My Post Graduation under QIP complications

Updated on 7th February 2014
Many times I thought about this page- whether to mention this or not. At last I decide that I should tell that story too, due to two reasons- 1. It is an integral part of the story of my triplets. Will never be forgotten. 2. It might in some way help someone in similar situation. If I had some kind of a guidance, this page would not have been there. I am going to write the post in a very unemotional way, just as things happened without mentioning the great emotional stress, anxiety, fear and worries that I had to undergo during my pregnancy which was complicated enough in the first place, without any of these. 

I am a teacher in a Government institution, and we have this opportunity to do our higher studies under quality improvement program. We get our full salaries during the period of our P.G or Ph. D course, only thing is that we have to execute a bond saying that we will serve the government for a specific period of time (4-6 years) after successful completion of the course, without resigning, or without taking long leaves of any sort. The application and bond has to be approved by the Director's office, and also by the Higher Education Department of the Government. A very good and convenient system, for which all of us junior teachers who join the job without a P.G. are thankful. Thus I too executed a bond, and joined my P. G. in Chennai.

The first two semesters went exceptionally well, I enjoyed the new place, new college, new-found thirst for knowledge, new friendships, new energy. My colleague and senior during my undergraduate course was also there, and she stayed in the same paying guest accommodation as me. In November 2011 my father had a severe cardiac arrest, and I came back and stayed at the hospital for a few days. We decided that we should continue the treatment- at least that much we should do for our parents, who are really desperate for a grandchild.

So we did our first IVF during my vacation (semester break of month after first two semesters). This was due to two reasons- 1. we were not getting any younger, and everyone advised that continuing the treatment and having a family is more important than any studies or career advancement. 2. we hoped that if I indeed got pregnant, I would still be able to continue the course until a week before delivery or so, and then can complete the course right after delivery and in another year life would be so much better.

How very wrong we turned out to be!

During the terrifying weeks of OHSS when I knew I was pregnant, I still hoped that I would be able to continue the third semester when college opened in July. But when the scan revealed triplets, travelling to Chennai became out of the question, as described in this post. 

The first thing I wanted to know was if I could go back to Chennai. DrTC said, yes, I could, but then if there was some mild problem, or if there was a spotting, then I might have to visit a hospital there, and as soon as they found out about the multiples, they’d make me stay in the hospital. Unknown hospital, unknown people, unknown city. And if there was any serious problem, then every single person in the family would blame me for going. So, really it was up to me to decide, and yet I had no options. I said I had a comfortable room to stay, good helping friends around. Doctor laughed at this and said I was saying all these because I had no idea how complicated and difficult life could become during pregnancy. Ramesh offered that he could come and stay with me, and again Dr said, the problem was that things were unpredictable. If something happened then all the effort, all the sufferings, all the money, all the prayers and hope everything would be wasted. And so, finally I had to face that tough moment of actually realizing that I was not going anywhere for the next year. I could not believe it.

As I had to undergo bed rest Ramesh and LR ma'am (cousin, friend and boss, she was always very supportive) went to Chennai, and my teachers were 

quite happy to learn the good news. After a very easy procedure of giving an application with medical certificate, I got my study period extended to another year. I was asked to join back in July 2012, when third semester started for our junior batch, and I would complete the course along with that batch. I would miss my friends I knew, still I could not ask for anything more! Then Ramesh went to my own institution, where again my colleagues were happy, and a leave was sanctioned for three months, which I could extend after three months.

Still, the ease with which the leave was sanctioned made me feel a bit uneasy. So I asked my husband to go to the Director's office, six hours away from my hospital, and inform the office about the developments. There he was informed that the procedure was not correct, I should have informed about my leave earlier itself, and even if I had informed, it would not have been any use because as I was discontinuing the course, even for a year, I was supposed to repay the salaries I received in the previous year, with interest. Also they were skeptical about the genuineness of my case. The medical certificate was from a private hospital, and thus unacceptable.  

None of what happened was anybody's fault. The rules simply did not take into account cases like mine. After my husband returned I searched all possible clauses and service rules and previous government orders in similar cases. The rule said that in a QIP course, the study leave is given for two years together without any break, and if someone needed extension (due to, say, an extended semester), then an application for extension can be given at the end of the two years, and the extended period will be considered as leave without salaries or other benefits. But there was no mention of course breaks due to medical reasons. And no mention of maternity leave. I could not complain because, may be I was not supposed to get pregnant during a post graduate course under QIP. So I sent my husband back again with a request for extension of the course and also asking to take my case under humanitarian considerations. They took the application and request, and later forwarded it the Higher Education Department of the Government with a note saying that my case could not be considered genuine as there is no solid proof, and as there is no rule for extension. Thankfully, before this forwarding note reached the Government we got to know about it. Then through one of my husband's friend's friend, who knew the Director personally, we were able to convince the Director that we were not lying, and that I was indeed undergoing bed rest due to multiple pregnancy. This eased matters considerably and the Director informed the Government that I could be given an extension. They were all doing their duties, and their skepticism came from the fact some people do take advantage of the system, especially when they have political connections. Now that they understood that I was telling the truth all along, they became quite helpful. 

Meanwhile Ramesh also took a request to the local Member of Assembly, who forwarded it the honorable Minister of Education. A copy of that also was sent to the Higher Education Department. So due to all these finally an approval for extension was granted, after six months of running around behind various people of power, and losing quite a number of working days for my husband. 

07-02-2012

Got the QIP extension order today. Ramesh went to the Director's office to get a copy of it. It just says I have to reapply for extension in August.

