Pain Management and Delivery

A friend of mine, another American living in Germany permanently, recently blogged about homeopathic pain management. She wrote about being offered Arnica, a homeopathic pain pill, while in labor at a German hospital. As if these people had never heard of an epidural?

I know. I know. It's a beautiful process. It's so much more rewarding to go through it naturally.

For the first five or six hours maybe.

My first labor took 48 hours. Intense for 12. Then it stopped for 12. 12 more intense. And then the REAL part. I was totally prepared to do it naturally. I was adamant I would not need drugs. But when they strapped me to all the machines, the permanent stress test, and forced me to lay on my back indefinitely, all bets were off. Where was the bouncy ball? The walks along the hall. A warm water bath maybe? Due to earlier complications in the pregnancy, a femoral deep vein thrombosis at week 28 and subsequent anticoagulant therapy, noone was taking any chances.

And strapped to your back, with no ability to move, is NOT natural childbirth.

Funny enough, they never asked ME if I wanted the epidural. They asked the baby's father, now my husband. After an hour of telling him that we would never be married, that the child would never have his last name, and that if they had to end up doing a C-section after all of this, then they might as well tie my tubes while they were in there, the nurses asked HIM if HE would like to have me sedated. What a relief!

I was a little loopy at first - they really don't mess around with that stuff in the USA - but it allowed both of us to enjoy the experience; we still had about 6 hours to go at that point.

So, I NATURALLY opted for an epidural the second time around as well. (24 hours total labor, 12 intensive in the hospital) This time the doctor wasn't sure she could accomodate me due to my blood values - I still wasn't clotting - but she gave me a dissociative drug until the lab work came back. Okay - that was a really cool, legal drug experience. I felt the pain, but it didn't bother me at all. Hence the term dissociative: your spinal nerves receive the incoming pain signals, but they don't get transferred to your brain. Totally interesting.

I'd heard about the German aversion to pain medication during delivery, so naturally I was psyched I would be an exception. I'd need an epidural, even though I was delivering "naturally", just in case we needed a rush C-section at any time. In went the needle; I was a happy pro at this point. Interestingly, the Americans put the epidural in during a contraction, so that you are concentrating on the pain of the contraction and won't notice the needle. The Germans wait til the contraction is over so that you can concentrate on it. Whatever. I remember telling a little Asian-American anesthesiologist that I loved her, really and truly, during devliery two.

So. The needle is in the third time. And I'm still feeling the pain. A lot of it, in fact. I take the trouble to explain to the nurse that she is going to have to put some medication INTO the needle if it is at all going to work. "Didn't you practice your breathing?" she asks. This with that smug, holistic German superiority. "No, I did not practice my breathing." I less than patiently replied, "This is my third delivery, I am delivering twins, and I want my drugs." She took a look at Aidan's head trying to force itself out of the 6 cm dilation in my cervix and goes, "ooh...that does look like it might burn a little." "Pull out the catheter right now." I directed Damon in English. "Why?" he asked. "Because I am going to pee all over that lady if she doesn't listen." Apparently she understood English. I got my epidural. (Although I ony had 6 hours of intense labor this time around.)

Later, after pushing Matthew out in the breach position, causing a three layer tear that took 2 months to heal - because, you see, episiotomies aren't natural either - the nurse had the nerve to smugly come by and say, "See. That wasn't so bad now was it?" Come to think of it, the tear was probably caused by Aidan's head coming out before the medical team was assembled, with the student-nurse frantically holding it in so that he wouldn't come out before the doctor came in. (We had a similar situation with our first, but the doctor made it in with Coke can in hand, ready to catch the baby in the other.) In the case of twins, it was approximately 10 obstetrical and perinatal doctors and nurses who had to sprint down the hall, some rushing in after Aidan was already born, to handle the second shift.

Wipe that smug smirk off your face. When we tell you the kids come fast, we mean it.

I'll be honest. The German delivery was the nicest I had, maybe because I was less sedated. I actually felt Matthew come out, the first of four, and it was cool. Since he was breach, I had to sit up and I had to watch. I was way more of a participant than with the other three.

