Archive for September, 2010

Dear Noah
September 22, 2010

You are two now.

You are the wildest, hardest and boyiest thing to ever happen to me.  You are also the best.

This year you learned to walk, talk, jump, eat with a fork, climb your dresser, take off your diaper and love a little sister.  That’s a tall order for someone who sleeps with a thing called Crib Bear and still dabbles in eating crayons.  The rate at which you’re learning astounds me.  Just this week, we were swinging, and I asked you to count to five with me, and instead you counted to ten, and then put your binky back in, like it was no big deal.

But it is!  Because I didn’t teach you to count to ten.  Just like Daddy didn’t teach you that bad word, but you still learned it after watching him hit his finger with the hammer.  (In all fairness, you could have learned it from me while I drove in rush hour traffic.)  You’re picking up all the little nuances of life, like wiping your mouth with a napkin or locking a door.  We no longer have to relentlessly coach you to learn something.  You watch, you imitate, you move on.  It’s alive, Dr. Frankenstein might say.

You became obsessed with belly buttons, which for reasons unknown, you called “mites.”  You had to inspect everyone’s mite upon seeing them, sometimes several times a visit.  No keys are safe around you.  Phones fare slightly better, but only slightly.  We can’t get you to sit through Elmo’s World, but you’ll watch a twelve year old Bollywood clip over and over and over again.  (Chaiyya Chaiyya…)

Your favorite books were Goodnight Moon, Big Red Barn, Are You My Mother?, and your pop-up castle book.  If you are the only kid in Sunday School who knows what a portcullis is, I know I’ve done my job right.

You moved into a big boy bed–a mattress on the floor.  You cried the first night, then fell asleep on the floor, resting your head on the mattress.  Most nights after that, your daddy and I woke up at three to hear the thunk-thunk-thunk of your footie-pajama-clad feet coming down the hallway.  More than once, we wouldn’t be able to see your head because your arms would be full of stuffed animals–Crib Bear, Clifford, Myrtle Beach Turtle and maybe a penguin or two.  The entire menagerie came to snuggle with us.  Lately, whenever we put you to bed, you ask “Night night too?” wanting us to lay with you.  To me, you demand, “Glasses off,” knowing I’ll probably fall asleep next to you if I don’t have my glasses on.  To Daddy, you say, “Blankie on Daddy?” trying to lure him into cuddling with you. We can’t resist you.

You and your Grammy are best friends, just like my grandma and I were close.  You love your Pepas (all three of them!) and your uncle Jerry.  I’m guessing you love your aunt Stephanie too, but chasing her with a dead cicada shell is no way to show it.  You got to meet your uncle Jason and aunt Heather, and play with your cousin Jake.  I can’t wait until you two are old enough to get in trouble together.

Most importantly, you met your baby sister this year.  You didn’t sleep very well when we first brought her home, and you had a rough couple of weeks, but now you’re the best big brother anyone could hope for.  You want to make sure she has a blankie and a binky (even if she doesn’t want it) and when I’m holding her, you remind me that she needs “Tummy? Time?” and then lay on your tummy next to her.  When she cries, you tell her, “Don’t cry, baby.”  I know that these little moments are sowing seeds for big moments later on.  You’ll be the one to teach her all sorts of cool tricks, drive her to places we forbade her from going, beat up boyfriends you disapprove of.  In the near future, I can’t wait for the nights when we hear two pairs of padded feet on the wood floors, and I can snuggle both of you (and all your stuffed animals.)

I feel bad for you, Noah, because you’ll always be my learning baby.  You taught me how to mother an infant, and now you’re teaching me how to mother a toddler.  Sometimes I worry that you got the worst parts of my personality, but then you’ll give me such a Josh look with a quirked eyebrow and o, rly? expression that I know you’ll be alright.  At least fifty percent of you is sane, intelligent and level-minded.  Did I mention that you are as handsome as your father?  Hazel eyes, thick, thick hair and loooong lashes.  Handsome like Josh, mercurial like me–girls are going to go crazy over you someday.

Thank you for this year.  I’m sorry for the times I cried while making your waffle because I was so tired (I was pregnant with your sister) and I’m sorry that we didn’t discover Deanna Rose sooner.  Next year will be better.

Love,
Mommy

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Breast-feeding in NICUland
September 15, 2010

NICUland is staffed by some of the warmest, smartest people I’ve ever met. Those NICU nurses fight constantly against death and sickness, and still manage to find various ways for parents to be involved and vital in their child’s care. But, in any hospital department, policies and realities can make individual experiences difficult.
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Teagan was born at 9:14 a.m. At 1:52 p.m., I finally got to hold her and nurse her. She was listless about breast-feeding; she nibbled and licked for a while before she latched on. She stayed on for a few minutes, then fell asleep. The nurse assured me that she was getting everything she needed through her IV line, so there was no need to fuss about my milk coming in.

