World Prematurity Day

Every year, 15 million babies are born premature worldwide. More than one million of these babies die, and many more face serious, lifelong health challenges. Preterm birth is truly a problem that can happen to every one of us, irrespective of the country we live in, our culture or socioeconomic status.

Worldwide, one in ten babies are born too early – more than 25,000 each year in Australia alone. Giving birth to a child is one of the paramount, most positive experiences in life. Having a baby born too soon is a significant trauma for families. Preterm birth also represents a severe financial burden for many families and our often struggling healthcare systems.

November 17 is World Prematurity Day, a globally celebrated awareness day to increase awareness of preterm births as well as the deaths and disabilities due to prematurity and the simple, proven, cost-effective measures that could prevent them. 

I haven't slept properly in a week. My body is tired. It has been poked, prodded, scanned, monitored and finally sliced open. My arms and belly are covered in bruises and bandages where needles have been inserted for various reasons: steroids, amniotic fluid drains, magnesium sulphate, fluids. Both hands still have cannulas attached.

My hospital gown is crumpled. I don't see it, but it is blood stained. My hair is a mess. Giving away a night spent writhing through contractions on my hospital bed alone. Biting my lips to stop the moans escaping.

I have waited five hours to meet you after your birth via a c-section. Your father has stayed by my side so we could meet you together. Despite everything I am excited. While we waited in maternity we have rung family and friends to announce your arrival. We have quickly finalised your names. Finally the midwife announces the arrival of the orderlies who will wheel my bed down the corridor and into the Neonatal Intensive Care Unit.

I am smiling. I am about to meet our daughters. Your father holds my hand as they manoeuvre the bed over to the first humidicrib.

Later I will notice the smell of the strong disinfectant and the incessant alarms that beep at each crib. But in this moment I don't smell or hear either. I see a crib, misty with condensation. A friendly nurse smiles and opens up the two little doors, so I can see you.

You are beautiful, and yet you terrify me. You are so, so small, and very red. Your tiny body is mostly covered by your nappy. There are wires and sensors attached to your chest. Your head and face are obscured by a strange hat and tubes that go up your nose.

I don't even realise at first, but hot tears are streaming down my face. I love you already, but I am so sad at what you now have to endure. The nurse encourages me to put my hand in and gently touch you. I overcome my fear and stroke your little hand. 

We nearly get the names mixed up, but once they tell us you are the first born twin, we name you Maggie. We know it suits you already.

I wish I could stay next to you for longer, but in the next crib lies your sister. The tug of two babies in the NICU has already started. They move my bed over, and despite what I've just seen, your small, fragile body shocks me again. An ache that will follow me throughout your stay in hospital crushes my chest. 

Elisabeth we name you. Your eyes are closed tightly against the bright lights. You seem a little more relaxed than your older sister. The tears keep falling. Such a surreal moment to meet our daughters and be so conflicted by love, fear, excitement and dread.

Remembering their birth day. If you have followed my blog for awhile you will know our daughters arrived at 26 weeks due to the acute onset of Twin-to-Twin-Transfusion-Syndrome. Maggie weighed 777g and Elisabeth 889g. They spent 112 days in hospital. They are about to turn three, we are incredibly lucky to have two healthy daughters.

Text at the top is from Miracle Babies Foundation. 

The indecisive weaner

I opened up the deep freeze in the shed this morning, and it is still full of carefully labelled plastic pouches. Reading the dates and times bring back with surprising clarity my daily routine at the time. That first express before breakfast. Day time expresses at the hospital in a tiny room. Pre-dinner express before a small pre-dinner drink. The final express before bed, and my least favourite the 2am special to keep the milk production going. Most are now more than a year old, which means technically I can no longer defrost and use them for feeding the girls. I should throw them away. But I can't quite bring myself to do it yet.  It is like a frozen time capsule. 200 hours of my life. Some of the most stressful moments I have ever experienced seem to be invisibly linked to those plastic packets.

Is it time to wean? A question that is swirling around in my mind at the moment. I have been producing milk for nearly 15 months, feeding the girls myself for 11 months. I always assumed the girls would self wean. That this decision would not be one I would have to contemplate or make.

I had not considered long term breast feeding before they were born. I assumed that feeding twins might not last that long. It would be too hard. I might not produce enough milk. I wasn't going to beat myself up if it didn't work out and we had to bottle feed or use formula.

My return to work hasn't brought on a sudden weaning. Much as I read that this could occur. Instead I am expressing twice a day and the girls drink, albeit reluctantly, from bottles when I am at work. Seems funny to have gone full circle and have the pump and bottles out again.

