To Helmet or Not To Helmet?

At the boys' two month wellness checkup, one of their pediatricians said, "Grayden has a flat spot on the back left side of his head." I nodded like I understood, but I didn't. I haven't slept in 8 weeks. We need more Size 2 diapers. Did I pump 40 ounces yesterday? They will eat in 25 minutes, so please hurry up. That's pretty much how my thought process went for the first 10 weeks, so when someone suggested there might be a problem with one of my children, it just didn't register. I was like an old computer programmed to run simple functions, unable to process any new information.

A few days later, Larry was holding Grayden on the couch and said, "I'm worried about his head. It's really flat on this side." Ren only ate 1 ounce this afternoon. I should order those bottles. I wish there was a sleep fairy. "Um-hmm," I said. "The doctor said we should move his head when he falls asleep, but he obviously doesn't have twins, because I am not going in there and waking up two babies."

A couple of weeks later, after the fog had lifted, I was holding Grayden on the couch and looked down on his head from above. I was shocked by what I saw. His head was FLAT! Why hadn't I noticed this before? Why didn't the doctor do something about it? I set him down and grabbed Ren. His head was flat, too! How did this happen? I had been vigilant about both boys spending at least 30 minutes a day on their tummy.

As soon as they went down for their nap, I ran to the computer and called up Dr. Google. Grayden clearly had deformational plagiocephaly, while Ren had a nice mix of plagiocephaly and brachycephaly. I learned that preemies are especially susceptible to flat heads because their skull bones are still so soft at birth. Twins tend to have issues more often, too, simply because one baby is almost always lying flat when the other is held. And the "Back-to-Sleep" campaign of the 1990s had been successful in reducing the number of crib deaths due to SIDS, but it was directly responsible for an extreme increase in infants with head deformities.

I read that babies with torticollis often end up with plagiocephaly, too. When I googled "torticollis," I got the following result:

"Torticollis is a twisted neck in which the head is tipped to one side, while the chin is turned to the other."

Huh. Ren always looked to the right. He had since he was born. Was that torticollis?

Plagiocephaly and torticollis were not only a cosmetic concern. Children who were left untreated tended to have chronic ear infections, misaligned jaws, and vision problems. The thought of Ren and Grayden having to deal with such issues broke my heart.

I wrote down all of my questions for their four month wellness visit and studied a pamphlet on repositioning techniques. I rearranged the furniture to help encourage them to look in the opposite direction of their flat spot. I bought pillows to put in their swing, carseats, and bouncers. And for the next 6 weeks, I forced them to lay on the rounded part of the head---when they were awake and when they were asleep.

But their heads were only getting worse. Plus, it was starting to affect the symmetry of their little faces. Ren's right ear protruded farther than the left, and both boys had cheeks and eyes that were smaller than their counterparts. You could also see where their foreheads were protruding; their heads really were starting to resemble the parallelograms that classically define plagiocephaly.

The next step was getting a referral to an orthotist, who would measure their heads and then recommend a plan of treatment. The most common "cure" is a molded helmet that puts pressure on protruding sides and leaves space over the flat parts for the head to fill out. The earlier you seek treatment, the better. Babies who start wearing helmets before 6 months of age tend to graduate in just three months, while older patients have to wear the helmets much longer. I became a woman possessed. The second to last thing in the world I wanted was for my babies to wear a heavy helmet in the hot South Carolina summer for 23 hours a day. But the last thing in the world I wanted was my teenage sons asking me why I didn't do anything about their flat heads.

The helmets are rarely covered by insurance and run about $3000 each. We have contemplated several ventures in the last three years that run about $6000; a fence, a deck, landscaping, hardwood floors, a fishing boat. I have vetoed all of them with "We don't have that kind of money." Oddly, I didn't think twice about spending it on our sons. They may not go to college, but they'll have perfect heads!

Through the Soccer Mom grapevine (which is so valuable in a small town), I learned that my current pediatrician refused to refer babies to an orthotist for helmets. But there was another pediatrician in the practice who was more willing to acknowledge plagiocephaly, so I quickly switched our appointment to the new pediatrician. When she saw the boys at 4 1/2 months, she agreed that there was an issue. I assumed she would recommend an orthotist in Savannah or Charleston, but instead she referred us to Physical Therapy. She said the Physical Therapist would refer us for helmets. Hmmm.