And I do feel the USA is rather careless in it's use of pain meds during pregnancy. I had a severe deep vein thrombosis with Ryan, and initially I did need some valium to withstand the pain. We later switched to Percusset, again because I needed SOMETHING. And no, Arnica wasn't going to cut it. But the doctors never informed me that the medication could cause heart defects in my baby, never explained the need for the frequent cardiac ultrasounds that final trimester. And they delivered that Percusset like it was candy. I took it every 6 hours at first, waiting until the pain in my leg became so intense that I was sweating and clenching every muscle in my body. But I was liberally ALLOWED it every 3 hours. I weaned down to once a day and then switched to Tylenol after 2 weeks. But they would have kept dispensing the Percusset indefinitely.

Would I like to try delivering without medication? There are no guarantees. If I dilate fast enough - none of this 24 hour nonsense - I think it'd be neat. I'm not against a natural childbirth. I just think that, like breastfeeding and male circumcision (another BIG no - no here in Europe), there is no right answer. Hey - maybe we can just have Damon catch the next one, and not worry about the doctor making it into the room.

I'm just tired of being lectured to on natural childbirth by smug mothers six months pregnant .....and sipping a Mai - Tai.

HELP! (Twin Gadgets)

One of the fun parts of being pregnant with twins was looking through all the twin catalogs/twin websites and seeing what cool equipment you were allowed to buy.

Okay - buying the stroller, a new car and TWO new car seats wasn't all that much fun - too much money involved - but the little stuff was neat.

Looking back, I didn't use too much of it, but there are one or two that did make my life easier.

The double baby carriers weren't worth it. When we did use them, we used them singlely - with each of us carrying one baby. Two at once was just too bulky to make it useful. One COULD do it, but it wasn't helpful. I'd suggest finding two single baby carriers and using those; they are cheaper than the official double or triple version. (Yes, they did advertise carrying triplets - things that make you go 'huh'?)

I didn't use the twin leashes either. They were one of the first things I bought, figuring I was going to be out and about a lot. I did see one couple in Florida using them for their 18 month old boys, but they were each following one child individually, which to me kind of defeated the purpose of the whole thing. I just never found a practical application for them, although I love them in theory. Aidan was walking at 10 months and Matthew at 14 - something which is very rare with twins; generally they learn within days of eachother, especially identicals. It worked out since I was able to keep up with Aidan while toting Matthew along on one hip. Also, I was able to leave Matthew on a blanket without great fear that he was going to go anywhere.

I stayed at parks and playgrounds where I was able to keep an eye out on everyone. There were more open parks and fewer playgrounds than with a single child since I wasn't able to follow them both up and down the slide. And they had more freedom to roam than a single child - with me running after the one who happened to be in the most difficulty at any particular moment. Precarious times. Hectic times. But I still wasn't able to figure out how a leash would work to my advantage.

The two things I did find indispensible were the twin feeding logs and the bottle holders. I used the feeding logs for the first six months, until I got the hang of a routine, and was sure that everyone WAS eating regularly. Really - whether you purchase them or make them yourself - these are a necessity with multiples. I carried them everywhere with me. And I also used them to jot down short notes and ideas I had at the time, the only way I remember some of those days in retrospect.

The bottle holders were the best investment I ever made. They are foam pads shaped to rest comfortably on your child's chest and to hold a bottle in position for feeding. They are La Leches's biggest nightmare. Not only are you obviously NOT nursing your child, you are also not resting quietly with your child while feeding it. Even less militant advocates than La Leche have qualms about the holders. Bonding and resting and spending time with your child are as important during feeding as the feeding itself. But, lets's face it - with two or more to feed, and others to care for, feeding isn't always as relaxing as it's cut out to be either.

Words of caution. Never leave a baby feeding unattended. Mine never had a problem pushing the bottle away when they were done, but the obvious risk of choking and/or drowning is there. I also didn't use them until the babies were over three months old. (To be honest, before that time, I don't think the holders would have stayed on their tiny little bodies.) The critical time period was the time from 3 to 9 months, when they were able to hold their bottles themselves.

I got a lot of looks - and laughs - at the two of them in the stroller with these huge, yellow cushions on their chest and two bottles sticking out. Did anyone criticize? Not here in Germany. My guess is you'd get more heckling in the USA, from self-righteous know-it-alls who have never had multiples, but feel they are experts because they personally nursed their two children, born three years apart, until they entered kindergarten.) I fielded some comments with the misgivings I personally had about not being able to personally, quietly feed my children. But for the most part, people were just amazed that I was managing with all four kids at all, and noone judged me for doing what I had to do.

