Thursday, October 23, 2008

Waiting to exhale

I finished up the third round of antibiotics on Tuesday morning. Last time, it took about 48 hours for the infection to come back, so I'm somewhat hesitant to declare that they've worked just yet. I'm still having some pelvic pain (it never entirely cleared up this time, even with the abx) but no fever or malaise at this point, so who knows.

I feel like my uterus is still a ticking time bomb, but that's probably to be expected after the events of the last four months -- I definitely have some work to do to sort out the psychological ramifications of it all. I'm still feeling pretty traumatized by the whole thing, and every little twinge and ache seems like a harbinger of doom. I am also very conscious that, even if the infection is healed, I'm still very physically debilitated from everything. My mom and I strolled the kids around the neighborhood on Tuesday, 30 minutes of leisurely walking, and that was the limit of my endurance. Still, it's progress, and I hope I can keep advancing now.

Andrew is a good baby overall -- he wakes me up at night about every three hours, which is as much as you can expect from a month-old baby. He seems to be a little needier than I remember the girls being at this age; they were content to sit in their bouncy seats between feedings, but Andrew mostly wants to be held or at least talked to. He doesn't really nap right now with any consistency, just dozes off whenever he's comfortable and wakes up and complains whenever I decide he's asleep and put him in his crib. He's reasonably fond of his paci, but cannot reliably keep it in his mouth, and I'm half-hoping he decides to switch to a thumb soon. He is also growing like a weed, and I'd be shocked if he's not ten pounds by now, the little piglet.

My nanny is still taking care of the girls right now, but G has been working some late nights recently, so I've been flying solo with all three of them in the afternoons and evenings for the last couple days. This was, quite frankly, a terrifying prospect. The reality hasn't been so bad, but I wouldn't exactly call it easy either. Since Andrew isn't keen on being put down, I'm less able to wrangle the little girls when needed, and they need more wrangling than normal lately. They usually play pretty independently, but this is complicated by the fact that they LOOOOVE the baby. They want to hold the baby all the time, and fight constantly about who gets to hold him. They're very good with him by two-year-old standards, which means that they only pinch his nose or poke his face about every five minutes, but they will. not. leave him alone, at all. If I can get him asleep in his bouncy seat, they immediately begin being "helpy" by covering him up with his blanket (face included), giving him his paci (whether he wants it or not), and patting him and saying "sssh baby no cry" (especially when he is sound asleep).

Honestly, they are fantastically good with him for their age, although it's a lot of work to manage at the moment. I'm looking forward to when he is a little sturdier and they are a tiny bit older. Two or three months makes such a difference in their maturity level, and it's obvious that he will adore his sisters when he's ready to be played with. When they're not messing with him, he seems to find them entertaining -- he'll be content in his bouncy seat or on his quilt if they're around, which is not the case if he thinks he's being ignored. A lot of people told me I was crazy for having Andrew with the girls still so little, but my MIL told me that there are definitely advantages to having children close in age, too. I think I'll see it soon, and that right now is the hardest time.

Tuesday, October 14, 2008

Round 3, and what comes after

I think I spoke too soon about the infection's being cleared up. I started hurting more again on Sunday, and the low-grade fever came back. I gave it yesterday to clear up, then when it didn't, called the doctor back this morning. She wants to do another round of the same antibiotic, about which I have mixed feelings. I felt much better while I was on it, but obviously, as soon as I stopped it, I started getting sicker again. Did I just not take it for long enough, or is it inadequate to the task at hand? I'll give it one more go, but if it doesn't clear everything up for good this time, we'll revisit the question of the D&C.

Speaking of questions to revisit, this whole infection business has pushed me to revisit the postpartum birth control question. We knew all along we were probably done after this one, but I couldn't quite bring myself to get a tubal done with the CS. I hated to rule out even the outside chance we might want another in a few more years, when the girls will be in school and I could better handle another awful pregnancy. Also, this may sound silly, but I wanted to make sure that Andrew was born and that everything would be okay with him. After all the drama of this pregnancy, some part of me didn't believe that we'd really have a live, healthy baby, and I knew that if something awful went wrong, I'd eventually want to try again. So, I said no to the tubal, and had planned on getting a copper IUD (not the Mirena, don't care for hormonal birth control after the events of the last several years).

