Selective Intrauterine Growth Restriction (sIUGR)

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Multiple pregnancies are categorized as “high risk” for a reason. It’s not just a matter of the limited room in our womb squishing our babies up against each other. The human female body is optimized to gestate one baby. When you add in more, there’s a chance that not all resources will end up being distributed evenly.

If you’re new to How Do You Do It? and didn’t come here specifically to learn about sIUGR, I encourage you to read through the amazing birth stories on this site. The MoMs of HDYDI have experienced the full range of multiple pregnancy possibilities, from full-term to micropreemie, from extended bedrest to working right to the end, from natural childbirth to C-section. Don’t be scared by this one set of potential complications. Most of us have perfectly healthy and happy children today!

Meet Jenn

Meet Jenn, HDYDI‘s newest contributor. One of her twin daughters was diagnosed with Selective Intrauterine Growth Restriction. We’ll explain exactly what that is after Jenn tells her story.

 My name is Jenn, and I’m a 32 year old mom of a sweet 4 year old boy and 3 month identical twin girls. This is my story about our experience with Selective Intrauterine Growth Restriction.

At 9 weeks pregnant, I found out we were expecting monozygotic/diamniotic (identical) twins. After the initial shock wore off (let’s be honest, I’m not sure the shock and wonder ever wear off!), I dove into books and the Internet to educate myself as much as possible as to what to expect for the next 7 months. I read about a million complications – preterm labour, how large I was going to get, and about Twin to Twin Transfusion Syndrome (TTTS).

Being a worrier to begin with, I began to go over all the things that could go wrong, but most of all, I feared my babies would be affected by TTTS. That fear became real at my 21 week OB appointment. After a fairly easy pregnancy to that point, my OB declared there was a problem. “They are identical, they should be the same size” he said. My Twin B was two weeks behind her sister in size.

“This isn’t good, I think you have TTTS”.

The next thing we knew, my OB was sending us four hours away to the top TTTS hospital in our province, and we were being prepared for surgery. My whole world caved in. I remember calling my mom in tears, telling her how I was so scared to lose my girls. I didn’t know what to think or do. When we arrived we were given an extensive ultrasound – over two hours long.

As we sat down to discuss the results with the doctor, he said that we had no signs of TTTS. I was confused. He then said our itty bitty Baby B had Selective Intrauterine Growth Restriction. What? I hadn’t read about that during my research.

He explained sIUGR is an issue that can arise only in pregnancies where the babies share a placenta. Then, he drew us a diagram showing us that Baby B had a marginal cord insertion, which means her umbilical cord wasn’t centrally located, instead being off to one side. This means she was only being supported by 25% of the placenta whereas her sister was getting the other 75%.

The doctor (who was a Maternal Fetal Medicine Specialist or MFM) said that I would need to be referred to my local MFM for weekly monitoring of growth and cord flow, but to expect a 36 week delivery by Caesarian section. The MFM also explained to me that many identical twins experience varying degrees of sIUGR due to cord placement, and that most sIUGR babies can catch up after birth.

I have to say I breathed a huge sigh of relief, considering we were expecting TTTS surgery that day. We headed home and started our weekly monitoring with my new MFM. He made sure to check UA umbilical artery (UA) and middle cerebral (MCA) artery dopplers, fluid levels, growth and bladder diameters at each ultrasound to stay on top of potential complications. At that point, we were watching UA cord flow to ensure it didn’t reverse, which would be cause for immediate delivery.

Every week was a rollercoaster. One week we would have intermittent/absent flow and our little would have only gained a few grams. Other weeks we had perfect cord flow and she was gaining beautifully. The most important thing I could hold on to was the advice I received on a Facebook support group for sIUGR/IUGR babies. I was advised that as long as there was SOME growth each week, and no reverse flow, we were okay.

I began to research more things I could do to help my babies grow. I read about a high protein diet so I made sure to take in as much as I could. Every week I either cried with worry, or felt cautiously optimistic.

Finally, as I approached 35 weeks, my sIUGR twin slowly stopped growing, and it was time to discuss induction. I had wanted to try for a VBAC, which my MFM was cautiously willing to try if I wanted to. However, after discussing the possible, and very real, risks involving a VBAC and my SIUGR twin, it was decided to schedule a C-section.

I made it to my scheduled date at 36.4 weeks, but oh, how I wished I could keep them in a little longer to grow a little bigger. When the MFM delivered my Twin A, she was a healthy weight of 5.6lbs. When my sIUGR twin was delivered, I remember the doctors saying how tiny she was, and the MFM said to me “I’m glad we got her out when we did”. She was 3.14lbs and the sweetest tiniest little pumpkin ever.

They whisked her off to the NICU, but assured me she was perfectly fine and would only be there 2-3 days max – she just needed to get her weight up before going home. She was alert, and nursing better than her “big” sister and we couldn’t wait to get them both home.

Unfortunately, she picked up a severe blood infection from an IV she received in the NICU, and her 3 day stay ended up being a scary 17 days full of close calls and a LOT of tears. Fast forward (and boy does time fast forward with babies) to today, where our sweet sIUGR twin Charlie is five months old. At three months, she was tipping the scales at over 11lbs, and her twin Addie was over 13lbs.