If you ask me at 3am I will say yes, I have to wean. They are waking me up between 1-5am nearly every two hours, and feeding for comfort. Unfortunately now they have top teeth, it is of no comfort to me. Their latch slips in their sleepy state, and those razor sharp new teeth drag down causing me to yelp out loud in pain. Honestly, it makes me very grumpy and they are not very happy either. Rob takes them after I try to reattach them properly a few times and rocks them to sleep.

Now I know that part of this problem is the girls sleep settling needs to be separated from feeding. Yes that is easy to accept in theory. Trying to do it in practise when we are both tired and desperate for the cries of one girl not to wake the other is another matter entirely. We tend to go with the flow when it comes to parenting the girls. Although we loosely have a routine, we don't enforce it, although perhaps sometimes we pay for skipping a nap, or delaying their dinner!

But during my days at home (I am only working five days a fortnight), I happily feed them during the day. They latch on much better when they are not half asleep, and it is so much easier than trying a bottle, sippy cup or normal cup. Weaning doesn't even cross my mind. 

I think sometimes breast feeding the girls is my last connection to those early days in hospital. It was my job. The one chance to be their Mama, sustaining them and helping them grow. Amongst the artificial, busy and clinical environment of a neonatal intensive care unit those moments when we practised feeding I really felt like their mother. I could close my eyes and ignore the beeps and alarms and nurses, it was just us, doing what we were meant to be doing; bonding, forming a relationship that had been paused because of their early and scary arrival. Maybe I need to shed a few last tears and move on to the next stage with Maggie and Elisabeth.

So where does that leave us? I suspect we'll muddle through for a bit longer until they are 12 months corrected (March 20), then wean the night feeds, I may keep up the day feeds a little longer before encouraging them to drink out of cups.

How did you wean?

How did it make you feel?

Returning to work

We had a very quiet day today after a very warm night (for us Tasmanians), both girls were quite unsettled after 1am, which resulted in them both in bed with us.

It had cooled down considerably today, and after breakfast while Rob had some time in the garden I pushed the girls in the pram down to the laundry hut to do some washing. I could see their eyes getting heavy, so I put up the hammock, and rocked Elisabeth in the pram with one hand whilst rocking Maggie and I in the hammock.

I could have snoozed, but instead I enjoyed the moment with my girls. I return to part time work next Wednesday. After 13 months of maternity leave it will be a bit of a readjustment. At the beginning the months ahead seemed to be such a long time, and even when I had a meeting in August with my supervisors, my return still seemed such a long time away. Since Rob has been on holidays with us, I have been mindful of the return date, but instead of letting sadness or worry ruin my remaining days as purely a stay at home Mama I have tried to enjoy each day. 

So today I looked down at a sleeping, snuggling Maggie on my chest in the hammock, and later this afternoon Elisabeth in my lap on the window seat and I soaked in the moment. No iPhone. Just us. I listened to the sounds of our home, the dogs panting in the shade, the washing machine sloshing through a cycle, the buzz of insects, the breeze rustling the grass, a swallow singing above me on the washing line. I looked at the hut, Rob when he walked by covered in Lily pollen, the peaceful look on the girls faces, and high above us,

a wedge tailed eagle, slowly circling higher and higher against the cloudy sky. 

Of course I will be a bit sad to leave next Wednesday morning, but for the first six months Rob will be taking some leave to look after them at home. So I know they will be fine and enjoy some time with their Papa. I am trying not to worry about all the tasks that await my return (I have been warned a few things have slipped in my absence). Or the fact that I thought the girls might have weaned themselves by now, well that will work out too. I'm no stranger to the breast pump, so it will come with me to work, and the girls can drink expressed milk from a bottle or a cup. I am only returning at 50%, so I will still be here most of the time anyway. 

All those things I gazed at or listened to will still be here. Sure I may miss some of those big firsts, but I have witnessed so many this past year, I shouldn't let it upset me so.

Finally I worked out this morning, that just because I'm returning this year, it is not set in stone that it has to stay that way forever. Once I repay my years service, if things are not working out, we can reassess and try a different arrangement that works for our family.  

A friend commented on Facebook recently that I might struggle to cope with tearing myself away from the girls. I replied that I haven't forgotten for the first 112 days of their lives, I did just that, tore myself away as I said goodbye and left them every day in the NICU. That was hard. At least at the end of a work day I will come home to my family. 

