Archive for January, 2012

Gotta stick to the schedule

Sunday, January 29th, 2012

The most-useful parenting book we’re reading so far is still Healthy Sleep Habits, Happy Child. Author Marc Weissbluth is a professor of pediatrics at Northwestern and founded the original Sleep Disorders Center at Chicago’s Children’s Memorial Hospital. He imparts essential ideas:

  • No newborn can comfortably stay awake for more than 1-2 hours at a time
  • Falling asleep is a learned skill and you can teach babies how to do it without crying
  • Tired babies are fussy babies and vice versa
  • Tired babies are less alert and learn less effectively
  • Babies who miss daytime naps do NOT make it up at night. In fact, the opposite is true: babies who miss naps crank out cortisol and other stress hormones to stay awake (but overtired) and subsequently have trouble falling or staying asleep
  • 4 out of 5 babies demonstrate drowsy cues so that you can get them to bed within their window (before they melt down), but 1 in 5 don’t. For these others, you have to watch the clock and start winding them down to sleep before they run out of go juice
  • Sleep cycles and durations are a function of brain maturity (age)

At almost 11 weeks past their due date, our babies are still in the process of firming up a daily sleep schedule. While the timing is a little fuzzy, and will be for several more weeks, they’ve settled into two nighttime sleep blocks and three daytime naps. As long as we keep this routine going, there’s almost no crying at our house.


Total Baby app: Sam’s timeline for the last week

On Saturday, Bill’s Mom invited us to visit and we made a valiant attempt. The upsides are that we saw Nancy, her sister, and brother-in-law; celebrated a belated Christmas; and enjoyed a yummy dinner. The downside is that we blew the girls’ nascent schedule.

We packed up the girls right after the late-morning meal and hoped they would sleep in the car… but they didn’t. Once we arrived, we set up their rockin’ new bouncy chairs in a dark, quiet bedroom and tried to get them to sleep there… but Sam didn’t. We scarfed dinner quickly, hurried home again, nursed, and bundled them for bedtime two hours later than usual and hoped they’d sleep, but for some time they didn’t. We limped along, managing to nap for an hour before midnight, pushed the middle-of-the-night feeding to 2 am, and hoped we’d get a long sleep block afterward. The girls each managed 4-1/2 hours… but not at the same time. As a result, our (parent) sleep since midnight looks like this:


Total Baby app: Bob’s sleep since midnight

Ugh.

I’m sure that we will venture out again, maybe even soon. But we need time to recover from last night first, and we’ll schedule it really carefully.

Speed blogging: what are the odds?

Saturday, January 28th, 2012

I like to sleep.
I’d like to sleep.
Actually, I’m scarily cognitively impaired and I desperately need to sleep more.
We need our girls to sleep so that we can sleep.
Sleep is a function of brain maturity, driven by their gestational/growth age.

Babies first develop a “long” 5-6 hour night sleep block around 6 weeks past their due date. Our girls did that on time, but it’s only rarely the same overlapping block of time. Our sleep is hemmed by the last baby asleep and the first baby awake — lowest common denominator style.

Babies begin to organize their day sleep into regular naps and eliminate the middle-of-the-night feedings around 16 weeks. That’s five weeks… or 35 days… or 175 sleep blocks from now: an eternity.

While two people in the last 24 hours have reassured me that it will happen “before you know it,” I feel like I have higher odds of winning the lottery that I don’t play or getting struck by lightning… twice.

Sister conversations

Thursday, January 26th, 2012

Babies become socially aware at about six weeks (or in our case, 10-11 weeeks), and most babies become especially interested in faces. For a while, Sam and Cate were interested in grown-up faces but didn’t seem to be interested in each other.

Well actually, they occasionally seemed to recognize that the parent across the room was holding someone else (not them) and frown, even as they were being held by the other parent. Jealousy! But they weren’t interested in each other’s faces.

But over the last week or so, we’ve been making a point everyday to give them several minutes to sit face-to-face and interact. When they’re close enough, they now look at each other with interest and seem delighted to talk at each other. Sisters!


Sam and Cate talking at each other

Last night, their new-found interest in each other spawned an unexpected activity. They woke up to nurse just before midnight, and for several minutes through the first let down, they were very focused on the business at hand. But when things slowed down a little, Sam opened her eyes, looked around, and really noticed Cate nursing just opposite her. Her face lit up and she began talking to her sister… with my left boob still in her mouth. It was awkward for both of us, but incredibly cute and good for a laugh.

