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Posts tagged ‘premature’

Consumer ALERT–> FDA Bans “SimplyThick” Breastmilk Thickener

SimplyThick

Does anyone use this product in your

NICU??

Did you use this product for your baby?

This product is used to help thicken feedings of breastmilk or formula for infants with swallowing issues or even to help with reflux.

Some Preterm Infants have become ill with a serious condition called NEC (Necrotizing Enterocolitis– where the lining of portions of the intestine become inflamed, lack adequate blood supply and subsequently, parts of the intestine can die). This particular problem is most often found early in the premature baby’s life before discharge home.

“To date, the agency is aware of 15 cases of NEC, including two deaths, involving premature infants who were fed SimplyThick mixed with mothers’ breast milk or infant formula products. “

Symptoms to watch for:

  • Bloated distended abdomen

  • Bloody stools

  • Vomiting greenish tinted milk or

  • green fluid

If you see any symptoms like this, please

contact your babies doctor and get

prompt medical attention.

Read more:  FDA ALERT

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Breastfeeding Evolution amidst the NICU Technology

 

 

Powerful Skin to Skin

Evolution

I love babies. I love being a nurse.

I love all the evolution of technology through which I have practiced. I love how I have had to continually evolve myself. I love helping mothers help themselves, advocating for them and their infants, facilitate when needed to support them making their own choices and watch as they evolve….. becoming the best mother they can be!

I know I haven’t blogged lately and it is because I have been having a bit of a rough transition… my latest evolution…  in my new NICU job. Orientation is somewhat difficult for me. I had previously been arriving at work already at the top of my game (for the last 25 years or so) and I have now found myself a student…. every. single. day. It is almost like I have gone to a totally new facility! EVERYTHING seems new or different. All new equipment/monitors/procedures/policies/protocols/doctors/practitioners/and staff.

The babies are the same. Since some are much more preterm than we have cared for in the past… their issues are more complex. Some are the same as we have always cared for, but with neonatologists now on board, the approach to the care of these babies is evolving.

I am unlearning some of what I have always known and relearning things in new ways.

Evolution

I was able to prepare and submit the mission statement and policy on Breastfeeding for our NICU population. The neo’s are extremely awesome on breastfeeding or breastmilk feeding promotion and support! So we have a very good start for breastfeeding support in our new unit. Excellent actually! I am happy to report that since opening our unit, most of the babies thus far have had a total exclusive diet of breastmilk or fortified breastmilk! I think that is fabulous! There have been some moms who after discussion and encouragement to provide breastmilk, wished to formula feed and their choice was supported without further discussion or question. My new co-workers have been very professional about that. There were a few who provided colostrum initially and then decided not to continue. This was also supported.

Coming from my previously comfortable world of lactation in the full term nursery, I find myself on a journey to find a balance between technology and nature……  precision, absolutes and finite accuracy vs the inconsistency, variables, and imprecise intake of an infant at the breast. We are calculating daily the actual fluid and kcal energy intake of each baby and comparing that with the kcal/fluid requirement per kilogram of weight. Changes are then made accordingly. Most of the preterm population is unable to take in their required fluid and caloric needs solely by mouth. Most have parenteral nutrition in the form of a glucose/ Amino Acid protein and Lipid (fats) at first by a central line or an IV (TPN) and gradually switch over to taking all their requirement by their GI system (Enteral). They don’t have the stamina to take it by sucking/drinking and they require a nasogastric (NG) tube so the remainder of food can go in by gravity or feeding pump (gavage feeding).

