Expecting Twins

two weeks old, and yes, they fit in a shoe box.

Okay, so unless I throw a recipe in here somewhere, this is a post about expecting and having twins.  If you're on the blog simply for fitness or food, feel free to skip ahead or look at past recipes.  It will be a little while before I have fitness posts again--about four more weeks not that I'm counting or anything! ;)

I just thought I would take advantage of a rare hour between pumping and feeding the twins to write a little about my experience in the hopes it may help someone expecting twins to feel a little more prepared.  I thought I would be completely prepared considering I am a twin, my little brothers are a set of twins and my mother (obviously) gave birth to two sets of twins.  And in many ways, I did know what to expect.

Blair and Ivy, our early Christmas presents

The Pregnancy:

My pregnancy was okay; I must admit I am not one of those women who love being pregnant.  As a very active individual, I was slightly depressed the first trimester when I was very sick and low energy.  I had to stop doing my bakery business before the second trimester began because I was constantly nauseous and fatigued.  I was banned from running early on which also was hard, especially the times I did feel good enough to run.  The second trimester was certainly better; I had more energy and walked daily and swam and did some barre exercises.  The third trimester was back to being tired and very, very uncomfortable.  I couldn't sleep and one baby (Blair) would often feel like she was trying to get up under my ribs, and Ivy was so low she was pressing on some nerves that made me feel like I constantly needed to be in the bathroom, and the low back pain was at times almost unbearable.  I did enjoy feeling the little kicks at times, and it was a little stunning to see the rate at which my belly expanded, but it was not a comfortable experience by any means.

Also twin mommas--be prepared for a ton of doctor visits.  I started out seeing my OB every 2 weeks, a neonatologist specialist once a month (to check the babies' growth and anatomies), an endocrinologist for my thyroid and then non-stress tests (NSTs) at the hospital once a week starting at week 29.  The OB appointments increased to once a week in the third trimester, and the specialist appointments every 2 weeks, and NSTs twice a week.  So be prepared for a LOT of ultrasounds!  Also, don't panic if something seems "wrong" initially.  With so many appointments, it is likely there will be an anomaly suspected at one point.
At one appointment, it looked like there might be an issue with Blair's heart so for a few days until my appointment in San Francisco, I was a distraught mess.  I kept imagining all sorts of heart problems and of course I imagined the worst scenarios.  After several sleepless nights, we went for a fetal heart echo test which revealed everything was fine, so it was a bunch of worry and stress for nothing.  So though it is hard, try not to panic at every little anomaly that pops up.

In terms of baby prep, I had the nursery done before my third trimester, and my hospital bag and the babies' bag packed at about 30 weeks.  I went on a hospital tour just before 30 weeks despite all the other mommas being about 40 weeks and ready to pop.  The nurse giving the tour described all the great hospital services and nice laboring room and accessories, and several times turned to me to say "except for you."  Yes, if you're carrying twins, you will be delivering in a sterile cold operating room with bright lights and a lot of people.  You won't be in a quiet dark room with your support person and gentle music playing, sorry.  For me, I was pretty sure I would have to have a C-Section anyways; both twins were breech or vertex since about 28 weeks, and as I was told, they did not change positions after 32 weeks.  Some nurses will tell you cheerfully you still have time for them to switch positions, but most of what I heard and read about was that they rarely switch positions after 32 weeks--there is just no room, and mine were definitely out of room by then.

I knew premature twins were a strong possibility.  It annoyed me when a nurse told me I should wait to schedule my pre-admissions interview (I scheduled it for 32 weeks) since "surely my twins wouldn't be that early."  I took a breastfeeding class at 31 weeks where I was told things like not to give the babies pacifiers or not to bottle feed as much as possible so that the baby will enjoy breastfeeding more and not be confused.  The lactation specialist teaching the class also told us not to give our baby formula as "breast milk is best", and that the hospital would not give formula without our request.  I had read several breastfeeding books and was determined to feed my girls breast milk only, so I was glad to hear this.

Of course, the same day after my pre-admissions interview at 32 weeks doing paperwork and birth certificate forms, etc, I started having horrible back pain and strong and intense contractions and was admitted for pre-term labor that night.  If I wasn't so uncomfortable, I would have told that nurse "See?? I told you!" Yes it is great to be positive and determined you will get to 37 or 38 weeks.  But be prepared that your body and the babies might have their own agenda.

