Monday, September 30, 2013

Breast feeding

No one ever really talks about how difficult breast feeding is. The only inkling I had from reading other infertility blogs of people who had "crossed over". I read many accounts of people who struggled and never found a blogger who successfully breast fed twins. 

This article recently explained exactly how much help and support most people need in order to be successful with breast feeding. As much as having the girls in the NICU was incredibly difficult, I'm so grateful it brought me into contact with the lactation consultation Char. I'm a firm believer in the fact that things happen for a reason. I'm positive that without Char I would not still be breast feeding. 

As part of our discharge from the NICU the doctor offered to send a home health nurse to the house to weigh the girls for the first two weeks. We gladly accepted and waited to hear from someone once we got home. 

Last Tuesday a nurse named Sue called me. We spoke briefly over the phone and she informed me that she was also a lactation consultation in addition to a nurse. I'm not going to lie, over the phone I didn't like her at all. She seemed a bit critical of how we were doing things; using a shield to nurse the girls, keeping them on a schedule, etc. We made an appointment for her to come over on Friday morning to weigh the girls and we scheduled it around a feeding time so we could get her input. 

On Thursday evening I noticed that Clara's tongue was a little white. I didn't think much of it but took note. That night while nursing I noticed that my nipples were super sensitive, almost itchy while the girls were feeding, and I had some weird sensations while pumping that were like super quick little shooting pains in my breasts. I didn't think much of that either to be honest. 

The nurse Sue came Friday morning and really redeemed herself. As soon as she saw how little the girls were and when I demonstrated my attempts to get Clara to latch without the shield I think she understood. She saw that their mouths are really small and that she really struggled without it. She was very positive about how the girls were gaining weight so well and how great they did nursing.

I had been doing a lot of reading about breast feeding and came across information on thrush. When the nurse came on Friday I mentioned Clara's tongue to her and she took a look. We got some wet gauze and tried to remove the residue on her tongue to no avail. She then asked if I had any symptoms. When she told me what they were I knew something was up. She told me she would call the pediatrician's office with the weights but also tell them about the thrush. She was hoping they would go ahead and treat it without making us go to the office. She also told me that Lucy and I would also need to be treated or else we could all pass it back and forth. 

I called the pediatricians office around 1:00. They wanted to see the girls and scheduled us an appointment for 2:50. I then asked if they would be able to treat me and they told me no so I called my primary and scheduled an appointment for 2:00. We quickly fed the girls, I pumped, and we dashed out the door to my appointment. 

My primary looked at my nipples and said they would be happy to treat it and call in the prescription cream to my pharmacy. I brought one girl into the exam room and W waited in the waiting room with the other. 

From there we headed to the pediatrician. We had been earlier in the week and were pleased with the Dr. Rather than seeing the Dr. they had us see a PA. She examined Clara and didn't seem convinced. She was really looking for lesions on her cheeks, lips, or gums and found nothing. She then said she wanted to call the Dr. in to get his opinion. When he came in he also looked and then concluded that he didn't think Clara had it. He said he would bet that she didn't but was willing to treat the girls if we really wanted. They asked us what we wanted to do and I was suddenly completely unsure. They said they would give us a few minutes to think about it and stepped out. 

W was more inclined to not treat it, especially if they didn't have it. I was super confused and faced one of my first tough mommy decisions. We decided since we would be back on Monday that we didn't necessarily have to treat it immediately. We could wait and see. When the PA came back in I asked her if she would look at me to see the whole picture and she said she couldn't since I wasn't a patient there. We left without the prescription for the girls and with me confused and overwhelmed and practically in tears. 

When we got home I saw I had missed a call from the nurse Sue. She wanted to know how we made out at the pediatrician and I called her back and told her. She was super frustrated and said she was  quite sure Clara and I both had it. She urged me to treat all of us and we talked for a bit. When we hung up I was even more confused. I had the home health nurse/LC and my primary telling me I had thrush and needed to treat it and the pediatrician betting we didn't have it. Since it was close to 4:30 at that point I asked W to call the pediatrician and get the script called in for the girls. That way we had it and could decide from there. 

At that point I pulled out Char's card and gave her a call. She was so happy to hear from me and wanted to know how we were all doing. She also told me that it was her first day back in over a week and that morning she had gotten my card. She said she was so touched by my card that it made her cry. We chatted for a few minutes and then I asked her about the thrush. When she asked about symptoms and I described what was going on she was quick to confirm what my gut was telling me; Clara and I definitely had thrush and we needed to treat it ASAP. 

