Tandem Feeding is Weird

After a rocky start, I breastfed my first kid for way longer than I ever intended. I thought I might make it to six months; then I thought, I will definitely be done at a year.

In the end, it was Theo who decided he was done: at 16 months, I went away for a few days. When I came back, I lifted up my shirt and Theo reached up and put it back down, like he was pulling down a blind. I tried a few more times, and the same thing happened. And that was it – that was the end of breastfeeding.

I’m lucky it happened that way, because breastfeeding was wonderful for me, but I definitely didn’t want to be the person still boobing her pre-schooler, and I goggled when women in my acquaintance said they hoped to cut their kids off by age three (because, I mean, to each their own. But that’s a whole lot of breastfeeding. No thank you).

This time around, both girls came out ready to go – some of my first interactions with each girl involved them smacking their mouths against my collarbone, desperate to get going. Babies don’t develop a coordinated suck-swallow-breathe reflex until about 34 weeks, and then our hospital has thresholds for how self-sufficient they have to be (high flow level 4 or below, to be specific). So I didn’t start the girls until a few weeks later, and then, the hospital deliberately staggered their feeds so I could do them sequentially.

I vividly remember my first time tandem feeding (I mean, it was only a few months ago). I had a Boppy pillow, which allowed me to hold both girls, each of whom still only weighed about 4 lbs (Fiona more, Daphne less). Once I got Fiona started, a nurse with a trendy brown bob plopped Daphne down and kind of shoved her into me while I adjusted the nipple shield (damn nipple shields) and got her latched. And then we were off.

In the hospital, I usually used the Boppy across my stomach but didn’t worry about any type of nursing cover or modesty shield – in part because tandem feeding was enough of a challenge, and in part because our corner cubicle gave me enough privacy (and anyway, everyone there had seen plenty of breastfeeding). The NICU had folding screens that they could set up for shyer parents; one woman (well, girl, really) set up a breastfeeding fortress every time she nursed her daughter. I just went for it.

Since coming home, though, I have struggled a bit more. My Peanut & Piglet nursing pillow – a formidable piece of infrastructure I have taken to calling ‘the baby shelf’ – has been a lifesaver. But feeding twins is both time- and space-consuming, which makes leaving the house a different proposition altogether.. The parents’ room at John Lewis – which is a lifesaver for many other new parents – has small vinyl chairs that do not accommodate two hungry babies (it is also windowless and smells like poo, so there’s that). I have not figured out a way to feed the girls that does not involve a substantial amount of boob exposure, a couch, and at least 45 minutes of sitting.

The other day, hunched over to feed the girls in bed, one baby head balanced precariously on my thigh, I googled ‘Tandem Breastfeeding’ to see if I was missing a trick. Surely there is a better way – a way that would allow me to leave the house for more than three hours at a time. Right?

There is not a better way.

What I found is that there is a vibrant subculture of women who breastfeed their babies and their kindergarteners simultaneously, and occasionally take professional photos of themselves and their children dressed as wood nymphs with heavy mood lighting. There was not a lot of practical advice for women who want to breastfeed twins without flashing the barista or looking like an image National Geographic rejected for being too sloppy and pathetic.

My google search was ultimately a little frustrating. I am pro-breastfeeding – its been great for my family – but I don’t really feel like a FUCK YEAH BREASTFEEDING type (also, hopefully it goes without saying, Fed is Best). I’m FYB-adjacent. And as such, looking through the images, I felt a little discouraged. I want to breastfeed, but I don’t want it to be a Whole Big Thing every time I try to feed my kids outside the house.

So this is the reality I’ve reluctantly come to accept: there ain’t no way to feed two kids in public without a degree of public spectacle.

Tandem breastfeeding is weird. That is a fact.

 

The Fetal Halfway House

Basically newborns on 20 April


My girls were born in February but were due in April. We spent a total of 9 weeks and 6 days in the NICU (Daphne came home a week after Fiona) and since then I have been trying to figure out the best response when people ask how old they are. If there was only one of them, just giving the adjusted age would do (i.e. they’re 11 weeks). But people generally ask ‘oh, they were on time?’ and then I have to awkwardly walk it back for the stranger in the checkout line/shoe salesperson/other parent at the playground.

