Are you home yet?

Yes. Ginger was released late this afternoon. Although we had been kicked out of the mom and baby wing, we stayed in the NICU with the girls until about 5:30 before heading home. We're back with Patrick and Charlie, all sleeping in our own beds for the first time since Tuesday. It's good to be home. Patrick and Charlie were thrilled and relieved to see us.

The lead nurse in the NICU moved the girls to the NICU East after we'd left. We consider that a promotion from NICU North, even though they'll be receiving all the same care in both places. Primarily it's a space issue because they keep having births at CPMC.

The IVs will come out once they're eating 33 ml at a feeding; right now Evelyn is at about 16 ml and Anna is still less. That's still a little bit away, obviously. The temperature probes seem to have disappeared. Another benchmark passed!

We didn't get a chance to speak with the social worker about transferring to Peninsula. I think perhaps the social worker doesn't have any weekend shifts, and asking to speak to her yesterday probably would have come off as pushy. Anyway, we're supposed to find her on Monday when we're in the NICU visiting. One of the NICU neonatologists seemed to think there were no medical reasons why they couldn't be released to Peninsula's step-down NICU as early as Monday. Notice the use of the adjective "medical"; we've been warned that HMOs don't like to pay for transport merely for the convenience of the parents. And the problem with twins is that they present twice the transport costs -- there doesn't seem to be a bulk rate on ambulances. So we'll cross that bridge when we get to it.

Anna Mouse

Evelyn Kitten

What's new this morning?

They're being weaned from temperature probes this morning. Temp regulation seems good. On the downside, Evelyn had an apnea last night. It's not the end of the world, but it's a definite break in the unrelenting string of good news.

Ginger's going to be talking to the doctor this morning. She'll probably be released, and this is one of a vanishingly small number of scenarios where being released from the hospital is utterly depressing. We hope there are in-rooms available, but we're not optimistic.

On whose Feast Day were they born?

Excellent question -- the one on everyone's lips!  As it turns out, July 31st is the feast of St. Ignatius of Loyola, founder of the Society of Jesus.  An added bonus is the fact that St. Ignatius Church was in view of Room 206 during our entire labor, and was beautifully lit at night.

Why do you keep saying "preterm" instead of "premature"?

Because that's what the people at CPMC say, and what, all of a sudden you know better than them?  Actually, it makes sense when you think about it.  Even a term baby is hardly "mature," and it's all a matter of whether the child has reached an ordinary gestational term, not whether it is "mature" or "premature."  "Preterm" has the benefit of being more accurate, and perhaps sounding slightly less judgmental of the baby.

How have Patrick and Charlie been in all of this?

Great.  They've been with Christine and my parents.  Charlie occasionally asks a question here and there, but is mostly just okay with the whole thing.  Patrick was clearly pretty worried about us when we had to leave in a hurry -- did we mention that this happened on Patrick's first day back at school? -- so it's taken some reassuring to get him to calm down.

Both of them have visited the NICU.  They've met the girls.  Patrick even patted them in their isolettes.  He's clearly in love, which is great.

Where are you going to stay during the NICU time period?

Don't know yet.  Right now Ginger hasn't been released, but that could happen as early as Saturday.  If so, CPMC provides "room in" services on a space-available basis.  The problem is that CPMC is in the middle of a baby boom, and we even had to wait for a recovery room following delivery.  It was also hinted that CPMC might not have had capacity to take us on Wednesday at all, but our perinatologist pulled rank.

If the girls look like they'll be at CPMC for a while, we might just get a hotel room in S.F., or Ginger might do so and I'll commute.  We'll see how it plays out.

Are they going to stay at CMPC?

Are they going to stay in the NICU?  Yes.  Are they going to stay at CPMC?  Possibly not.  The same folks that run the NICU at CPMC provide a "step-down" NICU at Peninsula.  This means that if Anna and Evelyn can prove they don't need a higher level of intervention, they can be transported to Peninsula and be provided the lower level of care there.  We're hopeful that can be accomplished in less than a week.

What kinds of care are they getting?

