled them alphabetically according to their birth order, so the Tituses decided to name them Arthur, Brannon and Charlie.

The arrival wasn't completely smooth. Charlie had to be resuscitated at birth and needed a blood transfusion; and all three had to be incubated and placed on oxygen.

Lori Titus had complications and needed a blood transfusion.

Three months later all are doing well, and Titus is sharing her story to encourage other women to explore all options before giving up hope with difficult pregnancies.

"Right now they're doing tremendously well considering what they've been through," she said.

"The good signs for us is that they can hear, they can track things with their eyes, but whether they can learn their ABCs and 123s, we don't know what damage, if any has been done to their brains," she said.

She joined the Columbia Area Mothers of Multiples for emotional support, as well as some extra hands to guide the triplets and family.

"There's a lot of help out there, it's just a matter of finding it," she said.

Baschat said the family won't know if there are any long-term effects until the triplets are about 2 or 3 years old. Cerebral palsy and motor skill problems, he said, can be a common outcome.

But considering the initial chance for survival and the difficulties the family has faced, the Tituses feel that they are in a good place now.

"Because those things happened, it put me in a position to stay at home and watch my daughter's first steps," she said. "It put us in a position where once I found out I was pregnant with triplets, we can stay at home and take care of triplets and run the family business."

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