Growing and Growing...

As most of you know, our girls were transferred to DeVos Children's in Grand Rapids last week Thursday. It has been so nice for Nate and me to be so much closer to home and to sleep in our own bed each night! I think it goes without saying that being closer to home is nicer for our family and friends who want to visit the girls too! We were so sad to leave the wonderful people in Ann Arbor, but it was definitely the right move for us, especially since there is a good chance one baby will come home before the other.

The isolette the girls traveled in from Ann Arbor to Grand Rapids. They rode in an ambulance while Nate and I drove our car over. We couldn't wait until we all made it to GR! The lady on the right is Kate, one of Sophie's favorite nurses! :)

Reunited for the first time since birth.

We were so sad to leave such a great place!

Mom and Dad were so excited to finally arrive at the hospital! Little did we know, we had beaten the girls there. The Children's Hospital is the blue round building in the middle of the picture.

This is Mary, the nurse from U of M, who traveled with the girls and made sure they arrived safely in GR. Here she is ready to "unload" Sophie in her new room!

An update on our sweet girls...

Last night, Evelyn weighed 3 lbs., 9 oz. She is now at "full feeds" for her current weight, meaning she has reached her goal! She is no longer on the TPN (IV nutrition) or any IVs, so her PICC line was pulled on Friday. She gets 32 mL (just over 1 oz.) of breast milk every 3 hours. She was having trouble digesting the milk, so they started putting it on a pump where it goes in over 1 hour instead of falling in quickly by gravity. This has really helped her! Normally, her feeding goes through her feeding tube and into her stomach, but because the babies are now at 32 weeks gestation and Evie was showing signs that she was ready to start sucking, she got to try a bottle for the first time today! It was so fun to feed her! She did an awesome job; she took 16 mL of her feeding before falling asleep (the remaining 16 mL was given to her through her tube as usual.) We are currently allowed to try bottle- or breast-feeding her once a day, and that will increase as she gets older.

Evie is still on room air and doing great! She is very alert and awake for what seems like long periods a few times a day. She has definitely gotten more calm and quiets down much more easily when she gets mad.

Sophie is doing wonderfully as well, although she likes to scare her Mom and Dad more often than Evie does. I'll try to make this long story short: Wednesday night, her nurse in Ann Arbor thought she was acting a little funny. She didn't show any signs of infection, but they pulled out her umbilical central line just in case. When we got to GR, they checked some labs, which were questionable for infection, and drew some blood cultures to see if there was any bacteria in her blood. This morning, those cultures came back positive. The doctors think (and we are hoping) that the sample was contaminated, since Sophie has been acting essentially normally since this all started. So, they drew more blood cultures today to see if there is actually an infection. Just in case, she has been on antibiotics for the past few days. Because our girls are so tiny and premature, their immune systems are underdeveloped, so even a minor infection could affect them a lot more than it could you and me; we are praying that there is no infection, and if there is, that the antibiotics will get rid of it ASAP! With all of the lab draws and the need for IV antibiotics, little miss Sophie has been poked a few more times than her Momma can handle!

Sophie resting on Daddy's lap with an IV in her foot.

Sophie hit the big girl 3 pound mark 2 nights ago! How exciting! She was having similar problems to Evie with having leftover feedings in her tummy that hadn't been digested, but because of the questionable infection, the doctors have treated her a little more conservatively. Twice now, they have put her feedings on hold and checked abdominal xrays and labs before restarting them. On Friday, her feedings were on hold for 15-18 hours, and today, they were on hold for 6 hours. Both times, the repeat xray looked great. Instead of starting her back up on the feedings she was at, they backed down a little bit, so she currently gets 20 mL every 3 hours. Hopefully soon they will be able to advance them so she can reach her feeding goal as well!

Sophie was taken off oxygen on Friday and did very well! Today, she was desatting a bit, so the nurse put her on just the teeniest bit of oxygen! (For my nursing friends, a tenth of a liter per minute.) This felt like such a step back to me, but the nurse told me it is completely common and not surprising for someone as premature and small as Sophie. She is awake and alert at times, but probably not as much so as Evelyn. The nurses all tell us that her slower progress is normal for preemies, especially for small ones like Sophie, but it's hard on us to see one baby progressing faster than the other.