There are also some specialized bottles made in England that you can place on the floor, put a pacifier-like plug into your child's mouth, and you don't have to hold the bottle either. These were something like 75 Euros EACH, and so I settled for the cushions. (The cushions are about 30 Euros each too, but totally worth it.)

A third item, the twin feeding cushion, was also totally essential, but not nearly as much fun. It took up half of the living room, was totally uncomfortable, and trapped me on th couch, upright, for feedings. But it was necessary to nurse, or even bottle-feed, two babies at once, alone.

I've got the baby carriers and the leashes ready - brand new - for the next person who'd like to try their hands at it. One of the bottle holders was lost at an amusement park just as the twins were getting ready to outgrow them, but I do have copies of the feeding log too. And I am more than thrilled to get rid of the feeding pad.

But really - check into those bottle holders. They are the gift of a second pair of hands.

Sleep Deprivation? First Thoughts.

I knew those twin logs would come in handy some day - and not just for feeding purposes. I remember being in awe (and I still am) at anyone who had managed to write one of the twins books I had devoured during my pregnancy. The best I could do was to jot down some notes on the log and hope that I'd have the chance to look back at them some day.

What was I thinking?

It's a blur now, but it's fun to see that most of my thoughts were positive - and that the thrill of parenting my two little guys vastly overshadowed the exhaustion.

The first 48 hours brought contradictory thoughts hourly - hormones maybe? Shock?

1. It's good that I already have two kids at home, so that I am better prepared to deal with this. A little naive maybe, but I still do think that having had experience parenting two children previously, kept me calmer and better able to cope than a new mother with two at once. (On the other hand, I had "grown-up" activities to deal with in addition to caring for the two babies.)

2. This is much better with two babies, than with one. One just seems so boring now. I swear to God, I thought this more than once, so take all the moaning with a grain of salt.

3. NOW I feel like a MOM, and not just some fat lady stuck at home with two kids. God bless maternal hormones; they'll get you through if nothing else will.

4. And then on midnight July 5 - I am DYING here, have had NO sleep, each baby has had two bowel movements, they are screaming and.....wow, finally the nurse came with pacifiers, some glucose, and an offer to take one of the kids to the nurse's station for a few hours. The nurse was summoned by one of the other mothers in the room, at her wits end only listening to the neverending battle going on in my corner of the room. The pacifiers were not MY idea, but something that the nurse INSISTED was going to be necessary with twins. Not a bad idea. Matthew used his 9 months and Aidan 18 months. I've never been a fan of pacifiers - but I am a fan of sleep.

Two days later, I'd learned a lot more.

5. At least I have learned not to bother TRYING to sleep. It is less frustrating that way.

6. Birds are not as cheery at 4:45 in the morning when you haven't slept all night.

7. I alternate between being jealous of the other moms - the time they have to themselves in comparison to me, and the ease of caring for only one baby - and feeling sorry for them. I have these TWO FANTASTIC PERSONALITIES to take care of.

8. Why is the woman with the C-section more mobile than I am? This because I was still trying to figure out how to get out of bed with two babies in my arms.

9. Once at home on July 11 I actually felt that I am playing house with two dolls. This is so much fun!

But the entry on July 9 is most astounding. I sleep more and easier with these two than I did with Andrew. Andrew was a monster - I was up with him 2 to 3 times a night for the first 7 months. I remember telling people that Andrew was a good precursor for twins because caring for two wasn't really all that much harder than caring for him had been.

And I realize only now - with my recent energy spurt - that I had been exhausted and depressed by the pregnancy for the last two months. I carried to 39 weeks with a dropping platelet count and was BEAT by the end. But who would have guessed that I had energy, and that I was having so much fun, that I actually didn't miss the sleep I wasn't getting at the time.

The July 9 entry also offers up an explanation for my twins' differing sleep and feeding patterns. Already I see them as two totally separate individuals. They don't seem to be at all like twins, or to be "the twins". It's like I just had two entirely different kids at once! They are fraternal twins, they still look nothing like eachother - and they are still as different as two kids can be. You wouldn't guess them to even be siblings if you didn't see them wearing the same outfits. And you would never believe that they have been exposed to the same parenting style and the same experiences.

