After talking to Sandra, a nurse practioner and mother of 4 year old twins, I wished I had called her earlier. She had a wealth of practical advice for me. When I told her about the hard time my mom was having taking care of the twins by herself, she said that they have to be put on a schedule, and they need to eat and sleep at the same time. She thought we were crazy for feeding them on demand as long as we have.

She put her twins on a schedule since they were one week old. Letting our girls eat and sleep whenever they want means that one of them is always awake at any point in time, and a single caretaker like my mom would never have time to go to the bathroom, let alone eat. Her twins went to a home daycare person who took care of six kids, including her twins! Once our girls’ day is more structured, she said my mom should have no problem. Well, that’s a relief to know.

Yesterday, we put the kids on an every four hour schedule of feeding, with each of us feeding one girl at the same time. Tonight we’re going to try feeding them in the car seats. Later, we’ll see if one person can feed both girls in their car seats at the same time. We’ll let you know how it goes.

[From this point forward, this entry is written by Bernard] This new schedule has been working out great. As Agnes said, on Tuesday her mom was absolutely swamped by the twins tag-teaming her. Yesterday (Wednesday), we tried the new schedule with her. The feedings on this schedule are currently set to 8:30, 12:30, and 4:30, both AM and PM. Agnes’ mom isn’t convinced yet that she can feed both girls at the same time, so for now I’m helping out with the feedings that happen while she’s here.

We pick up the girls at the same time. I change a diaper first. Agnes’ mom prefers to do it after the girl she’s feeding is halfway through her bottle. A feeding, including burping and holding, takes about an hour, give or take 15 minutes. The girls finish at about the same time, and then they go back to their cribs.

It doesn’t always work perfectly. Yesterday, Miranda didn’t want to wait until 4:30 PM for her bottle. Agnes’ mom had to soothe her from 3:30 onward until it was time to eat. Today, the girls were still sleeping at 4:45 PM and we weren’t sure if we should wake them up.

What is nice about this schedule is that it solves a number of problems that the on-demand feeding was causing. We no longer need to worry about if both girls are hungry at the same time — they’re supposed to be and we’re making sure we can feed them at the same time. We don’t wonder if crying means that we need to feed one of them another bottle, and then worry if they’re going to waste most of it. We know they’re eating enough, and that they’re not going to starve while waiting for the next feeding time. Aside from some soothing we need to do between feedings, we know that the day really isn’t that busy except at scheduled times of the day. And for some reason, the girls seem to fuss a lot less between feedings. Maybe the structure really is good for them.

It’s only day two of this new schedule and I’m sure we’re going to hit some bumps in the road. We’re going to have to learn when to adjust the schedule because of their changing needs. We’re going to have to deal with outside distractions that keep us from sticking to our schedule. But so far, it’s really been encouraging.

Last Sunday both Eleanor and Miranda started really smiling. Earlier, they would occasionally have a tug at the corner of their mouths when they’re sleeping or they might smile “due to gas” (what does that mean, anyway?), but now this is while they’re awake and in response to us talking and cooing to them. They’re more apt to smile if conditions are just right — they aren’t hungry, they have a clean diaper, they aren’t falling asleep, etc. We hope these smiles will become more and more common because they just look so happy when they’re smiling.

It’s taken us a little bit to write about this because it’s been hard to get a clear picture of their smiles without a flash. Most of these pictures end up a little blurry. These two are the best of the bunch, but they’re still a little blurry.

For those of you who still can’t tell Eleanor and Miranda apart, this first picture is Eleanor.

This second picture is Miranda.

I go back to work officially on October 6th, but yesterday and today I attended a Pediatric Epilepsy Seminar which is part of the annual meeting of the Child Neurology Society happening this week in Los Angeles. This means I left the house at 6:40 am and didn’t get back until 5:30 pm. Yes, it was my first full day away from the twins.

Actually, it wasn’t that bad. I didn’t cry–although the first thing I did when I sat down and introduced myself to the conference attendees next to me was pull out pictures of Eleanor and Miranda. Part of my calmness in being away from the kids is knowing that they are being cared for by my mom. She’s excellent with the babies. She talks to them all day and is very responsive to their needs. Pretty much the ideal caregiver. My mother quit her job as a preschool teacher to take care of the twins full-time. Although she lives 40 miles away, she commutes in with my father in the morning and leaves with him at around 5:30 pm. (My dad works 2 miles from where we live.)

