Thursday, October 6, 2011

Thoughts on the NICU - 4 of 4

If I had a dollar for every time someone asked me when the boys were coming home during their NICU stay, I’d be a rich woman and I wouldn’t have to work anymore.  There were several milestones that the boys had to accomplish before they were able to come home and that’s what I had to continue to tell people.  So for all those that were wondering, here are the NICU milestones in order of our achievement.
  • They had to be able to breathe on their own.  This was accomplished very early on for our little boys.  They were only intubated for a day and then it was a CPap machine for about a week and then it was just a nasal cannula.  The CPap and nasal cannula were not really helping them breathe, it was just allowing more pressure into their lungs to make them stronger.  We were blessed that the boys didn’t have any major lung issues.  It could have been because I was able to get the steroid shots, or it could have just been because they were strong and healthy.  We were thankful!

Nasal Cannula
  • They had to be able to maintain their body temperature.  For the first few days the boys were in an open warming bed.  This was the easiest bed at the time because they were under the jaundice lights.  Once their jaundice cleared, they were moved to the closed isolettes where you put your hands through the holes to touch and feel the babies.  These isolettes were set at a certain temperature and were adjusted down each day, so that they could get used to being in room air temperature.  By a week and a half in the NICU, the boys were boys were moved to a crib which they shared.  This was the best situation while we were there because they were in the same spot in the NICU.  At this point, they were able to maintain their temperature.  Goal accomplished!  They eventually moved us to a private room and separated the boys into their own beds once they were on their way to going home.  A very good feeling.
Open Air Warming bed
Shared Crib
The Private Suite
  • They had to be free of A’s and B’s.  Apnea is a pause in breathing that lasts 15-20 seconds.  Bradycardia is a heart rate less than 100  which can lead to the baby not breathing.  For the first several weeks, bradys were a problem for our little boys.  They would just stop breathing every once in a while and every time that happened the score chart would start over (you had to go 5 days without before going home).  So one of the main questions to ask the nurse each time I went was if they had any bradys that day.  The nurses actually gave them a daily dose of caffeine to help stimulate them to remember to breathe.  Truett overcame this issue faster than Ellis.  He was taken off caffeine on 6/12/11 after being brady free for at least two days.  Ellis continued on caffeine for another day and eventually overcame his bradys.  Another goal accomplished!

  • They had to be able to eat all 8 times a day by either breast or bottle.  This was the hurdle that kept us in the NICU the longest.  When babies are born so early, the sucking mechanism isn’t developed and so it’s a learning process for both baby and mom to learn how to feed these precious little people.  For the first several days, the boys got their nourishment through TPN (Total Parenteral  Nutrition).  The nurses were holding out for my milk to come in and until it did this is how they were fed.  Once it came in, they started feeding with a very small amount (about 7ml) through a syringe that they would just hold up and let gravity  take it to their tummies.  Once they were taking 20mL or more, they began using the gavage system.  They stayed on strict tube feedings for about a week and a half.  They started a trial run on the bottle on 6/1/11, and both boys took very little but did well for a first time.  They weren’t allowed to add a bottle feeding until they were able to complete one feeding.  It took us several days to master this and finally after about a week they moved us up to 2 feedings by bottle.  They stayed at this for about a week and then it was as if the lightbulb went off for the boys.  They moved up their bottles everyday.  We started breastfeeding a week before they came home and they really latched on well.  By 6/21/11, they were taking all their feedings by bottle and the nurses were preparing for us to take the babies home.  We came home 5 days later (6/26/11) after they had had several days of mastering bottle/breastfeeds. 
Truett's first bottle

NG Tube Feeding

Tandem feeding

  • They couldn’t have any other complications.  We were so fortunate that our babies weren’t sick.  They didn’t ever have any complications that so many babies in the NICU do.  Our babies actually were considered feeder/growers because they were not in critical condition.  They were just small and needed to learn to eat.  The nurses talked about how it was always two steps forward, one step back in the NICU, but I never really felt that while we were there.  I felt like the boys made great strides everyday, but it was just a learning process for them.  When we first had the babies, they said that it would be at least three weeks in the NICU, and we ended up with 5 weeks exactly.  Not too bad considering they were 8 weeks early.  

