Weight trend (update).

Anna

• 7/31: 3 lbs 8 oz
• 8/10: 3 lbs 11 oz
• 8/20: 4 lbs 10 oz
• 8/25: 4 lbs 13.5 oz
• 8/29: 5 lbs 4 oz
• 9/2: 5 lbs 15 oz
• 9/8: 6 lbs 1 oz
• 9/15: 6 lbs 13 oz (up 12 oz in one week)
  

Evelyn

• 7/31: 4 lbs 4 oz
• 8/10: 4 lbs 5 oz
• 8/20: 5 lbs 5 oz
• 8/29: 6 lbs 3.5 oz
• 9/2: 6 lbs 14 oz
• 9/8: 7 lbs even
• 9/15: 7 lbs 14 oz (up 14 oz in one week)
  

Evelyn has now surpassed both Patrick and Charlie's birth weights at full term, and she's still five days shy of her term. Anna is on a pace to match Patrick's full term birth weight by the time September 20th arrives.

How are Patrick and Charlie doing?

They're both fine.  Patrick is still smitten with the girls, and Charlie mostly follows his lead.  His adjustment issues at first seem to have died down; he's no longer being contrary just for the sheer hell of it.  (Patrick, on the other hand, is exactly as contrary as he always was.)

We made an odd discovery recently.  We think Charlie may have a photographic memory for certain things.  The way we know this is that he's constantly telling us what people were wearing at significant moments.  He's recently been very focused on clothing, particularly men's clothing, and he's especially interested in belts -- who wears them, and when.  As another example, he told me what shirt I was wearing when we picked Patrick up from camp months before.

And then today he asked whether it was okay to wear a tie with a short-sleeved shirt.

As we all know, a truthful answer to this question is complicated.  Some people do, but it's not exactly something I would encourage -- "live and let live" is my motto.  But I answered "no," for simplicity's sake, and to explain why he would never catch me wearing one.  His response was, "The man in 'Rio' wears a tie with a short sleeved shirt."  And so he does.  (Fast forward to 3:44 if you can't stand '80s music videos.)

We're currently looking for ways to capitalize upon this skill.  Maybe he'll grow up to be the first person kicked off "Project Runway" for plagiarism.

Can you recommend a good car seat for twins?

I was just about to ask you the same question, because the answer on this end is "no."

The car seats on which we had blown hot and cold are severely in the "cold" column right now. I don't want to bore you with the details, but then again, if you've been following this blog you clearly have some time on your hands, so here goes.

We selected a stroller and infant carrier combination on the basis that the stroller was the "Twin Sport" and was labeled as "Compatible with the Combi Shuttle." However, you find out when you read the manual (conveniently located inside the box) that this particular stroller is compatible with one Combi Shuttle, not two. The side-by-side stroller configuration is designed not to accommodate two infant carriers, which seems to belie the "Twin" nomenclature.

Never fear, say we, we'll just install the car seats into a universal infant seat carrier until they're big enough to sit in the stroller without the infant carriers. But then we discovered that the Shuttle is not compatible with any of the twin universal infant seat carriers. The various latching mechanisms that secure it to the base are proprietary. This fact is also omitted from Combi's marketing materials.

So we called Combi and asked for suggestions. "No problem," they say over the phone. "Our Counterpart 2 tandem stroller will accommodate two infant carriers! Just return the Twin Sport and get yourself a Counterpart 2!" Okay, "Counterpart 2" is a little less intuitive a choice for infant twins than "Twin Sport," but we go online to look. And indeed it appears you can install two infant carriers in a Counterpart 2. There's even a YouTube video demonstrating how it all works. But Ginger noticed something weird on Combi's website. It said it would accommodate a Shuttle infant carrier in the front. So what was the car seat in the back? It was a Combi Connection, an entirely different model car seat sold by Combi. In other words, Combi designed a stroller that will accommodate two different infant carriers, but has no stroller solutions that can accommodate two of the same model. Needless to say, the Shuttle is the most popular and widely available car seat offered by Combi, but God help you if you buy two of them. This seemed too insane to be true.

We called Combi again, and were directed to a supervisor. He admitted that Combi had no solutions whatsoever that involved twins in the same car seat model. Essentially, he said the store should have pointed this out to us, and alternatively that we should have paid better attention to the specific phrasing on the stroller box: "Compatible with Combi Shuttle." Notice: Not "Shuttles," plural. Ah, good one. You sure got us there, Mr. Customer Service Supervisor. And what about the word "Twin" on the box, which generally tends to imply plurality to the English speaking world? Well, he said, it was always possible to unbelt and remove one of the babies from the infant carrier and place them into the stroller without the car seat. "Works just fine," he said. "Used it myself, with my two kids," he said. Oh, you have twins? "No," he said. Do you see the flaw in the use of the word "Twin"? Can you market a car seat to parents of twins that is horrendously matched to the actual experience of removing twins from a car and placing said twins into a stroller, and how that experience of twins might be different from your own experience when one of the children is, in fact, a toddler, and therefore by definition not a twin of the infant in the infant carrier?

