We welcome your questions and comments regarding the process and protocols of bringing up preemie twins, so please feel free to use the comments section at the bottom of this page to participate in the discussion or email your questions to mofamily at mollenhauers dot us. (Why is the email address written like this? Because spam systems don't see the text written out the way we humans say the words and symbols, so if you convert this to include "@" and "." and take out the spaces, it is a legitimate address without giving out our address to the whole world of spambots.)
Q: Why is the care routine for Adam and Sara so different from other babies?
A: Almost everything related to the care of the twins is tied to the fact that they are premature. They were born at only 28 weeks gestation, basically two thirds of the time normally required for complete development and full functioning as seen in a full-term 40-week baby. More details are explained below.
Q: Do twins run in the family?
A: Yes, but not before they learn to crawl and walk. Actually, even though there are a large number of twins in our families, especially JoLynn's side, most literature indicates there is no hereditary connection that reliably predicts the occurrence of twins. Plus, these kids were test tube babies, so multiples were quite likely.
Q: What kind of schedule are they on?
A: Preemies are put on a very rigid schedule of assessment (temperature check, stethoscope listening if needed, stomach aspirates, etc.), care (diaper change, bed clothes change if soiled) and feeding every three hours, at 2:30, 5:30, 8:30, 11:30, around the clock. This is because preemies don't have large enough stomachs to take in and process the volume of food/calories needed to maintain development, metabolism, and body heat for more than 3 hours at a time. Once they reach certain size, they can move to a 4-hour interval and eventually will be on the "on-demand" schedule like full-term kids who just eat however much they need when they're hungry.
Q: How much do they eat?
A: At 34 weeks (6 weeks after birth), they are eating 30 to 35mL, or about 1 ounce. Sara gets 35mL in her bottle at home, but is only expected to eat 30mL. The other 5mL is bonus if she feels hungry. Adam is receiving 37mL because he is heavier. Everything about preemie nutrition and medication is based on body weight, so as they grow, their feeding volume goes up proportionally.
Q: What do they eat?
A: They both receive mostly breastmilk with a small amount of a formula which fortifies the milk with more calories than is available in straight breastmilk. Without the extra calories, preemies this size have a hard time gaining any weight because they burn so many calories just existing. Sara also gets a liquid multivitamin with her bottle once a day and Adam will start having that added as well.
Q: Why can't you just nurse them direclty instead of making bottles?
A: This goes back to the issue of carefully measured nutrition to ensure growth. Since you can't accurately measure how much milk they get by nursing, and can't add supplement for calories or vitamins, bottles are used for most feedings. Plus, it gets JoLynn off the hook for having to be present at every meal. They will try nursing one meal per day as long as their growth rate is steady so that they get used to the process and that frequency will increase as they grow and don't need as much calorie supplementation.
Q: How do you compare them to other babies at their age?
A: Since they were born 12 weeks before full-term, there is almost no comparison to other babies, especially full-termers who have been out of the womb the same amount of time. Even being discharged after 6 weeks and 8 weeks from birth, they are not even close to most of the maturity and capabilities of 2 month-old kids. For instance, they are only eating about 1.5 ounces per meal, whereas some full-term babies might be drinking 3 or 4 times that. For purposes of measuring developmental milestones, they'll be on a different chart for about the first one to three years. As of this writing, June 1, 2009, they technically should still have nearly 4 weeks of gestation and development before their due date.
Q: When can we visit?
A: We will probably take most of the first week with both of them home (June 1 through the 7th) to get oriented to having to care for them both on the same schedule, work out housekeeping rotations, and get used to having to pack up two kids and their monitors when we leave the house for appointments. We will post suggested times for visits and their public appearance schedule soon. The main limitation to visits with the kids is that they still need to spend most of their time growing, which is done mostly during sleep, and conserving their energy for the time they spend eating and getting diapers changed. So, most visits will probably revolve around their feeding schedule. That will give you the best opportunity to see them when they're out of the crib, awake, squirmy, noisy, and unbelievably cute.
Q: Who can babysit?
A: Because they are preemies and came home on monitors, the key qualifier is that you have had infant CPR training. Beyond that, it helps if you've had kids of your own or extensive caregiver experience so we don't have to worry about whether you know how to hold a baby, change their diaper, etc. As we return to work, we will probably be looking for more regular care, so keep that in mind as well. For now, just email us and let us know you're interested in helping when Mom needs to go out for a bagel with a friend or Dad needs to get in a quick round of golf (What? That's fair, isn't it?).
Q: How else can we help? (Supplies, meals, projects)
A: Most importantly, refer to the prayer requests section on the main page. We'll keep updating that as prayers are answered or new challenges arise. Materially, we've been greatly blessed with generous family and friends, so we will post specific needs as they come up. Initiallly the biggest challenge is meals because neither of us feels like planning a week of menus in between the babies' care schedule, so dinners are seat of the pants. We have received some offers via phone or Facebook comments already, so we're compiling a list of volunteers. If you have a Facebook account and want to stay in touch that way, search for Shannon Mollenhauer in FB and let's be friends.
more questions and answers to come.....