When we went to the girls’ development checkups (all good!) the doctor we saw stressed that we needed to think of the girls by their adjusted age rather than their actual age. And I said ‘oh, we know – we have a hard time thinking of them by their actual age.’

The need to go by adjusted age is pretty obvious to anyone who has given birth to babies that looked as undercooked as mine did. They were pinkish and had ears that looked like ears and eyes that opened occasionally (none of which is a given with preemies) but it was clear that they were not normal newborns. And as they were not in my uterus, they also were no longer fetuses. They were somewhere in between. It has felt natural to treat the NICU as a sort of developmental halfway house because the girls came home right around their due date and we almost immediately started acting like normal parents. Within days, we were dropping f bombs when the girls woke up at night while fumbling around to try and shove their pacifiers back in their mouths. They came home with feeding tubes and breastmilk fortifier, but they came home mostly as normal babies: no oxygen, for example.

Preemie babies can be expected to catch up somewhere between the first and (at the extreme end) third year of their life – that is the point at which medical professionals stop correcting their age. In the meantime, I have been working to perfect my response when strangers ask how old they are, and the girls are acting like perfect three month old babies: Fiona discovered her toes this morning and Daphne’s eyes light up when you blow raspberries for her. She flirted outrageously when she met er first non-familial baby this morning.

As the girls get older, its easier to avoid the question of when they were born relative to their due date (already! At three months, it happens so much less than when they were three weeks). And hopefully, by 2019, no one will even think to ask whether they were early or not.

Why I Need New Mum Friends

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A few weeks ago, I met up with some friends who have pre-schoolers and younger children for a Friday afternoon out. I pulled Theo out of nursery early, certain it would be a Grand Adventure, and schlepped one three-year-old and two twinfants to the Botanic Gardens.

Things immediately began to go awry. Moments inside the Gardens, Theo began nagging me to play video games on my phone. Then he asked to go to a different park. Then he licked the snacks the other parents had brought and put them back, declaring them ‘disGUZting!’ (but he ate all the raspberries, because of course he did). Then both girls started screaming and I had to tandem-feed them while yelling at my child not to trample all the rosemary varietals.

The whole event came to a head when the other two boys fell/jumped in the fountain. We ended up with two naked three-year-olds running laps around the centre of the gardens, with one ripping off his Pull-Up and waving it around his head like a helicopter and wiggling his hips at the spectators in the Victorian greenhouse. At that moment, with two sleeping babies and one fully clothed, dry child, I said ‘So I’m gonna go.’ I swooped up my spawn and headed for the door, feeling smug about the fact that I had somehow come out ahead despite the inauspicious beginning and – oh yeah – that whole two babies thing. But I was exhausted, and we had been there barely 90 minutes.

At that point, I realised I needed to make some new friends. I had an incredible baby group the first time around (which is how I have a posse of pre-school parents to hang out with now), but I don’t actually feel the need to take three kids on superfluous excursions far away from home, even if I get to hang out with the women who were so critical to my maternal homeostasis last time.

Thankfully there are tools available to me that didn’t exist three years ago. I downloaded two apps, Mush and Peanut, intended to help new mums connect (either for adult or child friendship — the apps are pretty agnostic as to their purpose). I never used dating apps, but Mush has what I imagine is a pretty standard format for traditional sites. Women (its all women) enter their age, location, age, basic info on their children, and a small bio. They choose from a selection of really cringey hashtags about you as a human and you as a parent, and you’re matched up with other people who live near you, have kids your age or, presumably (based on your hashtags) share your values as a parent. It is mesmerising.

You can filter for people near you, people with kids your age, etc., and then you can add friends and chat (or group chat) within the app. I live in a very fertile neighbourhood, but after about an hour, I had exhausted the possibilities. I added about 8 women as friends and called it a night.

That was about two weeks ago. Since then, I have gone on two friend dates through Mush. One women is an American expat (like I am) and lives just down the street from me. Her son is about a week older than my daughters, and they were in the same room of the NICU at the same time (though he was a NICU tourist – only there for a day). Its not clear to me that we will be besties, but she seemed cool, and we have a follow-up outing planned for later this week. The other date was similar – I liked her; we might hang out again; it wasn’t a total love connection. In both cases, the women lived in my neighbourhood and are people on whome I could presumably, at some point down the line, have a more casual relationship with – someone who could watch the girls in an emergency, or who might be available for spur-of-the-moment coffee.