My mother started coming up to take care of the twins about 4 weeks ago when Bernard had to go back to work. Basically, it’s been the two of us handling the kids during the day. I’ve also been able to take a daily nap while my mom’s been here. As I described in my last blog entry, the twins can keep one person busy 24 hours non-stop, and yesterday, my mom was by herself for the first time. And yes, the girls ganged up on her. By the time, I got home my mom was frazzled and exhausted. She couldn’t remember who ate when and how much. When I walked through the front door, she was feeding Eleanor and rocking Miranda in her car seat with one foot.

She started to express some doubts about her ability to take care of the twins. This has Bernard and me extremely worried, since we haven’t looked into other options such as daycare or a nanny. I decided to call the only mother of twins that I know, my friend Sandra, who used to work at my hospital. I figured she could answer some of my twin specific questions, like, did you have to hire two nannies when you went back to work?

I’ll talk about our conversation in my next blog entry.

During this past week, Miranda’s cry has changed. She used to work her way up to a wail, but recently she’s just been bursting out with a big “WAAAAAAH!” with no warning. It will be completely quiet, and then she just lets it out.

Last night, I was working in the office while listening for any sounds from the girls. Just after midnight, I heard a sudden big wail. I went into the nursery and I found Miranda sound asleep. Eleanor, on the other hand, was moving her head around and kicking in her blankets. Maybe she developed this same type of sudden crying? I picked her up and carried her over to the kitchen so that I could warm up a bottle. As our water boiler was heating up, I started to walk over to the changing pad to unwrap her from her blankets and check her diaper. I then realized something was wrong. Eleanor was out cold. When Eleanor wakes up crying, she pretty much doesn’t stop until you put a bottle in her mouth, so this was really unusual. I realized what had happened. It wasn’t Eleanor at all who had let out that wail — it must have been Miranda. I brought Eleanor back to the nursery and checked on Miranda. She was lying there quiet, but with her eyes open. I left them both in there until Miranda told me a half hour later that she really did want to get up.

As you know, Bernard and I have been splitting up the nights–he takes care of the girls until around 3 to 4 am, then I take over. This way, we can each get some uninterrupted sleep. The only problem is that it’s hard taking care of two babies by yourself, and this morning was especially hard.

I woke up at 3:45 am to the sounds of Eleanor crying. When I picked her up from her crib, I noticed that Miranda was stirring as well, so I knew I would have to work fast. I quickly changed her diaper, warmed up a bottle, and started feeding her. About one ounce into her bottle, Miranda started crying. I picked up Eleanor and went back to the nursery. Luckily, Eleanor burped during our walk to check on Miranda. Now, there are times when you can soothe Miranda and she’ll go back to sleep, but this wasn’t one of those times. She was crying loud and hard, so I put Eleanor in her car seat, and starting warming a bottle for Miranda.

While I was feeding Miranda, I was worried that Eleanor would start crying in the car seat. This happens often when they’re both hungry at the same time, and Eleanor had had only one ounce. But Eleanor was sitting calmly in her car seat looking at me feeding Miranda. Then, all of a sudden, her face turned bright red, and I heard the tell-tale sounds of a bowel movement. I kept calmly feeding Miranda, watching Eleanor turn all shades of red while she was straining. At least she wasn’t crying, I thought. My only worry was that she would stain her outfit, and eventually the car seat cover. Meanwhile, Miranda was sucking down her entire four ounce bottle.

Now, we usually burp Miranda halfway through her bottle, but I was so busy paying attention to Eleanor that Miranda had finished her bottle before I could take it out of her mouth. I quickly lifted Miranda onto my shoulder, burped her, then noticed that she had dribbled onto her outfit a little. Meanwhile, Eleanor had stopped straining, gave a small look of displeasure, but then fell asleep. I was relieved because I thought she would start screaming for me to change her right away. I took the opportunity I had while Eleanor was asleep to grab a new outfit and warm washcloth to clean up Miranda a little. This was my fatal mistake. While I was cleaning Miranda under her neck and moving her this way and that way to put on a new outfit, Miranda suddenly vomited what seemed like her entire four ounce bottle. The milk sprayed all her her outfit, my outfit, the couch, and the rug. I’m surprised it didn’t hit Eleanor who was sleeping in her car seat at my feet.

