Breastfeeding Twins!

I'm so excited today! Today marks six months of exclusively breastfeeding my twin boys! It has been an amazing journey so far and I plan to breastfeed them until they self wean. Accomplishing this milestone is especially satisfying since my first breastfeeding relationship with my eldest was a train wreck.  I want to share my story to encourage new moms because 85% of American moms don't meet this milestone.  This saddens me greatly. Only a very small percentage of these moms physically could not breastfeed! The rest fell in to booby traps like I did or didn't have the support or determination to succeed.

When my daughter was a week old, we gave her a bottle of formula because she seemed hungry. This started a downward spiral of bottle preference, nursing strikes, low supply and ended in her weaning at 8 months. I was heartbroken. I had no idea that this could happen! Everyone told me a bottle here and there wouldn't be a big deal, but they were wrong.

My next child was nursed on demand around the clock. I never gave him a bottle or a pacifier. I didn't start solids with him until he was around 8 months old. He was the healthiest and happiest little guy you could imagine!  I learned so much about what it takes to succeed at breastfeeding with him and I'm forever grateful for the lessons he taught me. I weaned him at 20 months old because I was 4 months pregnant and could not gain any weight.

Weaning my toddler turned out to be a good decision since we found out shortly afterwards that we were expecting identical twin boys.  I needed to devote all my resources towards growing them as big as possible and as fast as possible.

I had my twins at 34 weeks due to many factors including IUGR and TTTS.  They weighed 4 lb 15oz and 6 lb 5 oz. They went to the NICU and I went to my room to recover from the cesarean.  I wanted to breastfeed as soon as possible but was not able to see and hold them until that night. I was adamant that they not be given any formula. They had IVs so that held them over until I could nurse or pump.

The next day I was given my pump and I started right away. I was excited to get a good sized quantity of colostrum.  Later that day I was able to put them to the breast and see if they could latch. Preemies born before 35 weeks have problems with their suck/swallow coordination and are unable to concentrate on multiple stimuli. We were not sure if they could physically nurse. The first time we tried they were both too sleepy and just wanted to cuddly skin to skin. We could only keep them out of their boxes for 30 minutes at a time to allow them to sleep as much as they could and stay warm. Preemies can easily tire themselves out and expend more calories than they take in just by trying to nurse for too long.

So began our new routine of 30 minutes of nursing/cuddling per twin and then back to the room to pump. Every 3 hours my husband and I returned to the NICU to nurse the boys.  The second time we tried nursing, the bigger twin latched on and nursed for 30 minutes! The smaller twin took more time but he began nursing shortly afterwards. My milk came in on day three and we brought 3-4 oz of pumped milk with us every time we saw the boys. 

The doctors recommended topping off each nursing session with pumped milk.  Little warning bells went off in my head at this idea! I didn't want to use bottles after what happened with my daughter. The NICU nurse could see my alarm and explained the recommendation to us. The boys were expending so much energy nursing and trying to stay warm that they needed some milk they wouldn't have to work for in order to gain weight. This made sense to me so we started topping them off with tiny amounts (5-10 ml) of pumped milk.  My husband was awesome at bottle feeding while I was utterly incompetent so I would go back to our room and pump while he finished up with the boys.

Each day brought a new challenge. The boys got jaundiced and needed to be under the billi lights for two days, they were taken out of the warmer to see if they would maintain their temperatures (they didn't) and most of all they needed to gain weight.

I nursed and pumped every 3 hours day and night for a week and the boys passed every test. They gained weight, they maintained their temperatures overnight, and they passed the carseat test. On the eighth day we took them home! I brought a couple of gallons of pumped milk home with me as well.

At home we continued to nurse and supplement with pumped milk. I planned to nurse on demand but they were happy to stay on the same 3 hr schedule.  It got exhausting to wake up at 2 in the morning to nurse and pump but we did it for an additional 5 weeks until their due date. They seemed like they were nursing as strong as a normal newborn so we phased out the supplemental bottles over the next two weeks (42 weeks GA) and they breastfed exclusively at the breast from that point onward.

They began to nurse on cue more often as well and I nursed them tandem during the day and individually at night. They sleep on either side of me and I nurse whoever wakes.

With my first two kids nursing in public made me very self conscience, but I feel like a proper lactivist now. I can and do nurse one of the twins any time, any where I go. I've met no negative reactions either. I honestly don't think most people notice that the baby is nursing!

I hope my story can encourage you to have faith in your breastfeeding abilities.  If I can feed two preemie babies, surely you can meet your breastfeeding goals!  I want you to face booby traps armed with confidence and knowledge.  Nurse your baby as much as you can at home and when you are out. Weigh bottle feeding carefully and know the risk of bottle preference. Please don't let anyone tell you to supplement without good evidence that you need it.  Get help from a lactation consultant. Join La Leche League.  Determine that breastfeeding is your #1 priority and I believe you will succeed!

Jesse and Max's birth story (Part 6)

This is just the birth story of my twins.  It can be read alone or you can use the links below for the full story in 6 parts.

Jesse and Max's story really begins at the start of my motherhood journey.  I became a mother with the birth of my only daughter Lily in 2008.  It was during this birth my eyes were opened to the abuses within the medical community.  Her birth sparked a passion in me that is still burning 5 years later.  My son Ehren was born with a midwife at home.

When Ehren was around 17 months old my husband and I decided that two children would be enough for us and that possibly have two more 5+ years down the road if our finances supported it.  Then I found out I was pregnant again.  I was so busy and tired that I lost weight and my belly grew like it was in fast forward!  My midwife asked me to consider an ultrasound.

