Two Simple Acts

Mama Kanga and her Roo's, Lily (right) & Kali (left)
Mama Kanga and her Roo’s, Lily (right) & Kali (left)

When becoming a new parent, best practices, guidelines, and all of the “must-do’s” flood our mind.  All mom’s and dad’s want the best for their children. I find peace in getting back to basics and focusing on two simple acts: Kangaroo care and Breastfeeding.  Both of these can be practiced whether a parent takes their newborn home shortly after birth or for those trying to learn how to be mom and dad in a NICU setting.

Kangaroo care is an endearing term used to describe skin-to-skin holding.  This snuggle time has benefits for both mom, dad and baby. The newborn benefits from skin-to-skin holding because they learn their parents’ scents. The sense of smell is the first to develop and is quite strong, which is why many encourage the use of scent cloths. Additionally, the baby’s vitals mimic those of the person, which is holding them and can help to regulate their heart and respiration rates.  When mom is caring for her baby this way, the infant can be soothed by the sound of her heartbeat since it is what they heard for many months while in utero. Kangaroo care can foster quality sleep for infants. This is why it is typically done for at least 90 minutes at a time. We know that sleep is critical for a newborn, or preemie because it encourages both growth and healing. If time is of the essence, swaddling and hold the baby is also beneficial and many hospitals have “cuddlers” who are happy to help.

"Nana B" & Bella cuddling
“Nana B” & Bella cuddling

Kangaroo care also benefits parents as a unique bonding experience. One is able to simply hold, love and adore their baby. This is also a great time to sing, read or gently speak to the baby while they drift to sleep. A mother can specifically benefit from this practice because oxytocin is released during infant bonding.

Oxytocin is known as a love hormone, but plays a significant role in building, maintaining and letting down a mother’s milk. It also can cause uterine contractions that help the uterus return to its normal state. Therefore, it is evident how the first act leads to our second- breastfeeding.

The breast is best! Breast milk is often referred to as “liquid gold,” due to its nutritional superiority over other methods of feeding. A mother’s milk may vary in composition of nutrients, but on average it is 4.5 % fat, 7.1 % carbohydrate and 0.8-0.9 % protein. It is produced in the body by the mammary glands by pulling sugar, protein, cholesterol and other nutrients from the mother’s bloodstream. Therefore, good nutrition is also very important during the “4th trimester.” Most hospitals recommend fortifying breast milk to increase the calories from the natural 20 calories per ounce, to 22-24 calories per ounce. These fortifiers can also supplement the baby with much needed vitamins and minerals.

UnknownBreast milk is also unique because it contains IgA, or Immunoglobulin A, which is critical to helping to build the infant’s immune system. IgA is quite high in breast milk from day 10 through the 7th month. Additionally, if the mother is breastfeeding, the child can expose the mother to their bacteria and in turn the mother will create antibodies to fight the bacteria, which in turn will be delivered back to the baby via the breast milk.

I have never breast-fed; I have only pumped, but I certainly hope to in the future. The act of breastfeeding is a remarkable bonding experience that also provides an outlet for giving the infant attention. Pumping, with a caretaker present, is also not bad and can grant mother’s a few minutes alone to think, pray, or even grab a quick snack. Another benefit of breast feeding for mothers is that it can foster post-partum weight loss to help the mother achieve a healthier weight after pregnancy. Typically, mothers burn 300 to 500 Calories when breastfeeding or pumping 8 times per day, or every 3 hours. Again, it increases oxytocin which assists the uterus in returning to normal size. For further tips and information on breastfeeding, visit La Leche League.

Both of the acts described above may be simple on paper, but more difficult to practice in daily life. I hope the benefits listed above encourage mom’s and dad’s to explore these ways to attend to, bond and communicate with their baby.

Bon Voyage!

Prop Plane

This has been the week of travel for the Vanderwall quints. Isabella and Elliott celebrated their 3 week birthday by departing for a Madison NICU.  Early Saturday morning, August 24, we packed up Bella and Ellie into a single isolette and began our transition. I joined the sisters, a nurse and a respiratory therapist for the trek on the medical transport prop plane.

Elliott & Bella are ready to head home
Elliott & Bella are ready to head home

It was an emotional 24 hours to say the least and got a good taste of what it may be like to go back to work and leave my little ones at home. I truly felt heartbroken to leave Lily, Kali and Theo for that day and a half. Tears flowed until we boarded the plane. I am happy to say that my heart perked right up when we landed near green grass and fresh water lakes. It also was such a blessing to see how excited Frank was to welcome our daughters home.

