Monday, November 5, 2012

Special Care

Sam and Harper spent their first couple weeks of life in the special care nursery. They spent the majority of the first few days in a warming isolette. Due to their small size they weren't able to maintain their body temperatures on their own. They also were jaundiced, so were under bilirubin lights for a couple of days. Chris and I were only able to hold the babies in 30 minute increments a couple times each day that first week.
Grandparents and proud Aunties, Uncles and a few dear friends made their way to the hospital to meet the babies they had so patiently waited for. These little ones were so loved from the moment those closest to us heard of their upcoming arrival. Our hearts filled with joy as we introdued those most important to us to our precious little ones.
While Jen spent a few days in the hospital recovering, we made our way from the post-partum unit to the nursery every 2-3 hours and slowy became acclimated to the environment we would become all too familar with over the next couple weeks. Everyone in the unit took excellent care of the babies (and mom and dad, too!) The circumstances of the babies delivery was well known among the nurses and doctors in the unit. Only a few hours would pass before someone would pop their head into our little pod and say, "these are the babies with two different birtdays." Then another nurse would chime in, "and did you know, they were born on two different months!" And then a third, "and it was a blue moon!" and lastly another would usually mention, "and mom, she delivered one vaginally and another by cesarean!" Apparently the way these babies entered the world was far from the norm!
We were getting along fairly well until Jen's discharge day came. It was beyond difficult to begin thinking about leaving thr hospital. While we were so anxious to be home with Bennie, the reality of leaving our babies and being torn between home and hospital was sinking in. I don't think any parent can be prepared to leave their newborn children in the hands of others at just four days old, however we felt particularly ill prepared. When labor started on that Friday of Labor Day weekend we both assumed the babies would be discharged home with us and would not need any additional time in the hospital. After all, we had made it to the "golden week" of a twin pregnancy. The coveted 36 week mark (well a few hours shy of that anyway). After several preterm labor scares, each week that passed from 25 weeks on felt like it should be ended with a victory dance. My big goal was to make it to at least 36 weeks and with that goal, I always assumed if we made it that far that the babies and I would leave the hospital together. So to wrap my mind around leaving the babies was heartwrenching. They were so tiny and vulnerable, but by the time I was ready to be discharged it was clear that we would need to settle into a routine of traveling back and forth to the hospital, that the babies would need "special care" for at least several more days.
We leaned into the support of family, friends and neighbors and took full advantage of their generous offers to care for our oldest Beetle, help with rides and keep us fed. Two months later I look back on those days and don't know how we would have done it without their help.
While the babies were hospitalized, we left home early each morning to be present for the first set of morning cares and doctor's rounds. The babies worked on breastfeeding every three hour and when they tired out they would receive the rest of their goal volumes by a nasogastric tube. Vital signs were taken every three hours and feedings were grouped with the monitoring so as not to tax their precious energy stores.
The day after delivery, the neonatologists told us that Sam had been affected by assymetrical growth restriction. Essentially, everything below his head had stopped growing at some point in the pregnancy, most likely in the last few weeks before delivery. He was quite small for his gestational age, however the doctors told us this was not uncommon in twin pregnancies because the placentas typically mature more quickly than in a singleton pregnancy. We were also told that if growth restriction was going to happen, this was the best scenario (vs. symmetrical growth restriction, where all over growth slows or stops all together). Because of his small size the doctors recommended he receive donor breast milk until Jen's supply fully came in as they had seen better growth in very premature babies as well as growth restricted babies with breast milk compared to formua. The babies also received IV nutrition called TPN and lipids for the first week or so. While we were onboard with whatever was best for the babies, the IV nutrition unfortunately meant multiple IVs for both babies. Sam in paticular seemed to lose his IV access at least once every shift. The new mama absolutely hated when this happend, especially since it usually took mutiple attempts by multiple nurses to find a new site for his lines. He tolerated it like a trooper and I probably shed more tears than he did.
By day seven or so both babies had been weaned out of the warmers and were maintaining their body temepratures on their own. This was a huge accomplishment and meant we were able to spend more time snuggling our babes. By this point we had come to the realization that the babies progress was made up of two steps forward and one step back, but we were getting there. Both babies would need to take all of their goal feeding volumes by mouth, without the use of the nasogastric feeding tube for a full 24 hours before they could be sent home with us. The day before discharge the lightbulb seemed to turn on and both babies were waking more often and eager to eat. The feeding tubes were left in place, just in case they would need them the next day so they would not have to be replaced in the event the babies took one of the dreaded steps back. Well, our kiddos showed the nurses and doctors they were ready to come home because on the day of discharge I walked up to Sam's bassinet and discovered he had pulled his tube out on his own and was sucking on the end. If that doesn't say "get me out of here" I don't know what does!
The babies were discharged home after 13 days in the special care unit. We couldn't have been happier or more relieved to get them out of the hospital and home sweet home, right where they belonged. Of course there was some apprehension that went along with that joy, after all we had become accustomed to heart rate and breathing monitors and nurses at our disposal 24/7!
While Sam and Harper's time in the hospital seems like a distant memory now, during that time each day felt like eternity. We couldn't wait to have our family together. Balancing our time between home and the hospital was heartbreaking. When we were home, we felt we should be at the hospital and at the hospital we were missing Ben like crazy and wanted to be home with him. Our friends and family got us through those days. We've been home for seven weeks now and while many of the emotions we felt during those first couple of weeks have since faded, one that has not is our gratitude for each and every person who showed their support for our family during a time when we needed them most.
Here are a few pictures of young Sammie:
And Miss Harper:
































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