Peanut, unfortunately, was a total bust. It is like Tinder in that it involves swiping, but I got way less visceral pleasure from it than I expected. I’ve barely opened it since my first foray.

As a friend said, one of the hard parts about mum-friending is that its like an awkward, alcohol-free cocktail party – at which you’re trying to figure out who you’d want to drink with if you had the opportunity. Mush doesn’t make the initial conversations any less awkward but, when I’m meeting up with other parents of infants, we are both clear on what we’re looking for: we want a village. I don’t think anyone is looking for their new bestie, but they want to feel like they’re part of a community, and a village that originates online is still a village.

The That Stupid Pampers Ad

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pampers

Still from the exploitative Pampers ad

Maybe you’ve seen it – a Pampers nappies ad full of premature babies looking impossibly tiny and fragile (one looks a lot like Daphne did when she was a few weeks old) with swelling music and captions like ‘when you arrive early, every day is a battle.’ There are packs of Pampers nappies interspersed throughout the ad and a close up of adults hands holding a doll-sized nappy, for scale.

Pampers has unveiled their micro-preemie nappy – until recently, the smallest available (for commercial or hospital use) were for 2-5 lbs (1-2.5 kilos). They have donated three million tiny nappies to hospitals around the UK and have also sponsored a social media campaign, #powerofbabies, where parents are invited to tag pictures of infants with a raised fist. For every hashtag, Pampers will donate £1 to Bliss, a charity that supports families of NICU babies (‘For babies born premature or sick’ is their tagline).

I have a lot of feels about this ad campaign, which was launched on 26 April 2017 (or at least that’s when the HuffPost published an article about it). They are mostly negative feels.

On the one hand, it is amazing that Pampers has found a way to support micro-preemies, who are classified as babies weighing less than 800 g (1.8 lbs). Daphne was 820 g when she was born, so I have a firsthand understanding of just how tiny that is. The partnership with Bliss is great – they were amazing when we were in hospital. And three million nappies is a lot of nappies.

On the other hand, the ad feels exploitative and gross. It has a triumphant narrative – as, thankfully, most NICU journeys do – but it shows actual footage of preemies and parents in the hospital. Its using people’s personal tragedies for commercial gain. Furthermore, those nappies are not commercially available: they don’t need to be. There is no world in which a 1 kilo baby is anywhere but the NICU. And while Pampers may have made a cracking nappy, we used generic micro-preemie nappies for Daphne with no visible advertising before she graduated to Libero premature newborn nappies, so I can confirm that their claim to have revolutionised micro-preemie diapering with their new nappy does not hold up. And the #powerofbabies tag, which as of today has 1,517 posts on Instagram, is another opportunity for Pampers to leverage premature babes’ tragedy for commercial reasons. The one-minute advertisement has 90k views on YouTube.

In the end, it feels exploitative: the advertisement is leveraging people’s tragedies to hawk a product you can’t even buy. The donations with which it is coupled feel mercantile rather than altruistic. And while I am very much a believer in the #powerofbabies, I can’t quite bring myself to start tagging my Instagram posts accordingly.

 

Two babies at the same motherf*cking time.

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I found out I was pregnant on 4 August, 2017

On 24 August, we had an early scan at a private clinic in north Cambridge. I had had a tumultuous year, fertility-wise, and I wanted to see the heart rate ASAP. Chances of miscarriage plummet once a heart rate is spotted, so I booked an appointment for the middle of the seventh week after my last period – a happy medium between the NHS’ policy of 12-14 weeks and my desire to see the embryo THIS DAMN SECOND. Plus by 7 weeks the heartbeat should be clearly visible so I wouldn’t be setting myself up for any further anxiety. One way or the other, I would know. In the meantime, I went to Asda and bought two cheap pregnancy tests to corroborate the fancy digital one that had clearly said ‘Pregnant, 1-2 weeks.’ The cheap tests came back blue – clearly, irrefutably blue – but they were slow to change and they weren’t, I don’t know, flashing neon, which is the only thing that would have calmed me down.