Twin Diagnosis

After finding out we were having identical twins at 18 weeks we were relieved that it wasn't anything more serious.  I knew that with identical twins there was a risk of twin to twin transfusion syndrome. I thought that it was a black and white issue and that if you didn't have it your twins would have similar risks to singletons.  I figured we would be fine and be able to have a vaginal birth at home and if I had to, I would travel to Dallas to find a midwife who would attend me there.

We began seeing a Maternal Fetal Medicine group shortly after the diagnosis for ultrasound every 2 weeks. One baby was always measuring large and the other measured smaller.  I usually had high fluid levels as well.  But up until 24 weeks everything appeared to progress okay. We were constantly measuring the blood flow to the smaller twin and noting some abnormality in the umbilical  blood flow.  During the rest phases between heartbeats he would have no pressure and even a bit of back flow.  In a singleton baby this would be a cause for great concern but with identical twins it is common.  This is when I began to realize that this pregnancy was not a variation of normal.  There were serious issues going on here. 

High Risk Scare

Around 24 weeks we were diagnosed with stage 1 TTTS and sent to Houston to see Dr. Kenneth Moise who had handled over 400 TTTS cases.  After consulting with him he believed it wasn't classical TTTS but there was definitely a risk at any time it could turn into that and progress to dangerous levels within a matter of days.  For now, the smaller twin had adequate fluid and was measuring average size. He wanted to keep a close eye on me and told us that we should prepare for a cesarean early or even laser ablation surgery to sever the connecting vessels in the placenta.

We went in for weekly appointments with Dr. Moise until 27 weeks when it was decided that we were past the window for surgery and that we would squeak by if the boys continued to hold steady with their growth. We stayed in town for all future appointments. At each scan the boys continued to look good. Sometimes it would seem that we needed to worry about Max's heart enlargement and other weeks we would worry about Jesse's back flow through his umbilical artery. We would also be concerned that my high fluid levels would lead to preterm labor, but nothing got bad enough to merit intervention.

Intervention Time

At 30 weeks, Jesse started to show signs of growth restriction. He started falling in percentiles and by 33 weeks his abdominal circumference was equal to that of a 16 week baby. We knew that delivery at 34 weeks would give Jesse the best possible shot because at that age with growth restriction, babies do better out than in. It was determined that it would be via cesarean as the risk of acute TTTS (sudden blood flow to recipient twin due to stress of labor) was low, but would be potentially catastrophic to Max. I was nervous to be back in a hospital again and nervous for the babies.

34 weeks. My last belly shot.

The Big Day!

January 8th at 5:30am we were to report to the hospital to have vaginal bypass surgery.  We woke up bright and early and grabbed McDonalds on the way. Lucky me got to smell it but was not allowed to eat!  Brandon sure enjoyed his large coffee. True to tradition he wore his Superman tee for the birth of our final babies.

After checking in we went to preop to change clothes and get an IV. It felt cold going in and then we waited for a while the room was prepped for surgery. My doctor came by to chat with me and reassure me and find out if I had any questions. I gave her copies of my birth plan for all the nurses. Several were curious about what I was going to do with my placenta. They were surprisingly respectful when I told them I was going to encapsulate it.

Finally the room was ready and I walked in there and sat on the edge of the bed. My doctor introduced me to her husband who was assisting and the rest of the team. The anesthesiologist must have been in training because an older guy was watching and telling her what to do. She told me to curl into myself and I would feel a sting like an ant bite. Not exactly much room to curl when you have a belly full of twins. My doctor stood in front of me and held me and coached me through it. Yes I felt the "ant bite" sting and then the spinal needle! Not numb at all guys! It felt exactly like what it was... A big giant needle in my spine. I must have tensed up quite a bit and the anesthesiologist said she had to do it again because I was too tense. Yeah... It's my fault you aren't good at the whole numbing step. She proceeded to "numb" me again and once again it didn't numb at all before she was jamming the needle in my back again. I kept telling them I felt it and they must not have believed me and asked me which side. I told them the right side and they acknowledged that I was correct and must be feeling it.  Thankfully she got it this time around and I quickly became numb.

From there they quickly laid me down and Brandon came back in. They put comfy warm blankets over my chest and a little cap over my hair. The drapes were not on the side where Brandon was so he got to see everything!  Everyone seemed to be in a good mood and the husband/wife doctor team talked through what was going on as I had requested. Not long after little Jesse was lifted out and he screamed and cried loudly. I got to see him and then he was taken away to be checked out by the pediatrician. Then Max was lifted out one minute later and proceeded to pee all over Dr. David Damian. Everyone laughed because when both babies were screaming and crying they sounded like cats fighting! They all assured us that was a good thing. The pediatricians checked them out and they were blanketed and hatted and given to Brandon to hold. He showed me them one at a time and posed for pictures. I forgave the anesthesiologist for poking me twice because she took all the awesome pictures of the birth. 

Jesse

Max

Dad and the babies

Me and Max

As soon as the cutting started I started feeling like I was being stabbed in the shoulder. I told the anesthesiologist and she said it was called referred pain and could only give me morphine which she did giving me the maximum dose. It turned into a dull ache but I still felt it for hours afterwards. I had no idea that could happen. It was very strange. 

Brandon then went with the boys to the NICU and I was sewed back up. They were impressed with the size of my uterus and said my insides looked beautiful which I found charming and a little gross.  Once I was all sewed back up Brandon came back. One nurse made sure my placenta got bagged and given to Brandon to put in the cooler to take home.  I only got to see a glimpse of it but was told that it was large and looked good.