 

NG tube

I actually love learning all this. I thrive on having a detailed clear clinical picture of my patient. I am very detail oriented which is a good thing. Because of this precision, the measurements and the calculations—> actual breastFEEDING is not often seen until much later in the game. I understand this. I do. I want so much to be very helpful at transitioning to full feeds at the breast. I have to wrap my head around it each time (all the while being a student in all other aspects of the infant’s care) researching how to best advise each mother. We range from visits every other feeding to visits once or twice a day. Skin to skin is the most powerful tool I can use when faced with limited exposure or opportunity. Sometimes when the mom is arriving for my patient, I’m involved in other things and unavailable to do anything other than providing some private skin to skin time. Encouraging any licking, suckling or other feeding behaviors at the breast during gavage feeds is also good. When the baby gets more and more ready to take oral feeds… what I’ve seen so far is that they are already preferenced to the bottle nipple. The weight gain has been established, the precision of measurement seems to have become slightly less rigid. It seems that there is adequate physician support to encourage full feeds at the breast. There are hundreds of experts out there who have gone thru this, and reorganized policy and procedure to protect breastfeeding in the NICU.

I have to evolve myself again and re-learn more about transitioning to feeds at the breast before the bottle becomes a primary feeding implement. Once I can  find my footing- I hope to be strong and confident enough to start teaching moms and my co-workers.

Breastfeeding is NOT an exact science!

I need to figure out when the exact science of Neonatology can accept that….

into the feeding plan for each individual baby!

Our new NICU policy–>Breastmilk IS our babies food!

Yes! This HAS been accepted!!!


Here is an excerpt from our NEW NICU policy:

Policy Statement: It is the policy of the NICU to provide all mothers with factual information regarding the superior nutritional, immunological and therapeutic beneficial effects that human milk and breastfeeding will have on the health outcomes of their preterm or sick newborn so that their feeding decision will be evidence based. The healthcare professional has an ethical responsibility to avoid withholding information because of any unfounded concerns that informing mothers of research-based options may make them feel guilty if they choose not to breastfeed. The mother’s informed decisions will be totally supported and her infant will be provided nourishment in accordance with her decisions.  All mothers should be considered breastfeeding candidates until they specify intent to bottle feed.

Purpose: To promote and support human milk as the preferred method of providing nutrition. Provide assistance to the mother in establishing and maintaining breastfeeding.

Policy:

  1. Any mother desiring to breastfeed or provide breastmilk for her baby will be given consistent current and correct evidence-based information, emotional support and encouragement she may need to reach her individual goals. Healthcare professionals will avoid conveying information based on any personal breastfeeding experience as it may not be appropriate or applicable in discussions with mothers.
  2. Mothers may be asked/encouraged to temporarily pump/express and provide colostrum for their infant’s immediate protection and health needs regardless of their feeding choice.
  3. The mother will be involved in all feeding plans as soon as possible.
  4. All NICU infants will be fed according to their nutritional requirements as ordered by the physician.
  5. Early trophic feedings of colostrum/milk to stimulate intestinal maturity will be utilized as ordered and when there is colostrum available. It is beneficial for infant to wait a day or two until colostrum is available to maximize the transfer of protective components. Colostrum should be given to infant in the order it was pumped.
  6. Oral care/ mouth swabbing will be done using colostrum/ breastmilk.
  7. A multidisciplinary approach involving the physician, NICU team, the mother and a lactation professional to develop an individualized feeding plan will be utilized as soon as feasible in accordance with each infants requirements and feeding abilities.
  8. Cue-based feedings will be encouraged and utilized as soon as possible. All mothers will be provided educational information and encouraged to understand and participate in reading their infant’s feeding cues.
  9. Kangaroo care and/or skin-to-skin will be utilized and encouraged as much as possible..
  10. Stable premature infants should be allowed to go to mother’s breast during gavage feedings to ready infant for transition to breastfeeding.

Etc etc etc……………………………….. much more……………..

The policy I submitted was written using Marsha Walker’s  “Breastfeeding Management for the Clinician. Using the Evidence” as a major guide. I think I even used her words a lot. (Seriously-who can say it better?)

YAY! Thank you to my team and thank you Marsha!