When I got to the clinic, a compact, no-nonsense woman with an immaculate bob gave me an incredibly firm handshake and sat me down on the ultrasound couch. No sooner had she touched the wand to my stomach than we saw a grain of rice with a pulsating heartbeat flickering in front of us. I wanted to cry with relief. All three of us stared at it for a little while and then the sonographer – who had the air of a Uterus Tour Guide – said ‘ok, let’s just look at the pla…..do twins run in your family?’

And that’s when she showed us an unmistakable second grain of rice with a second, clearly visible heartbeat. She printed a picture and gave us some time to collect ourselves. I spread the picture on my polka-dot skirt and stared at it, waiting for it to feel real.

Now that I’m a Mum of Three

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Didn’t plan on having a litter.

 

When my first child was born, I remember walking dreamily around the hospital room telling a friend that I couldn’t believe something so perfect had come out of me. Objectively, this was not true – kid was a weird looking baby. He was super scrawny, and the first time my sister saw him, she squeaked ‘he looks like an alien!’

(she wasn’t wrong)

Maybe because of the persistent anxiety that defined this pregnancy, or because they were whisked away in incubators while I still felt too shaky from the c-section to touch them, or because two babies is a lot of baby – I didn’t have that this time. I have felt fierce, and protective, and grateful, and scared. But a couple days ago, I looked at my two daughters and said to them ‘I love you so much!’ and was surprised to realise that it was the first time the phrase had come naturally to me.

I learned I was having twins ten months ago, and today, I still struggle to believe that I have three kids – even with all three of them in front of me, it doesn’t seem real. I am still recalibrating my life as a parent – this isn’t the family I imagined, and the third kid is the hardest part. And to be clear, are all the third kid: Theo, when he runs into the bedroom at 6:30 on the nose to ask if he can watch Paw Patrol; Daphne, when she screams because she’s starving but the boob is RIGHT THERE; Fiona, when…well, she’s actually a pretty chilled out baby but she definitely has her moments. I want all three of these kids, but I didn’t want three kids, and I’m still mourning the vision I had for my family, even as I feel myself falling more and more in love with what I actually have.

 

Boobs.

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[Usual disclaimer about how I am not a medical professional, breast feeding peer supporter or anyone with any official knowledge about breastfeeding]


Its kind of lunacy to think that I can contribute anything much to the world of online breastfeeding resources when a. its extremely well-trod territory and b. my qualification is, I’ve done some breastfeeding. Both times I had a stressful start: with my first, mostly because of incompetence; the second time, there was that whole NICU thing.  But both times I gave birth, my baby had a nasal gastric tube. Theo had low blood sugar and, though he was full term, was tiny; he had a feeding tube put in directly after birth and spent an afternoon in Special Care. He was also born with an infection and was floppy and lethargic for the first 36 hours of his life, even by newborn standards.

Both times I was desperate to breastfeed. The first time I just couldn’t get the damn baby to latch. I ended up exclusively pumping after failing, every three hours, to get a latch, then dumping milk and formula down the NG tube into his stomach. The midwives didn’t believe me, but the whole depressing ritual – fail to latch, feed, pump, sterilise – took about two hours and forty minutes, leaving you with twenty minutes before it was time to start again. I have confirmed with other women: no matter how long the health professionals say it should take, it takes 2 hours, 40 minutes. For the first several days, no one bothered to tell me that you can pump on both sides simultaneously. Our hospital doled out single-breast packs (one bottle, one set of vacuum parts) and everyone on the ward shared a communal pool of hospital grade pumps.

On the third night, I called my husband, who was asleep at home, to act completely insane and accuse him of failing to support me in my attempts to breastfeed. I have no memory of what behaviour  of his set  me off, but I do remember that trying to get Theo on the boob had left me shrieking in frustration. I mean,  in the normal course of things, I’m not much of a shrieker.

Anyway. The thing that I originally wanted to impart is this: I have had three occasions where I have had kids on NG tubes and have had to introduce breastfeeding slowly, instead of doing the normal thing where you have a kid, put the baby on the  boob (or the bottle), call it a day and go home. Even if you do have a lot of success with breastfeeding (in which case, pin a rose on your nose) it can still be painful, time consuming, frustrating….my sister said she was glad she knows, from my experience, that feeding is not an easy and magical experience. And it seems obvious to me now, but three years ago I thought that I would have a baby and they would eat. I thought it was something I could prep for with classes and research. I was wrong.

