2 WEEKS OLD!

Get your tissues out...
I got to hold Sammy today! I've been waiting 14 days to hold any of my babies!!!

In preparation for Sammy to come off the vent in the next few days, they switched him to a different vent that monitors how much breathing is actually his and how much is the vent working.  Because of this, he has a little less tubing and Nurse Donna said if he was stable throughout the day we could try skin to skin care.  We got the blood work back mid afternoon and we were a go.  I got to sit holding him for a little over an hour.  

He did great, and Donna was able to lower his oxygen input to the lowest it has ever been.  It is amazing how the human body is meant to help a baby stabilize and thrive. He also did all the things a baby is supposed to do to breastfeed which is encouraging since preemies don't always evolve to feeders since they have a long delay before their first available moment.  Because they are still on small specific amounts of feeds, I am not allowed to let them feed as that would be comparable to eating 6 gallons of milk in one sitting. :) 

Here are a few more pics... (notice he is wearing Judy's homemade 'apple' hat!!!)

Also, it is funny to note that the entire time Sammy cuddled with me, both Elsie and Danny had almost identical stats of heart rate, blood pressure and oxygen saturation percentages.  The nurse said this is common with multiples, and is wicked cool in my eyes.

Until Elsie and Danny come off the jet vents, I won't be able to hold them, but it won't be long, and it will be just as enjoyable!

I really thought this would be a super emotional experience and I would cry the whole time.  I've been struggling with some Postpartum this last week times 3 and it seems everything else has made me cry.  I tie my shoe. I cry.  I eat my turkey sandwich.  I cry. I blow my nose.  I cry. Miguel keeps reminding me that pumping should be enjoyable.  I cry. Ok maybe I should be crying about that one! All this crying is utterly ridiculous, but the doctor said to expect this as I am technically losing 3 pregnancies at once and all the hormones that go with them.  But holding Sammy was so exciting and unexpected that I couldn't help but just be elated the entire time. And I felt great the rest of the day as well. 

The doctors think Danny might have a little pneumonia in his left lung, so we are doing some cultures and x-rays to treat that.  Thankfully, it doesn't appear to be bothering his comfort level, and he continues to stabilize and enjoy nap times. He also likes to be the surprise pee and pooper when you are in doing his diaper change.  He got Mommy good the other day when he pooped in one direction and shot up pee in the other at the same time.  Glad he is in an enclosure or that could've been messy on Mommy!  Here are a few highlights from the last few days :)

Miss Elsie is doing well also, and will most likely jump directly to the Cpap setting in the next 1-2 days.  This will mean she will be extubated and we will hear her when she cries.  She is also done with light treatments, so now she gets to show off her pretty eyes all day. The boys each have both eyes open now too, but not this wide, and not as alert.

 

Can't believe they are 2 weeks old today!  Another milestone!  Looking forward to the next one!

Hands, Feet, Eyes, and Mouths!

So what is more difficult than trying to get the hand prints and foot prints on 3 micro preemies?  Not much I say, not much at all.  They were fairly cooperative with their feet, but holding all 5 fingers out on each 1lb 10oz baby was challenging to say the least.  Patience was the key and Miguel proved to be more patient than them.  And me. :)

So we now have a total of 4 eyes open...67% of the way there!  Sammy and Danny each have an eye open and Elsie is leading the charge with both open for several days now.  We've been taking lots of pics trying to catch an eye fully open, but they are quick little rascals!

All babies are increasing feeds every day.  Sammy is almost at a full feed and we can see his body plumping up.  He gets 11ml every 4 hours.  Danny is in a close second with 10ml every 4 hours, and Elsie is up to 4ml every 4 hours.  Because she was smaller at birth, her stomach and intestines were not as fully developed and she just needs extra time to get there.  But the fact that she is taking 4 and not spitting it up and still pooping are all signs of progress.  I put pictures of their boards from today to see their current weights.  Danny is getting close to 2 lbs (900 grams=2lbs)

The doctors and nurses continue to wean down their ventilators so that the babies are challenged to do more breathing on their own.  Baby steps here in order to be successful. Feeding and ventilators are still the main focus of the doctors until each baby is off the vent.  Sammy tried to get off the vent on his own today when he decided to pick up his head and turn it to the other side.  This was no easy feat!  He probably has double his body weight in tubes to pull with him.  Apparently he was determined.

