Tuesday, September 30, 2014

Breastfeeding Twins

It has been hard for me to write due to limited time & feeling unsure about sharing my new mom struggles in this space. However, even while still trying to get pregnant I enjoyed reading these type of posts so I'm hoping sharing this might help another mom out there.

Oh breastfeeding... I felt so strongly about wanting breastfeeding to go well for a multitude of reasons. I knew it would be hard with twins. And it was. I knew that it would be worth it. And it is.

The first day they were born is a little bit of a blur now with being awake for 48 hrs before they arrived, the c-section, & duramorph in the epidural which resulted in a drugged & puking mama for 24 hours. But I know they latched pretty well at the same time as soon as we got into the recovery room & fed at least a couple more times that first day. Then the next day things changed. E became what we affectionately called 'hangry' & would thrust her head back and forth feverishly when trying to latch. She went from sleeping to hangry in seconds so it was really difficult to try to avoid. Thus began the practice of feeding them separately as it was just too hard to get them going together. O on the other hand seemed to be getting the hang of things. We saw the lactation consultant at the hospital & she gave us some tips (breastfeeding is not intuitive like you think it should be- at least it wasn't for me). I also started pumping after every feed to try to get my supply up & milk to come in.

Then that second night they were both down close to 10% from their birth weight & the nurse said the pediatrician would probably talk about supplementation in the morning. That was the night I kind of lost it. Breastfeeding 2 babies in a row one who is pissed the whole time & seems to hate it, then pumping for 15 min, and then changing them ect took over an hour. We would send them to the nursery between feeds overnight (a godsend- seriously people I love my babies but it was survival time). I think at the 3am feed that night when E would just not latch & was so, so, so mad I called the nurse & asked for formula. Then began the craziness that is breastfeeding, supplementing & pumping. For the next week I nursed them separately followed by my husband feeding them 0.5-1 oz of formula while I pumped. It was hell. Because there were 2 & they weren't on the same schedule I basically was feeding one of them constantly (or pumping). I don't think I slept for more than 1.5 hrs in a row for their first 10 days of their life. My husband kept telling me I needed sleep & that he would just feed them overnight one night so I could rest but I was convinced that I needed to breastfeed them every time they ate or we would fail. I honestly already felt like a failure & I was falling apart. When you are that exhausted for that long you think you have it all together but everyone around you is thinking "woah give that girl a bed or a drink or both." And they are right. My husband was amazing but unfortunately he cannot lactate.

Luckily I had somewhat planned for this chain of events. I had emailed one of the pediatricians that works in the breastfeeding medicine clinic at the hospital I work for during the pregnancy. She brilliantly had recommended making an appt with them when they were born regardless. Making that appt was one of my achievements on that first drug dazed day of their life & when it finally came it changed everything in such a positive way. 


Lesson 1- Breastfeed twins at the same time always. IT IS THE ONLY WAY YOU WILL SURVIVE. 


So first thing she told us was the goal of the appt was to get them both latched at the same time and this would be the plan from here on out.  Since O was the good feeder at the time she would be in charge.  Every time she wanted to eat we would feed E too.  If E got hungry in between these times we could give a little bit of formula (we never had to do this).


By the time of our appt, E usually wouldn't breastfeed unless she was given a little bit of formula first- she wanted that instant satisfaction.  But feeding them simultaneously helped this immensely as well- when I latched O first my other breast would start leaking and thus E would get her immediate milk without much effort.


Lesson 2- Positioning is really important.


My back was killing me that first week.  Primarily because I was trying to breastfeed them while sitting on our deep couch without any extra support.  I had bought this: My Brest Friend Twins Nursing Pillow but it was really too large for them at the newborn stage.


She recommended I get this: My Brest Friend Original Pillow to use for now and save the twin version for later when they are larger.  She also recommended using pillows or blankets underneath either side of that pillow to prop it up and then using little blankets or towels under there heads as sort of pillows for their heads to prop them up to the breast.


Lesson 3-Supplementing is not evil.


I am a pediatrician. I knew this but I had immense mom guilt.  It was nice to hear her affirm- for a full term healthy baby the difference between formula and breast milk is small. Yes, there are wonderful benefits for baby, mother & financially but happy & healthy mom & baby is most important.


At this appt at just over 1 week of age they were almost back to birth weight & my milk had really come in a few days before!  Yay! So she recommended supplementing if they still seemed hungry- otherwise no need to keep supplementing.


