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!

Intubated

C-pap

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

Isolette 

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

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 3^rd or 4^th 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 4^th 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.  

Thoughts on the NICU - 2 of 4

A day in the life of a NICU momma...

Truett

Ellis

• For the first week of the babies’ life, I slept at the hospital.  I was discharged from the hospital on Wednesday, May 25^th, 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.    

Ellis

Truett

• 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.

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...