We then were wheeled into recovery. We asked about the boys and were told they were well and given their stats. Max was 6 lb 5 oz, 19.25 in long and Jesse was 4 lb 15 oz, 18.5 in long. 

Jesse in the NICU.  Note how tiny his body is in comparison to his head.

Max in the NICU.  See how much bigger his body is compared to Jesse?

Brandon went with the boys while I was stitched up and watched as the boys were set up in the NICU. They were breathing fine but were given tubes in their mouths to help evaporate the fluid from their lungs, temperature monitors, heart rate monitors, blood pressure cuffs, and oxygen saturation monitors. He briefly visited with some family and friends that had come, grabbed a coffee and came back to me.

After we spent some time in recovery I was wheeled to the NICU to see the boys on my way back to the room. I couldn't see them very well and don't remember very much about it.  We were then taken to the largest and fanciest room (perks of twin births). I was instructed to relax and get some rest.

That's pretty much what happened!  It wasn't my dream home waterbirth but I was treated with dignity and respect.  My boys were given the care they needed and they did well.  Could we have had a vaginal birth?  In all likelyhood yes.  Could I have had the support to accomplish this and was I comfortable with the risks?  No.  I think I made the right decisions for me and the babies given our resources and I'm satisfied with how it all turned out.

Max was getting a whole lot more nutrients!

Umbilical cords.  Note the difference in thickness!

2 weeks old.  See the difference IUGR can make!

4 Months old - Jesse is catching up!

Links to the detailed story:

Ultrasound reveals all (Part 1)
High risk here we come (Part 2)
Houston Perinatal Consultants (Part 3)
Texas Fetal Center (Part 4)
The Final Stretch (Part 5)
Jesse and Max's Birth Story (Part 6)

The Final Stretch (Part5)

At 27 weeks we stopped driving to Houston for ultrasounds and started staying in town. We would see one of four doctors each week for our scans. We were also seeing an OB once a week. Because of the delay in sending her the results of the ultrasounds she would often ask me how things went and I would explain it as best I could. The delay was caused because the four doctors in the group would meet each week to discuss each patients results. I liked to observe each doctors methods at the ultrasounds and ask them the same questions to see if they would give the same answer.

One thing Dr. Moise told me in Houston was that he didn't expect I would make it full term and to prepare for a cesarean.  After two vaginal births I was devastated. I researched and asked and consulted but always came up with the same issue.  There was a risk in both kinds of birth, but the risks were different. What I could not justify in pushing for a vaginal birth was the relatively low risk of acute TTTS happening while baby A was born and B was in the womb. It was a small risk percentage, but it could be fatal to baby B or cause neurological damage.  With a cesarean there was more control because baby A and B could be born and cords clamped immediately to stop the blood sharing between them. Every doctor I saw (all 7 MFMs) were unanimous that a cesarean section would be best  as well.  Try finding a doctor in town who will go against the recommendations of 7 MFMs!

I made peace with the inevitability of a surgical birth but wanted to carry them as long as I could. I was huge because of too much amniotic fluid (polyhydramnios) but at each ultrasound they measured my cervical length via ultrasound and it was great. No signs of preterm labor. The doctors said it was good that my last baby had been large and "taught" my body to handle a larger than normal uterus.

Two times after my ultrasounds and once after an OB appointment I was sent to the hospital for a nonstress test. A nonstress test measures the babies movements for one hour to ensure their heart rates go up in response to their movements and basically measures their level of health. Every time the boys did well and I was released soon after. One nurse thought I should get a vaginal exam and when I told her I didn't need one she called my doctor. My doc told her the exact same thing. I knew they tell you nothing and might send you into preterm labor and introduce infection and I would have refused all the same but it was a bit annoying to have her try to go over my head.

As the weeks went by the babies continued to grow and look fine although my fluid levels continued to creep close to the levels at which it would be enough to drain. Thankfully we never needed that.

At 30 weeks we began to notice that Jesse was slowing down in his growth while Max continued to top the charts in size for his age. The blood flow through Jesse's umbilical artery was also not looking very good. Normally you have a bit of blood flowing even between heartbeats but Jesse had no blood flow between beats and even some back flow sometimes due to force of the pull of Max's heart. 

Even this compromised blood flow situation had been working enough to allow Jesse to grow up until now but his body started showing signs of IUGR. IUGR is a big deal because if the placenta is not functioning well enough to provide adequate nutrition, the body will use up its fat stores. The first thing to be cannibalized is the fat around the organs (visceral fat) so abdominal circumference is the first indication of IUGR.  The last fat to be taken is in the brain and from there you have neurological impairment and stillbirth. I watched Jesse's abdominal size shrink dramatically from one week to the next and my heart sank. I knew we would have to have the babies early to keep poor little Jesse from starving to death. 

I had read a study that twins delivered at 37 weeks do better and actually have higher birth weights than twins who are born later and couldn't understand why that would be possible until I understood more about IUGR and how important its effects are. 

So it was decided that at 34 weeks we would have our twins via cesarean. The cesarean was to give Max the best chance (non presenting twin B) and 34 weeks was to give Jesse the best chance.  I felt like we had been walking a tightrope between the two boys needs and now I was relieved that it was almost over. 

I had done the best I could to keep them inside and eaten as much as I could to help them grow and now it was time to finally meet the little babies who showed me the scary world of high risk pregnancy.