Down in my room, they brought in The Pump. There were several of these Pumps floating around the NICU for lactating mothers, so that they could pump and spend time with their baby. They even gave you free accessory kits, with the tubes and shields and whatnot, in addition to unlimited sterile bottles to express into. Despite the helpfulness and the fact that I had pumped for ten months with Noah, I found the whole array foreign and intimidating. I had dreamed for months (years?) of this blissful skin-to-skin breast-feeding heaven after her birth, where she’d latch on right after my awesome unmedicated VBAC, room in with me, and snuggle in my arms for days. Instead, I had The Pump, which, on its stainless steel rig, looked like it belonged aboard the Nebuchadnezzar in The Matrix. The top of it looked like the sleep-medicine machine from Inception. It had WHEELS, for crying out loud. Instead of my soft baby in my arms whenever I wanted, I got to hook up to the thing with wheels that the nurse wiped down with sterile wipes beforehand. Yay. (side note: I’m grateful for the breast pump as a tool–and it is a fantastic tool, especially in the NICU, but also for working and studying mothers.)

The second time we went up to see Teagan, the nurse laid down the law. We were allowed to sit with her as much as we liked, as long as we liked, but she was only supposed to nurse every three hours, and only for thirty minutes at a time. I’ve never had a baby not room in with me and I’ve certainly never breast-fed on a schedule (mostly because I’m too disorganized to put *myself* on a schedule) so I was a little taken aback. What if she got hungry in between feeding times? If I was holding her and she started rooting, was I supposed to ignore it? And with such an iffy latch, was I really supposed to pull her off if she was having a great nursing session? Everything about it was antithetical to my mothering instincts. But the nurse was firm: sick babies can’t nurse too much. It wastes their energy. Plus, they’re getting everything they need from the IV. Nursing is really more of a recreational sport at this point.

On the way down to our room, Josh shook his head. “You’d think sick babies would need their mommies more, not less.”

Why didn’t I fight this? After fighting off a c-section for 17 hours, you’d think this would be cake. But I don’t know. I was exhausted from the long labor and no sleep, emotionally numb from my failed VBAC and Teagan’s NICU admission, not to mention fogged out on drugs for pain. My gumption was gone. My energy to advocate was sapped. I just wanted everything to be easy and conflict-free.

Nursing was further derailed by the night nurse. Josh rolled me up to breast-feed, and Teagan was alone in her little booth (this was normal–since she wasn’t all that sick, her nurse usually had one or two other low-priority babies.) Josh, wanting to hold his less-than-a-day-old daughter, scooped her up from the warmer. One of the leads pulled loose. The night nurse, hearing the alarm, came in and literally TOOK TEAGAN OUT OF JOSH’S ARMS, snapping, “You can’t pick her up unless I am here!” With all the noise and jostling, Teagan started crying. The nurse gave Josh a disgusted look. “See? She’s crying now.” That nurse watched us like a hawk. If thirty minutes had passed, even if twenty-seven of those minutes was trying to coax a latch and only three were actual breast-feeding, she took Teagan away and put her back in the warmer.

It was true that it helped to have a nurse around when I tried to breast-feed. All the other nurses were much more lenient and compassionate about us handling Teagan (as in, we were allowed to.) But only the nurses seemed comfortable maneuvering her with the IVs and PIC lines and endless leads. Breast-feeding a newborn is hard enough, trying to find all the right places to support their heads and bodies and your own breasts. Juggling all this while trying not to strain or pull the lines was frustrating. It was easiest when I could sit with my Boppy and have someone hand her to me. One day, I went to hand her back to the nurse and saw blood all over her legs. The PIC line itself snapped, leaving blood to trickle out the ruptured tube.

By the second day, her latch wasn’t improving (although a wandering LC managed to get her on. Murphy’s Law of breast-feeding help: whenever an Lactation Consultant is there, they can get the baby to latch on fine. As soon as they leave, it all goes to pot again.) People started pestering me about my milk coming in. It was a good four or five days with Noah, so I knew it would be a while with Teagan. I also knew that colostrum was plenty for tiny babies. But it became a subject of concern and pity when people would ask and find out that I still didn’t have mature milk in. Still! And it’s day three already! Gasp!

