Tuesday, September 30, 2008

Upswing

Are you ready for some good news? For a change?

Henry has really gotten the hang of nursing! He just seemed to "click" with the idea of sucking and swallowing (and breathing) and has had a very good run of oral feeding. He got his first bottle at 1 a.m. last night and he did very well at that, too. The nurse practitioner who is in charge of Henry's case said that if he continues to do well he may be ready to come home this weekend. Did you catch that? This weekend.

I'm bringing in his car seat when I go in again this afternoon. Preemies need to have a "trial" in their car seat, hooked up to monitors for a period of time (15 min? 20 min? I can't remember what happened for Thomas). They want to make sure that their position in the car seat doesn't cause them to have apnea spells. Henry will also have another scan where he will be hooked up to very sensitive monitors for 24 hours and the doctors will see if he's having spells of not breathing or dropping their heartbeat that are too brief for the regular monitors to catch.

If he passes all of these tests, then he will finally be discharged and allowed to come home. Our house, of course, isn't anything to look at right now and is causing me more than a fair share of stress as the end of our remodel keeps getting pushed back. Everything is in disarray as we wait for the end of this (horrible) project. But I don't want to think about that right now. All I want to think about is that our time at the hospital may be coming to an END!

Hooray!

Tuesday, September 23, 2008

Temptation

Henry is learning to nurse. They want to give him a week to get breastfeeding established before beginning oral feedings with a bottle. Preemie babies don't experience nipple confusion the way a full-term baby will if you give them practice at breastfeeding first. They want me to come to the hospital for two feedings a day.

First, let me say that Henry has been doing very well for a wee 33 week preemie. He's latched on, mastered breathing and sucking as well as sucking and swallowing. He is an Olympic master. Someone should raise the American flag.

Now let me say this: Teaching a premature baby to breast feed is tedious, hair-pulling business. It is slow and often frustrating. It's all about giving them an opportunity to do something they aren't really ready for. You have to keep working at it, but you can't push too hard because too much effort will stress out your baby and you will have gotten nowhere. Even when they get kind of good at it, you need to figure out how much food they got while nursing and then supplement with either the bottle or the tube feeding. We are starting now, but it will take about two weeks before we are anywhere near having an adequately nursing baby. Even when we bring him home, he won't be stellar and we will have to carefully monitor his weight gain at the clinic for a few weeks to make sure he is getting enough calories. They just run out of energy so quickly and breast feeding takes a tremendous about of energy.

[Here is where our heroine stands shaking her clenched fists at the sky] I am so sick of doing all of this. I am tired of pumping, measuring milk output that isn't quite adequate, driving to the hospital and sitting for hours in the NICU. I don't want to have to worry about milk intake, minutes nursing, and weight gain like I did with Thomas. I want Henry to be wash-and-wear. I have done this all once before and I really feel like I've served my time. I feel like I'm on mile 18 of a 20 mile slog and I don't want to have to go another step. There is very little about this that is made better by previous experience. I appreciate that I'm not the only parent in the NICU that is going through this, or worse, but this is my temper tantrum and I'll have it, by God.

I want to give Henry a bottle. Bottling Henry would make so much easier in the short term. He could progress with his feedings whether I'm in the NICU or not. We would know how much he's taking orally at each feeding and would be able to supplement with the tube feedings as needed. I wouldn't have to worry about his weight gain as much after we've brought him home. I would know how much he is getting. Also, I wouldn't have to speak to another lactation nurse for as long as I live. There is one at the NICU who always stresses me out and makes me cry.

I know that breast milk is far and away better than formula. I know that. And that's why I'm going to keep breastfeeding until it's apparent that it isn't working. We need all of the immunities Henry can get particularly because of his prematurity. But I still wish I could quit and give this up entirely without worrying that he'll be the worse for it. It's so different with these little ones. Babies get all of their immune system stuff in the last few weeks of pregnancy. It's the same with their stores of iron, too. Premature babies don't really recover from that so they need iron supplements and the immunities from breastmilk more than a full-term baby.

It's just so hard to feel like you want to quit, but not feeling able.

