Happy BIRTHday, James & Simon!

Seeing as how the babies are approaching the three month mark, I knew it was important to write this post before my new mommy brain completely forgot this very special day: October 15, 2014.

PRE-BIRTH

I had downplayed generally every little concern for this pregnancy - don't get me wrong, I was taking care of myself physically, but I didn't turn to Google for every hiccup like I did for Nora.  I just prayed that it would all work out and felt mostly calm about the process of being pregnant with twins.  With as many appointments as I had with the high risk group and my OB, the chances of anything going horribly awry between ultrasounds were slim considering my track record of a previously healthy pregnancy.

Around 26 weeks, James "Baby A" turned breech.  With a multiples pregnancy, so long as the first baby is head down, a natural birth can be attempted even if Baby B is breech.  When James flipped - I instantly knew it.  His kicks were too low to be head down.  When confirmed by ultrasound, I started the process of doing everything I could to flip that baby back around - spinning babies exercises, Webster-certified chiropractor, handstands in the pool in September, hopping on one foot while clucking like a chicken - not really, but you get the idea.  I did NOT want a c section.  Yet, every week, there was Baby A nicely snuggled in his new position.  While we never knew the genders, this is when I began saying that Baby A had to be a boy because he was trouble already!

Five weeks before the boys were born

BIRTH DAY

On the morning of October 15, I had been up all night with a cough.  I knew I was sick but didn't want to go to the doctor between prenatal check ups.  I messaged a birth group I was in on FaceBook - one that focuses on all natural approaches to birth.  I was looking for homeopathic remedies to my symptoms when a physicians assistant warned that I could be in preterm labor.  That's when I realized that my back was cramping up the same as when I was in back labor with Nora.  I decided to call the doctor about a Z pack and thought I would just mention the back issue.

Dr. Mullenix (with MOGA) had me come in at nine and listened to my lungs.  That's when I mentioned my back.  He looked alarmed and asked to conduct a pelvic exam.  Afterwards, he calmly stood up and announced that I was "probably 6 cm and I just felt Baby A's butt in your birth canal."  I jumped off the table and promptly accused him of lying.  I just couldn't believe it.  The nurses started flurrying around to book an OR at the hospital next door.  It was a busy morning for L&D, and they couldn't get an OR ready for me for at least another hour.  Dr. Mullenix barked at one of the nurses, "tell them she can have her babies in their lobby or she can have them in an OR, but it's their choice!"  That nurse quickly returned with the news that they were ready for me next door and I walked over to L&D.

Poor JD was en route to Oxford, MS when I called him to turn around.  Physically, I felt fine, but I knew this was going to happen very soon.  He drove over 80 mph through Memphis streets to get to the hospital on time and ran up five flights of stairs.  I think he should have been given oxygen when he got to L&D because he almost couldn't talk.  When I got to L&D, a nurse checked me and said I was 8 cm (!), and the monitors said I was contracting every minute.  I felt like I was in a twilight zone because I still felt completely fine.  No pain other than being hugely pregnant.

There were a million healthcare staff in the OR - when a woman comes in at 35.5 it's considered preterm labor.  When it's twins they get pretty fussy about it all;)

I was very worried that the anesthesia wouldn't "take".  I asked for an epidural with Nora and it never worked.  I had a d&c last Christmas for a maintenance issue and I woke up in the middle of the surgery and tried to get off the table.  So far, my track record wasn't great for anesthesia.  Luckily, the anesthesiologist did a good job and I felt very little of my surgery.

Feeling pretty good from the anesthesia;)

Dr. M did a great job of keeping me relaxed and the surgical tech had a good sense of humor that kept things light in the OR.  When they pulled out the first baby and announced, "it's a boy" - I was excited but not terribly surprised given my prediction for this breech baby.  When they pulled out the second baby and announced that it, too, was a boy - we were SHOCKED.  Excited, but I swore that baby was a girl.  That's why it is so fun to not find out the genders.  We truly didn't care what the genders were, but it was fun to guess along the way.  I still remember how much we laughed when the second baby was a boy.

