Tuesday, July 31, 2012

Crash Course in NICU

So a lot has happened. Most significantly, I went down to Austin and visited my nieces for the first time. They are adorable!!!  I can't say just how incredibly helpful it was to me personally for so many reasons. There were several things it did for me aside from just the pure joy of being around two beautiful little babies and allowing my mother another day with her grandchildren:

1. I relaxed significantly with every passing hour. Seeing twins that are perfectly healthy and normal that were born at 28 weeks is very, very reassuring.

2. Baby care basics. I've been reading many books, a lot of the same ones my brother and sister in law did. But some of the concepts sound so much more complicated when you read them. However applying them seems much simpler. I relaxed about how to do parent directed "scheduled" feedings and logging everything, and getting them on the same schedule is not as complex as I thought. I was able to change diapers for really the first time, interpret their cues and crying without panicking, and for several periods of almost an hour handle two babies at once. Feeding time is more difficult though, but one person alone with two babies can be done. It's hard, but it is possible.

3. My breast pump. There is no goal of pressure/level to achieve. Do what works, and don't turn up the dial so high it hurts.

4. House setup. I realized my Eddie Bauer bassinet is just taking up space and will be relatively useless. I have a one story house and enough contraptions to hold babies in every room that this item that will hold two babies for a month or two tops is worthless. Out to the curb it went to someone who I'm sure was thrilled to have it. It was reassuring to see that though their house is much bigger and nicer, my setup will work just fine and is similar enough. I decided to do a system like they have on my kitchen counter tops with several plastic tubs to hold bottles and nipples and pacifiers in various stages of sterilization.

5. NICU advice. Hours and hours of it. They are sleep deprived parents of twins yet they stayed up until past 1am intensively coaching me on everything any of us could think of to prepare me for what to expect. This is after answering my almose ceaseless Q&A all day long! There is simply too much they told me to list here, but hopefully over the course of the blog I'll include most of it. Most of it was when they will be able to do what, such as kangaroo care or bottle feeding. They helped me understand that scary things will happen, but that eventually my baby stopping breathing or heart slowing down will be normal to me and I'll slap this tiny thing on the back rather hard to get it going again like it is no big deal. One step forward, two steps back will be the norm every time they try to wean them off oxygen or push them forward a stage. My existence will be a marathon of waiting and watching the heart rate, respiration rate, oxygen saturation, and blood pressure monitors. The pattern of these 4 numbers will be what my new world will revolve around. The babies will tell us when they are ready to do what. I figured that out fast enough to tell my father in law to back of off booking any plane tickets aside a one way ticket to India for me. A round trip ticket is just plain silly at this point.

6. Equipment. I was about to pack a half a suitcase with stuff I didn't need. The 4 oz Playtex drop ins....fuggedaboutit! The two bags of tiny slender 60ml mini-bottles they gave me will be plenty until we get them home and can use the larger ones. They gave me bags of rings and rubber nipples that were pre-sterilized tear-open bags. I got the same tear-open pacifiers and rubber nasal aspirators, as well as some medicine syringes and thermometers and hand and nail sterile sponge washers.  I likely won't need to bring newborn size clothes, so I bought up a bunch of preemie clothes instead. If they get bigger I'll have my mother bring in reinforcments the last 2 weeks. I even took advice from my hairdresser and went to the Build A Bear and bought doll clothes that I'm told will fit perfectly. 7 onesies per baby per week is plenty, by the way. Okay, okay....so I got more than that. Sue me. The clothes are friggin adorable!

7. Be grateful. Be really fucking grateful. 28 weeks and a 2 lb girl and almost 2 1/2lb boy is pretty damn good despite the risks and expenses involved.  My brother told me a story about a really bad day he had where he thought he was taking one baby girl home the next day only to have an episode while sitting in his lap that made sure she would spend a lot longer in NICU. In the elevator ride home he bumped into two people who each had twins in the NICU, but only one of each set had survived. The two parents were still grateful. So keep it in perspective and don't feel sorry for yourself. I've waited 8 long years and gone through so much pain for this, that I can't let myself forget that for a moment.

8. It's not about you. It's about them. You are not working hard. The nurses aren't the ones working so hard. Your little babies are the ones fighting hard to survive. They should still be in the womb, and our artificial one just isn't up to par. So remember whatever you are going through, they are going through so much more. They simply need a warm dark place to rest and grow with as little disruption as possible until they reach full term. So your need to hold them and touch them and see them without wires is irrelevant. For this reason initially a diaper change will be lightening fast to avoid any extra stimulation or heat loss.

9. You will look at parents of singletons born full term and laugh at them when they talk about how hard it is. You will be an old hand by the time your babies are out of NICU, and what overwhelms them will seem like nothing to you.

10. Not much will be different as far as NICU care. In the 1970's my babies would have roughly a 50/50 chance of survival. Now it is above 90%. But the thought lingers that these studies are based in U.S. based NICU's. What about India? We discussed that really the same things are done and are relatively simple to do. The same treatment protocols and medications. The level of hygeine and the newness of the equipment may be what differs the most. It is my hope that the NICU will be clean enough, and the appearance of less hygeine will relate more to how things look "old" but my hope is that I will find it is kept perfectly clean. We'll see. A tight level of control over sterilization and visitors and hand washing by the nurses may be the deciding factor. As far as equipment goes, older telemetry equipment make only differ by taking the same measurements every 15 seconds as opposed to every 5 seconds. We'll see what happens...

But for now we call Dr. Anita almost every night. Well every night that our washing machine drain hose doens't disconnect and spill 10 gallons of water all over our floor that is. Sigh. The conversations are always short. They are doing well. They are stable. They are being given surfactant therapy for their lungs (standard). Heart rates around 150 (normal).  She can't remember all the vitals and I'm vaguely familiar with the ranges but I should probably just wait until I get there to start getting these kinds of details.

By the miracle of the internet and thanks to this blog and the online forum for Dr. Patel's patients, I will not be alone. I have two new friends who will be in Anand with me. The first is a gal who talked to me about going to Anand, and is there now at Madhuban resort doing an IVF attempt. The second is someone I've been corresponding with for months beforehand and is also expecting twins. We were thinking we would miss each other, but now she will be there a few days before me. Since her twins will likely need a short NICU stay, I've asked and am crossing my fingers and praying she is able to send me pictures when she arrives on the 3rd. I won't get there until the 8th so here is hoping!

Until then I have so much on my to do list and have ran so many errands it is ridiculous! But my best friend is coming to town to throw the shower and will be a day early and can help. I'm also paying someone to come in and help clean, which will be well worth it. Hopefully I'll remember to post some pics of my finished Shangrila in my rush to leave!

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