I believe that this about wraps up my thoughts on our NICU experience though I'm sure that I have left out several things.  It's amazing how far we have come in 19 weeks and ultimately we are so thankful for our NICU stay.  Praise God for those NICU doctors and nurses because they took excellent care of Truett and Ellis and they taught us so much in our journey of being new parents.  

Family pic with Truett - 5/21/11
Family Pic with Ellis - 5/21/11

    Tuesday, October 4, 2011

    Thoughts on the NICU - 3 of 4

    I'm a milking machine!

    • My very first opportunity to pump came about 10pm, the night that the babies were born.  I had been given my pain medicine and also medicine to keep the itching down and I was given the pump (by a nurse I wasn’t real fond of) and was told to pump without much instruction at all.  As I sat up that night to begin the process, I nearly lost my lunch (of which I had had nothing to eat for approximately 24 hours at this point).  10 minutes of pumping and I had nothing to show for it.  That night is somewhat of a blur expect for nurses coming in to give me medicine, the next morning I had my first consultation with the Lactation Consultant, “LC” and was told the basics of breastfeeding multiples.  I was told to pump for 30 minutes every three hours and since my babies were in the NICU this would become my ritual for at least the first 5 weeks of their life.   This routine proved to be exhausting as even though I didn’t have babies at home with me, I was still getting up in the middle of the night to pump so that I could maintain my milk supply.  The nights when I accidentally slept through one of the alarms were nice in that I got more sleep, but bad in that I missed getting that milk.  By the 3rd or 4th week, I was pumping consistently 6-8oz per session 8 times a day.  It was a blessing that my milk was in and was abundant.  Thankfully we were stockpiling as the babies were not taking in near what I was able to produce in the beginning (they have definitely caught up, but we still have a healthy supply.)  It was not until the 4th week that they were in the NICU that they allowed me to try to breastfeed the babies.  The LC came and we set up to breast feed Truett and Ellis separately as that’s what they generally do in the beginning.  They took to the breast immediately with a little help from a nipple shield which the LC felt was amazing considering their prematurity.  I breast feed them separately each time I went to visit for the next two days.  Then on Saturday, a week before they came home, I brought out the Big Bertha of nursing pillows, the Twins/Plus My Brest Friend, which became my Best Friend.  Modesty went out the window, and I became the milking machine for my boys.  In the beginning, I would nurse them until they would fall asleep which would be maybe 10 or 15 minutes.  Then we would work to wake them back up and when they just couldn’t take anymore from me, we would try to give them supplemental milk of 15-20mL.  After nursing, I would then pump for an additional 30 minutes because I knew that the babies weren’t emptying me.  EXHAUSTING!  I tried my best to switch sides that the babies nursed on during each session because I knew that this would be better for my production.  It became a game trying to remember who was on what side at what time.  Sometimes we just gave up and fed without thinking about it too much.   The whole process took an hour and half from start to finish and then it would start all over again in an hour and half.  Crazy!  The nurses and LC just let me do my thing in the last week that the babies were in the NICU and it was nice because we had a semi private room once I started this breastfeeding venture with the boys.  I wouldn’t trade it for the world, but it’s not quite what you envision when you think of breastfeeding.  
    Daddy burps Truett
    Daddy burps Ellis

    Ellis' milk coma
    • This process has changed for the better now that the boys are getting older and we have fallen into a routine.  When first brought the boys home I was breastfeeding as much as I could so that they could maintain their ability to latch on.  They did great, but I was again exhausted because of the supplemental milk, and pumping afterward routine.  By about the 4th week of being at home with the boys, I started pumping almost exclusively since my in-laws were in town.  It was about this time that they started just breastfeeding once a day and then taking bottles (of expressed milk) the rest of the time.  It was a life-saver, since there were lots of hands at the house and the boys could be fed while I was pumping and we knocked out two birds with one stone.  This actually helped prepare me for going back to work since I knew that I wouldn’t be able to breastfeed the boys at work, it got me into the routine of breastfeeding once per day (sometimes twice) and pumping the rest of the time.  They do great when the breastfeed now and actually I think that they get even more than when they take a bottle because they are always spitting up afterward.  I’ve set goals for myself in the breastfeeding season that I am in and I’m about to make it to the 4 month goal.  The next goal is 6 months and I’ll just play it by ear from there.  I must take it one day at a time as it can start to get overwhelming.

