A Mom of Multiples

Even from my pregnancies I can tell you that having twins and having a singleton is very different. I didn't get really big really fast this time. I went into labor naturally (without a car accident) and delivered my baby a day before her due date. 

I know I've said it before, but life with one baby is just so different from life with two. 

As proud of I am of exclusively breastfeeding my twins, I wasn't able to do this from the start with Stella. On our third day in the hospital she cried and cried and acted so hungry. I tried pumping, hand expressing, and nursing her as much as she wanted, but she was still screaming and acting hungry. In addition, she lost 9% of her body weight and the nurses said things get concerning at 10%. I know this is totally normal, but something had to give. My baby was hungry and my milk hadn't come in yet. After talking to my favorite lactation consultant from the NICU I made the decision to supplement a little with formula. I used a syringe and squirted little amounts into her mouth as she was latched. I don't think she got more than 20 ml's total, but it was so different from the girls. I really struggled with this at the time. How could I exclusively breastfeed twins but not a single baby? I think them being preemies gave me a little buffer as they didn't get any milk for a few days. This allowed me time for my milk to come in and to build up a little stash before they started eating. Luckily, my milk came in the night I supplemented Stella with formula, and I haven't given any formula since. It was hard for me to accept at the time, but I look back and don't regret any of it. 

When the girls were in the NICU everything I read and heard said to keep them on the NICU schedule once they came home. I took this advice to heart and we kept them on the same schedule. From day one at home they were on a schedule. I rarely fed them more often than every two hours and when one woke to eat I'd wake the other. I remember when Lucy wasn't gaining weight well I was told to feed her on demand. The person who told me that didn't understand life with twins. I couldn't feed one baby on demand and keep the other on a schedule or feed one baby while the other just cried. Well, I guess I could have but it would mean feeding babies all day long. I wasn't up for that. 

When Stella was born I thought I'd approach parenting differently. There was only one baby and I wanted to be more relaxed about having her on a schedule. 

The thing I'm realizing is, I'm still a mom of multiples. I learned to be a parent to twins as I didn't know anything else. Being their mom molded me into the type of mom I needed to be to best take care of them. 

On Monday I went to a tea time circle of moms and their babies hosted by the yoga instructor I loved and took prenatal and mama baby yoga with. I noticed all these other moms just feeding their babies whenever they cried. I'm pretty sure I'm the only one that looked at my watch first. 

When the girls were little we used the Babywise book to guide our daytime routine. We did an eat, play, sleep routine. It made life predictable to both them and me and it worked well for us. Even though Stella is only a month old, we've been thinking about this routine and trying to keep her awake some after feedings. I try to be sure when she eats that she gets a full feeding rather than snacking, since I can't be available to feed her all the time. I have two year old twins to take care of. Even though Stella is a singleton, I'm still a mom to multiples. 

As time goes on sometimes I feel guilty that I'm not able to be the kind of parent to her that I envisioned. The thing is, with her reflux I can't feed her all the time. Feeding her more just makes her more uncomfortable. Also, there are times in the day when it's just not feasible. 

I shared at the tea time my feelings about this and the overwhelming response was, just do what works for you and your family. It doesn't matter what kind of parenting you decide to do as long as it works for you. This made me feel so much better. 

I guess even though I only have one baby now I'll always be a mom of multiples. I learned to be a mama with my twins and that's the only kind I know how to be. And you know what? I realize that a mom who needs schedules and structure is just as great as a mom who doesn't.

We all approach parenting differently and I'm learning there's no right or wrong way to do it. It's all about what works. 

Babies!

Yesterday morning my "little sister" Andrea had her twins. She was back in the hospital last Friday after her blood pressure was high at her OB appointment. On Saturday morning they sent her home. Sunday she attended her nephew's baptism, and that night she was back in the hospital. At this point, they were having a hard time controlling her blood pressure and they started magnesium sulfate. Monday morning they started an induction with cytotec, a pill that is supposed to help dilate the cervix. All day monday she went from 1-2 cm dilated. I figured it was going to be a long road with a possible c section at the end. 

When I woke up to pee around 3 AM I saw she had texted about an hour earlier saying they had broken her water and started Pitcoin. Up again around 6:30 AM I saw a text saying she was fully dilated and they were taking her to the OR to push. At 7:11 and 7:31 Abigail and Caleb were born weighing 4.8 and 4.15. I guess she was able to hold both of them briefly before they were taken to the NICU. 