The government grants a maternity leave of six months with salary, which is quite a blessing to the employees. I was looking forward to taking this leave from October to March, as well as two months' vacation in April- May and four months of leave without salary, so I could spend time with my newborns without a lot of financial loss. But as per the order I would be receiving salary till August 2012, and then a year without salary to complete the course. I also lost a consideable amount in taxes as because of the uncertainty about the leave I was late in filing the tax returns and thus I was unable to take the 'savings and deductions from income' into consideration. Also there was a fine for late filing.

Anyway, at least I did not lose my job. Nor did I have to repay a year's salary with interest, so I suppose I should be thankful.

I rejoined the course in July 2012. Initially we were planning to shift to Chennai- all of us. But there were many problems in that. Health problems of babies due to relocation and climate change, unpredictability of how convenient a new house would be, the expenses of shifting and renting a new house, loss of income for Ramesh if we relocate and so on. So I left alone, leaving my five months old triplets under the care of my husband and my parents. I tried to come home for every holiday, every weekend. At times it was very difficult. There simply were no tickets available in trains. And then there was a lot of work to be done during the weekends. Especially there was a highly demanding teacher, who used to consider his students' personal lives irrelevant. There were many nights when I traveled with a waiting list ticket, sitting when a kindly co-passenger permitted me to sit at the edge of her berth, or standing near the toilet when they were not so kind (most of the time I got to sit, passengers of second class sleeper compartments in India are exceptionally kind and graceful. In spite of all the difficulties in getting tickets, I still love to travel sleeper class). 

It was a pleasure to see my little ones grow. One weekend I would come and see them turning over onto their stomach and back! Another weekend, they would start crawling on belly! Then during a long holiday I saw them starting to move around on all fours! Then a tiny tooth came out! Then little sounds with meanings-words! Thankfully I did not miss any major milestones of their development. They were always happy to see me early on Saturday mornings. Then I would feed them cereals, rice, mashed potato, cooked carrots, boiled bananas, cookies, cheese.. Their development stages varied, their eating habits varied, sleeping patterns varied. These development stages I will describe in another post.

I completed the course in June 2013. Good marks. Rejoined my job right afterwards. I got my QIP extension sanctioning order later. I lost a year's seniority, but that did not matter. We shifted to my place of work, with my husband travelling everyday. Life fell into a pattern. All the dust settled in the professional front with uncertainties and challenges continuing and new ones coming up in personal life. But then, such is life.

 NEXT...Babies' Naming Ceremony

Oil massaging and bathing babies

Oil massaging babies is a very healthy,enjoyable and exciting activity. We asked our pediatrician if we should start bathing them right away, and he suggested giving them an oil massage only, for the first couple of weeks. He suggested extra virgin olive oil for the massage. So at 10 am every day, about an hour after their morning milk, me or my husband gave them the massage. We used to spread a towel on the table, place the baby on the towel, keep a small bowl of olive oil close by and start talking to the baby. The babies thoroughly enjoyed it, and so did we. We used to take the oil in our palm, and spread and massage it on the baby, over the tiny hands, legs, little body and face.  After the thorough massage (most of the oil gets absorbed by the body), we used to wipe them very gently before placing them back in the crib. After sleeping deeply for another hour the babies wake up all fresh and have their milk before going to sleep again. This massage ensured absorption of nutrition, good and uniform skin color and moisture, glowing skin, good sleep, good intake of milk and growth.  Our body has many tiny circulation channels in it, for blood and other fluids, air etc. A nice, good massage opens up and straightens the channels. Also when parents' finger tips touch babies' body parts and nerves, the nerves get stimulated which is good for the babies' growth both physically and mentally. The touch itself is very healthy. 'You should keep touching, massaging and pampering your babies with your fingers, and hug them a lot'- our physiotherapist used to say. The bare skin in contact with the loving parents' touch can do wonders to the babies' emotional development. So the oil massaging was one of the highlights of the day for both us and our babies. 

The right kind of massaging is very important for their development, as both the traditional prasavaraksha experts and the modern physiotherapists would tell you. Start by applying oil in the naval, push it inside with a finger- apply a little pressure. The naval of young babies tend to be out for the first few months, we can help it go inside by this gentle procedure.(Later after the baby starts crawling on the stomach, it will go inside). Then push the nipples inside in case of boys. Apply oil on hands from shoulder till finger tips, apply on thighs and massage inwards, apply on knees and feet. Apply on the back and massage. Massage in round motion on the buttocks. Exercise the body by moving hands, legs and whole body. Cross the hands, move them up and down, do the same with the legs. See the video below. And finally apply oil on the face, push forehead in, pull nose out, pull cheeks out, straighten the ears, apply on head, kiss the baby, and you are done!

After two weeks or so, we started bathing our babies. after the olive oil massage. We applied baby hair oil on the head. Then after a few months we replaced olive oil with virgin coconut oil, because being in Kerala, pure coconut oil is available in plenty. We follow the same massaging and bathing procedure now also, with pure coconut oil. And I highly recommend this.

Another tip I wanted to give is about a tree called Danthappala (Wrightia Tinctoria, also called Ayyappala and Vettuppala- Sweet indrajao). It is seen in many places in Kerala, a tree with small white flowers. The leaves have high medicinal value when it comes to skin problems, infection, discoloration, even psoriasis. According to http://kerala-junction-news.blogspot.in/2010/12/re-wwwkeralitesnet-treatment-for_10.html, the preparation of the oil with Danthappala is as follows- collect a half kg danthapala leaves. Take half a litre of pure coconut oil in vessel and dip the leaves. Allow the oil to heat in sun light for 3- 4 days.  Collect the remaining oil.  Smear the oil every day before bath and allowed the skin to receive some sun light. I tried this because the tree is available in my workplace, and it definitely is very good for the skin and hair.