    • It was during this time that Netflix and Facebook became my companions.  I needed something to do to occupy the time while I was pumping or breastfeeding and I found several shows to fill that time.  I have now watched all of Accidentally on Purpose, Samantha Who?, Drop Dead Diva (season 1) and Friday Night Lights (Seasons 1-4).  I’m currently working on season 5 of FNL.  I know that there are better things that I could fill my time with, but it just became a habit.  Now that I’m working, my pumping time is filled with reading my Kindle or taking a much needed nap.  
    The last post should be educational for all who have ever wondered what it takes to be discharged from the NICU.  

    Monday, October 3, 2011

    Thoughts on the NICU - 2 of 4

    A day in the life of a NICU momma...
    • For the first week of the babies’ life, I slept at the hospital.  I was discharged from the hospital on Wednesday, May 25th, but was actually allowed to stay on “courtesy” stay an additional 48 hours.  You wouldn’t think that anyone would actually want to stay at the hospital, but I was just fine there.  I was just one floor up from my babies and I could come and go from my room just as I pleased and I didn’t have any nurses checking on me every 4-6 hours.  It was like a sterile hotel and I loved it.  So while I was in the hospital for the first week, we went to see the babies every chance we could.  Usually the first morning feeding at 8am, then 11am, 2pm, 5pm and 8pm.  Sometimes we would skip the afternoon or late morning feeding just because we needed to take a nap, but it was a great blessing to be so close to the babies and to see their progress in the first week. 
    •  I learned the morning after the boys were born, the rules of the NICU.  We would get buzzed into the NICU just by telling our name, and we definitely became a fixture after being there for 5 weeks.  Once you got in, you put your stuff up, hand the pumped milk off to a nurse to put in the refrigerator and get ready to scrub in, 3 minutes (there was a timer) from your fingertips to your elbows.  There was no jewelry allowed in the NICU because that could carry bacterial which could in turn be passed to the babies (I broke this rule the first week.)   After scrubbing in, I would always use the antibacterial hand sanitizer.  Not only were we to use this when we first came in, but also when you handled a different baby and after every time that you left, you were told to use the hand sanitizer.  This took the place of having to wash every time you switched babies.  Speaking of washing hands, one critical piece of information I learned the first day was that you must go to the restroom before you come to the NICU, because there was no restrooms inside.  If you did end up needing to go to the restroom while inside, you would have to go through 4 doors to get to the lobby to go and then start the whole process over again.  Get buzzed in and then re-scrub in.  So lesson learned, take care of business before entering the NICU.    
    • There was a limit of 2 people per baby and one had to be a parent at all times.  We were labeled as parents at all times with the hospital bracelets that matched the boys.  I was given these bracelets before I was even wheeled out of the OR after my surgery.  We wore those bracelets religiously for 5 weeks straight and boy were they nasty when we finally took them off.  We were fortunate in that, we had two little boys, so we could technically get 4 people (including ourselves) in at all times.  In the beginning of their stay in the NICU, it was a little annoying because the boys were actually in separate beds across the room from each other.  So if we had visitors with us, then a parent had to be with each of the boys.  When the doctor would make his rounds, which often happened while we were there the first week, we would each hear the results for one baby.  By the end of the second week, we were moved to one bed, so we could be with each other and both of the boys.  So nice.  We were still in the open area of the NICU, so we didn’t have much privacy, but we did have both boys in the same crib.  Once we were stable and on our way to going home (a week and half before we left), they moved us into one of the 3 private rooms in the NICU.  This was by far the best arrangement because it was somewhat secluded and we didn’t feel as exposed to the rest of the NICU.  

