Monday, October 30, 2006

Scenes from a Monday

Today is my first official day as a stay-at-home-mom (on which more later). Given that the babies don't know one day from another, you'd think that Monday mornings wouldn't be any worse than any other day. However, I offer the following contradictory evidence:

2:30 AM -- Be woken by crying baby. Decide babies' schedule was thrown off by late-evening in-law visit. Feed, and hope babies will now sleep for four or five hours.

5:30 AM -- Be woken by crying baby. Curse in-laws vigorously.

8:30 AM -- Be woken by happy cooing baby. Change diaper and apply grapefruit-seed extract, mupirocin ointment in nose, and Nystatin (aka Sticky Banana Goo).

8:31 AM -- Get shirt covered in regurgitated Sticky Banana Goo.

8:50 AM -- Repeat process with second baby, including second application of Sticky Banana Goo to shirt.

9:10 AM -- Apply gentian violet to both babies' mouths and to nipples. Inadvertently apply to babies' ears, mama's thumb, the bathroom counter, and probably a stray poodle or two.

9:15-9:30 AM -- Inadvertently apply gentian violet to onesies, blankets, burp cloths, and pack-n-play, courtesy of spitty babies. Laugh at babies' purple mouths.

9:31 AM -- Decide that purple-mouthed babies can be Elvira for Halloween, thereby superseding previous costume idea of Babies Whose Mother Is Too Lazy For Halloween Costumes.

9:32 AM -- Wonder who the dickens decided that babies should all dress up for Halloween, anyway. Curse Halloween vigorously.

9:35 AM -- Replace Katherine's paci in mouth for 537th time.

9:37 AM -- Give up on paci replacement, pick up Katherine, and rock her.

9:39 AM -- Notice warm wet feeling, and discover that Katherine has peed through a) diaper b) onesie c) blanket d) mama's t-shirt.

10:30 AM -- Time to feed again. Give babies more Sticky Banana Goo and vitamin drops. Admire how vitamin drop stains on onesies coordinate with gentian violet and Sticky Banana Goo stains on onesies.

10:31 AM -- Curse thrush and all its medicaments vigorously. Make note to self to buy stock in Oxi-Clean.

10:45 AM -- While feeding Claire, notice warm wet feeling, and discover that Claire has peed through diaper, onesie, blanket, and t-shirt.

10:45 AM -- Curse self vigorously for deciding to try stupid Size 1 generic-brand diapers. Resolve to just go buy the Newborn Pampers after lunch. Preemptively curse Wal-Mart vigorously.

11:30 AM -- Realize Katherine has gentian violet in her hair. Look at sticky stained sour-milk-smelling babies, decide that the child-welfare people would take them away, and announce that it's bath time.

11:31 AM -- Go to get towels out of clean-but-unfolded laundry basket. Discover a slightly muddy-pawed poodle napping contentedly in the clean-but-unfolded laundry basket. Curse poodle vigorously.

11:32 AM -- Observe towels and half-heartedly brush dirt off them. Contemplate going upstairs for clean towels. Decide that they're probably clean enough, especially given the current state of the babies.

11:33 AM -- Deploy Weapon of Bath Destruction.

12:00 PM -- Observe washed, lotioned, de-stickied, mostly de-purpled, lavender-smelling babies sleeping peacefully and adorably in the co-sleeper. Give thanks that Monday morning is now over and done with!

Friday, October 27, 2006

The next time around

So, lots of chatter today about limiting embryo transfers to reduce multiple births. Given that I'm a post-infertility mother of multiples, you might imagine that I'd have a thing or two to say about it, and you'd be right.

Quick recap for those of you who tuned in late: I got pregnant on my first injectibles/IUI cycle, which had been planned as a test run for IVF. I had six mature follicles at trigger, and I'm damn lucky that there were only two (plus something at 5 weeks that could have been a third sac). I got pretty sick from OHSS, and wound up in the hospital -- I didn't have a lot of free fluid, but my ovaries were the size of oranges, and I was in so much pain that they put me in for pain management. While I had lots of scares during my pregnancy, nothing actually went wrong until preterm labor at 32 weeks, which was easily stopped, and I ultimately had a smooth delivery and healthy babies. Overall, we were unbelievably fortunate, again and again and again.