Enjoy the pics (since that is what you are all here for)  ;)

Miss Elsie Mae's prints & goggles that are retired now that she is done with light therapy.

Daddy with Elsie

Elsie with both peepers open and a fancy new hat the volunteers made.  Hopefully Judy's carrot hat will fit soon! 

Elsie's board today at what would have been 26 weeks

Mom and Dad with Sammy 

Dad and Nurse Donna getting Sam's right handprint

Sammy's board today

Sammy resting peacefully :)

Danny during care time

Danny giving the touchdown arms

Danny's board today - 800 grams!  

We were given an Edible Arrangement and the card reads 'For the fruits of your labor'

Ups and Downs

The first 72 hours of life, the doctors say the babies go through a 'honeymoon' phase.  This meaning they don't realize they are out of the womb, and so their vitals stabilize.  After this, the babies will experience some minor setbacks as they adjust to learning to do everything on their own outside the womb.  We have seen this a bit the last 3-4 days as they get a dip in body temp, or drop in oxygen when they are awake and getting care.  Alarms go off and it is a little nerve wracking, but it usually resolves quickly.   It appears they are most stable during the resting times between care which happens every 4 hours (1 hour of care, 3 hours of rest).

Because of this, all 3 babies now are on the 'jet' or 'oscillating' respirators.  This ventilator shoots small steady bursts of air into their lungs instead of a big, regular breath.  So they look like their little chests are vibrating.  The doctors say this mode of delivery is less invasive and can minimize the inflammation caused by respiratory therapy.  The doctors say the next 1-2 weeks they have but one mission and that is to get all 3 babies off the ventilators.  Miguel and I are hoping all 3 babies are cooperative participants in this plan.  Only time shall tell.

Both of Elsie Mae's eyes are officially open.  YAAAAA!  Sadly, she is still on photo light therapy and therefore wears her sunglasses all the time so we don't always get to see them.  Danny is opening the corner of his left eye in the last 24 hours, and we are hoping to see his little peeper soon as well.  He does this eyebrow raise to try to open it that is so adorable.  Sammy has zero interest in opening his eyes as this would mean he would need to be awake more and he thoroughly enjoys his sleep.

Feeding has increased in all babies, and they each get milk every 4 hours.  Sammy is now eating 9ml each feeding, Danny eating 8ml each feeding, and Elsie eating 3ml each feeding.  As long as each baby continues to tolerate feeding (no spit ups and consistent poops), the doctors add 1-2 mls everyday at rounds.  This is fantastic and will bulk up the babies a little.  We have seen the effect already as yesterday all three babies hit their birth weight again!  (on average babies lose 20% of their weight in the first week and then work back up)

Tuesday is day 10 of life, and now that they just hit their birth weight we are going to get their hand prints and foot prints done.  I am looking forward to doing that when we get to the hospital today.

I really want to give a shout out to my most amazing husband.  Miguel is driving us back and forth, packing and carrying numerous bags in and out of the hospital daily, enforcing rest times for his stubborn wife, setting up and cleaning up my pump parts every 2 hours, walking all visitors on and off the NICU floor all day, doing all the baby laundry the hospital sends home, learning about every machine and term associated with the babies so he can ask the right questions and know the settings, standing guard over all 4 of us for the 12 hours a day we are in the NICU, participating in the rounds with the doctors every morning, and anything else he feels Superman would do in this situation.  I really don't know what I'd do without him.  I am so blessed <3

Here are some pics :)

Danny enjoying his tummy time (look at that bum!)