Lesson 4- Listen to your husband.


So this amazing doc said, "You don't really need me. You've got this. But you do need sleep.  This is survival mode. I don't care if you don't feed them for 1 night or just get up once to pump.  It is not going to hurt your breastfeeding- you need the rest."


The hubby took over that night from 9pm-4am while I slept just getting up once at 12am to pump (I was too engorged not to).  Ahhh... what a night of sleep will do for a person.  Life changing how much better I felt the next day.


Lesson 5- If you are having multiples or have any breastfeeding issues at all see a breastfeeding medicine specialist/lactation consultant.


The consultants in the hospital are good but at an outpatient visit they have a lot of time to spend with you (our actual time with the doc was >1 hr).  They are able to go through the whole feed with you and trouble shoot and then you have their nurse line for questions/back up ect.


This appointment seriously changed everything for us. My husband talks about how the first month was hard.  It was, but for me nothing compares to those first 10 days.  The impact of that doctor's visit was immediate.  They were on a schedule from that night on and we haven't looked back.  And by schedule- I mean they still feed on demand just always together.  It has made our lives so much easier.  I am so very thankful that so much support exists for breastfeeding now days because in the end it has been hard but so very, very worth it.


Sunday, July 27, 2014

Our girls are 4 weeks old!

It's hard not falling off the face of the earth after having twins... so here I am emerging from my couch and bad reality television, smelling of stale breast milk and hoping for 10 minutes to take a shower.

Our girls were born on June 23.  I don't think I'll ever get around to writing a full detailed birth story so I'll provide the basic details now.  Despite our 2 false labors the real deal never came on it's own. So Saturday night we went to my hubby's graduation from Anesthesia residency and then went home to lie awake until 4am when we "awoke" to get ready for our 5am induction.  Basically most of my fears throughout the pregnancy came to fruition.

We got checked in and I got started on Pitocin around 6am.  Things were slow going... I progressed from 1.5cm to 2-2.5cm and they broke my water on baby A to try to get things moving around 10am. After that a had stronger contractions for a few hours and progressed to 3.5cm. At that point I got the epidural since I knew I'd be getting one at some point anyway with twins and the possibility that I may end up with a C-section.  Then over the next 12 hours or so despite high doses of Pitocin (up to 30, higher than the typical max of 20) nothing happened.  It was very frustrating.  My blood pressure was also high throughout- 140s/90s and was taken every 30 minutes which meant I did not sleep AT ALL.  They did not work me up for pre-eclampsia since the babies would be born within 24 hours either way and I had no other symptoms. 

Overnight they tried to drop the Pitocin rate for an hour then restart the gradual increase which was again unsuccessful.  Around 3-4am we started to talk to the nurse about what the plan would be realizing the likelihood I would reach 10cm and be able to push in the next few hours before reaching 24 hours post rupture of membranes was very low.  I was sad that the induction had been unsuccessful but also realize there are limitations of what medications can do.  My only regret/wonder is if I should have pushed harder to wait longer for induction since my pregnancy was uncomplicated.  I was induced at 39+1 which was already pushing their limit for twins (which they typically induce at 38 weeks) but with a completely healthy pregnancy I wonder if induction at that time was really necessary.

My doctor came in around 5 and we discussed going ahead with c-section since i had not progressed any further.  She warned me that my risk for hemorrhage was higher given I had been on a high dose of Pitocin for so long & was not contracting. Since Pitocin is what they give to help the uterus contract & bleeding stop after delivery she was concerned that I wouldn't respond & discussed the risk for hysterectomy.  I know she had to discuss all the possible risks with me & I certainly was higher risk for that potential complication but talking about that right before we went to the OR did not serve my nerves well.  We went back to the OR around 6am. They dosed up my epidural & my pain control during the c-section was excellent. I really didn't feel much at all. 

Elaina Grace was born on Monday, 6/23/14 at 6:23am. She came into the world screaming and has been a firecracker ever since.

Olivia Jane was born at 6:24 also healthy & hollering. She has been our chill baby with the most pathetic/adorable little cry & lower lip quiver. 