At this point, I had to prioritize who and what to clean up first–me, Miranda, the couch/floor, and there was still Eleanor who was sleeping in her poopy diaper. Well, I put Miranda on a big towel and wrapped her a little since she was in wet clothes, then I took a shower, cleaned the couch and the rug, and finally gave Miranda a bath. The whole time Miranda was just calmly looking around–she rarely gets upset when she spits up–she even enjoyed her second bath of the night.

By this time it was 6 am. Miranda started to look a little drowsy, although I knew she would be hungry again soon since she spit up all that milk. But I had to finally take care of Eleanor. So I put Miranda into her car seat, and woke up Eleanor to change her diaper. Luckily she didn’t get her outfit or the car seat cover. But I did notice that her outfit was the same one from the day before which means that Bernard didn’t give her a bath (we usually each give one of the girls a bath), and since she had just had a large messy bowel movement, I gave Eleanor a bath too.

After Eleanor’s bath, both of the girls were wide awake and hungry again. Remember, Eleanor had only had one ounce at 3:45 am and Miranda spit up her bottle. I hate it when they’re both hungry at the same time because you can’t feed them both simultaneously, so someone is always screaming. (Our friend, Sophia, recommends putting them in their car seats next to each other, crouching down, and giving them both a bottle, but I would prefer them to have better head control before we do that.) Well, I did have another option, and that’s the twin breastfeeding option. If you recall, I did buy a foam pillow specially made for breastfeeding twins, so I tried to get them both onto it. The problem though, is that they’re now both too big to fit on the pillow. Eleanor, especially, since she’s now almost 23 inches long, will scream because half her body is hanging off the pillow. Eventually, I did manage to get them to both latch on, although awkwardly, and they ate for about 15 minutes before my arms and back were too tired. Luckily, they were both somewhat satisfied. Miranda fell asleep and Eleanor was quiet and looking around.

Well, I could go on and on, because this is actually a pretty typical day for the twins. You can see that it would be impossible to be a single mother of twins because it is nonstop twenty-four hours a day with them. By nine a.m. I was completely exhausted and breastfeeding Eleanor when Miranda started crying. If it were earlier, and I didn’t want to wake up Bernard, I would have taken Eleanor off the breast, put her down, checked on Miranda, and decided either to finish feeding Eleanor or start with Miranda. But by this point I was so tired that I just kept breastfeeding Eleanor until Miranda woke up Bernard with her crying. He came out of the bedroom looking bleary-eyed and holding Miranda. “Good morning,” I said cheerfully.

Almost a month ago, we wrote about our sleeping arrangements. The girls were sleeping in the same room as us and had just outgrown the bassinet of the Pack n Play. They were also too big for the cradle that Agnes’ cousin lent us, and we were asking when people moved their kids out of their room. We’re quite grateful for the wide range of responses that we received.

Since that time, we decided that the crib would be too big for our room, but that we could put both the Pack n Play and the cradle in our room at the same time. We had to separate the girls, who had been sleeping together up until that point, but that was okay. Keeping them separate makes them less likely to wake each other up. We soon found we had another problem though. They make a lot of noise in their sleep. A lot. Grunting, snuffling and short cries. These sounds may precede when they actually need us by up to an hour, and they were keeping us (mainly Agnes) up all night. Agnes had taken to sleeping in a separate room.