NEXT...My Post graduation and Complications

Diaper use and disposal issues

In Kerala use of disposable diapers was not very common at least until a couple of years back. As expecting parents, we never planned to use them for our babies. But the first time I went to see my babies at NICU, they had diapers on. Later when our first baby was brought to the private NICU room, and the nurse fed him milk through the nasal tube, he pooped. I didn't know it, but the nurse said he did, and she said she'd show me how to change the nappy. The neonatologist, Dr.Abraham George was very particular that babies should not lie on their back, but should always lie on their stomach. Initially we had a lot of reservations about this, but nevertheless we trusted our doctor immensely and rightly, and hence did as was instructed. (There is a lot of debate on the issue of whether babies should be put on their backs or tummy to sleep, but for us it proved to be a good method to let them sleep on their tummy. It reduced gas formation, and made it easier for them to sleep. They always sleep on their tummy although at times they turn around in sleep and lie on their sides or back.) Hence during the first month, on Doc's strict instruction, we fastened the nappy on their backs. This made it possible for us to change nappies in their sleep, without turning them around. But after a month or so we found it unsuitable and started fastening it in the front itself. 

So unlike we planned, or rather not planned, our babies always had disposable diapers on during their first year. Initially we were apprehensive about heat build up in the covered area, but later we found that the babies were quite comfortable with nappies on. It is difficult to clean up three babies as soon as they poop or pee because as I clean up one, the others tend to make a mess. While diapers are on we get time to clean them one by one. So even though we bought some reusable diapers and briefs, we never used them in the first year. And somehow disposable nappies seemed much cleaner too. However, they had rashes whenever we used a different brand other than Godrej's Snuggy, which has a soft, cotton feel. So we stuck to Snuggy. (It is just my babies' case- my friends do use Pampers and other brands without any issue). 

It is good to reserve a table for diaper changing, preferably in a space near bathrooms. Absorbent sheets are very useful while changing nappies, and also when the babies are taking short nappy-free naps :) Also diaper rash creams are to be kept handy, and wet wipes are good to clean up. We do not use those regularly, but during travels, they are quite useful.

Now we were face to face with a major problem-disposal of the disposable diapers. Being environment- conscious and wanting to be green, we found this unsuitable to our principles, made us feel guilty. But we really had to use disposable diapers in our situation, and so tried to dispose them in as safely as we could. In the first few months, each baby used an average of 12 nappies per day, that is, we were left with 36 nappies at the end of the day! We tried burning them with all sorts of fuel, but only wood dust seemed useful- for complete burning. But getting so much wood dust was a problem, it took hours for it to burn and caused pollution. Diesel was the second choice, but that was too expensive and it caused too much pollution. Thus we finally made an arrangement with a neighboring hospital's garbage disposal group, and every second week we took the tightly sealed sacks with nappies to the hospital, where the garbage disposal team took our sacks along with the hospital wastes for treatment and disposal. This was the safest and greenest option available for us. It became a chore every night to unload the waste bin to the big sack, fasten the sack and keep it outside in a small shaded area in our tiny backyard. Once we had a problem when a stray dog jumped into our compound in the middle of the night and tore up the sack. Early morning we found soiled and torn nappies scattered around. Such nightmare! Then we started tightening the sack and also spraying the outside with Dettol, so the smell would keep the dog away. It worked. 

Update March 2013

After the first few months, the diaper use reduced to 6-7 per baby per day. Since one diaper costed Rs.10/-, the daily expense for it reduced from Rs.360/- to Rs.200/-. We weren't very successful in potty training them, so the nappy use continued. Probably it was a good idea to potty train them sooner, but when we tried we found that it increased their stress. So we left it at that, and left them to develop bowel control on their own. It took time, but it worked. They started to tell us when they wanted to poop or pee, they developed a routine according to their own biology, and the stress was much less for them and for us. Now at two and a half, they still use nappies when they sleep, that is 2 nappies per baby per day. Some times I think about Dr.Sigmund Freud's anal stage and wonder if it would affect their psychosexual development, but it seems very unlikely from the way they are progressing..It would all have been wild and messy and crazy moments every time, everyday, when they'd suddenly pee and poop and try to touch it or smear it or what not! So we chose to be safe, and we are still continuing the slow transition to diaper-free days :)

Oil massage for babies

Update on December 2013

I am so glad to say that now they are totally out of diapers, and potty-trained. Finally saying good bye to diaper days :D

Feeding triplets

Feeding triplets in the  first six months

Today (15-06-2012) my triplets started on cereals! :)

Feeding the babies is taking up the major part of the day everyday. We have kept a diary in which we write down each feeding's time and quantity each one consumed, each one's pooping time, colour and consistency of poo (Raman's is dark green, always. Chattu's is loose and Arya's is like tiny balls), if there is any throwing up then details of that, sleep timings, massage timings (we are still massaging with olive oil- bathing them has not started) and any unusual behavior like crying too much or sleeping too much. I think it is an extensive record of the babies' day, but I have no idea if there is any use doing it.

