Progress and Nighttime Feeding

I've been taking Ellie to the doctor every single week because she's been pretty stubborn about the growth thing... after that first week when she grew 18 ounces in 10 days, she stalled completely and stopped growing for a couple weeks. Sigh. BUT! Today, finally, my little Ellie bellie seems to be back on an upturn. She is over 9 pounds now, which still puts her way behind her siblings, but she's finally making some progress. She's the only baby that hasn't tripled her birth weight yet, but at least she's doubled it. The good news is that I don't have to go back until March 11th, which seems like an eternity. Dr. B. said I can come back sooner if I get a sense that she's slowing down again or she starts striking again, but if I have the sense that she's continuing to grow and she's continuing to improve, we can hold off for another 2+ weeks. Unbelievable.

Meanwhile, Abby and Sam continue to grow, but that's no shocker. Abby's got a new nighttime pattern for eating. She used to go to sleep after her 6 or 7pm feedig and sleep until about 2am and then eat and go back to sleep until about 6am. Lately, though, she's been waking up at 11pm starving (which is ridiculous, because we've actually started feeding her more than we had been). So we feed her at 11pm and then she either sleeps through the night or wakes up around 4, which isn't that far off of when we have to wake up anyway. But it's weird, and I'm not sure why she's changed her pattern. It's not that big a deal, but it's new.

Sam never stops eating. Dr. B. says that he's big enough that he should be able to sleep through the night now (calorically speaking), but every night at 2am, 4am, 5am, and 6am I have the same conversation with Sam:

Me: Dr. B. SAID you're big enough to sleep through the night!
Sam: Mommy! Please don't make me! I'm so hungreeeeeeeeeeeeeeeeee! I'm wasting away! I'll be so saaaaaad if you make me wait!
Me: But Dr. B. PROMISED ME that you're big enough to sleep through the night!
Sam (with the saddest look possible on his face, while screaming BLOODY MURDER): MOMMY! PLEASE! You wouldn't actually make me wait would you? I'm so hungry! Please don't make me! Please don't! I'm starving! Please!
Me: Well, I'm sure as heck not going to listen to screaming all night, of COURSE I'm not going to let you starve, no matter WHAT Dr. B. says.

Then after Sam's had his fill, Ellie and I go and have the opposite conversation:

Me: Ellie, Dr. B. SAID you're not big enough to sleep through the night!
Ellie: Mommy! Please don't make me! I'm so sleepeeeeeeeee! I need my beauty sleep! I'll be so saaaaaaaad if you make me wake up!
Me: But Dr. B. SAID that you need to eat more often!
Ellie (completely sleepy): *yawn* Please mommy, don't make me...*snore*
Me: huh? wha? What time is it? Can I go back to sleep now?

And then, it's usually time to have another conversation with Sam... But Dr. B. SAID you're big enough to sleep through the night!

Thank heavens J sleeps through the night!

Five Months and Some Milestones

My babies are FIVE MONTHS OLD today. Can you believe that I'm such a lazy sloth that in FIVE MONTHS I still haven't managed to write about the day of their birth??? Man, I suck. Maybe before they're six months old. Hah, I say, Hah!

It didn't escape my notice, though I failed to find the time to make a blog post, that February 14th marked an anniversary for us. A year ago, in the midst of a pretty nasty ice storm, despite J having school cancelled, and terrible road conditions, S and I dragged ourselves out to the clinic for IUI day, for an IUI that was doomed to fail. The IUI was SO definitely going to fail that I had my IVF consult two days later and Dr. Amazing told me flat out that it was time to move on, and there was no way I was going to get a positive beta out of that ridiculous cycle. Everything went wrong with that cycle. Everything. Except my three precious miracles. They were right. A year later and here I am, looking at my three beautiful babies, and I know that no matter how WRONG that cycle was... everything was exactly right.

I cried tears of emptiness every day that I didn't have any babies in my arms. And I cry tears of joy every day now that my beautiful babies are here. S heard me say that to someone recently and asked if I meant that literally. "I mean, I know that I'm dense sometimes, but did I miss you crying every day?" In the beginning, no, I didn't literally cry tears every single day... but by the end... yeah, I really did. Not sobbing, wretching, buckets of tears, but I wiped a tear or two off my cheek every day toward the end. Especially after the miscarriage. And now, sometimes I stand over my babies' crib at night and hold their tiny little hands as they sleep and I'm so overwhelmed with joy and love and even a little sadness for all the years of loss... that I still wipe a tear away. But these are hard-earned tears, and I wouldn't give them up for anything.

