We posted photos from Eleanor and Miranda’s second week. Things were pretty uneventful (eat, sleep, change diaper), but we are settling into more of a routine. During this week, we managed to get out of the house once or twice, and we gave the girls baths.

This morning we went in for the girls’ two week doctor’s appointment. We’re glad to say that the girls are doing well. Since their last appointment eight days ago, both of them have lost their umbilical cords, both have improved their color significantly (they were kind of yellow when they went home from the hospital), and both have passed their original birth weight. Like most babies, Miranda and Eleanor lost weight over the first few days after they were born. They had started regaining it by the time we measured them for their first doctor’s appointment two days after they left the hospital, and now they’ve surpassed their original weight.

We were shocked to find that Miranda now weighs 6 lbs, 9 oz, a gain of fourteen ounces in the eight days since they were last weighed! Eleanor also broke the six pound mark at 6 lbs, 1 oz. That was a gain of eleven ounces in eight days. I suppose it’s natural that they would be gaining a lot of weight to eventually catch up with other babies, but it was still quite a surprise. We’re starting to fear that the bassinet that we’ve been using for the both of them will not hold them for much longer. The bassinet part of the Pack n Play is rated for fifteen pounds and their combined weight is starting to get close. We thought they would be in there for maybe six weeks, but that’s starting to look unlikely. One of our cribs will be delivered this week, but we would still prefer to have them in our room, if possible. We’re going to have to find another option for keeping them in our room even when they pass a total of fifteen pounds.

Our next appointment will be when the girls turn two months. They’ll be getting their first immunizations at that time. I’m sure it’s going to be quite traumatic for us all.

Bernard and I have been keeping track of every minute of breastfeeding, every mililiter of formula, and every diaper change with Eleanor and Miranda. I average between sixteen and eighteen sessions of breastfeeding in a twenty-four hour period, and each session is about twenty-five minutes long. Yes, I feel like a mother pig feeding her piglets. Breastfeeding has taken over my life and no one told me how hard it would be! I suspect this is because for some women breastfeeding is very natural and easy, and for the rest of us, no one wants to be discouraging about it.

The main problems I’ve had are, initially, delayed milk production, and then subsequent low milk supply, although I suspect that if I only had one baby, my milk supply would be adequate. The first forty-eight hours went okay. I was breastfeeding every two to three hours, and I received help from the nursing staff with latching. The girls would suck for thirty minutes at a time, but sometimes up to an hour. I ended with sore nipples fairly early on because I let the girls basically soothe at my breast for as long as they wanted. Multiple nurses commented that their latch was good, and not to worry that my milk hadn’t come in yet.

By about sixty hours, I was instructed to start wearing my nursing bra because my milk would come in “any minute now”. Then, seventy-two hours went by, still no engorgement. By this time, nurses and the pediatrician were starting to comment on the girls’ weight loss and jaundice. In addition, the girls were getting extremely frustrated, pulling very hard on my nipples, with no result. The nurses and I couldn’t even express any colostrum manually. Finally, Bernard and I decided to start supplementing with formula by the end of the third day.

Now, I don’t really want to go into the whole formula thing, but the bottom line is that needing to give them formula was very upsetting to me. Granted, I was sleep-deprived and overly emotional, but watching the girls get formula from Bernard or my sister, Effy, made me feel defective as a mother. A few days ago, just making the formula (mixing the powder and water together) brought me to tears. Now, Bernard makes all the bottles.

For the rest of the hospital stay, I continued to breastfeed every two to three hours, and we would give them formula if they were still hungry. By ninety-six hours, the last day at the hospital, I still hadn’t had any sign of my milk coming in. The next day I went to a breastfeeding support group where a lactation consultant weighed the babies, had me breastfeed, then weighed them again. Miranda gained no weight after 15 minutes of breastfeeding and Eleanor gained 0.2 of an ounce (about 6 cc) after 30 minutes of breastfeeding. Again, examination of my breastfeeding technique revealed no problems. The lactation consultant then said, “You might be one of those women whose milk just doesn’t ever come in.” This was a bit shocking because everything you read and learn as a pediatrician says that all women, except those who have had major breast reconstructive surgery, can breastfeed. She then suggested that I try a herbal remedy to increase milk production called fenugreek, and also, a prescription medicine called metoclopromide.

That night, I started to be able to express some colostrum. I also tried fenugreek which made me extremely nauseous and drowsy. I refuse to try metoclopromide because as a neurologist I’ve seen many patients suffer from the adverse effects of that medication. Basically some patients suffer from dystonia after taking metoclopromide–their muscles become extremely stiff, and they go into these contortions of the head and neck.

Essentially over days 7-10, my milk production gradually increased. I still never experienced “engorgement” where the breasts rapidly swell with milk. When I breastfeed, I have to massage the ducts in all parts of the breast to encourage let-down. This means that I can’t breastfeed both babies simultaneously, hence, the sixteen to eighteen sessions a day of feeding. Formula now constitutes about 40% of their intake. I’m hoping that this will gradually decrease. The important thing is that the girls are doing well and they take pretty easily to both bottle and the breast.