22 weeks

24 weeks

26 weeks

28 weeks

30 weeks

33 weeks

34 weeks

Links to the detailed story:

Ultrasound reveals all (Part 1)
High risk here we come (Part 2)
Houston Perinatal Consultants (Part 3)
Texas Fetal Center (Part 4)
The Final Stretch (Part 5)
Jesse and Max's Birth Story (Part 6)

Texas Fetal Center (Part4)

After hearing we had stage 1 TTTS and being referred to a new MFM in Houston we were scared and nervous but still hopeful. We were already 24 weeks and the babies were viable at this stage and we had hundreds of prayers being sent up for our boys.

We left our big kids in the care of Brandon's aunt Angie and off to Houston we went. Everybody at the office in Houston was very nice and we felt a little less apprehensive. The specialists in Houston looked at the same things we had looked for previously and then we were sat down with Dr. Moise who explained what was going on and his prognosis. 

He did not think the babies had TTTS after all. The smaller twin had lower fluid but his size and fluid were adequate for an average size baby.  The larger twin had macrosomia (big baby) and some enlargement of the heart due to pumping extra blood. His fluid levels were also high. The boys shared some deep connections in the blood vessels running through their shared placenta. Dr. Moise explained that if we could get to 34 weeks the survival rate and chance of no neurological impairment were very good. If we continued to hold steady we could continue without further intervention, but if TTTS progressed quickly enough by 26 weeks we would consider laser ablation surgery to separate the vessels connecting the boys. To complicate things, I had an anterior placenta (located in the front) so they would have a much more complicated surgery to access it. 

We were told to travel to Houston for weekly scans and continue to see HPC on Fridays in College Station until 26 weeks.

The next two weeks were a flurry of dr appointments and scans and driving just waiting for the other shoe to drop.  It was on our second trip to Houston that i told Brandon we needed to settle on their names.  I felt like they needed names so I could bond with them and talk to them. Calling them twin A and B was so impersonal so we picked names for the boys. The smaller twin was Jesse Alexander and larger twin was Max Elliot. During this second trip to Houston we also got 3D ultrasound pictures so we got to see their little faces and an echocardiogram on Max's heart. They looked ok and even a bit better than before. I had begun to eat as much as possible and increase my protein intake and focus on resting as well. 

Jesse

Max

Jesse

Max

After our third visit to Houston at 27 weeks it seemed we survived the most critical phase and the laser ablation surgery was off the table. We agreed to be closely monitored in College Station by the HPC group instead of driving to Houston.

Links to the detailed story:

Ultrasound reveals all (Part 1)
High risk here we come (Part 2)
Houston Perinatal Consultants (Part 3)
Texas Fetal Center (Part 4)
The Final Stretch (Part 5)
Jesse and Max's Birth Story (Part 6)

Meeting Houston Perinatal Consultants (Part3)

Every Friday a member of Houston Perinatal Consultants would come over to College Station to see clients in this area and they rotate each week. Thankfully this was perfect for us since getting a sitter for all day would be difficult.

The first appointment was with Dr. Reiter. Brandon couldn't come so I went by myself. He was very businesslike and had his technician start the scan right away. They determined that the boys were indeed identical and needed intensive monitoring because TTTS can progress quickly and suddenly. The cutoff date for laser ablation to separate the vessels that connect the boys can only be done before 26 weeks. After 26 weeks, the babies are instead delivered. The most important reason to get the more advanced scans was to evaluate blood flow with a Doppler. Each boy had blood flow measured in the umbilical cord, a large artery in the head, the liver, and placenta. The heart is studied closely and each boy measured to ascertain growth. The kidneys and bladder are observed as well. The amounts of fluid are also measured because the first sign of TTTS is fluid discrepancy and disappearing bladder volume in the donor twin. Each scan took between one and two hours because so many facets were being monitored. Dr. Reiter was optimistic and said the boys were looking well and we would check again in two weeks.

Two weeks later (20 weeks) both boys showed good progress but the size discrepancy was increasing. We scheduled another scan for two weeks following but the office called and cancelled so it was three weeks before I was in for another ultrasound. Meanwhile I began to see an OB every two weeks.

When we made it to the scan at 23 weeks we were quite alarmed to hear that the boys had TTTS. The big twin had some enlargement around his heart, high amniotic fluid levels and the smaller twin was showing some abnormal circulation in his umbilical artery. We were immediately referred to the maternal/fetal medicine specialist (MFM) in Houston, Dr. Kenneth Moise. Our appointment was scheduled the next business day which was Monday. We were sent an informative video about TTTS and had a stressful weekend. I think it's impossible to watch that video and not cry when the mortality rates are laid out there. I was also a bit confused that we were diagnosed as having TTTS when we did not fit the criteria of low fluid on the donor twin.

Things were not looking good.  We asked for prayers from everyone we knew.

Links to the detailed story:

Ultrasound reveals all (Part 1)
High risk here we come (Part 2)
Houston Perinatal Consultants (Part 3)
Texas Fetal Center (Part 4)
The Final Stretch (Part 5)
Jesse and Max's Birth Story (Part 6)

High risk here we come! (Part2)

My third pregnancy was turning out to be a surprise in more than one way. After finding out we were having twins we scheduled an appointment with the most advanced ultrasound machine in town and a tech with experience in twins.

We took Lily with us because she begged us to go while Ehren went ahead on to preschool. Brandon and I had been throwing around the idea of finding out the sexes. He was fine not finding out when there was only one baby but felt strongly that with twins he wanted to be prepared. I gave in and decided twins would be enough adventure and it would make naming the kids easier if we found out what they were.