They used to have an average of 35 ml formula every 90 minutes in February 2012. Once (26th Feb) we had to use suppository on all three to ease stool passing. Not a very pleasant thing to do, and after using it, it takes a couple of days to get them back on track and poop on their own. In March(one month old) the quantity increased to around 90 ml every two hours. Next change came in May when they started drinking 125 ml (though they have only 60 ml or even less at times), but the number of feedings decreased to 6-7 times a day (the average quantity they drink per day is somewhere around 500 ml). They maintain the same quantities now. Initially feeding triplets was through needle less syringes and bondlas. See page. Then we started using feeding bottles from Avent. Very durable, and hygienic if sterilized after each use. (We immerse them in boiling water). The formula we were using was Enfamil, but now we have shifted to Nan Pro. Nan Pro-1 is for infants, then 2, 3 and 4 are available, 4 for toddlers of one and half years old and more. It claims to have enough Calcium, Iron and Protein required for the respective ages. And it does not fatten the babies up. We are not keen to give them cow's milk (cow's milk does not digest properly for babies below one year of age. Even when they become one year, I don't think I will prefer to give it to them because nowadays we do not get pure cow's milk, and what we get as cow's milk seems to cause allergies and mucus in kids).

Father and grandfather feeding the babies

Today we gave them cereal for the first time, for lunch. We gave Ragi cereal sweetened with jaggery, supposed to have a lot of Calcium and Iron in it. I am concerned about the Iron intake since they need about 7 mg per day at 4 months old (since they are not breastfed- if they were breastfed, then it will naturally take care of Iron intake till six months old, after which they will need 11 mg per day in their diet), but they may not be getting that much now. The brand for Ragi we use is Ragitone. Three tablespoons of the powder (for all thee babies together) mixed in the specified quantity of water and one-fourth portion of a jaggery ball powdered and added to it. It is boiled till it is semi solid. It is real sweet and jaggery is very good for health. It is good for adults too. We plan to increase the quantity in the coming months. On alternate days we are going to give them Banatone cereal which is made from raw bananas.

Update August 2012
Now they also eat little bit of boiled banana and boiled veggies like carrot, cabbage, beans and cucumber.

Feeding Raman is most difficult. He likes his milk (Nan Pro), and sometimes cereal. He does not like to try different tastes. Chaattu and Aryakkutty eat without a lot of fuss.

Diaper use and Disposal issues 

Guilty feeling over formula feeding

There are some things normally people take for granted- like having eyes. Only when you don't have them do you realize their value. A new mother's ability to breastfeed her baby is similar to this. When she suddenly finds that she does not have any milk to feed the baby, she feels absolutely inadequate, and feels that she missed a very important phase in her life.

 It took a while for me to come to terms with my guilty feeling over formula feeding my babies. I read about Breastfeeding vs Formula in many places, and I was sure I was going to breastfeed. But for a mother of triplets formula feeding may not be a choice she makes, but a necessity. But here I am, voicing my thoughts on the subject, based purely on my experience. I hope this helps at least a few new mothers in alleviating their emotional stress. Probably it is not an issue in societies where formula feeding babies is a way of life, and is not frowned upon. But in our society babies are always breastfed, so a mother feels like a failure when she is unable to breastfeed her baby.

It was always taken for granted for me that I would breastfeed my babies, given the nutrition, the immunity it provides, the bonding that would develop between mother and child, and the sheer pleasure of breastfeeding. That I should think about what to feed my babies long before I actually gave birth was not something I knew. Much later, after I passed all the stages where I could actually make any change, I saw some websites and books where the mothers (especially those of multiples) took the decision to breastfeed and worked towards achieving that. However I hadn't thought about it because I was too preoccupied with making it to the 37th week. And somehow I assumed in my subconscious that I was actually going to be able to breastfeed the threesome, only that they should come out safely.

Then during the 33rd week (20th Jan 2012), the nurses came to me and asked if I was ready to breastfeed physically- because nipples tend to depress while undergoing bed rest. I said I was ready, but after checking the nurses told me that it was not actually enough for babies to suck. So they brought a syringe without a needle, attached its open end to the nipple and sucked it out. It was quite painful when they did it, so I took the syringe and started practicing by sucking them out. Not good enough. Besides, I read that they should start producing milk long before delivery. Mine did not. Then many mothers, many books and many doctors told me that it was not a problem, once baby started sucking, naturally breasts would start producing, they told me. The more they sucked, the more lactation would happen. I certainly hoped so. I had never even considered feeding them anything else for the first six months.

(Wikipedia on breastfeeding, as well as many other wonderful sites give detailed information on the topic- the hormone production, lactation etc. I strongly recommend that all would be mothers, especially of multiples, or pregnant after IVF, or mothers in their 30s, should read it and be informed)

After babies were born, I could see them only on the second day. It is always best to start breastfeeding within an hour of delivery, but for me, they were  in the NICU and I was in the room. Nurses asked me to express milk (suck it using pumping machine ad collect the milk, or as in my case use the syringe and collect the milk in a bottle.) and give it at NICU. No luck. I could not get even 10ml of milk. Dr.AG, the neo-natologist who had met us before, advised that I stick with formula and not try to breastfeed. I said I wanted to, so he said OK, try it. He asked the nurses if they got any colostrum from me, and they said not really. I was crestfallen at that moment. I hated the doc, hated the nurses, hated myself, hated all other mothers who could so easily hold their babies the moment they are born and breastfeed till the baby was full. Oh, how jealous I was! I heard stories about triplets' moms who could feed all three till they were full. Here I was, not producing enough to satisfy even one, even partially.

