gestational age – Bump 2 Bab[y]ies

Halfway to a Year

Published on February 5, 2014February 5, 2014 by onesource4wellnessLeave a comment

Their a handful! — They’re a handful! (Left to Right: Bella, Ellie, Lily, Theo, Kali)

The Vanderwall Five are halfway to a year!

This past Monday the V5 turned 6 months old. It truly was a celebration to see how far these munchkins have come. Each month we review their milestones and continues to see these children hit their mark, despite their gestational age of 3 months. According to the CDC, a 6 month old child can:

Social/Emotional

Knows familiar faces and begins to know if someone is a stranger (Definitely true for Kali! She sounds the Stranger Danger alarm at first site)
Likes to play with others, especially parents (All of them love to play; they are social butterflies)
Responds to other people’s emotions and often seems happy (These monkeys see and do)
Likes to look at self in a mirror (Their look of amazement is priceless)

Language/Communication

Responds to sounds by making sounds (They are all progressing here, but Bella and Kali take the lead)
Strings vowels together when babbling (“ah,” “eh,” “oh”) and likes taking turns with parent while making sounds (We have some chatterboxes on our hands)
Responds to own name (We are still working on this one, but I believe Kali & Lily know their names. I also think Bella knows her name and chooses whether or not she wants to respond…little stinker)
Makes sounds to show joy and displeasure (Definitely!)
Begins to say consonant sounds (jabbering with “m,” “b”) (Another popular consonant is “g”)

Cognitive (learning, thinking, problem-solving)

Looks around at things nearby (They are curious little ones)
Brings things to mouth (Especially their fingers and rubber ball)
Shows curiosity about things and tries to get things that are out of reach (They love to reach and swat at their mobile birds)
Begins to pass things from one hand to the other (They are paci passing pros!)

Movement/Physical Development

Rolls over in both directions (front to back, back to front) (More work to be done here, but all are getting close)
Begins to sit without support (The bumbo seats have done wonders for their cores)
When standing, supports weight on legs and might bounce (Theo and Lily are great at holding their weight)
Rocks back and forth, sometimes crawling backward before moving forward (Everyone is scooting and spinning. Watch out Manny (the cat) crawling is definitely in sight)

It’s been awhile since we checked in with each quint individually, so we thought we would launch a series beginning with Mr. Theo!

A Day in the Life

Published on December 10, 2013 by onesource4wellness3 Comments

Several people inquire about what life is like for one of the Vanderwall quints. Many have come to visit and have peered into the world of the V-5. Some are surprised at their cool, calm and collected nature. Others have witnessed the choir of screeching alley cats (aka all 5 crying at once), which is enough to scare anyone into abstinence. All have to take a moment to allow reality to settle in that there truly are five.

When I was pregnant I was searching long and hard for example schedules and routines for high order multiples. I found suggestions but nothing clear and concise, so I thought I would share with the world what a day in the life of the Vanderwall quints looks like.

The life of an infant is fairly plain and simple; it consists of eating, sleeping and pooping. But, as a child ages the time allocated to these changes.

When the kiddos first arrived home at 2 ½ months, or a gestational age of 40 weeks, they ate every 3 hours and slept for the majority of the 3 hours between feedings. We inherited their care time schedule from the hospital, which was 12am, 3am, 6am, 9am, 12pm, 3pm, 6pm, and 9pm.

About a month ago we consolidated the evening so, there was only one evening shift: 1am, 5am, 9am, 12pm, 3pm, 6pm, 9pm.

More recently, we decided to challenge the quints to sleep through the night and. they did it! According to the research literature, “sleeping through the night” is 5 hours, however most, including any sleep-deprived parent or caregiver, would agree that that simply is not enough. However, it’s a start. The quints care times are now 5-6am, 9am, 12pm, 4pm, 7pm, and 10pm. It continues to amaze me at how adaptable they truly are. We are very grateful!

Those who have visited know the in’s and out’s of the quint’s cares, but I’ll give you the rundown for those of you watching from home. The sequence of care times mimics that of the hospital. We tried to maintain patterns that the kids knew.

“Cares” begin with whoever is awake, which is typically Ellie and Theo, but on some occasions everyone wakes up at the same time. Most of the time half of them wake up on the hour and then 2-3 wake up at the half hour. This works out perfectly for our feeding sequence. We start by changing their diapers and then feed them one-by-one. It will be a glorious day when they can hold their own bottles, but for right now each one takes 8-45 minutes to feed depending on how cooperative they’re feeling. That means that one “care” session can last 45 minutes to over 2 hours. When I’m running this ship solo, the average care session takes 90 minutes, but Frank and I can cut that time in half.