At the time we were hoping for g/g or b/g combo because I really wanted another sweet little girl and felt that Lily should have a sister.

When the technician looked at the babies she was checking for chorinicity. She also was looking at anatomy. She spent a lot of time on the placenta and the membrane. She told us that the babies were sharing a placenta and outer sac and asked if we wanted to know the sex and we said yes. She waved the wand around one baby and immediately we knew we were having boys. Both babies were approximately the same size at 17 weeks but they were already different just a week later. I asked her if the difference was a concern for .... I didn't even have to say TTTS because she knew what I was asking and told us that yes, it was a concern. My heart sank. Here I was pregnant with boy babies that were going to be high risk and may not even survive.

I was strangely mad at the babies for messing up all my home waterbirth plans. Then I would feel bad about feeling negative towards the babies. Lily told me she was upset that night and cried because she wasn't going to have a sister. I sympathized so much. Brandon told me that God knew what he was doing and he gave us these babies to teach us lessons we need to learn... Namely learn how dependent we need to be and how we need to accept his plans instead do focusing so much on our plans. He thought I was a birth snob (which I probably was) and that having to go back to OB care was to knock my pride down a notch.

I wallowed in self pity for a while and then decided to spend my time making a new plan and researching instead of worrying.

I needed to make lots of decisions quickly as to what doctor I would use for my care. I asked around and tried to read reviews and research. I decided to go with a doctor that was in the same group as Dr. Rice who said on her online info that she very seldom misses a client's birth. The main concern I had was that I would work hard to establish a relationship with a doctor only to have some random person attend my birth and wind up with another traumatic birth. Another plus was that she was Catholic and had worked in Guatemala which indicated to me that she understood what women were capable and likely respected natural birth and NFP but was qualified to be more interventive if the need arose.

I set up an interview with Dr Anna Damian for the next week. I suppose interviews are not really popular because when I got there the office staff wanted me to start paying when I hadn't even made a decision yet. I had a notebook with my concerns and my birth plans all ready to discuss with her. She seemed competent and caring and listened to my concerns and told me that there was nothing to be afraid of. I think she must come across moms who are scared of birth... I was scared of doctors! Birth was not my concern at all. She seemed supportive of natural vaginal birth as long as baby A was vertex. I thought she seemed reasonable and that I could work with her. I told the office that I wanted to have her for my care and scheduled an appointment to see her in two weeks. In the meantime she referred me to a maternal fetal medicine specialist group that sent a member to College Station from Houston every Friday.

Although so much was still in the air, I started to feel better about our situation now that I could have a little bit of a plan.

Links to the detailed story:

Ultrasound reveals all (Part 1)
High risk here we come (Part 2)
Houston Perinatal Consultants (Part 3)
Texas Fetal Center (Part 4)
The Final Stretch (Part 5)
Jesse and Max's Birth Story (Part 6)

The Ultrasound Reveals All (Part1)

I had planned to have my third pregnancy as low tech as possible, including skipping ultrasounds unless something did not seem right and my midwife wanted to. After Toni found that I was measuring very large for dates she recommended an ultrasound.

When I got to Dr. Rice's office she took me right back for my u/s. Brandon was running late. She put the wand to my belly and immediately we saw two heads pop up. "Well, it's twins," she said! It's hard to describe how I felt at that moment. It was actually mostly relief and excitement. ONLY twins... How hard could that be? Brandon came in just then and saw the two babies on the u/s and smiled! He seemed nervous. Dr. Rice said she thought there were two sacs and two placentas indicating fraternal twins and I was quite relieved. I was an avid birth junkie and knew all about TTTS and how scary it could be. If twins develop TTTS there is an uneven flow of blood through their shared blood vessels (in the placenta) that can kill both of them. Only identical twins who share a placenta can develop this complication.

To be sure the babies were ok (we did not want to know the sex) Dr. Rice recommended we get a more detailed ultrasound at another location.

I asked Dr. Rice if she delivered twins and found out she didn't. I already knew Toni didn't usually so I was going to have to transfer care to an OB. When we left the office that day we had a wonderfully exciting time telling everyone in our family. Everyone was so happy! Many had suspected as much from seeing how big I already was!

Our first look at the babies

Links to the detailed story:

Ultrasound reveals all (Part 1)
High risk here we come (Part 2)
Houston Perinatal Consultants (Part 3)
Texas Fetal Center (Part 4)
The Final Stretch (Part 5)
Jesse and Max's Birth Story (Part 6)

July 2012

Ok here's how it all went down...

After we had our two dear sweet children my husband and I were still deciding if we wanted more children.  We knew if we had more children it would probably mean buying a larger vehicle and a larger house.  I wanted more children in my heart but my head said I wasn't a good idea right now.

I pondered over it for months and had finally made peace with this decision in my heart. We would not have any more children or if finances were favorable have two more 5+ yrs down the road.  I was watching a friend's young baby at my home during they day so it made sense that I would be able to enjoy a little baby and be able to help out in this way for at least until she could go to school and I didn't need to keep her anymore. I was also nursing Ehren day and night and he showed no signs of being ready to wean.

A couple of weeks later at the end of June I was going to take out the trash and I caught a whiff of pizza box smell and it made me feel sick to my stomach. It was the same feeling I remembered from my previous pregnancies.  I knew something was wrong.