The girlies handled the flight and transition really well. Halfway through the flight Bella wet the bed through her diaper, living up to her latest nickname of “Bella Blowout,” and Ellie was not happy about it. For the remainder of the flight, Ellie proceeded to kick her sister to the side of the isolette. By the time we reached Wisconsin, Bella’s face was nearly plastered to the side of the chamber. Firsthand witness to sisterly love! Now settled into their new NICU home, they continue to advance in their feedings and are getting to be better breathers!

After a quick night in my own bed, I boarded a plane on Sunday morning to return to the remaining quints in Arizona. My Mama mission was and is to continue to urge the medical team towards quick, yet safe, transfers home.

Lily and Kali’s turn was early this morning. They have been ready to head home since yesterday morning but there wasn’t any room in the inn… or the new NICU.

Lily on her tummy ready to go see Daddy.
Lily on her tummy ready to go see Daddy.
Kali is bundled up and ready to go!
Kali is bundled up and ready to go!

So, we packaged these little ladies up this morning and watched as the ambulance drove away.

Loading up Kali & Lily

Again, tears flowed.  Although it truly is a bittersweet event and more of a “see you later” than a goodbye, I learned that a parent’s unconditional love does not make sense. There simply is no logic in my love for our children.

Lily and Kali also arrived safe and sound in Madison. They are now enjoying their new homes in a room right next door to their sisters. The nurses reported to me that the plane ride was uneventful, which is exactly what I was hoping for.

Now, all but one are only 20 minutes from their final destination- our home. Theo and I will remain in Arizona until he is also ready to get his wings. He is doing very well and has achieved 4lbs!

Clean baby Theo
Big Brother, Theo

He and I have already logged quite a few hours of Kangaroo care, which I believe has definitely helped his breathing to get stronger. It is amazing to watch how his vitals normalize as we snuggle together. It also helps me to continue to provide “liquid gold” for all of these hungry babies… as evidenced by the overflowing freezer dedicated to the V-5’s breakfast, lunch and dinner!

BM Freezer

So, that is the latest and greatest regarding the V-5. Prayers remain that all five and mommy and daddy will be reunited soon! Please join me in praying that we will all be back in Madison by Saturday to celebrate their 1 month birthday!

Elliott Rose

As many of you remember, Ms. Elliott Rose, formerly known as Baby E, has been quite the fighter from day one. Today, she continues to fight and has pulled ahead of the quints and is now breathing on her own! She can even hold her own pacifier and has successfully taken milk from a bottle on one occasion. God’s handiwork and healing is truly miraculous. This little peanut is still the smallest of the bunch, but you wouldn’t know it by her resiliency.

Ellie Rose is another fabulous self-soother. She will lie wide awake for an hour if you let her just looking about her isolette, chewing on her feeding tube and exploring her face with her miniature hands. She also is quite the smiler and can steal your heart in a minute. Of all the quints, she knows our voices the best, which could melt anyone’s heart.

Elliott also loves bath time and being clean. She enjoys being snuggled in her blankets and nest, but will bust out of her swaddle like Houdini if she wants to.  We are so proud of our little Rose for how she has bounced back from her obstacles early on.

Praise God for His mercy on Ellie Rose and please continue to pray for her health and healing.

Kali Mae

ATTENTION WORLD: Watch out for this one.

Kali is far and away my pick for “most likely to get her own way”.  She possesses the lethal persuasion combination of a 10/10 rated puss-in-boots face and a 10/10 rated ability to throw an international-crisis-level temper-tantrum. With her ability to attack from any angle at a moments notice she will undoubtedly be a handful.

Speaking of handful, it was surreal the first time I held Kali, because she literally fit into one of my hands. I am in awe of life because of the incredible intricacies of the human body and how they are replicated to scale in infants. I could hold her in one hand, but she already had perfectly crafted fingernails (on her pinky too!), footprints, eyebrows, a heart, lungs, intestines, and even a little itty-bitty tongue! Absolutely incredible.

Ok. Enough from me. Pictures!!!

Quick Kali Status Update: Little Kali is doing very well right now and continues to grow. Currently she’s up to about 2.5 pounds. Please pray she continues to tolerate her feedings so she can gain weight, and that her lungs continue to strengthen so they can function on their own.

Until next time. Stay classy San Diego.

Lillian Grace

Lillian Grace is one tough cookie. She has certainly had one of the more rough transitions to life outside of Mommy. This little love bug has faced breathing issues, a puncture in her lung, a brain bleed and an infection scare. But, she has conquered all of them! She is now leading the pack of ladies in growth and is one of the stronger breathers. You will notice below that she has fewer photos than the rest of the V-5. We did not want to bother her while she was healing, so we have some catching up to do now that she is well.