It didn’t help that I wasn’t pumping anything. Even the NASA grade Inception-Matrix-Medela contraption couldn’t coax any colostrum out, which started getting discouraging. I might get one viscous little dribble, which by the time it worked its way down the shield, through the flange and down the side of the bottle, wasn’t even enough to suck up in a syringe. I hated the obligation of pumping, the necessity of stimulating my supply because my baby wasn’t nursing enough because of their stupid schedule. By the time I went up to nurse Teags, got back down, double-pumped for twenty minutes, I had about an hour to sleep before I did it all over again.

Also on the second day, the nurse practitioner raised the possibility that Teagan might be able to go home the following day or, at least, move into the step-down nursery. But in order to do that, she had to keep her temperature without her warmer and produce so many grams of wet diaper without being hooked up to the IV fluids. We had a choice at that point: supplement with formula on the chance that she might be able to leave the NICU and come home with us sooner, thus freeing us from the restraints on nursing and cuddling OR we could leave her hooked up to the line and delay homecoming. We chose formula supplementation. This is something I go back and forth on in retrospect. I wish I would have talked with the neonatologist and maybe a lactation consultant before we agreed, just to make sure that those really were our only two options. At the time, the prospect of bringing her home put stars in our eyes. It was all we saw.

Cups and syringes weren’t allowed feeding methods in the NICU, and I didn’t think to ask about finger feeding, so it was going to have to be the bottle. Teagan’s first bottle experience wasn’t pretty. She turned her head away from the rubber nipple over and over again, making this disgusted face. The nurse grasped her by the neck in one hand and used the other to force the nipple into her mouth. Teagan gagged and sputtered, formula running down her cheeks and chin, fussing and squirming to get away. The nurse just adjusted her grip on Teagan’s neck. “Sometimes they just need to get a taste of it to learn it’s yummy food,” she told us cheerfully.

Unkind words ran through my mind.

After that, I tried to be the one to give her the bottle as much as possible (although, if I liked the nurse on duty, I’d let them do it so I could pump while I watched and potentially get more time to sleep.) There’s no reason that bottle-feeding can’t be a gentle and loving activity, and how much longer would it really take to allow a baby to “latch” onto the bottle themselves and drink at their own pace? Even when Teagan would turn her head away and cry when the bottle was put in her mouth–clearly done eating for the time–some nurses would force her to finish the full two ounces of formula. Why couldn’t they just let her eat to hunger? More things I wish I would have challenged… And, after a full day of bottle-feeding, nipple preference set in.

Hard.

Teagan only had to feel my nipple touch her lips to start shying away. This dead look of existential despair would appear on her face and she’d press her lips shut, as if waiting to die. Death would be better than have that awful fleshy thing that was so much *work* in her mouth. Even the LCs couldn’t work their magic. But as soon as she got that bottle, she’d chug the whole thing in no time. (Also, by this time, it was clear that she was staying the full week, so I didn’t think I had the option of banning the bottle altogether.)

At least my milk came in (four and a half days postpartum), so we could supplement with MamaJuice, but I didn’t want to be doomed to be an exclusive pumper. I wanted to breast-feed her normally! Early on, with her iffy latch, I’d been thinking about a nipple shield to help get her on the breat more. The LC who’d been working with me had been holding back on the shield, treating it like it was a freaking missile code or something. But the other LC gave me one straight away. And guess what? After shooting a little syringe of expressed milk on the silicone, Teagan was able to latch on long enough to get a let-down. With my newly minted supply, the let-down was a like a beer bong. Her eyes widened in surprise, but then she hunkered her body closer to mine, furrowed her brows and got to work.

The syringe of milk onto the nipple shield was Nurse Awesome’s idea. Just like Molly the LC was the reason I kept breast-feeding Noah, L the Awesome Nurse was the reason Teagan and I could shed so much NICU baggage. She was the first nurse to actually read the doctor’s orders regarding Teagan’s feeding. I was putting Teagan back in her warmer and telling L that I’d be back in three hours, when she bit her lip and started rifling through papers. “Dr. S wrote on here that you could breast-feed ad lib,” she said. I stared at her. She explained, “That means you can feed her whenever you want, as often as you want.”

Oh.

“And,” she continued, looking through the nurses’ notes, “I can see that you’ve been able to pump several ounces after each feeding? There’s no need to keep supplementing. Even if you weren’t pumping a lot, I’d still say let’s stop supplementing and see how her wet diapers are now that your milk is in.”

She peeked in the trash and shook her head at all the used bottles of expressed milk and formula. In the NICU, they had two kinds of nipples that were both technically newborn nipples, but were from different manufacturers. L always gives her breast babies the one with a single small hole, so that they have to work at the nipple like they do at the breast. The other nurses had been giving Teagan the other nipple–one with two larger holes. “The milk just pours out of those nipples,” L said. “No wonder she got nipple confusion.”