Sunday, September 21, 2008

Babies Sleep

It's a big day for wee Henry.  He's been practicing nursing for a few days now, but today he actually got some milk for his efforts!

Babies don't develop a reliable suck-swallow reflex until they're about 35 weeks.  Henry is showing signs that he is getting ready for life outside of the hospital.  He is over 4 lbs now and you can see by the picture that he is getting chubby cheeks!  I congratulated him on looking more like a baby and less like a fetus.  Perhaps that's only funny in the NICU.  When these babies are born so early they don't look like the babies you typically see strolling around malls in car seats and strollers.  Slowly, though, they grow and you start to see the baby they are going to be.

They have taken him off of that caffeine-like medicine.  He is still having the spells where his heart will stop beating or he will stop breathing for a bit, but the nurses don't seem concerned.  He bounces out of them pretty quickly and without intervention.

I have hopes that Henry will be home in about three weeks.  It could be as early as two weeks, but I'm not holding my breath.  And I'm willing to give him all of the time he needs.  Premature babies are more challenging to care for once they're finally home.  It's a pain to drive in to the hospital every day, but I am appreciating the 24 hour nursing that Henry has while I take care of things at home.  I can't wait until he is ready to come home!

Friday, September 19, 2008

The Land of Milk and Honey--but Mostly Milk

I don't know how many of you have been praying for me, but I thought you would be interested. My milk supply has nearly DOUBLED in the last two days.

I used to sit down and pump about half an ounce. It didn't matter much whether it had been two hours since I last pumped, or three. I would sit down and pump about half an ounce either way. Today I've been getting closer to a full ounce every time I pump (which is about every two to three hours)!

I'm still behind what Henry is needing, but it is extremely encouraging to see that my supply can go up and that I can hope to be able to meet his milk requirements when he's big enough to nurse.

So--Hurray!

Wednesday, September 17, 2008

Also!

I put on my pre-pregnancy pants today. While this would make normal people happy, I have to admit that it made me a little sad. The only reason I can fit into these pants three weeks post-partum is because I never had a chance to get very pregnant to begin with.

Things like this come up from time to time. I'll notice what I've lost in Henry's early birth and with my weeks in the hospital. I'll be able to let go of what should have happened eventually, but until then I'll have to simply be sad or angry on occasion.

Here's a small example: I live in Minnesota. It's winter here about six months out of the year and spring and fall another three and actual summer is only three months long. I went into the hospital in mid-July, right before my birthday. I was discharged at the beginning of September and got to enjoy a week of summer weather before getting smacked with hard core Fall. The high for today? Mid-sixties. I want my freakin' summer back.

Progress

I am so tired. I don't know how much of this is due to the bed rest and how much is due to irregular sleep patterns.

I've really given up pumping much milk at night. I pump about every two hours during the day and several times in the evening after the kids go to bed. I'm taking fenugreek in an attempt to increase my milk supply. It works great if you want to smell like maple syrup. For me, it is doing little to help me make more milk.

I am hoping that I'll be able to make enough milk to nurse Henry when he gets home. I'll have to do high-calorie preemie formula twice a day when he gets home and my doctor thinks that between this and what I'm producing he should have enough. I'll give it a trial, but it's hard to be optimistic when I spend time pumping and have so little to show for it. I am coming to terms with the idea that Henry might be my "bottle baby". In the meantime, if any of you have miracle ideas for increasing my milk supply while I'm pumping, I would love to hear them.

They had put Henry on a medicine that acts like caffeine to stimulate his heartbeat and breathing. It was working very well and now they want to try him off of it. They'll know pretty quickly if he needs some more time on it. If he doesn't, that's great; if he does, it's not a big deal since he'll do fine off of it as he matures.

They also moved Henry from his isolette into an open crib. We are waiting to see if he will maintain his own body temperature. So far he has done okay. He is hanging on to the bottom edge of what they deem acceptable. I imagine that he will improve as he gains more weight and that he won't need to be moved back to the isolette unless someone gets twitchy.

That's all for now. I need to put Anna down for her nap and see if Thomas feels sleepy. I need a break. It is amazing how tired a person can be and still go trough the motions of living.