She gave me a lot of instructions on sterilizing the shields and pumping equipment, using a vinegar and water solution to wash my nipples before and after every feeding, how long to take the medications for, what to do with my frozen breast milk during this time, etc. She was, as always, incredibly helpful. 

W ran to the pharmacy and picked up all of the medications. I will need to use a cream on my nipples four times a day for two weeks and the girls needs to have the same medicine in oral form also four times a day. 

I'm so glad we are being proactive about things. I don't want to wait until the girls mouths are covered in lesions before we take action. I was in enough discomfort already. 

I'm feeling a bit better. I'm less sensitive and nursing hurts a little less. I also noticed on Saturday that Lucy's tongue has the smallest little bits of whiteness on it. 

I didn't think breast feeding was going to come with so many challenges, but I'm so grateful for both lactation consultations who I've met. They really know what they are talking about. We are now 27 days into exclusively breast feeding and I couldn't be prouder. It hasn't been easy, but I will persevere, especially with support. 

Sunday, September 22, 2013

They're Home

The girls behaved themselves their last few days in the hospital, passed their carseat tests, and made it home yesterday afternoon. They spent 18 days total in the NICU.

It's so amazing to be home and to have them here with us. W has been such a good daddy and is a great burping/diaper changing partner.

For the last night at the hospital we brought the nurses a big box of coffee from Dunkin Donuts and a bunch of chocolate. The morning of their discharge we stopped at a bakery and brought a whole bunch of goodies. We got cards for our 3 favorite nurses and left them at the nurses station. I can't begin to thank them for being so great to our girls. They were so amazing in so many ways. One of our favorites came down to say goodbye to the girls and gave them big hugs before we left.

Our first night home went pretty well. Clara was pretty fussy from about 11:30 pm-1 am. We are trying to follow the NICU schedule of feedings every 3 hours so we tried to let her fuss some but then broke down and picked her up. I ended up rocking her in the nursery and that put her back to sleep. From 1-10 am they woke up every 3 hours to eat and then went right back to sleep.

For the 1 am feeding we gave them bottles to make it a little quicker. I'm still pumping after nursing them so the whole routine takes a little over an hour.

We purchased the Snuza Halo baby monitors which gave us huge peace of mind last night. They clip to their diapers and monitor their breathing. If it doesn't sense movement for 15 seconds it vibrates. If another 5 seconds pass without movement it sounds an alarm. I can't recommend them highly enough.

I just feel so lucky and blessed to have these girls. It's still somewhat surreal that they are ours.

Thursday, September 19, 2013

Bittersweet/Angel in Disguise

The girls are 16 days old today and getting closer and closer to being discharged.

Yesterday was our first tentative release date that came and went with the girls still in the NICU. Last weekend they decided the girls would be able to go home on Wednesday as long as everything went well. Lucy continued to have a few bradycardia episodes but all were brief and self resolved. Then Clara got upset one night and her nurse gave her her paci. She began to suck on it so hard she forgot to breathe and started to desaturate. Even when the nurse took it away she still didn't take a breath until she was prompted to. This bought her a few more days automatically.

Last weekend I continued to work closely with the LC/RN Char. She didn't feel like Lucy was ready to go and she was straightforward about advocating for her to stay. She was off the day following Clara's episode but was glad to hear they would both stay a few more days when she came back.

Char worked 5 out of 6 days in a row and every day we grew that much closer to her. As a speech language pathologist I have a lot of interest in feeding. I was eager to learn as much from her as possible. Even though she has 42 years of experience I was amazed at how she could take one look at my girls and know exactly what they needed.

We started to work on getting Clara to latch without the shield, something I still haven't been successful at without her. When Clara bought herself more time I figured it was ok because it meant more time to work with Char. This was what would make staying there more bearable.

Char was off on Tuesday and despite my best efforts I was unsuccessful latching Clara. On Wednesday she was back and we knew we'd get some more practice. With the first feeding Char told us this was her last day working for a week. With a new tentative discharge date of Saturday it meant this was our last day with her.

Suddenly our prolonged stay didn't seem as great and saying goodbye to my favorite staff member was imminent. I spent all day holding back tears and dreading our goodbye.

We stayed until 5:30 when I knew her shift was over. I told her we hoped to not see her agaIn and that we needed to say goodbye. She came out and gave me a huge hug. The tears started streaming down my cheeks at that point. I thanked her for all of her help and she told me I couldn't cry because it would make her cry. At that point I knew I had to get out of there before I totally lost it. At I walked away I glanced back and saw her saying goodbye to my girls. I heard her tell them she loved them.