I decided that maybe I was just having another health issue because I had not missed a period. I was tired and sick to my stomach so I was thinking it must be the flu. I bought a pregnancy test just to rule out pregnancy before going to the doctor. It turned POSITIVE immediately.  That took me by surprise.  How could I be THAT pregnant?  I consulted my chart (we were using NFP) and the only explanation that made sense is that my last period was really implantation bleeding and I was already 7 weeks pregnant.

Telling Brandon

For each of my other children's births Brandon wore a Superman tee shirt.  I ordered him a new  Superman tee shirt and coincidentally when the shirt came in the mail it seemed a bit small so I picked up an additional shirt at the store. When I gave it to him the shirts I told him he would need it!   When I told Brandon he was surprised but very happy!  I think the kids drive him nuts sometimes but he is proud to be a daddy all the same.

Brandon and Lily 2008

Brandon and Ehren 2010

Preparing

I knew right away for this birth I wanted to have a waterbirth at home.  I had wanted a waterbirth with Ehren but didn't like my bathtub when the big day came.  I was going to splurge with this baby and buy the big fancy birth pool with the handles.  I was going to have a photographer and it was going to be epic. So far I was having a rough pregnancy because I was more tired than usual and actually threw up.  I had never thrown up with my other pregnancies.  Sure I felt nauseated but not thrown up. I attributed this to the fact that I was nursing Ehren and chasing around three little children during the day. I was also losing weight and I thought it was kinda awesome and perhaps getting back into prepregnant shape wouldn't be hard this time around.

I scheduled my first appointment with Toni (my midwife) at 12 weeks.  When I got there she measured me (just for fun since its not very accurate until 20 weeks) and noticed I was measuring ahead a cm or so. She looked all around and found the heartbeat on the top left quadrant.  It was healthy and strong. I was excited to be working with Toni again.


That's ODD

My next scheduled appointment was at 16 weeks. In the meantime the baby had a big growth spurt. I didn't really think anything of it. When I got to Toni's office she took my vitals, drew some blood and went to measure me. I measured 12 cm ahead of what we expected. I was measuring like a 28 week pregnant lady would measure instead of my 16 weeks.  Toni told me she wanted me to have an ultrasound to find out what was going on in there.  We looked all over but still only found one heartbeat in the top left quadrant again. I had still not felt any kicks yet.  She told me dates might be off, I might have fibroids or extra fluid or there was more than one baby. I hoped it was only twins, because my dates were right and I was scared of the alternatives which could be serious.

Beginning of 14 weeks

End of 16 weeks

I called Dr. Rice ( a natural birth friendly Dr. In town and scheduled an ultrasound for the next week. Stay tuned for my next post... The reveal!

I'm BACK

Alright, So after almost a year hiatus I decided I should probably start updating my blog again since we won't be traveling as much because we had TWINS since the last update. I plan to fill in with a couple of stories you might find interesting that happened this past year. Here's an adorable little picture to tide you over. 

Spring Fun

Sorry I've been slacking on updating the blog lately.  With kids sick and Brandon out of town I just lost some momentum, but my Mom is wondering what's going on so here's a short update with pictures!

Playing in the sprinkler on the first scorcher of the season

The kids newest projects were finding three tadpoles which we took home and raised as our own children.  Two have turned into American toads and they are named Swirly and Flower.  We made a cute little terrarium for them and have been catching bugs to help them grow big and strong enough to be released into our garden.

The last tadpole (doesn't have a name yet)

Amazing transformation that happens in one afternoon.  The toad is so small it can fit on a dime with room to spare.

10 gallon fish tank turned into a toad habitat

Our garden has been growing well.  We decided to plant only flowers since the dog kept eating our veggies.  We had tons of volunteer tomatoes however so we're going to have lots of tomatoes and I have no idea what kind they will be - cherry, grape or beefsteak?  Guess we'll find out.  The other day we went to the park and caught about 20 lady bugs who have been really enjoying the volunteer sunflowers.  Lily has been picking them and enjoying fresh flowers in her room all week.

Lily and her sunflowers.  (best face she could make out of 30 pictures!)

My perpetual motion machine wearing her favorite new dress from Grandma

Tickling brother with a leaf

Lily loves to decorate and had previously covered her large wall with artwork she taped up with scotch tape.  Because I didn't like the way it looks, we made some magnetic boards that she could stick her artwork to.  She picked out the patter and was really proud of herself!  We made them with oil drip pans (Walmart $11) and a cheap twin sheet set we cut up.

My mother's day card from Lily.  (Yeah, she made it EXACTLY like the magazine instructed)

   I also crafted a new dress for Lily since she is growing so fast.  I took a polo that looked hideous on me and made a cute little dress for her.  I think its darling but I don't think she likes it!

So that's what we've been up to in a nutshell.  This is all I probably have time to update for now while the kiddos are asleep!

Pregnancy, Birth and Beyond: My advice to new moms PART 1

Pregnancy and birth is a subject that is near and dear to my heart.  Having children has profoundly changed me in so many ways.  I have also learned so much (the hard way) since I've become a mother.  I could elaborate all day but most people aren't going to read it so instead, here's a short list I've compiled of things I wish I had known so maybe you can avoid some common pitfalls.  The first three are general rules of thumb to set the framework for a healthy experience and the remaining are more specific.

*Disclaimer - I have had a hospital birth with an OB that included induction and epidural and a natural birth at home with a midwife.  I do not advocate that my way is the only right way.  I want women to make informed decisions and give birth where and with whom they feel safe. The views below are my own with resources are below.*

1. Consider the source - When someone gives you advice they are usually well meaning but not always qualified to dispense the advice. Trust the experts but not blindly.  Do the research and consider your instincts and your child. 

