Nursing

From the Twin-Mommy

Dominic and Alexander are both learning to latch onto Mom for nursing, and we’ve taken our twin nursing pillow to the NICU to start practicing the football hold for tandem nursing. So far, we’re still working with each boy separately. We had an appointment with a lactation consultant on Wednesday who helped give me pointers on how to hold the babies and ways to improve my still slow milk flow. (Unfortunately, Alexander was completely exhausted during the feeding that the lactation consultant was there, and we couldn’t wake him up enough to nurse.) We have another appointment with the same consultant on Monday afternoon.

They currently have Dominic eating 1 hour before Alexander since the same nurse takes care of both, and I’ve been going to the NICU for three feedings a day: 10:30/11:30, 1:30/2:30 and 7:30/8:30. I spend 15 minutes nursing and then 10-30 minutes finishing off a 60 mL bottle with each one. I’ve also been more active while pumping (per the lactation consultant’s advice), using a warm washcloth on the breasts before pumping and gently massaging them to help start and keep that milk flowing. The time with the boys and the more active pumping have already doubled my milk. Yesterday I was up to 20 mL (from 10 mL) at each pumping, and last night I almost made 30 mL at my last pumping before bed.

When you start out scrounging for every .1 mL of colostrum to fill a syringe and your milk takes forever to arrive, it can be an extremely frustrating experience. Many moms of multiples deliver early by C-section, and it is very easy to become discouraged and to give up because we typically take longer and have to work harder to get our milk to come in. I remember one particular morning just crying in my hospital bed after a particularly meager pumping session. I felt so inadequate because there was no way I could feed my babies on my own yet.

I’ve been lucky to have a wonderfully supportive husband who was willing to suck up every drop of colostrum he could get with a syringe that first week and to cheer with me for every tiny increase we achieved. Plus, my mom and the NICU nurses have been supportive. They stress that they will use every drop of colostrum or milk that we give them for our boys and how important it is for them. I also did reading on the Web which reassured me that this is not an atypical experience for mothers of multiples.

If you want to breastfeed your babies (or baby), don’t give up!

• Seek help from lactation consultants.
• Try to spend as much time with your babies as possible, but remember that you’re recovering from surgery or labor and need sleep to keep from becoming ill. Being exhausted can also slow milk production, and if you get sick, they won’t even let you in the NICU to see your little ones.
• Start nursing as soon as it is considered safe for your babies if they are preemies
• Be persistent.

I’ve enjoyed every nursing session with my little tykes. It is an amazing experience to feel them latch on or to see them eager to nurse again, and it’s so much more satisfying than simply pumping.

Also, remember that many people won’t understand why you aren’t producing more milk or why your babies are on formula. Their questions or comments may upset and/or discourage you because you are feeling down about your own milk production. However, everyone just wants what is best for the babies and for mom, and we can educate each other about the trials of NICU and multiples nursing. I’m still hoping to transition my boys completely off formula, and we’re on our way.

P.S. While writing this post during a 2 AM pumping session, I just collected 50 mL of milk! A new record and almost enough to feed one of my boys a complete meal!

From the Twin-Mommy:

Having our boys in the NICU seems like a type of limbo. We are parents, and our little tykes are no longer in my belly. However, at the same time, we are still waiting to be able bring them home to find our own rhythms as a family. Right now, Dominic and Alexander still haven’t been able to touch each other since they were born (and probably won’t until we bring them home), and we have to wash our hands every time we switch from holding one to the other. Their little world is filled with the motion and voices of nurses, other parents visiting their children, and the bells and bings of alarms and notifications from the variety of equipment.

The NICU – for very good reasons – has to be very careful about infections, but this also means that a cough, a fever blister, or any number of symptoms can leave you quarantined from your little ones. I wasn’t able to go in from Sunday morning until yesterday afternoon, and that has made it even tougher and more frustrating to have Dominic and Alexander in the NICU. The last few days I have continued to recover from my C-section and to feel a bit like I’m being converted into a plastic cyborg by my breast pump (whoosh, whoosh, whoosh…is the background sound to my life). Grandma has visited the boys every morning to hold and love on them, and Puck and Grandma returned every evening after he got off work to feed and love on them some more. They were taking lots of little videos for Mom, so I could see my boys.

Alex Wants his Grandma

Grandma holds Alex and Dominic Smiles in his Sleep

(Look for a classic smile around 1:40 into the video.)

Yesterday, I was absolutely elated to be able to go and hold Dominic and Alexander again. We made it there before their 7:30 (Dom) and 8:30 (Alex) feedings, so I was able to nurse them for 15 minutes (good practice for me and for the boys) before giving them their bottles. Both of them did a great job with their nursing workout which is still a lot of work for them with a lot less reward. Still, they were eager to get to business, and Alex drank up his full bottle afterward. Puck and I got to take their temperatures, change their diapers, and something new…. we put them in their first outfits from home – 2 little newborn onesies that were decorated for them at one of our baby showers.