Charlie is perfect in every way, and although the doctors say she will likely always be “petite” she has overcome everything she’s been through like the little warrior she is. The smallest babies are always the fiercest. Charlie was followed by a dietician for the first two months of her life as she aimed to make her place on the growth charts, but she’s now above the 10th percentile and growing on her own perfect little curve.

We are very lucky.

sIUGR has many levels of severity, and our situation could have been much more difficult. Educating yourself is key. My OB didn’t know what it was and assumed it was TTTS. In fact, too many health professionals aren’t privy to the details of sIUGR and TTTS. I’m thankful to have been sent away for more testing, because ultimately I ended up being well taken care of by a MFM who knew what to look for and how to monitor a sIUGR pregnancy.

The number one thing I recommend to a mommy who has been diagnosed with sIUGR is to find a support group full of other moms who have been, or are going through, the same thing you are. They are often very knowledgable on what questions you should be asking and what kind of care you should be getting. I’m so thankful for those moms and the constant information and reassurance they offered.

There is nothing I did or didn’t do to cause sIUGR, and there was nothing I could do to fix or help the situation. That, of course, doesn’t help the guilt or helplessness you feel as a mommy. This is just another curveball in the crazy journey that is being a mom of multiples! Our babies aren’t the only warriors here after all!

What Is sIUGR?

Multiples and singletons alike, some babies are affected by a condition called intrauterine growth restriction (IUGR). This term describes a baby who is growing significantly slower than expected in the womb, one who is smaller than 90% of babies of the same gestational age (the time that has passed since conception). Causes of IUGR can be related to the placenta, through which the baby receives nutrition and oxygen, maternal health, or chromosomal issues. Selective intrauterine growth restriction (sIUGR) is a specific type of IUGR that only occurs in identical multiple pregnancies. The “selective” part means that not all babies’ regions of the placenta are impacted.

sIUGR occurs in about 10% of monochorionic pregnancies. Those of us with mono/mono or mono/di twins are at risk. (For more information on these terms and general information about twin pregnancies, please see our primer.) In sIUGR, one twin is getting so little of his or her share of the placenta that it is impacting growth. To be blunt, that twin is malnourished and possibly under-oxygenated. This is particularly obvious when comparing the sIUGR twin to his or her wombmate, who, all things being equal, should be about the same size.

MoMs, we are masters of guilt. If your baby has been diagnosed with sIUGR, it is not your fault. These things just happen. The fact that you have a diagnosis means that you’re doing what you should for your children. You’re getting regular medical care. Your doctors can help get your baby healthy.

How Does sIUGR Develop?

Background

Let’s make sure we’re all familiar with the basic terms.

Basic terminology to describe babies in the womb. Your baby receives nutrition through the umbilical cord from the placenta attached to your womb.

Let’s now look more closely at the placenta. The placenta is your babies’ anchor and food source. It is the place where mom’s cells and babies’ cells meet. Mom’s blood vessels bring in her oxygenated and nutrition-laden blood, which transfer their goodies to babies’ blood in babies’ blood vessels. On the way out, Mom’s blood picks up babies’ waste so that her body can get rid of it for them.

The blood vessels that carry blood to and from the baby in utero embed in the placenta to get oxygen and nutrition from mom.

Umbilical Cord Insertion

Ideally, the umbilical cord attaches to the placenta near its center, allowing plenty of room for blood vessels to spread out and maximize the connections between Mom and baby. However, this becomes more complicated when there’s more that one umbilical attaching to a shared placenta.

In most cases, as with Sadia’s daughters, each twin’s umbilical cord is close enough to the middle to claim plenty of placental real estate for his or her blood vessels. Complications can arise when the placenta is shared unevenly.

TTTS and sIUGR are complications that can arise when identical twins (or more) share a placenta unevenly.

 

sIUGR and TTTS

In rare cases, as with Jenn’s daughters, one umbilical cord attaches off to the side and doesn’t get its fair share. The other umbilical cord’s placement is still optimal. Only the undernourished baby is negatively affected, his or her growth limited by the nutrition making it through. This is sIUGR, a condition often initially misdiagnosed as TTTS.

In about 15% of twins who share a placenta, one twin gets far more than his or her share of the placenta while the other gets far less. This is called Twin-to-Twin Transfusion syndrome, or TTTS. In effect, the donor twin is giving a transfusion of the blood to the recipient twin. One baby ends up overfed and the other undernourished, which is dangerous for both babies.

An initial diagnosis of TTTS may be modified to one of sIUGR if observation of the possible donor twin finds that there’s nothing to be concerned about when it comes to cord insertion.

Surgery

TTTS surgery involves using a laser to block blood vessels carrying blood between the twins. Its benefit is primarily to the twin who is receiving too much blood. Medicine has not yet advanced to the point where surgery is available to make a greater blood supply available to the donor twin or to a baby diagnosed with sIUGR. Frequent ultrasound monitoring is the only real option, allowing your doctor to determine whether it’s safer for your babies to be delivered pre-term than to continue to be nourished in utero by the placenta.