This went on till we were discharged. We got the babies one by one to our room. Doc said I shouldn't force the babies to suck, as sucking a lot and not getting milk would cause the babies to lose weight even more. Also it would frustrate them. The first day after I got my first baby, nobody would allow me to try feeding. The nurses would come every hour and tube feed him through the nose- 5ml of formula in the first couple of days. We were supposed to prepare the formula and keep it ready every hour (the recommended formula was Enfamil). At precisely every hour, baby would wake and start crying. Nurse would come, feed through nose, and he would stop crying and sleep. I would watch helplessly, like the ignorant and inadequate mother I was. I can still feel the frustration of not being able to pick up, cuddle the baby, or feed him. I was also fighting the raging hormones in me, getting depressed every now and then, crying at the silliest things. After the bed rest and all the care I enjoyed, I was suddenly supposed to get up, walk, prepare formula, change diapers, pick up the baby (damn, I have never held a newborn before, let alone a premature, low-birth-weight one) and do everything a normal person does.

The nurses were quite condescending towards me, as I was not even able to hold the baby properly. Also I wanted to be technically correct, and since the doc said the baby should not be overfed but just 5ml per hour, I wouldn't let the nurses feed him more, even when he cried. The nurses were talking among themselves that what a strange mother I was, not giving enough food to the baby. One nurse, who was especially concerned, advised me that it was only right to feed the baby till he stopped crying, whatever the doc said. I wasn't sure, so we limited the milk intake to precisely what was prescribed. And baby sometimes cried even after feeding.(Thankfully the dosage increased everyday and soon he got enough).

Anyway,the first night after we got our first baby in the room (Feb 17th,2012). Doc instructed that only the parents should stay in the room, so my mother left in the evening and Ramesh and I stayed with our baby. Sometime during late evening Ramesh went out to get something, the nurses wouldn't come for another half an hour, I was alone with my baby. Perfect chance. When he started moving in sleep I gently picked him up. That was the first time I was picking him up without assistance. I held him, lay him on my lap and put him to my chest. He tried to latch on, but both of us, especially I, was clumsy. Suddenly there was a knock on the door and I got tensed. Just imagine, having to feed my own baby secretly. (It all seems so silly and immature now. I could have just started feeding as soon as I got him, no matter what anybody says. But on those days it was unthinkable. We were all nervous, scared, praying and grateful that the babies survived and were healthy enough) Anyway when I opened the door it was Ramesh and although he too was telling me not to feed the baby, this time he said he would hold the baby so he can try and latch on. He did latch on and tried sucking, but nothing came I think. It was one of the most beautiful half hour of my life.

And so it went on. Next day the nurses helped with the feeding, but still no milk. We got all three babies, got discharged, came home, still no milk. We continued the formula, now fed through mouth, with the syringe first and later with a gokarna (a bondla) and still later with bottle. I was upset and very angry those days. And helpless. Anybody could feed the babies. That too upset me, but I knew I needed all the help I could get. Me, my husband and parents took turns feeding them. (In fact this made the babies to connect emotionally with the whole family even at a very early age, and how my parents and husband loved feeding them!)

As part of my Prasavaraksha (a post-delivery care for the mother) everyday a lady came to bathe me in the traditional way, and after the bath I ate hot rice with drumstick tree leaves. I had fenugreek, I bought and ate a lot of Lactare- granules containing asparagus, I tried using a breast pump every three hours, but all to no avail. There was some milk, but never enough. Finally I gave in, and the babies were entirely fed on formula.

Once my hormones sort of settled down, I started thinking a bit rationally and concluded thus-

1. It was a mistake to not think about feeding earlier on, a mistake I will never be able to correct, and thus no point in thinking about it anymore.

2. May be I should have started breastfeeding as soon as I got the babies. But then doctors and nurses know more than me, and they all insisted it was not good for the babies to suck and lose energy.

3. May be even after all preparations I might not have produced milk, due to my age,my IVF, medicines I took for OHSS etc.

4. I don't know if this is medically correct- at one time my eldest only was breastfeeding as he had more weight than the younger ones, and after his feeding, he used to throw up frequently. We were careful to burp all the babies after each feeding, and we always held them and laid them on their stomach in such a way that there was no gas formation, still he threw up. And I think it could either be because he sucked and got only air(causing gas) instead of milk, or because of the food I ate(it happened especially when I ate a little sweet, or mango or something out of the regular diet). So it is my understanding that the quality of breast milk, with all the advantages associated with it, depends a lot on the food the mother eats. If she doesn't have a nutritious diet, then may be the milk also will not have all the qualities it is supposed to have. On the other hand, formula has constant supply of nutrition, however inferior to breast milk. I am not recommending formula instead of breast milk, but I am saying that it should not be considered too bad if the baby can have only formula. Besides, by God's grace, my babies were not lacking in their immunity either, as can be seen from the way they were not any more sick than any exclusively breastfed baby.

5. Penelope Leach in 'Babyhood' says a lot about how it is a personal decision whether to breastfeed, how a working mother cannot always do it, how a mother who wishes to breastfeed but cannot due to low milk supply can still bond with the baby while feeding with a bottle (there is a distance factor- a newborn baby can clearly see things at a distance of 25-30 cm only, which is the distance of the mother's face when the baby is breastfeeding), and how it is rewarding for the rest of the family also if they are allowed to participate in the feeding-and-bonding-with-the-baby process. It is wonderful the way she says it, and it was sort of liberating for me.

update on 11/10/2014: I still feel a little sad about the missed opportunity to breastfeed, but now I am clear- it was not a mistake to resort to formula alone. The situation demanded it, and we did a very good job of formula-feeding. They were always fed in bottles sterilized by boiling, they were fed the right amounts at all right times. Sure, the formula is expensive, but even now they are fed that, and not cow's milk, or any other health powder. Enfamil was given till they were a year old, then Nan-Pro was given till they were two and a half. They had Enfagrow for a while, but did not quite like it, so they are continuing Nan-Pro. Now they have formula every morning 150 ml each, evening 240 ml and night just before sleep another 150 ml each.

