December 30, 2014

Five Months!

It is absolutely amazing to me what a difference one month can make in the life of a baby. A month ago my girls were wobbly and squishy, mostly mute and stone-faced and very much still like their newborn selves. Now we have genuine infants on our hands.

They are holding up their heads completely, pushing up and almost over when on their bellies, babbling, smiling and laughing constantly. They're curious and investigating everything. They recognize not only our voices but our faces and look for us when in a room of other people. They're sturdy and able to be carried on a hip without feeling like they're going to fly out of your arms. They have reversed their positions on sleep - now Jules fights it and Viv just passes out when less than a month ago they were opposite.

They're getting closer and closer to rolling over, twisting and turning but not quite there yet without some help. Viv is quieter but trying to sit up every time we sit her down and loves to push up with her feet on any surface. Jules is our talker, constantly babbling and exploring octaves with her voice. She's a little less active, preferring to play with her hands and feet rather than the toys around her. They really enjoy listening to music and Viv can often be caught bopping her head from side to side while Jules will fall asleep to anything we play. Regrettably they already love watching TV (especially football games!) so we're trying to limit that already.

They are chewing on EVERYTHING. Toys, hands, feet, clothes, me and dad and each other. They have noticed each other a few times but never at the same time so we're still waiting for that realization of that's not my reflection that's my sister! They hold hands all the time, especially while nursing or sleeping together.

They are over 12 lbs. and over 24 inches. We have almost completely transitioned out of 0-3 month clothes (major sad face) and are finally out of preemie socks.

Month five was filled with lots of firsts including their first Christmas and lots of family gatherings at Aunt Kate's, Great Nana's, Nova's and Papa-T's plus one here at home with Dad's family. The girls met Santa and had their pictures taken and then did some Christmas shopping and wrapping presents. CJ and I had our first night out so they enjoyed their first time being babysat at night by their wonderful Nova. We hit our first sleep regression last week after almost two months of sleeping through the night. We spent a week at Mom's old job at the daycare and had so much fun making new friends. We baked our first cake for Daddy's birthday and had our first birthday celebration as a family.  We also had our very first real colds a few weeks ago with runny noses, slightly elevated temps and all around cranky babies. On a sad note we received confirmation that our Juliette will in fact have surgery on her stubborn right kidney next month so month six will have one very unique first that we're not really looking forward to. In two weeks we have our appointment with the Developmental Pediatrician and we're excited to hear what they have to say as I'm pretty sure they're right on track for their adjusted age of 17 weeks tomorrow.

As we end the most exciting and life-changing year of our lives I am reflecting on how much has changed and how happy we truly are. I had no idea anything was even missing from my life until these beauties graced us with their presence. A year ago I didn't even know there were two of them. I am so incredibly excited for the next year, to be able to observe and celebrate all of their big firsts with them and to hold their hands as they grow. Happy New Year everyone.


December 28, 2014

So You're Having Twins - Here's (Some of) What You Need To Know

In case you got excited, I will not be thrilling you with my knowledge of successfully raising twins today (please, if you do know how to do this, get in touch with me.) Instead I want to talk about types of twin pregnancies. 

My twins are Monochorionic Diamniotic aka Identical. It is generally considered to be of medium risk. As grateful as I was to not be considered "high" risk, I quickly became aware of the potential problems and protocol for a pregnancy of my kind. I hated it at first and to this day wonder what would have happened if I had only... (read more on that here)  but I do know that I was lucky to have been in the care of people who knew what was best for this type of pregnancy, as I myself certainly did not. And I'm glad I live in a place where people advocated for the safety of my babies rather than providing me with a false sense of security via uneducated guesses as so often happens with twins.

When we came home after finding out about the twins the only thing I (thought) I knew about twins in general was that there were two types: Identical and Fraternal. One type was in the same sac (identical) and the other were in separate sacs. Our original ultrasound tech said there were two sacs but didn't elaborate much more. I was ecstatic that there could possibly be a boy and a girl. Upon leaving Dr. Margono's that day I was shocked to learn that it wasn't as simple as that.

There are a few things to consider when figuring out what type of multiple pregnancy you have.

Zygosity refers to how many eggs were fertilized and implanted prior to any splitting that might occur.

Chorionicity refers to the number of placentas that attach - either one or two (or more). Amniocity refers to how many amniotic sacs there are.

The combination of these things determines your type of pregnancy although they may not all be evident at any given time. Placentas can fuse, dividing membranes between amniotic sacs can appear invisible and eggs can split before implantation. Our bodies are weird, why would multiple pregnancy be any different?