We took a HUGE risk in going through with the cycle, one that I didn't really appreciate until well into the pregnancy. I was as informed as anyone could be -- my mother is the head nurse at my clinic, has 20 years of experience, has seen all the bad things that can happen, and told me all about them even when I didn't need to hear them. Still, I didn't really understand that a twin pregnancy was a big scary deal until, well, it got scary. In Julie's comments, I see a lot of sentiment that IVF patients should be better informed of the risks of multiple pregnancy, but honestly, my own opinion is that you could inform them until the cows come home and it wouldn't matter. Some things, you just can't learn by observation, only by experience; you think you understand what others are feeling, but then it actually happens to you, and you look back and laugh at your presumptuous self.

I don't think you could have told me anything that would have made me handle our cycle differently, short of looking at a crystal ball. But now that I've been through a multiple pregnancy, you better believe I'm giving a lot of thought to how we'll do things the next time around.

When you have twins, you learn pretty quickly that you could save yourself a lot of time and effort by just distributing a FAQ. You get asked the same questions over and over again, some disturbingly personal -- do they run in your family? (and its cousin, did you do infertility?) are they identical? can you tell them apart? do you nurse them, and at the same time? did you have a c-section?. Another popular one is "will you be having any more?", especially because ours are the same sex, and people tend to assume you want one of each. When I was pregnant, I would say I didn't know, but now that the babies are here, the clear answer is that we'd like to have more.

What's not clear, and won't be for some time yet, is just how possible that's going to be, and how much technology is going to be involved. Perhaps my unbelievable streak of reproductive good luck will extend to eventually start cycling on my own, and all these worries will be for naught. If it doesn't, though, we'll have a major dilemna on our hands about what to do about it. We know a couple of things from the last experience -- I don't respond to Clomid/Femara, I start slow and then go off like gangbusters with injectibles, G has great sperm, I'm prone to hyperstimulation, I can get pregnant if my ovaries can just be coaxed into spitting out the eggs. In a rather literal sense, all of our reproductive issues are in my head, tucked away in a questionably functional hypothalamic-pituitary axis.

If it weren't for the multiple thing, I think it would be a no-brainer to start off with injectibles/IUI, stimming a little more patiently to avoid the OHSS. And honestly, I'd be all right with risking twins again. I've had one successful twin pregnancy, making it somewhat more likely the second one would go OK. I'm doing reasonably well with twin motherhood, and while I suspect it would be a good deal harder if I had a pair of three-year-olds running around, I would also have the advantage of experience. I wouldn't consider it a desirable outcome, the way I did the first time, and I think I'd have a lot more oh-crap moments. But I wouldn't have a total meltdown about seeing two heartbeats, either.

What does make me want to go and hide under the bed is the thought of seeing *three* heartbeats, or more. We would not, we think, discuss selective reduction of triplets, but the idea of a triplet pregnancy fills me with fear. I don't think anyone has triplets without some pretty serious pregnancy and birth complications, and I'm not so desperate for more children that I'm really willing to put them, or myself, through that ordeal. Three or nothing is an entirely different proposition than five or two, and while I think I'd always be sad that we didn't have more babies, it's not the same as if we had none at all, or an only child.

So, if we're really serious about avoiding triplets, injectibles/IUI is off the menu -- even with a single follicle, I could still be in Jody's shoes. I think we'd go straight to IVF, transfer two, and hope that we wound up in the singleton 75% (contrary to the opinion expressed by a friend last night, who thought that almost all post-infertility births are multiples). I'm under 35, and have most of the factors that the studies say make single-embryo transfers successful, but my clinic's FET stats aren't that great. Fresh cycles are a big risk for me, with the OHSS, so regardless of cost, we'd have to lean toward FET to use up all our embryos if the single-embryo transfer didn't take. If the success rates were anywhere in the same ballpark, I'd consider it, but they're not and that's that. It's also an emotional thing -- I don't have the wherewithal to handle failed FET after failed FET.

So yeah, next time around, I think we'd just start with IVF and risk OHSS and twins again. Doesn't sound like much fun, though. I'd rather hope to just ovulate like a normal female.