However, this infection has officially been the straw that broke the camel's back. I can't handle the thought of ever doing this again. I held up through the hyperemesis, the T18 scare, and the months of bedrest for preterm labor. The asthma exacerbation was almost funny, in that "now what!" way where you have to choose whether to laugh or cry. But there's nothing funny about the fact that, four weeks after my son's birth, I'm still spending most of my days in bed because my pelvis feels like it's full of rusty nails and barbed wire. I was feeling so cheery last week when I was feeling well, but now I'm right back to wondering what it's going to take to cure this, and what kind of permanent damage I'm going to be left with before it's all said and done. For all I know, it may not even be possible or prudent for me to conceive again -- endometritis is a type of pelvic inflammatory disease, after all.

In any case, I never want to have another pregnancy, even an accidental one, unlikely as the idea of that seems to someone whose bathroom cabinet still holds a sharps container. I don't want my husband to get a vasectomy, since that is even less reversible in the event of future circumstances than a tubal ligation. If I get myself sterilized, I'd have the option of doing IVF if I wanted another pregnancy badly enough; but if he gets sterilized and anything happens to me, any future wife would be like my sister, permanently infertile as a result of a choice made in another marriage.

I haven't decided whether I will do the Essure procedure or a traditional tubal ligation, but this is mostly a question of logistics. I have to see what is covered by my insurance, and will cost me less. I have to see whether I'm going to wind up being anesthetized for another gyn procedure like a D&C or a lap, where it would be convenient to tie my tubes while I'm already out. Heck, for all I know, this still could end with a hysterectomy, which would render the whole question moot.

In any case, we've got to get the infection cleared up before I can make any decisions. I hope this round of antibiotics does the trick, though I'm less confident than I was.

Wednesday, October 08, 2008

Cognitive dissonance

Lady behind me in line at the Dollar General: "Oh, how old is your baby?"
Me: "Three weeks tomorrow."
LBMILATDG: "Oh, he's so big for three weeks old!"

Nobody EVER told me how big the girls were for their age. Oh, they'd ask the birth weights and say "They're a good size for twins!" or the like, but if anyone ever commented on their actual size, it was to say how tiny they were. So, it really threw me for a loop when LBMILATDG said that Andrew was big for his age.

Of course, it might actually be true. He's got to be above nine pounds by now -- he was gaining 2+ ounces a day as of a week ago, and it's not like he's slowed down his eating. He feels heavy to me, and he's starting to really fill out his newborn clothes. I can't tell whether he's bigger than other three-week-old babies, because everyone else's babies have always looked like giants to me, but I know he's not small. Still, it's just not something I had really expected to be told. Weird.

On another note, Claire is hobbling around the house pretty darn well for a kid with a fractured tibia. Casting the leg was definitely the right choice -- she's moving much more easily than before, even if she does look like Peg-leg Pete. She still prefers to sit on the sofa a fair bit, and be indulged with coloring books and Wow Wow Wubbzy, but she's not as hindered by it as I expected her to be. Good news, that.

Tuesday, October 07, 2008

From the department of I-am-not-making-this-up

Claire tripped over her toy vacuum cleaner yesterday afternoon. She wouldn't put any weight on her foot yesterday or this morning, and there was some swelling, so we took her to the pediatrician this morning, who sent her to the orthopedist.

No fracture was seen on the X-rays, but some types of fractures don't always show up very well. The orthopedist suspected that there probably was a fracture, and said that in children her age, he'd rather treat the kid instead of the X-ray, and proceed as if there is a fracture.

