A's and B's

One of the problems that preemies have to overcome is episodes of apnea (a pause in breathing) and bradycardia (a too-slow heart rate), or "A's and B's". Our babies are no exception. In some cases the apnea is caused by reflux (it hurts, so they hold their breath), in other cases it's just their brains not having matured enough to keep their breathing and heartbeat steady.

The monitors sound an alarm if the heart rate drops below 80 or if breathing slows too far or stops for more than 20 seconds, and there is a nurse at their side within seconds. Fortunately both James and Kathryn usually recover from their A's and B's on their own, often before the nurse even gets there. Sometimes they need a little stimulation, but nothing more than that. It's a scary few seconds, but we can take comfort in knowing that this isn't a life-threatening problem thanks to the close monitoring, and that it will go away eventually.

We are very fortunate in that our babies are not "sick", just premature. All of the problems they do have are ones they will grow out of over the next few weeks and months. All of the care and support they need right now is just there to take the place of the support they would have had in the womb. Even their beds, inside the incubators, are cozy little "snugglers" that give them the feeling of being contained, but still able to move a little -- just like they had inside.

On the good news side, James had his scalp IV removed last night, so they are both completely off of IVs now -- one less tube! One less invasive thing! Yay! They are still tolerating their feedings well, they have very little "residual", or left-over food in their tummies by the time the next feeding starts, and they've been having plenty of bowel movements. Their digestive systems are another thing that will take a little time to mature, which is the reason for the slow, gentle tube feedings -- they eat every four hours, but their little bit of formula is given over a three hour span.

I held each of them, kangaroo style, for about three hours yesterday, James in the morning and Kathryn at night. It is an incredibly peaceful experience, for them and for me. I'm starting to understand better what is going on with their little bodies and brains, and with their care and the NICU environment. I am starting to see changes in them even at this early stage... not just the medical changes, but more calm alertness in the times when they are awake. I am also learning what bothers them and what soothes them. With all of the helplessness that goes along with this environment, it's a great feeling when Mommy's touch or voice is the thing that helps them relax and get back to sleep.

Little gains are big steps

When I stop to think about some of the numbers, it amazes me. Kathryn is getting 30ml, or one ounce of formula, every four hours. The formula has 24 calories per ounce, which means she is getting just under 150 calories per day, plus a few more from a dose of MCT oil (medium chain triglycerides, or easily digestable fat). That's a couple of cookies, a can of coke, or a quarter of a Big Mac. James is eating a little less at each feeding, but is working his way up and should be taking 28ml by morning. He is off the IV lipids (extra fat) now, and if all goes well he should have the scalp IV out tomorrow night. He is having some goopy eye stuff, which we're hoping is just a clogged tear duct and not an infection.

The good news for the day is that they both had poopy diapers this evening, and both were on the plus side for the second weighing in a row. James is up to 1565 grams, or 3 lbs. 7.2 oz. and Kathryn is at 1585 grams, or 3 lbs. 7.9 oz. -- at this rate she may be back to her birth weight by Sunday's weighing. Their next big milestone will be "nippling", or feeding from a bottle. They'll have to be able to take their full measure of formula over an hour instead of three hours, and be able to coordinate sucking, swallowing, and breathing. Kathryn seems to have the sucking pretty well figured out, but James is clueless so far. They say that will come with time, as his little brain makes some more connections. Apparently boys tend to be slower to mature even at this tender age.

Since Russ is back in Florida for a few days, I gave them both their kangaroo time, baths (weighings and baths are on Tuesday, Thursday, and Sunday evenings), and diaper changes tonight. I also picked up a few books and read them some stories. I was running out of songs to sing and words to say, so I let Dr. Seuss and Beatrix Potter fill in for a while.

One week old

The babes continue to do well. James has gained a little bit of weight back, and is at 1490 grams, or 3 lbs. 4.6 oz. He is back on the NG (nasogastric) feeding tube, which goes into his stomach, after he pulled the NJ (nasojejunal -- into the beginning of the intestine) tube out last night. He's tolerating it well, getting 18 ml of Pregestimil (pre-disgested milk) formula every 4 hours. Kathryn is also up a bit at 1526 grams, or 3 lbs. 5.8 oz. and getting 28 ml (almost a full ounce) of regular preemie formula every 4 hours.

Theyr'e both having some reflux and getting medicine for it, but that's very very common in preemies. The worst part of it is that it hurts their throat, which makes them hold their breath, which makes their heart slow down, sometimes too far. Usually it comes right back up, sometimes they need a little pat or jiggle, but ideally the episodes will become fewer and less frequent as they get stronger.

They are also both still in the incubators, which means we can only do the kangaroo care once a day and they stay in the box the rest of the time. We can still touch them and talk to them through the portholes as much as we want, but it will be nice when they're back in the open and can be held more often. They'll get weighed again tomorrow night and will hopefully continue the upward trend.

Check the photo page for more new pictures from tonight's visit.

Where we are now - part 2

The babies, meanwhile, have several weeks ahead of them in the special care nursery here in Georgia before they will be strong enough to travel home with us to Florida. They are doing well, but are having some of the common ups and downs that preemies have along the way.



James had a touch of jaundice and had to spend a couple of days under phototherapy lights, but that has resolved completely. He is also having some trouble with feeding and reflux, which they're handling by giving him medication and putting the feeding tube directly into the beginning of his intestine instead of into his stomach. He is also still getting some nutrition through his IV. Kathryn still needs a tiny bit of oxygen to help her breathing, but she is feeding very well and has had her IV removed.