One advantage of Formula feeding is that it enables the whole family to bond with the baby. Grandmother with baby. He loves the posture!

The video shows me formula-feeding my firstborn with a bondla

If you are a mother who was forced to formula feed your baby, these links will help in lessening your guilty feeling about formula feeding-

 http://jezebel.com/5934750/sorry--you-cant-guilt-trip-me-about-bottle-feeding-my-kids

http://www.babycenter.com/0_top-7-mommy-guilt-trips-8211-and-how-to-handle-them_3654967.bc

http://guiltfreebottlefeeding.com/

Did you feel guilty formula feeding? Please share your experience in the comments section. 

Triplets First Months

Triplets at one month old

Had a check up for triplets at one month old (pediatric) today. Raman 3.1 kg, Arya (Kutty) 2.58 kg and Chaattu 2.1 kg. Chaattu cried a lot last night. Ramesh sat with him throughout. We have slightly changed their pet names. Chaattu is now Balu, since we plan his name to be Balavinayakan. Aryakkutty became Arootty and Kutty. So now it is Raman, Kutty and Balu. 
My Prasavaraksha has started- it is a post natal care for the mother in the traditional way. (see post Tips). This is to be done until March 28th it is decided.

 NEXT: Feeding Triplets in the first months

Architecture for Multiples

Being an architect, I can't help this post :D  There are hundreds of things to consider while designing a home for adults, but when you design for houses with babies and toddlers, who will soon grow up to be teenagers, there are many many more aspects. But then designing a house for a family with triplets...well, you simply can't be too careful.

Most of us may not be building a new house right after the triplets are conceived or right after they are born. We would be much too busy. So modifications to the present house with some modifications to the furniture is all we can do. And then once they are toddlers we might be able to build a new house, or make more serious modifications to the existing one. In any case, safety, convenience and flexibility are the most important factors to consider while doing these designs.
What I have shown here are some very inexpensive (you could say crude) modifications and details. There are hundreds of sophisticated furniture designs available, anything you can get to make life easier is worth every rupee. And after the babies grow up you can always pass them on to friends or relatives with new babies, or sell them online .

Here is a room (can't really call it a room, it comes to 500 sq ft) design for a triplet (two boys and a girl), assuming that the house design allows a room of this size and openings. (But even if the site or house is different, you can go for very efficient designs once you give it serious thought). The left side plans show the use of the area when the children are babies or toddlers, right side ones show how it will be after they are teenagers.

Updated on Sept 25, 2014
Apart from the functional and safety aspects, there are experiential aspects too. Keep in mind that most part of the baby and toddler's life is spent at home, mostly indoors. So let him/her have as many experiential qualities to the spaces around. The colors, sights, smells, sounds, textures- everything matters. Let the home be a sweet place with rich experiences for the baby.

This image shows a typical verandah in a traditional Kerala house. Extremely useful and live space. 

A small addition to the 6 feet cot- to protect them from falling down. The door slides up.

Once they start moving around, a detail like this might be necessary on a few doors. The traditional half door are very useful.

Cribs like this one have many functions

Then we should see to it that all edges are rounded, staircases and steps are either inaccessible, or if they are accessible, they should have enough safety measures. Projecting cupboards have dangerous edges. So do tables, slabs etc. Electric wires, switch boards etc should be kept at sufficient heights. T.v, table/pedestal fan if any, must be such that the cables are inaccessible, and if in case they are accessed, the equipment should be in such a way that it should not fall on the baby.

Triplets at one month old

Movies for kids

Tips to prepare for Triplets first months

Here are some tips to prepare for triplets' first months (from my experience)-

1. Prepare your home- you will not have time for this after  the babies arrive. So during your pregnancy, make arrangements to do some modifications  to the house and furniture. Try to arrange a space with good light and ventilation, where you can put a carpet on the floor and lay the babies. A comfortable chair close by, so you can feed them.

You need a counter with a tap and sink where you can place babies' bath tub and wash the baby without having to bend down. All necessary toiletries should be kept close by.

You should have cot sides so babies won't fall down. Find out nice spaces where you can have cribs placed.

2. Baby blues and postpartum depression- This is for the daddy. Your wife might be depressed and anxious for quite a few days after the babies' birth. Be patient with her. If you are not, then it can result in her being even more depressed, and that can be for a longer period, with at times, dangerous results. It is quite understandable that with three infants at home, the whole family will be very busy tending to their needs. But instead of concentrating all your attention to the babies, make the mom happy and energetic by giving her abundant love, so she can easily tend to the babies' needs- and you will be surprised to find that she can tend to them in a much better way. 

3. Feeding the babies- Read the post on formula feeding. If you are lucky to produce enough milk for the babies, then work out a schedule for feeding. If you have decided on formula feeding- 

- Be aware of the quantity of milk- consult the neonatologist or pediatrician

- Be careful to sterilize the bottle after each feeding.

- Take rotations in feeding. If you are feeding Baby- A in the morning, and daddy is feeding Baby-B and granny feeding Baby-C, in the afternoon, change it so you feed Baby-B, daddy Baby- C and so on. Look at the baby and smile and speak softly or sing softly while s/he feeds. It builds up a very strong bond.

4. Diapers- Read the post on diaper use. I personally find them to be very helpful. But you can always potty- train babies sooner, if you have the time and patience.