Saturday, September 13, 2008

Photos

I thought I'd share some pictures of Henry. He's back up to his birth weight now--a whopping 3 lbs 9 oz.

They moved him into a "satellite nursery". Since he is stable they decided he could go to the Level II NICU and out of the Level III NICU. They needed to make room for more critically ill babies. It means we have to give up our private room and that instead of one nurse to two babies, Henry is sharing a nurse with two to three other babies. I miss the privacy of our single room. I miss it a lot. Henry is in a big room that can be divided by curtains. I'm not looking forward to teaching Henry how to breastfeed in such an open area! But I am happy that Henry is doing so well.

Friday, September 12, 2008

Comfort Food

I've never been one for comfort eating. I understand the idea of having foods that are comforting in a nostalgic, sentimental way, and I certainly have cravings for junk food occasionally, but I've never been one who just eats because it feels good.

Since Henry has been in the hospital, that has certainly changed. I've not only been craving the crappiest food on the planet--Doritos, candy bars (I haven't had a candy bar in years!), ice cream, and chocolate in any form--but I've found that just eating any kind of food feels good. It may be because I'm actually hungry, but I'm surprised at how satisfying it is to eat.

I think it's a latent coping mechanism that I've never needed before. I've been under so much stress as I recover from the surgery, live through the last weeks of the kitchen remodel, try in vain to establish some kind of milk supply with the breast pump, and make as many trips to the NICU as I can in a week. I feel like I've had an emotional headache for two weeks now.

A lot of this is normal, post-partum hormonal wreckage. And a lot of it is just living in flux as we wait for Henry to grow big enough to bring home. Some of it is having my house, which I like to be a stable, familiar place, torn up. Eating seems to get me out of my head and helps me bring focus to my physical body. It's not a great place to be, either, what with the incision, the water retention, and the stretch marks, but it's certainly a better neighborhood than my mind is these days.

I think I'm glad that this is the last time I'll be having a baby. After everything we've been through with our babies there isn't a person alive who would think pregnancy is a good idea for me. It's just too much drama. And I'm not sure that there are enough candy bars in the world to keep me covered if this were to happen again!

Tuesday, September 9, 2008

The Verdict Is. . .

The doctors have decided for now that Henry's drops in heart rate and breathing are due to his prematurity. His hemoglobin is a bit low, but not low enough to make the doctors think that this is what is causing his problems. For now, they have decided to put him on a medicine that acts like caffeine to stimulate his breathing and heart rate. So, my baby is gestationally 31 weeks along now and already he's an espresso junkie.

I'm inexplicably pleased with this diagnosis. Because I knew that this might happen, it seems less frightening. It also means that Henry will get poked one less time than he would if this were a problem requiring a blood transfusion. Peter is still looking into donating some blood so that it will be available if Henry does require it. It won't go to waste in any event.

I'm hoping that in a few days he'll be off of the oxygen and back on track. He'll be 32 weeks on Thursday and I'm hoping that he'll continue improving and that he'll be on track to coming home. You know--in another month and a half.

Sunday, September 7, 2008

This Is What They Mean When They Say "Expect Setbacks"

I called Henry's nurse at the NICU to check in on how he's been doing today.

Premature babies often have what are called "spells" where they either stop breathing or their hearts stop beating. Sometimes they are subtle and the babies come out of them on their own (which is what Henry has been having periodically) or they are more dramatic and they require someone, like the nurse, to come in and rub their scalp or move them to get them going again. Thomas had these, like most premature babies, and Henry had been having them, too. They weren't a big deal and he was doing very well since he only had them occasionally and most of the time he came out of them on his own. Yesterday he started having them more frequently and they had to put him back on the oxygen.

I always suspect the nurses of down playing any of these "bumps" in the road to prevent parents like me from weeping on the phone and tearing their hair out overnight. However, the nurse was pretty casual about this little setback. She explained that they would be doing some blood tests to see if he was destating more due to low hemoglobin levels or if he was possibly not making his own red blood cells yet due to his prematurity. If this is the case, they would need to give him, what did she say?, a blood transfusion? It's hard to say because the buzzing in my ears was pretty loud at this point. I asked if Peter could donate the blood since he was a match, but there wouldn't be enough time to donate and have the blood processed for Henry to get it. I imagine if he needs multipule transfusions this would be possible for the future.