2. Pick your care provider carefully - Find a Dr or midwife you can connect with and trust.  Really research the statistics of safety and interventions for that care provider.  A midwife (in TX) is required to provide those statistics up front.  If your instincts are telling you your provider is not a good fit, do both of you a favor and switch.

3.  Accept responsibility - As tempting as it may be to relinquish your care into the hands of "the experts" you need to be responsible for your own health.  You can get opinions from others but ultimately you must decide what to do.  Its easier to live with the choices you make than the choices you let others make for you especially if things don't go well.  Put on your big girl panties and get the information you need to make the right decisions for you and your baby.

3. Do the research - Experts are people too and can and do make mistakes.  Do not assume any procedure done on you is in your best interest.  Do not assume that your Dr knows what you want without first discussing it. For example, two common procedures that cause more harm than good are immediate cord clamping and episiotomy (1).  Both of these are still routinely done on women and infants without scientific evidence and without consent. These are not the only procedures in this category nor are they the most dangerous or damaging.  A good place to start your research is Henci Goer's book, The Thinking Woman's Guide to a Better Birth

4. What you eat matters - What you eat when pregnant really matters and has far reaching health consequences for you and your baby.  Many pregnancy complications can be prevented by careful attention to diet yet most women under OB care are never counseled or referred to a nutritionist.  My personal pregnancy experiences and birth were vastly different when I became aware of this.  A good place to start is, Dr. Brewer's Pregnancy Diet

5. Exercise -  Labor is usually physically exhausting, but it will be smoother if you train for it.  Do as much physical activity as you can during pregnancy.  You will feel better and you won't swell as much.  Do specific exercises like pelvic rocks, squats and tailor sitting to prepare your body for labor and proactively move the baby into optimal position for late pregnancy.
 
6. Nap - Sleep as much as you can when you can and don't feel guilty for it.  Manufacturing a human is hard work!

7. Know your baby - Take the time to ask your care provider how to tell what position your baby is in.  You should be able to tell what your baby is doing with a little practice.  Once you have this mastered you can do exercises to ensure your baby will stay in a position that will make labor easier. (6)  Talk daily and connect with your baby.  You will be working as a team when the big day gets here.

8.  Natural childbirth - You may be under the impression that women who chose to have a baby naturally are macho masochists.  I know I thought that at one time.  What is the big deal?  What so wrong with an epidural?  Once again I found out the hard way.  It turns out the epidural has side effects that nobody told me about! (2)  After having a baby naturally I would never again chose an epidural.  Most women who have had both kinds of birth also prefer natural.  Does that surprise you?

9. Be prepared - If you do chose to go natural, don't assume it will just happen.  The hospital system is not set up to support a natural birth.  You must be determined and prepared.  I would recommend a Bradley Class(3) or Hypnobabies(4) class.  If you are planning on an epidural, remember that they do not always work or you may have a precipitous labor and not be able to have one.  I would prepare for a natural birth/unassisted childbirth in either case.

10.  Consider a Doula - A doula?  Seriously?  That is what my husband is for!  Ok, well that is what the Dr and nurses are for then.  What came a a shock to me was that my Dr was NOT there until the last 20 minutes of the birth and the nurses were busy and also NOT there for me.  It was just me and my husband all alone without knowing what to do.  Turns out expecting a husband to know when/how to support you is asking too much of someone who is probably just as inexperienced as you are.  A doula will take the pressure off of your husband and will bring knowledge that will make your birth go better.  Studies have shown that having a doula as a member of the birth team decreases the overall cesarean rate by 50%, the length of labor by 25%, the use of oxytocin by 40% and requests for an epidural by 60% (5).  Don't leave it to chance that you will have a good nurse who will support and spend time with you.  The nurses work for the hospital, not you. 

11. Eat - If you have a long labor you will probably get hungry.  You can eat if you need to and you don't need permission.

12.  Let go - There are many things in labor you cannot control. If you've done your homework, taken care of yourself and prepared as diligently as you can then it is time to surrender to the process and ride it out.  Labor is not the place for fear and anxiety - this is why I'm stressing mental and physical preparation before D-day.  Birth is as safe as life is. Women were made to give birth and you can do it.  Pray for peace and guidance from God and he will be there to help you out.  Enjoy your birth!

Stay tuned for PART 2 - Breastfeeding

Resources:
1. http://pregnancy.cochrane.org/
2. http://www.natural-pregnancy-mentor.com/epidural-side-effects.html
3. http://www.bradleybirth.com/
4. www.hypnobabies.com
5. http://www.americanpregnancy.org/labornbirth/havingadoula.html
6. http://www.spinningbabies.com/

February 2012

Is it that time again?  The days are long but the years are short.  I guess February blew by because I was so busy!  Brandon went to Sweden on business again, this time for 13 days!  My dear mother drove down to bring my sister to help me out and then Mom and Dad drove back to pick her up at the end of the week.  Very thankful to have family that LOVE me.

Now that I am 30 and "officially old" I'm going to stop coloring my hair and let it grow into its natural color - gray and all!  I figure if I keep it styled nice and work a little harder on not dressing like a slob then I won't LOOK old.  We shall see!  Oh - I need a GOOD stylist in C/S.  I want to pay for a good haircut but have not found anyone here who I like (even paid $50 for one and it was terrible!)  Please send me your suggestions!