Samanthaism #1

Thursday, January 26th, 2012

Here’s Sam talking despite hiccups at 15 weeks (or 10 weeks past their due-date) two days ago:

Get the Flash Player to see this video.


Catherineism #1

Thursday, January 26th, 2012

Here’s Cate talking at 12 weeks (or 7 weeks past their due date) on my brother’s birthday:

Get the Flash Player to see this video.


Speed blogging: noises

Wednesday, January 25th, 2012

Sleeping babies make you hear everything more clearly:

  • squeaky floor boards
  • squeaky door hinges
  • rattling window sashes
  • toilet flushing
  • hard-soled shoes
  • crinkle of plastic packaging
  • microwave latch and dinger
  • clatter of ceramic and glass dinnerware on similar surfaces
  • leaf blowers and lawn mowers
  • noisy neighbors who don’t know any better
  • Sandy, the fool-headed, country, barking-at-everything, yellow Laborador who should know better
  • muffler-less motorcycles
  • city garbage collector honking to “tell the guy to put his bins further apart
  • 20-something Cool Guy honking to “tell his dad to hurry up”
  • telephone(s)
  • sneezes and coughs
  • the other sister
  • etc

Fortunately, we have a few good sources of white noise: the air conditioner (12-minute blower cycle), the dishwasher (45-minute cycle), and Bill’s C-PAP (all night). These go a long way to mask the other noises and keep babies sleeping. But I’m ready to trade my kingdom in exchange for some reliable quiet around here.

Just cuteness: Attack of the hiccupotamus

Wednesday, January 25th, 2012

This time, both Sam and Cate were attacked by the hiccupotamus… at the same time!

Get the Flash Player to see this video.


Our latest baby-feeding challenges

Monday, January 23rd, 2012

Week 1 (Oct 11)

The day Sam and Cate were born, post-delivery hemorhaging left me too weak to go to the NICU to see our babies, never mind nurse them. Further, they were really too little to nurse, but they needed to eat every three hours. So they took Neosure formula from a tiny bottle, just 1/3 of an ounce (~10 ml) at first, working up to an ounce at each feeding. The little 2-ounce bottles looked enormous next to their tiny faces. As preemies, they were so very sleepy that it was a challenge to get them to eat that much. We were only allowed 30 minutes to feed them each time, because the nurses explained that the energy required for all that sucking would quickly exceed the calories they took in.

Bill’s first “daddy nightmare” was about not being able to get Sam to eat, and he made a point to be in the NICU for the 9:00 am, noon, 3:00 pm, 6:00 pm, and 9:00 pm feedings every day to master the skill. I was only strong enough to go up to the NICU once a day, and I had less luck getting girls to eat. On several occasions, the NICU nurses took back the baby I was attempting to feed after 20 minutes to help make sure she got the nutrition she needed within the prescribed time window. The grandmothers, Baba Jean and Gram Nancy, came to the NICU on several occasions to help and learn, too.

Each baby was tethered back to her isolette, with monitors tracking their heart rates and respiration rhythm. Breathe-suck-swallow is a complicated set of motor skills, and we had to pay attention, and let them rest when they got overwhelmed. To burp the girls, the NICU nurses insisted that we sit them on our knee, holding their chin in one hand while thwacking their backs with the other, much harder than seemed appropriate for such tiny babies. Cuddling them close resulted in them falling asleep almost immediately.

Week 2 (Oct 18)

Once we were home, we continued to feed the girls when they woke every 3-4 hours. As their mouths got stronger and their stomachs grew, they quickly worked up to two ounces at each feeding. With single-minded purpose, the girls would now finish a bottle in 4-6 minutes, sometimes taking only one break in the middle to pant and catch their breath. They sucked so hard they often collapsed the bottle nipple, and at their two-week check-up, Dr. W found “sucking blisters” on their lips, exacerbated when we weren’t careful to make sure their lips were flanged out around the nipples. Dr. W encouraged us to stop using the prefilled formula and Medela breast milk bottles and begin using our Dr. Brown’s bottles with an internal vent stack to reduce pressure in their mouths.

As my anemia improved and my strength returned a little, I also nursed each of them during two feedings a day as I was able. But I only made enough milk for each of them to get half a feed from me. So even when they nursed, they also took some formula. I would nurse one baby on one boob, then hand her off to Bill to take a bottle while I nursed the second baby on the second boob. After we finished nursing, I would then give her a bottle.

