Thrush. AGAIN.

Can I just say how truly SICK of having thrush I am? This is, I think, the third, maybe fourth, time that I've had it in the five months that I've been breastfeeding. ENOUGH IS ENOUGH. It is quite possibly the most painful, but most definitely the most unpleasant, thing I could possibly ask to experience. It hurts like hell, I'm bleeding, I cry nearly every time I nurse my babies, and pumping isn't any more pleasant than nursing, so it's not like I can just pump and forgo nursing for a bit.

Gah!

It's not enough to make me stop nursing, but ohmygodpleasemakeitstopseriouslyplease!

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!

Sometimes, Words are just Inadequate

Many times when I start a post, I regret that I am not more eloquent. I wish that I had better words to express the thoughts in my head for a lot of selfish reasons...but mostly so that people will enjoy reading my blog. But today, I regret my total lack of eloquence for a far more desperate reason. You see, I read a lot of blogs, and I don't always comment on them, and not everyone knows that I'm around, and I always think "I'll get around to commenting someday." And sometimes, "someday" is too late.

I've been reading Keira's blog on and off for a few months now, but I'm pretty sure I never commented before this week. And now... it's not too late, but mere words are just so inadequate to express my anguish over her loss of her little warrior princess, Sweet Zoe Rose.

If I were eloquent, I would say something meaningful and comforting and full of hope and life. But I am empty and sad and full of despair. I feel torn apart for this woman, for this family, who I have never met, who doesn't know me, who probably doesn't know I exist, and I feel like I am breaking into pieces. It's not right of me, it's not my loss and it's selfish of me to be feeling like this, but all I can imagine is the pain I'd be feeling if I lost one of mine... this was one of my deepest, most biting fears when I found out I was pregnant with triplets. And while I know that loss can strike any parent... for some reason, the fear gripped me harder in the face of triplets than in the face of a singleton.

What I do know is that last night, I hugged each of my four children a little tighter before bed, and wiped an extra tear away before anyone could see. And I so fervently wish that I had the eloquence to adequately express to Keira how much I care for her, despite the fact that she has absolutely no idea who I am.

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.

Answer to Anonymous

I still hate that Blogger doesn't do threaded comments, so I'll respond to Anonymous' questions on pumping here:

While driving to and from work can you steal some additional pumping sessions using something like a Whisper Wear pump?

My commute to work, thankfully, is really too short for this to be useful. And I do pump while at work, of course, but there's just only so many times I can do that. I'll point out that the Whisper Wear Pump has been discontinued by the manufacturer. While I don't know why, my guess is it's because it doesn't work. I actually have a Whisper Wear Pump and my experience is... it doesn't work (and, oh by the way, it's LOUD). From the reviews I can find online, it seems that it definitely does not work with women who are, uh, how shall I say... ahem... well endowed. And people who are small breasted seem to have only minimally good experience with it. I'm in the well-endowed category and I can't get a drop out of it, so I found it to be a phenomenal waste of money.

While a baby nurses from one side can you hand pump the other?

If I'm nursing only one baby, and I haven't recently pumped, I nearly always pump the other side. But I don't use a hand pump, I use my hospital-grade electric pump for that. But it also depends on whether I'm about to nurse another baby. My experience is that if I pump and then feed a baby, the baby doesn't get enough (remember that I weigh Ellie before and after feeding her, so I do have a quantitative way of measuring this), so if I'm feeding Sam and I know that I'm going to be feeding Ellie immediately afterward, I might pump for a few minutes on the other side just to get to the hindmilk stage (higher calorie), but I won't do a full pumping session. I am often, however, feeding two babies at once, so there's nothing to pump at the same time. (I've backed off on simultaneous feeding recently, because I'm finding Ellie doesn't eat as much if I feed them both at the same time... I'm not sure why this is, but it seems consistently true)

I do often pump AFTER nursing the babies, because in THEORY this is supposed to boost my supply. However, my experience is that I nearly NEVER get more than a couple cc's if I pump after feeding the babies. They're pretty good at fully draining me, which is a good thing. I can't pump after nursing them EVERY time they nurse, because, honestly, there are only so many hours in the day.

On Breastfeeding Triplets

You're pregnant with triplets? Well, you're obviously not going to breastfeed them, you're going to spend a fortune on formula!

I heard that a lot when I was pregnant. Over and over, I heard unsolicited opinions from people telling me that there was no way I would ever be able to breastfeed triplets. It's not possible, they would say. I didn't even bother trying with my twins, I would hear. Why would you even think about it? You'll never do anything but feed them all day long if you try! the incredulous voices would cry. They'll be preemies. You can't breastfeed preemies, you know.

I never expected to be the militant type...certainly not about breastfeeding, and certainly not about breastfeeding triplets. But these constant, unsolicited words of discouragement absolutely convinced me that I was going to do everything I could to breastfeed my babies, at least for the first few weeks. My premature babies were going to NEED the benefit of my colostrum and my milk for as long as I could give it to them, and I knew it wouldn't be forever, and even during my pregnancy, I mourned the loss of the ability to just KNOW that I could breastfeed with reckless abandon, but I set a modest goal. I wanted to get 3-4 weeks of exclusive breast milk into them if I could. And if I could do that, well, we'd go for 6 weeks and after that, I would give myself permission to supplement with formula, because it would be a miracle if I made it that far.

The babies did get a little bit of formula in their first few days. My colostrum was mixed with a few cc's of preemie formula to make up for lack of volume, but they DID get my precious drops as well. In their first 3 days they received a couple ounces of formula between the three of them. TOTAL. And then I started producing enough to feed them exclusively my milk. It helped that Abby started out with 2.5 cc feeds and Ellie and Sam started out with 4cc feeds, so the demand wasn't huge from the start. They were still getting the bulk of their nutrition through a TPN at that point while they figured out the whole suck/swallow/breathe thing.

And on Day 4, my husband asked the nurse how long it would be before I could try actually breastfeeding my babies, and she checked with the doctor and got permission for me to breastfeed them. She helped me get set up with Sam and showed me how to hold him and support him, and I fretted about whether he'd be able to latch, but he did! He didn't latch on for very long, but he definitely knew what to do and figured it out pretty quickly. He tired very quickly, so we gave him a feeding through his gavage tube afterward, but it was miraculous. I had no idea how amazing an experience nursing my baby could be until that moment. It felt strange and awkward and perfect and amazing all at the same time. My tiny little three and a half pound baby knew what to do and he nursed like a little champ! How incredible. And then it was time for Ellie's feeding, but she was having a harder time, so we gave her a gavage feeding while she was nursing so that she could associate a full tummy with mommy's breast...a technique we employed a lot with her in the NICU, actually. I was shocked at how exhausted I was after nursing just two tiny babies. Abby was still too small to try to nurse, so when her turn came, I held her skin-to-skin while giving her a gavage feeding, and then I pumped afterward while gazing at my beautiful two and a half pound angel and had the best production I'd ever had before. It was amazing to see that it was all true... being around your babies really DOES improve milk supply. Who knew?