We then had to wait 2 weeks to get into the therapy clinic. I felt like I could see my boys' heads getting flatter each day. I was trying to be so proactive and seek treatment as quickly as possible, but I was running into countless delays!

The Physical Therapist agreed that they had torticollis and plagiocephaly (SHOCKER!). She requested that they return twice a month for therapy on their necks, and that an orthotist would come in at their next appointment in two weeks to take a cast of their head for a helmet fitting. I knew from my research that it takes about 2 weeks to get a helmet after a fitting if you don't involve the insurance companies. If you do involve insurance companies, it can take 4 weeks! So I was looking at another MONTH at the minimum before the boys would be in helmets.

I also knew from my research that the best way to measure their heads was with a special scanning machine that took computerized images in just 2 seconds. Why would I make my babies endure a plaster cast molding if I could just take them to a place with a scanning machine? I got home from their therapy appointment and called a specialist in Charleston.

It proved to be a great decision. The orthotist in Charleston took their measurements, showed me their pictures, and then did the most amazing thing: he didn't sell me helmets. He knew that I was a concerned mom who was willing to dish out thousands of dollars on the spot. But he said "Let's wait 5 weeks and remeasure them. If they are getting worse, we'll get the helmets. If they're getting better, then I saved them from having to wear helmets and I saved you from having to pay for them."

If the pediatrician or Physical Therapist had told me to wait, I would have (and probably did) bulldozed right over them in an attempt to get a second opinion. But when a person who specializes in the field tells you to wait, you can breath a sigh of relief and know that you're doing your best as a parent. My TMJ has cleared up significantly since this appointment.

I still worry that by waiting I will have postponed the helmet wearing until the worst part of summer. Or that they might have to wear the helmet an extra month. But if we go back and prove that their heads are indeed getting worse, at least I'll know I am making the right decision. And if their heads are getting better, then maybe Larry and I can get that new fishing boat. Okay, okay, we'll set up the college funds.

The Hazards of Having Twins

My boys are beating me up.

It started with a thrown back. I was worried about back problems, as I've been prone to them ever since I out grew most of the boys in the 8th grade. Plus, I spent the last 16 weeks of my pregnancy flat on my back, letting those precious back muscles atrophy while putting on loads of baby weight. Then, boom!, your children are born and you're sent home to tote around baby weight and two children all day. I was a thrown back waiting to happen. I wish I could say it happened while I was exercising, or moving a crib, or carrying two kids, but it didn't. It happened when I lifted Gray's arm to put the car seat strap over it. Yep, that's it. A 6 ounce baby arm was all it took to stop me in my tracks.

Many clouds have silver linings, though. This lining was sleep. Valium and I snuggled like new lovers for the next 36 hours in the cool sheets of my bed. It was absolute heaven. Mom, Susan, and Larry took care of the babies and I took care of me. While I would not wish those first 3 hours pre-Valium on anyone, I would wish the next day and a half on every new mother of twins. Hint, hint.

Next came a clicking thumb. Every time I used my right thumb (which was about every 10 seconds), it would emit a strange cracking sound. Change a diaper--pop, pop, pop! Open a formula container--click, click, click! It got to the point that I couldn't even change the channel to PBS Kids without my thumb popping when I pushed the buttons on the remote. It didn't hurt, but it was certainly annoying. Even to Larry. "That's disgusting," he complained. I would have liked to show him all the things in my day that were truly disgusting--like soiled diapers, nose suction bulbs, and regurgitated milk--but I was too tired to put him in his place.

Then one day I woke up and the thumb was swollen and tender to the touch. It hurt to even screw the tops on baby bottles. As all new moms know, there is absolutely no time to take yourself to the doctor, so I asked Doc about it (he is so much more than a grandpa and a retired veterinarian!). "It's trigger thumb," he said. "You're using it too much."

Hmph. How do you stop using your thumb? According to Dr. Google, you must splint your thumb for 6 weeks to cure trigger thumb and avoid surgery. SIX WEEKS! Does Dr. Google understand that I must care for two infants? Or that I need to bend my thumb in order to change diapers, open formula, bathe babies, wash bottles, pick noses, button clothes, zip sleepers, and plug screaming mouths with pacifiers? Apparently not. Luckily, Walmart has this snazzy splint that I can slide on and off as needed. And it appears to be working, as the swelling and tenderness are gone and the annoying clicking is back.