James David III, Baby "A", born at 11:15 am

Simon William, Baby "B", born at 11:17 am

We stayed in the OR for a long time doing skin-to-skin with the babies.  JD was great about holding them up for me, but it was obvious that Simon was having trouble breathing.  The neonatologist wanted to keep Simon in the OR for a while in case he could come out of it, but it became clear after a while that Simon was headed to the NICU.  James was borderline.  His breathing was labored as well, but not as severe as Simon's.  Both babies were around five pounds each and received high APGAR scores of nines both times.

First family photo with the boys.  I'm starting to get a little puffy from all the fluids.

They took the babies to be assessed while I was in recovery and it was a few hours before I heard anything about Simon.  I knew he wasn't critical, but I was frustrated that it was taking so long to hear.  James was in recovery with me and we were contacting family about the last minute news.

Skin-to-skin with my sweet James

When I was moved up to a room, I accidentally disconnected my IV.  It was a minute before I realized what happened, and then I saw blood all over one side of my sheets and the more I moved my hands to talk (yes I'm a girl - it's what we do), the more I kept flinging blood all over the place, walls, TV remote, etc.  I told JD to call a nurse to let them know - keep in mind, I am totally relaxed, calm, and laughing at the mess - he hit the 'Staff Assist' button.  Well, the 'Staff Assist' button is an all-hands-on-deck emergency button so all these nurses came running into my room that looked like a murder scene with blood on the walls, yet I was sitting up in bed swearing I was fine.  We all had a good laugh about it, and they took out my hep lock so it wouldn't happen again.

POST-PARTUM

We sent James back to the nursery and we took our first of many trips down to the NICU.  Simon looked pitiful in his incubator down there.  I couldn't nurse him or hold him just yet.  They hadn't administered any medication for his lungs yet because they were waiting to see if he could overcome his breathing issues  Surfactant has a few side effects that aren't pleasant, but we were lucky in that when the NICU staff did decide to administer this medication, Simon had no side effects and his breathing quickly improved.  Then we were able to hold him and I could nurse him.  However, he continued to languish for a few days before being weaned to room air, and even longer before he started to gain weight.

Simon in the incubator in the NICU

Seeing Simon in the NICU for the first time a few hours after the c section.  I couldn't hold him yet because of the monitors.

Upstairs, James began to have issues over the next few days.  He had problems regulating his body temperature.  They put him in an incubator in the well baby nursery to warm him up.  I practiced a lot of skin to skin with him.  The doctors were concerned that his low body temp meant he was about to get an infection right before my discharge.  They administered an antibiotic that required a 48 hour hospital stay- one extra day than I had in the hospital.

James, Jr. and James III

First time I got to hold Simon in the NICU

This was when I started to get upset - I couldn't believe I was going to have to leave the hospital without either one of my babies.  I had begun to accept that Simon needed his time in the NICU, but James too?  JD and I discussed paying for an extra night when one of the nurses did the kindest favor for us.  She made a few calls and found out that most of our floor was about to be discharged.  She requested permission to let us stay an extra night - for free - off the books.  Her request was granted and we were responsible for my meals and medications, but could otherwise stay another night, close to James and Simon.  When she came to my room to tell me what she had done - I'm not going to lie - I cried.  It was so sweet of her to do that for us - and we were able to leave that next day with James.

The boys are starting to do consistently well with their growth and development.  Their two-month check-up was really the first time they had consistently gained weight. Since birth, they have been great sleepers and I feed them every three hours during the day.  Nighttime, I stretch out their feedings to whenever they wake me up.

I still can't believe I am a momma to two boys, and how much I love having boys!   This was a scary time for us, but we felt loved by all of you who prayed for us, fed us and constantly checked on our well-being.  We have the best family and friends!

James left, Simon right

Holy October!

Never has November been such a welcome sight for our family.  October was a difficult, joyous, crazy month for the Graffams.  Here's our month in a nutshell:

Sept. 28 - JD goes upstairs to get Nora ready for church.  He sets her down on the floor of her room, and she crumples over.  She stopped walking.  After talking to a nurse, we decide to take her to Methodist Germantown.  They run a bunch of tests and take x-rays and determined that they weren't equipped to handle her case.