So as I enjoy each day of my last week, including my birthday on Saturday, I will store away little memories to smile at during my work day. Of two happy girls with their Papa, a couple of German Shepherds and a small little hut. My family whom I adore in our home. How can I be sad about that?

We have a routine, who knew?

Yesterday we celebrated another milestone, the girls are now 7 months old and have spent 100 nights at home with us. I like celebrating these steps away from our scary premmie baby beginning. How did we celebrate? I searched our meagre wine cellar for a bottle of bubbles but there were none to be found. Luckily Rob must have read my mind and came home with our favourite house wine, the Montepulciano, a glass was perfect with a quick dinner of pasta carbonara. I am a cheap date these days, one small glass of wine is all I need to feel light headed after a year of not drinking at all.

This last week has been a little crazy. Family celebrations and visits, a lunch with friends and a trip to hospital for blood tests. I didn't realise we had developed a routine with our girls, until we broke it, five days in a row. Boy did I know about it then. 

So for one day when the memory of these early days with newborn twins fades, I'll document a typical day here.

We wake around 7am. Or earlier if the girls feeds have been a little crazy overnight. I have stuck to feeding the girls separately, twin feeding is a nightmare, especially as Elisabeth still uses a nipple shield, so I'd rather they feed properly individually. Rob will let me get set up with the My Breast Mate feeding pillow (so glad I bought it) and burpee cloth, sitting up in bed and he will pick the girl who is protesting the most from their cot. Sometimes the other sleeps on, other times they are treated to a nappy change and dummy while I feed their sister. Then we swap. Until recently we both got up then. But as the days have shortened, our enthusiasm for leaping out of bed before the sun is up has also waned. I find it too difficult to nap during the day, so a few extra minutes of sleep with a snoozing baby beside me is welcomed. 

Rob, stumbles out into the cold hallway (our bedroom is kept at a perfect 18 degrees thanks to a small panel heater and Percy the room temperature penguin). Followed by two excitable German Shepherds. Nigella has taken to sleeping out in the breezeway to escape the crying, but generally likes to come in some time early in the morning and sleep near the doorway. Perhaps so we don't forget her. Claudia braves the crying and sleeps on her mat on Rob's side of the bed, but she can look quite concerned at times. Rob dons a polarfleece jacket, a possum merino beanie, gumboots over his pyjamas and takes the dogs on a morning perimeter, taking a load of dirty washing to the laundry on the way. The dogs love the frosty mornings at the moment, especially frosted wallaby poop. We imagine to them they are like dog icy poles. Eew. Often I catch a glimpse of them chasing after balls or gambolling around like crazy things (the dogs that is). If the washing is done then he'll also hang it up (yes I am lucky and I love him very much!)

Back in the hut, I have usually moved the girls down to the living room. The heat pump brings the room up to a toasty temperature quickly. I will change the girls nappies and put one in the swing and one on a mini bed (actually a change mat) on the window seat. I realise that my days of doing this may be over soon once the girls start to roll. At the moment our breakfast of choice during the week is porridge, with I have to admit cream and brown sugar. Rob also makes us lattes from the machine. My only coffee for the day. 

I still have to express a few times a day, as my milk supply never settled down. I've tried stopping it but I get too uncomfortable, so my long term relationship with the electric pump continues. So I often do a quick express here. After bragging smugly about my daily shower, I have to admit that I am only getting one every second day at the moment. The extra sleep in eats into my shower time, and at the moment sleep trumps cleanliness. Besides, I'm saving water right?

Rob has a quick shower and heads off to work in his little car. Usually this morning nap for the girls means I can do something for myself, mostly baking a cake or some biscuits, or maybe reading some blogs, or a book! Phone calls to friends happen now too. I quickly tidy up the living room, even though I know by the end of the day there will be baby blankets and toys strewn across the window seat, table and side tables but it feels good to tidy it all up still. If lucky I might even get a moment for a quick cup of tea.

They usually wake up between 10.30-11. They are given their daily dose of Pentavite with a small syringe. A smelly, yellow, oily multi-vitamin, pineapple flavoured (why?) it often gets on their growsuits, face, hands or mine! Once they start solids that can at least stop. Both are fed now, and they enjoy a little chat post feed on the pillow, their cute smiles absolutely undo me at the moment. They are starting to like sitting up, but are not so keen on tummy time but we still do it. They have a play on the rug on the floor, with a few toys and now their new extremely psychedelic, all singing, flashing, crinkly playmat. They usually spend a few minutes chatting to each other too.