And our babies...our beautiful babies... they're growing up. I went through and took out all their Newborn clothes from their shelves. And I even took out all of Sam's 0-3 month sized clothes. Ellie still fits in 0-3 month clothes (and even some NB clothes, but I put those away anyway, since she's not lacking for clothes). They're getting bigger every day, and it's so funny to see it happen right before my eyes. My nanny tells me things don't fit and I don't believe her and then I take a look and it's true! How could this be!? But, despite my belief that they are as teeney as the day they were born, they just aren't. Abby is over three times her birth weight, and Sam is getting close to three times his birth weight. Ellie's not there yet, but she's finally double her birth weight, which is astounding. They just keep getting bigger and bigger.

In other milestones, Sam learned a new trick last week... If I leave the room and he cries, I come back! Yep, he's got me wrapped around his little finger. And when I walk back in the room, he smiles and coos and calms right down. And then if I walk back out of the room, he starts fussing again! And so it goes... He's still my little piggy and he wants to eat ALL NIGHT LONG nearly every hour and I have no idea how to break him of this habit, because he's clearly truly hungry when he wakes up. I tried explaining to him logically last night that Dr. B. said that at his weight he should be ABLE to sleep through the night, but Sam was having nothing to do with it and he responded quite indignantly.

Abby is our smiliest baby who coos the most of all. Yesterday S even got her to giggle for the first time! More significantly, this week she started sleeping laying flat in the pack n' play. She had been sleeping in a bouncy chair, which was really aggravating, because I was totally convinced she was never going to sleep in a crib, ever, but it's finally happening! Best of all, she wakes up happy and smiling in the morning, which is a beautiful thing.

Ellie didn't grow at all last week, but it's clear that she's growing now. She's far more alert now than she was even last week, and she's not nearly so skeletal looking. You can still see her ribs, but her thighs are chunking out a little and her face has a little more pudge to it. She's finally got enough fat on her face that we've discovered she has dimples! Now that she's more alert, she's been rewarding us with lots of beautiful smiles. She's also been fussing more than she had been, but I take that as a sign that she's more aware of her environment, so it's a good thing. She has another appointment on Friday, and I expect that she will have grown a bit then, so we'll see. She still has a gastroenterology follow up scheduled next week. I haven't cancelled it yet, but I suspect I might. I feel like her pediatrician is handling it appropriately and I don't see how the gastroenterologist will really add anything of value at this point. We'll see.

My father and his wife are coming to visit this weekend. It's the first time they've seen the babies since the day the babies were discharged from the NICU, over four months ago. Amazing how time flies when you're sleep-deprived. In many ways, parenting triplets (so far) has been a million times easier than I expected it to be. In other ways, it has been far more challenging than I could ever describe. I don't feel like it's more than I can handle, but I feel terribly inadequate for the job. I fear that I will be an inadequate parent for my children...that I will shortchange them in ways that I might not have if I'd had them one at a time. I fear that they will miss out on the individual attention they should be getting. I fear that J is missing out on individual attention that HE should be getting right now. But I also know that these are all fears I'd be having even with a singleton. I know that all parents fear inadequacy, and I know that the only thing I can ask of myself is that I strive to be the best parent I CAN be on any given day. Some days that will be enough, and some days it won't be, but every day it will be as much as it can be and that's really all I can ask of myself today.

Failure to Thrive is Not Failure to Nurture

Thank you to Emmie at "Better Make it A Double" for my subject line in her comment:

I'm so sorry you're dealing with this. I have a friend who dealt with this, and her GI put her arm around her and said, "failure to thrive is NOT failure to nurture!" She broke down crying at that point, because it gave voice to having to hear that awful term, and all the guilt she felt even though she was doing everything right, as I'm sure you are. I hope you get some answers soon. I think you're doing an incredible job with those three (plus one more).

My pediatrician said something similar as he was writing the diagnosis on my check-out form on Tuesday. He warned me that I'd see that diagnosis there, but it doesn't mean she won't thrive and it doesn't mean she's failing, "and it doesn't mean you're failing," he said. I was lucky that I wasn't freaked out by the diagnosis, but I was so overcome with emotion at how sensitively he handled that... if I'd been a different kind of mother and I hadn't been forewarned about that diagnosis code, I might have freaked the heck out. I love my pediatrician. I've known him for about ten years (long before I was married, let alone had kids), and every year he impresses me more and more. This week was no exception. Tuesday he wrote failure to thrive in her diagnosis box and referred us to a pediatric gastroenterologist. He warned me that I probably wouldn't be able to schedule an appointment immediately but told me to schedule the appointment then call him and he'd call over there and make them fit me in sooner. As it happened, the scheduler first offered me an appointment with my preferred doctor (Dr. D.) in March, but I sniffled at her and said, "I've got a four month old preemie who won't eat and hasn't grown at all in a month!" and they fit me in with a different practice member (Dr. C) the next day. My pediatrician's office faxed over Ellie's records that afternoon and life was good. Or so I thought.