Last weekend we finally got around to assembling our cribs in the nursery. Jeremy gave me an estimate of about two hours to assemble one and he wasn’t far off. We had two to assemble. The first took about two and a half hours, the second about an hour and a half. I’m glad to say that the instructions were very clear, and the parts were made very precisely. There was no hair-pulling frustration like there can be with Ikea furniture when the pre-drilled holes don’t quite line up. We only encountered two problems: the instructions for attaching the runner for the drawer showed four wood screws holding it in place. Only three are actually supposed to be used, and they fit in two different positions. On the first crib, I chose the wrong position and the drawer slightly blocked the drop gate from sliding down all the way. That was pretty easy to fix. The other problem was putting the mattress springs in place. It can be pretty difficult without an extra set of hands. On the second crib, I asked Agnes to help hold things in place for just a few moments while I put in the screws.

We moved Eleanor to her crib right away. On her crib we put a waterproof pad, a fitted sheet, the Ultimate Crib Sheet, and finally some burp cloths before putting her in. So far, she hasn’t soaked anything through the Ultimate Crib Sheet. Eleanor gets the Symphony in Motion mobile. She can be quite fascinated with it, tracking each animal as it circles around, and then turning her head to catch the next one as it comes into view. It plays a selection of Bach, Mozart and Beethoveen. The mobile sounds nice enough from inside the nursery, but from the home office next to the nursery, it sounds like there’s an ice cream truck constantly circling the house.

We built Miranda’s crib as well. We know that she also likes the Symphony in Motion mobile, but we don’t have two of them. We’re not quite sure how that would work — they would both be playing at the same time and the sound would probably mix in unpleasant ways. We need to give that one more thought. Instead, Miranda has a mirror that she looks at. I just hope we’re not raising a budding narcissist. Anyway, Miranda doesn’t spend nearly as much time in her crib as Eleanor does. We’re still finding that when Miranda lies down soon after eating, she’ll spit up. She’s been sleeping in her carseat where she can sit up more. It was just last night we started trying to get her to sleep in her crib more.

It wasn’t on the list of features that we were looking for in a crib, but one nice thing about them is that they have wheels. Our nursery is pretty small, and the only room arrangement we could come up with has Miranda’s crib blocking the closet that stores things like our supply of diapers and wipes. Fortunately, her crib rolls out of the way very easily.

Some estimates put a private university like MIT or Harvard at $95,000 per year for tuition and housing by the time our girls reach college age. That’s a lot of money, so we’re happy to say that we’ve started saving for college for Eleanor and Miranda. Overall, saving for college ranks below several other priorities for our budget, but on the other hand, the sooner we start saving, the more time we give for their savings to compound. Our financial priorities for this year have been:

1. Ensure that our monthly expenses don’t regularly exceed our income.
2. Rebuild our six-month emergency fund which has been partially depleted by our minivan purchase. The target amount for this fund has also grown because we spend more money per month now that we have the girls.
3. Ensure that our retirement investments are fully funded. If we don’t save enough for college, the girls can always take out loans of their own. We can’t do the same for our retirement investments.
4. Start college savings plans for Eleanor and Miranda and set up a recurring investment in them.

We considered four different college savings options: a 529 Plan, an UGMA/UTMA account, an Education Savings Account (ESA), and a 529 prepaid tuition plan. We eliminated the last option because our girls may not attend an in-state college (neither of us did), and the plans seem restrictive in terms of what we could invest in. The ESAs have a $2,000 annual contribution limit, which we may not reach, but the contributions are also limited when your income reaches a certain level. The UGMA/UTMA accounts are essentially a way of directly transferring money into your kids’ names. They’re okay, but you can’t change the beneficiary of the account. They may also have a strong effect on our girls’ eligibility for financial aid since the money is considered theirs. We finally decided on a 529 Plan. These plans are funded by after-tax money and the earnings are exempt from federal taxes and sometimes state taxes. The beneficiary can be changed to someone else if either Eleanor or Miranda decide not to go to college. Finally, the money doesn’t really affect Eleanor or Miranda’s financial aid eligibility since the money stays in our name. On a side note, the federal tax exemption is currently set to expire in 2010, but we’re hoping that this exemption will be renewed long enough for Eleanor and Miranda to benefit.

The next step was to decide which 529 Plan to pick. We were really choosing between the Golden State SholarShare program offered by the State of California and the Vanguard 529 College Savings Plan offered by the State of Nevada. The California plan offers investments by TIAA-CREF, which are very decent. The withdrawals will be tax-exempt from both federal and state taxes since we live in California. It offers some decent age-based investments which change their asset allocations automatically as the girls get older. The management fees are slightly on the high side at 0.80%, considering that the investments are mostly in index funds.