And while we're at it, can I have a pony too?

(NB: Mind you, I'm not about to start back into treatment just yet -- I want the girls to be at least two before we start trying. But never say I don't consider my options well in advance!)

Thursday, October 26, 2006

More burning questions

What's even less fun than recurrent mastitis?


Yep, that's right, apparently I have thrush on top of everything else. Y'know, I thought we were doing well with this whole breastfeeding thing -- Dr. Clueless even commented that my nipples looked good during my six-week checkup last week (she's my new OB, as Dr. Dreamboat left the practice recently under some rather upsetting circumstances). However, given that I subsequently got mastitis, my baby spat up blood, and I got chewed up to the point where one nipple blistered, popped, blistered, and popped again, I decided it just might be time to reassess that. Therefore, we went off to the Dixieland Breastfeeding Medicine Clinic yesterday afternoon.

Turns out that the recurrent mastitis is because I wasn't treated right on the first round -- not the right antibiotic, and I didn't take it for long enough. I had just finished up the 7-day course originally prescribed, but now I'll have ten more days of cephalexin. This makes sense to me, as I have had problems with recurrent strep in the past, and it usually takes a longer course of abx to knock it out. Hopefully, the cephalexin will render me germ-free, and treatment of the cracked nipples will make sure I don't reacquire more germs down the road. We're also treating my nipples and the babies' noses with an antibacterial ointment, as the doctor said that recent studies show that babies are often carriers of the offending bacteria in recurrent mastitis.

Given that I had some cracking at the base of the nipple, and that one of the cracks looked yeasty, and that the babies' mouths were a little suspect as well, the doctor diagnosed all three of us with thrush. This might explain the nipple soreness I had even when they weren't badly cracked, though latching has to take some blame there too. We have a terrifyingly complete protocol of how to get rid of it, involving antifungal creams, Nystatin, grapefruit seed extract, and gentian violet. It seems like a truly daunting amount of work, especially considering I have to do it for two babies, but it's worth it to stop the thrush before it gets really seriously embedded.

I got the most immediate relief from the latching and positioning work we did. I'd been using football hold since the babies were born, as at that time it was the easiest and most comfortable way. I tried cradle a couple times, but couldn't seem to get the hang of it -- there were too many arms and legs and hands in the way, somehow. When she had me try it again yesterday, though, it just worked sooooo much better. The babies did a much better job of getting enough nipple, even little Claire with her tiny mouth, and they seemed very comfortable with it. As for me, it's made a noticeable difference in the state of my nipples in less than 24 hours. Feeding is markedly more comfortable already, and the cracked skin is already showing signs of healing. I guess you mend pretty quickly when you're not being re-chewed-up every two or three hours, hey?

The cradle hold is also helpful with our oversupply/overactive letdown problems. I've been feeding each baby on a single breast per 24 hours for a couple weeks now, but they were still choking and pulling off the nipple. With cradle hold, it's easier for me to lean back just a little bit so they're actually above the nipple, which gets gravity working in our favor. For the first time in forever, neither baby is strangling or pulling their heads back, which has also got to be helping me heal. On the down side, feedings are taking more like 20-25 minutes rather than 10-15, but it's a small price to pay. If you're nursing twins and have oversupply problems, I'd really encourage you to try this -- it's working great for us already.

The other downside to all of this is that I'm currently a walking pharmacy. In addition to my usual routine (thyroid meds, prenatals, iron, calcium, and b-complex), I'm now taking antibiotics, Vitamin C, probiotics (to help prevent yeast overgrowth from the abx), lethicin capsules to help keep the ducts from plugging, and ibuprofen round the clock. Then there's the antifungal and antibacterial nipple ointments, the gentian violet, and the grapefruit seed extract. It's like rocket science to figure out which pills need to be taken before meals, with meals, and separate from each other, and to figure out what to put on my nipples and in the babies' mouths, in what order.