The popping thumb was followed by a popping jaw. I started waking up with the sensation that I had been clenching my teeth at night and this seemed to be true when my jaw began popping with every yawn or large mouthful of food. It progressed to popping when I talked and then started to get sore. Fortunately I had scheduled my next dentist appointment when I was still pregnant (because let's be honest--I wouldn't have had time to actually make an appointment once the babies arrived) and it coincided with the strange popping.

I told my dentist about it and he asked, "Are you stressed?"

Hmm. Does a bear make dookie in the woods? "I just had twins and haven't had a full night's sleep in 4 months." And I say things like 'make dookie' now. Okay, so maybe I didn't say that part about making dookie, but you get where I'm coming from.

"It's TMJ," he replied. "It may go away on it's own when you start getting some sleep. But if it gets worse, we can get you a splint." What is with me and splints???

So far, I am powering through it. I am pretty sure my level of stress won't go down until Ren and Grayden graduate from college, and even then I'll probably spend my days worrying about them marrying floozies who are just after them for their a) money b) green cards c) fishing boats d) autographs e) all of the above.

My final insult (and injury) occurred yesterday. Tired of toting around this extra baby weight, I daringly went searching for the lost Nordic Track in Larry's garage (those of you who have seen this Man Cave know just how brave I was to venture in there. For those who haven't seen it, let's just say "neat," "orderly," and "clean" are not in his vocabulary). After finding the Nordic Track, lugging it into our dining room, and setting it up, I was excited to get started. Hello energy, goodbye belly! Hardly. The Nordic Track is a cross-country ski machine with a large padded support right at your waistline. This support rests against you and keeps you stationary. Or in my case, it rests against my c-section incision and keeps me stationary on the couch. I must have developed some scar tissue because it hurts to lean against this pad. My outer incision is still as numb as a drunk on payday, but there is a pain deep down inside when I do sit-ups, lift too much, and now, exercise on a Nordic Track. Yea, me.

And I thought the boys were rough on me before they got here. Turns out they are way more abusive now that they are here. But you know what? When Gradyen grabs my cheeks and gives me a slobbery kiss or when Ren is overtaken with the shivers when I walk in the room, I have no doubt it's all worth it.

Bouncing Baby Boy

I wonder if the good folks at Fisher Price would tell me the name of the man or woman who invented the almighty jumperoo. If so, I would be willing drive cross-country just to thank them for giving me at least 20 to 30 minutes of uninterrupted "Mama Time" every single day.

A jumperoo is a free-standing toy for bungee jumpers in training. It's part walker, part saucer, and part parachute. It suspends babies above the floor and encourages them to develop their leg muscles by bouncing in place.

Grayden clearly loves his jumperoo. He bounces when he's happy:



And he bounces when he's mad:



He bounces when he's cool:



And even when he's tired:



Ren simply does not know what to do with the jumperoo. He just sort of sits there. We have faith that his slightly younger, yet much bigger, brother will soon show him the ropes.



***Updated 3/22/2011:
Ren has learned to leap!

Postpartum

Once the boys were home, I fell into a "routine," for lack of a better word, although there was nothing routine about it. When the boys were hungry, I fed them. If they were dirty, I changed them. And if they were tired, well, they slept and I cleaned or did laundry or research on how to be a better twin mother.

We came home on Monday and Larry left for work on Wednesday. I regretted having him stay at the hospital and use his time off. Even though we had doubled the occupancy of our house, it felt so empty when he left that morning.

I do not think enough women talk about the emotional difficulties encountered in the first few months postpartum. Instead, you only hear about how wonderful motherhood is, and how there is an instant, unbreakable bond the minute a child is born. Well, either that isn't always the case, or I am truly the only woman in the world who is missing this treasured motherhood gene, as I feared I was in those first few weeks and months after my boys' birth.

I loved my boys from the start, but it was a love that grew while they were in my womb and it was incomplete once they were born. It was innate to care for them and protect them without question or complaint. I could not ignore their cries in the same way that I could not stop breathing. But our bonding experience was flawed. I loved them because I was supposed to.