While having our little ones in the NICU is not ideal in many ways, we are so happy that they are being well taken care of by a large staff of very capable and friendly nurses and doctors. It’s important to also recognize and appreciate the other benefits. I’ve probably been able to recover faster after my surgery and to get a bit more sleep, and we’ve gotten lots of on-hand, expert advice about holding our babes, changing diapers, bottlefeeding, breastfeeding, etc.

How the Boys Are Doing:

Like most every baby, our boys initially lost weight after birth, but they are both almost back to their birth weights. For a time, they were only 2 ounces apart, but Alexander has pulled back ahead. Yesterday, Dominic weighed 5 pounds 11 ounces (2794 grams), and Alexander weighed 6 pounds 2 ounces (2583 grams). Plus, they changed them to bottlefeeding for every meal, and the nurse removed the tape and let them pull out their own hated feeding tubes under her supervision.

They are no longer monitoring Alex’s oxygen levels, and if Dom continues to do well, they will stop monitoring his soon too. Alex’s heart rate dipped sharply on Monday (though it came back up on its own), so we know that he has no chance to come home before next Monday as they monitor a preemie’s heartrate for a week after that. Alexander and Dominic are each eating 60+ mL at each feeding (and Mom is currently barely producing 60+ mL each day, though it’s milk now and not colostrum). In fact, I must go get ready to head to the hospital to see my little piggies right now.

From the Twin-Daddy:

Wendy, Trish, and Becca visited today, and Trish came out to the NICU to visit the boys.  Dominic was busy playing with his pacifier (binky), and Alex seems to be sleeping through his first growth spurt.

From the Twin-Daddy:

Dominic and Alexander are two little boys made from the same life-stuff.  One egg magically divided to bring two matching lives into being where previously only one had existed.  For 34 weeks and 3 days, they were always together and held close by their mother.

August 1st changed that, and Dominic’s wail at being born represented not only his struggle to live in a new world but also the pain of separation from his twin and mother.  Alone, in the bright lights and the cold,  his cry expressed a fear that everything was not okay.  Our careful plans to lay him on his mother’s chest and then his brother shortly thereafter were all dashed away by the necessity of the moment.

Taken to the NICU, each boy lay alone and separate from his brother unable to feel him or hear his cries.  That changed when both boys were upgraded to Room D, and they lay in adjacent cribs.  Yesterday, before Mary came home, she slowly made the painful walk to the NICU so that she could sit with the boys, and our entire family was reunited again for the first time since August 1st.

Mom and Dad with Alexander (left) and Dominic (right):

Mary is home and recovering, and while they are in the NICU, the boys will not share a crib, but when Alexander cries, Dominic reacts.  When Dominic cries, Alex hears him as well.   Every day takes them a little closer to being home with us.

In the days following the birth we skipped backward and forward through our experiences, but as yet, we still haven’t posted about those early hours when our sons were making their way into this world through their own rather small doorway.* My own memories of that transition are undoubtedly colored by the drugs they gave me afterward to keep me from having seizures from the preeclampsia – the same drugs that apparently led to me leaving some very bizarre and incoherent messages on a few answering machines.

To set the scene:

I honestly don’t remember much about what I did on Saturday, July 31st. I would guess that I ate, napped, tested my glucose levels, and watched some shows with Puck. I remember that by my last two meals of the day (because people with gestational diabetes have to eat like hobbits – second breakfasts, elevensies, and all that) I could barely force myself to eat because I just wasn’t very hungry.

I was in the house on the couch a lot because moving around had been getting increasingly difficult and tiring, and I decided I wanted to go on Shakti’s evening walk. (I often felt better after taking Shakti for a walk.) We finally all agreed that Puck and I would walk down to the end of the street. Then, we would turn back while Grandma and Shakti continued on their jaunt. Puck took a little stool for me, so I could stop and rest. We mosied slowly down the street, and on the way back we stopped a couple of times so I could sit – once to talk to one of our neighbors. Grandma made it around the block before we finished our stroll back to the house. I was definitely turning more and more into the tortoise, though I had told the boys repeatedly that we were trying for at least 36 weeks.

Some time that evening, I waddled down the hall to bed. Around 3:15, I woke to the calls of my bladder, and Shakti decided she needed a trip outside to do her business too. I ran into my mom in the living room, and we chatted very briefly before I headed back to bed and fell straight back to sleep.