If you have any questions about sIUGR or TTTS, please let us know. We’ll do our best to answer, although neither of us is a medical professional. You can find out much more about TTTS on the TTTS Foundation website.

 

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Cleft Awareness

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July is National Cleft and Craniofacial Awareness and Prevention Month! Find more #cleftawareness photos and stories on Facebook!

Sweet Pea’s Story

On a beautiful Colorado day in June of 2012, my heart was racing with anticipation and excitement. Our long awaited second child was about to make his entry into the world! When he was born, he made no sound because his cord was wrapped around his neck…twice. They removed it and within moments, he was screaming his head off. It was like music to my ears! Moments later, the doctor informed me that our son, our Sweet Pea, was born with a cleft palate. While we knew that this was a possibility as I was born with one as well, it was still a blow. I had walked this road, and I knew of the struggles that he would face.

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He was admitted to the NICU for observation due to his difficult delivery, but ended up staying for 3 days because he needed oxygen. He went home with oxygen, and remained on it for 13 weeks. During that time, feeding became a major issue. Our son was born without any of his soft palate, and was missing some of his hard palate as well. When people hear that we had cleft palates, they often say, “wow, you look so great!” While I appreciate the compliment, I realize that there is a lack of knowledge about clefts and choose to take these occurrences as a gift…an opportunity to raise awareness about clefts. For Sweet Pea and I, we do not have complete clefts, meaning our lips were not impacted by our cleft (see the bottom left picture in the chart below). While cosmetics were not an issue, feeding, breathing, speaking and orthodontics are.

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Because his cleft eliminated his entire soft palate, he was never able to latch to breastfeed. This was a huge blow to me and contributed to my post-partum depression. At only 6 weeks old, Sweet Pea was diagnosed with failure to thrive. We tried several methods of feeding him before we found the Haberman feeder. It is now called the Medela Special Needs Feeder and just one costs about $30. Obviously, the ability to feed our son was priceless, but it was very challenging. If it weren’t for this awesome bottle, our little man would have gotten a peg tube to feed him.

haberman

Many children have their cleft palates closed around 6 months of age…unless they have a craniofacial anomaly that impacts their airway. Our son also has Crouzon Syndrome, which makes his midface small, therefore making his airway small. Because of this, we had to wait until he was 12 months old before closing his palate. It was a long, difficult road, but well worth it!

A cleft palate repair typically takes about 3 hours…P’s took 5.  It was the longest day of my life.  When the craniofacial surgeon came out, he told us it was the most difficult repair he has ever done, but he believed it was successful. Two years later, I can attest to that claim. So far, P has had three surgeries, and the only surgery on the horizon is replacing his ear tubes. Today his biggest challenge is speech, but he has an amazing speech therapist and he is a resilient guy. We will continue to have him monitored by his Cleft/Craniofacial Team on a yearly basis. While we cannot predict his future, we do have a good idea of what to expect from my own experiences.

My hope is that this post will raise awareness about clefts and craniofacial differences, and that it will encourage parents who are on this road too. As someone who was born with Crouzon Syndrome, Craniosynostosis, Chiari Malformation, and a cleft palate, I can say that I am thriving today. My son has taught me a lot about myself, how I deal with our birth defects and how I view myself and him as we walk this path.  He has taught me that I am his voice, his advocate and his cheerleader. Maybe he can teach others too?

Here are some links for further research and support:

Risk of Oral Clefts in Twins

CCA Guide to Understanding Cleft Lip and Palate

Cleft Palate Foundation

CCA Kids

Do you, or someone you love, have a cleft?

Would you like further information about cleft or craniofacial support and encouragement?

Comment below or send a message!

Sara is a mama of four children, two of them being surprise identical twin girls. She is happily married to the love of her life, stays home with her children and is currently homeschooling her oldest child. Most of her writing is centered around raising awareness about Crouzon Syndrome and cleft palates, advocating for your child, homeschooling and raising multiples. Find her blog at Confessions of an Outnumbered Mom.

The Dad Network
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Multiples in the Womb – National Geographic documentary

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As if we needed any proof that our multiples are miracles, National Geographic has a wonderful documentary about the life of multiples in utero. See 4D ultrasound of siblings interacting before they’re even born.

The In the Womb series also includes a video entirely about identical twins in the womb, which we just loved. Do be aware that there’s a scene in both films with a silhouette of the act of conception that you may want to skip through if you haven’t had The Talk yet. There are also diagrams of male and female anatomy. You may want to watch it all the way through without kids at least once.

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Toddler Thursday: Getting the diagnosis…. Then (whew!) finding out it is wrong

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As a parent you will do anything to make sure your kids are safe and happy. With the first baby especially, you stress and worry and panic and wonder if you are ever going to do anything right. My oldest was an early talker, a very early talker and a late walker. I had always heard that you either talk or walk – that babies focused on one area of development at a time. She talked early and walked at 17 months. Perfectly reasonable and within “normal” ranges, so it is fine.