And that was my first day breastfeeding my babies. The next day, believe it or not, I was able to breastfeed all three of them, even Abby, and I breastfed them at least twice a day every day until they left the NICU and I pumped 8-12 times per day, every day. And then, on day 24, they came home. My once champion breastfeeders suddenly would not breastfeed anymore. None of them! I continued to pump 8-10 times per day, fed them expressed milk, attempted to breastfeed them at every feed, and never slept, because of the constant fight to get them to remember how to breastfeed. I thought all was lost. I developed my second clogged duct and was in misery until it resolved. And then... a few days later I woke up with painful, red, tender, swelling in my breast, a high fever, chills, flu-like symptoms... you guessed it, mastitis! The way to get through mastitis, I'm told, is to let your baby nurse as much as possible, but my babies wouldn't help me, so I gave up for a few days and just pumped, pumped, pumped, pumped and pumped some more. And gradually, it got better, and I was able to see the light at the end of the tunnel.

I thought there was no way my babies would ever return to nursing... but on the advice of a nurse, I got some nipple shields, even though lots of people told me that nipple shields would only lead to nipple confusion. Seriously...these babies were drinking from bottles, so how much more confused could they get? And lo and behold... suddenly, Ellie was nursing. Then Sam was nursing. Only Abby remained skeptical. She would latch occasionally, but would usually scream her head off at the mere mention of breastfeeding (er, that might be a SLIGHT exaggeration). And eventually I was able to rid myself of the nipple shields all together and I had two, perfectly normal nursing babies and one baby who would not nurse, but who still received only expressed breast milk.

I called the pump my FOURTH baby, because I spent as much time with her (I named her Maggie) as I did with my three babies, in order to make sure I always had enough milk for Abby. And pump, I did. I was able to reduce to 6-8 times per day without changing the amount I was producing, since I was nursing so much, and I still got lots of snuggle time with my beautiful Abby. Even today I still try to give her the opportunity to nurse occasionally, but she still hates it. She's got a tongue-tie, and has a really hard time latching, so it's not shocking that she won't nurse, but it's a little disappointing.

My babies will be five months old next week and today, for the first time, I'm faced with the need to supplement them with formula. I've finished my stash of milk in the freezer. And I'm pumping like mad. But I'm producing 40-45 ounces of milk per day in addition to whatever they get via nursing directly, and the three babies together are eating 52 ounces of milk per day, so I'm falling a little bit short on the supply. I've tried everything... domperidone, fenugreek, blessed thistle, some weird herbal concoction, reglan, oatmeal, breast compression before and during pumping... but I just can't produce more than I'm producing now, without adding additional pumping sessions in each day. I'm pumping about 6-7 times per day right now, and if I pump any more than that, I'll probably lose my job.

A piece of me feels like a big, giant failure, even though I'm obviously not going to STOP breastfeeding and pumping at this point. I'm not sure when my 6 week breastfeeding goal turned into a 3 month goal, or when that 3 month goal turned into a 6 month goal, or when that 6 month goal turned into a 6-month-adjusted goal, but I know now that I'll breastfeed as long as I can, as much as I can until they're a year old, and then I'll work on weaning them before moving on to my next round of fertility treatments. I'm not getting any younger, but I do want at least one more chance at this pregnancy thing. And I want my children to have lots of siblings. I had only one and he loathes me, so I've been determined my whole life to make sure that my children are surrounded with a big brood. They don't all have to like each other (though that would be nice), but at least the odds are good that they'll each find SOMEONE to love in the family.

But I digress. I do feel like I'm failing my children, though I don't feel that way toward any other woman who feeds their babies formula. I've told countless mothers of multiples that they should not ever beat themselves up over their breastfeeding decisions because it's HARD, and sometimes darned near impossible. And I know I should celebrate my five months of accomplishment, rather than focusing on my failure to continue the same pace, but I just can't get past it. I know very few women who made it through five months of feeding triplets only breast milk... so I should be thrilled, right?

But then this morning, the first morning that I was guaranteed that the babies weren't going to have enough of my own milk for the day, the guilt poured on. I thought it would be wise to try giving Abby a bottle of formula while there was still breastmilk in the fridge, just in case she didn't like it. After all... what would we do if she refused it and there were no other options? So when the nanny arrived this morning, I handed her a bottle of formula (no way was I going to be the one to give her the yucky stuff). Sure enough, Abby screamed her little head off. My poor persnickety Abby wanted NOTHING to do with the formula. NOTHING. I thought maybe she just wasn't hungry, but we gave her a bottle of breastmilk and, sure enough, she gobbled it right up. Sigh. Sam, fortunately, had no problem drinking the formula, little piggy that he is. Next week, I'll try making 50/50 bottles and see what happens with Abby, but oh gosh, my heart was breaking knowing how much she hated the taste of the formula! I was completely failing my child! Thank heavens I tried it out while there were still options!

In a couple months, we'll be starting them with some solids, and eventually their consumption of milk each day will go down slightly, so I may actually be able to return to being able to feed them 100% breast milk. But for now, each of them will probably get 2-4 ounces of formula each day. And I know that's still pretty amazing on my part. And I know there's nothing to be done, and no way for me to get around it.