Exasperating.

By the way, my wife pointed out to me after the fact that Combi is not an Italian company. It's based in Carol Stream, Illinois, but is owned by a Japanese company. I hereby retract all aspersions by implication against Italian designers, and am proceeding forthwith to buy myself a used Fiat 124 Spider, which, it turns out, is just as capable of accommodating two Combi Shuttle car seats as the strollers manufactured by Combi International Corporation.

So, the question remains: Can you recommend a good car seat for twins?

How are the girls doing?

Fine, thanks for asking.

Our last weight check was on Monday. They had gained only 3 and 2 ounces respectively since their last weight check six days earlier, which was a disappointment. In thinking through the possible causes for the fall-off in weight gain, we realized a few things may be at play:

• At the last weight check, their gains were so good that we were told we could let the girls direct the nighttime feedings -- feed them when they wake, and there's no need to wake them on strict three-hour schedules. Well, obviously they couldn't be trusted. In the week between the weight checks, mean time between nighttime feedings would stretch to four hours, then five. Eight daily feedings turned into seven, or perhaps even six. So we cracked the whip on them and now we're back to waking them up to eat, which means less sleep for us but more food for them.
• At the suggestion of the lactation consultant, we switched nipples from "fast" to "painfully slow." Sixty ml feedings that once took ten or fifteen minutes, tops, were now stretching to 45 minutes. And the girls would just tire out and give up, sometimes leaving as much as 20 ml of the bottle to go to waste. Anna in particular was hard to get to finish a bottle with the slow nipples. To remedy this, we switched to another set of nipples that seems to be a happy medium between too fast and too slow.
• Anna picked up some kind of nasal congestion, probably from Patrick. This may have put her off her feed a bit.
• In combination with these three factors, we had substituted two breastfeedings for two bottle feedings. I think this may have been okay had it not been for the other factors. But overall the girls were expending more energy in return for fewer calories, and that's why they weren't gaining the way they should.

If you ask me, and in a sense you did, all signs are pointing toward a much bigger weight gain at their next appointment on Monday. And in the non-food department, both girls are showing all signs of good health.

Another note of thanks.

A few days ago Ginger pointed out something I hadn't really thought about.  At both CPMC and Peninsula, we knew the day shift nurses pretty well, and the evening shift nurses too.  And we always took the opportunity to gush to them about how grateful we were for the entire NICU staff.  Because we had to go home to the boys every night, and (unlike some, who were able to room in at the hospital) we didn't visit the girls in the middle of the night.  And that means that there was an entire shift of nursing staff who cared for our girls every night and early morning, but whom we never even met.

Now that we're the ones caring for Anna and Evelyn between the hours of 11 p.m. and 7 a.m., the full import of this is sinking in.

Whoever you were, thanks.

So, they're still fraternal, right?

Right.  We think.  Or, now I should say, we assume.  Weeks ago at CPMC we were told they had different blood types, which pretty much settled it.  And we weren't going to pay for zygocity testing, so we were pretty certain we could leave it at that.

But at the doctor's on Tuesday, the nurse checked the chart again and mentioned that they're both B negative, just like their mother and their maternal grandmother.  This is the second rarest blood type in the U.S., second only to AB negative.  So it's good that we have some people in the family who are available to be harvested for any emergency blood transfusions.  If something happens to Ginger, we can tap into the twin of our choice for her.  An added bonus is the fact that I'm AB positive, the third rarest, also known as a "universal recipient," meaning that I can accept transfusions from any blood type.  It's essentially the complete opposite of a universal donor (O negative).  Because my blood already contains both A and B antigens and the RhD antigen, I can accept blood from pretty much anybody.  (People who know me well are already nodding, saying, "Yeah, it figures.")  So in the event of an emergency, I can already tap into Patrick or Charlie at my option.  Still, it's good to have a couple of kids who can help Ginger out if need be.

A few years back we were on a road trip and stopped at the In-N-Out Burger in Rohnert Park.  A fire engine was parked outside, so after our meal I took Patrick and Charlie outside to see it while Ginger straightened up our table.  An elderly Hispanic woman who had been sitting a few tables away approached Ginger, and said, "You must try again.  For a girl.  Someone who will care for you when you are old.  Boys will not do this."  She must have been psychic or something, although I doubt she could see either the twin thing or the blood type thing coming.

By the way, back to the whole fraternal/identical thing, we know they look nothing alike.  It's as plain as the nose on Evelyn's face.  But the nurses and doctors all say "Not necessarily," which seems to undercut the meaning of the word "identical."  Whatever.

What was new this past week?

