Friday, January 04, 2008

Doctors Galore and Your Questions Answered

GYN Appointment
I had an OB/GYN appointment on Wednesday back with my regular doctor (no more perinatologist for me!). It was the first time I've seen him since a few days before I delivered when he came to visit me in the hospital, so it was good to see him, though I could have done without the exam! I was surprised at how many of my old feelings were still with me sitting in the waiting room amongst all the pregnant women there. You'd think having been through a pregnancy (one that lasted, even) and having three babies to show for it, that I wouldn't still feel like a completely inadequate in a roomful of pregnant women. But I was never one of those women...I never had the luxury of taking my pregnancy for granted. I didn't get to ever assume everything was fine because I had a pregnancy that was nearly guaranteed to result in a premature delivery and one in which things seemed to be going wrong every week (and I didn't have as bad a time as I could have). Anyway, I don't mind pregnant women...some of my best friends are pregnant women..I just find it overwhelming to be around that many at once.

The doctor asked whether my husband and I were doing anything about birth control. I missed my opportunity to answer with, "Well abstinence is the preferred method of Congress..." because I burst out laughing. Instead of lecturing me about the fact that there are lots of women who end up with an "oops baby" after years of fertility treatment, he just asked whether I'd be depressed if I ended up surprised by a pregnancy. After I stopped laughing, I told him I would die of shock because it would be the immaculate conception, but that we'd be thrilled to pieces. That satisfied him, so he was okay with me not doing anything to prevent it. I was actually a little surprised not to get a lecture about not wanting to be pregnant so soon after a triplet pregnancy and c-section (I got that lecture from the perinatologist while I was pregnant), but I'm cool with that. I'm very certain I'm not going to find myself surprised with a pregnancy anytime soon, or, like, ever.

I told him I was still bitter about the c-section and he said, "what do you mean?" He was shocked that I'd ever thought I could have a vaginal triplet delivery, and was surprised to learn that two of the perinatologists in the practice I went to have done (and were willing to do) vaginal triplet deliveries. I always knew that the odds were against me avoiding the c-section, but had Abby not been so little, they would have let me try it. Anyway, I told him that I'm all ready for my VBAC because I'm definitely going for a normal singleton pregnancy some day, darnit! I told him that HE was going to deliver my next baby because it was going to be JUST ONE. I'm not sure that I really have that much confidence that I'll manage to get pregnant again, but I'm certainly going to try (while praying that the Big Guy Upstairs doesn't have a sick enough sense of humor to send me quadruplets next time).

I took Ellie to the pediatrician on Friday for a weight check. Well, I mean, all three babies went, but only Ellie got weighed and seen. I've known our pediatrician for about ten years (we used to attend the same synagogue, long before I had any kids), and I adore him. There are several other doctors in the practice, but I've made nearly all of our appointments with him because of Ellie's weight issues. I prefer seeing him because he's got a better appreciation of the trends we've been seeing with Ellie's progress (or lack thereof) and because I just like him in general. One time when I saw another doctor for one of Ellie's weight checks, she sort of shrugged me off as if I was overreacting. I admit that I was beginning to wonder if perhaps I was overreacting to Ellie's lack of weight gain - she's just so little compared to Abby and Sam. But she remains an enigma. She was 7 pounds, 7 ounces this week... which was only a 7 ounce gain in 17 days. Not terrible, but not quite what we would have liked to have seen, either. Even Dr. B said it would just be nice if she would go one way or another... slightly less gain and we would have known we needed to explore options, or slightly more and we'd know there was no problem whatsoever. She consistently gains less than he'd like to see her doing, but not so much so that it points to an obvious problem. He, like me, is somewhat worried, but not inclined to intervene too much at this point. She's not showing any other signs of reflux (she rarely spits up, she's not fussy when she goes on her all-too-frequent hunger strikes, she doesn't quit in the middle of feedings, she doesn't seem uncomfortable during or after feedings...), so trying reflux medication probably wouldn't do anything other than giving us one more thing to have to keep track of on a daily basis. He doesn't want to torture her with a huge blood draw for a metabolic screen, but he did do a small blood draw to check her thyroid hormone (T4, TSH), so we'll see if that illuminates us at all.