Sophie's pretty face without oxygen

We have been enjoying a little more freedom to hold our girlies when we want to since they are getting a little bit older! We can't get enough. We think they are absolutely adorable, and apparently, the nurses do too!...

Nate and I have declared tomorrow a "no visitor day." We are "over it," for lack of a better word. NICU life is stressful and hard, regardless of how well the babies are doing. It is so hard to see our helpless little babies getting poked and prodded and to know they don't understand why. It's sometimes hard to remember that, so far, most everything that has happened with our girls is normal based on their gestational age. After all, had I had a normal pregnancy, they would have been inside me for almost 2 more months! There are times we just don't feel like visiting, so we are giving ourselves a break.

For those of you who will visit us while we are at DeVos... just a heads up for you...

• Nobody under 16 is allowed to visit in the NICU.
• You will be asked/required to "scrub in" before entering the NICU... this just involves washing your hands/arms up to your elbows and removing all jewelry below your elbows. You may want to leave bracelets/rings at home.
• You will be asked to have any sleeves rolled up to your elbows while in the NICU.
• If you have artificial nails, you will be asked to wear gloves.
• Call/text us to make sure we're in the room if you're planning on visiting us. They keep track of whether either of us are there, and visitors aren't allowed back if we're not in the room.
• Each time our babies are stimulated, they burn calories, which slows their growth. Of course, they need some stimulation, but loud talking or noises, bright lights, camera flashes, etc. are unnecessary sources of stimulation! We want Evie and Sophie to grow and come home as quickly as they can, so please remember that if you come to visit!
• To prevent infection, right now we are the only ones allowed to touch and hold the babies. Once they are bigger, we are happy to pass them around, so you will get your chance!!

These are all measures DeVos has taken to prevent infection. It seems strict, but it's actually in the best interest of our babies and the rest of the babies in the NICU.

If you are praying for us and our girls, thank you! Here are some specific requests:

• Right now, our biggest worry and concern is Sophie's possible infection. If her blood culture from today comes back positive and they don't think it's a contaminant, she will have to have a spinal tap. We do NOT want her to have to go through that. Please pray that she does NOT have an infection, and that neither of our babies will develop infection during their stay in the hospital.
• That the girls continue to keep growing and tolerating their feedings. In particular, that Sophie will tolerate her feedings so that she can be taken off the TPN and start bottle- or breast-feeding like her sister. The neonatologist told me on Friday that since breathing has been stable for both girls, their big concern now is nutrition. They have to be growing consistently and taking all feedings from a bottle or breast before they can go home.
• This will just come with time, but please pray that the girls continue to make progress toward regulating their own temperature. This is something else that has to be met before the girls can come home.
• Please pray for Nate and me, as it is difficult being in the NICU all day every day. It is stressful and hard to see our babies with tubes and lines, and it is disheartening when we feel like our girls are taking steps backward, even though we are told this is normal for preemies. I have had a hard few days lately and would appreciate your prayers!

I'll leave you with a super cute picture of Evie (top) and Sophie (bottom) from Friday morning...

Love,

Nate, Sara, Evie, and Sophie

Picture Time

I'm guessing most people who read this are friends with Nate or me on Facebook, but for those of you who aren't, here are some pictures of our beautiful girls...

Sophie in the stabilization room immediately after birth. The girls were immediately taken into this room, where a neonatal resuscitation team was ready and waiting for each of them. Nate was able to follow the girls into this room while the surgeons sewed me up. It seemed like the longest 30ish minutes of my life!

Evelyn in the stabilization room

Evelyn (top) and Sophie (bottom) when Mommy and Daddy came downstairs to visit the first morning.

Both girls were under the bili lights for a few days on and off. Today (Sunday) is day #2 with both girls off. We're hoping they won't have to go back under. We hate that they have to wear those silly sunglasses! Also, both girls had breathing tubes put in on Sunday and removed on Monday. Here is Sophie with her blue lights and her breathing tube. She's sticking her tongue out too, which she loved to do for her first few days!

Daddy doing skin-to-skin with Sophie. These are our favorite parts of the day!

Evelyn just after her CPAP got taken off. One of our first opportunities to see her whole face!