    Truett & Ellis
    Truett & Ellis
    • Starting on Saturday May 28, I began going to the hospital 3 times a day.  I split my up and went to the hospital at 8am, 2pm and 8pm.  The boys were on different feeding schedules, so that the nurses would be able to feed them one after another.  Ellis was feed on the half hours at 830, 230, and 830 and Truett was fed on the hour at 9, 3 and 9.  Obviously, they were also fed at 11 and 5 and during the night, but these were the best times for us to be there.  The second week that they were in the hospital, Zach was still off from Home Depot, so he was able to go with me on Tuesday and Thursday.  He had had gone back to his design job though so he couldn’t come during the day on MWF, so my mom took me.  We would park in the Expecting/New Mother parking daily (a nice perk) and make our way to see the babies.  Once inside, we would watch the nurses as they did their assessment: measuring the belly, drawing any residual from the NG tube, checking the measurement of the NG tube, and checking the soft spot.  Then, they would allow us to take the temp, and change the diaper.  Then, it was time to feed.  I would usually get Ellis ready and hand him off to be held by my mom or whoever came with me during his NG tube feed, while I got Truett ready for his feeding.  Since their tummies were so tiny, they were being fed over an hour through the Gavage system, which is a machine that compresses a syringe over a period of time.  If we weren’t able to stay for the full hour, then we wouldn’t hold them because the nurses didn’t really like the babies to be jostled while feeding.  Once they were done feeding, we would hold them for a little bit, and then put them back in bed to rest until the next time.  
    • During the time that I wasn’t at the hospital, I was usually pumping or eating.  I took my breaks from the hospital during the lunch and dinner time hours, so it gave me ample time to get some things done like take a nap, or accept the food that was being delivered to our house by the many different friends and family who had signed up on the care calendar.  One night after being at the hospital, Zach and I decided to stop by Mickey D’s, for a snack and we tried the Frozen Strawberry Lemonade.  We were hooked.  I can’t remember how many I had, but during the time the boys were in the hospital we had quite a few.  Even after they came home, we were still hooked because it was so hot this summer. 
    It is possible to breastfeed and have babies in the NICU... it's just not easy.  Keep watch for the next post.

      Sunday, October 2, 2011

      Thoughts on the NICU - 1 of 4

      Since we are 19 weeks into this adventure with twins, I need to get my thoughts on paper (blogger) about our 5 week stay in the NICU.  We have been home with the boys for 14 weeks now and our world has changed, and it’s definitely for the better.  Our little boys are the sweetest and cutest little boys that I have ever met, but I might be biased.  Now on to my thoughts…
      The other day, I was reading the blog of a friend of a friend of a friend.  I got pretty deep into this girl’s blog because she shared almost the same story as me except that she had triplets.  It was pretty amazing how much of the same sentiments that she had that she had put on paper that she somewhat inspired me (without even knowing it) to put my story down.  It was a definite learning process.

      • I went into the hospital knowing that I would not come home until I had the babies and also knowing that once I had the babies that would have a stay in the NICU.  I didn’t know how long that stay would be, but I knew that the babies would not be strong enough to make it home with me the day or even a week after they were born.  It gave me a feeling of inadequacy since I wasn’t able to care for my babies on my own immediately.  It’s hard to be a parent or even grasp the concept of being a parent when you aren’t actually caring for your own babies.  
      • On the other hand of this inadequacy is opportunity.  We were able to learn so much from the nurses that were caring for our babies that we would not have known if we had been able to take our babies home with us.  I am actually very thankful for the time that the babies spent in the hospital because I was able to make a full recovery from my c-section before they came home.  I’m not sure how I would have been able to care for both babies and recover myself had I brought them home immediately after birth.  Ultimately, I think that the LORD prepared us by allowing us to have excellent nurses caring for Truett and Ellis for the first 5 weeks of their life.
      • It was such an eye opening experience to be in the NICU.  We were obviously not the only parents seeing their babies in the hospital on a daily basis.  We actually got to know the two other twin parents while we would scrub in daily.  We could cheer each other on as we each got closer to our goals of going home.  We also got to see some very somber times in the NICU that no one would want to experience.  I will never forget the day that the nurses called me at home to tell me that the NICU was on lockdown and would be until further notice.  I knew that it was because of an incident with a baby that I had witnessed earlier in the day.  When we came back that night and realized that the baby wasn't there, our hearts were heavy for the family.  I give thanks to the Lord for blessing us with happy and healthy babies who just needed a little jump start in life by a stay in the NICU. 
      Stay tuned for the next installment of our NICU stay...