Fast forward to twins.

Again, I stressed, I worried and I wondered if I would ever get anything right. Don’t get me started on sleep. The twins are now 2 ¾ and we still have sleeping issues…. The boy girl twins, like my older daughter, were early talkers. And late walkers. Sidney walked at 17 months just like big sister. But Spencer did not. He did talk early but at 17 months was not walking. It is ok, he will get there. And at about 18 months he took 5 steps into my arms. And I cried and screamed and attacked him with kisses.

He did not walk again.

He did not even cruise.

At 19 months I emailed the pediatrician and said, “I know you are going to tell me not to worry but at 19 months Spencer is not walking yet”. Her reply was like a dart into my heart. “Maybe we need to get him evaluated.”

I called Birth-to-Three and after a scheduling nightmare I gave up and called the pediatric rehab center on my own. My mother-in-law came with me. Her job was to listen to everything I missed and hold my hand. She did great. Spencer did great. I did not. In my defense, I did not mesh well with the therapist. I am 100% positive she is very qualified and good at her job, but I constantly felt blamed. “If you don’t pick him up he will walk.” That comment had me in tears. And had Spencer in tears. I will never forget his baby arms reaching up for me and his baby screams while this (evil) woman tells me that he is not walking only because I pick him up.

The therapist would hold toys just out of his reach and try to force him to reach for them to build up him muscles. Spencer would give up and move to a different toy. And I don’t blame him. But she did recommend that he wear braces on his ankles.  So I consulted with the pediatrician before making that appointment. She laid Spencer on the exam table and moved/manipulated/rotated his legs. She called them “spaghetti legs”. She could move them in any direction. His muscle tone was low, but she did not think that was a huge cause of worry, he could build up the muscles.

But she saw something else in his legs. “Beth, I want him to see a pediatric neurologist, I think he may have Cerebral Palsy”. And that was all I heard. She did talk me down (ish). She reminded me that if he did have it, it was not the end of the world, it was not a brain tumor (ok, an extreme example but she had a point).

First step, ankle braces. So we made the appointment and Spencer was fitted with baby ankle braces. Everyone told me that these braces were a miracle and that the minute they were on, their baby walked.  Spencer did not. (In his defense they measures the braces wrong and needed to redo them so he wore the wrong ones for a week or so…) Slowly, slowly, he started taking baby steps. But he still preferred crawling or being carried.

And then, one day, with my heart in my throat, I watched my baby boy walk. Those tiny little dinosaur printed ankle braces changed our world. At 21 months, Spencer walked barefoot. He had full control, turned, pushed toys, carried toys. He was there. I tear up now remembering that day.

With my mother-in-law in tow, we took Spencer to the neurologist.

You know when you have those days where every detail sticks perfectly in your brain? That day was one of them. The neurologist pronounced my son (he actually evaluated both kids and pronounced them both) as “perfect”. He said Spencer did have low muscle tone but that he did not even need physical therapy or the braces. I kept him in the braces for a few more months anyway because I bought a new wider pair of shoes to accommodate them. When he sized up in shoes, he left the braces behind.

My gorgeous, amazing, funny, cuddly, little man is perfect. He runs (not well and not fast, but he gets places faster than walking). He might not be a soccer player or football player but that will mean less concussions, so I am good with it. And one day, while waiting for big sister’s school bus, he jumped up in the air. Both feet off the group, jumped into the air. My baby boy. I have never been so proud.

Really, when he plays with his friends you would never know what we went through in the spring of 2014. We still have some work to do though. He does not like stairs and prefers to be carried, especially when he is tired. When we hold hands on the stairs, he turns his foot inward and we want to work on that.   When he moves to preschool, he will need to be able to walk down a long staircase to the playground and that staircase does worry me. But we will take it all day by day, step by step and now jump by jump.

As a mom you would do anything for your kids, and if Spencer did have Cerebral Palsy, we would have researched and become the experts at CP. It was only a few months. And in the grand scheme of things, it was nothing. But it was also everything.

I would check on him at night and put my hand on his back and watch him breathe and stroke his cheek and wonder if he would be able to walk without braces, if his peers would be cruel, how a disability might affect him and our family. We are so blessed that we don’t have to worry about these things. But if I ever do, I know that my support system is strong and I want to publicly tell everyone how fabulous the “how do you do it” group is. Because they got me through the beginning. They were a huge help in getting me from the emotional stage to the logical, research nerd stage. You need the emotional part. You need to cry when you get news like this, but you need to hit that research stage hard as well.

Our lives are “normal” now (or as normal as life with toddler twins can be). When I take the twins down the stairs, I hold hands and lead them down one by one and that is our normal. I help Spencer turn his foot on the stairs and that is normal for us. But when he does not want to come inside, I chase after him and now that is normal too. And even while I am chasing after him, I know how blessed I am to have a baby boy who can run away from me, as long as he never ever runs into the street!

 

Beth is known as mommy by a 6 year old and boy-girl twins who are almost 3.  She blogs about life, kids, and DIY, at Pickles in my Tea and in my Soup.