Hey, did I mention I just started a new job? Fortunately, my client didn't even hesitate to say that of course I needed to go to the appointment and not to worry, the good news is I'm not working against any critical deadlines yet, so I should go and take care of my daughter. Whew. And so, on Wednesday, I took Ellie to see Dr. C, the pediatric gastroenterologist. And I hated her. HATED HER. She came in, started talking really fast, spewing numbers (I like numbers, numbers are good, but you know what else I like? I like a doctor who comes in and says, "Hi, what brings you in to see me today?" and takes some time to listen to me before they start spouting off numbers), and the breezed out of the room, back in again with instructions, a can of fortifier, and orders to return in a month to be reevaluated for consideration for an NG tube. The end. Okay, that's admittedly the Cliffs Notes version, so I'll back up. She wasn't all bad, and she did give me a lot of valuable information.

1. Ellie is 37% underweight. She should be about 5 kilos. She's um, not.
   
2. Ellie's eating pattern is not atypical for a preemie. Many preemies (not all) go through this pattern of sleeping through feeds, preferring to sleep rather than eat and refusing feeds because they are too sleepy. You have to sleep to grow and Ellie is trying to grow despite the fact that she does not have the caloric intake to support growth.
   
3. The gastroenterologist does not believe that Ellie has any additional underlying physiological or anatomical anomaly or disorder which merits investigation at this time.
   
4. Ellie needs to eat 480 calories per day to maintain her growth curve and up to 620 calories per day to catch up to where she should be on the growth curve. She is falling short of that by nearly 200 calories on our best days, despite our best efforts.
   
5. There are two ways to increase Ellie's daily caloric intake:
   
   1. Increase the number of feedings per day (we've tried to do this, with little success, so in Ellie's case this would require putting an NG tube back in)
      
   2. Increase the number of calories per feeding by fortifying the expressed breast milk feedings that she gets (we've been fortifying to 22 calories per ounce, but that hasn't done enough)

That's all the good and/or neutral stuff from the visit. The problems centered around the fact that I couldn't get a word in edgewise and the fact that the gastroenterologist would ask a question about Ellie's eating pattern, not wait for the answer (or not be satisfied with how I was answering it, cut me off and make assumptions. That drove me a bit crazy and made me feel as if somehow this was all MY fault. For the first time, I found myself clinging to the thought that "Failure to Thrive is NOT Failure to Nurture." This is not my fault. Not my fault. I had to keep repeating that to myself, because I kept feeling like, "oh my gosh, if I'd just gotten one more feeding in, or kept my records differently, or oh-why-didn't-I-try-harder-to-wake-her-up-last-night??" I hate that I allowed her to make me feel that way. I hate it. Because I've worked so hard with Ellie. I've been at the doctor every week or every two weeks. I've fortified her milk. I've pushed extra feedings. I've done everything I can, and I know that, but her rapid-fire questions and her dissatisfaction with my answers just didn't made me feel like I could have done more.

"The nice thing about babies," she said, "is that it all boils down to simple equations. They are this tall, weigh this much, need this many calories. End of story."

My baby is not an equation! My baby is a person! My baby is a miracle, an angel sent to me by Hashem! My baby is more than numbers and formulas. My baby is special, darnit!

Her instructions were to fortify expressed breast milk to 28 calories per ounce for a month and bring her back in for reevaluation. If no significant improvement, we'll admit overnight to the hospital to put in an NG tube and teach me how to do it. Oh, and no breastfeeding. All the food she gets should be fortified. Oh, and please make sure to call and schedule that one month follow up immediately, because her next available appointment is IN a month. Have a nice day.

I left there realizing that a month of not breastfeeding my daughter would mean that Ellie would never breastfeed again. I left there realizing that with Abby not breastfeeding at all, that would mean pumping a full supply for Ellie, a full supply for Abby and 5 bottles per day for Sam (he usually only drinks 4 while I'm at work, but he's been known to drink 5). That's 21 bottles I'd have to pump. Right now I pump 13 bottles per day. It's just not going to happen. I was guaranteeing that one or more of my babies was going to end up on formula, in part or in whole. I am making NO judgments about formula-fed babies, but dammit, I have worked SO hard to keep these babies on exclusive breastmilk and I'm not giving that up. And if babies really do just boil down to equations and this really is all about the math then it doesn't make sense that I can't breastfeed. I should be able to give her 480 calories worth of fortified bottles and breastfeed any additional feedings, right? It's simple equations, right? RIGHT?

