Feeding and the NICU

While I was pregnant with the twins I often wondered what exactly they would be like. Because my only experience to date was with Bentley, it was hard not to picture them as being just like their brother. Matt and I may be biased, but we think Bentley is close to perfect. He's always cheerful and full of joy. He's bright, inquisitive, energetic... and a delight to be around! I found myself thinking that the only thing I would change about the twins, if I could, is eating habits. Bentley doesn't like to eat as much as I think he should and it's been a cause of stress to me - I'm always trying to get more calories into him.

So now I find myself with twins in the NICU, who are there because they have to learn to eat. In order to come home they have to be able to take a full days worth of food from the bottle, and they have to be gaining weight. Sometimes it seems like one step forward and two steps back.

They are fed every three hours. Every day the Dr. comes by and sometimes increases the amount of formula they have to eat in order to maintain/increase their weight. If they don't drink at least a certain percent of their bottle, then they have to be tubed (gavaged) so they can get adequate nutrition to stay hydrated and grow. Every 12 hours the nursing staff rotates, and you never know what you're going to get next. Every nurse is assigned 3-4 babies, and every nurse has some different thoughts on how to feed the twins, and the best "plan" for them. Because of this constant change, we (with a very large amount of help from my parents!) have made a point to be there at EVERY feeding. We know the babies and are starting to learn what works/what doesn't.

Genevieve has been a champ with the bottle from the get go:


Jackson started out great,


but now has started struggling to get the bottles down. Apparently this is common with preemie babies - they get off to a good start, but don't have the energy to keep going. They're still learning to suck/swallow/breathe (and all in the right order!) and for a tiny baby that's a lot of work. One of the nurses likens each feeding to running a marathon for them - they're exhausted when they're done and if you make them work at the bottle for too long they can actually burn more calories trying to eat than they get from the bottle.

Anyway, we worked very hard with Jackson to get those bottles down, but he started getting too tired to handle it. It was a hard decision for me, but we ended up taking the advice of the Dr. and giving him a feeding tube. So now he takes a bottle every 6 hours, and we feed him the other bottles through the tube so he can rest and build up his energy. It felt like a huge step back to agree to the tube, but the poor baby wasn't able to handle bottles yet. When he's able to take the full amount for his bottles at every bottle feeding, then the plan is to wean him off of the tube.

The most exhausing part of the NICU is never knowing what's going to happen next. The doctors and nurses can't provide a guess as to when any baby will be able to go home, because it's not something they can predict with any accuracy. Babies can be eating well for a week and suddenly quit. Babies can be eating through a tube and suddenly it will "click" for them on how to use the bottle. They have no way of knowing, and so we just go from one feeding to the next. Every feeding feels like a high stakes game, where you're watching the clock and trying to get as much as you can down them before the 30 minutes are up and you see if they "pass" - if they're closer to home, or if they're perhaps getting a little closer to needing a tube.

I'm very thankful that feeding is the only reason the twinks are in the NICU, and that they are otherwise healthy - but I still can't wait for this experience to be over. I was discharged from the hospital yesterday and had to leave without them... I can't drive yet, so the logistics of getting back to the hospital for feedings is fun. My Mother goes over for a large number of the feedings (even at night!) and that has been wonderful. Even with that help, between trying to catch a little sleep, spend some time with Bentley, pump/pump/pump to provide a meager supply of breast milk, and then travel to and from the hospital to feed and hold the babies - I now have a great deal of empathy for any parent who has a child spend even a short amount of time in the NICU.