Then I get one to sleep in the swing (usually Elisabeth as she is fighting sleep at the moment, note to self don't muck around with their routine!) and the other up on the window seat bed again. I quickly have some lunch, usually left overs or toast. Sometimes one of them is a bit cheeky and would like a top up snack or a nappy change.

They wake up again around 2 and we do it all again. They get a ferrous supplement in the afternoon. This one is clear, but stains brown if you spill any. I try to get a cup of tea and snack again. Sometimes it's still warm by the time I drink it. Around 3.30pm Nigella and Claudia start getting restive (they spend most of the day sleeping on their mats in the breezeway or in the sun on the terrace) and want to go outside to wait for Rob's return. I know how they feel. Sometimes things can unravel at this stage and one of the girls will be awake, no matter what I do! Clean nappies, full tummies, reading books, cuddling. Often the Putumayo yoga music is played on a loop, we have used this album since the girls first came home, I think more than anything it calms us down!

Around 5pm Rob calls from work to let me know he is on his way, often he stops to shop on the way home. The girls (both baby and furry) and I wait until his headlights come rushing down our 300m driveway, and shine right into the living room of the hut (as we have double glazed windows we don't require curtains or blinds). The dogs rush to get to him first and knock each other over in the process. A quick hello to me and the girls and then he'll head down to the laundry hut, to pop some washing in the dryer, play golf in the dark or quickly harvest some veggies.

Meanwhile, the girls are rapidly unravelling and cluster feeding. Sometimes one might give me a break and fall asleep, but sometimes not. The witching hour most definitely exists here at the hut. Rob will prepare dinner, we will try and discuss our days over crying or chirping. Then we'll quickly sit down at the table to eat. Poor Rob, I really should take a moment to savour and appreciate the lovely dishes he prepares for me, but I have one eye on the babes, and often I abandon or have to scoff it down. One day I hope to eat at leisure. Please tell me I don't have to wait 18 years.

I have to admit by now I feel quite tired myself, and am looking at the clock hoping for it to be 8.30. We will then pack up shop, take feeding pillows, nipple shields, drink bottles, phones, chargers, iPods and of course the babies and dogs down to our bedroom. On goes the yoga music, the lights are dimmed, and I sit up in bed and feed them one last time. Usually they fall asleep in Rob's arms. Usually. But recently it seems this doesn't happen until the magic time of 9.42pm. Then suddenly they fall asleep. They are placed in their sleeping bags in their shared cot, one down each end, and then we thankfully fall asleep too. 

If we are lucky they wake at 2am and 5am. If we are unlucky they wake at 1am, 3am and 6am. 

So that's our day at the moment. I really do enjoy being home at the hut with Maggie and Elisabeth. Our recent run of outings and visits to the hut have interrupted our routine, and poor Elisabeth has been the most confused by this. Over stimulated by new surroundings, or traumatic blood draws, she has forgotten how to sleep during the day. After a quiet four days at home, she is finally getting back to normal.

Weekends are lovely, as Rob is home too, we can chat at leisure, drink tea together, take longer over breakfast, cuddle babies on either end of the window seat, keep the dogs amused and bathe the girls. Hopefully soon the weather will be a bit nicer, and the girls will be able to sit up in their big double pram, (they don't really like the bassinet one much), and they'll be able to go out for some fresh air.

So that's what it's like with twins. Busy but twice as much love.

A reflection on motherhood so far.

Before I was pregnant, and even during my somewhat truncated pregnancy, I often wondered if I would be a good Mama. Not many of my friends were new Mums recently, so I hadn't spent a lot of time around babies. As the eldest of 5 children born in 6 years (ironically no twins) I have some vague memories of helping with my younger siblings, but it was all a bit foggy. As much as I love reading your many blogs and watching how you are Mama/Mum/Mom/Mother to your children, I couldn't help but compare myself to you; motherhood seemed somewhat oblique to me. I was worried about my own skills, for want of a better word.

I read your birth stories and those precious moments when you held your baby for the first time, how you fell in love, and to be honest I was worried I may not feel it.

Also with your honesty about the reality of sleep deprivation, crying babies and other keeping it real moments, I wasn't sure I would cope with one, let alone two babies.

Now I know that at 5.5 months it might be too early to call, but I can already tell my fears were unfounded. I realised it this morning as I enjoyed a shower, a precious moment of alone time that Rob ensures I enjoy every morning (well except in the rare days I decide to stay in bed all morning thereby forfeiting my shower token).

My start to motherhood has been quite different to what I expected, and certainly very different to all those stories I read. While I wouldn't wish the premmie journey on anyone, I feel it is important I recognise all the emotions I felt and celebrate how I became a Mama. Particularly as I have no photos during my labour or the emergency Caesarian to help trigger my memory. 