And once again, I feel like a failure. Once again, I feel like my body is betraying me. It's infertility all over again, even though I know that logically, this is the polar opposite of infertility. Somehow, I simply MUST make myself okay with supplementing, because there's really nothing wrong with it. It won't hurt my babies. They'll still grow and they'll still be healthy. I'll still be able to fortify for the extra calories that Ellie needs. I'll still be able to breast feed any time I'm home and feed them breast milk most of the time. 2-4 ounces per day just isn't the end of the world, so why do I feel like the world's worst mommy?



~~~~~~~~~~~~~~
Also, a quick update on Ellie... at her appointment yesterday she hadn't gained any weight, but on Wednesday we were able to convince her to start taking 120 ml bottles, so we're hoping another week of that will be enough to boost her back toward gaining. Bigger babies need more calories to grow, of course, so hopefully that's all that's going on. For the moment, she is a bit of an enigma, but she's definitely improving. She's more alert, and smiling and cooing almost as much as Abby now. She looks good, but is still far more sleepy than the other two. We'll go back in a week to see how she's improved.

My Place in the Blogosphere (Updated)

I've been contemplating the fate of this blog of mine... whether it really belongs here or not, in more ways than one. First, there's the simple question of whether I should stick with Blogger or move to Typepad or WordPress. I loathe WordPress, but I like that you can password protect individual entries, so it's tempting, though I'm entirely too lazy to make it happen anytime soon. Typepad is even more tempting, though I'm not sure I'm willing to fork over the cash to blog, since, well, this is, in essence, a useless pastime of mine. Mostly, I think I should switch to TypePad, but I've been saying that for two years, so my guess is that I'll be sticking with Blogger for the moment.

But the more pressing question is whether this blog even belongs here at all, in its present form. I don't know what my place in the blogosphere is anymore, and I know in some ways, I don't fit in and I never have... I never entirely fit the mold of a good and proper infertility blogger... I had primary infertility, but I had a foster son, so I wasn't a childless primary infertile, so I wasn't going through your typical primary infertility experience. On the other hand, I wasn't exactly going through secondary infertility either, was I? Still, I found my place in the infertility blogosphere, one way or another. And then I became one of "those people"... one of those bloggers who wrote about "pregnancy after infertility" and then "pregnancy loss after infertility" and then "pregnancy with higher order multiples after pregnancy loss after infertility". And now I'm a Mother of Multiples (MoM for short). And like many MoM's, I am parenting my multiples after experiencing infertility, so my life isn't JUST about the experience of parenting multiples. My perspective will forever be tainted with the infertility glasses. Some women move past infertility, but I don't think I ever will. Particularly since, crazy as it sounds, I want more kids and I know I can't "just" decide to have more.

But where do I fit? I hesitate sometimes to comment on infertility blogs these days, because do you really want a MoM commenting on your blog? (I don't know, I mean, really? Do you?) But I feel just as out of place on just plain parenting blogs (unless they're about parenting after infertility or about triplets or whatever...there has to be some common bond).

In some ways the name "My Perky Ovaries" isn't right anymore, except in other ways, it's more right than ever.

So what do I do? Do I stay here? Do I change my blog name? Do I make it more of a parenting blog? Do I stick with the whole infertility thing? (Considering that I plan to return to the fertility clinic for another round of fertility hell no later than the end of this year or beginning of next year, my guess is I'm sticking with the infertility thing) Do I start a whole new all-inclusive blog? Do I keep this blog for the infertility musings and start a separate parenting blog? Is that too much work? Do my infertile friends mind reading about my kids? Do I just realize that on some level we all hope and pray that someday ALL of us stirrup queens are writing about our kids so we can't ALL sit around being bitter about the kids that result from all these treatments? I don't know, maybe we can.

I think moving or abandoning this blog would be a bit on the tragic and somewhat melodramatic side. I get about 5,000 pageloads per week... about 3500 unique visitors per week... visitors from about all over the world. These are facts and figures that astound me, and surprise me whenever I see them on my statcounter summary. But they are there, every week, confirmed all the time. So... what to do.

Maybe I should just retire from this whole blogging business all together. I haven't been much of a good blogger anyway. But I'd be sad to leave my blog. Too sad, I think. So I don't think you'll luck out and be rid of me just yet. But for tonight, that's all you're getting out of me. I'm just too tired to be eloquent, even though I have far too much to say about the blessings in my life. It's been a long couple of weeks, and all the exhaustion of the last couple of months is finally catching up to me.

Your thoughts, as always, are appreciated.

Update:
Thanks for all your kind comments. I really wasn't trying to fish for compliments, but gosh, you all gave me lots of warm fuzzies. I don't think it's likely that I would actually stop blogging all together (Jess would KILL me!). I started my blog for me and only me, and if other people happen to read it, well, I find it amusing that anyone else would be interested in this dull life of mine, but I'm flattered. But I sometimes worry that I give a false impression of myself by passing this off as an infertility blog (what with the title and all), when I've got four kids (though, obviously, I fought hard for all of my children, including my foster son). But to discard the infertility label all together... well, that seems just as disingenuous. So anyway, here I will stay, and I'll post about... well, whatever. And you'll read it or you won't. And maybe I'll switch blogging services (most likely to Typepad), but I probably won't, because, you know, I've been threatening to move over to Typepad for, oh, two years now and I'm just too lazy and I don't want to have my archives scattered between two blogs and I'm too stupid to have a manual back up of my blog (which I really ought to do at some point, don't you think?). But the bottom line is, the Perky Household isn't likely to go anywhere, so you're stuck with me for the moment.

two steps forward, one step back

Ellie lost four ounces.

Self Esteem

Yesterday, the nurse manager at my pediatrician's office came out to the waiting room to coo at someone's baby and took several minutes to recognize me. I only had one baby with me, see, and besides, that she claims not to have recognized me since I apparently am continuing to lose weight (I'm not still losing much weight, but I think it continues to re-distribute). Those of you who have met me in person know that I'm anything but slender, but if you knew me pre-triplets, you know that I *have* lost a great deal of weight. I'm down about 70 pounds from my pre-pregnancy weight, but before you get all impressed, I still have 30 or 40 pounds to lose before I'm anywhere near my "ideal" weight.

Still, it felt great yesterday to hear the nurse say, "Oh my goodness, I didn't even recognize you, skinny mama!" and then she turned to one of the other mothers in the waiting room and told her I was a new mother to triplets and the mother looked at me and said, "You look AMAZING!" In fact, every time someone in my doctor's waiting room finds out I'm a mother to triplet infants, they tell me how fantastic I look. This must be why I love my pediatrician so much!

And then when I left the office, I ran into a member of my synagogue whom I haven't seen since I was on bed rest, when she paid a shiva visit to my husband last summer. And she couldn't get over how I looked. "You look incredible!" she said.

Gosh. Thanks!

