Wednesday, November 25, 2009

Baby Julia is home - our trio is complete

We finally have all three girls home! As you can imagine, we're trying to find a routine, getting to know each baby's personality and cues, and generally just settling into the schedule the NICU used. It's a zoo, but we are enjoying every minute of having them home.

I often walk into the nursery just to stare at them while they're sleeping. I still can't believe I have three babies - it just feels so amazingly surreal sometimes.

We're feeding them breast milk by bottle every three hours (10, 1, 4, 7), and I'm pumping breast milk every three hours, around the clock. It's been going really well. I've fallen even more in love with my husband who smiles at, talks to, and cuddles his babies at 4 am - after very little sleep. He is doing most of the work at night so I can get a little more rest before he goes back to work next week. For the past few nights, my parents have done the 10 pm and 7 am feeds solo, which have helped tremendously.

The girls have all had their first pediatrician appointments. Julia weighed in at 2.2 kilograms yesterday. Julia and Emma have to be screened by an opthalmologist for retinopathy of prematurity, and breech babies Ada and Emma have to get hip ultrasounds. Between scheduling the home health nurse visits (2x per week for 2 weeks), the pediatrician appointments, the opthalmologist and ultrasounds appointments, I'm struggling to keep track of it all. I guess I better get used to the idea of the girls having a busier schedule than I do!

Saturday, November 21, 2009

Baby Emma's homecoming

Emma came home on Thursday and everything has been going well with having two out of three babies home. When we swaddle Ada and Emma and lay them down in the crib together (spaced apart), they turn their heads towards one another, without fail. It's the cutest thing in the world to witness, especially after they had been separated for four weeks in the NICU. They definitely take comfort in one another's presence.

We are hoping to bring Julia home on Monday. The NICU was ready to discharge her on Thursday, but then a vigilant nurse spotted Julia's distended stomach. Fortunately, she doesn't have an infection, which was our primary concern. Since then, Julia has had a few desats, so it's better for her to be 100% before coming home to be with us and her sisters.

We can't wait to have our full house!

Tuesday, November 17, 2009

MoM postpartum update

I was worried about triplet pregnancy weight gain (and subsequent postpartum weight loss).

During the pregnancy, I gained approximately 50 pounds. Even though it's on the lower end of what Dr. Barbara Luke recommends in her book, "When you're expecting twins, triplets or quads," the girls were always right on target with their growth, which eased my fears about not gaining enough. I tried my damndest, but just couldn't stomach that much food.

While I was still hospitalized and recovering from HELLP Syndrome, I was making my way to the NICU when I spotted a scale in the hallway. Ha! I thought. This will be an amazing little experiment. I stepped on the scale, expecting to have dropped 12 lbs or so in four days. Wrong!

Turns out HELLP Syndrome made me swell up like a lead balloon. Even though I had given birth to a 3 lb 15 oz, 3 lb 14 oz and 3 lb 13 oz baby, their placentas, etc. I was only TWO pounds lighter than before the C-section. Shock! Horror!

Fortunately, as the edema subsided, and I pumped breast milk, the weight fell off. Now, 24 days after delivery, I've lost 45 of the 50 pregnancy pounds. My stomach is nowhere near what it was, but it's getting there. And bonus: no stretch marks!

I know it sounds stupid and vain, especially given how blessed we are with healthy triplets after infertility. The battle scars would have been worth it, but I'm pleasantly surprised and grateful to still have some semblance of my body after what it's been through.

NICU news and an update from the home front

If all continues to go according to plan, Julia and Emma will be coming home together on Thursday! We are beyond excited to have them all home with us. They will be moving to open cribs tomorrow, and I will be spending the day with them at the NICU. (Dad will stay home with Ada.)

Ada's first ped visit went well today. She now weighs 2 kg (up from 1.875 on Saturday) and is 17.25 inches long. She is nowhere on the full term singleton growth chart (just a lonely little dot way beneath the lowest curve), but the pediatrician is not concerned given she arrived 7 weeks early.

Ada and Emma are both breech babies and we will need to schedule an ultrasound to check whether their hip joints developed properly. If it didn't, they will need to wear a harness. Other than that, we are fortunate to have three healthy preemies so far.