The triplets are scheduled to return for their four month visit in two weeks, and he said we'll just keep an eye on her until then and if I feel that things are taking a turn for the worse in the interim, I'm more than welcome to bring her in for another weight check. I doubt that I'll feel the need, but you never know. It's nice to know that they don't think I'm just an overreacting new mom, but I do wish she would just gain a little more weight a little faster so we could stop worrying all together. Poor baby. The doc WAS impressed that Ellie is pretty consistently sucking her thumb. Thumb sucking is apparently a developmental milestone you expect of a full term baby at 3 or 4 months, so she's about 2 months ahead of schedule. Go Ellie! Anywho, we're back to our wait-and-see strategy with her, and that's fine. I just wish she didn't have hunger strikes!

Your Questions Answered
Allie posted this question in a comment recently:

Is it really going to be cost effective to pay for childcare for 3 kids?? I hear that childcare for 1 is bad enougth...but I can't imagine paying for childcare for 3 newborns!!!! Won't you just be working to pay for childcare costs??

I get this question (or similar questions) a lot and I don't really understand it. No one knows how much I make or how much we'll be paying a nanny, so why do people assume that it's not cost effective? And why does no one ask my husband whether it's cost effective for him to work?? We make the same amount of money! The truth is, it IS cost effective, not only in the short run, but definitely in the long run. I make more money than we'll be paying the nanny. Does that mean we can afford a nanny? No. We still have more bills than we know what to do with. But we can't pay much more than the mortgage and a few utilities with my husband's salary alone and we've eaten through what little reserves we had with me out of work for the last seven months (bed rest for three months and almost four months since... time flies when you're sleep deprived). Anyway, in the short run, yes, it is cost effective for me to work. It would not be if I made less money.

More importantly, however, it is cost effective in the long run. If I were to pull myself out of the job market until the kids went to kindergarten or 1st grade, I would no longer be marketable in my field because the standards and technology are changing too rapidly for me to keep up on my own. So even if we were losing money on a nanny at this point, it would be worth it in the long run because there is no other field that I'm qualified for in which I could maintain my current salary years down the road.

And while it's true that I have little desire to return to work, I find it odd that no one seems to consider the possibility that maybe I like what I do. (I do like what I do, though I'd gladly give it up for the opportunity to stay home with my sweet babies if we could swing it financially). Anyway, enough of that...

Tinker asked:
How do you add calories to breastmilk? Feed it from a bottle and add a supplement of sorts? What kind of supplement?

You can fortify breastmilk by adding a higher calorie supplement to expressed breastmilk in a bottle. Breastmilk and standard formulas have 20 calories per ounce. Preemie formulas have 22 or 24 calories per ounce (I think there is also 27 calorie, but I'm not certain). So Abby used to get fortified breastmilk by adding 1/2 a teaspoon of preemie formula to 3 ounces of breastmilk, which raised it to 22 calories per ounce. She's not getting extra calories anymore, though, because she's done sufficient catch up growth.

Several people have asked whether I will continue breastfeeding when I go back to work and the answer is, of course, yes. I'll be pumping during breaks and overnight (and obviously breastfeeding whenever I'm home with them). I'm very pleased that I've made it this far without needing any formula (who can afford formula for three babies??), and my hope is to make it until they are at least 6 months adjusted before adding anything else to their diets.

Any other questions?


Anonymous said...

Hi :)

I'm Allie. I wasn't trying to offend you with that question...neither by assuming you wanted to work or didn't want to, nor by assuming you had to work of didn't have to, nor by implying its the mothers job to stay home and raise babies while the father works :)

I was simply...well...shocked that with 3 newborns it would be cost effective to pay for childcare!! For all I know you have a parent of family friend who is looking after them, or you'r independently wealthy :) Either of which would be great too for the record.

I am a SAHM to 3 children, although my oldest just started Kindergarten this year. For added socialization and fun she attends an after school "Kindercare" program and I know how much that costs us just for the 3 hours a day after school. I have never paid for childcare aside from this. I've never actually used a babysitter either(thanks Grammas!!) So I was honestly asking out of curiosity(not for how much you make...thats not my business but...parent to parent).