This is the point where I wish my OB too had been a little more straightforward with me.  Though he was pretty great overall, I had some qualms about the information given to me as a twin mother.  He had told me along along my goal was to get to 37-38 weeks, which of course is full term for twins and would have been ideal.  Since my sister and I was born at 32 weeks though, I knew it was very possible to have them earlier than desirable.  What I didn't know was that if I started labor that early, I wouldn't get to stay at the nice hospital I was familiar with nor would my OB deliver the girls.

When my labor couldn't be stopped after being given Terbutaline and then Nifedipine and finally, magnesium sulfate, I was injected with Antenatal corticosteroids to help the babies' lungs develop faster.  The magnesium sulfate was also administered to help their brains.  I was then told I would be transferred to another hospital about 25 minutes north because they had a level 3 NICU that the twins would need if they arrived soon.  I wasn't dilating (only about 1-2cm) but my cervix was almost completely thinned and it seemed like the contractions wouldn't stop, and the doctors wanted me at the other hospital before things progressed.  My OB told me he wasn't surprised given my petite frame that they were early (why he hadn't ever brought up the correlation between being a smaller women and an increased likelihood of premature twins before, I'm not sure, but he repeated it often in my final weeks of pregnancy) and that the babies would be fine, and it wasn't my fault.  All were kind words to reassure me, but I wondered why he hadn't gone through a sort of "hey, you're small, you were born early, your twins might be too so just in case this is what it would be like if they are more than 4 weeks early," etc., with me during one of my many once-a-week OB visits.

The Hospital/False Start:

I was very upset and confused; I had no idea my OB wouldn't be delivering--instead whoever happened to be working at the other hospital would--and my husband had gone home to get bags and let the dogs out; he didn't know I would be transferred, either.  My back was in the worst pain I could imagine (hello, back labor!) and my phone was dead, so I had to beg a nurse to borrow her cell phone, as my room phone wouldn't allow an out-of-state cell number to go through.  I took a very painful and what seemed like an incredibly long and bumpy ambulance ride alone, and long story short, the next hospital was able to stop my labor with Procardia, and kept me there for a week to monitor me and the babies.  It was a horrible week at a hospital considerably less nice than the one I had been getting non-stress tests at and getting to know the nurses for the previous weeks.  But I knew it was for the benefits of the babies.

I won't go through every detail but I had a miserable time at the hospital north of where I live.
We could hear women giving birth every night in adjacent rooms, they did not have any heat packs like the last hospital did (bring your own heating pad if your hospital doesn't have them--this is a must if you get horrible back pain!)  I couldn't sleep, and the nursing staff wasn't quite what I was hoping for.

I definitely lost weight during my stay too as the food was horrible and I could only eat the rice and occasional applesauce.  Though I had an allergy bracelet and it was documented I am allergic to gluten, dairy, corn, soy and many nuts, I was served meals like this:

Beef, corn tortillas and veggies with corn and sprite and milk to drink.

And yes, the card on the tray says vegetarian and listed my allergies.  Next to the carton of milk...
I asked to speak to a nutritionist and was vaguely told she was off for a few days.
Dave ate my hospital food and brought me food he bought or made at home for me.  (He ate the pictured meal above and promptly got a stomachache).  My appetite was poor though especially being miserable and in pain.  I had a couple great nurses and many not-so-great.  One was so terrible I asked for a new nurse.  My request was ignored twice and finally my husband was able to speak to the head nurse and demand a replacement, only after he agreed to fill out a form explaining why the request was made.  I was told by a lactation consultant and several nurses that you can ALWAYS ask for a new nurse or doctor if you are uncomfortable, but at this hospital, it proved to be a very frustrating ordeal.
Finally, I was released when it seemed like labor wasn't going to start again immediately, and told to come back right away at the first signs of labor.  I'm sure the level 3 NICU was great there, but nothing else was and I was determined not to have to go back.

Waiting/Birth:

Home was wonderful after that.  I was told I was basically an incubator and to take it easy and somehow kept the babies in another 3-1/2 weeks!  I was still in pain though not as bad as week 32, and though at times laying or sitting around uncomfortably doing nothing was terrible, (good luck reading a novel; flipping through magazines or Instagram was all I could handle for a few minutes at a time) but it was considerably better in my home environment with goldendoodles to cuddle with!