She's now in an over-the-knee cast, which will protect her ankle and hopefully make her more comfortable. She threw epic tantrums throughout the doctor's visits, for which I really can't blame her, but stopped crying and got fascinated as soon as the doctor started wrapping the cast on her leg. It's not precisely a walking cast -- her foot is pointed, rather than flexed for easy walking -- but she was already putting a little weight on it at the doctor's office. We hope that as she gets used to the cast and as the pain abates, she'll be able to move around a little bit better. Still, we're probably looking at a lot of time on the sofa for the next two to three weeks.

What ELSE is going to happen to us -- raining locusts and frogs? This year has been just such an extraordinary string of bad luck in all things health-related, that I can't even imagine what we'll be in for next.

Sunday, October 05, 2008

Continued improvement

I was well enough yesterday to go over to my mom's with the girls for two hours (while G cleaned up yet another diaper disaster, on which more later). Today I sat at the sewing machine for a little while, dealt with some laundry from the diaper disaster, and then went over to Mom's again for our usual Sunday supper. That was the absolute limit of my endurance, and I'm now thoroughly wiped out, but it's more than I've been able to do since the infection took hold.

The low-grade fever is gone, I'm off the painkillers, and I'm feeling so much peppier. I still half-worry that it will come back when I finish out the antibiotics, but that's just because I can't quite fathom being fully well again after all this. Realistically, my odds are good, and I think I've dodged the D&C for now.

Saturday, October 04, 2008

Cautiously optimistic

Yesterday afternoon, I was still pretty worried that we were heading for a D&C after all. I had a little spotting, but certainly not the kind of uterine fireworks Dr. Pro had led me to expect, and my uterus still hurt. I'd felt so relieved when we left the doctor's office, crying this time from the shiny new hope that we were finally getting things back on track. By the evening, with nothing much happening so far, the gleam was starting to wear off a little bit.

However, I did start cramping more as the evening went on, and my bleeding picked up some. I've never been so glad to bleed in my life, even with my first period after all those months of hypothalamic amenorrhea. I'm still not reenacting Carrie or anything, but I'm having what seems like a normal period, so that's definitely progress.

This morning, my temperature was actually normal for the first time in weeks, and I didn't hurt as much even before the pain meds kicked in. Better still, I don't FEEL sick any more, have lost the underlying icky awfulness I've been carrying around since this started. I am still dreadfully fatigued -- my SILs came over this morning to see the baby, and the effort of sitting on the couch for an hour has nearly undone me. Clearly, I will be looking at several days yet before making a full recovery.

However, today is the first day since the beginning that I can unequivocally say I'm better than the day before. I'm really starting to believe that I'll get over this soon.

Friday, October 03, 2008

I want a new drug

I was really a lot more upset than I let on in yesterday's post. I didn't just cry in the doctor's office -- I cried on the way home, and on the phone to my mom, and later when my mom came over, and before going to bed. When I woke up this morning, got out of bed, and still hurt as much as ever, I found myself at the end of my rope, and I couldn't stop crying this time.

After bawling my way through a long hot shower, I decided it was time to do something about it. If there was a physical thing to fix, I wanted to get working on it; if not, then maybe it would be time to start talking about postpartum depression. In any case, though, I didn't have a week's worth of patience left. I called the doctor's office and told them I wanted to have bloodwork and an ultrasound done today instead of next week. That involved tears too, but I think those were actually useful, since they realized what kind of shape I was in and told me to come in ASAP.

Lo and behold, turns out I have a uterus swollen full of blood. I'd stopped bleeding before I even left the hospital, and while that was different from my previous pregnancy (in which I bled for eight weeks straight), I didn't think it was anything to be concerned about. Nobody even asked me about my bleeding, so I never mentioned it to anyone. However, the doctor thinks that is very likely the root cause of the problem.

