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Breastfeeding Triplets: A Battle of Love {Guest Post}

KangarooingTriplets

**The response to this post has been overwhelming! I truly hope it is helpful to others to hear the struggles and victories of a mama who is able to breastfeed – against many odds. Please take a moment and “like” us on Facebook so that you can stay up to date with the goings-on here at Growing Up Triplets! And leave a comment to say “hey!” =) **

Today I’m guest-posting over at Intoxicated on Life. Trisha is running a series on breastfeeding – the challenges, joy, obstacles, paraphernalia and stories of dozens of women and their children. And she asked me to join these women and share my journey. If you’ve been reading Growing Up Triplets long, you know sharing what God has done for me in this area is one of my biggest joys. So here’s a mini-bite:

There are times when mathematics simply don’t make sense. For instance, I remember crying and crying over short division in school. It didn’t make sense. And I had similar experiences over the past two years with three babies and two breasts. It just didn’t compute.

You see, I was told on April 26, 2011 that I was carrying triplets.

Immediately I began seeing my dreams of a drug-free, home birth evaporating. I saw many, many dollar signs floating before my eyes. I saw a plan unfolding for my life that I wanted no part of.

Well, as the news of spontaneous triplets sunk in, and my love for my three munchies grew to epic proportions, I began to research if some of those dreams might actually still be possible. There was very, very little research out there for higher-order multiples (HOMs). With the advent of fertility assistance, the numbers of triplets and HOMs has risen dramatically, but the research is still very minimal. Most books for multiples are written geared towards twins. But…I had three babies and only two boobs! Even my very logical brain couldn’t develop a plan for this!

The research I did find led me to believe it wasn’t likely I’d be able to nurse all three, but that switching two out every feeding would be more realistic. So I grabbed onto that: I can do that. Ha. Little did I know what awaited me.

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What To Expect – In the NICU {an interview, part 2}

Welcome back! We’re discussing what parents can expect during a NICU stay and are interviewing a couple of wonderful nurses our babies had during our stay. If you missed Part 1 of this interview, you can catch up really quickly here. All caught up? Great! Ok, let’s jump back in:

Laura and Mandy

Laura is above. Mandy is below, with the newest addition to their family: Ainsley!

So how beneficial is kangaroo-care, really?

Mandy: Very beneficial! It can contribute to a decrease in hospital stay for your baby(ies). Just ask the nurse if it is a good day to hold your baby. There are some days where it is not the best day or time to hold the baby due to medical reasons, such as excessive apnea/bradycardia spells, recent work up for infection, general instability, blood transfusion, etc., so it is important to ask the nurse caring for your baby if it is appropriate to hold your baby that day.

What do parents do if the nurses say they can’t touch or hold their baby(ies)?

Laura helping me give Noah a bath for the first time - under the warming lights!

Laura helping me give Noah a bath for the first time – under the warming lights!

Laura: There will be times this request is made, occasionally after a stressful day for the babies, due to a medical procedure or situation. Your baby may need a period of rest. Ask when it will be advisable to hold the baby again. And if you feel the current situation doesn’t warrant a no-touch time, feel free to ask the charge nurse for another RN to check into the situation. This way, even though you may really want to hold your baby, you can feel confident that for the time being it is best that the baby rest undisturbed. While touch can be SO beneficial, there are times when it can physically evoke stress responses, visible through the baby’s increase in heart rate, respiratory rate, blood pressure, and oxygen saturation.

Mandy: I agree – usually there is a good reason if the nurse asks you to not hold your baby that day. Most times it is still ok to touch your baby. There are ways to touch a preemie without disturbing them (talking very quietly, minimal stroking or “petting”, etcc) and your nurse can teach you how to appropriately touch. It is important to remember that they might look tiny and cute, but they are very sick and this should be respected.

If a mom plans to breastfeed, what can she do if the baby is too early to breastfeed?

David giving a bottle - before we knew what we were doing!

David giving a bottle – before we knew what we were doing!

Laura: A lactation consultant and/or your bedside nurse will work with you to facilitate education regarding pumping breast milk.  Breast milk will always be a first choice. Initially it may be through a feeding tube that is inserted through the nose or mouth that leads to the stomach. This may look and sound scary but this is very common early on in the NICU. As the baby grows, a nipple can then be introduced, typically a bottle and then the breast, as the baby is ready.