Little Lily has Daddy’s light hair, but Mommy’s nose. She is definitely a cutie like the rest! Our little Lily Bug is a great self-soother. Once you put on her little Lady Bug hat she is as happy as can be. She also cannot stand dirty diapers and she will let you know it. The minute she wets her drawers, she’s wailing. However, once you clean her up, she’s good to go.

If you click on an image, it will give you a full-screen slideshow of all the pictures.

We are so proud of Lillian and very thankful that God has granted her grace and has helped her to heal from her ailments. Please pray that His hand remains over Lillian and the rest of our Quints, so that they will continue to grow stronger and be able to return home together.

Isabella Marie

Big sister, Isabella Marie, is the oldest girl but one of the smallest at birth. She is our “I don’t do drama” queen. This blonde Bella has very keen senses of hearing and sight. When the others’ start sounding their alarms, or she has had enough photos for one day the little hands go up and shield her little eyes and ears. Bella also takes the cake (literally) as our best eater and grower. She is tolerating 6 times as much milk as her siblings.  “Beautiful Marie” gets her looks from her Daddy with her light hair, long face and tendency to crinkle her forehead. We are excited to introduce you to our little Bella Bean.

If you click on an image, it will give you a full-screen slideshow of all the pictures.

Not pictured above:

  • When Daddy gets the camera too close or her neighboring brother causes a racket, little Bella flashes her hands Vogue-style until peace resounds. Her little spirit finger-spread has caught on in this NICU pod as her signature move.
  • Our big sis also knows how to grab your attention. She’ll hold her breath just long enough to get mom or dad to pay her a visit and then rebounds back to healthy limits.

We are so thankful that Bella has been the most well of the bunch, evading spontaneous ruptures and breathing issues.  Prayer requests for Isabella include her continued tolerance of her feedings, as well as, sustained growth and development.

Keep coming back to meet Lily, Kali and Ellie, too!

Baby Theo

Theo is quite possibly, in our unbiased opinion, the cutest little infant baby-boy in the history of the world. It’s amazing how at just 31 weeks of age he is already showing quite a personality. It’s also amazing how much of a prototypical boy he can be at times. Here is a snapshot of  sweet little Theodore Joseph who has more than stolen mommy and daddy’s hearts. (If you click on an image, it will give you a full-screen slideshow of all the pictures).

 

Not pictured above:

  • In an unprecedented incident, during the night, Theo escaped out of his little bed, pulled himself across his isolette, and positioned himself right in front of one of the entry portholes. Apparently, he thinks he’s ready to go home :-)
  • We were photographing Theo and he felt the session was running a bit long. We kid you not, he looked right into the camera, conjured up an epic scowl for his little face, and then flipped us the bird. The picture was too obscene for this blog, but it was all captured in high-definition. We’re quite positive it will resurface in the years to come, accompanied by much laughter.
  • When Dad finally decided to jump in for one of Theo’s diaper changings, Theo made sure it was an unforgettable experience – if you catch our drift, literally :-) Welcome to fatherhood!

We hope you have enjoyed the pics and stories of our precious little Theo.

Please pray for his continued health, well being, and many smiles and blessings to come.

Stay tuned for photo galleries of all Theo’s little sisters!

Who Loves Cute Pictures of Little Quintuplet Babies?!

Over the next week, we will be starting a “Meet the Quints” series on our blog! Each post will feature one of our little cuties with lots of pictures and commentary. As we referenced in our previous somber-toned post The Quint’s First Two Weeks there have been many moments of pure joy in addition to the bumps in the road we’ve experienced thus far. These upcoming posts are our chance to share those joyful moments with you!

One last thing to prep you for the next five posts. The V5 are collectively in the best health they have been since birth. Still, they are hooked up to all kinds of Medical Miracle Machines (technical term) that are helping them to develop and grow into normal healthy babies. To help quell any concerns about their condition when we post wire-laden photos, below is a brief visual introduction into the anatomy of a typical NICU infant. Mr. Theodore Joseph has been selected to help enlighten you on the purpose of the lines and tubes you’ll see in the upcoming week’s pictures:

Anatomy of a NICU Baby, featuring Theodore Joseph
Anatomy of a NICU Baby, featuring Theodore Joseph

A: Free Baby Oxygen Bar/Spa Treatment – AKA: Nasal Cannula used to provide a variety of respiratory therapies

B: Hands-Free Food and Beverage Dispenser – AKA: Oral-Gastric (OG) tube used to provide breast milk and to check their bellies for residuals from prior feedings. It also can help to remove excess air from their tummies.