I think there are three possible reasons for my initial detachment. The first involves their birth. Every woman has an ideal birth plan, and it can be downright heartbreaking when this birth plan goes awry. Before the twins were born, I read about women who were upset over their birthing circumstances and thought that these women were overly dramatic or too controlling. But I know now that botched birth plans create a very real phenomenon.

I really wanted a natural delivery but I was forced into a c-section because Ren was breech. I knew the dangers of a regular delivery, for both him and me, and thought I had come to terms with the impending c-section. But the actual birth was so sterile and impersonal. I did not see or feel my children being born, so it was almost like they weren't really mine. They just suddenly appeared without meeting any of my expectations of a birth.

I think that I suspected I would feel a bit disconnected because I was very specific about what I wanted after their birth. No one in our extended family was to see them until I had a chance to feed them and Larry and I had an hour or two to be alone with our new family. This bonding time was essential to the start of my motherhood, and I was so worried about this not happening that I even asked relatives to stay home until I called them. That didn't go over so well! But neither did my request. While I was still in surgery, my children were wheeled out into the hall to meet all of their relatives. I still tear up, months later, when I think that I was the last person to touch my babies that day. Like a mother robin whose nest has been handled by an invader, I rejected my children. Granted, I rejected them emotionally rather than abandoning them physically, but I rejected them just the same. I can't say if they smelled like the invaders or if there were a biological reason for my disappointment, but I can say that they did not feel like they belonged to me. Several people have said I must have had postpartum depression to have such thoughts, but I wasn't depressed. I just didn't feel any bond with my children.

I believe that severe sleep deprivation also contributed to my ability to love my babies in the way in which I wanted. In the first 6 weeks, I was getting 2 to 4 hours of sleep a day, but it was broken up into increments of 10 to 30 minutes. It took over 2 hours to feed both babies and 30 minutes to pump milk. By the time I cleaned bottles and pumping supplies, it was literally time to start feeding them again. The only emotions that exist in the extremely sleep-deprived are dark, isolating feelings; there is no room for love or joy. I had everything I could do just to continue to exist, and on top of it I was the lifeline for two infants. There was no time or energy to put into our relationship.

At about 8 weeks out, I stumbled onto the third reason for my detachment. I was reading "Mothering Multiples" and the author said "It is more difficult to fall in love with two persons at the same time." This comment and the brief paragraph in which I found it helped me to accept the way I was feeling. I had started to believe that there was something wrong with me, but this book explained that forming attachments with twins was much more difficult than with a single baby. Some women can take years to bond with their multiples! While I prayed it wouldn't take me so long, the book gave me the strength to endure the lack of emotion I was so lost without.

Luckily, it only took 10 weeks. One morning I went in their nursery to start the day, and Ren smiled at me. My heart flooded with love and pride and I picked him up and hugged him. The same thing happened when I got Gray out of his crib. It was instant and wonderful and everything I had always imagined, even if it was 10 weeks late. I think that I had to put time between me and the birth experience and get some adequate sleep before I could see things---even things as wonderful as love---more clearly.

Postpartum seems like such a dirty word, but it simply means "after birth." I guess because it's so often paired with that other word, "depression," that "postpartum" gets a bad rap. I think it's important to understand that what women experience after birth isn't always depression, nor is it always maternal bliss. It may be a sort of purgatory in between, while she sorts through the hormones and emotions that result from the most significant change in her life. Whatever she feels, it is okay.

Handrails

It's weird what you remember looking back on the birth of your child. I am sure if I wrote this on my way home from the hospital, you'd be reading a very different story. But time has allowed the sharp edges to fade, and like with so many memories, only the best parts remain.

I finally had a formal introduction to Ren and Grayden in the recovery room. Ren was so tiny that I was glad he was swaddled. I don't think I would have felt comfortable holding him otherwise. He and his brother acted as if they hadn't eaten in a day (which they hadn't), and we were able to tandem nurse with the help of a lactation consultant. Once the recovery nurse decided that I was fit to be seen in public, we were wheeled to our room, the boys sleeping on my chest.