DUE TO REPEATED REQUESTS FOR THE WHOLE POLICY… HERE IS WHAT I HAVE… I HAVE INCLUDED THE REFERENCES

 

Policy  Statement:      It is the policy of the Special Care Nursery/NICU to provide all mothers with factual information regarding the superior nutritional, immunological and therapeutic beneficial effects that human milk and breastfeeding will have on the health outcomes of their preterm or sick newborn so that their feeding decision will be evidence based. The healthcare professional has an ethical responsibility to avoid withholding information because of any unfounded concerns that informing mothers of research-based options may make them feel guilty if they choose not to breastfeed. The mother’s informed decisions will be supported and her infant will be provided nourishment in accordance with her decisions.  All mothers should be considered breastfeeding candidates until they specify intent to bottle feed.

 

Purpose:         To promote and support human milk as the preferred method of providing nutrition. Provide assistance to the mother in establishing and maintaining breastfeeding for optimal growth and development.

 

Policy:

  1. Any mother desiring to breastfeed or provide breastmilk for her baby will be given consistent current correct evidence-based information, emotional support and encouragement she may need to reach her individual goals. Healthcare professionals will avoid conveying information based on any personal breastfeeding experience as it may not be appropriate or applicable in discussions with mothers.
  2. Mothers may be asked/encouraged to temporarily pump/express and provide colostrum for their infant’s immediate protection and health needs regardless of their feeding choice.
  3. The mother should be involved in all feeding plans whenever possible.
  4. All SCN/NICU Infants will be fed according to their nutritional requirements as ordered by the physician.
  5. Early trophic feedings of colostrum/milk to stimulate intestinal maturity will be utilized as ordered and when there is colostrum available. It is beneficial for infant to wait a day or two until colostrum is available to maximize the transfer of protective components. Colostrum should be given to infant in the order it was pumped.
  6. Oral care/ mouth swabbing will be done using colostrum/ breastmilk.
  7. A multidisciplinary approach involving the physician, SCN/NICU team, the mother and a lactation professional to develop an individualized feeding plan will be utilized as soon as feasible in accordance with each infants requirements and feeding abilities.
  8. Cue-based feedings will be encouraged and utilized as soon as possible. All mothers will be provided educational information and encouraged to understand and participate in reading their infant’s feeding cues.
  9. Kangaroo care and/or skin-to-skin will be utilized and encouraged as much as possible..
  10. Stable premature infants should be allowed to go to mother’s breast during gavage feedings to ready infant for transition to breastfeeding.
  11. Promoting non-nutritive suckling at mother’s recently pumped/drained breast will be encouraged whenever applicable. Although pacifiers are not routinely used for healthy term breastfeeding infants, preterm infants in the Special Care Nursery/NICU or infants with specific medical conditions may be given pacifiers for non-nutritive sucking.
  12. Feeding at the breast will be introduced as soon as possible for those sick or preterm infants as they improve and display appropriate feeding readiness cues.
  13. Supplementation, complimentary feedings and use of alternative feeding devices including nipple shields will be individualized in accordance with the multidisciplinary feeding plan above. (#7)
  14. Human milk fortifier may be indicated and will be added as ordered by the physician.
  15. Breastfeeding Policy  #6250-OB-B-3 and Breastmilk Collection and Storage Policy #6250-OB-B-3A will apply wherever applicable.
  16. If a mother is unavailable for feeding and/or has chosen to pump and store her breastmilk for infant feedings, she will be provided with written pumping instructions. These pumping practices to maximize early production and volume include:
  1. Begin pumping within 6 hours after delivery whenever possible (as clinically indicated by infants and/or mothers medical condition). Early and frequent pumping in the first week is crucial.
  2. Double pumping with high quality hospital grade pump (or pump which cycles 48-50 times/minute and with vacuums not exceeding 240mm Hg.)
  3.  Simultaneous pumping with properly fitting flange and added breast massage yields more milk and higher fat content.
  4. Pump at least 6 times in 24 hours (100 total minutes/day). Mothers pumping at least 8-12 times in 24 hrs yielded higher milk output.
  5. Evaluate any mother’s concerns over low milk volume promptly to promote maximal adequacy of milk expression.
  6. A mother may be encouraged to use the breast pump at the infant’s bedside as a means to increase milk production.
  7. Collect milk in plastic tightly lidded containers (ie Snappies) which are self labeled by mother with infant’s name, date of birth, MR#, date and time milk was pumped.
  8. Freshly expressed milk that can be immediately given to infant provides optimal protection factors.
  9. Milk must be promptly stored in the refrigerator if it is to be used within the next 48 hours.  Breast milk may be placed in the freezer for 3 months or in a deep freeze for up to 6 months.  If the infant is preterm or a sick term infant, frozen breast milk should be used within 3 months, however, it is preferable to use outdated breast milk as opposed to artificial milk.
  10. Mother should transport her milk to the hospital frozen in a cooler with an ice pack.  Thawed breast milk must be used in 24 hours.
  11. If milk brought by the Mother is thawed, it must be placed in the refrigerator.  It cannot be refrozen.