These are the smallest pacis they have... they are too big for our girls, but they still like them (sometimes).

Sophie on her special CPAP

Sophie 

Evie on her nasal cannula! Woo hoo!

Mom's craft to decorate Evie and Sophie's room doors.

Evie after a bath

Evie wide-eyed after her bath

Daddy can't get enough of the girls. :)

One week old. Evie (top) and Sophie (bottom).

Evie giving smiles to Grandpa K.

Sophie hanging on to her CPAP

Evie not wanting to be bothered. :)

Thank you for continuing to pray for our princesses! Both are tolerating their feedings, which are being increased daily. Both girls are now gaining weight slowly but surely. Sophie may be able to take her CPAP off later today or tomorrow! She has been doing great with breathing on her back today!

Love,
Nate, Sara, Evie, and Sophie

NICU Life...

We just love our girls so much!

Everyone told me how amazing being a Mommy was, but I never could have imagined the amount of love I have to give to these little peanuts. Don't tell them I said this when they're older, but I would do anything for them!

So much has happened in the last week! The girls are doing awesome, but both are still having some ups and downs as would be expected for such early preemies.

We will start with Evelyn. She is doing an awesome job with her breathing and was finally taken off CPAP yesterday. She was placed on a nasal cannula, which was actually taken off this morning just before I got there! I was soo excited! She did so great all day without the oxygen! Her problem is that when she gets mad, she is difficult to calm down, and her breathing suffers. She had a little meltdown this afternoon, and even though her oxygen levels stayed okay, we could tell she was really working hard to breathe. The nurse ended up putting her back on a little oxygen, and once she finally calmed down, her breathing seemed much easier.

Evelyn weighed 3 lb., 1 oz. as of yesterday, which is a loss of 3 oz. from her birth weight. This is pretty normal for any baby. Her feedings were increased today from 2 milliliters of breast milk every 3 hours to 4 milliliters every 3 hours. Every few days, they will ramp up the feedings as long as the girls tolerate them. Along with increasing the feedings into their tummies, the doctors decrease the girls' TPN (IV nutrition) so that eventually all of their nutrition will come from breast milk.. So far, there have been no issues with feedings, aside from the first night or two where Evie had some leftovers in her tummy that made her uncomfortable. Preemies are at a super high risk for reflux, so as we increase their feedings, we'll have to keep a close eye on that. I asked the nurse tonight what they normally do to treat reflux, and she said the babies just have to grow out of it. Poor things! We are praying that reflux won't be too big of an issue for either of the girls.

Sophie, our littlest peanut, is doing an awesome job too! While she still has the CPAP on, her breathing has pretty much stayed the same for the past few days. The oxygen level that is coming through the CPAP is equivalent to the oxygen level in the air, or occasionally just a touch more. She just needs the CPAP to help keep her lungs expanded. She is tinier, so it might take her a little longer to catch up to Evelyn. Sophie's breathing is great while she's on her tummy, but she usually needs a little oxygen boost when she lays on her back. We are told this is normal for preemies, and yet again, something she will grow out of. She will need to learn to breathe well on her back before going home, since that is the recommended positioning for sleep when babies are not on continuous monitoring. Sophie is a little easier to calm down than Evie when she gets mad, so her breathing usually doesn't suffer too much if she is upset about something. Occasionally, Sophie will do what is called "periodic breathing," where she breathes really fast for a little while and then stops breathing (apnea) for a while. Sometimes these are accompanied by "brady" alarms, which is when their heart rate drops temporarily because of low oxygen. Another common thing for preemies. The good thing is that Sophie normally comes out of these episodes all by herself and doesn't need us to remind her to start breathing again.

Sophie has gained 1 oz. from her birth weight! Her feedings were also increased today, from 2 mL every 3 hours to 3 mL every 3 hours (the amount they get per feeding is based on their weight, which is why she gets a little less than Evelyn.) She has had no tummy issues, but just like Evie, she will have to be watched closely for reflux as her feedings are increased.