We discussed doing a D&C today, but Dr. Pro was pretty clear that she wants to avoid that if possible. It involves anesthesia and surgical risks, and would cause breastfeeding problems too, so she wanted to take one more shot at fixing it surgically. I left with a prescription for a different antibiotic, as well as one for methergine, which will cause my uterus to contract and expel all the junk. Since that's probably going to be unpleasant, I have more pain medicine too, which is good because I'd run out. We're going to try that over the weekend, and if I'm not substantially improved by Monday, we'll do a D&C then.

I already feel better just knowing that we've got a different strategy in place. I'm not the world's most patient patient, and I have just about reached the limits of my ability to cope with crap, but I can hang in there for a couple more days. The space of a weekend, with enough pain medication to be comfortable and a new Plan B in place, is an entirely different prospect from waiting an entire week just to begin investigating.

Thursday, October 02, 2008

No milk supply problems here

When we came home from the hospital on 9/21, Andrew weighed 6 lb 10 oz, down from his birth weight of 7 lb 5 oz. Eleven days later, he weighs... 8 b 4 oz. That's a gain of more than two ounces a day. Nope, I don't think we have any milk supply issues!

I also went to the doctor today for a follow-up appointment. I'm feeling a small bit better, but still more crappy than not -- I'm still in worse shape than I was the day after the CS. The doctor said that the antibiotic I've been taking is the only one she really wants to prescribe a nursing mother, and that in her experience, uterine infections either get rapidly worse or slowly get better. Since I'm not getting a whole lot sicker, she thinks I'm going to improve, and it will just take some more time. I'm to come back in a week, and if I'm still fighting it, then we'll do bloodwork and a sonogram to check for abscesses.

I think that's a reasonable answer, on the merits, but it wasn't really what I wanted to hear. I know there's rarely such a thing as a magic pill, but... dammit, I wanted one. I'm so TIRED of struggling, and feeling rotten, and needing to wait just a little longer. I've spent FOUR MONTHS now trapped in my bedroom, and I am so sick of it and so desperate just to be able to get outside. I kept telling myself I had to hold on until the third trimester, until 32 weeks, until 34 weeks, until 37 weeks, until the baby was born. I really thought that once the baby was born, I'd be able to start leading a normal life again. When the infection started, I thought I'd go to the doctor and get antibiotics, and they'd start working. After a day or two, when I wasn't progressing, I thought I just had to hang on until today's appointment, and we'd try something different. Now, I have to hang on another week, and while a week isn't really a long time, I'm just flat out of patience.

I cried in the doctor's office, and she asked me if I felt like I had postpartum depression. I replied that there's nothing wrong with me that won't be fixed by getting healthy and being able to live like a normal person instead of an invalid. I *do* feel pretty freakin' depressed and disheartened right now, though. I don't need anti-depressants to fix it, though; a walk around the block, or a trip to the bookstore, would be all the medicine I need, if I just felt well enough to be able to do them. I hope that happens soon, I really do.

Wednesday, October 01, 2008

One is the easiest number

I'm only now coming to understand just how grueling the first couple weeks of the girls' life was, now that I have a singleton to compare it with. I had very easy babies, so my stint as a new mom of multiples was easier than most women's, but it really is a whole different ballgame when there is only one baby to contend with.

The memory of the girls' insane feeding schedule makes me thank the sweet baby Jebus whenever Andrew wakes me up to nurse. He's waking up at 1-2 am, 4-5 am, and 7-8 am, which was about the same frequency as the girls did. However, I don't have to turn on the light, strap on the giant twin nursing pillow, struggle to latch two tiny little mouths, spend the nursing session gritting my teeth in pain from cracked nipples, change two diapers, and then pump. With Andrew, I have achieved the impossible dream of being able to reach over, pluck the baby from the co-sleeper, latch the baby, and go back to sleep. (G is currently on diaper duty because the uterine infection makes it so unpleasant for me to get up -- as of today, I'm starting to feel a tiny bit better, but I have a long way to go still, and am likely to spend several more days recovering.)