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Maintaining the Silliness Quota

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Today, my daughter M and I went to her very own doctor, the one she doesn’t share with her sister. M’s twin sister, J, did not join us, instead staying at school with their 3rd grade class. This is quite the rare occurrence, since I usually try to schedule appointments outside school hours and therefore have both girls with me.

M was very silly at the appointment, needing more reminders than usual to focus on the doctors’ questions. I wondered what was going on, only to discover this was yet another sister thing.

M: I was super extra goofy for you at the doctor.
J: What?
M: You weren’t there, so I did your sillies for you.
J: WHAT!?
M: You weren’t there, so I had my own sillies and then I was extra silly to make up for you.
J: Yeah, I got that, and I repeat: “WHAT!?” That makes no sense.

At least she agrees with me.

M missed her sister. The appointment ran late enough that M risked missing lunch at school, so I took her to a restaurant for a meal. When I asked for a table for two, M let me know that it sounded wrong. She went through every combination of meal partners she could think of, pointing out that we always needed at least 3 seats.

By the time we were done eating, though, she was enjoying herself.

“I like this quality time with you, Mommy,” she confessed, “just the two of us.”

Now I need to find some Mommy-and-me outing time for J. She would be okay with M going on a playdate without her to make it work, “as long as it’s not with [one of their 3 best friends] S. We’re a trio.”

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Minor Illness: Better Unconsolidated

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“Mommy! It’s weird enough staying home on a Monday school day, but staying home without M is even weirder!” my daughter J told me while munching on dry rice cereal this morning.

We didn’t have the weekend we’d hoped for. I went to the gym Saturday morning, as planned. We spent part of the morning cleaning the house, then stopped by a store for a birthday present before getting on the road to a friend’s birthday party. About a mile from the house, I heard a sound from the back seat. I looked in the rearview mirror, and poor little M was vomiting. When she could finally catch her breath, she began to cry. “I wanna go home. Mommy, take me home.”

I was stuck at a red light in a turn lane, helpless to comfort her. As soon as I could, I turned the car around and headed home. I talked to her the entire very long mile home and she just took turns throwing up and crying. I opened J’s window for her when she began to gag. Thankfully, her breakfast stayed down.

As we pulled into our driveway, I told J that I needed her to fend for herself while I tended to her sister. I unlocked the door and let J in, then returned to the car to lift my sobbing, retching, vomit-covered M straight into the bathtub. By this time she was apologizing for the mess in the car, which I told her not to worry about. I got the shower set to a comfortable temperature, helped take off M’s clothes, then left her in the warm water to throw the soiled clothing in the washing machine. I washed the puke out of her hair and helped her wash her skin, which had her feeling much better. She asked to wear her pajamas, pathetically telling me she really didn’t want to go out again that day.

While she dressed herself, I pulled the nasty car seat out of the car. As I was pulling the cover off, I heard a wail from the girls’ room. M had thrown up again, this time on the carpet. I comforted her, dressed her, and tucked her under covers on the couch with a big bowl in her lap in case she felt nauseated again. The car seat cover went in the washing machine too, and I started it on the sanitary cycle. Then I took my carpet cleaner to the spot on the carpet.

M wanted me to hold her, which I did for a while, feeling her grow steadily warmer in my arms as she took breaks to throw up. I took her temperature, which was a miserable 102°F. Fortunately, she was able to keep a dose of ibuprofen down. By this time, J insisted that she was bored. I gave her a number of ideas for activities, but she wanted me to play with her. When M felt better, I hosed off the car seat and cleaned the car upholstery and carpet and then played a few rounds of Funglish with the girls.

(The things we moms do… comfort babies, clean up vomit, provide security and medical care. I would have never guessed this would become second nature and feel completely manageable. This stuff is easy after twinfancy!)

The next morning, M had her appetite back and was ready for cereal. The fever didn’t return, and by evening she was her normal goofy dancing self… but not before her sister began to complain of a headache, completely lose her appetite, and run her own fever.

Fortunately, J never threw up, but I elected to keep her home from school today. Daycare rules have been drilled into me for all time. No kids in school until they’ve been fever-free for 24 hours.

M tried to convince me to let her stay home, but was more than happy to go to school when she realized she wouldn’t have to go to after-school care. And that brings me back to the beginning of this post.

“Mom,” J told me, pondering the clock, “In a few minutes, M will be starting science.” An hour later, I got an update. “Now, M will be writing in her journal.”

I found it intriguing that J didn’t seem particularly concerned with what she was missing or what the class was doing. Her focus was on M’s activities. One of those twin things, I suppose.

When illnesses are minor like this, it’s so much easier to have one child be sick at a time.

Sadia (rhymes with Nadia) has been coordinating How Do You Do It? since late 2012. She is the divorced mother of 7-year-old monozygotic twins, M and J. She lives with them and their 3 cats in the Austin, TX suburbs and works full time as a business analyst. She retired her personal blog, Double the Fun, but now also blogs at Adoption.com and Multicultural Mothering.