Our hospitalization had a few rough spots (a post for another day) but we got to go home on Thursday 6/26 & have been slowly figuring out their personalities & this whole parenting thing.  We are all 4 happy & healthy & doing well but tired... Very tired. Twins are hard and wonderful in ways I did & didn't imagine. I wouldn't change a thing but I am counting my blessings that my husband's been home with me this whole time.  



We are 3 lucky girls that's for sure. 

Wednesday, June 18, 2014

Ready for the Real Deal

So yesterday my hubby and I were both convinced was it...

I woke up at 2:30am having infrequent contractions & laid in bed until 3:15 when I realized there was no way that I could sleep and got up to lie on the couch. The contractions got progressively stronger & more frequent until around 5am I had to run to the bathroom to puke.  Made me realize why they starve pregnant ladies who are in labor as there was still food in my belly for me to puke up when I had last eaten around 9pm. 

The puking woke up my hubby. I was trying to let him sleep in case this was the real deal so that at least one of us would be rested. By 6ish my contractions were 5-7 minutes apart. So we started packing up for the hospital & I was making the hubby wash the few dishes in the sink, straighten things up ect. Then I got in the shower around 7:30 & things just started to slow down.  I had an appointment with BPP since I'm over 38 weeks for 10am. We planned to call them & ask if we should come or go to the hospital but by 9 the contractions were only coming 2-3 an hour. I was actually very disappointed. We had gotten so excited to meet them & I thought I'd get to avoid induction. 

Things looked good at my appointment though. They both passed their BPP.  My weight was down 4 lb- being on my feet less at work has meant much less swelling, and my BP was slightly better although still a little high (128/90). And best news of all... I have gone from not even 1cm & thick (which I have been since 32 wks) to 1.5cm & 30% effaced. I know this is a small change but it means things are changing and gives me much more hope that an induction will be successful.

Yesterday was my second false labor... Had less frequent contractions but still for several hours at 35 + 2. After 2 trial runs we are ready for the real deal.

We are down to 3.5 days until induction... Sunday at 5am.

My PUPPP rash is killing me...
Yea... That is my belly today. It has spread & is out of control. The 90 degree blanket of heat outside is making it miserable, sweat + this = unhappiness.  At this point lying down so that my huge belly does not touch my thighs and covering my belly in ice packs is the only thing that provides relief.  This makes it difficult to sleep since I can't really keep an ice pack in place.  Delivery is apparently the cure and it better be because I thought the carpal tunnel was bad but this is much, much worse. 

Anyone else have this and have any ideas?  I have tried Cortisone cream and Benadryl both of which essentially do nothing.

I am learning to repeat the mantra 4 more days, 4 more days as I itch the shit out of my belly.  I think moving up the induction for a rash seems silly (but I do debate it on an hourly basis).  It will all be worth it when they are in our arms. I can do anything for 4 days just to see our girls faces.

Wednesday, June 11, 2014

Why Hello There...

I have started several posts which haven't been published because I was trying to avoid being a whiny bitch during the most challenging part of my pregnancy (at least to you all... my husband got the brunt of it).  I think I can declare victory at this point.


I don't know what happened at 32/33ish weeks but I hit this wall and wanted these girls out of me so badly.  I just felt horrible all the time... pain in the ribs from their butts/feet, squashed stomach which made it impossible to eat resulting in oscillation between ravenous hunger and overwhelming nausea, and worsened carpal tunnel with permanently numb hands.  I set my goal at surviving to 36 weeks and then planned to do anything in my power to get these chicas out into the world.


Then somewhere between 35-36 weeks things started to look up.  I think they dropped some and now I can breath and sleep slightly better (although now waking up every 1.5-2 hours to pee).  And surprisingly enough, here we are FULL TERM at 37 weeks and 3 days.  I am quite proud of myself even though it probably has more to do with luck... there were days in the past month I didn't think I could do it.  Now I am okay with them hanging out in there... just for a little while longer.  At the same time, I am so excited to meet them and would love for them to get this show on the road on their own to avoid induction. 


My fears/focus has now shifted to trying to get used to the idea of potentially not having the birth experience I desire.  My OB is telling me they will induce by the end of 38 weeks due to the risks outweighing the benefits with twins beyond that point... BUT I am not even 1cm dilated, the babies are still pretty high, and I have had absolutely no complications/risk factors (no gestational diabetes, good BP, GBS neg).  If my cervix does not start to change soon I think the risk of induction failure is relatively high... meaning C-section... which has been a huge fear of mine since they said "twins" at 6 weeks.  I know that I need to accept that I have no control and make peace with that but my type A planner personality means doing so is less than easy.