Here's a Breakdown of the Basic Types of Twin Pregnancy:

Dichorionic-Diamniotic Fraternal Twins (DiDi or DCDA)

The most common type of twins, they are no more related than ordinary siblings. They are created when the mother hyperovulates, or drops two eggs that are each fertilized by their own separate sperm. This is a trait carried and passed on only by the mother's father, so even if twins run in your husbands side that has no bearing on whether or not you will have twins, but your daughter might be predisposed to hyperovulation. 

They always have separate placentas (the chorionic sac) and always have separate sacs (the amnion). In rare cases the placentas may fuse shortly after implantation giving the appearance of one but an ultrasound can determine true chorionicity based on the size of the dividing membrane (thick and very clearly there) or it can be determined at birth.

Usually the Dr. can tell by the membrane thickness if it the babies share a chorionic sac or not. If it is not obvious with an ultrasound it should be upon delivery (there is an obvious "horn" or seam where the placentas fused) or you may have a DNA test performed. These twins can be conceived not only on different days but can even have different fathers or be different races entirely. It all depends on when the woman ovulates and the eggs are fertilized.

DiDi Fraternal twins are the ONLY twins that can be a healthy boy and girl (although frat girl/girl are 2nd most common followed by frat boy/boy) and they are never identical.

Dichorionic-Diamniotic Identical Twins

So there's this widely accepted misconception that di-di = fraternal. It does not. In fact, 30% of Di-Di pregnancies are actually identical twins. I know, I just blew your mind!  Turns out, if the eggs splits super duper early (during days 1-3 after fertilization) then you end up with DiDi Indenticals.

Since they will be the same sex usually a blood or DNA test is required to know for sure whether they are identical or fraternal. The children are identical twins although the pregnancy will likely not be cared for in the way that most identicals are as it is not as high risk since each baby has its own placenta. 

So many people have DiDi Identicals and don't even know it. I have my own speculation that this is the real case of the so-called fraternal twins, Mary-Kate and Ashley Olsen.

Monochorionic Diamniotic (MonoDi/MoDi or MCDA)

MoDi twins occur when the fertilized egg splits early, about 4-6 days after fertilization into two separate embryos that then implant on the uterus with a shared placenta.  They will have the same basic DNA and look very much alike although they rarely are "identical". 

Identical does NOT mean carbon copy. Your babies may look very different depending on weight discordance, placental sharing and positioning in the womb. The most common difference I have found is that one has a rounder, larger head and one has a more oblong, thinner head. I think this has something to do with the fact that Baby B is often stuck up under the ribs!

MoDi twins share a placenta (chorionic sac) but they are each in their own inner amniotic sac divided by a thin membrane. This is one of the most confusing type of twins to explain to others as most people only ever hear of sharing an amniotic sac. People think that determines whether the babies are identical or not when it really comes down to the chorionicity.  The doctor will look for the membrane separating the babies as well as the "horn" found when a placenta fuses to determine if they might be fraternal or identical.

MoDi pregnancies are usually treated as moderate risk as they may suffer from Twin to Twin Transfusion Syndrome (TTTS), Twin Anemia Polycythemia Sequence (TAPS), Selective Intra-Uterine Growth Restriction (SIUGR) and preterm placental degradation among other things. They should be monitored at least bi-weekly until week 30 and then weekly and should not be allowed to progress past 36 weeks (+/- 6 days) without daily monitoring due to the risks. Things can go very wrong very quickly and not only lead to a traumatic birthing experience but fetal demise as well.

As far as science knows identical twins DO NOT run in families - so it doesn't matter how many twins you or your husband have in your family. It is completely up to chance whether your egg will split.Although many modi dads will joke that their super sperm did it. Who knows? Thanks to this, identical twins are often called, affectionately of course, freaks of nature.

Monochorionic Monoamniotic (MonoMono/MoMo or MCMA)

MoMo twins occur when the egg splits later, usually 6-8 days after fertilization. These twins are separate but share everything and are always identical (again, mostly in DNA not just looks). They occur in less than 5% of twins pregnancies and are very high risk. Often Mom is on bedrest from as early as 20 weeks and usually will deliver by 34 weeks at the latest. This is because of the risk of the babies being able to touch each other, as well as proximity to each others' umbilical cord. This pregnancy is heavily monitored and may be induced around the 32nd week. Although it is very risky and requires special care that famous image of the twins born holding hands shows the beauty of a MoMo pregnancy.