Lily catching some p;oct-meal zzz's — Lily catching some post-meal zzz’s

After everyone is fed, they lay back down for a nap, some quiet-alert time, or play-time. We try to rotate their positions from lying on their back, to tummy time, to sitting upright in the swing or bouncy seat, or to a slight incline in a boppy.

We believe its important to vary the positions and locations of the room.

In between care sessions, we spend time documenting their “I’s & O’s” or “In’s & Out’s,” making bottles, and doing the laundry. It is important for us to track their care sessions because when we go to the doctor they always ask how many “voids” and “stools” they have each day, and there’s no way I could recall that for each one without writing it down. A sample of our tracker is below:

Date:		Care Time
		Feeding (mL)	Void	Spit-up	Stool
Percent of Daily Goal	Total mL

So, a day in the life of the V-5 consists of 6 feedings, 90 ounces of breast milk, about 6 scoops of Neosure, 18 teaspoons of rice cereal, at least 50 diapers, an abundance of boogers, drool, stinky butts and spit-up, and a whole lot of love!

Lucky Number 7

Published on July 28, 2013July 27, 2013 by onesource4wellness5 Comments

Friday we surpassed yet another milestone! The babies have been cooking for 7 months, which means we are now above the average gestational age for quintuplets. All of the babies were measured on Friday and they are all measuring within a day or two of the recommended size for babies at this point in pregnancy.

The picture below is a cool diagram that my sonographer drafted for us, which depicts where each of the babies are located in my belly, along with their current weights and percentiles.

The weight of each baby is estimated based on the length of the baby’s humerus (bone in upper arm) and femur (bone in upper leg), the circumference of their abdomen and their head circumference.

Baby B's Abdomen and Kidneys — Baby B’s Abdomen and Kidneys

The biggest one in the bunch is Baby B at 2lbs and 12oz at the 62^nd percentile. Little Elle Rose (Baby E) is the munchkin, but not by much as baby D and Theo (baby A) are also the same weight (2 ½ lbs) but just a bit longer. At this rate, when the baby’s are measured again at 32 weeks they will be about 1lb heavier each. Let’s just hope this Mama can keep up!

All of their organs (kidneys, bladders, hearts, brains, stomachs) look great and are also appropriate sizes. The blood flow to Elle has improved and has stabilized. All heart rates remain within normal limits, and are often on the higher side, which is probably because they just can’t sit still. We are truly excited to meet our little wiggle worms!

I am also doing well. It seems I am stretching by the day, but my body is adapting. Pregnancy is definitely a physical challenge, but the emotional, mental and spiritual journey that accompanies gestation is truly a blessing!

Happy 3rd Trimester!

Published on July 4, 2013 by onesource4wellness11 Comments

We have reached yet another milestone in this pregnancy! In just a few days we begin our 3^rd trimester!

Although the third trimester often brings aches, pains, and discomfort from gaining half of your original body weight it also brings the joy of knowing that- for me- in 9 weeks or less, I will be holding each of these beautiful miracles!

24 weeks, or 6 months, is a critical milestone because it is the point in the pregnancy where doctors will consider your pregnancy viable, or in other words if you give birth after 24 weeks your doctor’s will help to save your babies. Therefore, from this point on the babies are coming, it’s just a matter of when.

The average gestation for quintuplets is 26-27 weeks, which for me would be in 1-2 weeks. However, my current perinatologist’s average for quint pregnancies is 33 weeks and 1 day, and of course my personal goal is 34 weeks! When it comes to high order multiples average just isn’t good enough.

So, how does this compare to a singleton pregnancy if we make it to 34 weeks? Well, being born at 34 weeks for 5 babies is about the same as being born at 30 weeks for 1 baby. According to all of the statistics, the risk of brain bleeds, respiratory distress, cerebral palsy, etc. all plummet at 28 weeks (you can read more about this in my previous post, entitled Visit to the High Risk Clinic).

Our outlook is pretty good. At my last doctor’s visit on Tuesday, I was informed that I might be able to stay out of the hospital for another 3-4 weeks. This was music to my ears because:

Most make it another 4+ weeks after admission to the hospital before giving birth.
Our pregnancy is stable enough for me to continue to enjoy the perks of living in a home.
Hospital food doesn’t even come close to my mom’s delicious and nutritious cooking!