L was only Teagan’s nurse for twelve hours. In those twelve hours I got Teagan back on the breast, stopped supplementing and discovered the cause of her intense nipple confusion. Another bonus? After five days of scheduled feedings and aggressive formula supplementation, Teagan weighed one ounce under birth weight. After twelve hours of unrestricted, on-demand breast-feeding with no supplementation? She had gained four ounces. The nurse on the shift after L’s couldn’t believe it. He weighed Teagan three times to make sure the scale wasn’t malfunctioning.

Things were much better after that. It took about a week after we got home to wean off the nipple shield, but we took it slowly, and I let Teagan dictate the pace. I did get some plugged ducts and mastitis, probably because of the shield use in addition to my tendency toward oversupply, but we got over that too. She wisely rejected a pacifier, and decided that first week home would be all about building my supply. I sat in my glider for hours at a time. We had bottles and bottles of milk pumped in the NICU–Josh would have to cup feed her expressed milk just so I could take a shower. She ate constantly.

And here we are, two months later, no worse for the wear. Even though everything is fine now, looking back, there are a few things that I wish I would have done differently.

1) Most importantly, I wish I would have asked more questions about the mandated schedule. I knew Teagan wasn’t very sick, and I also knew that it was my right as a parent to question anything that felt wrong to me. It turns out that I could have breast-fed on demand her entire NICU stay, and those five days of scheduled feedings and headaches are days I’ll never get back. That she’ll never get back.

2) I wish I would have made sure there was no other options than formula or more NICU time (she ended up having to stay longer anyway…bad gamble on our part.) I also wish I would have remembered to ask about finger-feeding. I would have been willing to take the time to do it, and it might have prevented the nipple confusion and thus the shield and thus the mastitis later on.

3) I wish I would have spoken up about some of the more aggressive bottle-feedings. One nurse tried to get Teagan to eat four ounces in a setting so that she’d go FOUR hours in between feedings instead of three. I was so unhappy about it–why didn’t I speak up?

Teagan was only in the NICU for a week. I can’t imagine all those brave mamas who struggle through all the necessary and unnecessary concessions to NICUland for weeks or even months to continue nursing. Of course, we all know it’s more than worth it; breastmilk is even more vital to vulnerable preemies. But sometimes that fact is cold comfort when you’re pumping alone at three in the morning, staring blearily at your baby in her web of leads and tubes. All nursing mothers should be celebrated, but NICU mothers deserve something more. Praise. Limitless admiration. A nap, perhaps.

Life in NICUland, Part Two
September 7, 2010

It got easier. Leaving her and going to another room on another floor got easier. It helped that I was heavily medicated for pain, that I was exhausted, and that Josh and I at least had each other. We’d go to the NICU and breast-feed and cuddle, then back downstairs where we slept. Rarely did we go back to our room and not sleep.

Initial bloodwork–routine for babies born as traumatically as Teagan–showed that her white blood cell count was elevated, along with another marker for infection. Coupled with my long labor with ruptured membranes and my GBS + status, the neonatologist recommended a three day course of antibiotics to treat a possible infection. Even though her blood culture eventually came back negative, he later recommended an additional four days of antibiotics since a) her white blood cell levels were declining, but very slowly, too slowly if the levels were due only to a rough delivery and b) there was no indication that her levels weren’t declining because of the treatment, in which case it was important to continue in order to eradicate the infection entirely.

That’s the long-winded way to say that we were there for seven days, but that she wasn’t very ill. She didn’t act ill at all; she ate fine, she wasn’t lethargic (not any more so than your normal newborn), she peed and pooped fine. Because of this, because she wasn’t really sick, because she was full-term, I felt out of place in the NICU.

I felt like some ancient Greek sailor washed ashore some strange, sad island.

While I nursed Teagan, while we brought in an outfit to take her home in, parents around us were learning how to use feeding tubes, bringing in pictures and blankets to cheer up the lonely isolettes. The parents didn’t talk much. The parent resource room was a stopping-by place to eat and drink, and not much more. Moms pumped next to the warmers or isolettes, dads dozed in the recliners next to them. I’d nod and smile to other moms if I passed by, bonded by our aching postpartum bodies and empty arms, but we were all so wrapped up in our own intense struggles that the effort to strike up casual conversation was too much. The only thing on our minds was our babies’ health, but that’s not the easiest way to break the ice: “So I heard the respiratory therapist had to come in three times last night for your kid?”

The NICU is full of contradictions, though, and despite the fact that I never talked with the other parents, I felt strangely bonded to all the babies on Teagan’s row. It’s unavoidable that, spending hours by your baby’s bedside, you will hear every agonizing and joyful detail of the journeys around you. The hospital even requires all parents to sign a HIPAA form for this reason.