Boy-Girl Identical Twins

This is a phenomenon that I simply have to address due to the fact that there is SO much confusion out there. There cannot, EVER, be a pair of HEALTHY boy girl identical twins (unless of course one of the pair has undergone gender reassignment surgery). 

There can be twins with a chromosomal abnormality in which one of the boy twins from a split egg develops as a girl when the body drops a chromosome. This phenomenon known as Turner's Syndrome is EXTREMELY rare, although plenty of twin parents will make sure you know it can occur.

It gets even more complicated when you throw in semi-identical, mirror, conjoined twins, there might even be a few that I don't know about, but then it's likely you won't either!

So, do twins really run in your family? What common misconceptions have you heard about twins?


December 21, 2014

FIAO 5.6 - Feeding The Twins - Breastfeeding; with a twist!

I haven't done much research on it yet but I'm beginning to wonder how many women's journeys with feeding their children are as unique as mine. As I've said before I am very indecisive and tend to see both sides of something relatively easily. Just like everything else in my life this has become more apparent in my choices of nourishing the girls. Ten years ago I was anti-breastfeeding. A year ago I was absolutely sure I would do it. Finding out we were having twins originally strengthened my desire to nurse but as their arrival date drew closer I started to freak out. The idea of being a human milk machine terrified me. I pictured days spent glued the couch nursing on and off, bloody and bruised nipples and very little sleep for the first few months.

Ultimately I made up my mind to try exclusively breastfeeding but if it didn't work I would exclusively pump or formula feed if absolutely necessary. I fully support formula feeding but I wanted my girls to have breast milk either way. I was (mistakenly) under the impression that EPing would be easier, less stressful and less time consuming - because who has any extra time with newborn twins at home?  Unfortunately for us I didn't really get to actually make a choice in the beginning. My girls were formula fed in the NICU, with what little colostrum I was able to get to them, from day one. Because of their prematurity they had to learn the suck-swallow-breath reflex and the NICU wanted their feed amount to be documented, especially if we wanted them off the feeding tubes. So I pumped. Then, due to wanting to wean, I supplemented with formula (about 8 oz/day mixed with bm) for about a month total. And then, like magic, at around 3 months my baby girls decided to latch. So now, I breastfeed. Exclusively.

I have literally done it all with the exception of using donor milk or a wet nurse. I am not going to debate the benefits or downfalls of breastmilk or formula (not today at least although that would make a fascinating Great Debate post later on). Instead I want people to understand and learn from my experience.

Exclusively Pumping (for twins!)

For three and a half months, every three hours, around the clock, I hooked my heavy boobies up to a machine and expressed milk because I wanted my babies to have breastmilk. I don't even know why really. Yes, I know people think it's "better" but again I fully support formula feeding and only believe it is "better" for your wallet and because it is natural, as in not made in a factory. Really I figured if I was making it anyway then I wanted my girls to have it. So I pumped. Starting 6 hours after my c-section I was a mad woman about it. I pumped for 30-40 minutes, despite being told never to exceed 20 by numerous nurses and lactation consultants. I figured "oversupply" would not be a concern for me - I had two babies to feed and needed to build a stash!

I pumped while I visited them and all night long as if they were home. It was the hardest thing I've ever done, coming home that night after leaving them in the hospital and having to pump for them. It was also the night my milk came in so I had over 12 oz. to give them the next day which was the first time I really felt like a mom. I bought all sorts of pumping accessories (see links below!) and created the perfect pumping spot to streamline the process. Once the girls were home I fed them and pumped at the same time. It was perfect. They were eating on a schedule of every 2.5-3 hours (although I would have fed on demand they just carried this on the from the NICU themselves) and I wasn't a human milk cow with babies attached to me for days on end. It was the best of both worlds and it worked for us.

After three months, I was over it. I almost quit at 6 weeks, then managed to force myself to make it to 12 weeks when I promptly dropped from 8 to 5 pumps per day, effectively eliminating my middle of the night pumps and stretching my daytime pumps to every four or five hours. I lost about 10 oz. in the process but I was making 70 oz. per day at that point and they were only eating 50 max so it was fine. At 14 weeks I was absolutely ready to start weaning. We supplemented with formula on and off from the beginning, usually depending on my supply, which varied. I wanted to take in kids soon and definitely could not pump then so we started upping the amount of formula they got, which allowed me to bank a ton of breast milk while slowly lowering my supply to avoid mastitis. Then, at 15.5 weeks Juliette latched for the first time and my journey with exclusively pumping abruptly came to an end.

