Wednesday, September 23, 2009

NICU Day 13

Okay, so today wasnt a great morning visit. It wasnt bad, but it wasnt ideal. The nurse was okay. On a scale from 1-10, I'd give her a 7. Our favorites are 10s. Most are 9s. (The one I didnt like at all: a 4- maybe?). She wasnt a bad nurse. But she wasnt cozy to the babies. She was slightly rough when she turned them over and when she took the tape off of a lead she was changing. Both babies cried in that "that hurt" sort of way, which isnt normal for either of them. They will cry a "leave me alone" cry when they dont like being assessed, but it's been rare that we've heard a real cry. Like when IVs are going in, that sort of thing. So, anyway, she was a little rough with turning them and when removing tape, which irritated me. But, she wasnt terrible and it wasnt enough to say something. However, what I did talk to her about was feeding them and putting them on their backs. Both of them. All of the nurses we've had have said that belly time is best for their digestion right now. It is the only way they can keep up with the higher feeds. So when I come in, I see they are on their backs and she says "I wanted to try them on their backs even though I see they normally eat on their bellies." So, they both went from no residuals to 5cc's (Bobby) and 7 cc's (Maya). "Oh," she says. "For this feed, I guess I'll put them back on their tummies." Perhaps next time we can do what the NPs and the nurses have been doing and continue to do to help the babies. We've discussed back time with the NPs and how they will be weened from their belly time as they progress and get closer to the transitional nursery. They arent there yet. I wasnt rude, I just reiterated that all of the NPs and nurses we've spoken to have recommended they stay on their bellies to help aid with digestion. She agreed (hence the rough flipping over comment from earlier).

The other thing that was a little disconcerting was that she put Maya on a canula. Now, if either baby needs support, we want that for them. What we dont want is someone jumping the gun on something and delaying their progress. Last night while I was holding her, Maya got hiccups and her oxygen saturation dropped into the high 70s-low 80s (the alarm is set for below 82). When the hiccups went away, back to normal (high 90s). Now, we had talked to one of our favorite nurses the night before and she said they were doing great and that having apnea spells are normal, etc. and that, due to their normal breathing and oxygen saturation, they dont foresee putting them on canulas or back on CPAP. So, this morning, Maya has a canula. When I asked why, the nurse says "Oh I didnt like that her oxygen saturation was in the lower 80s and sometimes the 70s. She was lower than average for almost half an hour." Did she have hiccups? "I dont know. I didnt check." Please explain to me how the other nurses know this. How they have checked her and said 'Hmm... This is normal for her..." So, I asked if this was temporary and she explained that Maya isnt on oxygen, just that she has the canula in and that she has been better. (Part of me wanted to say that 99% of her day without the canula is normal! She only drops when she gets hiccups! Which she gets mostly when she lays on her back and gets air in her belly!) I think that this woman jumped the gun (or maybe got tired of the monitor) and put her on the canula. It seemed obvious that she was "concerned" that "these babies went from CPAP to nothing" because she "would have put them both on a canula for at least 2 weeks after the CPAP". Her words. I plan on asking the nurses we know about this. I know there is no harm in having her on there. And if it gives her less stress, fine. But she hates it. She cries and is pulls at the tape holding it in, which makes her cry more. She looked at me today with these eyes that said "Get this off me, Mommy" and all I could do was stroke her perfect little blonde head and tell her how much I love her.

The other thing and, yes, I know I'm sensitive, was a comment she made to my MIL. She asked if Maya and Bobby were her first grandchildren. MIL says "No, we have three older ones, but they passed away because they were very premature." And the nurse says "So these are your..." (struggling for a word: insert my thought as she is struggling "real") "first live grandchildren". It rattled my MIL and the comment stung. Our other nurses have read our file and many have asked details about Nicholas, Sophia, and Alexander. They have mentioned Bobby and Maya's brothers and sister. This nurse seemed very uncomfortable by the whole thing, even though she brought it up.

Now, since I've bitched, let me give the nicer update too. She was very competent. She moved the babies from the giraffe isolettes (the hardcore, baby-may-have-serious-issues bed) to the next level isolettes! And she was very excited to share that they moved very comfortably and were doing really well with their body temps and with the transition. She explained about the new isolettes and how they will be ready to be dressed and swaddled by next week. She also said that the hospital strongly urges the preemie onesies that snap up the front and only those. The other ones are a real pain with the leads. So, I'll go through the items we've been given and see what we have and need to get. She said that they are "happy" and "beautiful" babies (which I must say never gets old and endears the nurses who say it). She said that Maya had the most lovely golden hair she's seen on a baby. (It's nice to know I'm not the only one who admires those locks!) and that Bobby is very aware for a baby of his age, that whenever she did his care, he would wake and watch her and was very responsive. And she commented that I am an awesome cow (okay, she her words were that I have an "excellent response to milk production and pumping" but to me, I keep hearing Sarah's "Moooo-chele" on the "Moo-chine" comments and cant help but want to laugh).