Larry, the grandparents, and new aunts were waiting in our room. The babies were passed around while I told everyone about the end of the surgery and recovery. The rest of that day and the next one are very fuzzy; I don't know if time, pain, or medication is responsible for my lack of memory. I do remember finally being allowed to have something to drink around dinner time; the cafeteria sent me apple juice and it was a wonder to me that in a few short hours the diabetes was gone. I also remember getting out of bed around midnight. The rule for removing the IV and catheter was that I had to be mobile, so as soon as the 12 hour time limit was up, I was up.

Although the actual birth experience was quick and impersonal, my stay in the hospital was much longer and involved. Chaquita (yes, like the banana) was a great nurse and kept me on pain meds so that I was very comfortable. The second day was much harder, but only when I was up and moving around. I had one Nurse Ratched, who withheld my pain meds overnight, but that might be for another blog on another day. I'd rather concentrate on Chaquita who taught Larry how to diaper and swaddle the boys. Because I couldn't get out of bed for the first three days, Larry was the lead diaper changer, and he held the role without complaint. I was very proud of him.

I was the lead feeder, but the boys were too little to latch. Wendy, the lactation consultant, had me pumping right away, as it was doubtful I would be able to make milk with PCOS, gestational diabetes, preeclampsia, and a c-section. In the meantime, I fed the boys formula through a tube and a syringe, much like feeding a baby bird that had fallen from its nest. I attached the tube to my pinky finger to simulate a nipple and the boys ate heartily. Ren never even lost any weight while we were in the hospital! And it surprised us all when I was able to produce milk (Wendy nearly did jumping jacks over the few drops in the bottle), so the boys got a mixture of breast milk and high-calorie preemie formula.


We had many visitors even though the hospital was an hour away from home, and Larry would have been lost without them. He was ready to head home that first day, but I needed to stay in the hospital to recuperate. On Saturday, we distracted ourselves with college football and the boys first photo shoot.


They say that everyone recovers from a c-section at a different rate, and I was definitely a slow healer. I don't know if it was the fact that I was carrying twins or if it was because I was of "advanced maternal age," but I was not ready to go home when they tried to discharge me on Saturday, the third day. I needed to stay in the hospital where the bed, shower, and toilet had handrails! I wasn't ready on Sunday, either, but I felt pressure from both Larry and the doctors, so I hesitantly signed the discharge papers. I was nervous about caring for two newborns when it hurt so much to move. We were waiting for the boys to be discharged when Chiquita came into the room and said that Ren had dropped his temperature and needed to stay another 24 hours for observation. They allowed us to "room-in" for free; while I didn't have any services from the nurses, I did have access to those handrails for one more night! I can never prove it, but I think Chiquita made up the dropped temperature because she knew I wasn't ready to leave.

On Monday morning, Ren had held temperature overnight so we were all discharged. We got our first dose of twin attention as I was pushed through the hospital in a wheelchair with both boys on my lap. We must have passed 20 people, and they all got excited by the presence of twins. The attendant had to stop every few yards to let someone look at the babies. It was wonderful to be received so warmly.

Larry drove white-knuckled the whole way home, while I somehow managed to squeeze between two carseats in the back. I snapped a picture of each baby as we crossed the bridge to our island home.

It was good to be home, but I'd be lying if I said I didn't miss those handrails!

Tears for Fears

On the morning my children were born, I cried. Not because I was about to end a long journey or start a new one with two precious sons. Not because I had to endure the pain of birth or experience the joy of instant motherhood. I cried because I wasn't allowed to have any water.

Our c-section was scheduled for 11:00 am, but Dr. Royek had already warned me that the last time an 11:00 c-section started on time occurred when the 9:00 c-section didn't show up. I was not to have any food or drink after midnight. It's bad enough to starve a woman who is passing food through two placentas, but it's downright cruel to tell a gestational diabetic that she can't have any water. I easily consumed a gallon of water by lunchtime throughout my pregnancy, and now I couldn't have any. When we stopped at my parents on the way to the hospital, my mom held me while I sobbed over my severe thirst.

Once we got to the hospital, I was able to forget about my thirst for a little while as we checked in and I was hooked up to monitors and an IV. An odd calm overcame me; the fear, anxiety, and excitement were replaced by confidence and control. I could do this. I could have two babies today.