Week 3 (Oct 25)

I continued to nurse each of the girls twice a day, and after renting a baby scale, we began tracking how much milk they were able to get from me. With more nursing and more pumping, my breasts produced more milk, and I hoped that I’d eventually make enough to nurse them exclusively. However, the plastic flanges for my breast pump were chafing the areola around my nipples, and it became increasingly uncomfortable to nurse or pump.

Week 4 (Nov 1)

The red, raw, chafed area on my left boob became visibly infected. Concerned that I had developed a yeast infection. Regarding their milky white tongues, I worried that our babies were getting “thrush”, and I switched to pumping exclusively for several days. We made plans to see doctors first thing the following Monday morning.

Week 5 (Nov 8)

The pediatrician checked out the girls and assured us that they were perfectly normal and healthy. Meanwhile, a lactation consultant recommended a (nearly useless) topical goo for my boob and discouraged me from taking any antifungal medication.

gas and simethicone?

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Week 8 or 9

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Week 10 (Dec 13)

Catie became more selective about latching to nurse. After an initial spell, she would wiggle and dismount. Then she would open her mouth eagerly like she was hungry for more, but repeatedly let my nipple graze through her open mouth without latching. At the time, I couldn’t figure out why. By the end of December, Catie began resisting bottles altogether. After nursing, she would make hungry-looking fish mouths with protruding tongue, but when we presented a bottle, she would resist latching on to the nipple. We brainstormed possible causes and remedies: Does that nipple smell like dishwashing detergent? Do we have a bad batch of formula? Has she decided that she prefers breast milk? Burping her and swapping out nipples only occasionally led to her taking the bottle. Catie’s total consumption decreased dramatically, and as a result, her rate of weight gain fell further behind her sister. As the problem worsened, we became increasingly concerned. Slowly, Sam developed some of the same issues, though to a lesser extent.

Week 12 (Dec 27)

After a week of increasingly sporadic eating, we called the pediatrician’s office and learned that their behavior was typical of babies suffering from acid reflux, when stomach contents seep into the esophagus and throat. She said reflux is common among preemies, and reassured us they will grow out of it eventually, six to nine months from now.

In the meantime, she encouraged us to keep girls upright at least 30 minutes after each feeding, and to feed them less milk/formula more often, in case trying to manage our daily routine with two babies wasn’t already challenging enough. Bouncy seats, to keep their heads elevated relative to their bellies, have become essential gear. She also “prescribed” propping the head of the crib mattresses on phone books.

In this age of internet search, we have already recycled all of ours. And we wonder: will these girls ever need to know what a “phone book” was?

Photo of the day: spring walk

Monday, January 23rd, 2012

Today was temperate, so Claudia (the nanny we hired a week ago) and I took the girls for a brief walk outside.


Sam on the left, Cate on the right, wearing cute hoodies from my friend Valerie

To wean or not to wean…

Monday, January 23rd, 2012

If you’ve managed to get me on the phone in the last three months, you know that the topic I’m thinking about, more than any other, is breast feeding. For a host of reasons, it’s been important to us to feed our girls breast milk (rather than formula) for the first 12 months, if we’re able. (Since most of our peers came to the same conclusion, I won’t expend bits here outlining the many benefits.)


Sam and Cate nursing tandem

However, wanting to breast feed and succeeding at doing so don’t always go together. Nursing, while natural, is learned behavior for both moms and babies. If you know someone who has successfully mastered the skill of breast feeding and nourished their babies for months or years, know that they have accomplished something meaningful.

My boobs hurt most of the time, not just when our girls are nursing, but in between feedings, too. I’m taking 1600-2000 mg of ibuprofen a day (which is a lot), and have been for three months. The lactation consultant was horrified when I told her that.

Apparently, breast feeding isn’t supposed to hurt. Or, while it’s often uncomfortable for the first few weeks as one’s nipples get used to the experience of repeated wet suction, it’s supposed to stop hurting soon thereafter. If it continues to hurt, something isn’t right. In our case, several things apparently are not right.

First, I spent weeks using breast pump flanges that were too small. They chafed and rubbed and felt increasingly awful. No one at the hospital told me I was supposed to switch to bigger ones as my milk came in, and I was too sleep-deprived to figure that out on my own. Six weeks went by before I got the right flanges. And chafing my boobs while pumping made nursing painful, too. Ouch.