I left a message for my regular pediatrician that afternoon (thank heavens he doesn't work on Wednesdays, because I never would have been able to speak rationally to him that day). He called me the next morning and I told him I really hated Dr. C. And he said, "Okay, Tell me what happened." So I told him everything I told you just now, and I told him that I really felt like an NG tube would give us the most flexibility, allowing us to add extra feeds, enabling me to breastfeed as much as I wanted to (we could even do a gavage feeding WHILE I was breastfeeding, which I did a lot in the NICU), etc. I had even said to the gastroenterologist that I felt that the advantage to the NG tube was that it would enable me to preserve the breastfeeding and she said, "Yes, it would." I told my pediatrician that any solution that eliminated breastfeeding all together was not a solution if there was a viable alternative. It's just not acceptable. "No, it's not," he agreed. He did talk through some of the risks of home-managed NG tubes with me, and there certainly are risks that need to be respected, but he also knows us well enough to know that we can handle those risks, and he also agreed with me that the benefits outweighed the risks.

"I know it seems selfish, but I've just worked SO hard to not have to put my babies on formula and in one night Dr. C has undermined my ability to produce enough milk for all three babies. I had to pull six bottles of milk out of the freezer this morning with absolutely no hope of ever getting to put any back!"

And this is why I love him. Because here's how he responded: "Karen, it doesn't seem selfish, it's self-LESS. It's the most selfLESS thing you could possibly do for your babies. You are absolutely right that you can't sacrifice breastfeeding in the long run for a short term solution." See why I love him? I LOVE him!

And so, my pediatrician said he would call Dr. C. and advocate for moving forward with an NG tube and call me back once he had spoken with her. A few hours passed and he called me back and said, "Okay, here's what I was able to negotiate..." So the new plan is:

1. I may breastfeed twice per day (She noted to my pediatrician that she had told me that I could breastfeed Ellie after a full bottle, which is true, she had said that after I'd asked the question, but his response was, "Yes, but we're talking about a little girl who we've been trying to convince to eat! She's not going to breastfeed effectively when she's exhausted from drinking a bottle!")
   
2. I will bring Ellie back to my pediatrician in one week (Thursday) to be re-weighed. If she has not made significant improvement at that time, we will admit her for an NG tube.

"How does that sound to you?" he asked, in a rather trepidatious tone. I agreed that provided that it was just a week and that the discussion would not be closed at the end of that week I was fine with it. I have also ordered a digital baby scale so that I can accurately weigh Ellie before and after all breastfeeding sessions to calculate exactly how much she's eating so I know exactly how many calories she's getting per day, even with the breastfeeding sessions.

One problem we've been having is that Ellie isn't tolerating the 28 calorie bottles particularly well. She's thrown up a couple feeds, and this is a baby that NEVER spits up EVER. My pediatrician said it probably isn't sitting well in her stomach. The advantage to the NG tube is that we could push more feedings per day and therefore lower the concentration of calories per feed, which would be easier on her little tummy. We'll just see how it goes. Even with throwing up some feeds, she got 532 calories yesterday, which was a lot more than she's been getting, so I'm a lot more confident in her ability to grow and cope than I was before.

There's honestly a lot more detail I could put into this post, but I'm so exhausted just thinking about it now that I can't bear to write any more of the details. And THIS is why I still haven't gotten around to writing something as exhausting as my birth story!

What it boils down to is that I'm NOT worried about Ellie in the long run. I'm worried only about making it through the logistics of getting her through the next few weeks to get past this point of craziness. I know that ultimately she'll grow and thrive and bring me much joy, as she already brings me so much. I love her, and her three siblings, more than I ever thought possible. I cannot imagine my life without my four precious children.

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).

Pediatrician
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?

A Few Notes

• Last week we introduced the new, improved wireless version of Ellie... Ellie Version 3.0! She is now off her heart monitor! Go Ellie! We are unbelievably happy about this. :)
  
• I am awake right now because every time I put Sam down, he screams and the only thing that stops him is nursing him. Then he falls asleep in my lap, and if I put him back down he screams and the only thing that calms him is nursing him... lather rinse repeat. This would be worse except that I have a toothache and a headache (possibly related to each other) that are also keeping me awake.
  