I have my 37 week appointment tomorrow and I'm guessing we may talk about an induction date.  My hubby has his residency graduation on 6/21 which will be 38 + 6.  I am hoping that either a) my cervix has dilated some or b) they will let us wait to be induced until Sunday, 6/22 or Monday, 6/23 or c) both!  We shall see... The hubby says his graduation is not that important to him but considering it's the culmination of 4 years of undergrad, 4 years of med school, and 4 years of residency finally resulting in a real actual job I think it's kind of a big deal.  I agree with him that babies are a bigger deal but I thought they'd be here by now so we could do both. So I am hopeful we still can.


But mostly... mostly I am thankful... thankful that we have made it to full term, thankful that we have 2 healthy looking big babies (estimated 6lb 4 oz and 6lb 5 oz last week at 36 + 2), thankful that we are able to create this family we wanted for so long. 

Saturday, May 10, 2014

I am old and so are our babies

I turned 30 on Thursday.  I have been told I am ridiculous but 30 does feel and sound quite old (to me).  It was a pretty uneventful birthday with me being knocked up and all but the hubby gave me exactly what I wanted... had flowers waiting, cooked a delicious dinner, poured me a (small) glass of wine, and finished it off with an ice cream cake.  It was wonderful.  I told him I wanted to celebrate later after the girls arrive and he did it just right with this little birthday dinner now.


We had our 32 week appointment and ultrasound this week.  Tomorrow I will be 33 weeks which is just crazy.  Means we're only 3 weeks from our goal and 3-7 weeks from our girls arriving!  Everything looked great on the ultrasound:
Baby A weighed in at 4 lb 4 oz, pulse 145
Baby B weighed in at 4 lb 5 oz, pulse 153


They continue to weigh right around the 50% for singletons and the tech commented that if I make it to term they will probably both be over 8 lb!  So fingers crossed to go a little early- 16 lb of baby is a lot! One of them you could already tell has a ton of hair which got me so excited! I love hairy babies (makes them look more baby & less alien at birth I think).  My friend's daughter had this thick, dark hair and honestly looked like she was wearing a wig and she was just the most beautiful baby. 


The OB proceeded to completely freak me out after our ultrasound. I have mentioned here that my weight gain over the past couple months has been kind of odd.  I don't know if it is primarily due to fluctuations in swelling but one appointment (over 2 weeks) I will be up 5-6 lb and the next only up 0.2 lb.  It has been this way every other appointment to even out to about a 1-1.5 lb weekly weight gain over the month as a whole.  This week I was again up 6 lb.  I was pretty swollen in my feet and hands and I didn't think that much of it given my blood pressure remained normal at 120/81.  No protein in my urine either.  But my OB asks me if they are seeing me weekly to which I replied no every 2 weeks and she said well your weight gain just has me concerned for pre-eclampsia.  In my head I'm thinking "huh? but my BP and urine are normal."  I pointed out that my weight has done this the past 2 months and she agreed but she remained concerned.  I explained that I had an appt made for 34 weeks but I'd be happy to come in next week if she thought that was best.  She said we could keep the same schedule just to call if I notice any more swelling, headaches or just don't feel well.  Great... now I'm going to think any symptom I have is impending doom.


I'm glad the hubby was at this appointment because he helped calm me down.  I am just scared now and feel I need to get everything ready this weekend in case something happens.  I just want healthy me and healthy babies. I would feel much better if they keep cooking for at least 3 more weeks.  Our goal is to bring them home from the hospital with us to the new, crazy, hectic wonder that will be our lives.

Saturday, April 12, 2014

Hello Third Trimester & Creepy Strangers

This past week was a major milestone... I am currently 28 weeks & 6 days!  I am very excited to be in the third trimester and beyond the 28 week mark when most premies do okay.


I have still been struggling with uncomfortable hugeness, lots of swelling (especially given I am back on inpatient service working crazy hours mostly on my feet), and terrible carpal tunnel.  My right thumb, index, middle, and half of my ring finger are now numb 24/7- it is a strange feeling and drives me a little crazy.


