When the girls can come home

Many of you want to know when we will be able to bring the girls home. The doctors have told us to hope for two weeks, but plan for four weeks after delivery. Basically they will be ready to come home when they reach the age for a full term pregnancy. The due date was November 29th so they should be coming home around then. Several months ago I made a paper chain to count down to my due date. Now I'm using it to count down to when the babies should be ready to come home.

So what are we doing in the meantime? And what criteria do the girls have to meet before they are released from the special care nursery? Basically they have to be able to eat all their food through their mouths and gain weight.

Ever since they were born they received their nutrients in two ways. The first way was an IV that pumped sugars, lipids (fats), and antibiotics into their veins. The IV basically preformed the function that the umbilical cord would have done if they were still inside me. The downside to the IVs is that the lipids are basically the consistency of Elmer's glue. Pushing that stuff into the tiny baby veins was very hard on the veins. The IVs were constantly "going bad" and so they had to be moved from vein to vein about every 12 hours. Thankfully both girls were taken off their IVs on Sunday. I'm so glad the IVs are gone. I'm so much more comfortable holding the girls now that I don't have to worry about accidentally pulling out an IV. Also there are now 3 less tubes to worry about getting tangled. (We started referring to the mass of wires and tubes as Charlotte's Web) Here is one of the monitors on Charlotte's foot. I call it her ET foot.

The second way the girls get their nutrients is though milk. Unfortunately, we can't just feed them the milk through nursing or bottles like a full term baby. The suck, swallow, breath actions are very intense. (Try drinking through a bottle sometime - its hard) They are so intense that a small baby can use up more calories trying to eat then they gain by eating. Using up all the energy leads to weight loss - which we don't want. Each of the girls has a tube inserted in their nose that leads down to their stomachs. Milk is put into the tube and it feeds into their stomachs. This lets them get food without effort so they don't loose any weight. This is how the girls ate all their meals for the first couple days.

Of course we can't leave the tube in their noses forever so we are slowly teaching them to nurse. Each girl eats (or feeds) once every three hours. So in a day they feed 8 times. The day is broken up into two twelve hour shifts. So each girl is fed 4 times per shift.

We started out on Level One of the feeding protocol which meant I nursed each girl once every twelve hour shift. So out of four feedings I nursed them for one. As of yesterday we moved onto Level Two of the feeding protocol. This level lets me nurse them for two feedings per twelve hour shift. So I nurse them two out of the four feeding per shift. Each girl must show she can do two things for two consecutive days before she can move on to Stage Three. They are: 1. She must nurse for 10 minutes or more and 2. gain weight.

Stages Three and Four involve feeding the babies by mouth on demand instead of a strict schedule. I'm not sure of all the details because we aren't there yet. I'll blog about them later.

Charlotte and Lydia are both very good at nursing, but they approach it very differently. Lydia is less than 4 pounds, but she nurses like a pro. All I have to do with her is position her right, give her a minute to collect herself, and then she is off. She sometimes nurses as long as 23 minutes. She sucks so hard that her little cheeks get dimples. It is so cute to see this little peanut of a girl eat so much. She seems to know that nursing is her ticket to getting bigger and getting out of the hospital. Here are her itty bitty feet. (I'm not about to post pictures of me nursing)

Lydia also has developed a habit that shows she is eager to nurse. This morning I went in for her 3 am feeding. The nurse said, "it's I good thing you are going to nurse her because she pulled out her NG tube(the tube going in her nose to her stomach). I'll replace it next shift." I nursed her and went back to bed. The nurse replaced the tube for the 6:00 am tube feeding. When I came back to nurse at 9:00 am, the nurse on duty then said that Lydia had pulled her NG tube again. I nursed her, and the tube was replaced for the 12:00 pm tube feeding. When I came back for the 3:00 pm feeding the lactation consultant told me that Lydia had pulled her tube out for a third time! After that we found some baby mittens to keep Lydia's fingers from playing with the tube. They seem to be working so far. Here are Brandon and Lydia. You can see that she doesn't have a tube taped to the side of her cheek. (She even pulls the tape off her face)

Charlotte has been more of a challenge to nurse. She had such a rough start in life that she gets stressed out kind of easily. I expected her to be like Lydia who is up for anything at any time. Instead Charlotte gets worked up and freaks out. If she becomes upset while getting her temperature taken, her diaper changed, and any other measurements taken she will stay upset when it is time to nurse. She would latch on to my nipple and cry because the milk wasn't available immediately. We would try everything to get her to suck, but she was so worked up she couldn't focus. Eventually she would suck, but she would be so exhausted from crying that she would fall asleep after only about 5 minutes. Here are her tiny feet.

After about 3 of these frustrating feedings it dawned on me that this was my child. I knew what her problem was - I had the same issue. I can't focus when I am hungry and stressed. For example, today we went grocery shopping. We were in a hurry to get back to nurse Charlotte so I was rushing to find everything on the list. I was standing in front of where all the cheeses were, but I couldn't calm down enough to actually look at the individual blocks of cheese and find what I needed. Brandon finally had to grab the right cheese.

Once I figured out what the problem was I knew how to fix it. We had to keep Charlotte calm.

So now we change her diaper and let her calm down afterward. Then we do any measurements and let her calm down afterward. Then we place her on my nursing pillow, and let her get used to being there. And finally I pull out her binky and she latches right on. It will take her a minute to figure out that she needs to suck, but she gets it after a while and then she goes to town. We've now had 5 out of 5 "no drama" feedings and everything is going much better. Here we are after one of our good feedings.

We also make sure to keep her calm between feedings. She had an Echo cardiogram today to check on a chest murmur the doctor heard. He suspected it was nothing, but wanted to make sure. (It turned out to be nothing so don't worry.) Charlotte was good during the Echo, but afterward she started hollering. Brandon and I were just finishing up a meeting with all the people who are giving the girls care and so we went over and got her dressed and wrapped up again. Then I rocked her until she fell asleep. At her next feeding she was as relaxed as a baby can be and ate for over 10 minutes.

So anyway. To sum up this long post. The girls can come home when they can eat all of their meals through their mouths like normal babies. It's going to be a long process, but we are making progress. I'm glad that I can be just down the hall from them. I know that they wouldn't be nursing as well if I had to drive down from Bountiful every day.