• I am in an incredible amount of pain (aside from the toothache/headache) because I've done something to my back which was exacerbated by falling down the stairs last Wednesday. This was stupid, but unintentional. My doctor (actually, she's an NP) has suggested that this is only going to get worse because of the triplet factor and that my best option is physical therapy. I don't have time for physical therapy. Please give me pills! She's happy to give me pills, though she doesn't love that I'm breastfeeding (even though my pediatrician is okay with each of the pills that I'm taking), but says basically that the pills aren't going to help enough and that at some point I'm simply going to have to find the time for physical therapy. Yeah. First let's see if I can find the time for the dentist, shall we?
  
• My grandmother came to visit for three days and it was surprisingly lovely. I expected it to be stressful, but it wasn't. It was a bit difficult, because it was hard to get enough pumping sessions in with Maggie Moo (I eventually gave up getting enough sessions in, but I got enough to supply Abby, just not enough to have much excess). She was great with the babies, and fabulous with J. She turned 89 on Friday. It was nice to have pictures of my babies with their great-grandmother. Not many people get to take pictures like that. It was astounding. She's pretty easy to entertain and was content to just sit on the couch holding a baby for hours, which made my life easy. I managed to have breakfast, lunch and dinner on the table three days in a row, proving, once again, that I am super-woman. Admittedly, one lunch was purchased from a local restaurant, and the chicken for two dinners was rotisserie chicken purchased from the grocery store, but still!! I had to do all of the heating and arranging and um... other stuff! Anyway, it was a good visit.
  
• My tooth really hurts. I think it might be more than one tooth. Worse, I think I may have missed a dentist appointment last week. Whoops.
  
• Thanks for all the suggestions re: thrush. I got a script for Diflucan for a week from my NP today. I don't love the gentian violet idea because of the mess factor (even the lactation consultant didn't love the idea with triplets...she said it was just going to be a huge mess with three of them). I'm going to talk to the pediatrician tomorrow about switching the babies to Diflucan also. They've been on Nystatin for over two weeks and it's helped but not fully resolved the thrush in their mouths, so clearly some of the yeast is Nystatin-resistant, which is no good at all and I can't handle this cycle of the four of us passing it back and fourth and all around between us. Hopefully the Diflucan will do the trick!
  
• Thanks also for your suggestions re: milk supply. I think I was just being paranoid about milk supply. Further research suggests that all the signs that I was taking to mean I was experiencing a dip in supply were actually my body doing all the normal things (my breasts didn't feel as full as they used to, I've never felt a let-down response, etc). Also, I think my supply DID go down SlIGHTLY right before my period arrived, which is apparently normal. And my pumping output is slightly down from what it used to be (I pump 30-35 ounces per day whereas I used to pump 40-45 ounces per day), but it used to be that I primarily pumped and barely nursed and now I nurse all frickin' day long and pump far fewer times per day, so my overall milk production is probably significantly higher than it had been, it's just less measurable than it used to be (unless i wanted to be completely neurotic and weigh each baby after every feeding and even I'M not that neurotic...well, I am, but I'm too cheap to rent a scale right now). I did, however, order Domperidone and Fenugreek. The Domperidone arrived and the Fenugreek hasn't, so I've tried the Domperidone first. Actually, let me back up. Pam first sent me some Reglan which I used until the Domperidone arrived. It did help, but made me sleepy, which is no good when you have triplets. The Domperidone definitely makes a difference. When or if the Fenugreek finally arrives, I will stop the domperidone and try the fenugreek alone to give it a fair chance. Besides, my husband says there's no greater aphrodisiac than the smell of maple syrup and Jenna assures me that Fenugreek will make me smell like maple syrup, so it's worth a try, right? (Yeah, right, like we have time or energy for sex? Hah!)
  
• I think I will try to put Sam back down in a few minutes. It's risky, but I'm desperate.

Miscellaneous

Funny
One ridiculous thing about me is that despite having been a history major, I'm terrible with certain dates. It took me years to remember when my mother's birthday is (September 27, but I used to mix it up with the 17th). The only reason I know when my husband's birthday is is that it's six days after mine. The only reason I remember mine is because it's four days after Robert Burns' Day (I was supposed to be born on Robert Burns' birthday, and since I was born in Scotland, that would have been a huge deal, so my father has never let me forget it). And then there's my anniversary. You'd think this would be one date I'd remember, right? I picked the date, after all. I was there. A year of planning went into that date. It should be emblazoned in my mind, right? But the first time I received my wedding album, the wrong date was imprinted on it, and that set a bad precedent. I have a friend who got married exactly three weeks before me and so I routinely call her and ask her whether I got married November 2nd or 3rd when I have to fill out a form that requires my anniversary date. She laughs at me every time, but she does tell me, so that's good. Worse, I have to think really hard to figure out what YEAR even I got married. Hah. I never have to ask her that one, though, because all I had to do was figure out how long I'd been trying to get pregnant and subtract that from the current year, since we started trying immediately. Sad that my point of context is infertility...