Flash forward:  I convinced my husband to take me to the aquarium at 35-1/2 weeks as I was so bored hanging around the house taking it easy and it seemed like the babies were going to hang out for awhile yet.  As we were leaving, my water broke (as in gushed).  Yes it was super embarrassing and obvious what was happening!  Everyone will tell you it's not like in the movies and it's rare for your water to break dramatically like in the movies, but that is exactly what happened to me.  I didn't feel anything different than a minor contraction and then it just wooshed out.  I waited outside the aquarium looking like I was peeing my pants continuously while my husband sprinted for the car.  A couple of aquarium employees asked if they should call an ambulance, and blushing, I told them I was fine and that my husband was coming back for me.  Very awkward, but funny way later.  Side note: keep a towel in your car if you are carrying twins the entire third trimester.  Or two towels. The fluid soaked the seat, my clothes, my shoes--yes, your body keeps producing it.  I thought it would "empty out" or stop, but nope.

This was taken less than 30 minutes before my water broke.  Funny enough, two little girls that looked like twins were running and playing behind me.  

Things progressed quickly from there: I arrived at the hospital, they started monitoring the babies right away, and a c-section was scheduled in less than an hour (twin A, Ivy was breech and twin B, Blair, was vertex as they had been the last few weeks so it was no question of trying for a vaginal delivery).

The spinal block was the most painful part of the procedure, but honestly not that bad for me.  Then, everything went numb below my chest.  As I had read online, I felt tugging and pushing but no pain. (Yes, I cried.  I was scared, partly because I was certain I would be the person that the anesthesia wouldn't work on, and that I would suddenly feel my abdomen sliced open). You will hear everything the doctors say and your view is a big blue curtain.  I was crying mostly because I was irrationally scared about the entire thing and just hormones I'm sure, but my husband was near my head holding my hand until they pulled out baby Ivy.  He saw the babies right after they came out of me and got to hold them, and Ivy was handed to me to cuddle and kiss for a moment, then they whisked her and Blair out.  I got to see Blair briefly but not hold her--they were hurrying to give her oxygen which made me scared and cry again, but she was just fine.

Don't be alarmed if your baby's legs are doing this!  Ivy was breech, and her hips were fine.  They may check them with an ultrasound later, but this is not uncommon for breech babies.  The legs will lower normally soon!

They were pretty healthy but tiny (smaller than had been estimated) at 3 lb 11 oz and 4 lb 7 oz.  Ivy needed a gavage tube for feeding initially and Blair was briefly on oxygen but both were fine soon after.  They were given donor milk as I had requested, which I was very grateful for, though soon after I realized the nurses were giving them pacifiers to help them strengthen their suck-swallow-breath ability and the donor milk was being fortified with formula.  I was told everything I had learned for a singleton baby should be tossed out the window--for twins, the nurses and doctors informed me they needed the extra calories from formula and had to bottle feed initially and most disappointing: that I shouldn't breastfeed until they are closer to their original due date.  I was told they were burning too many calories attempting to breastfeed and not taking enough in.  Again, I wish I had been told this could be an issue earlier.  I never imagined they wouldn't be able to breastfeed, especially since I was able to pump and produce colostrum almost immediately after recovery from surgery, and breastmilk a few days later.  I had visions of putting them to my breast as soon as I was out of the recovery room, but I was not able to even attempt this.

This is what a gavage tube looks like: milk is pushed into a syringe and goes down the tube directly

The difference in the hospitals was astounding though, and I felt like I (and the babies) were in great hands.  An example too can be seen below in the food I was given--healthy, allergen-free items like fresh fruit, fresh salad, plain fish and tea.  The nutritionist called my room to go over my restrictions, and often sent up things like rice milk for me.  I felt taken care of and my many, many questions and concerns were answered even if not exactly to my liking.

Fresh healthy food at CHOMP

Basically, it was a world of difference.  Luckily the babies were fine in the NICU and didn't need the equipment in a level 3 NICU.  We were given the option to stay an extra week or take them home, and we elected to bring the babies home.  They fed better at home and we were able to rest a little more.  What I learned quickly is that they need to eat every 1.5 to 3 hours, max.  Preemie babies aren't able to go 4-5 hours at a time or partially through the night without feeding like some full-term babies can.  They need to be kept very warm, and ideally their temperature taken often.  I had skin-to-skin contact with them as much as possible, as this helped them regulate their temperatures as well.

skin-to-skin with Blair

In our case, the pediatrician wanted to see them once a week to check their weights.  (Also, our pediatrician did not see them in the hospital as I was first told he would.  Instead, he was kept informed by the neonatologist at the hospital, and we did not see him until after we were discharged).
Initially the goal is to get as many calories in them as possible without tiring them out and feedings are limited to 30 minutes--you will spend much of your time staring at the clock and frantically trying to calculate when they need to start feeding, when they have to stop, how much they drank, when you need to pump, and how much you pumped.  I recommend a notebook or feeding log as you not be able to remember this at all, I promise.