You make a VERY good point about the long run. I wasn't thinking about that. If you have a field in which you need to stay current then in makes sense. And you're children will one day be in school full time so it makes sense that you'd work then(I think I'm in denial about mine heading to school and me having days to do...well...anything!!). I do know people who have 3 kids and they say its not worth working because its working to pay the care costs and they would rather stay home with the kids as opposed to just work for someone else to care for them. completely their I also have friends that it costs them more in child care, but they feel they need to work ourside the home as they aren't SAHM material(thier words not mine...I don't judge either way). But their kids are all different ages and so the cost are lessened for older kids who only get child care part time. So...3 newborns strikes me as a huge "ouch".

Oh but for the husband and I both feel that the person who makes the most should work :) It just happens to be him. So I wasn't implying you should stay home and your husband should have the career.

Take care,

illahee said...

as a breast feeding mom of a singleton, i'm curious as to what and how much you eat. i eat a LOT, and not necessarily the 'right' things, though i've gotten better about that since my baby became 2 months old. (still addicted to donuts, i'm afraid!) are you still constantly hungry? i really admire you for b-f'ing three!

i love your posts, i hope your babies continue to grow grow grow!

pam said...

THANK YOU for answering the daycare question. we get it ALL THE TIME. if i didn't go back to work, we'd have to live in a box, period. yes, childcare is v expensive, but i do make more than what it costs! yeesh. and i don't think i'm cut out to be a SAHM anyway, to be honest. though i do wish i could stay home longer at this point. just not forever.


hadjare said...

Cool! I was wondering just yesterday how many calories are in formula (it doesn't say on the container). We also have to add the caloric intake from the thickener as well...and yeah. 40 calories (per two ounces) just doesn't seem like that much -- but then you add in the number of many calories a day do you think a baby has?

Anyway, great update post! I have a feeling we aren't out of the woods yet with the weight gain thing either. Aspirating babies are notorious for slow weight gain. :(

Rachel Inbar said...

I think that aside from the important things you pointed out (like keeping up with your field) that it's really important to get back to having an identity as a grown-up - talking to other people, taking time to do things for yourself (e.g., eat lunch uninterrupted; read the paper), etc.

I stayed home with my twins until they were 18 months and by then I felt that there was no 'me' left...

With Abigail & Nomi, I told Ohad that I don't even care if it looks as if it's cost-effective - long-term-therapy would cost much more than childcare :-)

The Dunn Family said...

I hear ya! I get that money question a lot. And I actually have the same exact answer! Except I have twins, not trips. But I work in the IT field, and walking away from it for 5 years would never allow me to walk back in with the same pay or position I have now. And I actually make slightly more than DH, so if anyone should be home, it should be him.

But at the end of the day, as unpopular of a view this may be, I NEED to go to work. Just being home for 6 months with them was really tough. I loved every single minute of it, but I don't know if I could do it for 5 years straight. I never felt like I had less of an identity as I did then. Now that might be because they were newborns and non-stop needy. As the kids get older, I might have gotten more me time, and not felt so isolated from the world, but I can't be sure. Going back to work saved my sanity. Now if I were rich, I certainly wouldn't work, but I still would probably be a nanny 2 days a week just so that I could still have some grownup me time. But that's just a fantasy. 8-)

Kudos on the pumping, breastfeeding. I didn't even try. And I'm ok with that, but I am in awe of the moms of multiples that do. Good on you!

Catherine said...

Hi Karen -

I feel like I could have written about half of your post (just not the breastfeeding part)! I know I owe you an email, but with the holidays I haven't been as good about staying in touch with anyone as I would have liked.

The child care cost question amuses me and bugs me all at the same time. Those weekly checks to our nanny do hurt, but for the reasone you mentioned and more it makes sense for my family right now.

I'm really curious to hear what they find out on Ellie's weiht gain issues. We are having some very similar struggles with my little guy (he weighs roughly 9 pounds less than his brothers right now who have been in a hurry to catch up on growth). It's a daily struggle for us worrying about how much he is eating, how many calories, etc. I actually need to make an appointment to get him weighed since I'm getting concerned again.

And as far as how much formula feeding triplets costs, I don't even want to know what I've spent on it (kind of like diapers and everything else that goes along with them).