Mandy: Breast milk is crucial for premature babies to receive. In fact, if the baby is born less than 1500 grams (or less than 30 weeks) and the mom is unable to provide breast milk, we use donated breast milk for the babies! Early feedings are very important for the babies, and breast milk helps them to tolerate these early feedings much better. There are antibodies in breast milk that cannot be found anywhere else. These antibodies help premature babies, who have a very lowered immune system (think: chemotherapy patient), to fight off infections. Infections are one of a premature baby’s most common complications.

But the babies are so tiny sometimes. What can a mom do if she can’t figure out breastfeeding?

One of the nurses feeding one of the babies while David and I fed two others - it took all of us!

One of the nurses feeding one of the babies while David and I fed two others – it took all of us!

Laura: Breastfeeding a tiny baby is going to be a journey! Together with your nurse and lactation, we will help as much as we can, based on the baby’s abilities at the time. As the baby grows and you become more comfortable, the process should become increasingly more successful. This may take months. Pump as you can to maintain your supply, and practice frequently with the babies. Lactation appointments after discharge (NICU baby or not) can be very helpful in supporting this oh so wonderful, but delicate process.

Mandy: We are here to help! Premature babies have the added challenge of not having the innate process of sucking, swallowing, and breathing in proper order yet, and must also learn how to complete this task. Breastfeeding can be harder for a premature baby initially, because it is more work to learn how to latch, and they have to produce more negative pressure with their suck to extract the milk, whereas the milk from a bottle comes out much more easily. However, it is much easier for a premature infant to breastfeed, once these tasks are learned, due to the fact that they are able to regulate the flow of milk coming out much easier while breastfeeding. I have found that it is a much slower start, but breastfed babies tend to learn how to eat faster than all bottle fed babies, due to the positive experience they get from it. Be available for feedings as often as possible, as the more time at the breast, the sooner it will be learned. Initially, the baby will only be eating once a day, then twice a day, etc. as they do better with it, so be sure to tell the nurse you are interested in breastfeeding for those sessions. Bottles will be used to supplement afterward, and for any feedings where the mother is unavailable. But again, any time at the breast is a learning experience, and the more, the better.

What happens when the parents aren’t there?

Laura: This is a hard thought, I’m sure. Having to walk away from your tiny babe will be one of the hardest things, every.single.time. But my, oh my, your baby has a skilled set of caregivers…the best baby sitters you will ever have! Your baby will continue to feed every 3-4 hours, receive needed therapies, treatments, and medications. Most hospitals also have volunteers whose job is to cuddle babies when they are in need of some TLC. You are also welcome to call at any time of day for an update on your baby!

Mandy: Also, assessments are completed every six hours on your baby (blood pressure, temperature, etc.). We change diapers every 3-6 hours, depending on how stable the baby is (the less stable the baby, the less frequently we will be touching them, in order to provide rest). If anything extremely out of the ordinary is going on with your baby, we will contact you.

As a NICU mom, I think one of the biggest unspoken questions I had was “do you enjoy taking care of my babies?

My NICU Visitor stickers for nearly a month!

My NICU Visitor stickers for nearly a month!

Laura: YES! So much. As mentioned above, this is a common thread among NICU nurses. We love our babies, and even become protective over them and their well-being. We want to see them grow and thrive! NICU staff turnover is the lowest in the hospital; it’s said once you go NICU you never go back.  This is not to say you will love all of your nurses, or feel everyone is super friendly, all the time.  I hope that’s your experience, but know that even nurses I didn’t care for personally as coworkers— are still people I would still trust with my baby.

Mandy: Most all of the nurses in NICU have a true passion for what we do, and love our job (or we wouldn’t be there!). Take comfort in knowing that we treat your baby just as we would our own, and really invest our hearts and souls into the care of your baby…and you. Your bad days are our bad days (even if we have our professional mask on). Yes, we go home and cry – we feel your emotions, too. We laugh with you, cry with you, worry with you. We feel these things because we love what we do!

Lastly, what is one thing you wish you could broadcast to every parent going into the NICU?

Our First Family Picture!

Our First Family Picture! The babies were one week old!

Laura: Ok it’s more than one thing… (1) Pray hard. This is a time where you will quickly realize that any control you thought you had is totally gone. Trust your baby to the Lord. (2) I am always encouraged when I see families on the other side of the NICU, with toddlers running around. It warms my heart so much, and reminds me why I do what I do. The NICU experience can be intense, and life changing – for sure—but it is a season. It will not last forever. (3) Be cautious of what you research online and whose stories you listen to. Every experience is SO different, every baby comes with unique circumstances— and, chances are, the way things played out for someone else’s baby is not going to be your story.  Work closely with your caregivers to receive the most accurate information about your baby’s specific circumstances. Family meetings are available for further discussion and education—you can get good one on one time with the provider this way.