I made it out if the hospital before I started sobbing. That night was incredibly rough. I cried a lot more than I had in days. Each time I got up to pump the tears would stream down my face and falling back asleep was difficult. I sobbed and sobbed in Walt's arms until I fell asleep.

This morning wasn't much different but once i got out of the house it really helped. I can't help but cry as I write this. I never thought I could be so upset about saying goodbye to someone.

I plan to write Char a thank you letter and tell her how special she was to us during our stay in the NICU. I don't feel like I can thank her enough. I have her email and contact info but know how busy she is when she's there. I'm hoping we can keep in contact with her.

Now we keep our fingers crossed that we get to bring our girls home on Saturday and that we aren't still there for her next shift.

The world needs more special people like her.

Saturday, September 14, 2013

Updates From the NICU

The girls are doing great. They are 11 days old today and both still in the NICU.

I started tandem nursing on Wednesday. By Thursday night Lucy was struggling. She was going strong for about 5 minutes and then losing steam and falling asleep. W would help as much as possible by burping her, rubbing her feed, or trying to wake her up. This would often work to wake her up, but then getting her latched again was difficult. 

On Thursday night I tried to nurse the girls but had to swallow my pride and give Lucy a bottle as she wasn't having success with nursing. I had to do what was best for my girl, not what I wanted. Getting the bottle into her wasn't easy either, but with a lot of persistence I succeeded. 

 The LC Charlene was off on Thursday but luckily was there on Friday. We talked about little Lucy in the morning and made a strategy. She said it was best to alternative every other feeding between the breast and the bottle. This way Lucy wasn't getting so tired nursing and we were making sure she was still getting full feedings. On Friday she had fewer dirty diapers and was very low energy. She also looked more jaundiced. Over these few days she also had quite a few bradycardia episodes where her heart rate would slow down. Most were self corrected, but it was obvious she was tired and working too hard. 

I cried quite a bit over this setback. Things went so well on Wednesday but it all was a little much for her. I didn't want to push her too much and knew I had to back off and do what was best for her. 

At the same time her sister Clara really took off. For feedings she was going for 25 minutes on the breast without any problems. She practically didn't even need me to hold her head. We would pull her out of her isolette and W would hand her to me, gaping mouth, ready to nurse. She was our little champ. 

To my surprise the LC is also an RN and was also working today so she requested she be assigned to the girls. That way we could work more on feedings and she could observe the girls more closely. She is so amazing and experienced and I feel so lucky to have her there to help us and take care of the girls. We woke up for the 7:00 AM feeding this morning because we planned to go to the mom's of multiples consignment sale at 9:30. 

I was up to pump at 2:00 AM and 5:00 AM and then we got up at 6:20. The 45 minutes between the last pumping session and waking up was rough. I was so emotional today and Charlene pointed out that  the less sleep I got the more I'd be crying. She wasn't lying. 

We found out today that Clara is going to move into an open crib tomorrow and will likely be discharged 48 hours later. Lucy is not ready for an open crib yet. Finding this out broke my heart. I never thought the girls would be discharged at different times. 

This afternoon we came home to nap and W and I snuggled together while I cried. We decided we aren't going to say that Clara is "coming home" since we aren't going to be at our house. We will be bringing the girls home together when Lucy is ready as well. Until then we will continue to stay at my in-laws house. It makes me sad to think that I had matching outfits to bring them home in and that we are going to be leaving Lucy without her sister for the first time. 

I'm a little worried about how I'm going to manage one here and one in the NICU. I'm sure we'll figure it out, but it's not how I pictured things. None of this is how I pictured it though.

Hopefully Lucy won't be far behind. I can't wait for us all to be together in our own house for the first time.

I never thought this time period in the NICU would be so tough. I'm hanging in there and doing my best, but it's not easy. Just like infertility, I wouldn't wish this on anyone. 

Thursday, September 12, 2013

Week 1

I know I'm a little late, but it's hard to find the time to update these days. To be completely honest, the past 9 days have been a bit of a blur. It's hard to keep what happened on what day straight. It feels like I'm on a roller coaster ride with post-partum hormones mixed into all of the emotions of having the girls in the NICU and having to leave them there. I've had a couple cry-fests and it hasn't been easy. Leaving the hospital was really hard because it meant leaving them behind. There was another night that I totally lost it and bawled on W's chest. 

