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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.

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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.

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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.

Read Full Post »

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.

Read Full Post »

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! 🙂

Read Full Post »

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! 🙂

Read Full Post »

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?

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