ANYWAY, the funny part is this: This morning, my Google Calendar reminder sent me an email to remind me that today is my anniversary. Except, uh, that's WRONG! Our anniversary was yesterday! Duh! I couldn't even get the date right when I was setting up my calendar reminders! Sigh. Yesterday we sponsored a kiddush (small luncheon) at shul (synagogue) in honor of three things: Our fifth wedding anniversary was yesterday, today is the third anniversary of J coming to live with us permanently, and celebrating the birth of our triplets (November 7th is the triplets due date, which is coincidentally our anniversary on the Hebrew Calendar). There is much to celebrate, even if I AM terrible with dates. :)

I am Super-Mom
Sometimes this whole being-a-triplet-mom thing is hard, but sometimes it helps remind me that I am superwoman. For example... how many women out there can say that they've been able to feed THREE babies at once? Well, I can say that! Several times now, I've managed to nurse two babies at once, while bottle feeding a third baby propped between my knees. It's not the easiest thing to do, but I've done it.

The triplets eat 6-8 times per day, depending. They eat between every 3-4 hours depending on how hungry Sam is... He's our measuring stick... the other two don't get hungry nearly as often as he does, so when he gets hungry, he gets fed and the other two follow, so that they all stay on close to the same schedule. We change close to 30 diapers per day. We have gone through about a case of wipes since they came home. We do about 3 loads of laundry per day, sometimes more. We sleep in chunks of 2-3 hours at a time. Occasionally, we are able to sleep for slightly longer, but it comes at a cost (if I sleep for longer, it means my boobs wake me up in agony from lack of pumping or nursing). Two of the babies are breastfeeding 85% of the time. Abby still refuses, but since she's the little one, she gets extra calories added to her expressed breastmilk anyway, so it's not an entirely bad thing that she gets expressed milk. Tuesday we'll see a lactation consultant to see if she can help us figure out how to reintroduce Abby to the breast. In the NICU she was my best breast-feeder, so it's a bit frustrating that she's now refusing to consider it. But at least her bigger siblings are getting to be pros. They weren't very good at all at breastfeeding in the NICU.

We are slowly getting the nursery together, but there's SO much stuff that people have given or lent us... we have clothes from all different ages that people are lending us (kids at this age outgrow things so quickly it's not worth buying much) that I have to sort through. The babies aren't sleeping in the nursery right now anyway... they sleep in my room in a pack n' play next to my bed. It's not a big deal either way, the nursery is only three steps further away than the pack n' play, but still... Eventually it would be nice if the nursery was finished. So Seth is working on that today.

Okay, super-mom has to go now. Babies are hungry. More later!

How's J Doing?

I keep forgetting that people are asking about how J is adjusting to the three little siblings in his life. He's actually doing really well with them. I know he spent a long time ASKING for a brother or sister, but I also know in his little mind he thought he was going to get a sibling his age to play with. I'm sure he has no idea what to think about having three little babies in his life. But he's very affectionate toward them. He likes to "pet" the babies (e.g. caress their soft heads) and he enjoys holding them and feeding them a bottle (Abby is still getting bottles all of the time and Ellie and Sam occasionally get a bottle still, though it's less common... but they all only get breastmilk regardless of the delivery method). I've never posted a picture of J, because I've been wary of his mother coming across this site, but at this point, I'm not sure that's such a huge danger, so I'll post one picture, with the caveat that it may not stay here forever:



That's J feeding Ellie about two weeks ago. It was the first time I'd let him hold a baby (and we were RIGHT THERE balancing her) and he loved every second of it. He has a particular fondness for Sam, but adores his sisters as well. He is generally respectful of their need for quiet and peace, though he sometimes forgets, but that's to be expected. He is very, very good with them. We are definitely seeing adjustment issues in less direct ways, of course. Our bedroom is downstairs and the babies are with us, and his bedroom is upstairs. This never bothered him before, but suddenly he gets lonely when it's bedtime and he's sad that no one is there to sleep with him. He's started claiming to have more bad dreams (but he comes down complaining of the bad dreams long before he's had a chance to fall asleep) and he makes many more claims of monsters and ghosts in his room than he used to, all in the name of stalling at bed time. He's slightly more clingy than he used to be, and doesn't enjoy having play time by himself the way he used to. He craves having someone to play with him, though it doesn't have to be me or Seth... it just has to be someone. He apparently requires a little extra TLC at school and has a little more difficulty reigning in his energy levels than usual.

