Plump at One Month

On Jan 11, Charlie and Bruno turned one month old. While they haven't gotten much longer, they have certainly grown much thicker. You can see it in their heads:

You can also see that they're losing their lanugo (downy fetus fur) from their heads, hopefully to be replaced by human child hair soon.

They are drinking ever-increasing amounts. It is now typical to down 120 mL (4 fl oz) at a time. We think our lives are hard, but to put theirs into perspective, I like to consider that we weigh 20 times what they do. Imagine drinking 80 oz (~2/3 gallon) of milk every three hours. I don't wonder that they feel a bit uncomfortable at times!

Tandem bottle feeding is a key strategy for preserving what is left of one's sanity.

One of Katy's favorites. Bruno on Jan 3.

Hiccups & gas on the floor, Jan 2

Charlie lively & hungry on Jan 8

Charlie gesturing & Bruno getting cranky on Jan 10

Happy momma on Jan 10 (though she's pretty much always happy).

Charlie with bottle propped. This is done chiefly so I can hold the camera or type things.

Bruno on Jan 8. I couldn't leave this out.

I would prefer the babies sleep like this, if only the pediatricians allowed!

Play by Day

I wrote that last post first so I'd be forced to follow up with something more positive and appealing. Here's a compendium of recent pleasurable daytime activities:

The boys' first bath at home led to immediate deep sleep:

 Bruno L, Charlie R

The boys enjoyed time together today on their new play mat:

Milo was not to be outdone:

Addled daddy attempts tandem bottle feeding, and the boys sort of helpfully sort of hold their bottles:

Yesterday night and tonight, we're going it alone, without help from parents or anyone, just to see what that feels like. It is going all right so far, but I think I'd better turn in. Thank goodness all I have to do tomorrow is help care for two babies!

The Evolution of Crying

Charlie's and Bruno's cries started off rather inoffensive and sympathetic, a single medium pitch started by a consonant -- either "Mmmaaaaah!" or "Nnnaaaah!" But I've seen enough of babies to know that it doesn't stay that way. They seem to develop the ability to curdle all blood within earshot using only their vocal cords. These boys seem to be headed in that direction. Recently, they have developed what Katy and I call the "Goat" cry. They only use it when they deem it absolutely necessary, so I'm still able to document a comparison. Here is the original "Nnnaaah," courtesy of Charlie:

And here, courtesy of Bruno, though both have mastered it, is the newest weapon in their arsenal. I know it will get even worse, but I would say this is not for the faint of heart:

It strikes me how energy-inefficient this form of communication is. It clearly takes the babies a lot of effort to make such a racket, and it's not necessary. If they just peeped, "Hello, parents, I'm hungry/cold/burpy/poopy" using some sort of brief and gentle gesture, I'm sure that would suffice to bring us to their side 90% of the time. I can only surmise that this type of gut-wrenching crying is left over from the days when there weren't enough resources to care for all the babies. The only equivalent to this in my world is when you're trying to get some approval past a chain of bureaucrats. Too bad this form of communication is not considered appropriate in that case!

Gotta go... I hear a "nnaaahhh!" from across the room...

A Week in the Digs

We had a happy Christmas. Katy's parents Bob and Laura were with us, and we got a visit from my parents and my brother and sister and their spouses. We also FaceTimed with Katy's siblings so that Charlie and Bruno could meet their cousin Hailey. Of course, the boys forgot to pose for pictures amid all the joyous stir. The best they could do was the following feeble attempt on the next day:

A day later, the boys enjoyed their first walk outside. We tried putting them in various wraps, but since they can't hold their heads up yet, they were relegated to the car seat stroller:

Bob and Laura left us on the morning of the 28th to fend for ourselves. We were a little terrified, and sure enough, the boys kept me awake from midnight to 6a. There are just too many reasons to fuss rather than sleeping -- hungry, needs more burping, peed/pooped again. I learned a shortcut: don't try to put him down, just fall asleep together with him on your chest. It is so nice. In the back of my head, a pediatrician was protesting, but at some point the body takes over the mind. Katy practiced this trick a day later:

We've begun giving the boys some play time together on the floor. It looks something like this (Charlie left, Bruno right):

I will leave you with a lovely image of sleep, which is inspiring me right now:

Merry Christmas

Fooled you!  No Christmas photos yet, just catching up.