Pumping and Nursing

I continued to pump for about a week but would try to nurse every chance I could. I learned what positions worked best and got myself comfortable with tandem nursing. CJ was a little worried about missing out on his "bonding" time during the evening feeding, which he often did on his own while I pumped and had some me time. However, something unexpected was happening: the more I nursed, the more I wanted to nurse. Then we started to notice something strange about the girls' behavior after nursing vs. after a bottle. They never seemed full or satisfied after their bottle - even when we upped their oz. to 5 or 6 in one feeding. We knew they weren't still hungry but still they would cry or suck aggressively on their pacifiers. They do not do this after nursing. They decide when they're done but at 4.5 months never nurse for more than 25 minutes and they are always content after - either sleeping or playing. So we decided to drop bottles altogether. I now pump only if someone else is with them and they've had a bottle recently. Sometimes I will pump if I am engorged before bed for comfort but I can now go 9 hours overnight and wake up pain free or nurse at 3am if necessary. I pumped tonight for the first time in 10 days as we were out to dinner (first night out as a couple since they came home!) and they were asleep for the night when we got home.

Exclusviely Breastfeeding

My experience with nursing is far from typical so I won't even attempt to give advice on how nurse a newborn. It took three months for either of my twins to latch, despite many futile attempts in the beginning. I admit I wasn't pushing it after a few weeks, just trying it when I thought of it. But the closer I got to ending my pumping journey the more I wanted to experience it - even just once. And at 13 weeks, Vivienne latched first followed by Juliette at 15 weeks. I was shocked. Not only was it easy but it felt so much more natural and comfortable than the machine that had been tugging at me for so long. I didn't feel that "bond" instantly although I have a new appreciation for the closeness it creates between mom and baby.

The major plus for me does not apply for moms who start out nursing twins - time! My girls were already sleeping for 6-8 hours at night and were eating on a 3.5 hour schedule by the time we started so I only nursed 6-7x/day. Some of my other twin mom friends nursed upwards of 15/day in the beginning - per baby! The girls were already 10 lbs. so learning how to tandem feed was much easier than weeks ago when I was trying to position two five pound china dolls on the My Breast Friend pillow in the NICU.  Their suck was strong due to months of practice and they already knew what to do and how to do it - things they originally had to learn thanks to initially eating formula with a tube and then a bottle. Feedings were peaceful and quick - 20 minutes max compared to 45 with a bottle due to needing to burp more and holding upright after finishing.

And then of course the amount of time I saved making, warming and cleaning bottles. It was so much easier to just pull down my shirt and feed my kids than to do all that. Again, I know our transition to exclusive breasfeeding was unique in that it was easy and for that we are so grateful. I also know for a fact that it was only so because I stuck it out from day one and did the dirty work keeping my supply up - and then we got lucky with two little late latchers. Now we have really found what works for us. For now.

Not all babies will latch. Not all mamas will produce enough (or any, in some cases). Not everyone is comfortable with it and, simply put, not everyone wants to do it. But if you can and want to do it then breastfeeding (with breast or a bottle) is so worth it. I know when it comes down to it feeding twins is hard, no matter how you do it, but having done it all I have learned some things worth sharing.

If you want/need to Exclusively Pump:

If you can't nurse for whatever reason but want your children to have breast milk, are worried about affording formula or want to be able to nurse in the future then get educated and start pumping! Here's some tips to get you started:
  • Invest in Pumpin' Pals and a hands-free bra or necklace, like the Simplicity from  LactaMed. Or make your own by cutting holes in a sports bra.
  • Get your hands on a hospital grade pump to build your supply. Call your insurance company ASAP and find out what they provide.
  • Learn about massage and compression - it makes a huge difference. 
  • If your baby is in the NICU look at a picture of him or her while pumping at home.
  • Commit to 7-9 pumps per day around the clock for at least 20 minutes for the first 12 weeks. This will establish your supply and then you can drop pumps as desired until you start to see supply drop. 
  • Research galactagogues and try them until something works if you need a supply boost - I had great success with Bob's Red Mill Five Grain Cereal as well as drinking a dark beer just before or while pumping.  
  • Pick a few shows to watch on Netflix during MOTN (middle of the night) pumps. 
  • Rub excess milk into nipples after pumping - it is great for soothing sore nipples and healing any other skin issues.
  • Drink a TON of water, eat a TON of food (do NOT worry about reaching your pre pregnancy weight but focus on fattening up that bundle of joy!)
  • Continue to try to latch your baby - you never know when they will get the hang of it, but also it is a great stimulant for your nipples and will help you produce more. 
  • Join the facebook group Exclusively Pumping Group and the Babycenter board The Exclusive Pumpers. The support is vital to making it through this journey.
  • Learn the signs of and how to handle clogged ducts, mastitis, thrush and nipple blebs (those are super fun. not.)
  • Do not ever feel bad if you have to supplement with formula or donor milk.
  • Most importantly: do not let yourself believe for one minute that you are giving your baby less than a nursing mother does. You ARE breast feeding and if anything your journey will be bumpier and more exhausting than nursing but it is so worth it if it's what you want.