C: Personal Fitness Monitors (e.g. Nike+) – AKA:  All of these wires are leads which are connected to a monitor which help to assess heart and respiratory rates.

D: Remote Thermostat Adjuster – AKA: The wire tucked under the heart sticker is a temperature probe which helps to identify the baby’s temperature and keep it in an ideal range.

E: Belly-Button Jewelry Clip – AKA: this is a clamp placed on the umbilical cords and is later removed.

F: Oxygen Bar/Spa Treatment Membership Card – AKA: This is a pulse oximeter which is used to assess and monitor the baby’s oxygen saturation.

The Quint’s First 2 Weeks

The quint’s first 2 weeks outside of Mama have been quite active. Frank and I have truly gotten a crash course in what it is like to be NICU (neonatal intensive care unit) parents. The highs are very high, the lows are very low, and often times they occur within minutes of eachother. We have been blessed with the time away from work to spend 8-12 hours everyday buzzing around the NICU watching nurses, taking part in our little ones’ care and meeting with the multidisciplinary team. Our most recent post announced the arrival of the V5 and told the story of our 24 hour honeymoon with five seemingly happy and healthy babies. After day 2 however,  the honeymoon was over.

Here is a summary of some of the medical trials and tribulations our quints have experienced in their first weeks:

  • Spontaneous Intestinal Perforation (SIP): Two of our little ones had bowel perforations within the first 3 days. Both required emergent surgery, which they handled well. One of the SIP’s may have been caused by NEC, which they found in surgery. The other occurred higher in the small intestine, and the informed us that this may result in a feeding intolerance later on.
  • Necrotizing Enterocolitis (NEC): NEC is one of the most common GI diseases in newborns and preemies. It is when the bowel does not get adequate blood flow (Ischemia) and begins to die (Necrotize). Early and aggressive treatment is imperative because it can result in dire consequences – NEC is the second leading cause of death in premature infants. The good news for our quints, is that they did identify it early and were able to remove the affected portion completely.
  • Gastritis versus Bleeding ulcer: Inflammation of the stomach wall and ulcers can be common as the immature digestive track is learning how to work. One of our little girls experienced this and as a result we found blood in her gastric residual. This appears to be resolving with the help of Zantac.
  • Spontaneous Lung Perforation: One of our quints got a hole in their lung, which required emergent chest tube placement. Luckily, this incident resolved quickly.
  • Complication of PICC: PICC lines, or Peripherally Inserted Central Catheters, generally have limited complications. So, yet another rare event for one of our girls where her PICC moved from her heart to near her shoulder. This resulted in infiltration into her subcutaneous tissues and ultimately her lung. She became very swollen as her upper body filled with fluid. But, this tough cookie fought it hard and it appears to have resolved rather quickly.
  • Grade 2 Intraventricular Hemorrhage (IVH): Infants born before 30 weeks are at the highest risk for brain bleeds. Grades 1 and 2 have similar outcomes and typically resolve within a month. They do cause an increased risk of developmental delay but not much more than from being a high order multiple. We continue to pray for the health of our little one diagnosed with a Grade 2 IVH.
  • Apnea and Bradycardia: Apnea is a pause in regular breathing lasting more than 20 seconds and bradycardia is a drop in the heart rate. All of our quints have experienced this at some point. “A’s and B’s” are typically caused by an immature nervous system. The good news is that all of our children are learning to pull themselves out of these events without stimulation (aka rubbing their backs).
  • Respiration machines: All of our little ones had to be intubated after day 2, which was expected. Unfortunately, one of their endotracheal (ET) tubes moved too low and collapsed their little lung. This has since resolved. All of them are continuing to advance through the variety of machines, but I thought it was noteworthy to introduce inquiring minds of the different types.
    • Intubation with an endotracheal tube (ET tube) with a ventilator
    • Intubation with an ET tube and continuous oscillation
    • RAM cannula with NIPPV (Nasal Intermittent Positive Pressure Ventilation)
    • Nasal Cannula on CPAP, Continuous Positive Airway Pressure
    • Nasal Cannula with higher concentration of oxygen than room air.

Needless to say, the first two weeks have been quite eventful. Although the events listed vary greatly in severity, it is difficult to watch our little ones experience any hardship. At the same time, it is certainly empowering to watch our children fight hard for life. Their resiliency is awe-inspiring! Today, we can say our little ones are collectively in the best health they have been since birth.  You will get to see and hear more about their progress and personalities in our posts over the next week or so.