 

 

References:

Bakewell-Sachs, S. and Brandes, A. (2003).  Nutritional Management. In Verklan, M.T. and Walden, M.  Core Curriculum for Neonatal Intensive Care Nursing, 3rd Ed. St.Louis,MO: Elsevier Saunders.

Crosson, D.D and Pickler, R.H. (2004). An Integrated Review of the Literature on Demand Feedings for Preterm Infants.  Adv Neonatal Care. 4(4): 216–225.

Dougherty, D.  and Luther, M. (2008). Birth to Breast—A Feeding Care Map for the NICU: Helping the Extremely Low Birth Weight Infant Navigate the Course. Neonatal Network. (27) 6.  Pp 371-377

Kirk, A.T., Alder, S.C., King, J.D. (2007).  Cue-based oral feeding clinical pathway results in earlier attainment of full oral feeding in premature infants:  Cue-based oral feeding clinical pathway.  Journal of Perinatology (27) 572-578.

Meier PP, Engstrom JL, Patel AL, Jegier BJ, Bruns NE. Improving the use of human milk during and after the NICU stay. Clin Perinatol. 2010 Mar;37(1):217-45. Accessed via PubMed July 17 2010

Walker, Marsha (2011). Breastfeeding Management for the Clinician- Using the Evidence 2nd ed. Jones and Bartlett, Sudbury MA

For Expectant Families… your “Due Date”…

Hi everyone! Happy New Year!

I have been very very busy over these past months and I’ve spent very little time on the computer….. many of you have had the same situation. Thanks to all of you who keep checking my blog anyway!

I’m here now to talk about one of my big concerns.

Your due date…

Every single year around the holidays, we have a surge of elective, social induction requests.  Here are some comments we occasionally may hear each year around this time on an L&D unit:

“Please, please induce me so I can have the baby and be home for Christmas…please!”

“I’m only 2 1/2 weeks from my due date anyway so I’m ready…”

“I can’t have this baby on Christmas day..I just can’t…you HAVE to help me!!”

“I’m so tired of being pregnant and I have so much to do…can’t you do SOMETHING and make me have this baby today??” (37weeks)

“I really really need another tax deduction this year… ” (heard quite often!)

“Please do something so this baby is born by the end of December…I’ll even have a C/S if you want.”

“Can you induce me while my family is all here?? Please??”

Young pregnant women~ Please don’t do something crazy for a special delivery date.

Please!

Please educate yourself about the risks of induction and the risks of late preterm births.

PATIENCE

“A little patience now adds up to long-term health benefits for your new baby.”

I have received this following information from the Mother-Friendly childbirth community.

I felt it was well worth sharing……..

This is an excerpt from a newsletter from the CIMS ~ Coalition for Improving Maternity Services.

Please read, check out their website link above and the other resources listed below the letter.

Thanks so much!

“For Expectant Families

What you need to know about your due date and late preterm birth

A little patience now adds up to long-term health benefits for your new baby.

You’re not alone if you’re secretly (or openly!) hoping that your baby will get here sooner rather than later.  But when it comes to your due date, it’s important to understand what it represents, what it does not represent, and the potentially serious consequences of agreeing to an induction or c-section before your baby is ready to be born.