I'm really glad I decided to go in and get seen yesterday, and I feel like all my boob-related problems are going to work themselves out quickly. Seriously, people, if you're nursing and having any issues, do yourself a favor and call a lactation consultant already. I know that's the all-purpose answer and you're probably tired of hearing it, but it has made a big difference for us already. Insurance covered my visit to the clinic, but even if you have to pay out of pocket, it's worth it.

Now, if only my upcoming visit to the knee doctor goes as well as the visit to the breast doctor!

Boobs in Dixieland

Did you know that there is an actual medical specialty of breastfeeding? I didn't, at least not before I started going to La Leche League meetings while I was pregnant. As it happens, there's only one breastfeeding specialist in the state, who just happens to be a leader of my LLL group, and also has a local clinic.

Normally, I would be surprised that Dixieland has something like this, as it is one of those states most commonly spoken of as a joke punchline. However, we actually have really good BFing support, especially here in my town -- a small-but-active LLL group, fantastic lactation consultants and BF-friendly policies at State University Hospital (where I delivered), and our very own breastfeeding specialist.

We also recently passed a state law that's drawn word-for-word from Florida's ground-breaking law, explicitly stating that a mother has the *right* to breastfeed anywhere she is otherwise authorized to be. For perspective, there are very few "positive rights" (i.e. the right to do a specific thing, as opposed to a "negative right" where the government can't stop you from doing something). The distinction's important, because a positive right can't be overridden by a private entity's policy, whereas a negative right doesn't convey as much power. If you have a positive right to breastfeed wherever you are, a store can't ask you to go nurse in the bathroom, at least not unless they want to get their asses sued. Given that this state was a civil-rights battleground not that long ago, people tend to take you really seriously when you start talking about how state law gives you specific rights!

Not, mind you, that I have actually really exercised my right to nurse my babies anywhere I damn well please. We're still not good enough at this whole latching and nursing thing that I can avoid waving my breasts around for the whole world to see, and I am just not down with that. I'm not hugely modest myself, but Dixieland is a very conservative state, and many people are uncomfortable with the sight of boobs. I do believe in politeness, and there's a certain rudeness in forcing people to witness something you know makes them squirm. I knitted myself a poncho specifically for that purpose, but not only has it been too hot, it also gets in my way. So until I can latch them discreetly under a poncho or blanket, we either nurse in the car, or seek out stores with nice lounge areas in the restrooms. But I *could* whip it out and nurse anywhere, if I wanted to, and that's the important thing. I don't mind making efforts to accommodate, as long as I know that I can nurse in public unimpeded if I should need to.

Interestingly, the breastfeeding law is fallout from Katrina. Something else I'd never thought of, in my pre-motherhood days, is that disasters are not very formula-friendly. Since our coast took a direct hit, the southern third of the state had no access to clean water for mixing formula. I live in the central area, and while water wasn't quite such a problem here, electricity was, for two weeks or so after the storm hit (I had power sooner, but many didn't). Formula was also hard to come by for the flood of evacuees from New Orleans and the Coast, and was one of the major donation items for which charitable groups begged. After Katrina, it didn't take a lot of convincing to get state legislators to throw their weight behind breastfeeding support -- a good thing blown in on an ill wind, in a rather literal sense.

This state is pretty crappy in a lot of ways, but when it comes to breastfeeding, we've got our act together.

Saturday, October 21, 2006

Asked and answered

What is less fun than mastitis?

Recurrent mastitis.


What's less fun than recurrent mastitis?

Recurrent mastitis which causes your baby to have bloody spit-up, scares you half to death, and sends your poor feverish self rushing out to the pediatrician on a Saturday morning, only to be told that the baby's fine and that the blood probably came from your infected breast. Ugh!

Wednesday, October 11, 2006

Things we can do

Things the babies can now do, at five weeks and change:

  • Smile -- Claire gave me two real smiles yesterday! No smiles from Katherine yet, and Claire hasn't repeated the performance today, but I know there will be more soon.

  • Reach -- Both babies are now starting to bat at things they think are interesting, principally our faces and the toys on the bouncy seat. Katherine has been doing this for a couple days, and I saw Claire do likewise for the first time today.

  • Hold things -- Katherine will grasp a finger and pull it into her mouth, and she now puts her hands over her pacifier to hold it in place. This backfires on her as often as not, since she's prone to jerking her hands and pulling it back out of her mouth, but the intention is there.