We also learned at our previous visit that all of the babies are growing at a similar rate now; they are all between the 60^th-70^th percentiles. My side of the family is known for making big babies, so we’ll see how this plays out. The only difference was that Baby B’s legs were much, much longer than everyone else’s. It looks like she takes after her Daddy and will be the speedy queen of the bunch. We also learned that everyone’s hearts, brains, kidneys and circulation look great!

The only concern from the visit was that Baby E’s umbilical cord did not insert centrally into her placenta, which is correlated with causing distress later in pregnancy. Right now, baby E is as playful as the rest, so my prayer is that her circulation stays strong. She has been the doctor’s concern since day one, so I know she is going to be our little fighter.

Now, for those that have bared with me to the end of yet another lengthy post, I plan to present to you the names of our five little miracles…with a bit of explanation of course in the next post!

17 weeks and counting

Published on May 12, 2013 by onesource4wellness3 Comments

We are now at 17 weeks and counting, which is halfway to 34 weeks!

I thought I would show the fruit of all those supplements that I referenced in my previous post. I’m growing, the babies are growing and apparently it’s a bit contagious!

We also thought we would share our bumps with my mom and Grandma-to-be!

This picture is very special to me!

Eating for…Six

Published on March 24, 2013 by onesource4wellness2 Comments

“Let food be thy medicine and medicine be thy food.” -Hippocrates

This is a statement I passionately believe in. Medicine is defined as “the science or practice of the diagnosis, treatment and prevention of disease,” and thus nutrition is also the science of the diagnosis, treatment and prevention of disease.

This is especially true when educating and counseling persons with chronic diseases, such as diabetes, high cholesterol, high blood pressure, kidney disease and the list goes on and on. Tweaks in what these persons eat on a daily basis can dramatically improve their disease state.

Many of you are probably waiting for the link to pregnancy, well here it comes. While I continue to believe in the power of nutrition, my view of food has shifted during pregnancy. I believe food during pregnancy is very similar to food for the elite athlete; it is its most basic form- fuel.

While dietary quality is of the utmost importance during both pregnancy and athletics, but quantity often is slightly more important. I have been intrigued by the amount of energy (Calories) required to grow and sustain life, let alone 2, 3, or 6 at one time. The average adult woman needs approximately 1600 Calories per day and the average adult male needs nearly 2000 Calories per day. These amounts of course vary depending on an individual’s metabolism, body composition and daily physical activity. But, the average woman pregnant with one child needs approximately 300 additional Calories per day beginning in their 2^nd trimester. However, this is not the case with multiples. This additional energy requirement starts in the 1^st trimester and quickly escalates with each fetus:

Twins: 3,500 Calories
Triplets: 4,000 Calories
Quads: 4,500 Calories
Quintuplets: 5,000 Calories

One may be jumping for joy at this amount, because it’s like Thanksgiving everyday! Unfortunately, when you add in morning sickness, indigestion and limited belly capacity, this feat requires a bit of creativity. Again, it is important to remember that quality is a close second to quantity and thus the type of Calories consumed is also very important.

The average dietary composition is 50-55% Carbohydrate, 25-30% Fat and 15-20% Protein. During pregnancy, this also shifts to approximately 40% Carbohydrate, 40% Fat and 20% Protein. Fat, primarily from unsaturated sources high in omega 3’s, like DHA, is critical for neurological development. Protein is known as the building block for life and food sources that maintain a complete amino acid profile, animal-based proteins, are ideal. The percentage of carbohydrates decreases during pregnancy, and my assumption for this decrease is two-fold: 1) To account for the increases in necessary fat and protein and 2) To limit edema, or swelling and bloating. Carbohydrates tend to pack on water has they are stored and extra L.B.’s from fluid tend to be unappreciated, especially later in pregnancy.

Overall, we know that nutrition is an individualized science and all of the energy goals have to be adapted to the individual. I believe the best outcome for measuring a person’s nutrition during pregnancy is maternal weight gain. Future mom’s of multiples are to gain an average of 2-2.5lbs per week beginning with week one, so that by 30 weeks mama has gained nearly 80lbs. Maternal weight gain is highly associated with fetal growth and gestational age, which we know are the two variables that often influence fetal complications.

So, for you “bump” lovers out there I will be sure to post a pic or two in the coming weeks along with some updated ultrasounds. Until then, hang tight…patience is a virtue (lol). And, for you nutrition geeks and foodies out there, much like myself, there will certainly be future posts on nutrition tips and meal planning for mom’s of multiples.