As far as temperature goes, most preemies born as early as Sophie and Evie have trouble maintaining their body temperature. The isolettes that Sophie and Evie are in maintain a specific temperature and humidity level to help them regulate their temps. Every few days, the humidity is weaned down, and by the time the weaning is complete (about 2ish more weeks), the girls should be old enough to be able to keep themselves warm. At that point, the tops can come off of the isolettes and we can start dressing the girls in clothes, swaddling them in blankets, etc. I can't wait!

Both girls have had some ups and downs with high bilirubin levels (jaundice) -- another very common thing for preemies. They have both been on and off phototherapy, which are the blue lights that help with jaundice (don't ask me how.) Evelyn was off for a day or two and then was put back on today. It's tough for mommy and daddy to see them laying underneath that light with little sunglasses on. Hopefully, when they recheck her bili levels in the morning, they will be lower so that the lights can be turned off.

Nate and I have started doing a lot of the girls' care, like baths, diaper changes, etc. It's so fun to be able to take care of our little munchkins! We also love doing kangaroo care with the babies, where we hold them skin-to-skin on our chest for an hour or two at a time. The babies seem to enjoy it too, and there is a lot of research to say that kangaroo care does a lot of good things, like helping babies regulate their breathing and temperature, increasing mom's milk supply, and helping with bonding, which can be an issue when babies are stuck in isolettes all the time.

We cannot say enough wonderful things about the doctors, NPs, and nurses at the NICU here at Mott. They are taking such great care of our girls, and of us too!

Prayer Requests:

• That Sophie and Evie's breathing will continue to improve; that Evie will calm down more easily and that Sophie will learn to breathe just as well on her back as on her tummy.
• That Sophie and Evie will continue to tolerate their feedings and not develop severe reflux so they can grow and the TPN can be turned off!
• That the girls will stay free of infection. The hospital is a great place to pick up a bug, especially with weak immune systems, central lines, and that nasty TPN, which is a wonderful breeding grounds for bacteria. Any infection could set the girls back quite a bit, especially if it's severe.
• That the girls' bilirubin levels will stabilize and they will no longer need to be on the bili lights.
• That Nate and I will get the rest we need. The NICU is quite a stressful place, and it's hard to leave our girls each night, but we have to remember the importance of taking care of ourselves too so that we can be the best Mommy and Daddy we can be!

Speaking of rest, I need to get some. I promise I WILL post pictures soon. If you are friends with Nate or me on Facebook, Nate does have a photo album with lots of adorable pictures of the twins! Thank you for keeping us in your thoughts and prayers, for all the cards, gifts, and visits. We appreciate it so much!

Goodnight!

The Vander Ploegs

Our Little Miracles Have Arrived!

Most of you probably already know that we welcomed our beautiful girls into the world yesterday morning, at 30 weeks gestation. Nate and I are loving being Daddy and Mommy and want to thank everyone for all the prayers and support throughout this entire process!

Friday night, I was having some abdominal cramping, which I initially attributed to a spicy Qdoba meal that I ate that evening. Around 11:30, when it hadn't gone away, I asked my nurse to connect me to the monitor, which showed I was having regular contractions. At first, they pretty much just felt like my stomach was tightening (similar to any contractions I had previously had), but as the night went on, they became more and more uncomfortable. By 2am, I was so uncomfortable that I got a strong dose of pain meds, and I was able to sleep for about an hour before the meds wore off and I was awake and in some serious pain again. I got another dose of pain meds, and they put me on magnesium again to see if they could stop or slow the contractions. The resident told me she had a feeling we were going to have our babies that day, which was pretty hard for Nate and me to hear, considering we were hoping to make it four more weeks before having babies.

The magnesium did slow the contractions down, but I was still having them regularly and they were pretty uncomfortable. Right away at 7am, I was seen by the high risk doctor, who wanted to wait it out a few more hours but told me he had a hunch we'd be having babies by the end of the day. My discomfort kept getting worse and worse, and when I started bleeding a couple hours later (sorry, TMI), the decision was made to proceed with a c-section.

Although the surgery wasn't considered an emergency, I was prepped and brought to surgery rather quickly after deciding it was time to deliver. I didn't have much time to process what was about to happen! Thankfully, we had been prepared for what a premature delivery would look like when we met with the neonatologist only a few days prior, so we had an idea of what to expect.