Those of you who followed our pregnancy blog will recognize this list from the blog entry of July 2nd, where I packed a bag for my hospital stay. I said I would revisit this list after the delivery.

1. robe and slippers
2. toiletries and cosmetics
3. extra pillows
4. socks
5. nursing bras
6. nursing pads
7. going home outfit and blanket for baby
8. going home outfit for mom–early pregnancy size
9. breastfeeding book
10. hair dryer
11. underwear
12. feminine pads (the ones in the hospital don’t have wings etc.)
13. nipple cream
14. bathing suit for partner (in case Bernard wants to help me labor in the shower)
15. heat/ice pack
16. list of hospital policies from the hospital tour (e.g. visiting hours, phone number to your hospital room, where you can use your cell phone, cafeteria hours, reminder to call your insurance company about the hospitalization and about putting your baby on your plan, how to order social security card and birth certificate)
17. mittens for baby (they’re not allowed to cut the baby’s fingernails, so you have to bring nail cutters or mittens)

I packed everything before I knew I was going to have a scheduled C-section, as opposed to going into labor, but overall, we did pack the right things.
The things I did not need included:

1. extra pillows — the hospital provided all the pillows I needed.
2. heat and ice pack — this was supposed to be for the pain of labor as well as breast engorgement, but I ended up not using it.
3. mittens for baby — mittens don’t work, period. they come off in a matter of minutes. just bring baby nail clippers to cut your baby’s fingernails.
4. bathing suit for partner — again, i didn’t go into labor.
5. underwear — the hospital provides these mesh underwear which you can just throw away after use. they’re fairly comfortable too.
6. feminine pads — again, provided by the hospital.

The only things I would add to the list are the following:

1. two nursing gowns — although it is easy to just undo one side of the hospital gown to nurse, you still end up flashing all of your visitors if they show up while you’re breastfeeding. This happened to me with the chairman of the department of neurology who visited me on the first day.
2. two nursing bras of the “sportsbra” type — i brought one regular nursing bra and one “sportsbra” type nursing bra, but you really only end up wearing the latter type. when you’re waiting for engorgement, you need to wear a nursing bra continuously, including during sleep, and the sportsbra type nursing bra is a lot more comfortable.

A couple of things Bernard would recommend bringing are enough clothes for Dad for the entire hospital stay (Bernard had to run home to get more clothes), and of course, laptop and camera. He formatted a lot of the photos while we were in the hospital.

We also brought a Child Health Record, which you can buy from the American Academy of Pediatrics. This is a great way to record all of the health information for your child, including the inital hospital stay, all well-child visits, growth charts, and immunizations.

After the pictures of the delivery and the hospital stay, we just had a few more photos to finish off week 1. After this, we may post a group of week 2 photos and then slow down to monthly photo updates, unless something interesting happens. At this point, many of their pictures are starting to look alike, but enough should happen on a monthly basis to warrant a new set.

Yesterday marked 48 hours that we’ve been home from the hospital. For the most part, we’ve been able to settle in okay. The first evening was probably the hardest, but it’s been getting better. In those 48 hours we managed to completely fill the kitchen trash bag that we put into our Diaper Champ. During that time, we’ve learned a bit of what (not) to do while changing diapers.

During one of our first diaper changes at home, Effy was visiting. We figured we would show her what we do when we change diapers in case she’s watching them some time in the future. We set out everything: a box of wipes, a bowl of warm water to warm the wipes and dilute the soap on them, a changing pad with a brand-new (and washed) pink terry cloth cover, a disposable waterproof pad to protect the changing pad cover, an alcohol prep to clean the umbilical cord, and a new diaper. We put Miranda on changing pad and unfastened the diaper. It was a mustard yellow swampy mess in there–both stool and urine. I warmed a wipe, moved away the soiled diaper and wiped her from front-to-back. I glanced up and saw Miranda grimace. Then, a moment later, more stool comes shooting out about three feet. It barely missed me, but she got an unprotected part of our changing pad cover, a laundry bag, and a bit of the floor. Luckily no one else was in the line of fire. All we needed to do was put the changing pad cover in the laundry, along with the laundry bag. Effy was kind enough to clean up the floor. Since then, I’ve started changing diapers standing to the side–not directly at the girl’s feet, and we’re pretty careful in keeping the girls covered one way or another while their diaper is off.

A little later, we found that the girls were constantly leaking from their diapers. It was soaking their onesies, the two receiving blankets that swaddle them, and sometimes the sheet on which they sleep. We were going through all those blankets and onesies that we thought we wouldn’t need. It turns out that the Huggies Newborn diapers are still a little too big for our girls’ butts. Pampers Newborn Swaddlers are a little smaller and they are what we were using while we were in the hospital. We had a couple of packages of Pampers among our hundreds of diapers, but I went out and bought more anyway. A diaper that doesn’t hold things in just isn’t worth using. Maybe when the girls hit the 6.5 lb mark we’ll try the Huggies again.

I mentioned that we have a bowl that we use to warm the wipes and to remove a bit of the soap on them. The theory (which we really haven’t tested) is that the soap may be a little harsh on their skin. Anyway, we’ve found that a warm wipe keeps the girls from crying their heads off while they’re being cleaned. On the other hand, a warm wipe seems to soothe and relax them just enough that they start to urinate again while they’re being wiped. That’s happened many times.