      Sunday, September 25, 2011

      4 months old - September 21, 2011

      The boys turned 4 months old this past week!  My how the time has flown by.  They shared their 4 month birthday with their Daddy's 31st birthday.  It was a special day for all of my men.  The boys gave their dad a special gift of tickets to the Rangers game on Friday night.  I bought tickets for Zach since we have missed out on our Rangers games this year due to some very special little boys.  The last one that we went to was in April the week before I went on bedrest.  

      So in honor of their gift to their dad, they wore their Rangers gear for their photo shoot.  I was glad that they were able to wear this gear since the morning of Ellis had a huge blowout and got his outfit dirty.  Thanks to Daddy's washing skills it was clean for our photos.  

      Truett (L) and Ellis (R)
      Truett (L) and Ellis (R) 
       This week Ellis really found his sense of humor.  The day before his birthday, Zach really got him giggling good.  He was giggling so hard at his daddy pulling his shirt over his head and waving his hands around like a silly man.  He also made some growling sounds at them to get them going.  Truett was slightly scared of the growling though and even got a very worried look on his face like he was about to cry.  We're going to have to work on Truett's giggle.

      Truett really is a happy baby, you just wouldn't know it with this picture.  He was caught at the right time for a mug shot.  He was the first to smile for us and now he's working on his little personality.  

      Truett (L) and Ellis (R)
      Truett (L) and Ellis (R)

      So not only did Zach get Rangers tickets for his birthday, but I got him this really cool ring called The Gear Ring.  Zach had shown this to me last year and I had considered getting it for him for his graduation, but decided on something else.  I figured that now would be a good time.  He really likes it even thought I completely got the wrong size.  We're shipping it out the week to get that issue resolved.  It has gears that actually work and I thought that it was perfect for my creative husband.  

      The boys went to their 4 month checkup on September 22, and did wonderful getting their third round of shots.  Such big little guys.  Here are their stats for 4 months old:

      Truett Reid
      12 lb 8 oz (10%)
      23.5 in long (5%)
      42.75 cm head circumference (63%)

      Ellis Jay
      12 lb 15 oz (15%)
      23.25 in long (4%)
      42 cm head circumference (45%)

      Apparently, our little men are small with huge heads.  The great thing is that they made it on the charts for their age group.  Since they were 8 weeks premature that's a big accomplishment.  Their weight is looking really good.  Their looking pretty short for their height, but this could just be a hereditary gene that they have picked up from their momma.  We'll see as the years go on.  Overall, their doctor was really impressed with their growth and told us to keep up the good work.  Our next big thing will be starting rice cereal at 5 months old.  Looking forward to that day!

      Ellis (L) and Truett (R)
      Truett (L) and Ellis (R)

      We're really proud of how far Truett and Ellis have come over the last 4 months and can't wait for the months to come!

      Tuesday, September 20, 2011

      3 months old - August 21, 2011

      Tomorrow, our little men will be 4 months old.  Can't believe that the time has flown by so fast.  Must post the 3 month pictures before tomorrow, when these won't be relevant anymore.

      These pictures were taken after church after having lunch at our friends house.  They were ready for their afternoon snack and nap.  We're still pretty much stuck to our schedule of 3 hours during the day and we are going about 6 consecutive hours at night.  Some nights they surprise us and go longer, but those are few and far between.  We will begin to train them to sleep all night starting this weekend.  Hoping it goes well.