The surgery went well. I did get to hear a tiny, pathetic little cry coming from one of my babies as she made her entrance into the world. Knowing she was breathing was so reassuring! As soon as the babies were delivered, they were taken into the next room where there was a NICU team ready to stabilize each of them. At that point, Nate left me to be with the newest loves of his life, Evelyn Joy and Sophie Grace.

The process of putting me all back together felt like it took forever, but Nate and my amazing nurses went back and forth between the babies and me and kept me informed of how the babies were doing. The babies were breathing on their own, but were hooked up to CPAP to help with their respiratory effort. This was not a surprise to us. After the initial phase of my recovery, my nurses wheeled me over to the stabilization room so I could catch a quick glance at my babes before they were wheeled down to the NICU... they were so beautiful!

During recovery, both sets of grandparents also arrived. After grabbing lunch, Nate took them to the NICU to meet their very first grandbabies! All four of them are as smitten with the girls as Nate and I are. The Grandpas and Grandmas stayed for a while last night and were here for a good portion of the day today too. It was so nice to have them here and share this exciting time with them!

The girls are doing very well, considering they were born 10 weeks prematurely. Evelyn (baby A) weighed in at 3 lb., 3 oz. and Sophie (baby B) weighed 2 lb. 7 oz. The estimates from the ultrasound we had 4 days prior were right on! The biggest concern for early babies is their respiratory status. Their lungs aren't fully developed, and it just takes some time for them to be able to breathe like a term baby would. All day yesterday and until this afternoon, the girls were both on CPAP, but when their oxygen requirements increased today, the decision was made to put a breathing tube down so that the doctors could administer surfactant right into their lungs. Surfactant is a chemical that helps to keep the air sacs in the lungs open, and babies don't produce a whole lot of it on their own when they're as young as Evie and Sophie. The steroids I received before delivery are meant to stimulate surfactant production, but the girls needed even more... they are hoping that, now that the girls have gotten their surfactant, the breathing tubes can be removed within the next day or two.

Since 30 weekers haven't yet learned to coordinate sucking/swallowing/breathing, they each have a feeding tube that goes into their stomach that can be used for breastmilk (and formula, if more calories are needed). For now, they are also receiving nutrition through their central lines, which will be discontinued after a while. In a few weeks, hopefully, we will be able to breast feed and/or bottle feed.

We're aware that things could have turned out much differently for our two peanuts. We thank God that they have arrived safely, and that they seem to be doing as well as expected for 30 weekers! We could not be more in love with our little miracles. Thank you, thank you, THANK YOU for praying us through this rough time.

I'll post pictures soon, but for now, I'm going to go snuggle my daughters. :)

Stabilized

Wednesday night was a rough one for me. Although the contractions I was having weren't painful, they were consistently 1-3 minutes apart, which became concerning for the doctors after a few hours. They decided to put me on a medication called magnesium sulfate to stop the contractions. This drug is also useful for protecting the babies neurologically if they were to be born before 32 weeks. The problem is, the magnesium has a lot of side effects, like hot flashes, nausea, muscle weakness, grogginess, etc. and it can depress your reflexes and decrease your blood pressure. Because of all this, you have to be on STRICT bedrest while on this medication, and they only allow you to eat ice chips and small sips of clear liquids. We were told they were going to put me on it and reevaluate after 24 hours. I quickly ate something and took a shower before starting the drip, knowing that I'd be in bed and hungry for at least the next day.

The first half hour of the drug is a "loading dose," where they give you 6 grams of the magnesium over a half hour. After that, you receive 2 grams per hour. On top of feeling crappy, I had to be hooked up to a blood pressure cuff, pulse ox, 2 IV lines, and 3 monitors on my belly the entire time. Not ideal for sleeping. If a baby moved (which they did a lot), the nurse quickly came in to adjust the monitor. In addition, my blood pressure was checked every hour, temperature every 2 hours, and reflexes every 2 hours. Luckily, my contractions slowed down nicely, and in the middle of the night, the chief resident came in to tell me that they were going to consider shutting the magnesium off in the morning. I had only gotten 45 minutes of sleep the entire night, so we were ecstatic that they decided to turn it off yesterday, only 14 hours after starting it. :)