Mayri Sagady Leslie, CNM, MSN, clinical faculty at Yale University School of Nursing, recently penned an insightful post for Lamaze International’s Science and Sensibility blog.  In “Beyond Due Dates: How Late is Too Late,” we’re reminded that, despite widespread belief that EDD stands for ‘due date’, it actually stands for ‘estimated date of delivery’!  Mayri writes, “No matter what you call that date on the calendar, it is nothing more than a formula derived from statistical averages which says that sometime within a range of 4-5 weeks your baby will probably be born.  Smack dab in the middle of that range is one of days on which the labor may start.  Yet when it comes to dates in our life, few take on more significance than this one.”

Appreciating this fact is something of considerable consequence when it comes to the immediate and long-term health of your baby.  There is mounting evidence that only the baby should have the right to choose her/his birthday.  Two recent reports add to this evidence.

The CDC’s National Center for Health Statistics recently reported a 20% increase in the nation’s late preterm (34 to 36 weeks ) birth rate from 1990 to 2006.  The report also cites alarming increases in the number of late preterm births among births for which labor was induced as well as among births that were delivered by c-section.  The report cautions, “…it is becoming increasingly recognized that infants born late preterm are less healthy than infants born later in pregnancy.  Late preterm babies are more likely than term babies to suffer complications at birth such as respiratory distress; to require intensive and prolonged hospitalization; to incur higher medical costs; to die within the first year of life; and to suffer brain injury that can result in long-term neurodevelopment problems.”

March of Dimes 2009For the March of Dimes, prematurity is an extremely important public health issue.  The March of Dimes launched a multimillion dollar, multiyear campaign in 2003 to prevent premature birth and raise awareness of its serious consequences.  Last month, the March of Dimes released its annual Premature Birth Report Card.  Sadly, for the second consecutive year, the U.S. earned only a ‘D’ grade, “demonstrating that more than half a million of our nation’s newborns didn’t get the healthy start they deserved.”

We know you’re anxious to meet your baby.  It’s perfectly understandable too if you’re just plain tired of being pregnant.  We just want to remind you that a little patience now adds up to long-term health benefits for your new baby.

Learn more:

  • Beyond Due Dates: How Late is Too Late” by Mayri Sagady Leslie on Lamaze International’s Science & Sensibility blog.
  • Born a Bit Too Early: Recent Trends in Late Preterm Births” a NCHS Data Brief from the CDC.
  • U.S. Gets A “D” For Preterm Birth Rate” press release from the March of Dimes.”
  • America Scores a “D” on the Premature Birth Report Card

    _

    Hello Everyone

    I haven’t disappeared… I’ve just been too busy outside for computer time!

    This is a copy of a letter I received today trying to

    spread the word

    about Prematurity in this country……

    Today is the release of the second annual Premature Birth Report Card, and I wanted you to hear the news from me: America receives a “D.” As a country, we are failing to give our babies the healthy start they deserve.

    Your state has received its own report card. I’m afraid you’ll agree we have a long way to go. In fact, before the end of this year, more than half a million babies will be born too soon, some very sick.

    It’s Prematurity Awareness Day® — the day when we’re all focused on the terrible toll of premature birth on babies and families. The report card reminds us how urgent the problem is. But with the support of people like you, we can continue to fund lifesaving research and programs.

    If you haven’t already, I hope you’ll visit our Web site and join the fight for preemies.

    Warmly,

    Dr. Jennifer L. Howse

    President

    WBW~ Breastfeeding in a Personal Disaster…. C.Michael’s Story

    SendPicture14 August 2nd…..Today is my son’s 24th birthday. Yeah…I’m old 😉 This is not really the theme of WBW but I will take this opportunity to tell his breastfeeding story on his birthday.

    In 1985, I gave birth to my second son. C. Michael. He was 37 weeks and behaved like many     near term babies… Breastfeeding got off to a slightly delayed start but then was awesome and without problems! Yay!