      Most of these events actually happened in their 4th month of life, but they are worth noting.  The boys began to be much better at holding their heads up and not being so bobble headish.  They are really recognizing people now by greeting them with a smile. They are growing like crazy and Ellis still remains in the lead.  We'll find out their 4 month weights on Thursday, but I know that Ellis weighs 12lbs from his first "sick" baby visit to the doctor last week.

      Truett (L) and Ellis (R)

      We have not mastered sitting up against something as you can tell, but they are tolerating their bumbo seats and enjoy playing on their playmats.  The boys made their first trip to Sunday School on August 28th and they loved it.  See the smile on Truett's face below.  Their teachers tell us that they are the sweetest and best little boys.  I'd have to agree.  

      They started smiling at about 3 months, or their adjusted age of 6 weeks.  Must remember that these boys were 8 weeks early, so we can't judge ourselves on the normal scale for babies.  My mom was able to capture this great picture of Truett's smile while she was keeping them during the first couple weeks I was back at work.  We have a little different arrangement now that Daddy is looking for a job again.  KK only has to keep the boys on Tuesdays and Thursdays while Daddy is at Home Depot.  We're hoping that a job will come soon.  

      If only I could have held my camera in the right place, I would have had a great picture of Ellis' smile on our first road trip to Marion, AR.  We made our first road trip on Labor Day weekend.  It wasn't so bad except for having to pack what seemed like the entire house.  It was trip that needed to be done though as there were lots of people for the boys to meet.  

      They met their great-grandparents on Zach's dad's side.  Grandma and Grandpa were so excited to meet these little boys and we were so thankful that they could make the trip from Jonesboro to see them.  

      Their other great grandmother, Mimi (Zach's mom's mom) was excited to see her great grandsons again. Mimi came to visit them when they came home from the hospital, while I was still home from work.

      Ellis (L) and Truett (R)
      They also met their first cousin, Leona.  Leona was born on the same day that we stayed in the hospital to prepare to bring the boys home.  We came home with our babies on the same and they are exactly 5 weeks apart.
      Ellis, Leona, and Truett

      Can't believe how far we have come since their days in the hospital.  Looking forward to the months to come and cherishing the moments that we have had so far!

      Monday, August 22, 2011

      2 Months Old - July 21, 2011

      Ellis is laying on Truett

      Truett and Ellis

      Now that the boys are three months old I should tell you about their two month appointment...  

      We went to the doctor on their two month birthday and they got their shots.  It was a relief to finally get their shots and then to let people hold them at church.  It's somewhat of a milestone to accomplish.  I was unsure how the boys would take the shots, but then again they were used to being poked and prodded while they were in the NICU.  Thankfully, our doctor gave the boys tylenol before even giving the shots.  The boys were actually really good with the shots.  They cried so hard in the beginning you couldn't even hear the cry and their little faces turned beat red, but other than that they were not fussy the rest of the day.  
      The doctor continues to be impressed with their strength as preemies.  For being 8 weeks early, they have incredible head strength and he feels that they will close the gap between their developmental and chronological age fast.  Not sure how fast that will be, but we'll just take each day at a time.  

      They were weighed at their two month appointment....
      Truett was 7lb 12oz  and Ellis was 8 lb 5 oz.  They are growing so fast and now that they are almost 3 months old, I believe that they are pushing 10 lbs for sure.  It's pretty crazy to think that they were only 4lb 1oz and 4lb 12oz when they were born.  

      Our next doctor appointment is at 4 months.  Can't wait to see how much they have changed by then.

      Ellis waiting for the inevitable shots
      "yummy Tylenol," says Ellis.
      My face is as red as a tomato - Ellis
      Truett preparing for his shots
      Truett taking it all in... ouch!
      Ellis recovering...

      Truett recovering from the trauma
      As a side note, these little outfits that they are wearing no longer fit.  They were newborn outfits.  We are now wearing 0-3 and 3 month outfits.  Thanks to our friends Andrew and Benjamin we haven't really had to buy any clothes.  Our other twin friends, Mary and Amelia were born today, exactly 3 months younger than Truett and Ellis.  So excited for all these little ones to grow up with lots of playmates.