At around 3:34, I woke again, looked at the clock and groggily debated just how much I needed to make another trip to the restroom and if it was worth the effort of pushing myself up and scooting off the bed. Puck and Shakti were both sound asleep. Suddenly, liquid simply poured out of me and soaked my legs and the sheet. My eyes popped wide, and I thought, ‘please, let it be water,’ which seemed much better than the alternatives.

Still in shock myself, I loudly called, “Puck! Puck! I think my water broke!”

When Puck first heard his name, he sleepily thought I was getting him up to take the dog out, but when the last sentence came out, he hopped out of bed and ran over to me.

Our first goal was to get me to the bathroom without having my water soak the carpet, so Puck dashed into the hallway for towels to make an impromptu mommy-diaper. We hurried me over to the toilet, and then we had to figure out what to do next: Wake up Grandma. Call our birthing center. Pack those last few items that you can’t put in your bag until you’re headed out the door.

The next hour was a flurry of activity during which I mostly sat in the bathroom and had very little to do. I called the Davis birthing center, and then waited for them to call us back. The Ob/Gyn on call told me that I had some choices. Since we were just barely past 34 weeks (34 weeks 4 days), we could deliver either at the birthing center or go to Sutter Memorial Hospital in Sacramento. However, if our boys needed more specialized care, they would be sent to the hospital after delivery while I would be stuck at the birthing center until I was released. At the hospital one of our Perinators would be on call and would deliver our boys. So…we opted to go straight to Sutter Memorial.

Now, the real scurry began as Grandma and Puck finished dressing, packing, and putting things in the car. I occasionally called out something that I would want packed in my bag. But the real question was how to get this leaky mom-to-be from the bathroom to the hospital without gushing water everywhere. Grandma devised a plan for a more advanced diaper system using two towels and a waterproof underpad with my large black pregnancy pants pulled on over it all. I must have looked absolutely hilarious, but our new and improved mommy-diaper got me all the way into the car without even soaking my pants.

After a 20-minute drive with Mom following close behind us, we arrived at the emergency entrance of Sutter Memorial around 5 or 5:30 in the morning. Puck hopped out of the car, grabbed a wheelchair, and came around to help me out of the middle-row passenger seat (to avoid those pesky airbags while pregnant). As soon as I stepped out of the car, my mommy-diaper sprung a leak, and I plopped into the wheelchair. After we went through the doors, the staff directed us on a rather long and circuitous route to the maternity and delivery area, and away we went down the hallway.

Outside, Grandma Myrtle was parked behind our minivan in the drop-off area, and she had seen Puck whisk me into the hospital…leaving the minivan running, unlocked and with the doors ajar. Getting Mom and babies to the nurses and doctors had been his first priority, and we had not realized we would be going on such an extensive journey to get there. Fortunately, Grandma was there to first park our minivan and then hers before tracking us down in the hospital.

The next hour or so was a blur of waiting and activity. I was quickly derobed, clothed in a lovely hospital gown and put on a bed to wait with Puck and Grandma Myrtle at my side. In no time, I soaked the sheets from my shoulders to my toes. When we brought this to the nurses’ attention, they seemed surprised but quickly changed the sheets right under me. Monitors were placed on my belly for each of the boys and constantly adjusted as the boys moved around. They checked my blood pressure and took my blood. I felt extremely parched and had since my water broke, but I had avoided drinking anything because I might be doing a C-section.

When the Perinator (the perinatologist) arrived, she outlined our options for us. Alexander (Baby B) looked like he would be breech, but they still gave us the option of a C-section (safer for the boys) or a regular delivery (a bit safer for me). After a brief discussion, we gave the go-ahead for surgery, and a flurry of activity occurred – navy scrubs for Grandma Myrtle and Dad, then Mom moved to a gurney and rolled into the operating room for her spinal. Finally, we were all in the operating room together, and I was sufficiently numb.

A blue sheet blocked my view of the belly, Grandma Myrtle had the camera ready (though we had told her we didn’t want photos of the birth itself), and Dad was right by my side to hold my hand. The delivery itself was a blur of anticipation. As they got ready to pull Dominic from my womb, I changed my mind and asked Mom to go ahead and take photos, and the Twin-Daddy poked his head over the sheet-shield to see our son Dominic pulled into the world (graphic photo). He was whisked away to be poked and prodded. When Alexander came next, there was both silence and activity, and he disappeared from the room without me seeing his still, blue form. Grandma followed Alexander for us, and they had him breathing again in seconds. Still, the worry takes your breath away, and then the joy of having two little sons fills the world.

Dominic with Mom and Dad

Alexander with Mom and Dad

*This post was started on August 5, 2010, and I finished it and added photos on February 26, 2011. I have decided to post it with date of August 5th.