1. An isolette, which provides warmth and also monitors their temperatures.
2. Probes for heart rate, respiration rate, and oxygen saturation.
3. A feeding tube.  This is meant for specialized infant formula, but can be used for breastmilk if the mother has begun producing and pumping (as we have).
4. An IV, by which they are given primarily glucose to speed weight gain, an occasional vitamin to supplement any deficiencies, and a course of antibiotics if needed.

That's pretty much it.  Other babies have oxygen masks or are intubated or have more interventions.  Ours don't.

When can they come home?

Don't know.  Lots of people have been told that babies typically don't leave a NICU until they have reached the equivalent of their natural term.  That would put us at September 20th.  However, we're told that this benchmark is not actually used.  What we were told by the pediatricians at CPMC is that they need to meet three benchmarks for release from the NICU:

• Ability to moderate own temperature.  This is an unknown for our girls.  It's typically related to weight.  Our girls are about half the size of many term babies, so this might take some time.
• Ability to gain weight from nutrition by mouth (i.e., no feeding tube).  Again, technically an unknown, but we have reason to be optimistic, since both girls took a bottle today.
• No apneas.  This means that the babies will have to prove they are able to suckle a bottle and swallow the milk without any pause in breathing.  Preterm babies are known for sometimes forgetting to breathe, since at this stage in the womb they don't need to breathe at all and the breathing they do is a matter of practice.  Now, of course, it's a matter of life and death.  However, the girls both began breathing spontaneously at delivery, which is encouraging.  They also haven't shown problems on their monitors.  So we're hopeful this will not be an obstacle for long.

On the other hand, this does not seem like a good area in which to be overly ambitious and to press for early release.  The purpose of the NICU is to simulate additional development time in the womb, and they will benefit from that.

Are they in any kind of danger?

Not really.  Thirty-two weeks is fairly close to the safety zone, since the NICU has done some amazing things with kids with much lower gestational ages.  Add to this the fact that our girls are proving to be relatively advanced for 32-weekers.  I'm not kidding about this.  Modesty prevents me from mentioning that Anna actually showed a suckling instinct today that we were assured shouldn't show up until 34 weeks gestational age.  They take after their mother, who was always a better achiever.  Both Anna and Evelyn took bottles of formula today even though tube feeding is de rigueur in the NICU.  Christa and Jen (each of whom had reason to know) both assured us that 32-weekers would look monstrously large compared to others in the NICU, and they were proven right.

Is there anything we can do to help?

Thank you for this question, which all of you have asked with real sincerity.  My first answer is that you can calculate the tuition at your favorite college or university, roll it forward to 2026 at 8%, and pledge to support one or more of them in our "Adopt-a-Twin" program, for which operators are now standing by.

Whether or not you pledge financial support, the best answer is "not yet."  Being the parent of a child in the NICU is absolutely bizarre.  You're mostly irrelevant to your child's care (with the exception of pumping colostrum and breastmilk, which I note is a duty for which none but Ginger have volunteered themselves).  We expect that things will begin to resemble a normal birth when the twins are released entirely from the NICU.  We'll certainly need your help then, but until that time, we honestly don't need much more than prayers.

Are they identical?

Almost certainly not.  We've never cared about the answer to this one, but at various points the health care professionals told us it was unlikely but they couldn't rule it out.  (Apparently, the fact they were dichorionic and diamniotic was not dispositive of the issue, because all fraternal twins are dichorionic, but not all dichorionic twins are fraternal, or something like that.)  We also know that the weight differential at birth isn't enough in itself to rule it out, nor is their apparent differences in appearance (which might be attributable, we are told, to weight alone).  We heard a rumor that they have different blood types, which would be a pretty conclusive answer to the above question.

Can I visit them?

Yes.  They're at the CPMC NICU, which is not an isolation chamber.  They're not sick, and they're not in danger.  They're being monitored because they can't be trusted to remember to breathe (they probably take after their father in that).

You'll need to scrub your hands and forearms as you enter the NICU, and you must be accompanied by one of us.  Two guests at a time are allowed at the bedside, and since we have two bedsides our visitor quota at any given time is four, not including Ginger and me.  (It's one of the perqs of having twins.)  Unfortunately, if you're a kid, you can only enter the NICU if you're a sibling.  We discovered this rule the hard way.  But feel free to come by if you're trekking up to S.F.