Danny trying hard to open his eyes 

Elsie showing off her peeper

Elsie loving her light therapy.  She goes from all curled up to completely sprawled out when the light hits her.  She will be a beach girl I think, thankfully she has Miguel's skin.

Sammy loving his nap time :)

This little doll is a sock.  It is thicker than Sammy's body, and almost as long. I will continue to use this as a size indicator :)

ONE WEEK OLD!

Another big milestone!  As of 9:30 Saturday the triplets have made it through their first week of life!  This is fantastic news and we keep reminding ourselves this is a long haul and everyday they are here and progressing is really the main focus.

Lots of updates from the last 2 days:

ELSIE GETS HER OWN ROOM- On Thursday night they moved Elsie into her own room.       The first 5 days all 3 were together and it was challenging to move in the room it was so crowded.  The doctors suggested moving her directly across the hall so each baby would have adequate space needed for emergency or procedural equipment should they need it.  At first this was a little scary, because I want them to be with each other, but now that it is done, it is wonderful.  It appears the nurses have more space to do their jobs  and it is easier for Miguel and I to be at each isolette without feeling we are in the way or preventing the nurses from doing what they need to do.  Also, I now feel confident that if there were an emergency that they would have enough room to get in quickly.   Miguel has made sure that all of Elsie's decorations moved with her to her room so that she feels cozy in her own space (He is such an awesome Dad!).  The doctors have said that in a few weeks when they start coming off machines they can be reunited.

NEW VENTILATORS - each baby has moved off of their original ventilator onto new ones. This is not really an improvement, just a new mode of delivery to break the cycle of the same ventilator from day 1.  Being on a ventilator causes inflammation and eventually leads to damage in the lungs.  Also, many babies adjust to the ventilator settings and they are less effective.  This is the case for Sam, who has figured out in order to eat and sleep more to his own schedule, he can 'ride his ventilator'.  He does this by allowing the machine to do the most of the work, and then taking a breath every now and then to keep the alarms at bay.  Miguel told the nurse he is going to give him a kick in the ass to make him stop being lazy (did I mention how much I love my husband?).  Miguel has been watching all the settings on the ventilators and talking to the doctors and nurses to understand all the details involved in ventilator breathing.  The next step is no ventilator, and even though there is no timeline for when that will happen, we are looking forward to having them remove the tube in the mouth and being able to hear our babies cry for the first time.

ELSIE THE PIRATE - ARRRRG!  One fantastic highlight on Friday was when Elsie opened one eye and looked right at her Mommy!  Her other eye started to crack open slightly today for Daddy, but she is still looking very much like a pirate with one eye squinting and one eye opened.  We were over the moon ecstatic to see that little one eye looking back at us this early, as the eyes don't normally open till into week 26.

PICC LINES - another major hurdle is converting all the babies over to PICC lines.  At birth the doctors use the umbilical cord as an entrance to delivering all the IVs.  They take 3 veins from the cord and insert 3 IVs that can deliver fluids, nutrition as well as draw blood without constantly sticking them.  This is great as it is non-intrusive.  However, this method only lasts 7-10 days before the cord starts to break down as a natural process after childbirth.  Now the babies must have a surgical procedure to insert an IV into a main artery.  A needle is inserted in the arm, and then a tube is placed through the needle and fished up the arm, takes the turn at the armpit and moves toward the heart into a main artery.  These PICC lines will also not last forever as the placement of the tube moves as they grow, but is a semi-permanent solution to getting poked with needles multiple times a day.  Danny was up first, and had a successful procedure on Wednesday.  Elsie Mae was next and had a failed attempt on Thursday night as they could not get the tiny tube to round her right shoulder.  They tried again yesterday in the other arm and were successful.  Sammy is up tomorrow or Monday for his.