We love having Ada home with us, caring for her, cuddling her. We're starting to see a glimpse of us as a family. She has the sweetest, funniest facial expressions that regularly crack us up. We talk to her, snuggle her, give her updates about her sisters - and every so often I have to pinch myself that our dream came true. Here I am: a mother, holding one of MY babies, one of OUR babies. And the realization is omnipresent: ugly, imperfect embryos really do make beautiful babies (as my RE consoled me on the day of our second transfer, when I thought all hope was lost.)

The surgeries, IVF cycles, pregnancy and postpartum period have all been extremely stressful. Even though I'm sleep deprived now - and will continue to be for many months - a heavy weight has lifted. The uncertainty of infertility and the risks of a triplet pregnancy have evaporated, leaving just the "normal" fears of any new mom of multiples.

It's still pretty unreal that Julia and Emma will be home in two days. We can't wait to start our crazy new life, with all three of our miracle babies home with us.

Monday, November 16, 2009

NICU update - Day 23

Wonderful news from the NICU today: Julia and Emma are both progressing beautifully. They are each drinking 31 ml of breast milk every three hours. Their nasal cannulas and Julia's IV have been removed, and Julia is no longer receiving phototherapy. Yay for not being hooked up to Vapotherm, hyperal and intralipids! Freedom.

Dad went to visit his two baby girls in the NICU today while I stayed home with Ada. My dh reports that they're still in their isolettes, but I'm sure the next step is to switch it to air and see if they can maintain their body temperature. Hopefully by the end of the week, we'll have at least one more baby home, if not both.

Ada is doing great at home. She's such a sweet, content baby. Ada is sleeping in her own crib in the nursery, and has adapted well to the new sounds and smells of home. We have her on the same 3-hour schedule the NICU used: 10, 1, 4 and 7 day and night.

Thank you for all the wonderful comments and good wishes as we're bringing the girls home one by one. Each comment is appreciated and means the world to us. The girls are fortunate to have so many friends rooting for them. While you're cheering us on, my thoughts are with my brave friend Kate, who had her ET today. Dear Kate, if you're reading this, just know that I'm sitting with you, willing the universe to work its magic.

Saturday, November 14, 2009

Baby Ada is home!

We brought our precious little Ms Ada home with us tonight. It is an indescribable feeling to know she's sleeping soundly in the next room. We are so excited to have her home and can't wait for her sisters to join her.

Before Ada was discharged, we were able to hold all three of our babies together for the first time. They were all moved to one area of the NICU two days ago, but since Julia and Emma are still on nasal cannulas, and Julia is still receiving hyperal and intralipids through her IV, it has been impossible to hold them all together. We've spent plenty of 1:1 time with each of them, though.

Julia and Emma are both drinking 20 ml of breastmilk every three hours. Emma pulled her IV out and even though she didn't quite get to the 24 ml of breast milk threshold, the neonatologist opted to wean her from the hyperal and intralipids early. She's done phenomenally well and has leapfrogged Julia. The prediction at this point is Emma might be coming home later next week.

Julia has had a few setbacks and is back under the phototherapy lights. There have been a few dsats today that she didn't recover from by herself, so she is still receiving oxygen and Vapotherm (4 litres). The neonatologist predicted she may be in the NICU for another couple of weeks.

Thursday, November 12, 2009

Crying over spilled milk and other postpartum adventures

In terms of being pregnant with triplets, I've had it pretty easy: no hospitalized bed rest and no major complications other than cholestasis and thyroid issues. However, the maternity gods have decided that I shouldn't get off scott free.

I developed post partum HELLP Syndrome while I was still in hospital and naively thought I had paid my dues. A week after I delivered, I developed a low grade fever. I phoned the on-call doc who asked me a bunch of questions and he pretty much dismissed it since there weren't any other obvious symptoms. So I happily waited until the routine follow-up with the peri three days later. Turns out my body was so run down that I had developed shingles. Lovely. And my blood pressure was sky high again.

Thankfully, the la.betalol helped bring my blood pressure down, but the shingles... well, that I'd just have to ride out with a little help from my friend Val.trex.

Since the rash is near my breast, the neonatologist and infectious disease specialist at the NICU advised me not to breastfeed, and to "pump and dump" the milk from that breast. Additionally, I have to express milk from one breast at a time, taking great care to disinfect everything.