Mandy: Take it ONE day at a time! It is going to be the wildest rollercoaster ride of your life, but taking each day as it comes helps to deal with it better. The nurses and doctors are here for you, and it’s important to remember that we are on your side. Please ask lots of questions (write them down as you think of them) if you don’t understand anything, instead of keeping it inside and letting it upset you. We are here to help, and want to help! Be there for your baby any way you can, but also try to get away to keep yourself emotionally centered.

Wow! I hope this interview is helpful to you (feel free to share with others who are in the NICU or may be entering a NICU stay!). This has brought back a flood of memories, some good and some bad. But they are parts of our babies’ lives – parts of our lives as we learned to trust God in new ways. Mandy and Laura were two of many wonderful nurses who made our month-long stay just that much easier.

Thank you so much, ladies, for serving countless families by taking the time to do this!

The babies at Easter - 18 months old!

The babies at Easter – 18 months old!

Were/are you a NICU parent? How did a nurse affect your stay? I’d love to hear your NICU stories!!! Or do you have a question for Mandy and Laura?

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What To Expect – In The NICU {an interview}

Thanks for joining us! We are currently in the middle of a series on Life with Multiples. Today we’ll hear from a couple of ladies who just happen to be two of my favorite nurses while the babies were in the NICU!

While in the Neonatal Intensive Care Unit, a good nurse is more than just a good nurse. She might be a shoulder you cry on, the person you (unexpectedly) share first milestones with, and most likely will become a good friend. Mandy was the babies’ nurse the day we celebrated them turning one week old. And Laura helped me give each of my 4-lb babies a bath for the very first time.

M

Emma, Noah, Makenna

David and I were at the hospital as much as we could be, so we got to know our nurses really well. We were usually there over a shift change, going to eat dinner while they did all the technical stuff and coming back in for one last feeding and diaper-changing. I usually spent a good 8 hours every single day at the hospital – for 30 days. Exhausted beyond imagination, David and I prayed over each baby and said goodnight…and thanked the men and women who remained to care for them. This was one of the hardest things I have had to do as a mom. Who imagines they’ll have to leave their tiny babies’ sides?! Even now it brings tears to my eyes as I remember all the different nurses who loved on and cared for our babies.

We tried to prepare for what life in the NICU would be like but there were so few resources available to us, even a couple short years ago! And they were often written in very clinical terms; so I want to give a more personal look into life in the NICU.

Laura and Mandy, thank you so much for taking the time to share with us! How long have you been a nurse and what is your favorite aspect of being a NICU nurse?

Laura was a precious nurse!

Laura was a wonderful nurse!

Laura: I’ve been a nurse for four years. And I love babies – especially newborns. I really enjoy working with families and educating them in terms they can understand during this difficult process. I love giving them a chance to be as involved as possible in their baby’s care – from feeding to bathing etc. I think this is so important, especially in the NICU!

Mandy and the newest addition to their family - Avery!

Mandy and the newest addition to their family – Ainsley!

Mandy: I’ve been a nurse for nine years. And I love meeting new people. My job is never boring. It’s nice to help the families understand what is happening and to help the parents emotionally cope with everything they are dealing with. I really enjoy educating the families on what everything means in the NICU and what they can do to best help their baby(ies) to have the best possible outcome.

As sweet as those newborns are, I’m sure there are many challenging days. What’s the most difficult aspect of being a NICU nurse?

Laura: These babies can, in the beginning, be so fragile. It’s hard to see families leave their baby in the care of others – not knowing how their baby will be doing when they return. No matter how skilled the caregivers, I can’t fathom the feeling of leaving the hospital without my new baby. I have such respect for you Mamas who have endured this day-in and day-out for weeks to months on end.

Mandy: It is always hard to lose a baby, but that is usually rare. I have always thought that we are giving preemies a second chance at life. But if that isn’t God’s will, it is comforting knowing they are no longer suffering.

When parents have an idea they may have some time in the NICU, what are some things they can expect?