Probably the best part of the visit and the talk with the nurse, though, was her suggestion that I hold the babies together! She said that since their IVs are out, she thinks that moving to the center of the pod and holding them together should be manageable now! Her suggestion was that one of us holds Maya for 30 minutes, then Bobby is added for 30 minutes, then they are moved to the other parent for 30 minutes, then Maya is put away and Bobby stays for another 30 minutes. It ups the holding from an hour to an hour and a half per baby, which she said is pushing it at this age (because you dont want them to get chilly) but that it could really benefit them to be together and for us to hold them together. She said that a lot of times, the twins reach for one another and hold hands and things. She said she would mention it to the night crew so that they can assess whether today would be a good time to try or if we should wait until Maya's canula is gone. But she seemed to be positive with this idea. She also said that it is paramount that I hold at least one of them once a day. That it will help with my pumping and that she often recommends moms hold more than dads (I think Peter might take issue with that one!)

The babies are doing well. They are eating well, growing, and going to the potty well. They are beautiful and wonderful. But my visit today left me wanting my visit tonight even more. I trusted the nurse to go home; she did seem a competent nurse. I just didnt care for her as much as some others. And that, I think, is to be expected. There are a few that have just really taken a place in our hearts and when we see them on duty in our pod, we get so excited. I cant expect to have that feeling for every single nurse. But you want it nonetheless.

We took their snugglies to them last night. The snugglie is a simply head only doll (fabric draped over a fabric circle and sewed off; it looks almost like a ghost but the fabric is well colored. Moms wear them for 3 days in their bras then they are put in the babies' isolettes or cribs so they can smell me. Peter wore the snugglies yesterday for a while too, so they can smell us both.

Well, my pumping is done for now and I am so tired, I think I'll take a brief nap... We'll be going back tonight for our holdings. I'll make sure to try and upload pictures tonight when we get home since I wont post an update tonight (unless there is something huge to post).


Christmas with Kasey said...

That is wonderful that you might get to hold them together tonight! Oh and I just LOVE the picture of you feeding Maya! :) She is so tiny and/ or you have lots of milk for them! ;) I am so excited for you!

Debby@Just Breathe said...

Sounds like the nurse is okay. She did come up with the suggestion of holding them together. I think that sounds so awesome. I think it will bring them back to the closeness they had in the womb. I think they will like it. Those snugglies sound wonderful. What a smart idea. Have a nice tap.
Enjoy your dinner and your time with the kids tonight. God Bless.

Natalie said...

Hi Michele,
You don't know me, but I am from the Dec. birth board and have been following your amazing story since you were put in the hospital. I just wanted to tell you how excited I am everyday I get on here and see a positive report on the babies. They truly are miracles! I have been praying for your family and will continue to pray for your speedy recover and the growth of your children! Keep up the good work momma!


Astrid said...

Oh my gosh. I took a break from blog reading over the last week and a half and I come back to find that Bobby and Maya are here and doing great!! I could not be happier for you - there is no one more deserving of a perfect ending. I know times are still tough but what a miracle story so far! I hope the good news keeps coming. Congratulations. And I mean that more than I have ever meant it in my life.

Anonymous said...

When I saw "bad" I got concerned. But a bad nurse is better than a sick baby. Whew.

Simbelmyne said...

I'm warmed by how wonderfully your little ones are doing! Will they be able to share an isolette/bed at some point?
At least "bad" nurse came through as competent. I'm hoping that she's just learning.

Sophie said...

Jordan and Caelan had snugglies. We call them Woobies... (I think the movie 'Mr Mom' called them that). I treasure both of them. Caelan was besotted with his right up until he was three. Jordan had hers with her everyday of her life.

Little things like that will be a big deal later on. I'd love to see a pic of them with theirs.

Mrs. Cline said...

Oh Michele,

I read all about the nurse, but the only thing I can think about is that you get to hold your babies! I can't get over it! Such a wonderful, joyous miracle!

I am overjoyed for you!!

<3 Natalie

A n T said...

Thats going to be wonderful when you get to hold them together!

Reba said...

Sorry about that nurse. I know there will be different qualities of nurses, but I just really feel like NICU nurses should be la creme de la creme. I'm glad the babies are doing so great.

Mackenzie's Mommy said...

I haven't commented in a while, but I'm reading all the time. I'm so glad they babies are doing well! I always look forward to seeing pics :)


The Swann's said...

Such beautiful babies you and Peter make! Each and every one... I'm so very pleased to read overall great reports! I will continue to say a prayer for each of you and that these two angels get to come home soon!

Michelle said...

So happy to hear your beautiful babies are doing so well! Hope your feeling better every day.

ME! said...

oooo- I hate no it all nurses!! I used to be an NICU nurse- and I have worked with ones that have 'just a job'. I wish those nurses would go to wal-mart for
'a job'. Does that NICU do care teams or do nurses take primaries? Meaning whenever they come in they have certain babies. I know at the two NICUs I worked at that was the unwritten protocol if parents requested it. We didn't assign all babies primaries or that would be a staffing assignment nightmare, but they would on parent request.

YES- the babies DO tend digest better on their tummies at this time. They should be on their tummies a lot- we would make babies back/side only when they graduated to open cribs/bassinettes. But I do believe I am preaching to the choir here. :) I think you are wonderfully educated and aware as a parent. I am proud of you.

It is not unheard of to have a baby go from CPAP to room air/no cannula. I have had babies on 21% oxygen(room air), but just with a little pressure support. Need for pressure doesn't equate need for oxygen. ARGH! Sorry, soapbox.

I will step back down off of it. I am SO excited your babies are doing so well! I pray for you all often.