5. Monthly budget- Be aware of the financial demands- Roughly you should budget for the new life. Assuming that you are feeding babies formula alone, you will need one tin formula for three days in the beginning. After 3 o 6 months you all need one tin per day until they are three years old. That is Rs.400/- per tin, makes Rs.12,000/- per moth on formula alone. Then if you are going for diapers full time, you will need two packets (20 numbers) average, per day (for triplets). That is another Rs.6,000/- Other expenses like salary to the nanny (if you have one), baby clothes, feeding bottles, medicines/ visits to doctor, toys etc. will be additional to your monthly expenses, which itself may increase due to increased use of electricity, water use etc. Roughly an additional average expense of Rs.35,000/- can be expected in the first six months to one year.

    

Baby-A.

Baby- B

Baby- C

6. You may find these items very useful in the coming months-

a. Good quality Feeding Bottles
b. A good quality Breast pump (Philips Avent Breast Pumps Manual Breast Pump I recommend this,     eventhough for me it was of no use), and Nursing Bra 

c. Baby carriers (Chicco Soft and Dream Baby Carrier New Fire (Maroon) - We did not use these        much either, but they are very useful while travelling or doing house chores)

d. Car seats

e. Re-usable diapers

f. Travel bag for babies

g. A basket in which bottles and food can be kept without spilling during travelling

h. A nappy changing table

i. Baby pacifiers

j. Baby nail cutter

k. A good audio/music player and CDs of lullabies. (our trio still need 'Omana thinkal kidavo..' to sleep)

l. Baby beds and cribs

m. Baby bath tub
n. High chairs for feeding
o  Potty
p. Baby hair trimmer (these last three items you will need only after several months)

and of course, toys, clothes, towels, absorbent mats, wet wipes etc.
 There are online stores providing specialized items for multiples. Good collection and very useful items, you can check them out. They are towards the expensive side, though.

7. See post on the Architecture for multiples

The trio

Baby A and B

Our babies were always made to lie down  on their belly, which was good in many ways. There is a risk called SIDS, but this happens only when we leave the baby unattended, in a situation where s/he can get hold of something that might choke her/him. We were always careful about this. 

As for me, a lady comes now to bathe the babies as well as me, a Kerala special postpartum care package. Feels good. She bathes me after applying turmeric, Rakthachandanam and coconut oil, and then feeds me hot rice mixed with raw moringa  leaves (drumstick tree), supposed to increase breastmilk. This, and many other tablets that I have had has no effect on the milk supply, but at least it feels good to have this hot rice and then breastfeed my babies (they latch on and try to drink, but I suspect all they get is gas) sitting on the bed. It creates a special bond between us. Blessed custom! 

We named them Suryanarayanan, Devasaraswathy and Balavinayakan. We call them Raman, Kutty and Balu.

The days are now too hectic, a lot of pressure on all of us, a lot of discords in the house, depression, health problems and so on. But this too shall pass.

Breastfeeding vs Formula

NEXT: One month old weights

'Triplets Kerala' - back at home from NICU

So we - 'Triplets Kerala' as I call them now, and us, and my parents- are back at home from NICU. Things should have been much easier. But we are totally off-balance now. We are all hoping that these hectic days will be over soon.We are starting a new life. Many relatives and friends come everyday. A pleasure to see them. Feeling blessed with their love in our lives. 

We have a single floor independent house with two bed rooms (one attached), a living cum dining room with a prayer space, study space and common toilet, an entrance room which can also function as office space, kitchen and work area. It is a nice house.  A few years back when both of us were looking for houses to buy we stumbled upon this one. This was unwanted by many because it does not have direct car access, you can come till the previous compound in a car but then the way is too narrow for a car. There is no hope that it will ever change or widen. Another thing is that there is a sarpakkavu (a sacred grove where snakes are worshipped) right in front of the house. 

The Sacred Grove in front of our house

In fact one generation before the house was part of a large area which contained many big trees, two big ponds, two sacred groves etc. There was only one house at the time- the owner’s- and the rest of the area coming up to around 2 acres was covered by these trees that it was very dark even during midday. There was a lot of wildlife including snakes, Asian palm civets, mongoose, and a variety of birds. People rarely disturbed the area. Then it was partitioned into various plots, some of the trees were cut down, most areas of the ponds were filled.(These were not completely filled as there is a belief that water bodies when filled should have some kind of an outlet- so tiny ponds of around 4 sq.m area was left open with walls and steps around. The plots were sold, for very good prices, as the land value was shooting up to the sky. One brother did not like another and wanted to trouble him, and so the right of way to the plot was only 4 feet wide. Later the plot was sold to another person who built the house and from whom we bought it. The sacred groves were both intact, but a lot cleaner and accessible and thus less sacred. Some of the wildlife remained too. We liked all these aspects, except the inaccessibility by car, but let that go, as we got the house of 1200 sq ft area and land of 6 cents in the heart of the town at an unbelievable Rs.9 lakhs in 2004. We park our car in the neighbour’s plot, for a small monthly rent. The house is deemed very lucky. The previous owner was very poor and jobless when he bought the land before land prices were shooting through the sky, with some money he got from his ancestral property. But after buying the plot and building the house as per Vaastu, he got many new projects and in six years he bought himself another plot with car access, close by, and built a mansion. After we bought the house I got my Government job, we had our first international tour sponsored by Ramesh’s office, and presently we got our three darlings. So we love the house.