That said, if you are in a situation similar to mine (especially if you have preemies) there are some things I recommend. First, it is important to be proactive, even if your child will not immediately be taking milk (ie if they are on liquid nutrition to start). You can start hand expressing immediately after birth, and – new in the last couple years – medela, the most common supplier of hospital-grade pumps, has created a ‘preemie initiate’ setting that stimulates the breast before hand expressing.

If you want to breastfeed, the best hing you can do is get after it. Milk yourself every three hours – the way a baby would if they were eating. Only expect a tiny amount at first – colostrum, the milk that comes right after birth, is meticulously collected in il syringes. But if it hurts or you aren’t getting any, ask for help: nurses, midwives and care assistants have experience milking new mums, and they’re probably better at it than you are. If your hospital is stressed for resources, ask for a lesson and have your partner help you collect it. It’s not dignified but…well…you get over it quickly. On my fourth day postpartum, I so get out one of the women who had helped me eke out my first drops and proudly showed her my freshly collected 35 mils. I actually got a little choked up – it was a mix of gratitude, pride, relief and Hormones.

Basically the biggest lesson – which I suspect is a theme – is advocate for yourself. Failing that, prep your partner and have them do it for you. There is no way to physically prepare for breastfeeding, so the best thing you can do if it doesn’t come naturally is ask for help – loudly and repeatedly if needed – and be patient with yourself.

And if, after all that, it doesn’t work out or you decide you actually kind of hate it, buy some formula and move on.

Tips on Surviving the NICU

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Daphne getting moved into special care!


So first of all, my post on do’s and don’ts for supporting families in the NICU has resulted in a few really sweet but totally unnecessary apologies. People took amazing care of us, and when missteps were made, it was always with the best of intentions. It was not at all my intention to make anyone feel guilty because my overriding sentiment is that people were amazingly kind and generous with us during the ten weeks we spent in the NICU. Which is particularly worth mentioning because that sort of emotional support is hard to sustain for months on end.

Which brings me here. I asked my husband for tips on the NICU and he said ‘Don’t.’

Spot on advice, I have to say.

I was lucky (as these things go) in that I knew I was facing a long time with babies in the hospital. When they were born, they were pretty fetal. I found it relatively easy to leave because it was so obvious that they couldn’t come home. It was later, when they looked and acted like regular babies and we had been in the home stretch for weeks that I began to really ache to have them home.

I prepped for the NICU by reading Alexa Stevenson, who wrote the book ‘Half Baked‘ and also gave a useful interview at Alphamom.com (I actually read the book twice – once while pregnant and once while in the NICU). I also listened to a really lovely interview with Rob Huebel on Longest Shortest Time, a parenting podcast that has hit some really high highs in the course of its five year (?) run.

Forty percent of NICU parents have some sort of PTSD (my coping strategy is…well, this). Here are the things that helped me (worth noting: I’m an urban planner, not a medical professional, so all the medical stuff in here I either picked up in NICU or googled. I’m pretty sure its accurate, but…).