FEEDINGS - all the babies are moving up in their milk intake and frequency.  This is great because it will add much needed calories to their diet and help them grow and be able to be stronger for any complications.  Mom is working hard pumping around the clock to make a large enough supply to grow 3 hungry babies.

We are starting to see some minor setbacks with the babies, which makes for an exhausting day emotionally, but Miguel and I are keeping each other together and strong.  The doctors thought Elsie could come off her ventilator and we agreed to let her be challenged to breathe on her own.  Then she waited until all 4 doctors came in the room to start the procedure and SHE FLIPPED OUT.  Set all of her alarms off, her oxygen level dropped, unsteady breathing and apnea, flailing her arms and legs, for a seemed-like-eternity-but-was-really-only-5-minutes episode.  One of the doctors turned to us and said 'So the great thing about babies is that they don't need to be able to speak to tell us what they want, and she DOES NOT want this'.  She made it clear she was not ready to breathe on her own and I'm glad she voiced her concerns because the next 24 hours were overwhelming to her body with the failed PICC line procedure.  She is rather opinionated I must say. :)

                                                             PIRATE ELSIE

                                                  SAMMY AND DANNY'S ROOM

                        DANNY FLEXING HIS MUSCLE SHOWING OFF HIS NEW PICC LINE

                                                    SAMMY PLAYING PEEK A BOO

                                             ELSIE HOLDING HER BREATHING TUBE

              MOMMY GOT TO HOLD DANNY WHILE THEY CHANGED HIS BEDDING

                                          SAMMY NAPPING WITH HIS BLANKET

The NICU routine

We've made it through Day 5!  Miguel and I are getting comfortable with the Neonatal ICU and the team of doctors and nurses in and out of the triplets' room.  They have invited us to sit in for rounds each morning and we have taken advantage of that, learning all of the acronyms and lingo.

Sammy is settled in nicely. He continues to be the overachiever and is now using 'room air' with his ventilator. This is great news that his body is developing enough to process the oxygen breathing in and CO2 breathing out without the mecanical devices doing it for him.

Danny has become more stable over the last few days, and is caught napping peacefully on his side cuddling his homemade body pillow set up by nurse Donna.  He is still secretly our trouble maker and likes to surprise pee during diaper changes and reach in his mouth and tug on his tubes.

Elsie continues to surprise everyone, even the doctors in her rapid improvement. She has stabilized her weight (she now weighs the most!) and her nervous system is finally welcoming touch (which mom and dad love!) so we can sooth her when she fusses. She is still on light therapy and loves to sunbathe. 

All the babies hit another milestone today by having their first poop. This means they are able to process the breast milk through the stomach and intestines and all are working properly.  After losing a little bit of their birth weight,  all are sitting around 1lb 7oz. You can see on the boards they use grams to weigh them. An average baby at delivery is around 3000 grams.

The NICU nurses amaze Miguel and I with their dedication to our babies and the genuine love they have for their job. They had us bring in blankets from home which they use for the babies bedding, and set up our room with decor from the nursery. We cannot thank them enough for caring for our whole family.

So now that I've been discharged,  Miguel and I travel back and forth to Dartmouth each night. As unbearable as it is for us to leave the babies, the doctors have told us to expect to be in the NICU until mid January. Therefore, we must establish a routine that gives us the most time with the babies while allowing us to rest so that we are physically and emotionally ready to handle all the ups and downs we will face.  We often leave before 7 and return after 8.

Many of you have offered help and we are so grateful.  My cousin Sharon asked to share her contact info with all of you. She would like to start a 'dinner train'. You can email her at smgavon@verizon.net or call her at 774-271-0018 for more info.

We are so blessed to be starting Day 6 with babies that continue to improve!

Miss Elsie Mae sunbathing (no tan lines please!)

The daily boards:

Danny side sleeping

Dad checking Sammy's temp

Mom and Dad with Danny as he gets a bedding change

Elsie wearing Daddy's wedding band on her arm and holding Mommy's in her hand (sometimes the pictures make them look bigger than they really are, I will try to include size indicators as they grow)

Day 3 and moving forward!