our tiny baby

Though we were allowed to bundle them up and walk them in the stroller around our neighborhood about a week after we brought them home, we were told to keep them away from people until closer to their original birth date.  Basically though your friend might have been carting her newborn around the grocery store and introducing their baby to friends immediately, that likely won't be the case with your preemie.  They are almost 3 weeks old, and our twins have only met my parents and a close friend in the first two weeks, then another friend, my sister and brother-in-law the next week, and it will be a little while longer before I take them out and about with me for more interactions.

So that's my preemie twin experience, in brief.  Of course, yours may be ENTIRELY different depending on your body and health, the babies, your doctor(s) and what hospital you deliver at.
I'm just grateful they did not have to stay in incubators or at the hospital for weeks and that they are healthy little babies.  So far, motherhood of two babies is beyond exhausting but amazing, and I cannot wait until our twins are a little bigger and stronger and I get to see more of their personalities develop.  At times it is so hard when one cries at a time and it seems like an endless cycle of crying, diapering, pumping and feeding, but you'll get through it as I will.  I am hoping to be able to breastfeed them soon and cease with the continual pumping, but at any rate I'm very happy they are able to eat my breast milk.  At week 3.5, I have started to introduce nipple shields and breast feed them anywhere from 5-20 minutes and then finish up with the bottle which adds way more time to the feeding and takes away even more of your precious minutes between baby care, but I am positive it will be a huge payoff when I can breastfeed them directly until they are full, and keep them growing and nourished without the constant pumping and bottles.

Pumping side note: Preemie twin moms, I recommend you rent a hospital-grade breast pump, at least for the first month or two.  DO NOT BUY a breast pump beforehand, or get one through insurance or Obama-care.  It may not be the model for you, and you'll have wasted a lot of money if you bought one.  Some people sell their used ones pretty cheap, and that's an option, but I still suggest waiting.  What worked for your friend may not work for you.  I used up my free insurance one on an Ameda Purely Yours, and yes, it sucked until my milk production was really up.  I have been using it only for the middle of the night and early morning pumpings when I'm trying not to wake my husband, and I rely on the Medela one I rented from Babies-R-Us they rest of the time.  The milk produced between the two is pretty different, so I plan on keeping the hospital-grade one a second month and stashing as much as I can in the freezer.

Also, you might hate pumping.  It's not painful for me, but it's not comfortable and I still feel like a cow being milked and I hate it.  Also, I get a lot of clogged ducts, which are painful and unpleasant (heat is the best cure: soak in a hot bath or apply heat packs).

But that's okay, because big picture: my babies are getting great food and every time they are weighed and their healthy growth is confirmed, I feel a sense of pride.  I am not putting any lofty goals or restrictions on how long I will pump or breastfeed: I am taking it day-by-day.  Initially I swore I would breastfeed at least one year, but I think everyone has a different experience, and you should not feel ashamed if you fantasize about stopping to breastfeed before a year or even before a month.  But I'm not even a month in, so I am not expert--again, day-by-day is how I'm doing it.  Just be warned that everything you read in breastfeeding books may not apply to you and your unique experience.  It took me awhile to readjust my lofty expectations and not feel like a failure.

just do the best you can

To all you twin mothers or anyone reading up on preemies just in case, good luck!  Mothers of multiples especially, I recommend being prepared for either premature or full-term babies, then you will better be able to handle what comes your way.  Though some of the books and resources I read were great (shout-out to my mom's co-authored Mothering Twins book!), just prepare to listen to your instincts and do what works best for you.

And if you can, join a multiples group or find someone in your situation or who has had twins recently.  I was contacted by a woman in my community a little bit ahead of where I am with our girls, and though I still haven't met her, her emails and texts have been amazing and encouraging.

Often you will cry, feel anger, or momentarily think "I can't do this", but you can.  You will also have moments of crying because you love your little premature babies so absolutely much, and you want the best for them.  Just remember they are tiny babies who need your love and support, so make sure you have a partner or people in your life where you can get love and support too.  My husband's Marine cohorts and their families made us meals in that first week, and it was an amazing help.  Take advantage of all help offered, because in order to be the best parent, you need to be nurtured and cared for too.  And definitely get the parents and in-laws to come as soon as you can because you will want the extra help, trust me!  Okay, time to rush to feed, I hear crying....good luck all!