This is the last photo of me pregnant, in a lovely hospital gown two days before Maggie and Elisabeth's birth. 

In the last few days as my Obstetrician balanced the risks of Twin to Twin Transfusion Syndrome (TTTS) to my babies, (we still didn't know their sex), against the risks of birth at 26 weeks, I refused to think about their birth. Perhaps in a vain hope it might delay that moment until it was safer for them.

At dawn on 12.12.12, despite all our worst fears, as I lay on the operating table, with a hastily erected curtain close to my face, Rob's hand holding mine ever so tightly, I heard our Doctor ask Rob if he'd like to stand up and see the first baby's appearance, and I felt excited. She joyfully announced "It's a beautiful baby girl", and as Rob's tears fell on my face, I quietly wept as I heard Maggie's tiny but determined cry, and I felt it. A love stronger than anything I had ever felt, particularly for someone I hadn't even seen, as I became a Mama. One minute later the Doctor asked Rob to stand up again and Elisabeth entered the world screaming just like her sister, and another wave of love washed over me for my second daughter.

The girls were whisked straight away into the care of a team of Neonatalogist Doctors and NICU nurses in the corners of the room. Rob was able to take a closer look and reported back to me that they looked like skun rabbits. Once stabilised their humidicribs were wheeled past me as I lay being stitched up on the operating table.  The nurse flipped down the side so I could see Maggie (at that stage still unnamed) for the first time. But given the number of tubes and the fact she was in a plastic bag for warmth I didn't see much. 

While we were in recovery and then in my room, the adrenaline of labour kept me excited as we waited to go and meet the girls and give them their hastily finalised names.

They wheeled my whole bed into NICU and as I got close enough to see into their cribs, my emotions overflowed yet again in silent tears as I fell in love hard with our tiny, red, jelly-skinned girls. Desperately wishing they didn't have to endure such a tough start to life.

I realised then the love part of motherhood is innate. The skills side of motherhood still worried me a little as I had my first cuddles (11 and 13 days after their birth), nappy changes and baths. But I treated our 112 day stay in NICU as a motherhood apprenticeship. Surrounded by professional baby nurses and lactation consultants, many of whom were mothers or fathers themselves, I asked questions constantly. But the wisest advice given by a few nurses about how to care for babies was to do what feels right for us. 

In doing that I have surprised myself. I can be a good Mama to Maggie and Elisabeth, and I have coped so far with the intense needs of two newborns; with Rob helping me of course!

I look forward to continuing to learn and trusting my instincts as a Mama.

My first twin cuddle 38 days after their birth. Arranged as a birthday present for me by the NICU nurses. The best present I have or may ever receive.

20/52

"A portrait of my child, once a week, every week, in 2013."

I know that originally I promised individual portraits, but this week something beautiful happened, the girls recognised each other for the first time. It is one of the most amazing things I will ever witness, the bond between my identical twin girls. They cooed and smiled, flapped their arms and wiggled their legs in the air. They even tried to gently touch each other's faces.

As a first time mother I really had no idea about the different developmental milestones and steps babies go through. It delights me every time Maggie and Elisabeth do something new. Little things like a smile or a coo could make me so happy all day.

I can't pick my favourite out of the following photos I took. Elisabeth is on the left and Maggie is on the right.

19/52

"A portrait of my child, once a week, every week, in 2013."

Maggie: her first cuddle with her Nan.

Elisabeth: it is beautiful to see how happy the girls are when they are cuddled and loved by our family.

Last week the girls reserved their smiles for us. This week when my parents and brother visited, and on our trip up North for a Mother's Day surprise visit to Rob's Mother, the girls started smiling at our family. Perhaps they can sense how much they all love them?

We had a quiet first Mother's Day at the hut. A mini sleep in, pancakes in bed, snuggling babies, thoughtful gifts, a lazy lunch and a chocolate and date cake for dessert. I am just so grateful I can celebrate today with my daughters at home. 

I wish all my readers who are mothers a happy day today. I did once naively think becoming a mother was the easy bit, but over the last year I have experienced the yearning to be a mother and faced the very real possibility of losing my babies. So today I also think of women who struggle with infertility, have suffered through a miscarriage or still birth, or have lost their baby or child later in life. I imagine they wish for the opportunity to love that wee dream baby or the chance to hold their precious child again, and today might be a hard day for them to bear. I hope they still feel loved and valued as a Mother. xxx