Now I know this doesn't sound like a big deal, but trust me. When you're pumping for an hour every three hours throughout the day and night, and then dumping half the milk, it's just heartbreaking. They say it's no use crying over spilled milk, but I've been doing just that. It's been pretty demoralizing, but I know it's to keep my babies safe.

I was still struggling to come to terms with the fact that I had shingles and couldn't breastfeed when the C-section incision started bleeding. Hmmm, I thought. I had probably been overdoing it. It was just a trickle on Saturday and I had a follow-up scheduled for Monday morning. I wasn't worried. But by Sunday night, I couldn't keep up with changing the gauze. By Monday morning, I was gushing blood, soaking everything. I couldn't get out of the shower without being covered in blood. My husband had to put pressure on the incision so I could get dressed. Even so, I had to get dressed twice, but by the time I made it to the car, the blood was everywhere again. And we had an hourlong drive ahead of us... I contemplated a detour to the ER, but figured I'd be waiting more than an hour anyway. So we drove.

There was a flurry of activity when we arrived at the perinatologist. They ushered me to the back and used scary words like, "hematoma," "we may need to open you up again" and "infection." Despite the blood bath, I'm fine. Fortunately, the large hematoma that had formed behind the incision seemed to be draining outwardly (no kidding!) The peri pushed on the incision (yikes, that hurt!) and opened it up ever so slightly in an effort to help the hematoma along. It looked like a massacre, and I'm not exaggerating.

They sent me on my merry way with a Rx for antibiotics. It had looked like this would end badly, but the bleeding has slowed significantly and the antibiotics have done their job. Hopefully the maternity gods are happy now.

Sunday, November 08, 2009

2 weeks old - NICU update

She is still on 2 to 3 litres of vapotherm and 30% oxygen. Her feedings have been increased from 3 to 6 ml of breast milk every 3 hours. The goal is to get her to 24 ml so she can be weaned from the IV feedings. A chest x-ray showed she has fluid in her lungs. The neonatologist said the hyperal and intralipids increase the retention of fluid, so they will be trying hard to get her to 100% breast milk asap. She is out from under the phototherapy lights!

She now weighs 1,902 grams (4lb 3oz). Like Julia, she is taking 6 ml of breast milk every 3 hours. She is on 4 litres of vapotherm, but is breathing room air. She is no longer receiving phototherapy.

She has moved to the stepdown nursery and is drinking 15 ml of breast milk every three hours. She still has her IV, but they're increasing her feeds of breast milk every shift. Once she takes 24 ml of milk every three hours, her IV will come out. She hasn't had any dsats or bradys. Her bilirubin level is up to 10.8 from 8.1 two days ago. They will check it again tomorrow. She might be coming home by this weekend if she's able to hold her temperature in an open crib, keep her blood sugar up, tolerate the increased feedings without spitting up, have no dsats or bradycardias, etc.

Sunday, November 01, 2009

One week old - NICU update

All three girls are now receiving gut stim "practice feedings" of 3 mls of breast milk three times a day. They're lovin' it! I can't believe they are already a week old.

She had been struggling the most, but is progressing wonderfully. Emma has moved to an isolette, just like her sisters, and has finally been taken off the ventilator. She is sporting a nasal cannula and breathing room air. While I was pumping, my husband was able to witness the gut stim in process. He reports that she was fussy, but the moment the breast milk hit her tummy she settled down. He took her temperature, a perfect 36.8 C, and was able to touch her head as the nurse unhooked her from all of the monitors. I held her for the first time today and it was just amazing to see her little face. She was wide awake, staring at me and her dad and seemed to really enjoy being swaddled and snuggled. After about 30 minutes, she was wiped out and needed to return to her isolette and the bilirubin lights.

She is no longer jaundiced and the bilirubin lights have been switched off. Her isolette is now covered with a pretty blanket to mimic the muffled, darker environment of the womb. For the second day in a row, her heart murmur couldn't be heard, so it seems as if the three doses of meds worked its magic.

Her nasal cannula has been removed and she is breathing room air. Ada is still under the bilirubin lights for jaundice, but doing terrific in every other respect. Her heart murmur can still be heard, but we hope it will resolve on its own. I had a chance to hold her for the 2nd time today. She was wide awake and stared at me. Like Emma, her eyes turned toward her dad whenever he spoke. It was lovely seeing her more comfortable, and receiving no breathing assistance whatsoever. Real progress!