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When Mommy Is Sick

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When Mommy Is Sick, from hdydi.com. Sadia reflects on how different it is to be a sick single parent with big kids than infants.Remember how my little M came home from her Christmas vacation feverish and pathetic? I caught her virus and became equally feverish and pathetic.

It started with a cough and quickly blossomed into what I suspect is this year’s flu. When I realized I might be contagious, I elected to work from home rather than bringing my germs into the office. That afternoon, my cough worsened and I was certain I was about to be very ill. I begged off work to stock up on easy foods and medication.

Let me tell you that it’s far easier to be a sick single mother of 7-year-olds than of infants.

When Mommy Is Sick with Infants

The last time I was this sick, my daughters were babies. I had a blog, but wasn’t blogging with any regularity and I certainly wasn’t recording how hard those first few months were. I have vague memories of those days of fever and pain.

On the worst day, my fever around 103°F, I remember thinking there was no way I could carry the babies and their car seats to the car to take them to daycare, so I kept them home with me. I was so weak that I remember crawling into the nursery and feeding my babies, one at a time, holding the bottles through the slats of the cribs as I lay on the floor. I changed their diapers through the slats, too. I was too weak to lift them out of their cribs. They stayed in there all day.

My husband was in Iraq and I was too proud/worried to ask the neighbours for help. The only close friends I had nearby had babies younger than mine–we had 5 little ones born on the block within a 12 month period–or were elderly. I wasn’t going to risk passing on what I had to them. Our families were thousands of miles away.

I was well enough to take the babies back to daycare the next day. One of the teachers didn’t live too far from me. She told me to call her if I were ever in the same situation again. She would be happy to bring the babies into school for me. It hadn’t occurred to me to reach out to my daycare community. I’ve never made that mistake again. I also make sure that my friends and my daughters’ friends’ parents know that I’ll be there for them in a crisis.

When Mommy Is Sick with 7-Year-Olds

When I was at the store last week, I focused on picking up food that my kids could prepare themselves: a fresh gallon of milk for cereal, hummus and pita chips, pre-sliced apples and baby cut carrots, sandwich fixings. For myself, I picked up generic multi-symptom flu meds, bananas, chamomile tea, and the few frozen meals available with sane quantities of salt.

That night, I took my acetaminophen-laced meds before driving out to get my girls from after school care. I explained to them that mommy was very sick and that I needed them to be very grown up. It turned out that M had eaten dinner at the Y, but J had skipped it. I showed them their self-service options and told the girls to clean up after themselves.

I didn’t feel like my temperature was falling even an hour later. I came out from my room and asked the girls to prepare for bed, telling them I didn’t feel good. J asked if she could take my temperature. I asked her to open the box of thermometer probe covers, applied one to our thermometer–we still use the two the NICU sent home with us 7.5 years ago–and popped it in my mouth.

102°F. Great.

M and J had changed into their pajamas and brushed their teeth. I reminded them to put their dirty clothes in the laundry and sent them off to bed after J brought me a wet washcloth to try to cool my neck and forehead. I kissed them on the top of their heads instead of nose and cheek as I usually do.

J asked me how to set the alarm clock because she was going to check on me every two hours. I told her that I appreciated the thought, but needed her to get plenty of rest to maximize her chances of staying healthy. She wasn’t pleased.

I posted my fever on Facebook and asked for advice. Several friends recommended taking ibuprofen, but I discovered that the only bottle I had had expired. I figured I’d try to push through.

I dozed feverishly until 9:00. On the hour, my two sweet girls scuffed into my room, each in a bathrobe and slippers and holding her nightlight. They wanted to see how I was. Since they were up anyway, I asked them to load up in the car so Mommy could pick up medicine. They were unable to help me at the 24-hour drive through at CVS Pharmacy, so we had to all go inside to pick up a bottle of ibuprofen.

I ordered pizza delivered a couple of times during the week I was most unwell. The girls’ Girl Scout leader took them to their scout meeting and their teacher dropped them home. I loaded and ran the dishwasher as my daughters made their way through plates and cups, and I disinfected around the house as best I could to keep my virus to myself. I also cleaned the cat litter and took out the trash.

Otherwise, though, my daughters have been pretty self-sufficient. I’ve reserved my energy to spend with my girls, talking to them about their days, talking about the things they find interesting, picking up after them, especially dirty dishes, dirty clothes, and dirty floors. They’ve helped out by making their own meals, putting away clean dishes and clothes, and taking care of their own basic physical needs. I’ve dropped them at school and picked them up, run their baths, and checked their homework.

Poor M felt terribly guilty for having passed on her virus to me, so she needed extra affection to help her understand that I had chosen to risk getting sick because I loved her … just as she was doing in caring for me. J tired of working to get along with her sister and needed me to intervene a few times.

There’s been a lot more TV at our house than I’d usually allow, but given that eating a meal wore me out so much that I slept for two blocks of 8 hours the following day, I feel like we’ve been doing really well.

Ever wonder if it gets easier? It does!

How do you manage care for your children when you’re sick?