But it seems a little crammed now, with seven of us living here. Mili was an integral part of our daily life before the pregnancy. She used live indoors, used to even lie down in the kitchen while I cooked. Now that the babies were home, my parents insisted that she be sent out, to sleep in the dog house or on terrace, else her hair might cause allergy. I tried to explain to them that it is good to be in close proximity with pet animals during babyhood, and it will lessen the chances of future allergies. But they were adamant, and I really did not have many options. We placed a table next to the dining table on which the feeding bottles, formula, bibs, water etc. are kept. The multivitamins and other emergency medicines like Paracetamol, Neosporin, cough syrups etc. are kept in the drawer. The master bed room with attached toilet and a small dressing area is our bedroom. The other bedroom next to it is being used by my parents, and they use the common toilet. The ironing table in the dressing space doubles up as diaper changing and oil-massage table, half of it being covered by a rubber sheet. Babies have not started taking baths. Once they start it, the oil massaging will no more be there. We are planning to bathe them in the counter slab of the work area, so we do not have to bend.

The feeding schedule for the triplets is synchronised now- every two hours they are given 30/40/50 ml of formula, the first feeding of the day being at 6.30 am. The intake varies sometimes as little as 15 ml only they drink. Multivitamins (especially vitamin D), iron and Calcium supplements are given at 10.30 am and at 8.30 pm. The olive oil massage is at 11.30 am, after which they have their formula and sleep soundly. They pass stools twice or thrice a day.  Baby-C usually passes stool after every meal. He cannot resist hunger for even a minute, and every two hours he starts crying and keeps crying till the milk touches his lips. Baby- A has bright green stool, it is slightly worrying, but doctor said that is not a problem as long as there is nothing wrong otherwise. He sleeps quite a lot during the day, but at night, he keeps me up till 3 am. Baby-C cries the most, followed by Baby- A, the other boy. Baby- B, our little girlie, does not cry at all, unless absolutely required. She smiles quite a lot, watches people moving around from her position on the couch in the hall. We show off by making her smile when guests come, and they enjoy it we think.

We go to bed after the 12.30 am feeding.  In the first week at home Baby- C used to sleep in my parents’ bed. But he used to wake up and cry in the middle of the night, and pass stool many times, so this became too tiring for my parents already exhausted from all the days’ work. So we made a different arrangement. Baby- A (Raman) sleeps in the bed room with me. Ramesh works in the study area late into the night, sometimes till morning. So both Baby-B and C’s cribs are placed near the study area and Ramesh rocks them occasionally using chords tied to the cribs. They sleep without much fuss, and at 2.30 Ramesh feeds them both formula, changes diapers and rocks them to sleep again. Raman (Baby-A) is a fussy sleeper. I walk carrying him for hours sometimes, singing to him. He sleeps as late as 3 am, but then he sleeps soundly till late morning. Baby-C (Balu) wakes up early in the morning, closely followed by B (Kutty).

Ramesh sleeps at 3-4 am. Then he likes to sleep till 9-9.30 am, and then he gets up, freshens up and leaves for site/office. I sleep by 2.30-3 am, because Raman sleeps only then.  So I sleep late, getting up only by 6.30 am for the first formula feeding of the day. My parents go to bed by 12 am, late for their lifestyle, and get up by 5.30-6 am. Then my mother prepares breakfast. They also help with the feeding. Then we put them back to sleep. Things should be fine here, but then starts the crying. Balu and Kutty don’t want to go back to sleep, sometimes Raman too wants to stay up.  Waking up early is fine, but all three would want our full attention as well. All of us would be sleepy, exhausted, and wanting some peaceful time before the hard work begins. Tempers flare up. Voices rise.  And every morning at least once I wish I hadn’t done the IVF.

Things aren’t that bad after sometime. After the second feeding at 10.30, and after everyone has breakfast, things settle a bit. I put the babies on the mattress in the living room, and sit with them, show them the toys, which they try to gab and try to put in mouth etc. Their hand- mouth coordination is not developed yet, so they just try to grab the toys. They smile at the sounds of the toys. I show them pictures. Raman especially likes to look at pictures of people. I read that they can see things as two dimensional only at this age, that too, things at a distance of 25-30 cm from their eyes. So I draw human faces and keep them at a foot’s distance from their faces. I also read stories to them, which of course, they don’t listen to, but they like the sound of my voice talking to them.

We got a maid from an agency. She comes at 9 am and leaves at 4.30 pm. She babysits during mid-morning so we can finish our chores. Her pay is Rs7500/- per month, of which Rs.2500/- goes to the agency. We tried to get someone more professional- someone with a training in taking care of babies, but no luck there. This particular maid is good. Before her there were two other maids from the same agency, both of whom had no skill in looking after babies. So they lasted only about two weeks or so, each.

I still have no milk. We are sticking with the formula. Although I am hoping that the post natal care (prasavaraksha) might increase the milk supply. The babies sleep in the afternoon. Full credit goes to my father in that he made it a point to establish the routine of putting them to sleep together. Raman sleeps in my arms and I lay him on the bed. Kutty and Balu sleep in their cradles.  All three sleep at the same time. This gives a much needed break and relief for us. We have peace for about two hours in the afternoon. Ramesh comes by early evening, relieving my parents from baby duty to some extent. I am able to spend so much time with them because my mother completely does the cooking. Soon, in another three months it will be time for me to rejoin my post graduate course. I have no idea how this will work out.

17-03-2012

Our Triplets

We posted photos and news about the birth in Facebook. I had not told anyone except a couple of very close friends about the pregnancy, so everyone who saw the update got a surprise :)

Breastfeeding vs Formula
Triplets Feeding in the First Months
Triplets one month old