    I wish C. Michael’s physical health was the same way.

    C.M. was born with craniosynostosis.  Specifically, saggital craniosynostosis. Infants skull bones are purposely NOT fused together at the time of birth so the head can mold as baby makes his way down the birth canal and into the world. The different skull bones will overlap easily along the suture line so as to fit thru the pelvis. These bones then gradually reshape and the sutures eventually fuse.

    My son’s saggital suture line was prematurely fused…causing a misshappen head. When there is a premature fusion, the growth can only occur parallel to the fusion. The saggital suture goes from the anterior fontanel along the top of the head to the posterior fontanel. Parallel growth would cause his head to be really oblong, or football shaped.

    We took him to 5 doctors to decide if we would have corrective surgery… Yes that’s right…. it had to be OUR decision. Although this is a birth defect and causes a visual deformity, it does NOT affect healthy brain function UNLESS there is fusion of more than one suture and growth is impeded. So it is cosmetic surgery.

    We decided to go ahead with the surgery at age 3 months and had everything arranged at CHOP (Children’s Hospital of Philadelphia). The craniofacial team was amazingly supportive. I was so very scared. My husband and I could not sleep. I hadn’t been able to sleep well since he was diagnosed. How many new mom’s tell you the baby is sleeping but they can’t sleep??? I’m not going to get into the whole surgical procedure… but the  main point of this story is how breastfeeding not only provided C.M. with the best nutrition and immune system protection, it also saved me thru my son’s ordeal.  My husband was able to pre-donate blood so we both felt like we were doing everything physically possible as his parents to help him tolerate and recover from this major surgery.

    I was so pleased to be able to sleep right next to him in the hospital. We had to go in the night before and the he was not allowed anything after 4 am… he could nurse up to that point. I woke him to nurse around 3 am. It was very bittersweet. I was crying and he was happily nursing, not know what was coming next. It was difficult just to see the IV placed, let alone the actual surgery.  I was so grateful and happy they had done alot of pre-op procedures the night before when I could nurse him after each study. Now , when they wheeled him off to the OR, I was almost happy he had been slightly sedated because as hard as it was, I could never have handled him screaming at that point.

    While he had the surgery, I headed first to the pumping room to try and get as much milk stored as possible. I had not been able to pump well before this so I had limited expectations. It was the first time I had used a hospital grade pump so I had much better volume than I expected. I stored a couple bottles and was feeling actively involved in his recovery already!

    They called us to meet him outside of recovery a couple hours later. It was very difficult to see his head swollen and heavily bandaged. He had had a blood transfusion once already in the OR and they expected he would need more. Apparently the bone edges ooze when cut.  We took turns with him until he wasn’t groggy any more, then, once awake…. I rarely left him.  I was told he had to have a little bit of an electrolyte solution in a bottle first before I could nurse him, just to make sure he didn’t vomit.  He was ready to nurse in about another hour. They took him out of the crib, with his massive head bandage, black and blue eyes and 2 IV lines….place him in my arms and we gently rocked and nursed.SendPicture12

    I felt completely lost, even as a nurse or especially as a nurse…. because seeing your child like that is very difficult. I kept thinking all the worst possible complications would happen to him. I wanted to keep him safe, protect him. I struggled with tremendous guilt, thinking I must have done something to cause this to happen… It must have been my fault.  Many parents go thru that, I’m sure. Breastfeeding him thru the hospitalization, two more blood transfusions and recovery period helped me feel like I was actively healing him. My husband felt similar thoughts because they used his blood for the first 2 transfusions. It was an empowering feeling.

    I’ll close by saying that finally being finished with the decision process, the surgery completed (sucessfully I’m happy to say) and on the recovery road also cured my sleeplessness.

    The night nurses at CHOP laughed at me! There I was, sleeping right next to my precious brave 3 month old post-op son…and they had to wake me up to tell me he was crying to feed in the night.  😉

    What a handsome guy now!