But basically, there's nothing we didn't expect. He loves the babies. He's adjusting, but not without some bumps. He's totally normal. We are very, very proud of him and we do our best to give him lots of extra hugs and kisses every day. He's a very sensitive kid.

Clean Bill of Health and Parenthood

I had my six-week post-partum appointment yesterday. I have a clean bill of health. It's kind of sad for me, really. It feels like I'm closing a chapter of my life. I'm officially not pregnant anymore. I mean, I haven't been pregnant for six weeks now, but something feels different and final now. And I miss it. And I'm sad that this may have been my last pregnancy. Even though I have four children now, I never wanted to have just one pregnancy (well, two, but the first one doesn't count in this sense).. I never thought I'd have three at once. I never thought this was how I would build my family. I don't want this to have been my last chance. And if I were a fertile myrtle, it would be easy to say, "well, okay, so if you get pregnant again, so be it, and that'll be great." But we all know it's just not that easy. So I know a lot of you are rolling your eyes that I have four kids and I'm not satisfied, and some of you probably think that this is just postpartum hormones, but I don't think it is. I'm sleep deprived, overwhelmed, can barely imagine handling another infant right now, but I long for the experience again.

Today would have been an easy day for me to say that I never want to go through this again. I was supposed to take J to school, which would have meant piling the triplets and J into the van and getting him up to school. This doesn't sound so hard, until you consider that all the babies have to be fed, changed, and put into car seats before they can be brought out to the car. Add that to the fact that J has to be changed, fed, and clothed and his lunch had to be made. Oh, and then there's the fact that Sam was up ALL NIGHT. He will NOT stop eating. He just keeps going and going. He woke up screaming with hunger at 2am (an hour before I expected him to wake up) and nursed from 2-4:45 when my husband took him away and gave him a bottle so that I could get some sleep. He wasn't just using me as a pacifier either, because he was really hungry and he would scream bloody murder if he unlatched, and he wouldn't take a regular pacifier. He was still hungry even after the bottle. He whimpered and whined for an hour and a half until he started screaming at 6:45 begging for food. So I nursed him until almost 9am when I gave up and gave him a bottle and he was STILL hungry. Meanwhile, I had three other kids to take care of, and I had decided that the four year old wasn't going to make it to preschool since none of us were dressed, fed or ready to go.

Today is the first day I have felt completely overwhelmed. But I STILL miss pregnancy. I still want to have another baby someday, even if people think I'm greedy for saying so.

Anyway, odds are good Sam's just going through a ginormous growth spurt. Babies apparently go through growth spurts approximately every 3 weeks, and he's six weeks old exactly today, so it makes sense, right? Apparently this should "only" last 2-3 days. Which would be totally manageable if he were a singleton, but hey, did I mention that there are TWO OTHER BABIES and a four year old to take care of? But this shall pass, right? Oh, and a friend of mine came and picked up J and took him to preschool an hour and a half late, but he got there regardless. Thank heavens. So the day is looking up, and I can do this. Parenthood certainly has its challenges, but I can do this, right? RIGHT?

The Great Debate

Yesterday afternoon I was speaking with a coworker about the whole triplet thing. She asked when I'd be leaving and I said probably mid-June and I'd be gone probably until close to the end of the year. She looked horrified and said, "I would expect that you'd be out a good deal longer than that!" I'd certainly like to be, particularly considering that by the time my disability pay runs out, the babies may not even be out of the NICU, but as it stands, I'll likely be back to work in November or December. Still horrified, she said, "but they'll be so young and little! How can you leave them alone!" Well, said I, I won't really have much of a choice about it. It's just the way it is. I will have 8 weeks off and that's all I get.

I didn't realize exactly where she was going with this horror at first. I thought she was empathizing with ME for not being able to take more time to get acclimated to three preemie babies in my house. But then she said, "but what about the babies? What about parenting? What ever happened to that?"

Frankly, she's lucky I didn't punch her. Let's get one thing clear: every family has different needs. Some parents are good parents. Some parents are less good parents. Some stay-at-home parents are terrific parents and some stay-at-home parents are lousy parents. Some working parents are lousy parents and some working parents are terrific parents. Judging me by my so-called "choice" to work after my children come into my life is not fair. No one knows what has gone into this "choice" of ours. Yes, we could move to a less expensive house. And we'd be giving up an amazingly supportive community and the ability to practice our religion in the way that we are expected to (e.g. we would have to move to someplace NOT within walking distance of an Orthodox synagogue). We could give up, you know, food, so that we could pay the mortgage without my salary, but I wasn't thinking that was a great idea either.