We had our doc visit and monthly ultrasound yesterday and our little minions are still growing wonderfully.  Baby A was 2 lb 10 oz and heart rate of 134.  Baby B was 2 lb 12 oz and heart rate of 163.  I can't believe I have 5 lb 6 oz of baby in there already- that could be a full term singleton (well almost).  They are both near the 50% for singletons which is amazing.  My doctor was impressed with how I've been doing.  I was a little freaked because I gained 6.5 lb in the past 2 weeks (but I did only gain 0.5 lb in the 2 weeks prior so I guess 7 lb over the month isn't terrible).  She said given the swelling I've been complaining of it's not surprising and my blood pressure was good so she had no concerns.


The hubby and I went to a multiples class this week.  I was hoping they would provide some good tips for breast feeding multiples ect. (advice for when they are actually here).  Instead it was a bunch of basic info about multiple gestation pregnancies and was pretty worthless for us.  There were about 8-10 couples and one woman in particular ruined the class for everyone (I'm pretty sure I am not alone in this opinion).  She knew everything (at least thought she did) and kept trying to correct the maternity ward nurse instructor.  It was painful.


I've been starting to get the "Oh my gosh when are you going to pop?" question.  It's mildly entertaining to watch people's reactions when I respond, "2 1/2 months."  I am tempted to stop telling people it's twins so they are embarrassed by telling me I'm huge... thankyouverymuch. I went out with girl friends last night for the start of a friend's bachelorette weekend.  We went to the Red's baseball game.  As we were going into the stadium the woman (in her 50s-60s) scanning our tickets squealed, "Oh! You must be about to have the baby!"  And before I could move out of the way started touching my belly.  This was my first stranger touching belly encounter and I WAS NOT A FAN.  I don't understand why being pregnant makes people feel they have an open invitation to invade your personal space. 


Seriously?


Do you go around rubbing bellies of non-pregnant people? I highly doubt it... so get your dirty strange hands off of me and my precious babies.

Tuesday, March 18, 2014

All Belly

I think this is every pregnant woman's dream- to have people say to you, "You're all belly."


I am not all belly.  I have gained a little weight in my arms and a decent widening of my hips and butt have occurred.  The last few weeks though it is just my belly that is growing out and out and out.  I like it for the most part, looking really pregnant instead of chubby vs. pregnant but I am starting to feel like there is no more room between my rib cage and pelvis.  At the end of the day I just feel so full and get this pain in my right upper abdomen.


Yesterday, I was post-call... I was up most of the night before trying to get 2 kids to stop seizing and awake for most of 36 hours + pregnancy is not a good emotional combination.  Last night in my exhausted state I just broke down... I started telling my husband I didn't know how I was going to make it three more months feeling this big and that there is just no more room.  He looks over at me and says, "Are you crying?"  Yes... I was crying.  Exhaustion and raging hormones will do that to you.  I called it a night and I am fine today.  This is just harder than I thought sometimes.  I love being pregnant, but being a medical resident working a ton of hours, having constant work pressure and serious chronic fatigue makes some days really, really hard. 


I have been trying to focus on all my nesting activities.  It makes me feel like I am accomplishing things and that someday I'll feel ready for their arrival.  I am currently in the process of making 2 quilts.  I don't exactly know how to sew...my mother bought me a sewing machine for Christmas and I've finally dragged it out of the box.  I am pretty excited to be making things with my own hands for our babies but a little scared of how wonky they may look.  Made with love is what counts right? 


I am slowly checking things off the nursery list:
The room is painted, cribs assembled and with mattresses, changing table set up.
I painted the closet 2 weekends ago and the hubby helped me hang a second rod with a shelf on top last weekend to accommodate all their tiny clothes :)
We have 2 built in dressers in the room (our house is a cape cod with such charming little features). One of them got new knobs and I got this awesome wallpaper to line the drawers with.
My mom gave me a little table to use next to the glider which I need to paint.
We ordered a chair and a half glider which should be here in May.
I need to finish my quilts and I am contemplating making 1 or 2 black and white mobiles for either above the cribs or above the changing table.
I ordered this awesome print from Etsy which I'm planning to put with this Hammerpress print, a cute mirror, and a little birdhouse I am painting in a collection above a little bookshelf.
I also want to get big wood or cardboard letters (the first letter of each of their names) to decorate somehow and hang above each crib.


Things are coming together... I will post pictures eventually when it is looking all calm and soothing and pretty just as I picture it in my head.  It's shaping up to be my favorite room in our house.