    What a handsome guy now!

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    No Prenatal Care? …..What are YOU Hiding??

    No Prenatal Care is usually a symptom of something--hiding some type of underlying problem. Sometimes it's very ugly. The most common encounters we have involve illicit drug use during pregnancy. We need to develop a comprehensive Maternal and Neonatal Drug Screening protocol to protect the newborn.

    Read more

    Tuesday Twins

      A Few 70’s Twins Tales

    • It was Autumn 1975 when she arrived on the unit in labor. She stood close to 6 feet tall and was very very pregnant. She knew she was having twins. Twins were usually diagnosed after a mom grew larger than dates and by finding two fetal heartbeats. I had never seen someone that big! I was amazed she could even walk. She was taken to a labor room for the standard prep and SS enema (3H..High-Hot and a Hell of a lot). They did an abdominal girth: 60 inches…. that’s 5 full feet! We did not have any U/S to check fetal position. We relied on our exam and assessments. If the first twin was head down (vertex), that was all that mattered for the moment. Labor progressed and when she was close to crowning, she awkwardly and with a great deal of difficulty, maneuvered over to the stretcher and then once again, across the hall, moved onto the delivery table. She was asking for anesthesia. They provided that with some nitrous oxide or something by mask. The first baby was born spontaneously. A boy!! a BIG BOY! He weighed 9 LBS 6 oz! Wheeh! The doctor checked the 2nd baby’s position and it was vertex and moving down. I think they used some low outlet forceps and within 3 minutes, the 2nd baby was born. A girl!! An even BIGGER GIRL! She weighed 10 LBS 7 oz! Both were strong, vigorous and pink.
      The placentas were delivered and Pitocin IV given (a Pit Drip we called it). She had no complications I can remember. These babies were just the biggest twins I had ever seen or ever did see so far…;-)

      How about you? I have a poll on this page…please answer! I’m interested in your twin stories.

    • The young wife of a prominent local attorney arrived with her mother-in-law to be admitted to the labor room for delivery of her second child in the late 1970’s. She was about a month early, 35 – 36 wks. Her husband was away at a conference. Her belly was pretty big for her small frame. The doctors were all quite concerned about the size of the baby and how it would fit through the birth canal. They decided to send her to X-Ray for Pelvimetry. They would take films and measure the internal size of the bony pelvic inlet, spines and outlet, the compare those with biparietal diameter of her baby’s head. The film showed TWO baby’s heads, not one! Surprise! I’ll never forget the phone call the dad’s sweet refined little mother had to make to her son. She maintained her composure…”Thurston dear, we are at the hospital. Elizabeth is in labor, dear……..yes dear, I am quite aware that she isn’t due yet….Thurston dear, there’s more….. You are having twins darling……..Are you alright dear?? Yes..they are all fine…. we’ll call you back soon. See if you can come home, dear.” Elizabeth and Thurston (names changed for this story) became the proud parents of identical twin girls by vaginal delivery later that morning.

    • One of our OB staff nurses, Sue, had a sister having her third baby. She had 2 boys at home and everyone was hoping for a girl. Nobody ever knew the baby’s sex before the birth back then, unless you had an amniocentesis for medical reasons. Even then, many moms did NOT want to know and it was written on the chart that way. The mom’s labor progressed very quickly and soon she was in the delivery room, her sister Sue at her side. I was designated to wait outside the DR and let all the anxious staff know if it was a girl..
      I couldn’t wait after I heard the baby crying. I peeked in- there was a little 5 pounder squirming on the Kreiselman! It was a boy! The doctor was saying “Check the belly—check the belly, I think there is another one!” Sue was huddled over her sister trying to help calm her while reaching back to hold oxygen oven the baby’s face. I came in to help. Quickly after that, another baby was born! Again, a squirming 4 or 5 lb baby boy! Surprise twins! Everyone was quite shocked! Sue was then holding the one oxygen mask over both babies together while hugging her sister. The boys turned out to be identical and quite handsome young men as they grew up.