Written by: Cassie Vanderwall, MS RD CD CDE CPT

Visit to the High Risk Clinic

Published on March 16, 2013 by onesource4wellness3 Comments

Keep Calm and Choose Life

It has taken me over a week to process our first visit to the perinatal high-risk clinic. Frank and I went into the visit excited and prepared to askour long list of questions about how we can make this pregnancy the most successful it can be. We anticipated a thorough discussion on treatments, tests and procedures as well as detailed instructions for each trimester. Much to our dismay, this is not what occurred.

The visit started off wonderfully. We had our second ultrasound and had the opportunity to see all five of our blessings at appropriate lengths and with strong heartbeats. The ultrasound tech was amazing! She walked us through everything we were looking at for each of the fetuses. It was breath taking!

Frank and I were so encouraged after the ultrasound that we decided to launch our announcement and once again we were overwhelmed by the love and support from everyone! We don’t have words to describe how thankful we are!

We then headed over to the consultation room to meet our maternal and fetal medicine specialist and his fellow. Even within the first few minutes I sensed tension that you could have cut with a knife. The doctor also did not congratulate us, but hopped right into reviewing my medical history and highlighted each condition that put this pregnancy at risk. Then, he decided to transition to the stat list and read the probabilities for each of the chronic and acute disabilities and conditions. I made it halfway through the list and burst into tears. The fellow kindly stopped and was very apologetic. He just kept saying, “Oh no, Oh no… I’m so sorry.” I sensed his compassion at this point, but unfortunately the floodgates had already opened. The specialist quickly took over and the fellow excused himself; I’m fairly certain he went out into the hallway to cry because he came back with tear-stained cheeks.

I knew where this conversation was going. Our perinatologist then walked us through additional studies on the risks of quintuplets and the benefits of multi-fetal reduction. I must admit his approach was much softer than our first doc, but it was clear he was on a mission. He told us that there was a chance that all five of our children could be born with cerebral palsy. This really hit home; would I be able to mother 5 children with several disabilities? My immediate answer was yes, if that’s what I was called to do.

He also shared several studies that highlighted the importance of gestational age and birth weight. There is no doubt that I comprehend the risks we are facing of CP, compromised lung function, IVH, blindness, deafness and the list goes on and on. But, as a mother-to-be I cannot help but be optimistic and fight for these little ones. I have catalogued the research articles that were shared by the docs below, and would love others’ opinions. But, I have also found countless studies that demonstrate that medical technology today provides strategies to prolong gestation and decrease the risk of neurological abnormalities and respiratory complications. If any others have additional research studies that have been pivotal to their care, please do not hesitate to share. My hope now hinges on the fact that I could make it past 32 weeks. For quints, this would resemble a birth at 28 weeks, which continues to pose a risk, but according to the articles the risks tremendously decrease for (Condition, probability):

Cerebral Palsy (10-20%)
Respiratory Distress Syndrome, RDS (65%)
Intraventricular Hemorrhage, IVH (4%)
Sepsis (25%)
Necrotizing Enterocolitis, NEC (25%)
Survival (80%)
Handicap Free (84%)
Intact (80%)

If we can make it to 34 weeks, the probabilities of RDS decreases to 55%, IVH to 2%, Sepsis to 11% and NEC to 15%. So, our Doom and Gloom conversation, part II, finished up on a very sad note. Frank and I drove home in a haze of what if’s, statistics, and desperately sought some good news. Our next visit back to this clinic is not until our 2^nd trimester, or one month. Until then, we continue to take one day at a time doing all that we can to prepare mentally, physically, emotionally, spiritually and of course financially to parent five beautiful babies.

Research Articles:

Multiple Gestation associated with infertility therapy: an American Society for reproductive medicine practice committee opinion

Contemporary outcomes with the latest 1000 cases of multifetal pregnancy reduction (MPR)

Estimation of neonatal outcome and perinatal therapy use

Long-term Medical and Social Consequences of Preterm Birth

Long-term family outcomes for children with very low birth weights

Multi-fetal Pregnancy Reduction, Committee on Ethics

Management of High-Order Multiple Gestation

High-Order Multiple Gestations

The Case Against Multi-Fetal Reduction

Determinants of Gestational Weight Gain

Outcomes in Young Adulthood for Very-Low-Birth-Weight Infants