  1. SLEEP. This one is pretty obvious, but it bears repeating, because if you have just given birth you have Hormones, and you might be expressing, and you might still be staying in the hospital or a place that isn’t home, and you are going through something that is just ridiculously stressful – but sleep (and self-care in general) is pretty critical.
  2. Express breastmilk (this one is for the birthing parent, obviously). Fed is best – I’m not hating on formula per se – but babies that receive milk in the NICU are less likely to develop infections. Infections are the worst. They can set your baby back weeks, and in the worst case scenario they can be fatal. Furthermore, breast milk is medicine. Some parents won’t even be able to hold their babies, but this is something you can do that is concrete and incredibly useful to your child. Its also good for women: it reduces the incidence of post partum depression; it burns calories and helps shrink your uterus; breastfeeding (if/when you get there) releases oxytocin and helps with bonding. There’s another weird thing about pumping, though, that I didn’t expect: most of the socialising I did with other parents, I did in the expressing room. I didn’t make any lifelong friends, but I did make some Facebook friends, and I was grateful for the interaction with people who knew what I was going through. Our hospital had a small room with three little cubicles separated by sheets, and while I often listened to podcasts or watched shows on my phone, I would occasionally chat with other women through the curtains. I suspect American hospitals don’t have pumping rooms (because babies have rooms rather than bays), so this may not be relevant to you.  But my point is, there is value in NICU solidarity, and there will always be ‘long termers’ both ahead and behind you. Its not a community anyone wants to be part of, but knowing other parents on the ward is certainly useful.
  3. Don’t be afraid to advocate for your baby, or to ask questions of the staff. My girls were on high-flow oxygen forever. FOREVER. They kept taking Fiona off high-flow, only for her oxygenation to dip into marginal territory. Her monitors would alarm on and off for an hour and then they would hook her back up. Finally, one day, as they prepared to turn her machine back on, I said ‘could we try low flow?’ (low flow is what you think of when you hear someone is on oxygen – tiny little nasal prongs that hook over the ears). Low flow is better because its easier on their lungs, it makes them much easier to handle (better for parent cuddles) and, on our NICU, it meant they could be moved into Special Care, which was quieter and calmer and less stressful for everyone. Anyway. Fiona killed it on low-flow. And then, a couple weeks later, almost the exact same thing happened with Daphne, except this time I spoke up earlier. The staff know what they’re doing, but you know your child best.
  4. If you live far away, or are unable to spend time at the hospital, ask if there are ‘cuddle clubs.’ Babies benefit from being held – they gain weight more quickly; their blood oxygenation goes up; and their breathing rate can slow too. A cuddle club is a program where volunteers hang out with a baby for a couple hours – the same way a parent would. The nurses will hold babies when they can, but it never hurts to ask for more.
  5. You can always call the NICU. I tried to call when I was pumping, or before I went to bed at night. The reports got less detailed as the girls got bigger and healthier – after Fiona moved into Special Care, I called and the nurse was like ‘…yeah, she’s fine. She’s settled and sleeping.’ and that’s when I realised we had entered a new phase of the NICU journey. But it meant that I never went to sleep worrying that I was missing something, and it also meant that I knew who the nurses were, and they recognised me as well. Once they started breastfeeding, I called to let the nurses know I was coming, and that was really helpful for the staff. Its also THE WORST when you show up to breastfeed your kid, only to realise you’re a little late and they’ve just been given a feed by the staff. The staff hate it too.
  6. Please please please take care of yourself (see: SLEEP). Eat real food, seek help if you need it (most hospitals offer grief counseling and/or have counselors on the NICU, which you may as well use, since its there and you’re clearly going through some stuff)(even if you don’t, make allies in the NICU. I was so grateful for a lot of the staff, but particularly the breastfeeding consultant and speech and language therapist, both of whom had more flexible schedules than the rest of the staff and were more available to answer questions and help  me chart a path through the NICU).
  7. Get some fresh air. NICUs are hermetically sealed so if its gorgeous outside, take a walk. In fact, unless its a torrential downpour or subzero degrees (Fahrenheit), I would suggest spending some time outside.
  8. Accept help when it is offered, and remember life is long, and you can reciprocate later. People want to help, so let them.

It turns out I had to really curb my instinct to write a LOT about boobs, so I think I’ll write more about that next time…? Lucky you.

Shit you shouldn’t ask NICU parents

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Sniff you later, NICU!

My twin daughters Fiona and Daphne were born at 31 weeks this February and were teeny tiny perfect little peanuts. We’d known from early on in the pregnancy that the girls would be facing a long NICU stay, and I think the advance warning was 100% key to my (relatively) stable emotional and mental state throughout the ten weeks we spent on the NICU.

But prepping the people around me was hard. I kept telling my dad we expected the girls to be about three lbs (1.5 kilos) and he would make a choking noise on the phone which, frankly, was not helpful.

In one memorable conversation, I said ‘we don’t know when they will come home even after we have a c section date’

He said ‘oh yeah, because they’ll be in the NICU for a few days.’

‘No, Dad. We’re hoping for 4-6 weeks in the best case scenario.’

‘WHAT?!’