(PS -- I complain a lot about having to be on the magnesium, but we are actually very thankful that it did such a nice job of slowing the contractions down and for its neuroprotective properties for the babies. We just hope that I won't have to be put on it again. :) )

Things have been looking up since I was taken off the magnesium. Since the babies looked great throughout the entire thing, they took me off continuous fetal monitoring, and now they are just going to monitor the babies for about an hour per day. After the contractions slowed down, they decided I didn't need an uncomfortable labor and delivery bed (with a hard bar behind your back) and my nurse yesterday hooked me up with a new comfy bed with an egg crate mattress cover. Score! I slept over 8 hours last night, so I'm feeling much better now.

The monitor is off!

Trying to get the babies to hold still

Nate keeping himself (and me) entertained

Our room. Everyone's sign is color coded. Pink happens to mean that you're not supposed to be having a baby/babies anytime soon. We hope our sign will stay pink for a few more weeks and not change to yellow (labor).

We are just playing the waiting game now and trying to keep ourselves occupied. We are looking forward to some visitors this weekend. Thanks for your prayers!

Sara & Nate and the Girls

Change of Plans...

This morning when I woke up, I noticed that I was leaking some fluid. I called the nurse in labor and delivery, and she talked to my doctor, who wanted me to come in to be evaluated. So, Nate and I made the trip to Ann Arbor and checked in to triage, where they did a few tests and confirmed that my water had broken.

I have been admitted, and will remain in the hospital until the babies are born. When will that be? That is a great question!! As of right now, I am having contractions every 2-3 minutes, but since they're not painful (and at times I can barely feel them), they're not considering it labor. If I do go into labor, if it looks like I have an infection, or if the babies start looking not-so-great, they'll deliver the babies immediately. If not, our delivery goal is still 34 weeks. We will be here until whenever we deliver!

I got my first dose of steroids to help mature the babies' lungs and other organ systems this afternoon, and I'll get the second dose tomorrow. I've also been started on IV antibiotics to help ward off infection, since the amniotic membrane has now been broken.

Our doctor just came in and did a quick ultrasound, and everything looks great. It looks like it was Baby A's sac that broke, which makes sense since hers is the one that has been poked and prodded multiple times (laser surgery + 2 blood transfusions.) I am also hooked up to a monitor that constantly watches both babies' heart rates and my contractions...

We are obviously praying that our babies will get a few more weeks inside, but thankfully, we were told yesterday that if our babies were to be born right now, they would most likely be in the hospital for a while but have very few, if any, long term complications.

We need your prayers more now than ever! Please pray for our little ones. Thank you all!

Here is a pic of our new home... :)

Grow, Babies, Grow!

Not that we're taking it for granted, but it's been almost 2 months since Baby A needed to have a blood transfusion, so we've come to almost expect dopplers, bladders, and fluid to be normal on each weekly ultrasound. Today, all these things were normal again (prayers answered!)

Our more immediate concern lately has been growth, particularly Baby B's. Today, they estimated Baby B's weight at 2 pounds, 7 ounces, which is a gain of 10 ounces from 2 weeks ago. This puts her in the 4th percentile (still just a little peanut, but the 4th percentile is better than less than the 3rd percentile!) The docs are happy with her progress! Baby A's weight is estimated at 3 pounds, 3 ounces, which means she gained a whole pound in two weeks! She is now in the 49th percentile. If this pattern keeps up, our doctors are hopeful and confident that we will make it to our goal of 34 weeks (only 4 1/2 weeks away!!)

My blood pressure is back down to where it normally is, and I haven't been experiencing any swelling that would be considered abnormal during pregnancy. They're still keeping an eye on it, but the immediate concern of preeclampsia is gone (more prayers answered!) I start my nonstress tests this Friday. If the results of any ultrasound or nonstress test from here on out happen to be concerning, which we're not planning on, they would most likely give me steroid shots to help mature the babies' lungs (two doses, 24 hours apart) and deliver the babies. If not, the shots will probably be given sometime around 33ish weeks so that they are most effective for a delivery at 34 weeks. It is CRAZY exciting to think that, even if everything goes as planned, our babies will be here in a month!

Thank you for praying. We are getting close!
Nate, Sara, and Babies