We can't afford for me not to work with only one child in our house (a child whose preschool tuition is paid for and whose most expensive needs are covered not by us). How on earth would we afford to pay for FOUR children in our house? Yes, we have some luxuries we could give up, but we don't live an extravagant lifestyle by any stretch of the imagination and giving up those few luxuries would not be nearly enough to make up the difference in what we'd be losing in my salary. And even if we DID lead an extravagant lifestyle... so what? Why should I have to stay home? Why should it be assumed that I will stay home and not my husband? What if I wanted to work? Okay, admittedly, I don't want to continue working full-time. But I would like to continue working at least part-time. I like what I do (sort of). I like having a field I'm very good at. I would also like having far more time on my hands to spend with my children.

I'm tired of hearing people make assumptions about people's parenting priorities based solely on decisions of day care vs. nannies vs. stay-at-home-parents vs. whatever. It's really none of anyone's business whether I work or want to work or don't want to work or whatever. I am just as dedicated to my childrens' futures as any other parent.

So there.

Blood, Guts and Gore!

So I don't care that this is likely in the realm of way too much information. This is an infertility blog, people! You guys write about cervical mucus and coochie-cams like they're the most natural things in the world to talk about. So I can discuss any TMI I want to in my own little realm.

For example, as I've mentioned, I have a three year old foster son. He's adorable, mostly, except when he isn't. And this morning he figured out exactly how to get my attention. (Note: Eema means mother in Hebrew, and that's what he calls me) He came walking up the stairs from the basement saying, "Eema, look, I have blood!" Ohmygodwhat??? As calmly as I could, I said, "What did you say, sweetheart? Let me see." Sure enough, he held out a tiny little thumb and there was a tiny sliver of a cut on his thumb. And it was, indeed, bleeding. I applied a spiderman bandaid to it and gave it a little kiss and asked him if he could show me what he touched that cut him. I was worried he'd found a sliver of glass or something. So he took me to the basement and showed me his book that is a glossy-paged pictorial history of the John Deere Tractor. One of his favorite books ever. And those glossy pages are perfect for causing paper-cuts, apparently.

Unconsoled, J started to cry. Apparently, spiderman is not good at healing papercuts. He wanted Spider man OFF his finger. NOW. And poor J looked up at me and said, "Eema, it really hurts me!" And I swear, I think he was more upset at his own fallibility than at the physical pain. I think the poor kid's feelings are hurt that his prized book could dare to cause him any unhappiness.

What? That's not the kind of blood and guts and gore you expected?

Okay, fine. No problem. I've got the good stuff, too. Never the master of good timing, my body decided that Thursday (when I was sick and drooling from exhaustion) would be the perfect time for my period to show her shy little self. This could not be worse timing. One more week and I would have been able to go get my E2, P4, hCG tests done so I could start Provera and get an IUI cycle going. But I couldn't just call that Day One and start an IUI cycle last week, because I still have to get my pap smear done (next week) and my Infectious Disease blood work updated (also next week) and Seth's ID blood work also needed to be updated (he did that on Friday). So now I'm going to have to wait ANOTHER four weeks to see if my period comes again (it won't) before I can do the E2, P4, hCG tests and start another round of provera. Which means January. Which means no more IUIs in 2006. Which isn't so horrible. But I'm running out of time. This time next year, I won't have fertility coverage anymore. I think I'm going to take this opportunity to go back to the clinic and consult with a different doctor and convince them to go straight to an IVF cycle instead of messing with another IUI. I'm running out of time. Pure and simple. I may be "only" thirty, but I'm thirty one next month, and next year I won't have insurance coverage for IVF, so you know... I'm running out of time, biological clock or not.

I've never heard that tick tock sound so loud. But it's all I hear anywhere I go. Tick tock. Tick tock. I don't care how "young" I am or am not. The point is biological clock or not, I'm running out of time. Tick. Tock. Tick. Tock. Will I have a baby before I run out of time? Tick. Tock. Will this period from hell never end? Tick. Tock. I mean, I know it's only been four days, but holy heck I've never (okay, not never, but it's been a LONG time) had a period this bad. This is worse than the post-D&C bleeding I had. In fact, that was mere spotting, mostly, even if it did seem to go on forever. Tick. Tock. I can't stop feeling like I'm running out of time. Quickly.

Tick. Tock.

By the way, when is bleeding heavy enough that you're supposed to worry? Because I think maybe I should be worrying. It's really a lot. There, is that the kind of blood and guts and gore you were expecting?