After loading Nora into an ambulance, she is transferred to LeBonheur Children's hospital downtown.  For the record - seeing my sweet little 19 month old on a stretcher in an ambulance is about the worst thing I've had to witness so far in my adult life.  LeBonheur decides that Nora has toxic synovitis - a virus leftover from an ear infection is attacking her hip - and recommends a daily regimen of ibuprofen until it passes.  No big deal right?  We take her home and hope for the best.

A few days later, Nora is running around, back to normal.  The Methodist ER doctor calls to report that her blood culture was positive for a bacteria.  Based on the fact that Nora seems to have recovered, the doctors at Methodist and LeBonheur decide the bacteria must have been a skin contaminant and dismiss the idea that she was misdiagnosed.

For the next two weeks, Nora relapses and recovers every few days.  Her mobility varies from not being able to walk, to limping, to running.  JD takes her in to every pediatrician in the pediatric group - our regular pediatrician is on leave.  They all observe the limp but tell us to wait it out.

Oct. 14 - JD and I go to dinner and a movie.  My mother babysits Nora so we can have a date night.  I have trouble sleeping.  I can't stop coughing.  I've had this lingering chest congestion for a week, but it was worse.  All night, I pace the house because my back hurts from coughing so much (so I thought).  I have to empty my bladder every 5-7 minutes.  I knew I was sick but I didn't want to call my OB.  That week was my last week 'off' as the next week would start twice a week pre-natal visits for the twins.  The babies were moving like crazy.  By morning, I was exhausted.

Oct. 15 - I call my OB's nurse to see if he will call in a Z pack.  The nurse says that Dr. Mullenix wants to see me at 9 am.  I really don't want to waste my last week off going in, but I also want to stop coughing.  After listening to my lungs and hearing my symptoms, Dr. M asks if he can examine me.  Sure enough, I am 6 cm dilated and Baby A was already in the birth canal.  This is not a good thing as I have to deliver these babies by c section, which was initially scheduled for Nov. 1.  Baby A was complete breech, and the risk of a prolapsed cord was too great to attempt a natural delivery.  Less than an hour later, we meet our sons.  I'll do a longer post about this later.

A few hours after my c section while I am in recovery, the day care calls about Nora.  The director is worried about her leg again.  I call the pediatrician again to find out that Nora's regular doctor is finally back and wants to see her.

Oct. 17 - Nora finally sees her regular pediatrician.  On top of her leg issues, Nora's oxygen level is so low that it takes three breathing treatments in the office before Dr. Hussain will let her leave.  An appointment is set up with Nora's pediatric ortho to look at the leg.

Oct. 20 - We leave the hospital with James.  Simon must stay behind in the NICU.

Oct. 21 - Dr. Beaty at Campbell's Clinic observes Nora.  He says if six weeks passes of symptoms, they would step up her treatment.  He schedules a follow-up appointment for next week.  Nora's leg continues to get worse.

Oct. 25 - JD takes Nora in to Campbell's after hours clinic.  The ortho who observes her is sympathetic, but recommends waiting for our next check-up.  I get a call from the NICU - Simon is coming home!  We are so excited to have everyone home!

Oct. 26 - Nora's leg pain is so bad today that she can't stop crying.  This is the first time when she has had an episode where she won't let us touch her leg.  JD takes her back to LeBonheur.  He calls me close to midnight to say they have admitted Nora and have ordered an MRI for the next morning.  My mom quickly comes over to watch the boys so I can stay the night at the hospital.

Oct. 27 - When Nora is in recovery from the MRI, her nurse is the same nurse she had earlier in the summer for a different issue.  Unlike last time, the nurse isn't hinting around that Nora's MRI was normal, and keeps asking questions about hot spots, inflammation, etc.  She says to wait in Nora's room for the results from the radiologist.  She says if Nora is an emergency case, the radiologist will see us sooner rather than later in case they need to operate right away.  I take this as a bad sign.  When we get upstairs to her room, her floor nurse calls the radiologist to see if Nora can have a snack as she has been NPO since midnight.  The floor nurse quickly returns to say Nora can't have anything to eat or drink, and the radiologist was on his way.  Soon after, the radiologist, pediatrician, anesthesiologist and nurse practitioner come to Nora's room.  Two things popped up in her MRI - excessive fluid behind her left knee and a possible bone infection in her left shin.  They need to wash out her knee first and test the fluid, and put her on IV antibiotics for the bone infection.