Oh, and one more update for everyone. We learned that our insurance company has agreed to cover the quints birth and NICU stay for each of our children. They have also agreed to cover medical transport of our children back to a NICU in Madison once they are stable enough to bring back to Wisconsin. What an answer to prayer! We now are hoping that everyone will be healthy, and ready to be transported at the same time.

Thank you for praying along with us through both the euphoric highs and near-death lows on this wonderful roller-coaster of a journey,

Zero to Quints

quintuplets31n-3-web

I believe further explanation of how we went from “status quo” to “the babies will be delivered within the next 45 minutes” is warranted.  I was settling in for a day’s work on the morning of July 31st, when I felt like I wet my pants. Now to be honest, I just assumed little Theo was going to be controlling my bladder for the day. But, upon further investigation, I realized he had popped his little sac and I had “broken my water.” I called my doctor’s office, but since they were closed it directed my call to the physician on-call, which just so happened to be Dr. Elliott’s “bat phone.” I felt awful for bothering him on vacation, but he didn’t mind one bit. He encouraged me to pack a bag and head to Ob triage (the moms’ ER).

We arrived at the hospital and were quickly shuffled in for an assessment. They tested the fluid and confirmed that indeed it was amniotic fluid. Then, they discontinued my nifedipine (calcium-channel blocker), gave me a steroid shot (Betamethasone) to enhance fetal lung development, and started me on 3g of Magnesium sulfate. I was then whisked away to ultrasound to confirm the culprit. It was indeed little Theo (baby A) whose deepest vertical pocket went from around 5cm to about 1.6 cm, which indicated that he only had about 1.6 cm of fluid surrounding his little body in his sac. His head was now so low in my pelvis he appeared as though his little body stopped at his neck.

The nurses assured me that once my contractions stopped, it was entirely possible I could remain pregnant for several weeks. This amazed me but they said it happens all of the time. Unfortunately, this scenario is only true if 1) your contractions do stop, 2) you tolerate the medicinal anti-contraction regimen and 3) you do not develop an infection. My contractions did stop, thanks to the “mag.” But, it was clear after 24h on the magnesium sulfate that I was not tolerating it, and my lungs began to fill with fluid.

Magnesium sulfate is used for contraction management. It is thought to affect calcium channels to slow uterine contractions. Typical side-effects include water retention, muscle weakness, sweating/flushing, nausea, vomiting, constipation, and blurry vision. For most, these symptoms are tolerable and some mom’s of multiples can again remain on magnesium sulfate for several weeks, in order to prolong their gestation. Unfortunately, I hit the jackpot and experienced all of the symptoms noted above.

My body was only able to combat these side effects for about 3 days. I was placed on b-pap to increase my oxygen saturation and Lasix to try and rid my body and lungs of the extra fluid.  On the morning of August 3, I was moved back to labor and delivery due to my pending diagnosis of pneumonia. When I spiked a fever and my white blood cell count shot up, we knew today was the day. It was then that we got the news that we would get to meet the quints within the next few hours.

They informed us that Dr. Elliott was speeding to the hospital, on his way back from vacation, and we were going to try and wait for him to arrive around 4pm. But, when he heard that I had a fever, he gave the go ahead to deliver in his absence.

A moment to smile before delivery.
A moment to smile before delivery.

Thus, they unraveled the most well-orchestrated delivery I have every heard of. With over 20 people in the delivery room (6 teams: one for me and one for each baby), they delivered the quints in about 3 minutes. The entire “operation” took about 45 minutes. I vaguely remember these moments, but Frank was right by my side to catalog it all.

Following delivery, Frank headed to the quints’ recovery room. By the time I arrived, all were gone and up to the NICU. My mom awaited me in the recovery room, and was over-joyed to see me safe and sound. I, unfortunately, could not see our little angels until my fever subsided and my breathing had stabilized.

Frank is ready to be a Daddy!
Frank is ready to be a Daddy!

Dr. Elliott arrived and it was clear he was upset that he could not deliver our babies, but we truly respected his decision. He shared with Frank that sometimes as a physician you have to make a decision with your head and not your heart. If we had waited even a moment longer my infection may have complicated the babies course.

Those 48 hours preceding the birth of our babies, were some of the worst of my life. But, I know that without that treatment regimen, our 5 little miracles would not have passed the “steroid efficacy window” and may have been at an even greater risk for serious complications.

Our heartfelt thanks goes out to Dr. Elliott and the teams at Banner Desert for their superb, patient-centered care, compassion and wisdom. For I know that if we were anywhere else, the circumstances and outcome may have been very different.

We have much more to share with everyone and are working on getting some fantastic pics of the quints, so look forward to some more baby updates in the near future!