The Vanguard plan offers Vanguard funds, which we like enough that we use them in our Roth IRAs. The fact that this plan can be managed along with our IRAs (combined statements, a single website, etc.) is a bonus. Like the California plan, it also offers age-based investments, which are mostly invested in a combination of index funds. The earnings are exempt from federal taxes, but the girls will probably need to pay California state taxes. At 0.60%, the Vanguard plan management fees are lower than the California plan’s. It’s not easy to say if the lower management fees will be a bigger benefit than having the earnings be free of California state taxes. We ran some numbers based on some assumptions about the girls’ incomes when they are in college and the results are pretty close, with a slight advantage probably going to the California plan. In the end though, we chose the Vanguard plan because the comparison was so close and we already have other Vanguard investments. The girls’ 529 Plan accounts are now open, and we have a regular monthly contribution going into them.

One extra bonus of the Vanguard plan is that it can be linked with a UPromise account. A UPromise account gives you money back for various purchases that can be put into your college savings plans. Some people are uncomfortable in giving UPromise enough information to track their purchases, but on the other hand it’s free money. We signed up for it. Friends and family are also welcome to sign up for a UPromise account with Eleanor and Miranda as beneficiaries.

For people who are looking for more information on these different options, we recommend Saving for College, Morningstar’s College Savings Section (free registration required) and Vanguard’s College Savings Section. The Vanguard material was probably the clearest of the three, but the first two are good neutral sources of information.

One last thing to note about 529 Plans is that anyone can help us out with putting money into them. If you’re feeling generous, please contact us about helping us save for college!

Two days ago, I went running for the first time since March 5th. That date sticks in my mind because it was the day before Bernard ran the LA Marathon. I was about 17 weeks pregnant at the time, and still able to run, but definitely feeling discomfort from having my uterus bounce up and down on my bladder. Since then, I’ve done very little exercise, so it was no surprise that my run two days ago was short, involved a little shortness-of-breath, and i’m still sore today from it. Nevertheless, I was still pleased that I could get outside to do a slow jog.

As I’ve heard from other people who have undergone a C-section, being able to run six weeks post-partum isn’t too bad. My abs are another story though. Last week, I couldn’t do a single leg lift–now, I can do two of them. I guess it will take a while for those muscles to regenerate after having been cut in half. Overall, my recovery has been better than others’, but my theory is that the people who had worse recoveries underwent labor prior to their C-section. I had a scheduled C-section, so I never experienced labor. Despite my relatively smooth recovery though, I think I still would have preferred a vaginal delivery.

Right after my C-section, I was feeling very little pain. They inject a long-acting morphine derivative into the spinal canal which lasts about 24 hours. I remember thinking, “Wow, this is great! I’m going to recommend C-section to everyone.” The morning after my C-section, my obstetrician told me to start taking pain medication by mouth since the spinal anesthesia was going to wear off. Well, I didn’t listen to her, and I paid for it later that afternoon when the pain was so excruciating that I couldn’t move at all. Now, not being able to move isn’t a huge deal after a C-section because you have a Foley catheter in your bladder so you don’t need to get up to pee, and your intestines have stopped moving after your surgery so you’re not going to have a bowel movement anytime soon. Also, the nurses come in and clean you up every eight hours or so. However, if you’re trying to breastfeed twins, you do need to do a bunch of shifting around, so that was really hard. Bernard became an expert at latching the twins onto me since I could barely move.

Two days after the C-section, they take the Foley catheter out–it’s not too bad, just a quick burning sensation as the tube is pulled out, and now you have to get up to go to the bathroom. Also, they start asking you constantly if you’ve passed gas yet. Basically, you can’t eat any solids until this happens. The important thing is to keep taking pain medication around the clock because if you wait too long, the pain is so severe that it’s hard to control it. For me, this involved 800mg of ibuprofen and one Vicodin every six hours.