Which is why I won’t write any of their names or conditions, even though their names and tiny faces, as I could see them through all the wires and tubes, are burned into my brain. Sometimes at night, when I’d drag my body into the hospital bed, I’d find myself praying for some of those other babies before I prayed for Teagan. Teagan had me there in the hospital. Those other babies had parents an hour away or teenage parents or a mom in the ICU. They were prayer magnets.

After I was discharged, I managed to snag a brand new room in the new NICU wing to board in while Teagan finished her treatment. The room was gorgeous, fantastic, and was even equipped with all the gizmos in the patient part of the NICU so that potentially your baby could room in with you (Teagan couldn’t). But compared to the constant noise of the NICU, with the monitors constantly alarming and the cries and the constant hum of chatter among the nurses, my room was uncomfortably quiet. Josh was at home with Noah, and I was alone. I ended up spending a lot of time napping in the recliner next to Teagan’s bed.

Time warped in strange ways. Sometimes my head would barely seem to hit the pillow before they called me back to nurse and sometimes I’d stare at the clock in the corner of her booth and swear that someone slowed it down. I’d forget to eat some days. Nights were interminable, pumping next to the warmer while I listened to the baby across the hall go bradycardic over and over again.

And I missed Noah. I missed his giant, tousled head, and his squeals, and falling asleep with his head resting in the crook of my arm. I just wanted to be home, where we could all be together for good.

Life in NICUland, Part 1
September 3, 2010

Imagine you woke up one morning unable to breathe. And you looked over across the room, and there were your lungs, sitting in a plastic box. You’d panic, of course, because how are you supposed to breathe without your lungs? And how are your lungs going to function without your body and blood? Now imagine that when you went over to the box, someone stepped in between you and the box and told you that you couldn’t have them right now, that your lungs were sick. But they’re my lungs, they belong with me, you’d want to say.

“Well,” the person would reply. “You can have your lungs back. But only for thirty minutes every three hours.”

Can I preface this by saying that the NICU is an incredible place staffed by incredible people? That the compassion and wisdom of the staff, from the neonatologists to the nursing assistants, still astounds me, even in my memory? And can I also say that I think NICU parents are allowed to have more than one emotion about their experience? Teagan’s stay was short and pretty uneventful, but the bundles of joy, hurt, loneliness, regret and longing are heaped in piles higher than I can see.

They wheeled me up to see Teagan over three hours after she was born. Nothing had hurt more than seeing her rolled away in the isolette after only one caress of her cheek. Nothing hurt more, except maybe having to give her back after we were finally reunited. I missed her first few hours, her first meeting with her grandparents, her daddy and her brother. That still makes my eyes sting–I missed the moment when Josh held Noah up to see her and he said her name. And now, when I finally got to hold her and try to nurse, after a few minutes of her apathetically nibbling and licking (Josh said in the hour right after birth, she was like a little bird, mouth open and searching for mama), now I had to give her back. The nurse tucked her back in her plastic box, and I went downstairs again.

The second visit was the hardest. Because this time, she latched on and nursed like a pro. This time, I was less groggy from drugs. This time, I unwrapped her from her never ending swaddle and explored all of her silky, tiny body. She was so little in my arms, with these sad wrinkles on her legs and arms. She had perfect lips, like a rosebud, and eyes a dark, dark blue.

Only the parents were allowed to hold her, and I was glad. I wanted to be selfish with her and hold her forever.

Friends and family started piling in to see us and her. I already had my parents and a friend in the booth with me, then several more people arrived at my postpartum room down stairs. The nurse came in and murmured noises about checking Teagan. I knew I had to leave, but as soon as I eased her into the nurse’s arms, I started sobbing. Not crying, where tears sort of leak out, but the sobbing where you can’t breathe (and yes, you make those awful sounds) and there’s snot and did I mention the sounds?

I felt like I was being cut open again, like my baby was being stolen from me, and that her being packed away in the box was the most unnatural and depraved thing that the universe could inflict.

Then my mom said to the nurse, “She’s just emotional, you know, being hormonal.”

I could have spit, I was so mad. Here I was, completely undone (and I don’t get emotional very often…the last time I cried in front of an audience was in 2006 at Krista’s funeral), and my own mother was dismissing my very real pain. I kept crying as Josh wheeled me back down to our room, where the visitors were waiting, and it was all I could do to keep those sounds at bay while everyone talked. I just wanted to hold her again, press my lips to her chest in thanks, thanks, thanks that she was alive and breathing through those little rosebud lips.