The day after the girls were born Clara needed some help with her breathing. Her little chest would rise and fall so fast so they put a nasal cannula with oxygen on her. It was so hard to visit with her because even touching her would agitate her and make her respiratory rates increase. There was one night where she had a horrible nurse who scared me when she talked about intubation and chest tubes. I was so scared to visit her the next morning for fear of finding her in worse shape, but to my surprise the next morning her settings were reduced.

At the same time Lucy was doing great. I was able to hold her quite a bit and at some point we started working with the lactation consultant. Lucy started in the most intensive part of the NICU (nursery A) because her IV was through her umbilical cord, but she quickly moved to the least intensive part (nursery G).

After I think 4 days Clara come off the oxygen. It was so nice to see her little face without everything on it and to be able to hold her and start to bond with her. I was feeling guilty at first because I felt so much more bonded to Lucy. After about 5 days she was also moved to nursery G right next to her sister. 

After a few days both girls were put under the lights to reduce billi levels. Since then they have come out of the lights, but their levels are still a bit elevated. They are planning to check again tomorrow, so they may end up back under the lights.

Yesterday I tandem fed the girls for the first time. Each feeding since I've tandem fed. The lactation consultant in the NICU is just so amazing. She is super knowledgeable and so helpful. I'm using a shield on both sides because my nipples are flat, but the girls do great with them. I'm hoping at some point I won't need them, but it's fine for now with W helping. It is so amazing to see them looking at each other and to be holding them at the same time. I honestly have no idea how I fit that much baby in my belly. They are both nursing really well and I couldn't be prouder of them. I'm also pumping after each feeding and building up a bit of a stash in the NICU.

The nurses do "care times" every 3 hours. This is when they get their vital signs checked, get their diapers changed, and get fed. These times fall at 7, 10, 1, and 4 for both AM and PM. We typically are there for the 10 AM, 1 PM, 4 PM, and 10 PM times. At the other times the nurses bottle feed the girls and I pump. We are staying at my in-law's house because it is about 10 minutes away. I haven't been home since the morning of the accident. I miss being at my house and sleeping in my bed so badly, but it's worth it to be close.

The girls are both still in isolettes. In order to go home they need to move into open cribs and then have no issues for 48 hours. To move to the open cribs they both need to increase their feedings a bit and maintain their temperatures. Last night we each gave a girl a sponge bath and they weighed them. Lucy stayed the same and Clara gained a little bit. Lucy has had a few episodes of bradycardia the past few days where her heart rate drops. Most are self resolved, but she has needed some stimulation a few times. Unfortunately last night she also had an apnea episode and need stimulation to recover. The nurse said this guarantees her 5 more days in the NICU.

That's what I have for now. I'll leave you with some more pictures.
Wearing the hats grandma made them. Lucy on the left, Clara on the right. 
First days with Lucy. Love this photo of us. 

First days of Clara
kisses for Clara
Fist time holding the girls at the same time.
W holding the girls for the first time.
First family photo.
If you don't want to see my boobs, you may want to stop look at pictures here. 
First time tandem feeding. Hope my boobs don't offend you. 
Working with the LC.
Yup, my boobs are well documented these days.
Reaching their hands towards each other.

Monday, September 9, 2013

Birth Story

On Labor Day weekend my sister, BiL, and nephew visited. We spent time at the lake and hung out a bunch. We had gone to the store and bought some junk food as that's what my sister and BiL like to eat. My sister also baked chocolate chip zucchini bread which I ate a ton of. On Saturday and Sunday mornings I woke up feeling almost hungover from eating junk. I didn't realize how much it could affect me. 

They left on Sunday afternoon and I spent most of Monday at home relaxing and snoozing, recovering from the weekend. I had a great time, but stayed up late both nights and didn't get as much sleep as I was used to. 

Early Monday morning I woke up because one of the girls was in the ribcage/on my diaphragm. I was completely unable to get comfortable and felt like the wind had been knocked out of the me for about an hour and a half. I was sitting up in bed at 4 AM in pain. When I woke up around 10:15 I said for the first time during my pregnancy that I was ready for the babies to get here.

On Tuesday by lunch time I was ready to get out of the house. I planned to go to the fabric store and the dogs were super excited to come along. When I got in the car I moved the seat forward as W had driven the car last. I remember thinking about how close my belly was to the steering wheel. 

As I was driving I heard a siren. I looked into my rear view mirror to try to locate it as I approached an intersection. When I didn't locate anything behind me I looked back up. When I looked back up the car in front of me had stopped completely. They had seen the ambulance at the intersection going the opposite direction. I had enough time to say "oh shit!" and slam on the brakes. 