As soon as the operation gets underway, the nurse calls JD to say that the fluid looked infected and they had to open up Nora's knee more than anticipated - but that was explained to us as a possibility beforehand.  Her white blood cell count confirmed the infection, and a few hours later we have a sweet, groggy toddler in the recovery room.  I stay a little longer, but then go home to be with the boys.  JD stays with Nora.

Oct. 29 - Nora was supposed to have a second surgery to washout her knee again, but the surgeons were confident that all the fluid is gone.  They still have no idea what type of infection she has in her knee, and this is causing a problem for treatment.  They send out for an infection diseases (ID) consult.

Oct. 30 - The ID doctors spend a lot of time interviewing JD and looking at Nora's chart, which leads them to diagnose her bacteria infection as Kingella Kingae bacteria - a bacteria that can grow out of mouth sores.  Nora has had hand, foot and mouth several times this year - and recently had mouth sores.  Once the ID doctors make this diagnosis, we are relieved because the treatment is easy.  Just oral antibiotics at home.

Oct. 31 - Nora finishes her IV antibiotics for the bone infection (not the bacteria infection), and they discharge our little girl.  We are finally all back together!

It was a hectic month with Nora's leg issues.  It was joyous with the birth of our sons.  Through it all, we felt incredibly supported, prayed over and well-fed (!) by our family, friends, neighbors and fellow church members.  'October' might be a dirty word in our house for a few years, but surely we will look back at the insanity one day and laugh, right???

15 months…and 20 weeks!

Our house has been busy with a silly toddler and a pregnant mama.  Here are updates on both of us:

Nora @ 15 months

Nora is a full-time walker, and sometimes runner!  She mainly runs towards the dangerous stuff - pools, ledges, etc.  I can't even remember the last time she crawled!

Officially ortho-issue free.  We switched pediatric orthopedics, who said take that baby out of her brace!  Her hips looked fantastic on x-ray, and (after a scary MRI to verify there were no fused vertebrae) her torticollis is gone as well.  She'll need to be monitored every six months or so to make sure the torticollis doesn't relapse.  I still laugh when I think about how they told us at birth (when her issues were obvious) that only '12 weeks' of treatment was needed.  At least we don't have to worry about it after 15 months!

She says a TON of words - Momma, Ball, Yeah, Uh-oh, Milk, Daddy, Hi, Thank You, etc.  I think 'doggie' is next.  She always makes the same sound when she sees a dog.

Growing big-time, mostly in weight rather than height.  She is 31 inches tall (50% height) and weighs 26.12 (90% weight).  I discussed switching to 2% milk, but the pediatrician says that Nora's weight should slow down over the next three months with all her walking and to keep her on the whole milk.  She still wears mostly 18mo clothes, but we have switched her to size 5 diapers.

Drinks from a straw cup, uses a fork 30% of the time, feeds herself all the time and eats EVERYTHING.  She is the most agreeable child.

I am constantly amazed at how she has switched to a deliberate style of play.  She will go into my cabinet under the bathroom sink, take all the tops off the bottles, switch them up, then match them back up again.  She loves putting buckles together, piling her toys in the same spot, 'reading' books and stacking things.  I can really see her brain working as goes…and grows!  Here are a few photos:

Taking a bath with favorite big cousin Emma

This is what happens when Nora is mysteriously quiet

First petting zoo on Easter weekend

What Mom, you really think I put all this stuff on the floor?

Letting me know exactly what she thinks of apples as a snack

Big Memorial Day weekend means big naps

Loving her Pottery Barn chair

Riding her toy like a horse - she thinks she is hilarious

She told me she has 'no idea' what happened to the tp, and she is out of here!

Using her fork like a big girl, getting better every day!

Our sweet neighbors gave Nora a pink basketball.  Every time she sees it, she yells "BALL!"