Anonymous said...

A wonderful update -- thank you for taking the time!
Is this the OB/GYN for whom you weren't sure of the best way to switch to the perinatologist without harming the relationship? It sounds like things between you are well. How nice that he visited you in the hospital!
Would adding calories to any EBM feedings Ellie takes be useful? Is the issue more to figure out what is going on, why she isn't eating enough, and that if it weren't for the hunger strikes, she'd be gaining fine?

Jody said...

I assume you have already considered this, but for the folks who find your site while pregnant with triplets, I wanted to say that Ellie's frequent hunger strikes put me in mind of some lingering oral aversion issues. I can't remember if she needed to intubated or not, or if she ever had her feeding tube down her mouth (they tend to switch those to the nose as soon as breastfeeding begins, for the readers without NICU experience), but I can tell you that we had a brief nursing strike with Elba, and it didn't occur to me at the time, but she's had oral aversion issues (mercifully very, VERY mild -- mostly only around brushing her teeth, and her gag reflex) her whole life.

Like I said, I assume you're already considering this possibility, but I thought I would throw it out there for the read-alongs. Google is forever! :-)

Glad to hear everything else is going so well.

Cindy & Brian said...

almost 4 months already - I can't believe it!!! how time flies.
Jody raises a good question about the oral aversion possibility. I wonder about that myself.
i hated seeing the feeding tube in my babies' mouths and wondered if it bothered them at all and if there would be any long term issues. luckily they're all in their noses now...and soon gone forever!!!

My Reality said...

I have a question. Can we have more pics of the trio? Please?

ABC Triplets said...

Yes, more pics please! :)

Anonymous said...

I am so glad you wrote this! I feel like sending a link to your entry about daycare to several people in my address book. People reacted in horror when they found out I was returning to work after having triplets... and seem surprised that it is indeed cost effective. I want to say, I'm a lawyer, um, yes, of COURSE I will make more than I'm paying a nanny! Not to mention that my job comes with free health, dental and vision benefits for my entire family. Furthermore, I hate to admit it, but it's a welcome break from changing diapers. It's incredibly hard to be a SAHM to triplets!
And those same people are beyond shocked that I'm still bfing my triplets (altho we do supplement w/ formula). It is so irritating when comments are made like "I'm sure you didn't even try to BF."
Anyway, I really enjoyed your post. Kudos to you and congrats on your 3 little ones!

In and Out of Luck said...

Congrats again and still, and kudos on making whatever daycare choice works for you financially and emotionally. I went back to work after 10 months at home (I was lucky enough to have that much paid maternity leave) and it was actually lovely to have my adult life back.

Carol said...

Yeah, I love how they ask you about birth control. ha! After what it took for me to get pregnant, thinking about using birth control would be a joke. The nursed pressed me about it at my OB appt - obviously didn't consult my chart. Fortunately my OB knew better, since he actually remembered my history. I told him that if I miraculously ended up pregnant, I'd be thrilled, and he left it at that. But yeah, at this point it would be the immaculate conception - too tired to even think about it.

I'm a little bitter about the c-section too - I definitely want to try for a vaginal birth sometime in the future.

Hey - when we were concerned about weight early on, we bought a small kitchen scale at the drugstore. It goes up to 11 pounds, and I put a tray on it that I would lay the babies on to weigh them. It gave us a lot of peace of mind between weight checks. Might be something to consider - it was not expensive.

Speaking of weight - how's yours going? are you still losing? I'm down 23 pounds from my pre-pregnancy weight now. Breastfeeding multiples is great!

es said...

I just want to say, now that I have my twins and am breastfeeding them, how truly amazing I think you are for breastfeeding your triplets. Just when I think that twins are hard... wow. I am in awe of you.

Anonymous said...

How funny...I had the same conversation with my OB after delivering my twins conceived through IVF. Sure enough 6 months later "oops baby" was conceived! Boy was I shocked, but I was so thrilled too! Now I have 3 who are fourteen months apart...not quite triplets! I hope you get that "singleton" baby. It's definitely a different experience. (I didn't get my VBAC either...other complications but no NICU!) Congratulations and good luck with your job.