I went to visit Andrea last night a little after W got home. She seemed to be doing okay, but was still on Magnesium so was not able to see or visit the babies. I asked the nurse for a pump and kit for her and got her started pumping. The nurse was so clueless, yet felt the need to "teach" her how to use the pump. It's hard to hear advice like, just pump 10-15 minutes every 4 hours or so. What?! She also didn't know how to operate the pump. I'm not an expert with the hospital pump since I only used it a few weeks, but I tried to stand back and bite my tongue while the nurse was there. Once she left I felt more comfortable giving her advice. Her first pumping session she got a bit of colustrum. It took me quite a while before I got that much so I was glad I was helping her get started so soon (I ended up waiting at least 24 hours before I started pumping). I'm sure having a vaginal birth will help her milk to come in more quickly too. 

I had stopped at Target on the way for a few nursing tank tops and also found two super cute preemie outfits. I know she didn't have much small stuff (newborn) so I figured she could use a few preemie things. I know they won't fit into them long, but preemie clothes are teeny tiny and adorable! I had a lot of fun buying them. 

She was able to see the babies this morning and hold the baby girl. They started the boy on antibiotics and had to put him on a ventilator this afternoon. She's doing well considering, but I know the scary feelings of having babies in the NICU. Please keep Andrea and her babies in your thoughts! 

Roadblock

I recently write about how I want to pursue my IBCLC (International Board Certified Lactation Consultant). Well, I got the really great IBCLC to agree to take me on and supervise me. I thought that was going to be the difficult part. 

Well, not so much. I've encountered a problem with the hospital approving it. Explaining all of the details would be boring, but basically the hospital and NICU currently have a staffing issue. They are currently looking to hire an IBCLC part time to fill the days that Char isn't there and they currently don't have anyone fully qualified to do it. The hospital told me they want to make the certification available to current staff first. 

Hopefully once they solve this issue I'll be cleared to start. I'm really disappointed but am staying hopeful it will work out. 

Me, Professionally

I always wanted to be a mom, I knew that. I also knew I wanted to work with children. The younger the better. My father is a special education administrator and my mother is a special education teacher who also has her bachelors in speech therapy. As a child my mother worked part time as a speech therapist at the end of the day after her full time job. I enjoyed going on therapy sessions with her as I loved the kids and thought it was really fun.

When it came to going to college I knew I wanted to work with children. I thought I wanted to study general education but with some guidance from my parents I decided to pursue speech therapy. They convinced me that it was easier to work 1:1 versus as a classroom teacher. I received my undergraduate degree in 2005 in Communication Disorders. This meant I could get a speech therapist job (generally in a school) go on to become either a speech language pathologist or an audiologist. I thought I wanted to work in audiology. I was so interested in cochlear implants but quickly realized most of audiology is testing hearing and dispensing hearing aids. That didn't sound very interesting to me.

Right after I graduated (I graduated a semester early in December) we moved out to Jackson Hole Wyoming for the winter. I became a ski bum and absolutely loved it. I worked for the ski resort and skied over 100 days that winter. It was amazing. Then the summer came. We quickly realized when you aren't skiing, you're just a bum. So, we moved back to NY. W decided that summer he wanted to be a physical therapist and signed up for prerequisite classes for the fall. I decided to try to get a job with my bachelor's degree. I landed a daycare job. It lasted about 10 days and I realized I needed to get my master's degree. I quit my daycare job and applied to graduate school.

I graduated with my master's degree in speech language pathology from Ithaca College in the spring of 2009. Prior to graduation I had a job lined up with a company working with early intervention and preschool aged children.

I loved my job but never felt like there was much room for growth or advancement. I became interesting in feeding difficulties with children and wanted to pursue more of that. I took continuing education courses and learned as much as possible without hands on experience. I landed a feeding early intervention case that didn't go well. The daycare provider didn't like all of my questions I asked her (about the child and what/how she was feeding him) so told the mother to request a different provider. Unfortunately, it stopped there. I didn't get any other feeding cases despite my interest and continued asking. I continued to work with the same kinds of cases. 

After everything we went through to get the girls I knew that if it was possible I wanted to stay home with them. W got laid off from his job around the time that I was 30 weeks pregnant but he lined up a new job that gratefully paid much better. This has allowed me to stay home with the girls. I work and do evaluations about 3-4 times a month. It's not much but it brings in a little extra cash.