Babies' Stats

How far along: 20 weeks

How big: Each baby weighs nine ounces and measures my exact gestational age as of the 19 week check-up.  They are di/di twins, which means that each baby has its own placenta and gestational sac.  It's basically like growing two singletons at the same time.  Some variability is expected in this situation, which is why my OB thinks it is funny that they keep pacing each other exactly.

Total weight gain:  Nothing major to report yet, maybe two pounds?  Hard to say.  I lost nine pounds in a half day thanks to food poisoning, so I've gained that back.  I expect to gain a lot more!

Maternity clothes:  Oh yes.  I feel like I look like I did when I was full-term with Nora!  I might even need maternity pj's this time.  Such a difference from Nora when I didn't even need maternity clothes all the time.

Sleep:  Sleep comes and goes.  I've stopped napping mostly, but it's hard to get comfortable at night.  Combined with babies sitting on my bladder, I get up quite a bit!

Best moment of the week:  It's always seeing the babies on the ultrasound.  I see my OB every two weeks and a high-risk specialist every 4 weeks.  Thanks to that wonky schedule, I go about every 1.5 weeks.

Food cravings: I crave more sweets than I did when I was pregnant with Nora, but still not nearly as much when I'm not pregnant.  Pregnancy seems to quell my sweet tooth.

Food aversions:  Big pieces of chicken.  It might be a texture thing.  I can take chicken shredded, but I don't want a grilled chicken breast.

Symptoms: Incredible pressure in my abdomen as these babies grow.  I'm trying to stay as active as I can for as long as I can, but I'm starting to see changes.  First, I couldn't run because the pressure on my bladder was too much.  Then, I had to switch my 4 mile walks to only 3 miles because I would tire out easily.  Now, I'm only walking 3 miles every other day because my hips are killing me.

Movements:  I'm feeling movements off and on, but I don't know which baby I'm feeling.  I don't quite have my bearings yet.  My OB says that Baby B's placenta placement is more than likely muffling a lot of the movement from being felt on my end.  I do know that Baby B's legs are right under my belly button, and that B is sitting on A.  B is completely kicked back, and A is balled up.  Both are head down, so we are hoping for another natural delivery.

Gender: Unknown - waiting until the big day!  That makes for LOTS of name combinations.  We won't have matching names.  It could be girl/girl, boy/boy or boy/girl.  If I had to make a bet, I would say maybe one of each?

What I am looking forward to:  Every ultrasound I get a little nervous that one of the babies won't have a heartbeat.  We had complications early on, and it's hard to let those experiences go.  I'm looking forward to feeling more frequent movement, and knowing which baby is kicking so I can relax between appointments.

What I miss: Summer cocktails!

Next appointment: July 1st we see our high risk specialist.  This is the 'big' ultrasound where they measure everything.  My OB already did this, but the high risk group looks for more.  The receptionist warned me that they devote a minimum of 60 minutes per baby, so to bring a snack and loads of patience as I'll be on the table for over two hours being scanned.  Since we can't look for a portion of the ultrasound as we don't want to know the genders, it makes for an awkward day!

National Infertility Awareness Week

Did you know that one in six couples in the US are clinically infertile?  That's right, there are more of us than you think.  It's me, it's JD, it's that sweet young couple on your street without children - we are everywhere.  Some of us are more public about our experiences while some prefer a more private approach.  RESOLVE, the national foundation for infertility, comprised this list of 25 things to say (and not to say) to couples who are having trouble conceiving.  It's a good read, but I've made my own personal short list:

What NOT to say to couples who are having trouble conceiving:

1. Maybe it's your hormones.  I had a friend tell me this in a doctors office once after she had trouble getting pregnant for 10 minutes.  Her doctor did in fact discover that it was her hormones and a pill fixed her issues.  That is not the type of couple that is diagnosed as infertile, especially when an OB can solve the issue.

2. You're too stressed out.  Did you know that stress has been found to actually have very little effect on your fertility?  Unless you're in a stressful environment where your hair is falling out and your skin is yellowing, it usually isn't the culprit.

3. You should stop trying, it'll happen then, that's how my cousin's neighbor's coworker finally got pregnant.  Oh, spare me.  Most of those stories aren't true anyway.