When the car came to a stop I felt a huge gush. I reached down and brought back up my soaking wet and shaking hand. I sat there in complete shock until someone came up to the window. He was a first responder EMT and asked me if I was okay. I said I was but that I was pretty sure my water had broken. He asked me if he could call anyone for me and I dialed W and handed him the phone. 

The ambulance was there shortly after and they brought a stretcher over to the side of the car. I never tried to get out of or move the car from the middle of the intersection. I was just so scared and in complete shock. The ambulance drivers spoke to me for a few minutes and we headed to the hospital I was planning to deliver at (as per my request at least 4 times). I called W, my mom, and sister on the way and texted a few other people including my chiropractor to cancel my afternoon appointment. On the drive I really had to pee and told the ambulance driver it probably wouldn't make much of a difference if I did since I was so wet already. I felt a few more gushes along the way.

 I've honestly never been so scared in my life.  I was so worried about the girls despite feeling a little bit of movement from each. 

We arrived at the hospital after probably a half hour or 45 minutes. They took me to the ER department but the doctors took one look at me and insisted they send me up to the L&D floor. When I got up there they transferred me to another bed and the nurses came in. My mom arrived shortly after. During that time there they hooked both girls up to the monitors, did an ultrasound, and an internal exam. I have no idea how long this took. I asked to go to the bathroom and with each step I took fluid leaked onto the floor. When I peed I noticed there was blood in my underwear. 

The nurses didn't want me to sit too upright in the bed. The babies were stable, but I was having a few contractions. I wasn't dialated at all. The ultrasound revealed that baby A was still breech. The nurses told me they were going to call the on-call ob at my practice and let me know the plan. Since I was on blood thinners, a spinal was not an option for at least 12 hours. Multiple people came into the room, but it's all a little blurry. My ob showed up shortly after and told me she wanted to deliver immediately since I was bleeding. I guess the blood meant the placenta could have ruptured so she wanted to get the babies out while everyone was still doing well. 

Before I knew it they were prepping me for the c-section. The anesthesiologist came in and talked to me and they started a different IV. I sat there in complete denial of the fact that they were going to deliver the babies so soon. They told me W was not able to be in the room as there's no point in him being there with me under general anesthesia. 

They wheeled me down the hallway to the OR. I gave W one last hug and kiss and the nurse took my camera into the delivery room. The room was so cold and I was so nervous so shaking like crazy. There were so many people in the room and I was so scared. 

My accident occurred around 1:00 and the girls arrived at 4:28 and 4:29. 

Next I knew I woke up in the recovery room with W and my mom at my bedside. W told me the weights of the girls and showed me pictures on the camera. The nurses would come every 15 minutes or so and push on my uterus to be sure it was contracting. Because I had general anesthesia I was able to feel everything so quickly. The nurses said that made things much more painful. 

A few hours later they wheeled me up to the NICU to see the girls. We first saw our baby B. She was so beautiful and they even let me hold her. After that we saw baby A. They had a really hard time getting an IV in her so she had one in her umbilical cord. Because of that I was unable to hold her. I couldn't believe how tiny she was. Baby A was 3 lbs 15 oz and baby B was 4 lbs 11 oz. 

We went back downstairs to my room. I was in a double room and W was able to stay with me since the other bed was empty. That night I slept horribly because I was in so much pain. They had me on pitocin which made me so crampy. I think the IV finally ran out of that around 1 AM. I was also bleeding really heavily. Since I had the catheter still in I didn't have to get up to use the bathroom so that was good.

The next morning we went up to see the girls again. W pushed me in a wheelchair. 

I'll try to update tomorrow as the girls will be a week old! That way I can write about their first week here and more about them.

Their arrival was so dramatic and unexpected, but I am already so in love with those little girls it's unbelievable. I feel so lucky to be their mommy.






Friday, September 6, 2013

They're Here!

On Tuesday (34 weeks exactly) I went out to run some errands. I brought the dogs with me. Unfortunately, around 1:00 pm I was involved in an accident. Myself and the dogs were okay, but my water broke immediately. I stayed in my car until they put me into the ambulance. A first responder called W and he headed over immediately to get the dogs and then headed to the hospital.

At 4:28 Lucy Rose was born weighing 3 lbs 15 oz and at 4:29 Clara Anne arrived weighing 4 lbs 11 oz. Both girls received a 9 for APGAR scores and were transferred to the NICU.

I will update the complete story soon, but we are all doing great. W and I are both so in love.