I mean, how would he know? He was just worried, as of course we were too. But managing other people’s expectations gets exhausting really damn fast, especially when you’re working so hard to manage your own. So here is a list of NICU do’s and don’ts for family and friends.

1. For the love of god, don’t ask when the baby/babies are coming home. Do not do this. DO NOT. I know it seems like a totally innocuous question but a. everyone asks and b. as with many long-term hospital stays, the kids are in there until they get discharged. Something can go wrong up until the moment you walk out the door, and I spent most of the ten weeks holding my breath. In Fiona’s case, she had a final, pre-discharge blood test – at which we discovered she was anaemic. She spent another week in the hospital while they monitored her haemoglobin levels.

The best analogy I have come up with, for those of you with friends in academia, is that it’s like asking a PhD student when they are going to graduate. The answer is ‘as soon as possible.’

2. Don’t expect photos. Even the relatively healthy babies are often hooked up to a lot of crap – oxygen, breathing, heart rate and apnea monitors are pretty standard. Really, really early babies are often a non-skin colour – blue or translucent – and breathing apparatus obscures their faces anyway.

3. Hopefully this goes without saying, but do your best not to express alarm at a baby’s weight or age at birth.  Daphne was under two lbs. I know that’s tiny. I dislike telling people because they look so startled. But of course, not all NICU babies are early; some have a rough start for other reason. A friend recently spent nearly three weeks in the NICU with a past-term baby, and the most alarming thing I witnessed in the NICU was a 37 weeker rushed in from labour & delivery (thankfully, that baby was home in under a week).

4. Do all the things you would normally do for parent of a newborn – bring food, send cards, keep in touch via text messages (I personally loved texting – you can’t speak on the phone in the NICU, but texting was allowed. When I was spending hours in a hermetically sealed room, with alarms beeping around me, I was beyond grateful for the friends who sent me chatty texts, especially when they kept texting over a period of hours or days). Basically cultivate the same ‘it takes a village’ approach that you would if the baby was at home. Virtual support is still support, and it’s something you can offer even if you are far away or pressed for time.

5. Don’t assume the mum is getting sleep because the baby isn’t home. You are strongly encouraged to pump breastmilk for NICU babes, and for first time mums especially, it can be stressful and time consuming. And it has to happen on a regular schedule – so even if the kid is in the hospital, there is a good chance the mum is getting up every four hours to milk herself.

6. Do send media recommendations. I found most books to be a little too much for me, and I didn’t like to bring books into the sterile environment anyway – when I read them, I read them on my phone (sterilised daily with a Clinell wipe)(my husband brought gross dusty paperbacks in all the time, though, so – personal preference). But I read longform journalism, listened to podcasts, and while I was expressing I watched Netflix shows that I’d cached on my phone.

7. Don’t send pics of your healthy baby, if you have one. A friend sent a pic of her healthy, smiling newborn with the caption ‘forgot how great these smiles are!’ And I wasn’t angry, exactly, but I had two kids hooked up to machines in incubators at the time and I had a hard time mustering enthusiasm for her sweet healthy baby. I’m not proud of myself – I wish I had been more generous of spirit – but I don’t think I’m alone among NICU parents. Stupid healthy babies and their stupid clueless parents.

One in ten babies are born early or unwell, so hopefully this advice will never be pertinent to you, but odds are it will. That said – to avoid ending on a dour note – most NICU babes are just fine. A rough start doesn’t necessarily dictate what happens when a baby goes home, but it sure does suck while it’s happening, and having the right kind of support can be a huge help.

So let me tell you about this horrific pregnancy I just had.

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It turns out I have a lot more to say about parenting in the abstract – having branded myself, officially, as a Mummy Blogger (ugh) I’m all of a sudden at a loss for words.

You guys, I am never at a loss for words.

So I decided to go for it. 


The girls at about three weeks old (34 weeks gestation)

I’m writing this because even three months removed from the actual pregnancy, it looms over me, as I imagine it does for other women (and men, and people) who have dealt with a scary or high-risk pregnancy. I would have loved to read my story six months ago and I would love for it to be a source of strength for families at a different stage of their own experience.

Lucky you, though, I decided to save miscarriage and the NICU for another day.