The last few days have included a wonderful milestone: at the last pediatrician visit, it was determined that the boys have surpassed their birth weights. This has allowed us to shift from strict feeding schedules, as one does with Peking ducks, to feeding when they're hungry, as one does with humans. Not coincidentally, our record-keeping has suffered, so we can no longer tell you exactly how many mL of each type of liquid each baby has ingested in the last N hours.

We've also been bad about taking photos, since we just sit in the dark living room all day feeding babies. But here are some from a few days back:

Charlie (L) and Bruno (R) making pirate faces on Dec 17

Caught with my own camera on Wed Dec 21 6p

On the way to the pediatrician on Sun Dec 18

I don't want to miss anything

You've got to keep a good nature in order to enjoy this process.  Katy just changed Bruno three times in a row, because he peed and then pooped in mid-operation.  Upon coming back, she grew serious and told me, "I just don't want to miss anything of this...," upon which Bruno promptly pooped again.  Hard to miss that!

Here, Take the Baby

A funny thing has been happening to me and Katy. No, I'm not going to ask you to take our babies.

A few nights ago, when I was awoken from delicious sleep in bed for my feeding shift, my first thought was, "Yikes, there's a baby in here, where is it?!" Not to worry, I had left both babies downstairs. This began happening to me every time I woke up.

Yesterday, I woke up together with Katy. Her first words were, "Is there a baby on me?" (Not to worry, we left them downstairs with Grandma!)

This morning, she stretched her hand out to me and said, "Here, take the baby." At that point I decided that something is definitely going on here.

We hear about all sorts of instincts that are built into us and the babies to promote their survival. Well, here, it seems, is one we did not know was coming!

Global Village

Katy and I went for a short walk today and remarked on how lucky we are to have the support of a vast network of amazing friends and family across the globe. We thought about yesterday, when Katy had an uplifting conversation with her friend Marci that included much-needed post-partum laughter, while I drove to Richmond to see my friends Jamie and Misti, who have 7-month-old twin boys of their own, and lugged back a load of clothing and baby-holding devices.

With things like this blog, e-mail, phones, and video chats, we're able to keep our closest friends close and get much-needed support from them. We also marvel at the physical support we've gotten: loads of hand-me-down clothing and equipment, post-partum care packages, three marvelous baby showers, a general profusion of presents, a meal train for after Katy's mom leaves – organized by Saint Shelby, as we privately dubbed her today (thank you!) – and of course absolutely vital assistance from the grandparents.

We've had two recent improvements in our daily process of twin alimentation. First, we've moved from "mini-days" (as previously described) to shifts. The day consists of 8 3-hour shifts (rather than the other way around). Each shift begins with Mom doing 10 minutes of Double Football (which see) and 30 minutes of pumping. She then returns to bed (if and when she wants to... another issue we'll tackle later), and then the helper takes over bottle-feeding for the remainder of the shift, whenever either boy is hungry. The helpers tag-team the shifts. Last night, I took 12:30a-3:30a, and Grandma and Grandpa took 3:30a-6:30a. This system works great as long as the number of helpers is greater than one. Thanks, Laura!

The second improvement has to do with the physics of rigid containers. Two nights ago, I noticed that Charlie was pulling vigorously on his bottle but not making much progress. Everyone knows that removing fluid from a rigid container is only easy if some other fluid replaces the volume that was removed. Case in point:

Nurses had mentioned that we should see bubbles entering the bottle as the baby drinks. So, while Charlie was laboring away, I held him with one hand, grabbed the screw top with the other, grabbed the foot of the bottle with my teeth, and turned it about 5 degrees to the left. Presto, bubbles began streaming in and Charlie chugged the bottle's substantial contents in a three-towed sloth's handful of minutes. I was both elated at my success and dejected at the hours that had been wasted so far by simply failing to look for bubbles.

At any rate, both of these improvements have helped make it so we are now hitting most of our feeding goals and still sleeping enough that we're not making too many mindless blunders.

Today is the boys' one-week birthday.  They are now the equivalent of 38w 3d gestational age, still ahead of their due date, had they not bifurcated days after coming into existence. They are doing very well. At a pediatrician appointment today, we found that Charlie had grown 130 grams (a quarter pound) since Friday, and Bruno 20 grams. So now Bruno is the one who needs to play catch-up -- but we feel a lot more confident that we have the situation in hand.

Thanks to all of you who have helped, and who continue to help. We look forward to being able to pass on what we are learning and accumulating to others who start after us.