I know I still have a really long way to go before I'm anywhere near where I'd like to be... but gosh... it's so nice that people notice that there's been SOME change. And it's nice that perfect strangers feel compelled to tell me I look great when they hear that I've got triplets. I've been feeling a bit blue the past couple weeks, but these little ego boosts are really kind of helping. So... wow!

My New Favorite Number

18.

That's how many ounces my sweet baby girl gained in TEN days! So bad math be damned, it worked. I asked the pediatrician whether I should alter the recipe so that the intended 28 calories/ounce is actually obtained and he said no, because he actually wouldn't want to see Ellie gaining weight any faster than she gained this week! So we'll stick with 24 calories per ounce, but I'm going to use an actual 24 cal/oz recipe because I enjoy precision (even though the lack of precision is obviously working fine for Ellie). He said he didn't necessarily care about the precise number of calories, so long as her growth is appropriate. This, to me, is the most logical approach.

He also said that since her growth is so great with the added fortification, there's really no reason I can't add in some more flexibility with the number of times per day that I breastfeed her. I noted that during the week I would really only get one more BF'ing session in anyway, so I was less concerned about that, but on the weekend, my preference would be to breastfeed her most of the time if possible, and he said, "so if she doesn't grow as much on the weekends, so what? She's growing plenty during the week to make up for it." I love him!

Finally, he said he would leave it to my discretion as to whether I even need to follow up with a GI doc at all at this point. He'll see Ellie again in a week to make sure she's still on track, and if she's really struggling at that point, he'll help me get in to see Dr. D. But otherwise, he's not super-stressed about continued follow up with the specialist, as we seem to have found the answer we need for the moment.

Meanwhile, the scale I ordered for Ellie arrived, so that I can make sure she's taking in enough when she's breastfeeding. I weighed her on it when we got back from the doctor's office to make sure that it's accurate and then just for fun, I weighed Sam and Abby, too!

Sam: 11 pounds 1 ounce! (Admittedly, he had just eaten, so he's probably actually a little under 11 pounds)
Abby: 9 pounds 14 ounces!
Ellie: 8 pounds 10 ounces!!!!! (can you believe it!?)

On Funny Math (Updated)

You know, I thought the math on Dr. C.'s 28 calorie recipe was a little weird, but math has never been my strong suit, so I just figured I was just a dumb blonde and she was the smart doctor, so I should just do what I was told. Um, I'm not actually blonde, but go with me on this one, okay? I mean, the thought had occurred to me to run the math by my pharmacist husband, but see... I never have a lot of faith in that either... I always think this sort of thing is some secret, highly complex code that even my super-smart husband can't possibly crack and I don't want to burden him with the embarrassment of straining his intellect. I mean, it would be a horrible blow to his ego, right? And I wouldn't want to be the cause of his mid-life crisis at such a young age (he and I just had birthdays, so I'm a bit sensitive about his age since I'm catching up to him). And so, I simply followed the doctor's directions, knowing that I could never possibly understand the highly complex calculus involved in mixing 28-calorie food for my under-fed daughter. After all, I am a mere mortal, and Dr. C... well, SHE went to medical school.

Ahem.

And then Lea Bea... Dear, sweet Lea Bea, was avoiding schoolwork, so she tried out the math for me. Because, really, apparently, schoolwork avoidance=too much damn time on your hands (see, some math isn't too difficult for me!). And apparently, this math is pretty damn simple. The piece I was missing was that I didn't know how many calories were in a scoop of formula, because I'm a total moron. See, I know that formula contains 20 calories per ounce. And I know that you mix one scoop of formula with 2 ounces of water when you're just making regular formula for a baby. So it would make SENSE that one scoop of formula has... YOU GUESSED IT... 40 calories! But I am tres stupid, so it never occurred to me that it was that simple.

Dr. C's directions were VERY clear. "1 scoop formula + add breastmilk until total volume = 5 oz" Now this is the exact opposite of how you make formula. When you're mixing formula for a baby, you pour water in a bottle to the desired volume, THEN add the powder (or so I'm told... I've never actually made formula). If you put the powder in first, and THEN add the liquid to 5 oz total volume, you only need to add about 4-4.5 ounces of liquid before you get to that 5oz mark. If you add liquid first to the 5oz mark and then add powder and then shake it all up, you end up with 5.25 oz of final volume. Go figure (I'm not really sure why this works this way, and I really don't WANT to know). I remember very specifically clarifying Dr. C's instructions, because it was the exact opposite of how I'd been taught to make formula, and she was very specific that she meant to put the powder in the bottle first and THEN add the liquid. So if you do it her way, here's the math, courtesy of Lea Bea:

1 scoop formula = 40cal
4 oz breast milk = 80cal
Total = 120 cal in 5oz bottle
divided by 5 oz = 24cal/oz.

Gah! So all this time*, I've allowed Dr. C. to make me feel guilty for hanging on to breastfeeding my daughter, despite the fact that it's making her fall short of her calories because she's only getting 4, 3-oz 28-calorie-per-ounce bottles per day, plus 2 breastfeeding sessions per day (approximately 3 oz of intake per session at 20 calories per ounce)... for an estimated total of... 456 calories per day (if I've done my math correctly, but remember I've already admitted math isn't my strong suit). Ellie's supposed to be getting a MINIMUM of 480 calories per day. However, if these are really 24-calories-per-ounce bottles, she's ACTUALLY been getting an estimated 408 calories per day, which is an even greater shortfall than I thought. And that's because of Dr. C's lousy math.

According to dear, sweet Lea Bea, however, if I added the powder to 5oz of milk, I'd get closer to 27 calories per ounce, which is a lot closer to what I wanted in the first place. And I trust Lea Bea's math more than Dr. C's at this point (plus, um, my husband concurred, because apparently it's insulting that I didn't trust him to be able to do the math in the first place). But honestly, I'm not making any changes until we see our regular pediatrician tomorrow. She's barely tolerating the fortified bottles as it is. But she IS definitely gaining some weight. Her cheeks have filled out a little bit and she's more alert than she was. And she's definitely getting more calories than she had been before, so anything's an improvement.

It's just... so frustrating! There's this doctor who already frustrated me with her recommendation to stop breastfeeding all together, but I could at least understand her logic. But then I thought there was a reasonable compromised reached which I assumed wouldn't pose any serious problems for Ellie since she'd still be getting pretty darned close to her calorie requirements, when it turned out that a problem in Dr. C's math was going to cause a pretty significant shortfall! Gah!

---------------------------
*Okay, to be fair, "all this time" is really only a week, but still! This is a tiny baby we're messing with!

Update:
I hate that blogger doesn't do threaded comments. Anyway, a couple comments I've gotten about the math:

It's a question of total calories vs. calories-per-ounce.
If you have 5 oz of milk and a scoop of formula, you'll have more total calories but fewer calories-per-ounce.
If you have 4 oz of milk and a scoop of formula, you'll have fewer total calories but more calories-per-ounce. It will be more concentrated.
So it's actually more a question of which is works better, filling her belly fuller with a lot of milk, or having her try to tolerate the more concentrated stuff. It also depends on how much she'll actually eat!
Hope that makes sense!!

It does make sense. However, since Ellie only drinks 3-ounce bottles (she throws up if we give her more than that), what actually matters is the calories-per-ounce. Obviously, I mix up more than I will use, and then just pour out 3 ounces worth into the bottle that I'm feeding her from.