Larry, on the other hand, seemed to have enough nervous energy for the both of us. While I laid in bed and watched The Price Is Right (as expected, the surgery did not start at 11:00), he paced the room. And paced. And paced. There is probably a wear spot that the janitor is still trying to get out of the floor in Room 203. If I weren't the one stuck in bed, a fly on the wall might have thought Larry was the one having major abdominal surgery.

When the nurses finally came to get me, Larry had to stay in the room and wait until after my spinal was administered. I think those were the longest 30 minutes of Larry's life. Yes, 30 minutes. After my IV stand and I made the long walk to the operating room, an inconsiderate woman in Room 206 decided to have her baby and thus hog the doctors who would be attending my c-section. The gall of some people. So after sitting on a skinny operating table with my backside flashing all of the young interns and nurses for what seemed an eon, the anesthesiologist came in with his team. I was anxious to get this show on the road so I could finally down a big glass of water!

After the spinal was done, another team of people came in and started working around me. I counted 16 people in the operating room at one point, and my view to many parts of the room was obstructed. The blue tent was erected, and without sight, I could no longer tell that anything was happening to me. A small woman came over to the table and introduced herself as the attending surgeon. I imagine she had to stand on her tiptoes to see the top of my belly; luckily, her two residents were much taller. Suddenly, I heard "Incision made at 12:25" and for the first time, I felt panic. Where was Larry? These babies were coming out of me and he was going to miss it! But the next thing announced was "Bring the dad in!" and with that Larry came through the operating room door. His mouth was covered by the mask, but I could still see a big smile on his face.

For the next ten minutes, we sat quietly and listened to the doctors and nurses. "Cut here." "Suction." "Almost there." And then, a different voice said "Time of birth: 12:38." I literally held my own breath as I waited for my son to breathe. When he let out an angry cry, I exhaled and smiled at Larry. One of the residents called out, "The breech baby came out first." I had met with her just before surgery and begged that she deliver him first since he was already named Lawrence Arthur V. I couldn't imagine having Grayden be the oldest baby and explaining why he didn't have the honor (or the curse, depending on how you feel about it) of receiving his father's and grandfather's and great grandfather's and great great grandfather's name.

A nurse whizzed by me with a tiny wailing ball of baby, and I sent Larry with the camera to take pictures. Not 30 seconds later, someone called out "Baby B at 12:39" but it wasn't followed by any cry. "Breathe, breathe, breathe," I whispered and then Spencer Grayden finally squawked like a little Canadian goose flying south for the winter. The goose squawks turned into real baby cries as he was also carried by me to another waiting baby warmer.

The rest of the surgery is fuzzy, so much that I wonder if the nurse anesthesiologist upped the pain meds once I witnessed the birth. I remember someone calling out Ren's weight--4 pounds, 11 ounces--and I just assumed that meant he would be heading to the NICU. Someone--maybe Larry--brought both boys for me to see, but it was a quick 10 second peek. I longed to touch them and hold them but my arms were strapped down so I had to settle for a peck on their cheeks. They did not look as I expected, or even like other newborns I had seen. I think their prematurity and low birth weight disguised their true looks. Moments later they were taken out of the operating room with Larry, and I was left, alone, while the doctors finished my surgery. The tugging I could feel was oddly comforting and I drifted off to sleep.

As soon as I was rolled into recovery, I asked two questions. The first, and most important, was "Can I please have some water?" You know what they said? "No. Not until 12 hours after the surgery." ARE YOU KIDDING ME??? Although the effects of the diabetes had already started to wear off, I was thirsty beyond words. I settled for some ice chips, but only because my legs were numb and I couldn't walk across the room to the sink by myself.

I was afraid to ask the second question. "How are my babies?"

The recovery nurse nonchalantly answered, "Fine," as she wrote in my chart.

"You mean they aren't in the NICU?"

"Hmm, I don't think so," she said. "We would have heard from the NICU if they were."

I couldn't believe it. I carried them 36 weeks and 1 day with a singular goal: no NICU time. And it appeared as if I had accomplished it. I had two healthy sons. I don't think I ever allowed myself to believe that this would ever really happen. After losing two pregnancies, after experiencing hemorrhaging, diabetes, a rescue cerglage, preterm labor, and preeclampsia with this one, and after spending the last 16 weeks on bedrest, I didn't dare dream that I would have one healthy baby, let alone two. I cried again, and although I pretended it was from extreme thirst, it was really from extreme relief.