4. You did IVF, wasn't that supposed to work?  Did you know that half of all IVFs don't succeed?  Just because you pay for it and endure it, IVF doesn't promise a pregnancy.  Four years of trying to conceive Nora taught us that.

5. I hid my pregnancy from you because I knew it would hurt you.  That's simply not true.  We obviously know that being pregnant and having a child is a joy, or we wouldn't put ourselves through this.  It is possible for us to see through our own pain and share this blessing with you.  Let us decide how we will react to your news.  Give us the opportunity to show grace.

What TO say to couples who are having trouble conceiving:

1. How's it going?  Sometimes an open-ended question lets the couple discuss it on their terms.  And, if they give you vague answers, they may not want to talk about it.

2. I don't know a lot about infertility, can you explain to me what these procedures are for?  Showing an interest in the trials we are experiencing means so much to us - you don't have to be a physician or someone who has endured the same thing.

3. I think about you and pray for you all the time, but is there something more that I can do?  Often times, just letting us know that you think about us is enough.  Some couples may have older children that need to be cared for - everyone has different needs.

4. Sometimes, talk about anything else other than fertility treatments.  We need a break from the conversation just like you. A fun date night with friends can relieve a lot of stress.

Our latest update:

Our reproductive endocrinologist recommended that we come back in for fertility treatments after Nora was six months old - assuming I'd recovered well and we were ready.  It took so long to get pregnant, especially since IVF is our only road to pregnancy, that we anticipated another long battle.  After completing all of the pre-fertility testing in October, I decided to wait a little bit longer for the holidays.  While we were waiting, I got a second opinion from a new fertility clinic in town - who found something major that my old clinic missed that would have doomed any fertility treatment.  After a d&c before Christmas, we went straight into the new clinic for a round of IVF following a completely different protocol than we had tried before based on the new doctor's recommendation.  It went incredibly well.  At the end of February, we transferred two good quality embryos in the hopes of achieving a pregnancy.  We have always transferred two embryos - it is usually all we had left after a round of IVF (with the exception of this latest round - we have two more on ice).  When I started having positive home pregnancy tests well before my blood test in the clinic, we were shocked.  We had expected to need a few rounds of IVF to get pregnant.  When my blood test measuring my HCG level came back sky-high, the doctor was concerned of a possible higher-order pregnancy (triplets or quadruplets because embryos can split, especially those that have undergone assisted hatching).  We were overjoyed when the ultrasound revealed fraternal twins.  Some people have said negative things about the timing of the twins, and having three children under the age of 2 in October - but they don't realize all we have struggled with to grow our family. We decided a long time ago that we would take any children God gave us, no matter the timing.  We are praying for a healthy, full-term pregnancy for the babies, and can't wait to have a full house very soon!

Happy 1st Birthday, Nora!

One entire year - we've made it!  No more sleepless nights, no more nursing merry-go-around, no more brace, no more physical therapy, no more bottles or gross formula.

Nora is all fun these days - she is a great sleeper, good eater and an even more fun belly-laughing little girl!  She is trying so hard to walk, and trying even harder to "hug" the dog while conspicuously detaching his ears.  Buddy is wise to her ways and constantly puts me between him and the baby.

Nora loves to imitate people, and won't settle for eating anything other than what is being served to the adults.  It really makes you evaluate your current diet!

She has several teeth, loves to clap and wave, enjoys her baths and "figuring" things out - like where I keep the glass measuring cups.  She isn't saying a whole lot right now - just Dada, Yeah, Ball and Oh No - but the pediatrician thinks she is about to start talking because she is constantly trying to communicate.

We celebrated Nora's special day with a big party at the house - I think there was somewhere around 20 babies (including three sets of twins) in attendance in addition to parents and other friends/relatives.  She really enjoyed all the attention (can you say diva?) and ate almost her entire smash cake.  I'm beginning to understand why she is in the 75% percentile for her weight;)  Here are a few photos from her party:

At one year, she weighs 21lb, 14oz., is 29.5 inches tall, "cruises" everywhere while taking a few independent steps here and there, loves ALL food, drinks whole milk, sleeps 12 hours a night plus one morning nap, wears 12 month clothes and is generally happy all the time.  We love you, Nora!