The calculation of one scoop at 40 calories plus 5 ounces of EBM at 100 calories totalling 140 calories divided by 5 ounces comes out to 28 calories per ounce. The problem apparently is that the powder isn't volumeless. You need to use the full 5 ounces of EBM, and then each fifth of the mixture -- each 1.05 ounce -- will contain 28 calories.

This is quite correct. HOWEVER, this is only correct if this had been what Dr. C's instructions had been. Her instructions were NOT to add powder TO milk, but rather to add milk TO powder. Which meant I was adding only about 4 oz of milk to one scoop of powder. My issue isn't with how to do the math at this point. My issue is that Dr. C's math was faulty and, frankly, after her attitude last week, I have little patience for sloppy math.

I Deserve a Medal (Updated Again)

For those of you who have never had the pleasure of fortifying breastmilk for a baby, it's disgusting stuff. But it's pretty simple. You use a recipe to add formula to breast milk so that the final product equals whatever calories per ounce your goal is. When we were trying to get 22 calories per ounce, we added a half teaspoon to 3 ounces of breast milk. You could barely tell the formula was in it. Now we put a full scoop of formula in a bottle and add breast milk until the total volume equals 5 oz (so we add approximately 4ish ounces of milk). It's disgusting stuff and smells to high heaven and pours out really thickly. Yick. No wonder poor Ellie doesn't love the stuff.

But anyway, tonight I had the displeasure of going and purchasing a can of formula for the first time. Do you know how much this shit* costs??? One 16 ounce can costs $27!!! Fortunately, CVS had it on sale for $22 with your ExtraCare card, and I had a $5 coupon a friend had given me. But seriously, even $17 per can! Imagine if I was really feeding formula to my babies as their primary foodstuff! I used to say that I HAVE to breastfeed my babies because we can't afford formula for all three babies, but I had no idea that I WASN'T JOKING. I don't think I could afford formula for ONE baby if I were feeding formula full time! (Hell, I'm not sure I can afford it just as the fortifier, sheesh!)

Okay, so I have no idea how much money I've saved our family by breastfeeding triplets for this long so far, but I do know I deserve a medal. Or perhaps a new laptop. Which, um, I need because mine died a grizzly death. Now, if only I could breastfeed them all through college to save on tuition too... we'd be all set. Except, um, I don't think it works that way.

*Okay what is UP with me and the profanity lately?? I have GOT to cut this out!

Update Answer to Anonymous:
No you can't fortify breast milk with breast milk. Simmering breast milk down to concentrate it wouldn't really work and would damage the breast milk. The proteins and antibodies in the breast milk would be damaged by the cooking process. Plus, you'd have no way of knowing what the calorie concentration was. The main reason for me to keep giving my babies breast milk (aside from formula costing a FREAKING FORTUNE as I just discovered tonight) is to give them the benefit of the antibodies and other good stuff they get from me. Cooking the milk destroys that goodness. I can get the concentrated calorie benefit by simply adding formula. Processing is not the root of all evil, in my opinion. (and I certainly don't have such an excess of pumped milk that I can afford to concentrate my EBM by simmering... it would be a guarantee that my babies would end up on formula supplements, because I could never pump enough to make up for that difference)

P.S. You didn't upset me with the way your question was phrased. It's just that it's an unrealistic solution. There's no way to really calculate the number of calories you'd end up with in your breast milk concentrate, and when you're dealing with a baby who's struggling to get enough calories , it's important to really work hard to get those calories into her. Spending the money on one can of formula to use as fortifier for her isn't a big deal. It would be a HUGE deal if I were using the can of formula as intended by the manufacturer... particularly with three babies. I'd be spending a FORTUNE on formula! As it is, this can that I bought last night should last for several weeks, thankfully. I have no idea how long a can of formula would last if I were making it straight for three babies full time. I don't think I want to know!

Updated Again: Anonymous says:
and what about WIC? Maybe you make too much money to qualify...but worth a try... especially since you have triplets to feed!

If we still had only one income we make too much money to qualify, now we have two incomes. (I'm quite grateful to not qualify, mind you) On top of that, since I'm not using formula for anything other than fortifier, I only need one can every couple weeks, so the WIC benefit would be wasted on us. We can certainly afford one can every once in a while. It's just the idea of having to pay for this all the time that makes me very grateful that I breastfeed.

Some Answers re: Failure to Thrive (Updated AGAIN)

I feel compelled to point out that the most recent anonymous comments I've received on my last several posts have been sensitive and kind, reminding me why it is that I continue to permit anonymous commenting on my blog. Like this one, for example:

Thank God for your pediatrician. Shame on Dr. C for not considering your situation better. Can you see Dr. D next time instead?
Um, so, there is no underlying cause?

I could see Dr. D. next time, but it's more complicated than that, which is why I didn't just schedule my one-month follow up with her. If I go to my follow up on Thursday with my regular pediatrician and we determine that Ellie isn't gaining enough weight, we'll have to coordinate with Dr. C. to admit Ellie for the NG tube. And if we get the NG tube, Dr. C. is the go-to person on that. And having continued follow up with Dr. C. on the NG tube then makes it weird and complicated to then turn around and follow up with Dr. D. So following up with Dr. D. only makes sense if we don't end up needing the NG tube, but if we don't end up needing the NG tube, then I guess we're okay with Dr. C. after all, right? So basically, so long as I have my pediatrician acting as our advocate, I think I'm okay with Dr. C. I have confidence with her medical knowledge, I just don't like her approach to me as a parent, but I have full confidence in my pediatrician's ability to intervene when necessary. At any rate, I intend to address this very question with him on Thursday when I see how Ellie's doing.

As for the underlying cause... The underlying cause at this point is being attributed to prematurity. My pediatrician is expressing some concern that there may still turn out to be another cause which will be more obvious once we get past being able to push sufficient calories into her system, but the only way to figure that out is to get this problem under control first. He is inclined to agree with Dr. C. that the simplest answer is likely to be the correct answer, but is not willing to dismiss the possibility that there might also be some other issue. (For the record, I don't think Dr. C. is completely eliminating the possibility of other causes either, but I think she's saying that in her experience this eating pattern and difficulty with growth is completely normal with premature babies, which is quite a relief, really)

Krissy asked:
This is probably a dumb question/suggestion after all you have been through...but have any of your doctor's suggested adding rice cereal to the EBM?

It's not a dumb question. No, noone has suggested it. However, adding rice cereal to the EBM wouldn't get the EBM anywhere NEAR 28 calories per ounce, so sticking with the fortifier is a better idea in this case.

From my original post on Failure to Thrive, Anonymous asked:
You did get the results of the blood tests, right? Does Ellie's output seem different from that of the others in any way? At what point did the growth first begin to slow? When Ellie is striking, will she take a bottle of water?