Both lost some weight after birth, which happens with almost all babies, but in preemies the loss is more significant since they're small already, and they have a harder time regaining the weight. On Monday they were both put in isolettes, or incubator boxes, insetad of the open warming beds they were in. This is to help keep them quieter and make it easier for them to stay warm, so that they expend fewer calories and can put some weight back on. At last night's weighings, they had both gained weight -- just a little, but it's a step in the right direction.

We had the babies baptized ("just in case") yesterday by a vey nice priest from the biological grandparents' church.

We are also doing "kangaroo care", where we hold the babies (one at a time! :-) skin to skin on our chests, covered with a blanket. This keeps them warm and relaxes them, and is thought to help them mature and develop faster as well as helping them bond with us. Last night we gave them each their baths, too. Kathryn loved hers, but James got quite upset at his.

Where we are now - Part 1

In the week since the babies were born, we've had some ups and downs both with them and with their birth parents. The adoption papers can't be signed until at least 48 hours after the babies are born, and during that time Christina was having a lot of difficulty with the idea of losing her babies. We plan to have an open adoption and keep in contact, but they will be living far away from her and she won't be parenting them. The birth father was also upset that there was no way to legally guarantee that we would keep in touch.

When the time came to sign the papers on Saturday, Christina and the birth father thought that they would try to raise the babies themselves, with help from their families and friends.

This news was, of course, devastating to us, but we decided to stick around for a few more days to see what happened. We knew that Christina had been very committed to the adoption throughout her pregnancy for some very good reasons, and we hoped that she would remember those reasons once she had some time to think about it.

Monday morning, she called us to say that she had thought about it and knew that going through with the adoption was the right thing to do, and that she was ready to go to her lawyer's office and sign the papers. We drove to the office with her, she signed the papers, and we brought her back to the apartment where she finally got some much-needed rest. We got a message from the birth father saying that he agreed that this was the right thing, and that he supported Christina's decision.

The Babies' Arrival

James Russell and Kathryn Ann arrived via C-section at 7:36pm and 7:38pm on Wednesday, June 20, 2007. They were at 32 weeks and 1 day gestation, or nearly 8 weeks premature. Fortunately the steroids had a chance to help, and both of them came out crying and breathing on their own! James weighed 3 lbs. 11 oz. and was 15.5 inches long, and Kathryn was the same length and weighed 3 lbs. 9 oz.

I was in the operating room with Christina when they were born, and I got to hold them both when they were just a few minutes old. I went with them to the special care nursery, where they had monitors, IVs, and some oxygen hooked up. They will need monitoring and some extra care for several weeks, at least, but they went directly to the "step down", or intermediate care side of the rather than the intensive care side. I had to leave while they ran tests and got the babies settled, and I started making phone calls to spread the news. Russ arrived around 10pm, about the same time we were allowed back in to the nursery, and when Christina was just getting back to her room.

How we got here - Part 3

On Tuesday, June 19, I took Christina to what was supposed to be a routine appointment with her perinatologist (specialist for high-risk pregnancies, like twins). The contractions she was having earlier had settled down, and at her appointment the week before, everything looked fine. She was at 32 weeks gestation, or two full months from her due date, and up to this point the doctor expected that she would make it at least to 35 or 36 weeks -- twins rarely make it to the full 40 weeks, but are usually considered full term around 37 weeks.

This time, however, her cervix had shortened quite a bit, and although she was not having contractions, the specialist advised a course of steroids to help the babies' lungs mature just in case she did go into labor soon. Because the medicine was not available from local pharmacies, her regular OB decided to admit her to the hospital that afternoon so that she could get the steroid shots and additional medication to help stop any early labor. By Wednesday afternoon, everything still looked OK, and they expected to send her home that evening after the second steroid injection, or possibly the following morning.

I left the hospital to get some shopping done in preparation for her having a few more weeks of bed rest. By the time I got back "home" (to her apartment, where I'd been staying with her), she called and told me she had suddenly started having contractions, was already dilated to 3cm, and that the doctor told her these babies were on their way!

We already knew she would need a C-section because both babies were breech (butt first instead of head first). I rushed back over to the hospital and called Russ on my way. As he headed to the airport to fly in, Christina and I got ready to go into the operating room.

How we got here - Part 2

Over the next couple of months, we kept in touch with Christina, our birth mom, and were able to help her with some things in her life. We visited again in April, and got her settled into an apartment. In mid-May, I flew up to Georgia for another visit, planning to stay for a week. She began having some signs of premature labor, so I ended up staying to help her as she was on and off of bed rest and having a lot of difficulty getting around anyway, and didn't have an easy way to get to doctor appointments or even to the grocery store.

Russ came up for a visit near the end of May, when it looked like the babies might make a very early arrival, but things started looking better over the next several days. I stayed to continue to help Christina, and we developed a close friendship along the way.

How we got here - Part 1

In October 2006, Russ and I embarked on the road to adoption. We wanted to start a family, but having biological children was not in the cards for us. Although our paths wouldn't cross until later, a woman in Georgia became pregnant just a month after we completed the first round of paperwork.

As our home study process crawled along with more paperwork, background checks, medical exams, interviews, and home visits by the adoption agency's caseworker, our birth mother was enduring her own struggles.

At the end of January, when our home study was completed, we posted a family profile on an adoption website. Over the next several weeks, a number of women contacted us. Some had not yet decided if adoption was the right choice for them, some weren't sure we were the right family for their babies, a few we decided would not be a good match for us.

Near the end of February, a woman contacted us and told us she was carrying twins, due in mid-August, and thought we would be wonderful parents for them. We talked on the phone, and a few weeks later travelled to meet her in person. She told us she was certain that she wanted us to be her babies' parents, and the legal process began through our adoption agency in Florida.