Finally, here is a photo I just got from my dad of us in the hospital:

Weighty Matters

21 hours after being discharged, we had our first pediatrician visit. Thank goodness we live close by!  This allowed us to double our experience with infant car seats. We actually made it on time, which caused us both to turn toward each other and ask, "Is that really you?"

The main finding of the visit was that Charlie's weight has been on a flat trajectory over the last 4 days. Down 10 grams one day, then up 10 the next, then down 10 since yesterday. The physicians were happy with how well we had executed the feeding plan, so the conversation turned to finding what else we could do. The conclusion was a duality of increasing energy intake and decreasing expenditure: try to increase supplementation from 45 to 60 cc per feeding, but don't make them work so hard to get it.

The central problem is really that it's hard to get a large serving of food into a late pre-term baby. They don't seem to know how voracious they ought to be in order to properly replace that umbilical cord. They'll start eating vigorously but quickly get tired and disinterested. At the hospital, we learned several tricks to get a tired feeder back into the groove: gentle things like tickling the chin and cheek and foot, and stronger measures to sort of startle them into attention, like checking their diaper and rubbing their backs and stomachs. We would use all such measures to re-ignite little Bruno's and Charlie's interest in their food when they drifted off. The problem is that these measures involve expenditure of the baby's energy.

How do B&C expend energy right now? Mainly on feeding and growing. They do little else (being asleep basically whenever they're not eating). So, given a finite reserve of energy, spending more of it on feeding means less available for growing. Breastfeeding takes a lot of energy. Crying and being cold takes a lot of energy.

So, the advice was to focus on delivering energy economically. Have time at the breast, but limit it. Bottle-feed until baby tires, then let him rest a while. If that means starting again after an hour rather than waiting for "the next feeding" to start, so be it. Thus, our work will get easier and harder: easier per feeding, but harder because it may be happening even more frequently in order to keep that flow going. Nominally, we are giving 8 feedings of 60cc each (about a half liter a day!). But really, we're just continuously administering food whenever they'll take it. I really feel like a parent now.

When we returned, we found a shopping bag hanging from our doorknob. An invisible force of good, having learned that we were home, had deposited some useful breast pump paraphernalia for us. Thank you, Shelby, you are to our morale as a bolster pillow is to tandem feeding!

Charlie after last feeding

A Succession of Mini-Days

After figuring out infant car seats in super-frigid winter weather in front of the UVA hospital, we relocated our operations to our home yesterday afternoon.  It really struck me how different life now is in our house when I found myself rushing down the stairs with one crying baby in my arms in search of where the sound of the other crying baby was coming from.

In order to keep the babies' weights up, we are feeding and sleeping 8 times a day, in a pretty strict 3-hour cycle.  It usually involves 10 to 60 minutes of sleep.  Consequently, each of these cycles feels like its own mini-day.  We refer to the last cycle as "mini-yesterday" and the next one as "mini-tomorrow.

Charlie on the left, and Bruno on the right., after arriving at home yesterday afternoon.  Charlie was born 2:44p Sunday, Dec 11.  Bruno was born 2:46.

Today, the boys stayed here and the 6:30a and 9:30a mini-days became one.

Discharge

After a marathon 24h in which we accomplished 8 full feedings and got the babies' weights to start increasing, we are packing up and preparing to head home.  It is hard to get them fed quickly enough that we can nap before we have to start feeding again!  Luckily, it will get easier as they grow.  Katy's milk is coming in.  I wonder what it will be like to try to do all this in our house!  Thank goodness we have Katy's mom Laura living in, and other family stopping by to help.  More photos etc. later.

Edit: Photos!

The hospital staff kindly stored Boy B's Guinness in their fridge for us.

Packing up

Packing in!  Thanks to Katy's aunt Liz for these handy baby containers.

Moving out!  For safety reasons, C-section patients and neonates are not allowed to walk out.

Misc Hospital Photos

I can hardly remember how to spell "photos" at this point.  Here's the view out of our room Monday night -- oh yeah:

And more of us and babies:

Milk Matters

We began today with a visit from the pediatrician team at 7:30, having not yet gone to bed.  We learned that the boys had lost around 10% of their birth weight -- which is not as alarming as it sounds, but at the outer limit of normal.  They recommended that we begin supplementing with formula.  A subsequent experiment with the breast pump supported the idea: Katy's supply had not yet risen to the level the boys needed.  I wonder if, had my brain been working last night, I might have made the connection as to why our neonates kept wanting more food every time we tried to put them down!