I was just begining to think that Henry's stay in the NICU would be as boring and uneventful as Thomas's had mercifully been. I had been hoping that my biggest challenge would be developing a decent milk supply using the breast pump. I guess patience is still the greatest virtue at this point. It's just so hard to be patient and brave all at the same time.

Spinning Plates

We're having a quiet day at home today. We're trying to settle into some kind of familiar routine, despite having a battery of childcare helpers coming while I recover from Henry's c-section. Our kitchen is still torn up (and thus the whole house) from the remodel and nothing is where is should be, including the plumbing, and this is contributing to a sense of disruption. A quiet day at home together is just what we need.

Any surface appearance of normality is purely an illusion for me, though. Most of my family is here with me, but it's not the same as it was. It's strange how Henry has changed our family even though he's never been here with us. I don't think our family will be the same while he's still in the hospital.

I don't feel as torn and guilty about Henry's hospital stay as I did when it was Thomas spending his weeks in the NICU. But days like today when I could go to the hospital and spend time with Henry, but instead choose to stay home with the rest of my family are a terrible balancing act. I need to weigh Thomas and Anna's need for time with me against Henry's need to have me there with him, bringing him pumped milk, holding him skin-to-skin, and hearing my voice. I can't be at the hospital every day, especially not while I am depending on someone else to drive me there and pick me up. But today I am choosing to stay home. Peter could load the kids into the car, make the 25 minute drive to the hospital, bring everyone home and then reverse the process to pick me up in a few hours. But instead we are here, just hanging out.

We'll go tomorrow and I won't be able to go Tuesday. Wednesday I'll go, but I don't know what is happening on Thursday and Friday. And I don't know what will happen when my Helpers go back to their work and I'm home caring for Thomas and Anna again during the day. I'll most likely drive to the hospital in the evenings.

This will only last a few more weeks (Five more? Maybe?) before we are all able to be home together. I'm so glad I won't always have to make decisions about who needs me most. At least not every day.

Monday, September 1, 2008

Re-Entry

Henry is still doing very well. He is breathing all on his own now, is maintaining his own body temperature, and is digesting the food they are giving him. They are feeding him what breastmilk I am able to pump and are making up the difference with formula. I'm a pumping fool, but I'm just not putting out that much in volume. I expect that in the next few days I'll start having an increase in output, but it's only hope that makes me think I'll be able to express more with Henry than I was able to with Thomas. If you have pumping tricks or tips, I'd be glad to hear them. For some reason I've never been one of those women who have stockpiles of breastmilk languishing in their freezers. I make some, but never enough to meet demand. Why is this?

I've been home for a day and a half now. I think it would be easier if our kitchen (and house) weren't all torn up for the remodel. I know there are only two more weeks left before it's done, but the whiny part of me hates that it's torn up now when I'm so fresh from bed rest and surgery. In two weeks I'll be feeling much better and it will matter less that I have to go up stairs to refill my water bottle. For now, I'm learning to deal with it as it is and to cope. Peter has been feeling overwhelmed with the added domestic responsibilities he's had the past seven weeks and so he has less energy to do some things for me. He'll do them; he's just less cheerful about it. Normally this would be fine, but I'm an emotional, hormonal mess on narcotics, so instead of being understanding I feel a little slighted.

The kids are delighted that I'm home again. I'm sure you can imagine. Anna didn't quite know what to make of me at first, but Thomas saw me this morning and cried out, "Mommy!" as though he were waking from a wonderful dream to find that it was really real. I felt like I was on Little House on the Prairie. It was a great feeling. I'm having a hard time keeping up with their energy, but it's still very, very good to be back with them again.

On another note, do any of you know anything about retaining water in your feet and ankles after delivery? I seriously have Hobbit feet. They are unrecognizable as human appendages. I want to know when they will go away. I can't even see my ankle bones anymore. If this coninutes, you'll be able to float me above Macy's parade on Thanksgiving Day!