I have been working almost every night this month on my quiet book and it is coming along nicely. I'm very excited!  Don't want to brag but it is the most awesome quiet book I have ever seen.  The kids keep trying to sneak into my closet to play with it. I will post pictures as soon as I am done.  It is ridiculously time consuming because I'm doing everything by hand and using the blanket stitch to join all the felt.

About the kids - My little Ehren has slept until 7 in his bed the entire week!  I am so proud of him and really enjoying getting more rest.  Its so weird sleeping through the night again myself because I haven't done it since Summer 2010!

When Brandon got back from Sweden he decided to take Lily ice skating!  She was really excited about the prospect but not as excited about actually skating.  She and Brandon took one trip around the rink before she called it quits.  She wanted to play with the ice and look around but not skate.  She did say that she had fun though.

Lily and Daddy trying out the ice

Now for my mini rant on breastfeeding (this is here just so I don't have to explain it over and over again).  I am still nursing my 14 month old.  I do not find this unusual in a global or historical context.  The American Academy of Pediatrics recommends breastfeeding at least 12 months and then however long after that the mother and baby desire.  The World Health Organization recommends breastfeeding at least two years and however long after that the mother and baby desire.  I plan on breastfeeding as long as my son wants to.  There are health benefits to my baby and to me the longer I breastfeed that outweigh any minor inconvenience extended breastfeeding may cause.  My pediatrician is fine with my not giving my baby cow milk and his blood tests show him to be perfectly healthy.  Ehren does not even like cow milk because he will suck it up and then spit it out all over himself (for fun!).  He also does not like to eat meat or carbs and prefers veggies and fruit (and chocolate) so I'm filling in the gaps in his nutrition by breastfeeding.  I do not make decisions based on what is popular or what everyone else is doing.  I have good reasons for everything I do.  I have a degree in Biomedical Science and my hobbies include researching health related topics so I'm not going to make a decision that affects my children without due diligence.  I don't think I'm always right - that is why I consult the professionals when necessary. :-) /end rant!

Ehren's latest adventures

My boy has grown so much in the past month I can hardly believe the leap in development!  Here's a list of his new accomplishments:

* Walking!  He walks everywhere and he's so proud of himself.  Still can't get him to wear shoes though!  Here's a video of him doing his favorite things - walking and cleaning.

* Self soothing himself to sleep -  For a whole year, Ehren had to nurse himself to sleep, be walked around, or fall asleep next to us.  I have gradually gotten him to read books in his room and then nurse a bit and finally we can put him in his crib and he will quickly fall asleep on his own!  Sweet success with no crying!  I knew it would happen some day and we just had to be patient and not push him to do something he wasn't ready for.

* Sleeping through the night - On 2/2/12 Ehren slept 8 hours from 9:00 - 5:30 am.  So proud of my little man!  The longest he ever slept previously was a 5 hour stretch.

* Sign language -  We started teaching him signs around 9 months or so and he never really seemed interested in learning them.  He really started using them all of the sudden and even seems to want to learn more.  He knows, food, more, thank you, all done, book, please, dog, ball.he also points and says "dat" (that) constantly.

* Reading - Lily wanted to read even as an infant.  With Ehren we were not as diligent about reading to him since things were a bit more chaotic and he didn't seem interested anyway.  BUT now, he has a favorite book.  It's an Eric Carle book about animals and he loves to turn the pages and giggles when I make a lion and sheep sounds.  So glad he wants to read now.  I was thinking he was a dud!

*Bible class - Ehren has had a difficult adjustment getting into Bible class.  He had more separation anxiety issues than Lily and vomits when he's really upset so we had been hesitant to leave him alone in Bible class.  As he's gotten older, he's become less anxious so we tried it again with a lovely grandmotherly lady holding him.  Success!  He made it through class.  Since then he has been spending more and more time in his chair.  Things are looking up.

*Independence - Ehren's separation anxiety issues are completely normal, although he was much more anxious than Lily.  Pushing him to do something that makes him upset is not a "solution" I was willing to try.  From my experience, this exacerbates the problem because the child now doesn't trust the parent and/or suffers from a reassurance deficit and becomes even more anxious and clingy.  With Ehren we needed to be patient and teach him in such a way that would help him learn to be away from us but without making him more anxious or distrustful.  If he will not do what I want him to do, I am willing to be patient and wait until he is ready. I am proud to say that my approach is working and we are seeing great strides toward becoming more independent.

*Playing with Winry - Before I started keeping a little baby, Ehren seemed so much more like a baby.  Now he's helping me entertain the baby and even doing "chores."  He will pick up books, throw away diapers, and play peek-a-boo with the baby.  He will even play by himself and come back to me occasionally for a cuddle and then resume playing.  One day I was holding both of them on the couch and he just took her hand and smiled at her.  It was so sweet!

 Cute little video of Ehren playing a flute!

*Temper tantrums!  Ugh!  I dreaded the day he started these.  He gets mad now and frustrated when denied and will slap the floor with both hands like a little Muslim.  He even threw something when I told him he had to wait.  Poor little dear.  We don't allow this behavior of course and with the way he is, a 1 min time out is working beautifully.  With consistency, I do not think he will be as challenging as Lily was/is.  Ask me in a year if I still think this!

All in all, I'm so proud of my little boy.  He's perfect in every way.  I kissed his head yesterday and he smelled like lavender baby shampoo and chocolate.  I just wanted to drink the moment in and make it last forever.  I am so grateful that God gave me such a precious soul and pray so hard every day that I will be a good mother to him.