The prescription was a "three-way" routine: breast-feed, then pump, and then add sufficient formula to make 20ml for each baby.  Do this six times in the next 24h, meaning every 3h on average.  This satisfies the needs to (1) feed the babies, (2) feed them breast milk, and (3) provide demand sufficient to raise the supply.  The problem was that all these steps took us... about 3h... leaving a nap time of... 0h.

In the afternoon, at the beginning (delayed, naturally) of our 2nd cycle, a lactation consultant visited and shared an ingenious trick of supplying formula during breastfeeding via a syringe with a thin feeding tube alongside the nipple.  I will add a useful photo if it's OK with Katy.

This alternative strategy addresses all 3 of the above needs in one go.  We tried it.  It worked!  We did the 3rd cycle on our own from 10:30p to 11:30p.  BAC and CAC rewarded us at the beginning with loads of poop and spit-up, and at the end with loads of burps and spit-up.  Try to imagine being happy at this.  I'm not sure it's possible without hormone therapy.  Maybe this pic of Charlie will help:

Katy is now napping.  In 45 minutes we are supposed to do it all over again.  I need a nap.

I've had Dad's open bottle of Veuve Cliquot sitting by the window since yesterday, to keep it as cool as possible.  (With a can of Guinness in the nursing staff fridge already, I was reluctant to ask them to store our open bottle of Champagne.)  Those natural bubbles have staying power.  It is still delicious.

Double Football

The good news: Katy achieved tandem feeding!  The bad news: we did it all night long.  Around 11, their eyes and mouths opened up permanently.  The word "Naaaaa!" has been uttered about 5000 times.  Charlie has figured out that my pinky doesn't provide milk.  Let's hope we all nap today!

Monday

I can't believe it's still Monday!  We're at the point where the days are all running together, except there really have only been 1.5 of them.  How does that make sense?

We had a visit from the pediatrics team today, followed by a visit from Katy's parents Bob and Laura, who brought Guinness, and then from my dad Phil, who brought Champagne.  Then I took a (not coincidentally) long nap while Katy visited again with her mom.  Then my dad came back and he and I ventured out and got me some dumplings.  I am now full for the first time since we checked in Friday.

Through all this, the boys slept tranquilly most of the day.  We had two visits from a really capable lactation consultant, and we learned enough tricks to continue feeding the twins the world's best baby food.  Katy's routine is to feed both (we have tried in tandem but not succeeded yet) and then to pump for a few minutes.  This stimulates supply and also offers (at this point) a few more drops of colostrum that we collect with a hose-tipped syringe and then try to shovel or squirt into the boys' mouths.

We were warned that newborns tend to get a lot more active and hungry after their first 24 hours on dry land.  This has not happened yet to the Bros Clark, perhaps because they are pre-term.  But we expect to be a lot busier at some point.

The last two posts have some pictures and videos.  We haven't had a good sitting with the two of them yet.  Maybe tomorrow...

Charlie Feature

Charlie fell asleep promptly after getting some blood drawn

Charlie the Thinker

Happy Mom

Bruno In and Ex Utero

These two documents make a nice comparison:

Stats

We just asked our nurse (because we didn't know yet) for the babies' measurements:

Baby	Length	Weight
Charlie	19"	6 lbs 1 oz
Bruno	18.5"	5 lbs 10 oz

Breakfast

We had a pretty active night of breastfeeding attempts, diaper changing, and a doctor visit, but we both got sleep here and there.  I have about a 50% success rate swaddling using a plain baby blanket, and we have about a 50% success rate breastfeeding.  We are looking forward to a lactation consultant visit sometime today.

Katy was served a real warm breakfast.  Bruno (L) and Charlie (R) are doing well.

Katy is ambulatory already!  She just walked out of the bathroom and back to her bed.

We are getting a family visit today.  We're not ready for other visitors at this point, but we'll let you know.  We will be here at the hospital through about Wednesday.

Feeding Everybody

Bruno made it up from the NICU just after Charlie finished his first meal and got his shots.  Thanks to the excellent nursing staff, Katy has managed to feed both babies -- Charlie just finishing his 2nd meal.  And Katie has had her 1st food since Fri -- graham crackers and peanut butter!  I am typing while holding Bruno, so signing off...