Sadia (rhymes with Nadia) has been coordinating How Do You Do It? since late 2012. She is the divorced mother of 7-year-old monozygotic twins, M and J. She lives with them and their 3 cats in the Austin, TX suburbs and works full time as a business analyst. She retired her personal blog, Double the Fun, when the girls entered elementary school and also blogs at Adoption.com and Multicultural Mothering.

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Stuck to Mommy

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Categories Guilt, Medical, Older Children, Relationships, Single ParentingTags , , , 1 Comment

My daughters returned home to me in Texas on Friday after a glorious 3 weeks enjoying the holidays with extended family in Washington and Oregon. Poor M caught the virus her father and grandmother suffered before her and came home with a fever. Things were looking a little worrying for twin sister J, but she’s managed to avoid the coughing, runny nose, fever and exhaustion.

Both girls insisted that they absolutely had to have Mommy snuggles all night Friday. Mommy could not sleep in her own bed. With M still feverish, I didn’t protest and took advantage of the opportunity to monitor her throughout the night. I just need to give up on keeping the girls in their room. If I’m giving in on their request that I sleep with them, I might as well do it a non-lofted bigger-than-twin bed. We are getting seriously squished as these girls of mine grow!

Saturday came and went, all the while M refusing to leave my side. If I sat, she sat next to me, thigh to thigh, arm to ribs, head to breast. If I stood, she hooked her hand in my pants waist and came with me. J wanted to be in the same room as me but she, usually the snugglier of my pair, wanted a typical amount of physical contact: the occasional hug, the odd moment tracing the lines on my palms, asking me to brush her hair a couple of times.

I thought that M might be needy because she didn’t feel well, or just because she’d missed me. After she let me release her for the period of her bath time, it occurred to me that at 7, she might know why she was so acting so needy.

“What’s up, M? Why such a snuggle bug?”
“I didn’t get enough snuggles while I was gone.”
“Oh? You know, you can always ask for snuggles. Grammy and Grampy and Daddy and Auntie love you as much as I do.”
“I know. I had four grownups for snuggles, but I snuggle you every day and them, it was more like every other day. And then I got sick and didn’t want to share my germs.”

I imagined my 7-year-old trying to emulate her grandmother and father in self-imposed isolation, protecting those around her from her germs, sacrificing the comfort of hugs to behave like a grownup. I was proud of her and yet it made it that much harder to know that my little girl had been sick without me there to care for her. A sick little girl needs her Mommy or at the very least her custodial parent. However you categorize it, M needed me.

As she fell asleep that Saturday night, one arm under me and one arm over me, breathing in my face and occasionally coughing, I was glad to know that my mature little girl thought me immune to her germs, able to give her all those missing snuggles while she still felt poorly. Usually, she gives a sleepytime squeeze before seeking personal space.

Sunday, and Monday too, she remained glued to me. By Monday, she allowed her sister in my lap, but only as long as I kept a hand on her head and a leg where she could rest hers. I had made a halfhearted effort to find childcare for the day, since school wouldn’t open until Tuesday, but the YMCA has been inconsistent in their full day care, M begged to stay home, and I wasn’t convinced J wasn’t still incubating the virus. I elected to work from home. Thank goodness that I have that option!
Snuggle bunnies from hdydi.com
This photo was taken with my iPad resting on my stomach. M is the farther child, but her legs are hooked over mine. She insisted that I type one-handed, allowing her sister next to me only as long as I kept a hand on her head.
How do your children seek comfort when they don’t feel well? Do they seek out one parent over the other?
Sadia (rhymes with Nadia) has been coordinating How Do You Do It? since late 2012. She is the divorced mother of 7-year-old monozygotic twins, M and J. She lives with them and their 3 cats in the Austin, TX suburbs and works full time as a business analyst. She retired her personal blog, Double the Fun, when the girls entered elementary school and also blogs at Adoption.com and Multicultural Mothering.
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(We Will Never Be) Full-Term

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Categories Infants, Medical, NICU, Parenting, PrematurityTags , , 3 Comments

My boys are almost two, and I’m 32 weeks pregnant with our third son. Over the weekend, I spent some time in L&D. Everything is fine, but to say I had flashbacks to NICU is an understatement. In order to lighten the mood in my own mind, I re-wrote the lyrics to “Royals” (originally by Lourde). So without further ado, here is:

(We Will Never Be) Full-Term

I’ve got fine hair upon my flesh
I cut my teeth on breathing tubes and a blue Soothie
And I’m not proud of my address
In the NICU wing, no nursery envy

And every nurse is like:
De-sat
Jaundice
That was a bad brady
Art line
PICC line
Puttin’ in an NG

Kangaroo care, we’re being snuggled in our dreams

But everybody’s like:
PDA
Caffeine
Bathing in pink basins
Surgeons
Breast pump
Unplanned extubation

We don’t care, medical terms are your affair

And we’ll never be full-term (full-term)
It don’t run in our blood
Mom’s uterus just ain’t for us, now the machines all beep and buzz
Let me be your ruler (ruler)
You can call me preemie
And someday I’ll breathe, I’ll breathe, I’ll breathe, I’ll breathe
Let me live that reality