I think it's awesome. I've read that fraternal boys are the ones least likely to exhibit that mysterious "twin bond", that they are way more competitive than cooperative. And maybe that's made it a bit harder. My guess is that identical twins, sharing the same DNA, would have similar sleep and feeding patterns early on, and similar play habits later on. Girls, in general, are supposed to be more cooperative, even with a male twin. Whenever I saw twin girls in the first two years, they always appeared to at least be running in the same direction.

Maybe I just have way too much time to think about it all now that I get a full night's sleep regularly.

Yesterday, I gathered the four kids around the table, and we planted seeds - just like I used to do when I only had the first two to contend with. Have I finally figured this whole mothering thing out? Far from it - but I do have my moments.

Sleep Deprivation - A Choice

That last blog on sleep deprivation wasn't totally fair. Turns out I am angry, in retrospect, at the lack of sleep noted in my logs.

At the time, I was so busy having a fantastic time with my two new dolls, that I didn't miss it at all.

Okay - that's an oversimplification too. The truth, as usual, lies somewhere in between.

I couldn't wait to have these babies. It was so cool - two at once - what could be better?! And we had so much fun with them. I do remember being tired, but also proud that I was doing as much as I was, doing it all and doing it well. I remember thinking how amazing it was that I was able to function on as little sleep as I was getting. And that - if you are doing something you love - you can do it no matter what. Sure - I was showing off a bit - but that's what kept me going all day. Those little guys were busier in the first few weeks of their lives than most babies are in the first two to three years.

They came home from the hospital on Friday, July 7 and were at the 100 Year Festival for the kindergarten the next day. They slept the entire four hours. Whose fault was it really that she wasn't home taking a nap while she had the chance? But I wanted to be there for the older two kids too.

On July 13, they wined and dined at a formal restaurant in Schlossplatz in Stuttgart to celebrate the opening of my husband's company's new office space. See. We can do it all. (This included climbing up 8 or 9 flights of stairs - to the loft space - less than two weeks after delivering two babies - because the elevators hadn't been installed yet.) On July 16 they went to their first animal park. On July 19 they hit the pool. (My mom was still with us at this point, so I had help.)

On September 8, when the twins were 2 months old, we flew to Mallorca (with help from Damon's dad). We got back in time for Ryan's first day of first grade - a major all- day bash that they naturally also attended. On October 13 we spent the weekend in Munich. We took advantage of the Christmas holidays to head to Strasbourg, France. (After attending every kindergarten and first grade and play group Christmas event in December) In April we saw Italy.

In retrospect, I figured I could give up or I could keep going. And I kept going. The older two kids didn't suffer. The twins didn't suffer. Damon and I suffered a bit - but no more than one is willing to for their kids. Let's face it - I could have stayed home, focused on a sleeping schedule, taken naps instead of heading to the pool - or to Italy for that matter. It was a choice.

I wouldn't trade that first year for the world. WE DID IT! And we did it well. Why I'm pissy now is beyond me. Maybe because I'm 40, stuck in a little apartment in a small German suburb, with 4 kids, and a figure that will NEVER look like it did at 30, no matter how many situps I do or how many miles I run.

Maybe I'm pissy because it's over.

Sleep deprivation and all - those were the happiest days - and nights - I can barely remember!

Sleep Deprivation and Multiples

I've been trying to find some useful data on the effects of sleep deprivation on the internet. Most of it is useless for my purpose - lots of prattle about how most of us today are so sleep deprived that we need 5 or 6 hours on the weekend just to catch up. Since the general rule of thumb goes that the average adult needs 8 hours of sleep a night, if you only get 6 or 7 a night during the week, you need those long Saturday mornings or your Sunday afternoon nap to catch up. Our society is apparently chronically overworked and over tired - all leading to debiliating effects physically, psychologically and emotionally.

When I look back on my first few months with the twins, I AVERAGED 3 to 4 hours of sleep a night - interrupted usually into spurts of 2 hours.

