It’s now been 96 hours since it all kicked off, so just short of four days since Smidge and Smudge arrived, and in the meantime they’ve been doing fantastically well.
The night I left Katie at the hospital on her own, she was moved from the private room (where I’d slept the night before) to a room with two other women who had a singleton and twins in the Neonatal Unit. As inconsiderate as some people are, they had their partners with them way past the time they should have left, and this annoyed and frustrated Katie. However, she had promised herself that she would go down and see the twins later on when it was quiet down there, so she resisted saying anything.
As parents, we can visit the Neonatal ward 24 hours a day, which is comforting in itself. The only time we can’t be in there is when there’s a shift handover between night and day staff, or visa versa, due to them bringing the new staff up to speed on the patients, and the privacy concerns that entails.
Night Time With Them
That night, she did indeed go down to the unit, and stayed with Smidge and Smudge until gone 1am. Within the relative peace and quiet (lights down low, but the usual alarms going off on the monitors), she applied comfort holding to both of them – this is where you hold the head quite firmly, while holding the bottom or other part of the body with the other hand, again quite firmly – since this cocooning reassures them. I think she experienced some bonding with them during this time, as she was back in the next morning, and doing their care with them before lunch. Care is simply washing the face, cleaning the mouth, and changing the nappy. (I’ve also changed two nappies so far, in case anyone was wondering!)
Night Time Without Them
Katie’s parents and I arrived that afternoon, and after seeing the twins for a while (who are now in the same room, which makes it easier, but not yet in the incubators next to each other), having some dinner at the canteen in the main hospital, and heading back to say goodnight to them, we took Katie home for the first time since she’d arrived, still pregnant, at ten past four in the morning in the back of an ambulance a couple of nights earlier. Understandably, we had a few tears from her as we had to leave them there (as I had had to the night before), but she knew that there were in the right place; before they arrived so early, we were never expecting to have them come home with us before the end of February, and nothing about that has changed.
Talk with the Doctor
We had a chance to catch up with the named consultant for the twins today, and we covered a few things. The main area of slight concern is that Smudge has a PDA. Basically, in the womb the lungs aren’t needed, so the blood bypasses the trip around the lungs to get oxygen, via a shortcut in the heart. Once born, this shortcut duct should close of its own accord with 3-7 days, and if it doesn’t, blood is getting sent around the body without having got the oxygen it should be delivering, and hence the whole system has to work harder than it would otherwise need to. It’s quite common, even in term babies. It can be detected as an extra sound when listening the to heart (a heart murmur), and in the case of Smudge, was confirmed with an echo (scan). She’s just started a course of drugs to try and correct it, and we’ll find out if that worked early next week.
Another part of the talk from the doctor was to prepare us for anything we (as untrained observers) might see as being negative – being put back on the ventilators, having their oxygen percentages increased (they are currently on ~20-22% oxygen, which is normal air) up to 70%, going on to insulin (which they both now are) to control their blood sugar levels, and so on. Its normal for premature babies to have apparent setbacks, or be given more support, before the doctors are really concerned with their stability.
Along those lines, she aimed a comment at me (as it’s mainly father’s who do this) about being concerned with the minute-to-minute, hour-to-hour, stats on the monitors. The advice she gave is that we should be parents, and leave it to the staff to look at the clinical data to see if there’s anything to be worried about. I said that I wasn’t worried, but being who I am, I found the information of interest to me, and it gives me something tangible to hold on to, so long as I don’t start worrying about it until the doctors do.
We’d always planned to have Katie breastfeed the twins, but having had them taken away to intensive care immediately after the birth, and them being in an incubator (of which the humidity has worked wonders to moisturise and improve the look of their skin by the way) in the meantime, meant the usual procedure had been disrupted. The next best thing was to express milk, so it could be stored (frozen if necessary) and given to the twins as they needed it, while reducing the Total Parenteral Nutrition that was currently sustaining their growth.
Since the night that I had stayed in the hospital, Katie had been trying to hand express the milk, but without success. Most women don’t get anything on the first few tries, as the breasts need to be stimulated for the milk to be produced. Katie was worried if her technique was right, or if she was physically able to get a result. Being able to provide them milk was the last big hurdle we’d yet to get across, but we knew that once it had started, then we’d be alright with it.
Today, with the promise of cuddles (getting the twins out of the incubator, still wired up), with the doctor’s advice to go from hand expressing to using a pump (since it was getting towards a now-or-never time in terms of getting the milk flowing), and the practical guidance of one of the neonatal sisters looking after Smidge, Katie was finally successful at expressing, and she did extremely well! She now needs to do this 8-10 times in every 24 hours, including some at night; my alarm is set for 2am every day. This will then be given to Smidge tonight (since Smudge is on the medication to address the PDA, she has to wait) and his quantity will be increased over the next two weeks.
One of the common beneficial tasks with any new baby is skin-to-skin contact, also called Kangaroo Care. This is when the babies are placed on the chest of either mum or dad, and talked to. This gets them used to the smell of the parents, hear a voice that will be familiar from their time in the womb, and by calmed by the heartbeart they should be able to hear.
Obviously, with tiny babies that are still wired up to several monitors, inside an incubator that is keeping them warm and their skin moist, it’s a little trickier, but still something that is encouraged if the baby is stable enough. We were hoping to have the cuddles yesterday, but both had their long-term central long line put in (since the temporary one in through their belly button would soon be closing off), so they had too much handling for that day.
This evening we went back after dinner, and we finally got our cuddles! Smidge was extracted from the incubator, semi-wrapped in a blanket (not quite sure why the nurse did that, as the point is there is nothing between the baby and the parent) and placed on Katie’s chest, and stayed there for 15 minutes or so. She was over the moon to have her first cuddle with her first-born.
I was even luckier – I had Smudge (no blanket) tucked into my unbuttoned shirt, and since she was comfortable and warm, she was there for 45 minutes 🙂 Hopefully she’ll behave for Katie tomorrow when she has her turn with her.
Shopping for Toys
This afternoon, before heading to the hospital, we went to Mothercare and picked up some toys for the incubators, some nappy wraps, and some hats (which are currently far too big for them) which Katie will sleep with to get her smell on them, which can then be put into the incubators with the toys and baby.
The next week or two should see results from breastfeeding, the PDA medication, and with the antibiotics stopped, and the insulin controlling the blood sugar levels, they should hopefully put on some weight – most babies lose weight in the first week or so after they are born, so we’re hoping there’s a healthy net gain over the two weeks.
I also wanted to say thank you for the congratulations, best wishes, and kind words that came about from friends, family and strangers after the last post here. I haven’t been able to respond to everyone on Facebook, Google+, Twitter and the SMS messages but each one was read, shown to Katie and greatly appreciated by both of us. Thank you. 🙂