The blood tests, by and large, came back normal. The CO2 level came back low, but that was probably an artifact of how it was drawn (heel stick into an open container, so the CO2 probably dissipated into the air, since it wasn't a vaccuum container). Everything else that could have been an indicator of a problem came back normal. Ellie's output is lower than the others, but it's understandable because her intake is lower. Her growth began to slow essentially right after she was discharged from the NICU (e.g. after she stopped getting gavage feedings through an NG tube). She was my biggest (by a couple of grams) upon discharge from the NICU but fell behind Sam by their second appointment with the doctor (a week or two after discharge from the NICU) and fell behind Abby by December. Considering that she used to be a full pound heavier than Abby, that's significant. She is now two full pounds behind Abby and three full pounds behind Sam. When Ellie is striking she will not suck on anything but her thumb. No bottles, period. However, even if she would suck on a bottle, we would not give her water, because that would fill her tummy with something that contained no calories which would be taking a step backward. Since the babies were two months early, I've essentially got three two-month old babies, so they are too young to be taking water just yet. It's all milk all the time right now.

I think I covered the majority of the unanswered questions.

The good news is that the more calories we've been able to get into Ellie with the 28-calorie fortified EBM, the more she's been willing to take in general. She's even told us she's hungry a couple times (unprecedented!). She's still slow to eat and is still throwing up feeds occasionally and is definitely not loving the 28 calorie stuff, but she's eating it. I think her cheeks are even filling out a little, which is a great improvement over the sunken, skeletal look she had before. I'm still worried about keeping up my milk supply for the amount of EBM I need to provide, but at least I know that if I have to supplement with formula, I'm doing so with the support of my pediatrician, rather than with the dismissal of the GI doc, so I feel better about it. I have some milk still in the freezer, so all is not doomed, YET. I'll just take it one day at a time. I've gotten them 4 1/2 months on only breast milk. I'll get them as far as I can.

Edited to Add:
A new question from another anonymous poster:
why don't you just switch her over to formula so she can gain some weight?
Formula vs. breast milk is not the question in this case. Breast milk has obvious advantages over formula for preemies with regards to the immunities and the easier ability to digest (preemies have a harder time digesting formula than breast milk). However, there's also a misconception that formula is higher calorie than breast milk, but it isn't. Both are 20 calories per ounce. You can get higher calorie preemie formula (standard preemie formula is 22 calorie per ounce), but you can just as easily fortify breast milk to 22 calories per ounce and accomplish the same thing without losing the benefits of the breast milk. That's what we're doing with the expressed breast milk at this point... we are fortifying quite a bit more than that, in fact. We are fortifying to 28 calories per ounce, which you'll see if you read my previous post, "Failure to Thrive is Not Failure to Nurture."

I make absolutely no judgments about formula fed babies. For some people, formula feeding is the right answer. But it is not the right answer for our family, and would not solve the problem. In our case, Ellie's problem is sleeping through feeds, refusing to eat and therefore not taking in enough calories. It wouldn't matter if it were breastfeeding or formula, because when she refuses a feed, it doesn't matter whether it's a bottle feeding or a breast feeding, she won't take it. Incidentally, my pediatrician feels strongly that Ellie is the one of the triplets that most definitely should NOT be switched to formula if the need arises. Fortifying the breast milk is fine, but she needs the benefits of the breast milk as well. She's having a really hard time stomaching the heaviness of the fortifier as it is.

From Trilcat:
BTW 1. I assume that you realize that you can feed a sleeping baby?
2. Trust your instincts! Not every baby grows the same. If your baby looks healthy to you, they probably are. If she doesn't, she probably isn't.

One of the first things we were told in the NICU, in fact, is you can't feed a sleeping baby. This may be different for a full-term baby. But a preemie will choke if you try to feed them while sleeping. I know many babies will reflexively swallow if you dribble milk into their mouths (and I know that Sam will actually nurse in his sleep), but Ellie will not nurse in her sleep, and if you dribble milk into her mouth with a bottle while she's sleeping, she chokes.

As for whether she looks healthy... she does, in many ways, look healthy. She's developing well. But when you look at her compared to her siblings... she looks almost emaciated with sunken cheeks and bony legs and you can see her ribs. These are not good things. The long term effects of malnutrition would take a terrible toll on her little body, even though right now she doesn't look unhealthy in other ways.

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.

Failure to Thrive

Ellie is officially "failing to thrive". She weighed 7 pounds 7 ounces on January 4th. She weighed 7 pounds 8.4 ounces on January 22nd. We spent a full week adding extra calories to any expressed breast milk (EBM) bottles she received (3-4 per day while I'm at work, none on the weekend), and pushing feedings every 3 hours during the day.

Today she weighed... 7 pounds 8.4 ounces.

So we're going to do a trial of Zantac, knowing that it probably won't help because she's not showing ANY of the classic signs of reflux except for failure to gain weight, but also knowing it won't hurt either. And I'm making an appointment with a pediatric gastroenterologist who will hopefully have some more answers for us (though I'm not counting on it).

My poor, tiny Ellie.

Moo!

I have pumped 7432.5 ounces of milk since September 19th, 2007. That is 58 gallons of milk. That is not counting any of milk they've gotten from direct breast feeding. My next project is to add up the number of hours I've spent breast feeding. When this is all over, I'm totaling up all the gallons I pumped, the hours spent breast feeding, and the number of diapers changed (I have a log of all of this stuff) and I'm sending them a bill before they go off to college.

But seriously folks, I do it with love. Really. Still, 58 gallons??? Can you believe it? I can't!

Nanny Bliss (Updated)

I do so hate leaving my babies behind each morning, but my nanny makes it so much easier. Because seriously, do you know what my wondermous nanny said to me this morning when I asked her how her weekend was?? She said, "I missed the babies!"

I love her!


(this is my 250th post. I'm a total slacker. With 3 months on bed rest you'd think I'd have written a helluva lot more than that. Bad Blogger. Bad Blogger!)

Edited to Add: Just to clarify, I do not have guilt about working and leaving my children with a nanny. I am sad to leave my babies. I miss my children during the day. I wish I could spend the day with them every day. But I don't feel guilty about it. Guilt is born from knowing you're doing something wrong and I know I'm not doing anything wrong. I am doing what I have to do to provide for my family in the best way possible.

I receive a lot of caring, supportive anonymous comments, so I won't turn off anonymous commenting or move to a password-protected blog as some others have suggested. Nor will I delete offensive anonymous comments, because all the comments I get are a part of my blogging history and deserve to be preserved. But I would like to encourage my readers who don't have a blog account to leave comments using blogger's "nickname" feature. You don't have to use your real name or initials, just a consistent one. That way, I know you're a person who cares and not some meaningless troll like this insensitive pig who found his or her way into my blog today.

Oh Ellie-Bellie, Why Won't Your Belly Grow?