After we got home, I wished we owned a hospital bed, because without those sidebars, I couldn’t get out of bed. Again, abdominal muscles are really important! Basically, I had to take pain medication around the clock for almost two weeks. Then, it became ibuprofen once in a while; then, I was completely off pain medication at about three weeks.

One thing I didn’t know about was the incredible amount of swelling that you get after the delivery. I had swelling in my ankles that was much worse than when I was pregnant. This took about one week to go away.

In terms of the actual incision, my obstetrician used absorbable sutures instead of staples, so those went away at about three weeks. The incision site was covered with little pieces of tape called Steri-strips which came off at two weeks. Now I just have a four-inch line on my lower abdomen. The next thing I have to worry about are keloids, which are basically thickened, overgrown scar tissue. My obstetrician told me to put on Neosporin Scar Solutions, which are silicone treated bandages to help prevent keloids. When I put them on at three weeks though, I developed these red welts along my incision. I stopped using the bandages and the welts have pretty much gone away. My obstetrician thought it was probably a reaction to when the sutures absorbed just underneath the skin, so i’m going to try these bandages again.

Six weeks later, I’m physically back to where I was before I became pregnant. Well, except for the fact that I’m constantly sleep-deprived, and I have a mildly protruding, stretch mark covered belly. But I wear that like a twin mom badge of honor. Also, I have huge biceps from constantly carrying around two eight-pound weights, i.e. the twins. I lost thirty pounds in the first two weeks, and now most of the rest of the forty total pounds that I gained. I think part of the weight loss was due to breastfeeding, but also, the fact that I don’t have time to eat! As Bernard mentioned in a previous blog entry, we barely fit in two meals a day, and those are shoveled into our mouths as fast as possible.

When the girls were born, they seemed so small. We went to a local breastfeeding group and all of the other babies were giants by comparison. We’re happy to say that our girls have been very busy growing. We have no idea how much they weigh. We’ll find that out when they have their next doctor’s appointment at the end of the month. But you can see it in their cheeks and their growing double chins.

There have been all sorts of other signs that they’ve been growing. We’ve had to retire their smallest onesies. We can still squeeze them in, but it kind of looks like it pulls at both the shoulders and down near the snaps. It’s a little sad to think that they’ll never be in those outfits again.

We’ve also upgraded the girls from size N (for newborn) diapers to size 1. The newborn diapers just didn’t quite fit around their round little bellies any more. It’s a good thing too. Size 1 diapers are less than half the price per diaper than the size Ns.

And finally, we’ve gone up a bottle nipple size. Our girls have been eating so much that a 4.5 ounce bottle was taking a better part of 45 minutes with the size 1 Avent nipple. We switched this week to a size 2 nipple and for the most part they’ve been much happier — they can down a bottle in about 10 minutes, with some minimal dribbling. I say “for the most part” because Miranda didn’t like it when we first switched all our size 1 nipples for size 2. She had woken up for one of her feedings the evening we made the switch. I put the bottle in her mouth and she sucked at it a couple of times before giving a bit of a squeal of frustration. I figured she wasn’t really hungry, so I held her for a bit. She kicked and cried and fussed. I checked her diaper — it was clean. I gave her the bottle again and she did the same thing as before: sucked for a bit and then spit it out with another squeal. I tried holding her, jiggling her, giving her a pacifier and she just got more and more upset. Finally, I realized that she had not dribbled one bit with her attempts at this new size 2 nipple. I turned the bottle over and squeezed the nipple between my thumb and forefinger and nothing came out. Not a drop. We had a defective nipple that had no hole. I guess she was hungry, and frustrated that I was essentially giving her a non-functioning bottle. Oops. I felt so bad. We threw away that nipple and got a new one and she was much happier.

Back on July 4th weekend, we attended Jon and Frances’ wedding. Jeremy and Susan were there with Sarah and their six-week old Maya. At the time, we wrote about how impressed we were that they made the trip, but now that Eleanor and Miranda have reached six weeks, we’re really impressed. We probably would have said we needed to skip the wedding rather than put the kids in the car for a 6-7 hour drive followed by several anxious hours at the wedding itself. This is what the Yungs looked like at the time. Don’t they (with the exception of Maya) look quite at ease? Amazing stuff.