Second, I often didn’t (don’t) succeed in getting our babies latched appropriately. Nursing effectively is a little bit about suction and a whole lot about compression. Specifically, an infant must draw not just a nipple (ouch!) but most of one’s areola into their mouth in order to compress the underlying milk sinuses with their tongue and squeeze milk out. But at 35-36 weeks, our preemie girls’ tiny mouths weren’t big enough to grasp my breasts effectively. A silicone shield helped initially, but even after they grew, we still struggled to get them latched deeply enough not to cause me pain. Further, we’ve been nursing tandem since December, which adds another challenge. Even when I get the first baby latched well, it’s easy for her to slip into a shallower, problematic latch, while my attention is turned to latching the second baby. Ouch.

At one point, all this pain convinced me that I had a yeast infection in my breast, and a trip to my OB’s office resulted in a two-week course of antifungal meds. But more research and another trip to the OB led to the conclusion that I never had an infection at all. Instead, I just have “mechanical” issues nursing my babies, which is the third issue.

In addition to sliding into shallow latches, our babies tend to clamp down with their jaws. The upside of our babies getting bottles every day of their lives is that they were able to eat and thrive when I was too weak to nurse them. The downside is that they have learned to do things to bottle nipples that just aren’t okay to my nipples. Specifically, they chomp down harder and longer than is necessary to get the milk flowing, and they mostly don’t let up. Most recently, Sam has learned that she can stop my letdown from hosing milk down her throat by clamping down further. They cut off blood flow to my nipples, and when it resumes after nursing, I get shooting pains (vasospasm) deep in my boobs, and they’re exacerbated by cold. Ouch.

Finally, because we’re tandem nursing (doing two at a time makes it MUCH easier for me to achieve the milk ejection reflex that lets the milk down), I need the girls to wake up and eat at the same time, even when one is still asleep. That means I sometimes have to wake a sleeping baby, and also that sometimes I have a full boob and a baby who’d rather sleep next to it than eat. Ouch.

And I almost forgot the obvious that afflicts every nursing mom: that I can’t sleep when the babies need fed. Since I’ve been nursing at every feeding, I rarely get to sleep through the night.

With chronic pain and frustration from nursing, one might ask why I keep nursing two babies when a lot of twin moms stop after a month or two. I have a bunch of reasons to stop: acute pain, chronic tenderness, risk of injury/infection, schedule constraints, diet constraints, wardrobe constraints, pump and scale rental expense, and anxiety about the whole thing. Bill summed it up: for breast feeding to make me cry so often is Not Okay.

I keep going partly because I looked to my friends’ breast feeding successes and set an arbitrary goal — nurse exclusively for a year — rather than recognizing that attempting to nurse twins is a wildcard. I go on partly because I’m stubborn.

Mostly I’ve kept nursing because of the validation I get from Sam and Cate. They communicate an excitement about nursing — faces lit up with wide eyes and big grins — that we haven’t seen yet over bottles of formula. It’s as if they’re saying, “Booooobs!!!” Their enthusiasm makes the rest of it seem worth it. And occasionally, nursing is comfortable and serene, just like it’s supposed to be. It’s an insidious random reward pattern.


My cousin Mary captured one of our Good Moments

In retrospect, the key phrase in the first paragraph was “if we’re able.” I’m beginning to recognize that continuing to nurse may be a misallocation of my finite capacity. I spend too much time and energy thinking about, preparing for, enduring, and recovering from nursing, and not enough time anticipating their other needs and what comes next. So I’m thinking about weaning our girls over the next month, so that I can become a good whole mom, instead of just a nursing mom.

It pains me to set aside all of the effort and energy I’ve put into nursing over the last three months (I’m a sucker for valuing sunk costs). I need ways to think of what I’ve done as a success: “I nursed twins for 3 (4?) months!” A possible self-serving rationalization could also be that nursing two for 3 months is like nursing one for 6, at least from a wear-and-tear perspective, right?

And to keep me motivated, I need to figure out what I’m moving toward instead of focusing on what I’m giving up. I’d like to think that in addition to eating a more varied diet, resuming caffeine and alcohol, and wearing shirts without buttons, there could be meaningful benefits for both me and the girls if we wean. What do you think? Can you help paint me a picture of improved quality of life?