With all of the hurdles we encountered breastfeeding I sought out lots of help. I spoke with at least 10 different lactation consultants. Initially I kept in contact with the IBCLC Char from the NICU. She was amazing and so great, but incredibly busy and difficult to reach. I remember one day in December when Lucy's eating was absolutely horrible I called at least 5 different places and spoke with so many different people. The La Leche League put me in contact with another IBCLC (International Board Certified Lactation Consultant) named Erin. She also had a NICU background and was incredibly helpful. She was the one that actually identified the oral aversion and helped me work through/past it. I still text her regularly.

It was through my contacting various people that I realized how difficult it is to find good help. I had so many horrible suggestions and people telling me things that were definitely not the problem. It was then that I started to think about pursuing my IBCLC. I researched it and read about it. I learned that there are different pathways to achieving this international certification, one of which is for "healthcare professionals" including speech pathologists.

Basically, to obtain the IBCLC I would have to: take a 90 hour lactation specific course (that is offered online), complete 1000! hours of clinical experience, and take an examination. I looked into the coursework and learned I could use it towards continuing education credits for my speech pathology license that I have to maintain. I then started to think about the hours. How on earth would I get the hours? It was there that I stopped. For months I didn't really think about it much. Then, the girls' birthday was coming up and I reached out to Char from the NICU. I invited her to the birthday party and we talked some on the phone. It was then that I brought it up to her about the hours (we had spoken about my interest in getting my IBCLC many times prior). She gladly offered that I could do the hours with her. I was surprised but didn't say much at the time. 

I spoke to W about it. He wasn't wild about me doing 1000 hours of unpaid work, but he said he would support me and my efforts if I really wanted to pursue it. So recently I spoke with Char again. I sent a resume to her that she brought to the charge nurse. The NICU has approved her mentoring me but now it's up to the hospital. I've spoken with educational services and am waiting to hear back. They were concerned that since I'm not with a university that I may not be covered for liability. 

To be honest, I'm super excited about getting an amazing experience and hours in a level 3 NICU. I know from experience how knowledgable and amazing Char is and I can't wait to learn from her. On the other hand, I'm incredibly nervous about being away from the girls. I've never really been away from them for more than a few hours at a time, and that's not all that often. We've introduced milk in sippy cups and dropped a daytime feeding. I'm hoping to drop another feeding soon (yesterday was great with Clara but a fail with Lucy). I know some time apart will be great for everyone, but at the same time making any changes comes with uncertainty. I'm not sure exactly when I will start but I'm so excited about learning new skills and information. 

Best. Day. Ever.

I always heard that the day your children were born was supposed to be the best day of your life. Well, when you get into a car accident and then have an emergency c section to deliver premature twins, it's not likely to be the best day of your life. 

I didn't see my babies for at least 4 hours after they were born. When I finally did see them for the first time I was wheeled up to the nicu on a stretcher. I didn't get to hold Lucy at all since she had her iv through her umbilical cord and I was in a lot of pain. 

For the first few days the girls were in the more intensive end of the nicu nursery. The nicu had letters A-H and A, B, and C were where the sickest babies were. Lucy was in nursery A and Clara was in B for those first few days. 

Lucy got moved to H fairly quickly but Clara needed more help breathing and stayed in B for the first 5 days. Then they moved them next to each other in H. 

I had been nursing both girls for a few days when the lactation consultant Char approached me and started talking about tandem nursing. It was at that point that I stopped her and told her I hadn't even held both girls at the same time yet. She responded with, "Really?!"

That's when she made it happen. For the first time I got to hold my girls and have that moment I dreamt about my entire twin pregnancy. We took our first family photos and soaked up those moments. 

We held and snuggled our babies as long as we could. When we left the nicu that afternoon it was a beautiful sunny day and W and I were so happy. We walked to our car and talked about how it really was the best day ever. We had been waiting for that feeling since the girls had been born. 

So, today I celebrate the year mark of that best day ever and I remember those moments of holding my tiny twins together for the first time. 

Tissues

I stayed the night at my in-laws house. W said he was feeling much better by the late afternoon yesterday and his passport was en route, so things are looking up. 

When the girls were in the nicu we stayed at W's parents house as it was only 10 minutes from the hospital compared to the 45 minutes our house was. 

This morning I reached over and grabbed a tissue to blow my nose. As I threw it in the trash under the bedside table I had a déjà vu moment. I remembered all the tissues I threw out in that same trash a little over 6 months ago. I remembered all those tears and hysterical sobs late at night as I was trying to sleep while my babies were in a hospital. 

It makes me so grateful that we are where we are today. I am so lucky!

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. 

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.