Laura: Unfortunately, expectations usually go out the window with the delivery of any baby and the NICU experience is no exception. No one expects to have their baby in an urgent medical situation. But you can expect for your baby to be cared for by a skilled team of doctors, nurse practitioners, nurses, therapists (speech and physical therapy as needed) … and much more. NICU staff all have one thing in common. They will love your baby. The NICU is overwhelming and emotional. Please visit often. Hold your baby. And ask tons of questions.

Mandy: A wild rollercoaster ride. Some days will be the worst of your life and some days will be the best. In the beginning, it is going to be very hard to see everything your tiny baby is going through. But they are the strongest people I have ever seen. Love really does go a long way: I have seen many babies with poor prognoses do very well because their parents are present and invested in their care. The babies feel the presence of their parents and do much better.

I know we were often torn between how much we wanted to be there and how often we could be there. How often should parents visit?

Laura: As often as you can! Babies are very aware of your touch and smells. Some very fragile babies will require lots of rest time in their isolettes. Hold your baby still to allow good sleep and digestion while bonding.

Mandy: Yes, as often as possible! There is evidence that babies who are held and bond with their parents have shorter hospital stays. Kangaroo the baby(ies) as often as possible, as this will regulate their temperature, breathing, heart rates, blood sugar, and pain levels for hours after holding has been completed. Babies who are given kangaroo care daily, generally go home about two weeks sooner than babies who are not held.

I remember there were soooo many doctors and nurses – any tips on keeping them all straight?

Laura: Whew. That’s a tough one. There will be constant new faces at your baby’s bedside, and hopefully everyone is working together as a team, so you can feel confident that your baby(ies) are receiving consistent care. Kindly point out discrepancies that you notice so we can better take care of your little one!

Mandy: This is a tough one. Our unit has over 150 nurses for both shifts, and many doctors and practitioners. I suggest writing down some notes to help yourself remember. As far as identifying who is who when they enter your room, we have badges on that say whether we are a nurse, nurse practitioner, doctor, etc.

Sometimes it happens: parents want to request a different nurse. What’s the best way to do this?

Laura: Ask to speak with the charge nurse or assistant nurse manager. If you don’t feel comfortable asking this of your current nurse, you could ask the receptionist to connect you with the charge nurse.

What if parents really love a particular nurse – can they request she be assigned to them again?

Laura: Yes, please ask. Different hospitals have different policies, but I think it is beneficial to the families and babies to see that familiar face in a caregiver. This may not always be possible, but when it is – it is a plus! Ask to speak with a charge nurse or assistant nurse manager as they can help with this!

Mandy: We always love to hear positive feedback! Some nurses do not care to have one assignment every time they are working, so do not take it to heart if they respectfully decline. There was a time after I had lost a patient where I did not want to get attached to another patient and didn’t want to “primary” for a while. Everyone has their reasons, so don’t be offended if the answer is no.

The language in the NICU is so hard to comprehend! How can parents understand what the doctors and nurses mean when using all those abbreviations and medical terminology?

Laura: Abbreviations and medical terms are like a whole new language and, no doubt, stressful to try to understand! As nurses and doctors, we are around them all the time and often forget it sounds like we are speaking another language. I try very hard to educate my families regarding terms and treatments their babies receive – in words and descriptions they would understand. Please know you can always ask your healthcare provider to explain things with which you are unfamiliar. Here’s a link to some common terms and abbreviations you may hear.

Should parents sit in on rounds and review their baby’s chart?

Beginning to learn how to care for our tiny 3.5 pound babies!

Learning how to care for our tiny 3.5 pound babies!

Laura: When possible, and offered by the staff, by all means be involved in rounds. As the parent at the bedside, who spends lots of time with your child and who sees a variety of different caregivers, you can bring valuable feedback and information to the practitioners. This process should hopefully give you a chance to offer feedback, share your thoughts, answer questions you may have, and maintain continuity in the care your baby receives.

Mandy: Yes! Rounds in our unit take a few hours to complete. But you are most definitely welcome and encouraged to attend rounds, and ask any questions you may have. If you would like to review your baby or babies’ charts, you can do so at any time, you just need a nurse present with you to be able to access the chart, and to answer any questions you may have about what you are looking at.

I hope this provides a glimpse into life in the NICU and proves helpful to you and your family. Join us next week as Mandy and Laura share on the very important aspect of practically caring for these (oftentimes) tiny babies. In the meantime, do you have a question for either Mandy or Laura? Or a wonderful experience with your baby’s nurse to share? We’d love to hear!

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