The Triplets had their four-month appointment today. Can you believe it? Four months have passed since they were born and I still haven't gotten my shit together to write about the day of their arrival into the world. I suck. Needless to say, it's not that I don't care, it's just that I've been wrapped up in their lives and in caring for them. Yeah, that's it. Uh huh. Anyway, they will be 18 weeks old tomorrow. It's amazing how quickly time flies when you're having this much fun. And seriously, how come no one told me it was going to get to be this much fun? All of a sudden they've started noticing people and they're all smiley and interactive and loveable! I adored them before, but now, ohmygosh, it's a whole new level of love that I didn't even know existed! Seriously, I knew before how much I wanted to be a mommy, but if I'd known it would only get BETTER after they were born, well, gosh I'm not sure I would have been able to wait five years for these little monsters to arrive!

Anywhozit, they went in for their four month check up this morning and Sam and Abby are definitely growing, but Ellie... oh poor, sweet Ellie. She isn't! I don't know what to do with my poor Ellie-Bellie! Here are their current stats:

Sam: (my little piggie!) 10 lb, 6 oz 21.5 inches long
Abby: (my smiliest) 9 lb, 7 oz 21.5 inches long
Ellie: (my teeney beanie) 7lb, 8oz 21 inches long

Ellie last got weighed on January 4th and she was 7lb, 7oz. Seriously! I actually made the nurse re-weigh her today to make sure we'd read the scale correctly, because I just couldn't believe she'd only gained an ounce. My poor, tiny baby. So we don't know why she's not gaining weight. We know that she doesn't like to eat as often as the other two, that's for sure. But we also know that when she does eat, she's eating a sufficient amount (she gets about 3-4 ounces when she breast feeds...we've weighed her before and after feeding and she consistently gets that amount). In the past her weight gain has been borderline worrisome, but never really, really awful. Now, obviously, she's definitely giving us something to worry about. In a way, it's almost better because now at least we KNOW that it's time to be more aggressive and we know that we're not poking and prodding her for no good reason this time.

So here's the plan: We drew blood from her today to run a CBC and a full metabolic panel on her (she'd previously had a thyroid panel drawn which came back normal). We'll also have her stool checked for blood. We'll add 22 calorie fortifier to her EBM feedings to try and get some extra calories into her. We will bring her back next week to be re-weighed and bring a copy of her feeding log so that we can calculate how many calories per day she's eating. We will aggressively wake her to eat every three hours (we've tried this before with little success, but we'll do our best).

I love our pediatrician and I'm very glad that he's very level headed, but being very aggressive about working with us to find answers on this. We are relieved that her head circumference growth is exactly perfect on the growth charts, that her neurological development seems spot on, and that her muscle tone and motor development does not seem impaired. These are all good signs, so perhaps the weight gain (or lack thereof) needn't be so alarming, but we still definitely need to explore it.

After the appointment, I went off to my first day of work. It was a very, very short day since I just really needed to fill out some paperwork and do a little reading, but that was okay with me. I think I'm going to enjoy this job. I hope so, anyway. I came home to smiling babies and promptly pumped 15 ounces, a new record for me.

Finally, I leave you with some pictures of my gorgeous trio...

The Trio:


Sam Playing:


Abby, Cute as a Button:


Ellie Sleeping:

To Anonymous

Two posts in one night! Imagine that!

In my last post, Anonymous asked, "Why are you leaving the babies to go back to work??? Who is keeping them and is it really cost effective?" A couple people got defensive, rightfully so, on my behalf and anonymous responded again with, "UMMMM....I don't know why everyone is so defensive...I was asking a serious question and wanting a valid response..."

Now, part of me doesn't want to dignify this with a response because the tone of both of these comments is quite condescending and rude. And this is clearly someone who doesn't read my posts very often or very thoroughly because the post RIGHT BEFORE THAT ONE CLEARLY EXPLAINED THE WHOLE WORK THING. So I suggest, Anonymous, that you simply go and read this post:

http://perkyovary.blogspot.com/2008/01/doctors-galore-and-your-questions.html

Scroll down to the part that says "Your Questions Answered" and then I even suggest reading the comments and seeing some of the other folks' in the blogosphere's perspective on this issue.

The tone of your initial question, "why are you leaving the babies?" is rather accusatory. You make it seem like I'm doing something selfish without thinking of them. But I AM thinking of them. I was thinking that I would prefer that they live in a house rather than a tent and I happen to know that we cannot afford to pay our mortgage with just one salary. I have been out of work for seven months (three months on bed rest and four months since they were born) and we are out of reserves. We are out of money. If I were to stay home another month, we couldn't continue to buy food, and I'm NOT exaggerating. Was it really necessary for you to add THREE question marks after your question? I understood you were asking a question without the extra punctuation. All you did was express your incredulity with those extra question marks which added to the accusatory nature of your question, which is why people jumped down your throat and defended me.

As for whether it's cost effective, that is really none of your fucking business and I'm so damn tired of that question. But here is the final word on that question: Yes. It is cost effective. My nanny is well-paid, but not as well paid as I am. I have a longer explanation of the long-term cost effectiveness in the above-referenced post.

But do you know what REALLY pisses me the hell off? Your statement that you want a "valid" response. Fuck you. Seriously. I don't curse a lot in my blog, really, but you deserve it. I don't owe you any explanation at all, valid or otherwise. Going back to work is MY decision. If I go back to work just because I ENJOY work that's a valid enough explanation for anyone, dammit. As it happens, I have NO desire to return to work, but I NEED to return to work and I don't owe you (or anyone else) any explanation.

And I don't give a damn whether that's valid according to your definition.

Finally Getting to Your Questions

Ilahee asked:
as a breast feeding mom of a singleton, i'm curious as to what and how much you eat... are you still constantly hungry?

I'm supposed to eat 3500-4000 calories per day. In reality, I eat far less than that. I eat at least ine Quaker Oatmeal To Go bar per day, as that's the only way I like oatmeal. When I do eat, I eat ridiculously sized portions, because I never seem to be hungry until I start eating and then I'm positively ravenous. I definitely crave more protein than I used to, and I have to work harder to make healthy choices because I don't have so much time to make food, so convenience foods are tempting. Mostly, though, I have unquenchable thirst and I go through water like you wouldn't believe.

Anonymous Wrote:
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?

Yes, this is the very same OB/GYN, and things did work out fine. I told him he'd be delivering my next baby, darnit, because my NEXT baby is going to be a SINGLETON, so help me! It was lovely that he visited me in the hospital and if I ever get around to writing about my last couple days in the hospital and my birth story (yes, I was supposed to write that before I start work tomorrow...yeah, um, that just didn't happen), I'll write about that visit.

Adding calories to Ellie's EBM feedings wouldn't necessarily have been useful before because she really wasn't getting any EBM feedings. Now that I'm going back to work she's getting many more EBM feedings so it may be more worth it. HOWEVER, what it will accomplish is curing the symptom (poor weight gain), but it will be unlikely to solve the underlying problem, if there IS any underlying problem. The real question is why doesn't she want to eat more often? Babies, as a general rule, do not go on hunger strikes, so why does she? Today she ate like a mad woman, but that's unusual. Most days she has to be woken up every 4 hours and force-fed. Anyway, it's not a bad idea, and certainly one we've thought about, but not necessarily one that fixes the problem.