  • Hold heads up -- Both of the girls have developed much better head control. When we hold them on our chests, they will hold their heads up for a good little while, then get tired and face-plant, over and over. This really helps me out, since they are much less floppy now, and it's easier to handle them both at the same time.

  • Look in mirrors -- They were so interested in the mirror during bathtime that I went to the Big Baby Store and bought mirrors for both of them. They really seem to enjoy being awake in the co-sleeper now that they can look in mirrors!

  • Melt Mama and Daddy's hearts -- no explanations needed for this one, I think.

Sunday, October 08, 2006

One Month

It's hard for me to believe that the babies are already a month old. G is always saying how he can't wait until they are toddling and talking, and he doesn't understand why that makes me a little sad. They've changed so much in the past month, and I'm aware of how fast the time is flying by, and how they won't be my sweet tiny babies forever. I can tell that, when they're older, I'm going to miss this stage, and that I'll want another baby (though who knows whether that will be possible...).

It's remarkable how much bigger they have gotten over the last couple weeks. At our two-week pediatrician visit, they had gained 13 oz each in the week since their final hospital weight check, and we were cleared to stop supplementing. I took them back for one more weight check a week ago, to find Claire was up to 6 lbs 6 oz, and Katherine clocked in at a massive 7 lbs 2 oz (9 oz gain for each). It's interesting to me that they are gaining exactly the same amount of weight -- they were born 3/4 lb apart, and they have stayed that way ever since. I'm guessing that Claire is now about 7 lbs, and that Katherine is rapidly closing in on 8.

They seem enormous to me, especially when I pick them up, and I'm a little taken aback to think that they are just now getting to average newborn size. I suppose this is appropriate, since yesterday was my official due date, and they are now 40 weeks adjusted (although I don't think adjusted age matters as much for near-term babies). I can't imagine how I would have felt if I'd carried them to 40 weeks (unlikely but possible for twins). I went to 35w6d, was physically miserable for that last week, and was probably getting close to being pre-eclamptic. When I looked at my newborn infants and thought, I had both of those inside me, I understood quite clearly why I could barely walk!

People would, and still do, tell me how tiny they are, and they just don't seem tiny in the slightest to me. The only way I can see it is by the fit of their clothes. I just today put away the last of the preemie sizes, which had all gotten too short for them, but most of their newborn-size things are still a bit oversized. Carter's/Child of Mine brand is a particular offender -- I think they just run large, as those were the last preemie things to go -- but I also have some NB things from The Children's Place, which are marked "up to 7 lbs" but which are still quite loose on my 7- and 8-lb babies. It pleases me to see them growing out of things, because of that initial weight loss, and because I've worked so hard to feed and grow them. I get a little thrill of pride, and think, I did that, it's my body which made them get so large.

As you might infer, breastfeeding is going really, really well. If we have any difficulty at all, it's on the oversupply end of things. While I don't have much trouble with leakage between nursing or with letdown, I can tell that I have almost too much milk for them. Both babies tend to choke during feedings, and will pull their heads back or come off the nipple entirely. After reading Cass's comments about oversupply, I'm feeding each baby on the same side for 24 hours, but I've been doing that for more than a week now and am not sure it's made a difference. I'm really not too fussed about it, though. It makes tandem nursing a little tricky, since I'm always relatching one or the other, and it probably contributes to mild nipple soreness, but overall it's pretty small potatoes.

Speaking of tandem nursing, it's always the second question whenever someone asks if I breastfeed them, though I don't quite understand why. It's not our default mode, but now that the babies are somewhat less floppy and can latch easily, I usually double-stack them at least once a day. If only one baby is awake, and I'm not sleeping or rushed, I prefer to feed them separately. That way, I can stroke her little head and talk to her if she's very alert, or read a few pages of a novel if she's too sleepy for much interaction, and have a hand free if I need one. However, if it's three in the morning and I just want to get them fed and back to sleep, or if we're going somewhere, or if they are both awake and hungry, I don't hesitate to pop them both on.