My twin and I aren’t gonna code
You watch our hearts on the machine when we’re sleeping
And everyone who knows us knows
That we’ll be home soon, give the hospital your money

But every nurse is like:
De-sat
Jaundice
That was a bad brady
Art line
PICC line
Puttin’ in an NG

Kangaroo care, we’re being snuggled in our dreams
But everybody’s like:
PDA
Caffeine
Bathing in pink basins
Surgeons
Breast pump
Unplanned extubation

We don’t care, medical terms are your affair

And we’ll never be full-term (full-term)
It don’t run in our blood
Mom’s uterus just ain’t for us, now the machines all beep and buzz
Let me be your ruler (ruler)
You can call me preemie
And someday I’ll breathe, I’ll breathe, I’ll breathe, I’ll breathe
Let me live that reality

ooh ooh oh ooh
We’re smaller than you ever dreamed
And I’m in love with clothes sized “P”

ooh ooh oh ooh
Life is great in Intensive Care
We’re your full-time love affair

And we’ll never be full-term (full-term)
It don’t run in our blood
Mom’s uterus just ain’t for us, now the machines all beep and buzz
Let me be your ruler (ruler)
You can call me preemie
And someday I’ll breathe, I’ll breathe, I’ll breathe, I’ll breathe
Let me live that reality.

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The Search for a New Pediatrician

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Categories Anger, Different Gender, Fraternal, Frustration, Guilt, Medical, Mommy Issues, Parenting, Parenting Twins5 Comments

A few weeks ago, I went through a semi-traumatic experience at my pediatrician’s office, one that prompted me to start searching for a new pediatrician. (Please read this letter first to get the full back story.)

I was actually very torn whether to even bring it up with the doctor, much less take the drastic step of actually switching to a different one. I don’t know why exactly, because I’m usually a very proactive and assertive person, especially when it comes to anything dealing with my kids.

I may have felt some guilt for having put my daughter in that situation in the first place. What if I had stayed with her the entire time instead of going back out to the lobby to check on my son? What if I had my husband meet me at the doctor’s earlier so he was there for the temp/weight checks? These thoughts went back and forth in my head, resulting in me sort of blaming myself for letting it happen. Yet, I couldn’t shake the upset feeling, and therefore I wrote the letter.

It was a source of anxiety for many weeks. Some fear of confrontation perhaps, or maybe just a fear of the unknown. What if I did switch doctors and it wasn’t any better at the new place, or even, it was worse?!? This is where HYDYI helped me. From the comments I got on my post, I garnered enough moral support to feel justified in what I was thinking. (Thank you!)

I rewrote the end of the letter, to strongly emphasize that I feel the conduct of his staff has become unacceptable. I demanded that I would be willing to work only with the single competent nurse/medical assistant on future visits. Then I mailed it and waited in anticipation of what would happen next.

Well, a few days later my doctor called and left me a voicemail. In it he thanked me for writing the letter and bringing the issues to his attention. He wanted to call and speak with me the next day. I was trepidatious because though the reply was prompt and the message was polite and sincere, there was no apology in his voicemail. I just had a bad feeling that a conversation with him would not turn out well.

It did not turn out well, indeed. He called at lunchtime the next day, and the conversation began nicely… but I was getting the vibe that he didn’t even have a clue who I was until almost the end of the conversation when he remembered that I was the parent with the side by side double stroller that didn’t fit in his exam room doors. He explained that his twin patients usually ride in tandem strollers, and they’re accompanied by many relatives, which I felt was his way of faulting me for the horrible visit that I had. I was getting more and more upset as the conversation continued, and he was having some trouble keeping his cool as well it seemed.

But the last straw was when he absolutely refused to ever see my twins in a joint appointment. For the first time I’ve ever heard this in the almost-year of my twins’ lives, he explained that his policy is that separate patients have separate appointments. He will not see them back to back, nor can shots be given to one after the other. Appointments are made together, but in actuality, they’re not at the same time. His rationale is that he never wants to make a mistake with a twin and give the wrong vaccinations, so wants to take his time as well as give his staff time to make sure no mistakes take place.

I could kind of understand if the patients were identical and very difficult to tell apart, but my twins are not, and his policy really applies to all sibling appointments, which makes absolutely no sense to me. Plus, really, what parent would let one child get a double dose of vaccines while the other got none? And couldn’t you easily tell which baby got shots by which one is crying hysterically and has little band-aids on the legs already anyway?

So that was it. His insinuation that I should bring a cadre of people to my kids’ appointments to help out, and that I need to buy a new stroller to accommodate his facilities, brought me to the conclusion that I never want to see him or his staff again.

On Veterans’ Day when my preschooler and I had the day off, I made an appointment with a new pediatricians’ office to meet their patient liaison. I knew the second I walked into the office that the vibe was different there. We liked it so much that I changed them to my provider that very same day. Fingers crossed that our first actual doctor’s visit will be everything I’m expecting it to be.

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