A welcoming surprise when I came in this morning: an open-air crib for Tzelia. She has been able to regulate her temperature adequately, so we are testing out an open-air crib. It is still her isolette: the top is just staying open. If she continues to do well, they can put her in an actual open-air crib. Nice progress!! Hopefully Meorah will be transitioning to the same shortly.
Both girls started their 26 cals/cc and seem to be doing ok so far. Lets hope they continue to do so.
I spent the morning with Susan, one of the LCs. We were trying to come up with a feeding plan, since the girls seem more and more ready to take oral feeds. Since different moms like to do it differently, Susan wanted to see what my thoughts were and watch the girls breastfeed. She was very impressed with how the girls did, and we had a nice chat about breastfeeding in general. She agreed that the girls will come home on some form of supplements, so bottles are going to be part of the picture. Interestingly, she said contrary to popular opinion, it is actually HARDER for the babies to take a bottle than to take a breast: they have to work to stop the bottle flow but are in complete control of the breast milk flow. So although the girls do fantastically at the breast, they may have issues with a bottle. Interesting. We also chatted about the ways the nurses do their best to keep the bottle flow as natural as possible: keep the babies laying on their sides, and gently tilt and raise the bottle to mimic the ebb and flow that comes from the breast. Unlike Linda (another LC) who recommended doing the bottles at night (higher cals = more sleep), she recommended bottles first thing in the morning and right before bed and breastfeeding at night (less bottles to clean, quicker to feed). Everyone has their own opinion and ways to do things...
What we decided to do: I am going to do my best to make one (and preferably two) care periods each day and see if the girls are up for feeding. If they are too sleepy, we can just let them sleep: part of this will be to learn their feeding cues. If they show signs of hunger, then we can try breastfeeding but they will continue to get their full supplement feeds via NG right after; if they start to show signs of reflux, we can change that, but for now the extra they get from me isn't really enough to over-fill them. When I am not around and they show signs of wanting to be fed orally, I gave permission to try bottle feeding.
Unfortunately, it just isn't possible for me to be there the 12-24 hours to do more breastfeeding. If I didn't have a toddler it may be possible. But, since I know they will need bottles anyway, we may as well start the oral feedings. Christine, the nurse yesterday, had mentioned to Jason that they are doing so well and it would be a shame to keep them longer because we were delaying the oral feeds. I tend to agree: we obviously want them home and the oral feedings are one of the big check-marks that need to be taken care of.
I do feel badly about the bottle feeding. Had they been full-term, I would have done what I did with Zev: exclusively breastfeed to the best of my ability until about 6 weeks and then introduced a bottle (since I am going back to work, a bottle is just necessary). And, having a bottle option does make it easier for me: Jason can also feed (as can Nicole) and I am less tied to the couch/girls. But the guilt complex is high: this is such a touchy subject for moms. Breast is best is just rammed into our brains. Of course, even with the bottles they will be receiving breast milk (just supplemented for extra cals), and I do have to keep that in mind. Some women chose to exclusively pump for their own personal reasons: baby won't latch, problems with the nipple, or personal reasons to not want to breast feed. And they will do that for a year plus. I hope to do it as long as possible, but I am doubtful how long I will last once I go back to work: with Zev, my supply tanked within a few days of returning to work. It was just far too stressful to make the time to get to the pumping room, set-up, rush through it, and get back to work. I ended up lasting a month when I returned to work and by the end I was so stressed that it became a complete chore. Maybe I'll be lucky this time: I have a good supply and am even hoping it will increase once the girls are home and I'll be breastfeeding more often rather than pumping all the time. Here's to hoping.
I met up with someone who had her own preemie a few weeks ago (hi Jurate!!). It was nice to commiserate about the trials of NICU life. She is at a different hospital but the concerns are the same. It sounds like her little boy is doing as well as he could be at this point: just typical preemie stuff. It certainly doesn't help the anxiety, though. At least I knew I'd end up in the NICU for awhile: it was a complete surprise to her so she had no preparation time. Regardless, its a stressful journey for everyone, and I hope we are both home with our little ones soon...
Zev is doing wonderfully, as usual. Typical two year old (I can't believe he will be two next week). I don't know where he gets all his energy... his favorite activity right now is running up and down the couch and throwing himself onto the cushions. Great. And I love how his key word for going to bed is now: 'Brush the teeth?' Yes, he is obsessed with brushing his teeth. Hey, whatever works. He and Nicole will be coming to the NICU this morning: Zev's third time and Nicole's first time. She has been really wanting to come in, but we had to wait until his cold was over. Now that it is, they will drop by for a bit and she will see the girls for the first time. It will be nice if she could make it over a few times in the next few weeks...after all, she will be caring for the girls as well when they come home.