Some quick updates on all the new changes in the first 3 days. 

Sammy is now 'showing off' by using a binkie to sooth himself, and he even advanced to tummy time in his isolette. (I included a pic below!)

Danny not to be outdone, also fussed until he got tummy time as well. He loves to suck on cotton swabs of milk and will direct the swab with his hands to the perfect location. He is being treated with light therapy to help with jaundice, and competes with his brother in the 'who can get the wettest diaper' contest.

Elsie demonstrates her fiery personality by reaching, waving, kicking, and trying to force her eyes open when she hears our voice. She also continuously sticks her hand and fingers in her mouth (no binkie needed for me Sammy!)

Miguel and I now have several care routines we participate in which are the highlights of our day. We were ecstatic to be able to feed all 3 of our babies some breast milk via a tube! We didn't expect that milestone till next week!

I will be discharged tomorrow and then our new routine of finding balance between the NICU and home will be upon us. Can't wait to see my pups tomorrow (my other babies!)

Thank you everyone for all the support!

Sammy, Danny, and Elsie make their debut!

What a weekend! Miguel and I got a surprise Friday night when Elsie's water broke.  Off to Women and Infants in Providence, where we spent the first 10 hours in Labor and Delivery monitoring and preparing for possible early delivery at 24 weeks 3 days. Once the babies and I stabilized they moved us out of L&D to a regular room, and we met with several doctors who had hopes of hospital bed rest and delivery in 8-10 weeks. 

Alas, this was not meant to be,  as we made it only 20 hours into our stay before I went into sudden accelerated labor, and less than an hour later we welcomed Samuel Joah, Daniel Michael, and Elsie Mae Castanheira into the world on September 28th at 9:30, 9:31, and 9:32pm via emergency C-section.  Both the boys weighed in at 1lb 11oz and Elsie at 1lb 9oz. Both very scary and very exciting at the same time!

Here is an update on how the first 24 hours went:
     Miguel was able to see all babies before they left the OR.
     He spent the next 2 hours with me in recovery and then we were able to visit the babies together briefly while they worked on stabilizing the babies at 1am.
     Miguel got a good report from the NICU nurses at 6:30 am saying that all 3 had good heart rates and although they all required a ventilator, none of the babies needed additional oxygen to sustain breathing.
     We both got to touch our babies for the first time this morning at 9:30 am. Although they are all too small to hold,  we can reach in each isollette and cradle each baby while soothing them with our voices.  It was wonderful!
     We had a busy day full of visiting family and friends, paperwork, medical exams, post op care and meds for me, as well as meeting with doctors and getting updates on all 4 of us.
     We can see the babies at anytime, and are working with the NICU nurses to maintain a healthy schedule of visiting and letting the babies rest to optimize the health of babies and Mommy. 
     At 9pm tonight we not only celebrated an important milestone of making it through the first 24 hours, but Miguel and I were able to participate in Danny's care by changing his diaper and taking his temperature...it's the little things!
    Although we are prepared for the numerous set backs we may encounter in the next few weeks and months, we are thrilled that each of the babies are holding their own and stabilized. We are keeping all thoughts positive!
   
As we settle on for the night we are grateful to all our families and friends for their loving support!  We really are so blessed. 

I will update the blog often in the next few weeks because it may be difficult to individually connect with many of you. 

Here are a few pics of our tiny precious ones in their first 24 hours.  First photo is Sammy, 2nd photo is Danny, and third is Elsie.

Triplet Shower

We had a beautiful day last Sunday at our shower.  Our friends and family went above and beyond all we could hope for to make this such a special and memorable day.  Miguel and I are humbled and grateful to have such wonderful people in our life.  Here are a few pics...

22 Weeks..Only 10 weeks to go!  Time to organize and await their arrival!