In February I gave birth to two extremely tiny identical twin girls, Fiona (at 1.3 kilos or 2.9 lbs) and Daphne, who weighed in at 820 g (1.8 lbs). They were 31 weeks gestation and had suffered from selective intrauterine growth restriction, or sIUGR. Both were small for 31 weeks, but Daphne was barely on the charts – she was somewhere near the 0.1 percentile, whereas Fiona was somewhere around the 9th or 10th percentile. That is also small enough to be considered growth-restricted, and the NICU consultants told me she was probably also somewhat compromised in utero.

We were diagnosed with sIUGR at about 16 weeks and had weekly ultrasounds to monitor growth and, more importantly, blood flow in the umbilical arteries. The gist of sIUGR is that one baby has a larger share of the placenta than the other, but it is also common for the smaller baby to have a narrower umbilical artery and/or a bad connection between the artery and the placenta. In Daphne’s case, she had a cocktail. She had All The Things. It wasn’t a great situation. Once diagnosed, we had a target C section date of 32 weeks, though I held out hope that we could make it to 34 if we were lucky.

Every week, we would watch the blood flow in the umbilical artery to make sure, essentially, that blood wasn’t backwashing into the artery between heartbeats. When that happens, intervention often follows fairly swiftly.

Things were going pretty well, actually, until the 23rd of December, when I had a bleed. I was 23+6. As my legs shook and the midwife put in an IV, the doctor stood above my bed and said ‘I don’t think we will deliver these babies tonight, but that is just a feeling.’

They never figured out what it was, but after about three hours the bleeding just….slowed, and eventually stopped. I spent the night in Labour & Delivery drinking water, staring at the blue computer monitor, and schlepping back and forth to the toilet. When a nurse in green scrubs brought me tea and toast the following morning, I sat with the tray in front of me and sobbed.

The following week, there was backwash in the umbilical artery and it was time to consider laser ablation surgery. The procedure was effectively a selective reduction. While in rare cases, the smaller twin thrives after connections to the bigger twin are severed, in most cases, the little one doesn’t make it; instead, the larger one gets more time in utero and a substantially mitigated chance of profound disability. Our little one – already named Daphne – was so little that we had to assess her chances of survival at about three weeks behind her gestational date. So when she was 28 weeks, we looked at statistics for 25 weekers.

At 25+4, we went to London to meet with a specialist. The procedure is not performed past 26 weeks so it was absolutely our last chance. We knew the moment might come but it was an agonizing weekend. There was a very real possibility that, without intervention, neither girl would make it. But there was an equally real possibility that both girls would be just fine. There was no right answer, but we went to London having decided that the procedure was the best thing for our family. I was so sure we were going to do it that I had already contacted grief counseling services at our local hospital.

And then, magically, everything looked fine.

My husband had by this point taken to carrying around a thick stack of scholarly articles covered in pink highlighter, and I had taken a case-study approach – I had scoured the internet for similar stories. So it was both alarming and gratifying to see a team of six medical professionals from around the world clustered around the ultrasound machine, all trying to figure out what the fuck was happening in my uterus. Spoiler alert: they decided that 32 weeks was still a reasonable goal, and that 33 was not unimaginable, and sent us on our way. We got Japanese food and almost missed our train.

I’ve tried to be succinct here, so I will skip the part about how I had another bleed, spent another weekend in hospital, got put on monitoring, and then ultimately delivered due to complications entirely unrelated to sIUGR (high blood pressure and reduced foetal movement).

We delivered at 31 weeks via emergency c section, and our girls spent 9 and 10 weeks in the NICU respectively. Despite the fact that that is a helluva long time, they had relatively straightforward experiences, or at least it could have been much worse.

Today the girls are 15 weeks old, or 6 weeks and 2 days, adjusted. Both have begun to smile but prefer to look quizzical, gifting me infrequent but radiant open-mouthed grins. They have largely held their growth curves but I am optimistic that they will nudge up a few percentiles in the next few months. In short: it all sucked but we appear to be coming out the other side. At this point, my day-to-day experience of these babies is like any other woman with six week twins, and the most amazing thing is how quickly the NICU has faded behind us.

If you are a stranger on the internet in the throes of a scary pregnancy, and I can be of use, please let me know.