When I finally found a site I thought might be useful it explained that the ethics of sleep deprivation were such that carrying out research was impossible. (I'd suggest studying the mothers of new born multiples, not in jest, but as an area that really requires research and that would benefit future mothers of multiples.) "The effects on the human body and mind are so serious that researchers find it difficult to investigate sleep deprivation." (www.insomniacs.co.uk)

Mothers often joke that sleep deprivation is used as a form of torture. Ha ha. According to this same site, "Sleep is a stronger basic need than food and water. Simply, the human body cannot do without sleep."

And yet mothers of multiples do it for months.

Looking back on the feeding charts I had for the first 6 months, I am appalled and relieved at how little sleep I had. Appalled because it is humanly impossible to survive the way I did those first few months. Relieved because I am finally realizing where I lost myself.

The twins were born on July 4, 2006. July 5 was my first night with no sleep. July 25 was my second night with no sleep. In between I slept approximately 3 hours a night, with no naps during the day. On July 12, I note that I slept from 10 PM - 12AM and stayed in bed while nursing Matthew from 1 - 2AM. (From 12 to 1 AM it looks like I was nursing and caring for Aidan.) I then slept again from 4 AM to 5:45 AM. At 2AM I had been changing Aidan's diaper and at 3AM I was still trying to nurse Matthew and get him to sleep. Looks like Aidan was nursing again at 5:30 AM.

According to the site, "Few people ever experience real sleep deprivation". My Psych 101 professor at Cornell University was a sleep expert, and I remember something about requiring not just sleep, but REM sleep, in order to function - also that it took 2 -3 hours of UNINTERRUPTED sleep before you hit the REM stage.

Some nights were better. On August 4 Aidan slept from 11 PM to 6 AM and Matthew slept from 8 PM to 1 AM and then again til 5:30. That gave me 4 and a half hours of UNINTERRUPTED sleep, to make up for the nights when I'd had less.

During the day I had the older two to get to school by 8 AM and to pick up again at noon. Since Ryan had just started first grade, I was walking with her. I'd get home at 9:30, nurse both boys with the cushion, and by 10:30, try to get up off the couch without waking them. It never happened. By 11:30 I was on my way back to school.

The afternoons were a blur of feedings and preparing meals for the older two.

A lot of twin books talk about the blur of the first few months, but sleep deprivation literally causes disorientation, impaired brain function and memory loss. When I started swaying on my feet after three months, my doctor diagnosed hypothyroidism - but even pills couldn't help a metabolic system with no sleep. A few months later, I was also diagnosed with anemia, and more pills. Also, could the fact that I now had an autoimmune disease - the Hashimoto's thyroiditis that caused the hypothyroidism - stem from the fact that my body had literally not been able to rest for months? Again, the research isn't there, because it isn't ethical to subject anyone to such conditions.

My friends with one new baby all looked fanastic, fit and happy, well-rested and content, in comparison to myself. So I took to jogging for an hour every day in the spring, when the twins were 9 months old and taking a momrning nap fairly regulary around 10 AM. (The twins, not I.) Or I took them with me in the stroller. I lost weight, I ate well, gave up meat and carbs, alcohol and caffeine. Before I finally collapsed the spring before the twins turned two, I looked good, and was still chronically exhausted.

I haven't wanted to put this into print - because it's not the picture I was painting for friends and neighbors. Or frankly, for myself. And I don't have a lesson or a moral for this. I can't tell someone who is now pregnant with twins how to avoid it. Getting night help is an obvious answer, but not real practical for most of us. (In case you were wondering where my husband was all those nights, I honestly can't remember, but he did do his best to help out as well.) And I do mean to confront La Lache at some point about their militant stance on nursing - not ALL women can or should nurse twins, and nursing two babies full-time just can't be in the best interests of most of us also trying to stay healthy enough to also raise other children - without help. (My mom was with us the first two months - during the day only, but she was as overwhelmed and exhausted as I was; it helped to have another two hands around, but they were a supplement, not a substitute for my own.)

I guess that's why we have all those books on surviving the first year with twins. But the useful hints can only take you so far. The humor, it's a way of dealing with the difficulty. Is it going to help anyone to know HOW HARD this is REALLY going to be? Honest numbers on how little sleep you are really going to get? Yeah - yeah - I read the books too - get them on a 3 -4 hour schedule, feed them simultaneously so you get it all over with at once. And, between 6 and 12 months it DID get easier, and by one year, my guys were sleeping through the night.