Nursing is somewhat easier simply because I'm experienced now, but the bulk of the difference is physical. I don't have cracks this time, because my nipples are only subject to half as much abuse, and it doesn't hurt that Andrew was as big at birth as Claire at six weeks. With the girls, I was so aggressive about ramping up milk supply so that I could nurse two babies AND supplement with pumped milk that my production went crazy -- I would nurse them, then turn around and pump 6-8 oz after each feeding. When you're making that much milk, you have to be religious about removing it promptly, which is why I constantly struggled with engorgement, plugged ducts, and mastitis. I haven't pumped at all with Andrew so far, though I really ought to start building a freezer stash, so I don't know how much extra I am making, but the oversupply troubles are far less. He's having some gas issues, which implies a foremilk-hindmilk imbalance, but this time I can actually use block feeding to resolve it.

Andrew likes to cluster-feed during the day -- really, what he does is nurse on one side, fall asleep for a bit, and then wake up for the other side 30 minutes later. I nursed the girls "on demand", but when one baby woke up and wanted to eat, I woke the second baby and fed her as well, and I made them stay awake long enough to eat full meals. With Andrew, I don't have to be as hard-core, and can allow him to nurse more frequently if that's what he wants to do; sure, I spend more time nursing, but it's nice not to force him to stay awake. As he gets a little older, I'll guide him to finish his meals more promptly, but I don't feel the need right now.

I also spend so much more time holding Andrew during the day than I did with the girls. He sleeps in his co-sleeper without complaint at night, but during the day, he takes one or two naps in it, and spends the rest of the day snuggled up with me. He might be soundly asleep on my chest, but should I try to put him down, he'll start howling like his bed is full of baby-eating crocodiles. Again, I'll steer him toward more naps in his crib or bouncy seat as we go along, but I really actually like holding him, so I'm indulging us both.

As a result of all the one-on-one nursing time and the holding time, I do feel like I'm closer to Andrew than I was each to the girls at this point. For the first month or two, they were a unit to me -- I did things with "the babies" or "the girls", not so much with Claire and Katherine, if that makes sense. Newborns don't express a lot of individuality anyway, so pair-bonding was the default. Now, there is just Andrew, so I can focus twice as much on him. We noticed this literally even in the delivery room -- G wasn't running back and forth from baby to baby, trying to focus on both at a time.

One luxury I do have is a nanny for the girls, so Andrew is an only child for me right now. I'm not physically capable of taking care of them myself, due to the infection and the c-section recovery before that, any more than I have been for most of the pregnancy. However, in a few weeks from now, I'll be letting the nanny go and spending some time as a full-time mom to all three kids. Our nanny is pregnant, and not having the easiest time of it, so she's pretty ready to stop chasing after three toddlers (her son is two years old, and she brings him and cares for all three children). I'm not sure what the long-term plan is -- we're discussing putting the girls in day care after Christmas, and I will stay at home and work around the baby for a few months -- but again, it's great to be able to focus just on the baby, instead of juggling the needs of all three children.

Even when the girls were tiny, I loved having twins. I always felt like they had a companion, and I think they found each other's presence comforting, even as tiny babies. Now that they're a little older, they have a built-in best friend, and entertain each other to a degree that makes my singleton moms envious. They fight too, especially in the last couple weeks (new baby upheaval, I'm thinking), and right now Katherine is sporting a set of Sister's toothmarks on her forehead. Plus, at 30 pounds each, they can be physically different to manage when they want to be ornery. Still, I'm glad that they are twins and sisters, and during my pregnancy, I wondered if Andrew would feel lacking because he didn't have a twin.

I still think he may do so, as he gets older, but at the moment, my perspective has completely changed. I feel that he's getting a chance the girls never had, to be my only child. He has not yet had to cry in his crib because I am feeding or changing his twin -- this will come in a few weeks, I'm sure, but for now he's able to get what he wants when he wants it. I'm able to give him undivided attention and love, and I'm wistful that I missed out on that with the girls, even if I didn't realize what I was missing at the time. I'm really thankful that I'm getting to experience what it's like to mother a singleton, and to have a "babymoon" with him.