After we change the diapers, the water in our bowl cools down and we need to refill it with the next diaper change. Yesterday, I emptied the bowl in the kitchen sink and left it there when we went in for our first visit to the pediatrician. When we got home, Agnes’ mom was cooking some vegetables as part of our lunch. I saw some of the leaves in the sink in the bowl we use for wipes (which I thought was labeled clearly enough). I asked if she had used the bowl for washing the dirt from the vegetables. She said yes. Eww. I mean, I’ve had a bit of stool on my hand while I dip the next wipe into that bowl. Luckily, she didn’t stay to eat lunch with us, and we were able to just eat other things. From now on, we keep this bowl with the diaper stuff, even when it’s just drying out.

We posted photos of the remainder of our four day stay at the hospital. These photos cover the period starting from our second day in the hospital until we arrive at home. While there are two pictures in here of Agnes doing some breastfeeding, don’t worry — she doesn’t flash anyone.

We left the hospital and came home yesterday (August 6th) after four days in the hospital. We’re starting to settle in now, but in the meantime, we thought we would post some quick stats from our visit to the hospital.

Effy is Agnes’ sister. She came by for a visit while we were in the hospital and Agnes showed her how to bottle-feed Eleanor.

I know that we said that we thought that the girls were identical, but we’re now pretty sure they’re not. If you see the girls’ pictures, their faces are pretty different from each other and it’s pretty easy to tell them apart. Yesterday, Agnes’ dad said “Eleanor has thick lips; Miranda has thin lips.” Agnes went a step further and described Eleanor as having fuller lips, higher cheekbones, and a longer neck. I also think she may have bigger feet, even though she was the smaller of the two girls. Miranda has a rounder face and an incredible pout that takes over her whole face just before she cries. Her brow furrows, her bottom lip sticks out and she’s silent for a moment. Then the wail comes on. When Eleanor cries, her jaw and lips are a little more slack.

The original guess that they were identical was based a few things that were observed in the ultrasound. The biggest clue was that it looked like there was only a single placenta to which both girls were attached. Even this isn’t a foolproof indicator of identical twins though — it’s possible for two placentas to fuse into each other as they grow, which would look like a single placenta in the ultrasound. Our OB said that the placenta(s) still needed to be examined further, but she thought that it was indeed a fused placenta in our case.

Anyway, just from looking at them, we think they are now fraternal twins. This means they are no more similar to each other than any other two sisters, other than the fact that they happen to be the same age.

We arrived at Labor and Delivery at 10:30 AM for a 12:30 PM scheduled C-section. It felt kind of odd to show up at the nurses station with our duffel bag saying, “Hi. We’re here to have our babies today.” I would imagine most people show up with their hands clutching their abdomens, saying, “The contractions are two minutes apart.”

Everything went very smoothly in terms of getting me ready for the operating room. The only glitch was that just before I was about to walk over to the C-section room, I had the most painful contraction that I had ever experienced, so I was lightheaded, short-of-breath, nauseous, and in pain walking over. Then, when I got onto the table to have my spinal catheter inserted I couldn’t position myself correctly and it took the anesthesiologist three tries to get the needle into the spinal canal. Anyway, by the time the needle was in and the anesthesia was infusing into my spine, I was dizzy and already disoriented.

A word about spinal anesthesia. This was the most bizarre sensation that I have ever experienced. It starts with warmth in the feet, which spreads upwards; then you get tingling up to the mid-chest level, then you realize you can’t move your legs anymore. In my case, I also got tingling in my arms and hands, which was a little scary, because last year, I was involved in an obstetrics case where the epidural went into the high spinal canal, and the woman lost all her brainstem reflexes, which means she stopped breathing and they had to intubate her. A spinal is really only supposed to go to mid-chest and not the arms, so I was frantically moving my arms and hands to make sure that the paralysis didn’t continue upwards. This wasn’t really necessary though because the anesthesiologist kept telling me that it’s not too uncommon for the sensory loss to spread into the arms.

Anyway, by this point, my obstetrician was asking me, “Agnes, can you feel this?” while poking me with the scalpel, and I really felt nothing, which is also bizarre, because you can imagine being sliced open but it’s really strange to not feel anything. Actually, it’s probably a good thing that there was a big sterile drape in front of my face so that my mind couldn’t make myself feel all the horrible things they were doing to my abdomen. The next thing I knew they were pulling the first baby out, and everyone was saying things like, “It’s a beautiful little girl! Wow, she’s big for a twin!” and then, I heard her cry which pretty much made me want to cry. And then it happened all over again a minute later for the second baby.

Bernard went over to the warmers to take pictures of the babies, and, as I later found out, put the umbilical clips on and cut the cords (which is cool that they let him do that). Then, they brought the babies over to me. I had imagined this moment the night before, and I thought I was going to say all sorts of things to the babies, but when they put the babies on my chest, I couldn’t say anything. Bernard took a picture of us, and I’m glad that I at least managed to smile because I was really overwhelmed.