You might have noticed that the posting volume on this blog has decreased.  This is because our life now runs on a three hour cycle, like the tides.  (Assuming tides change every three hours.  If only there were a way to find out -- some kind of searchable interconnected set of computers containing such information.  Memo to self: invent this and make money off it.)

The first week and a half of having the girls at home together resulted in a kind of rhythm.  It definitely requires two people, but it can be done.

A bit of that changed on Thursday.

We met with our lactation consultant.  This sounds like a made-up job, but it's not -- it's deadly serious.  She did many things, all of them helpful, and then she prescribed a course of blessed thistle, goat's rue, and fenugreek seed.

Regular readers of Bambine al Dente will assume that the foregoing paragraph is some kind of punchline, the kind you've come to expect of me.  I assure you it is not.  Each of these is a traditional herbal remedy to increase milk supply.  If you look up the Wikipedia entry for "galactagogue" you'll find a list of some of these herbs.  You will also find the statement that "[c]linical evidence for their efficacy is often lacking," which is a refreshing dose of skepticism by Wikipedia's standards.  This being Wikipedia, of course, another article vouches that one of them can increase breastmilk supply by 900%, which beggars belief, since if one did so, one would quickly be shanghaied into the dairy industry and never heard from again.

Whether or not there is clinical evidence, there is some anecdotal evidence, and if there's one thing I came to learn in helping (ha!) Ginger breastfeed our two older children, it is that you do not cross La Leche League ever.  You cannot even make breastfeeding jokes in their presence, and trust me, that's a shame because many breastfeeding jokes are hilarious.  These people have the power to make you disappear from the face of the earth.  Oh, and they're also really nice, as long as you agree with them that you Will.  Breastfeed.  Your.  Children.  Which we did, so we're cool, right?

Anyway, fenugreek is a spice and it's been used since ancient times.  You can find the capsules in any health food store.  Take enough of it, and your urine will begin to smell like maple syrup.  Which is nice, because who wants their urine to smell like pee?

Goat's rue is an invasive weed.  Apparently there's a survival guide that says that it can be used as a fish sedative.  Keep this in mind if you find yourself in the wilderness with a handful of goat's rue and some hyperactive fish on the hoof.  Like many medieval technologies, it's served up in a tincture -- you put a drop under your tongue.

Blessed thistle is an herb about which there is nothing interesting to say, except its name, which sounds like a mild swear word.

I'm focusing on the hippie-dippy crunchy granola aspect of the lactation consultant's advice, which is fun but totally unfair.  She is a medical professional, and she acted as such.  She gave us a lot of good information and help, and it's all working by degrees to keep the milk supply up.  We're talking about the wisdom of the ancients that used to be passed down from mother to daughter, but got lost some time after the invention of powdered infant formula.  Now there is an entire profession dedicated to keeping this knowledge alive.  So the techniques and herbal medicines that the lactation consultant recommended are invaluable.  You can't put a price on that kind of wisdom.  Oh, wait, you can.  $150 an hour with a two-hour minimum.  And yet I'd pay it twice if it gives us healthy babies.  Maybe even three times.  After that, don't push it.  I've got college tuition to think about.

What does this all have to do with the rhythm of the household?  Everything.  Because aside from the new age medicines, the lactation consultant also pooh-poohed our bottle feeding techniques.  Which is fair, because we're rank amateurs when it comes to bottle feeding.  Since we exclusively breastfed our boys, and because Ginger was at home full time (or at worst working very part time), we never had a lot of need for pumping and bottle feeding until now.  And now it's every moment of every day.  We had been using the bottles and nipples that the hospital gave us for free.  Bad idea, says the lactation consultant.  The hospital uses those nipples because they are really convenient for the nurses -- i.e., they're fast.  Milk actually pours down the baby's throat, and she has to gulp to keep up.  If you want to transition to exclusive nutritive breastfeeding, you need to train your baby to work harder.  The baby needs to earn its meal.

So she put us on a course of super-slow nipples.  This, in turn, has extended the time it takes to feed one girl from ten minutes flat to something more like 30 or 40.  And we're supposed to periodically interrupt the feeding by tilting the liquid away from the nipple to give them some non-nutritive sucking time, which they'll need to be familiar with also.  So if both of us are home, every three hours we're in for about an hour's worth of work -- or an hour and a half, if the person on duty needs to do both girls.  This has vastly expanded the time it takes to feed them.  It's all for the good, I know, but still a serious bummer.

Finally, the lactation consultant happened to mention that preterm infants are frequently quite easy to please, at first.  Feed them and they'll sleep, because developmentally they're still in utero.  When they reach term age, they'll act more like normal newborns.  So our sweet, easy little angels are only that way for a brief time, and then we might see some fussiness.  I told you I might regret posting about how "doable" this whole project is.  That day of reckoning might come sooner that I had thought.