Thankfully, the girls remain on similar schedules, and generally eat about every 3 hours (sometimes 2 during the day, sometimes 4 at night). While I'm not quite ready to declare that we've avoided colic, the early indications are promising, as they really do not cry much at all, unless they are hungry or needy. The biggest crying difficulty we have is Katherine's attachment to her pacifier -- Claire isn't much interested in one, but Katherine loves hers, and will squawk like a little goat if it falls out of her mouth while she's awake!

Sleep-wise, they are starting to remain awake between feedings a couple of times a day, and to have longer wake periods after others. I think we're on the verge of transitioning to a schedule of naps and bedtime, rather than going right back to sleep after every feeding. We don't have a very firm routine at the moment, which bugs me a little bit only because I myself am routine-oriented. However, they have not yet naturally fallen into one, and it just hasn't seemed right so far for me to work to get them on one. I'm still pretty much letting them tell me how things will work -- in fact, we call them the Tiny Mistresses, because they are firmly in charge of all our lives (and also because of Katherine's oh-so-imperious squawk!).

And, since the Tiny Mistresses are now summoning me, I'll have to come back and tell you later about the birth, and about our developmental milestones, and about how I'm doing, and all the rest of it!

Monday, October 02, 2006

Getting started with breastfeeding

[Transferred from my other blog, originally posted 9/17/06]

As part of the babies' birth announcement on my old blog, I posted that they were eating and growing well. Therefore, the babies immediately went and proved me wrong by developing excessive weight loss, dehydration, and jaundice. I blame this largely on the slow arrival of my milk, which didn't come in until day 5 postpartum, but Claire's size also caused us some latching issues (poor baby has a small mouth, like her mother, and has trouble opening wide enough). Additionally, my "normal" postpartum swelling got seriously out of control, and my blood pressure spiked up to hypertensive levels. However, an extra day in the hospital plus some diuretics got me sorted out, and an aggressive regime of every-two-hour feeding and supplementation (finger-feeding with formula and then expressed breastmilk) got the babies in better order, and we came home on Monday. After return visits to the hospital for bili levels and weight checks, the babies were released to the care of their pediatrician on Friday, and I think we're on the upswing.

As things stand, the babies are receiving exclusively breastmilk, in a rather grueling feeding schedule. I begin a feeding cycle by pumping for 10 minutes to relieve engorgement and make it easier for Claire to latch, then feed each baby separately for 10-20 minutes. I've tandem-fed a couple of times, but it's not something I'm very comfortable with yet, and it tends to result in me getting chewed up. Therefore, I've put it on hold until the babies are a bit bigger and less floppy. After feeding each baby, I pass her off to G to finger-feed an additional 20 ccs of pumped milk, which he does by taping a tube to his finger, letting the baby suck it, and using a syringe to slowly push the milk into the baby. The whole cycle takes at least an hour to finish, what with diaper changes and baby-waking time, and two hours later, the alarm goes off to start all over again.

One thing I was really pleased with my hospital about was how very pro-breastfeeding they proved to be. The babies were allowed to nurse in recovery, room in, and co-bed, and nobody (except my mother) ever encouraged me to give bottles; while we did supplement with formula for two days at the beginning, it was only until I was able to pump enough milk to replace it. We had two excellent lactation consultants, who got me pumping on Saturday afternoon and spent hours helping me latch babies; we also had one evil one, but I mainly hated her because she didn't do a very good job of teaching me to use a supplemental nursing system, and also because I was just kind of disposed to hate someone at that particular moment.

I give the lactation consultants a lot of credit for my current abundant milk supply, which had been a major topic of concern for me before and immediately after the birth. Between my thyroid issues, infertility, and anemia (severe enough after surgery that transfusions were discussed), there was a non-negligible possibility that I wouldn't make any milk at all. I wanted desperately to be able to breastfeed my babies, partly because of the bonding and health benefits, but also because I wanted to do just one part of this whole childbirth process like a normal woman. When my milk was slow to arrive and the babies were pronounced ill, I spent a night sobbing to G, my mother, my mother-in-law, and any stray nurses unfortunate enough to wander in -- I just knew my body had failed me yet again. That it did come through, that I've been able to nourish and grow my babies, has been incredibly healing.