I think it might help to know that it isn't as pat and dried as the tips suggest, and that it wasn't as easy - or humorous - in practice as it looks in print. (And let's be fair - noone pretends it was a walk on the beach.)

And that's why the best advice out there is still to know that this too shall pass. I loved every minute of the first six months - the reality of the impossibility of my situation didn't hit me until the second six months - but I'm wondering where to go from here. What are the lasting effects of chronic sleep deprivation? How long does it take to recover emotionally? Will the physical effects ever resolve?

I don't regret giving everything I had and was to my children. I'm just wondering if I can have her back again.

Third Grade Math - Part Three

Ryan's third grade is going to be taking the standardized math tests next week, the ones that are used to compare results state and nationwide and possibly even internationally. Naturally, the teachers are in an uproar. Me - I know where MY kid stands, and I'm even starting to get used to it and accept her for who she is.

The rest of the third grader's in the nation may well be open to page 17 in their math books, but my child not only isn't on the same page as everyone else - she's in a different book entirely.

I noticed it on her last math test - another 3 -4 , the equivalent of a C in the USA. The equivalent of trade school here in Germany. The funny thing is, she did fine on most of the math she actually did. Her problem wasn't the math, it was sticking with the program. And it didn't bother her at all to make something up entirely just because she didn't want to deal with the program at all.

Funny enough, I was relieved. Phew. She got the math.

The teachers call her a dreamer. In German, this isn't a compliment - probably more the equivalent to having her head stuck in the clouds. And no feet on the ground.

The practice standardized test the two of us just worked on for two hours was hysterically funny. Again, she had the math - and she had a great time with it - adding numbers, figuring out charts and graphs, deciphering patterns - anything at all, except for actually answering the question. Again, I am relieved - the mind works. But noone else is going to be impressed - because it's not working in the standardized way.

My husband just told me about the 2 year old who had been inducted into MENSA with an IQ of 154. Not to belittle the achievement, but I don't believe in IQ scores. Not that the kid doesn't have to be spectacularly brilliant to be able to UNDERSTAND the test at all. Poor thing. Where is that going to get her when she's already labelled at the age of 2? Is she too smart too throw herself off the back of the couch to see if she can fly? Or to paint- or write an essay -in crayon on the living room wall? Unroll the toilet paper?

I believe IQ scores test common intelligence - what society takes to be intelligence - and that it is an artificial label of intelligence. In the 1950's women scored consistently higher than men until officials "corrected" the test to reflect what they wanted. Blacks and minorities have also historically scored lower - until for the last 30 years developing countries have increased scores dramatically - due largely in part to a more sophisticated and technical society. (I read this recently, but will have to figure out where and document it properly if I ever decide to publish; I'm hoping you'll take my workd for it.) People with high IQ scores ARE intelligent, but I don't think it's the IQ scores that prove this.

As for me, I'm using my above average IQ score (in grade school at least) to try to understand a child who wouldn't break even on it - she'd be too busy doodling on the sides of the pages or building different configurations with the bricks. Possibly just staring into space.

I have to feel sorry for her teachers - after all, they are the ones who are judged on the scores. They will continue to tell me that she is unfocused and needs to learn to take things more seriously.

Me - I'm going to have to agree that she needs to memorize her multiplication tables at some point. (Maybe this summer when she's visiting my parents?) But I'm beginning to accept that she's not sticking to the script. Everyone else is studying their lines - and Ryan's making up her own.

Don't get me wrong - I'm terrified. I know where the script leads - college, career success, financial security. And I have no idea where Ryan's is leading her. (Add to that the fact that the government is threatening to close the small, local trade school she would be starting in fifth grade and to send the kids to a large, impersonal one with as little individual attention as the college track gets.....well, I'd finally begun to accept her path, and then they close it. But that's another essay for the German politicians.)

In the meantime Ryan's class continues to prepare for next week's testing. Her teachers keep hoping she'll shape up, wake up, get her head out of the clouds, keep her feet on the ground. Of course I'm hoping for good grades too - but I'm done trying to bring her down to earth.

What good would that do? She hasn't read the rule book anyway!