If you want to nurse:

Again, my experience is unique as I did not nurse my newborns but I have learned a few things:
  • RELAX. Baby feels your stress and gets stressed and will not latch or stay latched if they are anxious. Remind yourself that even you cannot force your baby to latch. Also, once a baby has latched you cannot force them to stay and drink. You can only provide a calm, safe place for baby to eat. They will decide when and if they will do so.
  • Try out every possible nursing position in every place to find the ones that work best for you. I prefer tandem nursing on the couch and side-lying nursing in bed because I can rest too. Neither of which I was comfortable doing without practice and patience.
  • Invest in coconut oil for sore nipples (this actually applies to both pumping and nursing).
  • It's worth repeating: Drink a TON of water, eat a TON of food (do NOT worry about reaching your pre pregnancy weight but focus on fattening up that bundle of joy!) 
  • Ask for help at the first sign of difficulty. Often women have no idea why it's not working and feel so defeated that they give up and regret it later. Whether it's a poor latch due to a tongue tie, low supply or fast letdown there are things you can do to help. Talk to an IBCLC or contact your local La Leche League. WIC also has lactation consultants on hand. The support is out there, you just have to look for it.
  • If your baby has been exposed to a bottle first invest in a nipple shield. They can help ease baby into nursing without too much of a battle at the breast.
  • Again, do not feel guilty if you have to supplement or switch completely to formula. 

If you want/need to formula feed: 

I've only done it for a little bit so far you but if you do need to supplement or choose to formula feed here's my advice:

  • If you're supplementing figure out which way of giving it works best, whether you have one bottle a day or mix it through out the day with bm. No baby eats the same way as others.
  • Don't just assume any brand will be fine, even those with similar make-up. Cheap isn't always good. Neither is expensive.
  • Do your research on formulas and find what works best for baby and your budget. 
  • Ask your doctor for samples. More often then not they are more than happy to give them to you.
  • Email and write to baby companies letting them know of your arrival for samples and coupons.
  • Do not buy all of one bottle until you know for sure your baby will drink from it and you won't lose your mind cleaning them.
  • Learn the signs of reflux and allergies as many babies can have difficulty keeping a bottle down for a number of reasons leading to miserable nights and more than a few ruined clothes.
  • Do not ever let anyone make you feel guilty for feeding your baby formula and do not feel the need to justify yourself to anyone. If they judge you they are the ones with the problem, not you. Be educated and confident in your decision. Own it.
The most important thing I have learned in all of this? Do not judge a parent for how they feed their child. Just because you see a baby with a bottle does not mean they aren't breastfed. Just because a baby is formula fed does not mean Mom didn't want to breastfeed or is lazy or doesn't love her baby as much. Nursing is amazing. Pumping is incredible. Formula feeding is awesome. Because at the end of the day as long as you are feeding your baby, you're doing the best thing for your baby.

How did you feed your baby(ies)?


December 5, 2014

FIAO 4.5 - Healthy Twins, Happy Family - Four Month Check-up

We had our four month check up and immunizations today. Juliette is 11 lbs. 10 oz, 24 in. long and Vivienne is 11 lbs. 8 oz., 24.25 in long. They have almost tripled their birth weights and are developing beautifully. Our PA, Joanne, is thrilled with their size and strength. She was so happy that I am now able to breastfeed and so proud that I kept with the pumping until it worked for us.

The girls were angels for Joanne like always and everyone in the office is starting to recognize us. We find out later in the month about Juliette's kidney so we talked a bit about that and then they had their immunizations. We are so lucky their reactions have been mild. They are always sleepy but no fevers yet or any tears from the pain. I even did a little Christmas shopping tonight and C stayed home with them. We are having Christmas with his family on Sunday so I picked up all their gifts, just photos of the girls with them from the blessing. We're not doing anything too big this year as funds are tight.

We cleared out the dining room almost completely so after the get together I'm going to start setting up my "lil' daycare", as we're calling it. If nothing else it will be the girls' playroom as they're quickly outgrowing our tiny living room!

I can't believe the next time we go back for a check-up they will be six months old!

It's been amazing so far!