My Reality writes:
I have a question. Can we have more pics of the trio? Please?

Yes! I'll take care of that next!

Carol Asked:
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!

I'm down 65 pounds from my pre-pregnancy weight, but that's a little unfair considering that I lost about 30 pounds while I was pregnant. I lost another 35 pounds within a few weeks of delivering the triplets and have been holding steady since then. Considering how much I'm eating compared to how little I normally eat, I'm surprised I'm not packing on the pounds. Truth be told, I still have about 40 pounds to lose before I'm down to my "ideal" weight, so I have nothing to brag about!


On a personal note... a lot of people write that they are in awe of me for breast feeding triplets... If I could get my shit together to write my birth story, I've got a post brewing about bresat feeding also, but the long and the sort of it is that I can't imagine it any other way. I can't say that I believe formula would be any easier, and it would certainly be more expensive. We've had every single breast feeding problem you could ask for... plugged ducts, mastitis, thrush, latching difficulties, short frenulum, sore nipples, you name it, but I still cannot imagine not breast feeding them. They have received no formula since they were four days old and the three of them together received a TOTAL of fewer than three ounces of formula in their lifetime (not counting fortifying Abby's EBM for a while), and I'm very proud of that. I'm terrified that when I go back to work I won't be able to keep up with it, but I'm going to do my best. I've got 99 ounces of milk in the freezer to help me keep up in case I slip with the production at first, so I feel fairly confident that I'll be able to keep up once I get a handle on my schedule.

Finally, two great things happened today: First, I got to meet Jessica and her Five Little Monkeys and her fabulous husband Jon today. They were fantastic and I'm so glad I finally got to meet them in person. Second, my friend Connie delivered her triplets at 34 weeks, 5 days gestation. She's a superstar. She had 2 girls and a boy, just like me, so I have someone I can pass on lots of stuff to! I'm so thrilled for her and now I have to convince her to start a blog! :)

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?

Resolution

I never make New Year's Resolutions. Until now.

This year I resolve to write out the details of the triplets' birth and NICU experience before I return to work at the end of this month.

It doesn't sound like much, but it might take a miracle to pull it off.

Book Review: Having A Baby...When the Old Fashioned Way Isn't Working

I was asked to review Cindy Margolis' new book, Having a Baby...When the Old Fashioned Way Isn't Working: Hope and Help for Everyone Facing Infertility, and I agreed. For those of you who don't know, Cindy Margolis is the celebrity spokesperson for RESOLVE: The National Infertility Association. While I realize now how crazy it was to agree to read, let alone review, a book with newborn triplets in the house, I did get the book read and I will now attempt to write a coherent review between feedings!

I really wanted to love this book. I think Cindy Margolis has done a lot of good for the world of the infertile myrtle, having been brave enough to talk about something no one talks about in a very public forum (Cindy first came out of the infertility closet on an Entertainment Tonight interview!). Alas, I can't say that I would recommend this book without some serious reservations. I enjoyed reading Cindy and Guy's personal tale of their infertility journey, and I wish that had been the true focal point of the book. Had Cindy presented her story, and the other personal stories of other people that she included in the book, and left it at that, I probably would have recommended this book heartily. But she took it a step further and tried to provide insight into the medical procedures one might endure in an infertility workup and treatment as well as insight into the surrogacy and adoption process.

I actually really appreciated Cindy's insight into the surrogacy process, including advice on how to identify a surrogate agency, identify the important considerations you might have in picking your surrogate, etc. But when it came to the medical information about infertility, the book fell short, in large part because the information was seriously out-dated. It's clear that Cindy has been writing this book for a long time, and while the information may have been true when she started writing the book, some of it is just plain untrue today (bear in mind that this book is being published in January 2008, so there's no excuse for outdated information). I'll give you one glaring example:

There is nothing normal about in vitro fertilization. Amazing, yes, but normal, no. Frankly, you have to ask yourself what normal even means, when more and more people have to turn to IVF to get and stay pregnant. Add to this the very real possibility of multiples with each attempt, and we're talking the outer edges of norm, people. And here's why. To maximize the chances you will get, and more important, stay pregnant, doctors have to play the odds. They're not going to waste their time and your money implanting only one embryo, as good quality as that embryo may be. Unless you absolutely beg them (and even then I'm not sure you would find a doctor to agree), you will typically want to try up to six embryos each time.

Now that doesn't mean you'll end up with sextuplets, although there's always that chance when you play with Mother Nature. Usually, however, despite the implantation of multiple embryos, only the strongest will survive past the first few days leaving you with a much more likely chance of having the one child you are planning for.

So I've got a few problems with the medical information in those paragraphs. First of all, Cindy repeatedly mistakes embryo transfer for embryo implantation. I know this may seem minor, but I think it's a major misconception which does the infertility community a major disservice. If the medical community could actually implant embryos, we'd never need to do more than a single embryo transfer. But that's not what happens. Doctors transfer embryos to your uterus and hope that at least one implants in the uterine wall. The fact that people believe doctors actually implant embryos, is one of the reasons that the fertile-myrtle community believes that women who end up pregnant with higher order multiples (this is more common with IUI than IVF, by the way) made irresponsible decisions in their fertility treatment, and that's just not so. That's problem number 1.

Problem number 2 is that while it may have been true 5 years ago that doctors would want to transfer as many as six embryos, this is no longer the recommended practice for fertility specialists. In fact, studies have shown that transferring multiple embryos does not increase the chance of pregnancy in a given cycle, it merely increases the chance of a multiple pregnancy! While under some circumstances, a doctor may recommend a 4, 5 or 6 embryo transfer, this is no longer the standard of care. Many doctors are considering single embryo transfer protocol for a large number of patients. Again, this may seem minor, but it isn't. The point is that there was a medical advisor for this book, so my guess is that this portion of the book was written several years ago and was reviewed then, but hasn't been re-reviewed since.

If this passage were my only problem with the book, I'd be fine. I didn't particularly care for the writing style, and I found it to be disorganized. I DID appreciate Cindy's assertion that it is important to take the stigma off of infertility and important to be talking about it publicly. I agree with her wholeheartedly, and for that reason, I think this is an important book. I just think it could have been executed better. That being said, Cindy's story is compelling and I appreciate having a first-person account of infertility available in mainstream literature. Anywhozit, I think it's an okay book for someone starting out on their infertility journey, so long as they ignore the medical information in the book. As for someone deeply entrenched in the infertility process... I'm not sure how much they would get out of it, but I've been wrong before.